The Significance Of Hospital-Acquired Infections

With high disease burden, hospital acquired infection has been a significant area of  research  around the globe.  In Australia, Russo et al. (2019),   reported that  approximately   165000 health care associated infection every  year  which reflected in higher hospital stays and readmission   and resources.  Therefore, it has been a significant quality improvement concern in Australia that require extensive intervention and support services. In this case, scenario one has been   chosen where Surgical site infection rates rapidly increased in the total knee replacements and population exhibited poor hand hygiene (5-Moments for Hand Hygiene protocol). NSQHS has been chosen   to discuss the quality improvement initiatives.   NSHQSH 3 (Preventing and Controlling Healthcare Associated Infection) suggested strategies and system in the place in order to prevent hospital acquired infecting effectively.  In this case,   the paper aims to discuss  quality improvement issue , NSQSH  Standard link to QI issue and central  activity  in the first part . In this case, Part B will focus on Analyze and evaluate the effectiveness of a quality improvement program in following paragraphs.

Part A:

Hand hygiene compliance in the clinical setting has been a significant issue around the globe. The case scenario suggested that surgical site infection rates where major quality issue was lack of compliance with 5-Moments for Hand Hygiene protocol.   The existing contemporary research suggested that even though health care providers, especially registered nurses are aware of importance of hand hygiene and exhibit positive attitude towards hand hygiene protocol, the gap in the clinical practice are highly observed in the clinical setting (Lin et al., 2019).  Mitchell et al. (2017), suggested that poor hand hygiene compliance increases approximately 60% of the hospital admission in Australia. Haque et al. (2018), suggested that hospital acquired infection are often developed due to poor timing, lack of education and training to use the protocol and lack of proper handling of invasive device and non-availability of alcohol hand lotions are often major reason behind poor    hand hygiene compliance.   While lack of knowledge is the major driver of poor compliance, availability of soap and water, alcohol-based rubs and negative attitude of the care givers are the major reasons in other countries and Australia is no exception (Engdaw et al., 2019).  While analysis professional specific factors, professional often rely on their personal judgment rather than systematic assessment for timing of compliance with hand hygiene and often skip PPE or wash hand with plain water.  Sharif et al. (2016), suggested that even though training and education ae in place, many of them believe they have low time in washing hands while working in the surgical setting.   It reflected in the compromised quality of health because antibiotic consumption, prolonged hospital stays create greater health care expenditure and economic burden of family (Lin et al., 2019).  Other impacts are increased risk of transmission, pre mature death and low health care satisfaction.  Therefore, compliance with the protocol and compliance with NSQSH are fundamental to improve safe and responsive care.  Improving Hand Hygiene Compliance And Preventing Surgical Site Infections Example Paper

In Australia, lack of   hand hygiene compliance has been a significant quality improvement issue which reflected in compromised quality of care of the patient.  The common forms of infections are urinary tract infection, surgical site infection and   after admission to the hospital. In this case, NSQHS Standard 3 (Preventing and Controlling Healthcare Associated Infection) has been developed in Australia to prevent the infection rate after hospital admission. The standard suggested professionals to improve clinical governance and risk identifications and management of the population at higher risk of infection as observed in this scenario. As this case scenario suggested surgical site infection rates develop after total knee replacement surgery, registered nurses play pivotal role   in  assessing risk of infection and open wound while improve surveillance in the clinical setting (NSQHS, 2020). For surveillance, NSQHS suggested to monitor the hand hygiene practice in the clinical setting awareness amongst nursing professionals and practice of aseptic techniques.  NSQHS standard 3 suggested to implement infection prevention and control program that ensure provision of knowledge of antimicrobial stewardship and physical demonstration of  5 moments and allocation of resources necessary for compliance of protocol (NSQHS, 2020). In this case, compromised quality of care developed from personal judgement of the professionals, lack of availability of resources and having perception that hand hygiene require extensive time and high workload often  limit the time of  performing hand hygiene (Barr et al., 2017).  Therefore, all of these contributing factors violate NSQHS  3 that further reflected in higher  rate of  surgical site infection  and pre mature death.

Poor Hand Hygiene Compliance And Its Impact On The Healthcare System

Clinical care activity:

Considering the clinical scenario, the clinical care activity can be infection control and prevention program in the clinical setting  that will integrate Multi-modal prevention strategies such as   educational workshop and allocation of resources to prevent infection rate.

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In Australian setting, Grayson et al. (2018), reported that Australian National Hand Hygiene Initiative has been developed after  8 years of  hand hygiene practice which focused  on educational workshop to improve the quality of care because formal hand hygiene education able to improve the awareness of the hand hygiene practices and exact timing of hand hygiene before and after  being in contact with  bodily fluid.   Therefore, ensuring formal education in the clinical setting using videos, poster and practical demonstration of hand hygiene will provide an insight into the appropriate aseptic techniques, duration of hand hygiene practice and alter personal beliefs regarding hand hygiene practice (Akanji,  Walker & Christian, 2017).  In this case, Weekly educational workshop for surgical professionals and other units work closely with the vulnerable patients would be most beneficial to improve their knowledge because it will enable them to monitor  their own practice and  improve frequency of hand hygiene such as done before and once touching the patient,  surgical wound dressing and  touching a contaminated body (Sendall, McCosker & Halton,2019).

