In nursing and other professions, evidence has shown that hand hygiene is highly important. Hand hygiene has helped reduce the spread of bacteria and infection. The World Health Organisation (WHO) has made a standardised step by step process that is known across the whole world. Hand hygiene can prevent most healthcare-associated infections if health professional wash their hands at the right moments.
Evidence-based practice, what is it? Evidence-based practice is used to find the best research in health interventions, best practise intervention provides our patients with high quality care in a safe manner. Ongoing studies provide researchers with evidence on what is best practice.
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Each year, 180,000 patients are affected by healthcare-associated infection (HCAIs) all around the world. (Allegranz, 2011) Our solution to this problem is practising great hand hygiene throughout the care of patients, doing so by using the correct method and right moments of hand hygiene. These 5 moments of hand hygiene include; before touching a patient, before procures, after body fluid exposure, after touching a patient and after touching a patient’s surroundings. (About SAVE LIVES: Clean Your Hands, 2009) This approach was designed to be simple, easy to learn, applicable in any setting and effective. It was created to enable health professional with a natural workflow
With all the knowledge that has been provided to health professionals, are these techniques being performed correctly? is hand hygiene being compromised in an area such as the emergency departments compared to a general ward? This question is being asked as emergency departments easily fill up quickly. Nurses and other health professionals in an emergency department are more than likely to be placed in a situation where they must act in a fast and timely manner. These emergencies could include conditions that have been suspected serious to requires acute schedule care. (Healthcare Associated Infection, 2018)
Research question
Is health professionals, effective in their hand hygiene in an emergency department, compared to a general ward being compromised?
In PICO Form
- P – Is health professionals,
- I – Effective in hand hygiene in emergency departments
- C – Compared to a general ward
- O – Being compromised.
This question will help determined whether hand hygiene techniques are being held even when placed in a stressful situation. This question is a prevention type of question as to the research data will enable health professional to revaluate their effort in performing the hand hygiene technique. Poor hand hygiene can cause bacteria to be transferred to a patient which causes hospital-acquired infection. This question aims to find out if health professionals are performing the technique adequately compared to a general ward. Less hospital-acquired infection means the patient is discharged in the appropriate time for their condition and less money is spent on hospital-associated infections.
Format to search my question
Using keywords within my question, I’m going to search with databases such as; clinical key, cinahl and the USQ Library. The keywords involved are Hand Hygiene and Emergency departments. I will then filter the journals by specifying what publish dates I’m looking for. When searching through a journal article, I will be looking at the title and the abstract, seeing if that is relevant to my question and then move on to the introduction. if I see that the paper isn’t relevant ill put it down and search for new paper. I will continue this method to find relevant research for my question. (Checklist for Systematic Reviews and Research Syntheses, 2017) The limitation will be placed on the publication date to be within the last 10 years.
Once finding my journals articles, I will be using the Joanna Briggs Institute. The appraisals to assess the methodological quality of a study, it used to check for the possibility of bias within the design, conduct and analysis.
My 5 research articles include;
- Keep it clean: a visual approach to reinforce hand hygiene compliance in the emergency department. This journal article is quantitative research, on the hierarchy this journal article fits into experimental studies level 1.b systematic review of randomized controlled trials and other study designs.
- The development of hand hygiene compliance imperatives in an emergency department. The journal article is quantitative Research. On the hierarchy, this journal article fits into Observational analytical studies level 3.a
- Hand and Hygiene Compliance in an Emergency Department: The Effect of Crowding. This journal article is quantitative research, on the hierarchy, this journal article fits into experimental studies level 1.a systematic review of randomized controlled trials.
- Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department. This journal article is qualitative research, on the hierarchy, this journal article fits into experimental studies level 1.a systematic review of randomized controlled trials.
- Interventions to improve hand hygiene compliance in emergency departments: a systematic review. This journal article is quantitative research, on the hierarchy, this journal article fits into Observational analytic studies 4.b systematic review cross-sectional study.
Reviewing and synthesizing the evidence
It is highly important to critically appraise when looking for evidence of best practice, the data within the journal article may be bias or perhaps the limitations don’t provide an accurate result. This may be because participant either dropped out of the study or they were not contactable. Is the article clear and concise? Critical appraising can help the reader to help identify whether it is reliable.
Why were these journal articles chosen? These articles were chosen as they had a research that involved information relating to emergency departments and hand hygiene. Research information on general wards hygiene competency was very limited. Although these articles have discussed briefly that the emergency department hand hygiene was considerably low compared to other wards. This is mainly due to the busy demand within the department, as well as the limited spacing. These articles are all within the last 10 years. They share the same core point of poor hand hygiene has an impact on patient’s safety and may prolong their stay. Hand hygiene compliance by health professional sits at only 40% according to the article Hand Hygiene Compliance in an Emergency Department: The Effect of Crowding Despite. (Muller, Carter, Siddiqui & Larson, 2015) These articles will enable me to formulate an answer to my research question, as each journal article has been thoroughly reviewed and provides a statistic of their research.
