Doc emendation

0 Comment

Minimizing Hospital Acquired Infections This project seeks to explain the connection between hand hygiene programs andthe reduction of hospital acquired infections (HAIs). The report is based on relevant statistical data that will enable healthcare providers to change their approaches to treatment so as to reduce the rates of HAIs and make the hospital environment safer for patients. The fact that patients can suffer from a wide range of infection while receiving treatment in hospitals challenges the essence of healthcare facilities in the country. Recent reports indicate that about 200,000 patients fall victim of HAIs, with a large fraction of them succumbing to the infections and passing away. The research studies have not adequately determined the actual figures of deaths resulting from HAIs, although all indications point to the fact that the numbers have risen high. However, existing literature points to the fact that hand hygiene plays a vital role in preventing HAIs. This project applies the quasi-experimental research design, which applies control and experimental groups to gather and analyze relevant data. The data will be collected through quantitative approaches for further analysis to assess the effectiveness of hand hygiene programs in reducing HAIs.
Keywords: Hand Hygiene, Hospital Acquired Infections (HAIs)
I. Section One: Overview of the Evidence-Based Project
Hospital Acquired infections (HAIs) present a serious challenge in provision of healthcare services to patients in hospital settings. Studies you cite only one study indicate that about 80 percent of patients who contract HAIs often succumb to the diseases and die while receiving treatment in the hospital (Ivers, et al. 2012). The numbers of patients and HAIs have continuously risen. hence, it has been increasingly difficult to identify the actual population of patients suffering from HAIs (Monnet, 2012). Nevertheless, existing literature has produced a great deal of evidence indicating that hand hygiene practices among providers reduces HAIs. However, compliance rates to hand hygiene practices such as hand washing and gelling remain low, which makes it difficult to prevent HAIs. Specifically, healthcare related infections have been on the increase in the recent years, prompting serious investigations as to whether healthcare facilities were taking hand hygiene seriously. Global statistics indicate that the rate of hospital-acquired infections revolves around 25 percent, while also increasing costs involved in treating and managing HAIs in healthcare facilities (Kim &amp.Kollak, 2006). However, substantive epidemiologic evidence supports the fact that hand hygiene helps to reduce the instances of HAIs in hospitals (Kim &amp.Kollak, 2006).
The main underlying factor is that compliance with hand hygiene practices reduces the rates of related infections to a greater extent (Ivers, et al. 2012). However, inadequacies exist in the literature available regarding how to increase compliance with hand hygiene practices before and after attending to each patient according to the guidelines stipulated by the WHO (Dennison &amp. Prevost, 2012).Thorough and proper hand hygiene is one of the most significant practices in eliminating cross-contamination and reducing incidences of hospital-acquired infections (HAI) (Kim &amp.Kollak, 2006).
The World Health Organization (WHO), Centers for Disease Control (CDC), and the Joint Commission have acknowledged the significance of hand hygiene globally (Ivers, et al. 2012). These organizations recommend hand hygiene practices as one way of reducing or eliminating Healthcare-acquired infections in hospitals. In the hospital scenario, the WHO recommends five main points when healthcare workers ought to observe hand hygiene (Parker, &amp. Smith 2010). These are before having contact with patients, before any antiseptic tasks, after exposure to bodily fluid, after contact with a patient, and after coming in contact with the patient’s surroundings. Healthcare workers are expected to comply with these guidelines in order to minimize healthcare-acquired infections.
However, compliance with hand hygiene has always been low historically with the average compliance rate at only 39 percent (Parker, &amp. Smith 2010). This situation has made it difficult to manage healthcare-acquired infections as well as alleviate the impact of health campaigns to minimize cross-contamination. Research has shown that failure to adhere with hand hygiene practices not only makes healthcare costly, but also undermines the efficacy of delivering healthcare services (Kim &amp.Kollak, 2006). Healthcare costs reportedly increase to 16 billion if hand hygiene is not complied with, and most of the costs involved in treating patients who stay longer in the hospital after contracting (Kim &amp.Kollak, 2006). HAIs Compliance is vital for measuring the rates of success of the various healthcare interventions that patients receive.
Re-education is a multimodal intervention aimed at inducing and improving compliance with hand hygiene practices. Re-education is based on theoretical frameworks of behavioral change at the individual, interpersonal and organizational level. At the individual level, re-education aims at providing healthcare workers with the right motivation and education that will help them inculcate a culture enshrined in hand hygiene practices. At the interpersonal level, re-education aims at empowering patients to understand the importance and impact of hand hygiene (Stewardson, et al., 2013). At the organizational level, this intervention measure aims at initiating a shift in thinking, restructuring the organizational structure, and developing appropriate philosophies aimed at supporting proper hand hygiene practices and other interventions that can reduce the rates of healthcare-acquired infections.
