PICOT Analyse – The Setting of the Problem

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Developing a PICOT Question

PICOT Question: In ICU patients, do wearing antimicrobial scrubs compared to the standard uniforms prevent the transmission of hospital-acquired infections during the hospital stay?

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  • P: ICU patients
  • I: Antimicrobial scrubs
  • C: Standard Uniform
  • O: Reduced transmission of hospital-acquired infections
  • T: The length of hospital stay

The Analysis of Literature

Description of the Problem

The unprecedented increase in the incidences of multidrug-resistant organisms (MDROs) has become a critical challenge in health care. Gaspard et al. (2009) have asserted that the rising cases of vancomycin-resistant enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) have exacerbated the risk of HIAs. As such, it is imperative to identify the strategies that will prevent the spread of these pathogens (Huskins et al., 2011). The primary concern is the lack of efficacious therapeutic options to treat these diseases. According to Weiner-Well et al. (2011), the use of evidence-based practices will be essential to reduce the spread of pathogenic material among hospitalized patients.

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. In addition, Huskins et al. (2011) have questioned the clinical significance of the microorganisms that contaminate these uniforms.

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 interact with their colleagues, as well as patients and their families. This string of statistics highlights the need to investigate this matter further (Dodek, Norena, Ayas, Romney, & Wong, 2013).

The Setting of the Problem

The intensive care unit (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 Impact of the Problem

Hospital-acquired infections (HAIs) are adverse, clinical events that 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 increases 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). Huskins et al. (2011) have found out that a positive strain contributes to approximately 400,000 hospital-acquired infections annually. 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).

Solution to the Problem

The realization that health care workers spread pathogenic materials through their uniforms has necessitated the development of prevention strategies (Gaspard et al., 2009). The past decade has witnessed the manufacturing of antimicrobial uniforms and scrubs to address this problem. Nonetheless, the clinical efficacy of these medical attires is still contentious (Burden et al., 2013; Dodek et al., 2013). Thus, the purpose of this study is to determine whether antimicrobial uniforms reduce the spread (MRSA) and VRE in clinical settings. The principal objective is to ascertain if the introduction of these clothing can reduce the prevalence and incidence of hospital-acquired infections.

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Significance to the Nursing Profession

The ongoing reforms in the health care have arisen from the demands for quality and patient safety. Health care workers, particularly nurses, carry the mandate of providing safe care (Huskins et al., 2011). Two imperative issues have emerged from the previous discussions. First, patients in the ICU are at an increased risk of contacting HIAs (Burden et al., 2013). Second, antimicrobial uniforms can reduce the incidences of HIAs by preventing the spread of pathogens in clinical settings (Bearman et al., 2013). Hospital-acquired infections are adverse clinical events that undermine the quality and safety of health care services. Thus, both nursing administrators and nurses should develop feasible strategies to prevent HIAs using sound evidence (Huskins et al., 2011). This intervention is one of the best practices that hospitals should adopt to reduce the incidences and prevalence of HIAs.

Rapid Appraisal

Bearman, M. L. G., Rosato, A., Elam, K., Sanogo, K., Stevens, M., Sessler, N. C., & Wenzel, P. R. (2012). A crossover trial of antimicrobial scrubs to reduce methicillin-resistant Staphylococcus aureus burden on healthcare worker apparel. Infection Control and Hospital Epidemiology, 33(3), 268-275.

This article has identified the bacterial burden on the apparel and hands of health care workers as a significant problem. The article has not provided statistical information but it has identified the implications of hospital-acquired infections. The article supports the proposed intervention.

Burden, M., Keniston, A., Frank, G. M., Brown, A. C., Zoucha, J., Cervantes, L., Weed, D.,… Albert, K. R. (2013). Bacterial contamination of healthcare workers’ uniforms: A randomized controlled trial of antimicrobial scrubs. Journal of Hospital Medicine, 8(7), 380-385.

This article has highlighted the extent of bacterial contamination on health care workers’ uniforms. The authors have provided statistics to explain the scope of the problem. This information includes the percentage of microorganisms that colonize the uniforms. The article supports the proposed intervention.

