Literature Review
HAIs received a great deal of attention in scientific circles. The researchers investigate the causes and effects of HAIs in various environments as well as develop strategies to tackle the issue.
As far as the identification of leading causes of HAIs is concerned, Weber and Rutala (2013) identify a number of the most persistent ones. They state that 40-60% of infections in the intensive care units are transmitted via the hands of medical staff. This fact is also mentioned in the research conducted by Ellingson et al. (2014). They underline that this problem was widely researched, tested for one and a half-century, but still, the adherence to hand hygiene remains at the level of approximately 40% (Ellingson et al., 2014).
Another factor that causes infections to spread in the hospital is the contamination of surfaces (Weber, Anderson, & Rutala, 2013). The study argues that pathogens such as noroviruses, Staphylococcus aureus, Clostridium difficile, Acinetobacter, and others are able to survive in the hospital environment for several hours, days, or months. They can infect and colonize patients and personnel becoming the risk factor for the health of both of these stakeholder groups (Weber et al., 2013). In addition, researchers revealed that bacteria could spread through the ventilation system.
Zimlichman et al. (2013) studied the economic impact of HAIs on the U.S. Healthcare system. It was estimated that bloodstream infections inflicted the direst consequences and resulted in $45.000-worth of expenses per case. The second and third place was attributed to pneumonia and infections at the surgery with $40.000 and $20.000 respectively (Zimlichman et al., 2013).
Electronically assisted monitoring of hygiene was researched by Ward et al. (2014). The systematic review of 42 articles on hygiene monitoring revealed that various devices and techniques were utilized to address the problem of hand hygiene adherence including electronically enhanced, and direct monitoring, video monitoring, automated monitoring networks. According to the results of the study, the effectiveness, and cost of these measures were mostly inconclusive or presented not enough data. Given the limited financial resources of clinics allocated to hygiene, the cost-effectiveness of such systems remains a major concern and also requires further studies. Ellingson et al. (2014) also noted that the main weakness of the technological approach was its high cost.
Among the identified strategies to combat hand HAIs in the clinical setting were hygiene training and the introduction of step-by-step procedures for medical staff. Ellingson et al. (2014) stated that this procedure was among the most effective and efficient. However, the scientists indicate that further research is also required as optimal dosages of hygiene products were poorly tested, which diminished the results (Ellingson et al., 2014).
Methodology and Design of the Study
To assess the leading causes of HAIs at the chosen facility a series of procedures will be required. Since hygiene is a complex matter that depends on many factors, a multifactorial analysis will be used. As such, the following perquisites will be studied in the clinic of choosing:
- supply of fresh air, water, and sunlight,
- the cleanness of surfaces,
- the level of personal hygiene adherence among personnel,
- overall hygiene reporting procedures utilized in a clinic.
To assess the identified parameters a scale from 1 to 10 will be used. To eliminate research biases insolation, aeration norms will be consulted with. Additionally, the expertise of surfaces with portable contamination test kits can be utilized if the researcher will be able to obtain one for the study purposes. If this is not an option, then a manual and visual inspection approach will be used instead. To evaluate hygiene reporting procedures, nurse managers will be interviewed to reveal the fact of absence or presence of such practices. Upon identification, appropriate literature will be consulted to review their soundness.
In order to test if electronic hygiene monitoring tools, enhanced reporting procedures, and additional training of nurses are effective measures to reduce HAI accidence in a clinical setting, the following interventions will be chosen:
- installation of video monitoring tool inpatient wards,
- introduction of product volume measurement,
- presentation of a lecture on evidence-based, safe hygiene practices to nursing personnel.
As far as video monitoring is concerned, the choice of this electronic monitoring tool was suggested among the less costly measures to enhance hygiene adherence (Ward, 2014). Manual inspection of the following occasions of hand washing procedures will be observed:
- before touching a patient
- before starting an aseptic procedure
- on the occasion of body fluid exposure or the risk of such exposure
- after touching patient surroundings (Ellingson et al., 2014, p. 938).
