NUR 590 Share Common Themes on HAIs and use of Hand Hygiene Measures

NUR 590 Share Common Themes on HAIs and use of Hand Hygiene Measures

NUR 590 Share Common Themes on HAIs and use of Hand Hygiene Measures

The wellness of a population’s health using improved patient safety protocols implores healthcare workers (HCWs) especially nurses, to develop evidence-based practice interventions to reduce and prevent occurrence of adverse events like hospital acquired infections (HAIs) and medication administration errors (MAEs) among others. These adverse events lead to poor patient outcomes, increase the overall cost of care and disease burden, and lowers the quality of care delivered by healthcare professionals. Hospital acquired infections are some of the leading healthcare concerns that affect patient safety and quality of care. Many patients suffer from these infections that result into lengthened stays in hospitals, increased cost of care, and in extreme circumstances death.

Share Common Themes on HAIs and use of Hand Hygiene Measures
Application of evidence-based Practice Interventions
HAIs as public health Concern
Stakeholders’ Role is essential in Mitigating HAIs
Need for More Studies to assess the effectiveness of hand hygiene Measures on Infection Control

Nurse practitioners and other healthcare professionals transmit infections to patients through poor hand hygiene measures and protocols (Alotaibi & Federico, 2017). As such, nurses and other providers should leverage evidence-based practice (EBP) interventions to reduce and prevent the occurrence of hospital acquired infections and guarantee quality care. The use of evidence-based practice interventions allows these providers to offer better services through increased quality, increased engagement of patients and their preferences, and leveraging clinical experience and expertise. The purpose of this evidence-based practice project proposal paper is to discuss how nurses in pediatric settings can integrate hand hygiene measures and protocols to reduce and prevent the occurrence of hospital acquired infections. These measures and protocols include handwashing using soap and water alongside hand sanitizers compared to handwashing with water and soap alone.

Problem Statement

Hospital acquired infections or nosocomial infections are newly acquired infections that patients contract during their stay in hospital settings or facilities. The transmission of the nosocomial infections happens through healthcare workers, patients, hospital equipment like catheters and interventional procedures that include catheterization. Studies demonstrate that healthcare workers who include nurse practitioners infect patients when they fail to adhere to effective hand hygiene measures like handwashing with soap or using alcohol-based sanitizers and hand rubs when handling and interacting with patient in the care process (Liana 2021). The use of evidence-based practice interventions using PICOT question is important in assisting nurses to implement better practices to reduce the susceptibility of patients acquiring nosocomial infections that have adverse effects on overall care delivery and quality. These infections lead to increased length of stay in hospitals, a rise in cost of healthcare and cause deaths, especially in critical care settings like pediatric units (Setty et al., 2019). Hand hygiene measures that include handwashing with soap and water alongside sanitizer will improve patient safety among healthcare workers. The implication is that healthcare workers will adhere to these measures in pediatric settings to reduce hospital acquired infections within six months’ period and improve quality outcomes.

PICOT Statement

Population- Healthcare workers in pediatric settings

Intervention-Hand Hygiene using handwashing with soap and water and sanitizer

Comparison-Handwashing with soap and water alone

Outcome- Reduced Hospital acquired infections

Time- in Six months

Refined PICOT Question

The refined PICOT question for the EBP project is “Among healthcare workers in pediatric setting (P), does hand hygiene practices that include handwashing with soap and water alongside hand sanitizer (I) compared to handwashing with soap and water alone (C) reduce hospital acquired infections (O) within six months (T)?”

Organizational Culture and Readiness

The culture of an organization is essential in implementing changes and it impacts its overall vision, mission and values and employees’ perception in embracing new ways of executing tasks. A culture entails employees with strong norms and values, management and approaches to overall way of doing things.  A culture that involves employees, possesses strong values and norms, and encourages an open-door policy with decentralized approach is important in achieving set change objectives in an organization (Real et al., 2017). To effectively implement this EBP project proposal, pediatric healthcare settings and practitioners should use a decentralized organizational and leadership structure. The model is effective in enhancing motivation of subordinates and enhancing growth and increased diversification. Decentralization in healthcare organizations leads to better communication and adoption of innovative practices, ideas and strategies to improve quality of care. Through decentralization, the management leads a transformational approach to enhance agility and respond to new and best practices in care delivery.

