Introduction
Critical care environment such as intensive care unit (ICU) is a clinical environment where nosocomial infections are common. The nosocomial infections are common in the ICU due to invasive procedures that patients undergo when they receive therapy. Poor maintenance of hygiene while using medical devices such as syringes, catheters, and ventilators predisposes the ICU patients to nosocomial infections such bloodstream infections, pneumonia, and urinary tract infections (Helder, Brug, Loonman, Goudoever, & Kornelisse, 2010). This means that poor maintenance of hygiene is an educational deficit in prevention of nosocomial infections in a critical care environment. Vandijck, Labeau, Vogelaers, and Blot (2010) argue that, “the intensive care nurses can make a significant contribution in preventing nosocomial infections by assuming full responsibility for quality improvement measures such as evidence-based infection prevention and control protocols” (p. 251). Thus, education of critical care nurses regarding the adoption and utilization of evidence-based practices is imperative in prevention and control of nosocomial infections in the ICU. In this view, this essay develops an implementation plan of preventing and controlling nosocomial infections in the ICU by educating critical care nurses.
Method of Obtaining Approval
The critical care nurses are the major stakeholders in the implementation of the educational program because they work in the ICU and play a central role in prevention and control of nosocomial infections. Since poor adherence to evidence-based guidelines and protocols is partly responsible for the occurrence of nosocomial infections, Vandijck, Labeau, Vogelaers, and Blot (2010) recommend that increasing adherence of the critical care nurses to the guidelines and protocols is critical. Thus, seeking approval from the critical care nurses is necessary so that they can express their willingness to participate in the implementation of the educational program aimed at reducing nosocomial infections in the ICU. Moreover, since critical care nurses are the major stakeholders in prevention and control of nosocomial infections, their participation significantly determines the successfulness of the educational program.
When critical care nurses approve to participate in the educational program, the next approval is from the hospital and appropriate nursing body. In the hospital, approval of the ICU’s nurse manager is crucial because the manager is responsible for all activities that take place in the ICU. If the nurse manager approves the educational program, critical care nurses receive a managerial mandate to participate in the implementation of the educational program. Given that hospitals have a nursing department under the leadership of the chief nursing officer or director of nursing, departmental approval is essential. Chief nursing officer can liaise with the hospital and allows the implementation of educational program to take place in the hospital. Moreover, for nurses, nurse manager, and chief nursing officer to approve the educational program, approval from American Association of Critical Care Nurses is imperative. The approval from American Association of Critical Care Nurses enhances the urgency of the educational program among critical care nurses and the hospital.
Description of the Problem
Incidences of the nosocomial infections have been increasing in the ICU due to poor maintenance of hygiene in the use of medical devices such as syringes, catheters, and ventilators. Nosocomial infections in the ICU have a negative impact on the clinical interventions and nursing care that patients receive. Since critical care nurses ensure that patients receive appropriate therapies and health care, presence of nosocomial infections complicates health conditions of the patients and consequently treatment requirements. Additionally, nosocomial infections increase the length of stay and the cost of medical care. According to Safdar and Abda (2008), “approximately 2 million patients each year in the United States acquire nosocomial infections, resulting in some 90,000 deaths and adding an estimated $4.5 to $5.7 billion per year to the costs of patient care” (p. 933). Hence, there is a need to educate critical care nurses on how to maintain hygiene when using medical devices that increase the risk of nosocomial infections.
Deficit in the application of evidence-based practices that are in tandem with current preventive measures is an issue that the hospital needs to address. As a baseline preventive measure, the critical care nurses in the hospital employ conventional practices such as hand hygiene, cleansing of catheter sites, and sterilization of the medical devices. Despite using these conventional interventions in prevention and control of nosocomial infections, the incidence rates of the infections continue to remain high. The increase in the incidences of nosocomial infections is attributable to the deprived hygienic conditions of the ICU, poor maintenance of catheters and ventilators, improper use of antiseptics, and lack of antiseptic-impregnated catheters. Thus, the hospital needs to upgrade preventive and control measures of nosocomial infections in the ICU.
Detailed Explanation of the Proposed Solution
The implementation plan proposes that education of the critical care nurses about the evidence-based practices that are applicable in the prevention and control nosocomial infections is an effective solution. Evidence-based practices are necessary because they are effective and in tandem with current strategies for preventing and controlling nosocomial infections. Vandijck, Labeau, Vogelaers, and Blot (2010) assert that, “maintaining confidence in the capacity to deliver safe, high-quality, and evidence-based patient care will increasingly be a challenge to critical care nurses” because of advancement in science and technology (p. 251). Adoption of practices such as hand hygiene, maintenance of catheters, use of antiseptic-impregnated catheters, and good hygiene practice in the ICU are central in reducing prevalence of nosocomial infections among the ICU patients. In this view, for critical care nurses to keep abreast with innovations and inventions due to advancement in science and technology, they need to adopt and utilize evidence-based practices in prevention and control of nosocomial infections.
