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Quality Improvement Project Healthcare Associated Infections Project

NURSING

Abstract

Healthcare-Associated Infections (HAI) are the ones that are caught by the patient when they are at the hospital for the treatment of another medical condition. One of the common infections is urinary tract infection, which majorly affects the urinary tract system and causes pain and distress for the patients for the rest of their lives. If no proper precautions are taken during catheter insertion, which is considered one of the leading causes of UTI, and no timely treatment is given to the patient, consequences could be severe.

The current project seeks to employ a quality improvement project by studying a similar retrospective project from literature. With the deployment of a PDSA cycle, need identification is made, and running a literature review and exploring the evidence-based practices for supporting the change. Further, the paper discusses the application of change theory and its various stages, selecting an inter-professional team for reviewing the area of change, tools and methods for data collection for the current status of change, data analysis procedures and their presentation in graphic forms, the establishment of measurable quality outcomes with the use of benchmark or nurse indicators, detailed account of change plan implementation for meeting the outcomes, estimation of the projected data collection and noting whether the achievement outcomes met the goals, and lastly, summarizing the changes impact on nursing as well as patient outcomes.

Nursing: Quality Improvement Project

For reducing patient events, it is crucial to have a continuous quality improvement in the healthcare industry so that cost-effective methods could be implemented for better patient outcomes, satisfaction, and healthcare sustainability. This paper aims at presenting a retrospective quality improvement project for healthcare-associated infections (HAI), specifically urinary tract infection, with the help of the PDSA model (plan, do, study, act). The changes that could be applied for its prevention and the strategy in which various participants would be involved are explained in the further sections of the paper.

Identifying the Need for Change

Urinary tract infection (UTI) is one of the most common types of healthcare-acquired or associated infections from the hospitals that account for up to 75% of the urinary catheter usage (Center for Disease Control and Prevention, 2015). It is estimated that 15 to 25% of hospitalized patients have to use a catheter for any of their medical conditions, for which it should be considered that prolonged use must be avoided.

The catheter-acquired UTI (CAUTI) is seen being prevalent in the patient who is either outside the intensive care units (ICU) that account for 70% or inside the ICUs, for which the percentage is 95% (Nicastri & Leone, 2021). The increment in CAUTI associated hospital charges and the hospital stay have surged up to four days, attributing to $876 inpatient cost. The daily rate of acquiring this infection ranges from 3% to 10% since there are high chances that 10% to 25% of the patients develop UTI symptoms during their stay at the hospital.

Compared to other hospital-acquired infections, UTI has gained significantly less attention due to less awareness about the topic. Being one of the most prevalent infections among females, it is predicted that womens body anatomy has more to do with the prevalence of this disease than shedding light on its actual reason (Huston, 2018). It is known that since women have a shorter urethra and bacteria do not have to travel a long way to enter the bladder to create an infection; women are more prone to developing this disease than men. Females are admitted to the hospitals for cesarean deliveries where they have to have a catheter attached to their urethra for the ease of urinating after the operation....

…for the efficacy of this method in controlling CAUTI, it is still considered as the standard infection controlling method, including the use of sterile equipment, strictly taking care of hygiene by washing hands before and after insertion, and proper unobstructed urinary draining (Medinngs et al., 2014). Adherence to basic hygiene principles is mandatory in any department or treatment area of the healthcare industry. The general infection control principles are guided by proper hygiene maintenance, education of healthcare workers, hand cleanliness, and continual surveillance of the patient for observing any uneasiness or time taken for first voiding, which would support successful change implementation and quality improvement medical institute.

Summary

HAI condition can affect patients re-admission, which implies that the patient discharge process should be transparent and effective to ensure that patients well-being in terms of guaranteed no HAIs, specifically CAUTI. The nursing outcomes would be seen in the form of reduction of the requirement of nursing staff once the successful change implementation has been applied since there would be fewer re-admissions and fewer numbers of patients to look after. There would be minimized nurse burnout and greater job engagement by the nurses, doubling the productivity of the medical staff and the entire hospital. On the other hand, the patient outcomes are innumerable since the frequency of patient re-admission would be the greatest and sole indicator of the success the new change would have displayed. Patients would not have any discomfort in urination since the first voiding after the medical treatment for which they had to make use catheter might give them trouble, which is predicted to finish after using the aseptic method for quality improvement.

