A STUDY TO ASSESS THE HAND HYGIENE PRACTICES AMONG HEALTH .
A STUDY TO ASSESS THE HAND HYGIENEPRACTICES AMONG HEALTH CAREWORKERS IN CSICU, SCTIMSTPROJECT REPORTSubmitted in the partial fulfillment of the requirementsFor theDiploma in Cardio vascular and Thoracic NursingSUBMITTED BYSHANU.S.JCODE NO: 6197SREE CHITRA TIRUNAL INSTITUTE FOR MEDICALSCIENCE AND TECHNOLOGYTRIVAND RUM, 695011November 2011
CERTIFICATE FROM SUPERVISORY GUIDEThis is to certify that Miss: Shanu.S J has completed the Projectworkon"ASTUDY TOASSESSTHEHANDHYGIENEPRACTICESAMONG HEALTH CARE WORKERS IN CSICU" atSCTIMST, Trivandrum under my supervision for the partial fulfillment forthe Diploma in Cardio Thoracic Nursing in the University of Sree ChitraTirunal Institute For Medical Sciences and Technology. It is also certifiedthat no part of this report has been included in any other thesis forprocessing any other degree by the candidate.Dr: SarammaP. PSenior Lecturer in NursingSCTIMSTTrivandrumTrivandrumNovember 201111
CERTIFICATE FROM THE CANDIDATEThis is to certify that the project on: “A STUDY TOASSESS THE HAND HYGIENE PRACTICES AMONG HEALTH CAREWORKERS IN CSICU”, at SCTIMST, Trivandrum is a genuine work doneby me, under the guidance of Dr: Saramma P P, Senior Lecturer in Nursing ,SCTIMST , Trivandrum. It is also certified that this work has not beenPresented previously to any other University for award of degree, diplomaOr other recognition.Miss.Shanu S JCode No: 6197SCTIMSTTrivandrumTrivandrumNovember 2011
APPROVAL SHEETThis is to certify that Miss. Shanu.S J bearing code no: 6206 has beenadmitted to the Diploma in Cardiovascular and Thoracic nursing, inJanuary 2011 and has undertaken the project entitled, "A study to assessthe Hand hygiene practice among health care workers in Cardiac SurgicalICU” in SCTIMST, Trivandrum, which is approved for the Diploma inCardiovascular and Thoracic nursing, awarded by the Sree Chitra TirunalInstitute for Medical Sciences and Technology Trivandrum, and is foundsatisfactory.EXAMINERS(1) (2) November 2011.Thiruvananthapuram,(1) . (2) .
ACKNOWLEDGEMENTFirst of all let me thank God Almighty for unending love, care and blessingespecially during the tenure of this study.I take this opportunity to express my sincere thanks to Dr: Saramma P P,Senior Lecturer in Nursing, Sree Chitra Tirunal Institute For MedicalSciences and Technology, Trivandrum. for the guidance , she provided forexecuting this study. Her advice regarding the concept, basic guidelines andanalysis of data were very much encouraging. Her contributions andsuggestions have been of great help for which I am extremely grateful. Withprofound sentiments and gratitude the investigator acknowledges theencouragement and help received from the following persons for thecompletion of this study.I am thankful to Dr: Jayakumar, HOD, Department of Cardio Vascularand Thoracic Surgery for the constant support and encouragement. All thestaff and departmental head of Cardio Thoracic and vascular unit, whohelped for completion of this study at some time I am indebted to them.Shanu. S J
AbstractTopic: - A study to assess the hand hygiene practices among healthCare workers in CSICU.Background of the study: - Health care associated infections persist as amajor problem in most Intensive Care Units. Hand hygiene is the mostsimple and effective method for the prevention of these. So assess thereported hand hygiene practices and observing is very much important tofind out gaps, plan remedial measure to reduce HAIs. Aims of the study: (a)To assess the hand hygiene practices among health care workers (b) Toassess the reason for non-compliance. Material and method:- This studywas conducted in CSICU of SCTIMST TVM. It was an observational, study50 HCWs were taken for observational study,50 for assess the reported handhygiene practices. Questionnaire and observation tool were used for datacollection. Result:. The study revealed that there is a disparity between theopinion and the practices of hand hygiene among health care workers. Theover all observed compliance was 67.08% (75 HCWs are included inobservation study , 111 number of opportunities are given only 76opportunities of hand hygiene being performed). The physiotherapist showshigher compliance rate (78%). The nurses and residents shows 68% and thetechnician and unit helpers shows low rate (60%). The reported handhygiene compliance among HCWs was above 90% (Questionnaire given to50 HCWs they were may or may not be included in observation study ).Nurses reported 98% compliance rate technician reported 81% and othersreported between 90-95%. Conclusion: There were two studies conductedby the investigator. The observational study and reported study. Theobservational study shows that the over all hand hygiene compliance was67.08% and the reported study give more than 90% of compliance amongHCWs.
