Problem Description
Incidences of nosocomial infections have been increasing in the ICU due to poor maintenance of hygiene in the use of medical devices such as syringes, catheters, and ventilators. Nosocomial infections in the ICU have a negative impact on the clinical interventions and nursing care that patients receive (Scales, 2011). Given that critical care nurses ensure that patients receive appropriate therapies and health care, the presence of nosocomial infections complicates the health conditions of the patients and consequently treatment requirements. Additionally, nosocomial infections increase the length of stay and the cost of medical care. According to Safdar and Abda (2008), “approximately 2 million patients each year in the United States acquire nosocomial infections, resulting in some 90,000 deaths and adding an estimated $4.5 to $5.7 billion per year to the costs of patient care” (p. 933). Hence, there is a need to educate critical care nurses on how to maintain hygiene when using medical devices that increase the risk of nosocomial infections.
The deficit in the application of evidence-based practices that are in tandem with current preventive measures is an issue that the hospital needs to address. As a baseline preventive measure, the critical care nurses in the hospital employ conventional practices such as hand hygiene, cleansing of catheter sites, and sterilization of the medical devices. Despite using these conventional interventions in the prevention and control of nosocomial infections, the incidence rates of the infections continue to remain high. In a study, Ding et al. (2009) find out that the rate of nosocomial infections in the ICU ranges from 22% to 32% depending on the clinical practices and nursing care that patients receive. Such figures are very high because they imply that about a third of patients in the ICU are at risk of losing their lives due to nosocomial infections. The increase in the incidences of nosocomial infections is attributable to the deprived hygienic conditions of the ICU, poor maintenance of catheters and ventilators, improper use of antiseptics, and lack of antiseptic-impregnated catheters (Kathleen et al., 2011). Thus, the hospital needs to upgrade preventive and control measures of nosocomial infections in the ICU.
Solution Description
The education of critical care nurses is an appropriate intervention for reducing incidence rates of nosocomial infections in the ICU. The rationale for using education as a proposed solution is that it facilitates the adoption and utilization of evidence-based practices (Chittick & Sherertz, 2010). Evidence-based practices are effective in the prevention and control of nosocomial infections in the ICU because they forestall medical errors due to the use of opinions and assumptions, which are quite misleading (Milstone, Passaretti, & Perl, 2008). Lack of evidence-based interventions in the prevention of nosocomial infections compels critical care nurses to employ outdated interventions, which are not only effective, but also increase morbidity and mortality rates associated with the nosocomial infections (Wilson, Wilde, Webb, Thompson, Harwood, Callan, & Gray, 2009). The education enables critical care nurses to update their knowledge and skills about current interventions for preventing nosocomial infections in the ICU. According to Mermel (2011), educational interventions have a significant impact on reducing the rates of nosocomial infections in the ICU. Hence, educational intervention supports the adoption and the use of evidence-based interventions in the prevention and control of nosocomial infections in the ICU.
Implementation Plan
The implementation plan of the educational program that aims at equipping critical care nurses with essential knowledge and skills derived from evidence-based practices consists of weekly seminars. As part of stakeholders, critical care nurses will be responsible for the implementation of the educational program. Critical care nurses will attend weekly seminars where they will receive updated preventive measures of nosocomial infections in the ICU. The educational program expects critical care nurses to apply the knowledge that will be gained during each seminar in preventing nosocomial infections. Since the nurse manager is in charge of the ICU, the manager will be responsible for initiating the educational program and overseeing the implementation of evidence-based practices gained during the seminar. Halm (2010) argues that the implementation of evidence-based practices requires leadership and administrative support. Thus, a managerial role is necessary for the implementation of the educational program. The seminar will ensure that critical care nurses gain preventive measures of nosocomial infections that are in tandem with current evidence-based practices.
