Statement of Purpose Research Paper

Hygiene refers to the practices that communities perceive as upholding or preserving healthy living, while an infection is an attack of parasites on a host organism. Hospitals being public places where both sick and healthy people mingle are likely to be more vulnerable to infections compared to other places. The sources of infections in hospitals include hospital staff, patients and the inanimate environment.

Maintenance of hand hygiene is one of the simplest yet most effective methods in prevention of infections. In spite of the society emphasizing on the importance of hand hygiene, many people including health care personnel, do not adhere to this practice as recommended. This study focuses on adherence of Health Care Personnel (HCP) to hand hygiene practices and nosocomial or hospital-acquired infections.Statement of Purpose Research Paper

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Numerous studies have shown that the hands of HCP are the most likely vehicle of hospital-acquired infections. Research has shown that, Proper hand hygiene can remove more than 90% of infection-causative pathogens present on the hands. It is, therefore, crucial that HCP adhere to proper hand hygiene practices. However, adherence to satisfactory hand hygiene by HCP has been poor. According to Beck and Schmidt, (2001), only 40% of HCP adhere to proper hand hygiene posing the risk of increased nosocomial infections.

The healthcare code of ethics calls upon HCP to uphold beneficence, or rather “act in the best interest of the patients”. Proper hand hygiene among HCP with the aim of decimating nosocomial infections is therefore, a beneficent practice. Notably, nurses are more in contact with patients than any other HCP. This means that nurses are more likely to transmit nosocomial infections to patients. Adherence to hand hygiene practices by nurses, therefore, has immense potential to reduce nosocomial infections.

Problem Statement/ Hypothesis

The main challenge from various researchers on hand hygiene has been, how to increase adherence. This study will seek to establish the relationship between the incidences of nosocomial infections reported in a given hospital to the adherence levels of its HCP to hand hygiene. To this end, the study hypothesizes that: The higher the levels of adherence to hand hygiene by HCP, the lower the levels of nosocomial infections.

Objectives

The main objective of this study is to study hand hygiene practices among HCP and its relationship to nosocomial infections.
Specifically the study aims at:
Studying hand hygiene techniques used by HCP and their levels of adherence to the techniques.
Establishing the number of nosocomial infections reported in a selected hospital and correlate the adherence of HCP to hand hygiene, to the number of infections.

Evaluating the reasons for or against adherence to various hand hygiene techniques.

Offering recommendations to increase adherence to hand hygiene practices.
Expected Outcomes

The study expects to establish an in-depth coverage of hand hygiene practices by HCP in a selected hospital. A correlation of the hand hygiene practices to the number of nosocomial infections in the hospital will be done. The resultant challenges and weaknesses will prompt appropriate solutions that can be implemented. Increased adherence to hand hygiene practices shall reduce nosocomial infections.Statement of Purpose Research Paper

Nursing Theorist/ Theory

Nursing theories recommend two basic measures to prevent nosocomial infections: Cutting off transmission routes and separating the source of infection from the rest of the hospital (Pratt, 2009). The nursing profession recommends the former measure since it is much more proactive. Nurses ought to eschew from implementing the latter because it could mean putting a patient in total isolation against their will, (Garner, 2006). Moreover, the threat of airborne infection could still loom even after isolation.

Two main types of microorganisms are present on the skin. These are the resident flora and the transient flora. Resident floras reside on the skin while transient floras are introduced into the body by medical devices such as catheters or during trauma. Studies have shown that it is transient flora and not resident flora that are responsible for the majority of hospital infections.

Hand washing easily removes transient flora. Hand washing removes loose transient flora by removing dirt. Hygienic hand washing using antiseptics (medicated soap or alcohol) added to detergents removes entirely all the transient flora and effectively reduces chances of infections. The reduction in the levels of transient flora (infection-causative agents) is the ultimate way of reducing nosocomial infections.

