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Hand HygieneThomas J. ColeFerris State UniversityAbstractThis paper focuses on a seemingly simple yet important question regarding hand hygiene in the healthcare setting. It begins by addressing the question itself, namely whether hand washing guidelines should be updated to place more emphasis on technique and increased knowledge among nurses about the benefits of hand hygiene in comparison with current the guidelines. From there, the methodology for finding the answer to the question is discussed. After that, a series of articles are discussed, including aspects of the articles such as if they pertain to nursing research and how they relate to the question at hand. After an analysis of these articles, a summary is given in which it is concluded that more attention should be given to the standardization and implementation of hand hygiene guidelines for all nurses and healthcare workers.Hand HygieneResearch and nursing go together like peanut butter and jelly. One without the other is just not complete. All good nursing practices are based upon research that has been analyzed, refined, and then put into practice. Without research, nursing would be a profession without a foundation and without regulation or guideposts. The purpose of this paper is to show how nursing research is important to the profession by analyzing a series of articles related to hand washing and how this relates to positive changes in nursing practice and theory.PICO QuestionThis paper is based on a design known as PICO, which stands for population (or problem), intervention, comparison, and outcome. PICO questions are effective ways of asking research questions in a way that promotes meaningful research and a focused response. The PICO question being analyzed in this research paper is whether hand washing guidelines should be updated to place more emphasis on technique and increased knowledge among nurses about the benefits of hand hygiene in comparison with current the guidelines. In this instance, the population is nurses, the intervention is emphasis proper hand washing, the comparison is current guidelines and knowledge on hand washing, and the expected outcome is the reduced frequency of infections and greater compliance.MethodologyOne of the most crucial elements of being able to effectively answer a PICO question through research is making sure that the question is clearly defined, thereby making it easy to search for answers that fit the criteria of the question. In this instance, the question at hand asks about hand washing compliance among nurses and whether compliance (or lack thereof) has an effect on the incidence of hospital acquired infections for patients. As such, researching the answer to this question requires a proper methodology in order to ensure that the scope of the question is met properly and that the information that is found matches that which was being searched for in the first place.Since the PICO question being addressed pertains specifically to nursing, the first thing to do while conducting a search for information is to ensure that the results are limited to nursing. The research articles that were obtained in response to the current PICO question were the result of searches made using Google Scholar, the PubMed database, and also Cinahl, which is a database dedicated to nursing journals. It is certain, then, that all of the articles retrieved from the Cinahl database are related to nursing, which fits with the parameters laid out in the PICO question. Searches were made certain to be exclusively for nursing articles in all of the databases checked by narrowing the search criteria using the filters that were provided. Furthermore, search results were limited to articles published within the last ten years. If the articles retrieved for this study included more than nursing articles, that would be too broad of a result given the scope of the question being asked. If the articles retrieved for this study had been older, the results could be been outdated. Limiting the scope of articles retrieved helps to ensure that the response will be focused, accurate, and up-to-date.Discussion of LiteratureThe following is a critical review and recommendation of each article that was acquired for the current PICO question.Article One: Hand Hygiene TechniqueThe first article up for review is titled Hand Hygiene Technique and it comes from a journal called Nursing Standard (Drey & Gould, 2008). Nursing Standard is British professional magazine that is published weekly and contains peer-reviewed articles and research pertaining to nursing. It is published by a company that is overseen by the Royal College of Nursing and is obviously a legitimate nursing journal ("Nursing standard: About," ). The stated purpose of the article is to explore the topic of hand washing technique for nurses in an effort to determine if adjusting the education level of nurses regarding technique can help to decrease the frequency of hospital acquired infections. The article employs a systematic review of 48 studies which were conducted in order to help compliance with hand hygiene in the hospital setting. The article notes that only eight of the studies mentioned the importance of technique for hand washing and no study exclusively focused on the concept of improving technique. In the article, the authors appropriately review studies concerning hand hygiene that date from the 1960s to the modern day and explore the ways in which suggested hand washing techniques have evolved and improved over time. The article examines studies that have looked at different methods of hand washing, whether using soap and water or alcohol-based cleansers, and also topics such as if nurses from different units of the hospital utilize better technique than nurses from another unit. In the end, the authors lament that, over the course of all of the studies that they had reviewed, there was little emphasis placed on technique in comparison to the stress placed on frequency of hand hygiene. That being the case, it could be argued that the article does fulfill its purpose of determining if further education regarding hand washing technique could help lead to a decrease in hospital acquired infections. Given the information, it would be the recommendation of this report that further investigation should be sought regarding hand washing technique, with an emphasis that technique may be just as important in preventing infections as frequency.Article