Introduction
Patients present to the emergency room with various medical ailments, including infectious infections, in a hectic and stressful atmosphere (Houghton et al., 2020). A crucial part of patient care in the emergency room is properly managing infections since prompt treatment can stop the spread of infection and possibly save lives (Houghton et al., 2020). However, the Emergency Room also presents particular difficulties concerning infection management, such as crowding, a lack of resources, and regular patient incidences. Some measures such as hand hygiene, screening, general hygiene and sanitation, and primary and supplementary precautions could be instrumental in combating Hospital Associated Infections (HAIs). Gathering information and understanding the obstacles to effective infection control and prevention is critical to instituting measures to prevent HAIs.
The rationale for the capstone topic
Infection control issues have been elevated to the top priority list. The emergency unit is an essential area that needs the most attention. Due to their weakened health and numerous entrance points for a range of pathogenic organisms, the clients in this situation are highly susceptible to infections (Houghton et al., 2020). The efficacy of the sub-sequential management processes can be harmed by improper patient handling regarding non-adherence to infection prevention. According to CDC (2021), 1 in every 31 hospitalized patients is treated for HAIs daily. One in every ten affected patients dies from the infection (WHO, 2022). This is a vast number, necessitating measures to eradicate HAIs. Thus, instituting and adhering to infection control and prevention protocols ensure a reduction in the number of HAI cases and promote the efficacy of sub-sequential management processes.
Background and significance of the proposed topic
The emergency room is just as crucial as other departments, like the inpatient unit. Poorly implemented infection control measures have been theorized to result in most HAIs in emergency rooms (Habboush et al., 2022). To facilitate infection management, the necessary precautions and resources for infection prevention control must be availed (Houben et al., 2021). Sadly, the effects of contamination in the emergency room may not be immediately noticeable. Still, they may do so later, especially after the patients have been transported to an inpatient facility for additional care (Bearman et al., 2019). Therefore, measures are needed to satisfy infection prevention and control criteria.
Problem Statement
In hospitalized patients, do appropriate infection control and prevention measures compared to prophylactic antibiotics affect HAI prevalence rates?
Literature Review
Studies have shown that appropriate Infection Prevention and Control (IPC) measures in emergency rooms are essential to eradicating most HAIs. Many authors have stressed the importance of asepsis, particularly while carrying out a wide variety of procedures, especially invasive ones (Alhumaid et al., 2021). The latter is highly transferable to the hospital setting. Hence, it is essential to investigate any obstacles hindering infection prevention in the ER. Hand hygiene, screening, general hygiene and sanitation, and primary and supplementary precautions are all examples of clinical best practices (CBPs) that have been shown to reduce the spread of infection in healthcare settings (Tchouaket et al., 2020). For example, the COVID-19 pandemic showed how vital the four CBPs are in stopping the spread of disease (Tchouaket et al., 2020).
Recent research reveals that everyone in the emergency room (from medical staff to patients to visitors) shares some of the blame for the spread of disease (Manchanda, Suman & Singh, 2018). Hence, a focus on education, surveillance of infection rates with periodic replies, and analysis of compliance with infection regulation measures are necessary to lower the frequency of infections in various emergency departments. Furthermore, the report argues that two central ideas define the essential procedures that must be taken to limit the spread of Hospital Associated Infections (HAIs) in healthcare settings (Manchanda, Suman & Singh, 2018). Before taking any preventive steps, the source of the virus must be isolated. Examples include isolating sick individuals with an infectious disease and using other aseptic precautions to prevent the spread of disease or contamination to healthy tissue (Manchanda, Suman & Singh, 2018). High-risk areas, such as operating theaters and hospitals, are much safer after being cleaned, disinfected, and sterilized (Manchanda, Suman & Singh, 2018).
Studies need to be carried out to identify the gaps in implementing these measures that have been proven effective. This will facilitate the drafting of recommendations to enhance IPC.
Proposal Plan Description
This study will incorporate doctors, nurses, cleaners, and the hospital management team. These are crucial resources for understanding the challenges of infection prevention on the ward (McCauley et al., 2021). Recognizing the significance of their involvement in the patient’s care and maintenance will allow them to take the necessary precautions to avoid spreading infection (McCauley et al., 2021). The nurse manager will give insights into the infection prevention policy of the ward and state the gaps they have identified in implementing the policy. The rest of the nurses will be required to provide information on the challenges they face in controlling infection in the ward, including information on waste segregation and disposal. The cleaners are responsible for the general hygiene of the ward. They will give information on the exact places they clean and the frequency at which they do. Moreover, the hospital management team will offer essential information on providing resources for implementing infection control measures in the emergency rooms. The data collected will be used to develop a strategy for making the necessary changes.
