Improving Nurses Hand Hygiene: Work-Based Project

This project aims to improve hand hygiene practices among nurses in healthcare organizations through educational interventions. The project design includes training sessions and data analysis to assess the knowledge level of healthcare staff. The expected outcome is an increase in knowledge and a decrease in healthcare-associated infections.

SNPG 905: Minor Project
Project Proposal
Improving nurses Hand Hygiene: work-based project
Autumn Session 2019
PratikshyaBhattarai
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Introduction
Hand hygiene is considered to be the cheapest and simplest element that assists to prevent
infections (Bauer, 2017). Practicing hand hygiene is considered to be the most effective way of
preventing infections. It is very much important to clean hands in order to spread of germs and it
becomes difficult to treat. The spread of germs and infections are considered to be a major
concern because it increases morbidity and mortality among people. The hands of a health
service provider should be kept clean and germ-free because it can be transmitted to the patient
while providing healthcare services (Guidet, Valentin &Flaatten, 2016). Old peoples are more
prone to infections because of low functioning of the immune system. Inappropriate practising of
hand hygiene imposes a significant impact on the quality of care provided to the resident in
nursing homes. The staffs should focus on adopting infection control measures such as washing
hands in order to decrease healthcare-associated infections (Russo, 2009).
The healthcare providers should wash their hands with water and soap as well as use sanitizers to
ensure cleanliness and hygiene within the work process. Clean hands of health workers help to
eliminate the carriage of germ that helps to prevent diseases and infections (Blumstein, 2014).
Appropriate hand hygiene is considered to be an only appropriate, simple and inexpensive way
to minimize the healthcare-associated infections in the health care system. Proper hand hygiene
resists the carriage of pathogens in the hands of health care professionals (Monnet & Sprenger,
2012).
The increase in the infections due to the respiratory and gastro-intestinal eruptions can be seen in
residential aged care (Bosek & Shaner-McRae, 2010). Experience is being shared as a registered
nurse in residential aged care. Health care staffs are the one who first comes in contact with the
elder people while providing them care such as dressing, feeding, toileting, shower etc. They
should have knowledge of the fact that the key to reducing infections is appropriate to hand
hygiene (Bauer, 2017). A project on examining the healthcare-associated infections will be
carried out and the main focus would be on "improving the level of knowledge regarding the
significance of hand hygiene for the healthcare providers through educational interventions in the
aged care facility”. The research will provide significant information and theories about the
topic. The collection of evidence and data will assist to improve the quality of the research topic.
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In 38 hospitals of Australia monthly infection rates were analysed for six different kinds of
healthcare-associated infections. The adoption of National Hand Hygiene Initiatives has assisted
to decrease the increasing rate of infection (Ryan et al., 2015). The National Hand Hygiene
Benchmark was being introduced by the Australian Health Ministers' Advisory Council. The
benchmark was being set to 80% from 2017 onwards. It was being found that hospital staffs have
83 per cent compliance with the hand hygiene practice (HHA, 2019). WHO focuses on health
facilities for preventing the healthcare associated infections through infection prevention and
control action and hand hygiene (WHO, 2019). It is estimated that Sepsis affects more than 30
million patients in each year all over the world. The project will assist to increase the level of
knowledge among health care staffs regarding the importance of hand hygiene practice. Before
providing the information, it is important to examine the level of knowledge of the healthcare
staffs. It is the responsibility of the management team of the healthcare organizations to develop
a guideline and ensure that the staffs are focusing on hand hygiene.
Aim
The aim of the research is to improve hand hygiene practices among the nurses within the
healthcare organization.
Objective
The objective is to provide all the necessary facilities, tools and techniques to the nurses in order
to achieve appropriate hand hygiene practices.
Project design and method
Project setting
A project will conduct in a nursing home and experiences as a healthcare provider. The nursing
home consists of 100 beds which consisted of residents who need adequate healthcare services.
The project will be carried out within a structured framework with the use of appropriate tools
and techniques.
Project Design
The project is to be carried out in a nursing home and experienced is to be shared as a registered
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nurse. The SMART technique (Specific, Measurable, Achievable, Realistic and Time-bound)
will be used to develop this project. Infections do breakout in the nursing home due to a lack of
knowledge regarding the significance of hand hygiene. The staffs should comply and follow to
the hand hygiene technique. It is very much important to enhance knowledge and ensure
acquiescence with the hand hygiene practice among the health care staffs of the nursing home
(Longuenesse et al., 2017).
