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DISSERTATION PROPOSAL
“A STUDY TO EVALUATE THE EFFECTIVENESS
OF STRUCTURED TEACHING PROGRAMME ON
HANDHYGIENE PRACTICES IN THE CARE OF
SURGICAL SITE INFECTIONS AMONG STAFF
NURSES IN A SELECTED HOSPITAL AT
BANGALORE, KARNATAKA.”
SUBMITTED BY
Mr. Alvin Delgado
4th YEAR BS. NURSING
College of Nursing
Ifugao State University
College OF Nursing, Philippines
2015-2016
0
Abra State University
College of Nursing
Ifugao
ANNEXURE-2
1. NAME OF THE CANDIDATE
AND ADDRESS
: MRS. SEENA SATHEESH
1 YEAR M.Sc NURSING
4th YEAR M.Sc NURSING
BS NURSING
Ifugao State University
College OF Nursing, Philippines
2015-2016
2. NAME OF THE INSTITUTION : Abra State University
COLLEGE OF NURSING
3. COURSE AND SUBJECT : 1 YEAR BSN
MEDICAL-SURGICAL NURSING
4 DATE OF ADMISSION TO
COURSE
: 06-07-2015
5. TITLE OF THE TOPIC : A STUDY TO EVALUATE THE
EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON
HANDHYGIENE PRACTICES IN THE
CARE OF SURGICAL SITE
INFECTIONS AMONG STAFF
1
NURSES IN A SELECTED
HOSPITAL AT BANGALORE,
KARNATAKA.
6.0 BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“ALL PATIENTS HAVE THE RIGHT TO RECEIVE CARE AND
COME TO NO HARM” -HIPPOCRATES
Hand hygiene is a topic at the forefront of patient safety. Hospital acquired
infection is one of the leading causes of preventable deaths in our health care system.
The Center for Disease Control and Prevention estimates that there are approximately 1.7
million hospital associated infections that cause up to 99, 00 deaths per year. These
infections not only cause a significant amount of morbidity and mortality, but they also
greatly increase health care costs. Hand hygiene compliance is one of the most effective
ways to combat the spread of infection within a hospital.1
The World Health organization estimates that 10-30 per cent of all hospital
admissions result in Healthcare acquired infections. An estimated 1.4 million people
suffer from Healthcare acquired infection at any given time. The average rate of
prevalence of Healthcare acquired infection in Europe is 7.1 %, resulting in 16 million
2
extra days of hospital stay and this accounts for a loss of approximately 7 billion a year
(excluding indirect costs), states annual report on communicable diseases.2
Health-care-associated infections are an important cause of morbidity and
mortality among hospitalized patients worldwide. Transmission of health-care-associated
pathogens most often occurs via the contaminated hands of health care workers. Hand
hygiene is the single most important means of preventing infections. Accordingly, hand
hygiene (i.e., hand washing with soap and water or use of a waterless, alcohol-based hand
rub) has long been considered one of the most important infection control measures for
preventing health-care-associated infections. However, compliance by health care
workers with recommended hand hygiene procedures has remained unacceptable, with
compliance rates generally below 50% of hand hygiene opportunities.3
Studies have documented the fact that the failure by physicians, nurses, and other
healthcare workers to perform the simple act of hand washing as they move from room to
room in medical-care settings is one of the leading causes of hospital-associated
infections. Yet the rate of this obvious hygiene practice has remained dismally low.4
Like the public reporting of other indicators, monitoring hand hygiene compliance
rate is about overall performance improvement. The information gathered will assist
hospitals in evaluating the effectiveness of their infection prevention and control
interventions and make further improvements based on this information.5
Infections can be minor or occasionally they can increase complications that
result in a longer length of stay in the hospital, or an increased readmission rate for
3
patients. Postoperative Surgical site infections are the most common health care-
associated infections in surgical patients.6
Surgical site infections are the most common and serious complications among
surgically treated patients. They result in extended length of hospital stay, pain,
discomfort and sometimes prolonged or permanent disability and finally, increase
medical costs. The last concern has become increasingly important, as physicians and
third party payers strive to gain control of the rising cost of medical care.7
Patients can also help reduce the risk for infections by following pre-operative
instructions given by the surgeon and health care team. Frequent hand cleaning is another
way to prevent the spread of infection. Hand hygiene involves everyone in the hospital
including patients.8
Surgical site infections account for approximately a quarter of all nosocomial
infections. The risk of developing a surgical site infection is associated with a number of
factors, including surgical, patient and microbial characteristics. Each Surgical site
infection is associated with approximately 7 to 10 additional postoperative hospital days.
