A quality improvement project to standardise decontamination procedures in a single NHS board in Scotland

A project was designed to improve decontamination procedures in our hospitals. This included: improving skills with training provided within clinical areas, simplifying procedures to reduce variation and increasing access to decontamination products.

To make it easy for healthcare workers (HCWs) to do the right thing and for HCWs to be confident that they were doing the right thing.

A pre-intervention survey of 120 HCWs in 10 wards on three hospital sites identified variations in the products used, variations in precautions taken and deficits in HCWs' capabilities due to unmet training needs.

We streamlined the available products, provided an education programme and then undertook a second survey involving 133 HCWs in 12 wards.

Significant improvements were attained in the reported time taken to clean and disinfect (P < 0.0001) and in HCW capability (P < 0.0001) (reported training received); other improvements in the use of appropriate products and the use of personal protective equipment were evident. The key finding was that a large, previously unrecognised, unmet training need existed; only 44% of HCWs in the pre-intervention survey reported having received training on the topic.

The utility of a pre-intervention survey is critical to knowing whether any change becomes improvement and to set the priorities for change. By focusing on the process rather than the outcomes, greater improvements can be attained. The assumption that all nurses know how to clean is erroneous.