The issue of controlling and preventing hospital-acquired infections is a major problem in the Healthcare system. Most patients admitted to hospitals are at some risk of contracting a hospital-acquired infection (Paterson, 2012).
Some patients are more vulnerable than others; these include the elderly, patients with defective immune systems, and premature babies. Hospital-acquired infections remain a major concern, and they can occur in any care setting, including acute care within hospitals, outpatient surgery centers, clinics, and long-term care facilities (such as nursing homes or rehab centers).
Four categories account for 75% of all acquired infections in the acute care hospital setting. These are surgical site infections, central line-associated bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections (Nassof, 2009).
Urinary tract infections comprise the highest percentage (Paterson, 2012).
These infections usually are spread by the contaminated hands of healthcare providers or the patient’s family members.
They are also caused by contaminated surfaces or hospital equipment that has not been properly cleaned (Nassof, 2009).
The rate of exposure to infectious materials could be reduced if healthcare providers adhered to certain standard precautions such as hand hygiene. The proposal for this nursing research utilization project is to educate nurses on the importance of hand hygiene using evidence base protocol and how they can implement it in order to prevent nosocomial infections. Most if not all healthcare providers sometime in their career fail to wash their hands. Regardless of staff views on hand washing, research evidence-based studies confirm that hand washing is the most important way healthcare providers can prevent the spread of infection among patients in the hospital (Chau, Thompson, Twinn, Lee, & Pang, 2010).
Based on safe infection control techniques using ADPIE (Assessment, Diagnosis, Planning, Implementation, Evaluation) These will be written up to demonstrate the links between practice and the supporting theory. Direct observation (2): Infection control. Assessment Hand washing is extremely important in clinical areas, as it reduces the risk of infections. Infections are caused by organisms which ...
Using evidence-based practice will help healthcare providers be more compliant with hand washing. The educational research utilization proposal project will include supportive data from reliable research studies, an action plan on how to implement different strategies to help healthcare providers come up with ways to eliminate hospital-acquired infections, and a post- test to measures and evaluate staff effort and interest in the proposal solution. Upper management and nurse educators will work collaboratively through all the phases of the evidence base proposal educational program to help staff by providing support, and tools needed to reach the goal outcomes of the project proposal.
.Nursing Research Utilization Project Section A&B
Section A – problem is identified
1. Describe a problem or issue that needs a solution.
The problem that has been identified and needs a solution is the issue of controlling and preventing hospital-acquired infections through education and working with healthcare providers to come up with techniques they can implement to prevent hospital-acquired infections. The proposed solution is to create an evidence-based education programs for nurses to teach them how to recognize and prevent the spread of infections. The rate of hospital-acquired infection is increasing every year regardless of different policies and regulation set by hospitals (Paterson, 2012).
Thus, nurses needs to be educated about key evidence-based clinical elements they can do early on to help prevent infections in hospitals. 2. Importance of the problem
This problem is a serious concern for both patients and healthcare providers. It puts a financial strain on the patients and their families and also on the hospital. An estimated $20 billion a year is spent treating patients who acquire some type of infection while in the hospital. Research indicates that 20% of all hospital-acquired infections are urinary tract infections; approximately 80% of these are linked to urinary catheters (Paterson, 2012).
The State of Illinois has several guidelines and activities in place as techniques to prevent nosocomial infections. In Illinois, Healthcare Infection Control Practices Advisory Committee (HICPAC), is charged with providing advice and guidance to the Secretary, Department of Health and Human Services; the Director, CDC and the Director of the National Center for Emerging and Zoonotic Infectious ...
When hospital patients acquire infections, they typically remain in the hospital longer, which increases the cost of their hospital bills. In some cases, patients die from the infections. The Centers for Disease Control and Prevention estimates that approximately two million people acquire infections while in the hospital each year, and approximately 90,000 of these patients die as a result of their infections (Limaye, Mastrangelo, & Zerr, 2008).
All of these negative reports suggest it is very important and necessary for healthcare providers to focus on an evidence- based confirmed clinical practice solution to help eliminate hospital-acquired infections. 3. Project objective that is specific, realistic, and measurable The outcome objective for this project is for nurses from the cardiac unit of Greenville Hospital System who attend the infection control educational classes to score a 95% or higher on the post test after each training session in order to evaluate employee knowledge on the topic. Any employee who scores less than 95% on the posttest will need to repeat the training session. The infection class will begin first week of August for the cardiac staff nurses and the last two weeks of July for selected charge nurses who will help facilitate during the implementation of the educational program. 4. Brief solution description and rationale
The way to reduce and eliminate infections in the hospital is to develop the proposed evidence-based solution of implementing an educational program with different training sessions to educate the nursing staff in regard to confirmed infection prevention practices to prevent nosocomial infection. Educational session on hand hygiene will be held in the fourth floor conference room of Greenville Memorial hospital including demonstrations of proper hand hygiene. According to the World Health Organization who develop the “My five moments for hand hygiene”, confirm that hand hygiene is the most effective method in reducing nosocomial infection (Mathai, George, & Abraham, 2011).
