Impact of Hand Hygiene Strategies on Reducing Hospital Acquired Infection

This research project aims to implement WHO’s Multimodal Hand Hygiene Improvement strategy among health care workers working in three countries namely Iran, Australia and US and find out the efficacy of the intervention in reducing rate of HAI and bacterial infection in health care workers working in a tertiary hospital of each of the country.

Sample Application for
HREC Approval
(NURBN3022)
Total word limit for this assessment item is 2000 words
1. PROJECT DETAILS
Project title:
What type of project is this? (Tick as many as apply)
Masters project Clinical Trial Postgraduate Diploma
Undergraduate Student Research Project Honours
PhD Staff Research Project Other
Through which School/Section is the research to be conducted?
2. RESEARCHERS
Principal Researcher (STAFF MEMBER ONLY)
Title & Name: Dr Joanne Porter
Position: Senior Lecturer
School/Section: School of Nursing, Midwifery and Healthcare
Phone number: 51 236996
Email address: [e-mail]
Please list academic qualifications: PhD, MN, GradDipCC, GradDipHSM, GradCertHeD,
BN, RN
Describe what this researcher will do in
the context of this project:
The lead researcher will be an expert guide though all
aspects of the project.
Include a brief summary of relevant
experience for this project:
Supervision of higher degree students, multiple
publications to peer reviewed journals and successful
competitive grants applications.
Student/Other Researcher/s
Title & Name:
Position:
School/Section:
Phone number:
Email address:
Student ID number:
Please list academic qualifications:
Describe what this researcher will do in
the context of this project:
Include a brief summary of relevant
experience for this project:
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Impact of hand hygiene strategies on reducing hospital acquired infection (HAIs), bacterial disease and viral
disease compared to other intervention in health care setting throughout the world.

Sample Application for
HREC Approval
(NURBN3022)
3. LAY DESCRIPTION
Provide a brief outline of the project describing in everyday, jargon-free language the key aspects of
the research (e.g., who will be participating, what information will be collected and by what means,
what participants will be required to do, etc.) and the key research aims. (300 words max.)
4. RESEARCH AIMS & SIGNIFICANCE
State the aims, key research questions, and significance of the project. Also provide a brief
description of the relevance of your proposed project to current research, supported by the literature.
(500 words max.)
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This research project mainly aims to implement WHO’s Multimodal Hand Hygiene Improvement strategy
among health care workers working in three countries namely Iran, Australia and US and find out the efficacy
of the intervention in reducing rate of HAI and bacterial infection in health care workers working in a tertiary
hospital of each of the country. The main rational for selecting three countries is to understand the impact of
the program on rate of infection in hospitals worldwide. The advantage of selecting the WHO’s multimodal
strategy is that it has the potential to address all types of barriers that contribute to non-compliance with hand
hygiene and risk of HAI in health care setting. The five key elements of the program will include system change
to promote access to alcohol based hand rub, ongoing training and education, evaluation of practice, use of
reminders and providing a culture of safety in the institute. The five elements have the potential to engage in
appropriate change process (Farhoudi et al., 2016).
The main research participants were health care workers working in the three hospitals and observation
method was used to collect information related to the compliance with hand hygiene, increase in use of alcohol
rub, reduction in HAI and attitude towards hand hygiene after the program. It is planned to conduct an
observation and interview based study. Observation by experienced medical staffs will help to understand
staff’s compliance with hand hygiene protocol and interview will help to evaluate experience of staffs after
participation in the program. The participants will be required to first attend ongoing training and education
session and then implement them in clinical setting. Their hand hand hygiene practices will be evaluated by
observation and interview. Hence, by the use of above approach, the research project aims to find out whether
hand hygiene strategies can reduce HAI in hospitals across the world or not.
