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Hand Hygiene Guidelines to Reduce Infections: Change Model

Hospital-acquired infections (HAIs) create a problem that negatively affects both patient health and the status of a medical organization. The number of HAIs is connected to the quality of hand hygiene practices and the antisepsis guidelines implemented in a hospital (Fernando, Gray, & Gottlieb, 2017). Therefore, these activities and policies should be targeted to resolve the issue. One can introduce a nursing plan focused on continuous training of employees, the development of specific antisepsis guidelines, and the incorporation of monitoring tools for workers to deal with the concern of high HIA rates in a clinical setting.

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Change Model Overview

To implement change, a nurse can use the ACE Star Model of Knowledge Transformation. This model has five main steps that can help nurses facilitate and institutionalize changes. The first step deals with knowledge generation – gathering recent and reliable data pertinent to the area of concern (Stevens, 2004). This step is followed by an evidence summary that reduces the amount of information and synthesizes its major aspects and translation to guidelines that presents specific points for medical workers to follow. The last two steps are practice integration which deals with the implementation of the new guidelines and evaluation of processes and outcomes concerned with patient and worker satisfaction.

The Scope of the EBP

In clinical practice, HAIs can affect patient health and satisfaction, hospital rating, and financial matters. Following the first and second steps of the Star Model, one can collect information relevant to the topic. For example, Fernando et al. (2017) state that half of all HAIs acquired in Australia annually could be prevented which shows that the problem of infections lies in the training of employees and mismanaged hospital practices. In the discussed work area, the scope of the problem can reach devastating levels if ignored further.


All types of medical workers depend on the quality of guidelines presented to them in a clinical setting. Thus, it is necessary to create a team of stakeholders that can reach all levels of healthcare providers. As a whole, nursing personnel should be engaged in the project as their work is directly linked to patients and their outcomes. Thus, medical-surgical nurses, nurse anesthetists, nurse managers, and other types of staff can become a part of the team to work on the steps of the Star Model concerned with guidelines development and implementation.

The Responsibility of Team Members

The discussed team members are chosen because of their roles in the hospital. Nursing managers’ influence on other personnel is significant as they have the power and authority to guide employees in the right direction. Their broad scope of reach and experience allows them to suggest practical solutions. Medical-surgical and anesthetist nurses may assist in evaluating the quality of antisepsis guidelines during surgery.


The research in the field of HAIs resulted in some studies that explore possible interventions for this problem. According to Luangasanatip et al. (2015), more than 1 million patients may deal with an HAI at any moment in time. Moreover, the authors find that improper hygiene of healthcare workers is the primary reason for the occurrence of this problem as many employees do not follow basic hygiene guidelines (Luangasanatip et al., 2015). The World Health Organization (WHO) has created some baseline rules for healthcare workers that include education, observation, safety climate creation, and frequent reminders.

Evidence Summary

As a result of analyzing several articles, multiple evidence-based interventions can be considered. According to Tanner, Dumville, Norman, and Fortnam (2016), patient’s health is at serious risk because of HAIs as they may experience difficulty healing, additional complications, and pain. Higher rates of death are also connected to HAIs. The results of studies discussed by Luangasanatip et al. (2015) suggest that hand hygiene is one of the most effective ways to decrease the rate of HAIs. Nurses fail to follow the WHO’s guidelines and have a low rate of compliance. Therefore, the discussed hospital needs to not only train them but also implement some monitoring tools to increase control and coordination (Fernando et al., 2017).

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Recommendations for Change Based on Evidence

The summarized research results show the role of education and monitoring in increasing the levels of compliance for workers. Thus, the hospital should focus on nurses’ understanding of hand hygiene and antisepsis practices, their importance for patient outcomes, and the necessity of following all presented guidelines. Furthermore, stricter rules of compliance should be introduced along with frequent reminders and check-ups of nurses following these rules. Here, the final step of the Star Model should be considered an observation that may ensure continuous improvements of compliance rates.


Action Plan

One has to develop the guidelines which will be introduced to the personnel. Here, the help of stakeholders must be requested to create rules which help all departments and benefit patients most effectively. Then, the developed framework has to be disseminated among employees who need to be educated on such topics as the outcomes of improper hand hygiene, the possible ways to improve sanitation, the types of antisepsis procedures and their effectiveness, and the necessity to follow guidelines. Monitoring tools that report about visits to hand hygiene stations and issue reminders to staff should be installed during the nurses’ training process. The implementation of the plan may take several months to complete. Nurses may be asked to assess the new program before and after deployment. Then, the outcomes of this plan may be measured every month by using the data from monitoring equipment and reports of HAIs.

Process, Outcomes Evaluation, and Reporting

It is expected that the rates of HAIs will decrease after the plan’s implementation. This result can be measured by comparing old statistics of HAIs in the hospital with newly acquired data. The reports from the installed tools may also be taken to the stakeholders as their results will show the level of nurses’ compliance with new hygiene guidelines.

Identify Next Steps

The plan can be introduced to other units through communication with nursing managers. The conversation may be based on the successful results of the present project and data from EBP research. This plan applies to all areas of healthcare because hygiene is a universal issue that is important to health in a global sense. To make the implementation effects permanent, regular check-ups of the HAIs rates should be done along with frequent training reminders to nurses.

Disseminate Findings

The findings may be disseminated in the form of reports that showcase old and new statistics of HAIs rates, compliance levels, patient satisfaction, and nurses’ personal opinions. To report the findings externally, statistics can be presented in a review of the plan’s results.


HAIs are a serious problem for all units of a hospital. They concern all levels of personnel from managers to regular nurses. Patient health is directly connected to nurses’ behavior. Low levels of nurses’ compliance with current hygiene guidelines facilitate the need for a new plan focused on training and monitoring activities. Following the ACE Star Model, the project is based on recent and reliable data and has to be implemented with ways to record and institutionalize change. New guidelines can be monitored with specialized tools and measured with the rates of HAIs and compliance levels.


Fernando, S. A., Gray, T. J., & Gottlieb, T. (2017). Healthcare‐acquired infections: Prevention strategies. Internal Medicine Journal, 47(12), 1341-1351. Web.

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Luangasanatip, N., Hongsuwan, M., Limmathurotsakul, D., Lubell, Y., Lee, A. S., Harbarth, S.,… Cooper, B. S. (2015). Comparative efficacy of interventions to promote hand hygiene in hospital: Systematic review and network meta-analysis. BMJ, 351. Web.

Stevens, K. R. (2004). ACE Star Model of EBP: Knowledge Transformation. Web.

Tanner, J., Dumville, J., Norman, G., & Fortnam, M. (2016). Surgical hand antisepsis to reduce surgical site infection (Review). Cochrane Database of Systematic Reviews, 1, 1-101. Web.

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