Specific area of care practice

Discuss about the clinical care practices and the various methods adopted within an acute care setup.

The current assignment focuses upon specific clinical care practices and the various methods adopted within an acute care setup. The focus is upon use of evidence based practices which helps in improving the overall quality of care. However, a number of barriers are faced in the implementation of evidence based practices. Some of these could be attributed to the lack of sufficient knowledge and skills within the healthcare staffs. Additionally, difference of opinions between different members of a healthcare team often makes implementation of the evidence based practices difficult. For the current assignment, a post operative set up of care has been taken into consideration with an emphasis upon maintaining effective hand hygiene.  The effective guidelines or standards of hand hygiene are often not effectively followed up within a post –operative setup, which further increases the chances of infection post surgery. The assignment tries to uncover the detailed methods and procedures which could be implemented to ensure safe practices within an intensive care unit, as most of the times the basic guidelines are not 100% effective.

In the current practice, a post operative care setup has been taken into consideration.  A patient admitted within an intensive care unit or discharged from the same after surgical process often undergoes a number of clinical complications.  As mentioned by Grile  et al. (2016), some of the post –operative complications arises due to failure in keeping up with the safety measures. With regards to hand hygiene one of the most important clinical criteria, which could be discussed over here is healthcare associated infections.  One of this is Staphylococcus aureus bacteraemia (SAB) which causes an infection of the bloodstream. It results in longer hospital stay and could often lead to fatal consequences. The bacteria are commonly found in the skin or in the nose are spread from person to person.  As reported by Labrecque  et al. (2016), the transmission mostly occurs through the hand of the healthcare workers. The bacteria can gain direct entry into the bloodstream through the patient’s wound. The chances of coming in contact with the pathogen is high while giving intravenous fluids or taking blood samples. The patients who are at greater risk of infection are the ones with open wounds, invasive devices such as catherers, weakened immune systems etc (White et al. 2016). Sometimes the SAB could results in surgical site infections   resulting in longer hospital stays and longer tome of recovery.

PICO question

Therefore, in order to ensure safe clinical practice sufficient amount of importance needs to be given on implementing and practising effective hand hygiene methods.   As reported by Ranjan  et al. (2017), between 15-40% people admitted in critical care could be thought to be affected by healthcare associated infections. One in every 136 patients is prone to be infected by pathogens in critical care. The fatality rate is between 4-56% and requires high degree of care and attention. The  hand hygiene is   pivotal  to implement safe and effective clinical care practices  and could be implemented through a number of steps such as-  using  alcohol based hand rubs  at the point of  patient care, education  of healthcare workers on correct hand hygiene techniques, display of hand  hygiene  reminders (Pop-Vicas et al. 2017).

A PICO question could be developed over here with regards to practising effective hand hygiene standards in clinical care. Here, PICO refers to Population, Intervention, Comparison and Outcome. The question could be represented below as:

Does health workers   (P) using effective hand washing techniques (I) compared to use of simple soap and water in post-operative setup (C) reduce the rate of healthcare associated infections (O)?

For the current study, secondary research has been conducted where data has been conducted from evidence based studies.  For the collection of data evidence based journals have been extracted from a number of secondary databases such as PUBMED, NCBI etc. Additionally, a strict search criteria have been followed that is articles from only the last seven years have been taken into consideration. The articles published prior to that have been excluded from the study design.  For the study purpose of study, only the articles published in English have been taken into consideration. The articles published in any other language than English have been excluded. The articles have been reviewed for the identification of similar themes which have been further used for doing a thematic analysis. The various ideas have been further compared for the identification of dissimilar data. These further form the point of comparison between the different article sources. The difference has been used for the identification of loopholes within the research.

In this respect, an evidence based study has been conducted where the research papers selected belong to the highest level of evidence. That is the most of the papers selected over here use systematic review,   randomised control trials and cohort groups.

Summaries of evidences chosen

Article 1: Luangasanatip, N., Hongsuwan, M., Limmathurotsakul, D., Lubell, Y., Lee, A.S., Harbarth, S., Day, N.P., Graves, N. and Cooper, B.S. 2015, ‘ Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis’, bmj, vol. 351, p.728.

The study undertaken over here was aimed at testing the effectiveness of WHO based interventions to promote hand hygiene   among healthcare workers. The design adopted here was systematic review and metanalysis. Therefore, it belonged to level 1 of the evidence based table. The data over here had been collected from a number of secondary databases such as MEDLINE, EMBASE, CINAHL and Cochrane library.

The review methods which had been adopted over here were randomised control methods .Additionally, network metanalysis were performed on studies reporting compliance with hand hygiene.

From the study, it had been concluded that promotion of hand hygiene was effective increasing compliance within healthcare workers. However, goal setting, rewarding schemes and accountability standards were effective in bringing about further improvements within clinical care and practice.

