Question

The Quality Issue

Hospitals across the country have seen an increase in methicillin-resistant staphylococcus aureus(MRSA), a bacterial infection that is highly resistant to some antibiotics. Patients who contract this infection can develop serious complications, sometimes leading to death. Area hospitals with MRSA outbreaks have been featured in recent media programs, resulting in a loss of public confidence and declining admissions. As the director of an inpatient unit at Madison Community Hospital (MCH), you understand the potential for an increase of methicillin-resistant staphylococcus aureus (MRSA) at your hospital. Your infectious disease physicians are concerned about the potential for an outbreak at your hospital. Infection prevention studies have reported that only 40% of healthcare workers sanitize their hands before treating patients. Hand-washing and other hand-sanitizing methods have been proven to reduce the transmission of dangerous infections from one patient to another.

Preliminary Actions at MCH

The MCH products committee has evaluated several hand-sanitizing products and selected an alcohol-based product that effectively eliminates the majority of bacterial micro-organisms that can be transmitted by contact. The hand hygiene policy at MCH requires staff members, physicians, and volunteers to apply the hand sanitizer before entering and after leaving a patient’s room. The Infection Prevention staff estimates an average of 15-20 individuals enter a patient’s room each day.

You have been appointed to serve on a task force charged with improving hand hygiene compliance. The Infection Prevention personnel have gathered preliminary data from various inpatient nursing units. (See table below) Staff on these units were observed in order to assess whether they sanitized their hands prior to entering and upon leaving a patient’s room. The Infection Prevention staff observing the inpatient unit personnel are routinely seen on these units as part of their surveillance activities. Staff members were not aware their hand hygiene practices were being observed. At first glance, the data indicates hand hygiene is not practiced, as required by the policy, in more than half the observations.

MCH has adopted the FOCUS-PDA improvement model and utilizes various tools for collecting data and analyzing processes. The hand hygiene task force will be applying these methods to address the hand hygiene concern.

Unit	Number of Staff Observed	Number of Sanitizing Hands	Percent Sanitizing Hands
2 North	15	8	53%
2 South	18	12	67%
2 East	16	6	38%
3 North	19	10	53%
3 South	13	7	54%
3 East	15	6	40%
4 North	18	9	50%
4 South	17	7	41%
4 East	14	6	43%
Total	145	71	49%

Questions:

The hospital is developing a hand hygiene task force to discuss the hand hygiene concern. Who should be on this task force to represent what hospital functions and why? To whom should the task force report their results and why?

What are some of the issues associated with caregivers sanitizing their hands? Why do you suppose only 40% of caregivers sanitize their hands? What other department personnel, besides nursing, may need to enter a patient’s room during their stay?

What are the possible causes for noncompliance? Are there other factors contributing to the issue?

How would the problem look different if it turned out only a handful of personnel were noncompliant? How would this affect the improvement process?

What process should be selected for improvement? Why?

How can MCH motivate its staff to be more compliant?

After reading the case study, please answer the questions above in a 2-3 page report. Be sure to include at least one, well-developed paragraph, to answer each question. please include references

Answer 1

The hospital is developing hand hygiene task force to represent the issues of staff of the hospitals are not washing the hands as needed. The issue was discussed based on the infection control data of staff hand-washing rate is only 40%. The doctors and the supervisors of each department should be on the task force to represent the hospital function. They address the issues and feedbacks of the employees related to the task force. The results should be reported to the hospital administration such as CEO so they can take necessary measures.

Issues related to caregivers not sanitizing the hands are

• Increase workload and busy schedules.
• Poor sanitazion area or less sanitazing product.
• Misuse of gloves.
• Inadequate knowledge regarding for need of hand washing.
• Ineffective method of handwashing.

Only 40% of staff sanitize their hands because the staffs are not strictly following hospital policy, does not know the importance of hand washing, does not do their job honestly.

The other personnel enters the patient's room are Dietary personnel, Janitor, House Keeping personnel, Administrative officers, Patient relation officers, visitors.

The possible causes of non-compliance are usually the ICU staff are not doing frequent handwash. Because most of the times they are dealing with one patient and also wearing gowns and gloves. so they think no need to hand wash most frequently. The other factors include the germs may spread through sink from one person to another person and through cross-contamination.

If the handful of personnel were non-complaint, then the issue of handwashing become serious and affected all areas of the hospital. Germs may spread to all areas of the emergency department, labor room, surgery room. All these areas of the hospital should be clean and handwashing is important in all these areas. If there is no available data to analysis then it will affect the improvement process.

The selection process for improvement includes

• Nurses should use proper techniques and should wash for at least 30 seconds.
• The hand should be washed with anti-bacterial soap or with alcohol-based hand sanitizer which is effective against most of the infectious agent.
• The hand should be washed before entering the room and after leaving the room to prevent cross-contamination.
• Sanitation area should be placed properly and handwashing technique board should be fixed next to it.

MCH can motivate the staff by

• Make alert of hand washing among the staff members.
• Training to the new staff members about the protocol of hand washing.
• Encourage to follow infection control policies.
• Monitor for compliance regularly.