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Running head: ABSTRACT FOR NURSING RESEARCH UTILIZATION PROJECT

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Abstract for Nursing Research Utilization Project Proposal

Nanncie Constantin

NUR 598

July 9, 2012

Dr. Colucceillo

NURSING RESEARCH UTILIZATION PROJECT SECTION A&B 2

Abstract

The issue of controlling and preventing hospital-acquired infections is a major problem in the

Healthcare system. Most patients admitted to hospitals are at some risk of contracting a hospital-

acquired infection (Paterson, 2012). Some patients are more vulnerable than others; these include

the elderly, patients with defective immune systems, and premature babies. Hospital-acquired

infections remain a major concern, and they can occur in any care setting, including acute care

within hospitals, outpatient surgery centers, clinics, and long-term care facilities (such as nursing

homes or rehab centers). Four categories account for 75% of all acquired infections in the acute

care hospital setting. These are surgical site infections, central line-associated bloodstream

infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections

(Nassof, 2009). Urinary tract infections comprise the highest percentage (Paterson, 2012). These

infections usually are spread by the contaminated hands of healthcare providers or the patient’s

family members. They are also caused by contaminated surfaces or hospital equipment that has

not been properly cleaned (Nassof, 2009). The rate of exposure to infectious materials could be

reduced if healthcare providers adhered to certain standard precautions such as hand hygiene.

The proposal for this nursing research utilization project is to educate nurses on the importance

of hand hygiene using evidence base protocol and how they can implement it in order to prevent

nosocomial infections. Most if not all healthcare providers sometime in their career fail to wash

their hands. Regardless of staff views on hand washing, research evidence-based studies confirm

that hand washing is the most important way healthcare providers can prevent the spread of

infection among patients in the hospital (Chau, Thompson, Twinn, Lee, & Pang, 2010). Using


evidence-based practice will help healthcare providers be more compliant with hand washing.

The educational research utilization proposal project will include supportive data from reliable

research studies, an action plan on how to implement different strategies to help healthcare

providers come up with ways to eliminate hospital-acquired infections, and a posttest to

measures and evaluate staff effort and interest in the proposal solution. Upper management and

nurse educators will work collaboratively through all the phases of the evidence base proposal

educational program to help staff by providing support, and tools needed to reach the goal

outcomes of the project proposal.

.


Nursing Research Utilization Project Section A&B

Section A - problem is identified

1. Describe a problem or issue that needs a solution.

The problem that has been identified and needs a solution is the issue of controlling and

preventing hospital-acquired infections through education and working with healthcare providers

to come up with techniques they can implement to prevent hospital-acquired infections. The

proposed solution is to create an evidence-based education programs for nurses to teach them

how to recognize and prevent the spread of infections. The rate of hospital-acquired infection is

increasing every year regardless of different policies and regulation set by hospitals (Paterson,

2012). Thus, nurses needs to be educated about key evidence-based clinical elements they can do

early on to help prevent infections in hospitals.

2. Importance of the problem

This problem is a serious concern for both patients and healthcare providers. It puts a

financial strain on the patients and their families and also on the hospital. An estimated $20

billion a year is spent treating patients who acquire some type of infection while in the hospital.

Research indicates that 20% of all hospital-acquired infections are urinary tract infections;

approximately 80% of these are linked to urinary catheters (Paterson, 2012). When hospital

patients acquire infections, they typically remain in the hospital longer, which increases the cost

of their hospital bills. In some cases, patients die from the infections. The Centers for Disease

Control and Prevention estimates that approximately two million people acquire infections while


in the hospital each year, and approximately 90,000 of these patients die as a result of their

infections (Limaye, Mastrangelo, & Zerr, 2008). All of these negative reports suggest it is very

important and necessary for healthcare providers to focus on an evidence- based confirmed

clinical practice solution to help eliminate hospital-acquired infections.

3. Project objective that is specific, realistic, and measurable

The outcome objective for this project is for nurses from the cardiac unit of

Greenville Hospital System who attend the infection control educational classes to score a 95%

or higher on the post test after each training session in order to evaluate employee knowledge on

the topic. Any employee who scores less than 95% on the posttest will need to repeat the training

session. The infection class will begin first week of August for the cardiac staff nurses and the

last two weeks of July for selected charge nurses who will help facilitate during the

implementation of the educational program.

