Based on the PICOT you developed for NUR-550, summarize the change initiative you will be proposing. How does this support the population of focus, your setting, and role? Justify how the problem you selected to investigate is amenable to a research-based intervention using the PICOT format

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Change Initiative

The proposed change initiative aims to reduce the rate of HAIs in the organization through increased adherence to hand hygiene by using alcohol-based hand rubs (ABHRs). A multimodal approach will be used to implement a sustainable hand-hygiene improvement initiative. The program will include placing adequate ABHRs dispensers at all points of care and educating nurses about the use of the ABHRs and the significance of complying with the hand hygiene techniques. There will also be visual cues in the form of posters displayed within the whole organization informing healthcare workers to use ABHRs. Reminders to use hand hygiene techniques (ABHRs) will be provided to also act as a visual reminder. Formal hand hygiene education will be provided to all healthcare providers, and particularly nurses in the form of an educational power-point presentation during a one-day workshop.  Template for Asking PICOT Questions Essay

Measurement will include hand hygiene adherence obtained through direct observation of the healthcare providers using hand hygiene technique. More importantly, the rate of HAIs in the healthcare organization will also be used to measure the efficacy of ABHRs in reducing the rate of HAIs in the organization (Musu et al., 2017). A reduced rate of HAIs will indicate that the ABHRs are effective in reducing HAIs.

The proposed change initiative is projected to reduce the rate of HAIs in the organization. The rate of HAIs has risen at an alarming rate and this has led to increased mortality and morbidity; increased healthcare costs; and a prolonged period of stay for the patients. Hand hygiene has been demonstrated to be the most effective strategy to reduce the HAIs, and the associated impacts. However, adherence to hand hygiene measures among healthcare providers is poor. Some studies have shown that ABHRs are associated with higher adherence to hand hygiene and are also more effective in reducing the rate of HAIs. (Vermeil et al., 2019) Therefore, the proposed quality improvement initiative (increased use of ABHRs) is meant to reduce the rate of HAIs in the organization. Healthcare providers have the role of using effective and well-established hand hygiene techniques to prevent HAIs. In addition, healthcare providers such as nurses, in collaboration with the management have the role of implementing quality improvement programs to ensure patient safety.

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PICOT Question

Among hospitalized adult patients (P), does the use of alcohol-hand rubs (I), when compared to handwashing using water and soap (C), help in reducing the rate of HAIs (O), within a period of 4 months (T)?

The population of interest in this quality improvement program includes hospitalized patients. This is because hospitalized patients are the only ones susceptible to HAIs. HAIs are the infections that occur to inpatients after being admitted to the hospital for over 48 hours (Wang et al., 2019). The proposed intervention includes the use of ABHRs while the comparative intervention is handwashing using water and soap. The intervention aims to reduce the rate of HAIs (outcome) in the organization within 4 months.

References

Musu, M., Lai, A., Mereu, N. M., Galletta, M., Campagna, M., Tidore, M., Piazza, M. F., Spada, L., Massidda, M. V., Colombo, S., Mura, P., & Coppola, R. C. (2017). Assessing hand hygiene compliance among healthcare workers in six Intensive Care Units. Journal of preventive medicine and hygiene, 58(3), E231–E237. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5668933/

Vermeil, T., Peters, A., Kilpatrick, C., Pires, D., Allegranzi, B., & Pittet, D. (2019). Hand hygiene in hospitals: anatomy of a revolution. Journal of Hospital Infection, 101(4), 383-392. DOI: https://doi.org/10.1016/j.jhin.2018.09.003

Wang, L., Zhou, K. H., Chen, W., Yu, Y., & Feng, S. F. (2019). Epidemiology and risk factors for nosocomial infection in the respiratory intensive care unit of a teaching hospital in China: A prospective surveillance during 2013 and 2015. BMC infectious diseases, 19(1), 145. doi: 10.1186/s12879-019-3772-2

Benchmark – Part A: Population Health Research and PICOT Statement

Population’s Demographics and Health Concerns

The selected health concern is hospital-acquired infections (HAIs). According to Wang et al., (2019).) HAIs are a major public health issue that affects millions of patients in healthcare organizations. HAIs refer to the infections that occur to inpatients after being admitted for over 48 hours. HAIs are among the leading cause of elevated mortality, morbidity, prolonged admissions, and increased healthcare costs. The prevalence of HAIs ranges from 3.6 to 12% in developed countries, while the prevalence in developing countries ranges from 5.7 to 19.1% (Wang et al., 2019). The predisposing factors to HAIs include prolonged hospital stay, presence of a serious illness, and excessive use of antibiotics, especially in patients within the intensive care unit (ICU).

