Quality

Improvement

Reducing Health Care

Associated Infections

NURS 362

Cody Gibo
Sylvia Lee
Meagan Kubo
Janalynn Rollins

Summery of Problems
HAIs are a major problem because
they increase length of stay, rates of
patient morbidity, and cost the
hospitals $33 billion per year
(ASTHO, 2011)
Hospital-acquired infections are
associated with 90,000 preventable
deaths of patients annually (Fox et
al, 2015)
www. marietta.edu

Summary of Problems
(continued)
Processes

Key Players

- Poor adherence

- Physicians

- Insufficient resources

- Nurses

- Inadequate staffing
- No desire to change

- PT/OT

- Improper staff and

- Nurses aids

patient education

- Housekeepers

(Flanagan et al, 2011)

- Patients

wp.hepb.org

PICOT

- Visitors

Population/Patient Problem: Pts w/HAI, at risk for HAI, (i.e. central lines,
catheters, ventilator, post-op, immunosuppressed)

HAIs in Hawaii vs.

National Indicators

http://www.cdc.gov/hai/pdfs/stateplans/factsheets/hi.pdf

QI Tools for Root Cause

Analysis
3 Step Study
(Fox, et al, 2015)

Open ended question

survey among hospital
collaboration
(Flanagan, et al, 2015)

www.cminstitute.net

Patient admitted to cardiac intensive care

unit
Intensive care unit nurse: review welcome packet
flyer on hand hygiene w/patient & patient family
Proceed w/intervention
Clean pts hands w/one 2 %
chlorhexidine wipe 3 times/day:
8am, 2pm, & 8pm
Document in medical record :
Yes, No (Why not)

NO

Contraindications to
chlorhexidine:
1. Allergy to chlorhexidine
2. Open wounds on hands
3. Other indications

Nursing assessment
Does patient have a
contraindication to
chlorhexidine?

YES
Does pt show signs
of drying, cracking,
or irritation?

YES

Continue w/the
Intervention as planned
& apply lotion 3 times/day
& as needed

YES

NO
Continue w/the intervention
as planned & assess hands w/
each application.
Study team will provide a
More thorough assessment

Does pt continue
to have dry, cracked
or irritated hands that
do not improve w/lotion?

NO
Continue w/the intervention as planned & apply
Lotion 3 times/day & as needed

Stop
Do not use
chlorhexidin
e
on patient
Alternative intervention:
Clean pts hands w/
step 1 foam & dry cloths
3 times/day: 8 am, 2 pm
& 8 pm

Hand Hygiene Protocol

from
Hand Hygiene
Study

Rates of Central Catheter-associated

Bloodstream Infection &
Catheter-associated Urinary Tract Infection

Recommendations to Eliminate
Root Cause Analysis
Educate staff, patients, and caregivers (repeat correct
demonstration of proper hand washing to the educator)
(Fox et al, 2015)
Increasing certification activities across the spectrum of
care (ASTHO, 2011)
Nurse lead/informatics lead interventions
(Bernard, Hunter & Moore, 2012)
Providing incentives for HAI prevention (ASTHO, 2011)
PICOT
Intervention: Education training, certification, incentives
Comparison: No treatment

Data Used to Evaluate

Success
Longitudinal study data
(rates of infection before
and after tools implemented)
If rates go down;
evaluates success
www.cambridgebrc.co.uk

PICOT
Outcomes: Reduction in pt HAI cases
Time: Varies but a particular study used was done in 5 years

References
Association of the State and Territorial Health Officials [ASTHO]. (2011).
Eliminating health
care associated infections. Retrieved from
http://www.astho.org/hai_policy_toolkit/

Bernard, M. S., Hunter, K. F., & Moore, K. N. (2012). A review of strategies to

decrease
the duration of indwelling urethral catheters and potentially reduce the
incidence
of catheter-associated urinary tract infections. Urologic Nursing, 32 (1), 29-37.

Centers for Disease Control. (2015). Healthcare associated infections

progress: Hawaii. Retrieved from
http://www.cdc.gov/hai/pdfs/stateplans/factsheets/hi.pdf

Flanagan, M. E., Welsh, C. A., Kiess, C., Hoke, S., & Doebbeling, B. N. (2011). A
national
collaborative for reducing health careassociated infections: Current
initiatives,
challenges, and opportunities. American Journal of Infection Control, 39
(8), 685-689.
doi:10.1016/j.ajic.2010.12.013