Is the use of alcohol based solution in hand washing more effective than soap and water hand washing in reducing nosocomial infection infections inside a nephrology unit of a hospital?

Is the use of alcohol based solution in hand washing more effective than soap and
water hand washing in reducing nosocomial infection infections inside a
nephrology unit of a hospital? – a proposed evidence-based practice healthcare
change project
Clinical Question
The proposed clinical PICOT question to be considered
for the healthcare change intervention is: “Is the use of
alcohol based solution in hand washing more effective
than soap and water hand washing in reducing
nosocomial infection infections inside a nephrology unit
of a hospital?” With respect to the same, the PICOT
components which will guide decision-making for
initiation of healthcare change intervention are:
•P: Population: Adult patients admitted in the
nephrology department
•I: Intervention: Alcohol-based hand rubbing solution as
a proposed hand hygiene practice
•C: Comparison: Soap and water as a hand hygiene
practice
•O: Outcome: Reduced rate of nosocomial infections or
infection incidences.
Synthesis of Evidence
While the effectiveness of hand hygiene practices
underlying the prevention of healthcare associated
infections has been researched in abundance, lack of
healthcare staff compliance with respect to following the
same continues to prevail. In addition to established of
training or educational based frameworks, the placement
of alcohol-based hand rubbing solution at critical care
locations like patient rooms or the bedside have been
proven to improve organizational compliance to hand
hygiene practices (Pires et al., 2017).
Thus, as per the given PICOT question, the proposed
healthcare change intervention necessitates the
introduction of alcohol-based hand rubbing solutions, in
comparison to water and soap, as the first line of hand
hygiene protocol to be followed immediately after
healthcare professionals have engaged in invasive
procedures or interventions involving adult patient
contact, in the nephrology unit of a chosen healthcare
organization. Alcohol-based hand rubbing solutions have
been evidenced to be a financial feasible and
ergonomically compliant way with which nosocomial
infections can be controlled at all almost all points of
patient care without causing dryness as compared to
traditional hand hygiene practices requiring soap and
water (WHO, 2020).
Table 1: Proposed Intervention Plan
Project Plan Components Characteristics Timeline
Development of Draft Project
Plan
To be discussed with supervisor 1st week of March, 2020
Approval of final Project Plan
To be discussed with project team members and stakeholders 2nd week of March, 2020
Educational plan formulation
Will comprise of designing audiovisual and printed resources containing
information on importance of hand hygiene, types of practices and
comparison between soap/water and alcohol rubbing.
3rd week of March, 2020
Team member roles and
project implementation
Motivational session by tenured staff and collection of swabs – to be
sent for colony counting
Deliverance of educational plan by inter-disciplinary team and
healthcare professionals and administration/management.
Feedback session by tenured staff ad collection of swabs for colony
counting
Final debriefing session and result evaluation.
Development of new hand hygiene protocols.
1st to 2nd week of April
Equipment required
Projectors, laptops, soap, water, alcohol solutions, paper, printers, cotton swabs, colony counter,
petri dishes. Medical costs of injuries to be covered by the organization.
Barriers
The key cultural or educational
barrier which can pave the way for
change resistance is inadequate
knowledge or inadequate health
literacy across healthcare staff. There
continue to remain misperceptions
and unawareness concerning
replacement of soap and water with
alcohol-based rubbing solutions since
it is commonly believed that the
latter is not as clinical effective as the
former (Kingston et al., 2017).
Additional organizational and
administrative barriers which can
cause change resistance include: lack
of hand hygiene protocols at the
organizational level, absence of
tenured or champion healthcare
professionals for change facilitation
and misconceptions that alcohol-
based solutions cause dryness and
gloves provide adequate protection
as compared to hand hygiene
practices (Bellissimo-Rodrigues et al.,
2016).
Project Team
The project team members will comprise of
the researcher, the nursing staff, the
operations manager, healthcare
administrator and inter-disciplinary
healthcare professionals like physicians,
practitioners and nephrologists, to assist in
not just evidence based research and policy
formulation, but also to facilitate
multidisciplinary approaches to change
fulfilment. Additional key stakeholders who
will be involved in the project team will
include tenured nursing staff or healthcare
champions who will not only assist in
delivering educational protocols but will also
be useful in motivating and encouraging
staff to comply with hand hygiene protocols
and proposed change interventions
(Kingston, O’Connell & Dunne, 2018).
Facilitation
Plan
A transformational leadership approach
will be used to facilitate change and will
comprise of encouraging staff to actively
participate in the decision making
activities and also provide their inputs and
insights concerning change
implementation. Considering the need to
overcome cultural and organizational
barriers, change will be facilitated via
educational and administration
interventions. This will comprise of
including staff in an educational workshop
on effectiveness of alcohol solutions for
hand hygiene as well as formulation of
novel organizational policies, protocols,
rules and regulations which will
necessitude the placement and usage of
alcohol-based solutions at critical points of
patient care (Kramer et al., 2017).
References
Bellissimo-Rodrigues, F., Soule, H., Gayet-Ageron, A., Martin, Y., & Pittet, D. (2016).
Should alcohol-based handrub use be customized to healthcare workers’ hand
size?. infection control & hospital epidemiology, 37(2), 219-221.
Gudza-Mugabe, M., Magwenzi, M. T., Mujuru, H. A., Bwakura-Dangarembizi, M.,
Robertson, V., & Aiken, A. M. (2017). Effect of handrubbing using locally-
manufactured alcohol-based handrubs in paediatric wards in Harare, Zimbabwe.
Antimicrobial Resistance & Infection Control, 6(1), 8.
Kingston, L. M., O’Connell, N. H., & Dunne, C. P. (2018). A comparative study of hand
hygiene and alcohol-based hand rub use among Irish nursing and medical
students. Nurse education today, 63, 112-118.
Kingston, L. M., Slevin, B. L., O'Connell, N. H., & Dunne, C. P. (2017). Attitudes and
practices of Irish hospital-based physicians towards hand hygiene and hand rubbing
using alcohol-based hand rub: a comparison between 2007 and 2015. Journal of
Hospital Infection, 97(1), 17-25.
Kramer, A., Pittet, D., Klasinc, R., Krebs, S., Koburger, T., Fusch, C., & Assadian, O.
(2017). Shortening the application time of alcohol-based hand rubs to 15
seconds may improve the frequency of hand antisepsis actions in a neonatal
intensive care unit. infection control & hospital epidemiology, 38(12), 1430- 1434.
Pires, D., Soule, H., Bellissimo-Rodrigues, F., Gayet-Ageron, A., & Pittet, D. (2017).
Hand hygiene with alcohol-based hand rub: how long is long enough?. infection
control & hospital epidemiology, 38(5), 547-552.
WHO. (2020). WHO | System change - changing hand hygiene behaviour at the point
of care. Retrieved 11 February 2020, from
https://www.who.int/gpsc/tools/faqs/system_ change/en/.
Evaluation Plan
Outcomes will be measured on an ongoing basis via the inclusion of
weekly debriefing and group discussion sessions where participating
staff, project team members and stakeholders will discuss and share
strengths, limitations and potential improvement areas. Outcomes of
nosocomial infections can include pre and post intervention colony
counts of hand swabs as well as organizational samples for
prevalence of common infection-causing bacterial strain such as
Acinetobacter, Staphylococcus, Clostridium species and Escherichia
coli (Gudza-Mugabe et al., 2017).