targeted search
undertake a targeted search to identify current best evidence , justify that evidence ,critically appraise the research using an appropriate framework and evaluate how the research results fits with other sources of knowledge.
A written piece of 4000 words.
this equates to 75% of the total mark for this module. you must achieve 50% or above to pass.
Background
Healthcare-associated infections (HAIs) are infections a patient acquires during the process of receiving care in any healthcare facility, appearing after 48 hours of admission or more and within 30 days of receiving healthcare (Haque, Sartelli, McKimm, and Abu Bakar,2018). The frequently contracted HAIs in hospitals and long term care facilities includes pneumonia, and those cause by Eschelichia coli (E.coli), meticillin-resistant Staphylococcus, aureus (MRSA), clostridium deficile, methicillin-sensitive Staphylococcus aureus (MSSA) and Catheter-associated urinary tract infections (CAUTI) .HAIs can be transmitted via air, direct contact (through the hands of the healthcare professionals) and indirect contact( through inanimate medical equipments)
The purpose of this paper is to identify a clinical practice problem that will need intervention through practice change. It will also be formulating a research question using the PICO fomat.
Problem Statement
Healthcare associated infection is one of the highest causes of mortality and morbidity occurring among residents in long term care facility (Mehta et al, 2014). The increase in the incidence of health care associated infection has caught the attention of the government, insurance companies, Health regulatory agencies, patients and would Health Organization (WHO).According to the European Centre for Disease Control and Prevention (ECDC), about 9 million cases of HAIs occurs every year across the Europe with about 1 in 15 patients in acute hospital and 1 in 24 patients in LTCF across Europe each year (Cassini,et al,2016). HAIs is becoming a huge threat all over the world exposing patients to severe pain and suffering.
The National Institute for Health and Care Excellence (NICE) states that about 300,000 patients in England acquire a healthcare-associated infection annually due to care within the NHS. Healthcare associated infection brings pain, prolong suffering, frequent emergency room visit by the residents of LTCF, increase hospital stay and also increase in the cost of care (Center for disease control and Prevention, 2013). Despite the fact that there are not much of intensive care being rendered in LTCF, HAIs are common among these vulnerable residents. This has caused frequent prescription of antimicrobial drugs leading to the development of antimicrobial resistance strain of microorganisms. There are evidences showing that LTCFs can serve as a reservoir for resistant microorganism for onward transmission to other healthcare settings (Dwyer,et al, 2013). Long term care facilities residents are considered vulnerable, frail and mostly elderly hence are susceptible to HAIs (Dwyer,et al, 2013).
Over the years, hand hygiene using soap and water have been approved by WHO and various Health agencies to prevents the transmission of infection vie the hand of the healthcare professional as the care for different patients, but it is facing a lot of challenges, which include, complaint from health professionals that it takes too much time, causes skin irritation, and sometimes there is unavailability of water leading to poor compliance( Gould, Moralejo, Drey, Chudleigh, & Taljaard, 2017). Despite the practice of hand hygiene by washing hands with soap and water, in various hospitals and LTCF, the incidence of healthcare associated infection continues to be on the rise hence the need for a practice change in other to prevent the continues increase in the incidence of HAIs.
Evidences have shown the efficacy of alcohol based hand sanitizer in the prevention of HAIs in hospitals and LTCF by eliminating microorganisms from the hands of health professionals preventing cross infection as they attend to different patients(Kampiatu & Cozean, 2015). The world health organization as well as the Center for disease prevention and control (CDC) has recommended the use of alcohol hand sanitizer in the prevention of infection in healthcare as it save time and can be used on the go hence increasing compliance. Following the identification of this clinical practice problem, a research question will be generated using the PICO criteria.
P- Population
The populations that will be focused on are patients/residents in long term care facilities (LTCF) irrespective of their age, gender and medical conditions. LTCF include Nursing homes, skilled nursing facilities, home health and assisted living facilities ( Holt , 2017).
