Techniques of Obtaining Necessary Approval and Support
The complex relationships inherent in the healthcare system make it difficult to change an established behavior. As such, Gale and Schaffer (2009) have underscored the significance of seeking approval and support before introducing the change initiative. On the one hand, the development of a business case will be crucial to get the approval of the hospital administrators (Newhouse, 2007). This official document will illustrate the rationale and benefits of introducing the proposed initiative in a well-structured manner. The business case will also outline the evidence level that supports the new intervention (Acheterberg, Schoonhoven, & Grol, 2008).
On the other hand, the change agent will garner support from the nursing staff using three strategies. First, clinical supervision will entail assessing the clinical specialties, education levels, and experiences of the nurses. This information will be essential to identify the gaps and barriers that may hinder the effectual implementation of the proposed project (Price, 2008). Second, memos will inform the nurses about the imminent change. The information will be structured in a manner that creates the urgency for change. Third, the staff will assume an active role in the decision-making processes by participating in the focus group meetings (O’Neal & Manley, 2007).
The Scope and Limitations of the Current Policy
The hospital’s current policy regarding the prevention of hospital-acquired infections (HAIs) involves effective hand washing. The administrators have adopted the CDC Hand Hygiene Guidelines. Accordingly, the health facility has developed performance indicators to measure the level of adherence and efficiency. The surveillance techniques include video monitoring, observations, and self-reporting. Nonetheless, these methodologies are not only costly but also consume too much time (Daniels, 2012). In addition, Haas and Larson (2007) have noted that the current literature does not validate these approaches.
Although hand washing is a viable strategy, the current practices have brought to the fore a myriad of limitations. Firstly, the hospital requires the nursing staff to provide self-reports about their hand hygiene practices at the end of every week. The nurses complete a questionnaire that contains standardized questions. Haas and Larson have asserted that nurses do not give accurate information when providing self-reported hand hygiene practices. The primary concern is that the participants are either selective or insincere during this process (Daniels, 2012). Although the hospital administrators have introduced diary cards, the rate of recall bias is still high.
Secondly, the hospital lacks a standard protocol for hand hygiene practices. For instance, the findings from the baseline review revealed a difference in handwashing techniques employed in the ICU and general wards. Second, the staff members have not conceptualized the significance of hand hygiene in clinical practice. Most of the nurses interviewed indicated that this practice is only necessary for the operating room and ICU where the risk of infection is high. Consequently, the nurses working in the general wards were not washing their hands before handling the patients. Finally, understaffing has reduced the frequency of handwashing significantly.
The Proposed Solution
The proposed solution will involve the replacement of the standard nursing uniforms with antimicrobial clothing. The implementation of this pilot project will employ a phased-out approach. First, it will not be financially feasible to introduce antimicrobial uniforms in all the hospital units at once. Second, this project requires complex logistics in terms of procurement, production, and supply. Thus, the initial stage of this program will entail the introduction of this attire in the ICU and post-operative recovery units.
The resistance to change is one of the aspects that may have an adverse effect on the proposed intervention. As such, the implementation process will encompass three stages based on Lewin’s Change Model. First, hospital-acquired infections have increasingly emerged as issues of critical concern in the health care industry. Thus, it will be imperative to highlight this fact to create the urgency for change. This process will involve the presentation of research findings that have established a correlation between medical clothing and the spread of pathogens.
Secondly, all the stakeholders will play a significant role in the planning and implementation phases. Price (2008) has argued that the involvement of the staff in the decision-making processes minimizes this risk significantly. In addition, efficient communication minimizes the risk of failure (O’Neal & Manley, 2007). The moving phase will require the development of adequate systems to support the introduction of antimicrobial uniforms in the hospital. For instance, it will be crucial to train the nurses on how to use the new uniforms. Information gaps will more likely stymie the realization of both the short and long-term goals.
The final phase of the Lewin’s Model (Refreezing) will constitute the evaluation of the introduced intervention. The purpose of these activities will be to identify any gaps and challenges. Price (2008) has asserted that the refreezing stage plays a crucial role in making the changes permanent. Another critical aspect of this stage will be to assess the incidence and prevalence rates of hospital-acquired infections. The essence of this exercise will be to determine if the introduction of the antimicrobial uniforms has generated any significant outcomes. Favorable outcomes from the preceding evaluation will support the scaling-up of the project to other wards.
