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Hand hygiene in the nursery during diaper changing

Authors

  • Koh Ni Phang RN BSc(Nurs)(Hons),

    Corresponding author
    1. Nursing Department, National University Hospital
    2. National University Hospital Center for Evidence-Based Nursing: A Collaborating Center of the Joanna Briggs Institute
    3. National University Health System, Singapore
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  • Nur Liyanna Maznin RN BSc(Nurs)(Hons),

    1. Nursing Department, National University Hospital
    2. National University Hospital Center for Evidence-Based Nursing: A Collaborating Center of the Joanna Briggs Institute
    3. National University Health System, Singapore
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  • Wai Kin Yip RN BHlthSc(Nurs)

    1. Evidence-Based Nursing Unit, National University Hospital
    2. National University Hospital Center for Evidence-Based Nursing: A Collaborating Center of the Joanna Briggs Institute
    3. National University Health System, Singapore
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Miss Koh Ni Phang, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074. Email: knwphang@gmail.com

Abstract

Aim  This project aimed to improve hand hygiene practice during diaper changing among nurses working in the nursery.

Methods  This project was conducted in one of the nurseries in a 935-bed acute care hospital with a sample of 15 nurses. A pre- and post-intervention audit was conducted utilising the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice module. A revised written workflow, which specified the occasions and process for hand hygiene during diaper changing, was introduced. Modifications to the baby bassinets and nursery were made after barriers to good hand hygiene were identified. The project was carried out over 4 months, from March to June 2011.

Results  The post-intervention audit results show an improvement in performing hand washing after changing diapers (20%) and performing the correct steps of hand rubbing (25%). However, the compliance rates decreased for the other criteria that measured whether hand rubbing or hand washing was performed prior to contacting the infant and after wrapping the infant, and whether hand washing was performed correctly. The improvement in compliance with hand washing – the main focus of the new workflow – after changing diapers was especially significant.

Conclusion  The results indicated that having a workflow on the occasions and process for hand hygiene during diaper changing was useful in standardising practice. Pre- and post-implementation audits were effective methods for evaluating the effect of translating evidence into practice. However, this project had limited success in improving compliance with hand hygiene. This suggested that more effort is needed to reinforce the importance of hand hygiene and compliance to the proposed workflow. In addition, this project showed that for change to take place successfully, environmental modifications, increased awareness and adequate communication to every staff member are essential.

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