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Moulded Paper Pulp Medical Products and Paper Sheets in Dermatology Clinic

Healthcare Disciplines Project 
 
 
Introduction of Moulded Paper Pulp Medical Products and Paper Sheets to a Dermatology Clinic in New Delhi, India.
 
Aim(s) of the Project 
 
The aim of the project is to replace metal and plastic medical products and linen with moulded paper pulp (MPP) medical products and paper sheets in a dermatology out-patient department (OPD) in New Delhi, India, to lower risk of cross infection and to prevent hospital acquired infections (HAI).
 
Background to the Project 
 
Rationale
I am a general practitioner with a special interest in dermatology. I operate in one of the 10 outpatient clinics which form a polyclinic, in New Delhi, India. Each clinic within the polyclinic is run individually by doctors from other specialities. The medical and administrative resources are shared by all the doctors and decisions pertaining to the polyclinic are taken with the consensus of all the specialist doctors.
In my local clinic, I personally attend to about 40 patients in one day, out of which approximately 50% of the patients present with dermatological complaints. The most common skin disorders I encounter in my OPD are scabies, pediculosis capitis and p. corporis, tinea, varicella zoster and measles among others, which are all associated with overcrowding, malnutrition and poor sanitary conditions. Such patients and diseases carry the risk of cross infection either via droplets or by direct contact. Hence the prevention of spread of infection is of paramount importance in a dermatology out-patient clinic.
In my clinic in India, we use linen on medical examination beds and metal products for patient care such as kidney dishes, bed pans and urinals. The linen and the metal products are sterilised by autoclaving with no guarantee of adequate sterilisation as the autoclaving process is not supervised in the polyclinic. Although autoclaving is a well-established method of sterilising equipment and linen, it remains an outdated, time consuming and an expensive method of sterilisation.
I, therefore, plan to bring about a change in my work environment with the introduction of disposable MPP medical products and paper sheets for medical examination beds which will save time, lower the risk of cross infection and improve the reputation of the clinic.
Drivers
 

  • In my local clinic, linen and medical equipment is autoclaved, however, the quality of sterilisation is undetermined due to lack of proper supervision.
  • Linen and patient equipment are stored in an open room with hospital staff walking in and out of the room, leading to potential contamination.
  • Stubborn stains left on linen and medical equipment often due to inadequate autoclaving or improper handling, cause embarrassment to the clinic and doctors, affecting the clinical reputation of the medical practice.
  • The process of autoclaving requires usage of enormous quantities of water and electricity which increases expenses of the clinic.
  • The nurses and hospital staff involved in sterilising medical equipment and linen, are underutilised intellectually, thus lowering productivity and overall effectiveness of the workforce.
  • To create a clean environment for the patients and hospital staff.
Intended Project Objectives 
Short term

  1. To establish the need of replacing existing patient care equipment with a relatively new concept by an Indian perspective.
  2. To identify the presence of HAIs in the polyclinic.
  3. Collect data on utility, cost, procurement and disposal of the new MPP products in India.
  4. Share the vision of a fact-based change with all the specialist doctors renting space in the polyclinic.
  5. To take approval from the other doctors for introducing MPP products to the clinic.
  6. Form a project team to plan and implement the proposed change.
  7. Start negotiations with local MPP suppliers to secure best prices and value-added services such as disposal of waste.

Medium term

  1. To educate hospital staff about nosocomial infections so that the need for a preventive measure is understood and accepted.
  2. Project team will review deals with suppliers of MPP products and decide on the best option.
  3. To introduce MPP products and paper sheets into the dermatology clinic as a pilot for 2 months.
  4. Evaluate staff and patients views about the introduction of MPPs.
  5. To enlist services of an external medical laboratory to conduct nosocomial infection surveillance to monitor effectiveness of MPPs.

Long term

  1. Gradual phase out of linen and metal products after the trial period.
  2. Introduce a phased strict non-reuse policy of disposable products and monitor staff adherence.
  3. To show financial and clinical benefits resulting from the introduction of MPPs to the polyclinic.

