Enhancing Hand Hygiene Compliance among ICU and NICU Visitor Families: The Impact of Advanced Nursing Roles, the Barriers and Challenges: A Review
DOI:
https://doi.org/10.70672/9ty9ej97Keywords:
Advanced Nursing Roles, Hand Hygiene Compliance, ICU and NICU, Infection Control, Visitor EducationAbstract
Proper hand hygiene is crucial for preventing, infections in intensive care units (ICUs) and neonatal intensive care units (NICUs). Despite the awareness among healthcare personnel and visitors of its importance, compliance with regulations is often inadequate. Advanced nurse educators and infection control professionals can significantly improve these habits. This review investigates whether advanced nursing positions improve hand hygiene among ICU and NICU families, as well as visitors, focusing on enhancing hand hygiene programs, identifying effective solutions, recognising practice shortcomings, and providing recommendations. The methodology involved a search of databases, including PubMed, CINAHL, Scopus, and Google Scholar, using relevant keywords related to hand hygiene and advanced nursing roles. The analysis included research on visitor hand hygiene in ICUs and NICUs, specifically focusing on advanced nursing responsibilities. Only articles published in English were selected. Out of the initial 1,430 articles, 36 met the inclusion criteria. The study found that advanced nurse roles had a positive effect on hand hygiene adherence in the ICU and NICU. Effective strategies included educational programs, proactive engagement, and regular follow-up. Challenges, such as nurse workloads, were also identified. Continuous training, family involvement, and infection control programs were highlighted as important for improving hand hygiene behaviours. Through structured programmes and education, as well as advanced nursing roles, nurses can significantly lower infection rates and improve patient outcomes. To improve hand hygiene in critical care, comprehensive interventions, and strong leadership should be prioritised.
References
[1]. Mangochi H, Tolhurst R, Simpson V, Kawaza K, Chidziwisano K, Feasey N, et al. A qualitative study exploring hand hygiene practices in a neonatal unit in Blantyre, Malawi: implications for controlling healthcare-associated infections. Wellcome Open Res. 2023;7. https://doi.org/10.12688/wellcomeopenres.17793.3.
[2]. Sands M, Aunger R. Determinants of hand hygiene compliance among nurses in US hospitals: a formative research study. PLoS One. 2020;15(4). https://doi.org/10.1371/journal.pone.0230573.
[3]. Salma E, Samiha K, Modupe O, Edward S, Karen V, Morgan K, et al. Can educational speech intervention improve visitors hand hygiene compliance? J Hosp Infect. 2019. https://doi.org/10.1016/j.jhin.2019.12.002.
[4]. Cheikh A, Fredj S, Bhiri S, Ghali H, Khéfacha S, Dhidah L, et al. Intervention on knowledge and perception of hand hygiene among healthcare workers. Eur J Public Health. 2019. https://doi.org/10.1093/eurpub/ckz186.364.
[5]. Hammerschmidt J, Manser T. Nurses’ knowledge, behaviour and compliance concerning hand hygiene in nursing homes: a cross-sectional mixed-methods study. BMC Health Serv Res. 2019;19(1). Available from: https://doi.org/10.1186/s12913-019-4347-z.
[6]. Shan Z, Kong X, Lamb K, Wu Y. High nursing workload is a main associated factor of poor hand hygiene adherence in Beijing, China: an observational study. Int J Nurs Pract. 2019;25(2). https://doi.org/10.1111/ijn.12720.
[7]. Ariyarathne M, Gunasekara T, Weerasekara M, Kottahachchi J, Kudavidanage B, Fernando S. Knowledge, attitudes and practices of hand hygiene among final year medical and nursing students at the University of Sri Jayewardenepura. Sri Lankan J Infect Dis. 2013;3(1):15. https://doi.org/10.4038/sljid.v3i1.4761.
[8]. Nguyen T, Hoang T, Doan T, Phan T, Ho T, Nguyen T, et al. Knowledge, attitude, and practice of hand hygiene among nursing students at Can Tho University of Medicine and Pharmacy. Tạp Chí Y Dược Học Cần Thơ. 2023;(5):120-5. https://doi.org/10.58490/ctump.2023i5.650.
[9]. Alzyood M, Jackson D, Brooke J, Aveyard H. The role of patient involvement in the promotion of hand hygiene amongst nurses in hospital settings: a qualitative study of nurses’ and patients’ experiences. Int J Infect Control. 2022. https://doi.org/10.3396/ijic.v18.22527.
[10]. Carter B, Willis T, Knackstedt A. Neonatal family-centered care in a pandemic. J Perinatol. 2021;41(5):1177-9. https://doi.org/10.1038/s41372-021-00976-0.
