Clinical Practice Improvement Project: Hand Hygiene in Nursing

This report details a clinical practice improvement project aimed at reducing hospital acquired infections (HAIs) through hand hygiene training and education for nursing professionals. The project utilizes the PICO format to define the population, intervention, context, and outcome, focusing on increasing hand hygiene compliance and decreasing HAIs, healthcare costs, and hospital stays. The project aligns with clinical governance principles, particularly clinical risk management, and emphasizes the significance of the issue, supported by evidence highlighting the prevalence and impact of HAIs. The PDSA cycle is employed as the CPI tool, outlining the plan, do, study, and act phases. Proposed interventions include training nursing staff and family of carers on hand hygiene protocols, using presentations, posters, and hands-on training. Project audits involve mid-point reviews, MCQ assessments, and open-ended questionnaires to evaluate training effectiveness and monitor the decrease in HAIs. The report also addresses potential barriers to implementation and provides an evaluation strategy using surveys and questionnaires to assess knowledge and compliance levels. The project's success is measured by reductions in HAIs and hospital stay durations.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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NURS2006 ASSIGNMENT 5
Clinical Practice Improvement Project Report
Student Name, FAN and ID:
Project Title:
Do training and education of hand hygiene among the nursing professionals helps to reduce
the incidence of hospital acquired infection by increasing awareness among the nurses and
thereby helping to decrease the healthcare cost and length of stay in hospital?
PICO format
1. Population: Nursing professionals
2. Intervention: Hand hygiene training and education
3. Context: Hospital acquired infection
4. Outcome: Increase awareness of hand hygiene and decrease in the incidence of
hospital acquired infection (HAIs) through contact contamination and decrease in
length of hospital stay and health care cost
Project Aim:
The aim of the project is increase the hand hygiene compliance among the nursing
professionals and measure the rate of decrease in the incidence of hospital acquired infection
post training session
Relevance of Clinical Governance to your project
The four pillars of clinical governance includes: Clinical Effectiveness, Clinical risk
management, Patient experience, Professional development and management. The main pillar

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of the clinical governance which is relevant to this project is clinical risk management. This is
because the project aims to highlight how the compliance of hand hygiene helps decrease the
risk of developing hospital acquired infection. The development of the hospital acquired
infection is enlisted as a potential clinical risk. Apart from increasing the length of stay in
hospital and increase in the overall cost of care, the nosocomial infection also increases the
clinical risk. The development of the hospital acquired infection through multidrug resistant
bacteria increases the overall fatal risk of the patients (Yallew, Kumie & Yehuala, 2017). Ray
et al. (2017) are of the opinion that the hospital acquired infection like methicillin resistant
Staphylococcus aureus (MRSA) are highly contagious and once infected, it colonises to
different parts of the body leading to the development of skin infection, infection at the site of
surgical wound, bloodstream, lungs and urinary tract. Such multidrug resistant infection is
difficult to cure and can affect the surrounding patients along with other healthcare
professionals and thus increasing the overall clinical risk.
Evidence that the issue / problem is worth solving:
According to Hor et al. (2016) hospital acquired infection or healthcare-associated infections
(HAIs) are one of the frequently occurring adverse events which hampers the quality of care.
As per the systematic review conducted by Mitchell et al. (2017) via the analysis of the
papers published in between 2010 to 2016, there are 165,000 reported cases of HAIs
occurring in Australia each year. The review conducted by Mitchell et al. (2017) also stated
that the main outcome of the HAIs under the Australian setting is increase in the rate of
urinary tract infection, Clostridium difficile infection, and surgical site infection, respiratory
tract infection among the patients who are recovering from acute stroke and skin or wound
site infection by Staphylococcus aureus. Other data reports the increase in the occurrence of
the pulmonary infection leading to pneumonia, gastrointestinal infection leading to stomach
upset and blood stream infection leading to sepsis. This increase in the tendency of infection

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increases the overall cost of care, increase in the length of hospital stay along with hamper in
the overall health-related well-being of the patients and their family members (Brewster,
Tarrant & Dixon-Woods, 2016). With the generation of the multidrug resistant bacteria, the
conditions are becoming worse because the HAIs developed through multidrug resistant
bacteria has no cure or definite antimicrobial therapy (Brewster, Tarrant & Dixon-Woods,
2016). Brewster, Tarrant and Dixon-Woods (2016) highlighted touch contamination as the
main source of HAIs. The hands of the healthcare workers are regarded as the primary vector
behind the transmission of micro-organisms between the patients and the surrounding
healthcare environment. Since the nursing professionals devote majority of their time with
the patient, they are highlighted as the principal target behind the spread of HAIs through the
touch of contaminated hands (Pan et al., 2014). According to Shinde and Mohite (2014)
under extreme pressure, the nursing professionals fail to abide by proper hand hygiene
protocol while procuring care to their patients. They also lack proper knowledge, attitude and
practices of five moments of hand hygiene among the nursing professionals as proposed by
the World Health Organisation (WHO). Huis et al. (2012) that that the proper knowledge of
the nursing professionals towards the compliance of the hand hygiene to reduce the chances
of developing HAIs. Monistrol et al. (2012) stated that use of hand hygiene mainly comprise
the alcohol based hand rub as a multimodal intervention to prevent HAIs.
Key Stakeholders:
1. Nursing professionals: They are the main target for training program as according to
NMBA Code of Professional Conduct (2018), the nurses are required to practice in a safe and
competent manner
2. Educators: They can be experienced and registered nursing professionals who will help to
increase the awareness about importance of hand hygiene among nurses

