Hand Hygiene in Nursery during Diaper Changing - The Joanna ...
Hand Hygiene in Nursery during Diaper Changing - The Joanna ...
Hand Hygiene in Nursery during Diaper Changing - The Joanna ...
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<strong>Hand</strong> <strong>Hygiene</strong> <strong>in</strong> <strong>Nursery</strong> dur<strong>in</strong>g<br />
<strong>Diaper</strong> Chang<strong>in</strong>g<br />
Presented by:<br />
SN Phang Koh Ni<br />
Team Members:<br />
SN Nur Liyanna Bte Mazn<strong>in</strong> (Leader)<br />
NC Sarah Ho-Lim Su T<strong>in</strong> (Facilitator)<br />
NE Yip Wai K<strong>in</strong> (EBNU Facilitator)<br />
NM He Xiao Cong (Facilitator)<br />
SSN Nora<strong>in</strong>i B<strong>in</strong>te Bujang<br />
SN Quek Yu T<strong>in</strong>g El<strong>in</strong>e<br />
SN Yang Yaj<strong>in</strong>g<br />
SN Anthony Devadoss Rosel<strong>in</strong>e<br />
Cl<strong>in</strong>ical Care<br />
Education<br />
Research
Background<br />
• <strong>Hand</strong> hygiene is the most effective measure <strong>in</strong> prevent<strong>in</strong>g<br />
nosocomial <strong>in</strong>fection<br />
• Nosocomial <strong>in</strong>fection is commonly transmitted via<br />
contam<strong>in</strong>ated hands of healthcare professionals<br />
• Newborns are susceptible to <strong>in</strong>fection due to immature<br />
host defense mechanisms<br />
• <strong>The</strong> process of chang<strong>in</strong>g diapers exposes newborns to<br />
higher chance of <strong>in</strong>fection<br />
§� (Lam et al, 2004)
Cl<strong>in</strong>ical Problem<br />
• Variation <strong>in</strong> hand hygiene practices especially after<br />
handl<strong>in</strong>g soiled diapers<br />
Aim<br />
• To implement best practice recommendations on hand<br />
hygiene practice when chang<strong>in</strong>g soiled diapers
• Phase 1<br />
o Assemble team<br />
Methodology (1)<br />
o Search for hand hygiene best practice
Evidence Review F<strong>in</strong>d<strong>in</strong>gs
• Phase 1<br />
Methodology (2)<br />
o Conduct pre-implementation audit<br />
o Conduct GRiP analysis<br />
§� Share audit results with ward staff<br />
§� Identify barriers<br />
§� Develop action plan
• Sett<strong>in</strong>g<br />
§� Ward 48 <strong>Nursery</strong><br />
Audit<br />
• Sample<br />
§� Nurses work<strong>in</strong>g <strong>in</strong> nursery<br />
• Sample size<br />
§� 15<br />
• Duration<br />
§� 4 months (March-June 2011)
Audit Criteria<br />
No Criteria Mode of assessment Met Not Met NA<br />
1 <strong>Hand</strong>s are decontam<strong>in</strong>ated<br />
immediately after contact with<br />
<strong>in</strong>dividual patient contact and/or all<br />
<strong>in</strong>animate objects <strong>in</strong>clud<strong>in</strong>g equipment<br />
2 <strong>Hand</strong>s are decontam<strong>in</strong>ated<br />
immediately before each and every<br />
episode of direct patient contact or<br />
care, and/or all <strong>in</strong>animate objects<br />
<strong>in</strong>clud<strong>in</strong>g equipment.<br />
3 <strong>Hand</strong>s are decontam<strong>in</strong>ated us<strong>in</strong>g an<br />
effective hand hygiene technique<br />
<strong>in</strong>volv<strong>in</strong>g three stages & 6 steps<br />
4 <strong>Hand</strong>s that are visibly soiled, or<br />
potentially grossly contam<strong>in</strong>ated with<br />
dirt or organic material, are washed<br />
with liquid soap and water<br />
Observe hand wash<strong>in</strong>g or handrub<br />
is performed after wrapp<strong>in</strong>g baby<br />
Observe hand wash<strong>in</strong>g or handrub<br />
is performed before handl<strong>in</strong>g baby<br />
1. Observe handrub is performed<br />
accord<strong>in</strong>g to 6-steps hand<br />
hygiene technique<br />
2. Observe hand wash<strong>in</strong>g is<br />
performed accord<strong>in</strong>g to 6-steps<br />
hand hygiene technique<br />
