HNN320 Deakin Wk 2 Strategies To Reduce Risk Of Hospital-acquired Infections For this assessment task, required to: Identify two (2) key strategies from the literature for reducing the risk of hospital acquired infections for patients. Your discussion must include how each strategy will reduce hospital acquired infections; To show understanding of the role of the Registered Nurse, critically discuss the implications for professional nursing practice in implementing each of the identified strategies.
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This assignment requested only 2 strategies. This part should include; explanation of the selected strategy, discussion must include how each strategy will reduce hospital acquired infections. This is the first part of assignment. For example, promoting hand hygiene practices (Strategy 1). Explain what is hand hygiene, what happened while poor hand hygiene compliance, reason for poor hand hygiene compliance, justify how hand hygiene promotion improves hand hygiene compliance to reduces hospital acquired infection (Explain what is happening if not follow proper hand hygiene practices and how proper hand hygiene compliance reduces hospital acquired infection, support with literature evidence & give statistical evidence also) – You can get some points from previous written assignments attached (Do not copy).
a) Explain the strategy
b) Static evidence, Australian current evidence is preferred (After & Before)
C) How monitoring & performance to improve hand hygiene
D) Relate to National safety Quality standard
Quality & Safety (1st Standard)
Preventing & Controlling (03rd Standard)
Strategy 2, Promoting proper infection precaution methods (Eg: Droplet, airborne, contact..etc). Explain the strategy and follow the above method of explanation.
Then go for implementation part; This part is critical analysis (Not descriptive). Critical means, discuss both sides in implementation (Facilitators and barriers when applying these strategies in hospital settings) of each strategy.
maximum References should taken from Australia. If any most important evidence can chose from out of Australia.
Sources as many as possible-35 Page |0
This is one of submitted
A worldwide systematic review found that the incidence of healthcare-associated
infections ranged from 1.7 to 23.6 per 100 patients (Pfoh, 2013). On average, at least seven
patients per hundred admissions acquire health care acquired infection (HAI) in developed
countries while around ten patients per hundred admissions acquire HAI in developing
country. This figure is high at about thirty patients per hundred admissions among critically
ill patients in intensive care units. (WHO, 2013) While many methods exist to prevent health
care-associated infection, most experts believe that improving hand hygiene (HH) is the
simplest and effective way. Many of the pathogens responsible for nosocomial infection are
transmitted by the hands of health care workers (HCWs); therefore, the primary measure to
prevent infections in hospitals is proper HH (as sited in Larson et al. 2009). The goal of HH is
to reduce the microbial count on the skin of HCWs to prevent cross transmission of
pathogens among patients (cited in WHO guidelines on HH in health care, 2009). However,
previous studies have shown that HH compliance is poor among the nurses due to various
Despite the adherence to hand hygienic compliance, the rate remains low within
patient care settings. WHO and Centres for Disease Control and Prevention (CDC) has
identified that lack of knowledge on proper hand hygienic practices among HCWs less than
optimal level. (WHO, 2012). Other than this, some other factors influencing to low
compliance includes health care setting system design, positive attitude on practices,
availability of appropriate products, ignorance of guidelines, time deficient, forgetfulness,
intensification of hand hygienic demand, work load and understaffing. Moreover, frequent
barriers have been reported by nurses that they are facing on HH that include developing
allergic reaction by antimicrobials, lack of systematic information, difficulties in accessible to
facilities such as provisions are lead to nonadherence. These factors can be overwhelmed by
adopting suitable strategies in the clinical settings. Two strategies are discussed in this essay
that significantly enhance the compliance of nurses HH practices by supporting recent
literatures. Implementing programs of hand hygiene promotions and institutional changes in
infrastructure facilities and clinical governance are selected as key strategies.