Two: Auditing Hand Hygiene PracticeThe next article is also from Nursing Standard but is from a couple years later, being published in the year 2010 (Gould, 2010). As such, it possesses the same credibility as a nursing article as the previous article that was reviewed. The purpose of this article is to provide an overview of hand hygiene audits and how they might affect hand hygiene technique and frequency. The stated problem is that, regardless of which type of audit is being done, whether it be via self-report, direct observation, product uptake, or electronic monitoring devices, there are flaws with each of them which makes careful and accurate auditing almost impossible. Literature from previous studies, as well as hand washing campaigns, are reviewed, detailing the importance of hand washing compliance, both in frequency and technique. There is no specified study framework or sample identified, as this article acts more as an appeal to the fact that the auditing process is not nearly as precise as it should be and is far from a cakewalk. To that end, it could be presented that this article fulfills its purpose of indicating the lack of consistency in analyzing hand washing compliance in hospitals. It could be recommended that studies should be done to determine the most effective way of auditing hand washing in healthcare settings and to establish a standard for measurement across the board.Article Three: An Observational Study of Hand Hygiene Compliance in Pediatric WardsThis article comes from the Journal of Clinical Nursing (Randle, Firth & Vaughan, 2013). The article was written by three authors, all of whom are RN's and have ties to Nottingham University in the UK. The objective of the article was to determine hand hygiene compliance among healthcare workers in a pediatric oncology ward and a pediatric respiratory ward in a hospital in England. The literature that is reviewed indicates that studies having to do with pediatrics have largely been conducted in intensive care units, while relatively few studies have been done in pediatric clinical units. This type of review helps to exhibit why a study of this kind might be of benefit. The study was conducted using direct observation of 315 of what the authors called "hand hygiene opportunities." The article states that the method of observation was one that had been previously validated as an observation tool, but no more detail is given regarding what the observation tool was or who validated it previously. Given that, it is difficult to ascertain how appropriate the observations were, though the authors make a point that was mentioned in another article reviewed for this paper, that being that observation is the gold standard for monitoring compliance. The study was carried out over a time span of eight hours. No differentiation was made between soap and water hand cleansing and alcohol-based antiseptics. Interestingly enough, the results of the study indicated that hand washing among nurses in this kind of healthcare setting was quite a bit above what was expected or what is considered average among all healthcare workers. This suggests that whatever protocol is in place at these hospitals has been effective, even though the exact findings of 74% compliance for nurses is still far below a perfect score. Based on this, however, it is recommended to continue to promote hand hygiene awareness as is done in these settings to help increase compliance, especially among pediatric patients, who are particularly vulnerable to healthcare acquired infections.Conclusion - Significance to NursingSeveral other articles were found that shared similar results to the ones reviewed in this paper. There were many studies that seemed to suggest that technique was not emphasized nearly as much as frequency of hand washing, and some studies showed that there was a general lack of knowledge among healthcare workers regarding the importance to 100% compliance with hand washing guidelines. In the field of nursing, two of the main focuses are quality of care and patient safety. It would be appropriate to define quality as being able to provide effective care that is centered on the patient and provides them with the best possible outcomes and safety as providing a nursing atmosphere in which a patient is at least risk for harm (Mitchell, 2008). With these as areas of importance, it makes sense to call attention to the importance of proper hand hygiene, which many have called the number one way to prevent the spread of infection. Seeing as how patients present themselves to the hospital to seek aid and wellness, it makes sense that something like hand hygiene, although seemingly simple, should be a focal point for all healthcare workers.To conclude, it seems apparent that the answer to the PICO question presented in this paper is yes, hand washing guidelines should be updated to place more emphasis on technique and increased knowledge among nurses about the benefits of hand hygiene. It was a bit surprising how many articles talked about how technique of hand washing is not stressed nearly enough and that there were many nurses and other healthcare workers who did not seem to have sufficient knowledge on proper hand washing technique. Given the limited amount of articles researched for this paper, it should not be suggested that there is a definitive problem or need for change. However, given the information found, it should at the very least be considered that some changes should be examined as possibilities in hand washing education and technique. As professionals whom others look to for support and care, it makes sense that nurses should want to provide the best care that they can. The resources are available, policies can be put in place, and the professional values of nurses and other healthcare workers demand that priority be placed on patient safety and quality of care.ReferencesDrey, N., & Gould, D. (2008). Hand hygiene technique. Nursing Standard, 22(34), 42-46.Gould, D. (2010). Auditing hand hygiene practice. Nursing Standard, 25(2), 50-58.Mitchell, P. (2008). Chapter 1: Defining patient safety and quality care. In R. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses. Retrieved from standard: About. (n.d.). Retrieved from , J., Firth, J., & Vaughan, N. (2013). An observational study of hand hygiene compliance in paediatric wards. Journal of Clinical Nursing, 22(17-18), 2586-2592. doi: 10.1111/j.1365-2702.2012.04103.x ................
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