Healthcare Paper on Associated Infections: An Intervention Proposal

Introduction

Patient safety is one of the biggest concerns of healthcare practice across the globe in the contemporary times. Healthcare facilities are tasked with the responsibility of not only making patients well but also ensuring that they are safe within the facility. As such, nurses and other healthcare providers have a dual responsibility, which requires multidisciplinary approach to problem solving to be addressed. Healthcare associated infections are some of the most common patient safety risks in healthcare facilities today. Outcomes associated with hand hygiene, healthcare associated infections and microbial stewardship continue to plague the safety of patients, costing healthcare facilities both clinically and financially. Each year, the healthcare industry incurs costs above $9.8 billion dollars in caring for patients suffering due to healthcare associated infections hence the need for addressing the issue of HAIs in healthcare. The objective of the present study is to explore the role of nurses in HAIs and to provide a strategy that nurses can use to reduce healthcare associated infections.

A blue print for NCLEX – RN centered on four thematic areas and other examinations was provided by The National Council of State Boards of Nursing (2018). One of these areas is the assurance of a safe and effective care environment. Reduction of healthcare associated infections is directly linked to the assurance of a safe and effective care environment as one of the tenets of patient safety in the healthcare environment. Preparedness in handling emergency situations in healthcare safety is one of the practices that could help in controlling HAIs and enhancing patient safety and care effectiveness. Any healthcare facility would need to reduce the prevalence of HAIs by putting in place preventive measures and being prepared for unprecedented outcomes in this area. The impacts of HAIs in terms of re-hospitalization, prolonged hospital stay, financial and social burdens warrant consideration of strategies for controlling patient safety issues. Without addressing the concern of healthcare associated infections, it will be impossible to control re-hospitalization, multiple morbidity and financial strains resulting from infections at the healthcare facility.

Patient Population

In the year 2011, HAIs were reported to be common in acute care healthcare settings than in other setting (CDC, 2016). According to the CDC, the prevalence rates for healthcare associated infections have reduced significantly over the years due to the preventive measures taken by different healthcare organizations. In acute care hospitals, the most common HAIs occur on sites associated with pneumonia, gastrointestinal illnesses, urinary tract infections, primary bloodstream infections and surgical infections among others. Pneumonia is associated with the highest percentage of healthcare associated infections among conditions for which people are admitted into acute care facilities. The distribution of HAIs in healthcare settings indicates the need for prevention of HAIs from the same settings and also portray that the population most at risk of HAIs are those in acute care. Individuals suffering from pneumonia are most at risk of HAIs followed by individuals who have undergone surgery. The third most at risk population comprises of those with gastrointestinal illnesses followed by those with urinary tract infections. Among those in acute care settings, those with blood stream infections are least at risk of HAIs (CDC, 2016).

Proposed Solution

More than 75,000 patients die as a result of HAIs in hospital settings. There were reportedly more than 722,000 cases of HAIs in the U.S in 2011 although more than 70% of the infections are preventable (CDC, 2016). Prevention of such infections is possible with the input of all the stakeholders of healthcare service provision. Nurses, clinicians, quality improvement groups and public health personnel all need to collaborate for the prevention of HAIs to be effective. According to Collins (2008), prevention of HAIs requires an understanding of the different causes of the conditions that result in such infections. One of the major causes of healthcare related infections is lack of hand hygiene in the healthcare setting. Other causes include disregard for personal protective clothing, understaffing and absence or ignorance of strategies for monitoring compliance to practices.

Based on the causes of HAIs, the proposed solution entails using a combination of approaches that require collaboration across different healthcare disciplines. Nurses and nurse leaders have a role to play in ensuring that hygienic conditions are maintained within the healthcare facility. The proposed solution thus involves the formulation of a healthcare hygiene policy, which provides stipulations for hand washing routines, compulsions for complying with the use of personal protective clothing and a routing for monitoring compliance to the stipulated rules and regulations. The strategy for implementing this solution would begin with creating awareness among healthcare facility nurses and subordinate staffs who contribute to hygiene. Following the creation of awareness, the policy would be developed by a select committee comprising mainly of nurse leaders and a few professional nurses in the healthcare facility. The next process would involve training of nurses and other practitioners on approaches for enacting the proposed solutions and documentation of the recommended practices as they are implemented. Efficacy of the proposed solution will depend on the willingness of the participants to play their roles effectively, and this is tied to the level of understanding of stakeholder roles in the organization.

