Applying the Iowa model to prevent healthcare-associated infections

Healthcare Associated Infections

The following is an Iowa Model examination of "Healthcare Associated Infections" (HAI). This paper presents evidence to show the nature and state of this problem. Possible solutions as well as how to manage change will be also be presented.

Healthcare-associated infections (HAIs) are acquired by patients while undergoing treatments for the conditions they are suffering from (Iowa Department of Health). They occur in pretty much all healthcare settings, including surgery and acute care centers, outpatient as well as facilities for long-term care like rehabilitation and nursing facilities (Iowa Department of Public Health). HAIs find associations with different causes, including medical devices usage like ventilators and catheters, post-surgery complications, transmission between health workers and patients or overuse of antibiotics, among others (Iowa Department of Public Health).

Identification of the clinical issue

Healthcare-associated infections together with other serious events are continuing to result in high morbidity as well as mortality among U.S. Patients in healthcare facilities and cost the nation billions of dollars in healthcare costs (Healthcare Associated Infections). Advances have been made in comprehending the prevention of specific HAIs through engaging in activities structured to help in the implementation of recommendations already made in the prevention of HAIs. However, current strategies for the prevention of HAIs are limited by science's current state and so not all HAIs can be prevented even if all the recommendations were implemented (Healthcare Associated Infections). It is critical to invest in prevention of HAI research so as to improve the existing strategies and move forward towards the elimination of HAIs. A survey done by CDC on prevalence of HAI gives an up-to-date estimate of the state of HAI problems in the nation's hospitals (Healthcare Associated Infections). Using a big sample of acute care facilities in the country, the survey reports that on any particular day, approximately one in every twenty-five patients in hospitals are infected with an HAI. Approximately 722,000 cases of HAI existed in acute care hospitals in the United States. Approximately 75,000 of these patients succumbed to their conditions while still hospitalized (Healthcare Associated Infections). At least half of these infections took place in the ICU. In modern healthcare, a lot of invasive procedures and devices are employed to help patients recover. The infections can be linked to the devices employed in various procedures, like ventilators and catheters. The resulting HAIs include catheter-associated urinary tract infections, line-associated bloodstream infections and ventilator-associated pneumonia (Healthcare Associated Infections). Infections can also be gotten at sites of surgery -- they are referred to as surgical site infections. CDC is working very hard towards the monitoring and the prevention of such kind of infections since they threaten the safety of patients.

Importance of issue to nurses, patients and organizations

A surgical site infection occurs in the body part that a surgical procedure was performed. These infections can at times be superficial infections and so infecting only the skin. Other infections of this nature may be serious and can infect body tissue found beneath the skin, body organs or implants (Healthcare Associated Infections). Central line-associated bloodstream infections (CLASBIs) cause thousands of fatalities annually and cost the healthcare system several billions in healthcare costs. Ventilator-associated pneumonia is an infection of the lung which develops in an individual who is using a ventilator (Healthcare Associated Infections). A ventilator helps patients in breathing by supplying oxygen by using a tube put in the nose or mouth of the patient, or sometimes through a hole in the neck. An infection might take place when germs go through the tube into the lungs of the patient (Healthcare Associated Infections). Urinary tract infections (UTI) infect any place in the urinary tract, including ureters, bladder, kidney and urethra. They are the most prevalent HAI type in reports to National Healthcare Safety Network (NHSN). Of the UTIs occurring in hospitals, about 75% are linked to urinary catheters -- a tube used in the drainage of urine from the bladder (Healthcare Associated Infections). It is estimated that 15% to 25% of patients who have been hospitalized use urinary catheters when in hospital. The most significant risk of the development of UTIs is prolonged usage of the device (Health Association Infections). Catheters should therefore be employed carefully and shouldn't be left unnecessarily in the patient's tract. The Iowa Department of Public Health (IPDH) appreciates that HAIs pose a major challenge to the health sector and it is needful that the rate of such infections, especially those that can be prevented, be monitored and decreased (Iowa Department of Public Health). CDC reports that almost two million patients are infected with HAIs in U.S. Hospitals every year. About 99,000 deaths result from these cases and the CDC estimates that the problem costs the nation between $28 billion to $33 billion. IDPH says that patients do not anticipate, not that they should ever anticipate, getting infections. It is critical that these infections are eliminated from the healthcare system so as to make it safe for everyone. They cause several deaths every year that can be prevented. They also burden the population with unnecessary financial problems.

