Table of Contents
Introduction
Health care acquired infections are infections that are acquired by patients at the time they are receiving treatment for surgical or medical conditions in a health care facility. They also include infections acquired by health care personnel in their line of duty and infections that patients acquire after being discharged from hospital. These infections are associated with medical procedures such as surgeries and use of medical devices such as ventilators and catheters. According to World Health Organization (2014), HIAs are a leading cause of morbidity in the United States and increase medical costs every year. At some point, it was noted that that in every 25 patients hospitalized in United States, one patient was affected by Health care Infections. While in the developing countries, 7 out 10 patients develop HAIs. The burden of HAI is higher in developing countries in comparison to the developed ones. The common types of HAI include blood stream infections, infections associated with use of catheter, pneumonia, surgical area infections and clostridium difficile (“Preventing Healthcare-associated Infections | HAI | CDC”, n.d.). Of all the health care associated infections, urinary tract infections are more common in developed countries while surgical site infections are leading in hospitals that have limited resources. Newborns are at higher risk of infection in the developing countries with rates of infections being 20 times higher compared to the developed countries.
Health care acquired infections are important because they are a major source of complications in continuum care that can spread to different facilities in a health care setting. Most countries do not have surveillance systems that are associated with health care infections. Hospitals lacking such facilities struggle to diagnose the infections due to lack of a standardized criteria (“Preventing Healthcare-associated Infections | HAI | CDC”, n.d.). While it is difficult to acquire accurate data on the number of patients who die as a result of health care acquired infections, it is quite clear that hundreds of millions of patients die every year due to such infections (“Preventing Healthcare-associated Infections | HAI | CDC”, n.d.). Health care acquired infections are mainly ignored and receive public attention when an epidemic occurs. This paper examines Health acquired infections with the objective of reducing central line-associated blood stream infections (CLABSIs). The target population for the research are the patient hospitalized in medical facilities due to various ailments.
Central Line-Associated Blood Stream Infections (CLABSIs)
Central line-associated blood stream infections are a major cause of deaths for thousands of people around the world. The medical fraternity views this as an added cost to the United States health care system yet it is possible to prevent the infections (“Healthy People 2020 Law and Health Policy Project: A Focus on Healthcare Associated Infections”, n.d.). Center for Disease Control and Prevention provides tools and guidelines to the health care community in order to help them in curbing CLABSIs. Patients that are diagnosed with the infections require more interventions and therapies and have to stay longer in hospitals (“Healthy People 2020 Law and Health Policy Project: A Focus on Healthcare Associated Infections”, n.d.). This makes them vulnerable to death or serious harm. Due to the increasing costs associated with treating CLABSIs, insurance companies stopped their reimbursement to the affected patients since they believe that they are preventable.
Nurses play an important role in stopping the costly and dangerous blood stream infections. The infections are mainly caused by improper positioning of catheters in the large veins located in chest, neck or groin. According to Patricia Stone a professor in the Columbia school of nurses, the devastating effects of the blood stream infections are not supposed to happen. She contributed to nurse practice by providing guidelines on the best practice that were published by Joint commission (“Guidelines Highlight Importance of Nurses in Preventing Bloodstream Infections”, n.d.). Stone has carried out intensive research on ways of preventing blood stream infections. Nurses are at the forefront and can take advantage of their high positions since they are in contact with patients and their care givers. They can always explain to them the techniques for infection control and facilitate in ensuring that medical facilities develop and enforce techniques of nursing care that have proved to be efficient in prevention of CLABSI.
Catheters are used to deliver nutrients and medicine to vulnerable patients that include premature babies admitted in the intensive care units and adults who are in the process of recovery surgery and trauma (“Guidelines Highlight Importance of Nurses in Preventing Bloodstream Infections”, n.d.). They are also used by the elderly who are in long term nursing facilities. If they are not properly inserted and maintained, they can lead to spread of dangerous infections to the blood stream of the patients. Nurses are therefore required to utilize their knowledge and training on infection control to ensure that they maintain a culture of creating patient safety (“Guidelines Highlight Importance of Nurses in Preventing Bloodstream Infections”, n.d.). Nursing practice is also important in prevention of CLABSIs since they are required to organize and implement strategies that are geared towards ensuring that preventions techniques are applied. Nursing techniques for preventing CLABSIs include replacing wound dressing regularly, proper catheter insertion, and proper hand washing techniques. With a good education background, nurses acquire relevant knowledge for informing their colleagues and patients about evidence-based ways of reducing CLABSIs. CDC also recommends that the importance of ensuring that catheters are removed when they are no longer required. Prevention of CLABSI plays a vital role in advanced nursing practice since it gives nurses the courage to speak up to other team members when critical care is needed to patients (“Guidelines Highlight Importance of Nurses in Preventing Bloodstream Infections”, n.d.). In collaboration with a multi-displinary team, nurses can create a dramatic impact in reduction of preventable bloodstream infections through thorough implementation of CDC guidelines.
