you will conclude your evidence-based healthcare improvement project in final

you will conclude your evidence-based healthcare improvement project in final written submission. The final project paper should address all feedback, suggested revisions, additional research, and/or modifications, as recommended by the instructor and preceptor for all previously submitted sections. (see a copy of the included final project plan below) The final project paper should consist of the following sections, modeled after the SQUIRE framework for reporting new knowledge about how to improve healthcare. Refer to the SQUIRE website and the assignment grading rubric for more guidance. Title Indicate that the manuscript concerns an initiative to improve healthcare (broadly defined to include the quality, safety, effectiveness, patient-centeredness, timeliness, cost, efficiency, and equity of healthcare) Abstract Provide adequate information to aid in searching and indexing (such as keywords) Summarize all key information from various sections of the text using the abstract format of the intended publication Introduction Provide a paragraph introduction to the paper Problem Description Describe the nature and significance of the problem. Include any site-specific data that supports the significance of the problem Summary of Available Knowledge Summarize previous studies and best practices related to the problem Use sources published within the last five years or seminal work or that may include the following: Peer-reviewed, scholarly articles from nursing-specific journals Publications from nursing-specific professional organizations Publications from health-related government (for example: Healthy People, AHRQ), civic, or community organizations Explain the search strategies you used (brief paragraph on method, key word searches, databases, date range, and description of sources/organizations). Summarize key findings from the literature search. Explain the significance of these key findings. Rationale Informal or formal frameworks, models, concepts, and/or theories used to explain the problem Any reasons or assumptions that were used to develop the intervention(s) Reasons why the intervention(s) is expected to work Specific Aims Description of the intervention Purpose of the project Specific Project Timeline Detailed outline of project timeline Context Describe the setting where the project occurred. What is the physical makeup of the setting? Who are the stakeholders-not just the target population? What else (social, political, sociocultural, etc., ) is going on in the environment that will impact the project? Anticipate barriers. Note: These factors, in addition to impacting the project affect the limitations as well as the generalizability of the intervention to other settings and populations which will be addressed in the conclusion and recommendations of the final project paper. Ethical Considerations Consider the potential for harm, burden, and cost to the stakeholders including invasion of privacy, staff distress, etc. Consider what if any institutional approval/review is needed. Verify that the project does not require IRB review. Intervention(s) What actually happened-what were the steps of the intervention (first, second, etc.) and what was the actual timeline? What resources were used? (before and during)? (Resources include training, instrument, staffing, materials, etc.) Who was involved or impacted before, during, and after each step? Evaluation (Process and outcome measures) Discuss measures chosen for studying processes and outcomes of the intervention(s), including: Rationale for choosing them, The operational definitions, The validity and reliability How were the evaluation metric collected? (Survey, observation, self-report, etc.) Who collected the evaluation metric? How was the data analyzed? Discuss qualitative and quantitative methods used to draw inferences from the data. Results Details of the process measures and outcome measures. How data were collected? How were data analyzed? Details about any missing data Analyze and discuss data. Present the data (tables, graphs, etc.) in an appendix. Explain any unanticipated internal or external factors that may have impacted the data (observed associations between outcomes, interventions, and relevant contextual elements). Unintended consequences such as unexpected benefits, problems, failures, or costs associated with the intervention(s). Key Findings Key findings, including relevance to the rationale and specific aims Particular strengths of the project Interpretation/Synthesis Nature of the association between the intervention(s) and the outcomes Comparison of results with findings from other evidence in the literature Limitations Limits to the generalizability of the work Factors that might have limited internal validity such as confounding, bias, or imprecision in the design, methods, measurement, or analysis (such as sample size, validity of the instrument, experience of researcher, time, type of population, etc.) Summary & Recommendations Sustainability Usefulness of the work – Potential for spread to other contexts, applicability on other persons or systems Recommendations for practice and for further study Project Reflection Evaluate