NURS4001 Nursing Capstone: Infection Control Audit at TTSH

This NURS4001 nursing capstone project presents a clinical audit conducted at Tan Tock Seng Hospital (TTSH) to evaluate the effectiveness of infection prevention and control practices, benchmarked against the National Safety and Quality Health Service (NSQHS) Standard 3: Preventing and Controlling Healthcare-Associated Infections. The audit employed a prospective design, collecting data through observations and interviews with nurses in a general medical ward over a six-week period. The project aimed to assess adherence to standard precautions, patient education on infection control, and nurses' understanding of best practices. The findings revealed strengths in nurses' practice of standard infection control measures, but identified areas for improvement in patient education and communication skills. The report includes detailed methodology, data analysis using descriptive statistics, and recommendations for enhancing communication strategies and patient teaching. The results are disseminated via tables and graphs, with recommendations for improved patient education on infection control. The study also provides a valuable resource for healthcare professionals, researchers, and students seeking to understand and improve infection control practices in healthcare settings.

Running head: NURS4001 Nursing and Midwifery Capstone 1
NURS4001 Nursing and Midwifery Capstone.
An Audit of Preventing and Controlling Healthcare-Associated Infections at Tan Tock Seng
Hospital.
(Author’s name)
(Institutional Affiliation)

NURS4001 Nursing and Midwifery Capstone 2
Table of Contents
1.0 Introduction................................................................................................................................3
2.0 Background Information............................................................................................................3
3.0 Aim of the Project......................................................................................................................5
5.0 The preventing and Controlling Healthcare-Associated Infections Standard............................5
6.0 Audit Methodology....................................................................................................................6
6.1. Location and Duration of the Audit.....................................................................................6
6.2 Recruitment process, Sample size, Inclusion, and Exclusion Criteria. 6
6.3. Consent Considerations........................................................................................................7
6.4 Measurement tool..................................................................................................................7
6.5 Data management..................................................................................................................8
7.0 Data Analysis.............................................................................................................................8
8.0 Dissemination of the Results.....................................................................................................9
9.0 Recommendations....................................................................................................................10
References......................................................................................................................................12

NURS4001 Nursing and Midwifery Capstone 3
1.0 Introduction.
Preventing and Controlling Healthcare-associated infections is one of the major and the
third National Safety and Quality Health Services(NSQHS) as provided by the Australian
Commission on Safety and Quality in Health Care(ACSQHC). This NSQHS standard was
developed to promote clinical governance and quality enhancements in healthcare systems that
support control and prevention of healthcare-associated infections and establish and develop
infection prevention and control systems(Australian Commission on Safety and Quality in
Health Care, 2012). Most of the health-care-associated infections are normally preventable.
Therefore, there is a need to minimize the rates at which infections spread across healthcare
settings(Fasugba et al., 2018). The process of infection prevention and control specifically focus
on identifying the risks and infectious agent and separating them from the patient. However,
because there is no single risk or causes of infections in a healthcare setup, there is need of
developing a vast of infection prevention strategies across the healthcare system for a successful
control(Huang, Stewardson, & Grayson, 2014).
2.0 Background Information.
Healthcare-associated infections are normally infections acquired as a result of either
direct or indirect contact with pathogens around the hospital environment. According to the
World Health Organization(WHO), long-termed hospitalized patients have higher chances of
contracting the hospital-acquired infections more than patients staying at the hospital for shorter
periods(European Centre for Disease Prevention and Control, 2014). In Australia hospitals and
acute care facilities, there are around 165, 000 of hospital-associated infection per year. This has
made hospital-associated infections to fall under higher priority for eradication by many