Outcomes
Short term

  1. Establishing presence of nosocomial infection in the clinic and the inadequacy of autoclaving in preventing HAIs.
  2. All the doctors practicing out of the polyclinic, the administrative staff and the sourcing department accept the need to introduce the use of MPPS to the polyclinic.
  3. Formation of an active project team with representatives from all divisions of clinical practice and administration.

Medium term

  1. Enlisting services of an external medical lab to conduct tests on medical equipment in the OPD to monitor the effectiveness of MPPs.
  2. Development of local infection control guidelines to maintain cleanliness in the polyclinic.
  3. Educational programme for doctors, nurses and clinic staff teaching them about basic hygiene such as hand washing, personal protection, proper disposal of waste, prevalence of nosocomial infection and strict adherence to guidelines for preventing cross contamination of hospital equipment.
  4. Good infection control and positive feedback from patients
  5. Record increased patient satisfaction with cleanliness of the clinic.

Long term

  1. Reduction in the incidence of hospital acquired infections based on information collected from patients and evaluated clinically.
  2. Clinical staff have completed training and are adhering to local infection control guidelines
  3. Enhanced patient satisfaction and increase in number of patients booking in to the clinic.
  4. Enhanced reputation in medical community.
Broad overview of project plan  
Practical Steps:

  1. Getting support of all the doctors in the polyclinic to go ahead with a 2 months pilot using MPPs in the dermatology clinic by displaying the urgency to curb HAIs prevalent in the polyclinic with laboratory data and by showing how the new strategy will improve the existing infection control and cost management.
  2. Identifying and effectively enlisting the skills of doctors with the best practice or those who have the maximum number of patients attending their clinic, to influence other doctors to introduce MPPs in the polyclinic.
  3. Form a motivated team of individuals working in the polyclinic to actively control the spread of infection by adhering to infection control guidelines and aid in the effective implementation of MPPs.
Specific Success Criteria 

  1. Monetary benefit to the polyclinic due to reduced expenditure on water, electricity and labour previously involved in autoclaving.
  2. Improved productivity and effectiveness of work force as less amount of time would be spent in autoclaving and disinfection.
  3. Increase in the number of patients booking into the clinic due to an enhanced reputation of achieving better healthcare and disease outcomes.
Critical factors for consideration 

  1. Acceptance by doctors and administrative staff to bring about change.
  2. Inability of the team to sustain enthusiasm or to work together.
  3. Risk of clinical staff reusing disposable paper products for convenience.
  4. Availability of a local supplier and ability to negotiate a suitable price for new service.
  5. Access to easy/ cost effective method of disposing of used MPPs

