Date of Graduation

Summer 8-5-2020

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions



Problem: Surgical site infections (SSIs) account for 20% of all hospital-acquired infections (HAIs). Performance of consistent, accurate hand hygiene practices by healthcare workers is the most effective means of preventing infection, yet the average compliance rates remain low. The preoperative (PREOP) unit carries tremendous responsibility for decreasing each patient's risk for SSI by adequately following the World Health Organization (WHO) guidelines for hand hygiene. The PREOP remains at a low average hand hygiene compliance rate of 69%, with decreased consistency, frequency, and knowledge deficit of hygiene practices. The aim of the quality improvement (QI) hand hygiene campaign is to increase compliance among the PREOP registered nurses (RNs) and patient care technicians (PCTs) to promote infection control and decrease the risk of SSIs.

Context: The PREOP serves multiple specialties with an average of 45 cases a day. The PREOP unit can significantly contribute to the reduction of SSIs with strict adherence to hand hygiene protocols. The RNs and PCTs provide direct patient care measures to several disciplines, including orthopedic, podiatry, head and neck, general surgery, gynecological, and urology surgery patients. A fast-paced work environment, lack of time, and low morale were listed as barriers to hand hygiene adherence. An SSI, on average, costs $30,000 for just one case. Diminishing the knowledge deficit by using WHO guidelines and improving overall cleanliness are the most influential factors for maintaining collaboration to support the efforts of reducing a patient's risk of SSI.

Interventions: The QI project involves the implementation of a multidisciplinary PREOP hand hygiene campaign using a multimodal approach over a single intervention strategy. The interventions include (a) hands-on training and education; (b) campaign slogan, signs, and songs; (c) daily direct observation audits and huddles to discuss barriers; (d) monthly secret observer audits; (e) RN and PCT scripting; (f) increasing access to supplies; (g) PREOP RN process map; and (h) patient prompting tools.

Measures: The outcome measures are the results of the daily direct observation audits by the champions and mangers, and the monthly secret observer audits by the quality department. The hand hygiene knowledge quizzes for staff and the patient participation tool survey are the two process measures. The balancing measure is the monthly tracking of the average PREOP RN patient preparation times using the electronic health documentation system.

Results: The PREOP hand hygiene campaign has reached a 13% increase in RN and PCT hand hygiene compliance within four months. Combined direct observation audits by champions and secret observations by the quality department revealed an 82% average compliance rate. Quiz scores have improved from 76% to 85%. PREOP RN preparation times have remained unhindered at the current time of 34 minutes. The project leader anticipates the patient prompting tools to increase confidence in patients' abilities to contribute to infection prevention.

Conclusions: Performance improvement projects using quality improvement tools, along with WHO standards, in combination with intervention strategies with patient participation, gained beneficial hand hygiene campaign outcomes. Linking theories into actions and improving team motivation and dedication helps push through the barriers. Achieving insights and growing awareness strengthens the efforts towards sustainability. Continuous monitoring and quarterly champion meetings, along with annual competency expectations, will ensure long-term project effectiveness. This hand hygiene campaign can be quickly adapted and spread from unit to unit to uphold a dedication to the pledge of reducing HAIs.