Community health centers often see patients with open wound infections that can become serious without proper treatment and prevention. A team of nurses, assistants, and observers at one health center conducted a quality improvement project to address wound infections by observing hand hygiene compliance and providing patient education. They utilized a PDSA cycle approach of planning interventions, implementing changes, analyzing data, and refining their approach. Key factors like hand hygiene, dressing procedures, patient knowledge, and available resources were examined to identify areas for improvement and reduce infection risks at the community health center.

1. Wound Infections in Community
Health Centers
Rachel Duffy
Phomolo Madome
Eva van Swaaij

2. Community Health Centers
“To reintegrate the traditional separation between
public health and personal health services by defining
health broadly and providing preventive, environmental
and outreach services as well as medical treatment in
one facility”
(Kark, S., Kark, D.)

3. Wound Infection
“Open injuries have a potential for serious bacterial
wound infections, including gas gangrene and
tetanus, and these in turn may lead to long term
disabilities, chronic wound or bone infection, and
death”
(WHO, 2012)

4. Wound Infection Problem Analysis
People Prevention
Nurses Knowledge
Patients
nurses
Assistants Lifestyle
Wound
infections
Appointments
Time Education
material
Dressing
procedure
Hand washing Dressings
Procedures Materials

5. Relevance Hand Hygiene
One of the most important factors in cross infections.
Compliance with hand hygiene and barrier
precautions remain suboptimal in all health care
settings and among all types of staff, and
improvement efforts frequently lack sustainability.
Despite the fact that hand hygiene and use of
barrier precautions are cornerstones of infection
prevention and control, they are practised with
varying degrees of rigour and compliance.

6. Quality Improvement: PDSA
Plan: Who? – Observer, Nurse, Patients
What? - Observation & documentation
Where? – Community health center
(patient education)
Do: The team executes planned activities for
change. Plan Do
(Data collection)
Study: Did data collection go right? Was the
necessary education given? Were proper
procedures followed?
Any problems encountered?
(Analyse the data)
Act Study
Act: Summarize what was studied.
Repeat test using suggestions given. Plan
for a new cycle if tests are successful.

7. Hand Hygiene Problem Analysis
People
Nurses
Patients
Assistants
Hand Hygiene
Time Handwash
station
Knowledge Availability
Custom of alcohol
Procedures Materials

8. Methods
Observer looking whether the nurse washes her hands
 Record hand hygiene compliance and quality
Positive Negative
Very little to no bias Expensive
Counts both opportunities for hand May not be very appropriate in an
hygiene and the action of hand understaffed setting
hygiene.
Can verify when hand hygiene was Compromising patient privacy
practiced
Hand hygiene quality can be assessed Staff members can change their
behaviours

9. Ethical Considerations
In undertaking our quality
improvement activity, we will take into
consideration and ensure all ethical components of nursing and
medicine are fully met. These include ensuring our quality
improvement activities has:
Social or scientific value Beneficence- an
Scientific validity obligation to do no Harm
and maximize benefits
Fair participant selection
Participants privacy will
Favourable risk–benefit
be maintained
ratio
throughout the study
Respect for participants
Informed Consent
Informed consent
Risk /Benefit assessments
Independent review

10. Discussion
Evaluation
Is our study:
Relevant Yes!
Evidence-based Yes!
Reliable Yes!
Reproducible Yes! Given a similar setting
Valid Yes!
Feasible Yes! With your kind
donations

11. References
Kark, S., Kark, D. Adopted from Kotelchuck, R., Lowenstein, D., Tobin, J.N. (2011) Community Health Centers
And Community Development Financial Institutions: Joining Forces To Address Determinants Of Health.
Health Affairs, 30, no.11 :2090-2097.
Larson, E., & Kretzer, E. K. (1995). Compliance with handwashing and barrier precautions. Journal of
Hospital Infection, 30. 88-106. Retrieved from http://dx.doi.org.dbgw.lis.curtin.edu.au/10.1016/0195-
6701(95)90010-1
Lynn, J., Baily, M., & Bottrell, M., et al. (2007). The Ethics of Using Quality Improvement Methods in Health
Care. Annals of Internal Medicine. 146(9. 666-673.
Meister, S (2011). QI tools, root cause analysis. Iowa department of Public Health. Retrieved from:
http://www.idph.state.ia.us/mphi/common/pdf/root_cause_analysis.pdf
Orb A., Eisenhauer L., Wynaden D. Ethics in qualitative research. JOURNAL OF NURSING SCHOLARSHIP,
2000; 33:1, 93-96. ©2001 SIGMA THETA TAU INTERNATIONAL. Retrieved from:
http://www.columbia.edu/~mvp19/RMC/M5/QualEthics.pdf
Patient Safety Curriculum Guide. Topic 7 Using quality-improvement methods to improve care. Retrieved
from http://www.who.int/patientsafety/education/curriculum/PSP_mpc_topic-07.pdf
Robichaud, T,. G. (2004). An innovative project to transform the acquisition and distribution of inventory
supply in an effort to lower procurement costs. College of nursing. The University of Arizona.
Varkley, P (2010). Medical Quality and Management. Theory and practice. American College of Medical
Quality. Jones and Bartlett Publishers. Sudbury, Massachusetts. Pg. 37.
WHO (2012). Prevention and management of wound infection. Department of Violence and Injury
Prevention and Disability.

12. Search Strategy
We didn’t need to look for new information, because
this is an overview and summary of all the work we
did before.

13. Collaboration Strategy
We divided this weeks presention into two parts-
Rachel worked on Ethical Theories and Flex related
ethics to our quality improvement issue. Eva began
working on the final presentation.