Evidence-Based Practice in Nursing: Importance of Hand Washing

Evidence-based practice may be defined as a problem-solving approach that requires nurses to be conscientious in their clinical practice. Therefore, the practice is emphasized on the incorporation of best evidence in making decisions with regard to patient care, from well-designed studies, and the preference and values of the patient (Vaidotas et al., 2015). The use of feedback by health care professionals is a way of creating opportunities for learning and reflection which will consequently lead to improved practice (Smiddy et al., 2015). The Nursing and midwifery council's (2015) code of conduct requires all healthcare professionals to make clinical and rational decisions using best practices.

This assignment will mainly focus on a research article on hand hygiene among healthcare professionals in a specific healthcare institution and the effect on patient care. Research indicates that most of healthcare workers around the world have been neglecting proper hand hygiene practices (Sadule-Rios et al., 2017). The neglect is also witnessed among the visitors that usually come to visit their patients in hospitals. As a result, many healthcare workers and visitors are at risk of being infected with other diseases because of neglecting hand hygiene practices (Kingston et al., 2016). According to research, the lack of hand hygiene practices remains at a low level in most medical institutions around the world. Many doctors and nurses have been reported to routinely forget to wash their hands before meeting their patients (Chassin et al., 2015). The WHO came up with guidelines on hand hygiene in health care, in 2005 as a way of improving hand hygiene among the health care workers in their facilities.

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The assignment will discuss the formulation of an answerable question that relates to how hand washing can be improved in health care facilities among the clinical staff and visitors. The assignment will use a systematic search using a database to identify a relevant research paper on handwashing practice that will be further discussed. To formulate the question, PICO is used, specified in the PICO table 1. The question formulated is “Does maintaining proper hand hygiene in health care reduce the spread of infections to patients?”. However, the formulated question does not allow for any comparison as the paper used for answering the question only includes a controlled group that quantifies whether hand hygiene reduces the spread of infections to patients which will provide a comparison by default.

Table 1. PICO

• Population
• Health care workers
• Intervention
• Maintaining hand hygiene through proper washing of hands
• Comparison
• Not applicable
• Outcome
• Reduce the spread of infections.

The Cumulative Index of Nursing and Allied Health Literature (CINAHL) was the chosen database as it covers a range of nursing and health journals. Each section of the PICO was populated with key terms with the primary purpose of focusing the search of the database once the question was chosen. During the search of the article, putting the quote marks around the phrase helped in returning materials that contain a full sentence. Also, during the search of the database, truncation was applied for searching for words with different endings using a database-specific symbol. However, it is usually advisable for researchers to use the truncation cautiously to avoid getting irrelevant hits. The wildcard is also another useful search tool that can be used in instances where a word has a variety of spellings. The Boolean operators ‘not’, ‘or’, and ‘and’ were used as a way of combining various aspects, shown in Table A. Each of the Boolean operator terms usually has a specific role for instance, ‘or’ serves the purpose of increasing the number of hits that include one or more of the key terms. On the other hand, the Booleans; ‘not’ reduces the number of hits while ‘and’ gives a list of hits that contain combined key terms. ‘Not’ also removes any hits that contain a certain key term, thus helping to prevent irrelevant hits from surfacing. Table 2 displays the number of hits that were returned after the inclusion and exclusion criteria were applied. The total number of hits found in the database was 33, including duplicates. Of the 33 hits, 23 were discarded, due to the irrelevant titles to the PICO question; the other 10 articles had good abstracts, using Table B. However, 5 of them were of poor quality; therefore, only 5 articles were read in full. The article on ‘Handwashing practices and techniques among health professionals in a tertiary hospital in Kano’ was found on the database and chosen for critical appraisal. The article was relevant in answering the PICO question and the search criteria.

Table 2. Database Search Results

• Database
• Number of Hits
• Number of Abstracts Read
• Number of Full Papers Read
• Cinahl

1. 33
2. 10
3. 5

Critical appraisal allows researchers to evaluate the research relevance and credibility of the findings to nursing practice. Various analytical tools of the appraisal can be applied to help in the evaluation of the quality of research. However, some of the critical appraisal tools may tend to be specific to the type of research while some others may take a generalized approach during the critical analysis of the study. Critical appraisal tools are essential in that; they act as guides to emphasize thorough appraisal being conducted on specific research. The tools usually consider the many aspects of a piece of research. For this research article, the critical appraisal tool chosen was the CASP Case-Control Study specified in Table C as the study will look at the relationship between hand hygiene among health professionals and the reduced spread of infections.