It is estimated that 77% of deaths among patients with surgical site infection are directly
attributable to surgical site infection. Postoperative neurosurgical infections have high
morbidity rates and are among the most life-threatening infections.9
Surgical hand preparation is probably the most important surgical site infection
prevention strategy, although there is no strict randomized study comparing surgery with
and without previous hand antisepsis preparation. Its importance is supported by expert
4
opinion, experimental studies and success stories of surgical site infections reduction via
mere hand hygiene promotion campaigns. However, owing to their multimodal design,
most hand hygiene campaigns cannot distinguish between surgical site infections
reduction due to improved antisepsis in the operating theater versus better patient and
wound care on the ward.10
Because of the potentially devastating consequences of infectious complications,
considerable efforts should be made for reduction of the infection rates. One of the key
components to any surgical infection prevention strategy should be a multi-disciplinary
approach and everyone should be committed equally to the process improvement.11
6.1. NEED FOR THE STUDY
There is convincing evidence that improved hand hygiene can reduce infection
rates. Failure to perform appropriate hand hygiene is considered the leading cause of
Health-care-associated infections. Several hospital-based studies of the impact of hand
hygiene on the risk of Health-care-associated infections have been published between
1977 and 2004. Most reports showed a temporal relation between improved hand hygiene
practices and reduced infection rates. The Center for Disease Control and Prevention,
Joint Commission, and World Health organization each promote the use of multimodal
and hygiene compliance programs within a healthcare facility. The recommended
components of this multimodal program typically are: Health care workers training,
patient education, practice measurement, and feedback for the healthcare team.
5
Hand hygiene compliance monitoring and Health-care-associated infections
incidence reporting are yet to be standardized across countries. This makes comparison of
data across nations a challenge. Hand hygiene awareness campaigns have achieved
limited success in various countries. In order to maintain the increased levels of hand
hygiene practices, education has to be imparted and health care workers awareness has to
be created on a continuous basis. Several companies continuously impart education and
training to health care workers on to keep hospitals and health care workers focused on
the importance of hand hygiene in infection control. The efficacy of these interventions
can be quantitatively measured only by means of an effective hand hygiene compliance
monitoring solution in addition to standardized Health-care-associated infections
incidence reporting. Until recently there was no single method to measure hand hygiene
compliance without human bias (direct observation) or without behavior detail (product
usage measurement). Measuring product usage includes the factors of product used,
patient bed days, and dosage of individual hand hygiene event. Results will indicate the
number of hand hygiene events performed in the hospital unit per patient per day. A
facility-wide report will show which hospital units are performing hand hygiene more, or
less, per patient. The shortcomings of these methods are the large number of man-hours
required to observe hand hygiene practices, alterations in the behavior of health care
workers when being watched and the time required to generate reports, which is typically
30 days.12
The first clear evidence of clinical benefit from hand hygiene came from
Semmelweis, working in the Great Hospital in Vienna in the 1840s. The hospital had two
obstetric departments, and women were admitted alternately, whatever their clinical
6
condition, to one or the other. The incidence of maternal death was as high as 18% in the
first department, with puerperal fever the main cause, but only 2% in the second.
Semmelweis observed that a colleague died from an illness similar to puerperal fever
after being accidentally cut during a necropsy. He concluded that the infecting particles
responsible for puerperal fever came from cadavers and were transmitted by hand to
women attended by medical students in the first department. He therefore instituted hand
disinfection with chlorinated lime for those leaving the necropsy room, after which
maternal morbidity in the first department fell to the levels achieved by the second
department. He was however unable to convince his colleagues of the importance of
hand-washing. Most of the medical community ignored his findings. He was committed
to a sanitorium and died at the age of 47. Editors note: “Those who can not remember the
past are condemned to repeat it” George Santayana.13
Hand washing should become an education priority. Since assessment is the ‘tail
that wags the dog’, marks for hygiene should be incorporated into all undergraduate
clinical assessment and into teaching quality assessment Part of any educational
intervention with medical students should be presentation of the very clear evidence that
healthcare workers' hands become contaminated by pathogens after patient contact, that
alcohol hand rubs are the easiest and most effective means of decontaminating hands
between patient contacts and that controlled trial evidence shows that hand-
decontamination substantially reduces surgical site infections in many clinical settings.
