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Final Report: Setting the Stage for Evidence-Based Practice in Healthcare Settings
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Abstract
Evidence-Based Practice (EBP) is a crucial part of improving nursing practice, which enhances quality care to patients. Implementing EBP in the organizational culture betters patient outcomes and family, patient, and healthcare provider’s satisfaction. EBP can minimize costs and the chance of harm by lowering unnecessary procedures. It can be applied in hand hygiene to help reduce the rate of spread of hospital-acquired infections (HAIs) among healthcare providers, families, and patients. HAIs are attracting increasing focus from patients, healthcare organizations, regulatory agencies, and governments. This can be explained by the size of the issue in light of the related mortality, morbidity, and treatment cost, as well as the increasing acknowledgement that most of these elements are avoidable. This report focuses on various issues involved in the implementation of EBP hand-washing hygiene program for the prevention or reduction of the transmission of HAIs in the hospital. Specific issues of focus include how to create an organizational culture that promotes the adoption of the EBP program, the implementation of the proposed solution, how to integrate the chosen change model, and the evaluation of the project implementation.
Keywords: Evidence-Based Practice, Stetler’s change model, Hospital-acquired infections, hand hygiene, hand-washing

Final Report: Setting the Stage for Evidence-Based Practice in Healthcare Settings
Section A: Organizational Culture and Readiness Assessment
Hospital acquired infections are widespread in most hospital systems, especially in the critical care unit, surgical unit, intensive care unit, and the emergency unit. The Center for Disease Control Prevention (CDC) report indicates that more than 2 million hospitalized patients attract hospital-acquired diseases when being treated (Adegboye et al., 2018). This requires organizational preparedness and cultural transformations that focus on settling this issue. In my workplace, the readiness level is apparent in the culture in which a sufficient nurse patient proportion is sustained to deter chain diffusion via numerous provider contact. Procedures have further been organized to achieve high hygiene standards. Despite these steps, an adoption hurdle exists due to the absence of regulations strengthening these procedures. Scarce facilities and resources, such as water, further raise the chance of hospital-acquired infections (HAIs) and weaken adoption.
The incorporation of clinical probe in a healthcare organization is the foundation for healthcare issues resolution. This has contributed to the understanding of the origins of high HAIs’ cases and promoted brainstorm in identifying the most viable and effective alternative. Through this, the hospital has managed to use interdisciplinary and inter-professional partnership attempts in acknowledging the hand-washing value in the effective contagious infection transmission control. Hands offer an appropriate pathogen diffusion path because of the rate of contact with the other body parts and other persons and outside elements such as door surfaces (Adegboye et al., 2018). Clinical review is significant in healthcare in the attempt to comprehend the infectious disease pathology and how multidrug resistant communicable infections are transmitted from one individual to another in hospitals.
Section B: Proposal/Problem Statement and Literature Review
Clinical Question/PICOT Statement
Among hospitalized clients of 18 years and above of age (P), how does washing hands using soap and water (I) compared to using sanitizers or face masks (C), assist in reducing incidences of HAIs (O) within five (5) months (T). The PICOT question based on the PICOT statement is that “does washing hands with soap and water within a time span of five months among patients of 18 years and above lower hospital-acquired infections?”
Research Summary and Key Findings
An evidence-based practice (EBP) culture development within an organization involves promoting critical thinking skills and systematic assessment of existing protocols, evaluation, and practices in a clinical setting (Fox et al., 2015). EBP enables healthcare providers to deliver updated guidelines to their patients. The culture can be realized by forming the professional self-reliance through the verification and creation of an inception for the professionals’ behaviors. When developing an EBP culture and policies for the shared knowledge of professional practice, the organization should consider patients’ concerns and experiences (Keller et al., 2018). Additionally, nurses often use hospital policies and protocols of their workplaces as sources of information. Consequently, appropriate evidence-based professional guidelines and regulations should be designed using the best available clinical expertise tools and facts to guarantee that the research process is integrated into clinical practice. The protocols and policies need to fulfill the established quality criteria for them to be a devise for the EBP implementation in the chosen workplace (Fox et al., 2015). A culture with a strong influence on the research use augments the EBP implementation. The beliefs and perception of nurses in the EBP further impact the EBP adoption in the healthcare setting.