and reflect on the entire project and process. Use the prompts as a guide. What were some of the key takeaways? What did you learn? What was difficult? Discuss how the knowledge you gained from this assignment impacts your practice. References Pages Update references as appropriate. PREVIOUSLY SUBMITTED FINAL PAPER: PLEASE ADD THE ABOVE TO THIS PAPER Final Project Plan This project’s main aim is to reduce hospital-acquired infections (HAIs) in the Cardiovascular Recovery Unit (CVRU) by improving hand hygiene practices among healthcare staff. This will be achieved through a comprehensive hand hygiene intervention program designed to increase compliance with hand hygiene protocols. The interventions focus on the systematic implementation of evidence-based hand hygiene practices. Implementing awareness and knowledge of the importance of hand hygiene among healthcare staff and patients’ families will result in improved hand hygiene behaviors. Summary of Available Knowledge Hand hygiene has been shown to be one of the most effective ways of reducing hospital acquired infections in the hospital setting. This prevents a significant percentage of avoidable infections in healthcare. Implementation of hand hygiene policies can generate economic savings averaging 16 times the cost of their implementation (WHO, 2023). To synthesize recent literature on reducing hospital-acquired infections (HAIs) in the Cardiovascular Recovery Unit (CVRU), particularly focusing on hand hygiene, a variety of search strategies were employed. Search Strategies To gather the most up-to-date and relevant information, the following searches were conducted in nursing-specific databases such as CINAHL and PubMed, as well as consulting publications from professional organizations like the Association for Professionals in Infection Control and Epidemiology (APIC) and government agencies like the Agency for Healthcare Research and Quality (AHRQ). The search terms included “hospital-acquired infections”, “CVRU”, “hand hygiene”, and related keywords. The date range was limited to the past 5 years to ensure the information is current. Synthesis of Literature A substantial body of research has underscored the critical role of hand hygiene in mitigating HAIs, particularly in high-risk areas such as the CVRU. Systematic reviews have consistently shown that multimodal hand hygiene interventions, which combine education, access to supplies, monitoring, and feedback, are more effective in improving hand hygiene compliance compared to single-component interventions (Smith et al., 2020; Erasmus et al., 2020). Comprehensive hand hygiene programs incorporating regular training, compliance monitoring, and the use of alcohol-based hand rubs significantly reduced HAIs in intensive care settings (Pittett et al., 2019). Various interventions have been explored to improve hand hygiene practices in healthcare settings. The review of literature emphasizes the need for accessible hand hygiene facilities and sustained educational efforts to ensure compliance. The Association for Professionals in Infection Control and Epidemiology (APIC) has developed a toolkit for hand hygiene to utilize as a resource for healthcare providers to aid in improving patient and healthcare worker hand hygiene in different settings. Continued progress in healthcare epidemiology and implementation of science research has led to improvements in our understanding of effective HAI prevention strategies. Despite these advancements, HAIs continue to affect about 1 out of every 25 hospitalized patients, leading to substantial morbidity, mortality, and excess healthcare expenditures (Apic, 2019; Butler, 2023; Haque, 2020). Rationale For this project intervention, the Health Belief Model (HBM) was selected as the primary theoretical framework. The Health Belief Model (HBM) posits that messages will achieve optimal behavior change if they successfully target perceived barriers, benefits, self-efficacy, and threat (Nortje, 2024). In the context of hand hygiene promotion in CVRU, the HBM can guide the development of interventions by addressing staff perceptions of the risks of HAIs, the severity of consequences, the benefits of proper hand hygiene, and barriers such as time constraints or lack of resources. The HBM suggests that health behaviors are influenced by individuals’ perceptions of the severity of a health problem, their susceptibility to it, the benefits of acting, and the barriers to action. By targeting these factors through the project intervention, the goal would be to increase healthcare providers’ intention and ultimately, their hand hygiene compliance in the CVRU. Compassionate Care Model Galen’s Compassionate Care Model aligns closely with the project intervention by emphasizing key concepts that foster a culture of patient safety and quality care. The care model was designed to improve several areas of care in nursing (Galen College, 2023). Healthcare workers in the CVRU recognize the high risk and severe consequences of HAIs, which enhances their perceived susceptibility and severity. Belief in hand hygiene’s effectiveness in preventing infections motivates adherence to hand hygiene protocols. The project aims to create a culture of hand hygiene compliance, which