Capstone Project Change Proposal

Answer

Benchmark – Capstone Project Change Proposal

Introduction

            The proposed capstone change project aims to evaluate the effectiveness of hand hygiene in the prevention and control of hospital-acquired infections (HAIs). HAIs are major public health issues that can be controlled and prevented through hand washing. Desirable outcomes expected out of the proposed intervention include reduced cost of care, reduced rate of antibiotic prescription among hospitalized patients, reduced length of hospitalization, and reduced incidence of the rise of antimicrobial resistance. Hand hygiene is a low-cost buy yet an effective intervention for preventing and controlling HAIs.

Background

            Hand-hygiene involves use of alcohol-based gels or soap and water to sanitize or wash the hands (Hiller, 2020). Hand washing is recommended before and after patient contacts, carrying-out of aseptic procedures, when there is risk of exposure to body fluids, and contact with patient surroundings (Onyedibe et al., 2020).

Clinical Problem Statement

HAI is serious problem faced by the healthcare system. HAIs may cause increased length of hospitalization, increased costs of care, poor patient outcomes, and increased rate of antibiotic administration (Hillier, 2020; Wiedenmayer et al., 2020). Increased administration of antibiotics, on the other hand, tends to increase the risk of antimicrobial resistance. Hand-hygiene is an effective approach for mitigating the problem of antibiotic resistance (Wiedenmayer et al., 2020). Hospitals provide perfect settings for occurrence of contact infections, leading to spread of infections. This type of infections can be prevented through maintenance of hand-hygiene standards and by following hand-hygiene guidelines (Okada, Yamamizu, & Fukai, 2016).
Purpose: To evaluate the effectiveness of hand hygiene in preventing and controlling HAIs.

Objectives:

1. To promote knowledge of positive health behaviours as well as enhance wellness in communities.
2. To curb the spread or emergence of antimicrobial strains.
3. To enhance efficacy in prevention of hospital-acquired infections.

PICOT question: In geriatric patient ward, does adherence to hand hygiene practices compared to lack hand hygiene practices contribute to significantly low prevalence of hospital-acquired infections within a period of six months?

Literature Search Strategy Employed

Evidence-based databases including Google Scholar, PubMed, EMBASE, and Cochrane Library were searched for relevant peer-reviewed articles. Search terms include hand hygiene AND effectiveness; hand hygiene AND hospital acquired-infections; hand hygiene AND antibiotics; hand hygiene AND length of hospital stay, Lewin’s change theory AND Organizational change; and hand hygiene AND cost of care. Selection criteria was based on relevance, currency (not later than five years from the date of publication), peer-reviewed articles, and access to full articles. Journal articles that did not met these criteria were excluded from forming the foundation of this proposed intervention.

Evaluation of the Literature

The proposed solution will be implemented in a geriatric ward since there is high prevalence of HAIs in this setting (Neo et al., 2016). Hand hygiene is a simple approach for preventing and controlling the spread or transmission of HAIs (Sands & Aunger, 2020). Benefits of hand-hygiene include reducing the cost of care and the risk of increased length of hospitalization. Prevention of HAIs results in reduced antibiotic prescription rates, reduced risk of antimicrobial resistance, and improvement of patient outcomes (Hillier, 2020; Wiedenmayer et al., 2020). According to Lotfinejad, Peters and Pittet (2020), hand hygiene is one of the major strategies used currently to prevent and control the spread of the novel coronavirus.

Effectiveness of the intervention can be improved through the following strategies. First of all, adoption of technology to enhance compliance and support monitoring and evaluation is recommended for the proposed change project. Electronic hand hygiene monitoring system can enable easy tracking of hand hygiene actions of individual healthcare professionals in order to improve compliance and promote realization of better healthcare outcomes (Pong, Holliday, & Fernie, 2019). Compliance can also be promoted through the use of strategies such as education and improved awareness among healthcare professionals and problem-based facility design and planning (Neo et al., 2016). Design may include appropriate placement of hand-washing sinks. Hospitals should also be supplied with necessary resources such as clean water, soap and alcohol-based hand rubs/gels (Onyedibe et al., 2020). Moreover, healthcare professionals need to adhere strictly to hand hygiene guidelines and standards throughout their active shifts for achievement of better outcomes (Hiller, 2020).

