Clinical Practice Report: Evidence-Based Hand Hygiene in Post-Op

This report delves into clinical practice within a post-operative care setting, emphasizing the critical role of hand hygiene in preventing healthcare-associated infections. It explores the specific area of care, focusing on Staphylococcus aureus bacteraemia (SAB) and the transmission of pathogens. The report formulates a PICO question to guide the analysis of effective handwashing techniques. It summarizes evidence from systematic reviews and meta-analyses, comparing and contrasting different literature sources to identify effective interventions like alcohol-based hand rubs, goal setting, and accountability measures. The report also identifies barriers to implementing evidence-based practices, such as lack of knowledge, motivation, and infrastructural support. The conclusion highlights the importance of safety and cleanliness standards in post-operative care and the need for continuous improvement in hand hygiene practices.

Running head: CLINICAL PRACTICE
Clinical Practice
Name of the student
University name
Author’s note

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Table of Contents
Assessment 3:.........................................................................................................................2
Introduction................................................................................................................................2
Specific area of care practice.....................................................................................................2
PICO question............................................................................................................................3
Summaries of evidences chosen.................................................................................................4
Compare and contrast of different literature sources.................................................................6
Barriers to the implementation of evidence based practices......................................................7
Conclusion..................................................................................................................................8
References................................................................................................................................10

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Assessment 3:
Introduction
The current assignment focuses upon specific clinical care practices and the various
methods adopted within an acute care setup. The focus is upon use of evidence based
practices which helps in improving the overall quality of care. However, a number of barriers
are faced in the implementation of evidence based practices. Some of these could be
attributed to the lack of sufficient knowledge and skills within the healthcare staffs.
Additionally, difference of opinions between different members of a healthcare team often
makes implementation of the evidence based practices difficult. For the current assignment, a
post operative set up of care has been taken into consideration with an emphasis upon
maintaining effective hand hygiene. The effective guidelines or standards of hand hygiene
are often not effectively followed up within a post –operative setup, which further increases
the chances of infection post surgery. The assignment tries to uncover the detailed methods
and procedures which could be implemented to ensure safe practices within an intensive care
unit, as most of the times the basic guidelines are not 100% effective.
Specific area of care practice
In the current practice, a post operative care setup has been taken into consideration.
A patient admitted within an intensive care unit or discharged from the same after surgical
process often undergoes a number of clinical complications. As mentioned by Grile et al.
(2016), some of the post –operative complications arises due to failure in keeping up with the
safety measures. With regards to hand hygiene one of the most important clinical criteria,
which could be discussed over here is healthcare associated infections. One of this is
Staphylococcus aureus bacteraemia (SAB) which causes an infection of the bloodstream. It

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results in longer hospital stay and could often lead to fatal consequences. The bacteria are
commonly found in the skin or in the nose are spread from person to person. As reported by
Labrecque et al. (2016), the transmission mostly occurs through the hand of the healthcare
workers. The bacteria can gain direct entry into the bloodstream through the patient’s wound.
The chances of coming in contact with the pathogen is high while giving intravenous fluids
or taking blood samples. The patients who are at greater risk of infection are the ones with
open wounds, invasive devices such as catherers, weakened immune systems etc (White et al.
2016). Sometimes the SAB could results in surgical site infections resulting in longer
hospital stays and longer tome of recovery.
Therefore, in order to ensure safe clinical practice sufficient amount of importance
needs to be given on implementing and practising effective hand hygiene methods. As
reported by Ranjan et al. (2017), between 15-40% people admitted in critical care could be
thought to be affected by healthcare associated infections. One in every 136 patients is prone
to be infected by pathogens in critical care. The fatality rate is between 4-56% and requires
high degree of care and attention. The hand hygiene is pivotal to implement safe and
effective clinical care practices and could be implemented through a number of steps such
as- using alcohol based hand rubs at the point of patient care, education of healthcare
workers on correct hand hygiene techniques, display of hand hygiene reminders (Pop-Vicas
et al. 2017).
PICO question
A PICO question could be developed over here with regards to practising effective
hand hygiene standards in clinical care. Here, PICO refers to Population, Intervention,
Comparison and Outcome. The question could be represented below as:

