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RUNNING HEAD: HEALTHCARE ASSOCIATED INFECTIONS
Public Health Program Promotion for Healthcare Associated Infections
Written Assignment #7
Tanya Staton
04/18/2014
MPH 585
Lea Pounds
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HEALTHCARE ASSOCIATED INFECTIONS
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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.
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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
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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 HAIs will 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.
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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 and will 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).
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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.
~ Installing DebMed and continuous data monitoring will
be costly.
~ Utilizing the NHSN provided by the CDC for data
reporting.
What are the opportunities your planning and program
will create?
What are the threats to your planning and program
success?
HEALTHCARE ASSOCIATED INFECTIONS
~ decrease HAIs saves billions of dollars annually.
~decrease morbidity and mortality annually from HAIs.
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~ 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.
~ Possibly tax/fine healthcare facilities that are not
compliant with the mandate for HAI reporting.
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
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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
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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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MATCH LOGIC MODEL
Phase 2: Intervention Planning
Select Intervention Approaches
Influence Governments
Identify Targets of Intervention
Government & Community
Leaders
Activists
Social change
Community development
Legislators
Phase 1: Health Goals Selection
Select Intervention Objectives
Healthful Governments
Polices
Hospitals
Hospital Administrators
Healthcare facilities
CDC Employees
Phase 3:
Development
Influence Communities
Education programs
Activists
Community Norm Shapers
Education
Staff that wash their hands
Communication
Resource development
Phase 4:
Implementation
Patients that take antibiotics
correctly
Healthful Communities
DebMed Resources
New Polices
Washing hands social norm
Political action
Department of health data
reporting
Influence Organizations
Organizational change
Organization Decision
Makers
Helpful Organizations
Consulting
Administrators
CDC
Networking
Legislators
Department of Health
DebMed CEO
Hospitals
Stakeholders
DebMed Company
Influence
Individuals
Education Training
Awareness
Conduct Process Evaluation
Individuals at Risk:
Healthcare staff
Patients in Healthcare facilities
CDC
Healthcare Staff in danger of
contracting MRSA
Conduct Impact Evaluation
Phase 5: Evaluation
Healthful Individuals:
Behavior
Health Status:
Risk factors
Morbidity
Mortality
Conduct Outcome Evaluation
Patient Safety
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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
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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:
Outputs
I. II.
Outcomes -- Impact
Inputs
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
Activities
Participation
III.
HAI Health Plan:
~ 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.
Increase HAI involvement by
including an extensive range
of stakeholders.
~ 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.
~ Healthcare staff
~ Report all HAI to NHSN
and have data posted so the
public can view.
~ 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.
Short
Increase hand hygiene
compliance by installing a
new DebMed GMS
monitoring soap and alcohol
dispenser to measure
compliance.
IV.
Medium
V.
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.
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.
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.
Long
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.
RUNNING HEAD: HEALTHCARE ASSOCIATED INFECTIONS
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Program Objectives
The current philosophy of the program is to provide a health promotion program that is
SMART: specific, measurable, achievable, realistic and time specific (McKenzie et al). Having
clearly defined goals and objectives is a way to achieve this. Goals tend to be broader statements
about the program, whereas objectives are clearly defined and are focused on long-range
direction (McKenzie et al, 2013). Below is a table representing the smart objectives in the health
promotion plan to reduce HAIs.
Goal 1: Discover HAIs that cause infection and actively report them.
Not So SMART objective 1: Obtain blood cultures on patients with infections to help discover HAIs.
Key Component
Objective
Specific - What is the specific task?

Test patients for infections that were acquired in a healthcare
facility.
Measurable - What are the standards,
measure or parameters?

Obtain blood culture prior to being admitted to make sure
patient does not already have an infection.
Obtain second set upon discharge status.

Evaluation period of measure is Short Term
(months), Intermediate (1-3 years), or Long
Term (3 or more years)?

This is a short term measure that measures to see if a patient
develops a HAI during a hospital stay.
Achievable - Is the task feasible?

Yes, this task can be achieved.
Realistic - Are sufficient resources available?
(Inputs from logic model)

Yes, but blood culture bottles can be expensive so the
healthcare facility will need to decide what department will
budget for the cost: the lab, the units or will government
funding be offered.
Time-Bound - What are the start and end
dates?

