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Daily Chlorhexidine (CHG) Bath in Oncology Patients to Prevent Hospital Acquired Infections (HAIs)

Daily Chlorhexidine (CHG) Bath in Oncology Patients to Prevent Hospital Acquired Infections (HAIs)

HAIs are disease process developed by the patients during hospitalization. According to Centers for Disease Control and Prevention, (CDC), (n.d),” healthcare-associated infections are infections that patients acquire during the course of receiving treatment for other conditions within a healthcare setting”. Healthy People 2020, (2014) explained that “Modern healthcare employs many types of invasive devices and procedures to treat patients and to help them recover. Infections can be associated with procedures (like surgery) and the devices used in medical procedures, such as catheters or ventilators” HAI includes central-line-associated bloodstream infection (CLABIs), urinary tract infection (CAUTI), surgical site infection (SSI), ventilator-associated pneumonia (VAP), and the issues of multidrug-resistant organisms (MDRO), including methicillin-resistant staphylococcus aureus (MRSA), clostridium difficile infection, and vancomycin-resistant enterococcus (VRE)( CDC, n.d).

HAIs are significant precipitate of sickness and death in the United States and are linked to extensive surge in health care expenses each year. Every now and then, 1 out of every 25 patients admitted in the hospital are affected by HAI” (Health People 2020, 2014). According to Donskey and Deshpande, (2016), “Patients colonized or infected with health care-associated pathogens often carry the organisms on their skin. Such contamination may lead to infection when factors such as devices, catheters, and wounds provide a route for pathogens on skin to reach normally sterile sites. Additionally, Waknine, (2013) also stated that notwithstanding prevalent application of evidence-based practice, up to $9.8 billion is disbursed yearly for management of HAIs, hence infection from wound post operatively is the most expensive to treat.

Nevertheless, skin infection can correspondingly be a contributory factor to the spread of pathogens because of environmental peeling and transference to the hands of employees. Consequently, there is a solid validation for efforts to diminish the problem of microorganism on skin (Donskey & Deshpande, 2016, P 17).

Problem Statement

Several studies on HAIs in United States (U.S) shows a rise in the infectious process leading to several diseases conditions that escalates costs and secondary complications. It is predicated that up to 250,000 patients are infected with central line-associated blood stream infections (CLABSIs) every year. The expenses for treating individual CLABSI is projected to range from $16,000 to $29,000, resulting in an additional admission, and increases the probability of causing death by 35% (Pagan, 2017). CAUTI is also budgeted to be treated with up to $350 million (Saint, Gaies, Fowler, Harrod & Krein, 2014). Other studies noted varying burden of costs and related death rate that are applicable to other HAIs (VAP, SSI, BSI). Healthcare members are supposed to handle patients with central lines, ports, catheters, v ventilators with extreme caution, observing strict aseptic protocol when caring for them. HAIs arise when there is a breach in this protocol.

Purpose of the Change Proposal

Owing to the increase in the incidence of HAIs, in addition to the percentage of death caused by HAIs and the burden of cost they create with prolonged hospital stay, the writer planned to get to the root of the problem by conducting a study to recommend a change among oncology patients in writer’s unit. The recommendation for change is likely to enhance patients’ survival rate, prevent infection, reduce hospital stay as well as increase satisfaction and reduce costs. Additionally, recommendation for change is supposedly anticipated to help in educating the healthcare providers based on evidence-based practices aimed to reduce/prevent HAIs by using chlorhexidine gluconate daily in bathing patients susceptible to HAIs.

PICOT

The utilization of the PICOT question formula has made the development of answerable research question easier and can be used to note if planned change actually occurred. The writer of this work used a PICOT declaration which was useful in the provision of positive rejoinders to the research question, “In Adult Oncology patients, does the use of Daily CHG bath compared to use of soap and water affect the incidence of HAI (CLABSI) throughout period of hospitalization.

Literature Search Strategy Employed

The writer of this work acknowledged EBP Solution of the PICOT declaration by engaging in thorough search for pertinent studies using goggle search and related database in the school online library. The writer is cognizant of studies and the year they were published ensuring all the studies were not 5years older than the year 2018. Significant and indicative words were utilized to make the searching much easier and they include, HAIs, Daily use of CHG in preventing HAIs.

Evaluation of the Literature

Evaluating previous works is imperative when conducting a study as it would help the researchers identify relevant materials to support their work or be useful in clarifying the identified study issue. of the literature is important as it facilitates the identification and clarification of the research problem. As soon as the necessary materials were gathered, they were prudently reviewed to establish its relationship with the writer’s topic as well as help validating the statement of problem. The writer evaluated the identified articles by ensuring they are current, accurate and the objective suits the proposal. Furthermore, writer compared the other studies making sure the essence of conducting the research are shown in the findings of the studies hence commendation for supplementary studies were made by the writer.

