Shannon Sheffer NURS 324 Reflection on the EBPP How did the planning process, where you thought

about what you wanted to change, prepare you for the EBPP. I believe the planning process was a crucial piece of the puzzle when preparing for this project. It aided in the formulation and organization of my critical thoughts and ideas. But I also believe that the planning phase can only take a person so far. The real test was revealed as I began to assemble my proposal and attempted to pull all of the information together to form a cohesive and complete action plan. How did the peer evaluation process prepare you for the EBPP. I believe the peer evaluation was the most valuable asset in this project. It allowed fellow professionals to analyze and critique my work. This process provided essential information such as the parts of my proposal that made sense, which parts needed further work, as well as suggestions of different ideas and ways to approach the topic that had not occurred to me. In essence, it helped to offer a fresh point of view. Do you feel you are prepared to elicit change in your practice with your proposal? How does it fit into quality health care. The hand hygiene initiative is a multifaceted undertaking that has been thoroughly studied and attempted by many. I feel it will require more than just me to truly elicit any sort of positive change. However, I believe that this project has brought about change in my personal hand hygiene practice. I believe I am on the right track to beginning the process of change. I hope that if I begin to follow the proper hand hygiene procedures, others may feel empowered to follow the same path. I believe hand hygiene is a staple in quality care and patient safety. Proper hand washing protects the patient and the health care worker by inhibiting the spread of germs which have the power to cause illness, infection, and possibly even death. Nursing is about safeguarding the patient from unnecessary harm. Hand hygiene is just one gateway that is able to fulfill that aim. What could you have done better. I believe that this initiative needs to be a group effort instead of a single person attempting to spearhead the entire project. I believe this would make the project more successful. Specifically, I could have spent more time on the concepts and ideas portion of the elements of reasoning. I believe that portion could be expanded and further detailed. How well do you think you are using the EOR? Do they make sense to you (why or why not). I believe that I have a fair understanding of the elements of reasoning. I was able to navigate through the project, anticipate and correct any potential issues before they became apparent, and I believe the final product was an overall success. Having stated that, there is always room for improvement. The next time I attempt a project such as this, I believe I will have a better understanding of what to expect as well as what does and does not work. The elements of reasoning do make sense to me. Each step acted as a helpful guide that walked me through the critical thinking process. The elements of reasoning acted to break down each piece of the critical thinking puzzle which made tackling this project much more feasible.

Article annotation 1 Erasmus, V., Huis, A., Oenema, A., van Empelen, P., Boog, M.C., van Beeck, E.H.E., et al. (2011). The ACCOMPLISH study. A cluster randomized trial on the cost-effectiveness of a multicomponent intervention to improve hand hygiene compliance and reduce healthcare associated infections. BMC Public Health, 11, 721. doi: 10.1186/1471-2458-11-721. This article was written by members of the Department of Public Health as well as medical researchers. This study inspects the approximate cost of hand hygiene as compared to the treatment of infections caused from germs acquired in the hospital. According to this article, public health officials have identified that hand hygiene is an important factor in decreasing and impeding the rate of sickness and death in the hospital. Moreover, the development of a nosocomial infection generates many negative and unwanted side effects. It creates harrowing circumstances that often require additional treatment in order to control and resolve the infection. This article states that a natural repercussion from the development of a nosocomial infection is high health care expenses. In some cases, a nosocomial infection may cause ongoing morbidity or even mortality. It is the worst outcome which is inessential and can be prevented. Article annotation 2 Huis, A., Schoonhoven, L., Grol, R., Borm, G., Adang, E., Hulscher, M., et al. (2011). Helping hands: A cluster randomized trial to evaluate the effectiveness of two different strategies for promoting hand hygiene in hospital nurses. Implement Sci, 6, 101. doi: 10.1186/1748-5908-6-101. The lead author of this article, Anita Huis, works for the Institute for Quality of Healthcare at a university located in the Netherlands. All other contributing members have a background in medical research. The goal of this study is to assess alternate approaches for encouraging proper hand sanitization. According to this study, the most successful and recognized action in circumventing a nosocomial infection is appropriate hand hygiene. However, even with this conclusive information, hand hygiene compliance rates are dangerously low the average ranging below 50% conformity. This study discusses that if a patient develops a nosocomial infection, it forces him to reside for a longer period of time in the hospital for treatment that otherwise would not have been needed. The result of this study states that if more of an effort was placed into bettering the hand hygiene initiative, it would have a greater chance of being more successful. Article annotation 3 Mathai, E., Allegranzi, B., Kilpatrick, C., & Pittet, D. (2010). Prevention and control of health care associated infections through improved hand hygiene. Indian J Med Microbial, 28(2), 100-106. doi: 10.4103/0255-0857.62483. All authors of this article work for the World Health Organization in the department of infection control and patient safety. This article states that within the last 200 years, the

