? Poor or missing attempt at describing template plan.
PART B: MULTIMEDIA / DIGITIAL PRESENTATION (20% of total mark)
CREATIVITY (20% of total mark)
? Presentation succinctly delivers an effective creative message, explaining the plan for a clinical audit.
Yokoe et al. (2014) note that adhering to correct hand hygiene practices is essential to the reduction of the risks of associated healthcare infections. In as much as multimodal programs meant for
improving healthcare worker, hand hygiene adherence, has demonstrated effectiveness, their efficacy is limited and often hard to sustain. Thus, observance to hand hygiene guidelines in a great
number of healthcare facilities has not been followed to the letter. Failure of hand hygiene practices has been demonstrated by nurses in acute care setting in xx hospital, who continuously score
low in the monthly clinical audits. Thus raising a question of what could be the causative factors and how the problem could be solved. Realistically, acute care nurses tend to be bombarded with a
lot of activities which lead to heavy workloads and thus ignorance to hand hygiene in the process of meeting the work demands.
Healthcare-associated infections (HAIs) continue to affect the results of healthcare in acute care environments given their related health challenges. Every year, over 2.6 million patients in the
US contract HAIs that lead to an estimated 90,000 deaths, costing the health care sector over $5 billion in health care costs (Goodliffe, et al., 2014). Nevertheless, despite the growing
surveillance for Healthcare-associated infections, evidence-based hand hygiene that curbs hand-to-hand or hand-to-skin infection stands out as the most effective means of reducing the risks of
contracting Healthcare-associated infections in an acute care setting (Dai, et al., 2015).
MY CLINICAL AUDIT QUESTION FROM ASSESSMENT 1 AND 2 HAS BEEN===DO NURSES IN AN ACUTE CARE SETTING IN XXX HOSPITAL PRACTICE BEST PRACTICE HAND HYGIENE?.
PART 3A AND 3B QUESTIONS.
Part A: 1,500-word written report Value 35%
Part B: 5 minute multimedia or digital presentation Value 10%
Part B: 5 minute multimedia or digital presentation that would be suitable to show colleagues that would be an overview of your plan for the conduct of a clinical audit.
Question: What would be an example of the content expected in such a presentation?
Answer: Just imagine you have only 5 minutes or so to catch your colleagues attention to tell them about your clinical audit topic, what evidence you found and the standard of best practice that
you have identified and then how the clinical audit could be implemented and the types of data to be collected to measure the degree to which current practice complies with best practice standard.
Question: What is an example of how I could do it?
Answer: You could film yourself on video talking to the clinical audit plan or you could use power point and record your comments to each of the slides? I would use no more than 3 slides in this
type of presentation. JUST USE A POWER POINT WITH COMMENTS ON IT.
? Clearly describes the QA and Clinical Governance system in the workplace, & identifies where the clinical audit fits within this system to improve clinical practice. Explains how quality
improvement using clinical audit supports a consistent approach to best clinical practice. (5 marks)
? Describes the QA and Clinical Governance system in the workplace, & identifies where the clinical audit fits within this system to improve clinical practice.
The studies appraised revealed interesting information regarding the compliance practices of nurses in acute care settings as summarized in the table.
Lack of knowledge 10 studies reported that nurses attributed failure to comply with hand hygiene due to the lack of awareness on the importance of the same
Lack of time 15 studies observed that most nurses lacked the time to properly scrub their hands as required by guidelines
Forgetfulness 20 studies reported that while some nurses are aware of the need to comply with hand wash they just forgot
Lack of means 7 studies noted that some facilities lacked the necessary resources required for proper hand washing measures.
Skin irritation 12 studies reported that some nurses feared that the chemicals used in washing their hands could lead to skin irritation.
Lack of training 15 studies indicated that some nurses lacked the necessary training on evidence-based hand hygiene practices
Conflict between the need to provide care and self-protection 20 studies noted that some nurses were torn between protecting themselves against elements such as dry skin and providing care to the
Distance to necessary and facility 8 studies claimed that the distance to the required hand wash facility demoralized the nurses
Uncomfortable equipment 5 studies cited awkward hand washing equipment as the barriers to proper hand hygiene practices among the nurses.
Using the best search strategy available, this paper has outlined the clinical audit question in a systematic way, highlighting the key factors that hinder the nurses in in xx hospital to comply
with the best standard in hand hygiene practices. These factors need to be taken into consideration by the whole health care system when taking the next step in putting these guidelines into
practice e.g. for the educators or nums to keep on updating the nurses on performance in their hand hygiene practices, also instructing new nurses on how to deliver the best care for patients in
regard to hand hygiene.
According to CourtneyandMcCutcleon,2010, Patient Intervention Compliance and outcome (PICO) is a framework that helps to construct an answerable question that aids in searching for current evidence
based practises in the clinical settings. Thus PICO format was applied in the construction of the clinical audit question as illustrated in the table below.
Clinical audit question?
Do nurses in an acute care setting in xx hospital, experience factors that hinder them from adhering to the best hand hygiene practices while caring for the patients?
Problem /population The risk of Healthcare Associated Infections
By the acute care nurses.
Intervention Nurses utilize soap and water or antiseptic hand rubs in order to curb transmission of infections from one patient to another in an acute care setting.
Comparison Simple hand hygiene is a mandatory practice in an acute health care setting and all nurses are expected to be consistent and conscious of it while handling acute patients.
Outcome It is reasonable to expect that nurses in acute care setting comply with the best practice of hand hygiene while caring for the acutely ill patients.
