Topic 6: Evaluating Practice Change; Evidence-Based Practice Proposal – Section F: Evaluation of Process

Evidence-Based Practice Proposal Section F

Evaluation of Process Rationale for Methods Used

The methods used in data collection included questionnaires, retrieval of documents, and observation. The questionnaire will allow the study participants to provide answers to the study questions aimed to assess their level of knowledge regarding the appropriate hand hygiene techniques. This will enable an analysis of inferential statistics important in determining the project’s outcome. On the other hand, observation will provide data regarding the adherence of nurses to the hand hygiene techniques while the retrieved documents will be used to determine the effectiveness of the project in reducing the rate of HAIs among the older adults in the organization by comparing the HAIs rate pre-and post-project implementation (Fischer et al., 2019).

Outcome Measures

In order to determine if the project achieved the intended outcomes, the study participants will be provided with a questionnaire in order to assess their competency and level of knowledge regarding appropriate hand hygiene. Improved knowledge about hand hygiene among nurses will be an indicator of the effectiveness of the proposed project. More importantly, the reduced rate HAIs among the older adults admitted to the hospital will be a positive indicator of the effectiveness of the proposed project. The project will be continually reviewed in order to determine if there are any required changes.

How Outcomes will be Measured

The measured outcomes and tools used will be evaluated for reliability, validity, and applicability. The applicability of the questionnaire was used to determine its appropriateness in addressing the knowledge needs of nurses about hand hygiene. Additionally, the reliability and validity of the questionnaire will also be assessed to determine if it meets the required quality measures (Aoki et al., 2019).

The outcomes will be measured by comparing the rate of HAIs among the older adults admitted to the hospital before and after the implementation of the proposed project. This will measure if the project was effective in reducing the rate of HAIs as projected.

Strategies to take if Outcomes do not Provide Positive Results

if the project outcomes do not provide positive outcomes, it will be important to find out what led to the failure. The first would be to analyze if the methodology may have contributed to the project’s failure. If it is discovered that the methodology had some problems, it would be appropriate to review the methodology and repeat the project all over again after correcting the methodology. If the findings do not discover any methodological problems, there will be no need to repeat the project since a valid methodology provided reliable findings.

Implications for Practice and Future Research

Proper hand hygiene is the cornerstone to preventing and reducing the rates of HAIs in healthcare organizations (Roshan et al., 2020). Therefore, implementing the project is projected to reduce the rate of HAIs in the organization. However, future research is essential to determine the most effective hand hygiene technique (between hand sanitizer and handwashing with soap and water) in reducing the rate of HAIs. In addition, future research should be performed to find out the most preferred hand hygiene technique among nurses as this will improve their adherence to hand hygiene measures.

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References

Aoki, K., Hall, T., & Takasaki, H. (2019). Reporting on the level of validity and reliability of questionnaires measuring Katakori severity: A systematic review. SAGE open medicine, 7, 2050312119836617. https://doi.org/10.1177/2050312119836617

Fischer, F., Helmer, S., Rogge, A., Arraras, J. I., Buchholz, A., Hannawa, A., … & Witt, C. M. (2019). Outcomes and outcome measures used in the evaluation of communication training in oncology–a systematic literature review, an expert workshop, and recommendations for future research. BMC Cancer, 19(1), 1-15.

Roshan, R., Feroz, A. S., Rafique, Z., & Virani, N. (2020). Rigorous Hand Hygiene Practices Among Health Care Workers Reduce Hospital-Associated Infections During the COVID-19 Pandemic. Journal of primary care & community health, 11, 2150132720943331. https://doi.org/10.1177/2150132720943331

Reducing Infections By Hand washing

The systematic investigation and questioning of clinically relevant events are essential in improving individual and community health care. Organizations such as those of nurses and physicians utilize organizational culture survey tools in giving a baseline of comprehending their medical culture’s strengths and weaknesses. Creating organizational cultures requires understanding an organization’s characteristics, as it highly implicates infection prevention and control by implementing several guidelines (Adegboye et al., 2018). In this paper, I explore Nursing Culture Assessment Tool on John Hopkins’s nursing organization and evaluate the effectiveness of hand-washing and sanitizing in reducing health Care-Associated infections (HAIs).

Organizational Culture and Readiness

I assessed the organizational culture and readiness at the John Hopkins nursing organization, and the nursing organization’s readiness level was facilitated through methodological strategies. The strategies promoted EBP implementation through close cooperation between researchers and clinical nurses. A survey was conducted to determine the clinical nurses’ evidence-based practice beliefs, organizational readiness, knowledge, and implementation levels. The barriers to conducting the EBP included insufficient educational programs and a lack of well-trained EBP experts. It was, however, facilitated by the skills, knowledge, and beliefs of individual nurses. The significantly high category scores included the EBP beliefs, while those that were low included organizational readiness, implementation, and knowledge (Yoo et al., 2019). The differences in significant variables were analyzed based on the nurses’ characteristics, such as higher educational status and research experiences. More research-related activities resulted in relatively firmer EBP beliefs, knowledge, and organizational readiness.

