HEALTH CARE 8 HEALTH CARE Health care Name of the student: Nosocomial Infeasibility in Health Care

Running head: HEALTH CARE
Health care
Name of the student:
Name of the University:
Author’s note

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Introduction:
The National Safety and Quality Health Service (NSQHS) standards have been created
with the aim of protecting public from harm and improving the quality of health service
provision (Australian Commission on Safety and Quality in Health Care, 2012). However, one
area that is threatening this goal is the high prevalence of nosocomial infection healthcare
associated infection (HAI). It involved all those infection that occurs during the process of care
due to exposure to infectious pathogens via direct or indirect contact. According to Mitchell et al.
(2017), HAIs are a major patient safety issue as despite improvement in HAI prevention
strategies, it continues to occur. The systematic review regarding the prevalence of HAI in
Australian hospitals from 2010 to 2016 revealed that the incidence of HAI may be about 1, 65,
000 per year. This is the reason for morbidity, mortality and high health care cost due to
prolonged period of hospitalization. For this reason, NSQHS established a separate standard for
preventing and controlling HAI. One of the strategies that were suggested in standard 3 was to
develop and implement a hand hygiene program (ACQHC, 2012). It is an evidence based
strategy that can prevent transmission of nosocomial pathogens. However, adherence to hand
hygiene procedure has been found to be unacceptably poor (Hammerschmidt & Manser, 2019).
Thus, to improve this practice gap, the main purpose of this literature review is to examine the
effectiveness of hand hygiene in preventing nosocomial infection. The review of robust studies
would clarify regarding the benefits and identify proper intervention to improve compliance to
HH program and reduce the burden of nosocomial infection in health setting.

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Result:
HH and rate of nosocomial infection
There were six studies that reported about the effectiveness of hand hygiene compliance
on improving rate of nosomial infection. Due to preference for high quality studies, systematic
review paper by Andriani & Nadjib (2018) was included in the review as it will gave an
overview of findings from various studies. The systematic review included studies done in
different countries like Africa, America and Asian regions like Thailand, Shanghai and China.
Out of 11, only five papers gave positive outcome of HH on HAIs. The reduction in rate was
higher for gastrointestinal illness compared to other HAIs. However, this study did not give
conclusive evidence on effectiveness of HH on overall HAIs. Several RCT papers were reviewed
too as they give most reliable evidence for effectiveness of any health intervention. Yeung, Tam
and Wong (2011) used RCT design to assess the impact of an HH intervention involving pocket
sized container of alcohol based hand rub to control rate of HAI in long-term care settings. The
statistical findings related to hand rubbing compliance and incidence of HAI revealed that
adherence to hand rubbing can reduce incidence of serious infection. Analysis of recently
published trials indicated the potential of WHO multimodal HH improvement strategy as it can
contribute to further refinement in HH strategies (Hongsuwan et al., 2015). A systematic review
by Mandoh, Mandoh and Kangbai (2018) further investigated about the estimate and revealed
that WHO multimodal strategy with alcohol hand rub can improve HAI rates.
In contrast to systematic review, individual observation based and before after study was
successful in giving statistically significant results related to relation between HAI and HH. The
study by Salama et al. (2013) reported about HH compliance in an ICU setting of a Kuwaiti

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hospital following implementation of WHO HH observation protocol. The intervention was
successful in improving compliance to hand hygiene and this in turn had remarkable impact on
rate of different types of nosocomial infection. The rate of bloodstream infection decreases from
18.6 to 3.4 per 1000 patient days, rate of lower respiratory tract infection fell from 17.6 to
5.1/1000 days. In addition, the overall rate of HAI fell from 37.2% to 15.1% post intervention.
Similarly, Thoa et al. (2015) reported about decrease in patient with HAI from 31.7% to 20.3%
after implementation of a HH program. A study done in Cambodia also revealed the
effectiveness of surveys and education on HH for reducing HAI. For instance, the study
demonstrated reported improvement in surgical site infection (SSI) rate from 32.26% to 0.97% in
three years time. The uniqueness of this intervention was that it specifically considered catheter
related infection and SSI, which are two common form of nosocomial infection (Sansam et al.,
2016).
HH and its impact on health care cost:
There were many papers that gave evidence for cost effective of HH intervention or
programs implemented in different setting. The before and after study of a hand hygiene program
implemented in two intensive care and 15 critical care units by Thoa et al. (2015) revealed tthe
success of the program in increasing compliance rate. In addition, to improvement in HAI rate,
the findings indicated the cost effectiveness of the intervention too. Estimating the overall cost of
the program and the per patient cost, the study revealed that per incidence of prevention of HAI
was associated with a cost saving of $1074. This figure is very significant as it gives clear idea
about how far a hospital can benefit if HH intervention is adequately practiced by staffs. The key
features of HH program in the study was upgrading of HH facilities, distribution of alcohol based
handrub at point of care, HH education and HH campaigns. Similar type of cost evaluation was