Surgical site infections are frequently found in post-operational patients. Shepard et al. (2013) state that healthcare-related infections are the primary cause of hospital-acquired complications and deaths in the USA. New ways of sterilization can have a positive effect on reducing post-operational infection rates. The purpose of this paper is to provide a design for change to be implemented in a hospital setting.
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Change Model Overview
The ACE Star model is an effective change framework that has been proven effective in numerous nursing researches. It facilitates a better understanding of knowledge and helps systematize past and present findings in a coherent system. Because of this, such a framework is best used in descriptive research, evidence evaluation, and practice integration. It can be applied to the proposed intervention, as the use of chlorhexidine pre-wash is based on EBP.
Define the Scope of the EBP
The scope of the intervention is to reduce the percentage of post-operational infections by utilizing a chlorhexidine pre-wash solution three days before the operation. The likelihood of contracting a post-operational infection in low-risk patients is 2.7%. For high-risk populations, that percentage increases over 3 times, reaching 9.1% (Webster & Osborne, 2015). Treatment of surgically-acquired infections ranges between 1000 and 3000 dollars per patient (Webster & Osborne, 2015). The scope of the practice issue includes all surgeon wards and medical hospitals that provide surgical treatment.
The stakeholders involved in this EBP include the project leader, the patients, and the nurses. The project leader’s responsibility is to educate the nursing team about the scope of the intervention, provide academic evidence and estimations of success for the proposed action plan, and evaluate the results obtained from research. The nurses create the core of the research and interact with the patients during its application. The patients are the main beneficiaries of the research.
Determine Responsibility of Team Members
The presented team roster possesses the bare minimum required to conduct this project:
- Research project leader. Plays the role of the main coordinator and instructor. Also conducts analytical research based on the qualitative and quantitative measures provided.
- Nurses. They are expected to follow the instructions provided by the project leader, administer chlorhexidine pre-wash to patients, and gather evidence on any incidents of post-operational infection.
The strength of this research lies in the availability and support of various academic sources that support the premise and the intervention proposed in this study. The evidence found was predominantly in the form of EBP articles. Administration guidelines were also a valuable source of information.
Summarize the Evidence
Hospital-acquired nosocomial infections cause serious distress to patients and hospitals and serve as causes of additional expenses for both. Shepard et al. (2013) claim that the costs of treating post-surgical infections often make up to 20% of total treatment. In addition, the prolonged stay exposes the patient to other types of infections and risks associated with the healthcare environment.
as little as 3 hours
According to Webster and Osborne (2015), there is no conclusive data on whether chlorhexidine shows better results than soap or any other antiseptic product. Noto et al. (2015) have also found no significant evidence that chlorhexidine bathing reduces the number of post-operational infections in critical patients. These results contradict with findings of Frost et al. (2016), who found that daily chlorhexidine bathing reduces the chances of contracting CLABSI or MRSA infections. The effectiveness of chlorhexidine is likely connected to the baseline threat of CLABSI and MRSA present in the hospital.
Develop Recommendations for Change Based on Evidence
Based on the available evidence, the recommendations are as follows:
- Bathe non-critical patients in chlorhexidine for three days before the operation.
- Use chlorhexidine pre-wash only in settings where chances of contracting CLABSI or MRSA are higher than the national average.
- Administer chlorhexidine not only on the body but on the cloth surrounding the operational area as well.
The action plan suggested for this research is as follows:
- Find the hospital with a surgical ward willing to participate in this research, recruit the nurses, prepare the required paperwork.
- Conduct the research, accumulate data.
- Analyze the data using statistical means.
- Disseminate findings.
Process, Outcomes, Evaluation, and Reporting
The desired outcome is the reduction of hospital-acquired infections in post-operational patients below the national average. The outcomes will be measured by comparing the results among the patients in the test group with the hospital averages and national averages. All key stakeholders will be informed of the results in written form.
Identify Next Steps
Due to the simplicity of the intervention, it could be easily repeated on a larger scale. It will apply to other surgical wards and hospitals with surgical units. Should the results of the research prove to be positive, I would look for opportunities to repeat the experiment in larger hospitals and advocate for the use of chlorhexidine over soap as a standard pre-operational disinfectant.
Preliminary results will be shared with the members of my organization through written reports. The outside medical community would be informed of the results of my research once it has been published in academic journals. Newspapers and websites could be used to inform the general populace.
Post-operational infections are dangerous to patients. Chlorhexidine baths are likely to reduce the chances of contracting infections. The proposed intervention will use the ACE Star change model. The five points of the ACE Star change model include discovery research, evidence summary, guidelines, practice integration, and outcome evaluation. The change plan will be maintained by re-evaluating and optimizing the approaches to change during every major step of the project.
Frost, S. A., Alogso, M.-C., Metcalfe, L., Lynch, J. M., Hunt, L., Sanghavi, R., … Hillman, K. M. (2016). Chlorhexidine bathing and health care-associated infections among adult intensive care patients: A systematic review and meta-analysis. Critical Care, 20(1), 1-6.
Noto, M. J., Domenico, H. J., Byrne, D. W., Talbot, T., Rice, T. W., Bernard, G. R., & Wheeler, A. P. (2015). Chlorhexidine bathing and health care-associated Infections. JAMA, 313(4), 369.
Shepard, J., Ward, W., Milstone, A., Carlson, T., Frederick, J., Hadhazy, E., & Perl, T. (2013). Financial impact of surgical site infections on hospitals: The hospital management perspective. JAMA Surgery, 148(10), 907-914.
Webster, J., & Osborne, S. (2015). Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database of Systematic Reviews, 2015(2), 1-41.