Facilitation Plan Barriers Assignment Report

Is the use of alcohol based solution in hand washing more effective than soap and
water hand washing inreducing nosocomial infection infections inside a nephrology unit of a hospital? – a
proposed evidence-based practice healthcare change project
Clinical Question
The proposed clinical PICOT question to be considered for the
healthcare change intervention is: “Is the use of alcohol based
solution in hand washing more effective than soap and water hand
washing in reducing nosocomial infection infections inside a
nephrology unit of a hospital?” With respect to the same, the PICOT
components which will guide decision-making for initiation of
healthcare change intervention are:
•P: Population: Adult patients admitted in the nephrology
department
•I: Intervention: Alcohol-based hand rubbing solution as a proposed
hand hygiene practice
•C: Comparison: Soap and water as a hand hygiene practice
•O: Outcome: Reduced rate of nosocomial infections or infection
incidences.
Synthesis of Evidence
While the effectiveness of hand hygiene practices underlying the
prevention of healthcare associated infections has been researched in
abundance, lack of healthcare staff compliance with respect to following
the same continues to prevail. In addition to established of training or
educational based frameworks, the placement of alcohol-based hand
rubbing solution at critical care locations like patient rooms or the
bedside have been proven to improve organizational compliance to
hand hygiene practices (Pires et al., 2017).
Thus, as per the given PICOT question, the proposed healthcare change
intervention necessitates the introduction of alcohol-based hand
rubbing solutions, in comparison to water and soap, as the first line of
hand hygiene protocol to be followed immediately after healthcare
professionals have engaged in invasive procedures or interventions
involving adult patient contact, in the nephrology unit of a chosen
healthcare organization. Alcohol-based hand rubbing solutions have
been evidenced to be a financial feasible and ergonomically compliant
way with which nosocomial infections can be controlled at all almost all
points of patient care without causing dryness as compared to
traditional hand hygiene practices requiring soap and water (WHO,
2020).
Table 1: Proposed Intervention Plan
Project Plan Components Characteristics Timeline
Development of Draft Project Plan To be discussed with supervisor 1st week of March, 2020
Approval of final Project Plan To be discussed with project team members and stakeholders 2nd week of March, 2020
Educational plan formulation Will comprise of designing audiovisual and printed resources containing information on
importance of hand hygiene, types of practices and comparison between soap/water and
alcohol rubbing.
3rd week of March, 2020
Team member roles and project
implementation
 Motivational session by tenured staff and collection of swabs – to be sent for colony
counting
 Deliverance of educational plan by inter-disciplinary team and healthcare professionals
and administration/management.
 Feedback session by tenured staff ad collection of swabs for colony counting
 Final debriefing session and result evaluation.
 Development of new hand hygiene protocols.
1st to 2nd week of April
Equipment required Projectors, laptops, soap, water, alcohol solutions, paper, printers, cotton swabs, colony counter, petri dishes. Medical
costs of injuries to be covered by the organization.
Barriers
The key cultural or educational barrier which
can pave the way for change resistance is
inadequate knowledge or inadequate health
literacy across healthcare staff. There continue
to remain misperceptions and unawareness
concerning replacement of soap and water
with alcohol-based rubbing solutions since it is
commonly believed that the latter is not as
clinical effective as the former (Kingston et al.,
2017). Additional organizational and
administrative barriers which can cause
change resistance include: lack of hand
hygiene protocols at the organizational level,
absence of tenured or champion healthcare
professionals for change facilitation and
misconceptions that alcohol-based solutions
cause dryness and gloves provide adequate
protection as compared to hand hygiene
practices (Bellissimo-Rodrigues et al., 2016).
Project Team
The project team members will comprise of the
researcher, the nursing staff, the operations manager,
healthcare administrator and inter-disciplinary
healthcare professionals like physicians, practitioners
and nephrologists, to assist in not just evidence based
research and policy formulation, but also to facilitate
multidisciplinary approaches to change fulfilment.
Additional key stakeholders who will be involved in the
project team will include tenured nursing staff or
healthcare champions who will not only assist in
delivering educational protocols but will also be useful
in motivating and encouraging staff to comply with
hand hygiene protocols and proposed change
interventions (Kingston, O’Connell & Dunne, 2018).
Facilitation Plan
A transformational leadership approach will be used
to facilitate change and will comprise of encouraging
staff to actively participate in the decision making
activities and also provide their inputs and insights
concerning change implementation. Considering the
need to overcome cultural and organizational
barriers, change will be facilitated via educational
and administration interventions. This will comprise
of including staff in an educational workshop on
effectiveness of alcohol solutions for hand hygiene
as well as formulation of novel organizational
policies, protocols, rules and regulations which will
necessitude the placement and usage of alcohol-
based solutions at critical points of patient care
(Kramer et al., 2017).
References
Bellissimo-Rodrigues, F., Soule, H., Gayet-Ageron, A., Martin, Y., & Pittet, D. (2016).
Should alcohol-based handrub use be customized to
healthcare workers’ hand size?. infection control &
hospital epidemiology, 37(2), 219-221.
Gudza-Mugabe, M., Magwenzi, M. T., Mujuru, H. A., Bwakura-Dangarembizi, M.,
Robertson, V., & Aiken, A. M. (2017). Effect of
handrubbing using locally-manufactured alcohol-based
handrubs in paediatric wards in Harare, Zimbabwe.
Antimicrobial Resistance & Infection Control, 6(1), 8.
Kingston, L. M., O’Connell, N. H., & Dunne, C. P. (2018). A comparative study of hand
hygiene and alcohol-based hand rub use among Irish
nursing and medical students. Nurse education today,
63, 112-118.
Kingston, L. M., Slevin, B. L., O'Connell, N. H., & Dunne, C. P. (2017). Attitudes and
practices of Irish hospital-based physicians towards
hand hygiene and hand rubbing using alcohol-based
hand rub: a comparison between 2007 and 2015.
Journal of Hospital Infection, 97(1), 17-25.
Kramer, A., Pittet, D., Klasinc, R., Krebs, S., Koburger, T., Fusch, C., & Assadian, O. (2017).
Shortening the application time of alcohol-based hand
rubs to 15 seconds may improve the frequency of hand
antisepsis actions in a neonatal intensive care unit.
infection control & hospital epidemiology, 38(12), 1430-
1434.
Pires, D., Soule, H., Bellissimo-Rodrigues, F., Gayet-Ageron, A., & Pittet, D. (2017). Hand
hygiene with alcohol-based hand rub: how long is long
enough?. infection control & hospital epidemiology,
38(5), 547-552.
WHO. (2020). WHO | System change - changing hand hygiene behaviour at the point of
care. Retrieved 11 February 2020, from
https://www.who.int/gpsc/tools/faqs/system_ change/en/.
Evaluation Plan
Outcomes will be measured on an ongoing basis via the inclusion of weekly debriefing
and group discussion sessions where participating staff, project team members and
stakeholders will discuss and share strengths, limitations and potential improvement
areas. Outcomes of nosocomial infections can include pre and post intervention colony
counts of hand swabs as well as organizational samples for prevalence of common
infection-causing bacterial strain such as Acinetobacter, Staphylococcus, Clostridium
species and Escherichia coli (Gudza-Mugabe et al., 2017).