Public Health Program Promotion for Healthcare Associated Infections

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Public Health Program Promotion for Healthcare Associated Infections

Written Assignment #7

Tanya Staton

04/18/2014

MPH 585

Lea Pounds

Abstract

A healthcare acquired infection (HAI) is one that a patient occurs while receiving treatment in a healthcare facility. It can be a hospital, nursing home, surgery center, dialysis clinic or free clinic. This paper will discuss a needs assessment on how to reduce HAIs through the use of innovative technology for hand hygiene compliance, tailored education courses on how to reduce HAIs for units and a federal mandate for HAI reporting. Stakeholders, committee members and investors will be identified. A clear mission and vision statement will be listed, along with objectives and goals of the program. The program will be planned using the MATCH (Multilevel Approach to Community Health) model. The health promotion program will also provide a marketing strategy and operating budget for a healthcare facility. Finally, a formative evaluation of the program will be discussed.

Introduction

A healthcare acquired infection (HAI) is one that a patient occurs while receiving treatment in a healthcare facility. It can be a hospital, nursing home, surgery center, dialysis clinic or free clinic. It is estimated that on average one in twenty hospitalized patients will contract and HAI (silverbook, n.d). Roughly 1.7 million Americans annually will acquire an HAI, and 99,000 patients will die from complications associated with them (scdhec, 2013). HAIs are the cause for unnecessary morbidity and mortality ever year and can cost on average anywhere from $28.4 to $45 billion (silverbook, n.d). These infections are a major public health concern not only because they cost billions of dollars to treat, but because they can be contracted from routine care, surgical procedures, catheters or ventilators and from overusing antibiotics. With the increasing rise of drug-resistant bacteria finding antibiotics to treat bacterial infections are becoming harder to find. At least one antimicrobial drug is resistant to 70 percent of HAIs (silverbook, n.d).

There is hope for reducing HAIs. There are simple prevention measures that healthcare workers and facilities can take to ensure the safety of their patients the reduce HAIs. Focus needs to be emphasized on proper hand hygiene practices. Better sterilization techniques for medical devices and importance of proper fit for respirators and ventilators. Training courses need to be established for healthcare staff that are tailored to their units/departments.Finally, there needs to be a more proactive approach to data reporting on HAIs. Currently, the Center for Disease Control and Prevention (CDC) collects data on HAIs through the National Healthcare Safety Network (NHSN), but not all states are required by law to report the data. Although, many hospitals still submit data to the CDC, there still needs to be a federal mandate that HAIs must be reported in every hospital facility in the United States.Hospitals are established to save lives, but they also want to make a profit while doing so. If their census starts to decline because patients do not want to have procedures done because of high infection rates they will find a way to implement better programs to decrease HAIs.

Needs Assessment

HAIs are infections that affect the health status of the patient by prolonging their hospital stay, making them sicker and can even lead to death. Patients not only suffer because of HAIs, but so does the community because of the medical costs that are associated with them. Our need for this health promotion program is to find an innovative solution to reduce HAIs that will keep infection rates on the decline and patient safety high. It will differ from other organizations because we will attempt to take a more proactive approach and focus not just on education but on reporting.Data monitoring will include a quantitative approach that specifically targets hand hygiene compliance. All HAIswill then be reported to the CDC’s NHSN.

Mission/Value Statement

Mission statements are sometimes referred to as a program aim (McKenezie et al, 2013). They provide a brief statement on the purpose that the program is trying to accomplish. The mission statement for this health promotion program is to reduce healthcare associated infections and promote patient safety through the use of innovate resources for hand hygiene practices, education courses that are tailored to specific units on how to reduce HAIs and data reporting that is mandated for all healthcare facilities in the United States. The vision statement for a promotion program is a brief description of where the program will be in the future(McKenezie et al, 2013). The vision statement for this program is simple: increasing hand hygiene, education and reporting leads to decreasing disease, deaths and costs.

