University Clinical Audit Report: Handwashing Practices in Polyclinic

This report presents a comprehensive clinical audit conducted to assess hand hygiene practices within a polyclinic setting. The audit begins by defining clinical audit and emphasizing its significance in improving the quality of care and patient outcomes, while also touching upon its role in professional development and clinical governance. The report then outlines the key components of a clinical audit cycle, including preparation, indicator selection, data collection, comparison with standards, and implementation of improvements. The core of the audit focuses on handwashing practices, posing the question of how many healthcare workers adhere to handwashing at critical moments. The rationale highlights the importance of hand hygiene in preventing hospital-acquired infections. The report details the criteria, which is adherence to hand hygiene based on the WHO's five moments, and the standard used, which is the WHO's five moments of hand hygiene, along with the method. The method section describes the steps taken, including planning, setting criteria, data collection, and implementing changes. Finally, it outlines plans for sustaining improvements through feedback and regular assessments. The report concludes by emphasizing the importance of continuous monitoring and improvement in healthcare practices.

Running head: CLINICAL AUDIT
Clinical audit
Name of the student:
Name of the University:
Author’s note

1CLINICAL AUDIT
Section 1
1. Audit is defined as the systematic process of inspection of data, statements, records and
performance of an organization to assess the accuracy of the organizational work process.
In the field of health care, audit is defined as the systematic analysis of performance of
individual staffs and team by collection data on clinical activities and their outcomes. The
ultimate goal of such audit in health care setting is to improve the quality of care and
enhance the likelihood of better patient ca . Thus, it can be said that clinical audit is a
valuable tool to improve the quality of care. It is one of the components of continuous
quality improvement process and all clinical outcomes are assessed against well-defined
standards. It is useful in identifying discrepancies in practice (Esposito and Dal Canton
2014).
Apart from improved patient outcome, clinical audit is also important to advance
professional development. It brings forwards the opportunities of extending clinical training
to staffs and making them aware about current standards of practice. In addition to this,
clinical audit is vital in health care organization as it is one of the cornerstones for clinical
governance. A good clinical audit process allows hospitals to conduct peer reviews, analyse
performance indicators and outcomes, plans areas of improvement and lower the cost
associated with patient care (Furia et al. 2014).
2. Some of the key components of the clinical audit cycle include preparing for the audit,
selecting appropriate indicators or standards, observing practice or data collection,
comparison of data with standards, implement and maintaining improvement related

2CLINICAL AUDIT
changes. These five step approach to clinical audit is a common approach used in most
organization to achieve the purpose of audit process (Esposito and Dal Canton 2014).
Section 2
3.
Audit question and rationale: In any polyclinic, health care staffs come in close contact with
patient and they are exposed to infected bloods or fluids during patient contact or while giving
injections to patient. Health care workers also acquire bacteria on their hand by touching
contaminated surfaces within the patient environment. Thus, this form of person-to-person
contact increases the risk of hospital acquired infection (HCAI), which is a major burden in
health care setting. In such environment, hand washing is the most important strategy to prevent
the transmission of bacteria from person to another (Monegro and Regunath 2018). They need to
engage in hand washing at various important moments during patient contact. However, how far
all health care workers engage in hand washing at all critical moments are not known. Therefore,
to get idea about compliance with hand washing standards and identifying improvement areas,
the clinical audit question that can be posed is :
How many health care workers adhere with hand washing practices at critical moments
during patient contact at the poly clinic?
This question is important to control risk of HCAI and ensure adherence to standard process of
hand hygiene as laid down by WHO.
Criteria: To conduct an audit on compliance to hand hygiene, the criteria that was selected was
adherence to hand hygiene or hand washing. This criterion has been taken because level of

3CLINICAL AUDIT
adherence to hand hygiene practice is the most important measure in the prevention of hospital
acquired infection. The compliance related criteria can indicate how far the set standards are
followed or how much changes are required to achieve the desired criteria (Hammerschmidt and
Manser 2019).
Standard: The standard chosen to assess adherence to hand washing includes the WHO’s five
moments of hand hygiene. It is a standard set by WHO that defines the key moments when
health care workers should perform hand hygiene. It recommends cleaning hands before
touching a patient, before aseptic procedures, after body fluid exposure or risk, after touching a
patient and after touching patient surroundings. The main rationale for choosing this standard is
that it is very relevant for assessing performance in health workers (World Health Organization
2020). In addition, it is an evidence based standard which has been used in many research to
identify health care staffs who are in default of appropriate hand hygiene practices (Shobowale,
Adegunle and Onyedibe 2016).
Method:
Planning for audit: At this stage, it is necessary for the auditor to contact the authorities of the
polyclinic and communicate about the need to conduct an audit on hand washing adherence at
the clinic. This purpose of audit should be explained and all resources needed for the process will
be arranged.
Setting standard/criteria: As hand washing is directly related to risk of HCAI, all the staffs at the
clinical will be observed to find out if they adhere to hand washing practice at all the five
moments as specified by WHO or not. Hence, the minimum level expected from each staff will

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be that they complete all the five moments of hand hygiene to achieve full points in adherence
level.
Data collection: During data collection process, only the policy clinics authorities will be aware
that the staffs are being observed. Other health staffs will not be aware about the audit process.
For each of the staffs in the clinic, the adherence to WHO five moments will be recorded and
total number of staffs will be recorded. Adherence level will be measures based on the numbers
of staffs who follow all the five moments of hygiene.
Implementing change or improvements: If the adherence level among employees is less than
90%, then change will be initiated. The main areas of action will include educating staffs about
the risk associated with hand hygiene and implementing training programs so that staffs have
better idea about hand washing, the ways to overcome barrier during the process and taking
precautions to prevent exposure to pathogens.
Sustaining the improvements: To ensure that all the changes are sustained, feedback from all
staffs will be taken after three or six months. This will be done to find out if training had been
useful for them or they require additional support or resources to comply with WHO five
moments of hand washing. Regular assessment of quality improvement plan post audit will help
sustaining the changes in practice.

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References:
Esposito, P. and Dal Canton, A., 2014. Clinical audit, a valuable tool to improve quality of care:
General methodology and applications in nephrology. World journal of nephrology, 3(4), p.249.
Furia, G., Poscia, A., Azzolini, E., Basso, D., Collamati, A., De Belvis, A.G., Cambieri, A.,
Ricciardi, W. and Volpe, M., 2014. The importance of clinical audit: a comparative analysis of
quality of medical records: Giuseppe Furia. European Journal of Public Health, 24(suppl_2),
pp.cku163-093.
Hammerschmidt, J. and Manser, T., 2019. Nurses’ knowledge, behaviour and compliance
concerning hand hygiene in nursing homes: a cross-sectional mixed-methods study. BMC health
services research, 19(1), p.547.
Monegro, A.F. and Regunath, H., 2018. Hospital acquired infections. In StatPearls [Internet].
StatPearls Publishing.
Shobowale, E.O., Adegunle, B. and Onyedibe, K., 2016. An assessment of hand hygiene
practices of healthcare workers of a semi-urban teaching hospital using the five moments of hand
hygiene. Nigerian medical journal: journal of the Nigeria Medical Association, 57(3), p.150.
World Health Organization 2020. About SAVE LIVES: Clean Your Hands. Retrieved from:
https://www.who.int/gpsc/5may/background/5moments/en/