Details:Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the Topic 1, 2, and 3 assignments and the guidelines below.PICOT Statement Revise the PICOT statement you wrote in the Topic 1 assignment.The final PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).Research CritiquesIn the Topic 2 and Topic 3 assignments you completed a qualitative and quantitative research critique. Use the feedback you received from your instructor on these assignments to finalize the critical analysis of the study by making appropriate revisions.The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT statement.Refer to “Research Critique Guidelines.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.Proposed Evidence-Based Practice ChangeDiscuss the link between the PICOT statement, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.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. Please refer to the directions in the Student Success Center.
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Running head: INFECTION PREVENTION
Hand Washing and Hospital Acquired Infections
Christine Nordet-Silva
Grand Canyon University
N433VN- Professor Byron Thatcher
February 9, 2019
1
INFECTION PREVENTION
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Hand Washing and Hospital Acquired Infections
PICOT: Among patients and healthcare workers, does hand hygiene (washing protocol) reduce
central line-associated bloodstream infection (CLABSI) and catheter associated Urinary Tract
infection (CAUTI) in one month.
References
Perin, D. C., Erdmann, A. L., Higashi, G. D. C., & Sasso, G. T. M. D. (2016). Evidencebased measures to prevent central line-associated bloodstream infections: a systematic
review. Revista latino-americana de enfermagem, 24.
Abstract
Objective:
To identify evidence-based care to prevent CLABSI among adult patients hospitalized in ICUs.
Method:
Systematic review conducted in the following databases: PubMed, Scopus, Cinahl, Web of
Science, Lilacs, Bdenf and Cochrane Studies addressing care and maintenance of central venous
catheters, published from January 2011 to July 2014 were searched. The 34 studies identified
were organized in an instrument and assessed by using the classification provided by the Joanna
Briggs Institute.
Results:
the studies presented care bundles including elements such as hand hygiene and maximal barrier
precautions; multidimensional programs and strategies such as impregnated catheters and
bandages and the involvement of facilities in and commitment of staff to preventing infections.
INFECTION PREVENTION
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Conclusions:
care bundles coupled with education and the commitment of both staff and institutions is a
strategy that can contribute to decreased rates of central line-associated bloodstream infections
among adult patients hospitalized in intensive care units.
McLaws, M. L. (2015). The relationship between hand hygiene and health care-associated
infection: it’s complicated. Infection and drug resistance, 8, 7.
Abstract
The reasoning that improved hand hygiene compliance contributes to the prevention of health
care-associated infections is widely accepted. It is also accepted that high hand hygiene alone
cannot impact formidable risk factors, such as older age, immunosuppression, admission to the
intensive care unit, longer length of stay, and indwelling devices. When hand hygiene
interventions are concurrently undertaken with other routine or special preventive strategies,
there is a potential for these concurrent strategies to confound the effect of the hand hygiene
program. The result may be an overestimation of the hand hygiene intervention unless the design
of the intervention or analysis controls the effect of the potential confounders. Other
epidemiologic principles that may also impact the result of a hand hygiene program include
failure to consider measurement error of the content of the hand hygiene program and the
measurement error of compliance. Some epidemiological errors in hand hygiene programs aimed
at reducing health care-associated infections are inherent and not easily controlled. Nevertheless,
the inadvertent omission by authors to report these common epidemiological errors, including
concurrent infection prevention strategies, suggests to readers that the effect of hand hygiene is
greater than the sum of all infection prevention strategies. Worse still, this omission does not
assist evidence-based practice.
INFECTION PREVENTION
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Haverstick, S., Goodrich, C., Freeman, R., James, S., Kullar, R., & Ahrens, M. (2017).
Patients’ hand washing and reducing hospital-acquired infection. Critical care nurse, 37(3),
e1-e8.
Background Hand hygiene is important to prevent hospital-acquired infections. Patients’ hand
hygiene is just as important as hospital workers’ hand hygiene. Hospital-acquired infection rates
remain a concern across health centers.
Objectives To improve patients’ hand hygiene through the promotion and use of hand washing
with soap and water, hand sanitizer, or both and improve patients’ education to reduce hospitalacquired infections.
Methods in August 2013, patients in a cardiothoracic postsurgical step-down unit were provided
with individual bottles of hand sanitizer. Nurses and nursing technicians provided hand hygiene
education to each patient. Patients completed a 6-question survey before the intervention, at
hospital discharge and 1, 2, and 3 months after the intervention. Hospital-acquired infection data
were tracked monthly by infection prevention staff.
