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Understanding Evidence-Based Practice
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Translating Evidence into Clinical Practice
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Background: Hand hygiene is widely regarded as the most effective means of preventing cross-transmission of microorganisms via health workers' hands thus reducing healthcare-associated infections (HAIs). The need to ensure consistent good hand hygiene compliance rates remains a challenge to many organizations. Hand hygiene compliance rates are frequently reported as overall compliance. An in-depth systematic analysis of the non-compliance to precise criteria is lacking and therefore prevents barriers to be specifically addressed.
National University Cancer Institute, Singapore (NCIS) is one of the two National Cancer Centers in Singapore and is located within NUHS, a 991-bed teaching hospital. NCIS comprises the ambulatory and inpatient units. From 2008-2010, the compliance rate of hand hygiene has increased from 31% to 71%. Although HAIs acquisition among the patients has been low, it has been observed that the rate is increasing. This therefore calls for a need to analyze the compliance rate and address barriers to the non-compliance systematically.
Aims: The overall aim of this project is to establish an effective multimodal approach to improve hand hygiene compliance and sustenance among oncology registered and enrolled nurses who work in inpatient and outpatient settings.
Methods: This project uses the JBI PACES (Practical Application of Clinical Evidence System) and GRIP (Getting Research Into Practice) which is an online resource data tool that helps health professionals conduct audits using evidence-based criteria, implement change, and audit their own results. JBI PACES simplifies the cycle of audit, feedback, and re-audit and promotes ownership of the practice change process among the stakeholders.
The audits utilized all the criteria recommended by the WHO Guidelines on Hand Hygiene in Healthcare and took place over six months from November 2010 to May 2011.
The project was conducted in the inpatient and ambulatory unit in the National University Cancer Institute involving a sample size of 130 registered and enrolled nurses. Direct observation method of monitoring hand hygiene compliance was used.
Results: The post-implementation audit findings showed a slight improvement in the criteria between 1 to 12% increments for each criterion.
Discussion: Focused interventions were conducted in a group setting and allowed the staff to relate and develop greater awareness in the area for improvement. The group setting promotes discussion and allows clarification to the hand hygiene principles. The discussion to clarify confusion and misconception in the hand hygiene practice generated thoughts in the team that a one-to-one feedback and discussion about missed opportunities with the relevant staff may be warranted although the staff had received basic hand hygiene education. The one-to-one feedback helps to bring awareness to the staff about their own hand hygiene practice. This prompts them to reflect upon their current practice and leads to customized interventions to the barriers that the staffs face.
Conclusion: The one-to-one engagement promotes long-term sustainability in good hand hygiene practice as the staffs are engaged personally in the reflection of their own practice and thus allows them to realign to recommended practice.
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