CONTENTSSl. NoTitlePage No1INTRODUCTION1-81.1Introduction1-21.2Background of study3-41.3Need and significance51.4Statement of problem61.5Objectives61.6Operational anization of report8IIREVIEW OF LITERATURE2.1Introduction2.2Studies on hand hygiene practice in9-1799-14critical care unit2.314-17IIIStudy to assess the attitude of HealthCare Workers towards hand search approach183.3Setting of the study1818-21
3.4Sample and sampling technique193.5Inclusion criteria193.6Development of tool193.7Description of the tool193.8Pilot study203.9Data collection20-213.10Plan of analysis213.11Summary21ANALYSIS tion of sample according todemographic dataDistribution of sample according toreported Hand hygiene compliance23-27Distribution of sample according toreason for lack of hand hygiene31Distribution of sample according tosatisfaction with hand hygienepractices in the unitDistribution of sample according tothe hand hygiene material used in theunitDistribution of sample according toopinion about the relationshipbetween good hand hygiene practiceand hospital acquired infections324.34.44.54.64.728-303334
5.15.2Summary5.3Major Findings of the eported hand hygiene complianceamong different Health CareWorkersDistribution of sample according toobservation of hand COMMENDATIONIntroduction36-3839-42393943-53
LIST OF ABBREVATIONSCSICU -- Cardiac Surgical Intensive Care UnitHAIs --- Health Care Associated InfectionsHCWS – Health Care WorkersABHRSs – Alcohol Based Hand Rub Solution
Chapter – 1INTRODUCTION1.1 IntroductionMost nosocomial infections are thought to be transmitted by the hands ofhealth care workers. It has long been known that hand hygiene among health careworkers plays a central role in preventing the transmission of infectious agents.Hand washing is the most effective way of preventing the spread of infectiousdiseases. But despite a Joint Commission requirement that Centers for DiseaseControl and Prevention hand hygiene guidelines be implemented in hospitals,compliance among health care workers remains low.The reasons of lack of compliance to hand washing include: lack ofappropriate equipment, low staff to patient ratios, allergies to hand washingproducts, insufficient knowledge among staff about risks and procedures, thetime required and casual attitudes among HCWs towards bio-safety ( Pittet2006).Hand hygiene is a core element of patient safety for the prevention ofHealth Care Associated Infection (HAIs) and spread of anti microbial resistance.Its promotion represents a challenge that requires a multimodel strategy. Handhygiene prevents cross infection in hospitals, but Health Care Workers (HCWs)adherence to hand hygiene guidelines is poor,. Easy, timely access to both handhygiene and skin protection is necessary for satisfactory hand hygiene behavior.Alcohol based hand rub may be better than traditional hand washing as theyrequire less time, acts faster, are less irritating, and contribute to sustainedimprovement in compliance associated with decreased infection rates (Pitett,2011) .1
Hand hygiene is the most simple, most effective measure for preventing HAIs.Despite advances in infection control and hospital epidemiological, Semmelweis’message is not consistently translated in to clinical practice, and HCWsadherence to recommended hand hygiene practice is unacceptably low. Averagecompliance with hand hygiene recommendations varies between hospital wards,among professional categories of HCWs, and according to working conditions,as well as according to the definitions used in different studies. (Asare A etal.2009). Compliance with hand hygiene recommendations is the most importantmeasure in preventing health care-associated infections. Transmission ofmicroorganisms from the hands of healthcare workers is the main source ofcross-infection in hospitals and can be prevented by hand washing (AkyolAD;2007).The use of alcohol-based hand rub solutions (ABHRSs) in health caresettings has been associated with increased hand hygiene compliance andreduced rates of nosocomial infection (Ahmed-Lecheb et al.2011).) Adherence tohand hygiene recommendations in the intensive care unit (ICU) is variable andmoderate, at best.(Qushmaq et al.2008).The hand hygiene practices of health care workers (HCWs) have longbeen the main vector for nosocomial infection in hospitals. So study to examineinfluences on risk judgment from the individual differences in knowledge levelsand health beliefs among HCWs is important (McLaughlin 2011).1.2 Background of the studyHand hygiene is the practice, which keeps the hands free from pathogensor decrease the amount prior to any procedure or touching the patient. Handhygiene prevents cross – infection in hospitals, but HCWs adherence to handhygiene is poor. Easy, timely access to both hand hygiene and skin protection isnecessary for satisfactory hand hygiene behavior (pittet, 2011).2
