Term and Year
Nosocomial infections are among the most causes of infections on hospitals. In fact, nosocomial infects are the cause of some of most prevalent complications occurring to patients admitted in hospitals. Conservative estimates in the United States show that nosocomial infections are attributable to over two million infections in the country’s hospital. Estimates in the country further show that over ninety-thousand people die every year from nosocomial infections. In addition to the prevalence of the nosocomial infections and its effect on patient outcomes, there is also the aspect of the economic cost (Guggenbichler, Assadian, Boeswald & Kramer, 2011).
Estimates from the United States in 2000 placed the cost resulting from nosocomial infections at five billion dollars (Guggenbichler, Assadian, Boeswald & Kramer, 2011). In Germany, nosocomial infections require almost two and half billion Euros annually for treatment (Guggenbichler, Assadian, Boeswald & Kramer, 2011). The solution towards reducing the prevalence of nosocomial infections in patients who are hospitalized is through improving hand hygiene. Kamptf, Loffler & Gastmeier, (2009) found through their study that hand hygiene can a result in a 40% reduction in nosocomial infections. This is an argument that is corroborated by Mathur (2011) who argues for increased compliance with hand washing to reduce the prevalence of nosocomial diseases. The nursing focused plan entails the implementation of this solution through a change model. The element of the plan is to increase compliance with hand washing.
Change Model Overview
The John Hopkins Nursing Evidence-Based Practice Process highlights three tenets that are essential for professional nursing practice. The first of the three tenets is practice which refers to the basic element in all activities in the nursing profession (Newhouse, Dearholt, Poe, Pugh & White, 2007). The second of the three tenets is education. This element relates to gaining the requisite skills and knowledge in order to enhance their proficiency in clinical practice as well improve their competencies (Newhouse, Dearholt, Poe, Pugh & White, 2007).The third tenet is research, something that provides the nursing profession with new information and knowledge so that they can base their nursing practice on scientific evidence. It is recommended for nurses to use this model in facilitating change because change is more readily embraced by the hospital when it is the grounded in evidence evaluated rigorously using the evidence-based practice process (Newhouse, Dearholt, Poe, Pugh & White, 2007).
Practice Question
Step 1: Recruit Interprofessional Team
The planned intervention to solve the identified problem requires an interprofessional approach. Various stakeholders are required to ensure the success of the intervention and by extension the resolution of the problem. The stakeholders include the chief nurses in the various departments in the hospital, the head physicians, in these departments, and the hospital administrators.
Step 2: Develop and Refine the EBP Question
The PICO question upon which this change model is based is does hand hygiene among the staff in the hospital reduce the prevalence of nosocomial infections? The identified problem for the change model is the prevalence of nosocomial infections in hospitals. The intervention that characterizes the preferred solution is improved hand hygiene among the staff at the hospital. Current practices in the hospitals are characterized by low compliance hand hygiene. The desired outcome is a reduction in the prevalence of nosocomial infections.
Step 3: Define the Scope of the EBP
A study by Nangino et al., (2012) showed that nosocomial infections resulted in increased hospitalization and the cost of treatment. As reported by Guggenbichler, Assadian, Boeswald & Kramer (2011) the financial costs associated with nosocomial infections amounted to five billion in the United States. Additionally, nosocomial infections also result in negative patient outcomes.
Steps 4 and 5: Determine Responsibility of Team Members
Part of the stakeholders include nurses in charge of the various wards within the hospital. The nurses in charge will communicate the efforts of the change model at the department level among the nurses. The other stakeholders chief physicians who head various departments, for instance, chief of surgery. This group of stakeholders is responsible for spearheading the hand washing efforts among the physicians working in their departments. Hospital administrators also form part of the stakeholders. Their role entails the sanctioning hospital-wide policies towards the compliance with guidelines for hand hygiene. The hospital administrators are also required to sanction any resources required above the norm towards the implementation of the intervention.
Evidence
Steps 6 and 7: Conduct Internal/External Search for Evidence and Appraisal of Evidence
The appraisal of evidence relating to hand washing as an intervention for reducing nosocomial evidence produced both quantitative and qualitative evidence regarding the efficacy of this intervention. The appraisal also yielded guidelines and recommendations for hand washing. The research was based on peer-reviewed article, some of which were based on primary data.