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Does health workers (P) using effective hand washing techniques (I) compared to use of
simple soap and water in post-operative setup (C) reduce the rate of healthcare associated
infections (O)?
Summaries of evidences chosen
For the current study, secondary research has been conducted where data has been
conducted from evidence based studies. For the collection of data evidence based journals
have been extracted from a number of secondary databases such as PUBMED, NCBI etc.
Additionally, a strict search criteria have been followed that is articles from only the last
seven years have been taken into consideration. The articles published prior to that have been
excluded from the study design. For the study purpose of study, only the articles published in
English have been taken into consideration. The articles published in any other language than
English have been excluded. The articles have been reviewed for the identification of similar
themes which have been further used for doing a thematic analysis. The various ideas have
been further compared for the identification of dissimilar data. These further form the point
of comparison between the different article sources. The difference has been used for the
identification of loopholes within the research.
In this respect, an evidence based study has been conducted where the research papers
selected belong to the highest level of evidence. That is the most of the papers selected over
here use systematic review, randomised control trials and cohort groups.
Article 1: Luangasanatip, N., Hongsuwan, M., Limmathurotsakul, D., Lubell, Y., Lee, A.S.,
Harbarth, S., Day, N.P., Graves, N. and Cooper, B.S. 2015, ‘ Comparative efficacy of
interventions to promote hand hygiene in hospital: systematic review and network meta-
analysis’, bmj, vol. 351, p.728.

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The study undertaken over here was aimed at testing the effectiveness of WHO based
interventions to promote hand hygiene among healthcare workers. The design adopted here
was systematic review and metanalysis. Therefore, it belonged to level 1 of the evidence
based table. The data over here had been collected from a number of secondary databases
such as MEDLINE, EMBASE, CINAHL and Cochrane library.
The review methods which had been adopted over here were randomised control
methods .Additionally, network metanalysis were performed on studies reporting compliance
with hand hygiene.
From the study, it had been concluded that promotion of hand hygiene was effective
increasing compliance within healthcare workers. However, goal setting, rewarding schemes
and accountability standards were effective in bringing about further improvements within
clinical care and practice.
Article 2: Schweizer, M.L., Reisinger, H.S., Ohl, M., Formanek, M.B., Blevins, A., Ward,
M.A. and Perencevich, E.N. 2013, ‘Searching for an optimal hand hygiene bundle: a meta-
analysis’, Clinical infectious diseases, vol, 58, no. 2, pp.248-259.
The study aimed to find out optimal interventions for implementing hand hygiene. A
number of studies on interventions to improve hand hygiene had been evaluated over here to
arrive at the best strategies for controlling the rate of healthcare infections. It consisted of six
randomised control trials and 39 qausi experimental studies. It evaluated a number of
parameters like education provided to the healthcare staffs in intervention methods, hygiene
reminders, feedback provided to staff on maintenance of hygiene, access to alcohol base hand
rub.

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A metanalysis was performed over here where evidence based literatures were
collected from a number of secondary databases such as NCBI, PUBMED etc. The search
was limited to the past 12 years. The Jadad score was used to access the quality of RCT. The
scale created by Larson was used to access the quality of the observational studies. The
results of the study concluded that evidence base supporting critical public health measure
needs to be supported.
Article 3: Huis, A., van Achterberg, T., de Bruin, M., Grol, R., Schoonhoven, L. and
Hulscher, M. 2012, ‘A systematic review of hand hygiene improvement strategies: a
behavioural approach’, Implementation Science, vol.7, no. 1, p.92.
The study aimed to find the determinants of safe and effective behaviour within an
acute care setup. It aims at finding out the several factors which promotes the healthcare
workers to follow effective clinical care guidelines.
An experimental and quasi experimental study had been conducted over here in order
to find out different hand hygiene improvement standards. Some of the most frequently
accessed determinants over here are- knowledge, awareness, and action control. Some of the
additional factors over here are social influence and intention. It was found that addressing
combinations of different determinants were useful that individual determinants in bringing
about desired changes.
Compare and contrast of different literature sources
The different literature sources could be compared in order to arrive at a conclusive
theory. One of the theories presented by an article over here says that apart from promotion
of hand hygiene, rewarding schemes and training on accountability standards could help in