Hand hygiene is the practice of evidence-based medicine. Medical school curricula
should now treat it thus and should study the efficacy of educational programmers to
improve hand hygiene. 14
7
The investigator observed that Hand hygiene is an important practice for
healthcare providers and has a significant impact on surgical site infections in hospitals,
when she worked as an infection control nurse in one of the neurosurgery hospitals,
before joining the Masters degree. The investigator found that Hand hygiene is a different
way of thinking about safety and patient care and involves everyone in the hospital,
including patients, visitors and health care providers.
The investigator felt that Effective hand hygiene practices in hospitals play a key
role in improving patient and staff safety, and in preventing the spread of health care-
associated infections. Hence the investigator under took this study to create awareness
about importance of hand hygiene practices and its impact on surgical site infections
among staff nurses thereby reducing the mortality rate, morbidity rate in patients and also
greatly decrease health care costs.
6.2. REVIEW OF LITERATURE
Review of the literature is an important step in the development of research
project .the investigator carried out an extensive review of literature on the research topic
to gain deeper insight in to the problem and to collect maximum relevant information for
building up the study in a scientific manner so as to achieve the desire result.
A descriptive study was conducted on pre-educational intervention survey of
healthcare practitioners' compliance with infection prevention measures in cardiothoracic
surgery at Mater Dei Hospital, Msida, and Malta. A structured observational method was
8
used to collect data about infection control practices among surgeons, anesthetists,
nurses, cardiopulmonary bypass technicians and orderlies practicing in the cardiac
operating theatre during open heart surgery. The study measured the 30-day SSI rate by
post-discharge telephonic surveillance among surviving open heart surgery patients.
30 operations were chosen randomly. The study revealed higher levels of inadequate
practices related to environmental disinfection, hand hygiene, operating room traffic and
surgical attire of non-scrubbed personnel, the study found poor compliance with infection
control practices by non-scrubbed personnel involved in cardiac surgery and observed a
high surgical site infection rate, the majority being leg wound infections following
saphenous vein harvesting.15
A multifaceted pilot program was conducted to promote hand hygiene at a
suburban fire department in Pasco County Fire Rescue Florida; written surveys were
administered to Firefighters and Emergency Medical Services personnel to assess their
practices, attitudes, and beliefs before and after installation of alcohol hand gel
dispensers, hanging of reminder posters, and completion of PowerPoint training.
Responses to Likert scale questions about attitudes, practices, and beliefs regarding hand
washing did not reveal any statistically significant differences between pre intervention
and post intervention surveys; however, responses to direct questions about the impact of
the intervention were more promising. The study concluded that implementation and
evaluation of an intervention to target groups of Firefighters and Emergency Medical
Services personnel can guide future efforts to improve hand hygiene practices in this
distinctive group. 16
9
A study was conducted on individual differences in judgments of hand hygiene
risk by health care workers in United States. Knowledge levels were assessed by
questions taken from published questionnaires. The health locus of control scale was used
to characterize internal health beliefs. Health care workers reported lower risk
assessments for touching surfaces compared with touching skin. The study concluded that
datas described the individual differences of health care workers related to hand hygiene
in ways that can be used to create targeted interventions and products to improve hand
hygiene. 17
A comparison study was conducted on hand hygiene knowledge, beliefs and
practices of Italian nursing and medical students. The comparison was done among 117
nursing and 119 medical students in a large university in Rome, Italy, the study revealed
a significant disciplinary differences in hand hygiene knowledge and self-reported
practices were apparent among undergraduate Italian healthcare students. Further
research is needed to determine the causative factors. The overall low scores on the
knowledge items indicate that these students require further education on hand hygiene,
particularly in relation to the use of alcohol-based hand rubs. 18
An observational study was conducted on Hand-hygiene practices in the operating
theatre in Division of Preoperative and Emergency Care in Netherlands Covert direct
observations of OT staff at an academic medical centre were performed by a single,
trained observer .Frequent interactions between patient, staff, and OT environment were
observed. The study concluded that adherence to hand-hygiene guidelines by OT staff
10
was extremely low. This potentially exposes patients to microbial transmission, Health
care associated infections, and patient harm. 19
A descriptive study was conducted to measure twenty-four-hour hand hygiene
compliance in hospitals in Nottingham University Hospitals NHS Trust The Queen's
Medical Centre, Nottingham, UK. This observational study was done in two hospital
wards using the 'five moments of hand hygiene' observation tool. Study revealed lower
levels of compliance for health care workers working during the early shift (P<0.001).
