The issue of hospital-acquired infections (HAI) is rather important in the context of hospital nursing care as it affects quality of health care delivery and deteriorates patients’ outcomes. In this regard, this paper will propose potential evidence-based practice (EBP) plan to enhance the current situation. Focusing on nursing care, it is essential to apply the WHO-5 campaign that implies change in employee behavior and also incorporation of incentives as well as accountability strategies.
Change Model Overview
The ACE Star model Evidence-Based Practice Process refers to the practical tool that can be used to comprehend relationships between several phases of knowledge transformation. The five areas included in the mentioned tool are presented below (Figure 1).
The key benefit of this model is that nurses may use it to convert research findings into practice, thus transforming acquired knowledge into practical actions (Dearholt & Dang, 2012). The model clearly identifies each of the phases in a step-by-step manner and presents valuable guidance for nurses to initiate the required change.
Scope of the EBP
The nosocomial infections cause serious consequences in patients’ health outcomes. In particular, according to the recent statistics provided by official agency, “in 2011, there were an estimated 722,000 HAIs in U.S. acute care hospitals; additionally, about 75,000 patients with HAIs died during their hospitalizations” (“HAI Data and Statistics”, 2016, para. 6). The detailed description of HAI rates is provided below (Table 1).
Considering the issue on a broader scale, it is possible to note that high rates of HAI affect not only patients’ health but also quality of care and the associated costs. In other words, this problem may impact the whole performance of a hospital. Therefore, it becomes evident that there is a dire need to initiate appropriate preventative measures, beginning with simple means such as increased hygiene awareness among nurses and a series of associated strategies.
Along with a leader of the project, other stakeholders are to be identified to assign corresponding responsibility areas and determine their roles. First of all, a Director of Nursing Department is to be contacted and notified of the project purposes and the expected results. Second, nurse epidemiologist will be included to observe the course of the project. Third, a charge nurse will also be involved to manage the process of change. Fourth, clinical nurses, including registered nurses and licensed practical nurses are to directly perform change. The identified stakeholders are to compose a team that will communicate and collaborate with each other to provide the best health outcomes possible.
Responsibility of Team Members
As the initiator of the project, a leader is to control all the aspects and areas of change. A Director of Nursing Department will take a role of the co-leader, serving as change plan co-creator. A nurse epidemiologist will provide surveys, train staff, and assess change implementation and results. The clinical nurses will initiate change according to the plan. All of the mentioned team members are essential for the implementation of the project as each of them has certain responsibility and role that cannot be performed by others.
The problem is presented by the extensive evidence, including research articles, official statistics, and other credible sources. EBP guidelines are explored by various scholars and serve as a basis for action (Ward, Clabaugh, Evans, & Herwaldt, 2012). Some studies emphasize that not only individuals but also systems are to blame for HAI, thus pointing out that quality improvement data should be employed to enhance the likelihood of expected outcomes (Mehta et al., 2014). The position statements and clinical practice guidelines are also considered to be advantageous to change accomplishment (Poe & White, 2012).
Summarize the Evidence
The article by Luangasanatip et al. (2015) proposes the promotion of hand hygiene among hospital staff as it is one of the main causes of HAI. This intervention focuses on WHO-5 campaign and some additional options, such as reward incentives to motivate team members, accountability culture to engage employees, and goal setting to raise effectiveness of change. Such a comprehensive approach to the issue, as stated by the authors of the systematic review article, is likely to decrease HAI levels (Luangasanatip et al., 2015).
Develop Recommendations for Change Based on Evidence
As affirmed by the founder of the contemporary nursing Florence Nightingale, “it may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm” (Knecht, 2017, p. 78). In this regard, it is imperative to create such an environment where patients would not acquire additional diseases. The recommendations to change plan can be identified as follows: utilization of WHO-5 tool, training of staff members, and setting clear and attainable goals. Each of the mentioned recommendations is to be monitored and adjusted, if required.
The plan for implementation may start with data integration and development of project guidelines for each team member. After that, they should be contacted to understand their role and responsibility in the project realization. Moreover, specific hospital requirements are to be taken into account to provide relevant interventions. The implementation of change will be accompanied by its continuous monitoring. The estimated timeline is six months after which some results are to be revealed. The evaluation of outcomes will focus on levels of morbidity and mortality as well nursing care effectiveness and care costs (Poe & White, 2012).
Process, Outcomes Evaluation and Reporting
As a result of the mentioned recommendations, it is expected to achieve significant decrease in HAI, hospital costs, and increased health care provision quality. They will be measured through the key indicators that were specified in the previous section with the help of statistical data analysis and patients’ perceptions. The results of the interventions will be reported to stakeholders on special meeting by presentation and the subsequent discussion.
Identify Next Steps
The suggested plan is pertinent to the facility as a whole as hand hygiene is relevant to all health care units. On a larger scale, it may be possible to engage more stakeholders and develop more comprehensive plan of action, depending on certain requirements. To ensure permanent implementation, it is necessary to provide constant monitoring, evaluation, and improvement of change plan.
The internal dissemination strategy may be conducted on the basis of conference so that every organization member would have the opportunity to understand main insights, ask questions, or suggest creative ideas. As for the external dissemination, online conference may be initiated to allow people from all over globe participating in the project discussion. Another potential option is to publish findings in nursing scholarly journals.
The issue of HAI, resulting in decreased patients’ outcomes and care quality may be eliminated by the implementation of ACE Star change model EBP process that focuses on the five areas, including research, evidence summary, translation, practice integration, and evaluation of outcomes. The recommended change plan involves the above phases and proposes continuous monitoring to ensure permanent change adherence.
Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Model and guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International.
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Knecht, P. (2017). Success in practical/vocational nursing: From student to leader (8th ed.). St. Louis, MO: Elsevier.
Luangasanatip, N., Hongsuwan, M., Limmathurotsakul, D., Lubell, Y., Lee, A. S., Harbarth, S.,… Cooper, B. S. (2015). Comparative efficacy of interventions to promote hand hygiene in hospital: Systematic review and network meta-analysis. BMJ, 351, 1-14.
Mehta, Y., Gupta, A., Todi, S., Myatra, S. N., Samaddar, D. P., Patil, V.,… Ramasubban, S. (2014). Guidelines for prevention of hospital acquired infections. Indian Journal of Critical Care Medicine, 18(3), 149-163.
Poe, S., & White, K. M. (2012). Johns Hopkins nursing evidence-based practice: Implementation and translation. Indianapolis, IN: Sigma Theta Tau International.
Ward, M. M., Clabaugh, G., Evans, T. C., & Herwaldt, L. (2012). A successful, voluntary, multicomponent statewide effort to reduce health care-associated infections. American Journal of Medical Quality, 27(1), 66-73.