Critical Analysis of Literature
There are several factors that make patients vulnerable to the risk of contacting health-care associated infections. This include inappropriate and prolonged use of antibiotics and invasive devices, high risk surgeries, immuno-suppression and severe conditions suffered by patients and lastly, poor isolation of patients and application of poor standards of treatment (World Health Organization, 2014). Some factors infection causative factors are associated with limited resources in the hospitals such as poor hygiene associated with improper waste disposal, understaffing, poor infrastructure, overcrowding, insufficient knowledge and lack of national and local policies and guidelines. The annual financial losses associated with infections are high and it is estimated to be $6.5 billion in US and 7 billion pounds in Europe. According to World Health Organization (2014), the economic burden caused by health care associated infections is poor reported in low income countries.
According to World Health Organization (2014), central venous catheters (CVC) cause disruptions to the skin therefore making it easy for bacteria and fungi to enter the blood stream. These infections spread the blood stream causing organ dysfunction and hemodynamic changes. World Health Organization (2014) further notes that CVCs cause close to 90% of hemodynamic and bloodstream infections. The best CVC to use in order to prevent infections are the ones coated with antibiotics although they are quite expensive. There are a number of benefits that people would realize if they concentrated on reduction of CLABSI. The patients would have better health outcomes, reduction of mortality rate, financial benefits, improved satisfaction for physicians, nurses, patients and families. According to World Health Organization (2014) central line bundle are the interventions that are taken to reduce infections to patients who have intravascular central catheters. When such interventions are implemented all together, the patients have better health outcomes that when they are individually implemented. Central line bundle interventions include, hand hygiene, good selection of catheter line where subclavian lines are selected rather than non-tunneled catheters especially for adults, reviewing the daily and removing the unwanted lines, maximum barrier protection and chlorhexidine skin antisepsis. World Health Organization (2014) also notes that it is important to ensure that hands should be washed properly with soap and water or alcohol based hand cleaner before palpating the sites where catheters are to be inserted.
“Challenge, A. G., & Global, A. Preventing Central Line–Associated Bloodstream Infections: Useful Tools, An International Perspective–Tools Directory” argues that CLABSIs are one of the deadliest health care associated infections and their treatment have become a priority nationally. The CDC and other private stakeholders have increased their efforts towards reduction of health care Acquired Infections and more particularly the CLABSIs. The National Quality Forum endorsed the measures suggested by CDC in 2003 that were driven towards reductions of CLABSI rates “Challenge, A. G., & Global, A. Preventing Central Line–Associated Bloodstream Infections: Useful Tools, An International Perspective–Tools Directory”. These measures are important since there has been progress in the past eight years after the measures were implemented. It is also notable that the measures have saved an excess of $1.8 billion that would be used to cater for health care costs.
Healthy people 2020 defines HAI as the infections that patients get while receiving treatment for surgical or medical ailments and are a leading cause of death in the United states (Guerin,Wagner, Rains & Bessesen, 2012). The infections are preventable and occur in different settings such as acute care centers, long term care centers and outpatients surgical centers. According to CDC, 722,000 people suffered from HAI in 2011 and of these, 75,000 died as a result of the infections in the United State during hospitalization (Guerin,Wagner, Rains & Bessesen, 2012). . The importance of reduction of HAI most particularly CLABSI have led to their inclusion in national health goals of the healthy people 2020 (HP2020). The first report for Health Policy Project and law of Healthy People 2020 focus on reducing the infections (Guerin,Wagner, Rains & Bessesen, 2012). One of the first reports in t he initial stages will focus on reducing HAI that affect the blood stream.
