Hand hygiene policy implementation to reduce healthcare-associated infections

¶ … Hygiene Proposal

World Health Organization, (2007) estimates that more than 1.4 million people suffer form one disease to the other and HAI (Health care-associated infections) are the most important infections that occurs globally. In advanced countries, between 5% and 10% of patients acquire one or more infections within the hospitals environment while between 15 and 40% of patients-to-critical-care are estimated to be affected. In the United States, one out 136 patients acquire one or more infection in hospital, equivalent to 2 million cases yearly. In the UK, HAI causes 5000 attributable deaths yearly. There is substantial evidence that hand hygiene reduces the incidence of HAI and hand hygiene is the fundamental action that enhances patient safety. Despite the importance of hand hygiene, there is still an unacceptable low compliance with the hand hygiene policy within the universal healthcare system. (World Health Organization, 2007).

Fundamental objective of this project is to develop the implementation plan to carry out the hand hygiene policy within the hospital setting to reduce the incidence of health care-associated infections.

Implementation Plan

This study develops an implementation plan that would be used to carry out the hand hygiene policy. The study population is healthcare workers and patients. To enhance effective implementation of the proposal, there is a need to secure a necessary approval and secure support for the proposal.

1:Approval and Secure Support for Proposal

Effective method to secure approval and support for the proposal is to raise awareness of key stakeholders within the healthcare setting. Key stakeholders include senior management, and healthcare practitioners. These are the target population that the proposal will focus. The support of top management is critical because they will need to approve the financial resources that would be used to carry out the implementation plan. The proposal will raise awareness of top management about the importance of hand hygiene within the healthcare setting and how hand hygiene policy could lead to the reduction of HCAI (Health care-associated infection), which will consequently lead to healthcare organizational effectiveness. (World Health Organization, 2009). The proposal will also raise awareness of healthcare providers about the importance of hand hygiene because they are the key personnel within the hospital to carry out the implementation plan. Through lobbying and education of healthcare providers and top management about the importance of the proposal, the researcher will get the approval and support for the project.

3: Detailed Explanation of Proposed Solution

As being discussed previously, the proposed solution is hand hygiene policy. Hand hygiene concept refers to the removal and killing of transient microorganisms from hands as well as maintaining the good skin integrity due to a hand care program. Microorganisms carried by human on the skin are divided into resident and transient bacteria. Transient bacteria are spread during direct contact with patients, clients and residents. On the other hand, resident bacteria are found in deeper layers of skin and these are more resistant to removal. Hand hygiene is the effective method of killing and removing bacteria from hand through:

hand sanitizing that consists of 70 to 90% ABHR (alcohol-based hand rub) is the preferred method.

hand washing with running water and soap must also be performed.

While hand hygiene improvement is not a new concept within the healthcare environment, lack of compliance to the system is a major setback to the policy implementation. This proposal will implement the sensitization of healthcare providers towards adherence of new policy. Successful hand hygiene could only be achieved through the implementation of multiple actions to address the behavioral barriers.

The key components that the proposal will implement will include the following:

Education: The proposal will provide health related education to healthcare providers about the importance of conforming to the rules. The policy will educate healthcare providers to adhere to the hand cleaning rules and the approach will encourage workers to clean their hands:

before touching a patient, before cleaning and aseptic procedures, after body fluid exposure and risk, after touching a patient after touching patient surroundings.

System change: This is to ensure that all necessary infrastructures are put in place to assist healthcare providers to effectively practice hand hygiene and the infrastructures include:

Access to a safe continuous water supply,

Access to soap and towels;

readily accessible to alcohol-based hand-rub at the point-of-care

Evaluation and feedback: The proposal will implement monitoring of hand hygiene practices among workers. The proposal will continuously evaluate the perception of workers towards the policy through feedback from workers.

Reminders in the workplace: There would also be a continuous reminding of healthcare providers about the importance of hand hygiene and the appropriate procedures to observe it.

