Infection Control and Prevention

Infection Prevention and Control
Proposal for Clinical Experience and Project
For this project, I elected to experience the leadership role in a clinical practice with a family nurse practitioner (FNP). Towards this end, my area of specialty will be infection prevention and control in a short-term and long-term rehabilitation facility.
The relevance of this clinical experience cannot be overstated when it comes to the further enhancement of my professional capabilities. As a matter of fact, I regard it a rite of passage as I seek to gather additional insight in my field of specialization for enhanced patient care in a clinical setting. Being fully aware of the diversity of the patient-care environment, I would want to be prepared to address various healthcare-related issues and concerns in an able and professional manner. This is more so the case given that the nursing field is very broad – effectively meaning that those in this noble profession ought to be prepared to function in a wide range of care settings and specialties. In general terms, therefore, my selected clinical experience would come in handy in this endeavor.
I selected my area of specialty, i.e. infection prevention and control, for a number of reasons. It is important to note that infection control and prevention is key to the further enhancement of patient outcomes. According to Gould and Drey (2013), the relevance of infection control in “protecting patients and reducing the risks of occupational exposure” cannot be overstated” (760). Towards this end, I would want to be well versed in the prevention of hospital-acquired infections by ensuring a safe working environment that does not pose the risk of infection. The role of nurses in this endeavor is largely front-line given their close interactions and proximity to patients. It is with this in mind that I would desire to be well-versed in the various infection control and management approaches so as to ensure protection for both myself and my patients. This is of great relevance given that “professional practice requires direct contact with the sick, handling material and implementation of invasive procedures” (Gomes, Mascarenhas, Mendonca, and Rebelo, 2016, p. 87). Below are my self-defined learning objectives for the clinical experience:
1. To have a practical feel of the various approaches and measures undertaken in seeking to ensure that pathogens borne by various body fluids are not transmitted in the course of healthcare provision or conduction of first aid. The said body fluids include, but they are not limited to blood, vaginal secretions, amniotic fluids, cerebrospinal fluids, etc.
2. To have better grasp of not only how infections occur, but also the manner in which various microorganisms behave and proliferate. In so doing, I would be seeking to have better comprehension of prevention approaches across all settings.
3. To familiarize myself with the various organizational procedures put in place in a clinical setting to not only prevent, but also minimize opportunities for infections. Towards this end, I would be interested in finding out the various strategies healthcare institutions adopt or embrace in an attempt to ensure that patient outcomes are not hampered by poor infection control and prevention by members of staff. In essence, infections such as influenza pose a significant risk of spreading amongst patients in a healthcare setting. This could have significant and far-reaching implications for healthcare facilities.
The fact that I will be in a supervised learning environment means that I will be sharpening my skills and abilities in my selected area of specialty under the watchful as well as keen eye of an experienced professional, i.e. a family nurse practitioner (FNP). In that regard, therefore, I will be developing the necessary capabilities at a more enhanced rate than I would on my own, without necessarily compromising the safety as well as outcomes of patients.
Regulatory Standards in Beverley Rehabilitation and Health Care Center
The role of regulation in nursing practice cannot be overstated. Towards this end, there are various regulatory agencies that provide guidelines as well as standards for various practice settings. For my practice setting, the U.S. Department of Health and Human Services (HHS) remains a key regulatory agency. HHS concerns itself with not only the protection of the health of the American public, but also the provision of services deemed essential. More specifically, HHS highlights its mission as “to enhance and protect the health and well-being of all Americans” (HHS, 2018). According to HHS, under Congress’ authority, agencies create laws from time to time with an aim of assisting the government to execute its public policy. In essence, my area of focus is infection control and prevention.
It is important to note that as various studies have indicated in the past, one of the most significant threats to the safety as well as wellbeing of patients are healthcare-associated infections (HAI). As per the recommendations of the Healthcare Infection Control Practices Advisory Committee, which advises the HHS secretary on the most viable strategies to implement in an attempt to control and prevent HAIs, “adherence to infection prevention and control practices is essential to providing safe and high quality patient care across all settings where healthcare is delivered” (Centers for Disease Control and Prevention – CDC, 2017). Towards this end, various infection control as well as prevention guidelines have been put in place for all healthcare facilities to adhere to – “regardless of the type of healthcare provided” (CDC, 2017).