The main aim of the research is as follows:
• to find out whether hand hygiene strategies can reduce the rate of HAI, bacterial disease and viral disease in
hospitals through the world or not
• To evaluated different types of hand hygiene strategies implemented in health care setting
• To achieve reduction in rate of HAI and burden of such disease for patients and other staffs
Research question: The following research question will help to get answer to the research aim:
‘Can hand hygiene strategies reduce HAI, bacterial disease and viral disease compared to other intervention in
health care setting across the world?’
Significance of the project:
Working on this project is important because of the increase in burden of HAI in health care setting. HAI or
nosocomial infection refers to the type of infection which are acquired by a person in the health care setting
(for example-long term care, ambulatory care and home care) where a person receives care (Magill et al.
2014). Hence, such infection occurs during the course of treatment and it leads to many undesirable
complications for patients. It also necessitates additional diagnostic cost and treatment cost. According to the
World Health Organization (2018) report worldwide, hundreds of millions of patients are influence by HCAI in
different countries and the burden is particularly higher in low and middle income countries. It is one of the
major patient safety issues in hospital and for this reason, patients, government and regulatory bodies are
paying attention to health care associated infection. Hence, finding the preventive steps to control such
infection in clinical setting is important.
This research project is particularly aiming to evaluated impact of hand hygiene strategies on reducing HAI
because of the link between hand hygiene and HAI. This is because HAI are mostly transmitted by means of
contact transmission and airborne spread. Hence, poor hand hygiene and lack of complying with good hand
hygiene practice increase the risk of transmission of blood borne pathogen from staffs to patient or other staffs.
Hence, hand hygiene has received attention as part of infection control activities. It is the most simplest and
cost effective means to reduce the prevalence of HAI and prevent spread of MRSA infection. However,
adherence to recommended hand hygiene practice has been low because of clinical, environmental and
behavioral factors. Clinical factors include overcrowding, understaffing and working in intensive care unit.

Sample Application for
HREC Approval
(NURBN3022)
5. RESEARCH METHODOLOGY
Provide an outline of the proposed method, including details of data collection techniques, tasks
participants will be asked to do, the estimated time commitment involved, and how data will be
analysed. (500 words max).
6. RECRUITMENT OF PARTICIPANTS
Participant Details
Describe your proposed recruitment strategy to source target participants. Provide the number and
age range, giving a justification of your proposed sample size. (100 words)
Target participants
Who are the target participants? (Tick as many as applicable)
Students or staff of this University
Adults (over the age of 18 years and competent to give consent)
Children/legal minors (under the age of 18 years, with parental consent)*
Elderly individuals
Individuals from non–English-speaking backgrounds
Pensioners or welfare recipients
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Research design: Quasi-experimental study design will be used to evaluate the impact of hand hygiene
strategies on reducing rate of HAI in the selected health care setting. It is a type of research design in which
the independent variable is manipulated to understand the affect on dependant variable (Campbell &
Stanley, 2015). Hence, the study design is suitable when the purpose is to test the effectiveness of an
intervention. By the use of quasi-experimental research design, the stepwise elements of the WHO’s
Multimodal Hand Hygiene Improvement Strategy will be implemented.
Data collection technique:
Each facility will be prepared for the change by making all resource like paper towels, sink and alcohol
based hand rub available for health care workers. Visual aids like poster, visual reminders and colorful
message at important point will also be used to attract attention of health care workers towards hand
hygiene. This will be followed by a two week protocol training where verbal instruction will be give regarding
‘Five moments of hand hygiene and best strategies to engage in hand hygiene. Infection control booklet will
also be provided to each staff. The evaluation of hand hygiene compliance will be done by means of direct
observation by two medical doctors. The observers will need to complete a direct observation form which
will have the following components:
• Before patient contact
• Before aseptic procedure
• After body fluid exposure
• After patient contact
• After contact with patient surroundings.
To eliminate the risk of bias during the observation, research participants will not be aware of the
observation method and observation will be done by CC TV. The observation method will be completed
after 1 months of training session.
