HOW CAN NURSES REDUCE THE RISK OF HOSPITAL-ACQUIRED INFECTIONS

HOW CAN NURSES REDUCE THE RISK OF HOSPITAL-ACQUIRED INFECTIONS?

Introduction

This essay presents a proposal for a dissertation on the topic “How Can Nurses Reduce the Risk of Hospital-Acquired Infections?” It includes information that helps the intended research. The proposed study is also justified and its purpose is outlined. Additionally, the essay demonstrates how the literature search was conducted. More importantly, a review of five research articles is done with a view of comparing, contrasting, and critiquing current research findings on the selected topic. The literature review section also includes illustrations of how current research on the topic is related to the proposed study. Furthermore, the proposed study is discussed in the context of the reviewed literature, and its limitations are identified. Finally, the implications of findings within the literature review for nursing practice are discussed in the essay.  

Background

Hospital-acquired infections or nosocomial infections refer to infections that patients get from health facilities (Fox et al., 2015).  They are caused by fungal, bacterial, and viral pathogens. Common types of hospital-acquired infections are ventilator-associated pneumonia, surgical site infection, urinary tract infection, and bloodstream infections. Mehta et al. (2014) demonstrate that healthcare facilities are paying more attention to sterilization and disinfection due to the increasing prevalence of hospital-acquired infections. Regardless of preventive efforts, nosocomial infections remain the top causes of alarm in hospitals because they affect 1 in every 10 patients (Jirojwong, 2011). They are also associated with increased mortality and morbidity (Arya, Agarwal and Agarwal, 2009). Patients and hospitals experience preventable financial burdens due to hospital-acquired infections. Malone (2005) argues that hospital-acquired infections challenge hospitals because all patients have a considerable risk of contracting them. These infections impact negatively the quality of care and patient satisfaction. They also prolong recovery time and contribute to the increasing rate of readmission. Therefore, hospital-acquired infections concern all stakeholders in the health sector including policymakers, providers, patients, and investors.

Justification

Nurses play a leading role in preventing infections (Labeau et al., 2014). However, they should do more to contribute towards the achievement of the objectives of Health 2020 in the context of hospital-acquired infections (Fox et al., 2015). The proposed study will indicate what more nurses need to do to reduce the increasing prevalence of hospital-acquired infections on the basis of valid research evidence. Therefore, the findings of the proposed research will enable nurses to integrate evidence-based practices in the prevention of hospital-acquired infections and the undesired effects on patient safety and quality of care. Masterton et al. (2008) indicate that the roles of nurses in reducing the risk of hospital-acquired infections are aligned with their ethical and professional obligations of promoting the health of their patients. Therefore, the proposed study will apply research evidence to discuss nursing considerations that will help to reduce hospital-acquired infections. The increasing concern of hospitals for nosocomial infections will be effectively addressed on the basis of the findings and recommendations of the proposed study.

Purpose

The purpose of the proposed study is to apply research evidence to determine how nurses can effectively reduce the risk of hospital-acquired infections.

Literature Search

Formulation of Research Question

Jirojwong (2011) asserts that the effectiveness of a research process is defined by the formulation of a research question that defines the focus of the study. The research question “how can nurses reduce the risk of hospital-acquired infections?” helped the proposed study to achieve its purpose. The research question includes broad and narrow topic areas, as well as a focused topic area in that order (Appendix 1). The focused topic area was used to formulate the research question which will also serve as the research topic.

PICO Question

The PICO framework was used to clarify the research question in the context of the problem, intervention, comparison, and outcome. Hastings and Fisher (2014) illustrate that the identification of the elements of PICO frameworks is necessary for the formulation of a good research question. The PICO framework is also useful in generating key terms for research (Davies, 2011). Therefore, the PICO framework was used to ensure that the literature search is relevant, accurate, and appropriate for the topic of interest (Appendix 2).

Electronic Search

EBSCO Information Services were used in an electronic search to access a wide range of online databases, including MEDLINE Complete, DynaMed Plus, CINSHL Complete, Nursing Reference Center Plus, eBook Clinical Collection and EDS Discovery Health. Boolean search operators were used to limiting the electronic search to the research topic (Appendix 3). The databases used in the electronic search are relevant to the healthcare field and are reputed for their credibility and publication of current and valid research reports.

Inclusion and Exclusion Criteria

The use of inclusion and exclusion criteria is vital in research processes as it enables researchers to collect evidence that is relevant to their topic of research. The inclusion criteria in the electronic search are as follows: scholarly (peer-reviewed) journals, full text, and primary research reports published between 2013 and 2017 and in English. The inclusion criteria used enabled access to current, relevant, and credible research articles for the literature review. The exclusion criteria are as follows: literature reviews, meta-analyses, secondary research articles, and articles published before 2013 (Appendix 4).

