Problem Statement (PICOT): Nosocomial Infections


Need Statement

In the contemporary clinical setting, there is an increasing burden associated with the prevalence of nosocomial infections, high severity of diseases and intervention complexity, coupled with multi-drug resistant infection. The Center for Disease Control and Prevention (CDC) (2017) perceive that nosocomial infections are complications that are associated with high mortality and morbidity. Additionally, CDC highlights that in every 25 patients in the United States, one is diagnosed with a Healthcare-Associated Infection (HAI).  These sentiments are reiterated by Danasekaran, Mani & Annadurai, (2017), as they highlight that “Of every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire at least one healthcare-associated infection” (cited in Haque, 2018) As such, it is evident that there is a need to come up with interventions that aim at reducing the cases of acquiring nosocomial infections. This is because the interventions to deal with the spread of nosocomial infections will reduce the prevalence of HAIs and the spread of pathogens, which are antimicrobial resistant. Ultimately this will reduce the cost of health and the associated morbidity and mortality; thus, promoting quality of care and patient safety.

Population and Setting

The target population will be Health Care Workers (HCWs) and patients. This segment of the general healthcare population is significant when addressing issues surrounding nosocomial diseases. Notably, HCWs are often in contact with patients; therefore, making them be at the risk of acquiring and spreading nosocomial infections. The patients, alike, may act as the point of origin or may acquire HAIs as they receive their treatment. Additionally, this project will be conducted in a clinical setting. This is mainly because the target population does interact in the clinical setting. Besides, nosocomial infections by definition refer to illnesses that are acquired and spread in hospitals. Thus, the clinical setting is significant in addressing the problems associated with nosocomial illnesses.

Intervention Overview

In order to address the identified need in the target population and setting, hand hygiene intervention strategy will be helpful. The hand hygiene intervention involves both HCWs and patients. In using this approach, HCWs and patients in the clinical setting will be required to wash their hands thoroughly using alcohol-based sanitizers. It is noteworthy that hand hygiene is more of a behavioral issue than a resource issue. As such, apart from providing the resources, the intervention will also focus on changing HCWs and patients’ behavior relating to hand hygiene. Hence, this will ultimately reduce cases of HAIs spread in the clinical setting.

Comparison of Approaches

Alternatively, HCW can reduce the spread of and acquisition of HAIs by complying to PPE protocols. Mainly, PPE is a primary strategy that can be used by the HCWs in the clinical setting to decrease their physical exposure to infection. This entails constant use of coveralls, hoods, masks, gowns, respirators, and eye-shields intending to prevent contamination of mucous membrane and skin. Given that the PPE protocols focus on every HCW, this encourages interprofessional care approaches. Additionally, the alternative fits the target setting and a section of the target population. PPE guidelines are designed to assist clinicians in the clinical setting as they conduct their mandate. Nonetheless, the PPE does not fit with the patients as it does not address ways in which patients are supposed to prevent themselves from nosocomial infections.

Initial Outcome Draft

The outcome of the intervention is to promote proper hand hygiene behavior. By achieving this, both HCWs and patients will regularly be washing their hands whenever they are in contact with people and facilities in the clinical setting. This will reduce the prevalence of nosocomial infections as the pathogens will be washed away, thus curbing their spread and acquisition. This outcome illustrates the intended purpose of the intervention and project. It is noteworthy that by so doing, the quality of care and patient safety will be improved tremendously. Quality of care will be improved as patients end up being treated for their illnesses as opposed to illnesses that have been acquired in the clinical setting. This also improves safety as morbidity and mortality associated with HAIs will be eliminated.

Time Estimate

The time estimate for developing the intervention will be two months. This time frame is realistic as it will present enough time for a board review, administration approval, conducting an assessment of what is leading to poor hand hygiene behavior among the target population, and acquiring of the right resources. Some of the challenges that may impact this time frame may be delayed communication from the administration and acquisition of needed resources. The implementation of the intervention will roughly take four months. This is a realistic time frame as the target group needs to take part in continuous training on hand hygiene, while hand washing facilities are being installed in various corners of the hospital. Additionally, since hand hygiene is behavior, it may take these months to achieve significant changes. One of the potential barriers to the implementation process will be the reluctance of the HCWs to engage in the process due to workload. Another possible challenge that may impact the time frame may be unavailability of needed resources.


