D221 Performance Assessment
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Jan 9, 2024
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Reducing Hospital Acquired Infections Through
Proper Hand Hygiene
Tyra Kim, RN
College of Health Professions, Western Governors
University
D221: Organizational Systems and Healthcare
Transformation
December 18, 2023
Reducing Hospital Acquired Infections Through Proper Hand Hygiene
A system-level safety concern that can affect patient outcomes in a large population of patients is hospital acquired infections. Although there are many contributors to hospital acquired infections, the lack of handwashing is a highly preventable contributor. The goal of healthcare includes preventing patient injury and harm through implementation of safety measures in healthcare. The use of alcohol-based gel, or handwashing with soap and water in
some situations will prevent the spread of hospital acquired infections. This will improve patient
outcomes and decrease costs in healthcare.
Background
Proper hand hygiene is the single most important, simplest, and least expensive way to prevent hospital acquired infections. The Joint Commission 2023 Hospital National Patient Safety Goals, state that providers should use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization and set goals for improving hand cleaning. This continues to be one of the 7 main patient safety goals for The Joint Commission. According to an article published by Indian Journal of Medical Research, “in most health care institutions, adherence to recommended hand-washing practices remains unacceptably low, rarely exceeding 40 per cent of situations in which hand hygiene is indicated (Hand hygiene: back to the basics of infection control, 2011). "Studies show that on average, healthcare providers clean their hands less than half of the times they should. This contributes to the spread of healthcare associated infections that affect 1 in 31 hospital patients on any given day (Clean hands count for safe healthcare 2020)."
Impact of the Safety Concern
Improper hand hygiene has many consequences to patients and healthcare workers. When healthcare providers fail to use proper hand hygiene, they are at risk of transmitting infection to themselves or other patients. When hands are not properly cleaned, viruses and bacteria can be introduced via the bloodstream, mucous membranes, GI tract, respiratory tract, and urinary tract. These infections put healthcare workers at greater risk of becoming infected. Improper hand hygiene can be introduced to patients as well. Patients who are at risk due to an underlying illness can experience increased length of stay, poor patient outcomes, or death. Healthcare associated infections have been a top contributor for increasing healthcare costs and
hand hygiene is the single most important way to prevent these infections. Recommendation
A systematic review found many recommendations for improving hand hygiene compliance in healthcare, including availability of alcohol-based hand hygiene products, education and performance feedback for staff, as well as administrative support and staff involvement. Twenty-six studies were included in the review and “fourteen studies assessed the
success of different combinations of strategies recommended by WHO to improve hand hygiene
compliance.” High reliability organizations have five key principles. This recommendation aligns
with sensitivity to operations because it includes continuous education and feedback. This is important to staff inclusion and compliance. This recommendation aligns with difference in expertise because it requires for staff to have access to alcohol-based hand hygiene products and provide feedback. The leadership team is responsible for providing feedback through their expertise and understanding of preventing healthcare associated infections. A potential barrier to this recommendation is the lack of compliance by healthcare providers. Since the increased workload in healthcare, implementation of practices has become increasingly difficult. Healthcare providers have been forced to cut corners to save time and provide a higher quantity of patient care, rather than quality. Another potential barrier could be the potential for skin irritation. When employees experience skin irritation on their hands, they are less likely to comply with hand hygiene practices.
To combat lack of compliance, staffing ratios can be improved initially to determine the effect on infection reduction. Staffing concerns affect all healthcare providers and ensuring adequate staff will help provide safe, high-quality healthcare to our patients. To decrease the potential for skin irritation, the product must be completed. It is important to select a product for sensitive or dry skin. Alcohol-based formulations are less irritating and cause less skin irritations when compared to handwashing with soap and water. Shared decision making is crucial in the implementation of this recommendation. As stated above, research must be completed in order to select the most cost-effective and safest product to help increase hand hygiene compliance. This will include financial team, as well as the compliance team. All teams are essential in developing a cost-effective, safe way to reduce the incidence of healthcare associated infections. An outcome measure to evaluate the results of this recommendation is comparison of hospital acquired infection rates monthly and quarterly. This will allow real-time data collection and will provide evidence needed to modify the process and help ensure compliance. In addition, staff can be surveyed to ensure compliance and identify barriers. The care delivery model currently being used varies by organization. On a national level, the CDC continues to provide education related to hand hygiene. There are four nursing delivery
models used in healthcare: primary nursing, team nursing, functional nursing, and total patient care. Most hospital settings use the team nursing care model. This includes a nurse manager overseeing the unit and operations. A RN oversees a group of patients and the clinicians providing their care. RNs, LPNs and CNAs are assigned to provide direct patient care. This ensures an adequate amount of support to those providing direct patient care. The team nursing model will be impacted by the recommended change in many ways. The RN, LPN, and CNA can ensure they have access to the needed products. This will help
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reduce the adverse effects of skin irritation, thus ensuring hand hygiene compliance. This recommendation will ensure adequate education and feedback to all staff. Continued education is key in healthcare and ensuring patient outcomes. Leadership will be responsible for positive feedback and engaging education. This will ensure clinicians are open to learning and feedback. Together, we can ensure patient safety and reduce the risk of preventable healthcare associated
infections. Mathur P. (2011). Hand hygiene: back to the basics of infection control.
The Indian journal of medical research
,
134
(5), 611–620. https://doi.org/10.4103/0971-5916.90985
Gould, D. J., Moralejo, D., Drey, N., Chudleigh, J. H., & Taljaard, M. (2017). Interventions to improve hand hygiene compliance in patient care.
The Cochrane database of systematic reviews
,
9
(9), CD005186. https://doi.org/10.1002/14651858.CD005186.pub4