Start date is upon admittance and end date is when being
discharged.
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SMART objective 1: To obtain data that is reliable to report, we must first correctly identify HAIs that actually
occurred in healthcare facilities. To do this we must obtain blood cultures on the patient before admittance and
after admittance.
Goal 2: Educate on antibiotic use and infection prevention
Not So SMART objective 2: Reduce HAIs through better education on antibiotic use and infection prevention.
Key Component
Specific - What is the specific task?
Objective


Measurable - What are the standards,
measure or parameters?


Have training courses tailored to specific units/departments on
infection prevention to avoid HAIs. This in turn will decrease
HAIs.
Have 75% of healthcare staff be able to tell their peers how to
reduce infections.
Qualitative data: test their knowledge to see how much they
know so the educator can stage them into an intervention
category.
By the end of the training courses re-rest and have increase of
knowledge on HAIs by 5%
Evaluation period of measure is Short Term
(months), Intermediate (1-3 years), or Long
Term (3 or more years)?

Achievable - Is the task feasible?

Yes, but healthcare staff might be resistant if they are forced to
take a course.
Realistic - Are sufficient resources available?
(Inputs from logic model)

Yes and No. Providing workshops, lectures, brochures and a
trained professor on the material is not hard. The problem with
taking education courses in a healthcare setting is it utilizes
valuable time. Time that would be spent taking care of patients.
If the staff took the course after the shift ended then the facility
would be utilizing another resource (money), because we
would have to pay them. The question then becomes what is
more valuable time or money?

Intermediate: evaluate to see if knowledge has been retained in
the refresher course.
Long term: evaluate and see if HAIs are decreasing and
knowledge is still spreading on infection prevention and
antibiotic use.
HEALTHCARE ASSOCIATED INFECTIONS
Time-Bound - What are the start and end
dates?
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

Starter courses vary depending on what stage of learning and
department they work for.
Refresher course annually
SMART objective 2: Have a qualified candidate teach courses on proper antibiotic use and infection prevention. The
courses will be section specific so each lecture will be geared and tailored to that department to make sure the material is
relevant and knowledge will be retained. The purpose of the courses is to have 75% of healthcare staff be able to tell their
peers how to reduce HAIs. The knowledge gain will reduce HAIs and provide a safe and healthy environment for patients.
Goal 3: Reduce HAIs by increasing hand hygiene compliance.
Not So SMART objective 3: Measure hand hygiene compliance to reduce HAIs.
Key Component
Specific - What is the specific task?
Objective


Measurable - What are the standards,
measure or parameters?


Use DebMEd GMS system to collect data from soap and alcohol
dispensers on hand hygiene in healthcare facilities to measure
hand hygiene compliance.
First year system is implemented a target goal of 75%
compliance for units/departments and 80% compliance for all
critical care units.
Quantitative measures. Sends electronic data to a computer
system every time a soap or alcohol dispenser is used.
This measures hand hygiene compliance and can track data to
see if healthcare staff are washing hands appropriately.
Evaluation period of measure is Short Term
(months), Intermediate (1-3 years), or Long
Term (3 or more years)?

Short term at first for a pilot program to see if the program will
be successful, then long term after feedback from healthcare
staff.
Achievable - Is the task feasible?

Although, hand hygiene compliance will never be 100% the task
is feasible. If healthcare staff are aware that the monitoring
system is in place they are more likely to make a behavior
modification.
Realistic - Are sufficient resources available?
(Inputs from logic model)

Resources can be made available, but the monitoring system
will be expensive.
HEALTHCARE ASSOCIATED INFECTIONS
Time-Bound - What are the start and end
dates?
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
The start date will be June 2014 and the end date will be June
2015 for the pilot program. If the monitoring system has shown
to increase hand hygiene compliance then the system will be
implemented and data the end date will continue till June 2020.
SMART objective 3: Use an innovative product like the DebMed GMS system that measure hand hygiene
compliance. The system sends quantitative data every time a soap or alcohol dispenser is used to a computer to
track hand hygiene compliance. The healthcare staff being aware of the data tracking system will increase hand
hygiene compliance in units/departments by 75% and 80% in critical care units and in turn reduce HAIs. Healthcare
facilities will get a more accurate measure of hand hygiene compliance, because the Hawthorne Effect will no longer
be present since direct observation will no longer be necessary.
Goal 4: Report HAIs to National HealthCare Safety Network (NHSN)
Not So SMART objective 4: Have data reporting on HAIs available to the public on all healthcare facilities.
Key Component
Objective
Specific - What is the specific task?

