Healthcare-Associated Infections in Patients - Research Proposal Example

Assignment 2: Project Proposal Healthcare-Associated Infections (HAIs) Name: Supervisor: Institution: Date: Contents 1.0 AIM 3 2.0 SETTING 3 3.0 BACKGROUND AND LITERATURE REVIEW 3 4.0 IMPROVEMENTS PROPOSED 8 5.0 METHODS 9 6.0 ETHICAL ISSUES 10 7.0 TECHNIQUES SELECTED TO ASSESS PROJECT OUTCOMES 11 8.0 DISCUSSION 12 9.0 CONCLUSIONS AND RECOMMENDATIONS 14 REFERENCES 16 APPENDICES 18 Appendix 1 18 Appendix 2 21 1.0 AIM The purpose of this project is to improve healthcare quality and safety through prevention, reduction and possible elimination of healthcare associated infections (HAIs) in patients admitted for treatment in healthcare settings. This is to be achieved through education and training on hand hygiene to ensure that nurses and allied healthcare staff adhere to hand hygiene compliance. 2.0 SETTING HAIs have been reported in all types of healthcare settings, which include: acute healthcare hospitals, dialysis facilities, ambulatory surgical facilities, outpatient care and long-term care facilities, such as community clinics, nursing homes and rehabilitation centres. This project proposal focuses on these healthcare places, although HAIs may also occur at home in the course of treating the patient. The common types of HAIs that occur in healthcare settings include: surgical site infections, catheter-associated UTI (urinary tract infections), pneumonia, bloodstream infections, and Clostridium difficile. HAIs can cause several complications during healthcare treatment and can also be transmitted between healthcare facilities. They can plague healthcare facilities, both financially and clinically. However, implementation of proper implementation practices can reduce the levels of HAIs in healthcare settings. 3.0 BACKGROUND AND LITERATURE REVIEW HAIs refer to infections that patients acquire whilst receiving treatment for a given medical condition. HAIs are also known as ‘nosocomical’ and ‘hospital’ infections. These infections are not normally not present in in at the time of admission to the healthcare facility. Sometimes, they can be a significant source of health complications in the continuum of healthcare. HAIs are caused by infectious agents, such as bacteria, viruses, fungi, and other types of pathogens. HAIs can result from medical procedures e.g. surgery, and the equipment used in medical procedures e.g. ventilators or catheters. In addition to increased healthcare costs, HAIs cause a significant number of patient deaths across the world each year (WHO 2010, pp. 1-4). Most health systems, especially in developing countries, lack surveillance equipment and systems for HAIs. This means that lack of adequate health systems to monitor HAIs or standardized criteria to diagnose infections leading to a complex health situation. HAIs only attract public attention when the infections result in epidemics. In Australia, there are about 200, 000 HAIs in acute healthcare facilities reported annually, making HIA the most regularly encountered complication that affects patients in treatment facilities (Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Government, Department of Health 2013, pp. 1-3). Healthcare sector has since undergone major changes to address the challenges of rising cases of HIAs. There is increased focus on patient safety and outcome; healthcare facilities have to account for patient outcomes and activity; they are expected to provide reports on adverse health conditions and publicly disclose rates of medical errors; and adverse medical outcomes are largely accounted by system failures. HAIs are not part of key performance indicators, or reportable medical errors, partly because HAIs are complex. They cannot be attributed to a single factor, but multivariable events (Hand Hygiene Australia, 2016). This is slowly changing due to the increased awareness of HAIs burden and the cost of prevention, as well as increasing HAIs incidence and increasing range of microorganisms that are resistant to antibiotics. The Australian Commission on Safety and Quality in Health Care came up with a proposal for a systematic national approach to build HIAs surveillance and clinician capacity, and promote hand hygiene and foster HAIs control guidelines. Risk Factors for HAIs HAIs occur in persons who are more vulnerable to a given infection, either because they are very sick, or because they had an operation. The risk for infection may also increase if the patient is very old or very young, have other underlying medical conditions, such as diabetes, or if one has a compromised immune system. Other reasons that may cause HAIs to occur include: surgery – length and type of the surgery, antibiotics used; poor hygiene by patient and staff; use of invasive devise – catheters or intravenous; longer stay in hospitals; a hospital admission in high risk areas – ICU and emergency departments; and use of