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Clinical Practice Improvement Project

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Project Title

The project revolves around the prevention and control of healthcare-associated infections (HAIs). It expounds on the “Effective Practices by Healthcare Workers to Reduce the Risks of Transmission of Infectious Agents.” There are practices that stakeholders in healthcare have implemented to reduce the risks significantly.

Project Aim

Healthcare-associated infections in healthcare facilities create complications that affect patients in Australian hospitals. There are approximately 200,000 cases reported in the country annually. The government and other stakeholders in healthcare facilities have combined to determine specific guidelines to reduce the risks of transmission in clinics. The project aims at determining the specific practices that healthcare workers can apply in both office-based and long-term healthcare settings. By the recommended practices, the project aims at reducing the infections in the country by 40 percent in one year. The significant reduction will consequently decrease hospital stays for patients and, in turn, decrease unnecessary suffering and pain for patients and their families. Healthcare-associated infections are preventable through effective control and prevention practices.

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The relevance of Clinical Governance to the Project

The project aims at creating a safe environment with high-quality patient-centered healthcare in both private and public hospitals. In order to enable effective service delivery, there are key clinical governance pillars that will lead the project to success. The key clinical governance pillars focus on consumer value, clinical risks, evaluation of clinical performance and professionalism in clinical management and development. The four pillars guide service providers in the healthcare sector in reducing healthcare associated infections. In order to improve customer value, clinical services should involve their patients actively in avoiding the risks arising from the healthcare environment. Customer value increases with improvement in maintaining current performance, as well as making plans for the healthcare organization’s future. Clinics should disclose information on possible risks and their efforts to reduce them to the consumers in order to ensure effective prevention. Evaluation of clinical performance is also a key pillar of reducing healthcare-associated infections. Clinics should maintain departments to monitor and evaluate the evidence-based standards in order to ensure that there are proper measures to reduce HAIs.

There are government councils that monitor and evaluate clinical performance with which HAIs are concerned. The Heath Care-Associated Infection Council provides the necessary standards that clinics should adhere to. They also send teams to individual clinics to monitor and assist healthcare workers in incorporating the standards in clinical practices. The monitoring teams also carry out audits to ensure transparency in clinical practices. In order to reduce clinical risks, stakeholders in all clinics should focus on improving safety and managing communicable diseases and infections. Each clinic should maintain an emergency team to manage and limit potential risks especially during adverse events such as outbreaks. The teams should examine the causative factors for all infections, as well as possible trends and patterns. Each nurse and doctor should undertake at least a month’s lessons on preventative practices for all diseases and infections. It is also important to liaise with other healthcare facilities to share information on emerging diseases and infections, as well as preventive measures. Professional management and development is also an important clinical governance method. It ensures that clinical personnel maintains the relevant professional standards to manage risks. Therefore, the project requires all the four pillars of clinical governance for success.

Evidence that the Problem is Worth Solving

HAIs are complications that leave patients questioning the clinical systems. They present an ethical problem with a lack of respect for patients’ rights and the obligations of healthcare workers and institutions towards providing quality health care. Government reports show that most of the infections that affect patients arise from direct contact with people in healthcare systems. Patients have reported infections from bacteria and viruses that are antibiotic-resistant either through direct or indirect contact with other patients or workers. Statistics from the United States show that approximately 99 000 deaths were caused by HAIs from the 1.7 million reported cases in 2008. The problem in Australia is similar to the United States. The Australian government has reported a cost of at least 1 billion US Dollars from the management and treatment of HAIs in the year 2009.

