The identified practice issue is hand hygiene that 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. Being an evidence-based issue, hand hygiene occupies an important place in the investigations of practices and their efficiency (Nguyen et al., 2022). 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. Such hierarchy has popularized randomized control trials (RCTs) as the most accurate evidence origin. 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 (Zia et al., 2022). 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. 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. 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 (Ahmed et al., 2020). 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 (Keleb et al., 2021). Thus, scholars suggest that successful alterations should be realized to eliminate the adverse outcomes of ineffective practices.
The research of required evidence is an essential part of nursing knowledge. Nurses need to combine various types of knowledge and practices to accumulate their knowledge base. Providing evidence-based care is the basic aim of professional nursing care (Alwatifi and Hattab, 2022). Nurse staff should realize the importance of enriching their knowledge with research pertinent to their practice (Krämer et al., 2022). 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. Thus, hand hygiene remains the basic preventive action against microbe transmission. Scholars have investigated the medical workers’ compliance with the practice requirements (Ayyappan, Varghese and Ismail, 2021), compare the level of diseases connected with health care in pre- and post-implementation of hygiene guidelines (Greene and Wilson, 2022), analyze how hand hygiene can prevent spreading of microbes (Rasmussen et al., 2021), and explore the causes of insufficient hand hygiene among medical workers (Sierra, Perez-Jaimes and DĂaz, 2022). Thus, numerous researches on hand hygiene have supported this practice to be an appropriately evidence-based issue.
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 (Kumar et al., 2021). 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 (Ayyappan, Varghese and Ismail, 2021). In this context, one of the successful prevention procedures is environmental cleaning, and another suggestion is to replace the use of water and soap with an alcohol-based waterless antiseptic.
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 (Ahmed et al., 2020). In their investigation of poor hand hygiene, Rasmussen et al. (2021) 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. Thus, factors regulating the lack of hand hygiene compliance are numerous.
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. One of the reasons why medical workers may neglect hand hygiene is that it is not always easy to comply with its requirements (Greene and Wilson, 2022; Lungu, 2023). 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.
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. Nnate (2022) defines 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 author, there are cases when two hand hygiene moments may happen simultaneously (Nnate, 2022). In order 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. Therefore, some scholars differentiate and explain a discourse of knowledge translation between research and knowledge. Nguyen et al. (2022) argue that a link between researchers and practicing 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 (Nguyen et al., 2022). Knowledge translation cycle illustrates the progressive process of knowledge interpretation and is characterized by a continuous dialogue about the arising findings (Greene and Wilson, 2022; Shikongo and North, 2023). Such dialogue 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. 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 (Ayyappan, Varghese and Ismail, 2021; Zia et al., 2022). According to the research by Ayyappan, Varghese and Ismail (2021), 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. The analysis of the nurses’ explanations allows 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 (Rasmussen et al., 2021; Zia et al., 2022). 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. Rasmussen et al. (2021) 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. 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 (Nguyen et al., 2022). 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 (Greene and Wilson, 2022; Nguyen et al., 2022). 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.
Nursing knowledge can also be classified into propositional and non-propositional. 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 (Greene and Wilson, 2022; Zia et al., 2022). 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 (Yingling, 2021). 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.
A different typology of knowledge has been suggested by other researchers. In the study by Keleb et al. (2021), the authors differentiate between such kinds of knowledge as tradition and authority, experience and intuition, logical reasoning, assembled information, and disciplined research. 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 (Keleb et al., 2021; Zia et al., 2022). 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 (Lungu, 2023). Research is the most reliable method of acquiring knowledge as it is based on evidence rather than assumptions. 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 (Keleb et al., 2021). 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 (Krämer et al., 2022; Pedersen et al., 2022). 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. 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 practice 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
Ahmed, J. et al. (2020) ‘Compliance and knowledge of healthcare workers regarding hand hygiene and use of disinfectants: a study based in Karachi,’ Cureus. Web.
Alwatifi, M. H. and Hattab, W. A. A. (2022) ‘Attitudes to Hand Hygiene Performance among Nursing Staff during Covid-19 Pandemic,’ Pakistan Journal of Medical and Health Sciences, 16(3), pp. 909–911. Web.
Ayyappan, J.P., Varghese, V.J. and Ismail, G.M. (2021) ‘Assessment of knowledge, practices, and attitude of hand hygiene among university nursing and optometry undergraduate students in their final year of training,’ Malaysian Journal of Public Health Medicine, 21(2), pp. 226–233. Web.
Greene, C. and Wilson, J. (2022) ‘The use of behaviour change theory for infection prevention and control practices in healthcare settings: A scoping review,’ Journal of Infection Prevention, 23(3), pp. 108–117. Web.
Keleb, A. et al. (2021) ‘Prevention practice of COVID-19 using personal protective equipment and hand hygiene among healthcare workers in public hospitals of South Wollo Zone, Ethiopia,’ Frontiers in Public Health, 9. Web.
Kumar, A. et al. (2021) ‘Assessment of healthcare worker’s hand hygiene and infection prevention practices of their personal belongings in a healthcare setting: a survey in pre COVID-19 era and literature review on standard disinfection practices.,’ PubMed, 62(1), pp. E104–E109. Web.
Krämer, A. et al. (2022) ‘Ethanol is indispensable for virucidal hand antisepsis: memorandum from the alcohol-based hand rub (ABHR) Task Force, WHO Collaborating Centre on Patient Safety, and the Commission for Hospital Hygiene and Infection Prevention (KRINKO), Robert Koch Institute, Berlin, Germany,’ Antimicrobial Resistance and Infection Control, 11(1). Web.
Lungu, D. (2023) ‘Patient safety: a systematic review of the literature with evidence based measures to improve patient safety in healthcare settings,’ Texila International Journal of Academic Research, 10(2), pp. 27–35. Web.
Nguyen, H. et al. (2022) ‘Assessment of knowledge, attitude, and practices of hand hygiene among nursing students in the south of Vietnam,’ International Journal of Health Sciences (IJHS), pp. 11145–11153. Web.
Nnate, D.A. (2022) ‘A competency-based approach to promoting effective hand hygiene in long-term care facilities,’ InvestigaciĂłn En EnfermerĂa: Imagen Y Desarrollo. Web.
Pedersen, L. et al. (2022) ‘Influential papers that shaped paradigms and changed practice in infection prevention in the last 60 years: then, now, and future directions,’ Current Infectious Disease Reports, 24(2), pp. 29–37. Web.
Rasmussen, L. et al. (2021) ‘Infection Prevention Performance among Hospital Staff during Vaginal Birth: Results from a Criterion-Based Audit at a Zonal Referral Hospital in Tanzania,’ East African Health Research Journal, 5(1), pp. 36–43. Web.
Shikongo, B. and North, N. (2023) ‘Prevention of injuries in children with a peripheral intravenous catheter: a modified evidence-based nursing practice guideline,’ Africa Journal of Nursing and Midwifery [Preprint]. Web.
Sierra, C.U.M., Perez-Jaimes, G.A. and DĂaz, L.J.R. (2022) ‘Interventions to improve knowledge or compliance to hand hygiene in nursing students: A scoping review,’ Journal of Infection Prevention, 24(1), pp. 30–44. Web.
Yingling, J.K. (2021) ‘Rationing evidence-based nursing practice: considering a resource-based approach,‘ Online Journal of Issues in Nursing, 26(1). Web.
Zia, I. et al. (2022) ‘Hand hygiene knowledge, attitudes, and self-reported practices among medical and nursing staff of a tertiary-care military hospital: a cross-sectional study,’ International Journal of Infection Control. Web.