Interventions to improving professional adherence to guidelines for prevention of device related infections Presented by

Introduction This study builds on the assertion that Hospital-acquired infections are: a common cause of lengthened hospitalization, increased mortality, and increase in hospital costs. Improper hygiene practices are a leading cause of infection in the NICU. This study intends to enact evidence-based care as a reliable way that nurses can use to address this problem Hospital-acquired infections are a common cause of lengthened hospitalization, increased mortality, and increase in hospital costs. Inconsistent and inadequate hygiene practices are a leading cause of infection in the NICU. Major reservoirs for infection include ventilators, central lines, and feeding tubes. Different management approaches have been derived in various countries to reduce the rate of hospital-acquired infections. The effects focus mainly on the roles of nurses in ensuring that the best practices in hygiene are utilized. Education focuses on hand hygiene and the use invasive device infection bundles in the NICU. Given that nurses are at the center stage when it comes to handling hygiene issues of patients in the NICU, nurses are upheld to the highest standard regarding ensuring that hospital-acquired infections are obsolete in the care setting. The use of evidence-based care is a reliable way that nurses can use to address this problem (Stevens, 2013).

Description of the Ace Star change model for this project. Its a simplified portrayal of the relationships between the different knowledge transformation stages. It includes : common nursing processes. application evidence-based practice This design proposal places relevant previous research results within the context of evidence-based practice. The ACE Star Model is a tool used for understanding knowledge characteristics, nature and cycles as they are implemented in different aspects of evidence-based practice. The model presents a logical tool for organizing both new and old ideas for improving nursing care into an innovative framework that identifies issues of evidence-based practice approaches and processes. As such, the model can be construed as a simplified portrayal of the relationships that exist between the different knowledge transformation stages even as new knowledge is used to modify old data before it is applied into practice. The model includes common nursing processes and accentuates the application of distinctive features of evidence-based practice (Ellis, 2016). The five steps involved in The ACE star model include the implementation of knowledge development, evidence review, interpretation into practice recommendation, assimilation into practice, and evaluation (ANA, 2015). This design proposal places relevant previous research results within the context of evidence-based practice, allowing the model to serve as an organizer for evaluating and using evidence, and mainstreaming nursing practice into the use of evidence-based practice

Practice Issue Is there any need for applying NICU bundles to reduce infections. Question chosen compares implementing versus not implementing new infection bundles. Comparison determines if there is any change. The practice issue that I have identified concerning my topic is whether or not the need for intense NICU infection bundles related to decreasing the incidence of ventilator-associated pneumonia, necrotizing fasciitis and CLABSI’s are recommended for the NICU population Will implementing new infection bundles versus not implementing new infection bundles significantly decrease acquired infections in NICU babies?

Scope of the problem To determine if implementing new infection bundles decrease infections. mortality rate linked with infection vary in different facilities. study in North America that revealed reduction in : VAP ,CLABSI, necrotizing enterocolitis The reduction came after following strict newly developed infection bundles.. The differences observed for infection rates can be attributed to variations links within nursing practices. The scope of the issue at hand is to determine if implementing new infection bundles versus not implementing new infection bundles decrease acquired infections in NICU babies. Flodgren et al. (2013) are succinct in noting that mortality rate linked with infection vary from 5% in well-managed facilities to 35% in poorly management facilities. Only about 50% of NICUs were found to implement strict NICU infection bundles (Flodgren et al., 2013). Hocevar conducted a study in North America that determined that meta-analysis revealed a statistically significant reduction in VAP, CLABSI, and necrotizing enterocolitis when following strict newly developed infection bundles. The study found the rate of infection decreased by 60% in the first year with this implementation. Hocevar et al. (2014) are more proactive in exploring the problem by noting that the differences observed for infection rates can be attributed to variations links within nursing practices. Following this awareness, the project proposes that applying new nursing management strategies in the NICU that include prioritizing hygiene and the use of consistent invasive line bundles will reduce the acquired infections in NICU babies.