Article 2: Schweizer, M.L., Reisinger, H.S., Ohl, M., Formanek, M.B., Blevins, A., Ward, M.A. and Perencevich, E.N. 2013, ‘Searching for an optimal hand hygiene bundle: a meta-analysis’, Clinical infectious diseases, vol, 58, no. 2, pp.248-259.

The study aimed to find out optimal interventions for implementing hand hygiene. A number   of studies on interventions to improve hand hygiene had been evaluated over here to arrive at the best strategies for controlling the rate of healthcare infections. It consisted of six randomised control trials and 39 qausi experimental studies.  It evaluated a number of parameters like education provided to the healthcare staffs in intervention methods, hygiene reminders, feedback provided to staff on maintenance of hygiene, access to alcohol base hand rub.

A metanalysis was performed over here where evidence based literatures were collected from a number of secondary databases such as NCBI, PUBMED etc. The search was limited to the past 12 years. The Jadad score was used to access the quality of RCT. The scale created by Larson was used to access the quality of the observational studies. The results of the study concluded that evidence base supporting critical public health measure needs to be supported.

Article 3: Huis, A., van Achterberg, T., de Bruin, M., Grol, R., Schoonhoven, L. and Hulscher, M. 2012, ‘A systematic review of hand hygiene improvement strategies: a behavioural approach’, Implementation Science, vol.7, no. 1, p.92.

The study aimed to find the determinants of safe and effective behaviour within an acute care setup. It aims at finding out the several factors which promotes the healthcare workers to follow effective clinical care guidelines.

An experimental and quasi experimental study had been conducted over here in order to find out different hand hygiene improvement standards. Some of the most frequently accessed determinants over here are- knowledge, awareness, and action control. Some of the additional factors over here are social influence and intention. It was found  that addressing  combinations of different determinants were useful that  individual determinants in bringing about desired changes.

The different literature sources could be compared in order to arrive at a conclusive theory.   One of the theories presented by an article over here says that apart from promotion of hand hygiene, rewarding schemes and training on accountability standards could help in improving the  quality of  care (Manivannan et al. 2018).   As supported by Chatfield  et al. (2016), the motivation to effectively use or implement hand hygiene standards are dependent upon a number of determinants such as knowledge and awareness levels.  However as argued by Hickox  et al. (2017), in the lack of intrinsic motivation the quality of care provided by the healthcare staffs may differ.  Therefore, some of the factors such as rewards and incentive bonus can help in generating increasing levels of motivation within the nursing and healthcare professionals.  As argued by Edmonds-Wilson  et al. (2016), there are several incidents where the quality of care have affected on grounds of negligence. The negligence most often arises due to factors such as compassionate fatigue. As supported by Sankaran  et al. (2016), the compassionate fatigue arises due to long hours at work and when the healthcare professionals are handling too many patients at the same time. The pathogens could get transferred from the hands of the healthcare workers, as they often forget to wipe their hand with an alcohol rub on dealing with too many patients. Therefore, some of the factors which had been highlighted over here are development of knowledge and awareness within the patients.  For the purpose of which the hospitals should focus upon effective training procedures.  However, as supported by Singh  et al. (2017), the lack of infrastructure and resources can make the provision of training difficult. It could be also attributed to monetary deficits. As argued by Kos  et al. (2017), the lack of sufficient support from the stakeholders affects the overall quality of the support and care services. In this respect, conducting an audit of hand hygiene performances can also help in improving the quality of care services provided.

There are a number of barriers in the implementation of the evidence based practices. Some of these are lack of adequate amount of knowledge within the healthcare staff, lack of motivation, insufficient infrastructural support, lack of initiative from the management. It has been seen that the alcohol rub has been seen to reduce the chances of infection by almost 36% (Luangasanatip et al. 2015). 

However, there is lack of effective support from the   management and the trainers. Due to which the healthcare staffs often fail to learn the standard guidelines as well as implement them. Additionally, the lack of reminders from management also affects services standards. For example, washing hand with soap and water before and after handling patients. Additionally, alcohol based hand rub is the preferred way to prevent antisepsis in most cases. The care should be taken to not use soap and alcohol based hand sanitization concomitantly.

Therefore, some of these reminders could be provided to the healthcare workers on a regular basis in the lack of which the overall care quality may suffer. As mentioned by Manivannan  et al. (2018), lack of adequate infrastructure in government based hospitals also affects the quality of the services.  However, long working hours, overworked staffs and less pay are some of the other factors which can affect the quality of care.

Conclusion

The current report takes into consideration a post –operative care setting. The safety and cleanliness standards are very important within post –operative care. This is because within an acute care setup the chances of contraction of an infections very much high as one generally has lower levels of immunity. Some of the infections spread through SAB are very common and are mostly spreads by the healthcare workers, as they fail to follow effective hand hygiene standards.