Introduction
The aim of my project is to introduce moulded paper pulp products and paper sheets to my dermatology clinic in India. The purpose of doing so is to reduce incidence of cross infection and spread of nosocomial infections. The project also involves enlisting services of an external medical laboratory to monitor and analyse the extent of pathogens in the out-patient department and the efficacy of replacing metal or plastic medical products with MPP medical products. The project will serve not only the patients but will also protect the hospital staff from acquiring infections.
A review by Borkow & Gabbay in 2007, stated that several studies have concluded hospital textiles to be a source of infection and contaminated textiles can spread infection via direct-indirect contact or via the aerosol route. An analysis conducted by Gastmeier et al in 2005, of 1022 published HAI outbreaks from 1966 to 2002, reveals that medical equipment and devices made up 11.9% of sources of infection, with patients making up 25.7%, environment making up 11.6%, and staff contributing to 10.9% of the sources of infection in a hospital (Gastmeier et al, 2005).
Clostridium difficile is a major contributor of HAIs and the incidence of Clostridium difficile–associated diarrhoea (CDAD) has been on the rise. CDAD patients suffer from diarrhoea and frequently use bedpans. Such receptacles which come in contact with faecal waste should show no evidence of Cl. difficile spores on reprocessing. However, very little evidence is available to prove the efficacy of washer-disinfectors in the removal of Cl. difficile spores from the surface of reusable medical equipment such as bedpans.
One such study conducted by Alfa, Olson and Buelow-Smith, (2008) to assess the efficacy of washer-disinfectors (WD) in killing Clostridium difficile spores from the surface of reusable stainless-steel bedpans, plastic bedpans, and plastic urinals concluded that WDs do not provide adequate cleaning and are ineffective in killing Clostridium difficile spores.
Mounting evidence points towards the prevalence of nosocomial infections in outpatient departments and inefficiency of traditional methods of sterilizing equipment. In my clinic in India, the autoclaving process used to sterilise medical equipment is unsupervised and inefficient. The medical equipment has never been tested prior to or after autoclaving to assess the efficiency of the autoclaving process. Linen is stored in an unsterilized environment and stubborn stains have remained on the linen post sterilisation, causing embarrassment to the clinic. Hence, my proposal of introducing disposable moulded paper pulp products and paper sheets in the dermatology clinic would by-pass the process of sterilization and improve hygienic conditions in the OPD.
SWOT ANALYSIS:
SWOT is an acronym for strength, weaknesses, opportunities and threats originally introduced by Weihrich in 1982 as The TOWS Matrix. The SWOT tool is commonly used to strategise management projects. The SWOT analysis clearly points towards an organisation or project’s strengths and weaknesses and indicates the areas for improvement.
The SWOT analysis (Figure 1) of my project for introducing moulded paper pulp medical products and paper sheets to my dermatology clinic in India, revealed the requirement of enlisting services of an external medical laboratory for conducting surveillance of nosocomial infections to reinforce the need as well as successful implementation of MPP medical products to my clinic. The SWOT analysis of my project led me to revise my proforma as well as help me to strategically plan the steps of implementing my proposed plan.
Figure 1:  SWOT ANALYSIS of Introduction of moulded paper pulp medical products and paper sheets to the dermatology outpatient clinic in India.

Strengths 
1.Doctors managing the polyclinic are key decision makers, approval from senior management is not required.
2. Project is supported by research evidence hence procuring approval / funding from medical colleagues should be straightforward.
3.The polyclinic is small and introducing MPP products on a small scale should be easier to adopt, monitor or discard if project is ineffective.
4.Patients are educated, middle to high class individuals who are aware of medical trends and welcome the introduction of a more hygienic hospital environment.
5.MPP medical products and paper sheets are available in India hence are easy to procure.
Weaknesses 
1.Polyclinic is small and does not have an infection surveillance system in place to monitor infection control following introduction of MPP medical products.
2. Setting up a surveillance system will increase expenses and require recruitment of additional staff which may dissuade some doctors from approving use of MPP products for the clinic.
 
3.Polyclinic has few employees and most belong to a class of people who consider living in unhygienic conditions to be a normal part of life. They lack understanding of maintaining clinic hygiene which may prove to be detrimental when trying to introduce MPP products.
4. Hospital staff are ill-equipped and not trained to discern high-risk patients or their relatives who are possible carriers of infection.
5. High turnover of patients in out patient’s leaves less time to monitor and observe visitors, potential carriers of infection may go unnoticed and untreated resulting in an unintentional spread of infection.
Opportunities 
1.Very few hospitals in India have adopted MPPPs and paper sheets. Project success could set a precedent in India to introduce MPP products as a preventive measure against HAIs.
2.Project could enhance awareness about prevalence of nosocomial infections in outpatient clinics for staff / patients.
3.Clinic could establish itself to be a forerunner in use of MPPPs for the prevention of HAIs locally.
4.Enhanced patient satisfaction leading to an increase in number of patients booking in to clinic and increased revenue.
 
Threats 
1.MPP products are still new in India and not widely used.
2.High tolerance for unhygienic conditions (staff and generalpopulation)
3.Local manufacturers of MPPPs may close their manufacturing units dueto lack of buyers thus limiting supply.
 