In addition, after six months of implementation of the program, follow-up evaluation will be done to
understand the impact of program effectiveness in reducing HAI and improving staff’s attitude towards
patient safety. The qualitative interview and feedback session will mainly explore participant’s experience of
applying the education and training knowledge to engage in hand hygiene practices. The interview data will
be audio-recorded and transcribed verbatim.
Data analysis: The analysis of compliance with hand hygiene will be done by the analysis of direct
observation form and identifying the number of staffs who have followed all the five moments of hand
hygiene. In addition, the analysis of participant’s response related to experience with hand hygiene
technique, knowledge related to risk of HAI and barriers faced in implementing the five moments of hand
hygiene will be done by adapting the thematic analysis method. Thematic analysis is a common method of
analysis in qualitative research and the main purpose of thematic analysis is to find out patterns in data and
categorize research findings into different themes (Braun, Clarke & Terry, 2014). This process will help to
identify common issues or facilitators for staffs implementing the hand hygiene strategies. Using thematic
approach can give a critical insight into the strength and weakness of the program and the success of the
program in reducing the rate of HAI and other types of infection in tertiary hospitals of the two selected
countries.
The target population for this project is health care workers who are involved in providing care to patient in
acute care setting. Main health care worker for the project will be nurses and others medical staffs who
come in contact with patient on a daily basis. The health administrator of each hospital will be approached
and permission for the project will be taken after distributing the project details to all health care workers. An
informed consent form will be provided that will give staffs idea regarding the project goal and method in
which the project will be implemented. The participants will be selected only if they give informed consent
for participating in research (Grady, 2015). It is planned to take 20 samples from each hospital and a total of
60 samples from the three hospitals. Low sample size has been taken because of the rigorous program
steps and too much time involved in collecting data related to compliance and experience with the hand
hygiene strategies.
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Sample Application for
HREC Approval
(NURBN3022)
Intellectually or mentally impaired individuals unable/with compromised capacity to provide
consent
Physically disabled individuals
Patients or clients
Prisoners, parolees, or wards of the state
Individuals highly dependent on medical care with a compromised capacity to give consent
Aboriginal and/or Torres Strait Island communities
Women who are pregnant and the human foetus
People who may be involved in illegal activities
*Parental consent may not be required in some instances - refer National Statement, 4.2.8 & 4.2.9
7. RISK MANAGEMENT
This section raises the issue of your duty of care toward research participants. To what risks are
participants subjected? What will you do should an emergency occur, or should a participant become
upset or distressed? What is your risk management strategy?
Refer National Statement: Section 2.1 Risk and Benefit
Research Activities
Which of the following activities will the research involve? (Tick as many as apply)
Use of a questionnaire (attach copy)
Interviews (attach interview questions)
Observation of participants without their knowledge
Participant observation
Audio- or video-taping of interviewees or events
Access to personal and/or confidential data (including student, patient or client data) without
participants’ specific consent
Administration of any stimuli, tasks, investigations or procedures which may be experienced
by participants as physically or mentally painful, stressful or unpleasant during or after the
research process
Performance of any acts which may diminish the self-esteem of participants or cause them to
experience embarrassment, regret or depression
Use of non-treatment of placebo control conditions
Collection of body tissues or fluid samples
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Sample Application for
HREC Approval
(NURBN3022)
Identify as far as possible all potential risks to participants (e.g., physical, psychological, social, legal,
economic) associated with the proposed research. Explain what risk management procedures will
be put in place, along with contact details of an appropriately qualified organisation for participant
reference in case of distress, eg: Lifeline (200 words)
8. CONSENT
Obtaining and Documenting Consent
How will informed consent be obtained/recorded?
Signed consent form
Recorded verbal consent
Implied by return of survey
Other (Please specify):
9. INFORMATION PROTECTION (DATA STORAGE & SECURITY)
Confidentiality
Tick which method will be used to guarantee confidentiality/anonymity?
Non-identifiable (anonymous) data, which have never been labelled with individual
identifiers or from which identifiers have been permanently removed, and by means of
which no specific individual can be identified.