Strategy No.01- Hand hygiene promotions
HH promotion is a main challenge for infection control. It is impossible to overcome
by single intervention to improve the compliance of HH among nurses. Therefore, executing
promotional programs may improve the knowledge of HH and it motivate to make
behavioural changes among nurses. Educational programs promote knowledge improvement
and create positive attitude in HH (Lee et al. (2014). HCWs used to perform HH in a routine
manner rather than following proper WHO guidelines. The reason behind this poor
compliance is lack of knowledge and poor attitude on HH. A study conducted in 2015, 67%
among the participants has agreed that they should be upgraded their knowledge on HH
(Asadollahi et al. 2015). Moreover, WHO stressed to provide knowledge regarding basic
principles, five moments, standards of practicing HH and appropriate procedure of hand
washing with the use of suitable agents (WHO, 2009). Therefore, carry out promotional
sessions with the scope of education and changing behaviours are important to enhance HH
compliance within healthcare facilities.
There are several studies conducted to elicit the strategy of conducting promotional
programs based on knowledge improvement that increases the compliance of HH. A study
done in Saudi Arabia by conducting successful HH promotional program across a 350-bed
community hospital has found significant results with increased HH compliance. This
promotion included; educational sessions, practical trainings and evaluation on performance
within HCWs. The result of HH compliance percentage got increased from a baseline of 38%
to 65% in 2006, 65% in 2010 and then to 85% in 2011 (Setoet al. 2013). Another study done
to enhance HH compliance by promoting education sessions. Which conducted with short
repeated educational sessions and found significant improvements in HH compliance along
with a reduction of nosocomial infections. After the session HH compliance rate increased by
23.6% (68.9%-86.9%) before touching a patient and 22.5% increased (68.9%-84%) after
touching a patient. Also, nosocomial infections rate decreased by 18.9% (Heldera, Brugb,
Loomanc, Goudoevera, & Kornelissea, 2010). Although, conducting educational programs
are inefficient when the lectures delivered alone. Alternatively, promotional sessions of
educating nurses could be delivered by conducting small group seminars, frequent written
and verbal information, discussions on practical issues, reminder systems by posters and
creative awareness sessions might be more efficient and effective. However, acquiring only
the theoretical knowledge insufficient to improve adherence to HH, unless it failed to make
behavioural changes among HCWs.
Intention of educational promotions strategy is to develop positive behavioural
changes within nurses to improve HH compliance. The educational promotions enabling to
gain evidence based knowledge, recent updates of statically analysed data of patient
outcomes and importance of adhering guidelines among HCWs. Similarly, practicing with
proper procedural knowledge may motivate and encourage them to change their behavioural
perception to practicing on professional way to ensure the quality of care. An evidence can
be given, a systematic study done in South Korea shown the HH promotions can change the
perception of HH; that leads to HH compliance. Further it illustrates that effective education
programs can change nurses perception about HH which causes to improve their positive
attitude and proper practice regarding HH. Research revealed about observational findings of
nurses went throughout the study are; changes in positive intention of HH adherence,
awareness of knowledge about indications, perception of knowledge relate to HH process,
perception on preventing HAIs, behavioural norms of HH, responsibilities to holding a
leadership role for colleagues and the improved motivation to do HH (Susan et al. 2013). Lee
et al. (2014) says as per their research findings those positive changes in attitude, knowledge
and perception lead to improve HH compliance among nurses.
The third standard of in bench mark point of national safety and quality health service
standards is saying about preventing and controlling and health care associated infections
(NSQHS, 2012). The purpose of this standard is to protect the institutionalised patients from
healthcare associated infections by implementing standard precautious infection control
systems such as HH and aseptic techniques. HAIs which is preventable and effective
management of HAI using evidence based strategies. Achieving this standard nursing leaders
and other responsible managers make awareness about standard procedures to institutional
staff by promoting educational programs by experts. It is the major responsible of nursing
leaders educating and following above mentioned HH promotional strategy to improve HH
compliance of HCWs to eliminate or minimise the prevalence of hospital acquired infections
Strategy No.02- Institutional changes in infrastructure facilities and clinical governance
Making opportunistic changes in institutional and management regards to improve
HH could be carried the result of ensured safety and quality care with reduced HIA via crosstransactional. In this strategy will be discuss about the changes should be made to provide
optimum institutional support to improve HH compliance to HCWs. Particularly the changes
in infrastructure of hospital facilities with adequate supplies and governance on real-time
monitoring by utilizing available resources are the criterions should be achieved to improve
Infrastructural changes should be made in convenient way to perform HH in the
healthcare facilities to manage crucial circumstances with concerning on appropriate units.