Problem Statement
Hospitals and other healthcare facilities play a key role in treating and preventing spread of diseases. This is because the hospitals possess adequate competencies needed in mitigating the disease. for instance, hospital staffs, budgeted financial resources, health technologies, and adequate medical supplies. However, the increasing rates of HAIs make the hospitals unsafe for patients and undermine the role of these health facilities in promoting good health. Recent research studies attribute the prevalence of HAIs to lack of adherence hand hygiene in healthcare settings (Dennison &amp. Prevost, 2012). Lack of adherence to hand hygiene practices is due to various reasons including negligence on the part of healthcare workers, inadequate care, and lack of sufficient knowledge and training regarding the importance of hand hygiene practices (Glanz, and Bishop, 2010). As a result, patients continue to suffer from low recovery rates, and become more vulnerable to contracting new infections while undergoing treatment (Dennison &amp. Prevost, 2012). If the situation is not checked, or addressed adequately, patients will continue to suffer and in other cases die from HAIs. Recent studied also point to the fact that efficiency can be ensured in healthcare settings through laying emphasis to the significance of hand hygiene practices in the treatment process (Glanz, Bishop, 2010). Re-educating healthcare workers will remind them of the important role that hand hygiene practices has on the treatment process.
Purpose statement and project objective
The purpose of the project is to assess how re-education can improve compliance to hand hygiene in hospital settings, thereby reducing the rates of HAIs. The project aims at applying re-education as an effective approach of increasing healthcare hygiene.
Project Question
The main question guiding this DNP project is. “How can re-education be used as an intervention strategy to increase compliance with hand hygiene in healthcare environments with an aim of reducing the rate of healthcare related infections?” This project assesses how reeducation can enhance compliance to hand hygiene in hospital settings thereby reducing the rates of HAIs.
Project objective
At the end of this project, the following objectives are expected to be achieved:
i To increase the rate of adherence to hand hygiene practices in the healthcare sector as a strategy in reducing HAI among healthcare practitioners
ii To advice and motivate stakeholders in the healthcare sector on effective ways of reducing HAI infections through re-education
iii To improve the level of understanding of healthcare practitioners on the importance and significance of hand hygiene in eliminating preventable HAI
The concern that I have is still the same from your last revision – your questions do not match your methods.
Significance/Relevance to Practice
Healthcare services are aimed at saving more lives by treating, curing, and preventing occurrence of diseases that can threaten the existence of human beings. Therefore, healthcare providers are expected to work hard to ensure that the patients receive the best possible care that can help them overcome their health challenges. One main critical factor in the provision of healthcare services is the environment within which healthcare is administered to patients (Glanz, Bishop, 2010). A good environment fosters and facilitates the recovery process of the patients. Hospitals are expected to create a favorable environment for patients to recuperate while undergoing treatment.
However, some hospital environments and the treatment process have become as threat to the health of the patients. Studies indicate that the number of patients succumbing to their deaths while undergoing treatment has been on the increase in the recent years (, 2014). The new wave of hospital-acquired infections has made it easier for patients to contract other diseases within the hospital environments. This makes it difficult for patients to respond to their treatment and eventually dying (, 2014). While there are many factors that can contribute to the increased rate of hospital related infections and deaths of patients while undergoing, hand hygiene has emerged as the most common factor. Hand hygiene, while being a very essential component of the treatment process, is often neglected by most healthcare providers and their organizations. Some of the healthcare organizations do not have appropriate structures and guidelines to enforce hand hygiene. Some healthcare workers also neglect hand hygiene because it is a simple exercise that should be repeated very often during the treatment process (Behnke, Gastmeier, Geffers, et al., 2012). Patients are the ones who suffer the most from this negligence and lack of adequate structures to address the problem of hand hygiene.
Evidence-Based Significance of the Project
The hand hygiene project is very significant in the healthcare industry. First, hand hygiene is directly linked to the quality of healthcare services. Hospital workers who do not adhere to hand hygiene practices often undermine the quality of their work, thus leading to poor patient outcomes and in some situations, death (Boyer, et al., 2009). The failure to observe hand hygiene often arises from the need for the hospitals expanding to accommodate the increasing number of patients and the rush that healthcare workers have as they try to cover more work in the shortest time possible. In some cases, the failure to observe hand hygiene results from sheer negligence where the healthcare workers overlook the importance of hand hygiene in treatment (Bull et al., 2011). The resultant factor is poor delivery of healthcare and the inability of healthcare providers to meet their objectives.
Second, the prevention of injuries and sickness through modern provisions such as high quality lighting and temperature-controlled environments is fairly standard, but the prevention of infections continues to be a challenge (Boyer, et al., 2009). Healthcare providers ought to ensure there is asepsis whenever attending to a patient in the hospital, that is, a state where the patient has a sterile environment free of external pathogens that can cause infections during the period of treatment (Hix, McKeon, &amp. Walters, 2009). Nurses and medical practitioners in close contact with the patient should have knowledge on the various techniques in order to prevent the patient from coming into contact with potentially harmful bacteria.