4. Brief solution description and rationale

The way to reduce and eliminate infections in the hospital is to develop the proposed

evidence-based solution of implementing an educational program with different training sessions

to educate the nursing staff in regard to confirmed infection prevention practices to prevent

nosocomial infection. Educational session on hand hygiene will be held in the fourth floor

conference room of Greenville Memorial hospital including demonstrations of proper hand

hygiene. According to the World Health Organization who develop the “My five moments for

hand hygiene”, confirm that hand hygiene is the most effective method in reducing nosocomial

infection (Mathai, George, & Abraham, 2011). The goal is to equip staff members with as much


information as possible, so they will recognize signs of infection early and seek proper

intervention (Cardo, Dennehy, Halverson, Fache, Fisherman, Kohn, Murphy & Whitley, 2010).

Section B—Description of the Proposal

The way to reduce and eliminate hospital-acquired infections is to develop educational

programs and training sessions that alert healthcare workers on different sign of nosocomial

infection. The goal of these infection control classes is to educate cardiac nurses on ways to

Prevent nosocomial infections through proper hand hygiene. This class will be entitled “Hand

Hygiene can save a patient.” The infection control prevention classes will be part of the World

Health Organization “My five moments for hand hygiene” concept. A nurse committee made of

infection control nurse and nurse educator from the cardiac unit will serve as the program

director, the committee will chose two charge nurses from each unit and trained them to help

facilitate the training classes.

The committee will promote the proposal program to the infection control director, upper

level management and the cardiac nurses three to four week before the first training session start

first week of August 2012 after the train the charge nurses the last two weeks of July. The

infection prevention educational classes will take place at the four floor conference room every

Wednesday from 8. Am to 12 pm for a period of three month, each classes will last about one

hour.

2. Consistency of solution with research support.

This solution is consistent with evidence-based practice and research. Educating staff on

how to eliminate hospital-acquired infections is the first step toward meeting the objective


outcome. Mathai and some of his colleagues conducted an Evidence base research study of a

mixed medical-surgical ICU of a tertiary level hospital to help identify reasons for non-

compliance among health care workers. Mathai found that the most common reason for non-

compliance among participant was lack of time. However, they researcher had an increase of

57% compliance after the educational session was implemented (Mathai, George, & Abraham,

2011). The World Health Organization “my five moments for hand hygiene” concept has

created awareness about preventing the spread of infections and is full of information and

beneficial tips that educate healthcare workers on infection prevention. The goal of this concept

was to provide information on hand hygiene and determine specific time when hand hygiene is

required during patient care in order to effectively prevent the spread of infection ( Mathai,

George, & Abraham, 2011).This study is relevant to clinical practice because it educate staff on

when hand hygiene should be perform, and also helps educators see the importance of educating

staff on proper hand hygiene when caring for patients in order to prevent transmission of

infection.

3. Feasibility of implementing the proposed solution in the work setting.

The proposed solution infection prevention educational classes is feasible to implement

in the work setting. Greenville hospital System will provide the fourth floor conference class

room for the training session free of charge, the training manual will incorporate information

from the World Health Organization concept. All training sessions and educational materials will

be provided to every employee for free by the hospital. The cost analysis for the educational

training sessions is about $4,000 for hourly wages for staff nurses and charge nurses, to promote

the program, Ink and to printing materials. The director of the infection control department has


agreed to allow the committee to implement the education program. They agree the educational

program will take a positive step toward reducing nosocomial infections and decrease the rate of

mortality among patients that is due to nosocomial infection.

4. Consistency of proposed solution with organization or community culture resources.

Greenville Hospital system has the resources, support, and equipment needed to

implement the Evidence-Base educational proposed program to prevent hospital acquired

infections. Reaching the outcome goal for this educational proposal can be successful with the

help of a good committee, administrative managers who reinforce the educational proposal’s

solution and employees who comply with hand washing.

