Quality Improvement Program
Needs Assessment and Quality Improvement Plan

Paula Stechschulte, PhD, N

Quarter

This paper discusses the process of drafting a quality improvement plan at a community level medical facility, a plan that is aimed at reducing days under urinary catheter and also reducing the rates of infections associated with the said catheters. As a high rate of incidence of infection related to catheter usage is costly for the hospital, this implementation strategy is aimed both at reducing hospital costs and boosting patient health, safety and satisfaction. The requirement for this strategy is a level of nursing education, dedication and commitment that will necessitate training and a "go-live" session of implementation which can be stressful for workers and for patients as both adjust to change. The management directors will need to not only monitor progress using the Six Sigma method but also will need to effectively maintain levels of employee morale and…...

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References

APIC (2008). -- Home. Guide to the Elimination of Catheter-Associated Urinary Tract Infections (CAUTIs). Retrieved January 16, 2016, from  http://www.apic.org/Resource_/EliminationGuideForm/c0790db8-2aca-4179-a7ae-676c27592de2/File/APIC-CAUTI-Guide.pdf 

Brusch, J. (2015, August 18). Diseases & Conditions - Medscape Reference. Catheter-Related Urinary Tract Infection: Transmission and Pathogens, Guidelines for Catheter Use, Diagnosis. Retrieved January 15, 2016, from  http://emedicine.medscape.com/article/2040035-overview#a2 

Cetina, K. K., Bruegger, U. (2001). Transparency regimes and management by content in global organizations: The case of institutional currency trading. Journal of Knowledge Management, 5(2): 180-194.

Cooper, A. (2002). Six Sigma deployment in a large integrated health system. Quality Congress. ASQ's Annual Quality Congress Proceedings, ABI/INFORM Global: 71-76.

hospital acquired infections, popularly known as the nosocomial infections in adults, specifically elderly adults. In this research paper, the focus is built on infections caught by elderly people and the preventions that can be taken as measures to eradicate the causes of this infection. esearch reports have been taken as references to describe the current situation of nosocomial infection spread in the American society and all over the world.
This infection is developed in a person after a visit to hospital within 48 hours or by patients who are discharged from the hospital and are diagnosed within 30 days of leaving the hospital. Patients who are diagnosed with such an infection carry diseases that are caused by fungal infections or through unsanitary conditions of the hospital environment (Norton, Barie, & Bollinger, 2008). Moreover, they catch infection through contamination from air droplets via sneezing or coughing and from contact with patients…...

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References

Allen, J.E. (2011). Nursing Home Administration. New York: Springer Pub.

Katlic, M.R. (2011). Cardiothoracic Surgery in the Elderly. New York; London: Springer.

Nelson, K.E., & Williams, C.M. (2007). Infectious Disease Epidemiology. Sudbury, Mass.; Toronto: Jones and Bartlett Publishers.

Norton, J.A., Barie, P.S., & Bollinger, R.R. (2008). Surgery: Basic Science and Clinical Evidence. New York, NY: Springer.

Nosocomial Infections
Synthesis

The evidence-based approach utilized and advocated by all the authors cited in this essay can be viewed through the lens of a PDSA process as described by Hadaway (2006). For example, Pronovost and colleagues were interested in reducing the incidence of preventable C-BSIs in the ICU setting in Michigan. They first identified an evidence base supporting an intervention and then planned how to implement the intervention to cause a small-scale change. This evidence base, as well, is nothing more than the sum of several research groups engaging in the PDSA process. The intervention(s) is then implemented to test its efficacy, the results studied, and significant positive or negative outcomes are acted upon. The research reviews by Kampf et al. (2009) and Hadaway (2006) represent a synthesis of the findings from several studies, which they used to support their theses regarding hand hygiene and C-BSIs, respectively. hine's (2006) editorial also…...

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References

Hadaway, L.C. (2006). Best-practice interventions: Keeping central line infection at bay. Nursing, 36(4), 58-63.

Kampf, G., Loffler, H., & Gastmeier, P. (2009). Hand hygiene for the prevention of nosocomial infections. Deutsches Arzteblatt International, 106(40), 649-655.

Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H., Cosgrove, S. et al. (2006). An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine, 355(26), 2725-2732.

Rhine, W.D. (2006). Eliminating nosocomial infections in the NICU: Everyone's duty. Journal of Perinatology, 26(3), 114-143.

coli bacteria was essential given the purpose of the study, which aimed at determining how repeated cases f urinary tract infections were caused. Specific strains of the bacteria were identified from each of the seventeen infants initially diagnosed with a urinary tract infection that were a part of the study, and these were compared to cultures taken from infant during subsequent infections. The results showed that each infant had at least one recurrent episode caused by the exact same strain of the bacteria, and that same-strain infections accounted for the vast majority of recurring infections. This suggests that infection occurs from pathogens still present in the body, and is therefore more effectively treated as a relapse then considering each case to be a separate infection.
Cohen, a.; Rivara, F.; Davis, R. & Christakis, D. (2005). "Compliance with guidelines for the medical care of first urinary tract infections in infants: A…...

A patient realizes increased need to urinate at night. There are episodes of chills and persistent fever that last for more than two days. A patient may also realize pain in the flank that runs along the back at about waist level (Harvey & Zieve, D, 2013). Vomiting and nausea is also common.
Urinary Tract Infections in infants and toddlers tend to be more severe than in young women. This is because it is more likely to involve their kidneys. Symptoms of urinary tract infections in older children tend to be more standard (Harvey & Zieve, D, 2013). The severity of UTIs in infants and young children calls for screening to establish whether they have persistent high fever of unknown cause often accompanied by feeding problems, debility, listlessness, and fatigue; painful, frequent, and foul smelling urine; cloudy urine; recurrence of bed wetting or poor urine control during the day especially…...

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References List

Harvey, S. & Zieve, D. (July 27, 2013). Urinary Tract Infections - Adults. New York Times.

 http://health.nytimes.com/health/guides/disease/urinary-tract-infection/symptoms.html 

Sobieszczyk, M.E. (2008). Urinary Tract Infections. Retrieved from  http://www.columbia.edu/itc/hs/medical/pathophys/id/2008/utiNotes.pdf

Healthcare Associate Infections
Hospitals are often associated with providing care and treatment in the face of an illness. However, what is not often discussed is that many patients who are admitted to hospitals contract infections from the hospital itself. Infections which are acquired from a hospital are known in the medical community as nosocomial infections (Avic, 2012). I am interested in exploring how nosocomial infection occurs and how they can be prevented. I am specifically interested in assessing how nurses can contribute to reducing incidents of nosocomial infections and the role that they play in patient infection rates. By analyzing the most vulnerable patients, this paper attempts to identify when an infection is likely to occur, where they are most likely to be contracted, and the safeguards that must be put in place to prevent the nosocomial infections.

Avic, et al., review the frequency, types, and outcomes of hospital acquired infections in…...

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References

Avci, M., Ozgenic, O., Coskuner, S., & Olut, A (2012). Hospital acquired infections (HAI) in the elderly: Comparison with younger patients. Archives of Gerontology & Geriatrics, 54(1), p. 247-250.

Rahim, R, A., & Barnett, T. (2009). Reducing nosocomial infection in neonatal intensive: An intervention study. International Journal of Nursing Practice, 15(6), pp. 580-584.

Urinary Tract Infection and Prevention
esearch write 5 literature review catheter acquired urinary tract infection prevention.

Catheter-associated (CA) bacteriuria is health care infection associated with the wide spreed urinary catheterization in hospitals and long-term care facilities worldwide. Considerable costs, personnel, time are spent by health care institutions to minimize the infection rate of CA infections, especially the urinary tract infections - CA urinary tract infections (Graves N. et al., 2007). Urinary catheterisation is defined as an intervention to enable emptying of the bladder by insertion of a catheter. Indwelling urinary catheterisation is categorised as either; short-term - less than 28 days, or long-term - greater than 28 days (Tambyah PA & DG., 2000). Urinary tract infections (UTIs) have been shown to be one of the most common in healthcare-associated infection (HCAI) with up to 80% related to the presence of urinary catheter (Gould CV, Umscheid CA, Agarwai K, Kuntz G, & DA.,…...

