Hand hygiene errors are some of the most common causes of infections in hospitals and other settings. For this reason, most studies, such as McLaws (2015), describe hand hygiene as the most important tool in the prevention of the spread of health-care associated infections. The choice of hand hygiene errors for this quality improvement project is informed by the fact that some health professionals do not observe the best standards of hand hygiene, and they have been contributed to the spread of infections among patients placed under their care. Consequently, setting the best standards for hand hygiene for the healthcare professionals may contribute to reduced levels of infections. This quality improvement project dissects hand hygiene in the context of the Miami VA Healthcare System, a veteran health hospital located in Miami, Florida. The hospital, according to its website, provides health care services to three counties in south Florida, which are Monroe, Broward, and Miami-Dade, which have an estimated veteran population of 149704 (US Department of Veterans Affairs, 2018). The hospital has been associated with high-quality healthcare services, which include inpatient and outpatient mental health, surgical, and general medical services. In attaining its objective, this paper addresses the background to hand hygiene, the current hand hygiene practices at the Miami VA Healthcare System, and describes the project plan for implementation.
Background of the Problem
The World Health Organization indicates existence of few definitive data on activities of patient care that have the potential of transmitting bacteria to health care worker’s hands, but it further indicates that many studies report numerous possibilities (WHO, 2018). As much as bacteria have been found on the hands of health care workers following patient care activities, such as handling patient secretions, respiratory tract care, intravascular catheter care, and wound care (McLaws, 2015), they have also been found on their hands following the so-called clean contact activities, including taking the patient’s blood, temperature, or pulse readings (CDC, 2018). Different species of organisms have been found on the hands of health care workers have widely varied, and they include MRSA, Clostridium difficile, gram-negative bacteria, Staphylococcus aureus, and Klebesiella ssp (Shafer, 2014). Nevertheless, it is important noting that patient contact is not the only way through which health care professionals can contaminate their hands. For example, it is reported that health care professionals may also contaminate their hands by touching contaminated surfaces in the patient environments, and other material (Shafer, 2014).
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The Centers for Disease Control and Prevention, CDC, reports that most of the germs, which cause serious infections for people are spread by the actions of people, especially health care professionals and patients alike (CDC, 2018). Consequently, the cited literature indicates that effective hand hygiene practices would be a great approach to preventing infections. It is important noting that on average, health care workers clean their hands less than half the number of times that they should (McLaws, 2015). For this reason, the hand hygiene errors contributes to the spread of infections in healthcare settings for 1 in 25 hospital patients daily (CDC, 2018). It is notable that each patient risks being infected while receiving treatment for something else. Furthermore, health care workers are at risk of being infected while they treat their patients. Dealing with the spread of germs is specially important within hospitals and other facilities that provide health care services, including nursing homes.
The ethics of medical practice indicate that health care professionals should contribute to the wellbeing of their patients, which implies their contribution to preventing the spread of infections. Consequently, adhering to hand hygiene practices is the most important recommendation for medical practitioners and their patients towards the reduction of healthcare-related infections in the healthcare settings.
Current Practice
At the Miami VA Healthcare System, medical health professionals have adopted the approach to improve an adherence to hand hygiene that the CDC and the World Health Organization recommend. The two bodies approach hand hygiene through addressing the misconceptions and myths around the practice and empowering their patients to play active roles in caring for themselves through reminding or asking their healthcare professionals to observe proper hand hygiene practices.
Healthcare providers at the hospital are required to clean their hands by as many as a hundred times during their twelve-hour shifts, which depends on the number of patients that they are required to attend to during their scheduled times. The health care workers are also supposed to comprehend the implications and use of the alcohol-based hand sanitizers, which the hospital management perceives as the best in killing most of the germs that could cause infections, except C. difficile (CDC, 2018) . Hand hygiene is always the topic of conversation when health care workers interact with their patients. In fact, the hospital has organized patient education programs that purpose to improve the awareness of patients about the need for proper hand hygiene practices.