Firstly, the project will be discussed with the manager of the nursing home in order to gain
approval. A printed copy of the project details will be provided to the project manager. The
selection of the participants will be on a voluntary basis. The name of the participants will be
written in paper and signed thereafter.
Intervention
A training session will be carried out in order to teach the nurses about the importance of hand
hygiene. The training session will also be conducted for three hours that will incorporate
lectures, group-discussions, audio-visual demonstration, power-point slides, posters and youtube
videos. The main focus would be on the significance of maintaining hand hygiene. Proper steps
will also be demonstrated to the health care staffs (Stewardson et al., 2015). Hand hygiene
practices will taught to the nurses that can be used in different healthcare service delivery
processes. A post a picture will be provided over the basin showing proper steps of washing
hand. This post will act as a reminder for the health care staffs to wash their hands properly
(Blumstein, 2014). The training session will be conducted on a regular basis and different
educational tools and techniques will also be used for educating the nurses. The nurses would be
able to gather knowledge about how they will manage their works and patients by ensuring hand
hygiene. Books, videos and posters will be provided to the nurses to learn hand hygiene (Pittet,
Boyce & Allegranzi, 2017).
Sample size
The project will be completed in a month (4 week period). Health care staffs will be the
participants in this project and with their consent. There would be around 22 healthcare workers
who will contribute their efforts.
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Data collection tools
The questionnaire would be prepared which consists of ten questions on the hand hygiene and
healthcare-associated infections in order to analyse the level of knowledge of the healthcare
staffs. Pre-testing and post-testing sessions would be carried out before and after 20 minutes of
the intervention to access the knowledge level of care staff educational intervention.
Data analysis
The scores of pre-testing and post-testing will be analysed of each healthcare staffs. The scores
would assist to determine and categorize the level of knowledge (0-3 will depict an inadequate
level of knowledge, 4-7 depicts satisfactory level and 8-10 depicts adequate knowledge). SPSS
would be used for analysing the data and co-related T-test would be used for evaluating the
outcome.
Expected Outcome
The knowledge of health care staff’s will enhance after conducting this project. The result will be
analysed by estimating and post-testing and pre-testing scores of the staffs. It is being expected
that more than 75 per cent of the healthcare staffs will have an appropriate level of knowledge
about the topic after the intervention. The improved knowledge of the health care staffs will
control and prevent infections in health care association. Healthcare-associated infections cause a
huge economic burden for both health facilities and residents. To prevent and control the
transmission of infections it is important to implement the control measures. To provide proper
care to the residents it is important to implement the control measures. Research studies
conducted at various intervals do suggest that there is negligible compliance for appropriate hand
washing practices among the health care staffs. Thus, nurse staffs should be provided with
adequate education about appropriate hand hygiene which needed during the healthcare
processes. Clean hands ensure high quality and safety for the patients.
Feasibility
Healthcare-associated infections have led to an increase in morbidity, mortality and
expenditures. Elderly individual faces more problems because they are more prone to the
infections because they have a weak immune system which is not so efficient in fighting with the
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germs. Hand hygiene needs to be taken into account for decreasing the rate of infection within
the healthcare system.
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References
Bauer, A. (2017). The Danger Within: Confronting the Challenge of Healthcare-Associated
Infections. Biomedical Instrumentation & Technology, 51(1), 12-23. doi: 10.2345/0899-
8205-51.1.12
Blumstein, S. (2014). Improving Hand-hygiene Compliance and Reducing Healthcare-
Associated Infections with Automated Hand-hygiene Compliance Monitoring. American
Journal Of Infection Control, 42(6), S117-S118. doi: 10.1016/j.ajic.2014.03.257
Blumstein, S. (2014). Improving Hand-hygiene Compliance and Reducing Healthcare
Associated Infections with Automated Hand-hygiene Compliance Monitoring. American
Journal Of Infection Control, 42(6), S117-S118. doi: 10.1016/j.ajic.2014.03.257
Bosek, M., & Shaner-McRae, H. (2010). Hand Hygiene as Standard Practice. JONA's
Healthcare Law, Ethics, And Regulation, 12(4), 101-105. doi:
10.1097/nhl.0b013e3181fcf82b
Campion, K. (2015). Don’t forget hand care when promoting hand hygiene in hospitals. BMJ,
h4436. doi: 10.1136/bmj.h4436
Guidet, B., Valentin, A., & Flaatten, H. (2016). Quality Management in Intensive Care (3rd ed.).