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improving the quality of care (Manivannan et al. 2018). As supported by Chatfield et al.
(2016), the motivation to effectively use or implement hand hygiene standards are dependent
upon a number of determinants such as knowledge and awareness levels. However as argued
by Hickox et al. (2017), in the lack of intrinsic motivation the quality of care provided by the
healthcare staffs may differ. Therefore, some of the factors such as rewards and incentive
bonus can help in generating increasing levels of motivation within the nursing and
healthcare professionals. As argued by Edmonds-Wilson et al. (2016), there are several
incidents where the quality of care have affected on grounds of negligence. The negligence
most often arises due to factors such as compassionate fatigue. As supported by Sankaran et
al. (2016), the compassionate fatigue arises due to long hours at work and when the
healthcare professionals are handling too many patients at the same time. The pathogens
could get transferred from the hands of the healthcare workers, as they often forget to wipe
their hand with an alcohol rub on dealing with too many patients. Therefore, some of the
factors which had been highlighted over here are development of knowledge and awareness
within the patients. For the purpose of which the hospitals should focus upon effective
training procedures. However, as supported by Singh et al. (2017), the lack of infrastructure
and resources can make the provision of training difficult. It could be also attributed to
monetary deficits. As argued by Kos et al. (2017), the lack of sufficient support from the
stakeholders affects the overall quality of the support and care services. In this respect,
conducting an audit of hand hygiene performances can also help in improving the quality of
care services provided.
Barriers to the implementation of evidence based practices
There are a number of barriers in the implementation of the evidence based practices.
Some of these are lack of adequate amount of knowledge within the healthcare staff, lack of

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motivation, insufficient infrastructural support, lack of initiative from the management. It has
been seen that the alcohol rub has been seen to reduce the chances of infection by almost
36% (Luangasanatip et al. 2015).
However, there is lack of effective support from the management and the trainers.
Due to which the healthcare staffs often fail to learn the standard guidelines as well as
implement them. Additionally, the lack of reminders from management also affects services
standards. For example, washing hand with soap and water before and after handling patients.
Additionally, alcohol based hand rub is the preferred way to prevent antisepsis in most cases.
The care should be taken to not use soap and alcohol based hand sanitization concomitantly.
Therefore, some of these reminders could be provided to the healthcare workers on a
regular basis in the lack of which the overall care quality may suffer. As mentioned by
Manivannan et al. (2018), lack of adequate infrastructure in government based hospitals also
affects the quality of the services. However, long working hours, overworked staffs and less
pay are some of the other factors which can affect the quality of care.
Conclusion
The current report takes into consideration a post –operative care setting. The safety
and cleanliness standards are very important within post –operative care. This is because
within an acute care setup the chances of contraction of an infections very much high as one
generally has lower levels of immunity. Some of the infections spread through SAB are very
common and are mostly spreads by the healthcare workers, as they fail to follow effective
hand hygiene standards.
Therefore, clinical audit along with provision of effective training and support to the
healthcare staffs can help in improving the quality of care such as highlighting the importance

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of alcohol rub. In this respect, a number of barriers are faced such as lack of sufficient
infrastructural support; lack of effective training along with longer work hours can further
affect the quality of care. Therefore, evidence based practices along with ethical approaches
in nursing can help in improving the overall structure of care.