In the United States, specifically, one out of 136 patients becomes seriously sick due to HAIs. This is equal to 1.7 million incidences per year, resulting in additional costs of between US$4 billion to US$5 billion and an approximated 90,000 deaths (Keller et al., 2018). Hand-washing in most healthcare settings is the most effective and important disease control protocol that deters pathogens transmission from an individual to another (Fox et al., 2015). The World Health Organization (WHO) reports that hand-washing with soap and water has a scientific foundation and the most suitable protocol that minimizes the transmission expenses of pathogens and HAIs’ rates. When used together with other disease control interventions, hand-washing yields improved outcomes.
Subjects
People within 18 years of age and older are considerably self-reliant as compared with adolescents and children (Haverstick et al., 2017). This can be adapted to the healthcare context although not exclusively frequent due to the nature of diseases and physical and mental state of a person that impact self-care. This phenomenon has further been supported by the reality that the hospital inpatient section shelters a big number of the adult population from 18 years of age (King et al., 2016). As a result, the aim of this project is to offer an alternative that decreases the related health risk among this population group.
Method
Finding a solution involved the use of a clinical inquiry data collection method. This entailed observing the patient and the hospital personnel and their culture in regards to the maintenance of hygiene standards and compliance. The researcher also gathered information from the inpatients via surveys and questionnaires. Remarkably, the researcher performed a systematic assessment of multiple literature resources on the hospital acquired information, the transmissions mode, effects and incidences in the health community, and prevention. For example, the CDC issued revised protocols and policies in 2002 on hand-washing procedures in healthcare systems that all healthcare entities are needed to comply with.
The literature materials explored and primary and secondary research performed yielded multiple findings. This encompasses the national and global HAIs statistics and the intervention role of the WHO and CDC in infection prevention. Additionally, the pathology and effects and the frequencies of transmission have been obtained from the inquiry. This has offered more understanding of the diseases and the effects of prevention via hand-washing using water and soap. HAIs are described as infections that advance within two days or more following an admission in a healthcare system or one month after obtaining care (Haverstick et al., 2017). Additionally, the illnesses are of public health importance because they add to morbidities, mortalities, increased healthcare costs, prolonged admissions, and inflict a threat to the patients’ safety (King et al., 2016). Alternatively, the major cause of high rates of HAIs among healthcare staff has been identified as poor hand hygiene practices.
Limitations
The limitation of the research is that it was restricted to evidence-based literature resources in which just a few researchers have explored HAIs and the effect of hand-washing with water over the sanitizers’ use. This requires further research in the future to make sure that the topic is extensively reviewed to deter the development and spread of HAIs.
Section C: Solution Description
The Proposed Solution
The utilization of Evidence-Based Practice (EBP) is essential for the implementation of reform, alongside facilitating the care improvement throughout a healthcare system. The selected healthcare problem is hospital acquired infections (HAIs). Adegboye et al. (2018) HAIs are widespread in most hospital systems, especially in the critical care unit, surgical unit, intensive care unit, and the emergency unit. More than 2 million hospitalized patients attract hospital-acquired diseases when being treated (Adegboye et al., 2018). This requires organizational preparedness and cultural transformations that focus on settling this issue.
Reflecting on the PICOT approach, the suggested solution for this problem is designed around the EBP protocols’ assessment on HAIs for adult patients (aged 18 years and above) and its effect on the nurses’ adherence levels and hygiene maintenance. Accordingly, the suggested alternative emphasizes the adjustments needed to expedite the early identification of HAIs in adults, as well as the most suitable prevention proposals. According to Fox et al. (2015), the suggested amendment will target the use of hand-washing with soap and water and to design procedure for screening patients and identifying the early indication scores to speed up the increased positive patient outcomes, including reduced intensive care unit (ICU) admissions and increased mortality. The procedures will commence with the assembling of installing hand-washing dispensers at different points of the hospital, including in the washrooms, kitchen, and gate. (King et al., 2016). Every practitioner will be informed about the need to wash hand with soap and water to prevent or reduce the spread of HAIs.
