This project was developed a er an ACHC survey of our homecare organizaon last June.  The surveyors noted that our clinicians did not adhere to hand hygiene guidelines and  misused hand sanizing gel .

Project Background
o This project was developed a er an ACHC survey of our homecare organizaon last June.
The surveyors noted that our clinicians did not adhere to hand hygiene guidelines and
misused hand sanizing gel . CDC and ACHC guidelines state that alcohol-based hand rub
should be applied and rubbed for at least 20 seconds. Our clinicians were not rubbing
the gel on their hands for 20 seconds and resuming paent care before the gel was fully
dry. Because of this, we were cited for hand hygiene and needed a plan of correcon.

o

Purpose:
This HIP aims to demonstrate the efficacy of increased educa
on and training using classroom and online plaorms, observing healthcare workers performing hand hygiene in the field, and printed instructons posted throughout the offices to increase
hand hygiene compliance among home healthcare workers in the organizaon.

o

Scope:
Hand hygiene is a crical first step in reducing infecon and illness for our paents. Our organiza
on provides in-home healthcare services to patents of all ages requiring hospital-level care at home. The New York State Department of Health and ACHC accredits us. When surveyors from ACHC came to perform our survey in June 2023, they found that our clinicians were not using hand sanizer for a full twenty seconds per CDC and ACHC guidance. If our organizaon does not correct this, we will face fines and potential closure if we fail to meet this requirement. This HIP aims to increase patient safety by having every clinician trained to perform hand hygiene c
orrectly and give a return demonstraon by June 30, 2024. This will be achieved through in-
person and online educaon. We will also follow up and monitor each clinician in the field performing hand hygiene to monitor the effecveness of the training. To implement and reach the goal of this HIP, we will require each clinician to attend a clinical meeting where we will provide hand hygiene instruction and supervise each clinician as they correctly perform a return demonstration of hand hygiene. We will also assign a mandatory hand hygiene teaching module on our online learning platform to explain the data and rationale for correctly performing hand hygiene.

The deliverables of this HIP will include decreasing risk to the organizaon by training each clini
cian to perform hand hygiene correctly and avoiding potential fines or closure. Another deliverable will be increased patient safety by reducing their risk for healthcare –
acquired infection, and our clinicians will have advanced knowledge and understanding
of the importance of hand hygiene.  Key performance indicators for this project are decreasing healthcare-acquired infection rates in our patients and improved hand hygiene compliance rates among our clinicians at our next ACHC survey. The goal outcome of this HIP is to train and sign off 100% of our clinicians to perform correct hand hygiene.


Synthesis of Literature

o

Hoffman et al. (2018) described a healthcare improvement project to increase hand
hygiene compliance in a German hospital. The hospital used a poster campaign, a Yearly
Day for Hand Hygiene conference, and in-house training. They also used an E-learning
platfjorm with mandatory hand hygiene training that must be done every two years. They
tracked results using direct observation , and hand hygiene compliance rates rose from
81.9% to 94% over five years.
o

Kamanga et al. (2021) described a nurse-led HIP to improve hand hygiene compliance a
er finding that 50% of patients in a burn unit acquired pseudomonas infections. They
used checklists and direct observation by leaders. They placed hand sanitizer and hand

washing buckets placed strategically to increase the availability of supplies needed for
hand hygiene. Posters and weekly educational activities were also used to reinforce the
need for effective hand hygiene. These methods increased hand hygiene compliance
from 37% to over 80% within six months.
o

In an article by Anderson et
al. (2021), researchers adopted overt observers to monitor hand hygiene practices to avoid false data due to the Hawthorne Effect. The Hawthorne Effect is when people perform at a higher standard when they know they are under observation. This was relevant to our HIP since
clinicians typically workby themselves at our organization , and there is no way to monitor them without their knowledge. While this strategy is effective , it would be challenging to
implement at our organization.

o

Ojanpera et al. (2020) found that observaon of clinicians performing hand hygiene is
the best practice. They conducted over 50,000 hand hygiene observations over six years
and found that hand hygiene compliance rates rose from 76.4% to 88.5% by 2018.
o

Pi
e
& Allegranzi (2019) discussed using soap and water versus alcohol
-based hand rubs. They found soap and water more effective against Clostridium difficile, but alcohol-based hand rubs were better overall . The authors did discuss modern electronic devices
and programs to monitor hand hygiene but found that direct observation is still the gold
standard.


Explana
on of HIP Proposal

o

The literature review taught us that best practices to encourage hand hygiene compliance include education and  direct observation . This HIP uses both. We will be  conducteng an in-person class to demonstrate correct hand hygiene procedures. After the class, each clinician will provide a return hand hygiene demonstration. They will not be credited for meeting attendance until they
demonstrate successfully. Each clinician will also be enrolled in  our online learning platform’s hand hygiene educaon module with a post-test. This will be mandatory, and they will be given two weeks to complete it.
In addition to the classroom and online education, our clinical supervisors will perform
supervision visits with the clinicians and will observe hand hygiene. We believe that by
following best practices, hand hygiene compliance will improve, our clinicians will have
increased knowledge of its importance and effectiveness, and our patients’ risk for healthcare-
acquired infections will decrease.