Literature Review

The reviewed articles report research findings based on different methods and study designs. Gocmez et al. (2014) used statistical analysis to identify risks that predispose patients to hospital-acquired infections. The statistical analysis enabled the researchers to collect reliable quantitative data pertaining to episodes of hospital-acquired infection among a diverse group of patients exposed to different risk factors. Gocmez et al. (2014) reveal that the factors nurses should consider in the prevention of hospital-acquired infections include the patient’s age, underlying conditions, device utilization, gender, the reason for hospitalization, and microbial culture results. Quinn et al. (2014) explain that avoidance of hospital-acquired infections is the most effective strategy in nursing practice as it saves lives and reduces healthcare costs. The research reported in the reviewed articles is reliable as it was based on valid primary research methods and a quantitative data analysis procedure. For instance, Gocmez et al. (2014) used the logistic regression model to present statistically significant data on the risk factors nurses must address to reduce the risk of hospital-acquired infections. Weedon et al. (2013) also conducted statistical analyses of their research data to demonstrate that intensify infection control (IC) strategies are effective in reducing hospital-acquired infections.

Marques et al. (2017) employed the Design Science Research Methodology (DSRM) to examine how information technology can be used to support nurses’ efforts of reducing the risk of hospital-acquired infections. The researchers successfully applied the DSRM to establish relationships between professional practices and hospital-acquired infections. However, the review indicated that there are gaps in the literature pertaining to the use of technology to promote nursing excellence in the prevention of hospital-acquired infections. According to Musuuza et al. (2017), nurses should work collaboratively with healthcare technicians to reduce the risks of hospital-acquired infections related to device-use within the ICU. Their recommendations are compelling because they were informed by qualitative content analysis of healthcare interventions that address patient, provider, and organizational barriers to infection prevention.

Weedon et al. (2013) conducted a quantitative study to assess the effectiveness of various infection control strategies in reducing the risk of hospital-acquired respiratory syncytial virus and influenza. The researchers reveal that hand hygiene plays a leading role in preventing the transmission of infections in hospitals. The reviewed studies were focused on specific patient populations. This means that the findings of the researchers may not be applicable to general patient populations. Regardless of the noted limitations, researchers agree that nurses should focus on urgent threats such as Clostridium difficile, drug-resistant Neisseria gonorrhoeae, and Carbapenem-resistant Enterobacteriaceae (CRE) in their efforts of reducing hospital-acquired infections (Quinn et al., 2014).

Musuuza et al. (2017) used 26 semi-structured interviews to engage healthcare technicians, registered nurses, and nurse managers in a survey meant to assess the impact of chlorhexidine gluconate (CHG) bathing in the reduction of hospital-acquired infections.  The researchers used statistical data to demonstrate that bathing patients in the ICU is a highly complex process that is constrained by several factors, including patient refusal, nurse workload, clinical stability of patients, presence of IV lines, and sensitivity to CHG. Therefore, there is a need for more research on strategies for improving hand hygiene in hospitals. Quinn et al. (2014) used a descriptive, quasi-experimental study to assess the effectiveness of oral nursing care in reducing the risk of nonventilator hospital-acquired pneumonia (NV-HAP). Their findings indicate that hospitals should elevate NV-HAP to the same intensity of effort, attention, and concern as ventilator-associated pneumonia. The review of the literature indicates that researchers focus on hospital-acquired infections that are related to hand hygiene and device use. Therefore, more research is required on other sources of hospital-acquired infections, such as those that occur due to tracking of germs from outside by visitors and providers.

The reviewed research articles are useful in the proposed research because they indicate evidence-based strategies that nurses can use to reduce hospital-acquired infections, including standard hand hygiene, monitoring of risks, focus on serious threats, implementing special transmission-based precautions, and compliance with healthcare procedures and quality standards. However, specific methodological limitations related to sampling and inadequate prior studies were noted during the review. The aforementioned limitations would be addressed in the proposed study.

Discussion

Two main themes emerged from the literature review: monitoring threats and reducing person-to-person transmissions. The reviewed literature indicates that providers should monitor risks and threats specific to nosocomial infection sites, such as surgical site infections, nosocomial bacteraemia, nosocomial pneumonia, and urinary infections. However, there was more emphasis on person-to-person transmissions. Researchers agree that hand decontamination and personal hygiene are critical in the reduction of hospital-acquired infections. Nonetheless, there are notable gaps in the literature on the use of technology in improving hand hygiene awareness. The proposed dissertation is expected to provide more research evidence on how nurses can use technologies, such as indoor location awareness and gamification applications to improve their consciousness of personal hygiene. The proposed study will also contribute new scientific knowledge on specific person-to-person transmission prevention strategies, such as safe injection practices, effective use of gloves and masks, and proper clothing among nurses. The reviewed articles are up-to-date, relevant, reliable, and easily accessible. Therefore, they will inform the proposed dissertation. Notably, the proposed topic will be changed with a view of focusing on a specific patient population. The feasibility of the proposed research will be improved by narrowing the topic to a single at-high-risk patient population.

Limitations

The proposed study may be restrained by methodological limitations, such as a lack of statistical tests in secondary research and inadequate data on hospital-acquired infections affecting a specific population of patients. Time constraints may also limit the proposed study.