Section C: Research Support

1. Research Supportive Base

Research supports that evidence-based education innovation can impact hospital-

acquired infections by improving staff knowledge, thereby improving compliance with

hand hygiene; the evidence-based practice (EBP) innovation proposed is to reduce

infection in the hospital by educating staff about the importance of hand hygiene through

the implementation of an education program classes. This proposed evidence-based

practice (EBP) will enable nurses and other healthcare providers to obtain the information

needed to identify signs of infection early and seek proper intervention to help eliminate

hospital-acquired infections.

2. Sufficient Research Support Base


There is a wealth of supporting evidence on hand hygiene practices and their impact on

hospital-acquired infections. Current research on the proposed innovation focuses on

studies conducted near the end of the twentieth century (Picheansathisan, 2003).

Research studies concluded that educating staff on compliance with hand hygiene

appears to be the best way to help reduce transmission of hospital-acquired infections

(Mathai, George, & Abraham, 2011).

3. Compelling research Support Base

Two evidence-based research studies, a Quasi-experimental, and a before-and-after

prospective observational intervention study, were used to explore the proposed

innovation described above (see Appendix A).

Nursing Research Utilization Project: Section D & E

1. Solution implementation plan

Reducing hospital-acquired infection and helping hospitals become a safer place for

patients is the responsibility of every employee. The first step in implementing the proposed

innovation involves forming a committee comprising the nurse educators from both the cardiac

units and the infection control department to help manage and become familiar with the project

description and solution. Once they approve the project, the implementation of this evidenced-

based practice (EBP) innovation can begin. The nurse educators will appoint two charge nurses

from each cardiac unit (B, C, D and CVICU) who demonstrate an interest and have enough

expert knowledge on the topic to communicate with staff; charge nurses will be required to


attend one of the two training session offer at the end of July, each training session will last

about 1hr in order to help improve their knowledge on the topic.

Once the charge nurses have been selected, the next step will be to train these nurses

using the methods proposed by the World Health Organization (WHO), which recently

developed a concept called “My five moment for hand hygiene”. An instructor’s manual and

handouts that focus on infection prevention will be made available for each training session. The

nurse educator committee will assign charge nurses from the cardiac unit to attend one of the 12

training sessions held at the fourth floor conference room from July 2012 onwards. The nurse

educator and the infection control nurse committee will need to ensure that the conference room

is available every Wednesday from 8 AM to 12 Pm during the training period.

Education handouts about infection prevention from the World Health Organization and

the hospital policy on hand hygiene will need to be obtained from the committee, placed in a

folder and distributed to each participant during the training sessions. The first training session

for staff nurses excluding charge nurses will begin the first week of August 2012.

The communication of the initial launch of the educational project will be the

responsibility of the committee. In addition, the committee will create and send email flyers

containing the purpose of the class and the date, time and location where the classes will take

place. The flyers will also be posted in each unit two weeks before the first session starts. The

committee will develop the educational program contents and its curriculum. The committee will

attend staff meetings in each unit in the cardiac ward to discuss the project in-depth before the

first session.


The committee will begin implementing the educational program in July with the charge

nurses. During the implementation of the program, the director of the infection control

department will allow the committee to devote two hours per week to the educational project.

The committee will present the project to the director of infection control and the upper level

management in the first week of July for approval. The committee will make any changes or

recommendations made by the upper level management on the project before the first session of

the training class starts in August. The training session for the charge nurses will begin in the

third week of July and a trial post-test will be carried (grammar) for the charge nurses to test its

reliability. The first educational infection control class for the proposed implementation will start

in the beginning of August. Having a specific starting date will ensure that the staff attends the

educational training session.

The key to the project’s success is the committee made up of nurse educators from both

the cardiac unit and the infection control department. Both groups must work well together and

support the project objective by focusing on the end result, which is to educate the staff on the

importance of hand hygiene to prevent hospital-acquired infections. The committee and the

charge nurses must be able to handle conflict, communicate well with each other and provide

clear and accurate information to the general staff in order to stay on target.