Organization Culture
Haverstick et al. (2017) confirmed that the recommended solution is fairly coherent with the communication and organizational resources and culture given that it is mainly oriented towards the care improvement, the development of a program, and the outcomes of patients who contract HAIs and those at risk. The solution also sets out a mechanisms of urgency among the engaged professionals founded on the proficiency needed in patient treatment. In this regard, the effectiveness of this program would interchange into a protocol advancement that gathers enough managerial support.
Expected Outcomes
Among the anticipated outcomes of the suggested solution is the intensified adherence extents from the personnel on the hand-washing EBP procedures. Second, another expected result is that the rate of spread and mortality rate due to HAIs will substantially drop while the stay time in hospital for a client will further be reduced via the painstaking and unswerving adherence to the procedures.
Methods to achieve the Outcomes
As Keller et al. (2018) highlighted, to realize the outcomes mentioned earlier, nurses will be trained and taught on the use of hand-washing machines or dispensers and campaign for the procedure in the entire organization. This will be done via group instructional seminars where they will be enlightened on the standards for EBP hand-washing with soap and water procedures and antibiotic treatment for those who have acquired the infection. Frequency of washing hands is the supreme principle in the HAIs’ outcome. In this regard, early recognitions is the key to a positive outcome. Awareness and education among health practitioners, including nurses, and susceptible patients about early warning signs should be a priority. Moreover, these nurses will further be required to be conversant with the implementation of the EBP procedures and how to ensure that every patient and provider follows the guidelines. To guarantee an accurate diagnosis and early intervention, nurses will be called upon to perform reliable clinical evaluations while assessing a patient’s background, simultaneously. A major limitation in the achievement of the outcomes is that the doctor contribution will be reduced by engaging the medical administrative committee in the protocol execution. An important element to note regarding how to achieve the outcome is that, considering the challenges and ease of spread of HAIs, there is a need for an interdisciplinary team approach. Various clinicians to be included are primary care/family physicians, pharmacists, specialty-trained nursing personnel, and professionals in various disciplines, including contagious diseases and hematology.
Outcome Impact
The outcomes will have an effects on professional knowledge that will be influenced positively via the improved awareness and understanding of hygiene and hand-washing procedures for nurses. Nurses will be introduced to the best hygiene EBP procedures that will enable the prevention and early detection and therapy, thereby adding to a decline in the mortality incidences and patient care quality enhancement.
Section D: Change Model
Settler’s Model of Research Utilization
The model was developed in 1976 and later improved in 1994. It intended to bridge the gap between medical research and practice by directly engaging clinicians in the implementation process, thereby improving the use of evidence-based research knowledge in medical practice (Camargo et al., 2017). The model helps healthcare practitioners evaluate the relevance of certain research findings in nursing practice. It further helps decision-makers in times of uncertainty while using research evidence to develop formal change within organizations. The model also focuses on reviewing studies for clinical relevance through the lenses of numerous systematic judgmental operations that directly involve healthcare practitioners (Kueny et al., 2015). This helps determine the validity and applicability of the research findings. As a result, one of the model’s major presumptions is that nurses are knowledge-centered critical thinkers, whose contribution to organization decision-making is vital.
The model assumes that the application of research findings can take place either in the form of instrumental use which involves direct use of knowledge, theoretical use that implies the use of research findings to identify a new perceptive of a particular issue, or symbolic use in which research findings are used to justify a decision or shape the behavior of others (Camargo et al., 2017). The model further assumes that while all the three uses can be incorporated, their specific use depends on the user’s inherent features, in additional to outside environment variables. It suggests that for effective results to be attained, other kinds of non-research-associated information can be mixed with research findings to enhance problem-solving (Kueny et al., 2015). Furthermore, research findings offer probabilistic information, as opposed to complete absoluteness, thereby can be fail.