Nursing Theory Utilized

Change is a characteristic mode of living that exist, is constant and purposeful in everything we do. Lewin’s theoretical model was applicable in the writer’s change proposal and was utilized. According to Peptiprin (2016), there are 3 phases of the theoretical framework and encompasses: unfreezing, change and refreeze model. The theory embraces propelling effort that thrust people in a course for transformation to happen and contrasting strength that constrain revolution. In the unfreezing phase individuals forgo attitudes or behavior that is not favorable, the second phase involves the changing step that necessitates reflective/ thoughtfulness of actions or attitudes that will increase productivity. Lastly in the refreezing stage, individuals are led to inculcate and embrace a transformational way of operating that do away with old methods.

Thus, health care providers should adopt the Lewin’s theoretical framework in changing their attitude towards new proposal such as the writer’s work as to provide quality improving care that is required by everybody. In order words, daily bath with CHG in oncology floor should be a norm since the benefits outweighs the disadvantage. CHG should be used instead of soap and water when bathing the patients to reduce the chances of HAIs. They should also adopt other measures such as proper handwashing and maintaining aseptic technique when providing care.

Proposed Implementation Plan with Outcome Measures

Partnering with collaborators is an esteemed way of implementing evidenced based proposal. Hence for successful execution of any project, lies on approval of the management board, leaders and colleagues. To develop a project, their contribution is needed in terms of funding, teaching and suggestions, (Institute of Catholic Bioethics, 2011). The important collaborators were sought out by the writer via electronic mails, negotiating plan during presentation/meeting and emphasizing on the need for change by writing memos.

The significant points such as emphasis on the death rates and infection rate were not left out, to encourage approval of the project as well as promote adoption of positive change by those involved with direct care. Measuring the outcome was achieved by organization of classes, where patients direct care personnel were assessed pre and post to ensure the message were effectively assimilated. The education and research committee were involved in ensuring appropriate measures were utilized in validating classes taken.

Identification of Potential Barriers to Plan Implementation and Ways to Overcome Barriers

Successful implementation and execution of EBP requires that all healthcare givers involved are adequately educated and are inspired to accept change. Also, those in leadership capacity should be supportive of the proposal and use their position to ensure its practicability, these are the hinderances the writer noted that may push back the implementation and continuity. Therefore, continuous education and training are essential part of the change implementation. Those involved in day to day care of the patients should be encouraged and incentives given to those that comply to the change that is daily use of CHG in bathing instead of soap and water. Mentoring and inspiring colleagues are intended strategy to ensure compliancy. Most important, it is obvious that HAIs are “never events” as hospital will not be reimbursed if occurred, this should be part of the strategy to bear at the back of the mind.

Conclusion

Effectiveness of daily use of CHG to reduce/prevent HAIs in intensive care units is an evidenced-based practice that have been noted by several studies. Although few studies have been on oncology patients (Page, 2017) but is applicable. Other measures that can be helpful in limiting the chances of contamination includes proper hand washing, maintain aseptic techniques and assessment of patients. The nurse’s role in implementation of this evidenced based practice cannot be over emphasized. However, other healthcare givers are also enjoined to participate in the right practice to reduce the rate of infection endangering the lives of patients and reducing the burden of costs.

References

CDC. (2018). HAI Data and Statistics | HAI |. Retrieved from https://www.cdc.gov/hai/surveillance/index.html Comment by Stacey Minor: Capitalization and italicized

Donskey, C. J., & Deshpande, A. (2016). Effect of chlorhexidine bathing in preventing infections and reducing skin burden and environmental contamination: A review of the literature. American Journal of Infection Control, 44(5), e17-e21. doi:10.1016/j.ajic.2016.02.024

Healthy People 2020. (2014). Healthcare-Associated Infections. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/healthcare-associated-infections Comment by Stacey Minor: See above comment

Institute of Catholic Bioethics. (2011). Health care reform: Duties and responsibilities of stake holders. Retrieved from https://sites.sju.edu/icb/health-care-reform-duties-and-responsibilities-of-the-stakeholders/

Peptiprin, A. (2016). Lewin’s change theory. Retrieved from http://www.nursingtheory.org/theories-and- models/Lewin-Change-Theory.php

Waknine, Y. (2013). Hospital Infections Cost Billions Study Shows. Retrieved from https://www.medscape.com/viewarticle/810372 Comment by Stacey Minor: Same as other comments