Applicable Change Theory Utilized

Lewin’s Three-Step Model of Change is utilized in this project. It informs that healthcare organizations are complex adaptive-systems, whereby change is a complex and challenging process with unpredictable degree of agreement and complexity among disciplines (Wojciechowski et al., 2016). Lewin’s Three-Step Model includes three steps; namely, unfreezing, changing/moving, and refreezing. Unfreezing stage would include creation of problem awareness perhaps through education and changing the status quo. On the other hand, the changing or moving step involves seeking of alternatives, demonstrating benefits of the intervention, and decreasing resistance to change. The final step, refreezing, involves integration and stabilization of new equilibrium into the healthcare system and to transform it into a habit (Wojciechowski et al., 2016).

Proposed Implementation Plan with Outcome Measures

            Implementation and evaluation of hand hygiene in practice will be done over a period of six months. Strategic plan will take into consideration the organizational factors, environmental factors, and effective communication. Contextual and organizational strategies that should be ensured include training of infection prevention and control agents, managerial support, and hospital management support (Atif, Lorcy, & Dube, 2019). Similarly, environmental strategies that need to be taken into consideration include putting in place additional sinks and hand hygiene stations, reorganization of the floor space, and ensuring that there are more single-patient rooms (Atif, Lorcy, & Dube, 2019). In addition, communication strategies will include development of hand-outs and reminders, hand hygiene audit reports publications, training sessions, having frequent and short meetings, use of ultra-violet light, and designing positive feedback systems (Atif, Lorcy, & Dube, 2019). Pong, Holliday and Fernie (2019) recommends implementation of hand hygiene electronic monitoring system to help calculate hand hygiene performance and levels of compliance. Besides, the system would enable detection of missed hand hygiene opportunities and areas for improvement (Pong, Holliday, & Fernie, 2019).

Utilization of the Evidence-Based Practice

The intervention is informed by evidence-based sources. Peer-reviewed journal articles were used to provide background and to give an overview of the expected outcomes of the project.  Evidence was drawn from recent (within 5 years of publication to date) articles to provide foundation of this proposed intervention since it has been applied before with desirable outcomes. It is also important to note that utilization of evidence-based sources may have expanded and realigned the scope of the proposed project to include use of technology and evaluation of outcomes such as antimicrobial resistance and rate of antibiotic resistance (Hiller, 2020; Pong et al., 2019). The intervention is not based on personal opinions but it is an evidence-based practice.
            Plan for Evaluating the Proposed Nursing Intervention

The proposed intervention needs to be evaluated through analysis of various outcomes. It is essential to determine whether the hospital has sufficient resources, consumables, and electronic monitoring systems. This is important since they may have significant influence on the outcomes of the intervention (Atif, Lorcy, & Dube, 2019). It is also necessary to evaluate the level of knowledge among healthcare professionals on hand hygiene and its effectiveness in prevention and controlling transmission of infections. This is important since knowledge deficits may be identified and addressed through education. Specific outcome measures for analysing the impact of the change project include average length of hospitalizations, average cost of hospitalizations, rate of antibiotic prescription to hospitalized patients, and patient satisfaction scores over a six-month study period compared to the previous period (Hillier, 2020; Wiedenmayer et al., 2020).

Potential Plans to Plan Implementation

            Potential barriers to plan implementation may be experienced. Clinical environmental factors such as lack of sinks, lack of hand hygiene stations, limited space, and lack of supply of consumables such as soap, water, and alcohol-based gels may act as barriers for implementation of the hand hygiene in practice. These need to be put in place or provided before implementation of the project by involving hospital administration or management in the project (Atif, Lorcy, & Dube, 2019). Organizational barriers may include inadequate staffing issues and heavy workload to the current staff, which may be addressed through utilization of advocacy skills. Communication barriers that may hinder implementation of hand hygiene practice include having a silo mentality, high employee turnover rates, hierarchical working relationship, negative perceptions of infection prevention, and control teams, and concerns about critical feedback. Communication barriers may be addressed through the use of effective communication skill and strategies (Atif, Lorcy, & Dube, 2019).

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