 
 

Strategy Plan
A strategic plan is an organisation’s process of analysing their competency, determining objectives for future development and allocating resources to pursue the desired outcome.  Strategy planning for implementing MPP medical products to my clinic in India shed a light on lack of cleanliness and absence of an infection surveillance programme in my clinic.
My project’s strategy plan defines the problem of HAIs, determines a cost effective and time saving method of preventing spread of infection by replacing reusable medical products with disposable products and outlines steps to be taken to achieve the desired outcomes by creating awareness among the doctors and nurses, instilling good hygiene habits such as hand washing and introducing MPPPs and paper sheets to the OPD. The strategy plan gives accountability of time, funds and human resources being used to achieve the defined objectives with review of each step at regular intervals.

Figure 2: Strategy Plan      
Outcome Issue Strategy Tactics Evaluation
Establish presence of nosocomial infections in OPD. Designate potential high-risk infection areas in OPD such as door knobs, hand rails, bed sheets. Visit hospitals successfully following an infection control programme to learn from them. 
Use facilities and team of another hospital with established infection control unit or an external lab to conduct HAI surveillance in the polyclinic.
Establish payment plan for services of external lab.
Testing of pre-and-post autoclaved bed pans, urinals, kidney dishes and bedsheets Analyse monthly scientific data collected by external lab and focus on areas with highest presence of microbial flora on laboratory testing.
Approval granted for introduction of MPP products and paper sheets to the clinic on a trial basis Forming a project team of doctors, nurse and hospital administrative staff that collates information gathered from the external lab on HAIs in the clinic. 
Appoint a team leader who oversees all activities of the project.
Submission of evidence proving the presence of HAIs in the clinic and the ineffectiveness of autoclaving. 
Project team coordinates with supplier of MPPPs.
Circulating approval document for introduction of MPP products and paper sheets to all the OPD specialist clinics and administrative staff. 
Project team ensures adherence by doctors, nurses and staff to non-reuse of disposable products.
Request doctors and clinic staff to give suggestions and feedback for improving hygiene in the clinic.
Introduction of MPP medical products and paper sheets to dermatology clinic Project team coordinates with local supplier of MPP products and paper sheets and establishes cost of procurement and disposal Implementation of MPP products and paper sheets in dermatology clinic as a trial to establish the benefits of MPPs. Comparing cost of using MPPs with water, electricity and labour expenses incurred by the clinic prior to introducing MPPs Lab testing of MPPs for microbial flora 
Establishing cost effectiveness of MPPs
Establishment of local infection control guidelines Project team enlists the help and guidance of a microbiologist and other specialist doctors in the clinic to formulate a guideline. Follow national & international guidelines for infection control and incorporate points relevant to local clinic. Share the guidelines being followed in the polyclinic with other hospitals and seek their recommendations for improvement. 
Ensure strict adherence to local guidelines.
Continuous update of guidelines
Educational programme for doctors, nurses and clinic staff teaching them basic hygiene such as hand washing, personal protection, proper waste disposal, prevalence of nosocomial infection and strict adherence to local guidelines for preventing cross contamination of hospital equipment. Appointing a continuing medical education(CME) coordinator to conduct relevant teaching programmes. Conduct additional CME activities involving doctors and hospital staff, for e.g. “hand washing week”, to create awareness. 
The project team in collaboration with CME coordinator conducts training programmes in correct handling and disposal of waste products and single-use medical devices, for doctors and hospital staff.
Incentives and rewards for participation in CME activities for e.g. free scientific reading material, snacks and drinks. Ask each specialist doctor to give a talk every alternate month about spread of infection in their clinic, measures being taken to reduce cross-infection and the results of those measures.
Improve patient satisfaction Appoint administrative staff to formulate feedback questionnaires. Highlight better hygiene and infection control following introduction of MPPPs with fliers and posters. 
Reduce waiting time for patients in waiting areas.
Enhance social media interaction between the clinic and patients. 
Ensure change of paper sheet on examination beds for every patient.
Identify number of new patients booking in for clinic appointments.

