Hand Hygiene Management - Term Paper Example

Hand hygiene Name Institution Course Lecturer Date Hand hygiene has been identified as the most effective method to reducing the transmission of healthcare associated infections or HAIs (Allegranzi & Pittet, 2009). Notably, extensive research has linked HAIs with severe complications and adverse patient outcomes, as well as high cost burdens, in the healthcare industry. Accordingly, since the hands of healthcare worker routinely served as transmission vectors for antimicrobial resistance pathogens, infection preventionists have recommended and enforced adherence to hand hygiene practices, which include thorough hand washing using water and soap for approximately 15 seconds, or the application of 3 to 5ml alcohol-based antiseptic solutions. However, in spite ofthe evidence on the benefits, compliance and adherence with hand hygiene practices and guidelines among healthcare workers in all healthcare settings is still low. As a result, the rate and outbreaks of HAIs continues to increase, further jeopardizing the health outcomes of patients especially those who an immune-compromised. This paper outlines the implementation of evidence based practice aimed at improving hand hygiene compliance amonghealthcare. Specifically, this paper will focus on the use of alcohol based hand rubs in the healthcare setting and its effect on reducing the spread of HAIs and improve hand hygiene compliance. Alcohol Hand Rubs and Their Role in Hand Hygiene Compliance Extensive research has shown that Alcohol based hand rubs (ABHRs) to sanitize hands are better than the traditional hand washing using water and soap (World Health Organisation, 2009).While soap and water are effective HH practices when the health care workers (HCW, henceforth) hands are visibly soiled, alcohol based hand rubs have been marked as the gold standard for sanitizing hands that are not visibly dirty. Miller, Borys & Morgan, (2009), state that alcohol based hand rubs (ABHRs, henceforth) often require less time to use; are readily available and easy to use; are less irritating;are fast acting; evaporate rapidly; contain rapid bactericidal action; act against clinically critical pathogens such as yeasts, viruses, and fungi; and enable improved HH compliance. In a systematic analysis of the efficiency of alcohol-based hand sanitizers Gordin et al. (2005) found that the overall adherence to hand hygiene guidelines appeared to be improving since the introduction of these products. According to the review, while hand hygiene encompassing alcohol hand sanitizers is increasing, comparatively few studies to date show a decline in the generalprevalence of HAIs as an outcome. On the other hand, another experimental trial examining the use of ABHRs in a hospital setting established that if HCWs were adequately persuaded to use ABHRs, then prevalence of HAIs will decrease considerably, particularly if this is integrated in a multidimensional approach to HAI decline. Accordingly it is upon this background that this implementation of an evidence based approach to changing the hand hygiene practices in a hospital setting. This implementation will seek to change HH practices from mainly soap and water to alcohol based hand rubs and in the process increase compliance with the hospital’s HH guidelines. Implementation of practice change Change is a vital element in the continuous quality improvement of any healthcare facility or organization. Accordingly, any improvement approach should encompass strategies for introducing change as well as measuring its impact on the organization as a whole. To this effect, this evidence based practice change will be based on Kurt Lewin’s Change Management Theory which provides strategic methodology that enables nursesto plan, implement, and evaluate the suggested change. Lewin’s Theoretical framework The Lewin model of change outlines a structured methodology that can assist nurses to identify and determine the need for change, traverse through the process of change, and accomplish a specifiedobjective or outcome. Lewin’s approach is useful in the health care settings since it allows organizations to strategically plan and implement changes in the attempt to satisfy evolving health care needs. Additionally, Lewin’s Force Field Analysis Model, also enables nurses to effectively analyze the change implementation process and identifyorganizational forces that either support or resist the changecategorized as driving forces and restraining forces, respectively (Payne, 2013). Kaminski (2011) defined the driving forces as those factors that initiate change and enable organizations to achieve their projected goals (Kaminski, 2011). On the other hand, restraining forces, are static factors that frustrateor oppose the driving forces and subsequently inhibit the change from taking place (Payne, 2013). Notably, where both the driving forces and restraining forces are equal, then an equilibrium state is attained. Consequently, for change to occur, this equilibrium state must be upset, which may occur either when the diving force exceeds the restraining force or vice versa (Kaminski, 2011). According to Lewin, organizational change comprised of three main stages (Kaminski, 2011). The first stage is Unfreezing, whereby individuals are able to recognize the need for practice change and subsequently prepare for the change to take place. This stagenormallyeduces and stimulates changes in the behaviors of individuals affected by the change. Consequently, this stage may record widespread feelings of apprehension, discomfort, and distress among the targeted individuals. As such, in order to advance to