Studies indicate that many patients lose their lives after surgical treatments due to infections that could have otherwise been prevented. For example, in Canada, 9% of all patients in the country acquire infections during and after the operation process leading to deaths amounting to around 5,000-15,000 victims per year (Prevention, 2014). Is this generalizable to the US? Evidence from scholarly journals, indicates that the most common type of healthcare-acquired infections results from open wounds, accounting for 38% portion of all surgical operation (, 2014). Lewis, Dirksen, Heitkemper, &amp. Bucher (2010), noted that in the United States, there are more than 500,000 cases of infections annually that are related to wounds during the surgical processes. Most of the wound infections affect adults and once the infections have occurred, the patients are forced on average to incur an extra $3,152 in medical costs to treat the infections (Lewis, Dirksen, Heitkemper&amp. Bucher, 2010).
The main responsibility of ensuring a safe and a healthy surgical environment rests on the nursing staff, meaning that negligence accounts for most of the infections that occur. According to statistics from the Center for Disease Control (2013), around 27 million patients undergo surgeries in the United States on an annual basis. Of these patients, there is a probability that a third of them will remain in hospital for longer periods due to infections that occur during the surgery process. As a result of the patients staying longer in the hospitals, they end up incurring more financial costs and in some cases, the infections are ultimately fatal (Bode et al., 2010).
Several audit reports in the healthcare sector in the U.S and other developed countries including Canada indicate that the levels of hand hygiene compliance have been deteriorating (Prevention, 2014). According to most of the reports, the main culprits of surgical infections were poor hygiene and staff not adhering to hand hygiene procedures (Darouiche, 2010). Therefore, it is recommended that hospital staff receive consistent education so that they could better understand causes of the healthcare-related infections and ways of eliminating the infections.
Implications for Social Change in Practice
Compliance with hand hygiene practices will be accompanied with social change strategies that will ensure the practice becomes entrenched in the daily practices of the people. Social change refers to significant alterations in behavioral patterns, cultural norms and values of a group of people of the entire society. Adherence to hand hygiene requires people to change their attitudes and perceptions towards their health and adopt better ways of improving their health. Healthy lifestyles often depend on how people change their lifestyles and adopt recommended ways of managing their health in order to prevent spread of diseases in the society (Costers, Viseur, Catry, Simon, 2012).
Hand hygiene has huge implications for social change because behavior varies significantly among both patients and healthcare workers in a given healthcare setting or a country. Therefore, individual features have a major role to play in determining how individuals respond to hand hygiene and their health behavior in general. Social psychologists try to understand these individual features like social cognitive determinants, which can determine an individual’s hand hygiene behavior (Allegranzi, Stewardson &amp. Pittet, 2012). Individual behavior is best understood as a function of the different perceptions and attitudes of individuals rather than as a function of their lives (Allegranzi, Stewardson &amp. Pittet, 2012). In this regard, it is easier to understand that individual behavior is shaped through a process of socialization in the different societies in which they grow and their environments. Through appropriate behavioral models, it can be easier to understand and influence individual behavior when initiating change programs.
Hand hygiene requires social change at all the three levels in the community in order to be effective (Darouiche, 2010). At a personal or intra-personal level, social change requires that the individuals change their attitudes and beliefs towards hand hygiene. This can be achieved through access to more knowledge and information about hand hygiene, its benefits and implications to health. At the interpersonal level, hand hygiene requires social change in terms of how the different social networks help to promote healthy practices (Allegranzi, Stewardson, Pittet, 2012). Social units such as the families are the basic units for socialization. If individuals are properly socialized in their families, their relationships with peers and friends, it will be easier for them to respond to social change. Families need to appreciate hand hygiene and inculcate hand hygiene practices in their socialization processes. On the other hand, at a community level, hand hygiene requires that community structures create an appropriate environment for health practices and promote compliance to hand hygiene. Policy and decision makers in the community need to focus more towards setting up appropriate frameworks where hygiene practices hand can thrive (, 2014).
Definitions of terms
a Hand hygiene products
These are the different agents used for removing microorganisms and microbial agents from one’s skin. Some of the commonly used hand hygiene products include.
i Alcohol-Based Rub
This refers to a preparation fluid (gel, liquid, or foam) that contains alcohol. It is meant for application on the hands in order to inactivate microorganisms by suppressing their growth.
ii Antimicrobial Soap
This is a soap that contains concentrated antiseptic agents that can suppress growth of microorganisms on the hands. The detergents can also dislodge transient microorganisms from the skin in order to facilitate their removal by water.
iii Antiseptic Agent
These are antimicrobial substances that inactivate contaminants by inhibiting their growth on living tissues of the skin (Lester, 2010). They include quaternary ammonium compounds and chlorhexidine gluconate (CHG) among others.
iv Antiseptic Hand Wipe
This refers to pieces of fabric that are pre-wetted with antiseptics. They are meant for wiping hands in order to inactivate microbial contamination.
v Detergents
Detergents are compounds that contain a cleaning action. They contain a lipophilic and a hydrophilic part. They can also be categorized into four main groups. cationic, amphoteric, anionic, and non-ionic.
vi Plain Soap
These are detergents that do not contain any added antimicrobial agents.