De bru’n and Pierce-smith (2013) argue that, proper search strategies need to be employed in order to yield rich results of current evidence based practises. Thus this paper, adopted a systematic
review approach. Specifically, the paper searched the databases of Medline, CINAHL, and Embase, January 2011 up to December 2016. The paper limited itself to scholarships of human beings, with
language restricted to English, data below seven years, all acute care nurses whether newly employed or old and nurses on duty. The exclusion criteria included, Data over seven years, nurses on
leave or days off and community nurses. The adopted search terms include the operational filters of the EPOC coupled with designated MeSH terminology (evidence-based practice) besides free text
terms (hand washing and hand hygiene, acute care settings and nurses) as advocated by studies. The EPOC approach is a widely used data collection worksheet that incorporates research objectives,
settings, and design, coupled with a study’s target populace, outcomes measures, a sketch of the treatment, and the selected analysis approach and results. The inclusion criterion included studies
with at least an outcome comparison with a randomized control group
The study’s initial search for published works from 2011 through 2016 and current studies resulted in 10,470 hits for all the consulted databases. However, only 623 publications met the inclusion
criteria. An assessment of the full text of the qualifying studies led to 590 more studies being excluded due to the lack of HH compliance outcomes or because they were not interventional. A
further appraisal and quality assessment lead to 28 studies being included for analysis while the remaining were omitted due to significant quality issues.
CLINICAL AUDIT PROCESS (15% of total mark)
? Clearly describes and explains the separate steps in the clinical audit process. The content would enable the reader to be fully informed on how to implement the clinical audit in their
? Describes and explains the separate steps in the clinical audit process and exacting information that show application of the concepts. The content would enable the reader to understand what
would be expected of them when implementing the clinical audit in their workplace (10-12 marks)
? Describes the separate steps in the clinical audit process and applies each to their clinical audit. The content would enable the reader to understand what was to be achieved but implementation
would necessitate more specific information.
? Describes a clinical audit process but missing information that demonstrates a basic application of the concepts. The content offers the reader an overview of what is to be done if the clinical
audit was to be implemented but a lack of specific detail would hinder implementation
This paper has utilized the Joanna Briggs levels of evidence in critiquing the clinical audit question. Please find below the levels of evidence as illustrated in appendix A. In addition, presented
below in table 1 is: managing the evidence-an overview (after inclusion and exclusion criteria have been applied).
Rating Evidence Number of studies.
Highest Level 1 10
Level 2 4
Level 3 3
Level 4 6
lowest Level 5 0
Ungraded items 2
Themes that emerged from the literature as examined below.
Lack of knowledge
Studies report that knowledge regarding hand hygiene compliance is linked with reduced levels of infection transmission in an acute care setting. For instance, one study observes that nurses with
good knowledge on hand hygiene are 3.8 times more likely to comply than those with poor awareness of the best hand hygiene practices. Another study by Nabavi et al. (2015) that studied nurses’
attitude and knowledge towards hand hygiene practices reported that the degree of knowledge about hand hygiene was moderate (65.7%) among the study’s 256 participants. Interestingly, the study
observed that 67% of the respondents had poor knowledge of hand hygiene, thus explaining the high incidences of infections. Nair (2014) hared similar results noting that even as the nurses had
better knowledge of the practice than medical students (p=.023), knowledge of evidence-based hand hygiene practices among nurses is still moderate (74%).
Distance to necessary facility
Alsubaie (2013) adopted an observational study design in five intensive care units with the objective of establishing the determinants of hand hygiene compliance among interns and observed that the
physical environment (distance between hand washing sink) determines the extent to which nurses comply with hand hygiene practices. Four focus groups employed by Efstathiou, et al. (2011) reported
similar findings noting that the stowage of hand hygiene equipment in locations far away from where care is needed contributes to noncompliance.
Lack of means
Studies revealed that while nurses were ready to comply with the necessary hand hygiene practices, the absence (Efstathiou, et al., 2011) or the shortage of proper protective equipment such as
gloves (Ahmed, 2011) also led to non-cooperation.
The cross-sectional study among 100 nurses by Shinde & Mohite (2014) noted skin irritation as an occupational hazard faced by most nursing staff. The paper identified that most hand washing
detergents leave the skin either dry or irritated hence pushing some nurses to avoid maintaining proper hand hygiene practices. Sharma, Sharma & Koushal (2012), however, reasoned that the concept
of skin irritation is a myth that when properly conducted, hand hygiene leads to no skin irritation.
Conflict between the need to provide care and self-protection
Specifically, while the nurses were very much willing to maintain high standards of hygiene while providing care, conflicts such as earlier discussed skin irritation make it hard to comply.
Lack of training
Training teaches nurses the necessary knowledge required of the necessary hand hygiene practices. However, despite its importance, most nurses are either training used age-old training manuals that
do not take heed of modern evidence-based hand hygiene practices.
Nurses need a conducive work environment for them to provide safe and quality care services. A conducive work environment, as explained by experts is characterized by several factors including
well-maintained and adequate equipment. Where nurses find the available equipment to be unfit, the possibility of their being non-compliance is high. Okhiai et al. (2014) non-experimental study
exposed that the height of hand washing sinks prevented some nurses from adhering to proper hand hygiene regimes.
Lack of time
One study reported that most nurses failed to practice effective hand hygiene practices because they are always occupied and that proper hand hygiene consumes up valuable time that could be devoted
to caring for patients.
Twenty studies reported forgetfulness as a major hindrance to compliance. Apparently, while most nurses were aware of the importance of maintaining high levels of hand hygiene during the provision
of care, the possibility of forgetting to do so is high especially during emergencies.