Hand hygiene compliance rates among HCWs rarely exceeds 50% contactprecaution are thought to increase HCWs hand hygiene awareness (Gilbert,2010). Health Care Associated infections (HCAIs) are the major cause ofmorbidity and mortality. Hand hygiene is an effective preventive measure(Gould, 2010).Hospital acquired infections posses a very real and serious threat to allwho are admitted in hospitals. Pathogens are readily transmitted through thehands of HCWs, and hand hygiene substantially reduces the chance thistransmission. Evidenced based guidelines for HCWs, hand hygiene practiceexist, but compliance with these are internationally low. (Creedon, 2005).Transmission of microorganisms from the hands of HCWs is the mainsource of cross infection in hospital and can be prevented by hand washing.Compliance with hand washing is moderate. Variation across hospital wards andtypes of HCWs suggests that targeted educational programme may be useful. Theassociation between non-compliance and intensity of care suggest that understaffing may decrease the quality of patient care. (Pittet, 1999). Nosocomialinfections are a leading complication in ICUs. Although hand hygiene is thesingle most efficient preventive measure, compliance with simple action remainslow. Nosocomial infection can be transmitted from microorganisms on the handof HCWs to patients. Hand Washing is has a proven benefit in preventingtransmission of infection, yet compliance with hand washing, especially inintensive care unit is very important ( Lipsett, 2011).My 5 moments of hand hygiene (WHO)The My 5 Moments for Hand Hygiene approach defines the key momentswhen health-care workers should perform hand hygiene.3
This evidence-based, field-tested, user-centered approach is designed tobe easy to learn, logical and applicable in a wide range of settings.This approach recommends health-care workers to clean their hands;1. Before touching the patient2. Before clean / aseptic procedures3. After body fluid exposure / risk4. After touching the patient and,5. After touching patient surroundingsSree Chitra Tirunal Institute for Medical Science and Technology(SCTIMST) is an institute of national importance by an action of IndianParliament. It is an autonomous institution under the administrative control of thedepartment of Science and Technology, Govt. of India, and is situated atTrivandrum, the capital city of Kerala. It has 246- bedded tertiary referralhospital with major specialties like cardiology, Cardiac surgery and NeurologyAnd Neuro surgery. There are 3 ICUs for cardiac and 2 ICUs for Neurodepartment. There are many critically ill patients admitted in this hospital formedical treatment and for surgeries.1.3 Need and Significance of the study(HAIs) affect 1.4 million patients at any time world wide, as estimated bythe World Health Organization (WHO) . In Intensive Care Units, the burden ofHAIs is greatly increased, causing additional morbidity and mortality. Multidrug– Resistant pathogens are commonly involved in such infections and rendereffective treatment challenge. Proper hand hygiene is the single most important,simplest, and least expensive means of preventing HAIs. According to Centersfor Disease Control And Prevention and WHO guidelines on hand hygiene in4
health care, alcohol – based hand rub should be preferred means for routine handantisepsis. (Tschudin-sutter etal. 2010.).Health care workers are the most common vehicle for the transmission ofHAIs from patient to patient and with in the health care environment (Allegranzi2009).A large proportion of the infection acquired attributed to crosscontamination and transmission of microbes from hands of HCWs to patients.Many studies have consistently shown that improved hand hygiene has reducednosocomial infections and cross contamination of multi resistant infection inhospitals (Mathai etal. 2011)Most of nosocomial infections are thought to be transmitted by the handsof HCWs. So assess the knowledge, attitude and practice of hand washing amongHCWs is important (Khaled etal 2006) Hospital acquired infections poses a veryreal and serious threat to all who are admitted to hospital. Pathogens are readilytransmitted though HCWs hands, and hand hygiene practice substantially reducethe transmission. So study to assess HCWs hand hygiene practices is important(Creedon, 2005).Transmission of microorganisms from the hands of HCWs is the mainsources of cross – infection in hospitals and can be prevented by hand washing.So identifying predictors of non-compliance with hand washing during routinepatient care is important (Hugonnet 2002).Health care associated infections persist as a major problem in mostIntensive Care Units. Hand hygiene is the most simple and effective method forthe prevention of these. So assess the reported hand hygiene practices andobserving is very much important to find out gaps, plan remedial measure toreduce HAIs. From this point of view the researcher decide to assess the hand5
