Students should select a topic that aligns to their area of interest as well as the clinical practice setting in which practice hours are completed.

Write a 500-750 word description of your proposed capstone project topic. Include the following:

• The problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project that will be the focus of the change proposal.
• The setting or context in which the problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project can be observed.
• A description (providing a high level of detail) regarding the problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project.
• Effect of the problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project.
• Significance of the topic and its implications for nursing practice.
• A proposed solution to the identified project topic with an explanation of how it will affect nursing practice.

You are required to cite to a minimum of eight peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice. Plan your time accordingly to complete this assignment.

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Topic: Infection control in healthcare organization 

Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention used to address the problem must be a nursing practice intervention. Include a comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and specify the timeframe needed to implement the change process.  Formulate a PICOT question using the PICOT format (provided in the assigned readings) that addresses the clinical nursing problem.

The PICOT question will provide a framework for your capstone project change proposal.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Describe the problem in the PICOT question as it relates to the following:

• Evidence-based solution
• Nursing intervention
• Patient care
• Health care agency
• Nursing practice

1 Running Head: PICOT STATEMENT PICOT Statement Paper Joe Blow Grand Canyon University: NRS-493-0501 Sometime this year PICOT STATEMENT 2 PICOT Statement Paper PICOT Statement For patients with a private room within the Emergency Department (P), will the use of privacy door blinds (I), compared to those that utilize privacy room curtains (C), have decrease in cross-contaminations (O)? Clinical Problem The Emergency Department (ED) consists of 15 small rooms with private doors but open windows with a hanging cloth curtain providing patient privacy. The curtain hangs from the ceiling directly at the foot of the patient’s bed. This makes the curtain a high touch area as it must be frequently moved to get around the patient’s bed to provide quick and appropriate care. Bedrails, intravenous poles, sinks, bedside tables, and privacy curtains are all in the top 10 hightouch items in the healthcare setting (Cheng et al., 2015). Quick and high turn-over of the department leaves ED staff members to quickly clean the rooms prior to the next patient entering. After cleaning, one high touch item remains – the privacy curtain hanging from the rod in the ceiling. Hospital privacy curtains have statistically been known to harbor germs bacteria and viruses. Common hospital-acquired pathogens such Vancomycin Resistant Enterococcus (VRE), Methicillin resistant Staphylococcus aureus (MRSA), Escherichia Coli (E.Coli), Clostridium difficile (C-diff), influenza, and the Rota virus (Carikas & Matthews, 2019). Evidence-Based Solution Several studies have been conducted to determine which type of privacy curtain will help slow and prevent growth. There have also been studies regarding how often curtains should be changed to decrease the likelihood of cross contamination. There have even been studies on who touches the curtain most often and where the curtain is most touched. At the end of each study it PICOT STATEMENT 3 is concluded that all types curtains regardless of how often they were changed had a high risk of cross-contamination. It is also decided, “Ideally, curtains could be eliminated from hospitals, but for the sake of privacy and convenience, and without feasible alternatives, this seems improbable for the time being” (Brown, Siddiqui, Mcmullen, Waller, & Baer, 2020). Implementation of privacy blinds or opaque glass doors (Brown et al., 2020) would eliminate the high touch items reducing the risk of infection. Privacy blind installation would be more cost efficient than changing out the door/windows. Patient Care Privacy curtains increase the risk of infection, delay patient care, and create periods of complete patient exposure. Since the rooms are small and the curtains invade patient space, they are frequently being touched and moved by healthcare workers, patients, and family (Cheng et al., 2015). Healthcare workers continuously move the curtain (breaking hand hygiene compliance) to move around the patient and provide care on both sides (Ohl et al., 2012). Open and closing the curtain to move around often leaves the patient completely exposed for a short period of time. Nursing Intervention Implementation of privacy curtains would be applied by engineering. Nursing wise hand hygiene compliance and utilizing appropriate patient privacy with blinds are key interventions. The primary concern with the removal of privacy curtains is maintaining patient privacy. When individual rooms are an option, utilization of the blinds would remove the element of a potential cross contamination. Nursing intervention is to provide privacy by knocking and waiting for a response prior to entering. In addition, it is important to keep doors and blinds closed unless in a situation that requires close monitoring. PICOT STATEMENT 4 Health Care Agency Most facilities have a cleaning or changing schedule for curtains based on availability of replacements, intervals, or when visibly soiled (Woodard, Buttner, Cruz, & Roeder, 2018). The infection preventionist at this facility reports the current guidelines are for Emergency Department curtains to be replaced every 6 months or if visibly soiled. Isolation/COVID-19 rooms must be terminally cleaned by environmental services and have different style of curtains that can be sprayed/cleaned more easily than the fabric counterparts. Implementation of curtains that are able to be cleaned as easily as other high touch areas would change the current cleaning guidelines. Nursing Practice Currently, healthcare providers complain about the privacy curtains “being in the way” and causing a delay in care. Raising concern for the safety of our patients and creating an argument for removal of privacy curtains is key. Implementing and utilizing privacy blinds appropriately will provide more space for patient care and family involvement while decreasing the risk of cross-contamination. PICOT STATEMENT 5 References Brown, L., Siddiqui, S., Mcmullen, A., Waller, J., & Baer, S. (2020). Revisiting the “leading edge” of hospital privacy curtains in the medical intensive care unit. American Journal of Infection Control. doi: 10.1016/j.ajic.2020.03.015 Carikas, K., & Matthews, S. (2019). Hospital Privacy Curtains -- What’s hanging around? Dissector, 47(1), 20–22. Cheng, V., Chau, P., Lee, W., Ho, S., Lee, D., So, S., … Yuen, K. (2015). Hand-touch contact assessment of high-touch and mutual-touch surfaces among healthcare workers, patients, and visitors. Journal of Hospital Infection, 90(3), 220–225. doi: 10.1016/j.jhin.2014.12.024 Ohl, M., Schweizer, M., Graham, M., Heilmann, K., Boyken, L., & Diekema, D. (2012). Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria. American Journal of Infection Control, 40(10), 904-906. doi:10.1016/j.ajic.2011.12.017 Woodard, D., Buttner, M., Cruz, P., & Roeder, J. (2018). Microbial contamination of privacy curtains in the emergency department of a metropolitan hospital. Journal of Hospital Infection, 100(3). doi: 10.1016/j.jhin.2018.06.018
 