Observe hand wash<strong>in</strong>g is<br />
performed after removal of diaper,<br />
and before wrapp<strong>in</strong>g baby
Gett<strong>in</strong>g Research Into Practice (GRIP) (1)<br />
• Barrier 1<br />
o Varies <strong>in</strong> hand hygiene practices after chang<strong>in</strong>g<br />
diaper<br />
• Strategies<br />
o Develop Workflow on the occasions and process<br />
for hand hygiene dur<strong>in</strong>g diaper chang<strong>in</strong>g<br />
o Create awareness & education of the new<br />
workflow<br />
§� Conduct brief<strong>in</strong>g dur<strong>in</strong>g roll call<br />
§� Demonstration dur<strong>in</strong>g roll call<br />
§� Placed new workflow <strong>in</strong> circular file
Gett<strong>in</strong>g Research Into Practice (GRIP) (2)<br />
• Barrier 2<br />
o Environmental constra<strong>in</strong>ts<br />
§� B<strong>in</strong> is far from hand wash<strong>in</strong>g s<strong>in</strong>k<br />
§� Inaccessibility of alcohol<br />
handrubs<br />
• Strategies<br />
o Modified the layout of nursery<br />
§� Placed extra b<strong>in</strong> next to s<strong>in</strong>k<br />
§� Shift <strong>in</strong>fant feed<strong>in</strong>g area<br />
away from s<strong>in</strong>k<br />
o Modified baby cot<br />
§� Placed alcohol handrub at baby<br />
cot<br />
§� Installed basket at baby cot
Methodology (3)<br />
• Phase 2<br />
o Implement change <strong>in</strong> hand<br />
hygiene practice<br />
o Brief staff of new workflow<br />
• Phase 3<br />
o Conduct Post implementation audit
Post Implementation Result<br />
<strong>Hand</strong> hygiene after<br />
wrapp<strong>in</strong>g baby<br />
<strong>Hand</strong> hygiene before<br />
patient contact<br />
Criterion <strong>Hand</strong> hygiene accord<strong>in</strong>g to<br />
6-steps technique<br />
<strong>Hand</strong> wash<strong>in</strong>g after removal<br />
of diaper<br />
Post-implementation, an <strong>in</strong>creased of:<br />
• 20% <strong>in</strong> hand wash<strong>in</strong>g after removal of diaper<br />
• 26% <strong>in</strong> handrub that was performed accord<strong>in</strong>g to recommended 6steps<br />
technique<br />
Post-implementation, a decreased of:<br />
• 7% <strong>in</strong> hand hygiene after wrapp<strong>in</strong>g baby<br />
• 13% <strong>in</strong> hand hygiene before patient contact<br />
• 30% <strong>in</strong> hand wash<strong>in</strong>g that was performed accord<strong>in</strong>g to recommended<br />
6-steps technique<br />
N=15
Conclusion<br />
<strong>The</strong> implementation of the best practice has:<br />
• Improved some aspects of hand hygiene dur<strong>in</strong>g<br />
diaper chang<strong>in</strong>g<br />
• Improved hand wash<strong>in</strong>g practice after<br />
handl<strong>in</strong>g soiled diapers<br />
Lessons Learnt<br />
• <strong>The</strong> importance of team work & plann<strong>in</strong>g<br />
• <strong>The</strong> importance of communication<br />
• Regular monitor<strong>in</strong>g – gantt chart<br />
• Change management is complex
References<br />
1. Lam, B. C. C., Lee, J., & Lau, Y. L. (2004). <strong>Hand</strong> <strong>Hygiene</strong> Practices <strong>in</strong> a<br />
Neonatal Intensive Care Unit: A Multimodal Intervention and Impact on<br />
Nosocomial Infection. Pediatrics, 114(5), 565-571.<br />
2. JBI. (2009). <strong>Joanna</strong> Briggs Institute Practice Application of Cl<strong>in</strong>ical<br />
Evidence System. Retrieved 25 March 2011, from <strong>The</strong> <strong>Joanna</strong> Briggs<br />
Institute: http://paces.jbiconnectplus.org/<br />
3. JBI. (2009). Basic hand hygiene. Retrieved 1 Nov 2010, from <strong>The</strong><br />
<strong>Joanna</strong> Briggs Institute: ttp://connect.jbiconnectplus.org/Search.aspx
Acknowledgements<br />
• Dr Emily Ang<br />
• NM P Stella Mary<br />
• Wd 48 Staff<br />
• NUH Keppel (Ma<strong>in</strong>tenance) Group<br />
Thank you<br />
for your attention !