certain medications. There are three general categories of risk factors of HAIs. These categories are: patient characteristics, medical procedures and antibiotic use. The behaviours of healthcare professionals and how they interact with the healthcare system also influences the rate at which HAIs occur. Patient characteristics that can be responsible for high HAIs risk include: severe conditions, such as immune-suppression; poor knowledge of HAIs; or overcrowding (Hughes 2008, pp.1-16). Medical procedures include: high-risk or sophisticated medical procedures; prolonged or inappropriate use of and invasive devices; insufficient isolation precautions; insufficient equipment and application of safety measures; and lack of procedure. Prolonged or inappropriate use of antibiotics poses a high risk of HAIs. Means of HAIs Transmission Microorganisms spread among healthcare personnel and patients through four main transmission routes; direct and indirect contact, common vehicle, airborne spread, and respiratory droplets. Others can be categorized as ‘vector-borne transmissions’ i.e. transmitted by fleas, mosquito etc. a) Contact transmission – Direct and indirect contact is the most common means of HAIs transmission within a healthcare setting. In direct contact, infectious microorganisms are transferred when a colonized patient comes in contact with a susceptible healthcare personnel or another person. In indirect transmission, microorganisms may be picked up by the intact skin or hands of the healthcare personnel and get transferred to another susceptible patient, or an infected patient may touch a door knob, leaving the microorganisms that may get transfer to another person using the same door knob. b) Common vehicle/source – HAIs transmission through common vehicle occur when many people get exposed to the microorganisms from a common source, e.g. contaminated water, food, devices, medications or solutions, and then become infected with HAIs. c) Airborne transmission – Airborne spread of HAIs may occur when microorganisms of smaller-particle size remain suspended in the air, exposing themselves to other people. Airborne spread from patient to other people can be controlled through use of protective equipment, patient isolation, hand hygiene, environmental control measures, and aseptic technique. d) Respiratory droplets – When an infected person sneezes, coughs, or talks, droplet-size microorganism-filled fluids can be generated and passed to other people nearby through mucosal surface. They can also be propelled on objects nearby, which may transmit the infection when touched by a susceptible person. Microorganism-filled fluids may also be generated during bronchoscopy and suctioning. Impacts of HAIs HAIs increases the cost of medical treatment to patients, in addition to crating medical complications and suffering. They prolong the patients stay in the medical facility, increase antimicrobial resistance, create a financial burden to the healthcare system, and result in long-term disability, or may lead to unnecessary deaths (Collins 2008, pp. 2). Preventing HAIs Most of the HAIs encountered in healthcare facilities are preventable and easy to cure, but may turn serous in some cases. This can be achieved by employing invasive devices and proper treatment procedures for patients using antibiotics to help them recover. However, some disease causing microorganisms have developed resistance to the antibiotics that are currently being used and are sometimes called “superbugs”. Examples of such bacteria are Staphylococcus aureus (MRSA) and Vancomycin resistant enterococcus (VRE). Studies have shown that proper education training of healthcare professionals can increase compliance and adoption of best nursing practices to prevent HAIs. Some of the best practices available include careful employment of antibiotics; careful insertion, regular maintenance, and timely removal of catheters, etc (Hughes 2008, pp.3-5). Other ways in which the risk of HAIs can be reduced include: i. Keeping hand hygiene by thorough cleaning of hands – patients, healthcare staff, and everyone else who enters the healthcare facility. ii. Complying with standard practices and guidelines for the insertion and maintenance of intravenous cannulas, catheter, and control and prevention of HAIs. iii. Maintaining hygiene in healthcare environments. iv. Taking prudent actions, e.g. isolation of patients with multi-resistant organism infections. Emerging Issues in HAIs A larger proportion of HAIs is accounted by surgical site infections, and infections that are associated with insertion devices – catheter-associated UTI, central line-associated bloodstream infections, and ventilator-associated pneumonia. HAIs associated with Clostridium difficile and anti-biotic resistant bacteria have become the common causes of infections in treatment facilities. Recent data have indicated that HAIs are undergoing revolution. More attention has been focused on the preventing infections from anti-resistant bacteria, such as methicillin-resistant Staphylococcus aureus, and Clostridium difficile (Hand Hygiene Australia, 2016). 