With most patients receiving services in the healthcare system having weak immune systems, the risks increase with extending of the patient population. There has also been a significant increase in resistant organisms, as well as infections that are potentially untreatable. About 10 percent of the reported cases are viral infections in the respiratory system with life-threatening consequences. In order to reduce the cases significantly, the healthcare system has to apply multidimensional practices aimed at maintaining hygiene for both the patients and the workers. HAIs have caused serious medical, ethical, as well as economic implications in the country. However, the problems are easily avoidable using effective clinical practices. Research shows that in the last century, healthcare workers are the main vectors for pathogens transmission leading to HAIs. The system has to embrace effective practices to reduce such transmissions significantly by more than 40 percent in the next year. The prevention process has less medical and economic implications than the management and treatment processes. The National Health and Medical Research Council publishes annual reports on prevention and control of HAIs in the healthcare system. The reports contain the latest information on the modes of transmission for the most common infectious organisms and on how to apply basic clinical principles in prevention and control. The budget for each clinic to ensure effective prevention measures is relatively low due to the available information on the infections. The management has to liaise with the government to ensure that they set the standards and train the healthcare workers on the preventive measures. There are set standards and available consultants to assist stakeholders in the transition process to safer clinical practices.

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Key Stakeholders

The project requires proper organization and coordination by all the participating parties. Clinical managers are the most important part of the project. They are responsible for the planning and coordination of all the relevant stakeholders. The managers make a plan to incorporate safe clinical practices into their organizations. They should be guided by government standards on the prevention of HAIs. They should also carry out audits and draw a budget in order to secure funding for the project. The government should provide consultants for individual hospitals to review the plans and provide funding where necessary. Healthcare workers should also take part in the project. They are the gears that ensure the project’s success through the smooth implementation of the plans. They should undertake training to familiarize themselves with preventive clinical practices to minimize the risks of spreading HAIs (Haas 2007). The success of healthcare workers will determine the success of the project to the target stakeholders, the patient population. Healthcare workers will ensure that patients and consumers in the healthcare system adhere to all the preventive measures and standards. The project also requires independent monitors from the government and other healthcare institutions such as medical research organizations. The monitors ensure that the project meets all the required standards and maintain its transparency.

CPI Tool

An appropriate Clinical Practice Improvement tool is crucial in the reduction of HAIs. The project deals with a CPI tool that focuses on hygiene for both the patients and healthcare workers in the clinical setting. According to publications in the Medical Journal of Australia, about 60 percent of the HAI cases reported in the country arise from nosocomial microorganisms transmitted through direct or indirect contact. Therefore, the main vector of transmission for such pathogens occurs due to a lack of proper hygiene standards. HAI rates can reduce significantly with simple hand and equipment disinfection before and after a clinical process. Achieving acceptable levels of hygiene in hospitals has proved to be a challenge for most hospitals in the country. However, each healthcare organization should try to achieve the maximum levels of compliance with low rates leading to discontinuation from clinical practice. To raise hand hygiene levels, every organization should introduce alcohol-based rubs for both patients and healthcare workers, as well as rubbing the equipment such as door knobs and beds for disinfection. Hospital management should also motivate senior clinicians to educate less-experienced workers on hygiene compliance.

Maintaining high compliance rates requires coordination between the workers and the patients. Therefore, the management should develop the proper plans in the organization to improve hygiene compliance rates. They should consult the relevant authority for guidelines on hygiene standards and the effective implementation process. The government has provided affordable payment plans to fund hygiene compliance projects in clinical practice. It is the responsibility of managers to decide on the payment plan that they would use in the organization to improve the processes. Recent research in Victorian and South Wales’ public hospitals shows that there has been a significant improvement in hygiene standards’ compliance. Doctors report that the compliance levels go up to 62 percent due to the incorporation of tools to assist workers to comply with the government standards. Hospitals in Southern Australia can apply similar tools to ensure that they raise their compliance rates. They should also put posters around hospitals to encourage visiting patients to comply with hygiene standards. The path towards achieving a HAIs free clinical system begins with hygiene compliance. The CPI tool is both affordable and possible in every hospital due to its simplicity. After hygiene compliance, it is possible to incorporate other CPI tools such as controlled wards to reduce other types of HAIs.

