Part A
Hospital Acquired Infections
Health care system is a very dynamic field that changes periodically; the practices that were deemed to be the most effective a decade ago may be rendered less useful or obsolete in the present day care. The changes are basically due to changes in patient needs, the emergence of new technologies, improved science research findings that develop new care methods as well as changes in healthcare policies and regulations. For example in the United States, the increase in the size of an aging population means an increase in number of patients that will suffer from chronic diseases. This together with various healthcare policy reforms such as the implementation of the Affordable Care Act 2010 (ACA) means that healthcare organizations should adopt new patient care practices so that they can adjust to the current changes. One of the notable changes that have emerged in nursing care, science, and education in the recent past is the use of Evidence-Based Practice (EBP).
Evidence-Based Practice (EBP) is the careful, precise and well-thought-out use of the best and up to date evidence for decision making in patient care. Thus, in EBP, a decision made should be tailored for an individual patient and integrates the different nurse or physician clinical expertise together with available most excellent external medical and scientific evidence from systematic research. EBP also takes into consideration the patient values such as personal preferences, religion, and expectation in the process of decision making in patient care. For EBP, best research evidence is usually found in various clinical researches that have been carried out using scientifically approved research methodologies. The primary goal of EBP use in clinical care decision making is to enhance patient outcomes and improve the quality of life of the patients.
Many health care problems need the use of EBP to manage effectively; one of such problems is the hospital acquired infections also known as nosocomial or health care-associated infections. These are common complications that affect patients in hospital care; they refer to infections which are acquired in healthcare facilities and hospitals when patients are undergoing treatment (Agency for Healthcare Research and Quality, 2015). For an infection to be considered as HAIs, the patient affected should have been admitted to the hospital for conditions other than the disease in question. The patient should also have been free of any signs, either active or incubating of the infection at the time of admission to the hospital. These health care-associated infections typically occur in a period of up to forty-eight hours after patient admission to the hospital, up to three days after discharge from a hospital and up to a period of thirty days after an operation.
According to research that was carried out by the Centers for Disease Control and Prevention (CDC), it was found out that at any particular day; around 1 in every 25 admitted patients in hospital suffers from at least one healthcare-associated infection (Centers for Disease Control and Prevention, 2016). Annually, approximately more than half a million patients admitted to various healthcare facilities in the United States are infected with HAIs. These HAIs are a significant threat to the well-being and safety of the patient, although they are preventable, health care-acquired infections are responsible for high morbidity and mortality rates in the United States. They lead to lose of many lives every year, and it is also estimated that more than $30 billion dollars are incurred every year by the federal government and hospitals in medical care costs for HAIs patients.
HAIs are usually caused by fungal, bacterial or viral pathogens. Most hospitalized patients become infected with these diseases because their immune systems are often compromised; therefore, their bodies’ ability to fight off new infections is reduced. Those who are at a higher risk of HAIs are patients in the intensive care units (ICUs). The most common HAIs include infections that are associated with indwelling devices such as ventilator-associated pneumonia, bloodstream infections, surgical site infections and urinary tract infections that are linked to the use of catheters. According to the Centers for Disease Control and Prevention (2016), the diseases mentioned above account for approximately more than half of all the HAIs reported every year in the United States. It’s evident from various studies that HAIs prevalence in the United States is very high; this has serious financial implications as well as adverse impacts on the quality of life of patients. As such, there is a need to take necessary measures towards preventing and reducing its incidence.
Health care-associated infections have several adverse impacts on both the healthcare organizations and the individual patients affected. To begin with, the reputation of hospitals that have high incidence of hospital-associated conditions is normally tainted; this is because HAIs rates are used as a measure of quality of care of a hospital. Patients seeking care for various illnesses will always avoid such hospitals because they presume the quality of their care to be poor. Furthermore, such hospitals may face some financial challenges due to existing regulatory policies on reimbursements. In 2008, the Center for Medicare & Medicaid Services came up with reimbursement limits for patient care cost for diseases associated with some HAIs (Agency for Healthcare Research and Quality, 2015).As a result; many hospitals are now focused more on risk reduction of HAIs than before. Critical disabilities or deaths resulting from HAIs are considered to be sentinel events by the various health care professional bodies. The impacts of HAI on patients are enormous; one is that they may cause emotional stress to patients. In certain extreme cases; it may lead to disabilities in some functional parts of the body which reduce their quality of life or even cause death. HAIs patients are also forced to stay longer in hospitals, this impact negatively on patient satisfaction as well as increasing financial costs burden for patients which can either be direct or indirect for cases of lost work hours.
Part B
PICO question
P – Hospital acquired infection
I – Hand washing
C – Wearing gloves
O – Reduced infections
In addressing hospital-acquired infections amongst patients, (P) is hand washing (I) more effective than wearing gloves (C) in reducing the prevalence of infections in all units (O)?
Part C
Search strategy for literature review
Conducting a literature review is the most important part of any study or research; it guides the researcher in identifying what has already been done on a specific topic by recognized scholars. It also helps to identify any knowledge gaps that need to be addressed on that particular subject. The literature review search strategy I employed for this study was analyzing online databases on prevention of hospital-acquired infections. The first step of my literature review was to identify the keywords including their synonyms that were used in the research question. The keywords for this study were: hospital acquired infections, hand washing, gloves wearing and prevention & reduction of HAIs.
