The implementation plan or any change will be directed towards the infection control department, the nursing staff, upper management, and with the nurse manager of the facility. The project will take time involving the nurse manager in the initial steps and planning. A presentation in the form of a verbal presentation with visual aid posters and PowerPoint presentation to leadership and nursing staff. Feedback and opinions from leadership would demonstrate that the plan is on track and valid for the facility.
Feedback from nurses will show their involvement and participation in benefiting the unit and optimal patient outcomes. The support by nursing is important for successful implementation. The current policy at the facility of this implementation holds every healthcare worker accountable for hand hygiene compliance. Their method to deal with noncompliance is accountability or it is reflected in the employee’s performance reviews and could result in escalating disciplinary actions. Periodic direct observations are done on all the units, with all staff members being observed for data.
This writer will implement change with positive reinforcement, refreshing new data and information, and encouragement. Healthcare workers are aware of the correlation between proper hand hygiene and HCAls, but compliance is still suboptimal. At MetroHealth (2015), as part of the Patient Protection and Affordable Care Act, there was a program put into effect this year called the Hospital-Acquired Condition (HAC) Reduction Program. Hospitals that have high HACs will have a 1% reduction in their CMS payment, therefore hospital leaders will find ways to decrease the frequency of HCAIS ecause of the cost to the facility. HCAI still are a leading cause of mortality and morbidity. Nurses make up the largest group in the healthcare system and can make a significant difference in influencing the reduction of HCAl with proper hand hygiene. Researchers have found that many healthcare workers do not follow their facility’s protocols for proper hand hygiene; HCAIS develop in about one in every ten patients in the United States. About 15-30% of HCAls are estimated to be prevented just by using proper hand hygiene technique, Biddle (2009) and Wilson.
Jacob, & Powell (2011). Evidence based interventions will benefit patients, be cost effective, and prevent complications. There are about 722,000 infections annually in the United States per the Center for Disease Control (CDC), 2015, which is for every twenty five patients there is an infection. Hand hygiene is the single most effective way to decrease healthcare acquired infections (HCAIs). Healthcare workers are aware of the correlation between proper hand hygiene and HCAls, but compliance is still suboptimal per the World Health Organization (2015).
Hand sanitizer locations will help compliance as per research that has been done. The decision of where to locate HH sanitizer dispenser will need to consider the accessibility, the workflow of the nurses and the unit, and visibility of the dispensers. “Hand decontamination, by handwashing or the use of alcohol-based hand sanitizers, is a key component in significantly reducing the transmission of infectious disease” per Bloomfield et al. 2007. The emphasis will be placed on further education by providing new data and fresh information.
The opinion of this writer is that the nurses are more compliant and involved when they have facts and encouragement. Gentle reminders to each other, being good role models, and positive reinforcement can go a long way. Nurses are continually involved in lifelong learning, continuing education, and point of care learning. The plans to implement change needs to be well researched and developed prior to the roll out of any new change. Initially the plan would include a hand hygiene champions to assist and be a leader with the creator of the program.
The resource or hand hygiene champion will start by involving and give some indicators of the project prior to the start of any initiative or campaign. During a staff meeting, some initial information will be given as this is an optimal opportunity to have everyone’s attention without distractions. Presenting hand hygiene in a new and refreshing way, in order to engage the staff would be the goal. Nurses with new current information can be excellent teachers and role models for the rest of the hospital staff.
De Bono, Heling, & Borg (2015) reveal that strong leadership encourages the implementation of new practices and strategies, and lowers barriers to infection control policy implementation, which would include hand hygiene. The proposed solution will include reminders and further education with more information on how each person is so important in making a difference in decreasing HCAls. There are so many healthcare workers, technicians, housekeeping staff. dietary staff, and others that come into contact with patients in all units on a daily basis.
Observations of HH practices of the nurses will be done by trained persons prior to the presentation. After the educational presentation and hand sanitizer dispenser locations have been decided, observations will done again to compare to the initial observation studies. Nurse champions on different shifts and units will be designated. The nurses need to be educated about the new recommendations that will be shared with all healthcare workers. A pretest (Appendix A) will be given at the start of meeting to assess the nurse’s knowledge.
A PowerPoint (attached separately) presentation with up to date information, data, and statistics will be presented at a staff meeting detailing the impact proper hand hygiene has on reducing infection. Part of the presentation will include a demonstration that would include HH using a germ simulation powder and UV light. Each person would apply the powder on both hands and under nails and then place under UV light to view the simulated germs. Then hands would be washed and dried with the results displaying each person’s hand hygiene practice. The results will demonstrate how effective and thorough the nurses’ HH practices are.
At the website: handwashingforlife. org, a training sheet scorecard (Appendix B) is offered to grade and view the results on each participant. Nurses perceive the rationale for HH, but the proper technique may not always be carried out. These results would be important to share with management and stakeholders as a basis for the further education. Ideas and feedback from the staff would be encouraged. A web based teaching module on the intranet will be done with the infection disease department and the information system department to ensure that each staff member will complete the module online when their schedules allows.
It will include the PowerPoint, pretest, and posttest to be used by those who cannot attend the presentation. The web based teaching module will become part of the facility’s annual competency testing, thus sustaining the culture of proper HH of the organization. After completion of the project, passing a posttest (same as pretest), and the hand hygiene compliance has increased using observation results, staff will receive a hand hygiene retractable badge holder and a magnet for their locker.
Feedback and suggestions along the way are essential to meet the outcome of the project, by change and further evaluation to remain on point with the original proposal. An additional part of the HH campaign will be to put signs in every in every bathroom and the entrance to patient rooms stressing hand hygiene (Wash before patient contact and after patient contact). The staff will have input by deciding sign and hand sanitizer locations. Posters with the correct method to use hand sanitizers (Appendix C) and proper handwashing (Appendix E) will displayed to be very visible.
Hand sanitizer dispensers will be placed near each patient’s bed in convenient locations, visible and accessible, to be conducive to proper hand hygiene. The location must align with the workflow of each unit to ensure compliance. The nurses would be encouraged to remind each other of hand hygiene practice when noncompliance is observed. Screensavers with hand hygiene information (from the WHO) will be applied by the information system department. Signs, posters, magnets on lockers, and screensavers would all be visual reminders.
With all the articles researched and read for this project, the common theme was that healthcare workers are aware of the importance of proper hand hygiene related to HCAls, but are still noncompliant. Interventions that effect an organization’s culture which can lead to the increased awareness of staff and their motivation to include proper hand hygiene incorporated into everyday practice has shown positive influences on healthcare workers’ hand hygiene compliance per Wilson, Jacob, and Powell, 2011 in their article Behavior-change interventions to improve hand-hygiene practice: a review of alternatives to education.
How better availability of materials improved hand-hygiene compliance, the article by Aziz (2013), showed that an increase in hand hygiene supplies and availability improved hand hygiene compliance. Providing alcohol hand sanitizers improves hand hygiene compliance Qeanes, 2007). Hand sanitizers, which costs approximately $3 per bottle, can prevent HCAl and millions of deaths annually states the WHO (2015). The project will need funding to include the time it takes to create and prepare the new education and implementation strategy.
Showing upper management how the program can help the facility save money and promote optimal patient outcomes would be the main selling point to obtain funding. Time would be utilized in staff meetings to educate staff. Also included would be the cost of new hand sanitizer dispensers and their placement or relocation, UV light, germ simulation powder, posters, working with information systems to create screensavers and online education module, time to research and prepare the PowerPoint presentation, and quizzes. When nurses are armed with education, they are excellent role models.