According to CDC, there has been rapid progress in eliminating infections that threaten hospitalized patients. According to a report released by Center between 2008 and 2013, central line-associated infections were reduced by 46% (Chopra, Krein, Olmsted, Safdar & Saint, n.d.). However, the agency insists that additional efforts need to be made in order to ensure continued improvement in the safety of patients (Chopra, Krein, Olmsted, Safdar & Saint, n.d.). The progress report by CDC on Health-Associated Infections offers a snapshot on the efforts made by different countries towards reduction of CLABSI. The report also indicates that 19% decrease on infections to surgical sites was realized while catheter related infections were increased by 6% in 2009 although in a report made in 2009, the infections have started decreasing (Chopra, Krein, Olmsted, Safdar & Saint, n.d.). The urinary tract infections occur when catheters are wrongly put, unclean or when they take too long time in patient’s bodies giving germs time to travel across the patient’s bodies.
Although there are different factors that facilitate spread of infection to patients, there are certain factors that are beyond the medical fraternity. These include age of the patients that may compromise the immune system. Healthcares, CDC and other partners have gained knowledge on prevention through surveillance of HAI, research, therapeutic procedures and investigation of outbreaks (“Healthcare associated infections (HAIs) – Premier Safety Institute”, n.d.). Currently more than 13,000 healthcare facilities are using the CDC report of guide them in prevention of diseases (“Healthcare associated infections (HAIs) – Premier Safety Institute”, n.d.).
Institutions also have an initiative for reducing CLABSI, they can do this by coming up with programs that insist on proper handling of patients and medical equipment (“Healthy People 2020 Law and Health Policy Project: A Focus on Healthcare Associated Infections”, n.d.). Nurses should be trained on monitoring and reporting infections through an effective infection control program. Consequently, education should be offered on assessment and implementation of effective control measures and having a periodic assessment of the knowledge on proper implementation of infection control (“Healthy People 2020 Law and Health Policy Project: A Focus on Healthcare Associated Infections”, n.d.). Despite the studies, recent surveys show that knowledge on practices associated with CLABSI is important.
Theoretical/Conceptual Framework
This proposal will be based on the theory of planned behavior (TPB) due to the relevance of its key suppositions, its potential usefulness in reducing healthcare-acquired infections, and the support provided for it by empirical evidence. The theory posits that human behavior is a product of the intention to engage in such conduct, which, in turn, is dependent on an individual’s behavioral, normative, and control beliefs. In this view, intention, which is defined as a cognitive illustration of one’s inclination towards a particular behavior, is seen as the immediate precursor of a person’s behavior (Rush, 2014). Further, the theory suggests that certain attitudes with regard to a particular behavior can indeed be used to predict human actions. People’s beliefs concerning others’ perceptions of their conduct as well as their discernment of their aptitude to undertake certain actions significantly influence behavior by forming intentions. By and large, a person with a more positive attitude and subjective norm, as well as greater perceived behavioral control is typically considered to have strong intentions to carry out the actions in question.
TPB is considerably influential in predicting and explicating human behavior and has been successfully used to structure and implement numerous healthcare interventions in the past (Rush, 2014). Moreover, this premise can be extremely useful when developing community and disease prevention strategies. Healthcare-acquired infections, such as central line-associated bloodstream infections (CLABSIs), develop when individuals get into direct physical contact with healthcare workers, visitors, patients, or with contaminated surfaces. As such, the TPB can be used to identify pertinent beliefs within healthcare settings and develop a strategy for intervention that may compel or boost the observance of established guidelines meant for reducing the risk of causing and transmitting HAIs (Rush,2014). Accordingly, the theory provides insight into the behaviors, or lack thereof, as well as their related intentions and beliefs among nursing practitioners that lead to HAI incidences with the view of proposing an intervention plan to lower or eliminate the pervasiveness of CLABSIs in healthcare institutions and to improve patient outcomes.
Intervention Plan
The aim of this health promotion intervention is to reduce the prevalence of central line-associate bloodstream infections among patients. According to (“Preventing Healthcare-associated Infections | HAI | CDC”, n.d.) hospital hardly use similar infection control methodologies and more often than not, multiple interventions may be used simultaneously. However, research shows that most hospital administrators base their decisions on observational or quasi-experimental data. An appropriate intervention plan should analyze the gaping inconsistencies between prevention recommendations and actual practices and propose ways of filling the gaps. For maximum efficiency, this plan will suggest a combination of actions that can be taken by hospital managers.
