A major issue that all health facilities face whether privately commissioned or government funded is observing and maintaining patient safety. The safety of patients is dependent on a variety of factors ranging from the prescription of medication to the communication between the patient and physician. Other factors that determine patient safety includes effective teamwork between healthcare professionals and procedural and surgical skills. Patient safety has, therefore, become a matter of concern for all health c are agencies around the globe including the respective governments for each country. Poor patient safety can bring about adverse outcomes. Therefore, this project aims to identify a clinical issue that can affect patient safety within a healthcare setting and ascertain the role of a nurse in eliminating the problems through the development of a plan that puts into consideration the various cultural values of the affected population. Moreover, the project will also outline the multiple barriers towards fruitful execution of the plan , and the benefits of the project are successfully implemented . Lastly, the project will describe the multiple parties that can aid in implementing the program .
One of the major clinical problems that affect patients’ safety is hospital-acquired infections. The incidence of health-acquired infections has been increasing over the years at an alarming rate (Nekkab et al., 2017). Originally, healthcare-acquired infections were related only to acute care hospital admissions and were referred to as nosocomial infections. However, with the new term HAIs, it now relates to infections attained in the continuum of settings where individuals get health care. The onset of HAI occurs as a patient is undergoing treatment and brings about significant morbidity and mortality (Nekkab et al., 2017).
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The healthcare-acquired infections are closely linked to the promise of a safe and effective care environment class of the NCLEX-RN examination blueprint (National Council of State Boards of Nursing, 2019). The major subcategory under this main category related to the HAIs is the safety and infection control. Through safety and infection control, a nurse must ensure that they protect patients, nurses and other healthcare persons from health and environmental hazards.
Importance
One of the patient population that is highly susceptible to healthcare-acquired infections in surgical patients (Chavan & Kelkar, 2017) Patients who have undergone some form of surgery is bound to have a higher affinity for HAIs especially in the regions that have undergone surgery . According to Cassini et al. (2016), the most common healthcare-acquired an infection that affects surgical patients is surgical site infections. The infections that occur at the surgical site tops the list of one of the most detrimental events occurring to admitted patients and a significant source of morbidity preceding a surgical process. According to a study conducted on Canadian cardiac surgery patients, the prevalence of HAIs increased within eighteen years to 20% in 2013 up from 8% in 1995 (O’Keefe et al.,2017). The increase in HAIs amongst the cardiac surgery patients occurred even though there was an advancement in infection management practices. Elimination of the HAIs on surgical based patients will play a vital role in improving the patient’s overall health outcomes.
If left untreated, HAI plays a huge role in increasing patient morbidity rates (Nekkab et al., 2017). Additionally, the patient can also end up succumbing to death following an increased and unattended HAI. For a patient who is discharged , they may end up being readmitted into the hospitals thus increasing their length of stay. The major setback linked to patient readmissions is more medicals costs, which might burden the families and patients. The psychological wellbeing of the patient and their families can also be affected in the end, as the patient will take a longer time to recover than anticipated. Increased cases of HAI can also negatively impact a healthcare facilities reputation in case patients file lawsuits. The healthcare professionals can even end up losing their practice licenses in case they are found guilty of not observing patient safety and causing more harm.
Patient Population
There are four types of health care acquired infections that are associated with surgical procedures or invasive devices; ventilator-associated events, central line-associated urinary tract infection, catheter-associated urinary tract infection and surgical site infection. Some organisms, which include; Acinetobacter, Staphylococcus aureus, Clostridium difficille, and Pseudomonas aeruginosa cause HAIs (Kampf et al., 2009).
Culture encompasses the patterns of behavior, ideas, and customs that are observed by a group of people. Through these patterns, people can identify themselves as being part of a particular group. Culture shapes the way people perceive the work and their experiences. One area that is substantially affected by the culture of healthcare. Culture will determine how healthcare practitioners and patients view certain illnesses, the causes of the diseases, the degree of compliance with various treatment methods and communication between patients and physicians. More importantly, culture can affect how specific measures are used in improving, preventing or eliminating the incidence of certain illnesses. It is, therefore, the duty of all healthcare professionals to ensure that they put the cultures of various patients into consideration while formulating different health improvement strategies. The practitioners must have the ability to understand what distinguishes their own beliefs form that of another individual and try to come up with a central point of agreements with patients.
