Prevention of Nosocomial Infection

Nosocomial Infections

Synthesis

The evidence-based approach utilized and advocated by all the authors cited in this essay can be viewed through the lens of a PDSA process as described by Hadaway (2006). For example, Pronovost and colleagues were interested in reducing the incidence of preventable CR-BSIs in the ICU setting in Michigan. They first identified an evidence base supporting an intervention and then planned how to implement the intervention to cause a small-scale change. This evidence base, as well, is nothing more than the sum of several research groups engaging in the PDSA process. The intervention(s) is then implemented to test its efficacy, the results studied, and significant positive or negative outcomes are acted upon. The research reviews by Kampf et al. (2009) and Hadaway (2006) represent a synthesis of the findings from several studies, which they used to support their theses regarding hand hygiene and CR-BSIs, respectively. Rhine's (2006) editorial also outlined interventions supported by research findings, which was motivated by a single study showing improved NICU CR-BSI rates can be maintained for a period of years.

From a nurse's perspective, however, the PDSA process is designed for small-scale changes. The first step would be to identify an evidence base relevant to an issue, such as a troubling increase in NICU catheter-associated infections. The editorial by Rhine (2006) would be a good place to start, with its recommendation to change NICU culture so that patient safety is paramount. For example, both Hadaway (2006) and Rhine (2006) suggest giving nurses the authority to stop a procedure if best practice guidelines are not being followed. One measure implemented in Michigan was the formation of a team consisting of a physician and nurse, who were given the responsibility for implementing the ICU intervention and helping to collect data for the study (Pronovost et al., 2006). Hadaway (2006) suggests that a change in ICU culture should begin at the top, with organizational leaders who champion a change in culture that emphasizes patient safety. Regardless of how an ICU cultural change is implemented, the PDSA process demands that a realistic goal be set first.

The four publications reviewed in detail here universally recommended improving hand hygiene habits for all ICU clinicians (Hadaway, 2006; Pronovost et al., 2006; Rhine, 2006; Kampf, Loffler, & Gastmeier, 2009). A possible intervention might include the installation of alcohol-based hand rub dispensers in convenient locations, such as doorways, along with a poster outlining best practice guidelines and soap and water myths (Kampf, Loffler, & Gastmeier, 2009). Best practice guidelines governing this measure might include the use of hand rubs and a change of gloves every time a clinician transitions from one patient zone to another (Rhine, 2006). The guidelines would probably also include the use of the antiseptic chlorhexidine whenever an invasive procedure is performed, such as inserting or removing a central line catheter, or administering fluids or medications (Hadaway, 2006). Implementing these guidelines would represent the first step towards engaging in a PDSA process.