Determine two internal and two external potential barriers to your project. What steps can be taken to mitigate these barriers? Remember, some barriers are inevitable. If this is the case, what is your plan for resolution for the impending issue?
Determine two internal and two external potential barriers to your project. What steps can be taken to mitigate these barriers? Remember, some barriers are inevitable. If this is the case, what is your plan for resolution for the impending issue?
Requirements: 200 words
Hospital Acquired Infections (HAIs) due to Inadequate Hand Hygiene Compliance
Antwanetta Boswell
HCA-650
Grand Canyon University
Professor Tucker
09/08/2023
Hospital Acquired Infections (HAIs) due to Inadequate Hand Hygiene Compliance
Identify the Problem: Hospital Acquired Infections (HAIs) due to inadequate Hand Hygiene Compliance.
Background and Significance:
Our healthcare organization has identified a significant issue related to acquired Infections (HAIs). HAIs significantly threaten patient safety and contribute to increased healthcare expenses. According to the CDC, 1 out of 31 hospital patients has at least one healthcare-associated infection. It further outlines that there are numerous HAIs, including Surgical Site Infections (SSI), Central Line-associated Bloodstream Infections (CLABSI), Catheter-associated Urinary Tract Infections (CAUTI), and Ventilator-associated Pneumonia (VAP). Neumark et al. (2022) illustrate a large percentage of HAIs can be prevented through effective hand hygiene practices by healthcare workers. However, hand hygiene compliance rates in many hospital settings are consistently inadequate, leading to avoidable patient illnesses and increased healthcare costs. Our healthcare facility has witnessed 18 HAIs in the last 30 days. For our facility to boost its success in the healthcare industry, it needs to come up with more evidence-based and effective practices that will enhance the quality of the care delivered to the patients. For our facility to boost its success in the healthcare industry, it needs to come up with more evidence-based and effective practices that will enhance the quality of the care delivered to the patients. This problem is significant for the organization due to the following reasons.
One, HAIs tend to compromise the patient’s safety. They can lead to serious patient complications, including extended hospital stays, increased morbidity, and mortality. Ensuring hand hygiene compliance is a critical component of patient safety. Secondly, HAIs result in additional healthcare costs, including longer hospital stays, increased antibiotic use, and potential legal liabilities. Improving hand hygiene compliance can mitigate these financial burdens. Thirdly, inadequate hand hygiene reflects on the quality of care provided by the healthcare institution (Neumark et al. 2022). Addressing this issue aligns with the organization’s commitment to delivering high-quality healthcare services. Also, addressing HAI issues will help the facility improve its compliance. Regulatory bodies and accrediting agencies, such as The Joint Commission, emphasize the importance of hand hygiene compliance as a fundamental element of healthcare quality and safety. Lastly, it will help the facility to make patients increasingly aware of the risks of HAIs and their perception of hand hygiene practices can influence their satisfaction with healthcare services.
The Stakeholders/Change Agents
There are various stakeholders who are concerned with our organization’s high readmission rates and are more likely to benefit from this proposal. These stakeholders include the patients and family caregivers, the healthcare organization leadership, insurers, healthcare providers, quality improvement teams, and regulatory agencies. To begin with, patients are the primary stakeholders who are directly affected by the facility’s HAI cases. Their experiences and outcomes are crucial considerations in any intervention.
Also, the physicians, nurses, and other healthcare professionals who are responsible for implementing proper hand hygiene practices are integral to achieving higher compliance rates. Hospital leadership, including executives and administrators, has a financial interest in reducing HAIs to avoid penalties and improve overall hospital performance.
Similarly, quality improvement teams. These teams within the hospital play a critical role in identifying and implementing evidence-based practices to enhance care quality and improve hygiene compliance. Insurance companies and Medicare/Medicaid are stakeholders because they may be financially impacted by high readmission rates as a result of HAIs and penalties. Regulatory bodies such as the Centers for Medicare & Medicaid Services (CMS) and The Joint Commission are change agents that set guidelines and standards related to hygiene compliance and HAI prevention.
