Quality Improvement on Improper Sanitary

Quality Improvement on Improper Sanitary/ Disinfection/ Sterilization 
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Quality Improvement on Improper Sanitary/ Disinfection/ Sterilization
Introduction
Health is a primary concern and need of any population. Healthcare organizations such as hospitals are places aimed at restoring the health of people. The healthcare setting should be designed to ensure the safety of patients and that of health workers. Proper sanitation, disinfection, and sterilization of the hospital equipment and surfaces are some of the measures that enhance acceptable and adequate healthcare services to community members (Mohapatra, 2017). Therefore, it is essential to address the issue of improper sanitary, disinfection, and sterilization in surgical wards in hospitals to ensure the safety of patients and improve the quality of patient care.
 In surgical wards, there must be proper sanitation, disinfection, and sterilization. Infection is a significant health risk in surgical wards in hospitals. Illnesses related to improper sanitation, sterilization, and disinfection is a challenge faced in many hospitals (Mohapatra, 2017). Achieving proper sanitation, sterilization and disinfection are essential in ensuring that surgical and medical devices do not transmit infectious diseases to patients and staff.  
Sterilization and disinfection of surgical devices play a critical role in preventing healthcare-associated infections. Indeed, substandard disinfection and sterilization of surgical instruments and reusable devices such as respiratory care equipment, endoscopic devices, and reusable hemodialysis devices still occur in many health organizations, resulting in healthcare costs infections (World Health Organization, 2016). Improving sanitation and the decontamination of the surgical devices enhances patient care quality and reduces the chances of infections.  
Quality change initiates reminders such as banners and sticker notes to ensure that healthcare workers maintain disinfection, sanitation, and sterilization procedures. Health care settings need to establish, maintain and document their policies and procedures for maintaining proper sanitation, sterilization, and disinfection in surgical wards (Sinha, 2020). The quality initiatives are vital in ensuring quality patient care and reduces healthcare costs.
Written policies and guidelines for reprocessing surgical devices and surfaces are critical in improving patient care quality. It is a shared responsibility of each person involved in a surgical ward to ensure that surgical equipment and surfaces are safe for use. Contaminated surfaces and devices must be cleaned and thoroughly disinfected, and sterilized according to the defined procedures that are acceptable and good for practice (Sinha, 2020). The written policies act as reminders of the importance of maintaining high standards in the surgical wards. 
The health risks from improper sanitary, sterilization, and disinfection result in increased healthcare costs. When a patient or a healthcare worker comes into contact with a surface that is not properly sterilized and disinfected, they are usually at risk of acquiring new infections. The health organization then incurs the cost of treating patients and staff members who get ill due to contamination. This then increases the healthcare cost for the organization.  
Improper sanitary, sterilization and disinfection in surgical wards is a critical health issue. Health care organizations must maintain high standards to ensure patient safety and staff members' safety and reduce healthcare costs. One means that can be used to improve sanitation, sterilization, and disinfection of surgical equipment in surgical wards is having written reminders such as banners and notes that emphasize the importance of maintaining high standards in the wards. In the following sections of this paper I will analyze the background and drivers for the quality improvement proposal, the proposal, a summary of key evidence, and an analysis of the leadership and management changes that will help implement the quality improvement proposal. 
Search strategy
Setting: The setting is a surgical ward in a hospital. Surgical wards require maximum levels of sterilization, disinfection and sanitation.
Outcome: The focus of the research is improper sanitation, sterilization and disinfection in surgical ward in a hospital and the possible drivers for quality improvement.
Factor: Need to improve sanitation, sterilization and disinfection in surgical wards to improve patient care and reduce healthcare cost.
People the people you are interested in: Medical and health care workers working in a surgical ward
Study design: systematic review of literature on improper sanitation, sterilization and disinfection and the drivers for quality improvement.