Infection Control in Healthcare Organization

Introduction: Problem Statement

            Healthcare-acquired infection (HAIs) is among the key safety concerns for both patients and clinical practitioners in all contexts of healthcare services. Generally, Healthcare acquired infections, also known as nosocomial infections, refer to infections that patients and clinical personnel get while receiving or providing healthcare treatment services for surgical or medical conditions (Kuhar et al., 2018). HAIs are shown to increase healthcare costs through increased morbidity and mortality in various areas of healthcare provision. As well, it is shown to increase healthcare costs by prolonging healthcare stays. In this light, despite significant progress has been achieved in the prevention of healthcare-associated infection, the prevalence of HAIs in various hospital settings is still alarming, thus presenting the need for effective infection control strategies accordingly.  

Setting/Context

            Fundamentally, all hospitalized patients are vulnerable to contracting HAIs, where certain patients face a greater risk than others like the elderly and young children and patients with compromised immune systems. Furthermore, alongside HAIs emanating from cross-contamination between clinical healthcare personnel and patients, surgical wound infections, and diminished immunity, catheter-associated urinary tract infection (UTIs) is among the common incidences of healthcare-acquired infections in hospitals (Haque et al. 2018). This assertion is supported by a report by the CDC, where they estimated that 32 percent of HAI incidences in the US encompassed catheter-associated urinary tract infections.

Similarly, catheter-associated urinary tract infections are associated with substantial financial implications as well as increased morbidity and mortality rates in hospitals (Hollenbeak & Schilling, 2018). Hence, catheter-associated urinary tract infections stand out as a significant healthcare issue that can be efficiently addressed by practicing appropriate catheter use in clinical settings. Specifically, effective infection control practices enable healthcare organizations to substantially improve the quality of healthcare provision, improve patient satisfaction, and reduce the healthcare costs associated with such incidences within healthcare settings.