The curriculum needs to accommodate their needs as well. For instance, one study found that healthcare providers mentioned various reasons that affect their ability and desire to adhere to particular infection control regulations when treating contagious respiratory diseases (Houghton et al., 2020). Considerations like management’s buy-in, an encouraging work environment, thorough training, an appropriate physical space, and adequate safety gear all played a role (Houghton et al., 2020).
Implementation
This project aims to identify obstacles to appropriate infection control in hospital emergency rooms to recommend adjustments to reduce the cases of HAIs. The project will be implemented in five hospitals in Texas. It is a one-year project that will take place from May 2023 to May 2024. The data collection and analysis will be done in one month, and change training will commence. By the end of the project, emergency rooms in our five target hospitals will observe proper IPC measures and reduce the number of HAIs by 85%.
Using the Texas Department of State Health Services data, I can determine the five hospitals with the highest rates of HAIs. I will then propose my project to the specific hospital management boards. With their permission, I will select my target population, which will include five doctors, ten nurses, two cleaners, and three members of the hospital management team in each hospital. The selection criteria will be based on how long these people have been in contact with the emergency room. The participants must have been in contact with the emergency room for at least six months. I will obtain informed consent from all participants before rolling out the study.
The data collection methods will comprise questionnaires, in-person interviews, and observation. I will administer questionnaires to all participants to acquire information on their knowledge of different infection prevention measures. The in-person interviews will collect information on the department’s challenges in implementing IPC measures. I will do an observational study to establish how IPC measures are implemented in various situations in the emergency rooms.
I will group information regarding the professionals associated with the specific shortcomings to analyze the data collected. I will also tailor the analysis to each hospital to develop facility-specific recommendations. Based on the data collection, I will identify areas that need adjustments.
Once the analysis is done and areas of change are identified, I will draft my recommendations and present them to the hospital management. I will then request a go-ahead to conduct training to implement the changes. The training will be done through Continuous Medical Education (CME) sessions. Doctors, nurses, cleaners, and managers will be trained separately since they perform different roles in the hospital. The training will be done monthly in the five hospitals through a presentational format.
The research’s conclusions will help point out specific areas for improvement. As one would now understand how and why one should adhere to the prescribed infection protocols, there shall be a need to raise awareness to inspire the change process (Alhumaid et al., 2021). According to a study, understanding Healthcare Workers (HCWs) is essential for successful infection control. Lack of familiarity with Infection Prevention and Control (IPC) regulations, forgetfulness of preventive indications during routine patient care, and unknown risks of transferring diseases all work against IPC compliance (Alhumaid et al., 2021). Ignorance of the appropriateness, effectiveness, and use of IPC measures leads to low compliance. Hence, instruction and training are foundational for building IPC practices to overcome these challenges. As HCWs, we must never underestimate the value of education (Alhumaid et al., 2021). With this, their participation will facilitate a smooth transition.
Evaluation
The effectiveness of the project will be assessed by measuring the number of HAI cases reported at the end of the one year of implementation. This data will be assessed against the number of cases at the beginning of the project in May 2023. The percentage of the difference in the data between the two will be computed. An 85% decrease in cases will mean I will have achieved the project’s objective. A slight decrease in the cases will denote that the measures are effective but must be vigorously implemented.
The decline in hospital readmissions could indicate the overall effect of the patients’ stays in the units to which they are moved from the trauma department. As a result, the latter will complement the inpatient departments’ initiatives, resulting in faster recovery times and lower rates of hospital-acquired illnesses (Azak et al., 2023). However, the inability to monitor patients’ progress after being transferred to the facility where they are managed further may make it difficult to assess the effects (Manchanda et al., 2018). Having an entry book where the people are listed, the wards they are transferred to, and their progress can help lessen the latter.
Dissemination
I will publish my project, including every step of the study. I will provide a detailed analysis of the collected data and recommendations. I will include the methods used in the study and document information on the evaluation of the study. I will distribute this report to hospitals in Texas through the Department of health services. I will also make a copy of this report available online for public viewing.
Moreover, I will be keen to attend health education workshops and present this report in such forums. I will request the department of state health services to facilitate continuous education programs where I will be able to make a presentation of my recommendations across hospitals in Texas. This will ensure enormous coverage and translate into positive health outcomes.
Excellent health outcomes controlled under the factors that have been identified and mitigated, leading to positive health outcomes for patients, will indicate the efficacy of infection prevention control measures in the emergency unit (Harun et al., 2022). Patients would benefit from the proposed approach since it emphasizes developing essential self-care skills and strict adherence to core principles of HAI management, such as sanitation and high hygiene (Harun et al., 2022). The hospital’s emergency department nurse manager can provide supervisory assistance until a culture of procedure adherence is established and sustained.