Proposed Solution
Health care employees represent the core transmission mechanisms for HAIs within a health care setting in this case on surgical patients every healthcare employee is colonized by physiological flora on a permanent and temporary basis, and this is highly dependent on the practitioner’s duties within the facility. One of the HAI causing organism’s Staphylococcus aureus is known to survive for more than two hours on one’s hands and is found in ten percent to seventy-eight percent of all hospital staff (Kampf et al., 2009). This is also the major HAI causing organism on surgical sites in patients. According to the World Health Organization, the top priority in minimizing HAI is through hand hygiene. As a result of this, according to the Action Safety Initiative that was held in Washington DC on November 2006, hand hygiene is among the five aims the World Health Organization pushed for with the aim of reducing HAIs (Kampf et al., 2009).
Hand washing should be an exceptional clinical routine within any healthcare facility (Bhagawati, 2018). This is irrespective of whether the healthcare professional had put on gloves for a whole day. Some of the gloves worn by health practitioners are prone to pathogens even before they are used . However, washing the hands only is not the only solution to eliminating HAI. This will just help in decreasing any visible soiling and reduce the microbial colonization by a minimal percentage. The best hand hygiene is through hand disinfection (Fernando et al., 2017). This will assist in eliminating Enterococcus faecalis , Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa that are responsible for HAIs (Kampf et al., 2009). Hand disinfection should be undertaken after direct contact with patients or after contacting infectious materials, such as bandages.
One of the most rooted ethical consideration in Western society is the privacy of people and their freedom to make free choices without manipulation. These ethical considerations are because everyone has an intrinsic right of making their individual decisions as long as they do not have adverse effects on other parties. This has therefore been the core foundation of various medical codes such as confidentiality, and informed consent. Therefore, before formulating the plan, it is vital that the respective staff are informed about the program. Additionally, the right to autonomy is respected by the fact that one should not use manipulative methods to push the staff into adhering to program requirements. Instead, one should use better persuasive arguments into allowing the patients and staff to comply with the plan.
Goals
The incidence of HAIs is substantially increasing, and there is a need to eliminate its prevalence in hospitals. Thousands of health care acquired infections occur every year , which contributed, to hundreds of millions of dollars in terms of financial cost. The shocking factor is that most of the HAIs are preventable. Therefore, the short goals of this plan will be to reduce the incidence of HAIs in all the surgical patients at the health facility. The plan targets to minimize the HAIs in the surgical ward by 30% within the first month. The main reason for this is that the patients within the surgical units have the highest probability of contracting HAIs due to the incisions made on their bodies. These can act as entry points for HAIs, and it is up to the nurses to ensure they are safe from infections. To determine whether this has been achieved , a Standardized Infection Ration (SIR) will be used in tracking the HAI within the one month . The Standardized Infection Ratio is used in comparing the current HAI infections within the surgical wards to predicted number of HAI infections The anticipated figure of HAI in most cases are estimated based on the local, state or national baseline data a nd have undergone some form of risk adjustments as some health care centers might have sicker patients than others.
The long-term goal for the plan is to lessen the number of HAIs within the entire hospital a nd this time involves the patients. HAISs also affect other patients within the facility and patients can contribute towards t he spread of HAIs. Patients will also be included in the plan, as they will be required to ensure proper hand, and body hygiene. In case a patient is not able to maintain cleanliness for oneself, it is the duty of the nurse assigned to ensure the hygiene is provided . The long-term goals will aim at reducing HAIs infection by about 75% within six months. To determine whether this is achieved . Patient and healthcare practitioner surveys will be carried out to assess the success of the plan. Moreover, the SRI will be used in tracking the HAIs within the facility to ascertain whether the required milestone has been achieved .