References

Agency for Healthcare Research and Quality. (2017, March). Guide to implementing a program to reduce catheter-associated urinary tract infections in long-term care. https://www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/guide.html#core

Babich, T., Eliakim-Raz, N., Turjeman, A., Pujol, M.,…

Sources used in this document:

References

Agency for Healthcare Research and Quality. (2017, March). Guide to implementing a program to reduce catheter-associated urinary tract infections in long-term care. https://www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/guide.html#core

Babich, T., Eliakim-Raz, N., Turjeman, A., Pujol, M., Carratala, J., Shaw, E., Grange, A.G., Vuong, C., Addy, I., Wiegand, I., Grier, S., MacGowan, A., Vank, C., Heuvel, L., & Leibovici, L. (2021). Risk factors for hospital re-admission following complicated urinary tract infection. Scientific Reports, 11. https://doi.org/10.1038/s41598-021-86246-7

Center for Disease Control and Prevention. (2015, October 16). Healthcare-associated infections: Catheter-associated urinary tract infection. https://www.cdc.gov/hai/ca_uti/uti.html

Goldfield, N.I., McCullough, E.C., Hughes, J.S., Tang, A.M., Eastman, B., Rawlins, L.K. & Averill, R.F. (2008). Identifying potentially preventable re-admissions. Healthcare Financing Review, 30(1), 75-91.

Hines, S.C. (2014). Strengthening national efforts to reduce healthcare-associated infections. Agency for Healthcare Research and Quality. https://www.ahrq.gov/hai/patient-safety-resources/advances-in-hai/hai-article2.html

Huston, K. (2018, April 16). Blame your anatomy: Women are more prone to UTI than men. Norton Healthcare. https://nortonhealthcare.com/news/uti-ecare/

Magers, T.L. (n.a.). Using evidence-based practice to reduce catheter-associated urinary tract infections. Lippincott Nursing Center. https://www.nursingcenter.com/ce_articleprint?an=00000446-201306000-00027

Manchester, J., Gray-Miceli, D.L., Metcalf, J.A., Paolini, C.A., Napier, A.H., Coogle, C.L. & Owens, M.G. (2014). Facilitating Lewin’s change model with collaborative evaluation in promoting evidence-based practices of health professionals. Available at: Scholars Compass, http://scholarscompass.vcu.edu/vcoa_pubs/3

Manojlovich, M., Martin, S. & Carraway, S. (2017). Breaking down barriers to aseptic catheter insertion [PowerPoint slides]. Agency for Healthcare Research and Quality, AHRQ. https://www.ahrq.gov/hai/cauti-tools/archived-webinars/breaking-down-barriers-slides.html

Medinngs, J., Rogers, M.A.M., Krein, S.L., Fakih, M.G., Olmsted, R.N. & Saint, S. (2014). Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: An integrative view. BMJ Quality and Safety Journal, 23(4), 277-289. https://doi.org/10.1136/bmjqs-2012-001774

Montalvo, I. (2007). The national database of nursing quality indicators (NDNQI). OJIN: The Online Journal of Issues in Nursing, 12(3). https://doi.org/10.3912/OJIN.Vol12No03Man02

Nicastri, E. & Leone, S. (2021). Guide to infection control in the healthcare setting: healthcare-associated urinary tract infections. International Society for Infectious Diseases. https://isid.org/guide/hospital/urinary-tract-infections/

Nicolle, L.E. (2008). Healthcare-acquired urinary tract infection: The problem and solutions. Patient Safety Network (PS Net). https://psnet.ahrq.gov/perspective/health-care-acquired-urinary-tract-infection-problem-and-solutions

Pandey, D., Mehta, S., Grover, A., & Goel, N. (2015). Indwelling Catheterization in Caesarean Section: Time To Retire It! Journal of Clinical and Diagnostic Research: JCDR, 9(9), QC01–QC4. https://doi.org/10.7860/JCDR/2015/13495.6415

Raynaldo, M. (2020). Implementing hospital-acquired pressure injury (HAPI) prevention program [Doctoral dissertation, University St. Augustine for Health Sciences]. SOAR. https://doi.org/10.46409/sr.RIDN4317

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