Operational plan
The operational plan for introducing moulded paper pulp medical products and paper sheets to the dermatology clinic is a layout of the steps that will be taken by the project team to achieve the goals described in the strategic plan, within a specified time-frame.
The operational plan (Figure 3), begins with establishing requirement of MPP products, gaining subsequent approval for introduction of MPP products and paper sheets to the OPD on a trial basis and formation of a task force or project team. The project team will enlist paid services of an external lab to perform necessary tests to determine presence of HAIs and to continue monitoring the reduction in microbial flora following introduction of MPP products, as such a facility is unavailable in my clinic.
The first leg of the project will be initiated in February 2018 and successful initiation of MPP products to the OPD is expected to be completed by December 2018.
FIGURE 3: Operational plan

Objectives Actions Targets Accountability Timeline
Establishing requirement of MPP products and paper sheets in the OPD. -Approval from doctors in the polyclinic for enlisting paid services of an external lab to conduct nosocomial infection testing of bedpans, urinals, kidney dishes and linen being used in the OPD. -Establish presence of nosocomial infections in the OPD. Myself July, 2018
Introducing MPPPs and paper sheets to the OPD -Approval from doctors in the polyclinic for introducing MPPPs and paper sheets to the OPD 
-Formation of project team that obtains funds from the finance department, coordinates with the supplier of MPP products, establishes a waste disposal method with the supplier of MPPs, procures MPPPs and paper sheets, ensures proper usage and disposal of MPPPs, ensures adherence to guidelines and non-reuse of MPPPs.
-Acceptance of proposed plan to introduce MPPPs to the OPD 
-Statement of approval of proposed plan circulated to stakeholders including administrative.
– MPPPs and paper sheets being used with ease in the OPD
-Marked, improvement in hygiene levels in the OPD
Project team November, 2018
Educating doctors, nurses and administrative staff -Appointing a CME coordinator -Interactive, educational activities initiated in the polyclinic which emphasise personal and environmental hygiene as well as prevention of spread of infection in a hospital environment CME coordinator July, 2018
Patient perspective -Assigning administrative staff to interact with patients either directly or via social media -Active social media participation of administrative staff with patients 
-Polyclinic website operational
Project team December, 2018

Gantt Chart
The Gantt chart was designed by Henry Gantt in 1910. It is a visual depiction of the timeline of the intended project. The Gantt chart (Figure 4) for introducing moulded paper pulp products and paper sheets to the OPD depicts the individual tasks which need to be started and completed in a specified time with considerable overlapping to show that many tasks would be carried out simultaneously.
FIGURE 4: Gantt Chart(Gantt, H.,1910)

Task Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan
Approval from doctors and administrative staff
Assessment of cost
Formation of teams
Enlisting paid services of external lab for detecting microbial flora
HAI surveillance
Research, Procurement of MPP products
Introduction of MPP products and paper sheets
Patient perspective and follow-up on improved hygiene

