NURS FPX 8030 Assessment 4 Methods and Measurement

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Capella university

NURS-FPX 8030 Evidence-Based Practice Process for the Nursing Doctoral Learner

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Date

Methods and Measurement

Hospital-Acquired Infections (HAIs) are a serious security concern in Intensive Care Units (ICUs), where natural sensitivity to severe sickness procedure intrusions is increased. In Memorial Regional Hospital, HAIs are a severe problem in ICU patients. According to 2023 figures, the frequency of Central Line-Associated Bloodstream Infections (CLABSI) and Catheter-Associated Urinary Tract Infections (CAUTI) were 0.554 and 0.925 per 1,000 device days, correspondingly exceeding national standards (Leapfrog, 2024).

Addressing HAIs among patients in ICU settings is a pressing issue in medical settings, which is frequently exacerbated by poor HAI prevention techniques such as Hand Hygiene (HH) policies and HH compliance among hospital staff. The paper aims to assess the effectiveness of HH protocol interventions using evaluation tools. Instruments were chosen based on their validity and supporting techniques, which provide a solid platform for assessing and enhancing HH practice compliance. Employing these tools aids in preventing HAI among patients admitted to the ICU by showing compliance levels and improving patient safety outcomes.

Instruments Used for the Effectiveness of Interventions

HAI is a safety and quality problem, especially in ICU patients, which requires an effective strategy based on HH protocol to answer the PICO(T) inquiry: In ICU patients at Memorial Regional Hospital (P), how does the implementation of Hand Hygiene (HH) protocol (I), as compared to current practices (C), affect the rate of HAIs (O) over 12 weeks (T)? HH protocols typically involve washing hands with soap, utilizing alcohol-based disinfectants, wearing gloves, and caring for skin to prevent infections (Buković et al., 2021). Adherence to proper HH measures is an effective intervention for preventing infection spread in hospitals.

It is critical to evaluate the effectiveness of solutions in addressing safety concerns and bringing about practice change in the hospital context. The success of an intervention can be assessed by utilizing tools that provide quantitative and qualitative information on HAI risks, HAI rates, and intervention compliance rates via surveillance and feedback. The chosen tools are: 

Hand Hygiene Self-Assessment Framework 

The Hand Hygiene Self-Assessment Framework (HHSAF) tool, created by the World Health Organization (WHO) in 2009, is valuable in assessing the intervention efficacy and sustainability of HH practices in medical facilities. The evaluation framework utilizes a mixed-methods approach involving qualitative adherence assessments with quantitative infection rates. The HHSAF is a self-reported survey created to gather an organized context evaluation of HH organizational structures, assets, promotions, or procedures in hospitals. The tool is validated to measure HH adoption levels linked to HAI rates (Kraker et al., 2022).

The present approach to applying the HH protocol intends to reduce HAIs among ICU patients; the HHSAF tool would help evaluate whether and how everyday HH practices are being accomplished and retained. Research by Kraker et al. (2022), has demonstrated its validity and accuracy and is credible. The reliability ensures that the data acquired is accurate and can be used to make informed choices about the efficacy of HH procedures. The framework entails 27 indicators in five categories, with the highest grade of 500 points: organizational change, staff training, assessment and feedback, HH practice alerts in the workplace, and organizational safety (Kraker et al., 2022).

Personnel can track changes in HH practices by using the HHSAF regularly before and after implementing the HAI prevention strategy. The tool divides hospitals into four levels based on compliance practices: insufficient (0-125), basic (126-250), moderate (251-375), or outstanding (376-500). The tool identifies current HH status and hospital development opportunities for HAI avoidance (Kasujja et al., 2024).

Infection Control Assessment Tool

The Infection Control Assessment Tool (ICAT) is an evaluation tool developed by the Centers for Disease Prevention and Control (CDC) that assesses HAI interventions, such as hand washing with soaps and sanitizer, utilizing Alcohol-Based Hand Rubs (ABHR), and protective supplies like gloves. The framework is crucial to assessing the efficacy of HH protocol interventions in HAI prevention in an ICU setting. The tool helps hospitals identify, manage, and prevent HAIs. HAI is simple to administer and assess, highlighting points of concern and recommending cost-effective solutions (USAID, n.d.).