4.0 IMPROVEMENTS PROPOSED About 50% of HAIs can be considered preventable through intensive hygiene and proper basic control measures and education programmes. Many prevention measures are simple and cost efficient, although they require healthcare staff accountability and change of behavior. The main perspectives and solutions proposed for the improvement include: Improving reporting and systems for surveillance of HAIs at facility level and national level. Identifying the determinants of the HAIs burden. Meeting minimum requirements within treatment facilities. Implementing the required standard precautions in treatment facilities, with emphasis on hand hygiene. Ensuring that measures for infection control are put in place, both at healthcare setting and national level. Improving healthcare staff education on HAIs, and staff accountability. This project proposal focuses on three improvement strategies; HAIs control measures, education programmes, and hand hygiene. 5.0 METHODS First, a healthcare facility will be chosen for this study. The facility chosen will be a multi-healthcare medical facility located in Queensland, and the study will be carried out in the ICU section and emergency department. Survey Questionnaire Prior to performing this study, a survey will be done on both the nursing staff and allied healthcare personnel to evaluate the level of knowledge they have concerning hand hygiene. This will be done by filling a pretested and validated questionnaire. The intention of the questionnaire was to ascertain adherence to hand hygiene, perception and basic knowledge, opportunities, steps to actions as well as people’s behaviour and attitudes towards hand hygiene. The questionnaire that will be used is shown in appendix 1. Hand Hygiene Observational studies will then be conducted in the surgical treatment facility and emergency section to assess compliance of hand washing among the nurses as well as other healthcare staff after an educational training program. Compliance to hand hygiene will be tested as per the guidelines for 5 moments of hand hygiene, provided by the Centre for Healthcare Related Infection Surveillance and Prevention & Tuberculosis Control (version 2, 2013). The sample size for this study will consist of the number of nursing staff (N1) and healthcare workers (N2). All the hospital staff will be taken through an orientation process and a training program in hand hygiene practices following the guidelines laid down by The Centre for Healthcare Related Infection Surveillance and Prevention & Tuberculosis Control. Observations for all the possible opportunities for hand washing will be recorded for a period of 14 days. A single observer will be allowed into the ICU and emergency section for a period of 12 hours to record all the observations for all the 5 moments of hand hygiene before contact and after patient contact. A checklist (appendix 2) will be used to indicate hand hygiene by placing a tick where appropriate, and leaving a blank where hand hygiene was not observed. If hand hygiene will be observed, the observer will tick under the ‘indication column’, and if hand hygiene occurred, then a second tick will be inserted under the column ‘occurred’. No insertion will be made if hand hygiene will not occur. 6.0 ETHICAL ISSUES Proper hand hygiene is one most important factors that determine the spread of HAIs, thus, the need to emphasize the practice in nursing training programs and medical facilities. Today, more convenient hand washing products exist, as well as a guideline to follow to encourage compliance to hand hygiene in the nursing practice. However, despite this, research studies still show that healthcare personnel regularly fail to emphasize on hand hygiene as they go about their day-to-day practice in the medical facilities. There is enough evidence that hand hygiene result in HIA’s related deaths, which could easily be prevented if healthcare professionals would follow the simple and straightforward guidelines of proper hand washing. The failure of nurses and allied healthcare workers to comply with the guidelines for hand hygiene, or failure to meet the required standards, is in itself a very important ethical issue. This behaviour stems from lack of leadership, low prioritization, and inconvenience placement of hand washing equipment, insufficient time, and intolerance to antiseptics. Sanctions for not complying with the hand hygiene policies and guidelines can only be justified in case it has been proved that non-compliance with the policies and guidelines can result to harm among patients (Ludwick & Silva, 2006). The most important ethical issues in regard to this project are discussed below: Respect for Autonomy – Just like