Hospital Acquired Infection and Nursing Interventions

This presentation discusses the impact of nursing interventions on hospital acquired infections (HAIs) and how to increase compliance of hand hygiene among healthcare professionals. It highlights the importance of proper training and awareness to reduce the rate of HAIs and improve the overall quality of care. The presentation also includes a PICO question and a literature matrix to support the findings.

Hospital Acquired Infection and Nursing
Interventions
Presented by:

Hospital Acquired Infection and Nursing Interventions
Background
Hospital acquired Infections (HAIs) are common incidence in healthcare organisation
(taylor et al., 2016). HAIs increases the rate of mortality and morbidity of the patients
along with an increase in the healthcare costs (Taylor et al., 2016, pp: 2). According to
Taylor et al. (2016), the cross-infection risk of the patient admitted in the infectious
disease ward or respiratory ward is high because these patients are immune-deficient and
more exposed to infectious micro-organisms within the hospital ward. The surrounding
environment of the infectious or the respiratory disease wards are infiltrated with harmful
disease causing pathogens like multi-drug resistant Pseudomonas, Vancomycin-resistant
enterococci (VRE), Clostridium difficile, Acinetobacter spp. and methicillin-resistant
Staphylococcus aureus (Taylor et al., 2016, pp: 2). According to Dancer (2014, pp: 2) the
spread of these infectious micro-organisms mainly occurs from the contaminated surfaces
like the no-sterile needle, towels and other hospital tools along with tables and beds.
However, study conducted by Dancer (2014, pp: 3) highlighted that the main reason
underlying the spread of HAIs in the infectious and the respiratory disease ward of
hospitals are the nurses. Since nurses spend most of the time with the patients in the
infectious ward, the contaminated hands are the main source of nocomial or HAIs in the
respiratory or the infectious ward. However, observing contact precautions is not
comprehensive in reducing HAIs this is because, admitting patients in separate wards or
cabins will further increase the overall healthcare costs (Taylor et al., 2016, pp: 1). Thus,
proper precautions coming from the nursing professionals in the domain of infection
control can be regarded to be effective in controlling the HAIs (Sarani et al., 2016, pp: 2).
Grunda and Sopjani (2017, pp: 3) highlighted the compliance of proper hand hygiene and
use of personal protective equipments like the face masks, gloves and clean aprons can
help to prevent the chances of hospital acquired infection.
Clinical Question
Do increase in hand hygiene compliance helps in decreasing the rate of hospital acquired
infections (HAIs)?
PICO Question
P Population Patients in the infectious disease ward and
respiratory wards
I Intervention Increase in the compliance of hand hygiene
among the nursing professionals
C Comparison No compliance of hand hygiene by the healthcare
professionals
O Outcomes Decrease in rate of occurrence of noscomial and
hospital acquired infection
Details of the Search Strategy
Type of evidence: Digital evidence: Search of the research articles through electronic
database search
Databases used for the search of the articles: Medline, PubMed and CINHAL
The search will aim to focus on the papers which are structured through evidence based
practice and the systematic review
Inclusion criteria Exclusion criteria
Articles published during 2012 to 2018 Articles published before 2012
Articles published in English Articles published in English
Peered reviewed: Primary and Secondary
Control of infection outside the hospital settings
Determination of level of evidence
Initial search of the literary articles with the help of electronic database highlighted 30 relevant RCTs,
qualitative studies, observational studies, cohort studies and systematic reviews. Of these total of
five studies are selected. Of them one discescriptive time series study, two prospective ecological and
interrupted time series study, one prospective observational study, one interventional studies
Determination of quality of the paper: Use of CASP tool
Recommendations
•According to Luangasanatip et al. (2015, pp: 2), in order to increase the compliance of hand hygiene the
nurses are required to be trained to follow World Health Organisation’s (WHO) five-step of hand hygiene
protocol.
