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Hand Hygiene as an Evidence-Based Practice Essay

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Updated: Aug 6th, 2020

The identified practice issue is hand hygiene. It is considered an essential element in preventing the spread of infection in the medical environment. The purpose of the paper is to present a critical discussion of the issue and analyze whether it is appropriately evidence-based and meets the best practice guidelines. The structure of the paper includes a critical analysis of the identified everyday practice, interpretation of the types of knowledge informing the issue, and recommendations for future practice.

Critical Discussion of an Identified Everyday Practice

Evidence-based practice is associated with the prevention of repeated practice, productive decision making, and improved clinical efficiency (Mantzoukas 2008). Being an evidence-based issue, hand hygiene occupies an important place in the investigations of practices and their efficiency. While the necessity of evidence-based practice is undoubted, its practical application may meet various obstacles. One of such restrictions is presented with the hierarchy of evidence (Mantzoukas 2008). Such hierarchy has popularized randomized control trials (RCTs) as the most accurate evidence origin (Mantzoukas 2008). Still, nurse practitioners frequently find it complicated to apply as RCTs tend to disregard some types of knowledge which eventually proves to supply beneficial data for nursing practice (Mantzoukas 2008).

Since evidence-based practice and reflection have common targets and methods, it may be necessary to disregard the hierarchy of evidence and allow reflection to evolve into the basic elements of the evidence-based practice activity (Mantzoukas 2008). Evidence, as a result, brings about subjective connotations related to reflective approaches.

Disregard of hand hygiene may lead to failure of patient safety. Thus, this evidence-based practice requires special attention of the medical workers (Hughes 2008). Patient safety is the most crucial purpose of healthcare activity, and therefore, its importance cannot be overestimated. Some scholars remark that the problem of evidence is that it is not always applied in practice (Van Achterberg et al. 2008). The necessity of evidence implementation is proved by numerous cases of inadequate practices. What is worse, such unproductive activity may lead to serious damage to patients’ health (Van Achterberg et al. 2008). Thus, scholars suggest that successful alterations should be realized to eliminate the adverse outcomes of ineffective practices.

Research of evidence is an essential part of nursing knowledge. Nurses need to combine various types of knowledge and practices to accumulate their knowledge base (Grove et al. 2013). Providing evidence-based care is the basic aim of professional nursing care (Grove et al. 2015). Nurse staff should realize the importance of enriching their knowledge with research pertinent to their practice (Grove et al. 2015). As it is further illustrated, research evidence about the practice of hand hygiene is successfully implemented in medical workers’ activity.

Explication of and Justification for the Origin of the Practice Associated with the Issue

Hand hygiene is one of the most crucial issues in nursing as disregarding it may lead to spreading disease among patients and staff (Allegranzi & Pittet 2009). Thus, hand hygiene remains the basic preventive action against microbe transmission. Numerous researches on hand hygiene prove it to be an appropriately evidence-based issue. Scholars investigate the medical workers’ compliance with the practice requirements (Allegranzi & Pittet 2009), compare the level of diseases connected with health care in pre- and post-implementation of hygiene guidelines (Larson et al. 2007), analyze how hand hygiene can prevent spreading of microbes (Sax et al. 2007), and explore the causes of insufficient hand hygiene among medical workers (Erasmus et al. 2009).

Healthcare workers’ hands are known to be a source of spreading the disease from patient to patient or other workers. While performing their usual work, medical staff can get contaminated with dangerous organisms. If they neglect hand hygiene, these organisms may survive and spread in the hospital environment (Allegranzi & Pittet 2009). Such evidence shows that proper hand hygiene conduct is a key element of blockage of infection connected with healthcare. Moreover, explicit site infections can be prevented by applying correct hygiene methods (Allegranzi & Pittet 2009). One of the successful prevention procedures is environmental cleaning (Allegranzi & Pittet 2009). Another suggestion is to replace the use of water and soap with an alcohol-based waterless antiseptic (Larson et al. 2007).

Due to the research, hand hygiene conduct may be typified into two kinds of practice: inherent and elective. The first one takes place when hands are dirty or greasy. The second kind encompasses the cases excluded from the inherent practice (Allegranzi & Pittet 2009). Factors regulating the lack of hand hygiene compliance are numerous. In their investigation of poor hand hygiene, Erasmus et al. (2009) conclude that the cases of negligence happen due to the lack of constructive examples and untrustworthy evidence of the ability hand hygiene to prevent infection.

Other issues causing the lack of hand hygiene include the understanding of the effect of infections, social tension, assessment of expected advantages against the present limitations, and the desire to carry out the hand hygiene procedures (Allegranzi & Pittet 2009). One of the reasons why medical workers may neglect hand hygiene is that it is not always easy to comply with its requirements. The most common determinants of poor hygiene are: being classified among a special medical profession category, operating in specialized care units, insufficient number of healthcare workers and exceeding the number of patients, and wearing gloves and robes (Allegranzi & Pittet 2009). Other cases of disregarding hand hygiene are connected with the apprehension of skin injury, inattention, time shortage due to more urgent tasks, and limited access to water facilities (Sax et al. 2007).

