New Approaches to Infection Prevention Practices

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Table of Contents

Introduction
Practices to Eliminate Nosocomial Infections: The Currency of the Science
The Difference of Expectations and Actual Outcomes: Possible Causes
The Effects of Nosocomial Infections in Practice
Current Research Evidence on Practices to Prevent Nosocomial Infections
EBP Models to Integrate New Approaches to Practice
Conclusion
References

Introduction

Nosocomial or hospital-acquired infections remain a crucial issue in clinical contexts. One barrier to successful infection prevention is staff members’ suboptimal compliance with hand hygiene standards and policies that hospitals promote. This paper explores the stated issue with reference to the currency of infection prevention practices, possible reasons behind insufficient actual outcomes, nosocomial infections’ effects in practice, evidence regarding new approaches to hand hygiene promotion and its quality, and the John Hopkins model of practice change.

Practices to Eliminate Nosocomial Infections: The Currency of the Science

Nowadays, hospital settings widely use infection control policies, but not all findings regarding how to increase practitioners’ compliance are immediately transferred into clinical practice. Depending on the unit and hospital type, current infection prevention practices include central line insertion bundles, chlorhexidine for pre-operative body washing, and policies to control the use of protective equipment, including masks, gloves, and reusable gowns (Elliott & Justiz-Vaillant, 2018). Despite not being a recent discovery, hand hygiene still remains a crucial component of infection prevention strategies. However, many effective approaches to compliance promotion, such as performance feedback for the staff, electronic monitoring of hand hygiene events, and innovative hand hygiene reminders, have not entered daily practice yet, which probably results in suboptimal compliance rates in diverse medical fields (Diefenbacher et al., 2019). Therefore, although there are attempts to implement the most recent research findings into infection prevention programs at hospitals, the human resource component of the issue, including the best strategies to ensure total hand hygiene compliance, remains unaddressed.

The Difference of Expectations and Actual Outcomes: Possible Causes

There is a profound difference between the anticipated and actual outcomes of hand hygiene internal policies, and the human factor might be the key contributor to this situation. In the absence of printed signs or other measures to remind healthcare staff of the need for hand-cleaning procedures, service providers may simply forget to complete these procedures, especially in highly stressful patient encounters or during heavy workload periods (McLean et al., 2017). Aside from the inability to keep all information in one’s working memory, the absence of perceived reputational and monetary risks might occasionally motivate providers to ignore hand hygiene rules. According to McLean et al. (2017) and Wong et al. (2020), hand hygiene performance can be increased when compliance rates are carefully monitored and reported, with non-compliance incidents followed by investigations. Basic forgetfulness stemming from the need for multi-tasking might be accompanied by the absence of personal responsibility for hand hygiene non-compliance, whether financial in the form of fines or reputational. Thus, considering the enormous effect of human psychology on approaches to work, the human factor in insufficient hand hygiene should be studied thoroughly.

The Effects of Nosocomial Infections in Practice

Hospital-acquired infections have a plethora of negative health, financial, and reputational effects. Regarding patient outcomes, nosocomial infections in inpatient facilities, such as hospital-acquired pneumonia and bloodstream and urinary tract infections (UTIs), are accountable for about 100,000 patient deaths in the U.S. every year, with bloodstream infections as the most widespread cause of lethal outcomes (Elliott & Justiz-Vaillant, 2018). Aside from patient mortality, these infections result in increases in organ dysfunction rates and hospital stay duration, thus creating an additional financial burden on the healthcare system (Elliott & Justiz-Vaillant, 2018). These circumstances and infection events with substantial media coverage may undermine public trust in healthcare. The abovementioned negative effects, not including the lethal outcomes, also affect my practice setting, with COVID-19 and S. aureus infections creating more heated competition with other local facilities and the need for additional healthcare interventions.

Current Research Evidence on Practices to Prevent Nosocomial Infections

Researchers do not leave attempts to find the best infection prevention strategy, and the GRADE evidence evaluation model can be applied to assess modern studies’ credibility. In their quasi-randomized study in non-intensive-care units, Diefenbacher et al. (2019) demonstrate the combination of goal-setting (guided team sessions and setting compliance rate goals collectively) and performance feedback (screens with information on the ward’s mean compliance rate for the week) as a viable measure to promote hand hygiene compliance for infection prevention purposes. Based on the GRADE evaluation criteria outlined in Guyatt et al. (2011), the study by Diefenbacher et al. (2019) offers moderate-quality evidence due to the limitations – unpredictable changes in the number of staff members in the control group that may affect the results’ accuracy. These deficiencies, however, do not undermine the study’s credibility since there are no obvious biases or inconsistencies.