Leadership Approach
I have a vision of implementing infection control measures and improving the cleanliness in my clinic in India by the end of 2018. The steps I plan to take are backed with evidence based on scientific research. My modus operandi as a leader would be of a visionary who leads people towards a shared cause, a coach who guides people to recognise their strengths and weaknesses, an affiliative leader who creates harmony in the workplace and encourages communication and interaction, a front runner who sets the pace for attainment of goals by giving clear directions and lastly a democratic leader who considers other viewpoints (Goleman, Boyatzis & McKee, 2001).
As a leader I plan to share my vision with my team members and colleagues, requesting their approval to introduce MPP medical products and paper sheets to my clinic to reduce incidence of HAIs. My efforts would lie in galvanising my team members to work towards a shared cause, encourage equal participation of every member, encourage communication and teamwork and to mould individuals for future projects. My project can be achieved only with team effort and my focus would be to collaborate with each member of the project team, strengthen bonds between team members and urge every individual involved in the project to keep in sight the long-term benefits of controlling hospital acquired infections.
I believe the benefit of implementing MPP products and improving cleanliness in my clinic will outweigh the financial constraints which my proposed project may face. I believe this small yet valuable step my clinic takes towards nosocomial infection control will pave the way for the rest of the country towards better hygiene control.
Team Considerations
In my opinion, people are the most important assets of an organization. My project involves coordination and cooperation between all the departments in the polyclinic hence forming a team which has a representative from each department would reduce time spent on reworking ideas as well as hasten decision making. I would therefore like to put together a cross functional team of people from different specialties who will bring with them a diverse range of ideas. The teams would be led by a project manager or core team leader.
I would bring in team members based on their skills which can contribute to the project, their competency in their respective field, their willingness to function effectively and responsibly in a stressful, time bound project, their ability to adapt proactively and engage for speed and conviction in decision making and lastly to be able to deliver reliably. Each member would be utilized based on expertise they bring to the project, while working in a collaborative environment. Each individual member would be answerable to the team leader as well as to their respective department heads. My aim is to successfully launch moulded paper pulp medical products and paper sheets to the dermatology out-patient clinic with the joint effort of a team of individuals from different medical and administrative backgrounds.
My approach towards team building would initially be to speak with each team leader individually, share my vision with them, assess their capabilities and address any concerns they may have before they join. Subsequently, I would encourage the team leader to develop an open communicative environment within the team, to acknowledge and applaud individual as well as team achievements and to resolve conflicts amicably and swiftly.
My emphasis would be on communication and frequent meetings of all team members which forms the basis of collaboration while keeping them aligned with the overall goals of the project. I would encourage the project team to participate in extracurricular activities together and to celebrate every positive accomplishment or milestone in the project plan so that the enthusiasm to continue working towards the project does not wane. I hope to see my team leader instilling a sense of accountability or ownership of tasks in the team members.
Conclusion
As defined in my strategic and operational plan, the role and contribution of every member to the project plan would be clearly defined at the start of the project planning. Every individual would be accountable for their task and would be aware of whom to report to. The operational plan defines the line of communication between the teams while decision making would be held jointly. Progress of the project plan would be assessed by measuring performance of each team member and in accomplishing a task within the assigned time frame. Periodic weekly evaluations with the team leader and monthly meetings with all members will be conducted to determine progress of project plan. The aim of my project is not just to launch MPP medical products but to also create a conducive, positive environment to promote healthy communication and to continuously evolve as a leader and a team player.
Prospective Evaluation Strategy to introduce moulded paper pulp medical products and paper sheets to a dermatology clinic in India.
Evaluation strategy assesses progress of a project while casting a light on the project’s strengths, weaknesses and cost effectiveness (Taylor, Purdue, Wilson & Wilde, 2005). Evaluation is an ongoing continuous process to check overall achievement of planning, organising and control of a project as well as appraising the likelihood of a project attaining its desired outcome in a specified time frame (Cleland,1985).
My project aims to reduce cross infection in my clinic by replacing reusable kidney dishes, bedpans, urinals and linen with disposable MPP products and paper sheets.
I propose to establish presence of HAIs in the polyclinic, collect data on utility, cost, procurement and disposal of the new MPP products in India, form a project team to plan and implement the proposed change, negotiate with local MPP suppliers to secure best prices and value-added services such as disposal of waste, educate hospital staff about nosocomial infections so that the need for a preventive measure is understood and accepted, and introduce MPP products and paper sheets into the dermatology clinic as a pilot for 2 months. I plan to outsource HAI surveillance services from an external laboratory to monitor effectiveness of MPPs, implement a phased strict non-reuse policy of disposable products, ensure staff adherence and exhibit financial and clinical benefits following introduction of MPPs to the polyclinic.
I would consider my project to be successful with establishment of adequate infection control and infection surveillance, increased patient satisfaction due to cleanliness of the clinic, reduced incidence of HAIs based on information collected from patients and evaluated clinically and well-informed doctors, nurses and clinical staff regarding basic hygiene and prevalence of nosocomial infection with strict adherence to guidelines for preventing cross contamination of hospital equipment. A successful trial of MPPs and paper sheets should result in all clinics in the polyclinic replacing linen and metal bed pans, urinals and kidney dishes with disposable MPP medical products and paper sheets.
Measuring Progress
Many events can unhinge a project during the planning and execution stage such as mismanaged budget, poor team dynamics, loss of enthusiasm among team members, and bureaucracy. To determine or to measure success of a project, it is critical to produce indicators of success which may be metrics that propose a high probability of success or those which reflect the present days performance. A balanced view of such leading and lagging indicators produces the best chance of success of a project (Pozin,2012).
The following table (Figure 5), measures progress of my project by forming a link between outcomes, indicators and data collection methods.
FIGURE 5: Linking outcomes, indicators and collecting data methods