In various core practice categories, the guidelines highlight not only the relevance of support from the leadership of facilities, but also the need to adequately train staff on the various aspects of infection prevention. Education and training on infection control, as per the guidelines, should be extended to both patients and family members, as well visitors. Training in this case could include basic information on the spread of infections and the various measures which could be adopted in an attempt to prevent the said spread. The relevance of implementing appropriate performance and feedback mechanisms is also highlighted. Towards this end, adherence to infection prevention strategies should be closely monitored and if need be, corrective measures undertaken. A variety of standard precautions have been highlighted. These include, but they are not limited to, proper cleaning and disinfection of the environment, medication as well as injection safety, and hand hygiene.
My project involves educating nurses working in a short-term long- term rehabilitation center/nursing home on how to insert indwelling Foley catheter and catheter-associated urinary tract infection (CAUTI). This would be more of a ‘refresher course’ for the more experienced nurses and a valuable knowledge acquisition opportunity for those with less experience. The relevance of this exercise cannot be overstated especially given that as Nicolle (2014) points out, “urinary tract infection attributed to the use of an indwelling urinary catheter is one of the most common infections acquired by patients in health care facilities” (23). Under the ‘temporary invasive medical devices for clinical management’ guideline, the need for the healthcare provider to see to it that all insertion and maintenance directions are adhered to is restated. Towards this end, reference could be made to ‘Guideline for Prevention of catheter-Associated Urinary Tract Infections 2009.’

Professional Contributions of the Nurse Practitioner
My preceptor is a Nurse Practitioner (NP). She is an infection control coordinator in the facility – a role in which she is generally responsible for the development, implementation, as well as assessment and evaluation of the infection prevention and treatment program. Amongst other responsibilities, she assesses patient infections that are either community acquired or health care associated. She is essentially the facility’s chief infection strategist. Further, between 3 PM and 8 PM daily, she is responsible for all wound-related admissions to the facility – both new admissions and re-admissions. In this case, she assesses the wounds and when appropriate, writes orders for them. She also evaluates patient orders from the doctor on call and signs for them so that the affiliate pharmacy can act on the said orders. From time to time and when called upon, the NP also performs patient observations and conducts physical exams.
In essence, there are various skills and competencies that are needed to perform in this particular role of NP. To begin with, to be able to ably perform her duties, a NP must have a strong foundation in medical sciences. This is more so the case given that as the American Association of Nurse Practitioners (as cited in Quallich, Bumpus, and Lajiness, 2015, p. 222) points out, NPs ought to be “clinical experts in managing disease and promoting health of the whole person.” Further, it is important that NPs be well versed with some of the key scientific concepts and competencies that are important for the effective performance of NP roles. These concepts include, but they are not limited to, evidence-based practice, clinical practice, and health promotion. Next, a NP also ought to have a number of other skills and abilities that come in handy in fostering good working relationships and advancing the care and health promotion agenda. These include leadership skills, communication skills, and critical thinking abilities. With regard to leadership skills, NPs ought to be able to delegate roles in an effective manner and play leadership roles in a team setting. Communication skills, on the other hand, come in handy because the NP is deemed to be an advocate of the patient. The NP, therefore, ought to be able to articulate and present the needs of the patient to the relevant hospital staff and other medical professionals. Critical thinking abilities would also come in handy for the NP as this role calls upon the NP to solve complex problems and make practical decisions on a daily basis.
It is important that NPs maintain expertise over time so that their competence to practice remains up-to-date and relevant. As a matter of fact, a professional NP, as Skees (2010) points out, “engages in lifelong learning that will influence practice and ultimately impact the quality of care that a patient receives” (105). To begin with, NPs could seek to maintain expertise over time by continuing professional education. In this case, NPs could enroll in planned education initiatives so as to further enhance their clinical skills or upgrade their competencies. NPs could also keep themselves up to date with developments in their areas of specialties by routinely reading the relevant professional literature, i.e. journals. Towards this end, a NP could either engage in such an activity alone by subscribing for the appropriate journals, or join a journal club. Third, NPs could maintain their expertise over time by joining the relevant nursing organizations. While some professional organizations send members the nursing literature on various topics so as to support their professional development, others offer continuing education opportunities for members at discounted prices.