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References

Cope M, Cevallos ME, Cadle RM, Darouiche RO, Musher DM, & BW., T. (2009). inappropriate treatment of Catherter-associated asymptomatic bacteria in tertiary care hospital. Clin Infect Dis, 48(9), 1182-1188.

Gould CV, Umscheid CA, Agarwai RK, Kuntz G, & DA., P. (2009). Guideline for prevention of catheterassociated urinary tract infections. Centre of Disease Control 22(5), 122-145.

Graves N, Tong E, Morton AP, Halton K, Curtis M, & Lairson D. (2007). Factors associated with health care-acquired Urinary tract infection. Am J. Infect Control 35(6), 387-392.

Nicolle L, Classen D, Arias KM, Podgorny K, & Anderson DJ. (2008). Strategies to prevent catheter-associated Urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol 29(1), 41-50.

Urinary tract infections (UTIs) are characteristically the most prevalent healthcare-associated infection or HAI for short, in critical care place in America. The CDC or Centers for Disease Control and Prevention has projected that up over 150,000 hospital-onset, indicative catheter-associated UTIs (CAUTIs) happened in 2013, which brought about in as much as $160 million in superfluous straight medical costs (Kuntz, 2010, p. 319). Existing research inspects the possible reasons for such an elevated incidence of infection by offering ways it can be improved or researched. oughly three quarters of healthcare-associated UTIs are associated with inappropriate use of indwelling urinary catheters. This comes as a result of over 25% of patients becoming exposed to prolonged and unnecessary catheter use. Adult ICUs have the maximum experience rate for catheter use and expose over 95% of UTIs connected to catheter use.
A study by Hyder et al. examined six key areas in their cross country…...

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References

Hyder, A., Syed, S., Puvanachandra, P., Bloom, G., Sundaram, S., Mahmood, S. . . . Peters, D. (2010). Stakeholder analysis for health research: Case studies from low- and middle-income countries. Public Health, 124(3), 159-166. doi:10.1016/j.puhe.2009.12.006

Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (2011). The Future of Nursing: Leading Change, Advancing Health. Retrieved from  http://www.aacn.nche.edu/government-affairs/IOMFactSheet.pdf 

Lavis, J.N., Permanand, G., Oxman, A.D., Lewin, S., & Fretheim, A. (2009). SUPPORT Tools for evidence-informed health Policymaking (STP) 13: Preparing and using policy briefs to support evidence-informed policymaking. Health Research Policy and Systems, 71-79. doi:10.1186/1478-4505-7-S1-S13

Lowery, B. (2009). Obesity, Bariatric Nursing, and the Policy Process: The Connecting Points for Patient Advocacy. Bariatric Nursing and Surgical Patient Care, 4(2), 133-138. doi:10.1089/bar.2009.9977

Toxoplasmosis is an infection involving the central nervous system. Until quite recently, it was considered to be a very rare disease. Now, however, the infection is more common, and is seen as a rather frequent cause of encephalitis, particularly among AIDS patients. The infection itself is caused by an obligate intracellular protozoan called Toxoplasma gondii (Caffazana, et al., 292). This protozoan has a worldwide distribution. In those that have AIDS, it causes encephalitis and neurological symptoms. Among the symptoms that should be looked for and are usually present are headaches that are nonpulsating, severe, and usually in both sections of the front of the head (Caffazana, et al., 295). These headaches caused by the disease are not relieved, as most normal headaches would be, by taking over-the-counter headache remedies such as analgesics. Having the headache pain in the front of the head does not reflect T. gondii lesions, but rather…...

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Works Cited

Caffazana, EJ, Rossitch, E, Jr., & Samuels, MA. (1989). "Cerebral toxoplasmosis in the acquired immune deficiency syndrome." Clinical Neurology & Neurosurgery, 91: 291-301.

