References:  1. Read about Prevention of a Healthcare Associated Infections- AHQR, (n.d.)  2. https://health.gov/hcq/prevent-hai.asp  3. https://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/index.html

Introduction to Best Practice

Part A

1. What four (4) infections were studied

2. What was shown to be effective against Prevention of Healthcare Associated Infections – AND what strength of evidence?

Part B – Locate an evidence-based research paper (less than 5 yrs old).  Describe:

1. What is the Title

2. What is the study about?

3. Purpose of the study

4.  What was the framework of the study

5. Protocol development?

 5.1.  Describe how the project began 

5.2 Did the topic have support from leaders, clinical nursing staff?  

5.3 Describe the members of the project team  

5.4 How long did the team meet?   

5.5 What materials. etc. were developed?

6. Describe the evaluation of the study

7. What were the findings and conclusions

Introduction to Best Practice Essay Sample

Part A

The four infections that were studied by the AHRQ in order to determine the prevalence of healthcare-associated infections across the US included ventilator-associated events (VAEs), catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs) and surgical site infections (SSIs) (AHRQ, 2023).

Different strategies were shown to be effective in the prevention of healthcare-associated infections. This strategy-included isolation, observing hand hygiene, following standard precautions, and following transmission-based precautions. Patients in the intensive care unit need to be screened for diarrhea, skin rashes, neutropenia, immunological disorders, non-communicable diseases, or being known carriers of an epidemic strain of bacteria(AHRQ, 2023). After screening the patients in the intensive care unit is therefore important to identify the type of isolation needed among patients with screened conditions. The two types of isolation that can be adopted in the intensive care unit include protective isolation, which is provided to patients who are immunocompromised and might have neutropenic conditions to reduce the chances of acquiring opportunistic infections (ODPHP, 2021). The second strategy of isolation that can be adopted in the ICU to reduce hospital-acquired infections is source isolation. Source isolation can play a significant role in preventing infected patients from transmitting certain HAIs to other patients or staff. According to the CDC isolation, rooms should have glass partitions, tight-fitting doors, and both positive and negative pressure while also having effective ventilation (AHRQ, 2023).

Another effective strategy for reducing nosocomial infections is identifying patients at risk of such infections and taking precautions to prevent them from such infections before they occur. Different factors that can increase the risk of patients getting nosocomial infections include shock, being more than 70 years old, major trauma, prior antibiotics, coma, drugs affecting the immune system, mechanical ventilation, prolonged ICU stay of more than three days, and indwelling catheters(Murni et al., 2022). Being aware of risk factors that might increase the probability of patients getting nosocomial infections is therefore important. Patients at a higher risk of nosocomial infections can therefore be given preferential treatment, such as being placed in protective isolation in ICU environments (Murni et al., 2022).

            Observing hand hygiene has also been consistently highlighted as an effective strategy to prevent nosocomial infections by the AHRQ and CDC. According to Kwon et al. (2023), the most common vehicle of transmission of different infection-causing organisms such as fungi, bacteria, and viruses are hands. Following a clear hygiene protocol such as the one provided by the World Health Organization can therefore play a significant role in helping to reduce the rates of nosocomial infections in healthcare facilities (Stewart et al., 2021). To prevent nosocomial infections, healthcare practitioners should therefore follow the five elements of hand hygiene, including washing their hands before touching a patient and washing hands before an aseptic procedure, which protects the patient (Despotovic et al., 2020). On the other hand, washing hands after body fluid exposure can be an effective strategy to prevent nosocomial infections among patients. Healthcare practitioners also need to wash their hands after touching a patient to protect themselves from hospital-acquired infections and from spreading hospital-acquired infections. Healthcare practitioners should also wash their hands after touching the patient’s surroundings to protect themselves and the healthcare environment from harmful germs (Sands & Aunger, 2020). 

