Hand
Hygiene and Hospital Acquired Infections (HAI)

                  Hospital-acquired
infections (HAIs) are a major concern in the United States due to its
contribution to increased patient mortality and increased health care costs. It
is estimated that over 80,000 deaths per year in the United States can be associated
with HAIs and about 1 in 25 patients will have at least 1 HAI during their
hospital stay (McCalla, Reilly, Thomas, & McSpedon 2017). Considering this,
the most significant modifiable measure in reducing and preventing HAIs from
spreading is hand hygiene, which is defined by properly washing hands with soap
and water or antiseptic agents before and after coming into contact with a
patient or the patient’s room. With the failure to adhere to proper hand
hygiene being the major cause of HAIs, it is important for caregivers to increase
and improve hand hygiene compliance to prevent the occurrence of HAIs.

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Problem and Significance

                  Non-compliance
and improper technique with hand hygiene is a serious matter because it effects
the ability of nurses to provide optimal care to their patients, which can lead
to increased transmission of HAIs and lead to a substantial increase in costs
incurred by the hospital and especially by the patient. It is estimated that
the direct healthcare costs for the 5 leading HAIs which include:
ventilator-associated pneumonia, central line-associated bloodstream
infections, surgical site infections, Clostridium
difficile infection, and catheter-associated urinary tract infections is
approximately $10 billion per year (McCalla et al., 2017). Furthermore,
patients in the intensive care unit (ICU) contribute to a higher rate of HAI
because ICU patients are much more susceptible to HAIs due to the invasive
procedures that the patients may require. For instance, nurses in the ICU are
involved in invasive procedures such as intravenous medication administration,
enteral diet administration, insertion of bladder and enteral catheters, and
dressing changes (Nunes de Freitas Luciano, Bezerra do Nascimento, Marques
Nunes, Ferreira Monteiro e Oliveira, Barbosa Davim, & Rubeiro Cesar Alves,
2017). Therefore, it is imperative for nurses especially in the ICU to improve
and adhere to proper hand hygiene compliance in order to protect the patient
and the nurses as well. Thus, the focus of this research paper is to provide
evidence-based nursing interventions to improve adherence to proper hand
hygiene to decrease the rates of HAIs in the ICU. As a result, our PICOT
question for our research paper is if increased access to hand hygiene products
and hand hygiene education could reduce the transmission of HAIs among patients
in the adult medical-surgical ICU.

Purpose of the Paper

                  The
purpose of this paper is to analyze and interpret two scholarly articles in
addressing the identified issue regarding hand hygiene compliance and HAIs. The
paper will apply research principles to interpret and evaluate the content of
the two scholarly articles that were chosen, which addresses the problem.
Furthermore, the credibility and the clinical significance of the two articles
regarding evidence-based practice will also be evaluated in this paper.

Levels of Evidence

                  There
are different types of question templates that we could have used for our
research question, such as therapy, prognosis, diagnosis, etiology, prevention,
or meaning. However, we determined that the type of question we are asking is
prevention. This is because we are asking if access to hand hygiene products
and education to increase compliance with proper hand hygiene among caregivers
in the ICU can reduce the rate and/or prevent patients from attaining HAIs.
Considering this, the best type of evidence available to answer the PICOT
question that is being asked is a mixed method design. Mixed method is a
research approach that combines quantitative and qualitative research, which can
be used to describe a measurable state and the subjective meaning of the data
(Houser, 2018, p. 37). For example, the quantitative aspect in the research is identifying
the rate of ICU nurses performing hand hygiene and the qualitative aspect is describing
and understanding how the importance of an improved hand hygiene compliance
plays a significant role in reduction of HAIs. 
After accurately identifying the type of PICOT question and the type of
evidence available to answer the question being asked, we will determine the
best way to address the problem.

Search Strategy

The major objective
of nursing research is to improve nursing practices by increasing ones’
knowledge; however, identifying a subject or a topic to research may be
problematic if the subject is too broad. Therefore, it is best for the
researcher to narrow down the topic of interest for researchable questions to
become more evident. Considering this, using specific terms relating to the
topic may help to narrow down the topic in question. For example, search terms
that were used with regards to answering the PICOT question included: hand
hygiene, hand hygiene compliance, hospital-acquired infections, intensive care
unit, and noncompliance rates. Additionally, it is important to use academic
databases, such as CINAHL and EBSCOhost, to find articles that are scholarly
and peer reviewed to prevent biases. With CINAHL database, we were able to
refine our searches by limiting the search for articles to have full texts and with
publication dates to be within five years so that the information is not
outdated.

                  With
the search, the two articles that were most relevant and helpful in providing
guidance in the next paper and the group’s work were identified. The article by
McCalla et al. (2017), proposed that it is vital to assess the healthcare
provider’s compliance to proper hand hygiene since hand hygiene is the leading
measure in preventing HAIs. As for the article by Nunes de Freitas Luciano et
al. (2017), it suggested that healthcare professionals, especially in the ICU,
are less compliant with proper hand hygiene and that they are more concerned with
their self-protection; therefore, it is important to implement and raise awareness
about the importance of proper hand hygiene to protect the patient and the
health care provider as well. As a result, the two articles are used to provide
evidence that increased access to hand hygiene products and education regarding
proper hand hygiene can reduce HAIs among patients in the ICU.

Conclusion

                  In
conclusion, many infections can be prevented through proper hand hygiene.
However, proper hand hygiene compliance among healthcare providers are low specifically
among health care workers in the the intensive care unit. Thus, it is important
to promote increased access to hand hygiene products and increased awareness
and education about proper hand hygiene practices because prevention of HAIs
are a priority since they are the major contributors to increased morbidity and
mortality in the United States.