Nosocomial Infections Change Paper

Nursing Leadership

Nosocomial Infections (hospital acquired infections) are infections acquired after 48 hours of hospitalization. These infections can be caused by viral, bacterial, and fungal pathogens. Risk factors for acquiring a nosocomial infection include having an underlying disease, immunodeficiency, malnutrition, advanced age, premature birth, and invasive devices such as intubation tubes, catheters, surgical drains, and tracheostomy tubes. Other risks include immunosuppression and antacid treatment, antimicrobial therapy, and multiple blood transfusions. Sites of infection include respiratory tract, urinary tract, bloodstream, surgical wound, gastrointestinal tract, and shunt infections. The article nosocomial infections in neurosurgery intensive care units by Sevim Akgul Celik was written so nurses could be educated on effective ways to prevent hospital acquired infections in intensive care settings. We found the article to be helpful for all hospital settings. The existing theory according to Celik is that in order to reduce infection rates it is useful to inform nurses about infection sources and it is useful to change their behaviors. We know that nurses should be informed about infection sources, but the most important thing is to educate nurses on ways to prevent infection. (Celik, 2004) The European Prevalence of Infection in Intensive Care study addressed the prevalence of nosocomial infections in 10,038 patients. According to this study 20.6% of these patients acquired a hospital related infection. Pneumonia was the most nosocomial infection prevalent nosocomial infection (46.9%), followed by lower respiratory tract infections (17.8%), urinary tract infections (17.6%), and bloodstream infections (12%). (Celik, 2004) From this study, one can see that a significant amount of patients acquire a hospital related infection and that measures should be taken to prevent these infections so quality of care can continuously be provided to patients.

The article Decreasing Urinary Tract Infections Through Staff Development, Outcomes, and Nursing Process states that nosocomial infections are a large prevalence in the hospitals across the south of the United States. Urinary tract infections account for approximately 35% of noscomial infections but are the lowest in mortality and cost (Ribby, 2006). The article also mentions that length of stay for patients with a secondary UTI was 9.1days compared to those without a urinary catheter whose stay was only 4.7 days. The purpose of the research for the article was to reduce the incidence of urinary tract infections. The article suggested several ways to manage catheters care and decrease catheter infection. The focus to significantly reduce the instances through educating the nursing staff in the form of a poster and video and also by providing protocols instructing when to insert, leave or discontinue the catheter. The project was conducted in the third largest rural health system in the United State which consisted of 6 hospitals system with 856 acute care beds. The outcomes manager used CarSciences Care Management System to identify outcome profiles of top-volume diagnostic related groups with and without UTIs to ascertain whether UTIs were a significant issue (Ribby, 2006). The researcher recommended developing poster and video for the nurses to become educated on ways to prevent and reduce infection in patients with a catheter inserted. As a result there was a range of 4% compliance on nursing units up to 100% compliance on 2 of the nursing units (Ribby, 2006). Because of the relatively low numbers on some units the posters were moved through the units and made mandatory for the entire nursing staff to complete including a posttest. At the end of 2003, there was a range of 93% compliance of a single nursing unit to 100% compliance of the 10 of the 14 nursing units (Ribby, 2006) Strengths of the research study was the increase of compliance amongst the units of the hospitals and the

increase in the compliance once the poster was relocated throughout the hospital on different units. The weakness and what was missing was the fact that they only used research for a limited amount of hospitals and beds and the absence of long-term goals. Lewins theory of change can be used to improve the problem of nosocomial infections. The first stage of change would be creating the motivation or readiness for change. (Huber, 2006) This would involve informing the nurses of the problem, the huge disadvantages it causes, and motivating them to help in making a change to prevent nosocomial infections. The second stage of change involves proceeding to a new level of behavior. (Huber, 2006) This means the nurses would have to start using effective methods to prevent infection that is different from the current way they are doing things thats not effective. For example, this could include things such as strict hand hygiene and sterilization of all medical equipment after patient use. The final stage is evaluating whether the methods used were effective at reducing nosocomial infection and integrating new ideas that could improve the current plan. Hospital Acquired Infections cost 28-45 billion dollars and contribute to more than 99,000 deaths in the United States each year. Some strategies for preventing nosocomial infections include washing hands before and after procedures, use of sterile technique when warranted, sterilization of all medical equipment after patient use, avoiding unnecessary catheterization, changing drainage bag and connection tube every week, replacing peripheral catheters according to hospital policy, and using universal precautions. It is important for these strategies to be implemented to reduce nosocomial infections. If this change is not made there will be more deaths and rising healthcare costs. Advantages and Disadvantages