Following standard precautions is also an effective strategy to prevent HAIs in healthcare facilities. Standard precautions will include the different preventative measures that are used at all times regardless of the infection status of a patient in healthcare facilities. Standard precautions include wearing sterile gloves that should be utilized at all times when touching the different parts of a patient (Hillier, 2020). Wearing a gown is also an important step in preventing hospital-acquired infections. This helps to prevent the soiling of the clothing of the health care practitioner and the skin during different procedures. The use of masks, eye protection, or face shields can also be used to protect healthcare practitioners from getting infected or spreading infections to their patients, especially in intensive care units (de Kraker et al., 2022). 

The following transmission-based precautions can also go a long way in preventing hospital-acquired infections. Transmission-based precautions include airborne precautions, contact precautions, and droplet precautions. Airborne precautions include negative pressure ventilation in intensive care units and the use of respiratory protection among healthcare practitioners when entering isolation rooms (de Kraker et al., 2022). Healthcare practitioners are also required to use the N95 respirator mask to prevent spreading infections in the intensive care unit. Contact precautions can also play a significant role in reducing the incidence of nosocomial infections in healthcare facilities and especially in the ICU. Non-critical patient care equipment should therefore be single-use. Limiting the transport of the patient can also go a long way in preventing nosocomial infections that originate from contact (Despotovic et al., 2020). 

The strength of the evidence provided by the AHRQ and ODHP is high because the two organizations rely on evidence from properly designed randomized controlled trials, which is of high quality. The evidence used to make recommendations for preventing nosocomial infections in healthcare facilities also includes evidence from multiple time series studies, a well-designed clinical controlled analytic study, and dramatic results from controlled experiments (ODPHP, 2021). The evidence to support the recommendations to reduce hospital-acquired infections in healthcare facilities was also from respected authorities’ opinions, descriptive studies, and reports of expert committees (ODPHP, 2021). 

Part B

What Is the Title?

The title of the reviewed evidence-based research paper is SHEA/IDSA/APIC practice recommendation: strategies to prevent healthcare-associated infections through hand hygiene: 2022 update.

What Is The Study About?

The study highlights practical recommendations that acute care healthcare facilities can utilize to prioritize and implement strategies that can prevent nosocomial infections through hand hygiene. The study is an update over previous practice guidelines that were published in 2014. The study provides advice from experts that work in different healthcare professional organizations across the US. The study includes advice on how to use hand hygiene to prevent nosocomial infections in a healthcare facility from experts from different organizations, including the infectious disease Society of America (IDSA), American Hospital Association (AHA), Association for professionals in infection control and epidemiology (APIC), and the joint commission. The inclusion of experts from different organizations across the US made the study more reliable (Glowicz et al., 2023).

Purpose of the Study

Beforehand, there were extensive guidelines provided to help identify and stop healthcare-related infections (HAIs). The aim of this study is to present practical suggestions in a brief format that can help acute-care hospitals prioritize and implement efforts to prevent HAIs through hand hygiene. This document is an updated version of the 2014 publication “Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene.” The SHEA sponsored this expert guidance document, which is the result of a collaborative effort led by various organizations and societies with content expertise, including the Association for Professionals in Infection Control and Epidemiology (APIC), Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), and The Joint Commission.

Such suggestions included a strategy to help acute healthcare facilities deal with antibiotic-resistant organisms that are mainly spread through the hands of healthcare practitioners. The study identifies that the interaction of healthcare practitioners with the healthcare environment can contribute significantly to contamination following activities such as touching a bedrail (Glowicz et al., 2023). The purpose of the study is, therefore, to deal with the rising prevalence of patients with antibiotic-resistant bacteria while also dealing with the current threat of the novel coronavirus in healthcare settings (Glowicz et al., 2023).

What Was The Framework Of The Study?

The study included three subject matter experts on the subject of hand hygiene who were charged with leading members of the different organizations that brought their input on effective strategies on how to prevent nosocomial infections in healthcare facilities through applicable hand hygiene products. The study also relied on a consultant medical librarian who developed a comprehensive strategy for Embase and PubMed, which considered articles published between 2012 to 2021. The members of the panel that was involved in the research study considered the use of article abstracts through the abstract management software covidence (Glowicz et al., 2023). The articles were eventually revealed as full text with different leading other groups voting to update the literature findings. The panel members were consistently involved in reviewing the abstracts and incorporating relevant references in order to provide a coherent and reliable guideline that could be used in acute care hospitals to prevent HAIs (Glowicz et al., 2023).