Search terms to exclude from search: improper sterilization, disinfection and sanitation
Publication date: March 21, 2021
Language: English
Geography: Glasgow University hospital
Databases used: peer reviewed articles, journals, books and other relevant material that emphasize the importance of proper sanitary, disinfections and sterilization in surgical wards.
Numbers of articles researched: 10
Background and drivers for the quality improvement proposal
Background 
 Health-acquired morbidity and health-associated infections are persistent issues in the health care system. Proper sanitation, good hygiene, and adequate drinking water are essential for optimum health. Controlling the microbiological load in hospitals is a vital component of hospital sanitation which can help reduce the rate of indisposition and the severity of various diseases. 
 The hospital environment can expose healthcare workers and patients to environmental pathogens and cause healthcare-acquired diseases. The provision of adequate sanitation and hygiene in health care facilities reduces the risks of infections and disease transmission (Mohapatra, 2017). Therefore, the hospitals must ensure that they have proper sanitation, sterilization, and disinfection measures to help protect the staff and patients from the risk of acquiring healthcare-associated infections and illnesses. 
In the United States, there are approximately 46.5 million surgical procedures conducted each year. There are even more invasive medical procedures carried out including roughly, 5 million gastrointestinal endoscopies done yearly. A majority of surgical procedures can result in contamination that can result in infections and other illnesses (World Health Organization, 2016). Failure to adequately sterilize and disinfect the surgical devices and surfaces puts healthcare workers and patients at risk for acquiring infections and diseases. 
Proper sanitation, sterilization, and disinfection are vital in ensuring that surgical and medical equipment and services do not expose patients and staff members to infectious pathogens (Mohapatra, 2017). The health organization management and leadership is responsible for ensuring that the health facility has proper sanitation, sterilization, and disinfection measures that help to prevent patient and staff infections and reduce the healthcare cost.
 Sanitation refers to general health conditions that relate to clean drinking water and sufficient treatment of waste. Healthcare generated waste management is a fundamental part of a hospitals' infection control and hygiene. Healthcare waste is a hub for various pathogenic microorganisms. If the waste management is inadequate in surgical wards, the organisms can transmit and increase the risk of infections among the healthcare workers and the patients. The water, hygiene, and sanitation (WASH) services is a World Health organization initiative that requires healthcare facilities to have proper sanitation to ensure patient and health workers' safety (Mohapatra, 2017). Therefore, surgical wards should have appropriate waste management procedures to reduce health workers' risk and patient infection. 
Sterilization and disinfection of surgical devices and surfaces are essential in ensuring that infectious pathogens are not transmitted to patients and healthcare staff. The sterilization process aims at destroying and eliminating the microbial life on surgical equipment and surfaces. The sterilization is carried out through physical or chemical methods. Disinfection describes the process of removing any or all pathogenic microorganisms (Sinha, 2020). Thus the disinfection and sterilization processes are a primary component of hospital control activities. 
Several infections and outbreaks have been reported in hospitals due to improperly disinfected and sterilized devices. A majority of the diseases are a result of the continuous use of contaminated endoscopes. Hence, effective sterilization and disinfection for surgical and medical devices are essential in healthcare facilities. The healthcare workers are responsible for ensuring that patients and offer staff members are not at risk of acquiring infections due to improper sterilization, sanitation, and disinfection. Currently, there is an increase in the frequency of new and drug-resistant pathogens in healthcare facilities (Sinha, 2020). Hence, laboratory technicians, health and medical personnel should have measures to improve sanitation, disinfection, and sterilization processes to reduce the risk of infections for patients and staff members. 
Drivers for the quality improvement proposal
Encouraging teamwork 
Improving patient and staff safety concerning the risk of infections requires the application of evidence-based practice. For example, healthcare-associated infections that arise from improper sterilization, sanitation, and disinfection processes, can be alleviated by medical and health staff members working in teams. Here, the two or more health care workers should cross-reference the procedures and chemicals appropriate for sterilization, disinfection, and waste disposal, such that before carrying out the decontamination procedure, they are aware of what they are doing (Rosen et.al, 2017).This imperative seeks to ensure that all the procedures are consistent with the sanitation, sterilization, and disinfection procedures.