Sax et al. (2007) define five points of hand hygiene: before patient contact, before an aseptic chore, post body fluid disclosure danger, after the contact with a patient, and after communication with the patient environment. According to the authors, there are cases when two hand hygiene moments may happen simultaneously (Sax et al. 2007). To eliminate the negative outcomes of risks, monitoring of and reporting on the medical workers’ compliance is suggested.

Analysis of Evidence-Based Practice

To provide the best knowledge practice, it is necessary to combine it with research (Baumbusch et al. 2008). Therefore, some scholars differentiate and explain a discourse of knowledge translation between research and knowledge. Baumbusch et al. (2008) argue that a link between researchers and practising nurses is simultaneous with data assembling and examination. The need for analyzing such a relationship is caused by the existing disparity between collecting of evidence and its application in practice. The main components of the relationship between practitioners and researchers are liability, cooperation, and esteem of each other’s experience (Baumbusch et al. 2008). Knowledge translation cycle illustrates the progressive process of knowledge interpretation and is characterized by a continuous dialogue about the arising findings. Such dialogue, according to Baumbusch et al. (2008), makes it possible for the practitioners to employ the research results in their everyday practice and thus guarantee that the research is consistent with the practice.

Apart from evidence-based practice, an important role in decision-making belongs to the autonomy of nursing staff (Skår 2009). Autonomy presupposes the jurisdiction of making resolutions and the ability to act according to professional expertise. Comprehension of autonomy is necessary for the interpretation and development of the nursing profession in evolving healthcare circumstances. Therefore, there exists a consideration about how the basic nursing components are dealt with when attention is paid to increase of nursing roles (Skår 2009). According to the research by Skår (2009), nurses’ characterization of autonomy falls under four types: having an integrated view, knowing the patient, understanding one’s knowledge, and being able to face the challenge. Analysis of the nurses’ explanations allowed Skår (2009) to conclude that autonomy presupposes the realization of one’s knowledge and confidence in it.

Nursing practice has some obstacles hindering successful work as well as some facilitators promoting better results. The basic restrictions include time and autonomy shortage. The most helpful issues are possibilities to learn, accessibility of resources, chances to cultivate culture and knowledge (Brown et al. 2009). To promote evidence-based practice, cooperation between managers and educators is necessary. Such cooperation will make it possible to deal with the obstacles and provide support for nursing practice. Brown et al. (2009) conclude that to organize successful practice, nurses need additional autonomy and time for their self-education on the most important professional issues. What concerns the practice of hand hygiene, the biggest obstacle to this aspect is presented by time shortage.

Analysis of the Types of Knowledge that Inform the Practice

Types of nursing knowledge informing the practice of hand hygiene are concerned with historically developed stages (Mantzoukas & Jasper 2008). The first stage perceives nursing knowledge as a combination of explanatory regulations, the second as the evolution of dualist analytical theories, and the third as the creation of analytical and unifying comprehension (Mantzoukas & Jasper 2008). The researchers dedicated their work to explain how the various types of knowledge are applied in practice and what influence they have on patient care. Each of the stages of nursing knowledge history has proven to be present in the current nursing practice (Mantzoukas & Jasper 2008). Descriptive knowledge is realized via procedural and ward experience, explanatory dualist knowledge is reflected via personal practice and theoretical experience, and integrative knowledge is represented by reflexive experience (Mantzoukas & Jasper 2008).

Nursing knowledge can also be classified into propositional and non-propositional (Barker et al. 2016). The first type is represented by so-called public knowledge and is included in educational programs. The second type is personal knowledge connected to one’s experience. What concerns the sources of knowledge, scholars recognize three: authority, a priori, and tenacity (Barker et al. 2016). Tenacity is connected with the issues which are automatically trusted because they have always existed in people’s minds as reliable ones. Authority represents the type of knowledge coming from a trustworthy source or person. A priori knowledge pertains to the mechanism of reasoning, which considers it acceptable to suppose that something may be true (Barker et al. 2016). In the clinical decision-making process, four kinds of knowledge are employed: superstition, craft, science, and folklore. Superstition is close to tenacity. Folklore is connected with earlier beliefs which are not easily replaced by more efficient modern ones. Craft knowledge is the one grounded on personal experience. Science knowledge is based on a wide notion of comprehending the world (Barker et al. 2016).

