Introduction

The alarming rates of nosocomial infections in intensive care units have become an issue of concern I many hospitals. Recent studies have proposed that handwashing is one of the cheapest and effective strategies for reducing the nosocomial infections (Antoniak, 2004). However, compliance with handwashing requirements is significantly lower in many hospitals. For this reason, about 10% of patients admitted to a hospital are subject to developing different nosocomial infections (Barrett & Randle, 2008). However, it is possible to reduce the hospital-acquired infections by promoting higher rates of compliance with hand hygiene (Dasgupta et al., 2015). Particularly, nosocomial infections pose a major challenge to the healthcare sector. These infections trigger increased levels of mortality, morbidity, as well as healthcare costs (Brown et al., 2014). There is evidence that handwashing with water and the appropriate detergents can register a significant level of effectiveness in the reduction of hospital-acquired infections.

Handwashing Interventions Increase Handwashing Compliance

A critical review of the included studies demonstrated that the implementation of handwashing interventions had a positive effect on handwashing compliance. Many of the studies sought to determine whether implementing handwashing interventions could register desirable outcomes in enhancing the adherence to handwashing by nurses and other healthcare workers (Panhotra et al., 2004). The studies focused on different care settings and various interventions (RN et al., 2017). The quantitative studies registered a significant increase in hand hygiene compliance after comparing the level of compliance before and after the intervention. According to Son et al. (2011), it became clear that putting in place handwashing interventions for the first time could provide a significant increase in handwashing compliance from 20% to 65%.

Undoubtedly, hospitals that implement handwashing interventions are likely to promote handwashing compliance and eventually reduce the number of nosocomial infections (Higgins & Hannan, 2013; Santos et al., 2013). Each of the studies reviewed demonstrated that handwashing interventions were necessary if hospitals need to improve handwashing compliance. As expected, handwashing compliance eventually resulted in a significant decrease in nosocomial infections (Pittet et al., 2006). Regardless of the intervention implemented, each study demonstrated that the efforts made by hospitals to increase handwashing compliance and reduce nosocomial infections were effective (Caglar, Yildiz, & Savaser, 2010). Many hospitals have failed to implement effective handwashing intervention strategies without realizing that each intervention strategy registers a measure of the increase in handwashing compliance.

Multimodal Interventions Are Effective in Reducing Hospital Acquired Infections

The literature review demonstrates that various interventions can register different levels of impact on handwashing compliance. Particularly, the implementation of multimodal types of interventions is likely to register more positive outcomes (Korniewicz & El-Masri, 2010). Specifically, the combination of interventions such as education, in-service training, and the attendance of various seminars and training sessions can increase the effectiveness of handwashing compliance (Gül et al., 2012; Higgins & Hannan, 2013; Langston, 2011; Lebovic et al., 2013; Mathai et al., 2011; Mayer et al., 2011; Sahay et al., 2010; Santos et al., 2013). The use of handwashing campaigns, posters, and pamphlets can increase handwashing compliance (Higgins & Hannan, 2013; Lebovic et al., 2013; Mathai et al., 2011; Sahay et al., 2010; Santos et al., 2013; Son et al., 2011; Song et al., 2013).

Similarly, the combination of different feedback systems such as peer review and monitoring also can increase the handwashing compliance significantly (Gül et al., 2012; Higging and Hannan, 2013; Langston, 2011; Lebovic et al., 2013; Mathai et al., 2011; Mayer et al., 2011). Undoubtedly, the combination of intervention strategies to promote handwashing has desirable outcomes as these studies demonstrated. Healthcare workers are likely to give attention to handwashing practices and hygiene after gaining knowledge of the adverse effects of non-compliance with handwashing (Klevens et al., 2007). The use of the multimodal intervention is recommendable in different hospital settings because it can register a significant increase in handwashing compliance (Hussein, Khakoo, & Hobbs, 2007). Hospitals that intend to reduce nosocomial infections should implement the multimodal approach to interventions (Vindigni, Riley, & Jhung, 2011). A single approach may not register the desired effects in increasing handwashing compliance and reduce the prevalence of hospital-acquired infections (Cummings, Anderson, & Kaye, 2010). Based on these studies, it became evident that hospitals that implement a single intervention strategy do not register long-term effects in reducing nosocomial infections.

Conclusion and Recommendations

Evidently, the literature review demonstrated the effectiveness of various intervention strategies in promoting handwashing compliance. The studies utilized various intervention strategies to enhance handwashing compliance. A critical analysis of the findings demonstrated that the use of the multimodal approach during the implementation process registers long-term effects in enhancing handwashing compliance. Notably, hospitals should focus on adopting the multimodal approach by integrating different interventions to promote handwashing practices. The integration of handwashing interventions should depend on the unique needs of the healthcare workers as well as the effectiveness of each independent intervention strategy. Hospitals may choose to implement training sessions, on-job training, peer reviews, peer monitoring, and handwashing campaigns. Hospitals need to determine the most effective combination of intervention strategies that will register long-term effects in handwashing compliance. There is evidence that the integration of approaches to promote handwashing helps the healthcare providers to understand the background information that surrounds the need for handwashing compliance.

