Healthcare EB Practice Change Assignment: Hand Hygiene

This assignment presents a proposed evidence-based practice (EBP) change within a nephrology unit, advocating for the use of alcohol-based hand rub solutions over soap and water to reduce nosocomial infections. The student identifies barriers to implementing this change, including lack of awareness, misperceptions, and organizational culture resistance. To overcome these barriers, the assignment suggests educational programs, protocol implementation, and transformational leadership. Key colleagues, such as senior nurses, physicians, and administrators, are identified to facilitate the change. Stakeholders include healthcare professionals, nursing leaders, managers, and administrators. The assignment thoroughly addresses the PICOT question, anticipated challenges, and strategies to ensure effective implementation of the proposed EBP change.

ALL WORK AND NO PLAN MAKES FOR A DISASTER
State your proposed EB practice
change, 15 points
The proposed EBP healthcare organization change
is centered around the PICOT Question: “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?”
Despite the proven effectiveness of effective hand
hygiene practice for preventing infections, there
continues to be non-compliance concerning the
same (Musu et al., 2017). Placing alcohol based
hand rubbing solutions at the point of care,
coupled with educational protocols have been
evidenced to correct this organizational issues.
The identified PICOT, thus implies the need to
introduce alcohol based hand rubbing solutions as
the first option of hand hygiene practices, in
addition to soap and water based solutions,
immediately after patient contact and invasive
procedures in a nephrology unit of a healthcare
organization (Siddiqui et al., 2017). As per the
World Health Organization (WHO, 2020), alcohol
based hand rubbing solutions are an ergonomically
and cost effective way to prevent the transmission
nosocomial infection, which do not harm or cause
skin dryness and can be placed effectively at
patient points of care in comparison to soap and
water based hand washing practices.

Describe the anticipated barriers to
the change process in your
institution (or where the change will
be implemented). Include the
organization's culture, anticipated
reaction to change, and your
leadership role for change. 20
points
Despite its proven effectiveness, it is likely that this
proposed organizational and behavior change is
likely to be encountered with barriers. One of the
key barriers which are likely to occur as a result of
this change is inadequate awareness or knowledge.
Healthcare professionals are generally reluctant to
replace soap and water hand washing with alcohol
hand rubbing practices since they are not aware
that the latter is as effective as the former in the
prevention of nosocomial infections (Presterl et al.,
2019).
Additionally barriers which may interfere with the
implementation of these barriers include:
misperceptions that gloves are enough to prevent
infection and that alcohol solutions can cause skin
dryness similar to soap and water, absence of
alcohol hand rubbing solutions at the point of care
and an organizational culture where there are no
specific hand hygiene protocols or healthcare
champions who may facilitate change. All these
barriers are likely to facilitate a negative reaction
associated with resistance to change at the
organization or time of change implementation
(Mearkle et al., 2016).
Thus, to facilitate change, the researcher/nursing
student formulating the change proposal must
adopt a transformational leadership role where he
or she must inspire, motivate staff to engage in
change and actively allow them to provide their
feedback and participate in the decision-making
process associated with hand hygiene change
implementation (Forer, Block & Frenkel, 2017).

Plans to overcome barriers
20 points
Since change barriers are largely associated with
unawareness and misperceptions concerning the
effectiveness of alcohol hand rubbing solutions, one of the
key plans will include implementation of an educational or
training program which can disseminate information to
staff regarding the same. Additionally, formulation and
implementation of hand hygiene protocols related to
alcohol hand rubbing can also educate and guide staff on
effectively implementing the same (Samjha et al., 2019).
Who are the colleagues you will
include to facilitate change?
20 points
Senior or experience nursing staff, that is
organizational ‘champions’ coupled with physicians
and general practitioners of the organization are the
colleagues who will assist in facilitating change. This
is because the functions of the nursing workforce
are not just facilitated ad influenced by nursing
leaders or nurse practitioners but also via a
multidisciplinary team of additional healthcare
professionals (West, Resendiz & Lustik, 2018).
Identify the stakeholders for the
change in practice you have chosen
for your EB project. 20 points
In addition to healthcare professionals and nursing
leaders as identified above, the key stakeholders who
have been chosen for this EBP change are the
managers and administrators of the concerned
healthcare organization. This is because of the role of
these stakeholders in designing and implementing
organizational rules, regulations and protocols of hand
hygiene which can in turn facilitate health behavior
change in the staff (West, Resendiz & Lustik, 2018).

References Forer, Y., Block, C., & Frenkel, S. (2017). Preoperative
hand decontamination in ophthalmic surgery: a
comparison of the removal of bacteria from
surgeons’ hands by routine antimicrobial scrub
versus an alcoholic hand rub. Current eye
research, 42(9), 1333-1337.
Mearkle, R., Houghton, R., Bwonya, D., & Lindfield, R.
(2016). Barriers to hand hygiene in ophthalmic
outpatients in Uganda: a mixed methods
approach. Journal of ophthalmic inflammation
and infection, 6(1), 11.
Musu, M., Lai, A., Mereu, N. M., Galletta, M.,
Campagna, M., Tidore, M., ... & Mura, P. (2017).
Assessing hand hygiene compliance among
healthcare workers in six Intensive Care
Units. Journal of preventive medicine and
hygiene, 58(3), E231.
Presterl, E., Diab-El Schahawi, M., Lusignani, L. S.,
Paula, H., & Reilly, J. S. (2019). Hand Hygiene.
In Basic Microbiology and Infection Control for
Midwives (pp. 17-27). Springer, Cham.
Samiha, K., Modupe, O., Edward, S., Karen, V., Morgan,
K., & Greenough, W. B. (2019). Can educational
speech intervention improve visitors hand
hygiene compliance?. Journal of Hospital
Infection.
Siddiqui, N., Friedman, Z., McGeer, A., Yousefzadeh, A.,
Carvalho, J. C., & Davies, S. (2017). Optimal
hand washing technique to minimize bacterial
contamination before neuraxial anesthesia: a
randomized control trial. International journal
of obstetric anesthesia, 29, 39-44.
West, G. F., Resendiz, M., & Lustik, M. B. (2018).
Assessing hand hygiene attitudes of inpatient
nursing personnel in a US military
hospital. Journal of Hospital Infection, 100(2),
214-217.
WHO. (2020). WHO | System change - changing hand
hygiene behaviour at the point of care.
Retrieved 3 February 2020, from
https://www.who.int/gpsc/tools/faqs/system_c
hange/en/.

Used Table to complete the
assignment. 5 points