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3. Family of carers: Their education and awareness will help to prevent spread of infection
while the patient is discharged
4. Patients: Education of patients will help to promote self-awareness and infection control
CPI Tool:
According to NSW Health (2018), CPI stands for Clinical Practice Improvement Training
Program. This training program assists the healthcare professionals to address clinical
problem which is adversely affecting the patients and thereby helping to improve the overall
quality of care. The methodology once learned can be applied under a variety of clinical
settings and thus ensuring patients’ security and care quality. The training also helps to
increase the skills of the healthcare professionalsThe CPI tool that will be taken into account
for this project is PDSA cycle or Plan, Do, Study, Act Cycle. According to NSW
Government (2018), PDSA’s are narrow on focus and can be implemented quickly over small
domain of work for continuous improvement. The ‘P’ stage helps to identify the key
measures of the project, tasks assigned against it and the expected outcome. ‘D’ stage deals
with implementation of the agreed plan through proactive approach in order to fix the
identified problem. ‘S’ signifies study of the process and ‘A’ signifies development of new
standards of practice.
The application of PDSA in accordance within the scope of the project. Under Plan (P), the
proper identification of the key measures will include analysis of the process or the pattern of
the training and educational program for the nursing professionals and the family of carers.
The expected outcome will be increase in the level of awareness among the nursing
professional and family of carers for the compliance of hand hygiene. To Do (D) will be
rigorous training and awareness of the nursing professionals along with the family of carers.
The training will be done under the hospital settings with the use of power-point presentation

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and use of posters and hands of training. Study (S) section will include review of the entire
training process in order to judge the knowledge acquired by the nursing professionals and
the family of carers. This review will be done through MCQ question related to hand hygiene
compliance and prevention of HAIs. Another survey will be conducted through open-ended
questionnaire in order t judge the overall experience of the training process by the
participants. This approach will help to bring positive change in the training process in future.
Act (A) will involve development of new standards for the proper application and compliance
of hand hygiene. Like compliance of WHO 5 steps of hand hygiene protocol.
Summary of proposed interventions:
Problem highlighted: Increase in the rate of hospital acquired infection and increased in the
length of stay in hospital among the patients
The interventions proposed: Training of the nursing professionals in the domain of
importance of hand hygiene and increase in the compliance of hand hygiene through WHO 5-
setps of hand hygiene protocol. Training will be given to the family of carers along with the
patients
The successful application of intervention will be done through proper training of the nursing
professionals. The family of carers and the patients will also be included in the training
process. The training and education will help to increase their level of compliance and
understanding the importance of hand hygiene.
Project design: Teaching the nursing professionals about the importance of hand hygiene in
preventing of the HAIs through poster presentation and power-point presentation orated by
experienced and trained registered nursing professionals under hospital settings. Training will
also involve training and awareness generate among the family of carers of the patients
through face-to-face training approach. They will be trained separately. Education and

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awareness will be generated in the domain of multi-modal intervention of hand hygiene
protocol and importance is the use of alcohol based hand-rub and use of personal protective
equipments like hand gloves (Loveday et al., 2014).
Project audit: Mid-point review after 2 days of face-to-face training in order make further
improvement in the training process from the feedbacks of the participants. Other audits will
be done through the use of MCQ questions in order to assess the level of understanding of the
nursing professionals and other participants in the domain of hand hygiene. Additional audit
will be done in order to analyse the decrease in the level of HAIs and increase in compliance
of hand hygiene by the nursing professionals (NSW Government Healthy, 2018).
The MCQ questions that will be used to judge the proficiency level of the participants of the
training post training session will be marked against zero or one. For each correct answer
marks assigned will be one and for each wrong answer, marks assigned will be zero. There
will be no negative marking. The feedback process within the middle of the training will be
done through the use of open ended-questionnaire and accordingly modification of the
training process will be undertaken (Perkins et al., 2013).
The outcome of the training will be ascertained from the decreases in the number of the
hospital acquired infection, decrease in the length of stay in the hospital as obtained from the
hospital data
Time period: The time period for the completion of the project is 1 week of training and
education and evaluation of the outcome after 3 months of training
Barriers to implementation and sustaining change:
The main barriers towards the implementation and sustaining the change include inadequate
resources, financing of the project, the time limit of the project, lack of necessary skills.