vii Waterless Antiseptic Agent
This is an antiseptic agent that does not need one to use exogenous water. After applying the antiseptic on the hands, an individual will have to rub his hands together until the skin dries out.
b) Hand hygiene practices
i Antiseptic hand washing
This refers to the process of washing ones hands with soap and water or any other antiseptic agents
ii Antiseptic hand rubbing
This is the process of applying an antiseptic hand rub on the hands to inhibit growth of microorganisms without using water or other drying agents.
iii Hand antisepsis/decontamination
This refers to the process of reducing the growth of microorganisms through application of antiseptic hand rubs.
iv Hand care
This is a general term referring to the various practices aimed at promoting hand hygiene
v Hand washing
This refers to the process of washing hands with antimicrobial soap and water or with plain soap.
vi Hand cleansing
This is the process of removing dirt on hands mechanically or physically in order to clean the hands.
vii Hygienic hand antisepsis
This is the process of treating hands using either an antiseptic hand rub or an antiseptic hand wash to reduce microbial flora without having to affect the resident skin flora.
c) Re-education
Re-education refers to the process of training or educating someone in order to help them change their beliefs or behaviors to reflect the desired norms.
Thorough and proper hand hygiene is one of the most significant practices, backed with sufficient evidence, which helps in eliminating cross-contamination and reducing incidences of hospital-acquired infections (HAI). Specifically, healthcare related infections have been on the increase in the recent years, prompting serious investigations as to whether healthcare facilities were taking hand hygiene seriously. Global statistics indicate that the rate of hospital-acquired infections revolves around 25%, while also increasing the costs involved in treating and managing HAIs in healthcare facilities (Brownson, 2011). However, substantive epidemiologic evidence supports the fact that hand hygiene helps to reduce the instances of HAIs in hospitals (Timby&amp. Smith, 2013). The World Health Organization (WHO), Centers for Disease Control (CDC), and the Joint Commission have acknowledged the significance of hand hygiene globally. These organizations recommend hand hygiene practices as one way of reducing or eliminating Healthcare-acquired infections in hospitals (, 2014). In the hospital scenario, the WHO recommends five main points when healthcare workers ought to observe hand hygiene. These are before having contact with patients, before any antiseptic tasks, after exposure to bodily fluid, after contact with a patient, and after coming in contact with the patient’s surroundings. Healthcare workers are expected to comply with these guidelines in order to minimize healthcare-acquired infections.
The project aims at using re-education as a way of increasing healthcare hygiene. Reduction in HAIs enhances the general hygiene conditions. Re-education is a multimodal intervention aimed at inducing and improving compliance with hand hygiene practices. This intervention is based on theoretical frameworks of behavioral change at the individual, interpersonal and organizational level. At the individual level, re-education aims at providing healthcare workers with the right motivation and education that will help them inculcate a culture enshrined in hand hygiene practices (Brownson, 2011). The re-education program will place greater emphasis on certain elements of hand hygiene that healthcare providers will rely on to help reduce the rates of HAIs. Healthcare providers will also understand the main causes of HAIs and work towards involving the patients in the process of managing their health through hand hygiene practices (Goldsteen, Goldsteen, &amp. Graham, 2011).
II. Section Two: Review of Scholarly Evidence
Search Strategy
The search strategy for this paper entailed analyzing several libraries and databases, for relevant information relating to the subject. The search included seeking for appropriate scholarly articles in libraries such as OVID, Walden library and Medline databases. The key words used during the search are. hand hygiene, hospital hygiene, and hospital acquired infections. Inclusion criteria for the articles were: articles published not later than 2009. studies conducted in the US or Canada in order to provide the most up-to-date information on the topic. Data for the project was also gathered from relevant online sources such as Department of Health (DOH) and Science Direct. In addition to these sources relevant websites were also used to acquire information. The websites were selected based on prior knowledge of their contents. The most commonly referred to website was which contains information on hand hygiene.
The search focused on specific key words such as hand hygiene, hand hygiene compliance, healthcare-related infections, and adherence to hand hygiene, hand hygiene practices, and hand hygiene compliance statistics. The search generated numerous results for different articles, including 850 articles on ebscohost, 753 articles on emerald, and another 1133 articles on ncbi resources. However, after analyzing the articles from these searches, 45 articles were deemed relevant for this project. The assessment criteria that were used to grade the articles reviewed during this research focused on the date of publication for the articles selected, thematic relevance of observations, year of publication and author(s) reputation. Based on these criteria, the articles that were selected from the research effectively addressed the issues of concern. Opinions and research outcomes gathered from the articles adequately informed the conclusions arrived at in this report to ensure the authenticity of the research.
The first step to controlling infections is effective washing of hands (Fry, 2013). An effective hand washing process requires three steps. The first step is preparation, followed by washing and rinsing. The first two processes ensure that any microorganism is expelled from the surface of the hands (Fry 2013). The last step is drying. Preparation first involves wetting the hands under running water without first applying any liquid soap or other antimicrobial disinfectant. According to American Medical Surgical Nurses, the solution to be used in hand washing must pass through all surfaces of the hands and rubbing them together is very important and must be done for a period of 10 seconds or more ( 2014). The staff washing their hands must concentrate on areas such as the fingertips and between the fingers. After the thorough washing process, the hands should be dried using paper towels.
