Hand washing compliance in home care settings is an imperative procedure that safeguards patients from potential transmission of bacteria. Home care settings can have likely contamination which makes it essential for care providers to strictly uphold hand hygiene quality improvement procedure ( Kingston, O'Connell & Dunne, 2016) . Hand washing is critical in protecting patients being attended to from severe infections. Care providers in home environments are also at high risk of getting healthcare associated infections which makes the handwashing practice important. A survey by Center for Disease Prevention and Control found that healthcare providers in home care settings observe hand washing practice less than half the number of times they are supposed to adhere to the procedure. On a given day, approximately one in every 31 home care patients contract at least one infection attributed to noncompliance to handwashing ( Haque et al., 2018) . Sensitization on the need for handwashing compliance is vital among care providers to realize improved healthcare outcomes. A plan to improve handwashing in home care health environments would provide a necessary road map for implementation of the quality improvement procedure. The paper purposes to develop course reflection and a plan to improve handwashing compliance in home care settings.
Quality Improvement Project
The quality improvement project focuses on enhancement of handwashing among practitioners providing care to patients in home environments. Hand washing practice needs to be improved to reduce or completely eliminate the potentiality of transmitting an infection from a health care provider to patients and the likelihood of acquiring disease causing germs from a patient to care providers. According to Haque et al., (2018), about 40% of all homecare infections emanate from improper hand hygiene by healthcare providers. The transmitted infections due to noncompliance of handwashing leads to prolonged illnesses, hospital admissions, and increased cost burden on patients and their loved ones. Approximately 21% of healthcare workers offering home care treatment completely fail to observe handwashing 1 in every 5 times they come into contact with a patient ( Haque et al., 2018) .
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Hand washing as a quality improvement procedure ought to be improved to make home care settings safe both for patients, their families and healthcare workers. The rate of infection transmission in home care environments remains high due to non-adherence to hand hygiene among care providers ( Al-Khawaldeh et al., 2015) . Noncompliance to hand washing practice occurs due to reasons such as heavy workload among providers, inaccessibility of hand hygiene amenities and total non-availability of hand cleaning facilities. Improving handwashing practice is regarded as a critical step towards minimizing infection prevalence in home care settings. Nurses offering care to patients in their homes either fail to observe hand hygiene or may use the wrong procedure while washing their hands consequently exposing them and the patients to deadly germs ( Kingston et al., 2016) .
The plan to improve hand hygiene will play a critical role in phasing out diseases such as influenza and Salmonella which are transmitted from one person to another via contaminated hands. The respiratory and gastrointestinal infections resulting from non-compliance to hand washing can result to acute complications to patients such as young children, those who have a weak immune system and elders being attended to at home. A World Healthcare Organization report elucidated that improving the practice of hand washing in home care settings would reduce the number of patients who suffer from diarrhoea by 23-40%. Strict adherence would also cut respiratory illnesses such as cold by 10-21% leading to improved health outcomes. Taneff (2015), notes that handwashing compliance assists in the fight against rise in antibiotic resistance among patients receiving care at home. This is true since there are germs spread through hand contamination but are immune to antibiotics. Compliance to handwashing would play a critical role in preventing the overuse of antibiotics, which is the primary reason behind rise of antibiotic resistance globally.
A logic model is a road map that details a systematic process necessary to achieve desired program outcomes. According to Boswell and Cannon (2020), the framework is instrumental in identifying underlying assumptions, clarifying desired outcomes and necessary processes required to achieve significant improvement. In the case of handwashing quality improvement project, creation of logic model will serve as a foundation for implementation of the entire hand hygiene program. Logic modelling will be vital in clarifying key strategies, activities, intended results and linking the outcomes with program activities ( Subirana et al., 2014) . The logic model will identify and describe inputs, outputs, outcomes as well as short term and long term impact. Additionally, an action plan framework will enable implementation through identification of projected completion timeline, action steps, accountable and assigned persons as well as actual completion dates.