PICOT Question
In healthcare professionals (P), does the implementation of evidence-based hand hygiene interventions (I) compared to standard practices (C) within six months (T) result in a minimum 20% increase in hand hygiene compliance (O) and a 15% reduction in HAIs within one year (O)?
Purpose and Project Objectives
The purpose of this project is to enhance patient safety by improving hand hygiene compliance among healthcare professionals and, consequently, reducing the incidence of Hospital Acquired Infections (HAIs) within our healthcare institution.
Project Objectives
To assess the baseline hand hygiene compliance rates among healthcare professionals in our institution.
To implement evidence-based hand hygiene interventions and educational programs for healthcare professionals.
To measure the increase in hand hygiene compliance rates within six months of intervention implementation.
To monitor and evaluate the incidence of HAIs within one year after the intervention.
Rationale
Hand Hygiene in healthcare is widely recognized as a critical component in preventing HAIs. Poor hand hygiene among healthcare practitioners is associated with an increase in the number of HAIs. Neumark et al. (2022) illustrate that there was an increase in the number of HAIs during the COVID-19 pandemic in the COVID Intensive Care Units, which was connected with poor hygiene among healthcare practitioners. Poor hand hygiene contributes to the spread of infections to other patients and healthcare practitioners. Some studies have evaluated the implication of implementing hand hygiene audits in healthcare on reducing HAIs and costs associated with overstay of patients as a result of infections (Knepper Miller & Young, 2020; McKay, Shaban, & Ferguson, 2020; Mouajou et al.2022). Anguraj et al. (2021) found that implementation of the HH audit reduced the number of HAIs
References
Anguraj, S., Ketan, P., Sivaradjy, M., Shanmugam, L., Jamir, I., Cherian, A., & Sastry, A. S. (2021). The effect of hand hygiene audit in COVID intensive care units in a tertiary care hospital in South India. American Journal of Infection Control, 49(10), 1247-1251.
Knepper Miller A.M., & Young H.L(2020). Impact of an automated hand hygiene monitoring system combined with a performance improvement intervention on hospital-acquired infections. Infection Control & Hospital Epidemiology.
McKay, K. J., Shaban, R. Z., & Ferguson, P. (2020). Hand hygiene compliance monitoring: Do video-based technologies offer opportunities for the future? Infection, Disease & Health, 25(2), 92–100. https://doi.org/10.1016/j.idh.2019.12.002
Mouajou, V., Adams, K., DeLisle, G., & Quach, C. (2022). Hand hygiene compliance in the prevention of hospital-acquired infections: a systematic review. Journal of Hospital Infection, 119, 33-48.
Neumark, Y., Bar-Lev, A., Barashi, D., & Benenson, S. (2022). A feasibility study of the use of medical clowns as hand-hygiene promoters in hospitals. Plos one, 17(12), e0279361.
Reducing Hospital Acquired Infections (HAIs) through Hand Hygiene Compliance
Antwanetta Boswell
HCA-650
Grand Canyon University
Professor Tucker
09/08/2023
Reducing Hospital Acquired Infections (HAIs) through Hand Hygiene(HH) Compliance
Reducing Hospital Acquired Infections (HAIs) through Hand Hygiene Compliance
Hospital Infections (HAIs) endanger patients and raise healthcare expenses. Healthcare workers’ hand hygiene compliance is a top HAI prevention strategy. HH compliance rates in hospital settings are generally inadequate, resulting in avoidable illnesses. According to the CDC report, approximately 1 out of 31 patients admitted to the hospital are affected by HAIs. CDC outlines that there are numerous HAIs, including Surgical Site Infections (SSI), Central Line-Associated Bloodstream Infections (CLABSI), Catheter-associated Urinary Tract Infections (CAUTI), and Ventilator-associated Pneumonia (VAP).
Among all HIAs, CAUTI is more likely to occur. According to the CDC, most germs associated with the most serious infections tend to be spread through people’s actions. In a greater way, HH plays a great role in preventing these infections. Studies have shown that most healthcare practitioners do not adhere to HH compliance (Basu et al. 2021). Due to this disregard of the healthcare practitioners to wash their hands as supposed, this results in the spread of HAIs in the healthcare settings. This illustrates that all patients are at risk of acquiring an infection from healthcare practitioners while getting treated for something else. At the same time, the healthcare providers are at risk of getting germs while delivering care to the patients. The HAIs have negative impacts on the healthcare organization, including overstays, increased healthcare costs, and mortality cases, especially when appropriate measures are not put in place in time. It is important to prevent the spread of germs, especially in hospitals and other facilities such as nursing homes and dialysis centers. Hand hygiene also serves as a cornerstone in infection prevention and control programs and is recommended by organizations like the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC).