Scope of the problem (CONT..) The project proposes that applying new nursing management strategies in the NICU will reduce infections The strategies should include : prioritizing hygiene use of consistent invasive line bundles The project has short term objectives Long term objectives The short-term objective is to improve prioritization of hygiene and safety and incorporate strict NICU bundles in nursing policies applied in NICU. Three long-term objectives have been identified to include improving nurses’ service delivery, improving NICU patients’ outcomes, and reducing incidences of NICU acquired infections.

Team/stakeholders The team will be inclusive of : a team manager, several NICU nurses, a clinical nurse coach, neonatologist Dietician one facility administrator . The team manager (researcher) will identify goals associated with change before ensuring that these goals are met by allocating each member of the team a set of tangible and achievable tasks and responsibilities. Additionally, the team manager is responsible for collecting and presenting the outcomes of the change to the other stakeholders who include medical personnel employed in NICU. The facility administrator will be the leverage for support for change. The three NICU nurses will work under the supervision of a charge nurse to monitor whether infection bundles are being implemented consistently and concisely among all members of the team. A clinical nurse coach would be utilized in educating staff members on infection-related research data and implementation of infection bundles. The dietician will be a resource in decreasing necrotizing enterocolitis by recommending adequate feedings for infants at risk

Evidence supporting need for change—from literature An evaluation of available literature identified three journal articles as the supporting material that highlighted the need for change Prevalence of infection in medical facilities (Flodgren et al., 2013) Efficacy of applying prevention bundles in reducing infections (Seham et al., 2014). Correlation of heightened cases of infection and manipulation of invasive line devices (Hocevar et al., 2014) Flodgren et al. (2013) report that facility associated infections are a source of concern in any medical facility. Consequently, a study by Seham et al. (2014) highlighted that the incidence of VAP significantly reduced from 67.8% to 36.4% after the implementation of prevention bundles On the other hand, Hocevar et al. (2014) Frequent manipulation of invasive line devices is found to be the leading cause contributing to infections arguing that heterogeneity linked with the different NICU activities may be to blame for the situation.

Evidence supporting need for change—from literature (continued..) Prevalence of infection in medical facilities (Flodgren et al., 2013) mortality associated with infections varies between 5% and 35%. 1 out of 3 babies in the NICU get infected 50% of hospitals enacting strict NICU infection bundles post a 60% decrease Flodgren et al. (2013) report that facility associated infections are a source of concern in any medical facility. That is because they are linked with mortality that varies between 5% and 35%. These statistics imply that about 1 out of 3 babies in the NICU who get hospital-acquired infections are expected to die from this. In the 50% of hospitals found to utilize strict NICU infection bundles, the incidence of CLASI, VAP, and necrotizing enterocolitis decreased by 60%. The article goes on to note that infections are linked to the use of invasive medical devices and the inability to adhere and implement newly developed infection bundles to prevent disease (Flodgren et al., 2013).

Evidence supporting need for change—from literature (continued..) Efficacy of applying prevention bundles in reducing infections (Seham et al., 2014). Implementation of bundles significantly reduced VAP from 67.8% to 36.4% necrotizing entero-colitis bundles decreased the incidence from 39% to 13% The incidence of VAP significantly reduced from 67.8% to 36.4% after the implementation of prevention bundles (Seham et al., 2014). This same meta-analysis showed that necrotizing enterocolitis bundles decreased the incidence of this disorder from 39% to 13% in a three-year time frame (Seham et al., 2014). Frequent manipulation of invasive line devices is found to be the leading cause contributing to infections.

