The Implementation Plan for Improving Hand Hygiene Complaince

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Introduction

HH has been recognized as the cheapest and one of the most effective interventions for preventing (HAI) in healthcare settings (Kelcikova, et al., 2012). However, health care professionals fail to effectively comply with HH protocols (Caglar et al., 2010). Effective intervention is necessary to improve compliance of HH which is a vital component of patient and infant care in hospitals and NICUs.

Research confirms that strategies to increase the frequency and effectiveness of HH are successful and have shown an increase in HH compliance among healthcare workers (Lam et al., 2004). The CDC (2002) asserts the importance of the development and implementation of HH programs for improved HH compliance among healthcare professionals.

This report outlines the several steps necessary for a successful implementation plan with the ultimate goal of reducing HAIs in healthcare settings. The plan includes several components, each of which is necessary for the success and outcome of the plan.

Methods of Obtaining Necessary Approval and Securing Support for Proposal

Written permission and consent from the medical faculty committee is a necessary approval (Calgar et al., 2010). The implementation plan is designed with a clear vision and intention of promoting HH among HCWs. The implementation plan will include training sessions, regular performance feedback, poster displays as reminders, provision of ABH and the distribution of individual bottles of ABHs.

All the details will be included in a letter to the director of the nursing department or the administrator to inform the researcher’s initiative and goals for the improvement of HH and simultaneous patient health outcomes. The healthcare staff and leaders of respective departments will be appropriately informed of the researcher’s plan to implement HH with the intention of reducing HAIs in the healthcare setting.

Focus group discussions will be held. Additional interventions include increased supply of ABHs for all healthcare professionals (Picheansathian et al., 2008). The improvements made through the implementation will aim at reducing morbidity and mortality due to HAIs in the healthcare setting.

Description of Current Problem, Issue, or Deficit Requiring Change

HAI is a global concern in developed countries as well as the developing nations of the world (Correa et al., 2012; Tarricone et al., 2010). HAI is one of the most serious patient safety issues affecting nearly 1.4 million people globally (Tarricone et al., 2010). The rate of HAIs has found to be highest in ICUs (Picheansathian et al., 2008). Nosocomial infections are transmitted primarily through the hands of healthcare workers and place a huge economic burden on hospital costs (Picheansathian et al., 2008).

In spite of the necessary interventions and prevention measures, HAIs continue to plague the health care setting with increased risk of morbidity and mortality and extremely high costs of hospitalization (Tarricone et al., 2010). With nearly 2 million cases of HAIs resulting in about ninety-thousand deaths annually, the burden of HAI is a whopping 6.5 billion dollars (Tarricone et al., 2010).

HH is the most effective and cheapest measures to prevent HAIs in health care settings (De Wandel et al., 2010). However, the proportion of adherence to compliance with HH is low despite the fact that it is the cornerstone for prevention of HAIs (Eveillard et al., 2011). Studies indicate that less than 50% health care professionals comply with effective HH guidelines (Eveillard et al., 2011; CDC, 2002).

Research indicates that implementation of HH promotion programs substantially increase compliance (Picheansathian et al., 2008). Implementation of HH strategies to improve compliance will help in reducing health care costs and bring down rates of morbidity and mortality due to HAIs (CDC, 2002).

Explanation of Proposed Solution

HH is necessary for patient safety and reduction of morbidity and mortality occurring due to HAIs in healthcare settings. Strict adherence of HCWs to recommended HH safety guidelines should become an essential aspect of patient safety (CDC, 2002). Contamination of hands can occur indirectly through activities such as lifting patients, touching their hands and shoulders, taking blood pressure or checking oral temperature (CDC, 2002).

Contamination generally occurs through direct involvement with patient wounds, handling secretions, respiratory tract care or catheter care (CDC, 2002). Infant care involving infections, feeding, changing diapers and other activities also leads to acquiring viruses by HCWs (CDC, 2002). Studies confirm that HH procedures such as washing hands with an antiseptic or alcohol based rubs reduce the incidence of HAIs (CDC, 2002; De Wandel et al., 2010; Picheansathian et al., 2008).

A research study by Eveillard et al (2011) confirms that compliance of HCWs with HH improved considerably with the implementation of interventions involving alcohol based solutions in healthcare facilities.

The intent of this study is to compare the effects of using an alcohol based sanitizer rather than traditional soap and water for HH procedures. Intervention trials confirm that mortality and morbidity rates were highly reduced when hospital workers used an antiseptic based solution rather than traditional soap and water for cleaning their hands (Eveillard et al., 2011). Hand washing with an alcohol based solution or ABHs as compared to plain soap and water reduces the transmission of health care associated pathogens among personnel, thereby decreasing the rate of HAIs (CDC, 2002).

Evidence-based Research from the Review of Literature Articles

Infections via hands is the most common and easy mode of transfer of acute diarrheal disease (ADD) and acute respiratory infection (ARI) in developing countries (Correa et al., 2012). A study was conducted in Columbia to evaluate the effectiveness of ABHs in reducing infections causing ADD and ARI among children between the age of 1-5 years. Participants were given ABH and were monitored. The research confirms that ABH is effective in preventing diseases and infections such as ADD and ARI (Correa et al., 2012).

In a research based study of a university hospital in Thailand, Picheansathian et al. (2008) conducted a program to identify its impact on HH practices and rates of nosocomial infection is the NICU of the hospital. The intervention was implemented and participants were evaluated before and after the program. The researchers found that compliance of HH guidelines and procedures among HCWs increased by 6.1% after the program.