Leport, C, Raffi, F, Matheron, S. (1988). "Treatment of central nervous system toxoplasmosis with pyrimethamine/sulfadiazine combination in 35 patients with the acquired immunodeficiency syndrome. Efficacy of long-term continuous therapy." American Journal of Medicine, 84: 94-100.

Snider, VM, Simpson, DM, Neilsen, S, Gold, M, Metroka, CE, & Posner, JB. (1983). "Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients." Annals of Neurology, 14: 403-418.

Reducing The Risk of CVC Related Infections Post InsertionMultiple lumen central venous catheters (CVCs) are used to administer large amounts of intravenous fluids, blood products, and medications. In the past, they were only used in the intensive care unit. However, they are now used in all areas of health care. CVCs are inserted through a large central vein like the subclavian vein, and they terminate at the junction of the superior vena cava and right atrium. There are cases where the catheter is inserted through the femoral vein and terminated in the inferior vena cava. However, this is not recommended due to the increased risk of infection. Catheters terminate in large veins where there is rapid blood flow around the tip of the catheter, allowing for the fluids and medications to be rapidly diluted and moved into the patient's circulation. The location, ease and rapid access of the CVCs to…...

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References

Ahmed, S. A., Jasim, A. H., Katea, M. J., Foaad, A. S., Hashim, H. A., & Noori, D. A. (2019). Assessment of Nurses’ knowledge concerning Prevention of Central Venous Catheter Infection in Intensive Care Units at Baghdad Teaching Hospitals. kufa Journal for Nursing sciences, 9(1), 1-7. https://www.researchgate.net/profile/Abd-Alkadeem-Mohammed/publication/353827976_Assessment_of_Nurses\\\\\\'_knowledge_concerning_Prevention_of_Central_Venous_Catheter_Infection_in_Intensive_Care_Units_at_Baghdad_Teaching_Hospitals/links/6113ef450c2bfa282a3a4aa0/Assessment-of-Nurses-knowledge-concerning-Prevention-of-Central-Venous-Catheter-Infection-in-Intensive-Care-Units-at-Baghdad-Teaching-Hospitals.pdf

Biehl, L. M., Vehreschild, J. J., Franke, B., Cornely, O. A., & Vehreschild, M. J. (2018). Chlorhexidine-containing dressings in the prevention of central venous catheter-related bloodstream infections: A cost and resource utilization analysis. https://www.researchgate.net/profile/Sebastian-M-Heimann/publication/324512558_Chlorhexidine-containing_dressings_in_the_prevention_of_central_venous_catheter-related_bloodstream_infections_A_cost_and_resource_utilization_analysis/links/5c0e69a3299bf139c74de3e4/Chlorhexidine-containing-dressings-in-the-prevention-of-central-venous-catheter-related-bloodstream-infections-A-cost-and-resource-utilization-analysis.pdf

Böll, B., Schalk, E., Buchheidt, D., Hasenkamp, J., Kiehl, M., Kiderlen, T. R., Kochanek, M., Koldehoff, M., Kostrewa, P., & Claßen, A. Y. (2021). Central venous catheter–related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Annals of Hematology, 100(1), 239-259.  https://link.springer.com/article/10.1007/s00277-020-04286-x

Urinary tract infection (UTIs) refers to urinary tract symptomatic bacterial infection. As mentioned in the lesson, Escherichia coli is the most common infecting microorganism with Staphylococcus saprophyticus as the second most common (Huether & McCance, 2015, p. 753). While other organisms like fungi or viruses can infect the urinary tract, bacterial infections are most common. The lower UTI is called cystitis and affects the bladder. The upper UTI is called acute pyelonephritis and affects the kidney. Although these are the main areas for both upper and lower UTI the symptomatic bacterial infection can extend past those anatomical areas. For lower UTIs, the onset can be sudden, with typical urgency, burning, and frequency of urination. There is often painful voiding of minor volumes of urine. Lower back pain is a common symptom. The urine may appear turbid and potential development of a low-grade fever (Huether & McCance, 2015). The symptoms for acute…...

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References

Huether, S. E., & McCance, K. L. (2015). Understanding Pathophysiology - E-Book (6th ed.). Elsevier Health Sciences.

