washing is one of the most important tasks that can be done to prevent infection. Infection control is one of the major initiatives that the Centers for Medicare and Medicaid Services (CMS) are placing as a top priority and plan to make unannounced visits to facilities to inspect their infection control processes (Brooks, 2013). The need for increased infection control practices stems from the high importance of decreasing hospital acquired infections. These HAI?s will cost hospital facilities a great deal of money. The CMS will be authorized to hold moneys for services if there is a hospital acquired infection (Brooks, 2013). It has been noted that the break in infection prevention is that of basic practice: hand hygiene
. One must investigate whether the break is due to an uneducated staff or those that refuse to follow protocols.
Change Model Overview
A Model for Change to Evidence-Based Practice is an article written by Mary Ann Rosswurm RN, EdD, CS, FAAN and June H. Larrabee RN, PhD, that ?guides nurses and other healthcare professionals through a systematic process for the change to evidence-based practice? (Rosswurm & Larrabee, 1999). In this day and age it is not sufficient enough to rely on clinical experience, opinion-based processes, and pathophysiologic rationale (Rosswurm & Larrabee, 1999). One must use critical thinking and evidence-based practices to determine if current processes are the most cost-effective and highest quality care. This article gives practitioners the tools to research systemically evidence-based research and determine the best process for high quality care.
Step 1: Assess the Need for Change
The first step is to ?collect internal data and compare it with external data? (Rosswurm & Larrabee, 1999). Surveys that question proper hand hygiene
technique and compliance to hand hygiene
would be one tool to use to collect internal data. Another way to collect internal data would be random swabbing of personnel?s hands
for certain bacteria, or anonymous surveyors of personnel?s practice with hand hygiene
. Are the nursing and hospital personnel using proper hand hygiene
, and are they compliant with hand hygiene
practices? Do they know what the proper technique is? Do they know the importance of being compliant with hand hygiene
Step 2: Link the problem, interventions, and outcomes
The next step is to define the problem using language that is standardized then link it with classification of interventions and outcomes (Rosswurm & Larrabee, 1999). Link hand hygiene
and compliance with teaching proper hand hygiene
techniques and the importance of compliance in regards to decrease in hospital acquired infections. Provide instruction regarding proper technique, educational material such as posters, health stream videos, and demonstration. Identify outcomes by improved correct responses on surveys, and increased compliance data by anonymous surveyors.
Step 3: Synthesize the Best Evidence
Synthesize best evidence includes refining the selected interventions and outcomes in order to research literature that is specific to the said problem. Literature to be reviewed regarding hand hygiene
include the article Prepare for enhanced scrutiny on infection control as regulators clamp down on unsafe practices related to health care-associated infections (Brooks, 2013) and Series 2: Infection prevention and control. 2:2 Hand Hygiene
(Jones, 2014) which both discuss the importance of hand hygiene
and compliance in order to decrease hospital acquired infections. Systemic review such as Interventions to improve hand hygiene
compliance in patient care (Gould, Moralejo, Drey, & Chudleigh, 2011) is a review that discusses different interventions to utilize to improve compliance with hand hygiene
in the patient care facility. Hand Hygiene
(Schub & Caple, 2014), Hand hygiene
and the use of personal protective equipment (Wyeth, 2013), and Status of the implementation of the World Health Organization multimodal hand hygiene
strategy in United States of America health care facilities (Allergranzi, Conway, Larson, & Pittet, 2014) all discuss interventions and strategies regarding proper hand hygiene
technique. These articles would be reviewed and critiqued by registered nurses assigned to a committee in charge of researching this issue.
Step 4: Design practice change
After synthesizing the research, registered nurses would be assigned to formulate a process or protocol regarding a standard in hand hygiene
. This process or protocol would then be implemented in a pilot study on, most likely, the smallest unit in the said health care facility, which in this case is the surgical unit.
Step 5: Implement and Evaluate the Change in Practice
The coordinator of the committee in charge of designing the process or protocol for proper hand hygiene
technique and improved compliance will then oversee the implementation of the said process/protocol. The coordinator will personally be available to staff in the pilot study to answer questions and further instruct in the implementation of the process/protocol. Follow up reinforcement in the pilot program is also important in order to ensure success of the new intervention, and this will also be overseen by the coordinator while continually evaluating the practice change.
Step 6: Integrate and Maintain the Change in Practice
The final step will be to integrate the process/protocol of proper hand hygiene
and compliance into standard of care. Any change will be disruptive and will need to be continually reinforced in order to become to the new culture (Rosswurm & Larrabee, 1999). It is important for the stakeholders to be active and maintain participation in order to change the environment into the new standard of care.
In order to make a change in practice or protocol for compliance and proper hand hygiene
there needs to be several steps taken. Assess the need for the change by gathering internal data and comparing it to external data. Link the problem with interventions and outcomes that are desired to become the new norm. Synthesize the best evidence in order to have solid research to back the need for the change. Appoint stakeholders to design a practice change. Implement and evaluated to practice change in a pilot study and be available for further questions and instructions regarding the practice change. Lastly, integrate and maintain the practice change in order for it to become the standard of care.
Allergranzi, B., Conway, L., Larson, E., & Pittet, D. (2014). Status of the implemenatation of the World Health Organization multimodal hand hygiene
strategy in United States of America health care facilities. American Journal of Infection Control, 224-230.
Brooks, D. (2013). Prepare for enhanced scrutiny on infection control as regulators clamp down on unsafe practices related to health care-associated infections. ED Management, 1-2.
Farrelly, R. (2014). NHS nurses' fight against infection. British Journal of Nursing, 121.
Gould, D., Moralejo, D., Drey, N., & Chudleigh, J. (2011). Interventions to improve hand hygiene
compliance in patient care. Cochrane Database of Systemic Reviews.
Jones, M. L. (2014). Series 2: Infection prevention and control. 2:2 Hand hygiene
. British Journal of Healthcare Assistants, 9-12.
Rosswurm, M. A., & Larrabee, J. H. (1999). A Model for Change to Evidence-Based Practice. Image, 31, 317-322.
Schub, T., & Caple, C. (2014, February 28). Hand Hygiene
. Cinhal Information System. Glendale, California, United States of America.
Wyeth, J. (2013). Hand hygiene
and the use of personal protective equipment. British Journal of Nursing, 920-925.
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