For patients and visitors there was no evidence of an association between moments of
hygiene and compliance. Levels of compliance were higher compared with previous
reported estimates. Medical staff had the lowest level of compliance and this continues to
be a concern which warrants specific future interventions. 20
An interventional study was conducted at Sree Chitra Tirunal Institute for
Medical Sciences and Technology, Trivandrum, Kerala, India to evaluate the effect of
alcohol-based hand rub before and after each patient contact on surgical site infections
after elective neurosurgical procedures. Two 9-month study periods were compared. An
infection-control protocol incorporating an alcohol-based hand rub was implemented for
a period of 3 months and continued thereafter. The e study concluded that Use of alcohol-
based hand rub before and after each patient contact in the neurosurgical intensive care
unit did not show a significant reduction in surgical site infections in the present study. 21
A cross-sectional survey was done on 1,700 health care workers for Predicting
hand hygiene among Iranian health care workers using the theory of planned behavior in
private and government hospitals associated with the University of Medical Sciences,
11
Shiraz, Iran between April and September 2008. The study revealed that Community-
based hand washing practices exerted a strong influence on hand washing compliance in
the hospital. 22
A study was conducted on strict hand hygiene and other practices shortened stays
and cut costs and mortality in a pediatric intensive care unit. They found that improving
practices of hand hygiene, oral care, and central-line catheter care reduced hospital-
acquired infections and improved mortality rates among children admitted to a large
pediatric intensive care unit in 2007-09. Used on a larger scale, the quality improvements
such as posters for an educational campaign , a training "fair," oral care
kits ,chlorhexidine antiseptic patches and hand sanitizers could save lives and reduce
costs for patients, hospitals, and payers around the country, provided that sustained
efforts ensure compliance with new protocols and achieve long-lasting changes. 23
A random Multivariate analyzing study was conducted to evaluate hand hygiene
adherence in a tertiary hospital in Spain., Evaluation of compliance with hand hygiene
was carried out in a Spanish teaching hospital .An adherence to hand hygiene was
evaluated hospital wide through direct observation, collecting data on hand hygiene
carried out whenever indicated (opportunity for hand hygiene). Multivariate analyses
revealed low adherence. Low adherence observed suggests that new interventions should
focus in modification of health care workers habits and attitudes, working at several
levels: individual and institutional. 24
A Cross-sectional survey was done at King Chulalongkorn Memorial Hospital in
Bangkok, Thailand to determine the baseline compliance and assess the attitudes and
12
beliefs regarding hand hygiene of health care workers and visitors in intensive care units.
Hand-hygiene compliance of health care workers and visitors in intensive care units
before patient contact for eight hours was observed. A self-administered questionnaire
was employed to measure attitudes and beliefs about hand hygiene for two-week period.
The study concluded that Hand-hygiene compliance of health care workers and visitors is
unacceptably low. Their knowledge, behavior attitudes, and beliefs toward hand hygiene
need to be improved by the multimodal and multidisciplinary approach. 25
A randomized equivalence study was conducted to compare the effectiveness of
hand-cleansing protocols in preventing surgical site infections during routine surgical
practice in France. Six surgical services from teaching and nonteaching hospitals in
France were chosen. The study concluded that Hand-rubbing with aqueous alcoholic
solution, preceded by a 1-minute non antiseptic hand wash before each surgeon's first
procedure of the day and before any other procedure if the hands were soiled, was as
effective as traditional hand-scrubbing with antiseptic soap in preventing surgical site
infections. The hand-rubbing protocol was better tolerated by the surgical teams and
improved compliance with hygiene guidelines. Hand-rubbing with liquid aqueous
alcoholic solution can thus be safely used as an alternative to traditional surgical hand-
scrubbing.26
A quasi-experimental study was conducted to assess the impact of the use of an
alcohol-chlorhexidine-based hand sanitizer on surgical site infection rates among
neurosurgical patients in Ho Chi Minh City, Vietnam. A hand sanitizer with 70%
isopropyl alcohol and 0.5% chlorhexidine gluconate was introduced, and healthcare
13
workers were trained in its use on ward A. No intervention was made in ward B. Centers
for Disease Control and Prevention definitions of surgical site infection were used. The
study concluded that introduction of a hand sanitizer can both reduce surgical site
infection rates in neurosurgical patients, with particular impact on superficial surgical site
infections, and reduce the overall postoperative length of stay and the duration of
antimicrobial use. Hand hygiene programs in developing countries are likely to reduce
surgical site infections rates and improve patient outcomes.27
STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of structured teaching programme on hand hygiene
practices in the care of surgical site infections among staff nurses in a selected hospital at
Bangalore, Karnataka”
6.3 OBJECTIVES OF THE STUDY
1. To assess the pre test knowledge on hand hygiene practices in the care of surgical
site infections among staff nurses.