NURS4001 Nursing and Midwifery Capstone 4
healthcare facilities in the country(Australian Commission on Safety and Quality in Health Care,
2012). In addition, healthcare-associated infections cause unnecessary costs, pain and prolonged
hospital stay that are avoidable and preventable. In Australia, there are about 7% of hospitalized
patients which will acquire hospital-associated infections of which an additional cost of around
8.6% will be increased(Brocket & Shaban, 2015). This health associated infections problem
affect a wide range of healthcare settings including healthcare facilities, general practice and any
other clinical setup making both healthcare workers and patients highly vulnerable(Khan, Baig,
& Mehboob, 2017). Therefore, it is crucial to reduce the rates of healthcare-associated infections
by practicing effective infection control and prevention strategies.
According to WHO 2016 report, healthcare-associated infections are among the major
public health problems and adverse events that usually occur during patient care. At any given
time, there are about 10% of patient in developing nations and 7% of patients in developed
nations who will acquire one or more hospital-associated infections(Khan et al., 2017).
According to the Center for Disease Control, in each day there are about 31 hospitalized patients
who have at least one healthcare-associated infection in the United States. In addition, the
European Center for Disease prevention and control shows that, in 2011-2012 prevalence survey
done in more than a thousand hospitals over thirty-three countries, there were about 80,000
patients with hospital-acquired infections in a day(Khan et al., 2017). Furthermore, one in every
eighteen patients in European hospitals had at least one hospital-associated infection. To combat
healthcare-associated infection, the WHO has developed an infection prevention and control
guidelines for nations and hospitals a basis recommendation(Cruickshank, 2015). Some
guidelines include identifying the risk factors of infection control, improving surveillance and

NURS4001 Nursing and Midwifery Capstone 5
reporting, ensuring all the facilities have the required minimum requirements for infection
control and implementing standardized precautions.
3.0 Aim of the Project.
The major aim of this clinical audit is to demonstrate the effectiveness of various
hospital-associated infection prevention and control in a general medical ward as compared to
NSQHS standard three which include ‘Preventing and Controlling Healthcare-Associated
Infections'(Menegueti et al., 2019). In addition, this audit will highlight the strengths and
weakness in current infection control practices and provide the recommendations.
4.0 Audit Objectives.
Below are the major objectives of this audit.
1. All nurses will directly practice standard infection control precautions including hand
hygiene, proper waste disposal and using of ascetic techniques.
2. All nurses will offer patient education to patients regarding infection control standards
precautions.
3. All nurses will demonstrate an understanding of the best practices required for effective
infection prevention and control.
5.0 The preventing and Controlling Healthcare-Associated Infections Standard.
The Preventing and Controlling Healthcare-associated Infection Standard is the third
standard of NSQHS that has been developed basing on best available practices and clinical
recommendations fro the Australian Guidelines for the Prevention and Control of Infections in
Healthcare(Australian Commission on Safety and Quality in Health Care, 2012). The major goal
for this standard is prevented hospitalized individuals and their families from contracting
avoidable healthcare-related infections and effectively eradicate those infections when they occur

NURS4001 Nursing and Midwifery Capstone 6
using best available interventions(Australian Commission on Safety and Quality in Health Care,
2016). This standard work hand in hand with the clinical governance standard, medication safety
standard and partnering with consumers standard.
6.0 Audit Methodology.
A clinical audit provides quality improvements of care basing on a particular national
standard. In this audit, a prospective audit design will be used to collect data as nurses perform
their normal duties including patient education and practicing of standards infection prevention
precautions(Lawrence et al., 2016). This is because, this study is descriptive, and involve more
observation and interviews than open-ended questions.
6.1. Location and Duration of the Audit
This audit will be a single centered audit that will happen on the general medical ward at
Tan Tock Seng Hospital for six weeks starting on 25th August 2019. The first week will involve
obtaining the permission to conduct the audit, arranging all necessary materials and preparing
psychologically for the process. The second week will consist of recruiting a team of nurses as
participants for the data collections process and the third and fourth week will involve collecting
data using observations and interviews. The fifth week will consist of data analysis and
establishing the results for presentation and the sixth week will involve the dissemination process
of the audit.
6.2 Recruitment process, Sample size, Inclusion, and Exclusion Criteria.
The participants will be recruited using a convenience sampling method. Convenience
sampling involves selecting the participants depending on their availability(Katie Kowalski,
2015). The inclusion criteria will include all nurses working on medical wards, both males and