Table 1. Logic Model Template
|
Inputs |
Outputs |
Outcomes Impact |
|||
|---|---|---|---|---|---|
|
Resources: What We Invest |
Activities: What We Do |
Outcomes Short Term |
Outcomes Long Term |
Outcomes Impact |
|
| Human resource (patient, healthcare providers, patient family members and hospital senior management) | Training and education of home care health providers on importance of hand washing compliance | Increased access to hand washing facilities for example necessary supplies. | Improved hand washing compliance among care providers in home settings | Sustenance of an appropriate handwashing compliance among home care providers | |
| Posters and other prompts | Establishment of a hand hygiene committee | Improved skin integrity | Increased confidence in the healthcare system by providers and patients | Empowered Healthcare providers and organizations to contribute to improvement of other issues pertinent to patient safety. | |
| Program education materials | Education of patients on need to remind care providers to always observe hand hygiene prior to attending to them | Enhanced normative beliefs among home care providers on hand cleaning behaviour | Sustained increase in adherence to hand hygiene by home care providers | Widespread improvement of patient and nurse safety in home care settings | |
| Hand hygiene fact sheet | Analysis of workflow for hand washing products such as alcohol based hand rub and other amenities. | Increased pre-dispositions to clean hands( knowledge/ attitudes and risk assessment on the essence of hand hygiene during home care | Emergence of home care providers as role models for hand washing excellence | Drastic reduction of transmission of home care associated infections | |
| Appropriate handwashing products such as alcohol based sanitizers, water and soap | Conducting regular feedback process on if home care providers are upholding hand washing compliance guidelines. | Increased confidence among patients on healthcare provided in home environments | Improved safety for healthcare workers, patients and their families | Increased patient quality of life and decreased hospitalizations due to acute ailments linked to viral infections | |
| Education plan | Undertaking direct observation using training programs and standard tools | Increased healthcare Management support and encouragement of nurses to uphold hand washing compliance. | Increased coordination between healthcare organization, home care providers and patients in upholding hand hygiene compliance | Reduction in costs related to healthcare associated infections in home care settings | |
| Hand hygiene module | Conducting patient and healthcare provider surveys | Emergence of champions on behalf of hand washing quality improvement program | Reduced visits by home care providers due to decreased incidences resulting from non-compliance | Increased healthcare system performance | |
Source: Boswell, C., & Cannon, S. (Eds.). (2020). Introduction to nursing research: Incorporating evidence-based practice (5 th ed.) . Burlington, MA: Jones & Bartlett Learning.
Table 2. Action Plan Worksheet
Target Completion Date |
Action Step |
Accountable Person(s) |
Assigned Person(s) |
Actual Completion Date |
|---|---|---|---|---|
| 4 th August 2020 | Developing handwashing implementation guide | Senior family physician | family physician | 20 th August 2020 |
| 12 December 2020 | Training and education of home care primary providers | Head nurse practitioner | nurse practitioner | 12 th November 2020 |
| 5 th May 2020 | Undertaking patient and home care provider surveys | Senior pediatric nurse | pediatric nurse practitioner | 12 June 2020 |
| 14 August 2020 | Designing hand washing posters and prompts | Head of physician department | physician assistant | 15 June 2020 |
| 27 May 2020 | Creating hand washing fact sheets | Senior clinical officer | Assistant clinical officer | 5 th April 2020 |
| 30 th July 2020 | Patient education to create awareness of hand washing | Senior pharmacist | Assistant pharmacist | 15 July 2020 |
Overview of Project Dissemination
The hand washing quality improvement report was presented to the hospital supervisor for approval or otherwise. Upon receiving the plan, the administrator termed it exceptional claiming that he would provide requisite resources to ensure full implementation. The supervisor noted that primary care providers were reporting increased infections among patients which were attributed to non-compliance to handwashing guidelines. Some of the strengths that caught the a supervisor‘s attention were the clearly enumerated short term, immediate and long term impacts that made the entire plan valid and feasible. The administrator also termed the projected and actual completion dates realistic and therefore achievable. The handwashing plan would be implemented to improve patient and healthcare provider’s safety, bolster hand washing compliance and ensure sustained adherence to hand washing guidelines.
Conclusion
Heath care associated infections in home care settings have increased due to non-compliance of handwashing among healthcare providers. The process of developing the handwashing logic framework and action blueprint is painstaking and requires great detail and thoroughness as any errors would render the entire plan invalid. The logic framework is essential in breaking down the resources, specific activities and desirable outcomes which provide a vivid picture on what is required to implement a program. The logic framework is a platform for integrating evidence into healthcare practice through recommendations, evaluation, knowledge discovery and translation into practice which aligns the handwashing quality improvement program to the Stevens ACE Star framework. I have learned that evidence based quality improvement is critical in care transformation and in fostering an efficient, effective as well as safe healthcare.
References
Al-Khawaldeh, O. A., Al-Hussami, M., & Darawad, M. (2015). Influence of nursing students handwashing knowledge, beliefs, and attitudes on their handwashing compliance. Health , 7 (05), 572.
Boswell, C., & Cannon, S. (Eds.). (2020). Introduction to nursing research: Incorporating evidence-based practice (5 th ed.) . Burlington, MA: Jones & Bartlett Learning.
Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Health care-associated infections–an overview. Infection and drug resistance , 11 , 2321.
Kingston, L., O'Connell, N. H., & Dunne, C. P. (2016). Hand hygiene-related clinical trials reported since 2010: a systematic review. Journal of Hospital Infection , 92 (4), 309-320.
Taneff, Y. G. (2015). U.S. Patent No. 9,030,325 . Washington, DC: U.S. Patent and Trademark Office.
Subirana, M., Long, A., Greenhalgh, J., & Firth, J. (2014). A realist logic model of the links between nurse staffing and the outcomes of nursing. Journal of Research in Nursing , 19 (1), 8-23.