2. To assess the post test knowledge on hand hygiene practices in the care of
surgical site infections among staff nurses.
3. To compare the pre test and post test knowledge on hand hygiene practices in the
care of surgical site infections among staff nurses.
4. To evaluate the effect of structured teaching programme on hand hygiene
practices in the care of surgical site infections among staff nurses.
14
5. To associate knowledge on hand hygiene practices in the care of surgical site
infections among staff nurses with their selected demographic variables.
6.4 OPERATIONAL DEFINITIONS
1. Effectiveness: Refers to an intended or expected result produced from the
structured programme as measured by the knowledge gain.
2. Structured teaching programme: It refers to providing information regarding
hand hygiene practices in the care of surgical site infections with the help of
written factual material and related audiovisual aids to staff nurses at selected
hospital in Bangalore.
3. Hand hygiene practice: Refers to the practice of hand hygiene followed by staff
nurses, before initial contact with the patient/patient environment, before
aseptic (sterile) procedure after body fluid exposure risk, after contact with
patient/patient environment while taking care of surgical site infected patients.
4. Surgical site infections: Refers to infections at the site of surgical incision,
developed within 30 days of surgery.
5. Staff nurses. Refers here to persons who have completed three years of diploma
in General Nursing and Midwives programme, working in selected Hospital and
registered in Karnataka Nursing Council.
15
6.5. NULL HYPOTHESIS
H0-1. There is no significant difference between the pre test and post test
knowledge score on hand hygiene practices in the care of surgical site
infections among staff nurses.
H0-2. There is no significant association between knowledge of staff nurses
regarding hand hygiene practices in the care of surgical site infections
with their selected demographic variables.
6.6. ASSUMPTIONS
1. Educating staff nurses in hand hygiene practices can prevent cross infections
among patients in hospitals.
2. Improved hand hygiene practices can reduce surgical site infection rates and
promote prognosis of surgical patients.
3. Optimal hand hygiene practices provide staff and patient safety.
6.7 DELIMITATIONS
The study is limited to
1. Nursing staffs who are present in the selected hospital Bangalore.
2. Prescribed data collection period of 4 weeks.
16
6.8. PILOT STUDY
A pilot study is the miniature of the main study. It will be conducted with
the 10% of sample with similar characteristics to that of main study to find out the
feasibility of the study, the tool and the informational booklet. The pilot study will
be done on10 staff nurse’s knowledge about hand hygiene practices in the care of
surgical site infections.
6.9 RESEARCH VARIABLES
Research variables are the concept at various levels of abstraction that are
entered manipulated and collected in the study.
Independent Variables: Structured teaching program on Hand hygiene practices in
the care of surgical site infections.
Dependent variables: Knowledge of staff nurses on Hand hygiene practices in
the care of surgical site infections.
Demographic variable: Age, professional qualification, work area, duration of
experience in present working unit, and total years of
experience.
17
7.0. MATERIALS AND METHODS (METHODOLOGY)
Seaman (1987) research design refers to the way in which the researcher
plans and structures the research process. The design provides flexible guide posts
that keep the research headed in the right direction.
It deals with the methodology selected for the study. It includes research
approach setting of study, population, criteria for sample selection, sampling
technique, selection of sample, development and description of instrument,
validity and reliability of the tool, pilot study data collection and plan of data
analysis.
7.1. SOURCES OF DATA
Data will be collected from nursing staff who will fulfill the inclusion
criteria.
7.1.1 RESEARCH DESIGN:
The research design adopted for the present study is “one group pre test -
post test design”.
Pre test Intervention Post test
O1
Assessment of knowledge
of staff nurses on hand
hygiene practices in the
care of surgical site
infections
X
Structured teaching
programme on hand
hygiene practices in
the care of surgical
site infections.
O2
Assessment of knowledge of
staff nurses on hand hygiene
practices in the care of
surgical site infections
18
7.1.2. RESEARCH APPROACH
The present study will be a Quasi experimental approach.