[11]. Le C, Lehman E, Nguyen T, Craig T. Hand hygiene compliance study at a large central hospital in Vietnam. Int J Environ Res Public Health. 2019;16(4):607. https://doi.org/10.3390/ijerph16040607.
[12]. Ghorbanmovahhed S, Shahbazi S, Gilani N, Ostadi A, Shabanloei R, Gholizadeh L. Effectiveness of implementing of an infection control link nurse program to improve compliance with standard precautions and hand hygiene among nurses: a quasi-experimental study. BMC Med Educ. 2023;23(1). https://doi.org/10.1186/s12909-023-04208-1.
[13]. Ghorbanmovahhed S, Shahbazi S, Gilani N, Ostadi A, Gholizadeh L, Shabanloei R. Effectiveness of implementing of an infection control link nurse program to improve compliance with standard precautions and hand hygiene among nurses: a quasi-experimental study. 2022. https://doi.org/10.21203/rs.3.rs-2102635/v1.
[14]. Alwatifi M, Hattab W. Barriers to hand hygiene performance among nursing staff during the pandemic of Corona Virus Disease. Kufa J Nurs Sci. 2022;12(1). https://doi.org/10.36321/kjns/2022/120113.
[15]. Sadafi M, Bahmanpour K, Nouri B, Valiee S. Effect of multimodal intervention on nursing students' adherence to hand hygiene: an experimental study. Creat Nurs. 2021;27(3):209-15. https://doi.org/10.1891/crnr-d-19-00078.
[16]. Ungerer M, Ringleb P, Reuter B, Stock C, Ippen F, Bruder I, et al. Stroke unit admission is associated with better outcome and lower mortality in patients with intracerebral hemorrhage. Eur J Neurol. 2020;27(5):825-32. https://doi.org/10.1111/ene.14164.
[17]. Matos L, Fumis R, Nassar A, Lacerda F, Caruso P. Single-bed or multibed room designs influence ICU staff stress and family satisfaction, but do not influence ICU staff burnout. Health Environ Res Des J. 2019;13(2):234-42. https://doi.org/10.1177/1937586719878445.
[18]. Gomarverdi S, Khatiban M, Bikmoradi A, Soltanian A. Effects of a multi-component educational intervention on nurses’ knowledge and adherence to standard precautions in intensive care units. J Infect Prev. 2019;20(2):83-90. Available from: https://doi.org/10.1177/1757177419830780.
[19]. Acharya R, Mishra S, Ipsita S, Azim A. Impact of nursing education on CLABSI rates: an experience from a tertiary care hospital in eastern India. Indian J Crit Care Med. 2019;23(7):316-9. https://doi.org/10.5005/jp-journals-10071-23205.
[20]. Livshiz–Riven I, Azulay H, Koyfman L, Gushanski A, Askira S, Abar V, et al. The long-term impact of immediate verbal feedback of hand hygiene compliance after overt observation sessions, as assessed by continuous closed-circuit television monitoring in an intensive care setting. Arch Public Health. 2022;80(1). https://doi.org/10.1186/s13690-022-00887-2.
[21]. Lary D, Calvert A, Nerlich B, Segal J, Vaughan N, Randle J, et al. Improving children’s and their visitors’ hand hygiene compliance. J Infect Prev. 2019;21(2):60-7. Available from: https://doi.org/10.1177/1757177419892065.
[22]. Sakihama T, Kayauchi N, Kamiya T, Saint S, Fowler K, Ratz D, et al. Assessing sustainability of hand hygiene adherence 5 years after a contest-based intervention in 3 Japanese hospitals. Am J Infect Control. 2020;48(1):77-81. https://doi.org/10.1016/j.ajic.2019.06.017.
[23]. McAndrew N, Schiffman R, Leske J. A theoretical lens through which to view the facilitators and disruptors of nurse-promoted engagement with families in the ICU. J Fam Nurs. 2020;26(3):190-212. https://doi.org/10.1177/1074840720936736.
[24]. Chattopadhyay S, Biswas T, Das P, Chaudhury N, Dasgupta A, Nath A, et al. A cross-sectional survey on hand hygiene among nursing students working in an eastern Indian hospital. Int J Endorsing Health Sci Res. 2023;11(2):84-9. https://doi.org/10.29052/ijehsr.v11.i2.2023.84-89.
[25]. Hammoud S, Amer F, Lohner S, Kocsis B. Patient education on infection control: a systematic review. Am J Infect Control. 2020;48(12):1506-15. https://doi.org/10.1016/j.ajic.2020.05.039.
[26]. Gaube S, Fischer P, Windl V, Lermer E. The effect of persuasive messages on hospital visitors’ hand hygiene behavior. Health Psychol. 2020;39(6):471-481. https://doi.org/10.1037/hea0000854.