Have all healthcare facilities in every state report HAIs to NHSN
by the year 2016.
Measurable - What are the standards,
measure or parameters?

Record all HAI that occurred from surgical sites, central lines or
pneumonia related.
Hospital keeps records -> reports to State Department of
Health -> NHSN

Evaluation period of measure is Short Term
(months), Intermediate (1-3 years), or Long
Term (3 or more years)?

Long term measurement. There should be continuous data
reporting.
Achievable - Is the task feasible?

Yes, only if federal legislation approves of the mandate for all
states to report.
Realistic - Are sufficient resources available?
(Inputs from logic model)

Currently no. To get legislation to change takes a lot of
lobbying, money and time.
Time-Bound - What are the start and end
dates?

33 states are currently already reporting. Lobby for other states
and get reporting mandated by the year 2016. There will be no
end dates for HAI reporting and the information will always be
available to the public.
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SMART objective 4: Currently 33 states require reporting to the CDC’s NHSN, but that is through their state
legislation not federal (CDC, 2013). The federal mandate will change this making all states report data to the CDC’s
NHSN so the public can view the information. This will allow the consumer to choose a healthcare provider (if they
have that option) they feel will provide them patient safety and care that they are looking for in a facility.
Tasks/Timelines
Goals and objectives are important in a health promotion program. Having
tasks/timelines to help guide the planning and implementation process is also equally important
in the success of the program. In reducing HAIs the tasks for the program will first include hiring
and training new program facilitators. Since the bulk of the program relies heavily on the
DebMed system the implementation of the pilot system on critical care units will occur next in
the timeline. During this time committee members will also start to lobby for political support for
a federal mandate on HAI reporting for all states to the NHSN. Target education courses to
specific units will be the next task. Making revisions to the DebMed hand hygiene system will be
done if necessary, and the product will slowly be implemented to the other areas of the
healthcare facility. Finally, the health promotion program on reducing HAIs will be evaluated.
Below is a guided figure for a timeline and gantt chart for the program.
Ga ther stakeholders & committee
members
Sta rt education courses for all
other units & departments.
Ga ther & evaluate data for hand hygiene
moni toring s ystem
Tra i n faciliators & s taff that will
i mplement the program
Start education courses on how to
reduce HAIs for cri tical care units.
Make adjustments to system if
necessary & begin to phase soap
& alcohol dispensers in other
areas.
Start Pi l ot program of DebMed
s ys tem on critcal ca re units
Start ga thering support & l obbying
for federal ma ndate on reporting
on HAIs for a ll s tates.
Ga ther Staff & Sta keholders &
eva l uate the program overall to see if
HAIs have been reduced s ince the
DebMed s ystem i nstalled a nd
education courses taught.
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Marketing
Along with having clearly defined objectives, tasks and timelines to help implement your
health promotion program you must be able to market your health promotion program. In the
plan to reduce HAIs healthcare facilities will be working closely with the DebMed Company.
Stakeholders, committee members and investors must “buy in” on the product so hand hygiene
compliance rates can be measured. The price of the product will be marketed to the healthcare
facilities by offering them free installation of all new DebMed soap and alcohol dispensers in
exchange for all data that is acquired during the testing phases. Once the product is implemented
banners and posters will be displayed in the facilities to promote the product and remind staff
that it is available. The dispensers will also be located in critical locations, so compliance can be
within reach. Product placement is part of the four P’s of marketing, and a more successful
program is one that has a product within reach (McKenzie et al, 2013). Promoting the product is
important in marketing. The healthcare staff will constantly be informed about what the system
is measuring, this will help reinforce that the product exists. Prizes will also be awarded to units
with the highest compliance rates. By providing incentives for compliance it helps persuade the
HEALTHCARE ASSOCIATED INFECTIONS
20
