NURS 629: Hand Hygiene Quality Improvement Project at IUP

This quality improvement project, completed by Kim Jackson from Indiana University of Pennsylvania (NURS 629), focuses on hand hygiene in healthcare settings. It emphasizes the importance of hand washing in infection control, using the STEEEP framework (safe, timely, effective, efficient, equita...Read More

Quality Improvement Project
Quality Improvement Project
Kim Jackson
Indiana University of Pennsylvania
NURS 629
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Quality Improvement Project
Hand washing is one of the most important factors that address the aspect of the infection
and its control. In nursing homes, infection control is the most priority area that need to be
maintained by the nurse. The aspect of the hand hygiene maintenance can be achieved by
implementing the accurate procedure of hand washing. In order to implement the infection
control measures, STEEEP (safe, timely, effective, efficient, equitable and patient centered)
framework and QI (Quality improvement) principles is considered. The paper also highlights the
various factors affecting hand washing hygiene (Lopes, Sauers & Valier, 2017).
In order to maintain the aseptic control in a health care setting the nurses need to wash
their hands following the basic protocol of five movements after every single interaction with
patients and any kind of medication or activities related to clinical treatment. For instance, one of
the strategies for the hand hygiene maintenance would be implementation of the no touch policy
by utilizing aseptic gloves. This strategy is related to each factors of STEEEP framework and the
no touch policy is effective in control of the infection while handling the patients. The safety,
time and effectiveness of the no touch policy would be assessed by the means of the qualitative
and quantitative analysis of the changes occurred due to implementation of the no touch policy.
On the other hand the QI factor should be considered that are the PDSA (Plan-Do-Study-
Act) and the Lean Six Sigma factor. The nurses should be able to adhere to the hand hygiene
maintenance processes developed by the World Health Organization (WHO). The processes of
the hand hygiene maintenances devised by WHO includes the components such as the alcohol
based hand rub, antimicrobial soap, antiseptic agents, antiseptic hand wipe, and detergent as
surfactant, plain soap and waterless antiseptic agents. All these components should be included
in the strategy (Who.int, 2019). The steps of PDSA would be considered as per the planning
procedure which has included the finance and timeframe aspect. On the basis of the planning, the
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Quality Improvement Project
management team should be able to create a policy for proper implementation of the plan and to
empower the health care staffs. Management team observes the proper implementation to see the
progress of plan and its limitation which needed to be addressed. On the basis of the evaluation,
the changes need to be executed. On the other hand the Lean Six Sigma policy which depends on
the Define, Measure, Analyse, Improve and Control (DMAIC) factors can be achieved by the
implementation of the no touch policy. The hand washing components and procedure according
to the WHO regulations would be demonstrated to the health care professionals, and its
measurements would be analyzed on the basis of the time needed and financial cost for
implementation strategy of the plan. (Shabot et al., 2016). After the analysis of the planning and
its implementation, the required improvement and amendment will done. Therefore, the no touch
policy and hand washing is best for implementation to control infection in the health care setting.
The quality improvement can be achieved by the implementation of the hand hygiene and the
proper observation of the effectiveness of the policy in the infection control (Hess, Leisher,
Limbu, Magige & Kahwa , 2017).
Thus, the plan would be of utilizing the aseptic gloves and the no touch policy in a
priority basis. On the other hand the usage of alcohol based hand rub, antimicrobial soap,
antiseptic agents, antiseptic hand wipes, and detergent as surfactant, plain soap and waterless
antiseptic agents in every regular interval of work or in while interacting with clinical tools and
patients must be entertain in every health care sector.
Based on this discussion it can be stated that maintenance of hand hygiene based on the
no touch policy and proper hand washing strategies of WHO would help in the reduction of the
infection n the health care set up. Hence, the hand hygiene by hand wash technique and protocol
would be effective in the same context. The policies of the hand hygiene would be implemented
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Quality Improvement Project
in terms of the proper control of the infections in a health care unit and quality improvement of
health care development. It is an important aspect that should be considered and addressed with
higher priority in every health care sector. Sepsis in the health care setting is a common issue
because transmission of microbial infections is common if hygiene is not maintained by health
care professional hence, there is the need to implement the changes in the setting (Neu et al.,
2016).