Summary of Proposed Intervention

The proposed intervention aims at creating a culture of hygiene maintenance in the healthcare setting. The behavior to maintain hygiene is a personal effort that one gains since childhood. The reported HAIs cases in the country are higher in hospitals with low hygiene compliance rates. Better compliance leads to better service provision without the fear of direct contact with patients and healthcare workers. In order to influence compliance among workers and patients, education and proper planning are the most important tools. After starting the project, the management should organize both internal and external audits to determine compliance, as well as feedback from healthcare workers. Maintaining set hygiene standards is the first step towards reducing HAIs significantly. The probability of success depends on effective implementation strategies. The organization can influence the procedures, protocols, education, equipment, communication, and training, as well as cultural change campaigns. The project also requires adequate staff and motivated team leaders to ensure that each healthcare worker promotes hygiene compliance in his/her departments.

 

Several hospitals in the country, especially in the eastern and western states, have improved control programs hence low HAIs rates. The hospitals have drawn up hygiene compliance standards with the help of the government. The control policies and jurisdictions ensure that every member of the healthcare workforce contributes to the compliance process. The members can also give suggestions on possible interventions. The project also relies on the accountability of management in healthcare organizations. The healthcare industry in the country is changing fast with events that call for drastic changes. The ability of an organization to control HAIs is a key performance indicator showing effective decision-making. Public and private hospitals should use the CPI tool to focus on hygiene compliance and consult hospitals that have already succeeded in expertise on implementation.

Barriers to Implementation and Sustaining Change

There are several barriers to the implementation of the CPI tool in the healthcare system. One of the main barriers is a culture change. Healthcare organizations are moving towards a clinical practice based on patient safety. Every institution should report on all the activities affecting its patients, as well as its workforce. In order to deploy the CPI tool in the healthcare system, the organization should instill the culture to its workforce. The process can be challenging especially with an aging workforce. However, the organization can organize training programs for all its workers to emphasize on the importance of hygiene maintenance. Consequently, the workers will pass the culture to the patients and, in turn, increase the compliance levels.

The analysis of HAIs in hospitals is a complex process. In Australia, very few HAIs have been reported as medical errors due to uncertainties in causative agents. The government has not given legislation managing the role of healthcare organizations in HAIs prevention. Therefore, patient protection after contracting HAIs is vague. The solution to the challenge falls on the government (Australian guidelines for the prevention and control of infection in healthcare, 2010). It should determine policies to examine HAIs and the role of the healthcare organizations to the patient. Every organization should have a responsibility to a patient that contracts an HAI during clinical practice. Funding is also a challenge in deploying CPI tools. Hygiene compliance requires special equipment, additional workforce, and training programs. It would be difficult for a healthcare organization to fund a project in six months. However, the government has availed funds to assist hospitals in the prevention of HAIs. The organizations can borrow money with low or no interest rates. Healthcare organizations that are able to overcome the challenges will be successful in the effective implementation of the CPI tool.

Evaluation of the Project

A significant reduction of HAIs rates requires a holistic approach in the healthcare system. However, its success develops to the extent to which individual clinicians are willing to embrace the relevant measures. Hand hygiene, as well as the disinfection of surfaces,  is the first step towards reducing HAIs. The CPI project aims at reducing HAIs by about 40 percent in the first year. By raising the hygiene compliance rates, it is possible to determine the causative agents for other HAIs and take the appropriate measures. Most healthcare workers have acknowledged that maintaining personal hygiene during clinical practice has been underestimated. Most workers fail to disinfect surfaces and hands and expose the patients and their workmates to the risk of disease-causing pathogens. Some are also ignorant and may leave contaminated equipment in uncontrolled areas. The management may also undermine the importance of hygiene compliance by clinicians leading to increased HAIs rates. The deployment of the CPI project in hospitals is a relevant step towards reducing the infections. It starts at the top levels of the healthcare system and goes down to individual clinicians and patients. The project ensures that all healthcare stakeholders comply with the set hygiene levels to reduce HAIs significantly.

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