Evaluation Plan
The use of surveys is one of the methods of evaluating the effectiveness of the educational program in reducing incidences of nosocomial infections and improving the quality of care in the ICU. The variables that the evaluation plan seeks to assess are knowledge, skills, and perceptions of critical care nurses, perceptions of patients, the prevalence of nosocomial infections, and the cost of treating nosocomial infections. The survey helps in gathering information regarding the perceptions of nurses about the implementation of the educational program and its impact on their knowledge and skills. Majid, Foo, and Mokhtar (2011) argue that perceptions, skills, and knowledge of nurses determine the effectiveness of adoption and utilization of evidence-based practices. The evaluation plan also surveys the perceptions of the ICU patients concerning the quality of care that they receive. In this view, a survey of nurses and patients before and after implementation of the educational program is necessary. Moreover, analysis of records, before and after implementation of the educational program, which shows the prevalence of nosocomial infections and cost associated with their treatment, is important in evaluating the effectiveness of the program in reducing nosocomial infections.
Dissemination Plan
The dissemination of the evaluation findings regarding the outcomes of the educational program focuses on aspects of the outcomes such as knowledge, skills, and perceptions of nurses, perception of patients, the prevalence of nosocomial infections, and the cost of treating nosocomial infections. Since the educational program aims at improving the competence of critical care nurses, dissemination of their knowledge, skills, and perceptions regarding the prevention of nosocomial infections is important in highlighting the impact of the educational program (Vandijck, Labeau, Vogelaers, & Blot, 2010). The perception of patients is critical information that requires dissemination. Satisfaction of patients normally signifies the nature of care and competence of nurses in the delivery of nursing care (Zavare, 2010). Thus, dissemination of patients’ perceptions is necessary so that nurses can understand how to deliver effective nursing care that meets the demands and expectations of patients. Given that the educational program aims at reducing the prevalence of nosocomial infections and consequently treatment of patients in the ICU, dissemination of the information regarding the extent of reduction in the prevalence of nosocomial infections and treatment cost is invaluable.
Annotated bibliography
Barsanti, M., & Woeltje, K. (2009). Infection prevention in the intensive care unit. Infectious Disease Clinics of North America, 23(3), 703-725.
The article emphasizes the impact of nosocomial infections on the economic, social, and psychological aspects of patients and families. Thus, to prevent the occurrence of nosocomial infections in the ICU, the article recommends minimization of risk factors, continual education of healthcare providers, and adoption of evidence-based practices.
Chittick, P., & Sherertz, R. (2010). Recognition and prevention of nosocomial vascular devices and related bloodstream infections in the intensive care unit. Critical Care Medicine, 38(8), 363-372.
The article reviews available tools that are integral in the prevention and diagnosis of nosocomial infections in the ICU. In this view, the article highlights that the use of antiseptic-impregnated catheters, hand hygiene, skin cleansing, catheter changes, catheter choice, and early diagnosis is central in the prevention of nosocomial infections.
Ding, et al. (2009). Retrospective analysis of nosocomial infections in the intensive care unit of a tertiary hospital in China during 2003 and 2007. BMC Infectious Diseases, 9(115), 1-109.
The article describes the experiences of patients with nosocomial infections through retrospective analysis. Since the experiences of patients are imperative in understanding the occurrence of nosocomial infections, the article declares that poor hygienic practices and a lack of evidence-based practices contribute significantly to the occurrence of nosocomial infections in the ICU.
Halm, M. (2010). ‘Inside Looking In’ or ‘Inside Looking Out’? How Leaders Shape cultures equipped for evidence-Based Practice. American Journal of Critical Care, 19(4), 375-378.
As leadership is critical in the implementation of evidence-based practices, the article comprehensively examines the role of leaders in the adoption and implementation of evidence-based practices in the healthcare system. Overall, the article suggests that healthcare leaders should help in shaping cultures that support the adoption and implementation of evidence-based practices.
Helder, O., Brug, J., Loonman, C., Goudoever, J., & Kornelisse, R. (2010). The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban neonatal intensive care unit: An intervention study with before and after comparison. International Journal of Nursing Studies, 47(1). 1245-1252.
Hand hygiene is one of the interventions that are central in the prevention and control of nosocomial infections. The article assesses the impact of an educational program on the reduction of nosocomial infections in the neonatal ICU. Hence, the article recommends the use of hand hygiene in the prevention and control of nosocomial infections among babies in the ICU.
Kollef, M. (2008). SMART approaches for reducing nosocomial infections in the ICU. Chest, 134(2), 447-456.