Mitchell, B., Ferguson, J., Anderson, M., Sear, J., & Barnett, A. (2016). Length of stay and mortality associated with healthcare-associated urinary tract infections: a multi-state model. Journal of Hospital Infection, 93(1), 92-99. doi:10.1016/j.jhin.2016.01.012

Mody, L., & Juthani-Mehta, M. (2014). Urinary Tract Infections in Older Women. JAMA, 311(8), 844. doi:10.1001/jama.2014.303

Introduction Advances in medicine have resulted in the further enhancement of patient outcomes in healthcare settings. It is, however, important to note that the treatment of many patients in close proximity does have some downsides. Hospital acquired infections (HAIs) are one such downside. In basic terms, HAIs are inclusive of all the infections that were not part of the original diagnosis of the patient during his or her admission at the hospital. Research studies conducted in the past have clearly indicated that HAIs are a major health care concern for not only patients, but also healthcare providers. For this reason, the relevance of reigning in HAIs cannot be overstated. Indeed, as Gupta at al. (2014) point out, taking into consideration “morbidity, mortality, increased length of stay and the cost, efforts should be made to make hospitals as safe as possible by preventing such infections” (150).
Discussion
In seeking to further conceptualize the HAI…...

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References

Gupta, A., Todi, S., Myatra, SN., Samaddar, D.P., Patil, V., Bhattacharya, P.K. & Ramasubban, S. (2014). Guidelines for Prevention of Hospital Acquired Infections. Indian Journal of Critical Care Medicine, 18(3), 149-163.

IOWA Department of Public Health – IDPH (2019). Surgical Site Infections (SSI): What is SSI? Retrieved from

Saint, S., Krein, S.L. & Stock, R.W. (2014). Preventing Hospital Infections: Real-world Problems, Realistic Solutions. New York, NY: Oxford University Press.

Schmier, J.K., Hulme-Lowe, C.K., Semenova, S., Klenk, J.A., DeLeo, P.C., Sedlak, R. Carlson, P.A. (2016). Clinicoeconomics and Outcomes Research, 8, 197-205.

World Health Organization – WHO (2002). Prevention of Hospital-Acquired Infections. Retrieved from http://apps.who.int/medicinedocs/documents/s16355e/s16355e.pdf

https://idph.iowa.gov/hai-prevention/information/ssi

Reducing Postoperative Infections in Obese Patients: ProposalProblem IdentificationThis proposal is to examine the heightened risk issue of postoperative infections in obese patients. This problem is relevant in todays practice, as obesity rates continue to rise globally (Bluher, 2019). In surgical care, obese patients often face increased complications, including a higher incidence of postoperative infections (Plassmeier et al., 2021). This issue is both a concern for patient safety and for quality of care. It also impacts healthcare costs and resource allocation.Investigation of the ProblemIn investigating this issue, I have relied on a combination of data from our healthcare organization, national healthcare databases, and existing research studies. These sources consistently show the increased risk and prevalence of postoperative infections among obese patients. This evidence also indicates that there is a need for targeted interventions in surgical care for this patient population.Analysis of the Current SituationSeveral factors contribute to the increased risk of…...

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References

Blüher, M. (2019). Obesity: global epidemiology and pathogenesis. Nature Reviews

Endocrinology, 15(5), 288-298.

Plassmeier, L., Hankir, M. K., & Seyfried, F. (2021). Impact of excess body weight on

ordinal list of the causes of death in the US. It has been reported that the disease causes more havoc in developing countries. During a flu epidemic, up to 20% of Americans are infected by the virus. Of this figure, approximately 36 000 people might die of the infection. It is reported that over 200 000 of those infected are infected in various hospital facilities across the country. Indeed, few viruses have inflicted as much damage and endured as the influenza virus. espiratory ailments blamed on influenza are documented in records that trace the infection back to Greece and ome of the ancient world. The word influenza when viewed from its original Greek form: influentia points to the popular belief that the epidemics that people suffered were a result of the influence of stars. Indeed, people including medical experts refer to the infection of influenza as flu, yet most…...