Project Plan Overview

o

Stakeholders:
The three stakeholders I chose to assist with this HIP were our Vice President of Patient Services,
the Community Health and Clinical Education Program  Director, and our Resident Onboarding Manager. The Vice President of Patient Services is in close contact with the organization
‘s management and leadership as well as the clinicians, giving valuable insight into the needs of the organization and the challenges that may arise when attempting to implement this HIP.
The Community Health and Clinical Education Director has vast experience developing and implementing healthcare improvement projects. She also has a role that gives her access to data on the number of infections occurring in patients under our care and rehospitalization reports.
The Nurse Resident Onboarding Manager was the Clinical Educator before I moved into that role.
Her role as an educator has taught her which teaching methods have the most success
with our clinicians, and her advice will be invaluable when developing teaching plans.
o

Hand Hygiene Champions:
We recruited clinical supervisors to assist with direct observation in the field.
We know clinicians may perform better when they are being watched. This behavior could alter our ability to assess the effectiveness of this HIP. The clinical supervisors regularly perform supervision visits with the clinicians to evaluate their skills and to meet the patients. While it is supervision, the clinicians are very comfortable with their supervisors and more likely to behave as they normally would in their presence instead of the education team.
They will supervise every clinician performing hand hygiene correctly in a patient visit at least once
.
o

Action Plan:
I will use the action plan our project team created. First, we will develop an evidence-based strategy and pro forma budget. Next, we will develop education plans for in-person training and the module for the online learning platform. Afterward, we will recruit and train the clinical supervisors as hand hygiene champions. We will hold four clinical meetings over two weeks to educate the clinicians on hand hygiene. We will then upload the online learning module and enroll all clinicians to complete the module with a due date of two weeks after enrollment. Once the meetings are over, the clinical supervisors will begin performing supervision visits, focusing on direct observation of clinicians performing hand hygiene. Last, we will collect data from the meetings, the online platform, and the clinical supervisors.That data will be entered into Excel to run reports and determine the efficacy of the HIP.


Implementation Plan Overview

o

Kick-off meeting: We will have a kick-off meeting to let the team get familiar with each
other , learn about the HIP and its purpose, identify roles, and set goals. Participants will
be encouraged to contribute thoughts and ideas for consideration. It is essential for all
members of the team to feel acknowledged and valued.
o

Training plan:
The clinical supervisors are the first clinicians we will train. We will teach
each how to perform hand hygiene correctly. Once they demonstrate correct hand
hygiene, we will teach them how to supervise the clinicians in the field and document
their hand hygiene performance. Next, we will hold four clinical meetings over two

weeks. Each clinician will be required to attend one session to learn how to perform
hand hygiene, then give a return demonstration. Next, we will upload the hand hygiene
module with post-test to the online learning platform and enroll all clinicians. They will
have a two-week deadline to complete the online education. After the meetings, the
clinical supervisors will begin direct observation of hand hygiene through supervision
visits with the clinicians.
o

Team and staff support:
Throughout implementation, the team will meet regularly to discuss the project, issues or concerns, and any necessary changes. We will include the clinical supervisors and address any concerns they may have. We will also support the clinicians by providing one-on-one teaching to anyone unable to attend the clinical meetings or who did not give a successful hand hygiene demonstration
.


HIP Proposal Conclusion:

o

Data collection: I will be hosting and teaching at the clinical meetings; after each, I will
collect the attendance sheets and enter the names of every clinician who attended and
performed a successful hand hygiene demonstration. I will then access the attendance
records from the online learning platform and record the names of all clinicians who
completed the online education and post-test. Every week the supervisors will turn in
their supervision forms to me, and I will record the names of each clinician they
supervised performing hand hygiene in the field and if they completed it correctly or
not. I will enter the collected data into  Excel. Using Excel will allow me to run reports to
evaluate the efficacy of the HIP.
o

Dissemination plan:
We plan to disseminate the results of this HIP at our quarterly leadership meeting in July 2024. This meeting includes our CEO, CNO, and CFO, as well as all members of the leadership team. This is an in-person meeting that occurs in our community ty room each quarter. We will be presen
ng our HIP using a Powerpoint slideshow. This presentation will begin with background informa
on explaining the HIP need. It will then explain the planning that went into the HIP and the evidence-based methods we identified to improve the problem. We will display the Gan
chart describing the steps involved in this HIP and who was involved in those steps. We will
explain how we prepared for and carried out the implementation process and any bstacles during the implementation period. We will display a bar graph showing the
baseline hand hygiene rate, the rate of compliance at the halfway point of the HIP on
March 30, 2024, and our final hand hygiene compliance rate on June 30, 2024. We will
also discuss any steps taken to overcome obstacles and why our hand hygiene
compliance rate reached 100% or fell short.
o

Future outcomes:
If this HIP is successful, we will have improved scores at our next ACHC survey and
health outcomes for our patients with fewer healthcare-acquired infecitons.
We will incorporate the training provided in this HIP into our onboarding
education for new clinicians. By doing this, we can ensure that all our clinicians know the
importance of following hand hygiene guidelines and are trained to perform hand
hygiene correctly. We will also include the online learning platform in our annual
mandatory competencies all clinicians must complete to encourage continued
adherence to hand hygiene policies.

 

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