The primary focus of implementing handwashing interventions should be to enhance a significant level of consistency in the compliance with handwashing practices. Hospitals need to recognize that this is the only approach to reducing hospital-acquired infections. For a long time, scholars have agreed that handwashing practices register a significant decrease in nosocomial infections. As a result, hospitals must develop regular intervention strategies that empower healthcare workers by teaching them the procedure and the importance of handwashing, especially in critical care settings. The acute care settings should be keen on improving handwashing compliance due to the increased vulnerability of the patients hospitalized in the intensive care unit. Nurses and other healthcare workers should recognize the susceptibility of patients to different nosocomial infections and their cumulative effects on the health of patients as well as the economic burden involved. Taking measures to promote handwashing compliance should be a significant step in hospitals in various parts of the world.

Proposal

Introduction

Handwashing is one of the effective practices that help in the reduction of nosocomial infections. Particularly, healthcare providers need to understand the basis of handwashing practices and its effectiveness in reducing nosocomial infections. In the intensive care unit, patients are vulnerable to the development of nosocomial infections. The reduced immunity of patients in the intensive care unit makes them vulnerable to developing hospital-acquired infections. Combining different intervention strategies will help in promoting handwashing compliance to reduce nosocomial infections.

Research Question

The primary research question for this study will be:

• What is the effectiveness of handwashing campaigns, peer reviews, and nurse education in promoting handwashing compliance?

Aims and Objectives

The primary aims and objectives will include:

• To determine the effectiveness of a multimodal intervention strategy in promoting handwashing compliance
• To assess the long-term effects of handwashing compliance in the intensive care unit

Methodology

The study will adopt a qualitative approach in which nurses from 13 different public hospitals around Kuwait will discuss their experiences of handwashing compliance after the implementation of an integrated intervention strategy to promote handwashing. The researcher will rely on purposive sampling to identify five nurses from the intensive care unit from 13 public hospitals in Kuwait. The researcher will rely on the use of semi-structured interviews to determine the perceptions of nurses towards handwashing after the implementation of an integrated intervention strategy. The use of semi-structured interviews helps the researcher to use open-ended questions and determine whether the intervention strategies had any impact on the perception of the nurses towards handwashing.

The interviewer will allow the nurses to provide an in-depth description of their perspectives, giving attention to the main lessons that the nurses have learned from the handwashing interventions. Through tape recording, it will be possible for the interviewer to transcribe the interviews and use them for the data collection analysis phase. Particularly, all the nurses will benefit from a multimodal intervention comprising lectures, in-service training, and peer monitoring before the interviews. The researcher will contact the nurses through a telephone to inform them of the main objective of the study and to schedule the most appropriate time for the interview. The data analysis process will be based on the thematic approach in which the researcher will discuss the main thematic frameworks evident from the interviews. The first step in the data analysis will be the sorting of the data and arrangement of the findings in agreement with the identified themes.

Ethical Considerations

In this study, the researcher will seek approval from the relevant boards before conducting the study. Moreover, the researcher will contact all the hospital and seek permission from the hospital administration. The researcher will also obtain informed consent from the participants before the beginning of the data collection process. Throughout the study, the researcher will maintain high levels of privacy and confidentiality with the aim of promoting the interests of the participants. The participants will be free to withdraw from the study at any time of their convenience. The study does not pose any potential harm to the participants, and the researcher will make them aware of this aspect before the beginning of the data collection process.

Summary

The researchers conducted a systematic literature review with the core objective of determining the effectiveness of handwashing interventions in promoting handwashing compliance as a way of reducing bacterial infections in Kuwait hospitals. Through a rigorous electronic search, the research was able to identify 13 relevant articles from different databases. The researchers relied on a comprehensive exclusion and inclusion criteria in determining the most relevant research articles to include in the literature review. Using the CASP tools, the researcher was able to evaluate the quality of the selected articles and to proceed to the data synthesis and extraction process. After the data synthesis, the researcher carried out a rigorous critique of the methodology used in each study included. The emergent themes of the literature review were that handwashing interventions could register positive outcomes in promoting handwashing compliance. The second theme was that the multimodal intervention approach is likely to register long-term effects of handwashing compliance and the reduction of nosocomial infections. It became explicit that hospitals need to combine various interventions if they need to register an increased level of handwashing compliance.

Particularly, the hospital should determine the best combination of intervention strategies that are likely to register positive outcomes in reducing hospital-acquired infections. Many of the studies reviewed demonstrated that a combination of various handwashing interventions could increase handwashing compliance and reduce the prevalence as well as the economic burden of hospital-acquired infections. In the recommendation section, the researcher highlighted the need for hospitals to focus on an integrated approach that creates awareness on the need for consistent handwashing with the purpose of promoting patient safety. The implementation of such measures should empower nurses and other healthcare workers to register remarkable levels of handwashing compliance and eventually prevent the occurrence of hospital-acquired infections. After the literature review, the researcher further presented a research proposal that highlights the best methodology for a study that will be conducted in Kuwait hospitals to determine how various intervention strategies impact nurses regarding handwashing.