1. Preventing HCAI’s through an education programme for nurses
Claire Comerford, MSc in Healthcare Management
Abstract
Healthcare associated infections (HCAI’s) not only negatively impact on patients, they also have a significant impact on healthcare organisations. Policies exist to prevent and control them, however a lack of knowledge of these policies and associated inadequate behaviours result in noncompliance issues. Being both a staff nurse and front line manager, the author is responsible to ensure that patient care is in line with best practice. This thesis reports the author’s journey in trying to empower the staff with appropriate knowledge and the best practice approach. The aim of this project is to improve the knowledge and associated behaviours of staff nurses in the area of infection prevention and control through the introduction of educational sessions.
The change was implemented using the HSE Change model, which provided a clear structure to the change process, while it also allowed for flexibility to return to previous stages if the need was required. Educational sessions were conducted on a medical ward within the hospital and all 19 staff nurses on the ward were educated in either individual or two person sessions. Kirkpatrick’s four level framework was used to evaluate the changes. Staff nurses overall satisfaction with the educational sessions was assessed using happy sheets. 91% of nurses were very satisfied with the education sessions. Questionnaires were utilised to capture the knowledge level of staff following the education sessions, with the nurses answering 90% of the answers correctly. Nurses’ compliance to hospital policy was assessed pre and post the educational session, using an audit tool. Policy compliance was found to have increased to 90% or above, in each section of the audit. Reflecting on the process the author notes that the project had certain strengths and limitations, and the organisational impact reflects these.

2. Introduction & Background Methodology Continued Organisational Impact
Preventing HCAI’s through an education programme for nurses
Claire Comerford, MSc in Healthcare Management
Introduction & Background
Methodology Continued
Evaluation Continued
Preventing and controlling healthcare associated infection’s (HCAI’s) is a key priority worldwide. In Ireland, the Health Information and Quality Authority has developed the ‘National Standards for Prevention and Control of Healthcare Associated Infections’1.
Local and national policies also exist to guide and cover this area.
However, a major barrier exists in implementing policy and best practice due to the lack of appropriate knowledge and skills2.
This change initiative focused on improving compliance to protocol through the implementation of an education programme.
Planning
Forming a project team helped build commitment and support.
Communication and engaging with all stakeholders was pivotal.
Creating and clearly communicating a shared vision - “Preventing HCAI’s by improving education and compliance to policy, a nursing endeavour”.
Implementation
Implementing the change as per the project plan.
Providing education sessions for all staff.
Carrying out audits to assess compliance.
Mainstreaming
Discussion regarding the results of project with all relevant staff.
New working relationship’s fostered.
Audits were used to identify if the educational sessons had an impact on the behaviour and practices of nurses. Compliance improved in all areas as highlighted below.
This was achieved by:
acknowledging and evaluating the success to date,
allowing time for change to be embedded, before attempting to roll out to other areas.
3. Behaviour
audit – apply learning to practice
4. Results
Effects on the organisation
Aims & Objectives
Aim: Improve nurses’ knowledge of and adherence to infection prevention and control policy.
Objectives :
Increase the knowledge base of staff in relation to infection prevention and control.
Assess the knowledge of nurses.
Audit practice pre and post education to determine the impact of education.
Evaluation
The education was evaluated using Kirkpatrick’s 4 level framework 4.
Staff knowledge after the education sessions was rated at over 90%.
Organisational Impact
1. Reaction
Happy sheets - how staff felt about training
High level of knowledge of infection prevention and control policy is now evident on the ward. Policy compliance has improved, resulting in higher quality care provided to patients. Ongoing evaluation and audit are needed to ensure continuous improvement and monitoring of standards.
Methodology
The HSE change model3 was used to guide implementation. It was chosen because of its simplicity and applicability to healthcare projects, and also because of the emphasis it places on the people involved in the change.
Initiation
Change mangement tools used included : SWOT, stakeholder analysis etc.These tools helped build a solid foundation while gaining support and creating a readiness to change.
Conclusion
The use of a systematic manner enables change to be achieved and sustained. Further audits will identify the impact of the educational sessions and highlight if a need exists for ongoing education.
2. Learning
Questionnaires - measuring increases in knowledge
References
Health Information and Quality Authority (2009). National Standards for Prevention and Control of Healthcare Associated Infections. Dublin: Health Information and Quality Authority.
Sung, H., Chang, A. & Abbey, J. (2008). An implementation programme to improve nursing home staff’s knowledge of and adherence to an individualized music protocol. Journal of Clinical Nursing, 17,
Health Service Executive (2008). Improving our services: A user’s guide to managing change in the Health Service Executive. Dublin: Health Service Executive.
Kirkpatrick, D.L. & Kirkpatrick, J. D. (2006). Evaluating Training Programs: The Four Levels. San Francisco: Berrett- Koehler Publishers Inc.
Figure 1: HSE Change Model