Visual Cues and Hand Hygiene: Reducing Hospital Infections

PICOT Statement

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 determine whether 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 to be mindful about reducing the risk of infection. Mindfulness about washing hands could translate to mindfulness about inserting catheters and maintaining them, where it is also common for infections to occur in hospital settings (Chenoweth & Saint, 2013; Wilde et al., 2015).

One problem with 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 water conservation is important. 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 infection risk is promoted. This in turn creates a risk-conscious environment that can facilitate quality care delivery to the patient.

Connections Between Research and Practice

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 ask patients if they would like to wash their hands before being treated, 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 patients' hands — or ask patients if they would like to wash their hands — would be useful in compelling nurses to ensure they wash their own hands before applying treatment, whether it is the maintenance of a catheter or the administration of 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 of the study by Doyle et al. (2017). It would also serve as potential further evidence to help provide the high-quality evidence requested by Srigley et al. (2016).

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 substantial evidence to support the idea that hand washing helps to reduce hospital-acquired infections. There is also evidence indicating that co-washing could facilitate a reduction in infection risk. Not all patients may be motivated to wash their hands every time a treatment process occurs; thus, the visual cue is intended to determine whether this approach encourages more hand washing among patients. If it does, this improved protocol could be used among all nurses in hospitals where a better hand hygiene approach is needed. The findings of this project could be communicated in a peer-reviewed journal, seminar, or conference, and shared among peers in a nursing association to help spread awareness of the evidence obtained.

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.