The implementation of this EBP project proposal requires organizational culture that focuses on patient-centered care delivery. Through being patient-centered, an organization can support change programs to improve patient safety, quality and access while minimizing the occurrence of hospital acquired infections (HAIs). Increasing patient engagement and promoting inter-professional collaboration leads to a competitive advantage for healthcare organizations.

The evaluation of an organization’s readiness for change based on its culture is essential in implementing evidence-based practice projects. Readiness demonstrates the level to which organizational members are prepared to implement and embrace change, behaviorally and psychologically. Dearing (2018) opines that readiness is a psychological state of the mind that shows commitment to certain course of actions. As such, this EBP project proposal will leverage the Organizational Capacity Assessment Tool developed by the United Nations Development Program (UNDP) that assesses an organization’s readiness in promoting and enhancing the use of global health interventions. Through the tool, organizations identify substantive capacities and strengths that are present and the required one to attain their set objective. In this case, pediatric settings that aim to implement this EBP recommendations should demonstrate exemplary capacities in their attributes, have a superb and influential culture based on their missions, purposes and better values (De la Perrelle et al.., 2020). The capacity assessment tool looks at the various capabilities that include human resources, processes, financial resources, and systems as critical components of readiness for change implementation. Ready organizations possess sufficient strengths that include having the best skills, effective communication and adequate resources, availability of sufficient nurse workforce and effective engagement of their stakeholders.

The organizational readiness also evaluates the process and systems that require improvement to effectively implement the requisite changes (Vax et al., 2021). For instance, the improvement that pediatric care settings require include their patient handling process, the need for healthcare workers to adhere to hand hygiene measures and protocols, and delivery of patient-centered quality care. The organization will need quality improvement and collaborative approaches to enhance implementation. These organizations will also require quality data assessment tools for better and accurate analysis of their respective data (Dearing, 2018). The readiness will also include engagement of stakeholders and integration of information and communication technologies to ensure that all components to implement the project proposal are present. Using selected technologies, the project team and practitioners will pursue outcomes based on patient needs through enhanced alerts, reminders, and notifications on the need to comply with set hand hygiene protocols and measures that include effective handwashing and use of hand sanitizers to reduce hospital acquired infections in the pediatric settings.

Literature Review

Several studies and existing literature supports the incorporation of hand hygiene improvement measures to reduce hospital acquired infections. In their study, Ni et al. (2020) demonstrates that implementation of hand hygiene measures leads to a reduction in hospital acquired infections transmitted by healthcare workers. Using a qualitative design, the authors discuss the outcomes of a research in a large teaching hospital in China about the incorporation of hand hygiene measures to prevent infections and improve patient safety. The authors demonstrate that using handwashing has the potential to reduce HAIs in different care settings, including pediatric units. The article is emphatic that healthcare workers should embrace these interventions as best practices to enhance quality of care and patient outcomes. The study by Setty et al. (2019) implores organizations and healthcare providers to establish hand hygiene measures as one of the evidence-based practices in care management. Using a narrative approach, the authors implore on healthcare workers to disseminate best information to manage and reduce the ever-rising cases of medication errors and adverse events that lead to longer stays in healthcare facilities and increased cost of medication.

Nurses as part of the healthcare workforce should embrace hand hygiene measures to reduce infections and guarantee patient safety and quality care as well as better outcomes. However, many do not embrace these measures. Therefore, it is essential for health organizations and other stakeholders to make the hand hygiene interventions more attractive to nurses since they are frontline care providers and interact more with patients than any other health and medical professionals. Zhao et al. (2017) emphasize the need to make hand hygiene interventions more attractive to nurses and other healthcare workers for effective integration. The study demonstrates that with requisite training and awareness, nurses can implement better practices and make informed choices and decisions on the incorporation of hand hygiene measures to enhance patient safety.

