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Measurement of
hand washing in
wound infections
Rachel Duffy
Phomolo Madome
Eva van Swaaij
Measurement: Process and Outcome
Indicators
Measures
There are 3 types of measures used in quality work:
     Structure: Physical equipment and facilities
     Process: How the system works
     Outcome: The final product, results
Structure and process are easier to measure; outcome is more important.
Difference between Process and outcome:
     Process:
         How Healthcare is provided
         How the system works
     Outcome:
         Health status
         Does it make a difference?
Building Measurement and Data
Collection into Medical Practice
  Aim: What are we trying to accomplish?
  Measures: How will we know that a change
  is an improvement?
  Changes: What changes can we make that
  we think will lead to an improvement?
Principles


1. Seek usefulness, not perfection, in the
   measurements- Helps to begin with a small, useful
   data set that fits your work environment, time
   limitations and costs constraints
2. Use a balanced set of process, outcome and cost
   measures
3. Keep measurement simple; think big, but small-
   focus on a limited, manageable, meaningful set of
   starter measures
4. Use qualitative and quantitative data- quantative
   measures are better at capturing the objective
   world; qualitative measures are better at reflecting
   subjective issues
5. Write down the operational definitions of measures-
provides a clear method for scoring or measuring a
variable in a reproductive manner
6. Measure small, representative samples- emphasis on
usefulness, not perfection
7. Build measures into daily work- help the person
capture the right information at the right time
8. Develop a measurement team- success in
measurement requires time and technical expertise.
Team up to lighten the workload, add knowledge and
boost moral
Fishbone-diagram
              People                  Prevention


        Nurses                                         Knowledge
                                   Patients              nurses

              Assistants
                                          Lifestyle
                                                                     Wound
                                                                   infections
     Appointments
                               Time                    Education
                                                        material
 Dressing
procedure
                    Hand washing               Dressings

      Procedures             Materials
What?


 Compliance with hand washing procedures in a
        community health care center
Why hand hygiene
• One of the most important factor in cross infections
• Adherence to hand hygiene recommendations remains
  poor, and improvement efforts frequently lack
  sustainability.
• To assess the performance of individual staff members
  and educate them by intervening in real time
• To assess the impact of a quality improvement
  intervention to increase adherence to hand hygiene
  guidelines
How?
Ask patients to register whether their nurse is washing her hands




  Positive                                    Negative
  Patients are likely to register correctly   A lot of work to inform the patients
                                              about their task
  Cheap                                       Possible bias: Nurse can wash her
                                              hands when the patients is out of
                                              sight
  Raise patients awareness about              Does not register the quality of
  infection control                           washing
  Does not compromise patient privacy
How?
Observer looking if the nurse washes her hands
 Record hand hygiene compliance



Positive                               Negative
Very little to no bias                 Expensive
Count both opportunities for hand      Not very appropriate in an understaffed
hygiene and the action of hand         setting
hygiene.
Can verify when hand hygiene was       Compromising patient privacy
practiced
Hand hygiene quality can be assessed   Staff members can change their
                                       behaviours
How?
Ask staff to register when they forgot to wash their hands




 Positive                              Negative
 Easy                                  Bias e.g. due to time constraints ,
                                       expectancy
 Cheap                                 Time consuming for a busy nurse
 Does not compromise patient privacy
Consequences
• Better adherence to hand washing
• Raise awareness
• Better knowledge of infection control in community centres
  • Specific actions for infection control in a community centre
• Less potential for infection transmission
Desirable Characteristics
•   Relevance
•   Evidence-based
•   Reliability
•   Reproducibility
•   Validity
•   Feasibility
Reasons against implementation
• Financial
  • Observer costs money
• Bias
  • Positive or negative
• Time
  • Nurse already has time constraints with patients
References
• Meister, S (2011). QI tools, root cause analysis. Iowa
  department of Public Health. Retrieved from:
  http://www.idph.state.ia.us/mphi/common/pdf/root_cause_a
  nalysis.pdf
• Varkley, P (2010). Medical Quality and Management. Theory
  and practice. American College of Medical Quality. Jones and
  Bartlett Publishers. Sudbury, Massachusetts. Pg. 37.
• Nelson, E., Splaine, M., Batalden, P., & Plume, S. (1998).
  Building measurement & Data Collection into Medical
  Practice. Annals of Internal Medicine, 128(6). 460-466.
  Retrieved from
  http://edocs.library.curtin.edu.au/eres_display.cgi?url=DC602
  62746.pdf&copyright=1