Results Significant correlations were found between hand hygiene and rates of infection with
vancomycin-resistant enterococci (P = .003) and methicillin-resistant Staphylococcus aureus (P
= .01) after the intervention. After the implementation of hand hygiene interventions, rates of
both infections declined significantly, and patients reported more staff offering opportunities for
and encouraging hand hygiene.
Conclusion This quality improvement project demonstrates that increased hand hygiene
compliance by patients can influence infection rates in an adult cardiothoracic step-down unit.
The decreased infection rates and increased compliance with hand hygiene among the patients
INFECTION PREVENTION
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may be attributed to the implementation of patient education and the increased accessibility and
use of hand sanitizer
Patel, P. K., Gupta, A., Vaughn, V. M., Mann, J. D., Ameling, J. M., & Meddings, J. (2018).
Review of Strategies to Reduce Central Line-Associated Bloodstream Infection (CLABSI)
and Catheter-Associated Urinary Tract Infection (CAUTI) in Adult ICUs. Journal of
hospital medicine, 13(2), 105-116.
Central line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract
infection (CAUTI) are costly and morbid. Despite evidence-based guidelines, some intensive
care units (ICUs) continue to have elevated infection rates. In October 2015, we performed a
systematic search of the peer-reviewed literature within the PubMed and Cochrane databases for
interventions to reduce CLABSI and/or CAUTI in adult ICUs and synthesized findings using a
narrative review process. The interventions were categorized using a conceptual model, with
stages applicable to both CAUTI and CLABSI prevention: (stage 0) avoid catheter if possible,
(stage 1) ensure aseptic placement, (stage 2) maintain awareness and proper care of catheters in
place, and (stage 3) promptly remove unnecessary catheters. We also looked for effective
components that the 5 most successful (by reduction in infection rates) studies of each infection
shared. Interventions that addressed multiple stages within the conceptual model were common
in these successful studies. Assuring compliance with infection prevention efforts via auditing
and timely feedback were also common. Hospitalists with patient safety interests may find this
review informative for formulating quality improvement interventions to reduce these infections.
INFECTION PREVENTION
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Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C., … & Bader, M.
K. (2015). Use of a patient hand hygiene protocol to reduce hospital-acquired infections
and improve nurses’ hand washing. American Journal of Critical Care, 24(3), 216-224.
Background Critically ill patients are at marked risk of hospital acquired infections, which
increase patients’ morbidity and mortality. Registered nurses are the main health care providers
of physical care, including hygiene to reduce and prevent hospital-acquired infections, for
hospitalized critically ill patients.
Objective To investigate a new patient hand hygiene protocol designed to reduce hospital
acquired infection rates and improve nurses’ hand-washing compliance in an intensive care unit.
Methods A PR experimental study design was used to compare 12-month rates of 2 common
hospital-acquired infections, central catheter–associated bloodstream infection and catheter
associated urinary tract infection, and nurses’ hand-washing compliance measured before and
during use of the protocol.
Results Reductions in 12-month infection rates were reported for both types of infections, but
neither reduction was statistically significant. Mean 12-month nurse hand-washing compliance
also improved, but not significantly.
Conclusions A hand hygiene protocol for patients in the intensive care unit was associated with
reductions in hospital acquired infections and improvements in nurses’ hand-washing
compliance. Prevention of such infections requires continuous quality improvement efforts to
monitor lasting effectiveness as well as investigation of strategies to eliminate these infections.
(American Journal of Critical Care. 2015; 24:216-224)
INFECTION PREVENTION
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Mauger, B., Marbella, A., Pines, E., Chopra, R., Black, E. R., & Aronson, N. (2014).
Implementing quality improvement strategies to reduce healthcare-associated infections: A
systematic review. American journal of infection control, 42(10), S274-S283.
Background: Comprehensive incidence estimates indicate that 1.7 million healthcare-associated
infections (HAIs) and 99,000 HAI-associated deaths occur in US hospitals. Preventing HAIs
could save $25.0 to $31.5 billion. Identifying effective quality improvement (QI) strategies for
promoting adherence to evidence-based preventive interventions could reduce infections.
