Discovery
The Topic and the Nursing Practice Issue Related to the Topic
Topic: Improving hand hygiene compliance in patient care.
Nurses’ personal knowledge and institutional support on hand hygiene and how they can formulate effective strategies to enhance compliance to the given recommendations that are aimed at lowering infections associated with hand hygiene.
The Rationale for the Topic Selection
Generally, hand hygiene is a major concern in the healthcare setting. Improving the compliance of practitioners towards practicing and maintaining proper decontamination is essential for both the patients and clinicians. Several infectious diseases are easily transmitted through body contact. Failure to have an effective system that promotes effective hand hygiene in hospitals is likely to increase the chances of increasing infections. The focus of the study is to evaluate whether effective compliance and adherence to hand hygiene have a positive impact on lowering healthcare-associated infections among patients and healthcare workers. The analysis will explore the role of practitioners in influencing hand hygiene compliance in the hospital setting.
Summary
The Practice Problem and PICOT Question
Currently, the number of cases involving healthcare-associated infections has increased, thus endangering the safety of patients and clinicians. Practitioners are ever committed, and sometimes, they forget to wash their hands effectively despite handling different patients suffering from varied illnesses. Improper compliance with hand hygiene is a threat that requires proper strategies to enhance the amenability of nurses and other stakeholders in the healthcare setting to wash their hands.
PICOT Question
In patient care settings (P), does improving hand hygiene compliance (I), compared to non-compliance (C), reduce rates of healthcare-associated infections in hospitals (O) over a given period of time (T)?
The Systematic Review
Wang, C., Jiang, W., Yang, K., Yu, D., Newn, J., Sarsenbayeva, Z., Goncalves, J., & Kostakos, V. (2021). Electronic Monitoring Systems for Hand Hygiene: Systematic Review of Technology. Journal of Medical Internet Research, 23(11). Web.
List and briefly describe other sources used for data and information. List any other optional scholarly source used as a supplement to the systematic review in APA format.
Hillier, M. D. (2020). Using effective hand hygiene practice to prevent and control infection. Nurse Stand, 35(5), 45-50. Web.
According to Hillier (2020), one of the most crucial and efficient ways to lower healthcare-associated illnesses and patient cross-infection is through hand hygiene cleaning. The article explains the proper steps for doing good hand hygiene and highlights the necessity for nurses to stay current with evidence-based recommendations. In addition, it describes the variations between hand decontamination using soap and water and alcohol-based hand gels, as well as the complicated variables that can obstruct good hand hygiene compliance.
Roshan, R., Feroz, A. S., Rafique, Z., & Virani, N. (2020). Rigorous hand hygiene practices among health care workers reduce hospital-associated infections during the COVID-19 pandemic. Journal of Primary Care & Community Health, 11. Web.
The purpose of this article is to better understand how HCWs’ strict hand hygiene practices during the COVID-19 epidemic affected the number of HAIs. Given the magnitude of the outbreak, it was discovered that HCWs now place a higher priority on hand cleanliness. The authors noticed a 4-fold rise in hand sanitizer use following the COVID-19 epidemic. Improved hand hygiene practices were a result of the growing use of hand sanitizers. Following the COVID-19 outbreak, there was a decline in the number of HAIs, and the authors believe this decline is due to recent improvements in hand hygiene habits. These results show that hand hygiene compliance by HCWs alone can help lower HAIs in a hospital context in the wake of the COVID-19 epidemic.
Gould, D. J., Moralejo, D., Drey, N., Chudleigh, J. H. & Taljaard, M. (2018). Interventions to improve hand hygiene compliance in patient care: Reflections on three systematic reviews for the Cochrane Collaboration 2007-2017. Journal of Infection Prevention, 19(3), pp. 108-113. Web.
This paper provides key findings from a regularly revamped systematic Cochrane review to increase hand hygiene compliance in patient care. It is an improvement over two former evaluations conducted on the same subject since it presents a very thorough synthesis of the data for the first time that such interventions can enhance practice. The authors present key findings from a recently updated Cochrane systematic review in this publication. The article points out crucial components of hand hygiene intervention trials that were outside the purview of the review and outlines shortcomings in the information that was reported.
The Main Findings from the Systematic Review and the Strength of the Evidence
In settings where healthcare is provided, maintaining good hand hygiene is crucial to preventing the spread of nosocomial pathogens and community-acquired infections. Florence Nightingale expressed an early understanding of the value of this straightforward practice when she recommended that nurses wash their hands regularly throughout the day in a letter from 1860. Hand hygiene is an essential intervention that can be utilized to stop the transmission of disease, as the COVID-19 pandemic has shown. The criterion for assessing hand hygiene compliance in healthcare settings is a direct observation by professional auditors. Monitoring hand hygiene compliance also frequently involves self-reporting by HCWs and measuring product usage. On the other hand, electronic hand hygiene monitoring systems are faced with many limitations, such as reliability, data integration, privacy and confidentiality, usefulness, associated expenses, and infrastructure upgrades.
Evidence-Based Solutions for the Trial Project
The first evidence-based solution I will consider for the trial project is camera-assisted observation as a compliance monitoring system. This will require camera installation on both the inside and outside of the patient rooms to capture all the five hand hygiene moments as recommended by the WHO. The captured and streamed videos can be manually coded by researchers. The management can also hire a remote video auditing company to perform compliance observations. In addition, fixing a camera on the chest of HCWs that is directed at their hands rather than placing cameras around the workplace can also work.