Significance to Clinical Practice

The number of patients dying due to HAIs is a whopping 90,000 of which 15% to 30% are caused due to poor HH (Alemagno et al., 2010). HH is a fundamental aspect of patient safety and one of the most cost effective ways of reducing HAIs (Alemagno et al., 2010). The WHO and CDC (2002) have emphasized the importance of HH in reducing HAIs and have laid down several guidelines for appropriate compliance (Alemagno et al., 2010).

Although prevention of pathogens can be effectively prevented by following HH protocols, adherence to HH is poor (Alemagno et al., 2010). Failure to comply with HH measures carries a high risk of infection to patients. Once the hands of a HCW are infected, the chain of infection puts potential patients at risk of infection (CWC, 2002). This chain of infection can be easily controlled by following effective HH procedures such as washing hands with ABH or disinfectants (CWC, 2002).

The primary objective of this research plan is to identify and highlight the importance of HH in clinical settings by emphasizing the effectiveness ABH solutions as compared to the traditional use of soap and water. By undertaking this project the researcher aims to improve HH compliance which will directly reduce the rate of HAIs and effectively help in reducing morbidity and mortality due to HAIs.

By promoting the importance of HH practice among HCWs, the researcher aims to enhance patient safety, which is a crucial aspect of healthcare. Finally, the researcher aims to contribute to the domain of healthcare by implementing a suitable HH plan which can be applied in multiple medical and healthcare setting for improved patient safety.

Rationale for Selecting the Proposed Solution

The CDC comprehensively provides guidelines and measure for the prevention of HAIs through effective HH procedures and techniques (CDC, 2002). Implementation of the proposed solution will have a critical impact in reinforcing the importance of HH among HCWs and improving patient safety.

Target Population

The target population includes all HCWs in different departments including but not limited to nurses, physicians, trainers, program coordinator, hospital staff and healthcare workers.

Benefits of the Proposed Solution

Implementation of the proposed solution will effectively improve HH compliance among HCWs and help in reducing HAIs in the healthcare setting (CDC, 2002).

Justification of the Cost and Budget

The cost is calculated on the continuous supply of ABH instead of soap and water in all departments, near wash basins and hospital sinks. HAIs can be effectively controlled through increased compliance of HH measures and guidelines (CDC, 2002).

CDC Guidelines and Interventions

The CDC (2002) lays down specific guidelines for the use of ABHs as preferred the preferred mode of HH as compared to traditional soap and water which is used when hands are soiled (CDC, 2002). The CDC (2002) provides research based rationale and studies to reduce HAIs occurring due to noncompliance of HH techniques.

Training and Education

HCWs will be trained and educated about the importance of compliance to HH using ABHs. Education will be imparted using a powerpoint presentation (appendix P), posters (Appendix , C & D) meetings and focus group sessions. HCWs will be mailed links to important data and researches related to HH for prevention of HAIs.

Resources for Implementation Plan

An approval document of the proposed solution from the leaders of various departments will be require. A letter of consent from the nursing director (Appendix A) will be needed. Education posters demonstrating HH time, place and method (Appendix C & D) of HH technique will be made along with ABH bottles and refill containers which will be placed in all hand wash areas. An observation tool (appendix B) will help evaluate the results of the implementation. Personal ABH bottles will be provided to professionals.

Evaluation and Feedback

The implementation will be evaluated on the feedback by all involved HCWs. A direct observation before-after study (Appendix B) will be conducted to test HH compliance using ABHs for the baseline and post-intervention stages with two phases. The difference will be used to calculate the rate of difference between HH compliance before and after the intervention.

References

Alemagno, S., Guten, S., Warthman, S., Young, E., & Mackay, D. (2010). Online Learning to Improve Hand Hygiene Knowledge and Compliance Among HealthCare Workers. Journal Of Continuing Education In Nursing, 41(10), 463-471.

Caglar, S., Yildiz, S., & Savaser, S. (2010). Observation results of handwashing by health-care workers in a neonatal intensive care unit. International Journal Of Nursing Practice, 16(2), 132-137.

Centers for Disease Control and Prevention (CDC) (2002). Guideline for Hand Hygiene in Health-Care Settings. Web.

Correa, J. C., Pinto, D., Salas, L. A., Camacho, J. C., Rondon, M., & Quintero, J. (2012). A cluster-randomized controlled trial of handrubs for prevention of infectious diseases among children in Colombia. Revista Panamericana De Salud Publica, 31(6), 476-484.

De Wandel, D., Maes, L., Labeau, S., Vereecken, C., & Blot, S. (2010). Behavioral determinants of hand hygiene compliance in intensive care units. American Journal Of Critical Care, 19(3), 230-239.

Eveillard, M., Raymond, F., Guilloteau, V., Pradelle, M., Kempf, M., Zilli-Dewaele, M., & Brunel, P. (2011). Impact of a multi-faceted training intervention on the improvement of hand hygiene and gloving practices in four healthcare settings including nursing homes, acute-care geriatric wards and physical rehabilitation units. Journal Of Clinical Nursing, 20(19/20), 2744-2751.

Kelcíkova, S., Skodova, Z., & Straka, S. (2012). Effectiveness of Hand Hygiene Education in a Basic Nursing School Curricula. Public Health Nursing, 29(2), 152-159.

Lam, B., Lee, J., & Lau, Y. (2004). Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection. Pediatrics, 114(5), 565-71.

Picheansathian, W., Pearson, A., & Suchaxaya, P. (2008). The effectiveness of a promotion programme on hand hygiene compliance and nosocomial infections in a neonatal intensive care unit. International Journal Of Nursing Practice, 14(4), 315-321.

Tarricone, R., Torbica, A., Franzetti, F., & Rosenthal, V. (2010). Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy. Cost Effectiveness & Resource Allocation, 8.

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