Methods: We searched MEDLINE, CINAHL, and EMBASE from 2006-2012 for Englishlanguage articles with _ 100 patients that described an implementation strategy to increase
adherence with evidence-based preventive interventions and that met study design criteria. One
reviewer abstracted and appraised study quality, with verification by a second. QI strategies
included audit and feedback; financial incentives, regulation, and policy; organizational change;
patient education; provider education; and provider reminder systems.
Results: We evaluated data on HAIs from 30 articles reporting adherence and infection rates that
accounted for confounding or secular trends. Many of the measures improved significantly,
especially adherence. Results varied by QI strategy(s).
Conclusions: Moderate strength of evidence supports improvement in adherence and infection
rates when audit and feedback plus provider reminder systems or audit and feedback alone is
added to organizational change and provider education. Strength of evidence is low when
provider reminder systems alone are added to organizational change and provider education.
There were no studies on HAIs in nonhospital settings that met the selection criteria.
INFECTION PREVENTION
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References
PubMed, Scopus, Cinahl, Web of Science, Lilacs, Bdenf and Cochrane
Studies addressing care and maintenance of central venous catheters, (2011-2014)
Perin, D. C., Erdmann, A. L., Higashi, G. D. C., & Sasso, G. T. M. D. (2016).
Evidence-based measures to prevent central line-associated bloodstream infections: a
systematic review. Revista latino-americana de enfermagem, 24.
McLaws, M. L. (2015). The relationship between hand hygiene and health care
Infection: it’s complicated. Infection and drug resistance, 8, 7.
Haverstick, S., Goodrich, C., Freeman, R., James, S., Kullar, R., & Ahrens, M. (2017).
Hand washing and reducing hospital-acquired infection. Critical care nurse, 37(3), e1-e8.
Patel, P. K., Gupta, A., Vaughn, V. M., Mann, J. D., Ameling, J. M., & Meddings, J. (2018).
Review of Strategies to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and
Catheter-Associated Urinary Tract Infection (CAUTI) in Adult ICUs. Journal of hospital
medicine, 13(2), 105-116.
Fox, C. Wavra, T. Drake, D. A, Mulligan, D. Bennett, Y. P. Nelson, C. & Bader, M. K. (2015).
Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve
nurses’ hand washing. American Journal of Critical Care, 24(3), 216-224.
Mauger, B., Marbella, A., Pines, E., Chopra, R., Black, E. R., & Aronson, N. (2014).
Implementing quality improvement strategies to reduce healthcare-associated infections: A
systematic review. American journal of infection control, 42(10), S274-S283.
American Journal of Critical Care. (2015; 24:216-224)
Medline, Cinahl, and Embase from (2006-2012)
Running head: QUALITATIVE RESEARCH ON CAUTI
CAUTI Qualitative Research- A Hospital Outlook
Christine Nordet-Silva
Grand Canyon University: NRS-433V
Professor Byron Thatcher
February 16, 2019
1
QUALITATIVE RESEARCH ON CAUTI
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Qualitative Research on CAUTI – A Hospital Outlook
Qualitative research is established on the understanding and clarification of a subject’s
questions and providing an answer to the problem provided. According to Grove, Gray & Burns
(2015), qualitative research is a path used to describe an individual’s event and direction for the
questions asked. The information obtained is then collected, grouped, and examined, in order to
determine an individual’s perspectives in identifying the outcome of the problem. This paper will
provide a summarization of a peer review article regarding catheter acquired urinary tract
infection (CAUTI), which will further explain how ethical decisions are made in conclusion to
studies conducted and then implemented in the nursing practices.
Background
Some patients who seek care at a hospital, may end up with a urinary catheter depending
on their diagnosis and their need. Ethics committees have determined that one of their biggest
issues are urinary catheters and the infections they may cause patients during their hospital stay;
therefore, the use of the catheters is constantly reviewed to see if a patient’s diagnosis warrants a
catheter or not, and if a doctor’s orders includes a specific reason why the catheter is needed. An
article by Safdar, Codispoti, Purvis, & Knoblch, (2016), states that CAUTI is the leading cause
of hospital acquired infections at a rate of 70 to 80 %. In a study by Safdar, et al., (2016),
interviews were conducted to determine if medical providers and nurses were providing proper
information regarding the care of urinary catheters and patient education to prevent CAUTI. The
author identified that a larger problem existed regarding this infection and identified using his
own data that only a 12 to 16% of patients admitted to the hospital, will have orders for a urinary
catheter to be placed during their hospital stay.