many activities in healthcare facilities, hand washing involves an element of professional judgement. As noted before, there may be circumstances where hand washing may not be reasonable. Care should be taken to ensure that non-compliance justifications prioritize the safety of the patient, and that non-compliance to hand hygiene is not tolerated where the practice is essential. Non-Maleficence – It is the duty of nurses and allied healthcare staff to ensure that the patients do not get harm, which in this case, harm to patients can be avoided by proper hand hygiene practices. However, this may result in a conflict with the time required to carry out a proper hand hygiene thus, reducing the time available for the nurse or healthcare worker to attend to a patient. Regular use of antiseptics may cause a dry skin or discomfort. Beneficence – A healthcare professional is expected to focus on the well-being of a patient. Every moment a healthcare worker fails to meet the standards for proper hand washing practice guidelines, it is the patient’s risk that is put at risk. Addressing Ethical Issues Before the commencement of this project, it will be ensured that all the reasonable steps to help facilitate compliance with hand hygiene are put in place. This will include: development of unambiguous policies and guidelines and communicate them to healthcare staff, provision of an educational program materials and hand hygiene products in a way that they can be easily accessed, and also introducing fair and transparent audit methods and result feedback. Clinical leaders will take the responsibility of promoting the culture of hand hygiene, especially in the facility units where patients stand a high risk of being infected by HAIs, like the ICU and emergency department. This will reinforce the fact that healthcare professionals have a moral and professional responsibility to follow evidence-based policies and guidelines motivated by principles of patient safety. 7.0 TECHNIQUES SELECTED TO ASSESS PROJECT OUTCOMES The method of data collection in this project will be the direct observation technique. The survey results from the questionnaire will be used to establish the number of healthcare staff who are well informed about hand hygiene, and behaviour and attitude towards the practice. The total number of hand washing opportunities will be recorded to establish the number of contacts by nurses and healthcare workers and compare to see if there will be any significant variation. The average compliance will be determined, and also the hand washing moment with the highest compliance. The nurses’ compliance will be measured before and after contact with patient. The level of compliance when the ICU and emergency section are busy or during multiple admissions and when these sections were not at peak. Measuring compliance in different situations will enable the determination of the moment that healthcare professionals adhere to hand washing the least, so as to make an improvement in that particular clinical work area. 8.0 DISCUSSION Demonstrations have shown evidence that nurses and healthcare workers can pick up disease causing microorganisms from patients or surrounding contaminated environment. Despite not being able to quantify the amount of contamination or the exact incidence of pickup of infectious microorganisms is not apparent, the activity occurs. Nurses can lower the risk for HAIs using evidence-based hand washing practice to minimize the entry of disease causing microorganisms via contact or invasive medical devices. Application of appropriate protective barriers and hand washing is paramount to lower the risk of HAIs transmission to self or another susceptible patient (WHOP Safety, 2009). Microorganisms in a patient’s environment can contaminate portable medical equipment and surfaces around that environment. Healthcare staff should be careful when operating in such environments, as they can pick up microorganisms from the contaminated environment via gloves or hands without direct patient care. Following proper hand washing guidelines after attending to a patient can significantly reduce the microbial load that can potentially be transmitted to uninfected person or self (The Research Committee of the Society of Healthcare Epidemiology of America 2010, pp.118-120). Hand hygiene promotion and compliance involve both individual and system factors to provide a safe environment for healthcare staff and patients. Methods used to manage HAIs require a multidisciplinary approach to identify adherence factors, individual beliefs, perceived barriers, and many other aspects of hand hygiene. Education programs can have a significant impact, but should be reviewed regularly to improve the culture of hand hygiene in a healthcare facility (Chavali, et al. 2014, pp.689-693). Observational studies to determine hand washing behaviors are of importance in implementing various interventions