Nosocomial Infections and Infections

Applying the Theory of Planned Behaviors to Nosocomial Infections

Identify a public health theory you will use to support the implementation of your prevention and health promotion activities. Provide evidence that supports the use of this theory within the program you designed

According to the tenets of the theory of planned behavior, individuals first think about a behavior (e.g., the intent to act) and only then proceed to act (Chambers & Benibo, 2011). The dependent variables of intent to act in the theory of planned behavior include individual attitudes, perceived behavioral control, self-efficacy, and behavioral norms which are in turn dependent variables to the actual behavior demonstrated (Chambers & Benibo, 2011). The theory of planned behavior has been applied in a number of different settings, including in the context of nosocomial infections (Hughes, 2008).

In this context, the planned behavior theory conceptualizes individuals' intent to engage in handwashing as involving three main factors: (1) attitude whether or not the behavior is beneficial to themselves, (2) perception of pressure from peers, and (3) perceived control on the ease or difficulty in performing the behavior (Hughes, 2008, p. 937). Further, the theory of planned behavior has also been used to evaluate patient perceptions of the benefit of participating in activities that can promote their health during inpatient stays. For example, a study by Davis and Anderson (2012) used the theory of planned behavior to identify the antecedents of safety-relevant behaviors among hospital inpatients. This study examined predictors of patients' intentions to engage in a safety behavior that could reduce nosocomial infections by reminding clinicians to wash their hands (Davis & Anderson, 2012). The findings that emerged from this study indicated that the extent to which patients understand why a behavior is beneficial will be the extent to which they perceive it as acceptable to engage in that activity (Davis & Anderson, 2012).

Therefore, this theory of planed behavior will be employed in the implementation of prevention and health promotion activities related to nosocomial or hospital-acquired infections (HAIs). Nosocomial infections can result in adverse clinical outcomes such as central-line associated bloodstream infections, catheter-associated urinary tract infections, surgical sites infections, and ventilator-assisted pneumonia (Types of healthcare-associated infections, 2017). Despite significant progress in addressing the problem in recent years, the proliferation of sophisticated medical devices has introduced additional sources of nosocomial infections and the problem persists. For instance, the U.S. Centers for Disease Control (CDC) estimate that on any given day, at least one out of every 25 American hospitals will experience at least one nosocomial infection case each day (HAIs at a glance, 2017). According to the CDC's most recent nosocomial survey surveillance report, the major sites of infection include those set forth in Table 1 below.

Table 1

Nosocomial estimates in U.S. acute care hospitals: 2011

Major Site of Infection

Estimated No.

Pneumonia

157,500

Gastrointestinal Illness

123,100

Urinary Tract Infections

93,300

Primary Bloodstream Infections

71,900

Surgical site infections from any inpatient surgery

157,500

Other types of infections

118,500

Estimated total number of infections in hospitals

721,800

Source: HAI data and statistics, CDC, 2017

Every tertiary healthcare facility will experience differing levels of nosocomial infections depending on their areas of specialization and the availability of resources (Bijari & Abassi, 2014). Moreover, a number of other variables can affect nosocomial infection rates in a given hospital, including patient characteristics and patient care requirements, nursing education and staffing levels as well as differences in the use of aseptic techniques by clinicians (Hughes, 2008).

2. Design evidenced-based prevention and health promotion activities that can be implemented to decrease the health risk among your previously identified population

Although there are a number of sources of HAIs, one of the most effective evidence-based prevention and health promotion activities identified to date for reducing nosocomial infections is ensuring strict adherence to institutional handwashing policies (Hughes, 2008). In this regard, Hughes (2008) emphasizes that, "Epidemiologic studies continue to demonstrate the favorable cost-benefit ratio and positive effects of simple hand washing for preventing transmission of pathogens in health care facilities" (p. 938). Despite its proven efficacy, the research to date also indicates that clinicians only wash their hands according to recommended hand hygiene protocols about 40% of the time on average, with an alarming range of between 5% and 80% (Hughes, 2008).