promotes an open-minded, non-judgmental approach to encouraging all healthcare providers to participate. Encouraging ownership of hand hygiene actions reinforces staff responsibility for infection prevention and control. Striving for excellence in hand hygiene involves utilizing knowledge and skills to provide high-quality, compassionate care, aligning with the project’s goals of reducing HAIs. Specific Aims The steps involved to reduce hospital-acquired infections (HAIs) in the Cardiovascular Recovery Unit (CVRU) have thus far included regular training sessions for all healthcare staff on proper hand hygiene techniques and the importance of hand hygiene in preventing HAIs, implementation of a system to monitor hand hygiene compliance and provide feedback to staff, establish a robust monitoring system to regularly observe and document hand hygiene compliance using direct observation and electronic hand hygiene monitoring systems and provide timely feedback to healthcare staff on their hand hygiene performance, highlighting areas of improvement and celebrating successes. Identifying key areas and moments where hand hygiene practices are suboptimal and conducting a baseline assessment of current hand hygiene practices and compliance rates among healthcare staff remains of high importance since the implementation phase has begun. This project’s main purpose is to improve patient safety and clinical outcomes by reducing hospital-acquired infections in the CVRU. This has been progressively achieved by enhancing hand hygiene practices among healthcare staff, thereby decreasing the transmission of pathogens. The project’s success has been evaluated using specific metrics, such as infection rates, hand hygiene compliance rates, and staff and patient satisfaction. Specific Project Timeline Phase 1 will be preparation in weeks 1-2. Preparation included conducting a baseline assessment of HAI rates and hand hygiene compliance, developing educational materials and training programs and setting up monitoring and feedback systems. Phase 2 will be implemented in weeks 3-12. During the implementation phase in weeks 3-6 training sessions for all CVRU staff began, implementing hand hygiene monitoring and feedback systems were initiated and ensuring the availability of hand hygiene resources and deploying behavioral nudges remains initiated and in progress. Phase 3 will be the evaluation process. During this phase a post-intervention assessment of HAI rates and hand hygiene compliance will be conducted and data on staff knowledge and attitudes towards hand hygiene will be obtained. The final phase 4, occurring in the final weeks of Practicum II, will be the analysis and reporting timeframe. This involves analyzing the data and comparing pre- and post-intervention outcomes to help prepare final report and recommendations. Context The project was conducted in the Cardiovascular Recovery Unit (CVRU) of The Christ Hospital. The CVRU is a specialized unit designed for the postoperative care of cardiovascular surgery patients. It comprises 20 beds, equipped with advanced monitoring and life support systems. The stakeholders on this unit include nurses, physicians, surgical staff, and support personnel. The patients on this unit are postoperative cardiovascular surgery patients requiring intensive care. Relatives and caregivers of the patients who visit the CVRU have been included. The management and infection control team on this unit are responsible for overseeing patient safety initiatives. Several contextual factors have at times impacted the project, including the hospital’s existing infection control policies, staff workload and schedules, and the sociocultural attitudes towards hand hygiene practices. Potential barriers include staff resistance to change, variability in adherence to protocols, and resource limitations. Ethical Considerations This project involves minimal risk to participants as it primarily focuses on improving hand hygiene practices. However, potential ethical considerations include psychological discomfort if staff feel overly scrutinized or judged based on compliance monitoring. The additional training and compliance monitoring may add to the workload of healthcare staff, potentially leading to staff distress. The project will incur costs related to the procurement of hand hygiene resources and monitoring systems. Institutional approval will be sought from the hospital’s administration and infection control committee. Interventions Conducting a baseline assessment did occur in week 1. The resources included observation checklists and compliance monitoring tools. This assessment involved the infection control team and the project team. A study by (Smith et al., 2020), highlighted the importance of regular hand washing, use of alcohol-based hand sanitizers, and education on hand hygiene practices. In Weeks 2-4, training began to be developed and delivered. The resources involved included training modules, multimedia resources and printed materials. Training coordinators and healthcare staff were beneficial. After 2-4 weeks, the implementation of hand hygiene promotion remains ongoing. (Johnson et al., 2019) examined the effect of a care bundle. The bundle is a set of practices shown to