Literature Review

Numerous researchers have conducted studies on hand hygiene in various social settings such as restaurants, schools, parks, sporting venues, hospitals, among others. In spite of increasing levels of pathogens in the environment; nearly all the studies have reported poor adherence to hand hygiene practices. Nursing researchers have touted hand hygiene among HCP, as one of the most effective ways of in preventing hospital-acquired infections through indirect contact. Pratt (2009) attributes 90% of nosocomial infections to indirect contact. Infected patients touch objects, instruments or surfaces. Subsequent contact from the object or surface is likely to result in an infection to a second (mostly a HCP) or a third (another patient). (Ryan, Christian & Wohlrake, 2001), concur with the nursing theory by stating that hospitals adherence to hand hygiene has the potential to reduce nosocomial infection by 80%. This makes proper hand hygiene a crucial practice that has tremendously beneficial outcomes.Statement of Purpose Research Paper

A study by (Kennedy & Burnett, 2011) identified the following as factors influencing adherence of HCP to hand hygiene: The status of the HCP, the place of work (ward, intensive care unit, theatre etc), the sex of the HCP (males show less commitment to hand hygiene compared to females). Others factors include the use of protective gear (gloves, gowns), the type of hand hygiene substances and equipment provided and their positioning (soaps, towels, sinks), the number of staff in a particular facility among others. A survey by Pratt (2009), reported 48% compliance out of 2,834 opportunities observed opportunities for hand hygiene.

There are various hand hygiene techniques. Pratt (2001) categorized hand hygiene techniques into three. (1) Routine handwash (using ordinary water and anti-microbial soap). (2) Hygienic hand washing (using water and medicated soap or alcohol-based hand rubs). (3) Surgical hand antisepsis (hygienic hand washing performed by surgeons prior to an operation). The study recommends HCP to conduct antiseptic hand washing prior to performing invasive procedures such as placement of indwelling and intravascular catheters, prior to dressing wounds and prior to handling patients at a high risk of infections such as newborns.

Alcohol based hand rubs are appropriate where hand washing facilities are inadequate and in case the hands are not soiled with dirt or contaminated with body fluids (Bloomfield, Aiello, Cookson, O’Boyle & Larson, 2007). Alcohol based antiseptics eliminate transient flora rapidly due to their mechanical detergent effects. Moreover, the rubs exert a sustained antimicrobial activity on the remaining flora (Ryan et al, 2001). According to Pittet, (2007), the disinfectants also retard the resident flora and, making them suitable in the elimination of microorganisms over long periods of time. The disinfectants are suitable in the elimination of all bacteria and the clinically relevant viruses, fungi and yeasts (Kennedy & Burnett 2011).Statement of Purpose Research Paper

However, surveys have shown that frequent exposure of skin to water and soap can result in skin irritation and consequently damage while alcohol based hand rubs have a tendency to cause drying of the skin (Ryan et al, 2001). Some surveys reported that 25% of nurses exhibited signs and symptoms of dermatitis at some point in their careers. Majority of them attributed the condition to frequent hand washing. Research has shown that repeated use of waterless alcohol-based hand antiseptics containing emollients can improve skin condition and curb dermatitis. Forced air driers are not appropriate for use in clinical areas (Van de Mortel & Murgo, 2006). The equipment is noisy, can only be used by one person at a time and they are responsible for a number of infections. In their place (Kennedy & Burnett, 2011) recommends the use of paper towels. They should be placed near the sink away from splashing water.

Expected Outcomes

Contrary to previous studies on this topic, this research proposal seeks to address hand hygiene using a two pronged approach. (1) Study the adherence levels to hand hygiene of HCP in a hospital setting. (2) Establish the number of nosocomial infections reported over a given period in the selected hospital. Attributing the rise in nosocomial infections in a hospital to poor hand hygiene, is likely to trigger an empathetic response from the HCP of the hospital. It is expected that HCP, hospital administrators inclusive will act in the best interest of patients.

The study is, therefore, expected to yield more a comprehensive coverage of the topic and present proactive approaches to solving the resultant challenges and weaknesses. It is expected that, the study will be a wake-up call to HCP to adhere to hand hygiene, while challenging hospital administrators to play their part to ensure that all HCP uphold hand hygiene. This could come in the form of availing more sinks per a given number of HCP, changing the substances the HCP currently use among other interventions.

It is also expected that the nursing students will implement the recommendations of this study. Nursing students are expected to adhere to proper hand hygiene practices and carry on the practices to hospital settings. It is expected that adherence to hand hygiene practices by all HCP, student nurses inclusive will decimate hospital-acquired infections.Statement of Purpose Research Paper

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