Reduce Hospital Acquired Infections in the Intensive Care Unit

Reduce Hospital Acquired Infections in the Intensive Care Unit
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Table of Contents TOC \o "1-3" \h \z \u 1. Project Aim PAGEREF _Toc10245094 \h 32. Background PAGEREF _Toc10245095 \h 32.2. Client Group Serviced: Nurses in the ICU PAGEREF _Toc10245096 \h 32.3. Anticipated Clinical Outcomes: Improve Hygiene Evidence PAGEREF _Toc10245097 \h 43. Literature Review PAGEREF _Toc10245098 \h 53.1. Hospital Acquired Infections in the Intensive Care Unit PAGEREF _Toc10245099 \h 53.1. Prevalence of Hospital Acquired Infections PAGEREF _Toc10245100 \h 63.2. Strategies to Minimise Hospital Acquired Infections among ICU Patients PAGEREF _Toc10245101 \h 74. Project Plan PAGEREF _Toc10245102 \h 94.1. Increasing the Awareness About Infection Control Protocols PAGEREF _Toc10245103 \h 94.2. Identifying the Barriers in Hand-Washing and Infection Control PAGEREF _Toc10245104 \h 104.3. Introducing Different Methods and Procedures towards Infection Control PAGEREF _Toc10245105 \h 114.4. Preparing an Assessment Plan for New Infection Control Strategies Program in the ICU PAGEREF _Toc10245106 \h 125. Objectives and Evidence of Achievement PAGEREF _Toc10245107 \h 136. Project Evaluation Plan PAGEREF _Toc10245108 \h 147. Project Conclusion PAGEREF _Toc10245109 \h 148. References PAGEREF _Toc10245110 \h 16
Reduce Hospital Acquired Infections in the Intensive Care Unit
1. Project Aim
“To establish an effective model of care to reduce hospital-acquired infections (HAIs) in the Intensive Care Unit (ICU) as well as decrease the length of patient’s stay in the ICU”.
2. Background
2.2. Client Group Serviced: Nurses in the ICU
The nosocomial infections or HAIs are a persistent medical problem that is important for employees of any level of health care, including the practitioners in the intensive care unit. The HAIs are one of the most common complications that occur in patients of intensive care units (Russo et al., 2018). They worsen the epidemiological situation in terms of the distribution in the hospital of antibiotic-resistant microorganisms, worsen the prognosis for recovery, increase the length of hospitalisation and the cost of treatment, and reduce the effectiveness of therapy. In this plan, the client group that is being serviced in the health care settings includes the nurse practitioners working in intensive care units. Since the nurses are generally in direct contact with the patients, any non-compliance with the hygienic measures may lead to an increased incidence of nosocomial infections.
The principles of preventive medicine should not be limited only to patients, but also to the medical personnel, including nurses (Saint et al., 2016). Health workers should implement a program aimed at detecting contagious infections such as tuberculosis, and exercise day-to-day monitoring of the immunisation of medical personnel who have contact with measles, mumps, polio, diphtheria or tetanus.
Moreover, nurses, involved in certain professional activities associated with frequent blood tests or direct contact with patients who are at high risk of disease or the presence of hepatitis B, should be vaccinated against this disease. An immunisation of medical professionals against infection should be carried out annually (Zingg et al., 2015). This immunisation has the double goal of reducing the frequency of nosocomial infection transmission to the sick and minimising the winter loss of working time due to the illness of the staff.
Similarly, if the nurse practitioner is infected with infectious diseases, contact with patients during the entire period should be avoided since they can serve as a source of spread of the pathogen. Most infections in the ICU have a polymicrobial character and are caused by problem strains of microorganisms. The resistance of such strains can extend to the main etiotropic antibiotics, which creates great difficulties in therapy and sharply worsens the prognosis of their diseases and complications
2.3. Anticipated Clinical Outcomes: Improve Hygiene Evidence
In modern medicine, hygiene is one of the most important measures to prevent the spread of nosocomial infections, aimed at interrupting their transmission. According to the World Health Organisation (WHO), about 80 per cent of all nosocomial infections is transmitted through the hands. However, numerous epidemiological studies of the practice of hand hygiene among medical personnel have shown unsatisfactory results as the frequency of adherence to the rules of hand hygiene was found to be very low (Al-Dorzi et al., 2016). Thus, there is a need to focus on the hygiene measures among the nursing staff in the ICUs to ensure compliance with the standard hygiene measures.