The biggest disadvantage of nosocomial infections is the infection itself. Patients who are going into a facility to regain health or fix a problem comes out with a infection that is now causing additional harm to their health. Unlike in the past, deaths from nosocomial infections now appear as headlines in newspapers and magazines as well as interest stories on local and national news broadcasts. (Ribby, 2006) There are 90,000 deaths in the United States annually that can be avoided by healthcare providers adhering to standard precautions and policy and procedure for promoting health. The astronomical price of 28-45 billion dollars spent on law suites, correction and services to eliminate nosocomial infections that can be spent on improving the facilities, raises, and funds for necessary products and services needed to work toward improvement overall. The inconvenience, pain, and suffering and additional hospital stay that the patients have to endure because of an infection that was encountered due to negligence. There really are no advantages of nosocomial infections except for better practices to be implemented through various studies done on this subject. To increase awareness to reduce the nosocomial infection and to maintain proper sterilizing and aseptic techniques at all times. Budgeting and Staffing Hospital-acquired infections represent an increasing financial burden and declining quality of health care in the United States. Approximately 95% of the estimated $5 billion total health care cost from hospital-acquired infections falls on the shoulders of the hospitals and patients. Total dollar costs added to the health care system are between $28 and $45 billion annually, with the average cost per infection of $13,973 and an increased cost to patients (who survived) of approximately $40,000. Quality costs include increased ICU stays by 8 days, and increased average hospital stay between 7.4 and 9.4 days.

The operating budget will include all expenses that will cover patient care, length of stay, hospital costs, nursing staffing and education. There is strong evidence that nursing shortage is associated with increased length of stay, nosocomial infection (urinary tract infection, postoperative infection, and pneumonia), and pressure ulcers. Rigorous programs are necessary to educate employees and increase their awareness of the rationale behind infection control standards and gain their buy-in for new processes and best practices. Most health care workers are very compliant when they realize that compliance does improve patient outcomes. Simply making the information available is not enough; there must be programs in place to check for understanding and compliance with the guidelines. Direct monitoring of individual employee performance ensures processes are correctly followed and provides proof that a positive change has been achieved. Investigations of patient outcomes in relationship to nurses and their professional responsibilities in hospitals commonly involve structural measures of care including numbers of nurses, number of nurse hours, percentage or ratios of nurses to patients, organization of nursing care delivery or organizational culture, nurse workload, nurse stress, or qualification of nurses. The cost-effectiveness of efforts to enhance hand hygiene was evaluated in one study; the cost of a patient education campaign was weighed against an estimated cost of $5,000 for each nosocomial infection. The annual savings was approximately $57,600 for a 300bed hospital with 10,000 admissions annually. Evaluation of Change The goal of the health care professional is to protect the patient from acquiring a nosocomial infection. Strict hand hygiene before and after procedures and contact with patient prevents the transfer of bacteria as the healthcare professional attends to each individual. Using sterile technique when warranted prevents the spread of pathogens to bones and tissues.

Avoiding unnecessary cauterizations has decreased the occurrence of UTIs amongst patients. Changing drainage bags, connection tubing, and IV tubing according to hospital protocol has been shown to reduce the prevalence of nosocomial infections because it reduces the availability of bacteria to its attracted substance. Using universal precautions protects the health care personnel from those infective agents that could potentially infect them.

References Celik, S. (2004). Nosocomial infections in neurosurgery intensive care units. Journal of Clinical Nursing, 13, 741-747. Huber, D. L., Leadership and Nursing Care Management. (3rd ed.). Saunders. Ribby, K. Decreasing Urinary Tract Infections Through Staff Development, Outcomes, and Nursing Process. Journal of Nursing Care Quality, 21, 194-198.