Surgical-Site Infections Prevention: Study Design

Introduction

Poor adherence to care guidelines is an important practice issue, as it increases the rate of hospital-acquired infections. Improving adherence to hospital guidelines using organizational change and nursing education could be an effective solution to the problem. The nursing plan proposed in this project is to use the ACE Star Model for Evidence-Based Practice Process to implement and improve the use of hospital central line care guidelines. The present paper will seek to review the change model and the evidence in support of the change while also translating it into an appropriate action plan.

Change Model Overview

The ACE Star Model of Knowledge transformation uses five steps to create and apply evidence-based processes. The stages of the model are research discovery, evidence summary, translation to guidelines, process outcome evaluation, and practice integration (Parkosewich, 2013). Nurses should use this model because it can help to ensure positive outcomes of a change process.

Define the Scope of the EBP

The chosen practice issue is poor adherence to hospital guidelines for central line care, which results in hospital-acquired infections. According to Esposito, Guillary, and Angelillo (2017), only between 40-72% of nurses adhere to hand hygiene standards. This issue is significant to nursing practice, as it extends patients’ length of stay and causes increased workload due to the need to treat infections. Moreover, the issue has a significant effect on the healthcare sector in the U.S. by increasing health care expenditures. Zimlichman et al. (2013) report that the total cost of major HAIs in the United States is $9.8 billion annually.

Stakeholders

As the proposed solution includes organizational change and nursing education, there are six main stakeholders to be included: a nurse leader, a human resources manager, a nursing educator, and two nurses with varied qualifications (e.g., an RN and an NP).

Determine Responsibility of Team Members

The management will be responsible for implementing organizational change and communicating it to nurses. A nurse educator will be responsible for providing the training needed to improve adherence to central line care guidelines. Finally, practicing nurses will be responsible for providing feedback during all stages of the change process to ensure change acceptance among other nurses.

Evidence

As part of the external evidence search, two new guidelines on HAI prevention were found. First of all, Loveday et al. (2014) offer evidence-based practice guidelines for preventing HAIs in hospitals. Also, Anderson et al. (2014) describe evidence-based practices for preventing surgical site infections. These evidence-based practice guidelines offer strong recommendations that can be used to review hospital guidelines for central line care and the prevention of HAIs.

Summarize the Evidence

The systematic review article focused on the role of preoperative care in the prevention of surgical site infections. Webster and Osborne (2015) found that preoperative treatment, such as bathing or showering with soap or skin antiseptics, did not have a significant impact on the incidence of surgical site infections. The evidence summary also found that infection prevention strategies, coupled with organizational change, innovation, and nursing education, helped to reduce central-line caused HAIs in the long term (Pronovost, Watson, Goeschel, Hyzy, & Berenholtz, 2015).

Develop Recommendations for Change Based on Evidence

Based on the research it is recommended to review hospital guidelines for preventing HAIs. In addition, it would be beneficial to use organizational change and nursing education to support the intervention.

Translation

Action Plan

First of all, nurse leaders should review the hospital’s guidelines for preventing HAIs based on recent evidence-based practice guidelines. Secondly, the management should develop a plan for organizational change that would promote innovation, communication, and support of new guidelines’ implementation. Thirdly, nurse educators should provide training and help to nurses to improve adherence to the new guidelines. The anticipated timeline for these steps is six weeks (two weeks on each step). After the implementation, medical data should be used to compare the rates of HAIs before and after the change. This is an ongoing process that should be repeated at least once every 1 or 2 months.

Process, Outcomes Evaluation, and Reporting

The desired outcomes of the process are the reduction of HAIs and improved adherence to guidelines, which can be measured based on medical records and nurse surveys. The results will be reported to the key stakeholders in a document consisting of graphs and written interpretations.

Identify Next Steps

This plan can be implemented on a larger scale by updating hospital guidelines for central line care throughout the organization. However, this will only apply to units where central line care is used, such as the ICU, acute care, and surgical units. To ensure that the implementation becomes permanent, it will be necessary to conduct regular evaluations and survey nurses to ensure compliance.

Disseminate Findings

The findings will be communicated internally using a report that will describe the intervention, outline the new guidelines, and provide results in graphs and writing. Externally, the results will be presented in the form of a scholarly article, which will describe the practice issue, methodology, findings, and conclusions reached as a result of the study.

Conclusion

Overall, poor adherence to guidelines increases the rate of hospital-acquired infections, thus compromising patient safety and increasing health care expenditures. The proposed change model takes into account individual and organizational factors that could affect adherence to guidelines among nurses. Using the ACE Star Model, it will be possible to collect evidence in support of new, evidence-based guidelines, as the model includes reviewing and evaluating evidence and updating policies as needed. The ACE Star model will also help to maintain the change plan using regular outcome evaluations and surveys.

References

Anderson, D. J., Podgorny, K., Berrios-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L.,… Kaye, K. S. (2014). Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(S2), S66-S88.

Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017). Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLoS ONE, 12(6), e0180473. Web.

Loveday, H. P., Wilson, J., Pratt, R. J., Golsorkhi, M., Tingle, A., Bak, A.,… Wilcox, M. (2014). National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection, 86, S1-S70.

Webster, J., & Osborne, S. (2015). Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database of Systematic Reviews, 2(CD004985), 1-35. Web.

Zimlichman, E., Henderson, D., Tamir, O., Franz, C., Song, P., Yamin, C. K.,… & Bates, D. W. (2013). Health care–associated infections: A meta-analysis of costs and financial impact on the US health care system. JAMA Internal Medicine, 173(22), 2039-2046.

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