with intention of improving hand washing culture. Direct observation is the most commonly applied technique for monitoring compliance with proper hand hygiene practice policies and guidelines in healthcare institutions. The method provides quantitative and qualitative data information about when and why failure to compliance do occur. However, studies by Marra et al. (2010, pp.796-801) have doubted direct observation as a gold standard method for collection of information on hand hygiene compliance because in their study findings, there was no correlation between mean product use and the observed hand hygiene adherence. They recommended the use of electronic counting devices and electronic antibiotic dispenser because these devices can accurately count and record all hand washing opportunities, and can perform the task for longer periods of time. However, these devices could not account for individual moments. Using direct observation will enable us to establish how the five moments fare in comparison to each individual moment. Direct observation also have some limitations; they consume a lot of time, are manpower intensive, and it is difficult to have a continuous monitoring. The information provided by direct observation accounts for a very low percentage of hand washing opportunities. Direct observation may also affect the behavior of healthcare staff when they become aware of the study. Addressing these challenges will require a well-trained observer, and making sure that the nurses and healthcare workers are not aware of the study and that no performance feedback is issued during the study. The questionnaire will be filled prior to the study as a feedback to regular training. The proposed improvements have been proved to be very effective in controlling and managing the dissemination of microorganisms from patient to patient or self. This will prevent an outbreak of HIAs or creating endemic healthcare flora. The benefits of HIAs control and management are numerous and cost-effective; not only do they contribute to improved patient health outcome and recovery, but also prevent transmission of infectious microorganisms to healthcare staff, increase awareness in healthcare settings, and maintain the acceptable nursing standards, which contribute to the overall goal of heath care institutions, which is to provide as best patient outcomes as possible. The potential future studies to further knowledge in this area can be done to establish the reliability of direct observation technique to study hand hygiene adherence among health professionals. 9.0 CONCLUSIONS AND RECOMMENDATIONS This study proposal aims to improve healthcare quality, safety and outcome through control and management of HAIs in patients admitted for treatment in healthcare settings. Effective prevention and reduction of healthcare-associated infections need application of a proper risk-management framework that can assist in the management of medical, human, and healthcare system factors. These are the factors that are associated with the transmission of infectious diseases. Basic knowledge and understanding of how transmission of infectious diseases occurs, and knowing the basic principles to apply in order to control the spread of infection is very critical in achieving a successful HAIs management. It is the responsibility of everybody who visits or works in a healthcare facility; patients, staff, carers and the administrators. This project has proposed some improvements that can be implemented to ensure that common infectious agents and evolving microorganism agents can be managed to lower the impact of HAIs in Australia. It is expected that the study outcome will reveal the level of compliance with hand hygiene guidelines among the hospital’s healthcare staff. This will provide a better insight of how the practice can well be incorporated in the nursing practice to ensure that healthcare professionals adhere to the highest standards of hand hygiene. Recommendations for future study of implications It is recommended that behavioural and management sciences be applied in order to achieve the desired implementation of the policies and guidelines required for compliance with hand hygiene with regard to the study outcome of this project. If anti-microbial measures are to be applied, then there will be need to have proper methods to enhance its appropriate use – based on the microbial susceptibility and control measures. It may also be necessary to identify the specific components required for prevention of microbial infection as well as control programs, they should be efficient in reducing rates of HAIs, and cost-effective as well. Efficiency and cost-effectiveness will be measured against pre-determined standard indices. REFERENCES APPENDICES Appendix 1 Questionnaire Appendix 2 Table 1: Checklist for adherence to hand hygiene Moments Observation Opportunity Adherence 1 2 3 4 5 TOTAL A B A/B Read More