All patients who get admitted to hospitals (Haynes et al., 2009) are exposed to the risk of acquiring new infections that they did not have before admission. Most patients become inflected through contact with healthcare workers. Traditionally, hand washing was emphasized for the healthcare providers but recently, the matter seems to have been neglected ( 2014). Healthcare professionals are currently using an alcohol-based solution to act as a replacement of the traditional washing elements of water and soap (Chambers &amp. Roche, 2010). Despite of the new innovative ways of washing hands, the level of compliance to the hand washing procedures remains too low. A study done by Patil, Gaikwad &amp. Kulkami (2013) showed that there are effective ways to improve the compliance of hand washing procedures. The study also showed that the introduction of alcohol as a replacement of soap and water is not enough to promote proper hand-washing.
Importance of staff training in controlling HAI
Training is basic because it endows the staff with the skills to deal with infections, but it must be mixed with other strategies in order to get the staff involved in the process. The first strategy that should be implemented is to include the staff in the planning process. This generates a feeling among the staff that they have a stake in the whole process (Fry, 2013). However, there are suggestions that more research is needed to identify more strategies that are required to promote the hand washing process. A program for promoting hand hygiene should be introduced in clinical care studies. The program would involve pocket-sized containers containing a washing gel and the program coupled with thorough education will educate and demonstrate to the healthcare staff how easy it is to adopt effective hand hygiene practices (Bull et al., 2011).
Washing hands is a routine that should always take place before and after surgery and if something becomes a regular habit, there is a tendency to make it a part of the standard practice. There is also scientific evidence that shows that traditional practices such as washing hands before surgery should be made a custom to make it a part of life of the healthcare professionals (Fry, 2013). More research needs to be performed to ensure that the healthcare professionals recognize the importance of hand washing before and after a surgical process and make it a part of their lives. The research should incorporate the techniques of hand washing, especially the rubbing of hands together, and the appropriate procedures that should be used (Jaffe, 2014).
General Literature
Monahan, Neighbors and Green (2010) emphasized that taking thorough sanitary measures is very important in preventing the spread of infections in the hospital environment. Proper disinfection reduces the chances of viruses and bacteria entering the system of patients and also the spreading of such organisms or infections caused (Monahan, Neighbors &amp. Green 2010). Careless disinfection measures significantly raise the risk of diseases and infections spreading between patients and the healthcare providers. The surgery rooms become more sensitive and rigorous cleaning practices should be utilized (Chambers &amp. Roche 2010).
Noone and Griffiths conducted research on the same topic by studying patients admitted in hospitals and they concluded that the best way to control the outbreak of the infection of glycopeptide-resistant enterococci (GRE) in a hospital situated in the United States was by thoroughly cleaning of the wards which would greatly reduce the contamination of the environment (White, Duncan &amp.Baumle, 2013). The research noted the number of infected patients as a way of ascertaining whether cleaning had any effect.
Methods of killing microorganisms on hands
Ultimately, the best way to kill microorganisms thoroughly is by the use of sterilization. Sterilizers can be in form of steam or liquid chemical and there are three ways of determining whether a particular sterilizer is effective. First, there are gauges and mechanical means to determine whether the machines are performing properly. Secondly, there are tapes or indicators that change color to indicate the right amount of heat or steam is reached (Lautenbach, Woeltjeand Malani, 2010). Lastly, there is biological testing that selects a microorganism even if it is resistant to high levels of heat and chemicals and the biological testing treats the microorganism as a challenge.
If the procedure is able to kill the microorganisms, then the machine is rendered effective. After a single procedure of the sterilizing machine, the machine should be cleaned thoroughly to prevent a barrier from forming since this might result in to the microbes not functioning appropriately (Marra&amp. Edmond, 2012). Moreover, the sterilization instrument is highly vulnerable and it should be taken care of to ensure that the instruments are free from contamination before they are used. Disinfection is the process of having chemicals on appropriate areas and the maintenance of the appropriate temperatures to offer a hostile environment to microorganisms that cause diseases (Weigelt, 2012). Disinfection aims at killing the microorganisms but the process is not as effective as sterilization because it leaves out bacterial endospores.
If all procedures are followed appropriately, sterilization is very effective, especially in ensuring that the bacteria do not spread. The process should also be applied in cleaning other medical equipment such as gloves and other instruments that have contact with the tissues of the patient or the blood stream (Vincent 2010). There are other sterilization methods in existent but their functioning remains controversial. Examples of such sterilization methods are gas sterilization and sterilization with paraformaldehyde.
*This is the same comment from your last revision – you indicate that you used 45 articles, yet your literature review does not present 45 articles….please address this.