Although evidence-based practices are available, critical care nurses do not apply them because they do not have essential knowledge and skills. In this view, the article outlines smart approaches such as hand hygiene, the use of antiseptic-impregnated devices, and the improvement of clinical practices. Therefore, the article emphasizes that new approaches are necessary to enhance preventive measures of nosocomial infections.
Kathleen, et al. (2011). Nurse-directed interventions to reduce catheter-associated urinary tract infections. American Journal of Infection Control, 30(1), 1-6.
Despite the fact that evidence-based guidelines are available, the article states that healthcare professionals do not follow them consistently. To establish the impact of evidence-based interventions, the study examines patients with catheter-related urinary tract infections. On this basis, the article establishes that compliance with guidelines leads to a decrease in catheter days and a reduction in the prevalence of nosocomial infections.
Majid, S., Foo, S., & Mokhtar, I. (2011). Adopting evidence-based practice in clinical decision-making: Nurses’ perceptions, knowledge, and barriers. Journal of Medical Library Association, 99(3), 229-236.
In the article, the authors claim that the adoption and implementation of evidence-based practices are dependent on perceptions, knowledge, and institutional barriers. To enhance the adoption and implementation of evidence-based practices, nurses and other healthcare providers should change their attitudes and perceptions, and improve their knowledge.
Mermel, L. (2011). What is the predominant source of the intravascular catheter Clinical Infectious Disease, 52(2), 211-212.
The article seeks to establish if intraluminal or extraluminal parts of the catheter are responsible for nosocomial infections. To establish the source of nosocomial infections, the article examines the extensive literature. Based on the literature, the article verifies that both intraluminal and extraluminal parts of the catheter are responsible for the occurrence of nosocomial infections.
Milstone, M., Passaretti, L., & Perl, M. (2008). Chlorhexidine: Expanding the armamentarium for infection control and prevention. Clinical Infectious Diseases, 46(2), 274-281.
Since chlorhexidine is a powerful antiseptic, the article reviews its uses and that of its derivatives in skin cleansing and impregnating syringes and catheters. The article attributes the occurrence of nosocomial infections to poor hygiene in the use of medical devices. As part of the findings, the article establishes that chlorhexidine and its derivatives are effective in the prevention of nosocomial infections.
Safdar, N., & Abda, C. (2008). Educational interventions for the prevention of healthcare-associated infection: A systematic review. Critical Care Medicine, 36(3), 933-940.
The authors hold that education is an effective intervention in preventing and controlling nosocomial infections. Despite the fact that evidence-based practices are in the literature, healthcare providers have not adopted and implemented them because they do not have relevant knowledge and skills. Therefore, the article supports the use of education as an intervention for improving the knowledge and skills of nurses so that they can apply evidence-based practices in the prevention of nosocomial infections.
Scales, K. (2011). Reducing infections associated with central venous access Nursing Standard, 25(36), 49-56.
The nature of clinical practices that nurses apply determines the occurrence of nosocomial infections. The article argues that poor hygienic conditions predispose patients to nosocomial infections. Hence, the article suggests the use of antiseptics and antiseptic-impregnated devices in the ICU to prevent and control the occurrence of nosocomial infections.
Vandijck, M., Labeau, O., Vogelaers, P. & Blot, I. (2010). Prevention of nosocomial infections in intensive care patients. Nursing in Critical Care, 15(5), 251-256.
The article stresses that ICU patients commonly experience nosocomial infections due to the unhygienic conditions of the ICU, outdated clinical practices, and invasive treatment procedures. In this view, the article affirms that maintenance of hygiene and the adoption of current clinical practices are effective in reducing the prevalence of nosocomial infections in the ICU.
Wilson, M., Wilde, M., Webb, M., Thompson, D., Harwood, J., Callan, L., & Gray, M. (2009). Nursing interventions to reduce the risk of catheter-associated urinary tract infections: Part 2: Staff education, monitoring, and care techniques. Journal of Wound, Ostomy, and Continence Nursing, 36(2), 137-154.
The article examines nursing interventions that are applicable in the prevention of urinary tract infections. Since the use of catheters predisposes patients to nosocomial infections, the article supports the use of evidence-based interventions. Hence, the article recommends the education of staff, constant monitoring of catheters, and the use of good insertion techniques as effective interventions for reducing the prevalence of nosocomial infections.