Problem/Evidence Analysis/Solutions

The format of the PICOT question can be made use of in the development of researchable and answerable questions (What is a PICOT Question?). Writing PICOT questions can be seemingly easy! However, writing effective ones do make the entire evaluation process more simple and straightforward (What Is a PICOT Question?) While it may sound strange, making the decision of what to look for in order to achieve the desired outcome can be quite difficult. The determination of the outcome aids in streamlining the evidence searching process. Note that evidence is not just the desired outcome you want to attain; it is the evaluation of evidence that leads to the outcome (What Is A Picot Question?)

Questions worth asking in determining the above issues:

1.

HAI problems are likely to affect which patients?

2.

What measures of interventions or solutions should be taken into account?

3.

Are there any alternatives to the methods of intervention?

4.

What outcomes are desired?

Current care standards

The term evidence-based practice (EBP) has been floated for quite some time now. Actually, if you need your views paid attention to in the community, just drop the term evidence-based practice into them. You will see practitioners in the field taking note of your views (Bauer, 2010). Having said that, how is an evidence-based project begun? Does an easy method which can be applied in bedside problem solving exist? Evidence-based practice actually comprises of many steps. First given its definition, the person must evaluate the evidence for the research (Bauer, 2010). Second, the resulting information is integrated with resources available and clinical experience. Lastly, consider the preferences of the patient in order to put together the best possible care for him or her (Pepe, 2003). An aim of the EBP movement is to improve how fast research findings are integrated into the care of patients (Bauer, 2010).

Details on current problem and solutions

History of current practice

The Iowa model makes use of key triggers which can be focused on the knowledge or problem in order to get the clinician to utilize the model's components. Initially, clinicians generate a question from either knowledge from research findings or a problem (Bauer, 2010). The model's second step is determining the presence of relevance to the priorities of the organization. If it is a relevant question, the next step is determining if there is evidence that can be used in answering the question (Bauer, 2010). On examination of the evidence, if the evidence is sufficient, a pilot practice is rolled out. If the evidence is insufficient, then the model allows for the gathering of more evidence through the carrying out of more research. There are therefore 2 possible outcomes to the model (Buer, 2010). First, an outcome would be the institution of change in practice on the basis of the research available following the pilot if the pilot demonstrates that it is appropriate to change practice (Ciliska et al., 2005).

The Iowa model is made use of as a basis for the analysis of the presented problem. The evidence in the section of practice shows that healthcare associated infections pose a major challenge to the health sector today. Problems are caused to patients, staff and the organization as well.

Implications of the current practice

The story below illustrates the problem posed by healthcare associated infections in the healthcare system. An examination of the problem will be done and a deserving solution proposed.

