This paper is based on using alcohol-based hand sanitizer rubs and hand washing methods with antibacterial soap and water in reducing hospital- acquired infections.

1) IMPLEMENTATION
Describe in detail the steps for implementation. Use appropriate change theory to describe the implementation process including a policy and procedure written as your agency would write one. This should be � page.
2) Policy & Procedure
� Within the body of the paper, describe the elements of HOW the policy and procedure was constructed. This is important as it will lay the basis of your intent for change. This should be � page
3) Appendix A: Policy & Procedure
Write out an actual policy and procedure as you would see on a nursing unit. Many different models may be used for this. This should be 2 pages.
Here are some articles you can use;
Article 1: Efficacy of alcohol-based hand sanitizer on hands soiled with dirt and cooking oil.
Authors; Picketing, Amy J., Davis, Jennifer, Boehm, Alexandria B.
Source: Journal of Water & Health. Sep2011, Vol. 9 Issue 3, p429-433. 5p.
Abstract: Handwashing education and promotion are well established as effective strategies to reduce diarrhea and respiratory illness in

countries around the world. However, access to reliable water supplies has been identified as an important barrier to regular handwashing in

low-income countries. Alcohol-based hand sanitizer (ABHS) is an effective hand hygiene method that does not require water, but its use is not

currently recommended when hands are visibly soiled. This study evaluated the efficacy of ABHS on volunteers’ hands artificially contaminated

with Escherichia coil in the presence of dirt (soil from Tanzania) and cooking oil. ABHS reduced levels of E. coil by a mean of 2.33 log colony

forming units (CFU) per clean hand, 2.32 log CFU per dirt-covered hand, and 2.13 log CFU per oil-coated hand NO significant difference in

efficacy was detected between hands that were clean versus dirty or oily ABHS may be an appropriate hand hygiene method forhands that are

moderately soiled, and an attractive option for field settings in which access to water and soap is limited. [ABSTRACT FROM AUTHOR]
Article 2: Alcohol-based hand rub and surgical site infection after elective neurosurgery: An intervention.
Authors: Saramma, Krishnakumar, Sarma, P.S.
Source: Neurology India. Jan2011, Vol. 59 Issue 1, p12-17. 6p. 3 Charts
Abstract: Background: Controlled studies on the effect of alcohol-based hand rub before and after each patient contact on surgical site infection

(SSI) among neurosurgical patients are scarce. Aim: To evaluate the effect of alcohol-based hand rub before and after each patient contact on SSI

after elective neurosurgical procedures. Setting and Design: Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and

Technology, Trivandrum, Kerala. An intervention study using a ‘before-after’ design. Material and Methods: Two 9-month study periods were

compared; between these periods, an infectioncontrol protocol incorporating an alcohol-based hand rub was implemented for a period of 3 months

and continued thereafter. Consecutive patients who underwent neurosurgery between January and September 2006 (control group, before protocol) and

between January and September 2007 (intervention group, after protocol) were included. Outcome measures included SSI rates, profile of

microorganisms and patient survival. Statistical Analysis: SPSS statistics version 17.0. Results: A total of 1,899 operated cases were reviewed.

The patients in the control and intervention groups were similar with regard to sex, age and type of neurosurgery. The surgical site infection

rates were 22 (2.3%) out of 974 in the control group and 14 (1.5%) out of 925 in the intervention group (P = 0.2). Patient survival
Article 3: Effectiveness of an alcohol-based hand hygiene programme in
reducing nosocomial infections in the Urology Ward of Binh
Dan Hospital, Vietnam
Authors: Kim V. Nguyen, Phuong Tran My Nguyen, and Stephanie L. Jones
Summary
Objectives: To determine the effectiveness of hand hygiene in a developing healthcare setting in reducing nosocomial infections (NIs). method
Prospective study measuring NI rates in a urology ward in Ho Chi Minh City, Vietnam, before
and after implementation of a hand hygiene programme with an alcohol-based decontaminant, and compliance rates of medical staff and carers with

hand hygiene using standardised observation sheets. Result: Incidence of NIs fell by 84%, from 13.1% to 2.1%, after implementation of the hand

hygiene programme. Extended-spectrum beta-lactamase production was detected in 38.2%�50% of Entero-bacteriaceae isolated from clinical samples.

Length of patient stay and cost to the patient for antibiotics were reduced after implementation of the hand hygiene programme. Conclusion: The

hand hygiene programme was effective in reducing incidence of NIs, leading to shorter inpatient stays and reduced treatment costs. Such

programmes with measurable outcomes can be implemented at minimal cost in developing health contexts and should be promoted in all healthcare

settings.
Article 4: Effectiveness of alcohol-based hand rubs for removal of Clostridium difficile spores from hands.
Authors: Jabbar U1, Leischner J, Kasper D, Gerber R, Sambol SP, Parada JP, Johnson S, Gerding DN.
Abstract
BACKGROUND:
Alcohol-based hand rubs (ABHRs) are an effective means of decreasing the transmission of bacterial pathogens. Alcohol is not effective against

Clostridium difficile spores. We examined the retention of C. difficile spores on the hands of volunteers after ABHR use and the subsequent

transfer of these spores through physical contact.
METHODS:
Nontoxigenic C. difficile spores were spread on the bare palms of 10 volunteers. Use of 3 ABHRs and chlorhexidine soap-and-water washing were

compared with plain water rubbing alone for removal of C. difficile spores. Palmar cultures were performed before and after hand decontamination

by means of a plate stamping method. Transferability of C. difficile after application of ABHR was tested by having each volunteer shake hands

with an uninoculated volunteer.
RESULTS:
Plain water rubbing reduced palmar culture counts by a mean (+/- standard deviation [SD]) of 1.57 +/- 0.11 log10 colony-forming units (CFU) per

cm2, and this value was set as the zero point for the other products. Compared with water washing, chlorhexidine soap washing reduced spore

counts by a mean (+/- SD) of 0.89 +/- 0.34 log10 CFU per cm2; among the ABHRs, Isagel accounted for a reduction of 0.11 +/- 0.20 log10 CFU per

cm2 (P = .005), Endure for a reduction of 0.37 +/- 0.42 log10 CFU per cm2 (P = .010), and Purell for a reduction of 0.14 +/- 0.33 log10 CFU per

cm2 (P = .005). There were no statistically significant differences between the reductions achieved by the ABHRs; only Endure had a reduction

statistically different from that for water control rubbing (P = .040). After ABHR use, handshaking transferred a mean of 30% of the residual C.

difficile spores to the hands of recipients.
CONCLUSIONS: Hand washing with soap and water is significantly more effective at removing C. difficile spores from the hands of volunteers than

are ABHRs. Residual spores are readily transferred by a handshake after use of ABHR.