Expected Outcomes Timing Actions Indicators of success Data Collection Method
Approval of doctors Short Term Prepare focus group meeting of doctors in polyclinic to establish need for replacing reusable medical products with MPP medical products and to outsource infection surveillance in the clinic from an external lab. 
Focus on improved hygiene, cost effectiveness and prospective increase in revenue generation from more patients visiting the clinic due to improved cleanliness and hygiene.
Written approval for joint funding of project. 
Support of clinic doctors
Laboratory analysis of pre- and-post autoclaved medical products being used in the clinic. 
Cost of procurement and disposal of MPP products and paper sheets.
Comparative analysis of present cost of water, electricity and labour involved in autoclaving with cost of using MPPs.
Establishment of local infection control guidelines. Medium Term Project team coordinates with clinic doctors to     establish local infection guidelines. Written guidelines for infection control with written statement by all doctors for strict adherence. Scientific research papers 
Seek guidance from other clinics with established infection control guidelines.
Awareness of nosocomial infections and their prevention Medium Term CME coordinator organises educational programmes for doctors, nurses and administrative staff Adherence by doctors, nurses and administrative staff in maintaining hygiene and non-reuse of disposable medical products Observation by project team 
Lab analysis of high-risk spots such as hand rails, examination beds, door knobs for microbial flora
Introduction of MPP medical products and paper sheets to dermatology clinic Medium Term Project team coordinates with MPP supplier and establishes cost of procurement and disposal. Good relationship with the supplier. 
Improved hygiene and cleanliness.
Decreased expenditure on water, electricity and labour.
Improved aesthetic appearance of clinic.
Observation by project team. 
Before and after photographs of the clinic.
Past and present water, electricity bills.
Invoices for MPPPs and paper sheets.
Increased revenue Long term Project team shares invoices of MPPs with accounts section of the polyclinic. Decreased expenditure on water, electricity and labour. 
More patients booking into the clinic.
Improved patient satisfaction.
Previous months financial report. 
Comparison with revenue generated in previous months before implementation of MPPs.
Feedback questionnaire from patients.
Improved reputation of clinic and recognition as a pioneer of innovative, cost-saving method to reduce HAIs. Long term Seek recommendations from other hospitals and clinics with established infection control and surveillance. Recognition and accolades from medical community. Feedback from patients, peers, other medical establishments. 
Surveys, market research.

Dissemination Plan
Dissemination is the process of sharing information on progress of a project with an audience which is affected by the outcome of the project directly or indirectly. Dissemination demonstrates commitment and accountability of the people involved in implementing a project.
Dissemination of evaluation findings of my project will demonstrate, benefits of increasing awareness of nosocomial infections, benefits of improving overall hygiene in the clinic and usefulness of introducing moulded paper pulp products and paper sheets to the clinic. Dissemination of my project’s evaluation will make other doctors in the polyclinic aware of the progress being made to implement the project and will provide an account of the resources being made available for the project. Sharing of information on usefulness of disposable medical products with other clinics and medical establishments will set a precedent for improving hygiene and cleanliness in an otherwise over polluted city.
There are many methods of dissemination of evaluation findings such as meetings, conferences, audio/video content sharing, social media, website and written publications. The following table (Figure 6), adapted from John Hopkin’s Nursing Evidence-Based Practice Dissemination Tool (2017), illustrates methods of disseminating information about my project to relevant people in the clinic and community.
FIGURE 6: DISSEMINATION OF EVALUATION FINDINGS