A different typology of knowledge has been suggested by Polit & Beck (2008). In their study, the authors differentiate between such kinds of knowledge as tradition and authority, experience and intuition, logical reasoning, assembled information, and disciplined research (Polit & Beck 2008, pp. 12-13). Tradition is helpful as it gives some common ground for health practitioners and patients. Authority is represented by a specialist with particular expertise and proper recognition (Polit & Beck 2008). Experience presents the ability to observe and discern the relevant information. Intuition is a kind of knowledge impossible to explain via instruction or reasoning. It plays a vital role in nursing practice, but it is difficult to base policies on it. Logical reasoning, divided into inductive and deductive, assists in problem-solving. Information assembled for different objectives helps the nurses in making decisions regarding their practice. Research is the most reliable method of acquiring knowledge as it is based on evidence rather than assumptions (Polit & Beck 2008). Modern evidence-based practice requires close connections to the research process.

Recommendations for Future Practice

A lot of investigation has been dedicated to the issue of hand hygiene practice. This evidence-based practice has been reflected in the studies by many researchers as a vital issue in the health care environment. However, not all aspects of the problem have been covered. Thus, specialists admit the necessity of future adjustments in hand hygiene practice to reach the most beneficial outcomes for medical staff and patients.

Further research is necessary to assess the relative productiveness of the key constituents in hand hygiene practice strategies. The usefulness of their implementation in environments with restricted resources and collecting the data on successful approaches is necessary (Allegranzi & Pittet 2009). The First Global Patient Safety Challenge has an aim of making accessible the application tools for hand hygiene practice and of evaluating their endorsement in countries with various income rates (Allegranzi & Pittet 2009, p. 307).

Another suggestion is to implement multidisciplinary programs at hospitals and collected the medical workers’ feedback, which would enhance the staff’s compliance. Such programs cannot be successfully introduced without an exhaustive approach including several levels in an establishment (Larson et al. 2007). Therefore, infection control units should employ supplementary aid from the administration.

Conclusion

Hand hygiene is one of the core aspects of providing patient safety and sustaining positive environment at the workplace. Hand hygiene is an evidence-based practice, which is illustrated by numerous scholarly researches. While a lot of publications have been dedicated to this aspect of nursing practice, some improvements are still necessary. For instance, further investigation is needed for investigating the reasons for disobedience with the hand hygiene requirements. Also, the causes of neglect of such practice need to be more thoroughly studied.

The practise of hand hygiene impacts not only the patients but also the medical staff and other people with whom they communicate. Therefore, it requires the most competent investigation and most thorough implementation.

References

Allegranzi, B. & Pittet, D. (2009). Role of hand hygiene in healthcare-associated infection prevention. Journal of Hospital Infection 73(4), 305-315.

Barker, J., Linsley, P. & Kane, R. (2016). Evidence-Based Practice for Nurses and Healthcare Professionals, 3rd edn. Sage Publications, London.

Baumbusch, J. L., Kirkham, S. R., Khan, K. B., McDonald, H., Semeniuk, P., Tan, E. & Anderson, J. M. (2008). Pursuing common agendas: a collaborative model for knowledge translation between research and practice in clinical settings. Research in Nursing and Health 31(2), 130-140.

Brown, C. E., Wickline, M. A, Ecoff, L. & Glaser, D. (2009). Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center. Journal of Advanced Nursing 65(2), 371-381.

Erasmus, V., Brouwer, W., Van Beeck, E. F., Oenema, A., Daha, T. J., Richardus, J. H., Vos, M. C. & Brug, J. (2009). A qualitative exploration of reasons for poor hand hygiene among hospital workers: lack of positive role models and of convincing evidence that hand hygiene prevents cross-infection. Infection Control and Hospital Epidemiology 30(5), 415-419.

Grove, S. K., Burns, N. & Gray, J. R. (2013). The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence, 7th edn. Elsevier, St. Louis.

Grove, S. K., Gray, J. R. & Burns, N. (2015). Understanding Nursing Research: Building an Evidence-Based Practice, 6th edn. Elsevier, St. Louis.

Hughes, R. G., (ed.) (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Agency for Healthcare Research and Quality, Rockville.

Larson, E. L., Quiros, D. & Lin, S. X. (2007). Dissemination of the CDC’s hand hygiene guideline and impact on infection rates. American Journal of Infection Control 35(10), 666-675.

Mantzoukas, S. (2008). A review of evidence-based practice, nursing research and reflection: levelling the hierarchy. Journal of Clinical Nursing 17, 214-223.

Mantzoukas, S. & Jasper, M. (2008). Types of nursing knowledge used to guide care of hospitalized patients. Journal of Advanced Nursing 62(3), 318-326.

Polit, D. F. & Beck. C. T. (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice, 8th edn. Walters Kluwer Health/Lippincott Williams and Wilkins, Philadelphia.

Sax, H., Allegranzi, B., Uçkay, I., Larson, E., Boyce, J. & Pittet, D. (2007). My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. Journal of Hospital Infection 67(1), 9-21.

Skår, R. (2009). The meaning of autonomy in nursing practice. Journal of Clinical Nursing 19, 2226-2234.

Van Achterberg, T., Schoonhoven, L. & Grol, R. (2008). Nursing implementation science: how evidence-based nursing requires evidence-based implementation. Journal of Nursing Scholarship 40(4), 302-310.

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