Strategic Plan

The purpose of the health promotion program is to save lives and money, increase HAI reporting and increase hand hygiene compliance.We want to recognize that HAIs are a major public health concern and prevention measures need to be in place to reduce them. The programs focus will be on healthcare facilities. This health promotion program will be similar to other healthcare associated infection prevention programs that are already implemented because it will be focusing on hand hygiene and education courses on reducing HAIs. The health promotion program will be unique because it will be utilizing new innovative technology to help monitor hand hygiene compliance andwill attempt to take a more proactive approach on HAI reporting to the NHSN.

There will need to be some political problems that need to be addressed in the reporting of HAIs. Not all states are required by law to report HAIs to the NHSN. Currently only 33 states use NHSN to meet their reporting requirements (cdc, 2013). There needs to be a federal mandate for all states to report HAIs to the NHSN. This might prove challenging since most state constitutions provide for the protection of public health matters not federal(Schneider, 2011).A social problem that needs to be addressed involving HAIs is why hand hygiene compliance continues to be so low. We recognize that when under direct observation hand hygiene compliance is almost 100 percent. We anticipate the fact that people often change their behavior because they are being viewed, not because of the nature of the change itself. This is known as the Hawthorne effect (Cherry, n.d). To prevent the Hawthorne Effect from occurring we are developing a new innovative approach to measure hand hygiene compliance. The DebMed system will replace direct observation and utilize an electronic wireless communication system that sends data to a computer system to monitor hand hygiene compliance (DebMed, 2014).

SWOT

SWOT analysis involves the strengths, weakness, opportunities and threats of a program (McKenzie et al, 2013). A major strength the program will offer is a quantitative way to measure hand hygiene compliance with the use of the DebMed system. By utilizing the system direct observation will no longer have to occur, thus eliminating the Hawthorne Effect. A major weakness of the program is that it will be costly to implement. Hand hygiene monitoring systems are expensive, and the product must constantly be filled and stocked with soap and alcohol for the product to be utilized effectively. Educational materials for healthcare staff can also be a hefty financial cost. However, if successful the health promotion program will create an opportunity to not only reduce mobility and mortality rates every year from HAIs, but also will decrease the medical costs that are associated with them. Finally, a potential threat of the program is some healthcare facilities may be hesitant to comply with reporting requirements, especially if they have a high HAI rate.

Strengths, Weaknesses, Opportunities and Threats (SWOT Analysis)
What are the strengths will contribute to planning and program success? / What weaknesses exist for your planning and program success?
~ having a program that is measurable using the DebMed GMS hand hygiene system.
~ Utilizing the NHSN provided by the CDC for data reporting. / ~ Installing DebMed and continuous data monitoring will be costly.
What are the opportunities your planning and program will create? / What are the threats to your planning and program success?
~ decrease HAIs saves billions of dollars annually.
~decrease morbidity and mortality annually from HAIs.
~ Possibly tax/fine healthcare facilities that are not compliant with the mandate for HAI reporting. / ~ Some hospitals might be hesitant to comply with the mandate to report HAIs especially if they have a high infection rate or they might under report their findings.

Identifying Stakeholders & Their Roles

When developing a health promotion program it is important to get the right stakeholders, committee members and investors involved in the planning and implementation of the program. Stakeholders are significant to health promotion planning because they are the ones that are showing a vested interest in the program that is trying to be implemented (McKenzie et al, 2013). There are numerous reasons why it is important to gain the support of stakeholders, committee members and investors when trying to implement a health promotion program. For starters, they can not only improve health promotion programs credibility, but they can also help increase chances that the program assessment will be useful (MySPH, 2012). Stakeholders also have the ability to help avoid conflicts of interests by providing a different point of view. A variety of committee members can also enhance cultural competency, which is important when trying to reduce health disparities. The main reason to gain support of stakeholders and investors is because they provide the funding for programs to be implemented. It does not matter if a health promotion program is on a small scale or is very large, all programs cost money, and without funding and support health promotion programs could not be achieved.

