Increased mortality rate in Newborn Intensive Care Unit (NICU) due to nosocomial infections is a serious issue in the unit where I work. This problem is caused by poor hand washing practices among the healthcare workers and other people visiting the NICU (Won et al., 2004). Prevention of nosocomial infections largely depends on the adherence to preventive measures by the health care providers. Newborns are very susceptible to these infections because their immune system that is supposed to protect them from infections is not yet fully developed (Pessoa-Silva et al., 2007). Healthcare providers should, therefore, maintain infection prevention measures in the unit.
Effective Hand Washing Practices
Planning for a realistic change would require answering the three significant questions that healthcare workers in this unit take for granted. The first question is why hand washing so important. Washing their hands using effective hand washing techniques can remove bacteria that can infect babies in the unit (Won et al., 2004). The second question they ask is whether there is a right way to wash hands. The answer is yes. The first step in hand washing technique is to take off your outdoor jackets or coat and hang it on the provided hook. Second, roll up your sleeves and remove your watch, bracelets, and rings. Third, wet your hands. Fourth, apply soap from the dispenser and wash your hand according to the hand washing techniques I will explain later (Pessoa-Silva et al., 2007). Fifth, dry your hands, wrists and lower arm with the paper towel provided. Sixth, finally apply the alcohol provided in the dispenser using the same technique as while washing your hands.
There are seven hand washing techniques while using water, soap, and alcohol gel. First, rub water and soap or alcohol gel into your hands from palm to palm. Second, rub back of each hand with the palm of the other hand with fingers interlaced. Third, rub the palm to palm with fingers interlaced. Fourth, rub with the back of fingers to opposing palm with fingers interlaced. Fifth, rub each thumb dashed in opposite hand using rotational motion (Pessoa-Silva et al., 2007). Sixth, rub tips of fingers in opposite palm in a circular motion. The last technique is to rub each wrist with the opposite hand. The last question that health care workers ask is when they should wash their hands. They should wash their hands every time they enter the unit to prevent germs from outside from getting into the unit. In the nursery, they wash their hands before they touch or handle a baby and after every nappy change. Hands should also be washed every time a person leaves the unit as this prevents carrying germs from the unit to the outside (Won et al., 2004). These hand washing precautions should be followed by any person entering or handling the babies in the unit.
Alignment of Hand Washing Practices to the Hospitals Goals and Objectives
The change in handwashing practices will align with my organizations mission, vision, values and the professional standards. Decreasing infant mortality rate is in line with our mission, which is fostering the wellbeing of the people we serve. Its still in line with our vision which is realizing the optimum health for our patient through an integrated health care system. Preventing nosocomial infections, promotes health of the infants (Won et al., 2004). Health promotion is in line with our core values such as creating an environment where everyone is treated with respect, dignity, and compassion. This change is also in line with nursing professional standards such as the provision of individualized high-quality nursing care to the patient.
Lewins Change Model
Lewins Change Model would be the most effective in planning this change. The rationale for choosing this model in planning this change is because the Lewins change model is simple and easy to understand (Levasseur, 2001). Hence, the people who are targeted by this change will not have a problem understanding and accepting it. Kotters eight steps change model is hard to understand as compared to that of Lewins. Lewins model does not use force like other classical change models such as power-coercive strategies. These models utilize the power to coerce people into accepting change and thus they face a lot of resistance from the people (Burnes, 2004). Lewins model is widely used because of its simplicity.
Change Planning Steps
Lewins change model consists of three stages, each with its different steps (Levasseur, 2001). These stages include unfreezing, change and refreezing. These are the steps that healthcare professional in this unit must follow to facilitate change. In the unfreezing stage, they will gather data and diagnose the problem which is the high infant mortality rate caused by increased hospital infections. Determining whether there should be changes in infection prevention measures will be the third step (Burnes, 2004). The last step in this stage will be to motivate all involved persons that there is the need for change in handwashing techniques to reduce nosocomial infections in the NICU.
The second stage is called change or movement. It has eleven steps. Developing a plan on how the change will take place represent the first step (Levasseur, 2001). The second step will be to step goals and objectives. The goal is to reduce infant mortality rate in the NICUby using effective hand washing practices within two weeks period. Identifying areas of support and resistance is the third step. The next step will be to identify all persons who will be affected by the change such as stakeholders, nurses, doctors, medical students, mothers and all NICU visitors (Burnes, 2004). The next step will involve setting a date when change will be achieved. In the next step, effective strategies will be developed such as effective communication skills and good leadership skills to facilitate the change. The next step will involve implementing the change. The next step will involve encouraging others to embrace the change. The next step will involve using good communication skills to overcome the resistance. The next step will be to evaluate the change, and the last step will be to modify the change where necessary. The last stage is refreezing (Levasseur, 2001). In this stage, the change initiators are supposed to continue supporting others so that the change remains.
Agents of Change
The persons who will be involved in initiating and managing this change will be the senior nursing officer based in NICU and the overall nursing officer in the whole hospital. Change initiators must use a relational, political and developmental expertise to ensure that change is not sabotaged (Levasseur, 2001). The change agent determines the success of the change process. He must use his leadership skills and abilities to deal with peoples emotions to ensure that change take place. In aIDition to good leadership and managerial skills, a change agent must also display vision and expert planning skills (Burnes, 2004). These are the skills required for a successful change process to occur. All NICU operators should adhere to the hand washing change to reduce nosocomial infections, which will consequently reduce the infant mortality rate.
Burnes, B. (2004). Kurt Lewin and the planned approach to change: a re?appraisal. Journal of Management Studies, 41(6), 977-1002.
Levasseur, R. E. (2001). People skills: Change management toolsLewins change model. Interfaces, 31(4), 71-73.
Pessoa-Silva, C. L., Hugonnet, S., Pfister, R., Touveneau, S., Dharan, S., Posfay-Barbe, K., & Pittet, D. (2007). Reduction of health careassociated infection risk in neonates by successful hand hygiene promotion. Pediatrics, 120(2), e382-e390.
Won, S. P., Chou, H. C., Hsieh, W. S., Chen, C. Y., Huang, S. M., Tsou, K. I., & Tsao, P. N. (2004). Hand washing program for the prevention of nosocomial infections in a neonatal intensive care unit. Infection Control, 25(09), 742-746.