In order to reduce hospital acquired infections, one must identify key evidence-based components which demonstrate how research can be translated into bedside nursing practice. This paper analyzes four nursing practice steps that address infection and helps healthcare workers understand how to incorporate evidence-based guidelines into nursing interventions. Thanks to recent studies, EBP has decreased infection rates greatly.
¶ … Urinary tract infections (UTIs) are typically the most prevailing healthcare-associated infection (HAI) in acute care facilities in the U.S. The Centers for Disease Control and Prevention (CDC) has estimated that up to 150,000 hospital-onset, symptomatic catheter-associated UTIs (CAUTIs) occurred in 2013, resulting in as much as $161 million in excess direct medical costs (Kuntz, 2010, p. 319). Current research examines the reason for such a high occurrence of infection. Roughly 75% of healthcare-associated UTIs are connected to improper use of indwelling urinary catheters, to which up to a quarter of hospitalized patients are exposed. Adult ICUs have the highest exposure rate for catheter use and reveal over 95% of UTIs related to catheter use.
In the last twenty years, various strategies have been implemented to aid in reducing the risk of CAUTI in healthcare settings. One of which includes identifying proper times to use catheters and proper care and insertion practices. When it came to poor practices, many of which are still ongoing, most were not acknowledged due to CAUTI being a somewhat low priority problem in comparison with other hospital acquired infections. In order to develop a proper method / implementation strategy to reduce CAUTIs, ordinary care practice must be changed to evidence-based practice (EBP). Furthermore, personal care practices and adherence to practice guidelines must be analyzed.
Direct observation of several instances of catheter use reveal several issues with reducing the spread of multi-drug-resistant organisms (MDROs). Many healthcare professionals do not properly wash their hands and walk into isolation rooms without the standard protective gear resulting in the spread of harmful pathogens. In order to prevent such situations, a series of actions must be implemented to control the potential spread of harmful pathogens. Evidence-based principles have four main tenets:
1. Hand Hygiene
2. Barrier Precautions
3. Decontamination of Environment, Items, and Equipment
4. Antibiotic Stewardship (Flynn, Martins, Burns, Philbricks, & Rauen, 2013, p. 37)
These four steps are vital for any strategy to reduce HCAIs. Research and evidence supports the significant impact of hand hygiene in prevention of infection dating back to the 1800's. In a book by WHO (2019), they state the guidelines that healthcare workers must follow to avoid transmission of organisms:
1. The organisms must be present on the patient's skin or inanimate objects and transfer to the health care worker's hands
2. The organism must survive for several minutes on the hands of the health care worker
3. Hand washing or antisepsis by the health care worker is inadequate or omitted
4. The contaminated hands of the health care worker come in direct contact with another patient or inanimate object that will be in direct contact with the patient (World Health Organization, 2009, p. 1).
The book also states hand hygiene must last at least between 40-60 seconds with an antibacterial soap or cleaning agent to all surfaces on the hand. Another step, Environmental Considerations, advocates for a collective strategy of standard precautions, specific isolation precaution interventions all based on the kind of vector of transmission the organism has. This could be contact, airborne, or droplet. At times decontamination of the room, equipment, and the clothing and items of the healthcare workers must be done to eliminate possible pathogen exposure.
Standard precautions involve using PPE or personal protective equipment and hand washing to ensure patient safety in regards to infection. Isolation precautions are based on infection control standards to prevent or contain infection and must be carried out when a pathogenic transmission risk increases. Often found in instances where HCAIs were high, medical staff's clothing were found to be contaminated. Laundering clothing and drying it at an adequate heat will prevent pathogens from staying on the clothing.
Antibiotic Stewardship prevents overuse of antibiotics that may create antibiotics resistant microbes or MDROs. Commonly, medical staff when treating an infected or ill patient put them in contact isolation upon admission to the ICU leading to unnecessary and additional expenses. Evidence-based practice calls for immediate isolation for patients who have known colonization of MDROs along with active infections. Along with this protocol, serum levels of procalcitonin should be monitored to aide in assessing the duration of antibiotic therapy.
In a study by Goeschel, Cosgrove, Romig, & Berenholtz (2011), they gathered data from Centers for Disease Control and Prevention (CDC) through the National Nosocomial Infections Surveillance System from the time period of 1990-2004 and the National Healthcare Safety Network from 2006-2007. In their study the authors' state:
"Infection preventionists in participating hospitals used standard methods to identify all CAUTI events (categorized as symptomatic urinary tract infection [SUTI] or asymptomatic bacteriuria [ASB]) and urinary catheter -- days (UC-days) in months selected for surveillance. Data from all facilities were aggregated to calculate pooled mean annual SUTI and ASB rates (in events per 1,000 UC-days) by ICU type. Poisson regression was used to estimate percent changes in rates over time (Deron, Edwards, Srinivasan, Fridkin, & Gould, 2011, p. 748).
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