Audience Key Message Communication Method
Interdisciplinary Stakeholders 
(Doctors)
Improved cleanliness, increase in revenue, growing patient satisfaction Written reports on progress, internal newsletters
Organizational Leadership 
(Project-team leaders)
Project plan-successes/loopholes, adherence to local guidelines by doctors and nurses, expenses incurred-necessary/undesirable, relationship with supplier Internal meetings, audio/video presentations, emails,
Departmental Leadership 
(CME coordinator, Microbiologist, Nursing Head)
Improved hygiene and cleanliness in clinic, adherence to local infection control guidelines including hand-washing and non-reuse of disposable products, improved awareness on nosocomial infections and general cleanliness Podium presentations, online presentations, poster presentations, CMEs
Frontline Staff 
(Project team members, nurses, administrative staff)
Adherence to local infection guidelines, adherence to strict non-reuse of disposable products, proper storage and disposal of MPPPs and paper sheets, protection from theft of MPP products and paper sheets Internal meetings, audio/video content sharing
External Community 
(Patients, other clinics and hospitals)
Improved hygiene and aesthetic appearance of clinic, pioneering use of disposable MPP medical products and paper sheets to reduce incidence of cross infection Written publications, posters, presentations, social media broadcasting, scientific journals

EXECUTIVE SUMMARY
My project aims to introduce moulded paper pulp medical products and paper sheets to the dermatology clinic in India where I work to create awareness of nosocomial infections, introduce methods of reducing cross infection, inspire local clinics and hospitals to adopt infection control measures and encourage patients to expect hygienic clinical environments.
The project’s objectives of replacing reusable clinic equipment with newer, improved and cost effective disposable products, were formulated with the approval of other doctors in the polyclinic. Project team was selected for the qualities and skills possessed by each member along with their willingness to accomplish the desired outcome in a specified timeframe. A SWOT analysis of the project highlighted deficits in the project such as lack of infection control surveillance in the clinic, yet it paved the way for the clinical team to consider outsourcing services of an external laboratory to perform tests in the clinic to sample microbial flora on equipment, clinic rooms etc.
The formulation of a strategic and operational plan gave direction and clarity to help introduce MPPs to the clinic which will be high on my agenda when I return to clinical practice. The time frame was set for each task using a GANTT Chart to achieve maximum impact as well as to maintain enthusiasm among the key stakeholders involved in the project while an evaluation plan outlined progress of the project.
A dissemination plan is planned that includes sharing of progress reports, presentations, social media broadcasting and scientific journal publications with key stakeholders and external community that will showcase the benefit of using disposable equipment in clinical areas for better hygiene in the clinic and patient community.
My intended project of introducing moulded paper pulp medical products and paper sheets to the dermatology clinic in India as part of the Health Discipline Project module has compelled me to observe and compare medical practice being followed in UK and India. I observed MPPPs and paper sheets being used routinely in hospitals in UK and I hope to introduce the same to my clinic in India. The HDP module assignment has necessitated reading about project management and I hope to utilise this knowledge to implement changes in my clinic and community.
The masters course in clinical dermatology has enhanced my understanding and grasp on dermatology, improved my communication skills and academic writing, introduced me to kind, respectful, mature and skilled tutors, made me reflect on my medical practice and has given me an opportunity to observe good medical practice being followed in UK. I aim to introduce these aspects of my experience to enhance my interaction with people as well as my clinical practice.
REFERENCES:
Alfa, M. J., Olson, N. and Buelow-Smith, L. (2008). Simulated-use testing of bedpan and urinal washer disinfectors: Evaluation of Clostridium difficile spore survival and cleaning efficacy. American Journal of Infection Control36(1), 5-11.
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