hygiene practices among HCWs. This study is conducted in Cardiac SurgicalICU SCTIMST.1.4 Statement of the problemA Study to Assess the Hand hygiene Practices Among Health Care Workersin CSICU, SCTIMST.1.5 Objectives of the study(a) To assess the hand hygiene practices among Health care workers.(b) To assess the reasons for non compliance in hand hygiene practice1.6Operational definition(a) Hand hygiene :It is the practice of keeping the hands free from pathogens by washingwith soap and water or using alcohol based hand rubs whenever indicatedas per 5 moments of hand hygiene(b) Health Care Workers:All staff working in ICU and give care to the patient including Doctors,nurses, physiotherapist, X ray technician, unit helpers and cleaningattendants.1.7 Research methodologyDesign: - Descriptive ApproachSetting: - The study will be planned to conduct in a selected ICU of SCTIMST,Trivandrum.6
Population: - All Staff in selected ICU who are engaged in giving Care toPatient.Sample size: - 50(knowledge assessment)75(practice assessment)Sampling technique: - Purposive samplingInclusion Criteria: - All Health Care Workers in CSICUDuration of the study: - Three months1.8 DelimitationsThe delimitation of the study is that the study conducted only in CSICU(Cardiac Surgical Intensive Care Unit).1.9 Organization of the reportChapter 1 deals with the introduction, background of the study, andstatement of the problem, Need and significance of the study, objectives,operational definitions and delimitation. Chapter 2 deals with review ofliterature, Chapter 3deals with the methodology, Chapter 4 presents analysis andinterpretation of data and chapter 5 include summery, discussion, conclusion,recommendation, reference and appendices are given towards the end.7
Chapter - IIREVIEW OF LITERATURE2.1 IntroductionReview of literature is the key step in research process, which helps to lay afoundation for the study. The literature review provides a background forunderstanding current knowledge on topic and illuminates the significance of thestudy. A literature review is a body of text that aims to review the critical pointsof current knowledge including substantive findings as well as theoretical andmethodological contributions to the particular topic. Literature review aresecondary sources, and as such, do not report any experimental work.The literature review relevant for this study is presented on the followingsections;2.2Studies on hand hygiene practices in critical care units.2.3Studies to assess attitude of health care workers towards handhygiene compliance2.2 Studies on hand hygiene practices in critical care units.Asare A et al (2009 Jun) conducted a study to assess the hand hygienepractices in a neonatal intensive care unit in Ghana. Unobtrusive observation ofpatient contact, hand hygiene practices, and hand washing technique amongnurses and physicians attending randomly selected newborns for five hours dailyfor two weeks. Patient contact categorized as low-risk or high-risk. Hand hygienepractice before and after patient contact categorized as clean uncontaminated,clean recontaminated, new gloves, unchanged gloves. Compliance to alcohol rubuse assessed. The result of the study was that the patient to nurse/physician ratiovaried from 9:1 to 12:1. There were 97 patient contacts of which 49 were high-8
risk and 48 low-risk. Most (73%) patient contacts were from nurses. Complianceto hand hygiene recommendations before versus after patient contact was 15.4%versus 38.5% for physicians and 14.1% versus 9.9% for nurses. Gloves wereused for 60.8% patient contacts (85.7% high-risk, 35.4% low-risk); however,compliance to recommended procedure occurred in only 12.2% of high-riskcontacts and none of the low-risk contacts. Gloves were not changed betweenpatients in 43.7% of high-risk contacts and 88.2% of low-risk contacts. Handwashing protocol was generally followed. Alcohol hand rub was alwaysavailable but was not used for hand hygiene. The researcher concluded that handhygiene compliance of physicians and nurses was low. Gloves and alcohol rubwere not used according to recommended guidelines. Incorporating effectiveeducation programs that improve adherence to hand hygiene guidelines into thecontinuing education curriculum of health professionals is recommended.Gilbert et al (2010) conducted a study to assess the hand hygiene practicesamong health care workers in Atlana Vetrence Affairs Medical center, todetermine any differences in hand hygiene compliance rates for HCW betweenpatients in contact precaution and those not in any isolation. The study was donein a hospital's medical (MICU) and surgical (SICU) intensive care units, a trainedobserver directly observed hand hygiene by the type of room (contact precautionor non-contact precaution) and the type of HCW (nurse or doctor). The result ofthe study was that the SICU had similar compliance rates (36/
Topic: - A study to assess the hand hygiene practices among health Care workers in CSICU. Background of the study: - Health care associated infections persist as a major problem in most Intensive Care Units. Hand hygiene is the most simple and effective method for the prevention of these. So assess the reported hand hygiene practices and observing is very much important to find out gaps, plan .
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