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Investigate Clinical Governance - Practice Issue



1. Project Aim

The aim of the project is to establish understanding of effective Hand Hygiene practices within health care organisations. The aim is to encourage these firms in implementing better health care services with focus on hand hygiene. The project also emphasize of using CPI tool to address the hand hygiene problems with evaluation of overall process to enhance the service quality given by health care o

2. Relevance of Clinical Governance

Clinical governance is a system introduce to improve the quality of healthcare by creating a safe and healthy environment for the patients as well as the other people in heath organisations. It is very essential to promote this system to reduce poor HH practices in healthcare. It can play a vital role in sustainable growth practices of hygiene and promoting a safe work practices within healthcare organisation. Nurses and staffs of healthcare must take active participation in developing the structure in ways that promote safety and quality in their services. The emphasis must be on enhancing the clinical performance and establishing proper healthcare practices. There is an increasing need of integrating hand hygiene into clinical governance. Every health organisation must have hand sanitisers available at every bedside. Along with this, these organisations in Iran must consider hospital acquired infection as a Key Performance Indicator to increase their service quality and care for patients.

3. Evidence

Hand hygiene has been one of the most underrated problems of healthcare in Iran. Many organisations ignore this factor which results in rise in transmission of various respiratory and gastrointestinal  diseases which can be lethal for patient's health. Moreover, nurses and staffs are careless sometimes in wearing safety gloves or washing their hands and even rubbing their hands with their clothes to dry them quickly. Guidelines of various hand hygiene modules provided evidence that pathogens on hands are transmitted if hand hygiene is not followed properly.

Not just for patients, poor hand hygiene also affect nurses. Pathogens from patients can transmit to nurses while taking a pulse, or taking blood pressure readings. Evidences from guidelines also suggests that some microbes are tend to stay active in hands even after applying sanitisers. This can be a cause for concern to solve this overdue problem.

Various surveys have identified that hospital acquired infection (HAI) have also resulted in deaths of many patients. Effective training programs must be implemented in organisations to educate employees in health care to effectively increase the quality care given to patients.

Poor hand hygiene in healthcare organisations effect outside visitors too when they physically come in contact with either the patient or nurses.

Poor hand hygiene majorly affects children and old people. They are prone to infections and proper care and effective hand hygiene practices can prevent such transmissions to a great extent.

4. Barriers to Implementation and Sustaining Change

Health care organisations are working towards implementing effective hand hygiene practices within the organisations. Steps for implementation are being taken with safety and quality of patients given utmost priority. However, there are barriers in implementation of hand hygiene practices and sustainable change which are as follows:

  • Lack of Training: Many health organisations give training to their employees regarding sanity and effective healthcare practices. But still there is a grave need for these set ups to train their employees in hand hygiene practices. Organisations sometimes dont pay enough attention on hand hygiene and as a result, Hospital Acquired Infections (HAI)  increases.
  • Lack of Knowledge: Health care organisations often fail to guide the visitors and patients about hand hygiene practices. There are not enough guidelines, verbal or written, issued to people within the organisation which results in their unawareness about hand hygiene. Such lack of knowledge causes them to transmit harmful pathogens to the patients as well as the staff members.
  • Emergencies: Spontaneous actions are taken at times of emergencies, which sometimes don't give enough time to the nurses and even doctors to take effective and preventive measures in spreading infections. Emergency situations are often the biggest barrier in implementing effective hand hygiene in health care.
  • Carelessness: In every organisations, there are individuals who are reluctant to rules and regulations and are often careless in adopting these practices. They tend to forget taking safety measures thinking that they might not affect much to the health of the people around them. Such nature often causes a barrier in implementing these practices. Moreover, such employees, patient and people within the organisation  expose themselves as well as others to Hospital Acquired Infections (HAI).
  • Reflexes: Often considered a small barrier to ensure sustainable change, reflexes too contribute in spreading infections in organisations. Often people tend to hold each other as a reflex and this too, expose others from infections.
  • Disabilities: Disability is one of the strongest barrier in implementing hand hygiene. Blind patients often sense others by touching and this phenomena is mostly spontaneous. Moreover, mental patients can unknowingly spread diseases to other patients or organisation's employees. This can be a strong barrier which might not be a eradicated.
  • Attention: People in the organisations sometimes take most precautions in preventing transmissions of pathogens but avoid minute details such as they rub hands from a used towel or their clothes, or sometimes nurses forget to wash their hands thoroughly after touching their patients. These limited attention to details are concrete barriers in facilitating better healthcare practices within organisations.
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