الفهرس 
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Abstract
Healthcare workers (HCWs) are frequently exposed to blood-borne pathogens and other microorganisms during routine clinical and nursing services, minor or major surgical procedures, handling of laboratory specimens, disposal of hospital waste, and emergency procedures. Such exposures put them at risk of acquiring healthcare-associated infections (HCAIs) and transmitting them to their patients, as well as to their families and communities.
The implementation of standard precautions and maintenance of a safe healthcare environment is essential for nurses to prevent and control the transmission of infections. Infected patients in hospitals can be a source of infection transmission to other patients, healthcare workers, and visitors, making it crucial for nurses to ensure the use of safe, effective, and ethical infection prevention and control measures. This requires nurses to be knowledgeable about the best practices and organizational policies related to infection prevention and control of microbial growth. However, due to the continuous genomic mutation of many bacteria, there is insufficient data to make definitive recommendations regarding which hand hygiene products should be used.
While there is no ideal hand hygiene agent or product, each has its advantages and disadvantages. Microbes have survived in nature due to their simplicity, with a basic genomic framework and genetic encryption of basic survival strategies. To combat these microbes, nurses must follow basic and simple HH protocols for infection prevention and control. Despite the obvious consequences for controlling microbial growth and infection, few studies have been conducted on the effectiveness of different HH types. Therefore, the current study was conducted to evaluate the effectiveness of application of hand washing versus alcohol based hand rub or both in controlling microbial growth.
Aim of this study:
Evaluate the effectiveness of application of hand washing versus alcohol based hand rub or both in controlling microbial growth.
Material and Methods:
Material
Research design:
A randomized clinical trial was utilized to fulfill the study aim.
Setting:
The present study was conducted at Alexandria Main University Hospital in ten surgical departments, which includes; Hepato-biliary and Pancreatic, Cardiothoracic, Vascular, Oncology, Gastrointestinal, Urology, Ophthalmology, Neurosurgery, Colorectal and ENT. Each department contains two patients’ rooms for males and the other for females. The hospital provides health services to three governorates; Alexandria, Beheira, and Matrouh.
Subjects:
A simple random sample of 45 nurses from the above mentioned setting was recruited and assigned randomly and alternatively into three equal groups, fifteen nurses each.
Study group (I): fifteen nurses were exposed to hand washing only.
Study group (II): fifteen nurses were exposed to alcohol based hand rub only.
Study group (III): fifteen nurses were exposed to hand washing first then alcohol based hand rub.
Tools of the study:
Four tools were used for data collection,
Tool I: Nurses Socio-Demographic characteristics and Medical Data
This tool was developed by the researcher based on reviewing of the relevant literatureGasaba et al. (2020). To elicit baseline data of nurses” socio-demographic characteristics and medical data, it comprised of ten closed & open ended questions and divided to two parts as follows:
Part I: Nurses’ socio-demographic data included age, gender, educational qualifications, years of experience, working unit, attending pre or in service training programs on infection control.
Part II: Nurses’ medical data such as vital signs, hands skin problems, prescribed medication taken as antibiotic therapy, presence of any infection currently or in the past.
Tool II:InfectionPrevention & Control Knowledge assessment:
This tool was developed by the researcher based on reviewing of relevant literature(Australian Commission on Safety and Quality in Health Care [ACSQHC], 2019; Sastry & Deepashree, 2019).It used for assessing nurses’ knowledge related to infection prevention and control and hand hygiene. It consisted of thirty multiple choice questions (MCQs) with two parts:
Part 1: Nurses Knowledge related to Infection Prevention and Control:
This part involved 15 MCQs to assess nurses’ knowledge related to infection prevention and control as: infection, microbes and infectious agents, chain of infection, infectious agents and pathogenic organisms, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host in vulnerable populations for example the immune-compromised, nursing actions to interrupt the chain of infection, infection control principles, as well as standard precautions of infection prevention and control. control measures of specific infectious diseases protocols during pandemics, also be included.
Part 2: Nurses Knowledge related to Hand Hygiene:
This part involved 15 MCQs to assess nurses’ knowledge related to hand hygiene as basic concepts of hand hygiene, indications, disinfectant types and concentrations, principles of hand hygiene, hand washing technique and timing of the entire procedure, alcohol-based hand rub technique and timing of the entire procedure.
Scoring system:
For each knowledge item, a correct answer scored as one and an incorrect answer or no answer scored zero. The overall score ranged from zero to 30 and the total expressed in percentage after summed it as follows:
- An overall score of 90 % and above considered as satisfactory level of knowledge.