As an enhanced reporting procedure product volume measurement will be used as it allows assessing the volume of used hygiene products, which will indicate the changes in the actual frequency of medical staff performing hygiene actions in addition to video monitoring (Ellingson et al., 2014). The resource manager will be consulted in order to inquire about the volumes of products distributed daily.
A presentation for nurses will state the prevalence of the problem, and raise awareness of the staff of the main techniques to reduce hand contamination and surface contamination in order to achieve a safe and healthy environment. Additional stress will be put on the positive results of adequate hygiene management and the costs of improper hygiene handling.
The research design will utilize quantitative and qualitative techniques to assess and evaluate the gathered data. Observation will be used as the main qualitative technique to interpret the gathered data. An experimental intervention such as the installation of video monitoring will be used, and the results will be measured by counting the number of hygiene actions and volumes of hygiene products used.
Sampling Methodology
Sampling will be based on using three separate intervention and control groups. The first sample will include three nursing teams of 5 people. The first team will be monitored by a video camera. The second one will not be monitored, and the third one will not be monitored but will be notified that they will be. The second sample will consist of two teams of 5 people one of which will be presented with a lecture about hygiene importance while the control team will not. Thus the sample will include 35 nurses from a clinic where the researcher is currently employed. The sample will include people of all sexes, ages, and levels of experience. The people will be asked to participate either by email or personally. The participants’ privacy and data security will be achieved through the collaboration with the clinic’s security staff to ensure that video files will not be publicly accessible, used only for research purposes. Also, each participant will be required to give his or her written or oral consent for participation.
Necessary Tools
When the necessary tools are concerned, the researchers will need a small video camera with a hard drive, which is able to store up to a 24-hour video session. Another possibility includes using standard clinical video-monitoring tools if access to them is be granted by a clinic security manager. The portable contamination test kit will be required to assess the cleanness of surfaces. Microsoft Excel will be used for storing the gathered data. SPSS statistics will also be a valuable addition to the research, as it will simplify the data management and final presentation.
Algorithm of Implementation
The implementation phase will begin with data collection about the initial state of the hygiene management. Two weeks will be allocated to gather and analyze the necessary baseline data.
Two weeks will be assigned to gathering a sample of 35 people via personal or electronic invitation. Intervention teams will be notified that their hygiene actions during the experiment will be monitored by a video camera.
A video camera will then be either accessed or installed in a certain facility with permission of a clinic chief of security gained prior to the installation. A clinical supplies manager will be approached with a request to access the data on hygiene products. A week will also be necessary to complete the preparation.
A presentation will be devised and scheduled for an appropriate date with the five people chosen for intervention implementation.
Observation will continue for a period of two months, after which the recordings and data on hygiene products volumes will be accessed.
Within a period of two weeks, the data will be analyzed and presented in a report.
References
Ellingson, K., Haas, J. P., Aiello, A. E., Kusek, L., Maragakis, L. L., Olmsted, R. N.,… & VanAmringe, M. (2014). Strategies to prevent healthcare-associated infections through hand hygiene. Infection Control & Hospital Epidemiology, 35(8), 937-960.
Ward, M. A., Schweizer, M. L., Polgreen, P. M., Gupta, K., Reisinger, H. S., & Perencevich, E. N. (2014). Automated and electronically assisted hand hygiene monitoring systems: A systematic review. American Journal of Infection Control, 42(5), 472-478.
Weber, D. J., & Rutala, W. A. (2013). Understanding and preventing transmission of healthcare-associated pathogens due to the contaminated hospital environment. Infection Control & Hospital Epidemiology, 34(5), 449-452.
Weber, D. J., Anderson, D., & Rutala, W. A. (2013). The role of the surface environment in healthcare-associated infections. Current Opinion in Infectious Diseases, 26(4), 338-344.
Zimlichman, E., Henderson, D., Tamir, O., Franz, C., Song, P., Yamin, C. K.,… & Bates, D. W. (2013). Health care–associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Internal Medicine, 173(22), 2039-2046.