WGU D221

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Apr 3, 2024

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Inadequate Hand Hygiene in the Healthcare Setting Andrew Buck Western Governors University D221: Organizational Systems and Healthcare Transformation Leslie Ferrygood December 2nd, 2023

Inadequate Hand Hygiene in the Healthcare Setting A1. Describe a Healthcare-Related Situation Prompting a Systems-Level Patient Safety Concern that has the Potential to Impact Multiple Patients. Inadequate hand hygiene by healthcare staff, workers, and visitors, in the healthcare setting can be detrimental to positive patient outcomes. Many patients in the healthcare setting are battling with one form of infection or another. Thus, their immune systems are likely to be vulnerable to opportunistic infection. Many patients are immunocompromised, and the result of inadequate hand hygiene can lead to the introduction of additional germs, bacteria or viruses. Hand hygiene is now regarded as one of the most important elements of infection control activities. In the wake of the growing burden of health care associated infections (HCAIs), the increasing severity of illness and complexity of treatment, superimposed by multi-drug resistant (MDR) pathogen infections, health care practitioners (HCPs) are reversing back to the basics of infection preventions by simple measures like adequate hand hygiene. (Purva Mathur, 2020). A2. Analyze Background Information about the Concern A2a. Data Inadequate hand hygiene has a significant impact on both patient safety and positive outcomes. As a result of inadequate hand hygiene patients are at an increased risk for developing a number of healthcare acquired infections. This includes but is not limited to, catheter associated urinary tract infections (CAUTI), central line associated bloodstream infections (CLABSI), hospital acquired pneumonia, c.diff, and surgical site infections. In 2014, the CDC published a multistate point prevalence survey of healthcare-associated infections involving 11,282 patients from 183 US hospitals. [12] According to this report, about 4% of hospitalized patients suffered from at least one of

the HAI. In absolute numbers, in 2011, an estimated 648,000 hospitalized patients suffered from 721,800 infections (Alberto F. Monegro; Vijayadershan Muppidi; Hariharan Regunath, 2023). A2b. National Safety Standard(s) Adequate hand hygiene is under The Joint Commission’s National Patient Safety Goal standard of infection prevention. By disregarding the task of adequate hand hygiene, patients are at risk of contracting a skew of hospital-acquired infections. A3. Assess the Impact of the Safety Concern on the Patient(s), Staff, and the Organization as Situated in the Identified Healthcare Setting Inadequate hand hygiene not only puts the patient at risk for serious complication, but its affects also play a huge role in the staff and organization. As patients become infected by contamination the risk in terms of the staff becoming ill is significantly high. If staff become ill, this can result in short- staffing and unsafe nurse-to-patient ratios. Healthcare acquired infections affect the organization not only financially but also on a level where the patient would rather go to another facility for treatment. A3a. Value Patients go to healthcare facilities to seek treatment. They want help. They want to get better. By not adhering to policy guidelines on proper hand hygiene you are ultimately placing no value on the patient or for the organization. When preventable complications come up, trust in the healthcare organization can be broken. That value that was once there is no longer. As healthcare professionals we took an oath to “do no harm”. It is our responsibility to value our patients and keep them safe at all costs. We also owe that responsibility to the organization we are employed through.

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A4. Recommend an Evidence-Based Practice Change that Addresses the Safety Concern An evidence-based recommendation is to provide the healthcare staff with information and statistical data regarding the negative effects of healthcare acquired infections. By shedding light on the negative effects on patients I feel that this can help staff adhere to proper hand hygiene. I would also recommend implementing hand hygiene checkoffs with real-time feedback. A4a. High-Reliability Organization A high-reliability organization prioritizes the importance of patient safety. One trait that this recommendation supports is sensitivity to operations. By engaging the staff in direct observations via checkoffs, concerns regarding the current practices can then be shared with stakeholders who can in turn implement improvements to the current practices. A4b. Potential Barriers Potential barriers to implementing proper hand hygiene checkoffs would be lack of hand hygiene supplies, such as soap, water, hand sanitizer, and lack of education or readiness to learn and improve amongst healthcare staff. A4c. Potential Interventions Potential interventions to adhere to proper hand hygiene include placing hand sanitizer dispensers in every patient’s room, high traffic areas such as halls, elevators, waiting rooms, etc. Have nurse leaders hand out education material and begin monitoring healthcare staff for proper hand hygiene before entering and when leaving a patient’s room.

A4d. Shared Decision-Making Relevant stakeholders include but are not limited to doctors, nurses, nursing assistants, charge nurses, unit managers and infection prevention team. Each role has a direct impact on every patient. However, nurses, nursing assistants and physicians have the most direct contact with patients. Charge nurses and unit managers are responsible for ensuring nurses are adhering to proper hand hygiene protocols by audits and they can ensure that all healthcare staff have direct access to all hygiene supplies such as hand sanitizer, dispensers, soap and paper towels. Infection prevention collaborates with all roles of the healthcare team by ensuring quality metrics are being adhered to. Each role mentioned above can collaborate with one another to strategically engage in a plan that will increase patient safety and reduce the risk for healthcare acquired infections. A4e. Outcome Measure To measure compliance with proper hand hygiene nurse leaders and unit managers can conduct audits. Audits could be conducted weekly and placed in a data metric that monitors compliance. By implementing audits, you are holding your staff accountable, therefore ensuring compliance. A4f. Care Delivery Model Currently, I work as a Registered Nurse in the ICU. My role as a nurse is to provide care for critically ill patients. Currently the care delivery model is the team nursing model. Our unit is composed of RN’s that are under the direction of the assigned charge nurse. The role of the charge nurse is to act as support for the other nurses and myself. Appropriately assign patients to nurses and ensure the unit functions optimally.

A4F1. Impact on Care Delivery Model By implementing the recommended change from A4, nurses in the ICU would receive statistical data showing the significant impact hand hygiene has on patient outcomes. I would have the charge nurse start the day in a huddle reminding staff of the importance of adhering to proper hand hygiene practices. I would also have the charge nurse do rounds with nurses and perform real-time audits on hand hygiene compliance and provide feedback when necessary. By implementing these practices, I would expect a significant decline in healthcare acquired infections.

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References Mathur P. Hand hygiene: back to the basics of infection control. Indian J Med Res. 2011 Nov;134(5):611-20. doi: 10.4103/0971-5916.90985. PMID: 22199099; PMCID: PMC3249958. Monegro AF, Muppidi V, Regunath H. Hospital-Acquired Infections. [Updated 2023 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441857/

WGU D221

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