•In order to increase the awareness of the importance of hand hygiene proper training of the nursing
professionals are important. This training can be given through multimodal approach through multimedia
communication, campaign, education, proper leadership and engagement (Aboumatar et al., 2012, pp: 3).
Barriers Strategies
Lack of proper nursing knowledge among
importance of hand hygiene Proper training of the nursing professionals in
order to increase awareness in hand hygiene
Lack of compliance among the nursing
professional
Implementation of WHOs five-step hand
hygiene protocol in order to improve the
compliance
Increase in work pressure among nursing
professionals creating barrier in effective
compliance
Increase in the overall nursing workforce
Evidence ‘Bottom Line’ Statement
Hand hygiene is an effective medium in order to reduce the rate of HAIs in the infectious and in the
respiratory ward. Increase in the level of hand hygiene compliance among the nursing or the other
healthcare professionals can be done through proper education and training of the nursing
professionals and helping them to follow WHO five-step hand hygiene compliance
Source: Australian Government National Health and Medical Research Council. (2009)
References
•Aboumatar, H., Ristaino, P., Davis, R. O., Thompson, C. B., Maragakis, L., Cosgrove, S., ... & Perl, T. M. (2012). Infection prevention
promotion program based on the PRECEDE model: improving hand hygiene behaviors among healthcare personnel. Infection Control
& Hospital Epidemiology, 33(2), 144-151. https://doi.org/10.1086/663707.
•Al-Tawfiq, J. A., Abed, M. S., Al-Yami, N., & Birrer, R. B. (2013). Promoting and sustaining a hospital-wide, multifaceted hand hygiene
program resulted in significant reduction in health care-associated infections. American journal of infection control, 41(6), 482-486.
https://doi.org/10.1016/j.ajic.2012.08.009
•Australian Government National Health and Medical Research Council. (2009). NHMRC additional levels of evidence and grades for
recommendations for developers of guidelines. Access date: 14th September 2018. Retrieved from: https://www.nhmrc.gov.au/_
files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf
•Dancer, S.J., 2014. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for
decontamination. Clinical microbiology reviews, 27(4), pp.665-690. DOI: 10.1128/CMR.00020-14
•DiDiodato, G. (2013). Has improved hand hygiene compliance reduced the risk of hospital-acquired infections among hospitalized
patients in Ontario? Analysis of publicly reported patient safety data from 2008 to 2011. Infection Control & Hospital
Epidemiology, 34(6), 605-610. https://doi.org/10.1086/670637
•Gruda, A. & Sopjani, I.,(2017). The Knowledge, Attitudes and Practices of Nurses Toward Management of Hospital-acquired Infections
in the University Clinical Center of Kosovo. Materia socio-medica, 29(2), p.84. doi: 10.5455/msm.2017.29.84-87
•Luangasanatip, N., Hongsuwan, M., Limmathurotsakul, D., Lubell, Y., Lee, A. S., Harbarth, S., ... & Cooper, B. S. (2015). Comparative
efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. bmj, 351, h3728. doi:
https://doi.org/10.1136/bmj.h3728
•Pincock, T., Bernstein, P., Warthman, S., & Holst, E. (2012). Bundling hand hygiene interventions and measurement to decrease health
care–associated infections. American journal of infection control, 40(4), S18-S27. https://doi.org/10.1016/j.ajic.2012.02.008
•Salama, M. F., Jamal, W. Y., Al Mousa, H., Al-AbdulGhani, K. A., & Rotimi, V. O. (2013). The effect of hand hygiene compliance on
hospital-acquired infections in an ICU setting in a Kuwaiti teaching hospital. Journal of infection and public health, 6(1), 27-34.
https://doi.org/10.1016/j.jiph.2012.09.014
•Sarani, H., Balouchi, A., Masinaeinezhad, N. & Ebrahimitabs, E., (2016). Knowledge, attitude and practice of nurses about standard
precautions for hospital-acquired infection in teaching hospitals affiliated to Zabol University of Medical Sciences (2014). Global
journal of health science, 8(3), p.193. doi: 10.5539/gjhs.v8n3p193
•Stone, S. P., Fuller, C., Savage, J., Cookson, B., Hayward, A., Cooper, B., ... & Roberts, J. (2012). Evaluation of the national
Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and
Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study. Bmj, 344, e3005. doi:
https://doi.org/10.1136/bmj.e3005
•Taylor, G., Gravel, D., Matlow, A., Embree, J., LeSaux, N., Johnston, L., Suh, K.N., John, M., Embil, J., Henderson, E. & Roth, V., (2016).