While playing their roles in preventing healthcare associated infections, nurse leaders have the imperative of ensuring that patient safety is attained. Their role is to incorporate ethical values in patient management to foster the management of patient safety. According to Kangasniemi, Vaismoradi, Jasper & Turunen (2016), ethically sensitive patient safety provides a strategy for sustainable practice which preserves the dignity and humanity of all healthcare stakeholders. There are various underlying values of ethical patient safety discussed by Kangasniemi et al. (2016) including: trustworthiness, human dignity, individual safety, utilitarian safety and accountability among others. The nurses applying the proposed preventive measures for HAIs have to put these values into consideration while making decisions in relation to patient safety. Human dignity is considered the ultimate guide for patient safety and those implementing measures for the prevention of HAIs have to put it before every other measure of safety compliance.

Goals

Implementing the proposed solution will be aimed at ensuring that a long term solution for HAIs is established. To accomplish this objective, the following will be the long term and short term goals for the implementation of the solution.

Long Term and Short Term Goal

The long term goal for the proposal will be to establish an organizational culture that supports hygiene and compliance to protective clothing wear as the tenets of patient safety and protection.

The short term goals for the solution implementation will include:

  • To develop a realistic and workable policy for hygiene and protective clothing wear within the healthcare facility in three months time.
  • To successfully conduct a training for nurses and nurse leaders for the implementation of the established policy, within one month after the completing of the policy document.
  • To establish an effective documentation process for monitoring compliance to the established policies within the next two months.

Through these goals, it will be possible not only to keep the implementation process within strict timelines but also to ensure that the policy is actually implemented successfully. The long term goal will be achieved through progressive accomplishment of the short term goals. To achieve the first short term goal, the first step will be to make an official communication to the healthcare facility administrators. This would be to enable them give permission for collaborative work among nurses and nurse leaders towards the development of the requisite policy. The approval of the hospital administration will be followed by the identification of a team of nurses and nurse leaders that will be tasked with formulating the policy and finally planning for the meetings and policy group discussions.

To accomplish the second goal for the solution implementation, the committee will submit the policy document to the facility management for approval. A date will then be set for training with a perceived effective training plan and design. Trainers will be identified and the curriculum for the training developed. From thence, all participating nurses and other interested healthcare practitioners will be invited for the training and the training conducted within the set dates. The last short term goal will also be accomplished with the collaboration of the members of the policy committee.

Barriers to Implementation

While the nurses and nurse leaders could be willing to participate in efforts towards reducing HAIs in acute care, there may be certain barriers to the implementation of the proposed plan. The most probable barrier is organizational structure. In any context, the organizational culture can be a great impediment to change and progress. The organizational culture should be supportive of change, and also flexible enough to allow room for consideration and evaluation of new ideas. In line with preventive measures for HAIs, CDC (2016) reports that preventive measures for healthcare associated infections require a collaborative approach engaging all the stakeholders of the healthcare organization. This may only be possible under the support of an organizational culture that is customer centric and change oriented. To address this challenge, a strategy for change management in an organizational setting could be used. Getting a few senior members of the organization’s administration to buy in to the proposal for change initiation will be the first step towards potential success of the solution implementation process.

Another potential barrier to the implementation of the proposed solution is resistance to change among the healthcare service providers. Most of the solution activities target nurses, and if most of them do not consider the implementation process necessary or have no motivation to change their behaviors towards HAI preventive practices, it will be difficult to implement the practices put in place. To address this issue, there is need for creating awareness among both the administration and the healthcare practitioners. This is the rationale behind having an awareness creation phase prior to instituting policy sittings or developing the policy document. The nurses need to understand the impacts of the identified problem and their roles in its solution for them to adopt the proposed measures for problem solving.