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The structuring of the training process will require proper set-up for power-point and poster
presentation along with proper fees to the training. For these funding and resources must
come from the concerned hospital authority of other government funding (Andrew Scanlon et
al., 2014). Lack of proper funding and resources will hamper the quality of training. The time
limit for the training is proposed for one week and the process of evaluation after 3 months of
training. This training process might hamper or increase the work hours of the nursing
professionals leading to decrease in the overall participation (Li & Jones, 2013). Nurses must
be unwilling to participate in training audit process leading to decrease in the overall scope of
the training. The educators of the trainer can lack the necessary skills of training leading to
decrease in the overall quality and hampering the expected outcome (Li & Jones, 2013).
Evaluation of the project:
The evaluation of the CPI project will be done through surveys and the use of open and close
ended questionnaire.
The close ended questionnaire with options (Multiple choice questions) will help to access
the level of knowledge of the nursing professionals in the domain of hand hygiene and HAIs
post training session. For against each correct answer score of one will be awarded and
against wrong answer zero will be awarded. The total score will help to analyse the increase
in the level of knowledge (Li & Jones, 2013).
The increase in the level of compliance will be ascertain via doing analysis of the hospital
data for detecting hospital acquired infection rate and increase in the length of stay in the
hospital due to HAIs. This will be done post 3 months of training and the last one month of
data will be accessed (Perkins et al., 2013).
The nature and the process of training will be evaluated through feedbacks from the

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participants of the training process through open-ended questionnaire (Li & Jones, 2013).

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References
Andrew Scanlon, D. N. P., Denise Hibbert, R. G. N., Freda DeKeyser Ganz PhD, R. N.,
Linda East PhD, R. N., & Debbie Fraser MN, R. N. (2014). Addressing issues
impacting advanced nursing practice worldwide. Online Journal of Issues in
Nursing, 19(2), 1.
Hor, S. Y., Hooker, C., Iedema, R., Wyer, M., Gilbert, G. L., Jorm, C., & O'sullivan, M. V.
N. (2016). Beyond hand hygiene: a qualitative study of the everyday work of
preventing cross-contamination on hospital wards. BMJ Qual Saf, bmjqs-2016.
Huis, A., van Achterberg, T., de Bruin, M., Grol, R., Schoonhoven, L., & Hulscher, M.
(2012). A systematic review of hand hygiene improvement strategies: a behavioural
approach. Implementation Science, 7(1), 92.
Li, Y. I. N., & Jones, C. B. (2013). A literature review of nursing turnover costs. Journal of
nursing management, 21(3), 405-418.
Loveday, H. P., Wilson, J., Pratt, R. J., Golsorkhi, M., Tingle, A., Bak, A., ... & Wilcox, M.
(2014). epic3: national evidence-based guidelines for preventing healthcare-associated
infections in NHS hospitals in England. Journal of Hospital Infection, 86, S1-S70.
Mitchell, B. G., Shaban, R. Z., MacBeth, D., Wood, C. J., & Russo, P. L. (2017). The burden
of healthcare-associated infection in Australian hospitals: a systematic review of the
literature. Infection, Disease & Health, 22(3), 117-128.
Monistrol, O., Calbo, E., Riera, M., Nicolás, C., Font, R., Freixas, N., & Garau, J. (2012).
Impact of a hand hygiene educational programme on hospital‐acquired infections in
medical wards. Clinical Microbiology and Infection, 18(12), 1212-1218.

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NSW Government Healthy. (2018). Clinical Practice Improvement (CPI) Training Program.
Access date: 29th October 2018. Retrieved from:
http://www.eih.health.nsw.gov.au/initiatives/clinical-practice-improvement-training-
program
NSW Government Healthy. (2018). Plan, Do, Study, Act Cycle. Access date: 29th October
2018. Retrieved from: https://www.health.nsw.gov.au/pfs/Pages/pdsa.aspx
Nursing and Midwifery Board of Australia [NMBA]. (2018). Code of Professional Conduct
of Nurses in Australia. Access date: 29th October 2018. Retrieved from:
https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/
professional-standards.aspx
Pan, S. C., Lai, T. S., Tien, K. L., Hung, I. C., Chie, W. C., Chen, Y. C., & Chang, S. C.
(2014). Medical students' perceptions of their role as covert observers of hand
hygiene. American journal of infection control, 42(3), 231-234.
Perkins, A., Burton, L., Dray, B., & Elcock, K. (2013). Evaluation of a multiple-mini-
interview protocol used as a selection tool for entry to an undergraduate nursing
programme. Nurse education today, 33(5), 465-469.
Ray, P., Manchanda, V., Bajaj, J., Chitnis, D. S., Gautam, V., Goswami, P., ... & Rao, R.
(2013). Methicillin resistant Staphylococcus aureus (MRSA) in India: prevalence &
susceptibility pattern. The Indian journal of medical research, 137(2), 363.
Shinde, M. B., & Mohite, V. R. (2014). A study to assess knowledge, attitude and practices
of five moments of hand hygiene among nursing staff and students at a tertiary care
hospital at Karad. International Journal of Science and Research (IJSR), 3(2), 311-
321.

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Yallew, W. W., Kumie, A., & Yehuala, F. M. (2017). Risk factors for hospital-acquired
infections in teaching hospitals of Amhara regional state, Ethiopia: A matched-case
control study. PloS one, 12(7), e0181145.