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Measurement edited

  • 1. Measurement of hand washing in wound infections Rachel Duffy Phomolo Madome Eva van Swaaij
  • 2. Measurement: Process and Outcome Indicators Measures There are 3 types of measures used in quality work: Structure: Physical equipment and facilities Process: How the system works Outcome: The final product, results Structure and process are easier to measure; outcome is more important. Difference between Process and outcome: Process: How Healthcare is provided How the system works Outcome: Health status Does it make a difference?
  • 3. Building Measurement and Data Collection into Medical Practice Aim: What are we trying to accomplish? Measures: How will we know that a change is an improvement? Changes: What changes can we make that we think will lead to an improvement?
  • 4. Principles 1. Seek usefulness, not perfection, in the measurements- Helps to begin with a small, useful data set that fits your work environment, time limitations and costs constraints 2. Use a balanced set of process, outcome and cost measures 3. Keep measurement simple; think big, but small- focus on a limited, manageable, meaningful set of starter measures 4. Use qualitative and quantitative data- quantative measures are better at capturing the objective world; qualitative measures are better at reflecting subjective issues
  • 5. 5. Write down the operational definitions of measures- provides a clear method for scoring or measuring a variable in a reproductive manner 6. Measure small, representative samples- emphasis on usefulness, not perfection 7. Build measures into daily work- help the person capture the right information at the right time 8. Develop a measurement team- success in measurement requires time and technical expertise. Team up to lighten the workload, add knowledge and boost moral
  • 6. Fishbone-diagram People Prevention Nurses Knowledge Patients nurses Assistants Lifestyle Wound infections Appointments Time Education material Dressing procedure Hand washing Dressings Procedures Materials
  • 7. What? Compliance with hand washing procedures in a community health care center
  • 8. Why hand hygiene • One of the most important factor in cross infections • Adherence to hand hygiene recommendations remains poor, and improvement efforts frequently lack sustainability. • To assess the performance of individual staff members and educate them by intervening in real time • To assess the impact of a quality improvement intervention to increase adherence to hand hygiene guidelines
  • 9. How? Ask patients to register whether their nurse is washing her hands Positive Negative Patients are likely to register correctly A lot of work to inform the patients about their task Cheap Possible bias: Nurse can wash her hands when the patients is out of sight Raise patients awareness about Does not register the quality of infection control washing Does not compromise patient privacy
  • 10. How? Observer looking if the nurse washes her hands Record hand hygiene compliance Positive Negative Very little to no bias Expensive Count both opportunities for hand Not very appropriate in an understaffed hygiene and the action of hand setting hygiene. Can verify when hand hygiene was Compromising patient privacy practiced Hand hygiene quality can be assessed Staff members can change their behaviours
  • 11. How? Ask staff to register when they forgot to wash their hands Positive Negative Easy Bias e.g. due to time constraints , expectancy Cheap Time consuming for a busy nurse Does not compromise patient privacy
  • 12. Consequences • Better adherence to hand washing • Raise awareness • Better knowledge of infection control in community centres • Specific actions for infection control in a community centre • Less potential for infection transmission
  • 13. Desirable Characteristics • Relevance • Evidence-based • Reliability • Reproducibility • Validity • Feasibility
  • 14. Reasons against implementation • Financial • Observer costs money • Bias • Positive or negative • Time • Nurse already has time constraints with patients
  • 15. References • Meister, S (2011). QI tools, root cause analysis. Iowa department of Public Health. Retrieved from: http://www.idph.state.ia.us/mphi/common/pdf/root_cause_a nalysis.pdf • Varkley, P (2010). Medical Quality and Management. Theory and practice. American College of Medical Quality. Jones and Bartlett Publishers. Sudbury, Massachusetts. Pg. 37. • Nelson, E., Splaine, M., Batalden, P., & Plume, S. (1998). Building measurement & Data Collection into Medical Practice. Annals of Internal Medicine, 128(6). 460-466. Retrieved from http://edocs.library.curtin.edu.au/eres_display.cgi?url=DC602 62746.pdf&copyright=1

Notas del editor

  1. http://patientsafetyed.duhs.duke.edu/module_a/measurement/measurement.html
  2. -An Article published by the American College of Physicians-Outlines 8 principles for successfully measuring change in Quality Improvement in Medical practiceNelson, E., Splaine, M., Batalden, P., & Plume, S. (1998). Building measurement & Data Collection into Medical Practice. Annals of Internal Medicine, 128(6). 460-466. Retrieved from http://edocs.library.curtin.edu.au/eres_display.cgi?url=DC60262746.pdf&copyright=1
  3. Nelson, E., Splaine, M., Batalden, P., & Plume, S. (1998). Building measurement & Data Collection into Medical Practice. Annals of Internal Medicine, 128(6). 460-466. Retrieved from http://edocs.library.curtin.edu.au/eres_display.cgi?url=DC60262746.pdf&copyright=1