- An overall score of < 90 % considered as unsatisfactory level of knowledge.
Tool III:Hand Hygiene observational checklist
This tool was developed by the researcher based on a review of the recent relevant literature Government of South Australia (2020)Elsevier (2020). It used to assess nurses’ practice in hand hygiene (rub or wash). It included two parts as the follows:
First part: Hand Wash Practice
This part used to assess nurses’ practicing of hand washing using soap and water. It involved the following 12 items:remove all hand and wrist jewelry from hands and fingers,wet hands with water,apply enough soap to cover all hand surfaces,rub hands palm to palm,right palm over left dorsum with interlaced fingers and vice versa. Continuing steps will include, palm to palm with fingers interlaced, backs of fingers to opposing palms with fingers interlocked, rotational rubbing of left thumb clasped in right palm and vice versa, rotational rubbing of left thumb clasped in right palm and vice versa, rinse hands with water, pat dry thoroughly with a single-use towel i.e. paper towel, use towel to turn off tap and the entire procedure should take 40 – 60 seconds.
Second part: Use of Alcohol Based Hand Rub
This part used to assess nurses’ practicing in carrying out effective use of alcohol-based hand rub. It involved the following 9 items:remove all hand and wrist jewelry from hands and fingers, apply 1 squirt (1-3mls) to the palm of the hand and spread over hands, ensuring that the finger nails are well covered, rub hands palm to palm,right palm over left dorsum with interlaced fingers and vice versa. In the same way, palm to palm with fingers interlaced, backs of fingers to opposing palms with fingers interlocked, rotational rubbing of left thumb clasped in right palm and vice versa, rotational rubbing, backward and forwards with clasped fingers of right hand in left palm and vice versa, and allow the entire product to dry and the entire procedure should take 20 – 30 seconds.
Scoring system:
Each practicing item; checked as either; done correctly or done incorrectly or not yet done. Done correctly scored (2); done incorrectly or not yet done scored (zero). The overall score ranged from zero to 42 and the overall scores expressed in percentage after summed it as follows;
- An overall score of 90 % and above considered as satisfactory practice level.
- An overall score of < 90 % considered as unsatisfactory practice level.
Tool IV: Microbiology Laboratory Assessment
This tool was developed by the researcher based on a review of relevant recent literature(Black & Black, 2018; Murray et al., 2020). It used to assess microbial growth count on nurses’ hands. It involved 6 items related to the followings;hand hygiene methods used, date and time of hand print, incubation hours of blood agar plate after hand print, number of colony forming unit (CFU) grown on nurses hands pre and post hand hygiene, and identification of the organisms colonization on hands.
Scoring system:
The overall scores expressed as follow:
- Colonization of microorganisms on hands 100 and above considered as heavy microbial growth.
- Colonization of microorganisms on hands from 50 to less than 100 considered as moderate microbial growth.
- Colonization of microorganisms on hands less than 50 considered as mild microbial growth.
- Colonization of microorganisms on hands = zero considered as no microbial growth.
Method:
The study accomplished as follows:
• An official permission was obtained from Research Ethics Committee of faculty of nursing, Alexandria University for carrying out this study.
• An official permission was obtained from the Research Affairs Committee to responsible authorities of the selected setting to obtain their approval to collect the data after explaining the aim of the study.
• An official permission was obtained from the hospital director and head of the surgical departments of the selected setting after explanation of the study aim
• Tool I & Tool II was developed by the researcher based on a review of relevant literature and translated into Arabic.
• Tool IIIand Tool IV was developed based on review the recent relevant literature, both of them used in English by the researcher.
• All study tools tested for content validity by 2 experts in Medical Surgical Nursing, 2 experts in Microbiology field and 1 expert in Surgical specialized field. The necessary modification done.
• Reliability of all tools tested using appropriate statistical test.
• A pilot study was carried out on 5 % of nurses not included in the study sample to assess clarity, feasibility and applicability of all study tools. The necessary modifications done accordingly. Those nurses excluded from the current study sample.
• Based on the Epi info 7 programs statistical calculations, a sample of 45 nurses selected by simple random sample and assigned randomly and alternatively into three equal groups 15 nurses in each group.
Study group (I): fifteen nurses exposed to hand washing practice only.
Study group (II): fifteen nurses exposed to alcohol based hand rub practice only.