Issue related to hand washing in nursing
The major issue that is being faced due to improper hand washing is related with high
chance of infection to the patient. It is evident from the study that hand washing is the most
important procedure that is to be performed by nurse before taking care of any patient. In
hospital there are various types of health issue and illness which are communicable and nurse are
responsible body to take care of patient which may involve physical touching. As an impact of
improper hand washing, microbial transmission is caused from both side of nurse and patients.
Proper hand washing is needed to prevent infection to patient as well as nurses. Nurse in health
care sector faces many issue with hand washing. Sink and dispenser for hand rub is located in
inconvenient place which is making the process infeasible. From the study of Fox et al. (2015) it
can be said that in hospital there is non-availability of soap or hand rub and nurse always faces
an issue to drying out their hand. Among the issue identified, constraint of time and workload is
the significant problem nurse face with improper hand washing towards patient care. Nurse
might get something failed to maintain the hand hygiene because of above mentioned reasons.
As an impact of this, there is high probability of transmission of disease from patients to the
nurse. If nurse do not have access to hand hygiene, the patients are at the verge of infections and
long stay in hospitals (King et al., 2016).
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Quality Improvement Project
Economic Impact
Hand washing has an economic impact in any country, if every health organization
advice peoples to wash their hands and maintained the hand hygiene, will minimize chances of
illnesses and infection, alternatively it will reduce cost of medical expenses and lower the health
burden. Hence, the hand washing will have positive impact on the economy (Stone, 2010).
Resources Needed To Implement the Plan
According to world health organizations, it is easy to perform the method of hand
washing which indirectly depends on the health status of the country. Resources is needed in
health departments to carry out seminars to educate nurses on the importance of hand washing.
The cost of implementing this plan is cheap but it may cost about $50,000 in the assessment
especially if the assessment team comes from an external source.
Projection of Timeline for Improvement
It can be expected that within a time period of 8 months the positive outcome proposed
will be evidently noticed with reduced cases of infections and viruses throughout the health care
organization.
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References
Ballard, D. J. (2014). The Guide to Achieving STEEP™ Health Care: Baylor Scott &
White Health’s Quality Improvement Journey. Productivity Press.
Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C., ... & Bader, M. K.
(2015). Use of a patient hand hygiene protocol to reduce hospital-acquired infections and
improve nurses’ hand washing. American Journal of Critical Care, 24(3), 216-224.
Hess, S., Leisher, C., Limbu, P., Magige, H., & Kahwa, A. (2017). CHANGES IN
HOUSEHOLD WELL-‐BEING AND RESILIENCE. Retrieved from
http://evidenceproject.popcouncil.org/wp-content/uploads/2017/10/Tuungane_outcome_a
nalysis_2011-2016_FINAL.pdf
King, D., Vlaev, I., Everett-Thomas, R., Fitzpatrick, M., Darzi, A., & Birnbach, D. J. (2016).
“Priming” hand hygiene compliance in clinical environments. Health Psychology, 35(1),
96.
Lopes Sauers, A. D., Sauers, E. L., & Valier, A. R. S. (2017). Quality improvement in athletic
health care. Journal of athletic training, 52(11), 1070-1078. doi: 10.4085/1062-6050-
52.10.15
Neu, A. M., Richardson, T., Lawlor, J., Stuart, J., Newland, J., McAfee, N., ... & Foster, D.
(2016). Implementation of standardized follow-up care significantly reduces peritonitis in
children on chronic peritoneal dialysis. Kidney international, 89(6), 1346-1354. Retrieved
from https://doi.org/10.1016/j.kint.2016.02.015
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Shabot, M. M., Chassin, M. R., France, A. C., Inurria, J., Kendrick, J., & Schmaltz, S. P. (2016).
Using the Targeted Solutions Tool® to Improve Hand Hygiene Compliance Is
Associated with Decreased Health Care—Associated Infections. The Joint Commission
Journal on Quality and Patient Safety, 42(1), 6-AP4. Retrived from
https://jointcommission.new-media-release.com/2016_jqps_jan/downloads/
JQPS0116%2001%20Shabot.pdf
Stone, P. W. (2010). Effect of Guideline Implementation on Costs of Hand Hygiene.
Author manuscript.
Who.int. (2019). WHO | WHO guidelines on hand hygiene in health care. Retrieved from
https://www.who.int/gpsc/5may/tools/9789241597906/en/
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