For example, increasing availability of sinks according to necessity and accessibility may
encourage to perform HH even in-patient zone, ICU settings and emergency rooms.
Furthermore, ensuring availability of clean running water, disposable towels, suitable soap,
and alcohol-based hand rub at the point of patient care will increase the HH compliance. A
study done by Mathur (2011) says, majority of the male participants complained on their poor
compliance on HH due to lack of sinks availability, inadequate washing supplies at the point
and sinks inconvenient sink locations. Another study stressed the inconvenient sink location
heavily effect the HH practice. Rate of HH habit reduced to 16.3% from 25.6% when the sink
located at inappropriate apart from patient zone (Deyneko et al. 2016). It is apparent that
HCWs required the changes in infrastructure of institution systematically to maintain HH
compliance up to a higher standard. According to the NSQHS (2012) standards under roles
for safety and quality in healthcare stressing, healthcare leaders should be ensuring the
maintenance of materials and proper system requirements to meet the HCWs demands to
deliver effective, safe and reliable patient care.
Other important component of system changing strategy is to improve proper clinical
governance on real time monitoring on HH compliance by institutional leaders such as
registered nurses, nursing managers to evaluate and encourage fellow workers or junior staff.
Dynamic nature of hospital environment keeps nurses involving with multiple tasks. Within
these crucial schedules they are more likely to un-attend or poorly perform the hand hygienic
practices due to less priority comparing with other tasks and procedures, ignorance and
forgetfulness. In this regard, real time governing system can overcome this issue to improve
HH compliance and it has proven as an effective strategic element. A recent study says, it is
seen that HH compliance drops in nurses whether their perception that they are not being
monitored. There is no any system to find whether they are performing HH or not in
appropriate method (Quan, Taylor, & Zborowsky, 2015). Therefore, following continuous
real-time monitoring or supervising is found to be effective to limit nonadherence to HH.
Nevertheless, frequent monitoring system implemented by many countries as an effective
component of quality assurance and it considering as major contributing factor to eliminate
HAIs by increasing HH compliance (Goulda et al. 2017). Hence, real time monitoring system
can be taken as an effective component to support to institutional system changes strategy to
improve HH compliance.
NSQH standard one states Governance for Safety and Quality in Health Service
Organizations is intended to create a combined governance system that sets procedures and
policies to maintain and improve the reliability and ensuring quality of client to obtain better
patient outcomes (NSQHS Standards, 2012). Our system changes towards monitoring to
improve HH practice meets the NSQH criteria. Moreover, institutional system changes
strategy should be implemented by nursing leaders. NSQH governing systems criterion 1.3
also requiring assigning responsible and accountabilities through workforce leaders. Above
discussed strategy also need to execute through nursing leaders to maintain HH compliance
to meet NSQH standard to prevent HAIs.
Barriers/facilitators influencing when implementing the strategies identified in clinical
The strategies of HH promotion and institutional system changes are an effective
approach to increase adherence of HH compliance, however carryout these strategies in to
real time professional nursing practice need to overcome towards barriers. To succeed these
strategies should be executed through leadership qualities within hospital settings. Nursing
leaders were chosen to apply these strategies, because they are playing a vital role dealing
with patients. Therefore, nurses should develop behavioural and social compliance to
demonstrate as a role model in the healthcare facility (White et al. 2014). In order to being a
nursing care giver, act as changing agent to deliver multimodal tasks to other group of people
is important role in nursing leadership. This could be possible by improving knowledge and
changing behaviours through multimodal promotional programs. Nurses as educators has
conducting educational sessions covering with both theoretical and practical content,
communication campaigns and leadership commitment to all nursing staff once a month is
beneficial to update knowledge (Pfoh, 2013).