[27]. Biswal M, Angrup A, Rajpoot S, Kaur R, Kaur K, Kaur H, et al. Hand hygiene compliance of patients’ family members in India: importance of educating the unofficial “fourth category” of healthcare personnel. Open Forum Infect Dis. 2019;6(Supplement_2). https://doi.org/10.1093/ofid/ofz360.1058.
[28]. Ali NAM. Educating parents on ‘speaking up for hand hygiene’ in PICU: perceptions and barriers. Int J Care Scholars. 2021;4(Supp1):70-78. https://doi.org/10.31436/ijcs.v4isupp1.202.
[29]. Diedrich S, Görig T, Dittmann K, Kramer A, Heidecke C, Hübner N. Active integration of patients into infection control, as perceived by health care professionals: results of the AHOI pilot study. Infect Drug Resist. 2020; 13:4009-4019. https://doi.org/10.2147/idr.s261343.
[30]. Khodadadi E. Investigating the factors affecting the hand hygiene compliance from the viewpoints of Iranian nurses who work in intensive care units. IntechOpen. 2020. https://doi.org/10 .5772/intechopen.81561.
[31]. Wenbin H, Chen X, Cheng X, Li Y, Feng B, Wang Y. Exploring the effect of novel six moments on hand hygiene compliance among hospital cleaning staff members: a quasi-experimental study. Epidemiol Infect. 2023;151. https://doi.org/10.1017/s0950268823000602.
[32]. Esfandiari A. Knowledge, attitude, and practice of hand hygiene among healthcare workers during the COVID-19 pandemic in referral hospitals: a case study from southern Iran. Res Sq. 2023. https://doi.org/10.21203/rs.3.rs-3128085/v1.
[33]. Nasimfar A, Sadeghi E, Bahrami N, Ghazavi A. Knowledge, attitude, and practice of hand hygiene among medical students in Urmia University of Medical Sciences. Stud Med Sci. 2020;31(9):700-711. https://doi.org/10.29252/umj.31.9.700.
[34]. Algaradi A, Sherif A, Wahdan I. Infection control procedures and practices in intensive care units of a general hospital, Sana’a, Yemen. J High Inst Public Health. 2019;49(1):10-18. https://doi.org/10.21608/jhiph.2019.29461.
[35]. Bell S, Roche S, Mueller A, Dente E, O’Reilly K, Lee B, et al. Speaking up about care concerns in the ICU: patient and family experiences, attitudes and perceived barriers. BMJ Qual Saf. 2018;27(11):928-936. https://doi.org/10.10.1136/bmjqs-2017-007525.
[36]. Rosa R, Pellegrini J, Moraes R, Prieb R, Sganzerla D, Schneider D, et al. Mechanism of a flexible ICU visiting policy for anxiety symptoms among family members in Brazil: a path mediation analysis in a cluster-randomized clinical trial. Crit Care Med. 2021;49(9):1504-1512. https://doi.org/10.1097/ccm.0000000000005037.
[37]. Gammon J. Impact of an educational intervention on hand hygiene practice among nursing students, with a focus on hand drying efficacy. J Infect Prev. 2023;25(1-2):3-10. https://doi.org/10.1177/17571774231224695.
[38]. Laher A, Rooyen L, Gerber L, Richards G. Compliance with hygiene practices among healthcare workers in the intensive care unit. S Afr Med J. 2020;110(8):791. https://doi.org/10.7196/samj.2020.v110i8.14512.
[39]. Xu N, Liu C, Feng Y, Li F, Meng X, Lv Q, et al. Influence of the Internet of Things management system on hand hygiene compliance in an emergency intensive care unit. J Hosp Infect. 2021; 109:101-106. https://doi.org/10.1016/j.jhin.2020.12.009.
[40]. Bala J. Assessment of hand hygiene practices and barriers to hand hygiene among healthcare workers of Government Medical College Hospital Jammu. Indian J Public Health Res Dev. 2022;14(1):110-116. https://doi.org/10.37506/ijphrd.v14i1.18803.
[41]. Moore L, Robbins G, Quinn J, Arbogast J. The impact of COVID-19 pandemic on hand hygiene performance in hospitals. Am J Infect Control. 2021;49(1):30-33. https://doi.org/10.1016/j.ajic.2020.08.021.
[42]. Casaroto E, Generoso J, Tofaneto B, Bariani L, Auler M, Xavier N, et al. Hand hygiene performance in an intensive care unit before and during the COVID-19 pandemic. Am J Infect Control. 2022;50(5):585-587. https://doi.org/10.1016/j.ajic.2022.01.018.
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