Synthesis of the five articles – the body of evidence
Throughout all five journals article, they all had one factor that was the same, all articles discussed lower percentages of hand hygiene being followed in the emergency department. The articles discussed the factors that are contributing to these low percentages, these include; medical emergency, heavy workloads, lack of time, poor work culture, higher patients load, limiting requirement, not knowing when to wash hands and improper technique of hand hygiene. (Jeanes, Coen, Drey & Gould, 2018) (Muller, Carter, Siddiqui & Larson, 2015) Each article introduced a program in aim to improve the compliance of performing correct hand hygiene within the emergency department. In turn, this would decrease the risk of hospital-associated infection and improve patient safety. The lower hospital-associated infections mean lower prolonged hospital visits and health care cost reduced. Each study had their strength and weakness based on their research methods however, all interventions had an impact on the staff’s hand hygiene overall compliance. These journals articles were unfortunately not Australian data, the search engines were very limited to finding Australian research.
The article named the development of hand hygiene compliance imperatives in an emergency department designed a program that allows health professionals to analyse a barrier of hand hygiene, as a team and plan of action to overcome this barrier. This resulted in positive work culture. Health professionals were more likely to action a plan to overcome a barrier within their workday. (Jeanes, Coen, Drey & Gould, 2018)
The article Interventions to improve hand hygiene compliance in emergency departments: a systematic review aimed to investigate hand hygiene compliance, they wanted to identify factors that contribute to poor hand hygiene. They did this by researching previous research study on this topic and compared the data. (Seo et al., 2019)
Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department. Aimed to assess the effects of multimodal hand hygiene strategy. They provided health professionals with education and continuous reminders around the ward, such as having computer screens as the 5 moments of the hand hygiene logo. An undercover nurse would also comment on rings to encourage health professional to follow procedures. These interventions resulted in compliance rising each week after education was given. (Arntz et al., 2016)
The article Hand Hygiene Compliance in an Emergency Department: The Effect of Crowding, aimed to see how overcrowding of patients affected hand hygiene, this was done by observing a sink bay for 20 minutes throughout Monday to Friday. Out of the 116 observed hand hygiene opportunities resulted in mean compliance of 29% and alcohol base of 66%. Overcrowding was associated with poorer hand hygiene. (Muller, Carter, Siddiqui & Larson, 2015)
Although these articles have great research results within, the article that best supports my research question is Keep it clean: a visual approach to reinforce hand hygiene compliance in the emergency department. This journal article implemented a visual way to identify poor hand hygiene, done within the emergency department. Participants used a glowing agent before performing hand hygiene, once hand hygiene had been performed participants were asked to place their hands under a ultraviolet light to highlight areas that were missed. The glowing agent was later found on keyboards, computer screens and medical equipment. A meeting was held, where this evidence was shown. After all, the finding was viewed by the Emergency Department staff, hand hygiene compliance rate rose to a baseline to 70% and continued to rise 3 months after. (Wiles, Roberts & Schmidt, 2015) This information helps me identify information related to my PICO question. Before this study took place, low hand hygiene practices were performed due to the heavy workload and lack of proper technique. This identifies that before having intervention placed to improve hand hygiene is poor within the emergency department.
Within these articles, they all provide strengths, weakness and limitations. Strength within them includes all the article emergency department had lower hand hygiene competency which was improved by the study designs method. They all had the overall goal to improve compliance in hand hygiene to in turn reducing the risk of hospital-associated infections. All journal articles were published within the last 10 years. However, the weakness includes not having information based within Australia, although the information is relatable. The article briefly discusses having lower infection control compared to other wards, however, there isn’t enough information. A limitation was some of the articles were only able to test the study within one emergency department. The development of hand hygiene compliance imperatives in an emergency department suggests that observing of practices help identify opportunities for areas to improve on, however, the perspective and ability of the observer may create bias and limitation based on what is seen and heard. (Jeanes, Coen, Drey & Gould, 2018) The article Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department stated that they did not count non-emergency department staff within the study (Arntz et al., 2016). Lastly, the article keeps it clean: stated that their sample was convenient, they would have like to have a larger nursing and emergency department population. (Wiles, Roberts & Schmidt, 2015)
Using the Joanna Briggs Institutes critical appraisal tool. This tool allows me to assess the article for its values, possible bias and overall appropriateness. The article is clear on what question they are asking, the journal article wanted to visually display the bacteria that can spread if poor hand hygiene is continued. The study was conducted using the 5 moments of hand hygiene that was developed by the world health organisation. The staff was given 3 research question to evaluate their knowledge and 25 questions on their baseline knowledge before using the glow agent. The researchers reinforced hand hygiene policy for those who didn’t comply with the centres for disease control. No evidence of bias throughout this article. The article has named all the authors and provides what they specialise in, the information researched within has been completely referenced. I believe this article is reputable as the article is dated, provides authors and can provide clinical hours towards Continuing professional development.
Overall emergency department hand hygiene compliances are lower than other wards. This is due to the high demand within the emergence department. Emergency departments are visited by millions of outpatients each year which means higher rates of bacteria within the department. Hand hygiene is highly important however, within the emergency department it can be delayed due to serious emergencies. Interventions to help reduce the barriers can improve effective hand washing in turn more frequent and quality moments of hand hygiene.
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