HEALTH CARE WORKERS HAND DECONTAMINATION PRACTICES: A QUANTITATIVE STUDY

CRITICAL APPRAISAL:

INTRODUCTION: The problem of hospital acquired infection is identified, effort have been made to eradicate or reduce the rates of receiving. The aim of the article notes the study of healthcare workers hand washing practices from behavioural aspect.

LITERATURE REVIEW: Researcher analyse various articles that describes the rates of hospital acquired infection that obtained from 6-15% of hospital admission. It also states 10-32% of acquired infection have been found in the intensive care unit (ICU).One of the study claim it is important to understand the rates can be reduced by up to one-third if the healthcare workers go along with the guidelines issued by CDC ( Centers for Disease Control and Prevention).Likewise, the factors that provide to healthcare workers non-compliance with hand washing guidelines have been identified ,such as inaccessible equipment, lack of time, busyness and deleterious effects on skin. Intervention to improve such as provision of an educational programmes, motivational programme and patient educational programmes have been enabled. After all, the researchers have concluded the hand washing compliance rates of health workers are difficult to change, therefore it can be argued that maintained improvement of compliance with guidelines requires a multi-faceted approach.

THEORETICAL FRAMEWORK: The framework used as the interest of the researcher is the modified version of PRECEDE health education theory; Predisposing, Reinforcing, Enabling, Construct in Educational Diagnosis and Evaluation.

It has four phases; social, epidemiological, behavioural and educational assessment.

THE STUDY:

AIM: The main aim of the study was to observe healthcare workers compliance with hand hygiene guidelines during patient care in an ICU in Ireland before and after implementation of a hand hygiene programme based on their knowledge, attitudes and beliefs.

DESIGN: A Quasi-Experimental design (the investigator can manipulate the independent variable and exercise some control over the experiment) was adopted. Data were collected in 2002.

PARTICIPANTS: The study was conducted in the Medical/Surgical ICU (eight bedded) of a large urban teaching hospital in Ireland (344 beds). In the study hospital, all nurses, doctors, care assistants and physiotherapists were invited to participate
Inclusion Criteria; * Willing to be involved * Involved in delivering direct patient care * Willing to be observed * Working only in the ICU * Willing to complete the questionnaire

DATA COLLECTION: Observation were made drawn from healthcare workers attending three beds randomly selected for each observational period (2 hrs. approximately) over a period of 20 hours during the shift of morning duty. A questionnaire was administered and the collection box was placed in the nurses station for completed questionnaire when the health care workers wished to return. The data for the post-test (4 weeks) phase were collected 7 weeks after the pre-test (4 weeks) periods.
Instruments:
* Structured observation schedule designed to capture observational data on compliance with hand washing guidelines.

* Self-report questionnaire designed about attitudes, beliefs and knowledge regarding hand washing.

ETHICAL CONSIDERATION: The study was approved by the local teaching hospitals ethics committee. Meetings were arranged, each participant was given written and oral information to allow them to reach an informed decision. A commitment of confidentiality was given by describing daily assignment of numbers to participants rather than using names.

DATA ANALYSIS: Statistical Package for Social Sciences were used for analysing both observational and self-report data. The two sets of data were regarded as independent- both individually and collectively. To provide descriptive statistics for hand washing rates, indication and observation of hand washing behaviour were tabulated. Compliance rate were expressed as percentage and were examined using CHI-SQUARE Test to determine the existence of a relation between pre and post test phase. Difference between rates and their 95% confidence intervals were calculated using MATLAB Statistical Package. Means and SD of mean scores from the pre and post-test phases are presented with their differences and 95% confidence intervals. Non-parametric Mann-Whitney U-Tests were performed to assess the statistical significance of differences.

RESULTS: Overall compliance rates with hand washing guidelines by groups and discipline revealed that nurses=23, doctors=5, physiotherapist=2 and care assistant=3 were observed in the pre-test phase of 152 indications for hand washing and 77 observations of hand washing practices in the overall group of health workers (n=73). In the post-test phase, 22 nurses, 8 doctors, 4 physiotherapist and 6 care assistants were observed, 135 observations of hand washing occurred out of 162 possible indication. The overall rate of 51% in the pre-test and 83% in the post-test. Attitudes towards compliance with hand washing were investigated and the positive attitude is in control. All mean score were over 5 (scores 1-3 considered negative, 4 neutral, 5-7 positive). In beliefs, data analysis revealed non-statistically significant differences between pre and post-test results in relation to outcome (n=32 and 34). Statistically significant differences were detected between pre and post-test [P<0.001]. Levels of knowledge appeared to be quite good, as not less than 79% and up to 91% correctly identified in the pre-test phase of hand washing guidelines. In the post-test phase the level of identification is not to less than 100%.

DISCUSSION: Limitation: * Lack of follow-on observational data limits the findings. * The study timeframe. * Lack of control group limit the generalizability of findings.

CONCLUSION: Critical appraisal is a systematic process through which the strengths and weaknesses of a research study can be identified. The present results were positive overall.