improve patient outcomes by reducing HAI’s in the acute care setting. The resources involved during these weeks will include posters, digital screens, educational brochures and information on electronic monitoring systems and their use. The marketing team, healthcare staff and families have become more involved. Weeks 7 and through the practicum break, compliance will be monitored, and feedback will be accepted. The resources involved will include observation checklists and data monitoring sheets on the electronic systems. The infection control team will be able to report this data and give feedback on the data collected. Lastly, incentives and recognition will be added. Incentive program materials and award certificates will be applied. The project team and hospital administration will apply for this. Evaluation A systematic review by the (CDC ,2021) emphasized the critical role of environmental cleaning and disinfection in preventing the spread of pathogens responsible for HAIs. The hand hygiene compliance rate will be assessed and the adherence to hand hygiene protocols obtained. The operational definition is the percentage of observed hand hygiene opportunities where proper hand hygiene was performed. The validity and reliability of the measure is by direct observation by trained personnel and electronic monitoring weekly which ensures accurate and consistent data collection. The incidence of HAI’s in the CVRU will be measured to evaluate the impact of improved hand hygiene on infection rates. The operational definition is the number of HAIs per 60 patient days. Standardized infection surveillance methods ensure accurate tracking and review of patient medical records and infection control databases will be collected every 3 weeks by the infection control team. Staff and patient satisfaction rates will be assessed to evaluate the perceived effectiveness and acceptance of the intervention. Satisfaction scores from surveys administered to staff and patients with validated survey instruments ensure reliable feedback. This will be completed at the end of the timeframe for the final project. Appendix Educational Materials used included hand hygiene training slides, instructional videos, educational brochures. Surveys and Tools included compliance observation checklists, staff and patient satisfaction questionnaires. This detailed methods plan follows the SQUIRE framework to ensure a systematic and comprehensive approach to reducing hospital-acquired infections through improved hand hygiene practices in the CVRU. The plan outlines specific aims, intervention steps, evaluation metrics, and ethical considerations, providing a clear roadmap for the successful implementation and assessment of the project. Figure 1 Wash your hands fact sheet Note. Wash your hands fact sheet by The CDC (Center for Disease Control and Prevention), located in the hallways of CVRU at The Christ Hospital. References CDC. (2021). Guidelines for environmental cleaning in healthcare facilities. Centers for Disease Control and Prevention Handwashing – Clean Hands Save Lives | CDC. (2021, May 14). Www.cdc.gov. http://www.cdc.gov/handwashing Smith, A., et al. (2020). The impact of hand hygiene compliance on HAI rates. Journal of Hospital Infection, 104(4), 376-383. Johnson, B., et al. (2019). Reducing CAUTIs through bundle care interventions. American Journal of Infection Control, 47(6), 689-694. Erasmus, V., Daha, T. J., Brug, H., Richardus, J. H., Behrendt, M. D., Vos, M. C., & van Beeck, E. F. (2020). Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infection Control & Hospital Epidemiology, 31(3), 283-294. https://doi.org/10.1086/650451 Hand Hygiene – APIC. (2019). APIC. https://apic.org/Resources/Topic-specific-infection-prevention/hand-hygiene/ Haque, M., McKimm, J., Sartelli, M., Dhingra, S., Labricciosa, F. M., Islam, S., Jahan, D., Nusrat, T., Chowdhury, T. S., Coccolini, F., Iskandar, K., Catena, F., & Charan, J. (2020). Strategies to Prevent Healthcare-Associated Infections: A Narrative Overview. Risk Management and Healthcare Policy, 13(1), 1765-1780. https://doi.org/10.2147/RMHP.S269315 https://classroom.galencollege.edu/courses/4002605/pages/compassionate-care-model-overview?module_item_id=108346307 Nortje, A. (2024, April 12). What Is the Health Belief Model? An Updated Look. PositivePsychology.com. https://positivepsychology.com/health-belief-model/ Pittet, D., Allegranzi, B., Sax, H., Dharan, S., Pessoa-Silva, C. L., Donaldson, L., & Boyce, J. M. (2019). Evidence-based model for hand transmission during patient care and the role of improved practices. The Lancet Infectious Diseases, 6(10), 641-652. https://doi.org/10.1016/S1473-3099(06)70600-4 Smith, J. A., Jones, B. C., & Johnson, D. (2020). Improving hand hygiene compliance in a CVRU: A randomized controlled trial. American Journal of Infection Control, 48(5), 546-551 ‌ Toney-Butler, T. J., & Carver, N. (2023, July 31). Hand Washing (Hand Hygiene). National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470254/ ‌‌ WHO. (2023). Key facts and figures. Www.who.int. https://www.who.int/campaigns/world-hand-hygiene-day/2021/key-facts-and-figures#:~:text=Appropriate%20hand%20hygiene%20prevents%20up

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