7.1.3. SETTING OF THE STUDY
The study will be conducted at selected hospital in Bangalore, Karnataka.
7.1.4. POPULATION
Population is the total group of persons or objects that mean the designed
set of criteria established by the researcher. The population in the present study
includes staff nurses, working in selected hospital, Bangalore, Karnataka at the
time of data collection.
7.2. METHOD OF DATA COLLECTION
Data collection technique used for the study is questionnaire method.
Questionnaire is used when particular information is derived and administered
personally to a group of individual.
The questionnaire was found to be the most appropriate for the study as
the respondents are more educated and respond by their knowledge.
7.2.1. SAMPLING TECHNIQUE
Simple random sampling techniques will be used for choosing the sample.
19
7.2.2. SAMPLE SIZE
The study sample consists of 60 staff nurses who are qualified in Diploma in
General Nursing and Midwifery and working in selected hospital, Bangalore,
Karnataka.
SAMPLING CRITERIA
7.2.3. INCLUSIVE CRITERIA
Registered staff nurses with a qualification of Diploma in General Nursing and
Midwifery.
Staff nurses working in post operative wards for at least one year in selected
hospital Bangalore.
Staff nurses who are available at the time of data collection.
Staff nurses who are willing to participate in structured teaching programme.
7.2.4. EXCLUSIVE CRITERIA
1. Staff nurses who have already attended any programme on hand hygiene practices
in the care of surgical site infections.
2. Staff nurses who are sick at the time of data collection.
7.2.5. TOOL FOR DATA COLLECTION
20
The total tool was designed in the form of a structured questionnaire. The
tool will be developed with the help of extensive review of literature from various
nursing experts and medical experts; the tool consists of two parts.
SECTION -A: Demographic Proforma will be used to assess the Demographical
variables such as age, professional qualifications, duration of
experience in present working unit, work area and total years of
experience.
SECTION -B: Questionnaire on knowledge will be used to assess the level of the
knowledge regarding hand hygiene practices in the care of
surgical site infections.
7.2.6. DATA ANALYSIS METHOD
The data obtained will be analyzed by using both descriptive and
inferential statistics. The plan for data analysis is divided as follows.
Descriptive Statistics
1. Frequency and percentage distribution will be used to analyze demographic
variable of staff nurses.
2. Mean and standard deviation will be used to identify the knowledge regarding
hand hygiene practices in the care of surgical site infections.
Inferential Statistics
21
1.‘t’ test will be used to analyze the difference in pre test and post test values
related to knowledge score of staff nurses regarding hand hygiene practices in
the care of surgical site infections.
2. Chi-Square will be used to find out association between post test knowledge
score of staff nurses with selected demographic variables.
7.3. DOES THE STUDY REQUIRE ANY INTERVENTION TO BE
CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?
YES
7.4 ETHICAL CLEARANCE
The main study will be conducted after the approval of research
committee permission is obtained from the following.
The research committee of SMT.LAKSHMI DEVI COLLEGEOF NURSING.
Staff nurses who are participating in structured teaching programme at selected
hospital in Bangalore, Karnataka.
Informed consent will be taken from the staff nurses who are willing to participate
in this study.
Confidentiality and anonymity of the subjects will be maintained.
8.0. LIST OF REFERENCES:
22
1. Ankur Gupta online medical publication on May 17, 2011-Hospital hand
washing compliance improved using a mobile app, available in
http://www.imedicalapps.com/ hospital-hand-washing-compliance-mobil-.
2. Beulah Devadason, Senior Research Analyst, Healthcare, EIA, 19 Sep 2011-
Hand Hygiene Compliance Solutions - What Manufacturers Need to Know,
available in www.frost.com › Home › Our Services › Research.
3. Pittet D, Mourouga P, Perneger TV, Compliance with hand washing in a
teaching hospital. Ann. Intern Med. 1999; 130:126-130, available in www.shea-
online.org/Assets/files/IHI_Hand_Hygiene.pdf.
4. Kristina Rebelo, From Medscape Medical News SHEA 2009: New Device
Monitors Hand-Hygiene Compliance by Healthcare Workers, available in
http://www.medscape.com/viewarticle/589931.