Despite the well-established importance of hand hygiene in preventing HAIs, the prevalence of these infections remains unacceptably high in healthcare facilities worldwide. HAIs continue to be a major public health concern, affecting millions of patients each year. The problem lies in the inconsistency and suboptimal adherence to hand hygiene practices among healthcare workers (Anguraj et al., 2021).
Several factors contribute to the problem of poor hand hygiene compliance in healthcare settings. These include high workloads, time constraints, inadequate access to hand hygiene facilities, lack of awareness or education about proper hand hygiene techniques, and sometimes even misconceptions about the necessity of hand hygiene in specific clinical scenarios. Healthcare workers may also underestimate their role in HAI prevention or may not fully appreciate the potential harm of non-compliance. The consequences of inadequate hand hygiene compliance are severe, both in terms of patient outcomes and healthcare costs. HAIs result in increased morbidity and mortality rates, longer hospital stays, and the unnecessary use of additional medical resources. Furthermore, healthcare facilities may face legal and financial repercussions when patients acquire infections within their walls.
The primary purpose of this paper is to synthesize evidence-based practice objectives that address the critical issue of HAIs by focusing on the improvement of hand hygiene compliance in healthcare settings. By analyzing a comprehensive set of research studies and evidence, this paper aims to provide a clear roadmap for healthcare facilities and practitioners to enhance their hand hygiene practices effectively. Specifically, this paper seeks to consolidate the findings from various research studies related to hand hygiene and HAIs (Anguraj et al., 2021). It will critically evaluate the strengths and limitations of these studies, identify common themes and trends, and extract evidence-based practice objectives. These objectives will be aligned with measurable outcomes to ensure their effectiveness in reducing HAIs. The ultimate goal is to equip healthcare providers and institutions with evidence-based strategies that can be implemented to improve hand hygiene compliance and, consequently, reduce the prevalence of HAIs.
Objectives
In the context of reducing Hospital Acquired Infections (HAIs) through improved hand hygiene compliance, evidence-based practice objectives are essential to guide interventions and evaluate their effectiveness. These objectives should be carefully crafted to align with measurable outcomes, ensuring that progress can be tracked and the impact of interventions can be quantified. Here, we discuss the evidence-based practice objectives for the project and the importance of achieving these objectives for HAI reduction:
Increase Hand Hygiene Compliance Rates:
Objective: Achieve a minimum of 90% compliance with hand hygiene protocols among healthcare workers within the next 12 months.
Measurable Outcome: Regular monitoring and data collection of hand hygiene compliance rates using a standardized protocol and electronic monitoring systems.
b. Decrease HAI Incidence:
Objective: Reduce the overall incidence of HAIs in the healthcare facility by 20% within the next 24 months.
Measurable Outcome: Regular surveillance and reporting of HAI rates, comparing pre-intervention and post-intervention periods.
c. Enhance Healthcare Worker Education:
Increase the proportion of healthcare workers who receive regular hand hygiene education and training to 100% within the next 6 months.
Measurable Outcome: Documentation of the completion of hand hygiene training for all healthcare workers
Method Used in Gathering Research
When searching for the articles to be used for this research, several databases were used, including PubMed, CINAHL, Cochrane Library, and Scopus. PubMed is a widely recognized and reputable database of biomedical and healthcare literature. It includes a vast collection of peer-reviewed articles, making it a valuable resource for research studies related to hand hygiene and healthcare-associated infections (HAIs). CINAHL is a specialized database that focuses on nursing and allied health literature. It is particularly useful for accessing research studies related to healthcare practices, including hand hygiene. The Cochrane Library is a gold standard for systematic reviews and evidence-based healthcare research. While it primarily contains systematic reviews and meta-analyses, it also provides access to individual research studies that are included in these reviews. Scopus is a comprehensive multidisciplinary abstract and citation database that covers a wide range of scientific disciplines. It provides access to a substantial number of research articles, including those related to hand hygiene and HAIs.
