Hygiene Intervention Strategies: Implementation in the Healthcare Environment

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Table of Contents

Annotated Bibliography and Critique
Description of the Proposed Solution
Relating Solution to Available Literature
Feasibility and Appropriate Goals, objectives, and expected outcomes
References

Annotated Bibliography and Critique

Tortajada, P., Alarcia, M., Coca, R., Gallemi, G., Garcia, I., Fernandez, M., Berbel, C. (2012). The 3/3 Strategy: A successful multifaceted hospital wide hand hygiene intervention based on WHO and continuous quality improvement methodology. PLoS ONE, 7(10), 1-13.

The article discusses the strategies that may be used to successfully implement hygiene intervention strategies in a healthcare environment. According to the authors, “healthcare-associated infections occur in 5–10% of hospitalized patients during their hospital stay” (Tortajada, Alarcia, Coca, Gallemi, Garcia, Fernandez, & Berbel, 2012, p. 5). The authors noted that although healthcare providers know that hand hygiene is the cheapest and most efficient way to prevent the spread of infections, compliance with hand-washing remains “suboptimal” (Tortajada, et al., 2012). This is evident by an increase in the spread of infections within our facility as evident by the multiple cases of C-diff. The article recommends instituting an extensive hand washing initiative program focused on changing the current culture of the facility, increasing management involvement, increasing staff accountability, and increasing staff compliance.

Rosswurm, M. A., & Larrabee, J. H. (2009). A model for change to evidence-based practice. Sigma Theta Tu International, 31(4), 317-322.

The article relates how utilizing evidence-based practice can ensure that patients are receiving the highest quality and most up-to-date care available. Rosswurm and Larrabee (2009) determined that there needed to be a systemic approach for any change to occur. The article notes that it was not just a matter of identifying the change needed and then collecting the data. The change process was more complex. The authors proposed the Change Model, which consisted of 6 steps, which are assess the need for change (identifying the problem and the stakeholders), link the problems to the interventions and outcomes, synthesize the best evidence (collecting research), design the practice change, implement and evaluate the change practice, and integrate and maintain the change practice (Rosswurm & Larrabee, 2009).

Carboneau, C., Benge, E., Jaco, M. T., & Robinson, M. (2010). A lean Six Sigma team increases hand hygiene compliance and reduces hospital-acquired MRSA infections by 51%. Journal for Healthcare Quality, 2(1), 61-70.

The article discusses how lean Six Sigma personnel might act proactively to reduce infections and increase hygiene in the hospital environment. Apparently, the authors are categorical that having a systematic approach to solving a problem will assist nursing with assessing a need for change and implementing the evident based practice into practice (Carboneau, Benge, Jaco, & Robinson, 2010). For instance, hand washing and universal precautions are used to prevent the spread of infection at any healthcare facility. Due to limited space and the needs of our patients, patients are not isolated. This increases the need for staff to be diligent with hand-washing procedures. A low hand hygiene compliance rate by health-care workers (HCW) increases hospital-acquired infections to patients (Carboneau et al. 2010).

Garus-Pakowska, A., Sobala, W., & Szatko, F. (2013). Obserrvance of hand washing procedures performed by the medical personnel before patient contact. Part 1. International Journal Of Occupational Medicine And Environmental Health, 26(1), 113-121.

The article discusses the ideal hand washing procedures that guarantee compliance, reduce the spread of infection. The authors note that staff knowledge is not the problem. Rather, compliance is the bigger issue. Garus-Pakowska, Sobala, and Szatko (2013) performed a study which included a group of 188 people (nurses and doctors) subjected to direct quasi-participatory observation. Their results concluded a low rate of hand-washing prior to HCW’s providing care to the patients. When it comes to hand-washing best practice for patients is to have a culture that instills a sense of urgency and “no tolerance” (Garus-Pakowska, Sobala, & Szatko, 2013).

Trampuz, A., & Widmer, A. F. (2004). Hand Hygiene: A Frequently Missed Lifesaving Opportunity During Paitent Care. Mayo Clinic Proceedings, 79(5), 109-116.

