Problem Statement :
Hand hygiene compliance amongst healthcare workers is insufficient, which increases the risk of hospital acquired infections (HAI) and adverse patient outcomes. This is a universal problem across the multidisciplinary health care team. In an article by Becker's Infection Control and Clinical Quality, Dr. Felix Aguirre states that most medical staff, "may not feel urgency to improve adherence because the consequences-infections or death-may not be obvious. Unless someone dies, [they think] it's not a problem" (para 5). In addition, the World Health Organization (WHO) in 2009 indicated the most common reason identified for lack of hand hygiene is an underestimated importance of the value hand hygiene in prevention of disease transmission (Pfoh et. al., 2013). Many of the road blocks, when it comes to hand hygiene compliance have been associated with limited education, poor resources, and difficulty in getting healthcare professionals to change their habits.
The scope of the problem is worldwide. Thousands of people die as a result of healthcare-associated infection and low compliance with proper hand hygiene. According to Huis et. al (2012), " Hospital Acquired Infections (HAIs) burden patients, complicate treatment, prolong hospital stay, increase costs and can be life threatening" (p. 1). Hand hygiene has been researched extensively, dating back to Florence Nightingale, as one of the most important nursing care practices in the prevention of HAIs. Unfortunately, we are still working on it today. All hospital employees need to comply with the proper hand washing hygiene to protect our vulnerable patient population...such a simple step and yet so hard to get compliance.
If the aforementioned evidence is not proof enough, the cost of treating a HAI far outweighs the cost of educating health care workers. Types of infection caused by lack of proper hand hygiene include urinary tract infection, upper respiratory infection, c-difficile, and more. HAIs account for an estimated cost of $6.5 billion dollars in the United States in 2004 alone. Hand hygiene (HH) practices could prevent up to 30% of HAIs but HH compliance remains at below 50% (Huis et, al., 2012).
With an estimated 80,000 deaths in the United States being attributed to poor hand hygiene, The Centers for Disease Control (CDC) and Joint Commission have partnered in promoting their hand hygiene campaign with an emphasis on these key areas that have proven to be most effective:
• Educational and staff motivational programs-enhancing knowledge of impact.
• Role modeling and mentoring of proper techniques and mechanics.
• Reinforcement and monitoring of practices, to include feedback to providers
• Administrative support in providing streamlined access to alcohol based products (Pfoh, et. al., 2013).
Literature search conducted by Huis et. al., (2012) has revealed that research studies relating to HH have historically had multiple design flaws which made recommendations regarding the effects of strategies to increase HH compliance ineffective.
Attempting to understand why hand hygiene compliance is not implemented more, who the target audience is for hand hygiene, and what strategies could be implemented to improve overall compliance is the first step. Hand hygiene is therefore a fundamental action for ensuring patient safety, which should occur in a timely and effective manner in the process of care. There is substantial evidence that hand hygiene reduces the incidence of HAI's .
Question:
Polit and Beck (2012) recommend using the Population, Intervention, Comparison, Outcome (PICO) method to assist with wording well written research questions (p. 36). In keeping with this recommendation, the green team has identified the following criteria as the basis for our research question:
• Population: Multidisciplinary healthcare team members
• Problem: Hospital Acquired Infection (HAI)
• Intervention: Hand hygiene
• Comparison: No hand hygiene
• Outcome: Decreased HAI
The foreground question is therefore:
For hospitalized patients, why is hand hygiene NOT routinely performed versus routinely performed by members of the multidisciplinary health care team despite the knowledge that hand hygiene decreases the risk of HAI?