Description of the Issue

            Catheter-associated urinary tract infection (CAUTI) is one of the most common infections that clinical practitioners encounter daily during their clinical practice at hospitals and primary care units around the world. Statistically, UTIs account for about 36 percent of healthcare-associated infections, whereby 80 percent of these cases are associated with inappropriate catheter use in hospitals and primary care units (Parker et al., 2017). Nevertheless, many UTIs in the healthcare setting are largely preventable when appropriate infection control strategies are implemented to support related clinical practices.

Particularly, high incidences of catheter-associated urinary tract infections in hospitals are because of inappropriate urinary catheter use and treatment practices. As a result, these cases of catheter-associated UTIs lead to potentially substantial patient distress, discomfort, embarrassment, pain, and mobility restrictions alongside increased healthcare costs, care burden, and hospitalization. Particularly, Letica-Kriegel et al. (2019) assert that most healthcare-acquired CAUTI incidences in hospital settings were associated with the duration of indwelling urinary catheters (IUC). This involved inadequate knowledge of clinical personnel concerning the placement of an IUC, delayed removal of ICUs, and inadequate observance of hand hygiene practices.

Effects of the problem

Generally, catheter-associated urinary tract infection, as a prevalent HAI, is associated with substantial financial implications as well as increased morbidity and mortality rates in hospitals (Hollenbeak & Schilling, 2018). Research conducted by the Agency for Healthcare Research and Quality (AHRQ, 2017) shows that the annual additional costs of healthcare services that adult inpatients incur due to avoidable catheter-associated UTIs were estimated to be about $13,793. Moreover, Brusch & Bronze (2021) show that catheter-based nosocomial UTIs were shown to increase hospital stays among patients, further increasing healthcare services' costs. This further impacts the quality of care provided since patients felt unsatisfied with the provided care. Nevertheless, appropriate healthcare guidelines and practices will enable healthcare organizations to minimize the incidences of these infections and improve the general patient treatment outcome.

 Significance and implication for nursing practice

Effective infection control strategies in healthcare settings are essential as they will help manage the occurrence of catheter-based nosocomial UTIs within hospitals. With regard to the nursing practice, the main goal is to increase the quality of healthcare services provided to patients. However, cases of catheter-based nosocomial UTIs and other types of hospital-acquired infections affect the attainment of this goal. Contextually, clinical practitioners are responsible for offering competent healthcare services by adhering to the established infection control guidelines intended to prevent the occurrence of healthcare-acquired infections among themselves and patients (Assadi, 2018). As well, guidelines promoting a high level of hygiene and catheter placement, removal, and maintenance should be adhered to by nurses and other clinical staff to support the prevention of HAIs incidences in hospital settings. Primarily, infection control guidelines act as the foundation for fostering patient safety within healthcare settings.

Proposed Solution

Hence, the proposed practice intervention for catheter-associated nosocomial UTIs involves establishing effective training and education programs for clinical practitioners to enhance their competence in the medical handling, placement, maintenance, and removal of indwelling urinary catheters. This will facilitate continual improvements in healthcare practices and infection control strategies aimed at preventing CA-UTIs and other healthcare-acquired infections within healthcare settings (Haque et al. 2020). Moreover, the infection control program encompassing the facilitation of training and education on appropriate catheter use will also aim to increase clinical staffs’ awareness of control practices, including optimal hand hygiene practices, collaboration and communication, and use of evidence-based practices to prevent the occurrence of healthcare-acquired infections.

PICOT Statement

For adult patients undergoing long-term care programs within a hospital setting (P), how does the implementation of a health administration protocol for supporting nurse training and education on appropriate catheter-use integrated with a collaboration approach (I), compared with no protocol (C), influence an increased capacity to prevent the incidence of catheter-associated urinary tract infection (CAUTI) in the hospital (O), over a one-year post-intervention period (T)?