Cambridge: Cambridge University Press.
HHA. (2019). National Hand Hygiene Benchmark. Retrieved from
https://www.hha.org.au/audits/national-data/national-hand-hygiene-benchmark
Longuenesse, C., Lepelletier, D., Dessomme, B., Le Hir, F., & Bernier, C. (2017). Hand
dermatitis: hand hygiene consequences among healthcare workers. Contact
Dermatitis, 77(5), 330-331. doi: 10.1111/cod.12825
Monnet, D., & Sprenger, M. (2012). Hand hygiene practices in healthcare: measure and
improve. Eurosurveillance, 17(18). doi: 10.2807/ese.17.18.20166-en
Pittet, D., Boyce, J., & Allegranzi, B. (2017). Hand Hygiene (4th ed.). Somerset: John Wiley &
Sons, Incorporated.
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Russo, P. (2009). Hand Hygiene Australia: Synopsis. Healthcare Infection, 14(1), 11. doi:
10.1071/hi09005
Ryan, K., Havers, S., Olsen, K., Stewardson, A., Cruickshank, M., & Grayson, M. (2015). The
keys to success: initial findings from the Hand Hygiene Australia (HHA) program
review. Antimicrobial Resistance And Infection Control, 4(S1). doi: 10.1186/2047-2994-4-
s1-p144
Sastry, A., R, D., & Bhat, P. (2017). Impact of a hand hygiene audit on hand hygiene compliance
in a tertiary care public sector teaching hospital in South India. American Journal Of
Infection Control, 45(5), 498-501. doi: 10.1016/j.ajic.2016.12.013
Sreeramoju, P. (2019). Recent advances in understanding the epidemiology of healthcare-
associated infections. F1000research, 8(3), 106. doi: 10.12688/f1000research.15891.1
Stewardson, A., Russo, P., Cruickshank, M., & Grayson, M. (2015). Implementation of the
Australian national hand hygiene initiative. Antimicrobial Resistance And Infection
Control, 4(S1). doi: 10.1186/2047-2994-4-s1-o46
WHO. (2019). SAVE LIVES: Clean Your Hands. Retrieved from https://www.who.int/infection-
prevention/campaigns/clean-hands/5may2018/en/
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Appendix A
Proposed Time Frame
This project will be done for one month of time that includes the following programmes:
Week Activities
Week 1  The project will be explained to the manager of the nursing
home.
 Project approval would be taken from the manager of the
nursing home.
 Literature review and gathering appropriate information
 Preparing posters, lesson planning and power-point slides for
educating health care staffs.
Week 2  Evaluating the outcome with post-testing and pre-testing
Week 3  Examination of data collected
Week 4  Preparing the report
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Appendix B
Questionnaire
1. Hand hygiene is the act of washing hand by.........
a. Water and soap
b. Antimicrobial soap
c. Hand rubbing alcohol
d. All of the above
2. The main objective to maintain hand hygiene is to.........
a. Maintaining skin integrity
b. Controlling the spread of infection
c. Minimizing microorganisms on the hands.
d. All of the above
3. When should we carry out hand hygiene?
a. After handling the patient
b. Before handling the patient
c. After carrying out any procedure
d. Before carrying out any procedure
e. When you leave or enter the facility
f. All of the above
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4. After hand washing, the faucet needs to be turned off by using.....
a. Top of the hand
b. The elbow
c. Paper towel
5. Duration of entre procedure of hand washing is.....sec.
a. 5-10
b. 10-20
c. 20-40
d. 40-60
6. How long the alcohol based hand rub should be applied?
a. 10 secs
b. 20 secs
c. 30 secs
d. 40 secs
7. Healthcare staffs are the main reason to spread infection. Thus, if the hands of the healthcare
providers are clean then it can be prevented.
a. True
b. False
8. ...... is the main source of pathogen's cross-transmission between the patients in the health
care system.
a. Hands of care provider if not clean
b. Circulating air in facility
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c. Exposure of resident to colonized surfaces
d. Sharing of the non-invasive objects9. Other measures which can be applied for ensuring
hand hygiene in order to reduce the cross contamination
a. Covering of abrasions and cuts present
b. Clean and short nails
c. Wearing no nail polish
d. Arm bearing below elbow
e. All of the above
10. If hand are soiled visibly.....if appropriate method of hand hygiene.
a. Washing hand with water and soap
b. Using alcohol based hand solution for rubbing hands
c. Wiping hands in cold water
d. Clothes soaked in water and soap used to wash hand
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