staff to utilize the system more often. Below is a figure that explains the seven P’s of promotion
on reducing HAIs.
Price
Product
DebMed GMS hand
hygiene monitoring system
Cooperative agreement
between DebMed & facilities
to install for free
People
Educational material for
lessons on reducing HAIs
Healthcare staff
Trainers & facilitators
Reducing
HAIs
Marketing
Mix
Place
Healthcare facilities
DebMed Company
CDC employees
Physical Evidence
NHSN for reporting
Healthcare facilities
Infrastructures
Promotion
Process
Prices for unit highest
compliance rate
Education classes on
reducing HAIs
Banners advertising
DebMed product
Installing hand hygiene
equipment
Data reporting to NHSN
NHSN
HEALTHCARE ASSOCIATED INFECTIONS
21
Program Pro Forma
Any public health promotion program large or small needs sufficient funds to operate.
The best way to keep up with your health promotion budget is with a pro forma/budget sheet
(McKenzie et al, 2013). The key components to a budget sheet include revenue or support and
expenditures. Data monitoring systems, like DebMed, are expensive so the HAI reduction
program will need a substantial amount of funding to implement the program. Instead of having
the organization or healthcare facility bear the cost of the soap and alcohol dispensers to measure
compliance the DebMed Company and healthcare facilities will have a cooperative agreement. A
cooperative agreement is when two parties share resources to offer a program or service
(McKenzie et al. 2013, p. 298). A Memorandum of Agreement will be signed by both parties.
The DebMed Company is willing to put the monitoring systems in place for free in exchange for
publishable data during the pilot program. The company is only providing the system and not the
supplies, therefore the healthcare will need to make sure soap and alcohol gels are budgeted
every year. Making sure blood collection bottles are budgeted and provided will also be an
expensive purchase. The healthcare facility will need to determine who will cover these costs.
Healthcare facilities rely heavily on grants and gifts for funding. Private investors will have to be
recruited and incorporated to make sure the health promotion program has an influx of funds to
support the program on reducing HAIs. Listed below is an example of a budget sheet that a
healthcare facility will use yearly with the HAI reduction program.
HEALTHCARE ASSOCIATED INFECTIONS
22
HAI Reduction Plan Budget
REVENUE & SUPPORT
Item
2014
PERCENTAGE OF INCOME SPENT
72%
Amount
DebMed GMS
$5,000,000.00
SUMMARY
Healthcare Facility
$200,000.00
Grants
$100,000.00
Total Yearly Income
$5,400,000.00
Gifts
$100,000.00
Total Yearly Expenses
$3,877,500.00
BALANCE
$1,522,500.00
EXPENDITURES
Item
Installing Hand Hygiene System
Blood collection bottles
Material for education courses
Amount
$3,000,000.00
$60,000.00
Soap and alcohol for dispensers
$100,000.00
Salaries for Infection Prev entionists
$150,000.00
Equipment upkeep
$100,000.00
Consultants
$200,000.00
Banners/Posters to display
Salary for education trainer
Meeting costs to evaluate program
$6000000
$200,000.00
$5,400,000.
00
$5000000
$3,877,500.
00
$4000000
$3000000
$5,000.00
$50,000.00
$2000000
$2,500.00
$1000000
Miscellaneous
$10,000.00
$0
Income
Expenses
HEALTHCARE ASSOCIATED INFECTIONS
23
Formative and Process Evaluation
Formative evaluation is important to stakeholders, committee members and investors
because data is collected along the way that can potentially change or improve a program before
it is even implemented (McKenzie et al, 2013). Unlike summative evaluation which occurs at the
end of the program, formative evaluation occurs from the creation of a program through
implementation. A comprehensive formative evaluation involves 15 important elements. Below
is a table listing the 15 elements and how they were applied in regards to reducing HAIs. A table
listing the elements involved in process evaluation are also displayed.
Process Evaluation
Fidelity
This entails how well the program was delivered or planned. The faciliators will
have to utilize the gantt charts and timelines to see if these goals were met.
Dose
1) Improving hand hygiene compliance rates with innovative technology
2) Tailored education courses on how to reduce HAIs specific to units/departments
3) federal mandate for HAI reporting to NHSN
CDC NHSN, DebMed Company
Hospital Administrators: Infection prevention, Laboratory, Critical Care Units,
Emergency Room and the Vice President of the healthcare facility
The entire healthcare facilities will be given the opportunity to participate in the
program
Recruitment
Reach
Response
Critical care units will be targeted first then the other units/departments will be
educated and trained on the DebMed system and reducing HAIs