 Health workers who are team players are more productive and effective. The sterilization and disinfection processes require keenness to ensure that all the infectious pathogens are killed. If these tasks are assigned to few individuals, the work can overwhelm them and thus produce poor results. To alleviate the risks of infections due to improper sterilization and disinfection, medical and health workers should be encouraged to work as a team. Teamwork reduces the monotony of work and increases motivation (Rosen et.al, 2017). Hence, health leaders should encourage staff members working in surgical wards to work as a team to ensure that all medical and surgical devices and surfaces are well decontaminated, and waste disposed appropriately to reduce the risks of infections.  
 Training and development 
Moreover, improving patient and staff safety regarding healthcare-associated infections entails staff education and training on how to manage medical waste, disinfect and sterilize medical and surgical devices and surfaces (Rosen et.al, 2017). The health facilities management is responsible for ensuring that healthcare workers working in surgical wards are well trained on proper sanitation, sterilization, and disinfection. 
Training includes cleaning, waste management, sterilization and disinfection, safety and occupational health issues, and infection control and prevention. Continuous education and orientation help remind the importance of maintaining proper sanitation, sterilization, and disinfection (Rosen et.al, 2017). The training programs also emphasize the importance of adequate sanitation, sterilization, and disinfection in promoting patient and staff safety and reducing healthcare costs.
Problem-focused strategies 
Healthcare-associated infection is a significant challenge in hospitals and other healthcare facilities. Chiang, Hsiao, and Lee (2017) maintain that using problem-focused strategies and stimulation of medication administration in controlled settings leads to alleviating medical errors by healthcare workers in hospitals. Therefore, the health facilities should develop strategies that will help ease the medical implications of improper sanitary, sterilization, and disinfection. 
The sterilization and disinfection procedures are precise, and a healthcare worker is responsible for cleaning, sterilizing, and disinfecting the medical and surgical devices should ensure that they follow the exact procedure and use the correct chemicals. To avoid a mix-up of the substances, can adopt the bar-coded medication administration (BCMA). The use of BCMA has been extensively promoted as one of the most effective ways of reducing administration errors in healthcare facilities (Chiang, Hsiao, and Lee,2017). Hence, to alleviate the problem of using the wrong chemicals during sterilization and disinfection processes, the health facility can adopt the mechanism of labeling all the chemicals and their intended purpose.  
Policies and procedures
The health care facilities should have their guidelines for sterilizing and disinfecting items based on their intended use of medical equipment and associated infections. The policies and procedures are established to ensure that the sterilization and disinfection processes follow infection prevention principles (Rosen et.al, 2017). The formulated principles are essential in ensuring that the right procedures are followed, and the healthcare workers exercise the appropriate measures that promote staff and patient safety. 
Also, the policies and procedures describe the responsibilities of management and staff. It is the responsibility of all medical and health workers to ensure patient safety and reduce healthcare costs (Rosen et.al, 2017). The policies emphasize the importance of maintaining proper sanitary, sterilization, and disinfection to ensure that patients and staff members do not face the risk of acquiring health-associated infections and illnesses. 
The policies and procedures also include documentation and maintenance of records for each component of the cleaning, sterilization, and disinfection process that are based on the manufacturer's recommendations and establish guidelines for the intended use of the product. The sterilization and disinfection processes of surgical and medical devices are specific to the manufacturer's instructions (Rosen et.al, 2017). Hence, a health facility can develop policies and procedures to ensure the staff follows the required procedure to reduce health-associated infections. 