Theoretical Framework
The health belief model (HBM) is a psychological health behavioral change theory that helps to predict health related issues of individuals, and also how they use health services. This theory gained popularity in the 1950s after it was developed by Irwin Rosenstock, Howard Leventhal, Godfrey Hochbaum, and Stephen Kegeles who were social psychologists in the Public Health Service in the US. The theory is based on the premise that people’s engagement with health behavior is informed by their beliefs about health problems, self-efficacy, and perceptions about the benefits and barriers relating to healthy lifestyles (Brownson, 2011). The key tenets of this theory are the changes in behavior of individuals in relation to the messages they receive. This project will use this as a basis for instituting social changes in the community with regard to health by making people understand the significance of hand hygiene compliance.
This theory relates to the hand hygiene project in various ways. Firstly, the theory predicts social change in terms of behavioral alterations that will help instill a culture of hand hygiene among both patients and healthcare workers. The theory informs social change at both interpersonal and intra-personal level where social change can be achieved through changing the beliefs, perceptions, and attitudes towards healthcare. In this regard, this theory will form an effective foundation of communicating promotional messages that will resonate with the beliefs and attitudes of the people.
III. Section Three: Approach
Project design/methods
This project will predominately entail data collection with regard to the rate or level of compliance to the hand-hygiene program. However, the project will also make use of data pertaining to the rate of hospital related infections. This project will zero in on any data that pertains to the health care providers’ compliance to the ideals or practises relevant to the hand-hygiene program. For instance, through surveillance by hand hygiene champions like hygiene nurses, the project will establish the number of times the medical staff members wash their hand before, in-between patients, or after attending to a patient before moving to another. The champions will have special training sessions with the medical staffs, to illustrate the health benefits of hand washing when handling patients. Similarly, the project can also establish the amount of time nurses and doctors gel after attending to patients. The targeted population in the projects is Nurses and physicians, who work in the in-patient medical units and also the surgical units.
This project will use a quasi-experimental research design. The quasi-experimental design has two groups. the experimental group and the comparison group. The subjects of the project will be chosen based on a convenience sample, selected from healthcare workers in the inpatient units. Nurses and physicians who work in the in-patient and surgical units were specifically targeted in the project. The nurses included in the sample will be identified based on prior experiences achieved from their narrations. In this regard, randomly selected groups of health care nurses will be interviewed, based on past experiences with HAI. This is a qualitative method. Those that have contracted any HAI prior to the time of interview will be incorporated into the sample category for further observations. The sampling frame is the entire population in which the sample is selected….The rates at which the selected sample contract HAI will be computed based on narrations from the nurses past experiences with the infections. The rates will then inform the process of re-education to investigate the relationship between re-education and the contraction of re-education. The primary method of data collection involves the pretest-post-test design that will involve a re-education program for the selected sample to assess their compliance rates before and after re-education. Two variables are applied. compliance to hand hygiene is the dependent variable, and the reduction of HAIs is the independent variable.
Data collection
The project through similar means (surveillance) will look at data on the compliance to hand-hygiene practices pertaining to three months before the commencement of the program and three months after the completion of the program. Compliance and infection rates between the two periods will then be compared and conclusions derived from the observations. As such, the data obtained after the education program will be compared to two sets data. the base or initial compliance rate established by medical bodies, which is fifty percent that of the data on compliance relating to six months before the program commences. The comparison between the base or initial rate and the compliance rate before the implementation of the hand hygiene program will ascertain if the health care providers who are subject to this project have realized the base level of compliance.
Data analysis
A comparison of the two categories of pre and post data will determine the impact of the hand-hygiene re-education program on the level of adherence to the relevant practices aimed at improving compliance rates and inadvertently reducing rates of hospital related infections. From the evaluation, if the program improves the rate of compliance to hand hygiene practices, then there should be a considerable drop. However, if there is no change in level of compliance, then the program may be deemed ineffective and no considerable reduction in hospital related infections is expected.
The data variations are effectively monitored through the control charts. Control charts differentiate special variation sources, from the common variation sources. Common sources are expected in the research. for instance, the differing professional competencies of the respondents may generate differing research data. The special variations are unpredictable. For instance, the differing effectiveness levels of the healthcare providers during the research process.
Project Evaluation Plan
Evaluation of hand hygiene program
Healthcare Acquired Infections (HAI) are undoubtedly a serious public health concern not only the United States but across the globe (The Joint Commission, 2009). It is unfortunate that significant numbers of patients continue to suffer in different ways ranging from loss of life, extended stays in hospitals and huge medical bills owing to HAI. Hand washing among health workers stands out as one of the most effective ways of eliminating HAI (Yokoe, D et al, 2008). A quality improvement project is a robust initiative aimed at ensuring the goals and objectives are achieved effectively.
Was the evaluation plan appropriate to the design of the project?
The evaluation plan was highly suitable to the design of the hand hygiene project because it was designed to cover the entire process of the project. For instance, the three major methods and tools of evaluation, which include previously collected data (archive), observation and review of infection control monitoring reports applied in the evaluation process, were consistent with the needs and goals of the project as stated in the design. The plan was also designed to be robust covering all processes but at the same time cost effective making it appropriate to the program design.
