Running head: ABSTRACT FOR NURSING RESEARCH UTILIZATION PROJECT
Abstract for Nursing Research Utilization Project Proposal
Nanncie Constantin
NUR 598
July 9, 2012
Dr. Colucceillo
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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 hospitalacquired 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
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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 post- test 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.
.
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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
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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
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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
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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 noncompliance among health care workers. Mathai found that the most common reason for noncompliance 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
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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 hospitalacquired 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
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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 evidencedbased 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
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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.
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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,
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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
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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.
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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 hospitalacquired 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
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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
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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.
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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.
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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 post- test 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
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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.
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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.
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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.)
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Part C Appendix A.
Author/ Date
Study Purpose
Helder, Brug, Looman,
Goudoever, & Kornelisse
(2010).
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).
Mathai, George, & Abraham
(2011).
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
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
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, &
and Selection Method
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Threats to Internal and External
Validity (One or two sufficient
to identify)
participant who took to
posttest 725.The selection
method used was one of the
convenience. (Helder, Brug,
Looman, Goudoever, &
Kornelisse, 2010, p. 1248).
Abraham, 2011, P.7).
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.
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 threat to validity:
Since the participants were
selected in a convenient
manner, generalization of the
finds is limited.
Data Collection Procedures
Used to Collect Data, Informed
consent.
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The Erasmus MC Institutional
Review Board approved the
study. A structured, selfdesigned 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
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.
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 Affairs3M Six Sigma Project and Veterans
Affairs” campaign title “infection:
Don’t pass it on”. The researchers
also conduct a 10 trials
NURSING RESEARCH UTILIZATION PROJECT SECTION A&B
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
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
24
observations period among
themselves where they crosschecked one in other to help avoid
any confusion during the really
study (Mathai, George, and
Abraham, 2011, p. 7).
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%
NURSING RESEARCH UTILIZATION PROJECT SECTION A&B
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
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
25
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 postintervention 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 preintervention period and 19.1%
during post intervention. The
study found that only 25.95% of
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
NURSING RESEARCH UTILIZATION PROJECT SECTION A&B
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 lowrisk 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
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
26
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).
NURSING RESEARCH UTILIZATION PROJECT SECTION A&B
27
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.
1. The questionnaire was
collaboratively selected among the
researchers.
The sample size was perfect for
the study.
Limitations:
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,
NURSING RESEARCH UTILIZATION PROJECT SECTION A&B
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Pre- and post-test
observations.
and they were both tested for
inter-rater reliability, which
supports the validity and reliability
of the study.
The timing of the pre-and posttest studies may alter the
results.
Limitations:
The Hawthorne effect.
They exclude visiting
healthcare professionals (lab
tech and X-ray techs that deal
with patients on a regular
basis) from the analysis.
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.
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NURSING RESEARCH UTILIZATION PROJECT SECTION A&B
Abstract for Nursing Research Utilization Project Proposal
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