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 :

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9. Ilker Uckay, Stephan Harbarth, Robin Peter, Daniel Lew, Pierre Hoffmeyer, and

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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.

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suburban fire department, available in http://www.ncbi.nlm.nih.gov/pubmed.

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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.

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2011 Jul 3, A comparison of the hand hygiene knowledge, beliefs and practices of

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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 :

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Signature :

12. REMARKS OF THE CHAIRMAN & :

PRINCIPAL :

Signature :

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