5. Andrew Morrison, FACT SHEET - Ministry of Health and Long-Term Care -
Ontario, available in http://www.health.gov.on.ca/patient_safety. Thunder Bay
Regional Health Sciences news, 2011, Surgical Site Infection Prevention
TBRHSC, available in www.tbrhsc.net/patient.../ surgical_site_infection
_prevention.asp.
6. Alina Petrica, Mihai Ionac, Cristina Brinzeu, Antoniu Brinzeu,Timisoara medical
journal,2009, Surgical site infection surveillance in neurosurgery patients,
available in http://www.tmj.ro/article.php?art=863461673127393.
23
7. Thunder Bay Regional Health Sciences news, 2011, Surgical Site Infection
Prevention - TBRHSC, available in www.tbrhsc.net/patient.../ surgical_
site_infection_prevention.asp.
8. PP Saramma, K Krishnakumar, PS Sarma Year : 2011 | Volume : 59 | Issue :
1 | Page : 12-17 ,Alcohol-based hand rub and surgical site infection ... -
Neurology India,available in http://www.neurologyindia.com/article.asp?
issn=0028-3886;
9. Ilker Uckay, Stephan Harbarth, Robin Peter, Daniel Lew, Pierre Hoffmeyer, and
Didier Pittet,, 2010 Medscape time news Preventing Surgical Site
Infections: ,available in http://www.medscape.com/viewarticle/723601_4.
10. Alina Petrica, Mihai Ionac, Cristina Brinzeu, Antoniu Brinzeu,Timisoara medical
journal,2009, Surgical site infection surveillance in neurosurgery patients,
available in http://www.tmj.ro/article.php?art=863461673127393.
11. Beulah Devadason, Senior Research Analyst, Healthcare, EIA, 19 Sep 2011-
Hand Hygiene Compliance Solutions - What Manufacturers Need to Know.
available in www.frost.com › Home › Our Services › Research.
13. S P Stone MD FRCP, Journal of royal society of medicine, volume 94, June 2001,
Hand hygiene the case for evidence -based education , available in
http://jrsm.rsmjournals.com/content/94/6/278.full.pdf.
24
14. S P Stone MD FRCP, Journal of royal society of medicine, volume 94, june 2001,
Hand hygiene the case for evidence -based education , available in
http://jrsm.rsmjournals.com/ content/94/6/278.full.pdf.
15. Tartari E, J Mamo, M Borg, From International Conference on Prevention &
Infection Control (ICPIC 2011), Compliance with infection prevention measure in
cardio thoracic, available in http://www.biomedcentral.com/content/pdf/1753-
6561-5-s6-o59.pdf.
16. McGuire-Wolfe C, Haiduven D, Hitchcock CD. American Journal Infection
Control. 2011 Sep 9, A multifaceted pilot program to promote hand hygiene at a
suburban fire department, available in http://www.ncbi.nlm.nih.gov/pubmed.
17. McLaughlin AC, Walsh F,American Journal Infection Control. 2011 Aug;
39(6):456-63, Individual differences in judgments of hand hygiene risk by health
care workers, available in http://www.ncbi.nlm.nih.gov/pubmed.
18. Van De Mortel TF, Kermode S, Progano T, Sansoni J. Journal Adavance Nursing.
2011 Jul 3, A comparison of the hand hygiene knowledge, beliefs and practices of
Italian nursing and medical students, available in http://www.ncbi.nlm.nih.gov/
pubmed.
19. Krediet AC, Kalkman CJ, Bonten MJ, Gigengack AC, Barach P. British Journal
of Anaesthesia. 2011 Oct; 107(4):553-8, Hand-hygiene practices in the operating
theatre: an observational study, available in http://www.ncbi.nlm.nih.gov/pubmed.
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SMT. LAKSHMI DEVI COLLEGE OFNURSING
BANGALORE – 560014
ETHICAL COMMITTEE
Sl. No.
Title Name Signature
1. CHAIRPERSON
2. MEDICAL SCIENTIST
3. CLINICIAN
4. SOCIAL SCIENTIST
5. LEGAL EXPERT
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6.PHILOSOPHER & THEOLOGIAN
7. LAY PERSON
8. MEMBER SECRETARY
9. SIGNATURE OF THE CANDIDATE :
10. REMARKS OF THE GUIDE :
11. NAME AND DESIGNATION OF GUIDE(IN BLOCK LETTERS)
:
Signature :
Co-guide if any :
Signature :
HOD :
28
Signature :
12. REMARKS OF THE CHAIRMAN & :
PRINCIPAL :
Signature :
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