Application of Theory and Project Summary
I must say that this practice experience has been largely amazing and enlightening. In addition to being a learning experience for me, it has also provided me with an opportunity to share my knowledge with others and thus positively contribute towards the betterment and advancement of patient outcomes. My preceptor, who is a nurse practitioner, has been of immense benefit as far as my professional growth is concerned. She has not only been understanding, but also eager to assist and further my learning experience.
My project was born out of the realization that there were no infection control guidelines available to staff of the short-term and long-term units. Upon this realization, I made a few enquires on, amongst other things, the number of times nurses insert a Foley for a patient and their comfort levels regarding the procedure. The responses I got in this case convinced me that this was an issue worth pursuing. Towards this end, I settled on the need to educate nurses working in the short-term and long-term units on the how to insert indwelling Foley catheter and catheter-associated urinary tract infection (CAUTI).
The support I have received from not only my preceptor, but also the director of nursing has been amazing. The nurses have also been eager to learn and they appreciate my efforts. Patricia Brenner’s From Novice to Expert theory advances the importance of experience in nursing and concludes that its relevance cannot be overstated as far as the further enhancement of nursing expertise is concerned. With this in mind, the utilization of the male and female Catheterization Simulator set brought a more practical feel to the whole undertaking. I am convinced that this, coupled with the real-life practice setting application of learned concepts, will equip nurses with hands-on skills in this area and help bring down the risk of urinary tract infections brought about by the utilization of indwelling urinary catheters.
It is important to note that one of the most important concepts I have learned is the relevance of advancing strong relations between patients and nurses in the care process. The said relations ought to be founded on mutual respect. This is a concept the facility is very specific about. In essence, this reminds me of Hildegard Peplau’s Theory of Interpersonal Relations. In this case, it is theorized that when nurses and patients share strong interpersonal bonds that are based on mutual respect, nurses are able to respond to the needs of patients in a better way. I am convinced that during my entire practice experience, my willingness to learn and adapt, coupled with an enabling environment has effectively sharpened my skills in infection prevention and control.
I would term my practice experience as enlightening, informative and above all, inspiring. This is more so the case given that in addition to further enhancing my practical skills in infection control and prevention, I have made a positive impact and possibly left a lasting impression. I believe that each and every human being can (and ought to) contribute positively to the society. I happen to be in a profession where I can contribute towards the prevention of disease and promotion of health. These are roles I intend to perform to the best of my ability. I also intend to influence those I interact with to embrace best practices so as to positively influence nursing outcomes. I am glad that this practice experience has furthered this resolve and agenda. I am also thankful that I have been able to interact with the most amazing and understanding persons including, but not limited to, the facility’s staff, my preceptor, and the facility’s administration.






References
Adams, L.Y. (2017). Peplau’s Contributions to Psychiatric and Nursing Knowledge. Journal of Mental Health and Addiction Nursing, 1(1), 46-51.
Centers for Disease Control and Prevention – CDC (2017). Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings – Recommendations of the Healthcare Infection Control Practices Advisory Committee. Retrieved from https://www.cdc.gov/hicpac/pdf/core-practices.pdf
Gould, D. & Drey, N. (2013). Student Nurses' Experiences of Infection Prevention and Control During Clinical Placements. Am J Infect Control, 41(9), 760-3.
Gomes, A.A., Mascarenhas, I.C., Mendonca, A. & Rebelo, C.M. (2016). Prevention and Control of Infection: An Advanced Nursing Practice. International Journal of Nursing June, 3(1), 81-88.
Hansten, R. & Jackson, M. (2004). Clinical Delegation Skills (3rd ed.). Sudbury, Massachusetts: Jones & Bartlett Learning.
Health and Human Services – HHS (2018). About HHS. Retrieved from https://www.hhs.gov/about/index.html
Nicolle, L.E. (2014). Catheter Associated Urinary Tract Infections. Antimicrob Resist Infect Control, 3(23), 43-51.
Skees, J. (2010). Continuing Education: A Bridge to Excellence in Critical Care Nursing. Crit Care Nurs Q, 33(2), 102-116.
Quallich, S.A., Bumpus, S.M. & Lajiness, S. (2015). Competencies for the Nurse Practitioner Working with Adult Urology Patients. Urology Nursing, 35(4), 221-230.