Introduction
Hand hygiene (HH) is among the most straightforward measures to effectively prevent transmission of infections in the hospitals. In 2019, the first case of a person having symptoms associated with Covid-19 disease was spotted in Wuhan, China (de Paula et al., 2020). The infection has since spread globally through different modes, including touching infected surfaces. Regular and thorough washing of hands is recommended to mitigate the spread of the Covid-19 virus. However, the level of compliance to HH among the medical team and the patients is generally low (Sands & Aunger, 2020). This report aims to show how the Donabedian conceptual framework can be used to improve healthcare quality problems, specifically hand sanitization for Covid-19 patients.
Defining the Quality Problem
Lack of hand hygiene has traditionally been linked to several hospital-acquired infections leading to a prolonged hospital stay. Recently, after the World Health Organization (WHO) declared Covid-19 a pandemic, it was discovered that the surfaces where the isolated patients had come in contact were tested positive for Covid-19 virus (de Paula et al., 2020). If a healthy person touches such areas, they acquire the pathogen, and the cycle continues. The quality of healthcare is, therefore, compromised since some of the victims are first responders and nurses.
Human beings are fond of regularly touching their face, thus spreading germs to critical organs such as the eyes, nose, and ears. For Covid-19, once the virus enters the body, the person can continue to pass on the disease to others. When many people are sick, they exhaust the capacity of healthcare workers to offer treatment. The quality of service is compromised because each medical worker has to attend to many patients.
Justification of Selected Population
There is an increasing need for evidence-based measures that will curb the spread of Covid-19, which has no cure. According to Worldometer (2020), the number of confirmed cases globally is 60,077,347and there are 1,413,704 deaths so far. Consistent HH is one of the protocols recommended by the WHO as an effective preventive measure in hospitals. This study will provide an understanding of the reasons for negligence and propose measures to improve hygiene quality.
This report is, thus, relevant to all healthcare settings which have been burdened by coronavirus-related deaths. The other justification is that the hospitals are already overwhelmed. Yet, according to Amati et al. (2018), one of the reasons for low quality in hospital settings is nurses attending to many patients. There is a need to clear space by improving the quality of care that will result in many patients being discharged. This report is also relevant for future policies and raising awareness since suggestions for improvement will be provided.
Applying the Donabedian Conceptual Framework
The Donabedian model is popularly used in the healthcare setting as it offers a strategy for examination and evaluation of healthcare quality. As stated by Murray (2017), the framework contains three aspects of quality, including process (all activities involved), structure (external conditions), and outcome (the desirable changes). In improving HH amidst the Covid-19 pandemic, the theory can be applied to implement new measures that will produce better results. The new developments will require the dedication of all people working within hospitals, visitors, and patients. An extra budget will be allocated to ensure that the new initiatives are implemented.
Structure
The focus is on improving the number of sinks in strategic places within the hospital and the compound, such as inside the wards and at every entrance. Moreover, the capacity of the water tanks will be increased because more people need to wash their hands. The other structural change will be the installation of disinfectants and soaps at strategic places. For the structures, data will be collected using a qualitative approach. For example, the experienced medics will be interviewed to determine the developments that need to be included. The rationale for using this type of data is that it provides in-depth explanations.
Process
The nurses and all visitors entering wards where Covid-19 patients have been isolated will thoroughly wash their hands using soap and running water. Colorful printed posts will be pinned on notice boards to create awareness on regular handwashing and the steps involved. At the main entrances, the security protocol will require all people to either wash or sanitize their hands before they are allowed on the premises. Individuals will also be discouraged from handshaking so that other forms of greeting can be embraced. While attending to patients, nurses must wear hand gloves.
Outcomes
The expected result is that there will be few Covid-19 infections per day, and with time, congestion in the hospital will reduce. Consequently, the ratio of nurses to patients will be low, making it possible to achieve patient-centered care. The data will be evaluated quantitatively using descriptive statistics and SPSS to determine the improvements. For example, the data collection tool includes closed questionnaires given to patients, healthcare providers, and visitors in the hospitals.
Literature Review
Quality concerns related to hand hygiene have always been an issue in the healthcare setting. According to Sands and Aunger (2020), among healthcare workers, nurses are the ones who get most contact with patients, yet they never comply with HH recommendations. In the study that focused on increasing handwashing centers in school, findings revealed an improvement, 5.5 to 65.0%, of regular washing (Mbakaya et al., 2020). The implication is that when there are many places for washing hands, people are more likely to do it. Finding water for many people may be difficult in regions prone to hot weather conditions. The study by Jing et al. (2020) indicates that sanitizers with 62%–95% of alcohol can also be equally effective. The disinfectants are readily available in shop centers and can thus be more efficient since people can carry them in their bag packs (Jing et al., 2020). One of the reasons for not adhering to HH is accessibility issues.
When introducing new strategies to enhance performance, it is essential to consider all stakeholders and integrate their individual needs. Proper communication is also important to ensure that the change process is accepted by all people that are involved (Murray, 2017). The quality improvement should consider the patients, the internal and external environment of the hospital (Chakraborty & Kaynak, 2018). When there is cooperation, the delivery of healthcare is enhanced.
Conclusion
Continuous improvement in healthcare settings is important to enhance the quality of life. The Donabedian model provides a strategy for evaluating the processes, structures, and outcomes. The initiative to improve hand hygiene to combat the spread of Covid-19 in hospitals throughout the globe States is relevant. The rationale is that country has the highest infection and mortality rate from the disease. Therefore, the strategy will include installing more sinks, bigger water tanks, and sanitizers at strategic places. There will be the creation of awareness for all people involved. The evaluation will be made through both qualitative and quantitative methods. Past studies have shown that water inaccessibility leads to noncompliance; hence this initiative is bound to succeed.
References
Amati, R., Kaissi, A. A., & Hannawa, A. F. (2018). Determinants of good and poor quality as perceived by US health care managers: A grounded taxonomy based on evidence from narratives of care. Journal of Health Organization and Management, 32(5), 708–725.
Chakraborty, S., & Kaynak, H. (2018). Towards a triadic quality measurement framework for U.S. healthcare. The Quality Management Journal, 25(1), 46–63.
de Paula, D. G., Francisco, M. R., Freitas, J. D., Levachof, R. C. Q., Fonseca, B. d. O., Simões, B. F. T., & Bilio, R. d. L. (2020). Hand hygiene in high-complexity sectors as an integrating element in the combat of Sars-CoV-2. Revista Brasileira De Enfermagem, 73(2), e20200316.
Jing, J. L. J., Yi, T. P. Bose, R. J. C., McCarthy, J. R., Tharmalingam, N., & Madheswaran, T. (2020). Hand sanitizers: A review on formulation aspects, adverse effects, and regulations. International Journal of Environmental Research and Public Health, 17(9), 3326.
Mbakaya, B. C., Kalembo, F. W., & Zgambo, M. (2020). Use, adoption, and effectiveness of tippy-tap handwashing station in promoting hand hygiene practices in resource-limited settings: A systematic review. BMC Public Health, 20, 1005.
Murray, E. (2017). Nursing leadership and management for patient safety and quality care. F.A. Davis Company.
Sands, M., & Aunger, R. (2020). Determinants of hand hygiene compliance among nurses in US hospitals: A formative research study. PloS One, 15(4), e0230573.
Worldometer. (2020). Covid-19 Coronavirus Pandemic.