This presentation builds upon and utilizes information gathered and reported in the first two assignments (RUA).
This presentation builds upon and utilizes information gathered and reported in the first two assignments (RUA). Suggestions for implementation of outcomes on preventing (HAIs) should clearly and delineate the following.
A) Measurable outcome 1 slide
B) Feasibility issues 1 slide
Strategies for the implementation of measurable outcomes
2 slides with speaker notes including in-text citations
1 Reference slide of both articles used.
www.ccnonline.org CriticalCareNurse Vol 37, No. 3, JUNE 2017 e1
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Patients’ Hand Washing and Reducing Hospital- Acquired Infection Stacy Haverstick, RN, BSN, PCCN Cara Goodrich, MS, AGPCNP-BC Regi Freeman, RN, MSN, ACNS-BC Shandra James, RN, DNP Rajkiran Kullar, MPH, CIC Melissa Ahrens, MPH, CIC
Background Hand hygiene is important to prevent hospital-acquired infections. Patients’ hand hygiene is just as important as hospital workers’ hand hygiene. Hospital-acquired infection rates remain a concern across health centers. oBjectives To improve patients’ hand hygiene through the promotion and use of hand washing with soap and water, hand sanitizer, or both and improve patients’ education to reduce hospital-acquired infections. Methods In August 2013, patients in a cardiothoracic postsurgical step-down unit were provided with individual bottles of hand sanitizer. Nurses and nursing technicians provided hand hygiene education to each patient. Patients completed a 6-question survey before the intervention, at hospital discharge and 1, 2, and 3 months after the intervention. Hospital-acquired infection data were tracked monthly by infection prevention staff. results Significant correlations were found between hand hygiene and rates of infection with vancomycin- resistant enterococci (P = .003) and methicillin-resistant Staphylococcus aureus (P = .01) after the interven- tion. After the implementation of hand hygiene interventions, rates of both infections declined significantly and patients reported more staff offering opportunities for and encouraging hand hygiene. conclusion This quality improvement project demonstrates that increased hand hygiene compliance by patients can influence infection rates in an adult cardiothoracic step-down unit. The decreased infection rates and increased compliance with hand hygiene among the patients may be attributed to the implementa- tion of patient education and the increased accessibility and use of hand sanitizer. (Critical Care Nurse. 2017;37[3]:e1-e8)
©2017 American Association of Critical-Care Nurses doi: https://doi.org/10.4037/ccn2017694
Hospital-acquired infections (HAIs) can lead to longer stays, higher health care costs, and greater mortality rates. According to Magill et al,1 who conducted a multistate point-prevalence study of health care–associated infections, 1 in 25 patients in the acute care setting will develop a health care–associated infection during their hospital stay. In 2011, roughly 722 000 patients had a HAI and around 75 000 of those patients died.1 Of those infections, pneumonia and surgical site infections had the highest rates.1 Because a common mode of transmission is via contaminated hands, hand hygiene is
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the single best method to prevent the spread of infection. Staff hand hygiene is always important, but providing access and education to patients is equally important. Cross-contamination shows the relationship between the environment, patients, and staff. A majority of hospitals’ efforts to prevent infection are focused on the attitudes and practices of staff members. After many interactions with patients on our cardiothoracic step- down unit, it became obvious that increased focus on patients’ hand hygiene practices and attitudes about hand hygiene was needed.
Local Problem While in the hospital, patients’ ability to practice
hand hygiene in the room is limited by accessibility to soap and water or to hand sanitizer. For example, in each patient’s room there is a sink by the door and a bottle of hand sanitizer that is placed on the wall oppo- site the patient’s bed. Many patients are unable to access either of these without assistance because of mobility issues or postsurgical intravenous catheters and drains. These barriers can lead to decreased hand hygiene com- pliance among patients.
Intended Improvement Our focus was on providing tools for patients to
protect themselves against HAI. Patients’ experiences and survey data demonstrated that the patient’s ability to practice hand hygiene in the hospital is limited and requires reinforcement by nursing staff. Before the inter- vention, 75% of patients reported that they had been encouraged to wash their hands (Figure 1). Increasing patients’ hand washing by educating patients on the importance of hand hygiene, as well as providing patients with access to hand sanitizer, was proposed to reduce infection rates.