The Relevance of the Model to the Project
The model helps identify the role of each healthcare stakeholder in executing hand-washing with soap and water and maintaining hygiene in the hospital. This ensures that every practitioner is engaged in the change process to minimize the risk of resistance or lack of adherence to the guidelines amongst them and patients (Indra, 2018). The model also guides the practitioners in determining the health factors and conditions that increase the risk of HAIs transmission, thereby assessing the compatibility of research findings to the health determinants in the hospital that relate to the contagious infections. The model offers a structure for a collection of judgmental activities that could be implemented by nurses to evaluate the validity and applicability of hygiene and hand-washing with soap and water procedures in the healthcare practice. By assisting in the appropriate use of current research-based expertise on hand-washing and hygiene protocols, the model will help deter the drawbacks of applying research inaccurately (Kueny et al., 2015). Further, it will help the health practitioners identify the suitability, viability, desirability, and the most suitable way of conducting hygiene and hand-washing protocols in the entire healthcare organization.
The Five Phases of Stetler Model
Preparation. The preparation phases involves identifying a priority need. Nurses should determine the purpose of the EBP Project, the context where the project will take place, and pertinent evidence sources (Holt et al., 2015).
Validation. The validation stage involves assessing sources of evidence for overall quality and quality at each organizational level. There is a need to identify whether the source has benefits and goodness of fit and whether to reject or accept the facts in light of the project purpose (Kueny et al., 2015).
Comparative evaluation/decision making. In this third phase, evidence results are logically summarized and analogies and differences among sources of evidence are reviewed. Nurses should identify whether it is satisfactory and practical to use summary of results in practice (Holt et al., 2015).
Translation/application. The fourth phase of the model involves formulating how the briefed results will be implemented. Healthcare practitioners should determine practice implications that justify the use of results for organizational change (Holt et al., 2015).
Evaluation. The final stage of the model identifies the expected outcomes of the project and identify whether the aims of EBP were successfully attained.
Applying each Stage in the proposed Implementation
In phase one, the healthcare team will specify the need that involves preventing or reducing the transmission of HAIs among patients and clinicians in the hospital, set the areas where hand-washing equipment will be installed, and conduct research on the EBP procedures to use. In phase two, the healthcare team will develop research findings on how hand-washing with soap and water and hygiene help prevent and minimize HAIs transmission and introduce the procedure to the organization (Holt et al., 2015). Phase three will involve comparing the EBP procedures of hand-washing in the organization as provided in different studies. The team will select the guidelines that are common in the majority of the evidence sources (studies). In phase four, the healthcare team will formulate how to implement the procedures in the organization, setting out the frequencies and venues, as well as monitoring activities to ensure everyone adheres to the new change/policy (King et al., 2016). In the fifth phase, the team will assess the new incidences of HAIs among patient, for instance, to evaluate the impact of the intervention and whether the goals are realized. The transmission rate at a particular time will be counterchecked against the predetermined rates to understand areas of improvement.
Section E: Implementation Plan
The Setting and Access to Potential Subjects
The EBP procedure/program will be implemented in the hospital setting with all patients and healthcare practitioners. The implementation of the program in within the hospital will allow close supervision and more importantly, the assessment of the effect of the procedure in light of nursing practice. The project will be financed by an institutional grant given by the management following the authorization of the comprehensive project proposal with an analysis of the anticipated benefits and risks was shown to the hospital administration for consent. Following a peer review process, the institutional review board accepted that the procedure was a possible quality enhancement program. Because this was sanctioned as a quality refinement program, participants (including patients, clinicians, and doctors) were not required to sign an informed consent form (Price et al., 2018). Currently, the organization uses hand gloves and alcohol-based sanitizers as the hygiene approach to reducing or preventing the spread of HAIs within the hospital. The organization will install adequate number of hand-washing dispensers of equipment in all targeted areas of the establishment, where everyone can access them conveniently.