The credibility and applicability are confirmed by its formulation and comprehensive analysis tool by CDC. Utilizing the ICAT will help evaluate whether daily HH practices have been performed and maintained. The incompliance with HH practices will be identified. The tool consists of modules adapted to various medical settings, including the ICU. The evaluation tool comprises 21 categories measuring infection avoidance and hospital management actions. The modules address many infection prevention themes and can be customized to align with standard guidelines and available resources in medical settings (USAID, n.d.).

The ICAT incorporates quantitative analysis approaches to measure compliance rate and incidence of HAIs, using checklists to measure HAI avoidance domains such as HH; the scale ranges from full adherence to nonadherence to HAI prevention practices. The validity of the tool is exhibited by evidence such as Abed and Eldesouky (2020),  have adopted ICAT to analyze the efficacy of HAI prevention solutions. ICAT provides a practical framework for baseline evaluation, intervention, and tracking of infection avoidance initiatives. Using ICAT ensures an extensive assessment of measures for infection prevention, improving patient security and minimizing the incidence of HAIs.

Relevant Studies

Relevant literature has supported the reliability and efficacy of tools to assess HAI avoidance programs’ success and adherence. For instance, Sakihama et al. (2020), conducted research utilizing the HHSAF tool, aiming to assess the long-term effectiveness of a comprehensive HH intervention on HH compliance rates among medical staff at five Japanese hospitals. Using HHSAF, the researchers closely monitored and observed HH compliance before and after the HH intervention. The results demonstrated that healthcare workers’ HH compliance rate increased from 18.1% to 32.8%, reducing HAIs.

The hospitals’ HHSAF scores, graded by HH compliance, reveal that hospitals A and B scored 336 and 291, moderate, respectively, while hospital C showed a basic score of 232.8. Further, Kraker et al. (2022), validated the effectiveness of the HHSAF in determining the level of HH adoption and its drivers in hospitals. The findings revealed that the HHSAF score implied an HH adoption level (350 points). Institutional change possessed the greatest score (86 points), indicating that alcohol-based hand rubs during care are a consistent practice in medical facilities to avoid HAIs.

NURS FPX 8030 Assessment 4 Methods and Measurement

The research by Abed and Eldesouky (2020), highlighted the efficacy and validity of ICAT by utilizing these tools to assess the HH practices among the nursing staff of Benha University Hospital for HAI avoidance. The study found that 7.2% of nursing staff come into class A and accurately follow proposed HH practices, 74% in class B, where HH protocol is typically followed, and 18.9% in class C, which needs staff training for HH practice adherence. The research shows the effectiveness of ICAT in analyzing the intervention adoption and offers insight for further improvement for effective HAI control.

Further, the study by Johnson et al. (2020), identified a significant improvement in HH compliance and a reduction in HAI rate, demonstrating the credibility of ICAT in assessing the impact of the intervention. The study analyzed the effect of a Unit-based Safety Program (UBSP) on boosting HH adherence to avoiding HAIs. The study revealed that medical staff compliance with HH practices increased from 59% to 71% after the CUSP intervention for HAI infection control and prevention. The underlined results demonstrate the tool’s effectiveness in assessing compliance with infection prevention measures relevant to the present HH protocol intervention.

The Rationale of Selection of Studies

The studies’ rationales establish their relevance to the subject or PICO(T) inquiry and the intervention for the quality enhancement project. The HHSAF and ICAT were used to measure intervention efficacy and medical staff compliance with HH guidelines because of their known validity, precision, and related approaches. The HHSAF provides a solid framework for rigorously monitoring and analyzing the implementation level of interventions such as HH, which is crucial for assessing progress over time.

Sakihama et al. (2020), demonstrate its exceptional credibility by declaring that HHSAF effectively analyzes the long-term efficacy of infection prevention methods like HH practices. Further, Kraker et al. (2022), present continuous obtaining data using HHSAF, making it suitable for recurring evaluations of execution level and staff compliance to boost the success rate of intervention and provide information on improvement over time. These studies are similar and relevant to the PICO(T) inquiry and improvement project, emphasize the prevention of HAI, and use an HH protocol intervention.