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References

Basarkar, S., 2016. Chapter-04 Infection, Prevention and Control. Practical Guide Book for Hospital Infection Risk Assessment, Prevention & Control, pp.27 -- 34.

Belser, J.A., Gustin, K.M., Maines, T.R., Pantin-Jackwood, M.J., Katz, J.M. and Tumpey, T.M., 2012. Influenza virus respiratory infection and transmission following ocular inoculation in ferrets. PLoS pathogens, 8(3), p.e1002569.

Centre for Health Protection, 2017. Statistics on Communicable Diseases. Centre for Health Protection - Sentinel Surveillance of Infectious Diseases among Chinese Medicine Practitioners (CMPs) Weekly Update. Available at:   [Accessed June 26, 2017].http://www.chp.gov.hk/en/sentinel_sur/26/44/419.html 

Cheng, V.C., Tai, J.W., Lee, W.M., Chan, W.M., Wong, S.C., Chen, J.H., Poon, R.W., To, K.K., Chan, J.F., Ho, P.L. and Chan, K.H., 2015. Infection control preparedness for human infection with influenza A H7N9 in Hong Kong. infection control & hospital epidemiology, 36(1), pp.87-92.

Part 1 Cellulitis, as Sullivan (2018) points out, happens to be an acute skin infection that largely affects the subcutaneous and dermis tissues. In the present scenario, the patient developed the symptoms described as a consequence of the entry of bacteria through the laceration/cut in the leg. According to Kellerman and Rakel (2018), there are two kinds of bacteria that are responsible for a majority of cellulitis cases, i.e. staphylococcus aureus and streptococcus. Once the organisms gain entry, defensive cells are overwhelmed. Under normal circumstances, the defensive cells are often instrumental in the containment and localization of inflammation. As a result, there is the accumulation of cellular debris. It is important to note that in the present case, tissue around the cut (point of entry) could have been invaded by the organism as cellulitis progressed.
Part 2
In the words of Herchline (2019), “immunogenetic factors may play a role in some families who…...

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References

Coleman, K. & Neilsen, G. (2019). Wound Care: A practical guide for maintaining skin integrity. Elsevier Health Sciences.

Carey, J.C., Cassidy, S.B., Battaglia, A. & Viskochil, D. (Eds.). (2020). Cassidy and Allanson\\'s Management of Genetic Syndromes. John Wiley & Sons.

Herchline, T.E. (2019). Cellulitis. Med Scape.  

Kellerman, R.D. & Rakel, D. (2018). Conn’s Current Therapy. Elsevier Health Sciences.

Sullivan, T. (2018). Diagnosis and management of cellulitis. Clin Med., 18(2), 160-163.

https://emedicine.medscape.com/article/214222-overview#a4 

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Infection control specifically refers to stopping the spread of disease in healthcare settings and during health care procedures, such as surgeries.  It is a catchall phrase that refers to a wide variety of behaviors or practices that can result in the elimination or reduction of disease transmission in these settings.  We are happy to provide you with some suggested topics and titles for an essay about infection control.

Essay Topics

Best hygiene practices for pre-surgical prep of skin to prevent surgical-site infections

Does the routine use of masks in non-surgical medical examinations and routines reduce infectious disease transmission....

One of the difficulties about writing a summary of any of the vaccines for the novel Coronavirus that is known as COVID-19 is that much of the information remains unknown.  In addition, because the vaccines created by Pfizer and Moderna are both mRNA vaccines, which are not a familiar type of vaccine, they create some additional questions.  How long will the vaccines be effective?  Are they safe?  Will they work to prevent infection by the newer strands of COVID-19?  Do they change your DNA as some people on the internet are suggesting? ....

Infection may be the biggest health risk for people who have wounds, making wound care critical to ensuring a positive patient outcome.  Wound care not only improves mortality but can also impact social and physical expectations for a patient, which means that appropriate wound care can be one of the biggest issues impacting doctors or nurses who deal with any type of injury.  However, wound care focuses substantially on infection control, because infections present the greatest long-term hazards from wounds.

Generally, wound care is broken down into four or five basic steps.  Those....