The goal is to equip staff members with as much information as possible, so they will recognize signs of infection early and seek proper intervention (Cardo, Dennehy, Halverson, Fache, Fisherman, Kohn, Murphy & Whitley, 2010).
Hand hygiene is a major health issue within hospitals, school systems and within the general public across the United States. Hand washing is one of the most important healthy actions a person can do. Proper hand hygiene aids in the prevention and spread of infections such as respiratory infections or gastrointestinal diseases caused by enteric pathogens. These along with other infectious diseases ...
Section B—Description of the Proposal
The way to reduce and eliminate hospital-acquired infections is to develop educational programs and training sessions that alert healthcare workers on different sign of nosocomial infection. The goal of these infection control classes is to educate cardiac nurses on ways to Prevent nosocomial infections through proper hand hygiene. This class will be entitled “Hand Hygiene can save a patient.” The infection control prevention classes will be part of the World Health Organization “My five moments for hand hygiene” concept. A nurse committee made of infection control nurse and nurse educator from the cardiac unit will serve as the program director, the committee will chose two charge nurses from each unit and trained them to help facilitate the training classes. The committee will promote the proposal program to the infection control director, upper level management and the cardiac nurses three to four week before the first training session start first week of August 2012 after the train the charge nurses the last two weeks of July. The infection prevention educational classes will take place at the four floor conference room every Wednesday from 8. Am to 12 pm for a period of three month, each classes will last about one hour. 2. Consistency of solution with research support.
This solution is consistent with evidence-based practice and research. Educating staff on how to eliminate hospital-acquired infections is the first step toward meeting the objective outcome. Mathai and some of his colleagues conducted an Evidence base research study of a mixed medical-surgical ICU of a tertiary level hospital to help identify reasons for non-compliance among health care workers. Mathai found that the most common reason for non-compliance among participant was lack of time. However, they researcher had an increase of 57% compliance after the educational session was implemented (Mathai, George, & Abraham, 2011).
The World Health Organization “my five moments for hand hygiene” concept has created awareness about preventing the spread of infections and is full of information and beneficial tips that educate healthcare workers on infection prevention. The goal of this concept was to provide information on hand hygiene and determine specific time when hand hygiene is required during patient care in order to effectively prevent the spread of infection ( Mathai, George, & Abraham, 2011).
In this task I am going to design a six week training programme for two selected contrasting clients, I will the explain the choice of activities for these clients. I will then justify these choices for both of my clients and I will suggest alternatives for activities. For my first client I have chosen two main areas of improvement, these areas would be core strength and cardiovascular endurance. ...
This study is relevant to clinical practice because it educate staff on when hand hygiene should be perform, and also helps educators see the importance of educating staff on proper hand hygiene when caring for patients in order to prevent transmission of infection. 3. Feasibility of implementing the proposed solution in the work setting. The proposed solution infection prevention educational classes is feasible to implement in the work setting. Greenville hospital System will provide the fourth floor conference class room for the training session free of charge, the training manual will incorporate information from the World Health Organization concept. All training sessions and educational materials will be provided to every employee for free by the hospital. The cost analysis for the educational training sessions is about $4,000 for hourly wages for staff nurses and charge nurses, to promote the program, Ink and to printing materials.
The director of the infection control department has agreed to allow the committee to implement the education program. They agree the educational program will take a positive step toward reducing nosocomial infections and decrease the rate of mortality among patients that is due to nosocomial infection. 4. Consistency of proposed solution with organization or community culture resources. Greenville Hospital system has the resources, support, and equipment needed to implement the Evidence-Base educational proposed program to prevent hospital acquired infections. Reaching the outcome goal for this educational proposal can be successful with the help of a good committee, administrative managers who reinforce the educational proposal’s solution and employees who comply with hand washing.