Ineffective hand hygiene among healthcare providers is the leading contributing factor to the high occurrences of HAIs. The hand of healthcare providers harbor micro-organisms like resistant gram-negative bacteria, MRSA, and clostridium difficile (Wang et al., 2019). Additionally, the skin contains numerous epithelial cells that are normally shed and contain viable pathogens that can cause contamination to the medical devices and equipment within the patient’s environment. The units with the highest incidents of HAIs within hospital settings include the ICU, critical care unit, the emergency department, and the surgical unit due to the high rates of hand contamination (Haque et al., 2018). The hands of the healthcare providers gets contaminated when the provider touches the intact skin of the patients, touches the medical equipment, or when performing medical procedures such as catheterization or taking the vital signs of the patients.  Template for Asking PICOT Questions Essay

Health data from the CDC  show that every year over 2 million patients are admitted to hospitals and get HAIs when being treated for other health conditions. Out of the 2, 000, 000 patients, approximately 10, 000 patients die from the HAIs (Despotovic et al., 2020). Accordingly, this shows that the mortality rate from HAIs is very high and therefore this health concern should be addressed. For the provision of high-quality care that ensures patient safety, the prevention of HAIs should be a priority. In the United States, 1 out of 136 patients gets severe health conditions due to HAIs. This is equivalent to 1.7 million cases every year; this leads to about 90, 000 deaths annually and an increase of healthcare costs between $ 4.0–5.0 billion (Despotovic et al., 2020).

Evidence shows that there are various reasons why the rate of HAIs has been rising at an alarming rate (Kalata et al., 2015). First, the medical and surgical procedures have significantly increased, as well as the weakened immunity associated with illness during hospitalization. Therefore, the transmission of pathogens from healthcare providers to patients during care and development of infection is very possible among the admitted patients.

Moreover, even though the majority of healthcare organizations have implemented hygiene protocols, including hand hygiene, adherence to these protocols is poor. Therefore, the leadership within healthcare organizations should facilitate the effective implementation of the hygiene protocols necessary in preventing HAIs (Vermeil et al., 2019). Healthcare providers should utilize the well-established and effective techniques to assist in preventing infections such as infection control policies and procedures (Vermeil et al., 2019). Healthcare providers also need to adhere to the implemented hand hygiene procedures, personal protection equipment, and other infection control procedures.

There is a significant advancement in the healthcare industry regarding the pathology of communicable diseases and the spread of multi-drug resistant infectious diseases from one individual to another within healthcare organizations. The evidence further indicates that the hands of nurses are the major sources of HAIs among hospitalized patients with critical illnesses (Vermeil et al., 2019). Such evidence supports the need for further research regarding how adherence to basic hygiene principles in healthcare organizations can be used to prevent HAIs.

Among hospitalized adult patients (P), does the use of alcohol-hand rubs (I), when compared to handwashing using water and soap (I), help in reducing the rate of HAIs (O), within a period of 4 months (T)?

Health equity involves the provision of equal care in terms of quality regardless of personal aspects such as socioeconomic status, ethnicity, gender, or age. For the healthcare-acquired infections, research institutions, and health bodies such as CDC and WHO  have published policies and guidelines that outline the appropriate hand hygiene practices within healthcare organizations. All hospitals are obligated to adhere to these policies and guidelines. According to the guidelines, healthcare providers are supposed to use alcohol-based hand rubs in decontaminated their hands while the visibly soiled hands, handwashing using water should be used as the hand hygiene technique (Toney-Butler & Carver, 2018). Template for Asking PICOT Questions Essay

References

Despotovic, A., Milosevic, B., Milosevic, I., Mitrovic, N., Cirkovic, A., Jovanovic, S., & Stevanovic, G. (2020). Hospital-acquired infections in the adult intensive care unit—Epidemiology, antimicrobial resistance patterns, and risk factors for acquisition and mortality. American Journal of Infection Control, 1(1). DOI number or Retrieved from info is required.

Haque, M., Sartelli, M., McKimm, J., & Abu Bakar, M. (2018). Healthcare-associated infections – an overview. Infection and drug resistance, 11, 2321–2333. https://doi.org/10.2147/IDR.S177247.

Kalata, N. L., Kamange, L., & Muula, A. S. (2015). Adherence to hand hygiene protocol by clinicians and medical students at Queen Elizabeth Central Hospital, Blantyre-Malawi. Malawi Medical Journal, 25(2), 50-52. DOI number or Retrieved from info is required.

Toney-Butler, T. J., & Carver, N. (2018). Hand, washing (Hand hygiene). Treasure Island (FL): StatPearls Publishing.

Vermeil, T., Peters, A., Kilpatrick, C., Pires, D., Allegranzi, B., & Pittet, D. (2019). Hand hygiene in hospitals: anatomy of a revolution. Journal of Hospital Infection, 101(4), 383-392.

Wang, L., Zhou, K. H., Chen, W., Yu, Y., & Feng, S. F. (2019). Epidemiology and risk factors for nosocomial infection in the respiratory intensive care unit of a teaching hospital in China: A prospective surveillance during 2013 and 2015. BMC infectious diseases, 19(1), 145. DOI number or Retrieved from info is required.

Rui, please review all comments/corrections in the graded paper. Dr. Pampkin

Heading should be in bold typeface. Correct all headings in the paper, as applicable.

All acronyms must be defined with first use. To use acronyms, you must write the written words with the acronym beside the written words in parentheses. After the acronym is identified appropriately with first use, using the acronym is appropriate. Correct all undefined acronyms in the paper.

Define the acronym PICOT.

Use bold typeface to write the heading.

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