In preparing for this study, I interviewed an infection prevention and control expert. I was committed to knowing the current developments in this field. They stated categorically that there is an overwhelming challenge in the number of healthcare staff who are adequately trained in implementing IPC protocols. This brought out the need to train healthcare workers on appropriate IPC practices.
Summary
The proposal is crucial in establishing a foundation for the necessary changes. The management and worker are both aware if they share similar opinions about the obstacles to infection control in the emergency room. When everyone agrees about what to do at each intervention to limit the risk of infection, the employees’ and customers’ health and safety are better protected. The transition is more likely to go off without a hitch.
References
Alhumaid, S., Al Mutair, A., Al Alawi, Z., Alsuliman, M., Ahmed, G. Y., Rabaan, A. A., Al-Tawfiq, J. A., & Al-Omari, A. (2021). Knowledge of infection prevention and control among healthcare workers and factors influencing compliance: a systematic review. Antimicrobial Resistance & Infection Control, 10(1). https://doi.org/10.1186/s13756-021-00957-0.
Azak, E., Sertcelik, A., Ersoz, G., Celebi, G., Eser, F., Batirel, A., … Kaya Kalem, A. (2023). Evaluation of the implementation of WHO infection prevention and control core components in Turkish health care facilities: results from a WHO infection prevention and control assessment framework (IPCAF)—based survey. Antimicrobial Resistance & Infection Control, 12(1). https://doi.org/10.1186/s13756-023-01208-0.
Bearman, G., Doll, M., Cooper, K., & Stevens, M. P. (2019). Hospital Infection Prevention: How Much Can We Prevent and How Hard Should We Try? Current Infectious Disease Reports, 21(1). https://doi.org/10.1007/s11908-019-0660-2.
CDC. (2021, June 21). Health Topics – HAI – POLARIS. Centers for Disease Control and Prevention. https://www.cdc.gov/policy/polaris/healthtopics/hai/index.html#:~:text=On%20any%20given%20day%2C%201
Habboush, Y., Yarrarapu, S. N. S., & Guzman, N. (2022). Infection Control. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519017/#:~:text=Poor%20infection%20control%20programs%20lead
Harun, M. G. D., Anwar, M. M. U., Sumon, S. A., Hassan, M. Z., Haque, T., Mah-E-Muneer, S., … Kaydos-Daniels, S. C. (2022). Infection prevention and control in tertiary care hospitals of Bangladesh: results from WHO infection prevention and control assessment framework (IPCAF). Antimicrobial Resistance & Infection Control, 11(1). https://doi.org/10.1186/s13756-022-01161-4.
Houben, F., van Hensbergen, M., Den Heijer, C. D. J., Dukers-Muijrers, N. H. T. M., & Hoebe, C. J. P. A. (2021). Barriers and facilitators to infection prevention and control in Dutch residential care facilities for people with intellectual and developmental disabilities: A theory-informed qualitative study. PLOS ONE, 16(10), e0258701. https://doi.org/10.1371/journal.pone.0258701.
Houghton, C., Meskell, P., Delaney, H., Smalle, M., Glenton, C., Booth, A., Chan, X. H. S., Devane, D., & Biesty, L. M. (2020). Barriers and facilitators to healthcare workers’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. Cochrane Database of Systematic Reviews, 4(4). https://doi.org/10.1002/14651858.cd013582.
Manchanda, V., Suman, U., & Singh, N. (2018). Implementing Infection Prevention and Control Programs When Resources Are Limited. Current Treatment Options in Infectious Diseases, 10(1), 28–39. https://doi.org/10.1007/s40506-018-0142-3.
McCauley, L., Kirwan, M., & Matthews, A. (2021). The factors contributing to missed care and non-compliance in infection prevention and control practices of nurses: A scoping review. International Journal of Nursing Studies Advances, p. 3, 100039. https://doi.org/10.1016/j.ijnsa.2021.100039.
Tchouaket Nguemeleu, E., Beogo, I., Sia, D., Kilpatrick, K., Séguin, C., Baillot, … Boivin, S. (2020). Economic analysis of healthcare-associated infection prevention and control interventions in medical and surgical units: a systematic review using a discounting approach. Journal of Hospital Infection, 106(1), 134–154. https://doi.org/10.1016/j.jhin.2020.07.004.
WHO. (2022). WHO launches first ever global report on infection prevention and control. Www.who.int. https://www.who.int/news/item/06-05-2022-who-launches-first-ever-global-report-on-infection-prevention-and-control#:~:text=Today%2C%20out%20of%20every%20100
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