Use of sticker notes and reminders
In the surgical ward, numerous activities entail patient care. The primary aim of healthcare facilities is to offer medical services to patients. People go to hospitals for treatment and not to acquire new infections. Hence, the medical and health workers should ensure that they offer quality patient care and reduce healthcare-associated infections (Dimitropoulos, 2017). Sticker notes and reminders are essential in reminding health care staff of the importance of maintaining proper sanitation, sterilization, and disinfection.
The sticker notes and reminders can demonstrate the cleaning, sterilization, and disinfection procedures. Medical and surgical devices require precision during cleaning, sterilization, and disinfection. Overworked healthcare workers can experience burnout and fatigue, and they might forget some essential cleaning steps. For instance, a doctor who has done several surgeries in a day can feel exhausted. When they are called in for an emergency operation, they might forget some of the safety procedures (Dimitropoulos, 2017). The sticker notes can play a vital role in reminding the doctor of the necessary safety precautions to ensure patient safety. 
Additionally, sticker notes and reminders help establish a new organizational culture and values that will enhance patient safety and help reduce healthcare-associated infections and illnesses. The sticker notes and reminders will act as reference points to maintain proper sanitation, sterilization, and disinfection in surgical wards (Dimitropoulos, 2017). The reminders and sticker notes will be vital in maintaining high standards of hygiene in surgical wards.  
Seminars and workshops 
In healthcare organizations, workshops and seminars play an essential role in reminding healthcare workers of the importance of maintaining high hygiene standards and cleanliness. Leaders and managers of a health organization can conduct seminars and workshops to train healthcare workers to maintain proper sanitation, sterilization, and disinfection (Rosen et.al. 2018). Hence, the seminars and the workshops can educate healthcare workers on the cleaning, sanitation, sterilization, and disinfection procedures that will ensure patient and staff safety and reduce healthcare costs.
 The seminars and workshops also help healthcare workers develop strategies that can help reduce patient and staff infections. Health-associated infection is a significant challenge faced by health facilities. One of the main goals of health facilities to reduce health-associated infections. The seminars can offer a platform where staff members and stakeholders can share ideas on how to solve the challenges of improper sanitation, sterilization, and disinfection (Sinha et.al, 2020). Hence, seminars and workshops are vital in developing problem-solving strategies.
Proposal and summary of key evidence
Study problem
Improper sanitary, disinfection, and sterilization in surgical wards can have devastating effects on the patients and healthcare workers. Surgical rooms are one of the riskiest and complex environments in a health facility. Therefore, healthcare facilities need to ensure that all the operating rooms' equipment and surfaces are well sterilized and disinfected. Also, the health facility needs to ensure that there is adequate waste disposal in the surgical rooms (Yazie, Tebeje and Chufa, 2019). Maintaining proper sanitation, sterilization, and disinfection in surgical wards enhances patient safety and reduces healthcare costs. 
Healthcare improper sanitary, disinfection, and sterilization in the operating rooms are some of the factors that pose risks to patient safety. In preventing healthcare-associated illnesses, policy changes, training and development, reminders, problem-focused strategies, teamwork, seminars, and workshops are of great significance. These measures will ensure quality improvement in the operating rooms and ensure maximum sanitation, sterilization, and disinfection (Bardowski et.al, 2018). Therefore it is essential for healthcare facilities to address improper sanitation, sterilization, and disinfection in the operating rooms.
Overall desired outcome 
Notably, addressing improper sanitary, sterilization, and disinfection in the surgical wards helps improve the quality of health care services. The primary focus of healthcare facilities is to offer quality patient care. One of the desired outcomes of quality improvement on improper sanitary, sterilization, and disinfection is to improve patient care quality. Medical and surgical devices that are not sterilized and disinfected properly expose patients to disease-causing pathogens (Gase, McMullen and Wright, 2019). Maintaining maximum levels of sanitation will reduce the risk of patients acquiring healthcare-associated illnesses.  
Also, quality improvement will protect healthcare workers' safety. In the surgical wards, the medical and healthcare workers are also at risk of acquiring healthcare-associated illnesses. The healthcare facility must ensure that th...