Barriers
The main barrier towards successful implementation of hand hygiene and disinfection in HAI reduction is that regular washing of the hands and disinfection can lead to the dryness that affects the skin. The skin will end up losing a lot of fat and water binding substances and brings about clinically manifested hand eczema. Therefore, some of the hospital staff might resist engaging in the plan, as they would not want to have flaking skin on their hands. According to Kampf et al. (2009), a substantial number of nurses believe that the use of alcohol-based disinfectants damages their skin and this will bring about burning sensation making them not be able to work. The negative impacts of having eczema are that it increases the chances of one contacting harmful pathogens as compared to healthy hands. However, to ensure that there is adequate protection of the skin, appropriate precautions must be taken by the healthcare facility to ensure that all healthcare staff engages in hand hygiene. This should involve the drawing up of skin protection plans and avail all information on the various products used as disinfectants. Skin protection creams should be provided to the staff to apply before working and after every break to prevent the drying of skin because of hand washing and disinfection. The skin care creams will also help in accelerating cutaneous regeneration after work.
Another significant barrier to eliminating HAI is the development of resistance from the respective pathogen. A considerable number of pathogens have over the years decreased the susceptibility of various antiseptic agents used by the health care centers as disinfectants (He et al., 2017). These resistant pathogens are the chief sources of healthcare-acquired infections. The resistance of pathogens to antibiotics has been known for long, and this has now translated into the disinfectants. To eliminate the resistance of pathogens to disinfectants, it is crucial that the various disinfectants used be replaced after about six months to prevent the development of resistance from the pathogens.
Benefits
Doctors take the Hippocratic Oath in most cases only after completing their studies. However, in the case of the nurses, they also take the Nightingale Pledge that is dependent on the respective nursing school policy. The first principle that arises from this pledge is nonmaleficence or do not harm (Schröder-Bäck et al., 2014). This principle requires that no nurses cause any harm to the patient . The second principle of beneficence requires a nurse to take all actions necessary in preventing and removing any form of harm and promote good (Schröder-Bäck et al., 2014). The principles on nonmaleficence and beneficence that is supported by the Nightingale Pledge ensures that nurse maintains optimum levels of patient safety . However , nurses will not be living up to their pledge is they are playing a role in spreading HAIs to patients. By engaging in hand hygiene and disinfection every time they visit a new patient, the nurses will be adhering to the pledge that binds their profession.
On the other hand, healthcare-acquired infections can bring about substantial financial costs and emotional setbacks to patients and their families. The costs associated with surgical site infections can go as high as $21,000 (Anderson et al., 2009). According to the Institute of Medicine, the prevention of HAIs can help to eliminate the more than 90,000 annual patient deaths and financial costs amounting to $4.5-5.7 billion annually (Hughes, 2008). The hospital stays will also be reduced including hospital readmission rates. In the case of patients affected by surgical site infections, they are evidenced by 21days after the surgical operation in 12-84% of the patients (Hughes, 2008). This is an indication that such patients will have to become readmitted. However, by maintaining hygienic conditions within facilities, this will become eliminated. Generally, this plan will help in eliminating patient deaths, hospital readmissions, emotional and financial costs amongst patients and their families (Kampf et al., 2009).
Participants and Interdisciplinary Approach
A multidisciplinary infection control and prevention committee is the crucial first step in formulating a successful plan. The committee must have stakeholder from various expertise areas who will aid in preventing the spread of HAI within the health care facility. The team will include a clinical microbiologist. The role of the microbiologist is that he/she has the ability to determining microorganism that causes various diseases and infections. The microbiologist will analyze the different microbial culture samples from the various patient locations and inform the team of the rampant organism that needs elimination . The team will also involve an infection control specialist. The role of the specialist is to use the information provided by the clinical microbiologist in developing and implementing the best and proactive strategies aimed at reducing the infections. This is by ascertaining the best disinfectants that will eliminate the microorganism from the hospital. The team will also have an information specialist whose duty is to manage and secure the data and files. The specialist will also analyze the information and relay it to relevant stakeholders on the progress of the plan. The reason for having a multidisciplinary team is that the infection control and prevention initiatives may overlap and intertwine with other departments or initiatives within the facility. The team will help in pooling knowledge from the various departments and coming up with a robust plan that will make sure the project is a success (Hartgerink et al., 2014).
