Hand Washing

Campaign in the
NICU
Jennifer Fine
 Background
Infection is one of the leading causes of death for
neonates and accounts for 36% of deaths (WHO, 2011)

Hospital-acquired infections and sepsis can cause an

increase in hospital charges up to as high as $10,055 per
patient (Johnson, Patel, Jegier, Engstrom, & Meier, 2013)

Many hospitals have started campaigns to improve hand

hygiene, but have continued to struggle with compliance
of these campaigns among workers
 PICOT
Among nurses working in the NICU, does a standardized hand
hygiene campaign to improve hand hygiene compliance
compared to no campaign result in decreased incidence of
nosocomial sepsis among neonates over a 6-month period?
P Neonates admitted to NICU
I Compliance to hand washing campaign
C No compliance to hand washing campaign
O Decreased hospital-acquired sepsis rate
T Over a 6 month period
 Literature Review
Five studies incorporated some type of education in their
campaign to increase compliance
Chhapola and Brar (2015) used 30-minute education sessions along
with reminders, audits, and feedback
Saw an increase in compliance by 23% with education and infection rate
dropped 25%

Fuller et al. (2012) used a feedback intervention using behavioral

theories
13% increase in hand hygiene compliance

Three studies utilized direct observation as a way to increase

compliance
Not as effective alone without education
Some studies used overt observation rather than covert, which may
cause bias
Hierarchy of Evidence

One level I Systematic

review of RCTs

Two Level II RCTs

Four Level III

Observational and cohort
studies

One Level V Cross-sectional

 Clinical Implications
EBP modeled after the My Five Moments for Hand Hygiene
campaign (Sax et al., 2007)
Response to WHOs infection control initiative in 2005

Nurses come 10 minutes before shift to thoroughly scrub hands

WHO guideline: 40-60 sec scrubbing fingernails, all parts of fingers,
palms, and lower wrists

Weeklong workshop with 30 min educational materials (videos,

posters, discussions)
Interactive and engaging

Direct and covert observation by hired team to ensure compliance

Nurse will know someone is watching, but wont know who or when
Barriers to Implementation
Nurses may not want to come in 10 minutes before shift
Nurses may also not want to come to educational meetings
Incentive
Get paid for extra time
Food will be provided during educational meetings

Older hospitals may not be designed conveniently to make it

easy for healthcare workers to use proper hand hygiene
techniques
Make sure sinks in hallways are automatic
Soap, towels, and gel are stocked appropriately
 Ethical Considerations
Ethical values touched on:
Beneficence
Non-maleficence

By not performing adequate hand hygiene, nurses are

putting neonates at risk, exposing them to harmful
bacteria
 Outcomes
Hand hygiene compliance will increase
Nurses and other healthcare workers will be educated on
proper techniques as well as why it is so important
Measured through observation

Neonatal sepsis from hospital-acquired infections will be

prevented and rates will drop
Golden Standard for diagnosing sepsis
Three consecutive blood cultures positive for bacteria
 Conclusion
In conclusion, hospital-acquired infections should be avoided at
all costs
They cost the hospital thousands of dollars extra
Put patient at risk and cause suffering

This literature review showed that infection rates and neonatal

sepsis can be decreased with improved hand hygiene techniques

Compliance to these hand hygiene techniques can increase with

education, direct observation, and feedback
 References
Beauchamp, T. & Childress, J. (2009). Principles of Biomedical Ethics (7th ed.). New York, NY: Oxford
University Press

Chhapola, V. & Brar, R. (2015). Impact of an educational intervention on hand hygiene compliance and
infection rate in a developing country neonatal intensive care unit. International Journal of Nursing Practice, 21,
486-492. doi: 10.1111/ijn.12283

Fuller, C., Michie, S., Savage, J., McAteer, J., Besser, S., Charlett, A., , & Stone, S. (2012). The feedback
intervention trial (FIT) Improving hand hygiene compliance in UK healthcare workers: A stepped wedge
cluster randomized controlled trial. PLoS ONE, 7(10), 1-11. doi: 10.1371/journal.pone.0041617

Johnson, T., Patel, A., Jegier, B., Engstrom, J., & Meier, P. (2013). The cost of morbidities in very low birth
weight infants. Journal of Pediatrics, 162(2), 243-249. doi: 10.1016/j.jpeds.2012.07.013

Sax, H., Allegranzi, B., Uckay, I., Larson, E., Boyce, J., & Pittet, D. (2007). My five moments of hand
hygiene: A user-centered design approach to understand, train, monitor, and report hand hygiene. Journal of
Hospital Infection, 67(1), 9-21. doi: 10.1016/j.jhin.2007.06.004

World Health Organization (2005). Clean Care is Safer Care. Retrieved from http://www.who.int/gpsc/
5may/background/5moments/en/

World Health Organization (2011). Newborn Death and Illness. Retrieved from http://www.who.int/pmnch/
media/press_materials/fs/fs_newborndealth_illness/en/