2. Resources Needed for Solution Implementation

To implement the education classes, the committee will have to make arrangements for a

projector to show the PowerPoint presentation, a DVD player to show short plays on infection

control and hand hygiene, a printer to publish flyers and handouts for the participants, and ink for

the printer. The conference room, which will be supplied by the hospital at no additional charge,


has a projector and a DVD player already installed. The out-of-pocket cost that the committee

will need for the educational classes will be $4,000. The twelve training sessions for the charge

nurses and staff will cost around $3,100, because the hourly cost of each charge nurse and

regular staff is $26 and $24 respectively. The committee salary to implement the innovation is

built into its schedule as approved by upper-level management in order to develop and manage

and complete the educational program. A total cost of $600 will be spent on promotional flyers

and handouts to the staff. The committee will meet the manager of the marketing department to

discuss the cost for implementing the program.

3. Monitoring solution implementation

The committee will continually monitor the implementation of the innovation to

ensure consistency and accuracy of the topic. The attendance of the staff, the class

content, and the PowerPoint presentation will also be monitored very closely by the

committee. Each employee will sign in using an employee ID number to ensure that

attendance is recorded accurately. The nurse in charge of each unit will be responsible for

turning in the sign roster to the committee of nurses overseeing the educational training

session. Several steps must be taken in order to monitor the implementation of the

proposed plan. First, the committee must perform a pilot study by conducting a need

assessment survey of clinicians regarding their interest or knowledge on the topic of

infection control practices. The survey selected is clear and to the point, will help the

committee determine how important the prevention of infection is to clinicians. A leader

or several facilitators should be chosen for this task, preferably from the infection control


department; members of this department are familiar with the hospital and have a good

working relationship with the staff, as well as a good understanding of the issue of

infection control prevention that will enable them to oversee and monitor the staff during

the implementation process. The committee will also monitor staff compliance by

directly observing hand hygiene procedures. Facilitators will monitor the units to which

they have been assigned by periodically checking in with staff during the training

process.

4. Using Planned Change Theory

This implementation plan uses the theory of reasoned action (TRA). The TRA was

developed by Fishbein and Ajzen in 1975 and defines the links between beliefs, attitudes, norms,

intentions, and behavioral intention to perform something (Fishbein and Ajzen, 1975). A person's

decision about whether or not to take an action is determined by three things: intention, attitudes

toward the specific behavior under consideration, and perceptions about the subject matter

(Fishebein, & Ajzen 1975, p. 302). The reasoned action theory proposes that a change in a

person’s behavior depends on his or her attitude toward change. In other words, the first step in

getting staff members to change their behavior is to find out their intention, attitude, and

perception toward preventing hospital-acquired infection. Once the committee completes this

step, it can move on to identifying different ways to help change staff behavior through proper

education and by explaining the need for the change. Based on the TRA theory, the best way to

change a person’s behavior is to determine his or her beliefs of the consequences of the change.


The committee will need to persuade upper-level management and staff on the importance of

hand hygiene in preventing hospital acquired infection. In addition, the committee will continue

to support staff by providing feedback during and after the change is implemented. After the

completion of the training session, the committee can reinforce the project by monitoring and

keeping staff updated on their compliance and the reduction in the percentage of hospital-

acquired infection. The information presented during the training session and the posttest will

hopefully capture the participants’ attention and motivate them to change their behaviors and

views on preventing hospital-acquired infections.

5. Feasibility of the implementation plan

The hospital staff and upper-level management are aware of the consequences of

hospital-acquired infection, and in order to improve patient outcome, the staff must be

willing to change. This proposed innovation will ensure that the cardiac staff has the

necessary information they need to help identify and prevent hospital-acquired infections.

Starting the educational classes with the charge nurses in mid-July allows the committee

enough time to train the charge nurses and prepare the materials needed for each training

session to be successful. This solution is practical to implement within the Greenville

Hospital system setting with the support of the nurse education staff and infection control

nurses. Upper level management, including the director of the infection control department,

is very supportive of implementing infection control classes in order to help reduce

infection rates in the hospital. It will take a lot of work and dedication to eliminate

infections in the hospital, requiring increasing awareness among clinicians who will ensure


compliance with the educational program and infection control policy set by the hospital.

