Quality and Patient Safety in a Hospital Setting

::written circa. Fall 2013.

According to the Protocall Healthcare Group [PHCG] (2013), approximately 2 million patients acquire hospital-related (nosocomial) infections, each year.  It is also estimated that at least 90,000 of those patients will die from their infection, amounting to approximately $4.5-5.7 billion, according to the World Health Organization [WHO] (2007).  Due to the more direct delivery of care, the Centers for Disease Control and Prevention [CDC], in 2002, justified that the frequency of hand-to-hand pathogen transmission in a hospital setting is far more severe than any other facility.  And as a result, measures have been incessantly taken, in order to improve quality and patient safety.

Over the years, the WHO and CDC have issued guidelines for healthcare workers, specifying appropriate hand-washing techniques.  In addition, according to the governing bodies of the Joint Commission on Accreditation of Healthcare Organizations [JCAHO] (2009), collaborative efforts have been made, with the Healthcare Epidemiology of America and the National Foundation of Infectious Diseases, to enforce and encourage the proper use of these techniques.  The JCAHO strives to monitor and measure hand-washing compliance in the hospital setting, through frequent observatory methods, as well as population surveys. The observation of staff adherence to hand-washing techniques and product usage (soaps, anti-septics, etc.) are highly considered (JCAHO, 2009).  However, the observatory method still holds significant limitations that include labor-intensive focuses on cost management and the training of researching bodies (JCAHO, 2009).

The greatest challenge for administrators in hospitals, ensuring patient safety, stems down to the compliance of approved hand-hygiene techniques from both the healthcare workforce and the patient population (WHO, 2007).  For example, according to Canola, Eck & Salemi (2002), hand-washing compliance at the Kaiser Foundation Hospital, in Fontana, California, has shown to be less than 50% in intensive care units (ICUs).  More importantly, the associated nursing staff was recorded to be significantly more compliant than physicians.  Still, aside from compliance there are also several key potential barriers to implementation: (1) institutional barriers involving economic challenges, (2) the lack of awareness to the burdens of disease and (3) the lack of existing cultural support (WHO, 2007).  Considering, all of which are only a few examples.

With the challenges facing healthcare administrators, finding strategic solutions to increase hand-washing adherence should be a top priority.  As many sources have justified, I believe that the only factor in achieving greater compliance is through promotion and education.  And promoting hand hygiene compliance would require leadership and administrative support (WHO, 2007).  Rather than hospital settings alone, hand-washing techniques should be promoted on a global scale to both macro and microenvironments.  Lectures, as well as literature, on hand-washing protocol should continue to be given on a regular basis, to all healthcare organizations. In addition, collaborative efforts with various media channels would significantly contribute to the cause.





The Protocall Healthcare Group. (2013). Protocall 2013 healthcare in-service: osha/infection control & bloodborne pathogens. Retrieved from http://protocallgroup.com/homecare-staffing/files/2013/03/2013-Inservice-OSHA-Infection-Control-Bloodborne-Pathogens.pdf 

The Centers for Disease Control and Prevention. (2002). Guidelines for hand hygiene in health-care settings. Morbidity and Mortality Weekly Report. 51 (16).

World Health Organization. (2007). Improved hand hygiene to prevent healthcare associated infections: patient safety solutions. World Health Organization & Joint Commission International. 1(9).

Canola, T., Eck, E., Salemi, C. (2002). Hand washing and physicians: how to get them together. The University of Chicago Press. The Society of Healthcare Epidemiology of America. 23(1). 32-35.   

The Joint Commission on Accreditation of Healthcare Organizations. (2009). Measuring hand hygiene adherence: overcoming the challenges. The Joint Commission. Division of Quality Measurement and Research. Oakbrook Terrace, IL. Retrieved from http://www.jointcommission.org/assets/1/18/hh_monograph.pdf 

Author: nursesarereal

My nursing professor once said that keeping a journal, over time, will allow me to see growth. In myself? I’m not sure yet. I’m hoping. I like to believe that nursing school saved my life. Maybe I’ll have some fun doing this. Cheers.

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