Project Plan
Mission Statement
The hand hygiene project will target to improve the levels of patient and health care providers’ adherence to hand hygiene standards. The goal of the project, therefore, would be to create a culture, which enhances high standards of hand hygiene.
Goals, Importance, Risk Factor, and Best Practice Standard
When effectively adopted, the project would reduce the risk of healthcare-related infections at the hospital for all categories of patients. However, the risk factor for the project is the fact that some of the patients, especially those from backgrounds that do not value proper hand hygiene procedures may not always remember to remind or ask their health care providers to stick best practices. In this some of the patients may consider that their health care providers may be sticking to hand hygiene practices through wearing gowns and gloves while attending to them (Grol & Grimshaw, 2013). Furthermore, the medical health providers who work in intensive care units may not attain the best standards of hand hygiene because of minimal interactions with their patients, especially on issues concerning proper hand sanitization. Consequently, it would important to apply the gold standard for hand hygiene, which relevant literature identifies as soap and water (Grol & Grimshaw, 2013). Using this approach, the patients and their providers would be required to apply between three and five millimeters of soap to their hands, avoiding bar soap, before rubbing their hands together for not less than fifteen seconds and rinsing off with water. The concerned persons should then dry their hands thoroughly using paper towels and use the same towel in turning off the faucet.
Initial Plan
|
Strategic Direction |
Criterion |
Comment |
| Leadership and Culture | The hospital should develop and sustain a hand hygiene culture that would be embedded in the organization | The health care workers should walk the talk through leading by example—they should prioritize hand hygiene in their encounters with the patients |
| Accessibility of hand hygiene products and facilities | Physical infrastructure is a prerequisite for the improvement of hand hygiene practices | Hand hygiene facilities should be availed in all clinical and non-clinical areas of the hospital, and they should include those that meet the SARI guidelines |
| Training and Education | Training and educating the patients and their health care providers to bolster their attitudes, beliefs, and knowledge of hand hygiene with the objective of bettering their adherence levels | The responsibility of hospital administration to run educational and training programs |
| Hand hygiene audits | Hand hygiene audits should be adopted to monitor the rate of hand hygiene compliance | The national hand hygiene audits would also be undertaken using the HSE audit tool and the team should report to the hospital management |
| Feedback | Feedback on primary performance indicators in a timely manner | Findings of the primary performance indicators will be disseminated widely from the infection prevention and control committees to al department heads for distribution to the rest of the staff. |
| Hand hygiene policy | The hospital may want to develop guidelines for hand hygiene | Consult specialists in hand hygiene to develop a hand hygiene manual for use in the clinical and non-clinical settings |
Stakeholders
The implementation of the hand hygiene program described in this document would require a collaboration of internal and external stakeholders. The internal stakeholders would constitute infection prevention and control committee that would then link with the external stakeholders in the implementation of the program. The committee would include clinical directors, nurse managers, hospital managers, heads of services, and clinical nurse managers. Since the hospital operates on the patient-centered model of care, it would be critical for the committee to include patient representatives because of the critical role that they would play in policy formulation. External stakeholders necessary for the implementation of the plan would include social workers, the public, and representatives from the state department of public health.
References
Centers for Disease Control and Prevention (CDC) (2018). Clean Hands Count . Retrieved 15 December 2018, from https://www.cdc.gov/features/handhygiene/index.html
Grol, R., & Grimshaw, J. (2013). From best evidence to best practice: effective implementation of change in patients' care. The lancet , 362 (9391), 1225-1230.
McLaws, M. L. (2015). The relationship between hand hygiene and health care-associated infection: it’s complicated. Infection and drug resistance , 8 , 7.
Shafer, E. (2014). Infection prevention in hospitals: The importance of hand hygiene. Infectious Diseases in Children , 27 (6), 1.
US Department of Veterans Affairs. (2018). About the Miami VA Healthcare System - Miami VA Healthcare System . Miami.va.gov . Retrieved 15 December 2018, from https://www.miami.va.gov/about/index.asp