Section C: Research Support
1. Research Supportive Base
Research supports that evidence-based education innovation can impact hospital-acquired infections by improving staff knowledge, thereby improving compliance with hand hygiene; the evidence-based practice (EBP) innovation proposed is to reduce infection in the hospital by educating staff about the importance of hand hygiene through the implementation of an education program classes. This proposed evidence-based practice (EBP) will enable nurses and other healthcare providers to obtain the information needed to identify signs of infection early and seek proper intervention to help eliminate hospital-acquired infections. 2. Sufficient Research Support Base
The Keirsey Temperment Sorter II results imply that I am an EST (Supervisor) and the Strengths Finder Profile results suggest that my five top strengths are ideation, maximizer, input, arranger and command. In the following paragraphs I will identify what I do and how I integrate these strengths in relation to my job, which is administrative specialist for the fundraising division of a not for ...
There is a wealth of supporting evidence on hand hygiene practices and their impact on hospital-acquired infections. Current research on the proposed innovation focuses on studies conducted near the end of the twentieth century (Picheansathisan, 2003).
Research studies concluded that educating staff on compliance with hand hygiene appears to be the best way to help reduce transmission of hospital-acquired infections (Mathai, George, & Abraham, 2011).
3. Compelling research Support Base
Two evidence-based research studies, a Quasi-experimental, and a before-and-after prospective observational intervention study, were used to explore the proposed innovation described above (see Appendix A).
Nursing Research Utilization Project: Section D & E
1. Solution implementation plan
Reducing hospital-acquired infection and helping hospitals become a safer place for patients is the responsibility of every employee. The first step in implementing the proposed innovation involves forming a committee comprising the nurse educators from both the cardiac units and the infection control department to help manage and become familiar with the project description and solution. Once they approve the project, the implementation of this evidenced-based practice (EBP) innovation can begin. The nurse educators will appoint two charge nurses from each cardiac unit (B, C, D and CVICU) who demonstrate an interest and have enough expert knowledge on the topic to communicate with staff; charge nurses will be required to attend one of the two training session offer at the end of July, each training session will last about 1hr in order to help improve their knowledge on the topic. Once the charge nurses have been selected, the next step will be to train these nurses using the methods proposed by the World Health Organization (WHO), which recently developed a concept called “My five moment for hand hygiene”.
The aim of this essay is to ascertain what hospital acquired infection entails, the detrimental effects it causes and to highlight the active role nurses can take in the prevention of this type of infection. Hospital acquired (or nosocomial) infection is: ‘one that originated in the hospital environment; i.e. was not present or incubating on admission and which appeared 48h or more after ...
An instructor’s manual and handouts that focus on infection prevention will be made available for each training session. The nurse educator committee will assign charge nurses from the cardiac unit to attend one of the 12 training sessions held at the fourth floor conference room from July 2012 onwards. The nurse educator and the infection control nurse committee will need to ensure that the conference room is available every Wednesday from 8 AM to 12 Pm during the training period. Education handouts about infection prevention from the World Health Organization and the hospital policy on hand hygiene will need to be obtained from the committee, placed in a folder and distributed to each participant during the training sessions. The first training session for staff nurses excluding charge nurses will begin the first week of August 2012. The communication of the initial launch of the educational project will be the responsibility of the committee. In addition, the committee will create and send email flyers containing the purpose of the class and the date, time and location where the classes will take place. The flyers will also be posted in each unit two weeks before the first session starts. The committee will develop the educational program contents and its curriculum. The committee will attend staff meetings in each unit in the cardiac ward to discuss the project in-depth before the first session.
The committee will begin implementing the educational program in July with the charge nurses. During the implementation of the program, the director of the infection control department will allow the committee to devote two hours per week to the educational project. The committee will present the project to the director of infection control and the upper level management in the first week of July for approval. The committee will make any changes or recommendations made by the upper level management on the project before the first session of the training class starts in August. The training session for the charge nurses will begin in the third week of July and a trial post-test will be carried (grammar) for the charge nurses to test its reliability. The first educational infection control class for the proposed implementation will start in the beginning of August. Having a specific starting date will ensure that the staff attends the educational training session.
The key to the project’s success is the committee made up of nurse educators from both the cardiac unit and the infection control department. Both groups must work well together and support the project objective by focusing on the end result, which is to educate the staff on the importance of hand hygiene to prevent hospital-acquired infections. The committee and the charge nurses must be able to handle conflict, communicate well with each other and provide clear and accurate information to the general staff in order to stay on target. 2. Resources Needed for Solution Implementation
To implement the education classes, the committee will have to make arrangements for a projector to show the PowerPoint presentation, a DVD player to show short plays on infection control and hand hygiene, a printer to publish flyers and handouts for the participants, and ink for the printer. The conference room, which will be supplied by the hospital at no additional charge, has a projector and a DVD player already installed. The out-of-pocket cost that the committee will need for the educational classes will be $4,000. The twelve training sessions for the charge nurses and staff will cost around $3,100, because the hourly cost of each charge nurse and regular staff is $26 and $24 respectively. The committee salary to implement the innovation is built into its schedule as approved by upper-level management in order to develop and manage and complete the educational program. A total cost of $600 will be spent on promotional flyers and handouts to the staff. The committee will meet the manager of the marketing department to discuss the cost for implementing the program.