The health promotion program on reducing HAIs will involve a variety of stakeholders, committee members and private investors. A private investor that will help with planning and implementation will be DebMed. Their main focus will be in helping increase hand hygiene compliance with the use of innovative technology that sends electronic data back to a computer monitoring system every time healthcare staff uses a soap or alcohol dispenser. There will also be various hospital administrators from major departments that serve on the committee to reduce HAIs. Representatives from departments will include: Infection prevention, Laboratory, Critical Care Units, Emergency Room and the Vice President of the healthcare facility. They will be there to help guide the needs of not only the staff but the patients. The CDC will also be involved in reducing HAIs, because data will be reported to the NHSN. Together the stakeholders, committee members and investors will work together to develop a plan to help increase hand hygiene compliance with the use innovative technology, increase education among the healthcare staff about HAIs and focus on reporting requirements for all HAIs.

Stakeholder / Level of Engagement Needed / Action Needed and By When
Hospital Administrators: Infection prevention, Laboratory, Critical Care Units, Emergency Room and the Vice President of the healthcare facility / High / They are involved in the program operations.
CDC NHSN / Low / Data reports to them and displayed for public viewing.
DebMed GMS / High / This is the company that will provide the hand hygiene monitoring equipment.

MATCH Logic Model

The use of logic models help serve as frames to build your health promotion program. The MATCH (Multilevel Approach to Community Health) model with be utilized to help reduce HAIs. MATCH can be applied to interventions at multiple levels and it is a great model to utilize when risk factors are already known (Havlena & Ray, n.d). Most healthcare workers are fully aware of how HAIs are spread and the complications that can be associated with them. Since HAI prevention programs are not new, the MATCH logic model is a great model to utilize for reducing HAIs. The model consists of five phases: goals selection, intervention planning, program development, implementation preparation and evaluation (Havlena & Ray, n.d). Phase one of MATCH is goal selection. The main goal of the health promotion program is to reduce HAIs by 15 percent in the first year the program is implemented. This reduction is to be accomplished through phase two which involves intervention planning. The intervention of the program will involve using new technology that measures hand hygiene compliance, a more tailored education program on how to reduce HAIs and a federal mandate on HAI reporting for all states to the NHSN. Phase three of MATCH is program development (Havlena & Ray, n.d). During this phase the program will be fully outlined and all stakeholders will be on board and ready for the program to be implemented. In phase four the reducing HAIs program will be implemented, but first there will be a pilot program with the DebMed GMS hand hygiene data system with a few critical care units in the hospital. Feedback will then be asked on what the healthcare workers liked and did not about the new system. Installing the hand hygiene data system will be expensive so pilot testing and preliminary review is crucial to avoid lost revenue if the system is not effective. If compliance rates are increasing with the pilot program the DebMed system will then be phased into the rest of the units. According to Mckenzie (2013), phasing in rather than implementing in its entirety allows for more control over the program (pg. 355). The final phase is evaluation (Havlena & Ray, n.d). In this phase the health promotion program will be evaluated to see how successful the program has been over all. Below is a diagram outlining the MATCH logic model and organizations that influence the HAI health promotion program

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Select Intervention ApproachesIdentify Targets of InterventionSelect Intervention Objectives

Conduct Process EvaluationConduct Impact EvaluationConduct Outcome Evaluation

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Inputs/Outputs/Outcomes

The use of logic models also helps health departments and organizations define their short term, intermediate and long term objectives of their health promotion program. Inputs and outputs are utilized to develop outcomes for their programs (McKenezie et al, 2013). The inputs are the various resources that go into a health promotion program. Some of the resources involved in reducing HAIs will involve the healthcare facilities, CDC, DebMed Company, private stakeholders and healthcare staff. Output involves activities and participation (McKenezie et al, 2013). The activities involved for the HAI reduction plan will include an integrated surveillance system called the DebMed GMS. It will be installed to monitor hand hygiene compliance. Real time data will be sent to a computer data system so direct observation will no longer have to be utilized. Other activities will also include having tailored education classes that are specialized to units/departments to allow for maximum information to be retained and to prevent boredom. Lobbying will also occur for a federal mandate to report HAIs to the NHSN and have data posted so the public can view the information in the healthcare facilities. Output participation only happens if certain criteria is met. For example, if we receive funding for the DebMed soap & alcohol dispensers then we will start a pilot program in certain units to test the product to measure compliance before implementing on all units. If we can get federal legislation approved then all healthcare facilities in every state will report HAI data to the CDC for public viewing.