Using the theory of planned behavior, behavioral devotion to control guidelines will be investigated to identify any attitudes and beliefs that hinder various stakeholders, particularly nursing practitioners, from adhering to the established principles. Dr. Elaine Larson’s Attitudes Regarding Practice Questionnaire will be modified and administered to a sample of randomly selected respondents, the results of which will be essential in structuring the intervention plan. This survey will help in ascertaining the present knowledge, beliefs, and attitudes concerning the recommended prevention practices as well as adherence to the same.
The intervention itself will take the form of training sessions for the nurses. The contents of the training will include proper wound dressing and catheter insertion techniques as well the recommended hand washing methods. Berenholtz, et al connotes that attitudes and beliefs can be changed by providing relevant, accurate, reliable, verifiable, and truthful information. Using current data on the prevalence and mortality rate of CLABIs, nurses will be informed on the seriousness of the condition and its effects on individuals, families, the society, the healthcare institution, and on national budgetary allocations. In recognition of the fact that such immense changes hardly happen in a day, the training session will be conducted over a period of three weeks. In addition, monthly sessions will also be arranged to ensure that the participants do not forget what they learnt or relapse into a state of ignorance and other detrimental attitudes. Print materials, such as brochures, instructional booklets, and posters, will be provided to the nurses and placed at strategic locations to serve as constant reminders during ordinary working hours.
This plan could produce tangible benefits with regard to health promotion and the reduction of central line-associated bloodstream infection incidences. Being continuous project that will be carried out for the foreseeable future, it will have the implication of increasing and ensuring adherence to HIA prevention guidelines. The fact the training will be conducted on-site implies that there will be minimal cost implications. Costs will only be incurred in the provision of educational materials and questionnaires, to total of which will be approximately 400 US dollars. The facilitators will also have to be compensated at a cost of approximately 2500 US dollars. The total cost for the project will be roughly 2900 US dollars. Funding for the project will be sought from the Office of Disease Prevention and Health Promotion, the US Department of Health and Human Services, the Health Promotion Advocates, or the American Medical Association.
Evaluation Plan
The evaluation for the project will be conducted using surveys, case studies and focus group discussions (Phillips, Phillips & Ray, 2015)
Surveys
Typically, the surveys will be conducted before and after the completion of the project. The survey will measure the prior and after knowledge of the medical staff regarding prevention of CLABSI, achievements and esteem of the patients. Surveys can be conducted through one on one interviews, questionnaires and observation. If the survey shows an improvement after the project is completed, then the project will be a success.
Case studies
Case studies will be conducted on patients in selected hospital in order to determine if they suffered from CLABSI during their time of hospitalization. Case studies will also be used to determine whether patients who suffered from HAIs were treated and the prevention measures that the hospitals are undertaking to prevent such cases.
Focus Groups
Focus groups of 3-6 participants will be conducted who will come together to represent the target audience. There will be open minded questions which will enable the interview to know the impact the of the program before it began, as it runs and the end of it. Focus groups will be conducted by experienced nursed who will record all the findings.
Conclusion
Health care acquired infections are the complications that patients get in the course of treatment or surgeries in a health facilities. The health personnel are also at a risk of getting infections in the course of conducting their duties. They are the leading cause of deaths in hospitals and can be prevented. HAIs are common in developing countries than in are in the developed countries. CLABSIs are a form of HAI that are potentially preventable using evidence based mechanisms. The cost associated with the treatment of CLABSI is high and has significantly increased the cost for medical care. Nurses are at the forefront of ensuring that patients do not contact health acquired infections since they spend most time with the patients and are in direct contact with them. they can explain to the caregivers the techniques for infection control and enforce techniques that have proved to be effective in the medical facilities. CLABSI prevention plays an important role in advanced nursing practice since it gives them the courage to speak up when there is need for critical care. Various literature show that CDC and healthy people2020 have been working hand in hand to ensure prevention of Health Acquired Infections. Between 2008 and 2013, there was 46% reduction in CLABSI.
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