Clinical Problem

Catheter-associated urinary tract infection (CAUTI) is shown as among the most common infections that clinical practitioners encounter daily during their clinical practice at hospitals and primary care units around the world. Statistically, UTIs account for about 36 percent of healthcare-associated infections, whereby 80 percent of these cases are associated with inappropriate catheter use in hospitals and primary care units (Parker et al., 2017). Similarly, Kakkar, Bala & Arora (2021) argue that the high incidences of CA-UTI in hospitalized patients under long-term care programs are mainly associated with poor adherence to clinical practitioners' recommended infection control guidelines. Scenarios such as delayed removal of indwelling urinary catheters, ineffective catheter sterilization, and improper catheter insertion are shown as the common risk factors for catheter-based nosocomial UTI within hospitals. Moreover, such risk factors can be effectively prevented through training and education on the appropriate use of catheters (removal, duration, and insertion), including proper handwashing practices (Mitchell et al., 2017). Moreover, the training and education will also involve promoting a collaborative and multidisciplinary team approach to developing and implementing infection control guidelines and strategies to minimize the incidence of CAUTI and other healthcare-acquired infections.  

Evidence-Based Solution

Various researches have been performed to determine effective infection control interventions that efficiently reduce the incidences of catheter-based nosocomial UTIs among long-term care patients within healthcare settings (Khan et al., 2017). As well, some studies have also examined the best clinical practices for the insertion, removal, duration, sterilization of catheters to decrease the likelihood of CAUTIs in hospital-based long-term care programs (Kakkar, Bala & Arora, 2021). Some studies show that antibacterial prophylaxis treatments are ineffective in managing healthcare-acquired catheter-based UTIs among patients, particularly asymptomatic patients (Wawrysiuk et al., 2019). Generally, most recent research concluded that education and training increase the awareness of clinical staff on the established and suitable infection control guidelines for preventing catheter-associated UTIs. Furthermore, training also enhanced adherence of clinical practitioners to best catheter-use practices and supported effective collaboration and implementing multidisciplinary collaborative team models to control nosocomial infections in healthcare settings. This was based on the premise that continual training and education on HAIs prevention guidelines improved the attitudes and knowledge of the clinical staff on infection control and ability to collaboratively address the issue, which also led to substantial long-term improvements in the reduction of incidences of nosocomial infections (Kuhar et al. 2019).

Patient Care

The recommended intervention on enabling continual training and education on best catheter use and treatment guidelines and practices to prevent the incidence of catheter-associated nosocomial UTIs will enhance the quality of care offered by clinical practitioners. This involves increasing patient satisfaction with the care provided, where the costs associated with nosocomial infections will be effectively managed. Furthermore, hospital stays for patients under long-term care will be significantly reduced, and thus further reducing the healthcare costs associated with a patient's treatment. Moreover, a multidisciplinary collaborative approach will optimize healthcare delivery, enhancing the patient’s ability to receive quality healthcare services (Assadi, 2018).

Nursing Intervention

Continual training and education on best catheter use and treatment guidelines and practices shall act as a nursing intervention for enhancing the quality of healthcare provision and clinical practices. This is because it will increase awareness and adherence to infection control guidelines by nurses in their clinical practices. This involves enhancing adherence to appropriate hand hygiene practices and insertion, duration, and removal of indwelling urinary catheters. Hence, the nursing intervention encompasses increasing awareness of HAI control guidelines and promoting a multidisciplinary model to support healthcare service delivery.

Health Care Agency

As well, continual training and education practices will also improve the attitudes and awareness of infection control strategies in healthcare organizations. This will involve enabling healthcare administrators to actively support the development and implementation of established infection control strategies in healthcare organizations. Healthcare agencies will also improve existing communication channels to support multidisciplinary team collaboration to develop, implement, and measure the performance of infection control mechanisms in healthcare settings.  The practice change will also enhance cooperation between health care agencies to develop effective models to efficiently integrate infection control guidelines with competent healthcare service delivery in healthcare organizations.

Nursing Practice

  Continual training and education practices on proper catheter use and nosocomial UTI prevention guidelines will substantially improve the nursing practices and healthcare delivery to patients under long-term care practices. This aligns with the main goal of the nursing practice, which involves increasing the quality of healthcare services provided to patients. Similarly, the practice change will increase the nursing practice’s level of accountability on offering competent healthcare services and following the established best nursing practices that prevent the occurrence of healthcare-acquired infections among themselves and patients (Haque et al., 2018). The nursing practices will also integrate infection control guidelines and thus act as the foundation for ensuring patient safety within healthcare settings.