In her study, Liana (2019) explores the effectiveness of hand hygiene practices with the aim of reducing hospital acquired infections. The author notes that all patients hospitalized are at risk of contracting nosocomial infections with certain categories being at the greater risk than others. The study observes that children, the elderly and individuals with compromised immunity are more likely to get an infection while in hospitals. Longer stays in hospitals, use of indwelling catheters, overuse of antibiotics, and the failure by healthcare workers to wash their hands increase the risk for getting nosocomial infections. According to Centers for Disease Control and Prevention (CDC) hospital acquired infections (HAIs) account for close to 1.7 million infections with close to 100,000 individuals dying each year due to associated complications (Liana, 2019). The implication is that healthcare workers should practice proper hand hygiene based on the World Health Organization’s recommendations. These include before touching a patient, after touching them patient, after getting into contact with inanimate surfaces and objects in the patient’s environment, and after having exposure to bodily fluids. They should also have proper hand hygiene before cleaning and aseptic procedures.

Hand hygiene lowers the transmission of pathogens in healthcare settings and healthcare providers need to encourage patients, their families and visitors to regularly decontaminate their hands to reduce infections. The implication is that establishment of proper hand hygiene measures and protocols help reduce nosocomial infections. The study by Staniford et al. (2020) is a systematic review of literature on hand hygiene and environmental disinfection strategies that enhances hygiene standards in pediatric settings. The study emphasizes the need for healthcare workers to change their behaviors with the aim of embracing best practices in handwashing like using soap and water as well as alcohol-based products. nurse practitioners and other healthcare workers should have positive attitude toward hand hygiene measures, have information on protocols and procedures to integrate these interventions with the aim of enhancing patient safety.

In their study, Hillier et al. (2020) explore correct procedures needed for effective hand hygiene. The authors emphasize the significance of nurses possessing relevant knowledge and understanding about evidence-based guidelines like increased use of sanitizers alongside handwashing with hands and water. The authors are categorical that healthcare workers need sufficient knowledge, information and awareness to enhance and integrate the use of these interventions to reduce hospital acquired infections. Using hand hygiene measures, healthcare workers can control and stop the spread of emerging and re-emerging disease’ epidemics and pandemics like the Coronavirus disease of 2019 (COVID-19) in different healthcare settings. The study implores these providers to leverage evidence-based interventions in their care practice and settings to mitigate infections’ transmission.

Clean hands protect individuals from serious infections when they are hospitalized in any facility. The Center for Disease Control and Prevention (CDC) asserts that hand hygiene is the best way to prevent infection. However, many healthcare workers are hesitant to clean their hand leading to healthcare associated infections. In their study Akanji et al. (2017) emphasize the need to institutionalize formal hand hygiene education and feedback compliance among nurses to mitigate and prevent hospital acquired infections. The study shows the need to increase engagement of nurses and other healthcare workers to offer feedback on the most effective interventions to improve patient safety through reduce rate of nosocomial infections. The implication is that organizations and healthcare providers should develop and implement evidence-based practice interventions to reduce different types of infections associated with healthcare settings like central line-associated bloodstream infections that are among the leading types of HAIs.

The study by Azar et al. (2017) shows the need to use agile implementation model to mitigate HAIs among healthcare workers to reduce nosocomial infections. The authors are categorical that nurses and other healthcare workers can deploy various interventions to prevent and reduce the possibility of infections like central line associated bloodstream infections (CLABIs) and catheter-line associated urinary tract infections (CAUTIs) as well as ventilator-associated pneumonia. These studies show that hospital acquired infections are a major healthcare challenge that requires effective evidence-based interventions and best practices as demonstrated in this research proposal. Healthcare workers in pediatric settings have an obligation to reduce and prevent these infections through effective hand hygiene protocols and measures that include handwashing with soap and water as well as using sanitizer.

Assessment Description

The dissemination of an evidence-based practice project proposal is a critical component of the final project. Distributing your project to a local association or clinical site/practice informs key stakeholders about evidence-based interventions that can improve clinical practice and, ultimately, patient outcomes.

For this assignment, develop a professional presentation that could be disseminated to a professional group of your peers.

Develop a 12-15 slide PowerPoint detailing your evidence-based practice project proposal. Create speaker notes of 100-250 words for each slide. For the presentation of your PowerPoint, use Loom to create a voice-over or a video. Refer to the topic Resources for additional guidance on recording your presentation with Loom. Include an additional slide for the Loom link at the beginning and an additional slide for References at the end. Be sure to consider your personal demeanor and tone during the recorded presentation.