Re-identifiable data, from which identifiers have been removed and replaced by a code,
but it remains possible to re-identify a specific individual by, for example, using the code or
linking different data sets.
Individually identifiable data, where the identity of a specific individual can reasonably be
ascertained. Examples of identifiers include the individual’s name, image, and date of birth
or address.
Security and Storage
Does the Principal Researcher accept responsibility for the security of the data
collected?
Yes
Who will have access to data?
Access by named researchers only Access by other(s) than named researcher(s)
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The project that will be implemented does not have any invasive procedure or conditions that can cause any
physical risk to participants. Hence, any physical risk from the program is nil. However, the process of
implementing training and education session related to hand hygiene technique and interview process might
increase mental burden and exhaustion of health care workers. Hence, the participants might be at risk of
psychological stress as they will have to spend extra time at work. However, to motivate the staffs and
increase participation in the program, it is planned to keep the duration of education session to only 1 hour
and provide only four sessions in two weeks. In addition, a very short interview of up to 20 minutes will be
done to save time of health care workers.
There are many ethical risk in conducting the research too because to increase the reliability of study findings,
it has been planned to not make staffs aware that they are being observed. However, the ethical issues will be
managed because indirect observation will not lead to any breach of privacy and confidentiality requirement.
The data regarding compliance rate will be recorded and personal information will be used during the process.
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Sample Application for
HREC Approval
(NURBN3022)
Which of the following methods will be used to ensure data security?
Data will be kept in locked filing cabinets
Data and identifiers will be kept in separate, locked filing cabinets
Access to computer files will be available by password only
Other (please describe)
10. RESEARCH TOOLS
Please check that the following documents are included in your application by writing in the box
below (300 words)
Are the following research tools are included in this
application?
Yes No N/A
Questionnaire Draft
Interview Questions Draft
Other
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The research project mainly uses two research tools to collect data from health care workers. The first tool is
the WHO direct observation form which will record the number of times the ‘Five moments of Hand Hygiene’
has been missed or effectively completed. This will help to tract the impact of education and training on
improve hand hygiene practice and reducing risk of HAI. The program will also spread the awareness for
improving hand hygiene practices so that related diseases can be avoided. The interview will be conducted on
50 staff members and basis their response it can be determined whether the awareness program has been
successful or not.
The form will give details about the department, service, country and professional category of health care
workers.
Another important document of this research project is questionnaire for interview. This will be prepared and
no tool will be used for interview process. The following questions will be used to explore experience of staffs
regarding the intervention:
1. How do you feel after participating in hand hygiene training?
2. Has the experience changed your knowledge and attitude towards hand hygiene? How?
3. Did you experience any barrier in following the five moments of hand hygiene?
4. Do you think the use of WHO guideline can reduce risk of HAI in health care setting? How?
5. Do you think you will follow the hand hygiene protocols in future as well?
6. How will you ensure that others are also following the hand hygiene techniques?
7. Why do you think it is important to maintain hand hygiene?
Based on the results of the interview it will be determined whether the intervention has been a success or not.
It is important for the staff to follow hand hygiene protocols so that further risk of infection can be avoided.

Sample Application for
HREC Approval
(NURBN3022)
11. DECLARATIONS
Researcher Declarations:
The information contained herein is, to the best of my knowledge and belief, accurate. I have read
the University’s current human ethics guidelines, and accept responsibility for the conduct of the
procedures set out in the attached application in accordance with the guidelines. I and my co-
researchers have the appropriate qualifications, experience and facilities to conduct the research set
out in the attached application and to deal with any emergencies and contingencies related to the
research that may arise.
Principal Researcher
DR JOANNE PORTER
(Print name in block letters)
Date: …..../…...../….....
Other Researcher
………………………………………………
(Print name in block letters)
Date: …..../…...../….....
Other Researcher
…………………………………………………
(Print name in block letters)
Date: …..../…...../….....
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