Infection prevention has been an issue in the hospital system for many years. Therefore,

implementing an EBP innovation program will have positive results for patient outcomes

and for Greenville hospital system’s reputation.

Section E: Evaluation Plan

1. Develop an Outcome Measure

Outcome measure (Instrument is attached as an Appendix)

The objective for this project is for nurses from the cardiac unit at Greenville Hospital

System who attend the educational classes to correctly identify different signs of infection

potential in the hospital by scoring at least 95% or higher on the post- tests that will be

administered after each training session. The questions will be based on the training session

handout title Infection prevention, which will be giving during the training sessions. The test

will consist of 10 questions. Six questions will be scale type questions in order to measure

participant perceptions about the material, while the other five will require true and false or

forced answers (see Appendix B).

2. Describe the ways the selected outcome measure is credible (validity, reliability,

sensitivity to change, appropriateness).

The committee are experts on infection control prevention with additional educational

training on infection control. The criteria they use to classify the outcome are base on the World

Health Organization (WHO) concept of “My five moments for hand hygiene”. Therefore, this


measure is valid to measure staff knowledge on the topic at the end of each training session. The

outcome measure used is reliable because the committee used the same criteria to classify

employee knowledge on the topic.

They survey is another valid instrument that the committee will be conducted to gather

information on staff compliance with hand washing based on the EBP guideline. This outcome

measure is reliable because it evaluates employee interest, perception, willingness and

knowledge on the topic. This measure was an appropriate method to collect staff’s compliance

with hand washing because it allowed the committee to collect information before the training

session in order to have a better outcome.

Evaluation of Data Collection

3. Describe the methods for collecting outcome measure data and the rational for using

those methods.

A post-test design will be used to evaluate the program. Information will be collected

after each training session by the charge nurse after the participant has completed the education

program. This will help determine the staff’s knowledge and attitudes after they finish the

educational program. The charge nurses will collect post-test data while ensuring that all the

questions are answered and then return the test to the committee for analysis. The charge nurses

must consistently be given the test right after the training sessions to avoid any alteration in the

results. The post-test evaluation will serve as a measure of the reliability of the instrument,

because the percent of nursing staff that score 95% or higher will determine how effective the

educational program really was to the staff.


4. Identify resources needed for evaluation.

The information and materials needed to evaluate this project was collected during a pilot

study, so the committee needs only minimal additional resources in order to evaluate this

project. However, the committee will need to spend some extra time analyzing the data from

the post-test. The committee will have one week after each training session to analyze the data

and to present its findings to upper management and the director of the infection control

department. The committee needs to be clear and precise about the data collection process, and

effective communication is vital when presenting both the data and the results.

5. Discuss the Feasibility of the Evaluation Plan.

The success of any infection prevention program depends on healthcare knowledge levels

and on the willingness of participants to learn how to prevent the spread of infection. It is very

important for staff members to change their behaviors, use common sense, and take active roles

in preventing hospital-acquired infections. Nurse educators and charge nurses have the

information they need to help employees identify the different signs of infection and the ways

they can prevent infection. The post-test evaluation results will help the committee determine

where it needs to make any changes in order to help employees comply with hand hygiene

guidelines to prevent hospital-acquired infections and to improve patient outcomes.

Section F: Decision-Making Strategies

1. Maintaining the Solution.


The way the committee will continue on maintain the infection control educational

classes is to monitoring staff compliance on a continual basis for a period of one year. Staff

competency will be monitor through Computer training classes (CBT) program offer by the

hospital on hand hygiene. The CBT will be free to all employees.

2. Extending the solution.

Infection control director and upper level management from Greenville Hospital system

are all committed to reducing nosocomial infection in the hospital and improve patient care.

Upper level management agrees that having the infection prevention educational program show

that the hospital his committed to their patient well being and the community in which they

serve.

3. Revising the solution.

The committee will revised the posttest administered after each training session base on

participant score. If a participant score last then a 95% on the post-test the committee will

review the question miss the most and make any adjustment to the infection control classes. The

committee will meet with the charge nurses to analyze the program and discuss any possibility

to revise the material from the training session and help improve the educational program.