Protocol Development

The study by Glowicz et al. (2023) involved the retrieval of abstracts highlighting different evidence-based strategies that could be utilized to improve hand hygiene adherence in acute care facilities. The abstracts were then reviewed by three subject matter experts. Different associations that had been invited were also allowed to provide input (Glowicz et al., 2023).

How the Project Began

The project began with the recruitment of three subject matter experts on the hand hygiene topic by SHEA. The subject matter experts LED a team of different associations that were interested in hygiene, such as the joint commission in the American Hospital Association. A medical librarian was also recruited who engaged in the retrieval of scholarly articles on Embase and PubMed. After the retrieval of the Article abstract, all the abstracts were reviewed by the panel members in a double-blinded fashion. The articles were then reviewed as full text. Eventually, the panel voted to update the literature findings and to provide more updated guidelines related to hand hygiene in the prevention of hospital-acquired infections (Glowicz et al., 2023). The recommendations that were related to the literature review process were classified based on the quality of the evidence and other potential and desirable undesirable related to different interventions. The panel members involved in the study met via video conferencing tools such as Zoom to discuss recommendations, literature findings, and the quality of evidence that was available for the different recommendations that were made. All the panel members eventually reviewed and approved the recommendations and also the quality of evidence that was used to back up every recommendation (Glowicz et al., 2023).

Did The Topic Have Support From Leaders And Clinical Staff?

The topic explored in the study had support from five partnering organizations and stakeholders, including the CDC. The evidence-based guideline discussed in the study was therefore supported by the joint commission and the boards of the different partnering organizations such as IDSA, SHEA, and APIC (Glowicz et al., 2023).

Members of the Project Team

The members of the project team included three subject-matter experts who led the panel of members representing different partnering organizations such as AHA, IDSA, APIC, CDC, and the Joint commission. All the members of the project team played a significant role in voting to update the literature findings and classifying the literature findings depending on the quality of evidence. The members of the project team also consistently sought to balance between potential undesirable effects of various interventions and the desirable effects of such interventions.

The team met numerous times through video conferencing tools such as zoom until the full practice guideline was completed. After meeting and reviewing different literature, the team eventually developed updated practice recommendations on maintaining hand hygiene in acute healthcare facilities (Glowicz et al., 2023). 

Evaluation of the Study

The evaluation of the study by Glowicz et al. (2023) included conducting a literature review that defined the current understanding of different issues related to hand hygiene, such as healthy fingernails and hand skin, hand hygiene, product safety, and efficacy. In the study hand, hygiene was highlighted as beginning with the healthy hands of healthcare practitioners that needed to be free from any wounds, cracks, redness, pathogenic transient or resident flora, and having short natural fingernails. The study also evaluated the safety and efficacy of hand hygiene products such as alcohol-based hand rubs. Finally, the study evaluated the efficacy of hand hygiene formulations in preventing nosocomial infections among patients in a healthcare facility (Glowicz et al., 2023). 

Findings and Conclusions

The findings and recommendations of the study by Glowicz et al. (2023) included that acute-care healthcare facilities should promote the maintenance of healthy fingernails and hand skin to prevent HAIs. In this regard, acute care healthcare facilities should train healthcare practitioners to perform hand hygiene as per the recommendations of the WHO and the CDC. Acute care facilities should also establish facility-specific policies to deal with fingernail care, such as ensuring that all healthcare practitioners maintain natural and short fingernails and that the fingernails of healthcare practitioners should not be extended past the fingertip(Glowicz et al., 2023). The study also recommended that healthcare facilities should provide Healthcare practitioners with gloves to wear to prevent themselves from pathogens that can eventually spread and cause nosocomial infections (Glowicz et al., 2023).