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Boutin, M. A., Thom, K. A., Zhan, M., & Johnson, J. K. (2014). A randomized crossover trial to decrease bacterial contamination on hospital scrubs. Infectious Control and Hospital Epidemiology, 35(11), 1411-1413.

This article discusses the colonization of the healthcare workers’ attire with bacteria. The authors have provided statistics to support their claims. The information includes the type and quantity of pathogenic material. This article supports the proposed intervention.

Sanon, A-M., & Watkins, S. (2012). Nurses’ uniforms: How many bacteria do they carry after one shift? Journal of Public Health and Epidemiology, 4(10), 311-315.

This article has identified the contamination of nurses’ uniforms as a primary concern in the health care system. The article has provided statistics to support claims. This information includes the scope and magnitude of microbial contamination. Findings from this study support the proposed intervention.

Lovedaya, H. P., Wilsona, J. A., Pratta, R. J., Golsorkhia, M., Tingle, A., Baka, A., & Wilcoxc, M. (2014). epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection, 86(S1), S1-S70.

This clinical guideline provides the best practice for managing hospital-acquired infections. The guideline has provided statistics to support claims. The data includes incidence and prevalence rates of HIAs. This guideline supports the proposed intervention.

Kundrapu, S., Sunkesula, V., Jury, L. A., Sitzlar, B. M., & Donskey, C. J. (2012). Daily disinfection of high touch surfaces in isolation rooms to reduce contamination of healthcare workers’ hands. Infectious Control and Hosp Epidemiology, 33, 1039–1042.

This article has addressed the problem by highlighting the spread of pathogenic materials in health settings. The authors have used statistical information to support their viewpoints. This information includes the incidence rates of HAIs. The data includes incidence and prevalence rates of HIAs. This guideline supports the proposed intervention.

Dodek, P. M., Norena, M., Ayas, N. T., Romney, M., & Wong, H. (2013). Length of stay and mortality due to Clostridium difficile infection acquired in the intensive care unit. Journal of Critical Care, 28(4), 335-350.

This article has addressed the problem by highlighting the burden of hospital-acquired infections. The authors have provided statistics to support their claims. This information included the prevalence rate for Clostridium difficile infection. This study provides the rationale for implementing the proposed intervention.

Gaspard, P., Eschbach, E., Gunter, D., Gayet, S. Bertrand, X., & Talon, D. (2009). Meticillin-resistant Staphylococcus aureus contamination of healthcare workers’ uniforms in long-term care facilities. Journal of Hospital Infection, 71, 170-175.

This article has explored the correlation between the colonization of healthcare workers’ uniforms and the spread of MRSA. The authors have not provided statistical information. The article has provided the frequency of MRSA contamination in clinical settings. Findings from this research support the implementation of the proposed intervention.

Huskins, W. C., Huckabee, M. C., O’Grady, P. N., Murray, P., Kopetskie, H., Zimmer, L., Walker, E. M.,… Goldmann, A. D. (2011). Intervention to reduce transmission of resistant bacteria in intensive care. The New England Journal of Medicine, 364(15), 1407–1418.

The authors have discussed the susceptibility of ICU patients to the risk of HIAs. This article has provided statistics to support the authors’ claims. The information includes the rate of HIAs in the ICU unit. This article provides the basis for implementing the intervention.

Wiener-Well, Y., Galuty, M., Rudensky, B., Schlesinger, Y., Attias, D., & Yunon, M. A. (2011). Nursing and physician attire as possible source of nosocomial infections. American Journal of Infection and Control, 39, 555-559.

This article has addressed the problem by highlighting the effect of medical attire on nosocomial infections. The authors have not provided statistics to support their assertions. Nonetheless, the information includes the frequency and sources of contamination. This research supports the intervention.

Nseir, S., Blazejewski, C., Lubret, R., Wallet, F., Courcol, R., & Durocher, A. (2011). Risk of acquiring multidrug-resistant Gram-negative bacilli from prior room occupants in the intensive care unit. Clinical Microbiology and Infections, 17, 1201–1208

This article traces the care pathway to identify the sources of microbial contamination. The authors have used statistical information to support their viewpoints. This information includes the incidence rates of HAIs. The findings from this study will support the implementation of the intervention.