Benefits

Clinical care nurses have the responsibility of monitoring, providing collaborative knowledge on the implementation of aseptic work practices and assuring that there is compliance with the recommended aseptic work practices. Both nurses and patients can benefit from the implementation of the recommended solutions. Once a sturdy organizational culture of hand washing hygiene and the use protective clothing has been established, the responsibility of nurses in continuous monitoring can be reduced. Furthermore, CDC reported that when preventive strategies are implemented for HAIs, there can be up to 50 percent decrease in the number of central- line associated infections of the blood stream. Other forms of HAIs such as those arising from pneumonia and urinary tract infections are also reduced significantly through implementation of HAI preventive measures (CDC, 2016).

The reduction of HAI prevalence as a result of preventive measures results in other benefits including economic and social impacts. Prolonged hospital stays is one of the impacts of HAIs and it results into various negative social impacts including affecting relationships with loved ones and reducing productivity due to the need for constant care giving. Additionally, higher hospital mortality and higher hospitalization costs are linked to HAIs. According to Rattanaumpawan & Thamlikitkul (2017), implementation of interventional measures such as the aforementioned can benefit the community by eliminating some of the negative impacts of infections. For individuals in acute care settings, the cost of treatment can reduce significantly post interventions.

Participants and Interdisciplinary Approach

Preventing HAI is a risk reduction strategy which requires collaboration between several stakeholders across multiple disciplines. Organizational leaders are the drivers behind organizational values and the values drive organizational behaviors, which influence the performance of the organization. The role of nursing leaders in HAI intervention entails collaboration with co- workers, implementing effective communication strategies, fostering teamwork and maintaining patient safety among others (Collins, 2008). Other stakeholders such as institutional administrators, individual healthcare practitioners and directors in the healthcare facility have specific roles with regards to prevention of HAIs. The intervention proposed therefore is a multi disciplinary approach that will require input from different stakeholders. When the intervention measures are woven and implemented appropriately, they can create a framework for the implementation of evidence- based practices and new technologies. Such a framework would provide an opportunity for improving the quality of healthcare services provided to patients.

Conclusion

Healthcare associated infections are a major concern for patient safety in any healthcare setting. Research has shown that they are more common in acute care settings compared to other healthcare contexts. The proposed solution aims at establishing an organizational culture that will emphasize adherence to hand washing and protective clothes wearing routines, and subsequently result in lower prevalence rates for the mentioned healthcare problems. The proposed solution is intended to be implemented over a four month period and will entail policy development, training of participants and repetition of the routines with the objective of having a clear and firm organizational culture. If implemented appropriately, the proposed solution will result in benefits such as reduction of hospital stay durations, reduction of healthcare costs and improvement of the quality of care given to patients in acute care. However, the implementation of the recommended solution may be hindered by barriers such a retrogressive organizational culture and the resistance from other members of the organization. With the collaboration of hospital administrators, individual healthcare practitioners, nurses and nursing leaders, it will be possible to achieve the intervention objectives.

References

CDC (2016). HAI data and statistics. Centers for Disease Control and Prevention. Retrieved from www.cdc.gov/hai/surveillance/index.html

Collins, A.S. (2008). Preventing healthcare associated infections. In R.G. Hughes (Ed.), Patient safety and quality: An evidence- based handbook for nurses. MD, Rockville: Agency for Healthcare Research and Quality. Retrieved from www.ncbi.nlm.nih.gov/books/NBK2683/

Kangasniemi, M., Vaismoradi, M., Jasper, M. & Turunen, H. (2016). Ethical issues in patient safety: Implications for nursing management. Nursing Ethics, 1- 13. Retrieved from citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.821.9146&rep=rep1&type=pdf

National Council of State Boards of Nursing (2018). NCLEX & other exams. National Council of State Boards of Nursing Inc. Retrieved from www.ncsbn.org/nclex.htm

Rattanaumpawan, P. & Thamlikitkul, V. (2017).Epidemiology and economic impact of health care–associated infections and cost-effectiveness of infection control measures at a Thai university hospital. American Journal of Infection Control, 45(2), 145- 150. Retrieved from www.ajicjournal.org/article/S0196-6553 (16)30760-X/abstract