Keywords
To effectively gather research studies on hand hygiene and HAIs, a combination of relevant keywords and phrases would be employed. Some of the keywords and phrases that might be used include hand hygiene, Healthcare-associated infections, Infection control, Healthcare Workers, Surveillance, and effectiveness. These keywords would be combined using Boolean operators (AND, OR) to refine and broaden the search as needed. For example, “hand hygiene AND healthcare-associated infections” would focus the search on studies that specifically address the relationship between hand hygiene and HAIs.
Criteria for Inclusion and Exclusion of Studies
While searching for the studies to be utilized for this research, several inclusion and exclusion criteria were considered, which are discussed in detail here. For an article to be included in this study, it must be peer-reviewed and published in the past 5 years, conducted a randomized control study or qualitative study, studies conducted within healthcare settings (hospitals, clinics, long-term care facilities), and studies published in English.
Exclusion Criteria
The exclusion criteria include studies published before a specified date (if applicable) not related to the topic. Also, studies with inadequate or unclear methodology, not available in full text, and non-English language studies were excluded.
The number of the studies that were selected and used for this study was 10. Fifty articles were selected, but 40 were excluded after failing to meet the inclusion criteria.
Summary
Basu et al. (2021), the authors conducted a retrospective hospital-based study in a 700-bed multispecialty teaching hospital in Eastern India. They aimed to understand the impact of the COVID-19 pandemic on various hospital-acquired infections (HAIs) and healthcare workers’ hand hygiene compliance rates. One strength of this study is its real-world setting, which provides practical insights. However, it also has limitations, such as its retrospective nature, which may be subject to biases, and the lack of a control group for comparison. Knepper Miller and Young (2020) conducted a quasi-experimental study conducted in a 555-bed urban safety-net level I trauma center. The researchers implemented an automated hand hygiene system and performance improvement interventions to reduce HAIs. A notable strength is the use of technology for monitoring and intervention. Nevertheless, the study lacks specific recommendations, and the observed outcomes might be influenced by other variables not controlled for.
Mouajou et al. (2022) conducted a systematic review to evaluate the effect of Hand hygiene in the prevention of hospital-acquired infections. This review analyzed 35 articles from high-income countries to determine the optimal hand hygiene compliance (HHC) rate associated with the lowest HAI incidence rate. The study follows the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, ensuring rigorous methodology. However, it only provides general trends due to limitations in the study designs reviewed, and causality inference is challenging.
Phan et al. (2020) conducted a quasi-experimental, observational study at Hung Vuong Hospital in Vietnam to examine how a multimodal campaign influences hand hygiene improvement compliance and HAIs. The researchers implemented a multimodal hand hygiene promotion strategy. Strengths include long-term observation and the focus on specialized healthcare settings. Nevertheless, the study lacks specific recommendations, and the absence of a control group limits causality determination. Swanson et al. (2020) conducted a quasi-experimental design in an urban, 353-bed Level I trauma hospital. The study evaluated the implementation of an electronic hand hygiene compliance monitoring system (eHHCMS) to reduce HAIs. A strength is the use of technology for continuous monitoring, but the study’s generalizability might be limited to trauma hospitals, and potential confounding variables were not extensively discussed.
McKay et al. (2020), the researchers conducted a literature review and exploration of concepts to address the barrier of healthcare-associated infections (HAIs) related to hand hygiene compliance. They investigated the potential of video-based technologies as an alternative method for monitoring hand hygiene compliance. One of the key strengths of this study is its forward-looking approach to exploring innovative solutions for hand hygiene monitoring. However, it also highlights the need for further research to evaluate the technical feasibility, cost-efficiency, and acceptability of such video-based systems.
Anguraj et al. (2021) aimed to understand the roles and responsibilities of healthcare aides (HCAs) in infection prevention and control (IPC) in long-term care settings, addressing the barrier of a lack of standardized roles for HCAs. This qualitative scoping review contributes by shedding light on the importance of HCAs in IPC activities, emphasizing the need for clear role definitions and training. However, it primarily focuses on long-term care settings, and its findings might not be directly transferable to other healthcare contexts.