NURS4001 Nursing and Midwifery Capstone 7
females and all age groups of a nurse. Other healthcare workers will be excluded from the study.
In addition, all other nurses not working in a general medical ward will also be excluded. Other
than that, student nurses will not be included in the study. A sample of 50 participants will be
selected.
6.3. Consent Considerations.
Before the beginning of the clinical audit, informed consent will be sent to the ethical and
research committee in the university and forwarded to the hospital ethics committee for
approval(American Nurses Association, 2016). The consent will contain the benefits and reasons
for the audit and its implications for clinical practice. In addition, all the nurses will be informed
to sign the informed consent together with the patients involved during the procedures and be
informed what observations and expected questions to be asked(International Council of Nurses,
2012). All participation will be made voluntary and possible benefits will be highlighted in the
consent form.
6.4 Measurement tool.
All observational and interview questions that were used to conduct this audit were
retrieved from NSQHS Standard three- Preventing and controlling healthcare-associated
infections Audit Tools. Below are the specific questions that were used;
1. what are standard precautions used?
2. What practice do standard precautions include into details?
3. In which way does the nurse understand the knowledge regarding the multi-resistant
organism

NURS4001 Nursing and Midwifery Capstone 8
4. Does the nurse know the local infection prevention procedures, policies, and general
information?
5. How competent is the nurse’s hand hygiene?
The data will be collected while counter checking and filling the outcome measure audit tool to
checkout the nurses understanding of standard precautions and infection control strategies.
6.5 Data management.
All data will be stared in a cabinet with keys at which only the auditor will have the keys
for security and confidentiality{Formatting Citation}. All forms will remain without names to
allow anonymity. After the forms have been analyzed, the data will be transferred to a flash disk
with password-to allow data confidentiality(Kulju, Stolt, Suhonen, & Leino-Kilpi, 2016). The
analyses data will be presented into themes and how they have addressed the objectives. After
the dissemination has commenced, all data will be destroy leaving only the processed data.
7.0 Data Analysis.
Simple statistical analysis method will be employed using the Microsoft excel to
illustrate and present descriptive statistics. Such statistics are important as they help in
calculating the bio-data percentages and average from a sample population. The descriptive data
from the audit has been generated and presented in the graph below.
Fig 1, Objectives Archived Over Two Weeks.
percentage
first objective second objective third objective
0
10
20
30
40
50
60
70
80
90
Attained
not attained

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Table 1percentage of males and females participant and their age bracket.
Males Females
26% 74%
Aged between 23 to 55 years Aged between 21 to 54 years.
From the graph above, the majority of the nurses were able to demonstrate and perform all
standard infection control and prevention precautions where both objectives one and three
achieved by 80%. However, most of the nurses were unable to give effective patient education
regarding standard precaution and infection prevention strategies probably due to poor effective
communication. This second objective achieved with a score of 75%. The total number of male
nurses were around 26% and female nurses around 74% with both groups at the age bracket of
21 to 55 years old.
8.0 Dissemination of the Results.
At the end of the six weeks, all data will be analyzed and organized into tables and
graphs. The results of the study will be discussed with all study participants and other relevant
educational bodies within the hospital. In addition, the results will be presented to the hospital
management for clinical and policy purposes. A poster that includes the audit summary using
RAG rating as demonstrated below will be issued in every ward for practical and improvement
purposes.
Table two. RAG Rating Scale
RED0-49% YELLOW50-79% GREEN 80-100%
1. All nurses will 80

NURS4001 Nursing and Midwifery Capstone 10
directly practice
standard infection
control precautions
including hand
hygiene, proper waste
disposal and using of
ascetic technique
All nurses will offer
patient education to
patients regarding
infection control
standards precautions.
75
All nurses will
demonstrate an
understanding of the
best practices required
for effective infection
prevention and
control.
80
From the scale above, the green represents positive and better achievements, the yellow
moderate and the red poor. Both objective 1 and 3 scored better but objective 2 scored
moderately and thus much more effort is needed.

NURS4001 Nursing and Midwifery Capstone 11
9.0 Recommendations
The first recommendation is by enhancing and teaching nurses basic communication
strategies and patient teaching skills. The nurses had enough knowledge about prevention and
control of infectious diseases but unfortunately, they could not deliver the message to the
patients using the right methods.
The second recommendation is increasing in knowledge and skill concerning current policies and
procedures among nurses by using of continuous medical education sessions. Most of the nurses
were aware of the standard precautions but not the most current ones.

NURS4001 Nursing and Midwifery Capstone 12
References
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