The second step was to narrow down my study to the particular online database that I would find both research and non-research articles and reviews. I chose PubMed online database because it comprises millions of biomedical literature citations ranging from online books to biomedical journals. To ease my search for relevant literature, I further narrowed down the limits for search based on the type of the publication, language, and year of publication. Therefore, my literature search was limited to articles published in the English language, either qualitative or quantitative research articles. Furthermore, since I wanted most recent articles with latest data and statistics on my research question, I limited my research to articles published between the years 2010 to 2016.
After conducting the literature research from the PubMed database, I found a total of 120 articles on my study topic. However, after further analysis and appraisal of the items through their respective titles, I found out that some of them were unrelated to my research question and therefore had to be discarded. The number of the discarded articles was 90, the remaining 30 articles titles and abstracts were further reviewed, and 18 did not meet the final criteria for inclusion and therefore were also rejected. Finally, the remaining 12 articles, with 8 being research articles and 4 being non-research articles were selected for a full-text review. A brief discussion of the investigation and non-research evidence sources that were considered to address the research PICO question were is as outlined as follows.
Bucher, J., Donovan, C., Ohman-Strickland, P., & McCoy, J. (2015). Hand Washing Practices Among Emergency Medical Services Providers. Western Journal of Emergency Medicine, 16(5), 727.
This article emphasizes the importance of hand hygiene as an element of reducing infections in healthcare units. This research study article objective was to establish rates of hand washing and also cleaning of stethoscope by emergency medical services (EMS) healthcare providers. The study carried out surveys via email in various emergency units of healthcare organizations. It was found out from this study that, hand hygiene of pre-hospital care providers in almost all clinical conditions was generally poor. The author of the article therefore, recommends that there is need to develop interventions in future that are aimed at enhancing hand washing by healthcare providers.
Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C., & Bader, M. K. (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.
Pfoh, E., Dy, S., & Engineer, C. (2013). Interventions to improve hand hygiene compliance: brief update review.
According to Pfoh, Dy & Engineer (2013), HAIs causes more than 80,000 deaths annually in the United States. However, such deaths should not be occurring because such conditions are preventable. This review article clearly shows that there is substantial evidence linking transmission reduction of hospital-associated conditions to hand hygiene. Many healthcare bodies such as the WHO, Centers for Disease Control and Joint Commission acknowledge that hand washing play a critical role in prevention of such conditions. Therefore, a healthcare organization should put measures in place that ensures their healthcare providers complies to hand hygiene practices wherever they provide patient care. Some of the interventions that can be used to enhance compliance include education increasing availability of sink and disinfectants such as alcohol-based solutions.
Agency for Healthcare Research and Quality. (2015). Health Care Associated Infections | AHRQ Patient Safety Network. Retrieved from https://psnet.ahrq.gov/primers/primer/7/health-care-associated-infections#
According to this article by Agency for Healthcare Research and Quality, HAIs are the most frequent complications in hospital care affecting more than 600,000 hospitalized patients annually in the United States. Furthermore, this article identifies hand hygiene as the cornerstone for prevention of such healthcare problems. Despite this prevention technique being known for many years, rating of hand hygiene among almost all clinicians is still low. This finding comes at a time where evidence has shown that there is a direct link between hand hygiene and lower rates of HAIs. Many hospitals are currently implementing strategies that aim at improving hand hygiene; they include traditional education on the importance of hand washing, better supervision of hand hygiene and socio-cultural approaches.
Part D
Evidence Matrix
Part E
Hand washing in prevention of HAIs
Healthcare organizations and associations such as ANA recommend that the present day patient care should be evidence-based. Similarly, management, control, and prevention of hospital-acquired infections interventions and practices should consist of evidence-based knowledge and practices. The interventions should also be up-to-date and utilize best available options for patient care to improve patient outcomes and also enhance the quality of life. From the reviewed literature presented in the evidence table, it is clear that there is no match for hand washing or hand hygiene in prevention of HAIs. The studies show that hand washing is an important patient safety practice. Therefore, nurses and other clinicians should embrace hand washing as standard practice within their health care organizations because it reduces rates of healthcare-associated infections significantly
According to Fox et al. (2015), their study to investigate new hand hygiene protocol in patient care among nurses in intensive care unit found out that there was a significant relationship between hand washing and rates of HAIs. The study was carried out for a period of twelve months, compared the rates of two major HAIs before and after the use of new nurses’ hand washing protocol. The two HAIs that were under study are catheter-associated urinary tract infections and central catheter-associated bloodstream infection (Fox et al., 2015). The results of their study showed that with new hand washing protocol, rates of the two infections reduced significantly. They concluded, therefore, that the hand hygiene protocol in intensive care unit was associated with a reduction of infections acquired at the hospital. Healthcare provider hands are the most common avenue through which disease-causing microorganisms are transmitted from one patient to another, to avoid this kind of transmissions clinicians should wash their hand with various hand hygiene products such as soap or antiseptic agents e.g. alcohols, iodine and chlorhexidine.