the next stage of the change process, infection preventionists must identify and sufficiently address these feelings and behaviors, alongside other resistive forces. Furthermore, the infection preventionists should conduct an analysis of the change driving forces to establish whether they are stronger than the change restraining forces. Notably, educating involved individualsconcerning the motives for change will boost the strength of the change driving forces and hence facilitate the progression from the first to the second phase of Lewin’s model (Kaminski, 2011). The second stage in the change process is moving where change management strategies are organized and aimed at strengthening the change driving forces, or abatingthe restraining forces encountered within the organization. At this point, the infection preventionist implements initiatives geared towards encouragingand motivating employees and stakeholders that the envisioned state will result in positive organizational transformation. Notably, when key stakeholders and employees are able to understand and acknowledge these benefits, they are able to strongly support the suggested change and actively participate in the various activities that will propel the change forward and ultimately ensure that the change transpires. The third, and final, phase of Lewin’s change process is refreezing, whereby, at this stage, equilibrium has been attained successfully. Consequently, change is integrated into the routine practices and procedures within the healthcare organization. However, the infection preventions must ensure that individuals do not regress to their previous pre-change state. As such, it is critical to constantlyreevaluate and monitors the establishedchange. This may be accomplished through supportive mechanisms such as rewards sytems, policies, education sessions, and champion leadership (Kaminski, 2011). Barriers to Effective Hand Hygiene compliance According to Grayson et al. (2011), poor compliance with hand hygiene policies and guidelines among healthcare staff has been propagated by extensive system failures within healthcare facilities (Grayson , et al., 2011). Further, numerous observational studies have demonstrated that that noncompliance with hand hygiene (HH, henceforth), is multidimensional (Erasmus, et al., 2009), and contravening these barriers is vital for a successful implementation of a HH program (Bimbach, et al., 2010). The most commonly reported barriers include: Skin irritation and dryness , mainly caused by hand washing with soap and water Lack of institutional commitment Inconvenient location and insufficient numbers of sinks Time constraints, especially when hand washing due to high workload and understaffing The misconception that patient needs take precedence over HH practices and that HH leads to interruption of care The notion that use of gloves dispenses the need for extra HH Frequent lack of supplies (e.g., soap, paper towels) Forgetfulness Lack of guidance, social norms and positive role models Lack of effective educational programs on guidelines, techniques and protocol for HH High workload and understaffing Inability to recognize the risk of cross-transmission of microbial pathogens Lack of scientific information demonstrating the definitive impact of improved HH on hospital infection rates There is effective approach to facilitation of effective hand hygiene compliance. To address a problem, all the partied must recognize the issue as a problem and acknowledge their personal responsibilities (Marra, et al, 2010). As identified in Mah, Tam & Deshpande (2008), there must also be finite measurements and definition of the level of approach performance. That way, they become part of the problem and meetings, communication and promoted reporting effectively helps to identify the difficulties that are faced in an attempt to change. According to Anderson, et al (2008), in various instances, education, consultation and resources provision are identified by most staffs after which improvements can be promoted. The management can focus to unresponsive health providers through co-option and particularly by assigning them a role like weekly reporting and progressive evaluation with another more committed member. Where a number of members are highly uncooperative, implicit and explicit coercion then can be applied where sanctions are applied accordingly. Relevant implementation strategies to promote/influence uptake of evidence According to Allegranzi, et al. (2010) study in Mali, hand hygiene implementation took 6 months from November to April. It was launched in an official ceremony attended by Minister of Health and WHO representative and hospital director. The launch of an event impacts the members in an organization to follow the requirements enthusiastically. There is therefore need for kick-off event that will create such enthusiasm for use of alcohol antiseptic with prominent personalities attending and addressing the facility. The persons might be a director from another facility that has been highly rated in application of such method. In Mali event, posters that featured WHO project, indications of hand hygiene, hand washing and rubbing techniques were displayed in various wards. As Van Achterberg, Schoonhoven & Grol (2008) points out that, the facility can make use of such materials to ensure that the approach is observable and easily recalled when needed as well as to cater for those who do not attend the event or new comers in the facility. In January 2008, hospitalists from participating wards were offered a 3-hour education and learning sessions. The approach accompanied slide show learning, a