Project Timeframe
The program will consume approximately two months to implement, with outcomes expected within the following three months. The project completion time is short because there are not many components to be considered. The main facets of the program are essentially tied to the establishment of the protocols that the hospital is applying and then contrasting them with the CDC EBP guidelines to set out the change component in the patients’ and healthcare practitioners’ outcome in light of the HAIs transmission and acquisition rates. The implementation stage of the initiative will entail the setting out of the supervision actions, planning for each of the procedures/instructions involved, arranging and scheduling nurse leaders responsible for the follow-up of the protocols, and collaboration features of the program participants to ensure that all facilities are available (Mbakaya et al., 2017). Additionally, for the two months of implementation, the first two weeks will involve mobilizing organizational resources and reconfigure the organizational culture in agreement with the program’s components and requirements. This involves combining resources and presenting a budgetary proposal to the organization’s administration for approval and communicating the program in the entire organization. The next three weeks will involve preparing for the implementation by streamlining and employing the hand-washing equipment, soap, and water, among other materials. Other activities done within this period include training healthcare practitioners and patients on the need for this program and the instructions they need to follow, as well as scheming and mitigating the non-compliance risks. The last three weeks will be used to engage everyone, including clinicians, doctors, nurses, and patients, to the hand-washing exercise, and contacting and informing them via education and availing the materials to them (Price et al., 2018). The involvement of program participants will be an ongoing activity, and the fifth month will be meant for the first assessment to identify the program’s effectiveness in reducing or preventing the spread of HAIs.
Resources required
There are various resources that will be vital for the program’s success. One element of these resources are the human resources. Human resources will include competent nurses and other healthcare teams required for the efficient and results-focused program implementation (Mbakaya et al., 2017). There will also be a need for hand hygiene and aseptic materials and equipment for every organization member. Examples of resources will include paper towels, warm running water, detergent or soap, and garbage containers.
Methods and Instruments
The program will be implemented in two stages. The first phase will involve assessing the current methods and strategies used in the hospital. The findings related to the incidences of HAIs transmission and the effectiveness of the existing control methods will be recorded. The second stage will involve the analysis of the Center for Disease Control (CDC) EBP’s guidelines for the prevention and reduction of the spread of HAIs from 2011. The findings of this second stage will also be recorded. An assessment will subsequently be conducted to determine the disparity between the current practices used in the hospital and the review for the alterations after implementing the CDC EBP’s procedures. This is key to the final strategy for minimizing the HAIs’ diffusion.
The Delivery Process of the Solution
The strategies for delivering the EBP hand-washing with soap and water intervention will be through education/training, financing, and policy. First, training is a critical success element and shows one of the foundations for the enhancement of hand hygiene practices. Nurse leaders will deliver training to all organization members on how to wash hands at recommended time intervals, including after using the toilet, and before and after eating. Patients require training or education on the significance of hand hygiene and the appropriate protocols for hand washing and hand rubbing (Lydon et al., 2017). Clear training and educational messages on hand washing will help stimulate cultural and behavioral change and guarantee that competence is established and upheld among patients and healthcare practitioners in regards to hand-washing hygiene.
Second, the intervention will be delivered as an organization policy. This will be implemented in two approaches: first by developing an institutional safety atmosphere, and second by placing reminders in strategic points in the hospital setting. The institutional safety climate will entail developing a surrounding and perceptions that enhance conscious-raising and consideration of hand-washing refinement as a high priority at all organizational levels. This should include active involvement at both individual and organizational levels, together with awareness of organizational and individual capacity to change and refine self-efficacy (Lydon et al., 2017). Second, reminders in the hospital setting will be crucial instruments for encouraging and reminding patients and healthcare practitioners about the value of hand washing, as well as the suitable indications and protocols for performing it. Multimedia approach can be used to present these reminders. For example, posters will be placed in noticeable sites close to the eating, toilet/washrooms, and hand-washing points. Additionally, pamphlets will be distributed to patients and healthcare teams as reminders of how, why, and when to wash hands.
