Benchmark Change Proposal


Nurses are expected to adopt and implement evidence-based practice (EBP) to improve the care they provide to their patients. One of the issues that affect their care outcomes is the high prevalence of hospital-acquired infections (HAIs) (Barnes, Morgan, Harris, Carling, & Thom, 2014). Such challenges occur when nosocomial infections are transferred from the hands of the care provider to the patient in the course of offering care (Martínez-Reséndez et al., 2014). The infections are common among patients in the ICU because of the use of treatment devices such as catheters. Therefore, it is critical to implement effective interventions to reduce the rate of HAIs in ICU. The current proposal entails hand hygiene compliance training among ICU nurses in a healthcare facility. Therefore, to reduce infections and enhance care outcome, nurses will undergo training to improve their compliance with hand washing behaviors to prevent HAIs.

Problem Statement

Patients require a safe environment to receive care. However, this goal is not always achievable because they face the danger of infections in the same settings they should be safe. Infections are spread easily from the hands of care providers to the patients. Many ICUs have experienced a high rate of HAIs because of the use of catheters and other devices to provide critical care to hospitalized patients (Martínez-Reséndez et al., 2014). Consequently, patients remain in the hospital longer than they should and suffer a high cost of treatment. The disease burden and cost of hospital-acquired infections are considerably higher for patients in the ICU (Haverstick, Goodrich, Freeman, James, Kullar, & Ahrens, 2017). Thus, it is critical to implement effective interventions, such as hand washing practice, to reduce the prevalence and effects of HAIs.

Purpose of the Change Proposal

The most critical step in solving a clinical problem or issue is to identify an effective intervention that meets the requirements of evidence-based practice. EBP interventions are supported research evidence of effectiveness in similar settings (King, McKeon & Medina McKeon, 2015). The proposed change aims at reducing the prevalence of hospital-acquired infections through hand hygiene compliance. Prior studies have indicated the efficacy of such interventions in reducing the incidence of such infections and improving patient satisfaction and outcomes (Jackson, Lowton, & Griffiths, 2014; Martínez-Reséndez et al., 2014; Septimus, Weinstein, Perl, Goldmann, & Yokoe, 2014). The recommendation from previous studies is to implement hand hygiene training in hospital settings to achieve the objective of infection prevention and control.

PICOT Statement

Hand washing has been proven to be an effective intervention in the prevention of hospital-acquired infections. However, to ascertain the efficacy of the intervention through a new study, it is essential to create a research question and focus it in the form of a PICOT statement. It is a researchable statement with the five crucial elements (P-population, I-intervention, C-comparator, O-outcome, T-time). From the research question, among patients in the ICU (P), how effective is hand washing (I) compared to lack of it (C) in reducing the rate of hospital-acquired infections (O) within a month (T) after implementation of the intervention (Foddai, Grant, & Dean, 2016). The PICOT statement will help the research to focus on the implementation of the intervention in reducing the rate of HAIs in ICU. The concept will identify the population of study, the intervention and comparison, the outcome, and timeline for the evaluation of the impact.

Literature Search Strategy

The literature search strategy was used to identify the most relevant articles for the study. The process involved the use of key terms to search for sources from the identified journals. The researcher developed keywords to help in the search. The keywords used in the search were: hand washing; hand hygiene; compliance; hospital-acquired infections; ICU patients. Only articles with information about prevention of HAIs through hand hygiene were included in the study. The study also incorporated articles published within the past five years. Overall, the search identified eight relevant articles.

Evaluation of the Literature

The reviewed articles closely relate to the effect of hand washing and hygiene compliance in the prevention and reduction of hospital-acquired infections. The studies indicate the importance of hand hygiene knowledge and compliance among nurses who provide critical care to patients in hospital settings (Jackson, Lowton, & Griffiths, 2014; Marimuthu, Pittet, & Harbarth, 2014). The information from the sources indicated the importance of effective implementation of hand hygiene practices in the prevention of infections (Lambrechts, Human, Doughari, & Lues, 2014; Septimus, Weinstein, Perl, Goldmann, & Yokoe, 2014). The studies also proposed some of the effective measures to implement the intervention, including training nurses who provide care to hospitalized patients (Barnes, Morgan, Harris, Carling, & Thom, 2014). Besides, the studies indicate the strategies that are useful in implementing the change, such as the use of chlorhexidine (CHX) bathing and hand hygiene (HH) compliance in preventing the infection (Martínez-Reséndez et al., 2014) and hand washing using soap and water, hand sanitizer, or both to reduce infections (Haverstick et al., 2017). The authors also revealed that hand hygiene monitoring and auditing are important to ensure continued compliance among the health care providers following implementation of such mechanisms (Lambrechts et al., 2014; Srigley, Furness, Baker, & Gardam, 2014).  The consulted articles are a source of evidence on the effectiveness of the intervention in preventing and reducing the rate of hospital-acquired infections among hospitalized patients.

Change Theory

A theory applies in research to make it practical for implementers to create and adopt the proposed improvement. Lippitt’s theory will be used because of its significance in integrating nursing change into practice. The model is a Seven-Step Change Theory, which is an expansion of Lewin’s theory to emphasize the change agent role. The first step is diagnosing the problem by looking at the possible effects and determining the stakeholders. Secondly, implementer evaluates the motivation and capacity for change by considering the available resources, human, and material. Thirdly, the change process involves assessment of the motivation and capability of the change agents. Fourth, implementers identify the change process, including objectives and action plans. Fifth, the concept explains the change agent role to all employees. Sixth, they maintain change by focusing on feedback, communication, and coordination. Lastly, they gradually end all relationships with the change agent after the change is adopted (Rogers, 2014). Hence, the engagement of all stakeholders and availability of resources will ensure achievement of a successful change process.

Proposed Implementation Plan with Outcome Measures

The proposed project is to improve hand washing behavior among health care providers in the ICU to prevent hospital-acquired infections. The initiative will begin with an education plan to teach the importance of hand hygiene compliance within a healthcare facility. A nurse educator will train nurses about the importance of hand washing behaviors using an antimicrobial soap such as hand rubs concentrated with alcohol (Marimuthu, Pittet, & Harbarth, 2014). The nurse leader will conduct audits to establish an increase in compliance with hand washing behaviors among nurse working in the intensive care unit (ICU). The expected outcome is an increase in the compliance with the hand washing practice and a reduction in the rate of hospital-acquired infections in the facility because the infections are spread from the caregiver’s hands to the patient. Therefore, if nurses comply with hand washing practices, they will prevent the infections and improve patient outcomes, such as reduced hospital stays and lower treatment cost.

Identification of Potential Barriers to Plan Implementation

Various barriers will affect the change process and should be identified and addressed to achieve successful implementation. Resistance to change and poor communication are the most common barriers to such a major change in health care settings because nurses are used to prevailing culture. As a result, they might find it difficult to accept a new change. Besides, lack of effective communication and collaboration between the affected stakeholders in the implementation setting might affect the success or delay the completion of the project (Rogers, 2014). These challenges will be addressed by engaging all stakeholders from the beginning of the project. The project manager and team should communicate the objectives and deliverables of the project team. Engaging stakeholders, including employees, will assist in overcoming resistance and other conflicts that arise in the change process. Overall, it is also essential to realize actual collaboration among the stakeholders of the project to achieve success in the plan.

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