Evidence of Nosocomial Infections

According to the World Health Organization (WHO) (2016), nosocomial or HAIs are prevalent among patients who are receiving clinical care in the hospital and other clinical facilities. Particularly, patients do acquire the infections when they are being treated for other clinical condition and even after being discharged. Furthermore, WHO (2016) hold that medical staffs are also at a higher risk of nosocomial infections as they are constantly in contact with equipment and conditions that promote the spread of these diseases. In line with this, Emily and Sydnor (2011) highlight that in the acute-care setting, an estimated 15% of hospitalized patients have nosocomial infections. These infections contribute to between 4% and 56% of neonates deaths, with an incident rate of 75% in countries within Sub-Saharan Africa and South-East Asia (WHO, 2016).

Despite the general prevalence of HAIs in the clinical setting, the population that is significantly affected by these infections is that of Intensive Care Units (ICU), burn units, and surgical units. The Extended Prevalence of Infection In Intensive Care (EPIC II) conducted a study that determined that the portion of patients with HAIs in the ICU is at 51% (Vincent et al., 2009).  Similarly, Allegranzi (2011) report that extensive studies conducted in Europe and the USA depicted that HAIs’ daily incidence density in the regions was between 13 to 20.3 episodes in every one thousand patients.  Besides, Allegranzi (2011) highlights that HAIs prevalence in the patient population is detrimental to their health status. With the increased incidents hospital stays are prolonged, long-term disabilities develop, and the mortality rate among the infected patients increase as well.

Catheter-associated Urinary Tract Infections (CAUTI), Surgical Site Infections(SSI), Central Line-Associated Bloodstream Infections (CLABSIs), and Ventilator-Associated Pneumonia (VAP) are the most frequent kinds of nosocomial infections that may affect both HCWs and patients (Khan, Baig & Mehboob, 2017). CAUTI is considered as the most common HAI globally. According to the CDC (2016), these infections make up 12% of the reported cases of nosocomial infection transmission. CAUTI develops into complications such as orchitis, prostatitis, cystitis, meningitis, and pyelonephritis. Secondly, CLABSIs are considered to be deadly as they have a death incident rate that ranges from 12% to 25% (CDC, 2011). Thirdly, SSIs are prevalent in 2%-5% of patients in the surgical unit. Lastly, VAP is found in 9 – 27% of patients who are mechanically assisted by ventilators (Hunter, 2012).

Khan, Baig & Mehboob (2017) categorized determinants of nosocomial infection into environment, susceptibility, and unawareness. In terms of environment, the authors stipulated that poor conditions of hygiene coupled with inadequate waste management and disposal from hospitals and other clinical settings determine the spread of these infections. They highlighted that patients with suppressed immunity, who have prolonged their stay in the ICU, and often use antibiotics are more susceptible to HAIs.  Also, the authors established that unawareness among patients and HCW is a determinant in the transmission of HAIs.

Existing Health Policy

The hand hygiene policy exists and is relevant to the identified need. The purpose of this policy is to promote effective hand hygiene in the healthcare setting as it eliminates transient microorganism, organic material, and dirt from hands and reduces the incidences of cross-contamination from patients, HCWs, the environment, and care equipment. According to the policy, all stakeholders within the clinical setting are required to thoroughly and promptly clean their hands whenever they are in contact with bodily fluids, equipment and surrounding that is potentially contaminated. The basis of this policy were guidelines for hand hygiene as stipulated by the CDC and WHO (CDC, 2002; WHO,2009).

Based on the hand hygiene policy, there are various considerations that may be effective in addressing the HAIs concern in the clinical setting. According to the policy, the necessary tools and measures required for effective hand hygiene are stipulated. In this regards, it is stipulated that hand should be washed using alcohol-based hand rub, and there is no use of bar soaps (WHO, 2009). Accordingly, I need to consider that the intervention plan will use alcohol-based sanitizers as opposed to bar soaps. Additionally, the policy is an enabler as it dictates to HCWs on compliance with PPE guidelines. In this case, the intervention plan needs to entail strategies that will promote compliance with the PPE guidelines. Thirdly, the policy dictates hand hygiene in a surgical and invasive procedure. As such, the intervention initiative will need to cover surgical or invasive procedures uniquely. This is mainly because in the invasive and surgical unit, specialized activities and equipment are used that expose nurses and patients to be exposed to objects and fluids that are probably contaminated (CDC, 2002). Backed by the Staff Dress Standards, the policy highlights personal effects as inhibitors of hand hygiene. As such, the development of these project needs to consider the influence of personal effects (such as wedding rings) on hand hygiene.


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