On the other hand, in order to improve compliance with the protocol, resource allocation is one of the fundamental system changes. Zimmerman et al. (2020), argued that lack of resources is one of the major predictor of poor compliance with the guideline because majority of the   registered nurses and other allied health professionals   encounter challenges in terms of  in terms of availability of the resources such as lack of soap,  water and availability of the basin  and available protocol which resulted in   poor compliance. In this case, allocation of resources such as continuous water supply, presence of adequate alcohol-based rubs at the point of care can be effective strategy to improve compliance (Sendall, McCosker & Halton,2019).

Poor compliance with hand hygiene protocol in Australia breach NSQHS standard 3 that Further increase surgical site infection followed by hospital stays and premature death.  In this case, infection control and prevention program   would be suitable to improve quality of care.  Two major implementation strategies can be   development of   policy and frequent meetings of monitoring for compliance in the infection control team.   Initially, develop infection control committee   can be developed that will collaborate with the stakeholders to assess the hand hygiene compliance with protocol after program implementation (Kuhar et al., 2018).  In this case, weekly meeting with committee will monitoring for compliance will provide the idea of infection rate every week, frequency of resource use and educational workshop adherence will indicate the compliance with the protocol (Mckay, Shaban & Ferguson, 2020). Weekly meeting with committee will also ensure identification of the gap in the practice even after resource allocation and provide reminders to comply with the infection.  On the other hand, development of policy by mandating hand hygiene compliance will provide idea of compliance and reduce negligence exhibited by professionals (Hor et al., 2017). Mandating hand hygiene compliance will improve their compliance by utilizing resources and attending training.

The NSQHS Standard And Quality Improvement Initiatives

Conclusion:

On a concluding note, hand hygiene compliance in the clinical setting has been a significant issue around the globe. While lack of knowledge is the major driver of poor compliance, availability of soap and water, alcohol-based rubs and negative attitude of the care givers are the major reasons behind poor compliance.  NSQHS standard 3 suggested to implement infection prevention and control program that ensure provision of knowledge of antimicrobial stewardship and physical demonstration of  5 moments and allocation of resources necessary for compliance of protocol In this case, the clinical care activity can be infection control and prevention program  in the clinical setting  that will integrate Multi-modal prevention strategies such as   educational workshop and allocation of resources to prevent infection rate.

Evaluation of the paper:

The incidence of delirium has been significantly higher for the population especially older people after hip fracture. In this case, the objective of the study is to assess the   how implementation of tailored intervention will increase compliance of the professionals with National Safety and Quality Health Service Standards.

In this case, the study adopted interrupted time series design for examining changes in practice over tome for the individuals admitted to hospital with hip fracture (Oberai et al., 2021).  It is suitable for collecting the data consistently before and after the interruption (Hudson, Fielding & Ramsay, 2019). In this case, it is suitable to observe the changes in the practice  and compliance with  NSQSH.     The author applied the comprehensive care standard that ensure that consumers receive coordinated delivery for addressing all of the needs of the patient. Therefore, Clinicians must  identify patients at risk of specific harm while they seek clinical assistance from the professionals and address the health complications after performing any medical procedure.

Before implementing the intervention, Delirium prevention process were identified in a Level 1 University Trauma Centre. Woodhouse et al. (2019), reported that Preventing delirium practice able to decrease of delirium incidents and support professionals to assess the risk and improve  the clinical outcome of the patients who show risk of the disease. In this context, the researchers collected data  using A retrospective quality assurance medical record audit where 200 participants were incorporated for assessing frequency of delirium. On the other hand, apart from audit, researchers included  key stakeholders and ensure collaborative  relationship  for assessing barriers and enablers of the practice (Oberai et al., 2021).  Lastly, Knowledge to Action (KTA) framework were used for the project   for addressing perception of the barriers  and enablers.

The common components of the interventions are environmental restructuring, change in champions, feedback of audit report  and infographs.  The education through online, in-person training and change champion were identified for the population to improve quality of care and adherence. On the other hand, environmental restructuring can improve adherence  to NSQSH   by  adaptation of  existing documentation and  improving  accessibility of documentations  so that , pre-existing cognitive impairment and level of physical activity can be addressed (NSQHS, 2020).  Lastly,  the third component of the  intervention is quality management such as reminders through providing infographics an improving  auditing and feedback. All of these components of the intervention are crucial to prevent the delirium because the post operative   incidence rate is especially 35% (Rengel, Pandharipande & Hughes, 2018).. Such higher level of the intervention requires extensive support which require compliance of NSQSH standard in Australian clinical setting.

The Need For A Quality Improvement Program To Address The Issue

Primary outcome of interest was rate of delirium and it was obtained using medical records and documentations. All of this information were obtained from focus group discussion.  The data was collected over 28 months for assessing the intervention (April 2018 to December 2019) (Oberai et al., 2021).  The secondary outcome is   4AT screening tool has been used for assessing hip fracture patients.    In  this case, length of stay  were also obtained using mean between pre and post intervention.

Traditionally, evaluation method such as participant engagement, responses to the intervention and audit, assessment or survey has been conducted for evaluating the intervention.  However, in this paper, the researchers conducted evaluation by using  interrupted time series approach  because it enable researchers to allow  detection of any significant shifts in the rare of delirium at the time of the interventions .

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