connection has been made regarding hand hygiene hindering the development of nosocomial infections. Additional research states that common antiseptic hand cleansers (chlorhexidine gluconate and povidone-iodine) have been affiliated with skin issues, such as contact dermatitis. This discovery is one of the biggest deterrents for proper hand hygiene. The article also states five necessary actions to increase hand hygiene compliance 1) improving accessibility of hand sanitation products; 2) providing accurate instruction on hand washing; 3) supervising hand washing efforts; 4) frequent visible prompts; and 5) decreasing the risky practices of staff. Furthermore, the study states that hand sanitation must be performed before and immediately following any contact with a patient to prevent the spread of germs from the health care provider to the patient and vice versa. Article annotation 4 Sharma, S., Sharma, S., Puri, S., & Whig, J. (2011). Hand hygiene compliance in the intensive care units of a tertiary care hospital. Indian J Community Med, 36(3), 217-221. doi: 10.4103/0970-0218.86524. The authors of this journal article are all medical doctors with extensive experience to guide their research. The purpose of this study is to measure hand hygiene procedures, recognize obstacles to hand washing, and to detect the types of behaviors that predict deterrents to the practice of hand hygiene among those who work in health care. According to this article, the development of a nosocomial infection is a common, yet avoidable complication in the health care field. In this study, the total hand hygiene compliance rate was 43.2%. Although hand hygiene itself is a simple task, the article found that understanding the issue of non-adherence to preset standards is intricate and involved. When surveyed, staff listed lack of information and high patient volumes as reasons to the low compliance rate. In addition, the study found that a decrease in the workers inspiration and enthusiasm is also attributed to the insufficient hand washing process. Article annotation 5 World Health Organization (2009). WHO guidelines on hand hygiene in health care: First global patient safety challenge clean care is safer care. WHO Library Catalogulng-In Publication Data. Retrieved from http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf. The World Health Organization (WHO) is a renowned institute that specializes in conducting research, establishing standards of practice, and supporting other agencies and countries in their search for the betterment of health. The results of this study examine scientific data in an effort to evaluate current hand hygiene practices, effects on germ and infection rates in patients and health care workers, and provide more comprehensive guidelines in the practice of hand sanitization. This guide is divided into six parts. Part one inspects scientific information collected on hand sanitization procedures in the health care arena. Part two discusses approved hand hygiene actions from an elite board of experts convened by the WHO. Part three calculates the effect of proper hand hygiene and the consequences of poor practice. Part four recommends the advancement of hand hygiene on a widespread level. Part five endorses patient contribution

to the hand hygiene initiative. Part six appraises the current worldwide procedures for hand sanitization.

1. Purpose (all reasoning has a purpose)

2. Questions at issue or central problem (all reasoning is an attempt to figure something out, to settle some question, solve some problem) 3. Point of view (all reasoning is done from some point of view; think about the stakeholders)

4. Information (all information is based on data, information, evidence, experience, research)

5. Concepts and ideas (all reasoning is expressed through, and shaped by, concepts and ideas) 6. Assumptions (all reasoning is based on assumptions-beliefs we take for granted) 7. Implications and consequences (all reasoning leads somewhere. It has implications and when acted upon, has consequences) 8. Inference and interpretation (all reasoning contains inferences from which we draw conclusions and give meaning to data and situations)

The purpose is to increase hand hygiene compliance of nurses. This can be done with adequate education on proper hand hygiene practices and techniques. Does hand hygiene help prevent the spread of germs? Is lack of hand hygiene a patient safety issue? When/how often do hands need to be washed? View # 1: Inadequate and improper hand hygiene is the gateway to the development of infection. Lack of hand hygiene serves as a liability to patient safety. View # 2 : Hands do not look/feel dirty, sanitization is not needed. I wear gloves; my hands do not need to be washed. During research, I found many reputable articles discussing hand hygiene with information about dangerously low hand hygiene compliance, hand washing versus infection rates, when hand hygiene needs to be performed, and the use of soap and water versus alcohol gel. Nurses need to wash hands before and after contact with patient or contaminant in order to provide the best possible care. Hand washing prevents the spread of germs, which decreases infections. Hand washing protects nurses and patients. Adequate hand washing protocol needs to be adhered to in an effort to keep both patients and staff safe and healthy. Hand washing decreases germs/infections and hospital length for patients. Promotes a healthier work environment