How to Have Good Hand Hygiene

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 the quality of evidence may be low, the study does show that evidence exists corroborating the idea that patient hand hygiene can be useful in decreasing the risk of hospital acquired infection. 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 that allows them to promote patient hand hygiene. Fox et al. (2015) developed a protocol of this type. Nurses were trained on how to adhere to the protocol, interact with patients and use an electronic medical record for recording whether the patient was compliant with invitations to wash their hands with the nurses. The prompt would be given at the nursing console and a response from the patient would be required for entry in cases where the patient chose not to wash hands. This process helped to ensure that nurses at least were washing their hand. In other words, by extending the invitation to patients, nurses were reminded more and more of the importance of washing hands before treating a patient, and this helped to keep them in the practice of using good hand hygiene.
The practice change proposed for my hospital is a co-washing approach to hand hygiene that uses a visual cue to stimulate patients to agree to wash their hands before being treated. The idea of a visual cue is based on the evidence supplied by Ford, Boyer, Menachemi and Huerta (2014) who conducted a qualitative study on the power of visual suggestion with regards to hand washing. When users of a restroom saw a towel hanging from the towel dispensary they were 25% more likely to wash their hands than when the dispensary showed no towel. This would allow the proposed change to be evidence-based in a number of ways: first, it would be based on the studies by Doyle et al. (2017), Chenoweth and Saint (2013), Fox et al. (2015), Srigley et al. (2016) and Wilde et al. (2015) regarding the utility, agreeableness and effectiveness of co-washing to prevent hospital acquired infection; second, it would be based on the study by Ford et al. (2014) regarding the effectiveness of visual cues in stimulating individuals to want to wash their hands.
The visual cue in this case would be the use towel dispensers near the sink, with a towel hanging where the patient can see it; the nurse, too, would hold a towel when posing the question to the patient to make the offer that much more inviting. The end goal of the change would be to reduce the risk of hospital acquired infection for the patient. This would be a change from current hand hygiene practice in the hospital as right now there is no protocol for promoting patient hand hygiene and no usage of a visual cue to stimulate the patient’s desire for hand hygiene.
The outcome of this change proposal and the use of a visual cue to help stimulate patient hand hygiene could provide more evidence as to whether or not patient hand hygiene is effective in reducing the risk of hospital acquired infection. As of now, no study of this kind has been conducted. The evidence quality, as shown by Srigley et al. (2016), is low and a study of this nature could be effective in providing a higher quality of evidence to facilitate the development of evidence-based practice.
The outcome of this project could help to reshape the way nurses approach the practice of hand hygiene. By introducing a protocol that invites the patient to co-wash with the nurse, using a visual cue to stimulate the patient to want to engage in the safe practice, this proposal aims to provide an improved working environment for nurses and patients alike so that hospital acquired infections can be reduced.
Conclusion
The PICOT for this study focuses on assessing whether the intervention of using a visual cue to promote patient hand hygiene is more effective than not using a visual cue during the protocol implementation process. There is plenty of evidence to support the idea that hand washing helps to reduce hospital acquired infections. There is also evidence indicating that co-washing could facilitate the reduction of infection risk. Not all patients may be stimulated to want to wash their hands every time there is a treatment process; thus, the visual cue is to be used to see whether this helps to encourage more hand washing among patients. If it does, this improved protocol could be used among all nurses in hospitals where there is a need for a better hand hygiene approach. The findings of this project could be communicated in a peer-reviewed journal, seminar, or conference with colleagues as well as shared among peers in a nursing association to help spread awareness of the evidence obtained herein.





References
Chenoweth, C., & Saint, S. (2013). Preventing Catheter-Associated Urinary Tract Infections in the Intensive Care Unit. Critical Care Clinics, 29(1), 19-32.
Doyle, G. A., Xiang, J., Zaman, H., Neiman-Hart, H., Maroon, M., Arghami, E., ... &
King, D. E. (2017). Patient attitudes and participation in hand co-washing in an outpatient clinic before and after a prompt. The Annals of Family Medicine, 15(2), 155-157.
Ford, E. W., Boyer, B. T., Menachemi, N., & Huerta, T. R. (2014). Increasing hand
washing compliance with a simple visual cue. American journal of public health, 104(10), 1851-1856.
Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C., ... & Bader,
M. K. (2015). Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses’ hand washing. American Journal of Critical Care, 24(3), 216-224.
Srigley, J. A., Furness, C. D., & Gardam, M. (2016). Interventions to improve patient
hand hygiene: a systematic review. Journal of Hospital Infection, 94(1), 23-29.
Wilde, M. et al. (2015). Self-management intervention for long-term indwelling urinary
catheter users. Nursing Research, 64(1), 24-34.