Eshley May Pacamalan University of Central Florida

Significance of Problem Healthcare associated infections (HAIs) pose a major threat to patient safety and affect hundreds of millions of people worldwide (WHO, 2009) Seen in approximately 722,000 patients in acute care hospitals in 2011, with approximately 75,000 patients dying during hospitalizations (CDC, 2014) Cost $6.5 billion in 2004 and increased to $33.8 billion in 2009 (Spruce, 2013) The long-term care (LTC) setting further contributes to the susceptibility of infection Resident socialization and use of common areas allow for increased person-to-person spread and exposure to contaminated surfaces (Schweon et al., 2013) Hand hygiene has been proven to be the easiest, least expensive, and most significant practice to prevent the spread of pathogens (Mathur, 2011). However, it continues to be a problem among healthcare workers due to lack of compliance (WHO, 2009)

Baseline Data Setting: 95-bed assisted living facility (ALF) with 18 staff members Data collection: Administer surveys to measure employees’ existing knowledge regarding hand hygiene Utilize direct observation – Complete in the period of two months prior to implementation Record the number of clients hospitalized due to HAIs within six months prior to implementation Tools: From the WHO’s Clean Care is Safer Care initiative Questionnaires Observation forms (WHO, 2014)

Potential Strategies Install touch-free hand sanitizer dispensers in high-traffic areas Place hand sanitizing wipes in common areas Provide an educational program for healthcare professionals Provide educational information about the program to residents Monitor compliance (Schweon et al., 2013) Show positive role modeling Utilize performance indicators (Mathur, 2011) Integrate compliance into the culture of the organization Reminders Appropriate rewarding Enhancing self-efficacy Ensure a multimodal and multidisciplinary approach (CDC, 2002)

Culture & Change Management Strategies Stakeholders of the plan Managerial staff Administrator – Must grant permission for the project Stakeholder engagement benefits Early buy-in, successful design, & establishment of long-term support Can help contribute suggestions for formation and implement continuous quality improvement Obtaining stakeholder buy-in Present the PI Plan, emphasizing: The current growing issue of hand hygiene practices The potential effects that may negatively influence the health of the clients and the success of the business Positive outcomes, with the goal of improved safety throughout the entire organization Achieving continued engagement Regular communication & management of expectations(AHRQ, 2008)

Plan Design – Performance Improvement Method TeamSTEPPS Model Step 1: Assessing the need Form a change team Perform a needs analysis Identify issues Define goals Step 2: Planning, training, & implementation Outline a plan for intervention Develop an evaluation plan Prepare the organization Establish a communication plan Implement the interventions Step 3: Sustainment Provide continuous feedback Measure success Update Plan (AHRQ, n.d.)

Plan Design – Interventions Education Implement a teaching program for all staff Offer educational opportunities for all residents Both would focus on the basics of hand hygiene, with visual and written materials How & when we wash our hands Factors for noncompliance Environmental adaptation Install hand sanitizer dispensers in high-traffic areas Place sanitizing wipes in common areas Display posters for reminders to residents and staff Active Participation Front line staff Administrative staff – Shows support and positive role-modeling

Plan Design – Resources Timeline Educational materials Tools for presenting Laptop Projector for slide and video Written documents for questionnaires, handouts, and posters Additional supplies to be added to the physical setting Dispensers and wipes Personnel who will be teaching and observing 4 staff (2 RNs and 2 CNAs) would serve as liaisons, facilitating proper practices and observing for improvement Two month period of baseline data collected by the liaisons Divided among three shifts to ensure complete record of all staff Use of a standardized observation form Two month period of training for all staff With weekly meetings for questions and concerns Two month period for outcome evaluation by the liaisons Utilization of the same methods used with initial data collection Yields six months of implementation Plus continuous adjustment and application

Plan Design – Projected Goals Feasibility To increase staff knowledge and implementation of proper hand hygiene 100% on the knowledge-based questionnaire 100% compliance To decrease facility acquired infections By 50% in the first 6 months of implementation Completely eradicated after a year of implementation and every year thereafter Very high Resources have already been developed Personnel are already employed within the organization All required components are within the scope and capabilities of the staff Its application is reasonable and its goals are achievable Multimodal strategies have been highly advised by various studies, therefore, multiple aspects of improvement are preferred for this facility.

Possible Cost & Potential Savings Very cost efficient All teachings and interventions done by existing staff No additional individuals needed for the collection of data Additional costs Educational materials Supplies for physical environment Total estimated cost: $300, plus the continued cost for refilling the dispensers/wipes Laptop and projector (already owned)$0 Printed materials$100 Hand sanitizer dispensers$100 (5 units at $20 each) Sanitizing wipes and sanitizer refills$100 (initial cost) Savings Determined by the number of clients who were prevented from experiencing an HAI Based on the current HAI rates and the financial losses associated with hospitalization The benefits of the PI Plan far succeed its financial aims, as the improved health and wellbeing of the clients are the main focus of its implementation.

Outcome Evaluation Measure the knowledge and compliance of the staff, compared before and 6 months after implementation Questionnaire scores Based on percentages of correct answers Observational accounts Based on adherence rates: Number of times the hand hygiene practices were performed compared to the number of opportunities that had arisen(TJC, 2009) Measure the number of facility-acquired infections, compared by the time period 6 months before and 6 months after implementation Sustainability Annual administration of questionnaires Quarterly observations for compliance Semi-annual evaluations of facility-acquired infections

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