Financing will also ensure that the hospital has the required infrastructure available to enable patients and healthcare staff to carry out hand washing. Adherence to hand washing among patients and healthcare providers will only be possible if the hospital ensures that infrastructure and a reliable and permanent sourcing of hand hygiene materials are in place at the right times and locations (Mbakaya et al., 2017). Overall, the delivery of the solution will assume a multi-level intervention. The solution be address the individual patients, healthcare providers, and the whole organization’s needs, thereby aiming three different sources of influence at the minimum. The multi-level interventions will influence interdependent interaction, yielding desirable results.
Data Collection and Management Plan
The data will be seamlessly collected by electronic hand hygiene monitoring technology. The electronic systems will monitor hand hygiene adherence and gather data on hand washing activities. The system will also remind participants to wash hands when they forget to do so. Direct observations by nurse leaders will also provide data on the hand washing procedures. Data analytics will be used to manage the collected data to establish the compliance level among patients and healthcare teams (Reilly et al., 2016). Nurse leaders, clinicians, and the administrative team will be involved in the data management using analytics and ensure that the system functions as intended. The analyzed data through the data analytics will be interpreted determine the next course of action in regards to deterring the spread of HAIs.
Management of Barriers, Challenges, and Facilitators
The possible factors that will manifest as either barriers, facilitators, or challenges to hand washing program include the adequacy and accessibility of hand hygiene supplies, the absence or occurrence of skin irritation caused by hand washing soaps/detergents, wearing of gloves, the absence or presence of knowledge of hand hygiene guidelines, the level of workload and staffing, the time available for hand washing, lack or presence of scientific information indicating a definite effect of enhance hand hygiene on HAIs incidences, and whether or not patient needs are seen as a priority over hand hygiene (Li et al., 2015). To deal with these three aspects (barriers, challenges, and facilitators), possible strategies will include regular training on hand hygiene, use of cleaners with surfactants and offering a skin lotion to prevent irritation, ensuring adequate supply of hand hygiene materials and placing them at accessible, strategic places, providing evidence of how hand hygiene reduces or prevents HAIs’ spread , and assuring patients that hand hygiene is part of the hospital areas of focus and contributes to their wellness.
Feasibility of the Implementation Plan
The implementation plan is feasible as the costs of implementing the program will be moderate, given that the organization will only need to install the hand hygiene equipment, train participants, and analysis the CDC guidelines. The costs related to the personnel will not be high because the healthcare teams will just require training on how to implement, administer, and monitor the hand hygiene procedure, as well as how they will communicate with patients to ensure compliance (Li et al., 2015). Besides, the equipment required are possible to procure by the hospital as it mainly includes soap, consumable supplies (such as water), the hand-washing machines, and data analytics to aid in monitoring the procedure compliance. Other costs relate to training patients and healthcare teams, and regimens to supplement the prevention or reduction of the HAIs transmission.
The Plans to maintain, extend, revise, and discontinue the proposed Solution after Implementation
The proposed solution will be revised and continued in the hospital after its implementation because hygiene is an ongoing process. The compliance data from the analytics and direct observation will be used to identify areas that require improvement. Furthermore, the CDC guidelines will be reviewed to ensure that the organization’s members adhere to the protocols and make it part of their culture. Additionally, more training will be conducted to ensure proper use of hand hygiene equipment by participants and regular communication to be conducted on how hand hygiene helps prevent HAI transmission in the hospital (Reilly et al., 2016). The proposed solution will be continually revised and maintained to sustain the hygiene culture and prevention of the contagious infections transmission.