Atif, Lorcy, & Dubé(2019) conducted a multicentre qualitative study aiming to explore the factors influencing healthcare workers (HCWs) hand hygiene compliance and their perceptions of HAIs. This study addresses the barrier of low hand hygiene compliance among HCWs. It provides insights into the individual, environmental, organizational, and communication factors that affect hand hygiene compliance. However, the absence of a publication year is a limitation for referencing the study accurately. Salma et al. (2019) sought to assess the effectiveness of an educational speech intervention (ESI) in increasing hand hygiene compliance among hospital visitors. It supports the barrier of low hand hygiene compliance among hospital visitors by demonstrating that ESI substantially increased visitor hand hygiene compliance rates. This intervention offers a practical strategy for improving hand hygiene among a group that is often overlooked. Nevertheless, the study’s generalizability to different hospital settings should be considered.
Villareal et al. (2022) conducted a feasibility study to assess the potential of using medical clowns to promote hand hygiene among hospital physicians and nurses. This study addresses the barrier of poor hand hygiene compliance among healthcare workers. The findings indicate that medical clowns can engage healthcare practitioners effectively, promoting positive behavioral change and reducing healthcare-associated infections. However, as it is a feasibility study, further research is needed to confirm the long-term impact and scalability of this approach.
The Validity of Internal and External Research
The internal validity of the research studies appears robust, with rigorous methodologies, data collection, and analysis methods. However, the external validity varies, as some studies focus on specific healthcare settings, potentially limiting generalizability to broader contexts. Nevertheless, the findings collectively contribute valuable insights into hand hygiene compliance and healthcare-associated infections.
References
Anguraj, S., Ketan, P., Sivaradjy, M., Shanmugam, L., Jamir, I., Cherian, A., & Sastry, A. S. (2021). The effect of hand hygiene audit in COVID intensive care units in a tertiary care hospital in South India. American Journal of Infection Control, 49(10), 1247-1251.
Atif, S., Lorcy, A., & Dubé, E. (2019). Healthcare workers’ attitudes toward hand hygiene practices: Results of a multicentre qualitative study in Quebec. Canadian Journal of Infection Control, 34(1).
Basu, M., Mitra, M., Ghosh, A., & Pal, R. (2021). Journal of Family Medicine and Primary Care, 10(9), 3348. DOI: 10.4103/jumps.jfmpc_742_21
Knepper Miller A.M., & Young H.L(2020). impact of an automated hand hygiene monitoring system combined with a performance improvement intervention on hospital-acquired infections.Infection Control & Hospital Epidemiology.
Mckay, K. J., Shaban, R. Z., & Ferguson, P. (2020). Hand hygiene compliance monitoring: Do video-based technologies offer opportunities for the future? Infection, Disease & Health, 25(2), 92–100.
Mouajou, V., Adams, K., DeLisle, G., & Quach, C. (2022). Hand hygiene compliance in the prevention of hospital-acquired infections: a systematic review. Journal of Hospital Infection, 119, 33-48.
Neumark, Y., Bar-Lev, A., Barashi, D., & Benenson, S. (2022). A feasibility study of the use of medical clowns as hand-hygiene promoters in hospitals. Plos one, 17(12), e0279361.
Phan, H. T., Zingg, W., Tran, H. T. T., Dinh, A. P. P., & Pittet, D. Sustained effects of a multimodal campaign aiming at hand hygiene improvement on compliance and healthcare-associated infections in a large gynecology/obstetrics tertiary-care center in Vietnam, 2020.
Swanson, S., Baken, L., & Bor, B. Implementation of a Hospital-wide Electronic Hand Hygiene Monitoring Program Reduces Healthcare-acquired Infections in a Level I Trauma Hospital.
Villarreal, S., Khan, S., Oduwole, M., Sutanto, E., Vleck, K., Katz, M., & Greenough, W. B. (2020). Can educational speech intervention improve visitors’ hand hygiene compliance? Journal of Hospital Infection, 104(4), 414–418.
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