Rationale for Selecting Proposed Solution
The education of critical care nurses is an appropriate intervention for reducing incidence rates of the nosocomial infections in the ICU. The rationale for using education as a proposed solution is that it facilitates the adoption and utilization of evidence-based practices. Evidence-based practices are effective in prevention and control of nosocomial infections in the ICU because they forestall medical errors due to the use of opinions and assumptions, which are quite misleading. Lack of evidence-based interventions in the prevention of nosocomial infections compels critical care nurses to employ outdated interventions, which are not only effective, but also increase morbidity and mortality rates associated with the nosocomial infections. The education enables critical care nurses to update their knowledge and skills about current interventions for preventing nosocomial infections in the ICU. According to Safdar and Abda (2008), educational interventions have significant impact on reducing the rates of nosocomial infections in the ICU. Hence, educational intervention supports the adoption and the use of evidence-based interventions in prevention and control of nosocomial infections in the ICU.
Evidence from Literature Review
Nosocomial infections pose significant challenge to critical care nurses and endanger the lives of the ICU patients. To reduce the prevalence of nosocomial infections, numerous interventions exist, and one of the interventions is education of the critical care nurses on how to prevent and control the occurrence of nosocomial infections in the ICU. Although evidence-based practices exist in the literature, critical care nurses do not implement them because they lack sufficient knowledge and skills, thus leading to poor compliance with preventive measures that are critical in prevention and control of nosocomial infections (Barsanti & Woeltje, 2009). Therefore, to increase compliance and adherence to the evidence-based practices that are effective in preventing the occurrence of nosocomial infections, education of critical care nurses is essential. Constant education and assessment of nurses improve their knowledge and skills, thus helping nurses to prevention nosocomial infections effectively (Kollef, 2008). On this basis, the literature review recognizes education as one of the strategies of empowering critical care nurses to prevent occurrence of nosocomial infections.
Description of Implementation Logistics
Implementation of the educational program that aims at equipping critical care nurses with essential knowledge and skills derived from evidence-based practices consists of weekly seminars. As part of stakeholders, critical care nurses will be responsible for the implementation of the educational program. Critical care nurses will attend weekly seminars where they will receive updated preventive measures of nosocomial infections in the ICU. The educational program expects critical care nurses to apply knowledge that will be gained during each seminar in preventing nosocomial infections. Since the nurse manager is in charge of the ICU, the manager will be responsible for initiating the educational program and overseeing implementation of evidence-based practices gained during the seminar. Halm (2010) argues that the implementation of evidence-based practices requires leadership and administrative support. Thus, managerial role is necessary in the implementation of the educational program. The seminar will ensure that critical care nurses gain preventive measures of nosocomial infections that are in tandem with current evidence-based practices.
Resources Required for the Implementation
Speakers of the weekly seminars are important resources that the educational program requires. The educational program will select advanced practice nurses, from renowned hospitals, who have massive experience in a critical care environment so that they can provide insights about novel ways of preventing and controlling nosocomial infections in the ICU. A nurse manager is another critical resource because the manager aids in the preparation of educational materials such as handouts, PowerPoint presentations, questionnaires, and posters. Moreover, a nurse manager needs to conduct a survey before and after the seminars using questionnaires to assess the level of understanding of nosocomial infections’ preventive measures among critical care nurses. Pre-test and post-test surveys provide a means of assessing the impact of an educational program on the knowledge and skills of critical care nurses concerning preventive measures of nosocomial infections. The essential software tools are Microsoft Office tools for PowerPoint presentation and Statistical Package for Social Sciences (SPSS) for data analysis. Ultimately, successful implementation of the educational program requires about 3000 dollars.
Conclusion
The prevalence of nosocomial infections in the ICU increases morbidity and mortality rates of patients under critical care. Given that numerous interventions for preventing nosocomial infections exist, the education of critical care nurses is essential because they are important stakeholders in the critical care environment. Poor compliance with the available guidelines derived from evidence-based practices is an issue that has increased cases of nosocomial infections. Essentially, education enhances knowledge and skills of the critical care nurses as it ensures that they are updated with current evidence-based practices. Therefore, nurse managers need to organize educational seminars for the nurses in the ICU because they have great responsibility of reducing nosocomial infections in the critical care environment.
References
Barsanti, M., & Woeltje, K. (2009). Infection prevention in the intensive care unit. Infectious Disease Clinics of North America, 23(3), 703-725.
Halm, M. (2010). ‘Inside Looking In’ or ‘Inside Looking Out’? How Leaders Shape cultures equipped for evidence-Based Practice. American Journal of Critical Care, 19(4), 375-378.
Helder, O., Brug, J., Loonman, C., Goudoever, J., & Kornelisse, R. (2010). The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban neonatal intensive care unit: An intervention study with before and after comparison. International Journal of Nursing Studies, 47(1). 1245-1252.
Kollef, M. (2008). SMART approaches for reducing nosocomial infections in the ICU. Chest, 134(2), 447-456.
Safdar, N., & Abda, C. (2008). Educational interventions for prevention of healthcare-associated infection: A systematic review. Critical Care Medicine, 36(3), 933-940.
Vandijck, M., Labeau, O., Vogelaers, P. & Blot, I. (2010). Prevention of nosocomial infections in intensive care patients. Nursing in Critical Care, 15(5), 251–256.