Quality assurance of Patient Safety within the Health Care System

Introduction

Quality assurance (QA) is ‘a program for the systematic monitoring and evaluation of the various aspects of a project, service, or facility to ensure that standards of quality are being met’ (Merriam Webster Dictionary, 2018). Within the healthcare system all healthcare workers must go through a process of credentialing. Credentialing is ‘the process of assessing the academic qualifications and clinical practice history of a healthcare provider’ (Bhimji and Sharma, 2018). Although all healthcare workers go through this process there are still things that can go wrong within the healthcare system. ‘Quality assurance within the NHS is made up of 3 main components. These are Patient Safety, Patient Experience and Clinical Effectiveness.’ (NHS)  All other components fall under these main headings. (Figure 1) Quality assurance within the healthcare is so important as if anything drops below the standard of quality it should be at no matter how small an aspect, it can have catastrophic consequences. The QA of patient safety within the health care is of upmost importance as any drop below the level of standards expected and required in the quality assurance system can result injury, sickness or in worst case scenario, deaths of patients. Cleanliness and healthcare associated infection falls under the heading of Patient Safety and errors such as not following the correct hand washing procedure, in this field have serious consequences. . NICE points out that one in 16 people being treated on the NHS picks up a hospital acquired infection such as methicillin-resistant Staphylococcus aureus (MRSA).The World Health Organisation (WHO) stated that in some facilities up to ‘90% of health workers do not clean their hands effectively.’ This is a very serious statistic as all health care workers are provided with clinical guidelines on how often and how thorough they should be washing their hands and these guidelines should be strictly followed to ensure effective patient safety within the health care.

Figure 1 – NHS quality assurance 3 main components.

Main body

Healthcare workers’ hands are the most common vehicle for the transmission of healthcare-associated pathogens from patient to patient and within the healthcare environment (B, Allegranzi, D, Pittet, 2018). There are a number of tools used to support the quality assurance of cleanliness and healthcare associated infections such as ‘The code of practice’ for all providers of healthcare on the prevention of infections under the ‘Health and Social Care Act 2008’ (Department Of Health) shown in Table 2 below. ‘A health care associated infection can develop either as a direct result of healthcare interventions such as medical or surgical treatment, or from being in contact with a healthcare setting, (NICE). Controlling these infections is of key importance to the NHS as there is a high cost associated in dealing with them and they pose a high risk to all users and workers of the health care system.

Table 2- Code of practice under the Health and social care act 2008

The National Institute for Health and Care Excellence (NICE) have now produced a quality improvement guide in association with the Health Protection Agency (HPA) to help improve the quality of care and practice in prevention and control of infections. This was aimed at not only people working within the NHS but also to local authorities and the wider public in order to try and educate people on the dangers of health care associated infections. It is important that these guidelines are followed precisely and that progress is monitored so as any areas for improvement are identified as soon as possible. This means all incidents no matter how small must be reported within the NHS so it can be evaluated quickly to find out the cause of the incident and make changes before more incidents of the same nature may occur.

Although all health care workers are trained in effective hand cleaning techniques, there is research that has been done and it has shown that there are multiple reasons why compliance rates are very low in some health care practices. Comparison studies that were carried out have showed that hospitals with low nurse staffing levels and patient overcrowding, lead to poor adherence to hand hygiene and was associated with higher adverse outcome rates and hospital out break investigations. The studies showed that during the highest workload times the staff only washed their hands 25% of the time when expected to, in comparison to 70% of the time when the understaffing and overcrowding period had ended. This shows that the staff didn’t comply to the clinical guidelines when they were under pressure or simply just did not have enough time. Professor Gillian Leng, director of Health and Social Care at NICE said “Infections are a costly and avoidable burden. They hinder a patient’s recovery, can make underlying conditions worse, and reduce quality of life. ‘The gold standard in monitoring hand hygiene compliance is direct observation’ (Emily Landon, MD, assistant professor in the section of infectious diseases at The University of Chicago department of medicine and medical director of antimicrobial stewardship and infection control at the University of Chicago Medical Centre). Landon said, ‘reliability of this method to measure true, actual compliance with hand hygiene is questionable.’ It is impossible for all health care workers to be monitored 24/7. In one observational study done on hand hygiene in a health care facility, a well experienced practitioner observed close to 70% compliance to hand hygiene whereas a new student observed only 30% compliance to hand hygiene. This tells us that there is discrepancy between what is observed by a brand new observer and by someone well known to the unit. ”Meticillin-resistant Staphylococcus aureus (MRSA) is one of the main HCAI that occurs very often in health care settings. It is a ‘type of bacteria that’s resistant to several widely used antibiotics. This means infections with MRSA can be harder to treat than other bacterial infections’ (NHS, 2018). MRSA spreads very easily through touch and it lives harmlessly on the skin of many people. People who are in hospital are at high risk of being infected with it as they usually have a way of it getting in to their body such as a cut or burn or because their immune system is low. If educated correctly, ‘patients can play an important role in promoting safe care and hand hygiene practices’ (Maryam Ahmed Awaji, Khaled Al-Surimi). ‘Hand hygiene products should be made very accessible to patients and visitors and steps should be in place to create an environment in which patients feel comfortable asking and reminding their caregivers to sanitize their hands’ (Andrea Albrecht, global hand hygiene marketing manager, 2013). Patients should have the right and be encouraged to remind the health workers to wash hands thoroughly as this will increase the compliance rates of hand hygiene and therefore reduce the amount of HCAI and this will reduces costs having to be paid by the NHS.

