Hand Hygiene PICOT

The revised PICOT statement for this proposal is: For hospital patients (P), how does the use of a visual cue to stimulate hand hygiene compliance (I) compared to no visual cue usage to stimulate compliance (C) affect hospital acquired infection (O) during their hospital stay while the patient hand hygiene protocol implementation process is ongoing (T)?

Research Critiques

The quantitative study by Doyle et al. (2017) focused on testing whether co-washing could be accepted by patients as a concept to help reduce the risk of infection among hospital patients. The researchers used the survey method to see if patients embraced the concept. Doyle et al. (2017) found that the overwhelming majority of patients approved of co-washing. The findings of the study could be applied in nursing practice in a number of ways. First, co-washing could be adopted by nurses whenever they are treating patients in order to promote the idea of hygiene and effective practice with respect to being mindful about reducing the risk of infection. Mindfulness about washing hands could translate to mindfulness about inserting catheters and maintaining them, where it is common for infections to also occur in hospital settings (Chenoweth & Saint, 2013; Wilde et al., 2015).

One of the problems of this practice, however, is that twice as much hand washing would be occurring, which would mean twice the water expense. If a hospital is concerned about sustainability, washing hands excessively could be viewed as a problem in nursing practice, especially if stakeholders in the facility feel that it is important to conserve water. Sustainable practice is a large focus of much of today’s corporate social responsibility programs, and water conservation is a common feature of sustainable practice policy.

The qualitative study by Srigley, Furness and Gardam (2016) used the systematic review method “to determine the efficacy of patient hand hygiene interventions in reducing HAIs and improving patient hand hygiene rates compared to usual care” (p. 23). The researchers found that patient hand hygiene interventions could be useful in reducing hospital acquired infections, but the quality of evidence identified in their review was low, indicating that stronger research designs are required.

While...

As nurses make it part of their protocol to encourage hand washing before treating a patient, mindfulness about reducing risk of infection is promoted. This in turn creates a risk-off environment that can facilitate quality care delivery to the patient.
Proposed Evidence-Based Practice Change

Connections

The link between the PICOT statement, the research articles and the nursing practice problem is that hand hygiene is an important factor in reducing hospital acquired infections. Nurses and patients should take this issue seriously—especially patients as they are the ones who are at risk. The implementation of a policy in which nurses must wash patient hands or in which patients are asked if they would like to wash their hands before being treated by the nurse could be a way to further reduce the risk of hospital acquired infection. The PICOT statement seeks to establish whether or not this would be the case. The research articles suggest that patients would be open to the idea, but the study by Srigley et al. (2016) also indicates that the quality of evidence regarding the actual effectiveness of patient hand hygiene on hospital acquired infection rates is low. Thus, there is a need to better understand the actual effect of patient hand hygiene on reducing the risk of infection.

It is possible that implementing a protocol in which nurses are required to wash patient’s hands or ask patients if they would like to wash their hands would be useful in compelling nurses to make sure that they wash their own hands before applying treatment to patients—whether it is the maintenance of a catheter or administering an IV. By being mindful of the need to practice safe hand hygiene, the nurse and patient would be working together to keep the patient as safe and free from the risk of infection as possible. This would align with the focus on the study by Doyle et al. (2017). It would also serve as potential further evidence to help provide the high quality level of evidence requested by Srigely et al. (2016).

Practice Change

The proposed practice change is for nurses to adopt a protocol…