Simple hand-washing video for visitors could reduce rapidly increasing hospital infection rates

A simple video-based awareness programme significantly improved hand washing among family members visiting sick children in a Paediatric Intensive Care Unit, according to research in the June issue of the UK-based Journal of Clinical Nursing.

Researchers monitored visits by123 families to see how they could improve hygiene and reduce hospital acquired infections like MRSA, which are a major cause of ill health and death among children in intensive care.

“Research has shown that hospital acquired infections occur in about 10 per cent of patients on general hospital wards, but that children on paediatric intensive care units have a 20 to 30 per cent chance of becoming infected” says nurse researcher Dr Li-Chi Chiang from the China Medical University in Taiwan.

For the first two months, 62 families were shown posters illustrating hand-washing techniques and discussed the 10 key steps involved with staff.

During the second two months, 61 different families were shown a hand-washing video and took part in the same discussions with staff.

The groups, which included parents, grandparents, aunts and uncles, were then observed during subsequent visits to the unit in Taiwan, which cares for about 30 children each month.

“Both groups significantly improved their hand-washing behaviour, but the video initiative proved much more effective” says Dr Chiang.

“When we marked each group on a scale of zero to 10, we found that in both groups compliance increased with each of the five visits monitored after guidance was provided.

“The video group started with an average score of 7.0 the first time we observed them and this rose to 8.6 by the fifth visit. The poster group were much less efficient at hand washing, starting at 4.7 and rising to 5.9.

“Both the groups had similar profiles and education levels and the researchers took part in the initial viewing and discussion sessions to ensure consistency. There was also a 20-day gap between the groups to ensure that families only took part in one training initiative.”

Dr Chiang and co-author Yong-Chuan Chen from the Taichung Veterans General Hospital in Taiwan argue that showing simple hand-washing videos in healthcare settings is an efficient, low-cost strategy that could make a real contribution to reducing infection rates.

“The video can be shown repeatedly in areas such as intensive care unit waiting rooms and hospital staff can be trained to reinforce the information in the video when interacting with visitors” says Dr Chiang.

“The Taiwan study is of particular interest because the majority of hand-washing studies have concentrated on healthcare staff” says Roger Watson, Editor of Journal of Clinical Nursing and Professor of Nursing at The University of Sheffield.

“We are very keen to highlight how steps are being taken to tackle hygiene issues among members of the public visiting hospital patients, as they play a key role in initiatives to halt the spread of hospital acquired infections such as MRSA.

“Here in the UK, Government statistics issued earlier this year showed that one in 500 death certificates issued in England and Wales between 2001 and 2005 mentioned MRSA and that Clostridium difficile was mentioned on one in every 250 during the same period. The vast majority of these infections will have been acquired in hospital.

“It is clear from international research that this picture is being repeated in healthcare settings worldwide. Hospital acquired infections continue to rise at an alarming rate and urgent steps are needed to halt their spread.

“This research identifies a very simple and inexpensive initiative that yielded effective results and could easily be adopted in a wide range of healthcare settings.”

• Effectiveness of hand-washing teaching programmes for families of children in paediatric intensive care units. Chen Y-C and Chiang L-C. Journal of Clinical Nursing. 16, pp 1173-1179. June 2007.

• Source for UK figures quoted by Roger Watson: Deaths involving MRSA and Clostridium difficile continue to rise. National Statistics News Release 22 February 2007. http://www.statistics.gov.uk/pdfdir/deaths0207.pdf

• Founded in 1992, Journal of Clinical Nursing is a highly regarded peer reviewed Journal that has a truly international readership. The Journal embraces experienced clinical nurses, student nurses and health professionals, who support, inform and investigate nursing practice. It enlightens, educates, explores, debates and challenges the foundations of clinical health care knowledge and practice worldwide. Edited by Professor Roger Watson, it is published 10 times a year by Blackwell Publishing Ltd, part of the international Blackwell Publishing group. www.blackwellpublishing.com/jcn

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