Practice Issue
The topic
Hospital-acquired Infections.
The nursing practice issue
My project will focus on hospital-acquired infections (HAIs); in particular, it will be necessary to identify the methods that can effectively address this problem.
The scope of the practice issue
The scope of this practice issue will be restricted to several aspects. Firstly, the project will examine only the infections caused by central lines and acquired in surgical settings. Furthermore, it is necessary to examine the effects of implementing hospital guidelines. One should determine if this strategy can minimize the prevalence of HAIs caused by central lines.
The practice area
The practice area is clinical.
How the practice issue was identified
- Safety/risk management concerns
- Unsatisfactory patient outcomes
- Significant financial concerns
- Clinical practice issue is a concern
There are several reasons why I identified this issue. Firstly, HAI is one of the key safety risks to which many patients are exposed. It can pose a threat to the health and life of an individual. This argument applies to the infections caused by central lines. It is also important to mention that HAIs result in readmissions and various health complications. Due to this reason, the costs of healthcare can increase substantially. Therefore, medical workers should find the most effective solutions to this problem.
What evidence must be gathered?
- Literature search
- Guidelines
While gathering evidence, one should focus on literature search and guidelines based on evidence. Much attention should be paid to randomized controlled trials, meta-analyses, and systematic reviews describing the protocols and interventions that can best protect patients from the threat of infections.
Evidence Summary
The practice problem
The practice problem can be formulated as a PICO question:
- Does adherence to hospital guidelines minimize the number of HAIs caused by central lines in adult patients?
To evaluate the efficiency of the intervention, one should focus on the incidence of these infections in the healthcare organization.
The objectives of the systematic review article
In their study, Webster and Osborne (2015) want to determine if pre-operative showering and bathing with chlorhexidine can reduce the risk of surgical site infections (SSIs).
The questions being addressed in the work and in relation to the practice issue
Can bathing and pre-operative showering with chlorhexidine diminish the incidence of surgical site infections in medical institutions?
To some degree, this question is related to my practice issue. The authors want to determine if certain interventions can help medical workers address the problem of SSIs. I intend to answer a similar question. The only difference is that my project is focused on a specific type of HAIs, namely the ones that are caused by central lines.
The interventions the author(s) of the systematic review article suggest to improve patient outcomes
The analysis of randomized controlled trials does not provide convincing evidence in support of bathing with skin antiseptics (Webster & Osborne, 2015). The authors admit that one study confirmed the positive impacts of this intervention. Nevertheless, it is not sufficient for arguing that this technique is more effective than other approaches.
The main findings by the authors of the systematic review
The scholars note that the use of chlorhexidine for bathing and pre-operative showering is not more effective than other wash products (Webster & Osborne, 2015). The main outcome examined by the authors was the incidence of SSIs. There is little evidence indicating that this outcome can be significantly improved by the proposed interventions. This source will help me implement my project because it will prevent me from discussing ineffective infection prevention techniques.
It is also possible to consider the article written by Allegranzi et al. (2016) who discuss and evaluate various methods of minimizing the risk of SSIs. This article will assist me in identifying various interventions that can adequately safeguard patients from the threat of HAIs.
The evidence-based solutions to consider for the project
- Hair removal;
- The applications of antiseptic solutions containing alcohol;
- Application of nasal ointment (Allegranzi et al., 2016).
Limitations to the studies
Webster and Osborne (2015) acknowledge that their research has certain limitations; in particular, they mention such issues as the inconsistency of some findings as well as deficiencies in the design of the studies. In their turn, Allegranzi et al. (2016) note that their study does not fully analyze the financial aspects of different interventions.
References
Allegranzi, B., Bischoff, P., de Jonge, S., Kubilay, N., Zayed, B., Gomes, S.,… WHO Guidelines Development Group. (2016). New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. The Lancet, 16(12), 276-287.
Webster, J., & Osborne, S. (2015). Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. The Cochrane Database of Systematic Reviews, 20(2), 1-39.