The second solution I would suggest is increasing the availability of ABHR in healthcare facilities. When one’s hands are not obviously dirty, the ABHR is preferable since it is more successful at reducing the amount of the most transient germs than washing your hands with soap and water.
Translation
Care Standards, Practice Guidelines, or Protocols to Support the Intervention Planning
The main practice guidelines that can be put in place to support the first intervention is erecting cameras outside and inside the patients’ rooms to capture all five hand hygiene moments as recommended. The management will have to employ the technical team to manually code the streamed videos or hire a remote video auditing company to perform compliance observations.
On the other hand, in order to accomplish the second intervention, the organization must allocate a budget for an additional supply of the ABHR. The organization must then make sure that these reagents are available at the HCWs’ disposal for use.
Stakeholders and Their Roles and Responsibilities in the Change Process
Nurses– guide patient care by advising methods and practices to enhance patient outcomes.
Pharmaceutical firms– supplying the ABHR
Management – responsible for funding the installation of the cameras and employing the team to code the streaming videos.
Patients– Work together with all healthcare professionals by sharing pertinent medical data that can be utilized to make decisions at the point of treatment.
The Nursing Role in the Change Process
In the facility, I am responsible for administering medication to patients. Other roles include acting as front-line communication managers to oversee the care planning for all intensive care unit (ICU) patients with caregivers and other healthcare professionals. In addition, practitioners maintain the health records of sick individuals, keep close monitoring of patients’ progress, including changes in their signs, and provide emotional support to enable the individuals and their families to have hope.
Stakeholders by Position Titles
Lead care nurses – should administer and coordinate care in accordance with the suggested specific provisions and standards with families and other healthcare professionals.
Lead care doctors – should make sure that all decisions regarding the treatment or prevention of patients adhere to the established policies and procedures.
Managing Director – Should ensure the provision of the funds necessary for the project and oversee the management of the project.
The chosen members are vital because they will facilitate effective hand hygiene compliance by reminding other practitioners to adhere to the approach in place. Furthermore, being the leaders, it will be easier to initiate change from the top and other staff members to follow.
Type of Cost Analysis Needed Prior to a Trial
The type of cost analysis that would be needed before a trial is Cost Effectiveness Analysis (CEA). Cost-effectiveness analysis is used to evaluate the costs and health effects of one or more interventions. By evaluating how much it costs to obtain a unit of treatment outcomes, like a life year gained or mortality prevented, it contrasts one intervention to another intervention (or the status quo). CEA provides an opportunity to compare the health and financial effects of several interventions on the same health outcome. It is beneficial to know how much a certain intervention might cost in comparison to an alternative intervention (per unit of health gained). A person in charge would find it helpful to know, for instance, whether an intervention is cost-saving and, if not, how much extra it would cost to adopt it than a less effective intervention.
Implementation
The Process for Gaining Permission to Plan and Begin a Trial
Both the head of critical care nursing and the director of critical care medicine will send a letter to the hospital’s administration requesting approval to carry out the trial. This should cover the identified clinical issue, how it affects patients, employees, and the organization, as well as why change is necessary. Included should be a thorough explanation of the suggested intervention strategies to be used in the change process, as well as the anticipated results.
The Plan for Educating the Staff About the Change Process Trial
The staff training session will last for one week, and all the staff members who are involved in the change process in one way or another will receive education on the change. Staff will be called upon to engage by signing up for training, suggesting alternative ideas, and coming up with intervention methods. Additionally, the staff’s input will be taken and later applied to enhance other facets of practice.
The Implementation Timeline for the Change Process
21-11-2022 to 27-11-2022 Education of the staff members and healthcare providers involved about the procedures of hand hygiene and its benefits.
28- 11-2022 to 4-12-2022- Installation of the cameras inside and outside the patient rooms.
5-12-2022 to 11-12-2022- Developing guidelines and protocols to decode the transmitted videos and procedures on the judgment of the HCW’s performance.
12-12-2022 to 18-12-2022- Evaluating outcomes in improving compliance to recommendations for hand hygiene and reduction in rates of healthcare-associated infection.
The Measurable Outcomes Based on the PICOT
Changes in the number of patients who have suffered from healthcare-associated infection. This can be measured using the incident report for the related cases. Furthermore, the outcome will be determined based on the necessary medication to treat such diseases.
Researchers will examine the first-person view video recordings in light of the WHO’s five key hand hygiene moments.
Forms for Recording Purposes During the Pilot Change Process
During the pilot changes, electronic record management (ERM) will be used. As a result, recording and managing activities will be easier and quicker.
Resources Available to Staff During the Change Pilot
The resources that are available for the staff, including me, during the research include cameras and equipment for handwashing, such as water and soap, and ABHRs.
Meetings of Stakeholders Throughout the Trial
In order to evaluate the experiment’s progress through feedback, the critical care nurses, doctors, and a member of the hospital’s administration will meet daily throughout the trial time. The goal of the conference will be to present daily updates that will be used to weigh the trial’s advantages and disadvantages for patients, medical professionals, and the organization. On the basis of this data, choices will be made regarding whether or not to continue the experiment and make other necessary adjustments.
Evaluation
Reporting the Outcomes of the Trial
The research committee will produce a thorough report outlining the results and conclusions, which will subsequently be printed in a peer-reviewed publication.
What would be the next steps for the use of the change process information?
The quality improvement committee of the organization will use this data to implement the suggested change internally, improving health outcomes for patients, such as reducing rates of care-associated infections and improving HCWs’ satisfaction.