In comparison to wearing of gloves, hand washing is more effective in HAIs prevention than gloves wearing because of some reasons which include the integrity of gloves; type and quality of gloves materials are an important factor to consider in patient safety. Wearing gloves does not replace the need for hand washing, this is because some hand creams may make some types of gloves to become weak, as a result, may break during the process of patient care hence exposing the patient to infections. Thus, healthcare providers are advised to wash their hand thoroughly before putting on gloves. Secondly, changing gloves in between patient care may contaminate the hands of the care provider hence transmitting infection on to the next patient. It is recommended that nurses and physicians wash their hands with alcohol-based sanitizer after removing gloves. Moreover, gloves use protects caregivers from infections from patients, especially while providing care where contact with the blood of the patient is likely. Because of the above evidence, I would recommend that hand hygiene be adopted as a standard practiced for care in prevention of HAIs rather than giving priority to gloves.
Part F
Implementation process of hand washing intervention
The first step in implementing the above recommendation is by ensuring that there is a clearly defined policy regarding the same within the healthcare organization. Policies are very critical tools towards realizing change; they provide guidelines on how things done. For a policy to be successful in its implementation stage, it must involve all the relevant stakeholders during the earlier stages of designing. Carrying out a participatory policy design process, which gives every individual that will be affected by that policy an opportunity to contribute their opinions and concerns, reduces significantly the chances of that policy facing resistance when it comes to adoption and implementation. I would therefore involve the top management and leadership of the organization, including the organization managers. I will also involve the entire unit and departmental leaders, nurse managers, nurse assistant managers and all other staff so as to make sure that they are all aware of the expected changes in our organization. With their approval, the next step will be to provide detailed procedures of how to adopt the hand washing practice in the hospital setting.
Implementing a change process, especially within an organization comes with a number of challenges. In applying the hand hygiene intervention so as to reduce and prevent HAIs, the barriers I may encounter in the nursing practice setting are many. They include lack of information and awareness among the staff on the importance and benefits of hand hygiene in patient care, some nurses for example may not see the need for hand washing before putting on gloves due to lack of scientific knowledge of healthcare-related infection rates. Secondly, is the issue of the tendency of care providers forgetting to wash their hands due to insufficient time needed for hand hygiene and washing. Furthermore, lack of or inaccessibility to hand washing supplies such as sinks and other products, for example, antiseptic agents can be an enormous barrier to successful adoption of hand washing culture in our hospital.
In addressing the challenges and obstacles mentioned above, a number of strategies can be employed. On the issue of lack of awareness and information, education would be the most viable strategy. Nurses and other caregivers will need to be educated on the prevailing rates of HAIs and the importance of practicing hand hygiene in addressing the issue. It will be therefore imperative to recruit nurse educators within the organization to facilitate dissemination of the new hand hygiene guidelines and policies to all staff in the facility. Use of learning materials such as brochures, flyers, posters and pamphlets can be efficient means of sharing such information. Another strategy will be reducing the workload of care providers so as to address the issue of forgetfulness and lack of time. Most nurses forget to wash their hands due to large workload caused by nurse shortages, this challenge can be solved by increasing nurse-patient ratios and also putting hand hygiene posters in every patient room to remind all staff about hand washing policies. In order to effectively address the barrier of inaccessibility of hand washing supplies, the organization will have to set aside a budget to facilitate the placing of hand washing supplies such as cleansing agents’ dispensers and sinks in more accessible locations preferably outside every patient room so that caregivers can wash their hands before and after handling the patient. The indicator that would be used to measure the outcomes of the above recommendation is the reduction in the rates of HAIs.
Conclusively, HAIs is serious healthcare problem that affects the quality of life for patients. It also has serious adverse financial implications to both the healthcare facility and the patient. It therefore needs effective interventions for preventing it. Many researches show that hand washing practices in healthcare organizations is the most cost effective and efficient intervention for reducing and preventing it. As a result, many organizations have put up policies to that effect, however, in most cases healthcare givers do not comply with those hand hygiene policies. It is crucial to put strategies in place to improve compliance by healthcare workers and also developing a culture of hand hygiene practice.
References
Agency for Healthcare Research and Quality. (2015). Health Care Associated Infections | AHRQ Patient Safety Network. Retrieved from https://psnet.ahrq.gov/primers/primer/7/health-care-associated-infections#
Bucher, J., Donovan, C., Ohman-Strickland, P., & McCoy, J. (2015). Hand Washing Practices Among Emergency Medical Services Providers. Western Journal of Emergency Medicine, 16(5), 727.
Centers for Disease Control and Prevention. (2016). HAI Data and Statistics | HAI | CDC. Retrieved from http://www.cdc.gov/hai/surveillance/index.html
Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C., & Bader, M. K. (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.
Murni, I. K., Duke, T., Kinney, S., Daley, A. J., & Soenarto, Y. (2014). Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study. Archives of disease in childhood, archdischild-2014.
Pfoh, E., Dy, S., & Engineer, C. (2013). Interventions to improve hand hygiene compliance: brief update review.