Outcomes are the short term, intermediate and long term goals the health promotion program is trying to accomplish. The short term goals of the program include increase HAI involvement in the program by including an extensive range of stakeholders. A quick goal to accomplish will be to install the new DebMed GMS soap and alcohol dispensers to measure compliance. Informing hospital administrators on why HAI reporting is necessary and should be made available to the public is also a short term goal that will be addressed. Intermediate goals include that the DebMed GMS system is working as intended, and hand hygiene compliance rates have increased dramatically. Tailored education courses are effective and 80 percent of staff can tell their coworkers how to reduce HAIs. HAIs are decreased by 15 percent in the first year that the new health promotion program is implemented, and it is now mandatory that all states report HAIs to the NHSN. A long term goal of the HAI program is that the national average of hand hygiene compliance in healthcare facilities is now 70 percent and 85 percent on critical care units. Above all the main objective is HAIs continue to decline and morbidity and mortality rates are rarely a problem in healthcare facilities. Below is a detailed chart listing the input, output and outcomes for the health promotion plan on reducing HAIs,

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Program Focus: _____MATCH______Logic Model

Implementation Planning:

Inputs / / Outputs / /

1. Outcomes -- Impact

Activities / Participation /

1. Short

/

1. Medium

/

1. Long

The Various resources that go into a program:
~ Private Stakeholders
~ CDC
~ Department of Health
~ Hospital administrators
~ Creator of DebMed GMS hand hygiene system
~ Outside sources from local colleges to provide different view points
~ Patient input
~ Healthcare staff / HAI Health Plan:
~ Integrated Surveillance System: DebMed GMS system installed to monitor hand hygiene compliance. Real time data sent to computer data system so direct observation will no longer have to be utilized.
~ Educate staff on glove use and WHO 5 moments of hand hygiene.
~ Educate healthcare staff on correct antibiotic use.
~ Report all HAI to NHSN and have data posted so the public can view. / ~ If we receive funding for the DebMed soap & alcohol dispensers then we will start a pilot program in certain units to test the product to measure compliance before implementing on all units.
~ If we can get federal legislation approved then all healthcare facilities in every state will report HAI data to the CDC for public viewing.
~ If we receive funding for educational courses for healthcare staff then a trained microbiologist can lecture on antibiotic resistance. Continue education credits can be offered to staff if they pass an exam after completion of the class. / Increase HAI involvement by including an extensive range of stakeholders.
Increase hand hygiene compliance by installing a new DebMed GMS monitoring soap and alcohol dispenser to measure compliance.
Increase awareness for healthcare staff on antibiotic resistant bacteria.
Inform Hospital administrators on why HAI reporting is necessary and should be made available to the public. / DebMed GMS system is working as intended, and hand hygiene compliance rates have increased dramatically.
80 percent of healthcare staff can tell their coworkers and patients about the importance of taking antibiotics properly.
HAIs are decreased by 15 percent in the first year that the new health promotion program is implemented.
It is now mandatory that all states report HAIs to the NHSN. / HAIs continue to decline and morbidity and mortality rates are rarely a problem in healthcare facilities.
ll hospitals are compliant with reporting HAIs and there is not an issue with having to penalize because they neglected to report or underreported.
Infections associated with MRSA decline and there are less cases of Vancomycin resistant bacteria.
The national average of hand hygiene compliance in healthcare facilities is now 70 percent and 85 percent on critical care units.

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