Conclusion

 All the studies I have looked at have shown that hand hygiene is the most important factor in trying to control health care associated infections. Being able to control these infections effectively leads to reduced costs for the NHS and it ensures patient safety as people can go to the hospital to get treated without having to worry about getting a HCAI while being there. At the minute there is no standardized method or tool for measuring adherence to institutional policy of hand hygiene and hand washing. The lack of consensus on how to measure compliance in the health care to hand hygiene makes it difficult to assess the effectiveness of hand hygiene expectations within and across health care settings. This is most likely the reason for low compliance rates as people are not being regularly monitored on their expected hand washing routine and can therefore get away with not doing it. All hospitals and health care facilities should have hand washing stations available with signs and posters educating patients on how good hand hygiene can stop the spread of harmful infections. If there is adequate and easy to use hand washing station with signs and posters this will encourage visitors to the health care facilities to wash their hands before the come in and before they leave. Good hand hygiene education should also be supported online and in schools or the workplace more to help people start hand washing in a regular routine as they will understand just how important it is.  Although a lot of the compliance issues really comes down to the individual themselves, the gold standard of monitoring hand washing needs to be improved to something that can be more reliable as simple observation is clearly not enough to get workers to comply with the guidelines.

REFERENCE LIST

         Ahmed Awaji, M. and Al-Surimi, K. (2016). Promoting the role of patients in improving hand hygiene compliance amongst health care workers. BMJ Quality Improvement Reports, 5(1), pp.u210787.w4336. [Accessed 15 Oct. 2018]

• Assets.publishing.service.gov.uk. (2018). [online] Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/449049/Code_of_practice_280715_acc.pdf [Accessed 15 Oct. 2018].

         B, Allegranzi, D, Pittet. (2010). Role of hand hygiene in healthcare-associated infection prevention. [online] Available at: https://www.journalofhospitalinfection.com/article/S0195-6701%2809%2900186-8/abstract [accessed 15 Oct. 2018.]

         Backman, C., Zoutman, D. and Marck, P. (2008). An integrative review of the current evidence on the relationship between hand hygiene interventions and the incidence of health care–associated infections. American Journal of Infection Control, 36(5), pp.333-348. [Accessed 15 Oct. 2018]

• Bhimji, S. and Sharma, S. (2018). Credentialing. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK519504/ [Accessed 15 Oct. 2018].
• Corbyccg.nhs.uk. (2018). [online] Available at: http://www.corbyccg.nhs.uk/modules/downloads/download.php?file_name=652 [Accessed 4 Oct. 2018].

         Healio.com. (2018). Infection prevention in hospitals: The importance of hand hygiene. [online] Available at: https://www.healio.com/infectious-disease/nosocomial-infections/news/print/infectious-disease-news/%7Bdd1e115b-8a00-4889-9e85-8566391f2541%7D/infection-prevention-in-hospitals-the-importance-of-hand-hygiene [Accessed 15 Oct. 2018].

         HSE.ie. (2018). Preventing infections – HSE.ie. [online] Available at: https://www.hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/hcai/hcai-amr-information-for-patients-and-public/preventing-healthcare-associated-infections/ [Accessed 15 Oct. 2018].

         Infection Control Today. (2018). Patient Empowerment as a Hand Hygiene Strategy. [online] Available at: https://www.infectioncontroltoday.com/hand-hygiene/patient-empowerment-hand-hygiene-strategy [Accessed 15 Oct. 2018].

• Merriam-webster.com. (2018). Definition of QUALITY ASSURANCE. [online] Available at: https://www.merriam-webster.com/dictionary/quality%20assurance [Accessed 15 Oct. 2018].
• Nice.org.uk. (2018). Healthcare-associated infections: prevention and control | Guidance and guidelines | NICE. [online] Available at: https://www.nice.org.uk/guidance/ph36/chapter/Introduction#ftn.footnote_1 [Accessed 15 Oct. 2018].

         nhs.uk. (2018). MRSA. [online] Available at: https://www.nhs.uk/conditions/mrsa/ [Accessed 15 Oct. 2018].