In terms of validity, Abdulsalam et al.’s (2015) research paper presented its main focus. The authors broke down their presentation into primary and secondary outcomes. The primary outcomes of the research were the effect of proper hand hygiene on reducing the spread of the impact. The type of study in the research was a descriptive cross-sectional one. It was mainly conducted among the nurses and doctors of the AKTH between August 2014 and February 2015. Upon getting permission from the Ethics Committee of AKTH, Kano, and consent from the nurses and doctors, the authors proceeded with the research.

The research applied the use of questionnaires as a way of obtaining the required information from the participants to know about their daily clinic sessions and ward rounds. The main contents in the questionnaire were; years of experience, washing hands before wearing and after removing hand gloves, age, having seen a poster on hand washing technique, profession, whether or not taught on hand washing technique, five moments in hand washing and ability to list them, adherence to the principle of hand washing, agents used in hand washing, washing hands before and after touching patients or handling secretions or body fluids of patients, steps in hand washing, and washing hands after using toilets (Kapil et al., 2015).

After obtaining the required data, the authors entered and subsequently analyzed it using the Statistical Package for Social Sciences version 16 by Microsoft Corporation 2007. A summary of the quantitative variables was also done using medians and means. On the other hand, percentages and frequencies were used for summarising the qualitative variables. The Chi-square test of significance was used for comparing the categorical variables. The authors considered P less than 0.05 as statistically significant for the research. The study recruited 140 health professionals as participants. Of the total participants, 30% of them were doctors while 70% of them were nurses. There were 71 females who accounted for 50.7% and 69 men which accounted for 49.3% (Abdulsalam et al., 2015). Therefore, the ratio of males to female was 1:1.03. The recruitment of the participants was acceptable as it encompassed both the doctors and nurses without any biases. The ages of participants involved in the study ranged between 20 to 60 years with a mean of 36.95+-6.59 years.

From the study, 90 (64.3%) of the health professionals are aware of the WHO global hand washing day. However, only 21 (15%) of these professionals were able to accurately state the date of the WHO global hand washing day while another 50 (37.7%) of these professionals were not even aware of the WHO global hand washing day, and consequently, none of them could even state the exact date. According to the authors, this (χ2 = 21.21, df = 2, P = 0.000) is statistically significant (Abdulsalam et al., 2015). However, 139 of these professionals strongly believe that the risk of infections can be reduced if hand washing is correctly done. Twenty-five of the health professionals (17.9%) failed to wash their hands before meeting patients. Over one hundred and thirty-one of the health professionals (93.6%) attended a hand washing lesson. Sixty-six of the members (47.1%) were well are of the five moments in hand washing while 65 of them (46.4%) did not have an idea of the five moments in hand washing. Nine professionals never attended lessons on hand washing (6.4%) while 4 of the professionals said they are aware of the five moments of hand washing (2.9%). These results were not statistically significant (Chi-square = 0.119, df = 1, P = 0.73).

The results from this study can be applied to address the challenges facing hand hygiene in healthcare both in the African continent and the world at large. Important and critical findings on hand hygiene in health care were revealed after the investigation by the authors. The study revealed the moderate knowledge that health professionals have about the WHO global hand washing day. The study validates the importance and benefits of hand washing with regard to reducing infections. The health professionals also have knowledge about the importance of using soap and water or other agents when washing their hands. The main limitation of the study is that research was only concentrated at one institution with a controlled group of participants while its main strength was the ability of the authors to get as much information as possible from the participants.

The authors attribute to the awareness of the health professionals on the importance of hand washing to the recent Ebola awareness and personal protection seminar that was conducted by hospital staff. The health professionals also have knowledge about the importance of using soap and water or other agents when washing their hands. Adherence to hand hygiene among health care professionals is still low, despite the evidence of benefits.

Overall, the intervention measures that aim to encourage health care professionals to adhere to hand hygiene are limited. Therefore, there is a need for intervention techniques to promote the need for hand hygiene among health professionals (Gould et al., 2017). The findings of this research can be significant especially in health care to improve on hand washing campaigns. Change theory can also be used as a strategy of changing the perception of doctors and nurses toward hand washing. The application will have a huge impact on changing the behavior of health professionals.

In conclusion, hand washing should be enhanced in all health care facilities to reduce the rate of infections that are being largely contributed by health care professionals. More training should be included in hospitals to encourage nurses and doctors on the importance of hand hygiene when handling patients.

References

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3. CASP Randomised Controlled Trial Checklist. (2017).
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