Context
These are the external factors that amy affect the program. A problem that might
arise is if the DebMed had hygiene system is not operating properly. Then the data
will not be accurate.
HEALTHCARE ASSOCIATED INFECTIONS
24
Formative Evaluation
Justification
First realizing that there is a problem in the number of healthcare associated
infections.
Evidence
1) Roughly 1.7 million Americans annually will acquire an HAI.
2) 99,000 patients will die from complications associated with them
3) cost on average anywhere from $28.4 to $45 billion anually
Making sure the stakeholders and committee members that are involved in the
program are dedicated and share the same passion
Capacity
Resources
Consumer-Orientation
Multiplicity
Support
Inclusion
Accountability
1) Having an approiapte budget
2) DebMed system, educational materials
3) CDCs NHSN
Making sure the DebMed system is placed in critical areas so it can be utilized best
1) Improving hand hygiene compliance rates with innovative technology
2) Tailored education courses on how to reduce HAIs specific to units/departments
3) federal mandate for HAI reporting to NHSN
1) NHSN available for reporting.
2) DebMed Company available for any hand hygiene needs
CDC NHSN, DebMed Company
Hospital Administrators: Infection prevention, Laboratory, Critical Care Units,
Emergency Room and the Vice President of the healthcare facility
Have meetings regularly to make sure everyone is on track and doing what is
outlined and planned.
Adjustment
After the pilot program for the DebMed hand hygiene system feedback will be
given and modifications will be made to the program before implementing
Recruitment
Healthcare staff will be recruited first, but then hope to spread knowledge to
patients and their familes on reducing HAIs.
Reach
The entire healthcare facilities will be given the opportunity to participate in the
program
Response
Critical care units will be targeted first then the other units/departments will be
educated and trained on the DebMed system and reducing HAIs
Interaction
1) Constantly reminding them about the DebMed hand hygiene system
2) engaging in active conversations about reducing HAIS with healthcare staff
to keep open communication on the issue
To address if healthcare staff are content with the program the program faciliators
will send out questionaires to see if they think the program is working.
Satisfaction
HEALTHCARE ASSOCIATED INFECTIONS
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Summary
It doesn’t matter how healthy you are, anyone can contract and HAI. Unfortunately, since
this is not an indivuidal problem but social everyone must work together to prevent HAIs from
occurring. Patients should not be afraid to speak up and tell their healthcare provider to wash
their hands, or ask for a new nurse or physician if they fail to comply. As a patient they should
want and expect the best care possible, as a healthcare provider it is our job is to provide optimal
care and to make our patient’s safe. HAIs can be reduced if we focus on using 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. HAIs
are not a new problem, and every day we move one step closer towards working on ways to
prevent them from occurring. Working together we can reduce morbidity and mortality rates
caused by HAIs annually, and see a decline in this public health problem.
HEALTHCARE ASSOCIATED INFECTIONS
26
References:
McKenzie, J., Neiger, B., & Thackeray, R. (2013). Planning, Implementing & Evaluating Health
Promotion Programs. (6th ed.). Pearson
Havlena, A., Ray, M., (n.d). MATCH. Retrieved from
http://programs.weber.edu/hpstudents/minjeeray/MATCH.pdf
Silverbook. (2013). Healthcare-Associated Infections. Retrieved
from http://www.silverbook.org/uploads/images/SilverBookHAI_FactSheet.pdf
South Carolina Department of Health and Environmental Control. (2013). Hospital Acquired
Infections in South Carolina. Retrieved http://www.scdhec.gov/health/disease/hai/
Cherry, K. (n.d). What is the Hawthorne Effect. Retrieved from
http://psychology.about.com/od/hindex/g/def_hawthorn.htm
Schneider, MJ. (2011). Introduction to Public Health (3rd edition). Sudbury, MA: Jones &
Bartlett
Center for Disease Control and Prevention. (2013). Healthcare-associated Infections. Retrieved
from http://www.cdc.gov/HAI/surveillance/QA_stateSummary.html#a18
DebMed Engineering Hand Hygiene Compliance. (2014). Automatic measurement and reporting
of compliance rates in virtually real-time. Retrieved
Fromhttp://www.debmed.com/debmed-program
OPHP MySPH (2012, December 11). CDC's Framework for Program Evaluation in Public
Health [video file]. Retrieved from
https://www.youtube.com/watch?feature=player_embedded&v=tOjieBh1ce0