Department of Health. (2007). Decontamination of re-usable medical devices in the primary, secondary and tertiary care sectors (NHS and independent providers). London: Department of Health.

This guideline provides the best practices for preventing the contamination of the clinical environment. The authors have used statistics and evidence from various studies to support the recommendations. The data includes the prevalence of HIAs in the UK, US, and Australia. This article will support the implementation of the intervention.

Kundrapu, S., Sunkesula, V., Jury, L. A., Sitzlar, B. M., & Donskey, C. J. (2012). Daily disinfection of high-touch surfaces in isolation rooms to reduce contamination of healthcare workers’ hands. Infectious Control and Hospital Epidemiology, 33, 1039–1042.

This article has addressed the problem by highlighting the spread of pathogenic materials in health settings. The authors have used statistical information to support their viewpoints. This information includes the incidence rates of HAIs. The data includes incidence and prevalence rates of HIAs. This guideline supports the proposed intervention.

Dancer, S., White, L., Lamb, J., Girvan, E. K., & Robertson, C. (2009). Measuring the effect of enhanced cleaning in a UK hospital: A prospective cross-over study. BMC Medicine, 7, 28-36.

This article traces the care pathway to identify the sources of microbial contamination. The authors have used statistical information to support their viewpoints. The information includes the frequency and sources of contamination. This research supports the intervention.

National Patient Safety Agency. (2009). The revised healthcare cleaning manual. Web. 

The National Patient Safety Agency has identified poor hygiene as the primary source of microorganisms in the hospital. This manual has provided statistics to support the implementation of the guidelines. The information supports the intervention.

References

Bearman, M. G., Rosato, A., Elam, K., Sanogo, K., Stevens, M., Sessler, N. C., & Wenzel, P. R. (2012). A crossover trial of antimicrobial scrubs to reduce methicillin-resistant Staphylococcus aureus burden on healthcare worker apparel. Infection Control and Hospital Epidemiology, 33(3), 268-275.

Burden, M., Keniston, A., Frank, G. M., Brown, A. C., Zoucha, J., Cervantes, L., Weed, D.,… Albert, K. R. (2013). Bacterial contamination of healthcare workers’ uniforms: A randomized controlled trial of antimicrobial scrubs. Journal of Hospital Medicine, 8(7), 380-385.

Dodek, P. M., Norena, M., Ayas, N. T., Romney, M., & Wong, H. (2013). Length of stay and mortality due to Clostridium difficile infection acquired in the intensive care unit. Journal of Critical Care, 28(4), 335-350.

Gaspard, P., Eschbach, E., Gunter, D., Gayet, S. Bertrand, X., & Talon, D. (2009). Meticillin-resistant Staphylococcus aureus contamination of healthcare workers’ uniforms in long-term care facilities. Journal of Hospital Infection, 71, 170-175.

Huskins, W. C., Huckabee, M. C., O’Grady, P. N., Murray, P., Kopetskie, H., Zimmer, L., Walker, E. M.,…. Goldmann, A. D. (2011). Intervention to reduce transmission of resistant bacteria in intensive care. The New England Journal of Medicine, 364(15), 1407–1418.

Wiener-Well, Y., Galuty, M., Rudensky, B., Schlesinger, Y., Attias, D., & Yunon, M. A. (2011). Nursing and physician attire as possible source of nosocomial infections. American Journal of Infection and Control, 39, 555-559.

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NursingBird. 2022. "PICOT Analyse - The Setting of the Problem." May 4, 2022. https://nursingbird.com/picot-analyse-the-setting-of-the-problem/.

1. NursingBird. "PICOT Analyse - The Setting of the Problem." May 4, 2022. https://nursingbird.com/picot-analyse-the-setting-of-the-problem/.


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NursingBird. "PICOT Analyse - The Setting of the Problem." May 4, 2022. https://nursingbird.com/picot-analyse-the-setting-of-the-problem/.