4. Discontinuing the solution.

The decision to discontinue to infection prevention classes will be made by upper level

management and the director of infection control department. They will need to consult with the

infection control committee to discuss different reason as of to why they feel that the infection

control classes need to be discontinue. They reason may be finances, or either a significant


increase rate of improvement among staff over certain period of time preferable one year from

the first training session. After they decided on a reason, the committee will communicate the

discontinuance of the program to the cardiac staff.

5. Plans for work setting and professional feedback.

The best way to broadcast the project information and outcome is for the committee to

publish the project results of the infection prevention classes in the hospital quarterly news letter

that the hospital mail to every employee home for other staff and their families to see the

positive impact that the educational program has on patient outcome. The committee can also

discuss the success of the educational program during town hall meeting through power point

presentation to attract other department and staff within the Greenville Hospital System.

Conclusion

The problem of hospital-acquired infection is a major issue with regard to patients’ lives

and the financial burdens on both the patients and the healthcare facility. Effective monitoring of

infection rates can alert a healthcare provider to different causes of infection in hospital and aid

the provider in resolving the problem in a timely manner. Following basic infection control

measures, such as good hand hygiene, and using standard precautions for all patients at GHS or

in any type of healthcare setting can reduce rates of nosocomial infection.


References

Cardo, D., Dennehy, P., Halverson, P., Fache, M., Fisherman, N., Kohn, M., Murphy, C., &

Whitley, R. (2010). Moving toward elimination of healthcare-associated infections: A

call to action. By the Association for Professional in Infections Control and

Epidemiology.

Chau, J., Thompson, S. T., Lee, D., & Pang, S. (2010). An evaluation of hospital hand hygiene

practice and glove use in Hong Kong. Journal of Clinical Nursing, 20, 1319-1328.

Fishbein, M.A. & Ajzen, I. (1975). Belief, attitude, intention and behavior: An

introduction to theory and research. Reading, MA, Addison Wesley.

Helder, o, k,. et al. (2010). The impact of an education program on hand hygiene

compliance and nosocomial infection incidence in a urban Neonatal Intensive Care Unit: An

intervention study with before and after comparison. International Journal of Nursing Studies

47. 1245-1252

Limaye, S., Mastrangelo, & Danielle, M,. (2008). A case study in monitoring hospital-associated

infections with count control charts. Quality Engineering. 20: 404-413.

Mathai, A. S., George, S. E., & Abraham, J., (2011). Efficacy of a multimodal intervention strategy

in improving hand hygiene compliance in a tertiary level intensive care unit. Indian Journal of Critical

Care medicine, Vol. 15 issue 1.


Picheansathian, W,. (2004). A systematic review on the effectiveness of alcohol-based

solutions for hand hygiene. International Journal of Nursing Practice. 10:3-9

(please double check my APA Format for citing references. I Use apastyle.org as

one resource. Thank you.)


Part C Appendix A.

Author/ Date Helder, Brug, Looman, Goudoever, & Kornelisse (2010).

Mathai, George, & Abraham (2011).

Study Purpose To study and assess “the impact of an educational program on compliance with hand hygiene and its influence on the incidence of nosocomial bloodstream infections in VLBW infants. Additionally, differences for infants nursed in incubators and cribs were determined” (Helder et al., 2010, p. 1,246).

To assess the rates of hand hygiene compliance among healthcare workers, to evaluate the levels of awareness and reasons for noncompliance with hand hygiene, and to study the efficacy of an intervention strategy based on “My Five Moments for Hand Hygiene” (Mathai, George, & Abraham, 2011, p. 7).

Research Design Used A Quasi-experimental, observational, correlational research design was use

A before and after prospective, observational intervention, study.


Sample Description, Size

and Selection Method

Target population: the sample size consisted of all health care personal includes nurses, MD, NP, Nurse assistants, and visiting healthcare professionals (laboratory, workers, and X-ray technicians). The final number of participant partook in this study was 1300. The number of participant who took the pretest 575, and the number of participant who took to posttest 725.The selection method used was one of the convenience. (Helder, Brug, Looman, Goudoever, & Kornelisse, 2010, p. 1248).