The Rationale and Supporting Literature
Hospital-acquired infections (HAIs) are adverse, clinical events during the course of treatment and hospitalization. Burden et al. (2013) have reported that HAIs often cause significant morbidity and mortality among hospitalized patients. In addition, HIAs increase the cost of medical care because they prolong the length of time that patients stay in the hospital. The incidence rates of both VRE and MRSA have continued to increase worldwide (Gaspard et al., 2009). Urinary tract infection constitutes the most frequent HIA that affects the majority of patients. Other conditions include surgical site infections (SSIs), bloodstream infections, pneumonia, and gastrointestinal complications (Bearman et al., 2012).
Healthcare workers (HCWs) act as conduits that facilitate the transfer of pathogens from one patient to the next. Bearman et al. (2013) have reported that gram-resistant microorganisms colonize the attire of nurses and other clinicians during the caring process. Consequently, the health care providers transmit these pathogens during their regular routine (Burden et al., 2013). Conversely, the bacterial contamination of medical clothing has remained a contentious issue. Thus, the proposed project will ascertain the extent to which antimicrobial uniforms reduce the incidences of HAIs. The hospital can then introduce these attires in all the units if the findings are statistically significant.
Although medical clothing may not constitute a significant route for spreading pathogenic materials, findings from various students have disputed this assertion. For instance, results from the study conducted by Wiener-Well et al. (2011) found out that pathogens had contaminated 63% of the 135 uniforms included in the study. Another investigation by Gaspard et al. (2009) recovered MRSA from 40% of the nurses’ standard scrub suits. The antibiotic-resistant bacteria colonize the uniforms of nurses when interacting with their colleagues, as well as patients and their families. This string of statistics highlights the need to introduce antimicrobial uniforms (Dodek, Norena, Ayas, Romney, & Wong, 2013).
The first phase of the project will entail the introduction of the antimicrobial clothing in the ICU. The ICU has emerged as a suitable environment for the localization of bacteria. Huskins et al. (2011) have found out hospital-acquired infections affect ICU patients disproportionately. MRSA and VRE are the main antibacterial-resistant pathogens that contribute to the incidences of adverse events in the ICU (Dodek et al., 2013). The rationale underpinning the preceding findings is that ICU patients have a compressed immunity. The use of invasive devices, coupled with open surgical wounds increases the susceptibility of ICU patients to HAIs (Gaspard et al., 2009).
The proposed project will have several logistical implications, which may affect the implementation process. First, the hospital has been procuring standard uniforms from a trusted company for many years. Nonetheless, this supplier does not produce antimicrobial uniforms to meet the current demand. The primary challenge will involve the costs that the hospital will incur by switching between two suppliers. In addition, it will take more time before the health administrators receive and approve tenders for the antimicrobial clothing. The principal concern is that some of the companies are yet to get approval for producing and supplying antimicrobial scrubs and uniforms.
Second, the implementation of the proposed project will affect the fiscal calendar of the hospital. The administrators had not anticipated this change when formulating the budget for the previous year. The regulatory bodies are yet to endorse the shift from standard to antimicrobial uniforms. In essence, the aim of this pilot project is to validate the rationale for using antimicrobial uniforms to reduce the incidence rates of HAIs. Thus, the implementation of this intervention will experience delays until the hospital makes financial commitments in the next fiscal cycle. Conversely, the cost of treating the HAIs is more than that of implementing the project.
Thirdly, the hospital will have to change its current policy to accommodate the introduction of antimicrobial uniforms. This process will be both complex and time-consuming. In addition, the transition from the standard to antimicrobial uniforms will require the development of new policy guidelines. Despite this challenge, the change agent has proposed the incorporation of antimicrobial uniforms into the hand hygiene policy. The essence of this assertion is that the purpose of the antimicrobial uniforms is not to replace hand hygiene practices. By contrast, this intervention will complement the current procedures to enhance positive outcomes.
The Required Resources
The implementation of the proposed project will require extensive resources. Firstly, the hospital will need additional funds to procure and transport antimicrobial uniforms from the suppliers. Secondly, the health facility will also incur the costs of producing educational materials, which will be essential to notify the nurses about the new intervention. Thirdly, the refreezing phase necessitates the development of systems to evaluate the effectiveness of antimicrobial systems. As such, the administrators will have to develop a surveillance system to track the incidences of HIAs. Finally, the success of this project will mandate the hospital to embark on the process of developing a new policy, which requires financial resources.
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