Evidence supporting need for change—from literature (continued..) Correlation of heightened cases of infection and manipulation of invasive line devices (Hocevar et al., 2014) The report highlights: heterogeneity of different NICU activities highlighted as probable cause proposes hygiene and safety in NICU nursing practices as strategy. Infection buddle's could reduce infections in NICU babies Hocevar et al. (2014) makes a similar assessment but adds that the heterogeneity linked with the different NICU activities may be to blame for the situation. Frequent manipulation of invasive line devices is found to be the leading cause contributing to infections. Activity heterogeneity places a strain on nursing personnel and inhibits their capacity to follow the set nursing policies. There is a need to emphasize hygiene and safety in NICU nursing practices as a possible strategy for reducing the incidence of facility-acquired infection (Hocevar et al., 2014). As a result, it is projected that implementing new infection bundles decreases acquired infections in NICU babies.

Notable points from literature facility-acquired infections are an occurrence in the NICU. Elimination of infection is possible Measures taken should entail prioritization of measures deemed as likely to instigate infection The reports all agreed that facility-acquired infections are an occurrence in the NICU. Reason being babies' deficient immunity an environment that collects many pathogens from different sources, Elimination of infection possibilities can have the preferred outcome. The reports mentioned that some diseases could have been avoided if medical personnel prioritized on: hygiene safety utlization of strict infection bundles.

Action Plan Plan entails: Pointing out team members who will implement change NICU nursing personell to be informed of the project intentions Nurses will be required to implement the new bundles Results acquired wil be used to determine if there is any change in affected hospitals It will be based on the awareness If nursing practice changes present positive outcomes The action plan will point out NICU inter-professional team members who will directly implement change. NICU nursing personnel will be informed of the project intentions and will need to apply implementation of newly developed infection bundles. The results from the control group (using standard nursing practices) will be acquired from past NICU performance, whereby the outcomes of past and present NICU results will be paralleled to ascertain how the change affected hospital-acquired infections This will be based on the awareness that if the nursing practice changes present positive outcomes. then the difference in care will be justified.

Timeline for the plan The changes will be implemented for a year then the results shall be compared Emphasis will be on observation of nursing practices: prior to enactment of bundle after enactment of bundle The change program will be implemented for a year after which the findings will be correlated for before and after the nursing practice changes, following which the results will be offered, and concluding commendations made for NICU action.

The nurse's role and responsibility in the pilot program For the pilot program : Nurses will monitor if the infection bundles are thoroughly implemented. The change nurse will be incharge of the nurses The clinical coach nurse will educate team members about the findings and how they should be implemented The three NICU nurses will work under the supervision of a charge nurse. They shall monitor whether infection bundles are being implemented consistently and concisely among all members of the team. A clinical nurse coach would be utilized in educating staff members on infection-related research data and implementation of infection bundles.

Procedure (what steps are to be taken to complete this change process, from start to finish?) After completion, the clinical nurse coach will advise the stakeholders on implementation including the need for The changes shall be incorporated into nursing practice The changes shall be utilized within the facility Other facilities shall be advised to adopt the findings. Following the program completion and publication of the results, the clinical nurse coach will suggest to the stakeholders whether or not the program outcomes be implemented into the NICU. If implementing NICU bundles produces a beneficial result, then it will be suggested that it be incorporated as part of customary nursing practice. The project should then be utilized within the facility. Should the data provide negative results, then the status quo will be conserved while highlighting that change is not warranted. Also, a recommendation will be made that other facilities should adopt the implementation of invasive line infection bundles in their NICU.

Forms that will be used (if applicable) The key strategies for this case include Incorporating the findings into procedures Educating staff Journals Recommendations NICU. If implementing NICU bundles produces a beneficial result, then it will be suggested that it be incorporated as part of customary nursing practice. the clinical nurse coach will suggest to the stakeholders the program outcomes be implemented into the NICU. The outcomes of the project will be circulated through distribution in medical publications such as journals. Dissemination using this strategy will guarantee that medical practitioners and other stakeholders can easily access the results a recommendation will be made that other facilities should adopt the implementation of invasive line infection bundles in their NICU.

Resources available to the staff Library Journals Internet materials Facility equipment's Journals internet Some of the facility equipment's that will be required will be made available to the team Journals will also be used The internet And other relevant

References

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