Conclusion
Health acquired infections are causing the deaths of thousands of patients annually from all over the globe. Another negative element linked to the HAIs is the increased financial and emotional burden to the patients and their families. A patient will have to become readmitted into the health care facility because of HAIs. All healthcare practitioners must ensure that they are maintaining the highest levels of patient safety. However, this dream is not being realized as HAIs continue to wreak havoc in the health care sector. As a result of this, this project aimed to ensure that there is a reduction in HAI within the surgical based patient population. The plan is also focused on long-term rolling to other patient populations within the healthcare facility. The plan proposes the use of hand hygiene and disinfection as the core HAIs prevention strategy. This will see all nurses participating in the program, which will later be rolled out to patients. The plan will be formulated and implemented by a multidisciplinary team of professionals comprising of nurses, clinical microbiologists, infection control specialists, and information specialist. The benefits of successfully implementing the plan do not just focus on the patients’ safety but healthcare professionals. The nurses will have the ability to living up to the pledge, which is, maintain patient safety. Additionally, the state and federal governments will also benefit from reduced medical care expenses resulting from the HAIs.
References
Anderson, D. J., Kaye, K. S., Chen, L. F., Schmader, K. E., Choi, Y., Sloane, R., & Sexton, D. J. (2009). Clinical and financial outcomes due to methicillin-resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study. PloS one , 4 (12), e8305.
Cassini, A., Plachouras, D., Eckmanns, T., Sin, M. A., Blank, H. P., Ducomble, T., & Velasco, E. (2016). The burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modeling study. PLoS medicine , 13 (10), e1002150.
Chavan, A. R., & Kelkar, V. (2017). Study of healthcare-associated infections in the surgical unit in a newly established tertiary care hospital of Nanded, Maharashtra, India. International Journal of Surgery Open , 9 , 30-35.
Fernando, S. A., Gray, T. J., & Gottlieb, T. (2017). Healthcare‐acquired infections: prevention strategies. Internal medicine journal , 47 (12), 1341-1351.
Hartgerink, J. M., Cramm, J. M., Bakker, T. J. E. M., Van Eijsden, A. M., Mackenbach, J. P., & Nieboer, A. P. (2014). The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients. Journal of Advanced Nursing , 70 (4), 791-799.
He, X. F., Zhang, H. J., Cao, J. G., Liu, F., Wang, J. K., Ma, W. J., & Yin, W. (2017). A novel method to detect bacterial resistance to disinfectants. Genes & diseases , 4 (3), 163-169.
Kampf, G., Löffler, H., & Gastmeier, P. (2009). Hand hygiene for the prevention of nosocomial infections. Deutsches Ärzteblatt International , 106 (40), 649.
National Council of State Boards of Nursing. (2019, April). Test plan for the National Council Licensure Examination for Registered Nurses. Available at https://www.ncsbn.org/2019_RN_TestPlan-English.pdf
Nekkab, N., Astagneau, P., Temime, L., & Crepey, P. (2017). Spread of hospital-acquired infections: A comparison of healthcare networks. PLoS computational biology , 13 (8), e1005666.
O’Keefe, S., Williams, K., & Legare, J. F. (2017). Hospital-acquired infections after cardiac surgery and current physician practices: a retrospective cohort study. Journal of clinical medicine research , 9 (1), 10.
Schröder-Bäck, P., Duncan, P., Sherlaw, W., Brall, C., & Czabanowska, K. (2014). Teaching seven principles for public health ethics: towards a curriculum for a short course on ethics in public health programmes. BMC Medical Ethics , 15 (1), 73.
