Introduction

This paper will illuminate hospital-acquired infections and propose a detailed strategy to implement an evidence-based practice designed to improve patient care by mitigating these infections. Hospital-acquired infection (HCAI) is among the most frequent forms of adverse event to affect patient care. HCAI can contribute to pain, prolonged hospital stay and permanent impairment, and they can cause death. With limited data from community-based healthcare facilities at higher rates than in well-equipped facilities, the prevalence of such infections varies worldwide (Marques et al., 2017).Although all patients are vulnerable to these infections, their prevalence in the Intensive Care Unit (ICU) is exceptionally high. Most ICU patients are chronically ill and have suppressed immune due to injury, trauma or blood loss, which increases their susceptibility to infections. Also, mechanically ventilated ICU patients are at elevated risk due to tracheostomy, reintubation and multiple central venous catheters where lines and tubes can act as vectors for transmitting bacteria and result in ventilator-associated pneumonia.

Local Problem

Prevalent pathogens that have promoted drug-resistant and difficult-to-treat bacteria are Clostridium difficile, enterococci, Staphylococcus aureus, and improper use broad-spectrum antibiotics. Various infections, including abscesses, surgical site infections, urinary tract infections and endocarditis, are caused by aureus (MRSA)(Lewis et al., 2016).It is transmitted by the colonisation of the skin or nose, and direct contact with an infected person or environment. Similarly transmitted, Vancomycin-resistant contributes to urinary tract infections, skin or wound infections, and intra-abdominal infections. Some conditions cause diarrhoea following antibiotics administration and are transmitted via the faecal-oral route through an infected individual or environment. Empirical evidence suggests that the respiratory, abdominal, bloodstream and renal urinary tract are typical infection sites in the ICU. In this regard, the development and implementation of an evidence-based practice to combat and minimise hospital-acquired infections and associated morbidity and mortality rates is essential for healthcare facilities and practitioners.

Proposed Intervention

ICU nurses subject their patients to increased invasive monitoring and surveillance. Mechanically ventilated patients may have central venous catheters, arterial lines, intravenous catheters, urinary catheters, and post-surgical wounds (Samavedam, Reddy & Pande, 2020). All of these aspects escalate the exposure of infection transmission in a patient population with reduced immunity. Using an antibacterial solution that disinfects the entire skin area or body existing germs and bacteria can be destroyed quickly. Chlorhexidine’s ability to form a protective coat around the cleaned area increases its efficacy against hospital-acquired infections such as CLABSI, CRBSI, CAUTI and VAP in this highly susceptible population(Kumar et al., 2020).While Chlorhexidine is characterised by skin irritation, proper concentrations and integration with other disinfectants are likely to mitigate this problem and increase its bacterial potency. The inclusion of Chlorhexidine in various interventions, such as antibiotics and improved hospital hygiene, is expected to improve patient outcomes by dramatically reducing HCAI rates.

Change model: Kurt Lewin’s Change Implementation Model

Implementation of this evidence-based practice will adhere to Kurt Lewin’s change model that involves three steps: unfreezing, changing and refreezing.

1. Change-Facilitation and Buy-In Process

Before implementing the proposed technique, it must be unfrozen to create an awareness of how the current practice impacts patient comfort and extended hospital stay and permanent disability and even death(Burnes, 2019). At this stage, all healthcare stakeholders must be shown how the old approach has affected patient well-being and the subsequent burden of HCAI on healthcare services. Communication is of paramount importance during the unfreezing phase. It ensures that all healthcare providers are informed about imminent changes, the logic behind them and how they will improve patient care. After unfreezing healthcare providers, the change implementation process can start to transition the nursing process.

During the implementation phase, practising nurses are likely to be confused as they struggle with the new reality. This step is marked by confusion and anxiety, as individuals discover the latest practices, procedures and ways of thinking in delivering treatment. Knowledge, communication, encouragement and time are critical to healthcare as they become acquainted with Chlorhexidine in cleaning patients and their surroundings (Burnes, 2019).Refreezing is the final step defined after the transition by stabilising and solidifying the new state. In this process, it is necessary to ensure that patient care improvements are continued and that nursing does not return to the traditional approach to care delivery.