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References
Chatfield, S.L., Nolan, R.D. and Hallam, J.S. 2016, ‘ Hand Hygiene Intervention Design
Recommendations Derived from a Cross Sectional Factorial Survey Given to 460 Acute Care
Nurses’, American Journal of Infection Control, vol, 44, no. 6, pp.S5-S6.
Edmonds-Wilson, S.L., Pelz, R. and Moore, L.D. 2016, ‘Electronic Hand Hygiene
Monitoring with a Complementary Improvement Program Significantly Increases Hand
Hygiene Rates’, American Journal of Infection Control, vol, 44, no. 6, pp.S6-S7.
Grile, J.R., Nguyen, C.H. and Gritters, D. 2016, ‘Evaluation of an Intra-Operative Bundle of
Care Model in the Prevention of Surgical Site Infections among Colorectal Surgical Patients’,
American Journal of Infection Control, vol, 44, no. 6, p.S92.
Hickox, N., Clifton, L., Coe, C., Cox, F., Gardenhire, M., Goins, D., Hunter-Watson, H.,
Lewis, M., Maile, P., McKinney, C. and Thomas, H. 2017, ‘ Strategies to Reduce Central
Line-associated Bloodstream Infections in a Critical Care Unit’, American Journal of
Infection Control, vol.45, no.6, p.S112.
Huis, A., van Achterberg, T., de Bruin, M., Grol, R., Schoonhoven, L. and Hulscher, M.
2012, ‘A systematic review of hand hygiene improvement strategies: a behavioural
approach’, Implementation Science, vol.7, no. 1, p.92.
Kos, M., Dziewa, A., Ksykiewicz-Dorota, A., Drop, B. and Kos, M. 2016, ‘Nursing care
quality and post-operative wound infections’, Polish Journal of Public Health, vol. 126, no.
1, pp.13-18.
Labrecque, S., Patricia, B., Sauerland, C., Lauren, W., Tana, P., Bubb, T.N., Tedjarati, S.,
Chen, D. and Pua, T. 2016, ‘ Significant Reduction in the Rate of Surgical Site Infection

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(SSI) Post Abdominal Hysterectomy (AH) at an Academic Tertiary Care Hospital’, American
Journal of Infection Control, vol. 44, no. 6, p.S25.
Luangasanatip, N., Hongsuwan, M., Limmathurotsakul, D., Lubell, Y., Lee, A.S., Harbarth,
S., Day, N.P., Graves, N. and Cooper, B.S. 2015, ‘ Comparative efficacy of interventions to
promote hand hygiene in hospital: systematic review and network meta-analysis’, bmj, vol.
351, p.728.
Manivannan, B., Gowda, D., Bulagonda, P., Rao, A., Raman, S.S. and Natarajan, S.V. 2018,
‘Surveillance, Auditing, and Feedback Can Reduce Surgical Site Infection Dramatically:
Toward Zero Surgical Site Infection’, Surgical infections, vol.19, no. 3, pp.313-320.
Pop-Vicas, A., Musuuza, J.S., Schmitz, M., Al-Niaimi, A. and Safdar, N. 2017, ‘ Incidence
and risk factors for surgical site infection post-hysterectomy in a tertiary care
center’, American journal of infection control, vol. 45, no. 3, pp.284-287.
Ranjan, K.P., Ranjan, N. and Gandhi, S. 2017, ‘ Surgical site infections with special
reference to methicillin resistant Staphylococcus aureus: experience from a tertiary care
referral hospital in North India’, International Journal of Research in Medical Sciences, vol,
1, no. 2, pp.108-111.
Sankaran, S.V., Rajagopal, G.K. and Achamkulangara, S. 2016, ‘Effects of antibiotic
prophylaxis on surgical wounds: A study in a tertiary care centre of central Kerala’, Journal
of The Academy of Clinical Microbiologists, vol, 18, no. 1, p.12.
Schweizer, M.L., Reisinger, H.S., Ohl, M., Formanek, M.B., Blevins, A., Ward, M.A. and
Perencevich, E.N. 2013, ‘Searching for an optimal hand hygiene bundle: a meta-
analysis’, Clinical infectious diseases, vol, 58, no. 2, pp.248-259.