Section F: Evaluation of Process
The Rationale for the Methods used in collecting the Outcome Data
The outcome data collection methods were chosen for different reasons. First, interviews were used as it offered a close setting to which the interviewers intermingled with different hand-washing with soap and water project’s participants. Additionally, interviews gave a podium where persons could learn different elements that could impact the project deliverables. In the same vein, interviews offered a wide information pool that enabled the interviewers to access information varieties (Balasubramanian et al., 2015). Consequently, the close contact with various project participants, including patients, nurses, and clinicians, provided a platform to which specific data findings is derived for the project. Another outcome data collection method used was questionnaires due to its ease of use and flexibility in outcome data collection (Dufour et al., 2017). Questionnaires can help obtain large amounts of information from large sample cohorts within a short time and lower costs. Further, results received using questionnaires can be quantified easily both analytical software and manually and, consequently, the organization can identify change founded on data comparison (Boswell et al., 2016). Alternatively, scaled checklists were also used as they facilitated the evaluation of the situation and the most vulnerable areas of HAI transmission, thereby adding to decision-making on the best strategies for encouraging a quality hospital environment described by minimal or no transmission of HAIs. The scaled checklists can be incorporated into daily practices of the hospital, allowing for continuous determination and prevention of HAIs’ spread.
Ways in which the Outcome Measures evaluate the Extent to which the Project Objectives are achieved
Outcome measures nurture enhancement and implementation of best procedures, thereby enhancing project outcomes. Comprehending outcomes is hey in offering value and shows an opportunity for restructuring the hospital to realize better healthcare quality. Outcome measures can used to assess the attainment of project objectives by tracking change and comparing the targets with a predetermined standard over time (Birnbach et al., 2015). The measures also offer data that inform the hospital on what progress is being made towards the project targets’ attainment. Outcome measures can also documents whether the project is being executed as scheduled (Pantaleon, 2019). They can show how the status of HAIs’ transmission rate at the end of the project and comparing the results with the statistics before the project to know whether the objectives have been attained or not to what extent.
How the Outcomes will be measured and evaluated based on the Evidence, and addressing Validity, Reliability, and Applicability
Outcomes can be measured by activity data such as HAIs’ transmission rates and admission level due to HAIs. Safety of care, readmissions, patient experience, and effectiveness of care are the outcomes measures that can be used to measure and evaluate the hand-washing project outcomes. For instance, the effectiveness of care is an outcome measure that can be used to determine the compliance with the hand-washing care procedures among patients and healthcare teams (Boswell et al., 2016). Similarly, patient experience, obtained via patient-reported outcome measures, can be used to assess the patients’ perception and experience of the hand-washing guidelines. Similarly, readmissions is an outcome measure that can help assess the number of patients being readmitted due to cases of HAIs (Birnbach et al., 2015). Clinical guidelines and established EBP outcomes and best research literature can also be used to evaluate the outcomes of the new change in the hospital. Aside from that the validity, reliability, and applicability of the outcome measures can be achieved by asking healthcare teams and patients to rate the applied outcomes’ regarding the three aspects as it seems to them. For example, a Likert scale can be used to assess the validity of the measures as participants indicate. According to Balasubramanian et al. (2015), regarding applicability and reliability, healthcare teams and patients can be given semi-structured questionnaires on different occasions and the responses they give can be used to show the reliability and applicability of the outcome measures.
Strategies to take if Outcomes do not provide Positive Results
The inferences are established via determining the factors that do not advance or contribute to the existing protocols. The verification is about the status quo and some cases include outcomes that do not offer any positive results. If the issue is methodological, there is a need to begin afresh using distinct techniques (Pantaleon, 2019). However, if the problem does not exist with the methodology and nothing new was identified, there is no urge to begin all over again.
The Implications for Practice and Future Research
Nurses and other healthcare practitioners should avail hygiene interventions to the entire hospital to reduce the rate of HAIs’ transmission and enhance the quality of care. Hand-washing program is a simple procedure to observe and implement in the hospital and is widely considered the best hygiene approach in the hospital. No safety issues are evident with this intervention and its benefits can be applied or generalized to different healthcare organization (Dufour et al., 2017). However, further research should be performed to identify if the duration or frequency of hand-washing procedure impacts its effect on the spread of HAIs. Moreover, future research must be performed to identify the most suitable behavioral recommendations that can be combined with hand-washing with soap and water to improve the quality of care and prevention of HAIs’ transmission.

