Implementation and Management within a Queensland General Hospital
The notion that hand-washing could reduce mortality has existed since Ignaz Semmelweis discovered that the incidence of puerperal fever could be drastically cut by the use of hand disinfectant in obstetrical clinics in the mid 1800s (Wikipedia, n.d.). Florence Nightingale is renowned for her campaign that clean water, food and environment could reduce the death rates in military hospitals and her interest in hospital hygiene lasted the whole of her career. In more recent times, “Hand washing has been proven to be the single most important technique in the prevention and minimisation of the spread of infection within the hospital environment” (New South Wales Government, n.d.).
Approximately 3 years ago, the hospital being discussed in this paper (‘The Hospital’) introduced a Hand Hygiene Program in line with the National Hand Hygiene Initiative (NHHI), a national approach to improving hand hygiene based on the World Health Organization (WHO) – “Clean Care is Safer Care,” that was launched in 2005 (Hand Hygiene Australia, n.d.). The launch campaign consisted of posters, screensavers, distribution of polo shirts and stick pins. Alcohol foam hand sanitiser dispensers were installed on the foot of every patient bed, at the entrance to every ward and patient rooms and other strategic places within the hospital. Outside every patient room there is a “5 Moments for Hand Hygiene” poster. An education program was run solely by the Infection Control Clinical Nurse Consultant. The program consisted of small group face to face sessions and directions to the Hand Hygiene Australia online training for which a link was installed on the hospital intranet.
Standard 3 of the National Safety and Quality Health Service Standards is “Preventing and Controlling Healthcare Associated Infections.” One of the actions required to meet this standard is auditing of compliance with the current national hand hygiene guidelines. Compliance rates are to be reported in accordance with the governance structure and actions are to be taken to address non-compliance (Australian Commission on Safety and Quality in Healthcare, 2011, p30.) In order to meet its requirements, The Hospital is required to submit audits of 800 moments of hand hygiene 3 times per year to the Centre for Healthcare Related Infection Surveillance and Prevention (CHRISP.) This department provides “clinical governance, leadership, expert advice and statewide systems and processes that underpin quality improvement and patient/staff safety” in relation to preventing harm caused by infections (Queensland Health. n.d.).
The national benchmark for hand hygiene compliance is 70% (Australian Institute of Health and Welfare, n.d.). The hospital has never reached this target, and despite attempts to maintain awareness of the importance of hand hygiene, there has not been an increase in compliance for the most recent 3 reporting periods. The auditing is largely undertaken by the Infection Control Clinical Nurse Consultant (CNC) and Clinical Nurse (CN) despite there being 6 trained auditors elsewhere within the hospital. As submission deadlines draw near, increasing amounts of time are taken up with auditing, leaving little time for other tasks and responsibilities.
The development of alcohol based hand gels and foams is a relatively recent development. The Centre for Disease Control (CDC) released its hand hygiene guidelines in 2002, advocating the time saved by using these products rather than soap and water hand washing and their greater efficacy against microorganisms (Dix, 2002). However, as discussed above, the need for hand washing in a hospital environment has been known since long before anyone working in healthcare today was born.
In order to develop a hand hygiene program that is sustainable and becomes automated practice for healthcare workers, a structured, stepwise...