Modern studies also cite electronic tracking systems as a viable way to improve compliance. Xu et al. (2021) explore a sensor-based platform that monitors and analyzes individual providers’ compliance rates by means of high-tech wristbands, and their study reports increases in combined compliance rates (hand hygiene events with either partial or full compliance) from 8% to 41%. Using the GRADE criteria listed by Guyatt et al. (2011), it is possible to classify the article as a source of moderate-quality evidence due to the lack of randomization (Xu et al., 2021). Banks and Phillips (2021) study the use of personal devices with alcohol sensors that track the time washing hands and alcohol concentration on the hands, and the researchers detect significant decreases in hand hygiene non-compliance and Clostridium difficile infection cases. Regarding this study, the GRADE evaluation process indicates the source’s moderate quality due to certain limitations – particularly, the study uses the pretest-posttest approach to comparison, with certain statistics from the pre-COVID-19 period when infection control awareness was lower than nowadays (Banks & Phillips, 2021). Therefore, there are credible studies testing modern technology in hand hygiene promotion endeavors.

EBP Models to Integrate New Approaches to Practice

The model that will be utilized to integrate new approaches to hospital-acquired infection prevention by increasing hand hygiene compliance rates is the John Hopkins Nursing Evidence-Based Practice (JHNEBP) model. The JHNEBP model uses the three-phase process in which the formulation of a practice question is followed by evidence collection/analysis and evidence translation measures (Dang & Dearholt, 2017). As per the PET (practice, evidence, translation) Management Guide from the model’s creators, the practice question phase should be organized as a six-step process requiring interprofessional team formation and stakeholder analysis, whereas the evidence phase comprises five steps, including internal/external search for evidence, quality appraisal, synthesis, and recommendation formulation (Dang & Dearholt, 2017). The translation phase requires eight steps related to pre-implementation feasibility analysis, action plan development, securing resources, and reporting outcomes to stakeholders (Dang & Dearholt, 2017). Because of the emphasis on collective decision-making and clearly formulated steps, the model will be instrumental in developing an improved infection prevention plan informed by the most recent evidence.

Conclusion

In summary, decreasing nosocomial infection rates might require measures that would maximize personal accountability for skipped hand hygiene events and implement effective visual reminders for staff members providing care services. Multiple potentially helpful infection prevention practices exist, including compliance feedback, collective goal-setting, and automated hand hygiene compliance tracking systems. These and other practices can be further evaluated and translated to practice with the help of the JHNEBP model.

References

Banks, M., & Phillips, A. B. (2021). Evaluating the effect of automated hand hygiene technology on compliance and C. difficile rates in a long-term acute care hospital.American Journal of Infection Control, 49(6), 727-732.

Dang, D., & Dearholt, S. (2017). Johns Hopkins nursing evidence-based practice: Model and guidelines (3rd ed.). Sigma Theta Tau International.

Diefenbacher, S., Fliss, P. M., Tatzel, J., Wenk, J., & Keller, J. (2019). A quasi-randomized controlled before-after study using performance feedback and goal setting as elements of hand hygiene promotion.Journal of Hospital Infection, 101(4), 399-407.

Elliott, C., & Justiz-Vaillant, A. (2018). Nosocomial infections: A 360-degree review.International Biological and Biomedical Journal, 4(2), 72-81.

Guyatt, G., Oxman, A. D., Akl, E. A., Kunz, R., Vist, G., Brozek, J., Norris, S., Falck-Ytter, Y., Glasziou, P., DeBeer, H., Jaeschke, R., Rind, D., Meerpohl, J., Dahm, P., & Schünemann, H. J. (2011). GRADE guidelines: 1. Introduction – GRADE evidence profiles and summary of findings tables.Journal of Clinical Epidemiology, 64(4), 383-394.

McLean, H. S., Carriker, C., & Bordley, W. C. (2017). Good to great: Quality-improvement initiative increases and sustains pediatric health care worker hand hygiene compliance.Hospital Pediatrics, 7(4), 189-196.

Wong, S. C., Auyeung, C. Y., Lam, G. M., Leung, E. L., Chan, V. M., Yuen, K. Y., & Cheng, V. C. (2020). Is it possible to achieve 100 percent hand hygiene compliance during the coronavirus disease 2019 (COVID-19) pandemic?Journal of Hospital Infection, 105(4), 779-781.

Xu, Q., Liu, Y., Cepulis, D., Jerde, A., Sheppard, R. A., Tretter, K., Oppy, L., Stevenson, G., Bishop, S., Clifford, S. P., Liu, P., Kong, M., & Huang, J. (2021). Implementing an electronic hand hygiene system improved compliance in the intensive care unit.American Journal of Infection Control.

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