training film and baseline data was presented. The staffs were given leaflets and brochures which were developed by WHO. The content of education and vital messages were hand rubbing which was set as a “gold standard” of hand hygiene. There was also “My 5 Moments for applying Hand Hygiene” concept. To effectively implement the hand hygiene with alcohol antiseptics, the message has to lay emphasis on the desirable activity and events in which it should be applied. The identified concepts also impact on the physical facilities that might be added depending on where each moment of hand wash will be required. WHO knowledge questionnaire were administered to the participating staffs immediately and before each session. It is advisable to develop such questionnaires as they will allow the staffs to identify what they already know or applying and the deficiencies for improvement. Participating staff were provided with 100 ml pocket bottle with alcohol-based hand rub then trained to use. Alcohol-based hand rub were regularly distributed in the study wards. Subsequently, the staffs would clean, recycle and refill as WHO recommended. When members are going to be engaged in such activities, it will avoid the use of haphazard approach since WHO parameters will be used. It is also possible to see a common application among all staff as they all act from similar point of view and approach. Plan for evaluating outcomes; process and outcomes, pre-testing & post-testing Baseline evaluation should proceed. Survey and questionnaires will be carried to assess self-report perceptions of hand hygiene impact. Its effectiveness, importance given by the institution, personal intention to comply and effectiveness of different strategies will be assessed at this point (Allegranzi, et al, 2010). Unobtrusive observation will be carried to see the number and how correct staffs carry out hand washing and rubbing activities. Infrastructure survey is needed to assess sink-to-room or sink-to-bed ration, availability of clean water, alcohol-based hand rub, disposal towels at points of care (Gould, Moralejo, Drey & Chudleigh, 2010). Follow-up evaluation can be repeated with the above baseline survey that was carried as pre-test in the above activities. It is possible to make comparison with the initial and current responses. That way, it is possible to assess whether predefined opportunities are met (Gould, et al, 2008). There are two other main methods which will be used to measure hand hygiene performance. Direct observing and measuring product use by watching then recording health care workers behavior as well as guidelines adherence will be done. This is easily observed by the amount of alcohol-based hand rub used and paper towels which can be covered by video camera in intensive care units and pre-natal units (Zhang, et al, 2009). References Allegranzi, B., & Pittet, D. (2009). Role of hand hygiene in healthcare-associated infection prevention. Journal of Hospital Infection, 73(4) , 305-15. Allegranzi, B., et al. (2010). Successful implementation of the World Health Organization hand hygiene improvement strategy in a referral hospital in Mali, Africa. Infection Control and Hospital Epidemiology, 31(2), 133-141. Anderson, D. J., et al. (2008). Strategies to prevent surgical site infections in acute care hospitals. Strategies, 29(S1), S51-S61. Bimbach, D., Nevo, I., Scheinman, S., Fitzpatrick, M., Shekhter, I., & Lombard, J. (2010). Patient safety begins with proper planning: a quantitative method to improve hospital design. Quality and Safety in Health Care, 19 , 462-465. Erasmus, V., Brouwer, W., Van Beek, E., Oenema, A., Daha, T., Richardus, J., et al. (2009). A qualitative exploration of reasons for poor hand hygiene among hospital workers: lack of positive role models and of convincing evidence that hand hygiene prevents cross-infection. Infection Control And Hospital Epidemiology: The Official Journal Of The Society Of Hospital Epidemiologists Of America, 30(5) , 415-9. Gould, D. J., et al. (2008). Interventions to improve hand hygiene compliance in patient care. Journal of hospital infection, 68(3), 193-202. Gould, D. J., Moralejo, D., Drey, N., & Chudleigh, J. H. (2010). Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev, 9. Grayson , M., Russo, P., Cruickshank, M., Bear, J., Gee, C., Hughes, C., et al. (2011). Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative. Medical Journal of Australia, 195(10) , 615-619. Kaminski, J. (2011). Theory applied to informatics – Lewin’s change theory. CJNI: Canadian Journal of Nursing Informatics, 6(1) , 1-4. Mah, M. W., Tam, Y. C., & Deshpande, S. (2008). Social marketing analysis of 2 years of hand hygiene promotion. Infection control and hospital epidemiology, 29(3), 262-270. Marra, A. R., et al. (2010). Positive deviance: a new strategy for improving hand hygiene compliance. Infection control and hospital epidemiology, 31(1), 12-20. Payne, S. (2013). The Implementation of Electronic Clinical Documentation Using Lewin’s Change Management Theory. Canadian Journal of Nursing Informatics, 8(3) . Van Achterberg, T., Schoonhoven, L., & Grol, R. (2008). Nursing Implementation Science: How Evidence‐Based Nursing Requires Evidence‐Based Implementation. Journal of Nursing Scholarship, 40(4), 302-310. World Health Organisation. (2009). WHO Guidelines on Hand Hygiene in Health Care. In World Alliance for Patient Safety, First Global Patient Safety Challenge Clean Care is Safer Care. 1 ed. Geneva: World Health Organisation Press. Zhang, L., et al. (2009). Hand Hygiene Management by Video Monitoring in Neonatal Intensive Care Unit [J].Chinese Journal of Nosocomiology, 10, 032. Read More