NURS FPX 8030 Assessment 4 Methods and Measurement

ICAT helps to check compliance with HH practices in different medical settings. As stated by Abed and Eldesouky (2020), it provides an extensive assessment of intervention efficacy. The study is similar in that it covers hospital infection in healthcare settings and uses similar techniques. Furthermore, Johnson et al. (2020), found that employing identical tools for assessing HH compliance among staff resulted in consistency and similarity.

The dissimilarity between the project or PICO (T) query and study resides in a different context or care setting.   The study focused on UBSP intervention to boost HH compliance,  whereas the present initiative focuses on HH protocols, resulting in a different intervention scope but a similar observation approach. The only discernible difference between previous representational research and the present project is particular intervention. However, the concurrent use of structured instruments for monitoring HAI control compliance is consistent with the project’s goals.

Summary

Managing the HAI issue in medical facilities using HH protocol solutions is critical to optimizing patient results. Tools like HHSAF and ICAT are beneficial for evaluating solutions’ effectiveness and protocol adherence to prevent HAI among ICU patients. The rigorous and quantitative data provided by these tools help to develop a cohesive strategy to improve HAI preventative intervention and minimize HAI incidences in hospitals like Regional Memorial Hospital. The use of these instruments is supported by findings from the literature, which demonstrate their utility in previous studies. Using these techniques to evaluate the effectiveness and performance of interventions in medical institutions can improve HAI avoidance efforts while achieving better patient security outcomes.

References

Abed, N. T., & Eldesouky, R. S. (2020). Infection control: Hand hygiene practices among nurses in the neonatal intensive care unit at Benha University Hospital. The Egyptian Journal of Hospital Medicine, 80(1), 619-626. https://dx.doi.org/10.21608/ejhm.2020.92540

Buković, E., Kurtović, B., Rotim, C., Svirčević, V., Friganović, A., & Važanić, D. (2021). Compliance with hand hygiene among healthcare workers in preventing healthcare associated infections–A systematic review. Journal of Applied Health Sciences, 7(1), 57-69. https://doi.org/10.24141/1/7/1/6

Johnson, J., Latif, A., Randive, B., Kadam, A., Rajput, U., Kinikar, A., & Milstone, A. M. (2020). Implementation of the comprehensive unit-based safety program to improve hand hygiene in four NICUs in Pune, India. Infection Control & Hospital Epidemiology, 41(S1), s8-s10. https://doi.org/10.1017/ice.2020.480

NURS FPX 8030 Assessment 4 Methods and Measurement

Kasujja, H., Waswa, J. P., Kiggundu, R., Murungi, M., Kwikiriza, G., Bahatungire, R., & Niranjan Konduri. (2024). Enhancing infection prevention and control through hand hygiene compliance in six Ugandan hospitals using quality improvement approaches. Frontiers in Public Health, 12(2024), 1465439. https://doi.org/10.3389/fpubh.2024.1465439

Kraker, M. E., Tartari, E., Tomczyk, S., Twyman, A., Francioli, L. C., Cassini, A., & Pittet, D. (2022). Implementation of hand hygiene in health-care facilities: Results from the WHO hand hygiene self-assessment framework global survey 2019. The Lancet Infectious Diseases, 22(6), 835-844. https://doi.org/10.1016/S1473-3099(21)00618-6

Leapfrog. (2024). Hospital details table. Hospitalsafetygrade.org. https://www.hospitalsafetygrade.org/table-details/memorial-regional-hospital

NURS FPX 8030 Assessment 4 Methods and Measurement

Sakihama, T., Kayauchi, N., Kamiya, T., Saint, S., Fowler, K. E., Ratz, D., & Tokuda, Y. (2020). Assessing sustainability of hand hygiene adherence 5 years after a contest-based intervention in 3 Japanese hospitals. American Journal of Infection Control, 48(1), 77-81. https://doi.org/10.1016/j.ajic.2019.06.017

USAID. (n.d.). Infection Control Assessment Tool (ICAT): A standardized approach for improving hospital infection control practices. USAID.gov https://pdf.usaid.gov/pdf_docs/PNADK023.pdf