4-5: Rationale for Selecting Proposed Solution/Literature Reviews

Provincial Infectious Diseases Advisory Committee (2010) argues,

"adherence to hand hygiene recommendations are the single most important practice for preventing the transmission of microorganisms in health care and directly contribute to patient safety."(P 15). Hand hygiene is one of the disease prevention initiatives set forth by the "World Alliance for Patient Safety Challenge." (P 15). The World Health Organization also states, "the goal of Clean Care is Safer Care is to ensure that infection control is acknowledged universally as a solid and essential basis towards patient safety and supports the reduction of health care-associated infections and their consequences." (World Health Organization, 2009 P. 15). The global burden Health care associated infection is a major problem within the health care environment, which is the major problem for the safety of patient. The spread of microorganisms has caused massive financial burden to patients and their families. Typically, the overall estimates indicate that the 1.4 million patients are affected by HCAI. The annual economic impact of HCAI in USA was approximately U.S.$6.5 billion in 2004.In Canada, it has been estimated that there are 220,000 incidents of HCAI occur yearly leading to more than 8,000 deaths. (Klavs, et al. 2003, Klevens, 2007).

Dubberke et al. (2011) also argue that the transmission of infection through hand is one of the most common methods of disease transmission within the healthcare setting. Thus, hand hygiene is one of the most effective methods in the prevention of cross infection and cross contamination. The author further argues that alcohol gel or foam is not effective in removing the dirt from the hand. More importantly, alcohol gel or foam is not effective against Clostridium difficile and Norovirus. However, World Health Organization (2008) states that the risk associated with infectious disease that has been transmitted through hand is very high and this has been associated with the problems that include acute respiratory illness as well as gastroenteritis. Hand hygiene remains the principal effective strategy to prevent and control disease.

WHO (2009) suggests that healthcare providers needs to implement hand cleaning procedures such as alcohol-based rubs and hand washing. The principles and components of routine practice for the implementation of hand hygiene needs to be observed to prevent the spread of disease through hand. However, Dubberke et al. (2011) argue the use of soap and water as well as alcohol is recommended to prevent the CDI (Clostridium difficile infection). The author further argues that the use of alcohol is not effective for the removal of C. difficile spores because the alcohol does not kill C. difficile spores. Thus, antimicrobial soap water is an effective method for hand cleaning, which is very effective to remove C. difficile spores

While hand hygiene is considered the most effective method to prevent the spread of disease, compliance with hand hygiene protocols continue to be challenging. The acceptance of hand hygiene protocols by healthcare providers continues to be low. The proposal provides the implementation logistics to enhance the greater understanding of the strategy to initiate changes.

6. Description of implementation logistics

The implementation of multidisciplinary and multifaceted hand hygiene program is critical to enhance the sensitization of people towards changes. The program will include education, motivation and system changes aimed to improve the compliance of healthcare providers towards hand hygiene. The key hand hygiene program will include:

Motivation programs and staff education use of performance indicators

One of the most effective methods that will be used to improve compliance towards hand hygiene is through education of staff to enhance the behavior pattern of healthcare providers. The occupational hand hygiene behavior patterns will assist in altering healthcare providers' attitudes. The education program will be used to correct the inappropriate patient-care practices that could lead to the spread of disease through hand contact. There would be an education for health care providers about the:

importance of hand hygiene;

hand hygiene agents hand hygiene techniques;

Moreover, combination of individual reinforcement technique, enhanced self-participation, and administrative sanction would be used in the combination of educational program.

7: Resources Required for Implementation

The resources required for the proposal will be financial and human resources. Senior staff will be required to disburse fund that would be used for the implementation plan. The financial resources will be used for the promotion of hand cleaning program, which include:

hand-rub poster hand-wash poster

Clean hands poster

Clean environment poster

Clean practices poster

Clean products poster

There is also a need to distribute the education material to staff, which include the handout, PowerPoint presentations and pamphlets. The contents of the education material will be hand hygiene procedure to advise healthcare providers:

To keep their nails short and clean

To clean hands for minimum 15 seconds

Clean wrists and forearms

To ensure hands are dry

To apply lotion to hands frequently

To remove bracelets and rings

To desist from wearing artificial nails

To remove chipped nail polish

A website will be developed to display all information that healthcare providers will need to enhance effective hand hygiene policy. The staff will also be used to evaluate the effectiveness of hand hygiene implementation. The evaluation will include survey, and interview. The percentage rate of the health care-associated infection within the healthcare environment will be used to evaluate changes.