Clinical Governance and Hand Hygiene Audit in Nursing

Introduction to Clinical Audit and Clinical Governance

This paper demonstrates an understanding of the procedure of clinical audit (CA). The focus of this CA is the high-risk area of patient safety, and with regard to how this is linked to patient safety, hand hygiene has been selected. The findings and recommendations that follow, combined with the CA tool and the selection criteria, are outlined in the form of a clinical audit. For the purposes of improving clinical practice, CAs form an integral aspect of clinical governance. It is notable that CAs encapsulate practice which, through analysis, can result in quality enhancement — particularly for patients.

Various definitions of the term exist, which are invariably similar and tend towards verbosity, but a concise and precise definition is provided by Coffey (2009), who states that a CA is a systematic evaluation of clinical processes through careful interpretation and fact-finding. A methodological process commonly known as a CA cycle, or stages, should be adhered to when implementing or considering a CA (Ashmore & Ruthven, 2008).

The five major aspects that should be considered include: selection, preparation, gathering data, analysis, subsequent recommendations, and continued changes for improvement. Preparation is necessary for clinical relevance and decision-making on the matter under consideration. This is followed by selecting the standards and criteria through which measurable results are categorized. By employing relevant tools, data gathering is accomplished, and interpretation of the data is achieved through analysis by comparing the chosen standard or criteria. Based on these findings, recommendations are then developed (Ashmore & Ruthven, 2008).

Rather than a prospective audit, a retroactive audit is preferred because this eliminates the likelihood of subjects changing their conduct or practice during the audit process (Ashmore & Ruthven, 2008). Lack of time is an acknowledged impediment to auditing despite its recognized advantages. However, it is noteworthy that the importance of CA in enabling best practice cannot be overstated. The strength of conducting CAs is based on consistent discussion of identified issues and the implementation of strategies that can lead to improvement. It is also important to note that a CA might produce evidence that standards are being complied with, and in such cases staff and participants should receive commendation.

Background: Hand Hygiene and Healthcare-Associated Infections

Nursing and evidence-based practice currently place strong emphasis on a clinical governance agenda geared towards quality improvement (Iggulden, Macdonald & Staniland, 2009). In order to ensure NHS organizations are held responsible for improving clinical practice, adhering to standards, and implementing safety systems as safeguards for practice, clinical governance should be deployed as a comprehensive system.

The prevalence of healthcare-associated infections (HCAIs) can be reduced through proper hand hygiene decontamination, yet HCAI incidences continue to rise, creating barriers for healthcare workers seeking to reduce such infections. Earlier research indicated that compliance with hand hygiene standards among healthcare workers (HCWs) is widely sub-standard, and any improvement in compliance is difficult to sustain (Bennett et al., 2012).

Objectives, Aims, and Standards

This paper examines hygiene practice and handwashing from a behavioral perspective in a study of healthcare workers. To achieve this objective, an observational audit tool was used. The hand hygiene policy was compared against relevant documentation (Pontivivo et al., 2012) as a procedural requirement for clinical practice. A 100% compliance rate was selected as the criterion, with no exceptions. The paper also defines clinical governance and traces its emergence as a way of discussing current best practice, and evaluates what this means for executives and boards of directors intending to implement clinical governance in the health services they provide (Braithwaite & Travaglia, 2008).

The paper also examines whether proper hand hygiene can prevent or reduce healthcare-associated infections. Existing results indicate that advertised auditing is associated with improvements in general hand hygiene compliance rates, including within subgroups before and after patient contact, and that this approach appears acceptable to healthcare workers (Hui et al., 2014).

Methodology

This retroactive audit was conducted in a 30-bed pediatric ward, examining the completion rate of audit forms across 50 instances. The audit was carried out over a timespan of 90 minutes. The audit tool examined different aspects, such as whether gloves were used, whether charts indicated the correct moment of hand hygiene, and whether the tool was straightforward to complete. As a result, no recommendations for changes to the tool itself were required.

Results

The mandatory compliance rate (CR) of 100% was not achieved; the criteria were met by only 88% of instances. Moment 1 achieved a CR of 87%, while Moment 5 achieved only 60%. The overall average CR was 89.14%.

Central issues identified in the literature as responsible for effective clinical governance included: the application of clinical governance to improve safety and quality through continuous improvement and quality assurance; ensuring links are made between corporate and clinical governance and clinical services; the implementation of strategies for proper data exchange, expertise, and skills; the development of clinical governance structures as a means of improving quality and safety; and the promotion of patient-centered service delivery.

Specific barriers perceived to affect hand hygiene compliance included clinical procedures, time and business pressures, lack of knowledge, glove use, and skin conditions. Notably, participants believed that healthcare workers were the primary influencing factor in hand hygiene compliance, stemming from the perception that those working in clinical areas should model the behavior expected of all staff (Braithwaite & Travaglia, 2008).

Conclusion

The result and outcome of this clinical audit outlined various aspects that need both improvement and further education. It also enabled and instigated important staff debates. This led to the implementation of various strategies aimed at improving the compliance rate, which it is hoped will have a positive impact on patient safety. An unexpected but highly welcomed result was the increased staff synergy and unity brought about by the implementation of this CA.

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