Reasons why patients were not able to perform hand hygiene included that patients did not know how import- ant hand hygiene was to preventing infection, that they did not usually wash their hands at home, and that they were unable to wash their hands because they rely on
Authors
Stacy Haverstick is a staff nurse on a cardiothoracic step-down unit at University of Michigan Health System, Ann Arbor, Michigan.
Cara Goodrich is a staff nurse on a cardiothoracic step-down unit at University of Michigan Health System.
Regi Freeman is a clinical nurse specialist in the cardiovascular intensive care unit University of Michigan Health System.
Shandra James is a clinical assistant professor at University of Michigan, School of Nursing, Ann Arbor, Michigan.
Rajkiran Kullar is an infection preventionist at University of Michigan Health System.
Melissa Ahrens is an infection preventionist at University of Toledo Medical Center, Toledo, Ohio.
Corresponding author: Stacy Haverstick, RN, BSN, PCCN, 4C Cardiac and Thoracic Surgery Unit, University of Michigan Health System, 1500 E. Medical Center Dr, Ann Arbor, MI 48109 (email: haversts@umich.edu).
To purchase electronic or print reprints, contact the American Association of Critical- Care Nurses, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; email, reprints@aacn.org.
Figure 1 Patient survey results: were you offered to wash your hands during your stay?
Pe rc
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es 100
90
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70
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0 Yes
Before intervention 1 Month after intervention
2 Months after intervention 3 Months after intervention
No Sometimes
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staff to offer the opportunity to do so.2 The typical postsurgical patient was not readily able to get to the sink without help. With a fostering innovation grant provided by the University of Michigan, bed-bound patients received alcohol-based hand sanitizer, hand- sanitizer wipes, or both. Staff were educated and encour- aged to be aware of patients’ access to hand hygiene after any tasks that necessitated hand hygiene, including after using the restroom, before meals, before touching incisions or wounds, and before leaving their room and upon returning to the room.
Study Question This study was done to determine if increased access
to hand hygiene products and patient education could improve patients’ hand hygiene and reduce the trans- mission of HAIs. In particular, rates of infection with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile were assessed to determine if rates were decreased.
Methods Ethical Issues
The project received exempt status from the hospi- tal’s institutional review board. Informed consent was waived because the project met criteria for a quality improvement project. No ethical concerns were noted for this project. A $2350 fostering innovation grant was provided by the University of Michigan Health System and was used to purchase alcohol-based hand sanitizer as well as hand-sanitizing wipes.
Setting The patient hand hygiene initiative was implemented
in August 2013 on an adult 36-bed cardiothoracic surgi- cal step-down unit at the University of Michican Health System, a large academic medical center in the Midwest. The majority of patients were unable to get to the sink to wash their hands without assistance. Patients in the unit typically arrive from the intensive care unit or the pos- tanesthesia care unit with chest tubes, nasogastric tubes, jejunostomy feeding tubes, epidurals, left ventricular assist devices, and intravenous fluids and medications. Patients are taught not to get up without assistance because of the increased risk of falling, so getting up freely to wash their hands is not easily accomplished. Unit staff nurses observed that patients need to have access to alcohol-based hand sanitizer, hand wipes, or soap and water at the bedside instead of relying on the hos- pital staff to give patients an opportunity to protect themselves from HAIs.
Planning the Intervention/Planning the Study of the Intervention
Before implementation of the patient hand-washing project, staff completed an anonymous 6-question survey (Table 1).3 Permission was granted to use a modified survey from the article, “Hand Hygiene: What About Our Patients?”3 Unit staff were asked to complete the questionnaire and return it within 1 week. We received a total of 33 staff responses. Upon discharge, patients also completed a 6-question survey (Table 2) before the intervention, as well as 1, 2, and 3 months after
Table 1 Staff questionnairea Question Did you offer an opportunity to your patient to enable them to wash/clean their hands?
Patients encouraged to carry out hand…
