Background Clinical problem statement. Purpose of the change proposal in relation to providing patient care in the changing health care system. PICOT question. Literature search strategy employed. Evaluation of the literature. Applicable change or nursing theory utilized. Proposed implementation plan with outcome measures. Discussion of how evidence-based practice was used in creating the intervention plan. Plan for evaluating the proposed nursing intervention. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome. Appendix section, if tables, graphs, surveys, educational materials, etc. are created.

Background:

In recent years, the healthcare system has witnessed significant changes, resulting in the emergence of new challenges and opportunities. One of the most pressing challenges faced by healthcare providers is the increasing prevalence of healthcare-associated infections (HAIs), which pose a significant threat to patient safety and quality of care. HAIs refer to infections that patients acquire while receiving treatment for another condition in a healthcare setting. HAIs are a major source of morbidity and mortality, resulting in increased healthcare costs, prolonged hospital stays, and increased antimicrobial resistance. The Centers for Disease Control and Prevention (CDC) estimates that approximately 1 in 31 hospitalized patients in the US have at least one HAI, with an estimated 75,000 deaths annually attributed to HAIs.

Clinical problem statement:

The clinical problem that this change proposal seeks to address is the high prevalence of HAIs in the healthcare setting, particularly in the intensive care unit (ICU) setting. Despite the availability of evidence-based infection prevention practices, HAIs remain a persistent problem in the ICU, with many hospitals struggling to implement and sustain effective prevention strategies.

Purpose of the change proposal in relation to providing patient care in the changing healthcare system:

The purpose of this change proposal is to implement a multifaceted infection prevention intervention in the ICU setting to reduce the incidence of HAIs and improve patient outcomes. This proposal aims to address the changing healthcare system by promoting evidence-based practice and quality improvement initiatives to improve patient safety and reduce healthcare costs.

PICOT question:

In adult ICU patients, how does the implementation of a multifaceted infection prevention intervention compared to usual care affect the incidence of HAIs over six months?

Population: Adult ICU patients

Intervention: Multifaceted infection prevention intervention

Comparison: Usual care

Outcome: Incidence of HAIs

Time: Six months

Literature search strategy employed:

A comprehensive search of relevant databases, including PubMed, CINAHL, and Cochrane Library, was conducted using keywords related to healthcare-associated infections, infection prevention, ICU, and multifaceted interventions. The search was limited to studies published in the last ten years, and only studies conducted in the United States were included.

Evaluation of the literature:

The literature review identified several studies that evaluated the effectiveness of multifaceted infection prevention interventions in the ICU setting. The studies showed that multifaceted interventions that incorporate multiple evidence-based practices are effective in reducing the incidence of HAIs in ICU patients. The studies also highlighted the importance of implementing these interventions using a systematic approach and involving all stakeholders, including healthcare providers, patients, and families.

Applicable change or nursing theory utilized:

The proposed change will be guided by the Diffusion of Innovations Theory. The theory provides a framework for understanding how new ideas or innovations are adopted and spread within a social system. The theory will be used to identify the barriers and facilitators to the adoption and implementation of the proposed intervention and to develop strategies to promote its adoption and sustainability.

Proposed implementation plan with outcome measures:

The proposed implementation plan will involve the following steps:

1. Establish a multidisciplinary team comprising ICU nurses, physicians, infection preventionists, and quality improvement experts.
2. Conduct a baseline assessment of current infection prevention practices and HAI rates in the ICU.
3. Develop and implement a multifaceted infection prevention intervention that incorporates evidence-based practices, such as hand hygiene, daily chlorhexidine bathing, and oral care.
4. Provide education and training to ICU staff on the new intervention and its implementation.
5. Monitor the implementation of the intervention and provide ongoing feedback to staff.
6. Evaluate the effectiveness of the intervention by comparing the incidence of HAIs in the six months before and after the intervention.

The outcome measures will include:

1. The incidence of HAIs in the ICU before and after the intervention