3. Monitoring solution implementation
The committee will continually monitor the implementation of the innovation to ensure consistency and accuracy of the topic. The attendance of the staff, the class content, and the PowerPoint presentation will also be monitored very closely by the committee. Each employee will sign in using an employee ID number to ensure that attendance is recorded accurately. The nurse in charge of each unit will be responsible for turning in the sign roster to the committee of nurses overseeing the educational training session. Several steps must be taken in order to monitor the implementation of the proposed plan. First, the committee must perform a pilot study by conducting a need assessment survey of clinicians regarding their interest or knowledge on the topic of infection control practices.
The survey selected is clear and to the point, will help the committee determine how important the prevention of infection is to clinicians. A leader or several facilitators should be chosen for this task, preferably from the infection control department; members of this department are familiar with the hospital and have a good working relationship with the staff, as well as a good understanding of the issue of infection control prevention that will enable them to oversee and monitor the staff during the implementation process. The committee will also monitor staff compliance by directly observing hand hygiene procedures. Facilitators will monitor the units to which they have been assigned by periodically checking in with staff during the training process.
4. Using Planned Change Theory
This implementation plan uses the theory of reasoned action (TRA).
The TRA was developed by Fishbein and Ajzen in 1975 and defines the links between beliefs, attitudes, norms, intentions, and behavioral intention to perform something (Fishbein and Ajzen, 1975).
A person’s decision about whether or not to take an action is determined by three things: intention, attitudes toward the specific behavior under consideration, and perceptions about the subject matter (Fishebein, & Ajzen 1975, p. 302).
The reasoned action theory proposes that a change in a person’s behavior depends on his or her attitude toward change. In other words, the first step in getting staff members to change their behavior is to find out their intention, attitude, and perception toward preventing hospital-acquired infection. Once the committee completes this step, it can move on to identifying different ways to help change staff behavior through proper education and by explaining the need for the change. Based on the TRA theory, the best way to change a person’s behavior is to determine his or her beliefs of the consequences of the change.
The committee will need to persuade upper-level management and staff on the importance of hand hygiene in preventing hospital acquired infection. In addition, the committee will continue to support staff by providing feedback during and after the change is implemented. After the completion of the training session, the committee can reinforce the project by monitoring and keeping staff updated on their compliance and the reduction in the percentage of hospital-acquired infection. The information presented during the training session and the posttest will hopefully capture the participants’ attention and motivate them to change their behaviors and views on preventing hospital-acquired infections. 5. Feasibility of the implementation plan
The hospital staff and upper-level management are aware of the consequences of hospital-acquired infection, and in order to improve patient outcome, the staff must be willing to change. This proposed innovation will ensure that the cardiac staff has the necessary information they need to help identify and prevent hospital-acquired infections. Starting the educational classes with the charge nurses in mid-July allows the committee enough time to train the charge nurses and prepare the materials needed for each training session to be successful. This solution is practical to implement within the Greenville Hospital system setting with the support of the nurse education staff and infection control nurses. Upper level management, including the director of the infection control department, is very supportive of implementing infection control classes in order to help reduce infection rates in the hospital. It will take a lot of work and dedication to eliminate infections in the hospital, requiring increasing awareness among clinicians who will ensure compliance with the educational program and infection control policy set by the hospital. Infection prevention has been an issue in the hospital system for many years. Therefore, implementing an EBP innovation program will have positive results for patient outcomes and for Greenville hospital system’s reputation.
Section E: Evaluation Plan
1. Develop an Outcome Measure
Outcome measure (Instrument is attached as an Appendix)
The objective for this project is for nurses from the cardiac unit at Greenville Hospital System who attend the educational classes to correctly identify different signs of infection potential in the hospital by scoring at least 95% or higher on the post- tests that will be administered after each training session. The questions will be based on the training session handout title Infection prevention, which will be giving during the training sessions. The test will consist of 10 questions. Six questions will be scale type questions in order to measure participant perceptions about the material, while the other five will require true and false or forced answers (see Appendix B).