Therefore, clinical audit along with provision of effective training and support to the healthcare staffs can help in improving the quality of care such as highlighting the importance of alcohol rub. In this respect, a number of barriers are faced such as lack of sufficient infrastructural support; lack of effective training along with longer work hours can further affect the quality of care. Therefore, evidence based practices along with ethical approaches in nursing can help in improving the overall structure of care.

References

Chatfield, S.L., Nolan, R.D. and Hallam, J.S. 2016, ‘ Hand Hygiene Intervention Design Recommendations Derived from a Cross Sectional Factorial Survey Given to 460 Acute Care Nurses’, American Journal of Infection Control, vol, 44, no. 6, pp.S5-S6.

Edmonds-Wilson, S.L., Pelz, R. and Moore, L.D. 2016,  ‘Electronic Hand Hygiene Monitoring with a Complementary Improvement Program Significantly Increases Hand Hygiene Rates’, American Journal of Infection Control, vol, 44, no. 6, pp.S6-S7.

Grile, J.R., Nguyen, C.H. and Gritters, D. 2016, ‘Evaluation of an Intra-Operative Bundle of Care Model in the Prevention of Surgical Site Infections among Colorectal Surgical Patients’,  American Journal of Infection Control, vol, 44, no. 6, p.S92.

Hickox, N., Clifton, L., Coe, C., Cox, F., Gardenhire, M., Goins, D., Hunter-Watson, H., Lewis, M., Maile, P., McKinney, C. and Thomas, H. 2017, ‘ Strategies to Reduce Central Line-associated Bloodstream Infections in a Critical Care Unit’, American Journal of Infection Control, vol.45, no.6, p.S112.

Huis, A., van Achterberg, T., de Bruin, M., Grol, R., Schoonhoven, L. and Hulscher, M. 2012, ‘A systematic review of hand hygiene improvement strategies: a behavioural approach’, Implementation Science, vol.7, no. 1, p.92.

Kos, M., Dziewa, A., Ksykiewicz-Dorota, A., Drop, B. and Kos, M. 2016, ‘Nursing care quality and post-operative wound infections’, Polish Journal of Public Health, vol. 126, no. 1, pp.13-18.

Labrecque, S., Patricia, B., Sauerland, C., Lauren, W., Tana, P., Bubb, T.N., Tedjarati, S., Chen, D. and Pua, T. 2016, ‘ Significant Reduction in the Rate of Surgical Site Infection (SSI) Post Abdominal Hysterectomy (AH) at an Academic Tertiary Care Hospital’, American Journal of Infection Control, vol. 44, no. 6, p.S25.

Luangasanatip, N., Hongsuwan, M., Limmathurotsakul, D., Lubell, Y., Lee, A.S., Harbarth, S., Day, N.P., Graves, N. and Cooper, B.S. 2015, ‘ Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis’, bmj, vol. 351, p.728.

Manivannan, B., Gowda, D., Bulagonda, P., Rao, A., Raman, S.S. and Natarajan, S.V. 2018, ‘Surveillance, Auditing, and Feedback Can Reduce Surgical Site Infection Dramatically: Toward Zero Surgical Site Infection’, Surgical infections, vol.19, no. 3, pp.313-320.

Pop-Vicas, A., Musuuza, J.S., Schmitz, M., Al-Niaimi, A. and Safdar, N. 2017, ‘ Incidence and risk factors for surgical site infection post-hysterectomy in a tertiary care center’, American journal of infection control, vol. 45, no. 3, pp.284-287.

Ranjan, K.P., Ranjan, N. and Gandhi, S. 2017, ‘ Surgical site infections with special reference to methicillin resistant Staphylococcus aureus: experience from a tertiary care referral hospital in North India’, International Journal of Research in Medical Sciences, vol, 1, no. 2, pp.108-111.

Sankaran, S.V., Rajagopal, G.K. and Achamkulangara, S. 2016, ‘Effects of antibiotic prophylaxis on surgical wounds: A study in a tertiary care centre of central Kerala’, Journal of The Academy of Clinical Microbiologists, vol, 18, no. 1, p.12.

Schweizer, M.L., Reisinger, H.S., Ohl, M., Formanek, M.B., Blevins, A., Ward, M.A. and Perencevich, E.N. 2013, ‘Searching for an optimal hand hygiene bundle: a meta-analysis’, Clinical infectious diseases, vol, 58, no. 2, pp.248-259.

Singh, S. 2017, ‘ Study To Assess The Effectiveness of Planned Post Operative Nursing Care Rendered By Registered Nurses To The Patients With Conventional Abdominal Surgery With Reference To The Patients Outcome In Selected Hospitals’, pp.106-212.

White, L.A., Brent, K., Eherenman, H. and Vance, C. 2016, ‘ Infection Prevention and Quality Coordinators Collaborating to Decrease Central Line Associated Blood Stream Infections (CLABSI) by Monitoring Central Line Catheter Maintenance’, American Journal of Infection Control, vol.44, no. 6, pp.S94-S95