Assessing the magnitude and trends in hospital acquired infections in Canadian hospitals through sequential point prevalence
surveys. Antimicrobial Resistance & Infection Control, 5(1), p.19. https://doi.org/10.1186/s13756-016-0118-3
Keyword 1 Keyword 2 Keyword 3
Hospital Acquired
Infections Hand Hygeine Nursing Professionals
OR OR OR
Noscomial infection Hand Sanitization Nurse
OR OR OR
Hospital infection Hand Cleaning Healthcare professionals

Literature Matrix
Author/
Date Research Question/
Aim Population Study Design Findings Conclusions and Implications for
Practice Level of
Evidence
12
Limitations
Al-Tawfiq, J. A., Abed, M. S., Al-
Yami, N., & Birrer, R. B. (2013) Study the compliance of hand
hygiene in relation to decrease
in the rate of HAIs
Healthcare professionals in the
community hospital in Saudi
Arabia
Descriptive time series study Compliance rate of hand hygiene was
found to be highest among the
nursing professionals and doctors.
Increase in compliance rate lead to
decrease in rate of methicillin-
resistant Staphylococcus aureus and
ventillator-associated infection
Multimodal observance of interventions of hand hygiene
is highest among the nursing and the healthcare
professionals and increase in compliance help to
decrease the rate of HAIs
4 The study was follow-up during the tenure of 2006 to 2011.
This follow-up studies might lead to decrease in the sample
size leading to biased results
Stone et al. (2012) To analyze the impact of clean-
your-hands campaigns in
reducing the rate if HAIS
Nursing professionals in infection
control ward of England
Prospective, ecological and
interrupted time series study
Use of alcohol hand rub by the
nursing professionals helps in
reducing the rate of HAIs of
methicillin resistant Staphyllococcus
aureus and Clostridrium difficile
Proper compliance of hand hygiene b y the nursing
professionals helps in reducing the rate of HAIs and thus
helping to improve the overall quality of care and
reducing the cost of care
3 The study did not undertake randomization in selection of
the focus group and this may tamper the over results
through selection bias
Pincock, T., Bernstein, P.,
Warthman, S., & Holst, E. (2012)
Measuring decrease in health-
care associated infections
through hand-hygiene
interventions
Reviewing multimodal approach
to improve hand hygiene
compliance and application of
bundle strategy
Observational study Application of bundle strategy helps
to increase the compliance of hand
hygiene and thereby reducing the
rate of HAIs
Increase in the compliance of hand hygiene is effective in
reducing the incidence of HAIs
3 Application of bundle strategy helps to increase the
compliance of hand hygiene and thus reducing HAIs
Salama et al. (2013) To determine hand hygiene
compliance rate among the
nursing professionals and
studying its effects on reducing
nosocomial infection in ICU unit
Education and increasing
awareness about HAIs among the
nursing professionals
Interventional studies for 7
months
Increase in hand hygiene helps to
reduce cross-infection in ICU patients
Increase in the compliance of hand hygiene helps to
decrease cross-infection under ICU settings
3 Non-randomized control trial might include biased outcome
DiDiodato, G. (2013) Study the association between
hand hygiene and infection
control in Canadian hospital
Review of the data collected from
the database on Ontario patient
safety from October 1 2008 to
2011
Prospective ecological Increase in the compliance of hand
hygiene helps to reduce HAIs
Proper training of the nursing professionals in hand
hygiene will help to reduce HAIs
3 Long follow-up study lead to problem in the sample size