            Another recommendation made by Glowicz et al. (2023) included that healthcare practitioners should select appropriate products, including alcohol-based hand rubs. Acute care healthcare facilities should also involve healthcare practitioners in selecting hand hygiene products, which include alcohol-based hand rubs that do not cause any negative impact on the skin of patients. On the other hand, the study recommended that healthcare practitioners should ensure the accessibility of hand hygiene supplies in different sections of healthcare facilities. The study also emphasized that healthcare practitioners should ensure the appropriate use of gloves to reduce environmentally and had contamination across a Healthcare facility. Glowicz et al. (2023) also recommended that healthcare facilities should actively take steps that can help in the reduction of the contamination of the environment associated with sink drains and sinks. On the other hand, the study also recommended that acute care healthcare facilities should also consistently monitor adherence to hand hygiene in their care environments. Finally, Glowicz et al. (2023) also recommended that healthcare facilities should provide meaningful and timely feedback to different healthcare practitioners to enhance a culture of safety.

References

AHRQ. (2023). Previous Initiatives | health.gov. Health.gov. https://health.gov/about-odphp/previous-initiatives

De Kraker, M. E. A., Tartari, E., Tomczyk, S., Twyman, A., Francioli, L. C., Cassini, A., Allegranzi, B., & Pittet, D. (2022). Implementation of hand hygiene in health-care facilities: results from the WHO Hand Hygiene Self-Assessment Framework global survey 2019. The Lancet Infectious Diseases, 22(6). https://doi.org/10.1016/S1473-3099(21)00618-6

Despotovic, A., Milosevic, B., Milosevic, I., Mitrovic, N., Cirkovic, A., Jovanovic, S., & Stevanovic, G. (2020). Hospital-acquired infections in the adult intensive care unit—Epidemiology, antimicrobial resistance patterns, and risk factors for acquisition and mortality. American Journal of Infection Control, 48(10), 1211–1215. https://doi.org/10.1016/j.ajic.2020.01.009

Glowicz, J. B., Landon, E., Sickbert-Bennett, E. E., Aiello, A. E., deKay, K., Hoffmann, K. K., Maragakis, L., Olmsted, R. N., Polgreen, P. M., Trexler, P. A., VanAmringe, M. A., Wood, A. R., Yokoe, D., & Ellingson, K. D. (2023). SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infection Control & Hospital Epidemiology, 1–22. https://doi.org/10.1017/ice.2022.304

Hillier, M. D. (2020). Using effective hand hygiene practice to prevent and control infection. Nursing Standard (Royal College of Nursing (Great Britain): 1987), 35(5), 45–50. https://doi.org/10.7748/ns.2020.e11552

Kwon, J. H., Nickel, K. B., Reske, K. A., Stwalley, D., Dubberke, E. R., Lyons, P. G., Michelson, A., McMullen, K., Sahrmann, J. M., Gandra, S., Olsen, M. A., & Burnham, J. P. (2023). Risk factors for hospital-acquired infection during the SARS-CoV-2 pandemic. Journal of Hospital Infection, 133, 8–14. https://doi.org/10.1016/j.jhin.2022.11.020

Murni, I. K., Duke, T., Kinney, S., Daley, A. J., Wirawan, M. T., & Soenarto, Y. (2022). Risk factors for healthcare-associated infection among children in a low-and middle-income country. BMC Infectious Diseases, 22(1). https://doi.org/10.1186/s12879-022-07387-2

ODPHP. (2021). Previous Initiatives | health.gov. Health.gov. https://health.gov/hcq/prevent-hai

Sands, M., & Aunger, R. (2020). Determinants of hand hygiene compliance among nurses in US hospitals: A formative research study. PLOS ONE, 15(4), e0230573. https://doi.org/10.1371/journal.pone.0230573

Stewart, S., Robertson, C., Kennedy, S., Kavanagh, K., Haahr, L., Manoukian, S., Mason, H., Dancer, S., Cook, B., & Reilly, J. (2021). Personalized infection prevention and control: identifying patients at risk of healthcare-associated infection. Journal of Hospital Infection, 114, 32–42. https://doi.org/10.1016/j.jhin.2021.03.032

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