Identify the goals and objectives of the evaluation plan
The goals and objectives of the hand hygiene evaluation plan are as follows: assess whether the program met its stipulated goals and objectives, measure the long-term effect of the hand hygiene initiative, measure the quality of the hand hygiene programs implemented in hospitals, and assess the satisfaction level of the key stakeholders.
What were the activities related to this evaluation?
The evaluation process took in to consideration a wide range of activities key among them building a conceptual model of the entire process including identifying the key stakeholders, and stipulating their respective roles and responsibilities. Another vital activity involved carrying out member surveys concerning the project and this covered the survey of impact, goals and the processes. Additionally there were constant reviews of impact indicators, such as, infection control monitoring reports to establish the reported cases of HAI at specific intervals, for instance every month. The final activities of the project plan, involves recording of the gathered data, analyzing it and finally presenting it to the concerned parties.
Based upon the data, how valid are the outcomes?
It can be said the outcomes are well founded considering most of the stipulated long-term goals and objectives of hand hygiene programs were effectively attained based upon the data gathered. For instance, it was observed that healthcare settings that observed and took hand-washing initiatives seriously reported significant reduction in Healthcare Acquired Infections (HAI) estimated at 70% within the first year of practice. The same results were also observed from the infection control monitoring reports by hospitals practicing hand washing initiatives.
Hand washing is a very basic procedure yet very vital in the prevention of HAI that is spread by healthcare personnel. This proposal is designed to establish the effects of poor hand hygiene in the propagation of HAI. Statistics by CDC have indicated almost half of patients admitted in the hospital suffer from the HAI-related complications. It also has been documented and established through research that these infections have resulted in a number of deaths (approximately 100,000 annually). Death is the ultimate effect of the infections though other issues are also evident.

Allegranzi B, Stewardson A, Pittet D. (2012). Nationwide benchmarking of hand hygiene performance. Infect Control HospEpidemiol. Jun.33 (6):621-3. doi: 10.1086/665720. Epub 2012 Apr 19., (2014).Academy of Medical Surgical Nurses. [online] Available at: [Accessed 6 Sep. 2014].
Behnke M, Gastmeier P, Geffers C, Mönch N, Reichardt C. (2012). Establishment of a national surveillance system for alcohol-based hand rub consumption and change in consumption over 4 years. Infect Control HospEpidemiol. 2012 Jun.33(6):618-20.
Bode, L. et al. (2010), Preventing surgical-site infections in nasal carriers of Staphylococcus aureus, New England Journal of Medicine, vol. 362, no. 1, pp.9–17.
Boyce J. M. (2011).Measuring healthcare worker hand hygiene activity: current practices and emerging technologies. Infect Control HospEpidemiol 2011.32:1016-28.
Boyer, A, Vargas, F, Coste, F, Saubusse, E, Castaing, Y, Gbikpi-Benissan, G, Hilbert, G &amp.Gruson, D (2009), Influence of surgical treatment timing on mortality from necrotizing soft tissue infections requiring intensive care management, Intensive care medicine, vol. 35, no. 5, pp.847–853.
Brownson, R. C. (2011). Evidence-based public health. Oxford: Oxford University Press.
Bull, A, Wilson, J, Worth, L, Stuart, R, Gillespie, E, Waxman, B, Shearer, W &amp. Richards, M (2011), A bundle of care to reduce colorectal surgical infections: an Australian experience, Journal of Hospital Infection, vol. 78, no. 4, pp.297–301.
Chambers, K. &amp. Roche, V. (2010).Surgical technology review: certification and professionalism, 1st edn, F.A. Davis Company, Philadelphia.
Costers M, Viseur N, Catry B, Simon A. (2012). Four multifaceted countrywide campaigns to promote hand hygiene in Belgian hospitals between 2005 and 2011: impact on compliance to hand hygiene. Euro Surveill. 3.17(18).
Darouiche, R, Wall Jr, M, Itani, K, Otterson, M, Webb, A, Carrick, M, Miller, H, Awad, S, Crosby, C, Mosier, M (2010). Chlorhexidine–alcohol versus povidone–iodine for surgical-site antisepsis, New England Journal of Medicine, vol. 362, no. 1, pp.18–26.
Dennison, R., &amp. Prevost, S. S. (2012). Future of advanced registered nursing practice. Philadelphia, Pa: Saunders/Elsevier.
Fry, D 2013, Surgical infections, 1st edn, JP Medical Publishers, London.
Fuller C, Michie S, Savage J, McAteer J, Besser S, et al. (2012). The Feedback Intervention Trial (FIT) – Improving Hand-Hygiene Compliance in UK Healthcare Workers: A Stepped Wedge Cluster Randomised Controlled Trial. PLoS ONE.7(10): e41617.
Glanz, Karen. Bishop, Donald B. (2010)."The role of behavioral science theory in development and implementation of public health interventions".Annual review of public health31: 399–418.