Include the following in your presentation:

  1. Introduction (include PICOT statement)
  2. Organizational Culture and Readiness
  3. Problem Statement and Literature Review
  4. Change Model, or Framework
  5. Implementation Plan
  6. Evaluation Plan
  7. Conclusion

You are required to cite a minimum of six peer-reviewed sources to complete this assignment. Sources must be published within the

last 5 years and appropriate for the assignment criteria and nursing content.

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.


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The dissemination of evidence-based practice (EBP) information is an important part of effective care delivery for providers as it allows stakeholders to implement different changes to meet patient expectations. Dissemination involves the spread and sharing of clinical, research, and theoretical findings with goals of transitioning new knowledge to points of care (DeNisco, 2019). Dissemination requires organizations to have effective culture and be ready for change as well as selection of the best EBP model to implement new change. The use of Fall TIPS to reduce falls in medical-surgical units reduces the adverse effects of fall, improves patient safety and overall satisfaction. The purpose of this presentation is to disseminate the outcomes of the proposed EBP project for effective implementation in the medical-surgical unit to reduce the prevalence of patient falls.

The evidence-based practice process involve the integration of research findings, clinician’s care experience and patient preferences. EBP projects focus on optimizing providers and team conduct to support changes for patients to get quality care and reduce adverse effects of falls like injuries and associated complications and costs. Patient satisfaction and engagement are important while implementing EBP in health care settings. In this case, the need to reduce falls through tailoring interventions for patient safety (TIPS) is essential to offering quality care and considering the concerns that patients may have and critical to improving their response to safety measures by providers

Among hospitalized adult patients in medical-surgical units (P) does the use of TIPS toolkit as a bundled care approach (I) compared to normal falls prevention approach (C) reduce the prevalence of falls by 20%(O) within 6 months (T)?

Organizational culture which entails values, mission, vision and operational efficiencies is important on implementing or introducing changes to nursing units or workplace. The implementation of EBP project proposal to reduce falls through Fall TIPS approach requires organizations to have a change-oriented culture and values. Evaluation is essential as it allows project team to determine the level of readiness and acceptance of change. In this case, the organizational structure in the medical-surgical unit is positive. The findings from the Organizational Capacity Assessment Tool (OCAT) created by the United Nations Development Program (UNDP) shows that the unit has decentralized structure that allows engagement and participation of nurses to implement changes to improve the quality of patient care (Ratnapalan, 2019.

The OCAT tool assesses  overall readiness and highlights organizational capacities and strengths. Based on the model, the overall organizational culture and readiness for change is positive since the unit as part of the entire facility has capacities and strengths. These include having effective teamwork to improve communication, integration of providers’ perspectives when implementing new approaches to care, and better communication and effective collaboration among the internal stakeholders. Data analysis tools are also essential to improving overall efficacy of the proposed solution (DeNisco, 2019). The organizational culture also focuses on health promotion and saving lives through involvement of all stakeholders at different levels of care delivery.

Falls are a major concern and public health issue because they affect quality of care and patient safety. The Centers for Disease Control and Prevention (CDC) (2021) observes that one in every four older people experiences falls. Close to 800,000 individuals are hospitalized each year due to falls, especially in critical care settings. more than 95% of hip fracture occur due to falls and falls are the most prevalent cause of traumatic brain injuries (Heng et al., 2020). The Centers for Medicare and Medicaid Services (CMS) categorize falls as never events since a majority of them are preventable. Falls also increase hospital stays and increase cost of care. Therefore, reducing falls is a critical part of improving patient safety ad overall care delivery (PSNet, 2019). Existing literature supports the use of Fall TIPS as an EBP intervention to reduce and prevent falls.

The proposed interventions should be appropriate through a review of existing literature consisting of previous research studies to support implementation and expected benefits to the targeted population. In this case, through a comprehensive search of the literature, one can ascertain if the interventions meets the stakeholders’ goals and aspirations (Zhao et al., 2018). The literature review for the project involved the definition and use of terms associated with Fall TIPS and its benefits for patients, especially in medical-surgical settings. The review also employed appropriate search engines and databases associated with the nursing issue to ensure that the generated articles focus on the problem under investigation (Khan et al., 2018). The main inclusion criteria included article published within the last five years, articles that capture aspects of the PICOT question and focus on effective interventions to reduce falls and efficacy of Fall TIPS implementation.

