clitical audit proposal

MARKING CRITERIA SHEET FOR INDIVIDUAL CASE STUDY
Running Head: CLINICAL AUDIT PROPOSAL
2
Clinical Audit Proposal
TOPIC: COMPLIANCE OF STAFF WITH HAND HYGIENE PRACTICES IN MENTAL HEALTH INPATIENT UNIT
Audit Period: June 2018 to Aug 2018
Report Date: Aug 2018
INTRODUCTION
Hand Hygiene is considered as a most important factor to prevent the infection (Department of Health,2014). According to the National Hand Hygiene Initiative, the hospitals in Australia started a program named- Five Moments for Hand Hygiene. The program signified the five indicators of hand hygiene in terms of physical contact between the health care workers, the patient and other people around these two. According to Population Health Services 2015, the ‘five moments’ of opportunity for hand hygiene in hospitals are;
1. Before touching a patient or shaking hand with him or before any examination;
2. Before conducting the procedures like dental care, wound dressing, or giving medicines;
3. After any contact with body fluids like defecation, handling urine, blood, and waste;
4. After any contact (non procedural) with the patient;
5. After touching and handling the things like bed linen, equipments and the curtain.
The paper presents a clinical audit proposal for compliance of staff with hand hygiene practices in local mental health inpatient unit of the city. The study uses appropriate relevant literature review in support of the audit.
BACKGROUND
Since 2010, it has become mandatory for all the public and private hospitals of Australia to send their quarterly reports of compliance rates with Five Moments Program (Government of Western Australia,2010). Another determinant of patient safety as observed in the hospitals is the blood infection caused in the patients due to Staphylococcus aureus. The two incidents being observed in most of the hospitals are linked together. The program Hand Hygiene Australia (HHA) exhibited immense success by improving the hand cleaning habit in the healthcare workers and reducing the infection rate. The website of Hand Hygiene Australia reflects remarkable improvements in national rate of hand hygiene from 2010 to 2013.
Audit question
What is the compliance level for medical and nursing staff with the hand hygiene practices in a mental health inpatient unit?
Rationale / Objective of the Audit Question
Mental health is considered as a low risk area for infection.
However in few studies it is observed that the in- patients admitted to mental health inpatient units generally incept the infection of bacteria like Staphylococcus aureus which is associated with the presence of unhygienic conditions.
The literature review will analyse the evidence of past studies, government policies, programs and reviews submitted by different researchers on this topic so that we could propose an exact action plan for our clinical audit proposal.
Goals & Aims
The past studies have revealed that the compliance of hand hygiene by doctors in mental health inpatient units is considerably lower than the nurses (Ott & French,2009). Most of the mental health units have been reported to have hand hygiene compliance.
The aim of the literature review is to find out the rate of compliance to hand hygiene by the doctors and nurses with 5 moments program in mental health inpatient units; and to refine the research to focus on the compliance rate and infection probability in mental health inpatient units .The audit will be conducted to confirm whether these units adhere to the five moments program policy as recommended by the HHA.
Design, Method, Data collection & Analysis
The audit would be performed to check the cu
ent practices of hand hygiene policy involving the clinical review of mental health inpatient units in the audit period. The audit would include the feedback and reports from doctors, physicians, nurses, pharmacists, midwifery, and others (Ott & French,2009). Only the patients who have been admitted to the hospital from March 2018 to May 2018 would be reviewed and investigated. The sample would be collected randomly from the mental health inpatient unit.
A research performed by Azim and Mclaws (2014) in Australia found that the hand hygiene for all the medical healthcare staff members was below a certain level of threshold value (68%) while the compliance rate of nurses was 84% approx in the time period of January to March 2013.
The government of Australia also issued specific guidelines describing minimum hand hygiene requirements to be followed by all the public or private hospitals. In December 2008, the health ministry in Western Australia endorsed the National Hand Hygiene Initiative (NHHI) in this regard to monitor the compliance with Hand Hygiene. This initiative was based on Global patient safety challenge of WHO namely ‘Save lives: Clean your hands’ and directs the adoption of five moments of hand hygiene. The initiative aimed to reduce the chances of infection transmission in healthcare workers in Australia. It required a major culture change initiative to enhance the use of alcohol-based hand rub liquids (ABHR).Alcohol-based hand rubs could reduce the rate of intravascular catheter infection considerably.
The main five elements of the program were change in practices, appropriate education and training, feedback and evaluation, implementation of reminders at the workplace, improving the safety of environment in both the clinical and nonclinical areas.
It is necessary that the products used in hospitals to disinfect the hand hygiene must be approved by the Australian Therapeutic Goods Administration and meet the required recommended standards of EN1500 European Committee, for bactericidal influence.
The mental health inpatient units have been exempted from the regular auditing of NHHI, while all other key elements of the programs can be implemented by the staff. The research performed in 2014 disclosed the following points in compliance to hand hygiene by a survey of 82 Australian Hospitals:
Source: https:
www.mja.com.au/journal/2014/200/9/doctor-do-you-have-moment-national-hand-hygiene-initiative-compliance-australian
It shows the compliance is greater in nurses than in doctors. As a major step in implementing the HHA policy, the Hand Hygiene Compliance Application is developed with an aim to help all the units in Australian Hospitals to report about their compliance rates as a part of NHHI or National Hand Hygiene Initiative. The application allows the entry and reporting of hand hygiene data on its platform by the trained auditors. The website also provides lot of information and awareness about the 5 moments and alcohol-based hand rubs. The HHA invites applications for participation from interested participants all around the world and organizes meetings, conferences, and seminars to conduct the workshops. In the same context, a recent 2107 HHA workshop was organized by HHA in Canbe
a where more than 200 participants took part(Hand Hygiene Australia, 2017). Such initiatives encourage and devise new ways to implement the hand hygiene in a better way.
Data Collection & Analysis
As our study may be confined to mental health inpatient units in Australia, we would collect data from all these units regarding their compliance with hand hygiene. We can use the HHA application and websites to assess their complaints and registered reports on the HHA portal. It is recommended that we should collect data after state wide hand hygiene campaign is over. During the campaign the alcohol based hand rub solutions would be distributed in the hospitals, and around five observatory surveys would be conducted. We can collect data after this initiative as it will increase the awareness and will definitely improve the hand hygiene level in hospitals since the last periods of observation.
Data can be collected from the mental health inpatient unit by personally visiting the setting and informing the management about the...