Goldsteen, R. L., Goldsteen, K., &amp. Graham, D. G. (2011).Introduction to public health. New York: Springer Pub.
Haynes, A, Weiser, T, Berry, W, Lipsitz, S, Breizat, A, Dellinger, E, Herbosa, T, Joseph, S, Kibatala, P &amp.Lapitan, M (2009), A surgical safety checklist to reduce morbidity and mortality in a global population, Nesw England Journal of Medicine, vol. 360, no. 5, pp.491–499., (2014).United States Department of Health and Human Services, [online] Available at: [Accessed 6 Sep. 2014].
Hix, C, McKeon, L &amp. Walters, S (2009), Clinical nurse leader impact on clinical microsystems outcomes, Journal of Nursing Administration, vol. 39, no. 2, pp.71–76.
In LoBiondo-Wood, G., &amp. In Haber, J. (2014).Nursing research: Methods and critical appraisal for evidence-based practice. Washington, D.C: National Academies Press.
Ivers N, Jamtvedt G, Flottorp S, et al. (2012). Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 13.6:CD000259. doi: 10.1002/14651858.CD000259.pub3.
Jaffe, R (2014).,Anesthesiologists manual of surgical procedures, 5st edn, Lippincott Williams &amp. Wilkins, Philadelphia.
Johnson, J (2010).,Handbook for Brunner &amp.Suddarth: textbook of medical-surgical nursing, 12st edn, Wolters Kluwer/Lippincott Williams &amp. Wilkins, Philadelphia.
Kim, H. S., &amp. Kollak, I. (2006). Nursing theories: Conceptual &amp. philosophical foundations. New York, NY: Springer Pub. Co.
Parker, M. E., &amp. Smith, M. C. (2010). Nursing Theories &amp. Nursing Practice. Philadelphia: F.A. Davis Co.
Lautenbach, E, Woeltje, K &amp. Malani, P (2010). Practical healthcare epidemiology, 3rd edn, University of Chicago Press, Chicago.
Lester, S (2010). Manual of surgical pathology, Saunders/Elsevier, Philadelphia.
Lewis, S, Dirksen, S, Heitkemper, M &amp. Bucher, L 2010, Clinical companion to Medical-surgical nursing: assessment and management of clinical problems, 1st edn, Elsevier/Mosby, St. Louis.
Marra A. R, Edmond M. B. Hand hygiene: state-of-the-art review with emphasis on new technologies and mechanisms of surveillance. Curr Infect Dis Rep 2012. 14:585-91.
McGuckin M, Govednik J. Electronic hand hygiene compliance interventions: a descriptive guide for the infection prevention team. Am J Med Qual 2012.27:540-1.
Monahan, F, Neighbors, M &amp. Green, C 2010, Swearingens manual of medical-surgical nursing care, Mosby Elsevier, St. Louis.
Monnet DL, Sprenger M. Hand hygiene practices in healthcare: measure and improve. Euro Surveill. 2012 May 3.17(18).
Morgan DJ, Pineles L, ShardellM,et al. Automated hand hygiene count devices may better measure compliance than human observation. Am J Infect Control. 2012 Dec.40(10):955-9., 2014, American Nurses Credentialing Center – ANCC. [online] Available at: [Accessed 6 Sep. 2014].
Parker, M. E., &amp. Smith, M. C. (2010).Introducing palliative care. Oxford: Radcliffe Medical Press.
Patil, R, Gaikwad, V &amp.Kulkami, R (2013), A comparative study of chlorhexidine-alcohol versus povidone-iodine for surgical site antisepsis in clean &amp. clean contaminated cases, Journal of Medical Thesis, vol. 1, no, 1, pp. 33-34.
Prevention, C (2014), Centers for Disease Control and Prevention. [online] Available at: [Accessed 6 Sep. 2014].
Pudner, R (2010). Nursing the surgical patient, Elsevier, Edinburgh.
Stewardson A, Pittet D. (2011). Quicker, easier, and cheaper?The promise of automated hand hygiene monitoring. Infect Control HospEpidemiol 2011.32:1029-31.
Stewardson A. J, Allegranzi B., Perneger T. V., Attar H., Pittet D. (2013). Testing the WHO Hand Hygiene Self-Assessment Framework for usability and reliability. J Hosp Infect.83:30-5.
Timby, B &amp. Smith, N (2013).PrepU for Timbysintroductory medical-surgical nursing, 10th edn, Lippincott, William &amp. Wilkins, Philadelphia.
Vincent, C (2010). Patient safety, 2nd edn, Wiley-Blackwell, West Sussex.
Weigelt, J (2012). Surgical critical care, an issue of surgical clinics, Elsevier Health Sciences, London.
White, L, Duncan, G &amp.Baumle, W (2013).Medical-surgical nursing: an integrated approach, 3rd edn, Delmar Cengage Learning, New York.
Winkelman, C, Ignatavicius, D, Workman, M. (2012), Medical-surgical nursing: patient-centered collaborative care, Elsevier Saunders, St. Louis.