Target population: the sample consisted of all health care personnel who have direct contact with ICU patients that was selected randomly for the study. Health-care personnel include, doctors, visiting consultants, nurses, and paramedical personnel. One of the researchers observed physiotherapists, ward helpers, radiographers unobtrusively (Mathia, George, & Abraham, 2011, P.7).

Threats to Internal and External Validity (One or two sufficient to identify)

Internal threats: With the Hawthorne effect an improved of hand hygiene practice was observed before the actual educational study took place as well as after. This knowledge may have caused participants to act in a proper manner.

External threat to validity: Since the participants were selected in a convenient manner, generalization of the finds is limited.

Internal threats: The Hawthorne Effect, participant knows they were being observed, this may caused them to act in a proper manner and alter the study results.

External threats: Interaction effect of testing is an external threat to validity due to the pretesting of participant, the results may not generalize to an untested population.


Data Collection Procedures Used to Collect Data, Informed consent.

The Erasmus MC Institutional Review Board approved the study. A structured, self-designed observation tool was used by three researchers to collect data during the observational study. The data was collect from 8:00 am to 10:00 Pm from each sub-unit for a period of 1hr. the research record hand hygiene before and after each patient contact, if participant fail to wash their hand the researchers recorded that incident as non-compliant.

In additional the researchers also observation participant using hand disinfection and the amount of time participant allow for their hand to dry. They recoded the mean of hand alcohol used in patient room for a period of 1 week two period before and two period after the educational study. the reliability of this study was assess using the Cohen’s Kappa with a mean above 0.86. The researchers uses a time period to determine the percentage of infants who develop nosocomial bloodstream infection. they uses a 1000 patient daily before and after the intervention for a period of 30month period before they

Two observers were involved in conducting both the pre- and post observation during the study period. The tools that was used for observation and questionnaire where invented by the “National Center for Patient Safety of the Department of Veterans Affairs- 3M Six Sigma Project and Veterans Affairs” campaign title “infection: Don’t pass it on”. The researchers also conduct a 10 trials observations period among themselves where they cross-checked one in other to help avoid any confusion during the really study (Mathai, George, and Abraham, 2011, p. 7).


implement the educational program and 18month after the educational program (Helder, et al, 2010, p.1247).

Data Analysis Procedure Used to Analyze the Data and Results Obtained.

The data analysis used in this study was expressed as a median and interquartile range (IQR). Data from the previous year shows that 50% of VLBW infants developed nosocomial infection. A Pearson Chi-square test was used to differentiate between the groups. The differences were then analyzed by ANOVA. This type of analysis pertained only to clinicians who followed the correct hand hygiene protocols. A log linear regression analysis was used to divide the time series into pretest and posttest segments. Statistical analysis was performed using SPSS version 15 and R version 2.7.1. A P value of less than .01 was considered statistically significant for completeness of hand rubbing, and a P value less than 0.05 was used for all other tests (Helder et al., 2010, p. 1248).

Results: During the periods of both pretest and posttest, the researchers performed a total of 1360 structured

Statistic data was analyze using a fisher exact test (EPI info software). 91.4% of these respondents were aware of an ICU protocol on hand hygiene. 67% estimated their hand hygiene compliance rate at more than 50%. 33.7%% stated the reason for noncompliance was a lack of time. The educational session included 72.5% of resident trainees, 82% of bedside staff nurses, 95.3% of physiotherapists, 30.33% of visiting consultants and 45.7% paramedical staff. They had 82 observation periods with 1001 opportunities for hand washing in the pre- intervention period and 90 observation periods with 1026 opportunities in the post-intervention period. Bedside nursing staff took advantage of 46.9% of pre-intervention hand washing opportunities and 41.6% of those during the post intervention periods followed by resident trainees who took advantage of 18.46% of opportunities during the pre-intervention period and 19.1% during post intervention. The study found that only 25.95% of