I – Intervention
The intervention is the introduction of the use of alcohol base hand sanitizer as a method of hand hygiene in the LTC facilities. The product must contain at least 65% alcohol as recommended by WHO and CDC (Edmonds et al,2011). At each use, the individual is expected to use at least 2 ml of the hand sanitizer each time following the recommended procedure by rubbing hands together for at least 30 seconds, covering all surfaces of hands and fingers until sanitizer is absorbed.
C-Comparator
The comparator is hand hygiene by hand washing with soap and water alone. Hand hygiene with soap and water must follow WHO recommended 5 steps procedure. The procedure is:
1. Wet hands with running water and apply soap.
2. Lather hands by rubbing them together, do same to the back of the hands between the fingers and under the nails
3. Spent at least 20 minutes scrubbing the hands
4. Using clean running water rinse the hands.
5. Dry hands using a clean towel or by air drying
O- Outcome
The expected outcome is a reduction in the incidence of HCAs among residents of LTCF. This will be evaluated by knowing the incident rate of HCAs among residents of LTCF prior to the practice change and then comparing it with the result after a 6months of pilot study before implementing the use of alcohol based hand sanitizers all over the LTCF.
There might be some barriers against the practice change which may include complaints about alcohol causing skin dryness hence leading to poor compliance. To eliminate this, Hand sanitizer with emollient propertied will be used in other to eliminate skin dryness problem.
The PICO question states :among patients/residents in long term care facilities (LTCF), does the use of alcohol based hand sanitizer for hand hygiene result in lower incidence of HAIs compared to the use of hand washing with soap and water only.
In conclusion, Healthcare associated infection among LTCFs residents leads to avoidable deaths, suffering, incapacitation, increase financial cost for the client and healthcare facility. Therefore, there is need for a change in practice in order to reduce the incidence healthcare associated infection and improve patient outcome.
Reference
Cassini, A., Plachouras, D., Eckmanns, T., Abu Sin, M., Blank, H. P., Ducomble, T., Haller, S., Harder, T., Klingeberg, A., Sixtensson, M., Velasco, E., Weiß, B., Kramarz, P., Monnet, D.L., Kretzschmar, M.E., Suetens, C. (2016). Burden of Six Healthcare-Associated Infections on European Population Health: Estimating Incidence-Based Disability- Adjusted Life Years through a Population Prevalence-Based Modelling Study. PLoS medicine, 13(10), e1002150. doi:10.1371/journal.pmed.1002150
Center for Disease Control and prevention (CDC) (2013) . Public health focus: surveillance, prevention and control of nosocomial infections. Mmwc morb.mortal.wkly Rep. 2013 (42):783-787.
Dwyer, L.L., Harris-Kojetin L.D., valverde, R.H. et al (2013) infections in
long – term care populations in the United States. JAM Geriat. Soc 2013; 61:342-349.
Edmonds, S. L., Macinga, D. R., Mays-Suko, P., Duley, C., & Arbogast, J. W. (2011). Meeting global standards for hand sanitizer efficacy: formulation matters. BMC Proceedings, 5(Suppl 6), P26. doi:10.1186/1753-6561-5-S6-P26
Gould, D. J., Moralejo, D., Drey, N., Chudleigh, J. H., & Taljaard, M. (2017). Interventions to improve hand hygiene compliance in patient care. The Cochrane database of systematic reviews, 9(9), CD005186. doi:10.1002/14651858.CD005186.pub4
Haque, M., Sartelli, M., McKimm, J., & Abu Bakar, M. (2018). Health care-associated infections – an overview. Infection and drug resistance, 11, 2321–2333. doi:10.2147/IDR.S177247.
Kampiatu, P., & Cozean, J. (2015). A controlled, crossover study of a persistent antiseptic to reduce hospital-acquired infection. African journal of infectious diseases, 9(1), 6–9.
Mehta, Y., Gupta, A., Todi, S., Myatra, S., Samaddar, D. P., Patil, V., , Bhattacharya, P.K Ramasubban, S. (2014). Guidelines for prevention of hospital acquired infections. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 18(3), 149–163. doi:10.4103/0972-5229.128705
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