A 72-year-old woman, Jerri Allen, was enthusiastic about getting a hip replacement so that she could always join her husband on the dance floor. She had endured hip pain for several years and had heard her comrades talk of successful procedures and she was looking forward to her own so that she could be free of pain or reduce it (IOWA CAUTI). The surgery procedure went on successfully and her recovery was proceeding well until the 3rd day following the procedure, as she was waiting for a transfer to a rehab unit, did fever spike. Tests were carried out and they ruled out pneumonia and blood infection but there was presence of an infection in the urinary tract (IOWA CAUTI). The surgeon said that it must have resulted due to the blood catheter used. After four days at home, the situation changed. The incision made inflamed tremendously and a reddish yellow fluid was being discharged. She was immediately readmitted by her surgeon to the hospital and taken to the theater to reopen the incision. The diagnosis made was a surgical site infection. Culture tested positive for the organism that was present in her urine (IOWA, CAUTI). The surgeon said that the infection could have been seeded from the infection in the urinary tract. The following months proved quite trying for Jerri -- long stays at the hospital, continuous surgeries to clean her wound up, and lastly the removal of the fresh hip. She was taken to a skilled nursing facility to wait for her wound to clean up to a level it would be safe to have a new one implanted. Depression set in and Jerri did not want to engage in physical therapy (IOWA CAUTI). She stopped eating and subsequently lost a lot of weight. A feeding tube had to be administered. After three months, at the time the surgeon replaced the hip, she wasn't the same person that came for the initial surgery. The troubles were compounded by financial problems. Her care was fully covered by neither Medicare nor the supplemental insurance, and her husband had to dig deep into their savings to foot the medical bills that had now exceeded $200,000 (IOWA CAUTI).

The story of Jerri is an example of the way healthcare-associated infections, like catheter associated urinary tract infections in Jerry's case, can affect lives. The HAIs cause a high level of morbidity, costs and mortality (IOWA CAUTI). The Centers for Disease Control and Prevention (CDC) gives an estimate of two million HAIs occurring in United States hospitals 99,000 individuals losing their lives every year due to these infections. An approximate 4.5 HAIs exist for every one hundred hospital admissions. The figure is 9.3 infections for every one thousand patient days in the ICU and two surgical site infections for every one hundred operations (IOWA CAUTI). The infections cost the nation five to six billion dollars every year, with the average incremental cost per patient being $8, 832. CAUTIs account for the highest number of HAIs in hospitals in the United States (Stone, Braccia, and et al., 2005). In 2002, almost 450,000 CAUTIs were identified in United States hospitals. With the average cost for every infection being about $1,000 in the year 2007, the total cost estimate stands at a staggering $450 million every year (Stone, Braccia, and et al., 2005).

Recommendations of a different approach

While no magic bullets exist for the easy eradication of these infections, medical literature assessments has brought about the development of guidelines that are evidence-based and that can be made use of in the coming up of best practices to prevent these infections (IOWA CAUTI). Particular guidelines that have been accepted by practitioners include the ones developed by the Centers for Disease Control and Prevention, the Society of Healthcare Epidemiology of America, the Infectious Disease Society of America and the Association for Professionals in Infection Control and Epidemiology (IOWA CAUTI).

The Goal: Guiding and supporting efforts being made in hospitals in IOWA in the development of systems for surveillance for catheter-associated urinary tract infections (IOWA CAUTI). Additionally, the project aims at supporting collaboration aimed at defining and implementing effective and efficient prevention as well as control strategies in hospitals so as to reduce catheter-associated urinary tract infections.

Project Timeline (IOWA CAUTI): The program was scheduled to run from January 1, 2010 till the end of the year 2011. Prevention collaboration in the district were to be supported by the Center for Acute Disease Epidemiology (CADE) as well as Iowa Healthcare Collaborative (IHC).

Importance and impact of problem for the organization and for the patient

The CDC supports the major strategies aimed at the elimination of CAUTIs (IOWA CAUTI):

Catheters are only to be inserted for the right indications

Catheters are to be left in place only for as long as is needed

Making sure that only the adequately and properly trained medical personnel insert and also maintain the catheters

Insertion of catheters using only the aseptic technique and by using sterilized equipment (acute care setting)

After aseptic insertion, a closed drainage system is to be maintained

An unobstructed flow of urine is to be maintained

Maintain proper precautions of standards of hygiene (or of proper isolation)

Further, CDC supports other strategies, including (IOWA CAUTI):

Considering alternatives to insertion of catheters

Using movable ultrasound machines for the assessment of volume of urine so as to ensure reduction of avoidable catheterizations

Using antiseptic-impregnated/microbial catheters