The EBP beliefs score was 51.7 out of 80; organizational readiness was 76.4 out 0f 125; implementation was 15 out of 72, while knowledge was 52.5 out of 98. Integrating clinical inquiry into the organization required the organization’s flexibility to respond to the fast-altering environment and support the existing nursing practice with professional autonomy. That was a significant way of strengthening the nurses’ values and beliefs on EBP and fostering their capabilities to lead its implementation effectively. In that culture, the nurses performed several EBP steps in creating searches for evidence and logically assessed and applied them practically.

Problem statement: Hand washing using soap and water or hand sanitizer is a vital means of preventing HAI incidences among admitted patients aged 65 (McLaws, 2015).

Literature review

PICOT Statement: Among admitted patients aged 65 years old K (P), does hand washing using soap and water or hand sanitizer (I) aid in reducing HAIs incidences (O) within three months (T)?

The spread of HAIs is associated with poor hand hygiene practices, as asserted by Fox et al. (2015). They conducted a study on using patient hand hygiene protocol in reducing HAIs, used a pre-experimental study design, and collected data from an Intensive Care Unit from 2009 to 2012. The sample used was 2183 patients admitted to the ICU, with 57% males and 43% females. The HAI incidences were reported using the Centers for Disease Control and Prevention and summarized before and during the Patient Hand Hygiene Protocol implementation. The mean monthly HAI rates reduced from 9.1% to 5.6% (Fox et al., 2017).

Among all the patients, there was only one case of Chlorhexidine hand-sanitizer irritation. The patient experienced raised red blotches on both of his hands’ dorsal surface. The hand-cleaning compliance levels were measured and compared among groups. The comparisons were also made by the time of hand washing, that is, before getting into a patient’s room and exiting. The compliance rate within the period under investigation was 86%, which represented a mean of 35%. Before implementing the protocol, the hand-washing rate was 41%, which represented a mean of 66%. During the implementation, the compliance rate was between 51% and 71% when getting into a patient’s room and between 65% and 87% when exiting. A 38% reduction in HAIs was experienced (Fox et al., 2017).

Haverstick et al. (2017) point out that healthcare workers’ hands are the most regular vehicle in the transmission of healthcare-associated viruses and bacteria to patients and the entire healthcare system. They also assert that hand hygiene is the leading prevention measure in the spread of HAIs. They explored several literatures on hospital-acquired infections and found out that 1 in 25 patients in acute care setting develop HAIs during their stay in hospital. They concluded that hand hygiene is the best method of preventing HAIs, and should be accompanied by providing education and access to patients. McLaws (2015) conducted a descriptive case study to test the effectiveness of antibiotic stewardship and hand hygiene education using experimental designs of randomized control trials and quasi-experimental designs including time series and before intervention. Due to the effectiveness of hand-washing and sanitizers in reducing HAIs, patients and their loved ones became eager to wash and sanitize their hands frequently. The Nurses were also driven into full adoption of the protocol and incorporated adequate preparation, training, and validated competencies. Compliance auditing revealed that approximately 97% of the patients’ hand hygiene lasted 12 months (McLaws, 2015).

Adegboye at al. (2018) looked into the awareness, knowledge and practice of infection control among health care workers in an intensive care unit, using a descriptive cross-sectional study. From the results, 86% of the respondents were aware that hands are the most common infection transmission vehicle. They also practiced six steps of the hand washing technique, and resident doctors constituted a large portion of the technique. Their study is corroborated by that of Yoo et al. (2019), who identified clinical nurses’ evidence-based practice at a university-affiliated tertiary hospital. A cross-sectional and descriptive design was conducted among 521 nurses and data analyzed using SPSS. They all had positive levels of EBP knowledge of the importance of hand washing in effectively reducing HAI infections.

All the articles supported that hand washing is an effective practice to reduce HAIs. However, limitations encountered in the studies included the comparison of results with pre-intervention results as opposed to a randomized control group. As such, the confidence in the protocol impact was limited. Since many factors influence infection rates, the results can’t be only attributed to the intervention. In Yoo et al.’s paper, there was no evaluation of physician training, and the Hawthorne effect might have been experienced as the patients and nurses were aware they were being observed. McLaws (2015) does not fully support that hand washing alone is enough to prevent HAIs as he states that hand hygiene alone is limited as it cannot wholly impact formidable risk factors that include immunosuppression, old age, and indwelling devices. Concurrently undertaking hand hygiene interventions serves as a potential for the coexistent strategies to confound the hand-washing program. Nevertheless, the impact of hand-washing and the use of sanitizers exceeds the sum of every infection prevention strategies.

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References

Adegboye, M. B., Zakari, S., Ahmed, B. A., & Olufemi, G. H. (2018). Knowledge, awareness, and practice of infection control by health care workers in the intensive care units of a tertiary hospital in Nigeria. African health sciences18(1), 72-78.

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 Care24(3), 216-224.

Haverstick, S., Goodrich, C., Freeman, R., James, S., Kullar, R., & Ahrens, M. (2017). Patients’ hand-washing and reducing hospital-acquired infection. Critical care nurse37(3), e1-e8.

McLaws, M. L. (2015). The relationship between hand hygiene and health care-associated infection: it’s complicated. Infection and drug resistance8, 7.

Yoo, J. Y., Kim, J. H., Kim, J. S., Kim, H. L., & Ki, J. S. (2019). Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture. PloS one14(12), e0226742.

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