Zavare, M. (2010). Patient satisfaction: Evaluation nursing care for patients hospitalized with cancer in Tehran Teaching Hospitals, Iran. Global Journal of Health Science, 2(1), 117-126.
As different parameters of assessing the quality of nursing care exist, the article asserts that patient satisfaction is the best. Patient satisfaction is a reliable parameter because it assesses the quality of healthcare from the viewpoint of patients. In this view, the article recommends the assessment of the quality of healthcare using the perception of patients.
Conclusion
Nosocomial infections challenge the health care system because it threatens the lives of about a third of patients in the ICU and markedly increases medical costs. The major factor that contributes to the occurrence of nosocomial infections is poor hygiene in the use of medical devices such as catheters and syringes. Although the literature review shows that ample evidence-based practices exist, nurses do not apply them in the prevention and control of nosocomial infections because they do not have essential knowledge and skills. In this view, the project recommends the use of the educational program as an intervention of improving the knowledge and skills of nurses so that they prevent and control nosocomial infections effectively in accordance with the current evidence-based practices. In the implement the educational program, nurses will attend weekly seminars where they will learn evidence-based knowledge and skills, and then the program undergo an evaluation to determine its impact in enhancing nurses’ knowledge and skills, and in reducing incidences of nosocomial infections. Since the literature review supports the use of education in the prevention and control of nosocomial infections, the projects will disseminate the evaluation findings through publications and seminars.
References
Barsanti, M., & Woeltje, K. (2009). Infection prevention in the intensive care unit. Infectious Disease Clinics of North America, 23(3), 703-725.
Chittick, P., & Sherertz, R. (2010). Recognition and prevention of nosocomial vascular device and related bloodstream infections in the intensive care unit. Critical Care Medicine, 38(8), 363-372.
Ding, et al. (2009). Retrospective analysis of nosocomial infections in the intensive care unit of a tertiary hospital in China during 2003 and 2007. BMC Infectious Diseases, 9(115), 1-109.
Halm, M. (2010). ‘Inside Looking In’ or ‘Inside Looking Out’? How Leaders Shape cultures equipped for evidence-Based Practice. American Journal of Critical Care, 19(4), 375-378.
Helder, O., Brug, J., Loonman, C., Goudoever, J., & Kornelisse, R. (2010). The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban neonatal intensive care unit: An intervention study with before and after comparison. International Journal of Nursing Studies, 47(1). 1245-1252.
Kollef, M. (2008). SMART approaches for reducing nosocomial infections in the ICU. Chest, 134(2), 447-456.
Kathleen, et al. (2011). Nurse-directed interventions to reduce catheter-associated urinary tract infections. American Journal of infection Control, 30(1), 1-6.
Majid, S., Foo, S., & Mokhtar, I. (2011). Adopting evidence-based practice in clinical decision-making: Nurses’ perceptions, knowledge, and barriers. Journal of Medical Library Association, 99(3), 229-236.
Mermel, L. (2011). What is the predominant source of the intravascular catheter infections. Clinical Infectious Disease, 52(2), 211-212.
Milstone, M., Passaretti, L., & Perl, M. (2008). Chlorhexidine: Expanding the armamentarium for infection control and prevention. Clinical Infectious Diseases, 46(2), 274-281.
Safdar, N., & Abda, C. (2008). Educational interventions for prevention of healthcare-associated infection: A systematic review. Critical Care Medicine, 36(3), 933-940.
Scales, K. (2011). Reducing infections associated with central venous access devices. Nursing Standard, 25(36), 49-56.
Vandijck, M., Labeau, O., Vogelaers, P. & Blot, I. (2010). Prevention of nosocomial infections in intensive care patients. Nursing in Critical Care, 15(5), 251–256.
Wilson, M., Wilde, M., Webb, M., Thompson, D., Harwood, J., Callan, L., & Gray, M. (2009). Nursing interventions to reduce the risk of catheter-associated urinary tract infections: Part 2: Staff education, monitoring, and care techniques. Journal of Wound, Ostomy, and Continence Nursing, 36(2), 137-154.
Zavare, M. (2010). Patient satisfaction: Evaluation nursing care for patients hospitalized with cancer in Tehran Teaching Hospitals, Iran. Global Journal of Health Science, 2(1), 117-126.