The article relates hand hygiene to chances of saving lives in the healthcare environment. Trampuz and Widmer (2004) argue that hand hygiene compliance is required before and after all patient contact, before performing any aseptic task, after exposure to any bodily fluid, after removing gloves, and after contact with a patient’s surroundings. Interventions proposed in the article include re-educating staff, performing audits and direct observations, providing feedback, and enforcing with disciplinary actions as necessary. Outcomes would include increased compliance and cultures where the members of staff are encouraged speak when they witness others not performing up to par (Trampuz & Widmer, 2004).

Erkan, T., Findik, U. Y., & Tokuc, B. (2011). Handwashing behaviour and nurses’ knowledge after a training program. International Journal of Nursing Practice, 17(3), 464-469.

The article outlines the ideal hygiene behavioral changes that may be influenced by a proper training program. Data collected by the authors suggest that handwashing is severely lacking and that HCW perform hand hygiene more when the risk to themselves is high versus to protect the patient. The findings indicate that proper hyegine is an important initiative to increase staff compliance. In each of the environent where hyegne training programs were in place, the authors observed reduced number of infections (Erkan, Findik, & Tokuc, 2011).

Description of the Proposed Solution

The hygiene initiative would be a multi-step, multi-discipline approach for sustainable hand washing procedures in the healthcare environment. The stakeholders include doctors, nurses, management team, environmental and dietary services, therapy department, and eventually finance. Data would be collected for a 6 month period prior to initialization phase one in 2015. This data would include direct observation of staff’s hand washing compliance when performing pre-determined tasks, monitoring purchasing habits for hand hygiene products, and staff questionnaires related to their knowledge of hand hygiene and current hand-washing culture of the facility. This internal data would then be compared to external data of peer-reviewed research, like data collected in Table 1. Facility specific data would also be reviewed over the last 3 years for trends of infection spread throughout the facility. Also the internal data of there being a lack of a monitoring/disciplinary system in place for hand-washing would be compared to the researched articles of putting a monitoring/disciplinary plan in place.

Relating Solution to Available Literature

There is plenty of research available that supports hand washing as being the best practice to break the cycle of spreading infection. As proposed in the above literature, the plan would consist of two phases. Both phases would incldue staff education, performing audits of staff’s hand-washing episodes, questioning patients, and families about staff’s hand washing practices. Besides, the plan will include providing feedback at staff meetings and nursing forums. Phase two would include more frequent audits as well as disciplinary actions.

Feasibility and Appropriate Goals, objectives, and expected outcomes

Feasibility of the plan

Since the hand washing initiative will be maintained by a yearly competency performed by all staff as well as an anonymous culture questionnaire, it will be easy to monitor and report rates of infectious outbreaks. This makes the proposed plan feasible since hand hygiene will be monitored and decreased infection rates tracked without any major challenge through simple observation and recording.

Appropriate goals

This plan will address the goal of creating a culture of excellence in patient safety through observing hygiene practices such as hand-washing to prevent infections. Besides, the plan will also address the goal of sustainable healthcare provision through efficiency of the targeted nurses.

Expected outcome

The rate of infections in the healthcare provision as a result of nurses’ carelessness is expected to decrease by at least 80% at the end of the first six months of implementation of the proposed plan.

References

Erkan, T., Findik, U. Y., & Tokuc, B. (2011). Handwashing behaviour and nurses’ knowledge after a training program. International Journal of Nursing Practice, 17(3), 464-469.

Garus-Pakowska, A., Sobala, W., & Szatko, F. (2013). Obserrvance of hand washing procedures performed by the medical personnel before patient contact. Part 1. International Journal Of Occupational Medicine And Environmental Health, 26(1), 113-121.

Rosswurm, M. A., & Larrabee, J. H. (2009). A model for change to evidence-based practice. Sigma Theta Tu International, 31(4), 317-322.

Trampuz, A., & Widmer, A. F. (2004). Hand Hygiene: A Frequently Missed Lifesaving Opportunity During Paitent Care. Mayo Clinic Proceedings, 79(5), 109-116.

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