Healthcare-associated infections (HAIs) are infections acquired in a hospital or other healthcare facility. The prevention and control of pathogens that cause these infections remain an unresolved practice problem for the majority of US hospitals. Being a leading cause of morbidity and mortality, HAIs are associated with significant complications for patients. This highlights the need for the consideration of the evidence-based practices to reduce the rates of HAIs. The given paper focuses on the appraisal of evidence to address the selected practice problem and the elaboration of the evidence translation path.
The prevention of the incidence and prevalence of HAIs should be preceded by an explicit articulation of the practice problem, its significance, prevalence, and economic ramifications, as well as critical review of research evidence. The purpose of the paper is to discuss these components in order to create a translation path to support a practice change aimed at addressing the given medical condition. After external and internal factors have been considered, the appropriate change model will be chosen and the expected outcomes will be discussed.
Practice Problem Identification
HAIs are a major issue that is associated with patient suffering, including increased length of hospital stay and a high probability of readmission after discharge, not to mention deterioration in the quality of life and a higher risk of mortality. Approximately four in one hundred hospital patients have an HAI, and two of them are older than 65 years (Schmier et al., 2016, p. 198). HAIs can occur in different healthcare settings, such as hospitals, nursing homes, outpatient care, and medical centers. Thus, the practice problem on which this paper focuses is the reduction and control of HAIs.
The Role of Evidence to Address the Practice Problem
Research evidence can be helpful in addressing the practice problem as it contains strategies and practices that have been proven to effectively tackle the reduction and control of the rates of HAIs. In order to investigate the practice problem, four sources of evidence published within the last five years have been chosen. They will be critically assessed and used as a basis for the translation path.
The Role of the DNP Practice Scholar in Evidence Translation
Care delivery to patients can be more efficient if it is based on the latest robust evidence. Apart from staying informed about the current best available evidence-based practices, the DNP practice scholar should seek to apply them in order to improve patient outcomes. Being a change agent, the DNP practice scholar is responsible for disseminating the evidence to the healthcare staff and leading the change effort.
Practice Problem and Question
The practice problem is the reduction and control of the rates of HAIs. The question of the given project is: how can the rates of HAIs be reduced or controlled?
HAIs place a considerable burden on patients as they have an increased length of stay, as well as an increased probability of sepsis and death. High prevalence rates of HAIs made this medical condition a critical patient safety indicator and a major concern of the US healthcare system (Office of Disease Prevention and Healthcare Promotion, 2018). Thus, the integration of evidence-based practices to reduce HAIs is a top priority for US healthcare organizations.
HAIs have become a major source of concern due to their prevalence. Despite a decrease in some types of HAIs, 1.7 million infections are acquired in US hospitals annually (Arefian, Vogel, Kwetkat, & Hartmann, 2016, p. 1). Approximately 4% of hospital patients get hospital-acquired infections (Schmier et al., 2016, p. 198). High prevalence of HAIs is attributable to poor hand hygiene of healthcare workers and the use of indwelling catheters.
HAIs represent a serious economic concern to healthcare providers since a great proportion of direct healthcare costs is associated with prolonged hospitalization due to hospital-acquired infections. The overall costs of HAIs incurred by hospitals are equal to approximately 10 billion dollars (Schmier et al., 2016, p. 200). The five major healthcare-associated infections are catheter-associated urinary tract infections, surgical site infections, ventilator-associated pneumonia, central line-associated bloodstream infections, and clostridium difficile infections.
Practice Problem Question in PICOT Format
Which current evidence-based practices can reduce (T) the rate of HAIs (O) in hospital patients (P) that receive either inpatient or outpatient care (I), compared to common practice (C)?
Evidence Synthesis of Literature to Address the Practice Problem
The types of evidence that has been reviewed are the qualitative study, literature review, longitudinal analysis, and a report. The qualitative study found that the use of gowns and gloves protects healthcare professionals from contacts with bodily fluids, thus reducing the possibility of MRSA transmission (Albrecht, Croft, Morgan, & Roghmann, 2017). The literature review discovered that human factors engineering frameworks could contribute to the prevention and control of healthcare-associated infections (Drews, Visnovsky, & Mayer, 2019). The longitudinal analysis highlighted the importance of sustaining high compliance with hand hygiene practices by the personnel (Sickbert-Bennett et al., 2016). The report presented strategies and practices to reduce the rate of catheter-associated urinary tract infections, such as the use of chlorhexidine for disinfection, the use of the aseptic technique for insertion, and the timely removal of catheters (Septimus & Moody, 2016).
Scope of the Evidence Synthesis
All the sources chosen for the given project concentrate on the prevention of pathogens leading to HAIs. The evidence synthesis focuses on the discussion of the main points of each source and their comparison. After that, the evidence will be appraised, and the high-quality articles will be selected to guide the practice change.
Main Points of Each Source and Their Comparison
The two studies emphasize the need for the use of personal protective equipment, such as gowns and gloves (Albrecht et al., 2017; Drews et al., 2019). However, in contrast to Drews et al., Albrecht et al. (2017) claimed that glove and gown use was primarily a self-protective measure for healthcare workers rather than a tool to prevent the transmission of the pathogen. The need for compliance with hand hygiene practice was mentioned in the three studies (Drews et al., 2019; Septimus & Moody, 2016; Sickbert-Bennett et al., 2016). Both Septimus and Moody (2016) and Drews et al. (2019) focused on catheter-associated urinary tract infections. However, Drews et al. (2019) concentrate on engineering principles and frameworks, while Septimus and Moody (2016) discuss the medical aspects of a care bundle.
