Hand Hygiene in Nursery during Diaper Changing - The Joanna ...

Hand Hygiene in Nursery during
Diaper Changing
Presented by:
SN Phang Koh Ni
Team Members:
SN Nur Liyanna Bte Maznin (Leader)
NC Sarah Ho-Lim Su Tin (Facilitator)
NE Yip Wai Kin (EBNU Facilitator)
NM He Xiao Cong (Facilitator)
SSN Noraini Binte Bujang
SN Quek Yu Ting Eline
SN Yang Yajing
SN Anthony Devadoss Roseline
Clinical Care
Education
Research

Background
• Hand hygiene is the most effective measure in preventing
nosocomial infection
• Nosocomial infection is commonly transmitted via
contaminated hands of healthcare professionals
• Newborns are susceptible to infection due to immature
host defense mechanisms
• The process of changing diapers exposes newborns to
higher chance of infection
§� (Lam et al, 2004)

Clinical Problem
• Variation in hand hygiene practices especially after
handling soiled diapers
Aim
• To implement best practice recommendations on hand
hygiene practice when changing soiled diapers

• Phase 1
o Assemble team
Methodology (1)
o Search for hand hygiene best practice

Evidence Review Findings

• Phase 1
Methodology (2)
o Conduct pre-implementation audit
o Conduct GRiP analysis
§� Share audit results with ward staff
§� Identify barriers
§� Develop action plan

• Setting
§� Ward 48 Nursery
Audit
• Sample
§� Nurses working in nursery
• Sample size
§� 15
• Duration
§� 4 months (March-June 2011)

Audit Criteria
No Criteria Mode of assessment Met Not Met NA
1 Hands are decontaminated
immediately after contact with
individual patient contact and/or all
inanimate objects including equipment
2 Hands are decontaminated
immediately before each and every
episode of direct patient contact or
care, and/or all inanimate objects
including equipment.
3 Hands are decontaminated using an
effective hand hygiene technique
involving three stages & 6 steps
4 Hands that are visibly soiled, or
potentially grossly contaminated with
dirt or organic material, are washed
with liquid soap and water
Observe hand washing or handrub
is performed after wrapping baby
Observe hand washing or handrub
is performed before handling baby
1. Observe handrub is performed
according to 6-steps hand
hygiene technique
2. Observe hand washing is
performed according to 6-steps
hand hygiene technique
Observe hand washing is
performed after removal of diaper,
and before wrapping baby

Getting Research Into Practice (GRIP) (1)
• Barrier 1
o Varies in hand hygiene practices after changing
diaper
• Strategies
o Develop Workflow on the occasions and process
for hand hygiene during diaper changing
o Create awareness & education of the new
workflow
§� Conduct briefing during roll call
§� Demonstration during roll call
§� Placed new workflow in circular file

Getting Research Into Practice (GRIP) (2)
• Barrier 2
o Environmental constraints
§� Bin is far from hand washing sink
§� Inaccessibility of alcohol
handrubs
• Strategies
o Modified the layout of nursery
§� Placed extra bin next to sink
§� Shift infant feeding area
away from sink
o Modified baby cot
§� Placed alcohol handrub at baby
cot
§� Installed basket at baby cot

Methodology (3)
• Phase 2
o Implement change in hand
hygiene practice
o Brief staff of new workflow
• Phase 3
o Conduct Post implementation audit

Post Implementation Result
Hand hygiene after
wrapping baby
Hand hygiene before
patient contact
Criterion Hand hygiene according to
6-steps technique
Hand washing after removal
of diaper
Post-implementation, an increased of:
• 20% in hand washing after removal of diaper
• 26% in handrub that was performed according to recommended 6steps
technique
Post-implementation, a decreased of:
• 7% in hand hygiene after wrapping baby
• 13% in hand hygiene before patient contact
• 30% in hand washing that was performed according to recommended
6-steps technique
N=15

Conclusion
The implementation of the best practice has:
• Improved some aspects of hand hygiene during
diaper changing
• Improved hand washing practice after
handling soiled diapers
Lessons Learnt
• The importance of team work & planning
• The importance of communication
• Regular monitoring – gantt chart
• Change management is complex

References
1. Lam, B. C. C., Lee, J., & Lau, Y. L. (2004). Hand Hygiene Practices in a
Neonatal Intensive Care Unit: A Multimodal Intervention and Impact on
Nosocomial Infection. Pediatrics, 114(5), 565-571.
2. JBI. (2009). Joanna Briggs Institute Practice Application of Clinical
Evidence System. Retrieved 25 March 2011, from The Joanna Briggs
Institute: http://paces.jbiconnectplus.org/
3. JBI. (2009). Basic hand hygiene. Retrieved 1 Nov 2010, from The
Joanna Briggs Institute: ttp://connect.jbiconnectplus.org/Search.aspx

Acknowledgements
• Dr Emily Ang
• NM P Stella Mary
• Wd 48 Staff
• NUH Keppel (Maintenance) Group
Thank you
for your attention !