Steps 8 and 9: Summarize the Evidence
Mathur (2011) reported the preventive role of hand hygiene in reducing nosocomial infections. This is an argument that is reminiscent of the findings by Kamptf, Loffler& Gastmeier (2009) that hospitals can reduce nosocomial infections by up to 40%. Even more recently, Fox et al., (2015) found a reduction in the nosocomial infection rates over a twelve-month period when hand washing was used as an intervention. This is which hand hygiene comes highy recommended as an intervention to reduce the infections (Kamptf, Loffler& Gastmeier, 2009; Mathur, 2011; Mehta et al., 2014 & Fox et al., 2015).
Step 10: Develop Recommendations for Change Based on Evidence
It is recommended to pilot a program to enhance hand washing in one unit in the hospital. This recommendation is based on the finding that hand hygiene can contribute to a significant reduction in the infections (Kamptf, Loffler & Gastmeier, 2009).
Translation
Steps 11, 12, and 13, 14: Action Plan
The piloting of the project will be in surgical wards. The employees assigned to this ward will be trained on the importance of hand washing, indications for hand washing, and proper hand washing techniques. Reminders will be placed appropriately in the wards. The piloting will be done over a period of one year. This is the period used by Fox et al., (2015) to determine the significance of the reduction in nosocomial infection rates owing to hand washing. However, process evaluation will be performed on a monthly basis, the interval in which the incidence rates will be tracked and reported. The results will be disseminated through progress reports and incidence reports.
Steps 16and 16: Evaluating Outcomes and Reporting Outcomes
The desired outcomes are reduced incidence rates of nosocomial infections on a monthly basis and the reduction of the prevalence of the infections when assessed annually. The outcomes will be measured through the normal tracking of the infections. However, the incidence rate will be reported weekly and average after a month. The results will be communicated to the stakeholders through progress reports.
Steps 17: Identify Next Steps
The implementation of the plan on a large scale requires the support of the heads of departments and the hospital administrators. Seeing that they are stakeholders in the implementation process, they will be required to initiate the plan into their various departments after it is sanctioned by the hospital administration. The intervention is very applicable to the facility in its entirety. All the hospital departments will implement initiatives to promote hand washing. To ensure the permanence of the implementation, the plan will be backed by hospital-wide policies with the support of the hospital administrators who are stakeholders.
Step 18: Disseminate Findings
The findings will be communicated hospital-wide through memos, staff meetings and through the newsletters. The findings will also be communicated externally through an article detailing the methodology and the findings which will be published in appropriate nursing journals.
Conclusion
Nosocomial infections have negative effects on patient outcomes. They also have severe financial impacts on health care. However, hand hygiene as an intervention has been shown to reduce the infection rates. Using the Johns Hopkins Evidence-Based Practice Model, this intervention will be piloted in the surgical ward with the aim of implementing it in the entire facility. The change is based on evidence-based research. The change will require the training of the health care team in line with the education tenet of the John Hopkins EBP process. This is in order to achieve a change in practice.
References
Fox, C., Wavra, T., Drake, D., Mulligan, D., Bennett, Y., Nelson, C., Kirkwood, P., Jones, L. and Bader, M. (2015). Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses’ hand washing. American Journal of Critical Care, 24(3): 216-224.
Guggenbichler, J., Assadian, O., Boeswald, M. and Kramer, A. (2011). Incidence and clinical implication of nosocomial infections associated with implantable biomaterials – catheters, ventilator-associated pneumonia, urinary tract infections. Hygiene and Infection Control, 6(1): doi: 10.3205/dgkh000175
Kamptf, G., Loffler, H., and Gastmeier, P. (2009). Hand hygiene for the prevention of nosocomial infections, Deutsches Arzteblatt, 106 (40): 649-655.
Mathur, P. (2011). Hand hygiene: Back to the basic of infection control. Indian Journal of Medical Research, 134(5): 611-620.
Mehta, Y., Gupta, A., Todi, S., Myatra, S., Samaddar, D., Patil, V., Kumar, P., and Ramasubban, S. (2014). Guidelines for prevention of hospital acquired infections. Indian Journal of Critical Care Medicine, 18(3): 149-163.
Nangino, G., de Oliveira, C., Correia, P., Machado, N., Dias, A. (2012). Financial impact of nosocomial infections in the intensive care units of a charitable hospital in Minas Gerais, Brazil. Journal of Intesive Care, 24(4):
Newhouse, R., Dearholt, S., Poe, S., Pugh, L. and White, K. (2007). Johns Hopkins Nurisng Evidence-Based Practice Model and Guidelines. Indianapolis. Honor Society of Nursing,
Sigma Theta Tau International.