The proposed project reviewed several research studies based on the inclusion and exclusion criteria to ascertain support for the intervention to enhance patient safety and quality of care through fall prevention using the Fall TIPS model. Literature synthesis and critical analysis show increased support for the intervention of using Fall TIPS model to reduce falls. Studies by LeLaurin et al. (2019); Xia et al. (2022); Kelly (2022), and Dykes et al. (2020) agree that fall prevention bundles through the TIPS model reduce incidences of falls and improve overall patent safety. The studies show that Fall TIPS is effective and should be implemented on diverse settings that include medical-surgical units because of their benefits like being customized to meet patient needs and situations. The studies also emphasize the need for effective guideline for providers to enhance their adoption of fall TIPS in their practice settings.

The selected model is the Iowa EBP framework. The Iowa model focuses on the entire healthcare system and stakeholders who comprise of patients, practitioners, and infrastructure. The framework uses a problem-solving and implores staff to question the current nursing practices and if they can improve care through using current evidence. The model is effective for the project as it focuses on promoting quality care using EBP interventions (DeNisco, 2019). The initial stage of the model is identification and selection of a health problem while the second stage involved determining if the issue is healthcare organization’s priority areas for patient care (Melnyk & Fineout-Overholt, 2019). The third stage requires reflection about the issue of interest and engaging stakeholders while the fourth stage is to identify availability and merit of the chosen evidence (Cullen et al., 2020). The fifth stage entails implementation of a pilot change based on the available evidence and its credibility. The sixth stage is to appraise the pilot practice change based on the degree of success and subsequent dissemination of findings to the providers and organizations.

The project will be set in the medical-surgical unit/ward with the patients as the main participants. They will have informed consent and voluntary accept to participate in the study. The implementation timeline would be six months. The timeline will have different aspects as defined by the project scope and activities. Nurse training and requirement definition as well a project schedule will be part of these activities. Resources needed will include both financial and human for the implementation of the project. The project will employ a qualitative approach in collecting data. The qualitative approach is appropriate as it allows the use of different techniques like interviews, observation, review of literature and even focus groups (Tang, 2019). The implementation team will use an audit tool and a patient survey. The survey tool will collect feedback and opinions from participants on the effectiveness of the fall TIPS framework. Using these tools will help determine the overall effects of the Fall TIPS

The delivery of the intervention will entail having an inter-professional team consisting of different healthcare providers in the medical-surgical unit. The interventions will entail staff training on all components of the TIPS bundles, development of safe toileting, effective communication and patient education. The project will have different stakeholders who would include nurses and nurse leaders, nurse managers, project team and manager, trainers and patients as well as their families (Amit-Aharon et al., 2019). Others will be organizational management and health information technology vendors. The implementation plan will encounter barriers and challenges like resistance to change, limited resources to implement the plan, and insufficient knowledge and skills by nurses on Fall TIPS (Pop et al. (2020). There will also be facilitators like sufficient resource allocation. The project’s overall feasibility is high due to its cost-effectiveness and associated benefits to patients and the healthcare system.

The main outcome is to reduce patient falls in the medical-surgical unit by 30% in six months of its implementation. The Fall TIPS will enable nurses and other providers to customize fall prevention intervention based patient’s conditions and preferences and not a one-fits-all approach. The EBP project will employ qualitative design implying that it will use questionnaires and focus groups to collect data. It will also observation to determine the level of implementation (Grove et al., 2019). The statistical test in this case would be the t-test because of its suitability to the project.

Using data collected through semi-structured questionnaires, the researchers will measure patient outcomes and experiences (Lengnick-Hall et al., 2020). They will then tabulate the data to determine if there are changes after the implementation of the Fall TIPS. The research will the deploy computation tools to determine rates of improvement based on the reduction of falls within the unit. Strategies to improve outcome will include re-examination of the implemented intervention through analyzing the process and all associated components at each level. The team will also formulate timelines and explore corrective measures to improve outcomes . The sustenance of the EBP will entail training, continuous monitoring of quality care, and creating teams that will review areas of concern and ensure that Fall TIPS integrate patients and concerns.


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