PICOT – Prevalence of 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 the World Health Organization, as it highlights 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.” 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 nurses and patients. This segment of the general healthcare population is significant when addressing issues surrounding nosocomial diseases. Notably, nurses 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 HCW and patients. In using this approach, nurses 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.


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