Measurement of hand washing in wound infectionsRachel Duffy

Phomolo Madome

Eva van Swaaij

Measurement: Process and Outcome Indicators

MeasuresThere are 3 types of measures used in quality work:

Structure: Physical equipment and facilitiesProcess: How the system worksOutcome: The final product, results

Structure and process are easier to measure; outcome is more important.Difference between Process and outcome:

Process:How Healthcare is providedHow the system works

Outcome:Health statusDoes it make a difference?

Building Measurement and Data Collection into Medical Practice

Aim: What are we trying to accomplish?Measures: How will we know that a change is an improvement?Changes: What changes can we make that we think will lead to an improvement?

Principles

1. Seek usefulness, not perfection, in the measurements- Helps to begin with a small, useful data set that fits your work environment, time limitations and costs constraints

2. Use a balanced set of process, outcome and cost measures

3. Keep measurement simple; think big, but small-focus on a limited, manageable, meaningful set of starter measures

4. Use qualitative and quantitative data- quantativemeasures are better at capturing the objective world; qualitative measures are better at reflecting subjective issues

5. Write down the operational definitions of measures-provides a clear method for scoring or measuring a variable in a reproductive manner6. Measure small, representative samples- emphasis on usefulness, not perfection7. Build measures into daily work- help the person capture the right information at the right time8. Develop a measurement team- success in measurement requires time and technical expertise. Team up to lighten the workload, add knowledge and boost moral

Fishbone-diagram

Wound infections

Prevention

MaterialsProcedures

People

Nurses Knowledge nurses

Hand washing

Education material

Dressings

AssistantsLifestyle

Time

Dressing procedure

Patients

Appointments

What?

Compliance with hand washing procedures in a community health care center

Why hand hygiene

• One of the most important factor in cross infections

• Adherence to hand hygiene recommendations remains poor, and improvement efforts frequently lack sustainability.

• To assess the performance of individual staff members and educate them by intervening in real time

• To assess the impact of a quality improvement intervention to increase adherence to hand hygiene guidelines

How?

Ask patients to register whether their nurse is washing her hands

Positive Negative

Patients are likely to register correctly A lot of work to inform the patients about their task

Cheap Possible bias: Nurse can wash her hands when the patients is out of sight

Raise patients awareness about infection control

Does not register the quality of washing

Does not compromise patient privacy

How? Observer looking if the nurse washes her hands

Record hand hygiene compliance

Positive Negative

Very little to no bias Expensive

Count both opportunities for hand hygiene and the action of hand hygiene.

Not very appropriate in an understaffed setting

Can verify when hand hygiene was practiced

Compromising patient privacy

Hand hygiene quality can be assessed Staff members can change their behaviours

How?

Ask staff to register when they forgot to wash their hands

Positive Negative

Easy Bias e.g. due to time constraints , expectancy

Cheap Time consuming for a busy nurse

Does not compromise patient privacy

Consequences

• Better adherence to hand washing

• Raise awareness

• Better knowledge of infection control in community centres

• Specific actions for infection control in a community centre

• Less potential for infection transmission

Desirable Characteristics

• Relevance

• Evidence-based

• Reliability

• Reproducibility

• Validity

• Feasibility

Reasons against implementation

• Financial

• Observer costs money

• Bias

• Positive or negative

• Time

• Nurse already has time constraints with patients

References

• Meister, S (2011). QI tools, root cause analysis. Iowa department of Public Health. Retrieved from: http://www.idph.state.ia.us/mphi/common/pdf/root_cause_analysis.pdf

• Varkley, P (2010). Medical Quality and Management. Theory and practice. American College of Medical Quality. Jones and Bartlett Publishers. Sudbury, Massachusetts. Pg. 37.

• Nelson, E., Splaine, M., Batalden, P., & Plume, S. (1998). Building measurement & Data Collection into Medical Practice. Annals of Internal Medicine, 128(6). 460-466. Retrieved from http://edocs.library.curtin.edu.au/eres_display.cgi?url=DC60262746.pdf&copyright=1