2. Describe the ways the selected outcome measure is credible (validity, reliability, sensitivity to change, appropriateness).
The committee are experts on infection control prevention with additional educational training on infection control. The criteria they use to classify the outcome are base on the World Health Organization (WHO) concept of “My five moments for hand hygiene”. Therefore, this measure is valid to measure staff knowledge on the topic at the end of each training session. The outcome measure used is reliable because the committee used the same criteria to classify employee knowledge on the topic. They survey is another valid instrument that the committee will be conducted to gather information on staff compliance with hand washing based on the EBP guideline. This outcome measure is reliable because it evaluates employee interest, perception, willingness and knowledge on the topic. This measure was an appropriate method to collect staff’s compliance with hand washing because it allowed the committee to collect information before the training session in order to have a better outcome.
Evaluation of Data Collection
3. Describe the methods for collecting outcome measure data and the rational for using those methods. A post-test design will be used to evaluate the program. Information will be collected after each training session by the charge nurse after the participant has completed the education program. This will help determine the staff’s knowledge and attitudes after they finish the educational program. The charge nurses will collect post-test data while ensuring that all the questions are answered and then return the test to the committee for analysis. The charge nurses must consistently be given the test right after the training sessions to avoid any alteration in the results. The post-test evaluation will serve as a measure of the reliability of the instrument, because the percent of nursing staff that score 95% or higher will determine how effective the educational program really was to the staff. 4. Identify resources needed for evaluation.
The information and materials needed to evaluate this project was collected during a pilot study, so the committee needs only minimal additional resources in order to evaluate this project. However, the committee will need to spend some extra time analyzing the data from the post-test. The committee will have one week after each training session to analyze the data and to present its findings to upper management and the director of the infection control department. The committee needs to be clear and precise about the data collection process, and effective communication is vital when presenting both the data and the results. 5. Discuss the Feasibility of the Evaluation Plan.
The success of any infection prevention program depends on healthcare knowledge levels and on the willingness of participants to learn how to prevent the spread of infection. It is very important for staff members to change their behaviors, use common sense, and take active roles in preventing hospital-acquired infections. Nurse educators and charge nurses have the information they need to help employees identify the different signs of infection and the ways they can prevent infection. The post-test evaluation results will help the committee determine where it needs to make any changes in order to help employees comply with hand hygiene guidelines to prevent hospital-acquired infections and to improve patient outcomes.
Section F: Decision-Making Strategies
1. Maintaining the Solution.
The way the committee will continue on maintain the infection control educational classes is to monitoring staff compliance on a continual basis for a period of one year. Staff competency will be monitor through Computer training classes (CBT) program offer by the hospital on hand hygiene. The CBT will be free to all employees. 2. Extending the solution.
Infection control director and upper level management from Greenville Hospital system are all committed to reducing nosocomial infection in the hospital and improve patient care. Upper level management agrees that having the infection prevention educational program show that the hospital his committed to their patient well being and the community in which they serve. 3. Revising the solution.
The committee will revised the post- test administered after each training session base on participant score. If a participant score last then a 95% on the post-test the committee will review the question miss the most and make any adjustment to the infection control classes. The committee will meet with the charge nurses to analyze the program and discuss any possibility to revise the material from the training session and help improve the educational program.
4. Discontinuing the solution.
The decision to discontinue to infection prevention classes will be made by upper level management and the director of infection control department. They will need to consult with the infection control committee to discuss different reason as of to why they feel that the infection control classes need to be discontinue. They reason may be finances, or either a significant increase rate of improvement among staff over certain period of time preferable one year from the first training session. After they decided on a reason, the committee will communicate the discontinuance of the program to the cardiac staff.
5. Plans for work setting and professional feedback.
The best way to broadcast the project information and outcome is for the committee to publish the project results of the infection prevention classes in the hospital quarterly news letter that the hospital mail to every employee home for other staff and their families to see the positive impact that the educational program has on patient outcome. The committee can also discuss the success of the educational program during town hall meeting through power point presentation to attract other department and staff within the Greenville Hospital System. Conclusion
The problem of hospital-acquired infection is a major issue with regard to patients’ lives and the financial burdens on both the patients and the healthcare facility. Effective monitoring of infection rates can alert a healthcare provider to different causes of infection in hospital and aid the provider in resolving the problem in a timely manner. Following basic infection control measures, such as good hand hygiene, and using standard precautions for all patients at GHS or in any type of healthcare setting can
reduce rates of nosocomial infection.
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