One of the main barrier for educational promotion is lack of active participation to the
sessions. This habit is due to negative perception towards the sessions that carries knowledge
perceiving that they already have enough. To encouragement of active participation of other
nurses, nursing leaders and managerial positioned individuals also to be participated in to the
sessions to inspire other co-workers. Interactive interventions could be implemented as a
nursing leader with utilising leadership qualities of critical thinking and creativity. preparing
educational materials to increase involvement of participants; multimedia presentations,
leaflets, poster presentations, concise pocket notes and explanatory videos are ideal to
increase interaction of audience. Research find of King et al. (2015) shows 33% HH practice
improved by displaying awareness posters at the entrance of clients room. Absent rate
increase by the availability of nurses on duty due to roster circulation; and they miss the
opportunity to participate to the session. It can be adopted by knowledge sharing among the
peer groups (Pittet, 2001).
Hierarchical barrier impact on non-compliance of HH within the hospitals. The
physicians and surgeons perform poor adherence on HH due to crucial work schedule and
negligence. In this situation developed positive behavioural changes guided to overcome this
problem by demonstrating proactive ability and applying technical knowledge to encourage
them without hurting to adhere HH is to ensure the patient safety. Experimental researches
done to check viability of real time practices in to clinical practices. A complain executed to
the ward nurses with the theme of Helping doctors with HH compliance during ward rounds
in November 2012 by infectious disease control of Australia; nurses initiating HH in front of
doctors and then requesting them to do politely. Awareness posters also displayed in this pilot
with the theme of Help your doctor for excellence in HH. Physicians compliance rate of
HH dramatically increased to 65.1% from 36.9% (Seto et al. 2013). In this practice exhibit
the applying higher leader ship quality of being inspirational modal can increase the HH
Organisational factors effecting HH compliance among HCWs which availability of
product using to HH, accessibility to HH stations. A study finding says, inconvenient sink
location, HH supplies could not meet to requirement or unavailability at washing stations,
unsuitable supplies, lack of motivational factors are providing poor HH outcomes. HCWs
mostly engage in busy situation and that tasks prioritise than HH, more time consuming due
to readily unviability of hand washing products at the site and insufficient motivational
factors including reminder posters and guidelines are reducing HH (Chagpar, Banez, Lopez
& Cafazzo, 2010). However, it is the responsibility of nursing leaders to arrange adequate
facility from organisational resources to establish patient and HCWs safety.
The direct monitoring enabling to provide real time feedback about HH compliance of
individual and to the nursing leaders. Therefore, the individual nurses are motivated and
imposed to perform proper HH practice on the supervision of expert senior nursing leaders.
Indirect observation implemented by electronic monitoring systems such as continuous video
recording, computing of HH product consumption, usage of HH devices and automated
reporting (Koss et al. 2009). Practicing with this latest system limited within high grade
hospitals due to lack of funding. However, direct observation can be implemented in all the
institutional levels with minimal cost. Moreover, providing real time feedback make
facilitators to improve more responsibilities other nurses getting opportunities correct their
faults on time (Goulda et al. 2017). There is a barrier for implementing this strategy is, it
demands extra job role with trained nurse for supervision. Yet, it could be overcome by
splitting this responsibility over nursing leaders by rotationally; which make more
competence nurses over the period.
In conclusion, although it is apparent that HH adherence is a vital less cost-effective
practice for patient and HCWs by reducing HCAIs, compliance with this practice is keeping
low. The reason behind this are barriers to implement multi modal approach to increase HH
compliance; some were discussed above. Two main strategies discussed that would be more
significant to execute; which can achieve by providing strong and multi-dimensional
leadership support towards nursing leaders (WHO, 2009). Finally, strategies need further
researches to implement up to the standard expected by NSQH.
P a g e | 10
Asadollahi, M., Bostanabad, M. A., Jebraili, M., Mahallei, M., Rasooli, A. S., &
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Individual and Organizational Predictors. Journal of Caring Science, 45-53.
Chagpar, A., Benaz, C., Lopez, R., & Cafazzo, J.A., (2010). Challenges of Hand Hygiene in
Healthcare: The Development of a Tool Kit to create Supportive Processes an
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Deyneko, A., Cordeiro, F., Berlin, L., Ben-David, D., Perna, S., & Longtin, Y. (2016). Impact
of sink location on hand hygiene compliance after care of patients with Clostridium
difficile infection: a cross-sectional study. BMC Infectious Diseases, 16, 1-7.
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Improved Hand Hygiene Compliance is Associated with the Change of Perception
toward Hand Hygien…
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