QUALITATIVE RESEARCH ON CAUTI
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Many insurance companies are no longer reimbursing hospital for patients who develop
CAUTI. Each time a patient develops CAUTI and it is not their primary diagnosis at the time of
admission it becomes a financial loss for the hospital and the treatment for the newly acquired
infection can become financially expensive to treat and sometimes can even lead to death if the
treatment is not done on time basis. Studies have shown that 10% of patients who develop
CAUTI also become septic (an infection that can lead a very low blood pressure and or organ
failure). According to the Center of Disease Control (CDC, 2011), there was an estimated 90,000
hospital acquired urinary tract infections reported in the United States. The cost to treat this
infection is over $900.00 per person according to HAI Date and Statistics, (2014).
Research Questions
1. How do you feel?
2. How has your care been during your hospital stay?
3. Have you ever had a urinary catheter before? If not, do you know why you have one
now?
4. Has your medical provider informed you why you have a urinary catheter and for
how long you will need it?
5. Has the nurse provided education on how to care for the catheter to prevent infection?
6. Do you feel the catheter prevents you from doing your daily routines?
7. What are your thoughts about having a catheter?
8. Do you understand the necessity that the catheter remains in place?
9. Do you understand at no time should you remove the catheter? And how removing it
yourself can cause you irreparable harm to your bladder?
10. Have we answered all of your questions regarding your urinary catheter? Is there
anything else you need help with?
QUALITATIVE RESEARCH ON CAUTI
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These types of questions can help hospital providers understand a patient’s knowledge
about their urinary catheter and can help create a dialogue between the medical provider,
the nurse, and the patient in order to provide better care and prevent CAUTI.
Method of Study
The author begins the study using Ten hospitalized adult patients (excluding ICU
patients) of various background (age, race, religion, diagnosis). The study showed that a
Qualitative approach to the questions asked were correctly depicted in order to provide correct
and concise answers to each research question based on each patient need for a urinary catheter
to be in place. The author identifies the patient’s point of view on the necessity for the catheter.
The authors begin to make a distinction as to why “most patients” do not know why an
indwelling catheter was placed or the health risks it can cause to them. The author identifies in
order to have a concise research a quantitive research will also be needed in order to determine
exactly how many patients are afflicted by this type of infection. Some of the references we find
today may be older than five years, but clearly there are many more that are current. The author
also identifies weaknesses in the study due to the number of patients interviewed and the lack of
education provided to these patients about their urinary catheters. While many components may
not be there to determine on how to prevent CAUTI, it can be said that most patients feel the use
of their catheters is warranted to their procedure or to their health, therefore not questioning their
medical providers for their decision or the nursing staff.
Results
The study finds that there is room for improvement in promoting patient awareness
regarding CAUTI and the prevention of infections. Education provided to the patient by medical
providers and nursing staff is key. By engaging the patient in the decision-making of the use of a
urinary catheter can significantly reduce CAUTI. The study also shows that nurse are ultimately
the one responsible in providing patients with the proper education. Nurses should provide
patients with the benefits and risks of the indwelling catheters and the proper way to care for the
QUALITATIVE RESEARCH ON CAUTI
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catheter in order to prevent infections. It is believed that nurses are ultimately held responsible
because they are the ones that carry out the physician orders and insert the urinary catheter.
Ethics
This study was not approved by any review board. No patient information was
compromised therefore, Health Insurance Portability and Accountability Act (HIPAA) laws were
never violated. The study does not identify patients by name, background, education or financial
status.
Conclusion
In the study we notice an unclear division of responsibilities. Documentation is hard to
overlook, the patient’s way through different units and diverse record are factored involved. We
also see a various handling routines and knowledge materials. There is a need for further study
on factors influencing CAUTI, such as routine and materials that require a system where
indwelling urinary catheters can be traced through a treatment time, seen and followed by all
categories of health care professionals involved. Also, same as operations, physicians are the
ones that should obtain consent from the patient in order to insert an indwelling catheter they
should also explain the pro and cons to the patients. Although, nurses are ultimately the ones
held responsible should CAUTI be determined in their patients: Physicians should also have
some accountability as well. Together, infections can be minimized while helping to put patient
safety first.
QUALITATIVE RESEARCH ON CAUTI
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References
Burns, N., Gray, J., & Grove, S. K. (2015). Understanding nursing research: Building an
evidence-based practice. St. Louis, MO: Elsevier.
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