1. Anticipated Challenges in Change Implementation

While implementing the new practice is essential, resistance is expected as the new practice will disrupt the current status quo. Common problems include lack of experience, skills and understanding of nurses, nurses’ negative attitudes, and lack of confidence or competence in the use of EBP. Empirical evidence suggests that nurses are not flexible in using evidence-based practice tools and expect to use only the techniques they have studied at nursing colleges(Alatawi et al., 2020).The lack of autonomy in nursing has led to resistance in implementing evidence-based approaches in the world’s healthcare sector. Lack of understanding, experience, and expertise are also likely to hinder the reform’s adoption, as it significantly affects nurses’ behaviour as it disrupts the routine. At the organisational level, change implementation might be impaired due to lack of training and education, limited resources and time restriction.

Implementation Roadmap

Change Implementation road map

Ensuring a step-change improvement of quality care at a significantly lower cost necessitates that healthcare leaders to acknowledge that all stakeholders have a role to play. Implementation of the proposed strategy will attain the designed outcomes by:

Training existing nurses on needed skills

current healthcare providers need behavioural, teamwork, communication, flexibility, and critical thinking skills. All nurses will be trained on patient hygiene, particularly on using Chlorhexidine as an antibacterial and steriliser to bath admitted patients to safeguard them from HCAI, causing bacteria.

Implement new performance goals

Implementation of the new paradigm will necessitate healthcare facilities and nurses to reduce readmissions, VBP, individual performance, and concentrate on cross-care coordination and handoffs, patient communication effectiveness, and minimisation of patient utilisation.

Optimise process across facilities

Since the use of Chlorhexidine as a cleaning agent is a new phenomenon, healthcare facilities and nurses should prepare to revaluate and standardise their operating procedures across the entire health system to ensure consistency.

Sustain personnel engagement

Healthcare leaders must focus on availing executive actions, quality of care, and consistent training to ensure the new practice is sustained, and nurses do not revert to the old methods.

Conclusion

Summarily, implementing this evidence-based practise is essential in mitigating the adverse implications of HCAI on patients and the overall healthcare system. It is possible to avoid morbidity and mortality associated with such infections. Patients in the ICU are at high risk and enhancing the effectiveness of routine patient care and hygiene using Chlorhexidine to minimise the infection rates will benefit the healthcare system globally. Implementation of the recommendation strategy will attain the desired results if the implementation process adheres to Kurt Lewin’s change implementation model to ensure optimal and sustained stakeholders’ participation. Excellent communication strategies will ensure the implementation process overcomes anticipated challenges as all stakeholders will be aware of the anticipated benefits to them, patients and the entire healthcare system. In this regard, the proposed change is patient-centred as it is designed to enhance patient outcome by eliminating HCAI in ICU patients as they are the most vulnerable.

References

Alatawi, M., Aljuhani, E., Alsufiany, F., Aleid, K., Rawah, R., Aljanabi, S., &Banakhar, M. (2020). Barriers of Implementing Evidence-Based Practice in Nursing Profession: A Literature Review. American Journal Of Nursing Science, 9(1), 35. https://doi.org/10.11648/j.ajns.20200901.16

Burnes, B. (2019). The Origins of Lewin’s Three-Step Model of Change. The Journal Of Applied Behavioral Science, 56(1), 32-59. https://doi.org/10.1177/0021886319892685

Kumar, R., Arora, H., Singh, R., & Singh, K. (2020). To study the role of various preventive measures in reducing the device-associated infections in ICU. Indian Journal Of Clinical Anaesthesia, 7(3), 385-388. https://doi.org/10.18231/j.ijca.2020.070

Lewis, S., Butler, A., Evans, D., Alderson, P., & Smith, A. (2016). Chlorhexidine bathing of the critically ill for the prevention of hospital-acquired infection. Cochrane Database Of Systematic Reviews. https://doi.org/10.1002/14651858.cd012248

Marques, R., Gregório, J., Pinheiro, F., Póvoa, P., da Silva, M., &Lapão, L. (2017). How can information systems provide support to nurses’ hand hygiene performance? Using gamification and indoor location to improve hand hygiene awareness and reduce hospital infections. BMC Medical Informatics And Decision Making, 17(1). https://doi.org/10.1186/s12911-017-0410-z

Samavedam, S., Reddy, R., &Pande, R. (2020). Central Line Related Blood Stream Infections (CRBSI). In ICU Protocols (pp. 553-562). Springer, Singapore.