The first anticipated outcome of this project is the increase the awareness among the nursing staff in the ICU regarding the compliance of infection control protocols. These protocols are significant in reducing the incidence of morbidity due to HAIs (Lake et al., 2018). The second anticipated outcome is to identify the barriers involved in the following of infection control protocols and hand washing by the nursing team working in the ICU. Afterwards, a plan will be suggested to encourage the nursing staff in complying with the hygiene measures, resulting in improved infection control practice. The third anticipated outcome is to identify and review significant procedures and methods developed by several health care settings in order to achieve measurable goals and adequate approaches for maintaining the infection control protocols. Finally, the last anticipated outcome is to develop an assessment plan or evaluation method in order to evaluate the impact of recent infection control protocols in the intensive care unit.
3. Literature Review
3.1. Hospital Acquired Infections in the Intensive Care Unit
The infections associated with the provision of medical care in the intensive care units are the main problem in ensuring patient safety, which is why preventing their occurrence should be a priority for medical organisations of any profile (Mody et al., 2017). According to the World Health Organisation, at least 7 out of 100 hospitalised patients are infected with the HAIs. Among seriously ill patients whose treatment is carried out in intensive care units, this figure rises to approximately 30 cases of HAIs per 100 people. The HAIs may occur in any of the departments from health care settings (Jun, Kovner, & Stimpfel, 2016). However, the most serious infections are the ones that occur in the ICUs.
The microorganisms associated with the provision of medical care quite often can be found not only on the surface of infected wounds but also in areas of healthy skin (Jahansefat et al., 2016). After direct contact with a patient or environmental objects, microorganisms can survive at the hands of medical workers for quite some time, most often from 2 to 60 minutes (Haverstick, Goodrich, Freeman, James, Kullar, & Ahrens, 2017). The hands of medical personnel can be inhabited by representatives of their own, resident microflora, as well as contaminated by potential pathogens (transient microflora) during various manipulations, which is of great epidemiological importance. In many cases, the causative agents of purulent-septic infections, released from patients, are not found anywhere except in the hands of medical professionals, including the nursing staff.
The importance of this problem of the increasing extent of HAIs in connection with the progress of medicine is extensively increasing. It is mainly due to the wide and unsystematic use of antibiotics, an increase in the number and range of surgical interventions, the intake of corticosteroids and cytotoxic drugs, an increase in the number of operated children previously considered incurable (Gribble, Powell, & Essoka, 2017). The number of cases of nosocomial infection reaches, according to various estimates, from 10 to 70 % of those hospitalised in the hospital; while in 2% of cases, the disease is fatal. For example, during artificial lung ventilation in patients of intensive care units and emergency units, pneumonia develops in around one-fourth of patients for longer than this time (Russell et al., 2019). However, in many cases in surgical patients, a manifestation of nosocomial pneumonia is possible even earlier.
3.1. Prevalence of Hospital Acquired Infections
HAIs or nosocomial infections are one of the most acute public health problems. According to various estimates, they affect 5.0 - 10.0 % of hospital patients and rank tenth among the causes of mortality (Pokrywka et al., 2017). The patients with nosocomial infections stay 2.5 times longer in hospital than patients with no signs of infection, and their risk of death is 7 times higher compared with patients similar in age, sex, primary, concomitant pathology and severity. According to Russo, Stewardson, Cheng, Bucknall, Marimuthu, and Mitchell (2018), the “National HAI point prevalence studies” was the only HAI-related surveillance conducted in Australia in the year 1984. According to this survey, the prevalence of HAIs was found to be 6.5 per cent.
The prevalence of HAIs varies widely and depends on a number of factors. In particular, it includes the type of hospital, the degree of invasiveness and aggressiveness of the treatment and diagnostic process, the nature of the underlying pathology, the tactics of using antibacterial drugs and disinfectants (Chiu, Liu, Huang, Lin, & Chen, 2015). The frequency of development of nosocomial, associated with artificial ventilation of the lungs (mechanical ventilation) of pneumonia is also evident in the ICUs. The ventilator-associated pneumonia is any infection of the lower respiratory tract that developed after 48 hours of mechanical ventilation (Trudel et al., 2016). It depends on the specifics of the main pathology of patients, duration of artificial ventilation of the lungs, use of protective filters in the respiratory circuits and a number of other factors (Neo, Sagha-Zadeh, Vielemeyer, & Franklin, 2016). Moreover, in Europe, the incidence of this complication after planned operations is on average 6 %, and in trauma patients, it is also very high. Therefore, preventive strategies are crucial to limit the prevalence of HAIs in the ICU.
