Hospital Aquired Infection and Hand Hygiene

Executive Summary

Hospital acquired infection (HAI) is most common problem in healthcare. According to recent report, our hospital has one of the highest rates of HAIs in the region. Hand hygiene is the simplest way to reduce HAIs in hospital. Our hospital’s hand hygiene compliance rate is 80%, however, this might be overrated due to the Hawthorn effect. As a CEO of the hospital, I drew from two evidences currently available to improve levels of hand hygiene compliance. Evidence suggest that a hospital wide hand hygiene interventions and a team and leader- directed interventions to improve hand hygiene compliance. However, hand hygiene cannot be achieved through any single intervention. Therefore, multifaceted interventions are vital to improve hand hygiene in healthcare. I would suggest some recommendations to the Hospital Board to consider as hand hygiene interventions. Appropriate leadership, provide adequate education and training, implement environmental changes, initiate organisational culture and system changes and use appropriate measurement are all to consider by the Hospital Board. These interventions also should align with patient’s quality and safety of care. Through these hand hygiene interventions, our hospital will be able to achieve hand hygiene compliance, then as a result, HAI rates will be reduced.

Introduction

Hospital acquired infections are the major concerns in hospital settings (Huis, 2013). The Board and District Health Services set to reduce HAI rates as one of our hospital’s key performing indicators. However, local newspaper recently published that our hospital has one of the highest rates of HAIs in the region. Hand hygiene is one of the most important intervention to prevent healthcare associated infections (Kirkland, 2012). Although, our hospital has met the state’s minimum requirement for accreditation, this might be overestimated because of the Hawthorn effect. Recent survey shows that about 7.1% of patients were affected by HAIs in Europe (Huis, 2013). Although hand hygiene is the most effective intervention to prevent HAIs, hand hygiene compliance rate in healthcare workers continues to be low and most hospitals still facing a challenge to improve hand hygiene (Kirkland, 2012).

Purpose of this report is examine hand hygiene interventions from two evidences currently available and then introduce interventions into our hospital to improve hand hygiene compliance to finally decrease the HAIs rate. Both studies were conducted in acute hospital settings. One of the study was an interrupted time series and data was collected from all types of healthcare workers in a teaching hospital in rural New Hampshire (Kirkland, 2012). The other study was a cluster randomised trial and data was collected from nurses of three different hospitals in Netherland (Huis, 2013).

Study and Outcome Factors

In Huis study, leadership, social influence are study factors and reduce HAI is outcome factors. In Kirkland study, leadership, hand sanitiser availability are study factors and nurses’ attitude, knowledge are outcome factors.

Study Validity & Bias

Both studies clearly defined participants sample but did not report baseline characteristics of participants. 6months post intervention follow-up data reported in Huis study and 1year post intervention follow-up data reported in Kirkland study. Therefore, both studies have the intervention sustainability. There is high risk of bias in Huis study. First, performance bias risk is high because intervention was led by ward leaders, therefore, unable to blind participants. Second, detection bias risk is high because researchers aware of undertaking analysis. However, selection bias risk is low because study used a computer generated sequences. Attrition bias risk is also low because baseline measurement of outcome was similar between groups. In addition, study outcome was measured pre and post intervention. On the other hand, Kirkland study has no high risk of bias. Study adequately addressed outcome data and intervention was unlikely affects data collection. However, performance bias risk is unclear because Kirkland did not report whether participants were blinded or not. Both studies used direct observation. Direct observation is considered the possible bias of having Hawthorne effect because the risk of participants altering their behaviour due to knowledge of being observed. To prevent this, Huis used an unobtrusive observation and Kirkland used a direct covert observation for data collection.

Major Findings & Their Significance; Applicability

Appropriate statistical analysis was conducted in both studies. Huis study showed a significant improvement in team and leader-directed strategy. Hand hygiene compliance rate was used to measure outcome of the study. In the experimental group, rate was increased from 20% to 53% and remained at 53% post intervention. Random regression analysis was used to assess the impact of the intervention. The analysis showed a significant odds ratio of 1.64 in favour of the experimental group. High rates of hand hygiene compliance and longest sustainability were found with a multimodal and team leader-directed strategy. Kirkland study showed that the HAIs was significantly decreased when hand hygiene intervention implemented. There was a significant and sustained decline in the HAI rate from 4.8 to 3.3 (p < 0.01) per 1000 inpatient days after a hospital wide hand hygiene intervention was implemented. The study appears to have been strongly designed and measured, and have consistently attained compliance rate over 90%.

Study limitations

Both study have strengths and limitations. Huis study has methodological strengths because of the large numbers of observations and participating wards and the use of unobtrusive observations. Kirkland study use a tracer condition adds strength to conclusion that better hand hygiene contributed directly to lower infection rates. Huis study has limitations because study did not measure hand hygiene compliance in other health professionals. Limitations of Kirkland study was that individual intervention will increase HH performance were unclear. Kirkland also did not measure all interventions and compliance audits did not include during patient care. In addition, there was no cost analysis of the study. Because it is a long time study research for three years, study cost would be high.