Implications for Nursing

Researchers report that hospital-acquired infections rank fourth among the top causes of illness in developed countries (Guggenbichler et al., 2011). Therefore, it is important to research strategies for reducing nosocomial infections to support nurses’ efforts in dealing with this major health concern. A study on the role of nurses in reducing the risk of hospital-acquired infections will impact the integration of technology into hospital-wide programs for promoting hygiene. The study will also support evidence-based practice in the implementation of person-to-person infection prevention strategies within nursing care environments. The assignment has enabled me to gain useful insights into threats of focus in the prevention of hospital-acquired infections. In addition, I have identified gaps in the literature on the topic that would be addressed through the proposed study. More importantly, the assignment enabled me to determine the importance of narrowing the proposed topic to make it feasible and relevant in addressing challenges that face nurses in reducing hospital-acquired infections among patients within high-risk populations. Doing the dissertation will be interesting as I have already developed adequate background information on the topic and conducting reliable research.

Time Plan

The proposed timeframe for the proposed dissertation is seven months. The research will begin in April 2017 and end in October 2017. The specific tasks and associated timeframes are highlighted in Appendix 6.

References

Arya, S.C., Agarwal, N. and Agarwal, S. (2009) ‘Regular Surveillance Can Reduce Hospital-Acquired Infection’, American Journal of Critical Care, 18, 2, pp.100-100.

Davies, K.S. (2011). Formulating the evidence-based practice question: a review of the frameworks, Evidence Based Library and Information Practice, 6(2), pp.75-80.

Fox, C., Wavra, T., Drake, D.A., Mulligan, D., Bennett, Y.P., Nelson, C., Kirkwood, P., Jones, L. and 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, pp.216-224.

Gocmez, C., Çelik, F., Tekin, R., Kama?ak, K., Turan, Y., Palanc, Y., Bozkurt, F., & Bozkurt, M. (2014) 'Evaluation of risk factors affecting hospital-acquired infections in the neurosurgery intensive care unit', International Journal of Neuroscience, 124, 7, pp. 503-508

Guggenbichler, J.P., Assadian, O., Boeswald, M. and Kramer, A. (2011) ‘Incidence and clinical implication of nosocomial infections associated with implantable biomaterials-catheters, ventilator-associated pneumonia, urinary tract infections’, GMS Krankenhaushygiene interdisziplinär, 6, 1.

Hastings, C. and Fisher, C.A. (2014) Searching for proof: Creating and using an actionable PICO question, Nursing management, 45, 8, pp.9-12.

Jirojwong, S. (2011) Research methods in nursing and midwifery: pathways to evidence-based practice, Oxford University Press.

Labeau, S.O., Vandijck, D.M., Rello, J., Adam, S., Rosa, A., Wenisch, C., Bäckman, C., Agbaht, K., Csomos, A., Seha, M. and Dimopoulos, G. (2009) ‘Centers for Disease Control and Prevention guidelines for preventing central venous catheter-related infection: Results of a knowledge test among 3405 European intensive care nurses’, Critical care medicine, 37, 1, pp.320-323.

Malone, B. (2005) ‘Good practice in infection prevention and control’, Guidance for nursing staff, Royal College of Nursing, pp.1-16.

Marques, R., Gregorio, J., Pinheiro, F., Povoa, P., da Silva, M. & Lapao, L. (2017) 'How can information systems provide support to nurses' hand hygiene performance? Using gamification and indoor location to improve hand hygiene awareness and reduce hospital infections', BMC Medical Informatics & Decision Making, 17, pp. 1-16

Masterton, R.G., Galloway, A., French, G., Street, M., Armstrong, J., Brown, E., Cleverley, J., Dilworth, P., Fry, C., Gascoigne, A.D. and Knox, A., 2008. Guidelines for the management of hospital-acquired pneumonia in the UK: report of the working party on hospital-acquired pneumonia of the British Society for Antimicrobial Chemotherapy. Journal of Antimicrobial Chemotherapy, 62(1), pp.5-34.

Mehta, Y., Gupta, A., Todi, S., Myatra, S.N., Samaddar, D.P., Patil, V., Bhattacharya, P.K. and Ramasubban, S. (2014) ‘Guidelines for prevention of hospital acquired infections’, Indian journal of critical care medicine, 18, 3, p.149.

Musuuza, J., Roberts, T., Carayon, P. & Safdar, N. (2017) 'Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran's Hospital by examining nurses' perspectives and experiences', BMC Infectious Diseases, 17, pp. 1-11

Quinn, B., Baker, D., Cohen, S., Stewart, J., Lima, C. & Parise (2014) 'Basic nursing care to prevent nonventilator hospital-acquired pneumonia', Journal of Nursing Scholarship, 46, 1, pp. 11-19

Weedon, K., Rupp, A., Heffron, A., Kelly, S., Zheng, X., Shulman, S., Gutman, P., Wang, D., Zhou, Y., Noskin, G. & Anderson, E. (2013) 'The impact of infection control upon hospital-acquired influenza and respiratory syncytial virus', Scandinavian Journal Of Infectious Diseases, 45, 4, pp. 297-303

Appendices

Appendix 1

Appendix 2

 Appendix 3