3.2. Strategies to Minimise Hospital Acquired Infections among ICU Patients
The clinical hygiene of the nursing staff is understood as a set of mandatory rules and activities carried out by the nursing personnel. It is aimed at limiting the spread of nosocomial infection during contacts with other medical staff, patients and people outside the intensive care department (Dramowski, Whitelaw, & Cotton, 2016). The main focus of these rules and measures is the interruption of the infectious process at the level of the propagation pathway of the infectious agent. This is achieved by influencing the microbial transmission factors available to the day-to-day and direct control of the nurse practitioner in the ICU.
The most frequent causative agents of nosocomial infection in the surgical department are such representatives of nonspecific pyogenic flora, such as Staphylococcus aureus, Pseudomonas aeruginosa, E. coli, Streptococcus, and Proteus (Halaby et al., 2017). The hospital strains of these microbes are characterised by high antibiotic resistance, virulence, and pathogenicity. Therefore, the prevalence of nosocomial infections in the ICUs is extremely diverse. It includes suppuration of wounds, sepsis, pneumonia, postoperative peritonitis, various forms of infection of the urinary tract and the gastrointestinal tract (Lee et al., 2017). Infections with syphilis, hepatitis B and HIV infection also include nosocomial infections.
Among the objects listed above, the hands of a nurse certainly have the greatest epidemiological potency for developing HAIs in the ICU. The nursing staff of the ICU should take care of the condition of the hands on a regular basis. The skin of the hands should be soft and supple, while it is more resistant to micro trauma (Flanagan, Cassone, Montoya, & Mody, 2016). Unfortunately, this is hindered by frequent hand washing with antiseptic solutions and alkaline soaps. Therefore, it is advisable to regularly take care of the skin using softening and moisturising creams and solutions based on glycerine. Traumatic skin work should be done with gloves.
Another aspect related to hand hygiene of nursing practitioners is the use of medical gloves. The use of gloves is an important component of the system of universal precautions and infection control in health care facilities (Zhang, 2015). The gloves significantly reduce the likelihood of occupational contamination by contact with patients or their secretions and reduce the risk of medical personnel contaminating the transient microflora and then transmitting it to patients (Vokes, Bearman, & Bazzoli, 2018). In addition to this, the gloves also prevent patients from becoming infected with microorganisms that are part of the resident flora of nurses.
Hygienic disinfection of the hands is carried out after contamination of the skin of the hands with biological fluids, after contact of the hands with the patient's body of a purulent-septic disease, and after dressings (Stahmeyer et al., 2017). If there is massive contamination of gloves with blood or pus, hands should also be treated with antiseptic solutions after removing the gloves.
By creating an additional barrier for potentially pathogenic agents, gloves are at the same time a means of protection for both the nurse and the patient (Chen, Chou, & Lin, 2015). However, the nursing practitioners often neglect to use or change gloves, even in cases where there are clear indications for this. As a consequence, it potentially increases the risk of transmission to the medical worker himself, and from one patient to another through the hands of the nurse practitioners.
Furthermore, disinfection is another important strategy for the prevention of nosocomial infection (Dix & Schraag, 2018). This aspect of the activity of nursing personnel is multicomponent. It has as its goal the destruction of pathogenic and conditionally pathogenic microorganisms in the external environment of the chambers and the functional premises of the inpatient departments, medical instruments and equipment (Currie et al., 2019). However, some of the cases indicate that the organisation of the disinfection case and its implementation by the junior nursing staff is complex as well as time-consuming daily duty.
4. Project Plan
4.1. Increasing the Awareness About Infection Control Protocols
In this programme, the increasing awareness among the nursing staff will be assessed. The understanding of daily activities and monitoring of staff will be conducted for his purpose. In order to achieve this learning outcome, the direct observation methods among the nursing staff will be conducted (Demirel et al., 2019). Moreover, accurate data and statistics will also be obtained by the health care setting records. It will help in the identification of new cases of HAIs among the patients admitted in the ICU over a certain period of time.
The staff of health care organisations, regardless of their speciality and qualifications, must have theoretical and practical training in the prevention of HAIs and constantly improve their qualification level. The mandatory training of nursing staff in the ICU should be carried out during their employment according to specially created training programs (Farotimi, Ajao, Nwozichi, & Ademuyiwa, 2018). To this end, health organisations should have the necessary forces and means to organise staff training at a modern pedagogical and methodological level on the prevention of HAIs both in the institution itself and on the basis of institutions of secondary, higher medical and continuing professional education.
In the health care settings, differentiated educational programs should be developed for training nursing specialists of different profiles on the problems of preventing HAIs, taking into account the specific features of the intensive care unit. Moreover, it is also advisable to accompany training with incoming and final test controls, tests, use interactive for...