Cora Yoose and Dr. Ana Birkhead, Nursing
Healthcare-associated infection (HAI) is described as infection acquired in a hospital or healthcare setting. HAI is a problem in the health care setting that can be drastically curtailed by the implementation of proper hand hygiene practice. Increased cost of care for patients and the increased incidence of death are associated with HAI. Hand washing is the single most important measure to prevent transmission of infection. Indeed, hand hygiene is a very simple and cost effective way to prevent HAI.
The purpose of this study was to (1)review literature on the effectiveness of hand washing in preventing infection in the hospital setting; (2)collect data by performing research to evaluate the effectiveness of hand washing in a specific hospital setting in Ecuador; and (3)conduct a workshop to educate nurses on how to improve their hand washing skills.
The research project involved a two step process consisting of observation and teaching. First, nurses were subtly observed performing hand hygiene and evaluated on the appropriateness of each time they washed their hands based on a checklist derived from the Feldman’s Scale (1969). Second, nurses had the opportunity to attend a workshop where they were instructed on proper hand washing techniques as outlined by the Centers for Disease Control (CDC). At the workshop nurses also took part in a pre and post test to evaluate their learning.
The results of the project were as expected for the pre and post tests. Answers from the post test were significantly more in compliance to the proper hand washing techniques than the pre tests. The results from the observation though varied from the expected outcomes. Hand washing practices in one hospital area were observed to be worse than practices before the teaching. The majority of the hospital areas did however show vast improvements on hand washing practices. For the most part nurses learned the importance of hand hygiene in the clinical setting and applied that knowledge to reduce the incidences of infection; therefore, they were able to decrease the amount of money and illness associated with infection acquired in the hospital. A positive unexpected result was the opportunity to teach a great deal in the community setting to families about the importance of proper hand hygiene in their homes. From my teaching experiences I also learned how to teach more effectively and produce desired results from those I teach.
Some unforeseen problems did arise. Many nurses did not want to take the time to attend the workshop and fill out the tests. The problem involved not simply getting the nurses to agree to come to the workshop, but to actually get the nurses to attend after they had committed to attend the workshop. It was also hard to observe the same nurses who attended the class to the same nurses observed later in the clinical setting because the tests were taken anonymously and the observation was done a couple weeks after the teaching. It was thus unknown which nurses changed practice because they attended the class. I felt the best way to encourage other nurses to attend the workshops was to get the nurses who were attending the classes and excited to learn motivate the other nurses to commit to these nurses and attend the classes together.
This information will help further researchers know what other areas need to be studied and how to effectively teach nurses to reduce the amount of HAI. More students and staff from the College of Nursing should go to Ecuador and continue research and teaching proper hand hygiene both in the hospital and community settings. My biggest advice for further work in the hospitals and the community in Ecuador is to set up programs to teach a few people, who will then teach others. By having permanent native Ecuadorian teachers, improvements continuously can be made, money saved, and lives preserved.
My research did fit the BYU Objectives by “contributing to the world’s storehouse of knowledge by engaging in research and creative efforts to make a difference in the world.” Also, I was able to “advance truth and knowledge to enhance the education of students, enrich the quality of life, and contribute to a resolution of world problems” like infection. I was able to “extend the blessings of learning to spread learning around the world.” The BYU Mission encourages “scholarly research and creative endeavor among both faculty and students” as well. With continued efforts hand washing practices will improve, money will be saved, and lives will be preserved and enriched.