Appraisal of the Evidence
The first article has definitive conclusions, yet among its limitations are poor understanding of MRSA among the nursing staff and limited generalizability of findings. The second study has consistent results and clear objectives, but it has rather low generalizability of findings. In contrast to the other studies, the third one is based on quantitative research data. Its possible limitation is the presence of the lurking variables that have not been taken into account when explaining a decrease in the rate of HAIs. The findings of the fourth article are applicable only to catheter-associated urinary tract infections. The first study has level 6 of evidence, and the second study has level 5 of evidence. The third study has level 4 of evidence because it is based on quantitative research data, and the fourth study has level 8 of evidence. All the articles have good quality, except for the third one, which has high quality due to consistent and generalizable results.
Suitability of the Evidence to Address the Selected Practice Problem
For the hospital setting in the US, all four articles can be considered suitable. Despite the limited generalizability of findings, practices suggested in the first article may be helpful in protecting healthcare personnel from MRSA transmission. The second study offers valuable insights into the human factors design approach to hand hygiene. The third study gives tips on how to sustain hand hygiene compliance among healthcare workers, and its limitation is not significant. The fourth study provides a number of important evidence-based strategies and techniques to reduce the rate of catheter-associated urinary tract infections. Thus, the translation path will be based on the four sources of research evidence.
Strong and reliable evidence should be translated in order to enhance patient outcomes. The translation path consists of several stages, which are staff education, the creation of a healthcare-associated infection prevention care bundle, and the evaluation of the results. Staff education is perhaps one of the most important parts because the success of evidence translation can be possible only if the workers embrace the change. The DNP practice scholar is responsible for communicating the need for reducing and controlling the rates of HAIs, as well as persuading that the chosen evidence is the best available one. The healthcare-associated infection prevention care bundle should include practices from the selected sources of evidence. These practices will include the use of gloves and gowns by the staff to prevent MRSA transmission to their hands and clothes and the modification of the workplace (including the intentional placement of hand sanitizer dispensers in convenient locations).
Potential Internal and External Factors for Consideration and the Change Model
Among the internal factors that should be taken into account are the perceptions of staff about the use of gowns and gloves as a self-protective measure. External factors are costs associated with the treatment of HAIs and the cost of the implementation of the care bundle. Lewin’s three-stage model of change can be used to implement the change. In particular, its first stage will help the DNP practice scholar to create awareness in the personnel about the need for change. This will reduce the potential active and passive employee resistance.
Evaluation Plan and Anticipated Outcomes
For further evaluation, the following critical indicators will be chosen: hand hygiene compliance rates, the incidence of catheter-associated urinary tract infections, the prevalence of catheter-associated urinary tract infections, as well as the incidence and prevalence of other HAIs. These critical indicators will be measured before the implementation of the care bundle and six months later. The results obtained can be analyzed using the t-test in SPSS or any other software for statistical analysis. Anticipated outcomes include the reduction in the prevalence and incidence rates of HAIs and an increase in hand hygiene compliance rates.
Strategies for Sustainability
Sustainability relates to the maintenance of certain practices at sufficient frequency in order to reach desired outcomes. Challenges associated with the implementation of the care bundle may adversely impact its sustainability. Some strategies for ensuring sustainability include strong leadership, communication strategies that involve the explanation of the importance of and the need for change, as well as its benefits for patients and the personnel, and the interprofessional collaboration.
In summary, healthcare-associated infections have a negative impact on patients as they suffer from pain, increased length of stay, and an increased probability of readmission. The appraisal of the evidence allowed for choosing the appropriate high-quality sources and applying their findings to the practice problem. The DNP practice scholar is responsible for the implementation of evidence translation, including the search for evidence, its critical review, and the creation of the translation path.
Albrecht, J. S., Croft, L., Morgan, D. J., & Roghmann, M. (2017). Perceptions of gown and glove use to prevent methicillin-resistant staphylococcus aureus transmission in nursing homes. Journal of the American Medical Directors Association, 18(2), 158–161.
Arefian, H., Vogel, M., Kwetkat, A., & Hartmann, M. (2016). Economic evaluation of interventions for prevention of hospital acquired infections: A systematic review. PLOS One, 11(1), 1–15.
Drews, F. A., Visnovsky, L. C., & Mayer, J. (2019). Human factors engineering contributions to infection prevention and control. Human Factors: The Journal of the Human Factors and Ergonomics Society, 61(5), 693–701.
Office of Disease Prevention and Healthcare Promotion. (2018). Healthcare-associated infections. Web.
Schmier, J., Hulme-Lowe, C., Semenova, S., Klenk, J., Deleo, P., Sedlak, R., & Carlson, P. (2016). Estimated hospital costs associated with preventable health care-associated infections if health care antiseptic products were unavailable. ClinicoEconomics and Outcomes Research, 8(1), 197–205.
Septimus, E. J., & Moody, J. (2016). Prevention of device-related healthcare-associated infections. F1000Research, 5(1), 65–76.
Sickbert-Bennett, E. E., Dibiase, L. M., Willis, T. M. S., Wolak, E. S., Weber, D. J., & Rutala, W. A. (2016). Reduction of healthcare-associated infections by exceeding high compliance with hand hygiene practices. Emerging Infectious Diseases, 22(9), 1628–1630.