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Appendices
Appendix A: The Conceptual Model for the Project

Appendix B: Data and Evaluation Collection Instruments
a. Scaled Checklist: Please provide your remarks on the following checklist questions regarding the application of hand hygiene
Hand-washing with soap and water Comment/Compliment
Yes/Satisfactory No/ Non-Satisfactory
1. Checked that sinks are supplied with soap and paper towels
2. Turned on valves and regulated water temperature
3. Wet hands and applied enough soap to cover all hand surfaces
4. Rinsed thoroughly keeping fingertips pointed down
5. Dried hands and wrists thoroughly with paper towels
6. Discarded paper towels in wastebasket
7. Used paper towel to turn off valves to avoid contamination to clean hands
8. Performed hand hygiene for about 15 seconds, using plenty of friction and lather
b. Questionnaire: Hand Hygiene Staff Questionnaire
Please read the questions carefully and respond spontaneously. Your answers are anonymous and will be kept confidential. Please highlight your responses.
1. Did you obtain education or training on hand hygiene in the past year?
Yes or no
2. Did you routine use soap and water for hand hygiene?
Yes or no
3. What step was needed for you to perform proper hand hygiene?
{No effort}; {slight effort}; {above average}; {a big effort}
4. Did you require reminder to participate in hand hygiene procedure at different points of care?
{Never}; {sometime}; {often}; {always}
5. Who did you want to remind you to involve in hand hygiene? (Check all that apply)
{Poster}; {nurse}; {demonstration}; {clinician}
6. How effective did you find the illustration of hand hygiene conducted?
{Not effective}; {slightly effective}; {averagely effective}; {very effective}
7. Do you wish such demonstration to be repeated in future?
Yes or No
8. If yes, how frequent do you expected of such demonstration?
9. Did this demonstration altered your hand hygiene practice or behavior?
Yes or no
1. Do you feel hand hygiene is an effective method for preventing the spread of HAIs?
{Not effective}; {slightly effective}; {averagely effective}; {very effective}
Appendix C: Timeline
Project Activity Time
Project Preparation 10 days
1. Establishing protocols that the hospital is applying and comparing with the CDC EBP guidelines Four (4) days
2. Planning for each of the procedures/instructions involved Three (3) days
3. Developing the supervision actions Three (3) days
Project Implementation and Evaluation 50 days
1. Arranging and scheduling nurse leaders responsible for the follow-up of the protocols Five (5) days
2. Combining features of the program participants to ensure that all facilities are available Three (3) days
3. Mobilizing organizational resources and reconfigure the organizational culture in agreement with the program’s components and requirements. One (1) week
4. Combining resources and presenting a budgetary proposal to the organization’s administration for approval One (1) Week
5. Communicating the program in the entire organization. One (1) week
6. Streamlining and employing the hand-washing equipment, soap, and water, among other materials Four (4) days
7. Training healthcare practitioners and patients on the need for this program and the instructions they need to follow, and scheming and mitigating the non-compliance risks. One (1) week
8. Engaging everyone, including clinicians, doctors, nurses, and patients, to the hand-washing exercise, and contacting and informing them via education and availing the materials to them One (1) week
9. Assessment to identify the program’s effectiveness in reducing or preventing the spread of HAIs. Three (3) days
Total Project Duration Two (2) months or sixty (60) days
Appendix D: Resource List
1. Water
2. Paper towel
3. Clean Water
4. Hand-washing dispersers/machines
5. Training manual
6. Posters materials
7. Databases for CDC EBP guidelines
Appendix E: Budget Plan
Cost element/consideration Value Source of Funds
1. Soap $4,500 The Hospital
2. Paper towel $11,600
Institutional grant
3. Adequate water
4. the hand hygiene promotional campaign (Training and Education, research of CDC guidelines, posters materials) $2,000 The hospital
5. Hand-washing dispenses/machines and installation $20,250 Institutional grant
6. Miscellaneous cost factors $3,000 The hospital
Total Costs $41,350
The portion of the budget contributed by the hospital $9,500
The portion contributed by the institutional grant $31,850

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