observations. The research excludes 60 observations from the total analysis. Ninety-nine observations were made of visiting clinicians, such as lab techs and x-ray technicians; these were analyzed separately because they were not part of the educational program. A total of 1201 observations remained for the main analysis. They had a 26% of an increase in compliance before patient contact a total number of 352 out of 512 (68.8%): from pretest to 599 out of 689 posttest.; P < 0.001. The rate for hand hygiene after patient contact also increased by 22.5%, from 327 out of 512 (68.9%) pretest to 579 out of 689 (84%) posttest: P < 0.001. Compliance with high- and low-risk procedures also has improved by 64.4% a total number of 174 out of 270 pretest to 85.8% a total number of 413 out of 481, P< 0.001. Large improvements were noticed among participants after the education program for both before and after patient contact. At the conclusion of the educational program, the median shows a 35% increase in the amount of hand alcohol solution used among participants: It had been

overall staff was compliant with hand hygiene in the ICU. Following interventions the number increased to 57.36% (P<0.0001). Research found that compliance was improved among all health care worker groups. Staff nurses went from 21.62% to 61.59% (P<0.0000) compliance. Nursing students went from 9.86% to 33.33% (P<0.0000). Resident trainees went from 21.62% to 60.71% (P<0.0000). Visiting consultants’ compliance increased from 22% to 57.14% (p=0.0001). Physiotherapists’ rates went from 70% to 75.95% (p=0.413) and paramedical staff compliance increased from 10.71% to 55.45% (P<0.0000) ((Mathai, George, & Abraham, 2011, pp. 9,10,11).


40 ml/day/patient (IQR 25 to 56) rising to 54 ml/day/patient (IQR 40 to 71), p < 0.001. Before the interventional study, the rate of nosocomial infection was 17.3 (95%, CI 15.2 to 19.7) per 1,000 patient days; after the study, the rate decreased to 13.5 (95%, CI 11.2 to 16.2) per 1,000 patient days (p = 0.03). The pretest showed a baseline trend of +0.07% per month (95%, CI – 1.41 to +1.60; p = 0.93); after the intervention, the level of infection per day decreased by -14.8% (p = 0.48). The posttest showed a decline in the infection ratio of -1.25% per month (95%, CI – 4.67 to + 2.44; P=0.50). Overall, the study showed a 26.3% increase in hand hygiene compliance after interventions (Helder et al,. 2010 p. 1248-1250).

Conclusions This study concludes that a multifaceted education program does affect the way healthcare providers view infection control in the hospital. There was an increase in staff compliance with hand hygiene after the educational program was implemented.

The study concludes that even though hand hygiene practices are a low priority among most healthcare providers, it is possible to improve compliance among healthcare workers through educational intervention.

Strengths/Limitations Strengths: Strengths:


The tools that were used to collect data allowed the researchers to reach the best answers for the research study.

The sample size was perfect for the study.

Limitations:

The Hawthorne effect.

Pre- and post-test observations.

The timing of the pre-and post-test studies may alter the results.

They exclude visiting healthcare professionals (lab tech and X-ray techs that deal with patients on a regular basis) from the analysis.

1. The questionnaire was collaboratively selected among the researchers.

2. The tools used for the observations were invented by the National Center for Patient Safety within the Department of Veterans Affairs and were well validated.

3. Only two observers were used, and they were both tested for inter-rater reliability, which supports the validity and reliability of the study.

Limitations:

1. Funding and time issues.

2. The number of people involved in the study, because the researchers did not involve evening or night-shift staff in the study.

3. The timing of the posttest study.

4. This study was done in an ICU; there is some question of whether the findings can be generalized to the medical and surgical areas.


Reason for Including for

Supporting your Proposed

Evidenced-Based Solution

This study demonstrated a significant improvement in hand hygiene. The educational program’s model that was applied in this study helped improve employee compliance with hand hygiene. It also helped decrease the rate of infection in the hospital (Helder et al., 2010, p. 1251). A way to help staff acquire this knowledge is to educate them on the topic.

This study demonstrated that improved hand hygiene practices have reduced the occurrence of hospital acquired infections and that the best way to help healthcare workers acquire this basic knowledge is to assess their interest in, and comprehension of, the topic and educate them about the topic using the interventional model applied in this study.





Abstract for Nursing Research Utilization Project Proposal

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