Introduction
Healthcare-associated infections (HAIs) can be considered one of the central and significant problems of the majority of medical units today. In accordance with the statistics, at least one in 31 patients who receive treatment in a hospital setting face this problem (CDC, 2018). Additionally, it remains one of the major causes of the appearance and development of various types of complications (CDC, 2018).
For this reason, one of the central tasks of the sphere is the attainment of a significant reduction of HAIs’ incidence and elimination of other associated problems. Clsotridioides difficult (C. diff) can also be related to this cohort of issues as it causes the emergence of multiple states in patients. One of the possible ways to improve the situation is the improvement of existing hygiene practices. For this reason, the purpose of this paper is to investigate the effectiveness of existing guidelines regarding C. diff incidence in hospitalized patients.
Background
C. diff is the bacterium responsible for the emergence of diarrhea and colitis in various groups of patients. For this reason, one can admit a significant scope of the problem as there are wide populations affected by it.
For decades, it has remained a topical question that deteriorated treatment results and preconditioned the emergence of undesired complications and outcomes. In the modern healthcare sector, regarding its focus on the promotion of appropriate care provision, creation of a beneficial environment, and increased satisfaction level among patients, there is certain progress in dealing with C. diff and minimizing its incidence (CDC, 2018). However, it still remains topical for many medical units because of the disregard of some basic hygiene patterns that are introduced to prevent the further spread of bacteria and its additional harm done to patients along with the negative side effects and complications.
Clinical Significance
Considering the information provided above, the problem acquires a high clinical significance. Accepting the fact that improvement of patients’ quality of lives is the main goal of the healthcare sector, the emergence, and development of C. diff can deteriorate results and make the achievement of this purpose impossible. Recent hospitalizations increase the risk of being infected, which means that healthcare setting becomes dangerous for clients (CDC, 2018).
In its turn, it results in the decreased quality of treatment, comfort levels, and safety. Additionally, complications might precondition the critical deterioration of patients’ states as statistics show that 29,000 patients die within every 30 days because of the initial diagnosis of C. diff (Haque, Sartelli, McKimm, & Abu Bakar, 2018). 80% of these cases are associated with clients aged 65 and older (Haque et al., 2018).
Moreover, in accordance with the latest research, 1 out of 5 patients who were diagnosed with this type of infection experienced its recurrence in the shortest terms (CDC, 2018). For this reason, there is a critical need for the creation and introduction of an effective solution to minimize the incidence and avoid lethal cases among various groups of patients to ensure better outcomes and higher satisfaction levels.
Purpose
Regarding the information provided, the purpose of the research is to investigate the effectiveness of different hand hygiene protocols regarding C. diff incidence in hospitalized patients. The following PICOT question is formulated:
In hospitalized adults infected with C. diff (P), does hospital hand hygiene protocol (soap and water and hand sanitizer) (I), compared with CDC recommended hand hygiene protocols for C. diff, (C) increase prevention of C. diff infections (O), after the first 48 hours or after 3 midnights of the patient’s hospital stay (T)?
Literature Review
The following literature review was created with the primary purpose to provide information related to the discussed topic and create a theoretical framework that can be utilized to revolve around the problem. To achieve higher credibility levels, only relevant sources from databases such as NCBI, PubMed, SAGE, and PMC were analyzed. The key search terms used to find appropriate works included C. diff, hand hygiene, HAIs, CDC protocols. It helped to create a pool of articles that were discussed within the proposed question.
First of all, speaking about HAIs and their role in modern healthcare, Haque, et al. (2018) state that 1,7 million of all hospitalized patients in the USA acquire this sort of medical problems, and more than 98,000 of all these clients die due to the emergence and development of undesired states. In such a way, the scope of the problem is evidenced by the involvement of wide population groups and substantial harm done to the quality of people’s lives.
Regarding the complexity of the outlined problem, C. diff also becomes one of the important issues for the modern healthcare sector. Dinleyici and Vandenplas (2019) assume that it remains the most common causative agent of diarrhea and colitis which means that there is a critical need for the introduction of effective measures to struggle against it and attain significant improvement. In many patients aged 65 and older this disease can precondition the emergence of severe and dangerous states.
Taylor, McHale, Saenz, and Plaxe (2017) agree with the increased importance of the outlined problem and the fact that C. diff is a major cause of nosocomial diarrhea characterized by the high potential for morbidity and mortality. There are multiple risk factors that might result in the emergence of this sort of health issue in patients including age, poor hygiene, weak immune system, recent hospitalizations, and previous cases of C. diff (Taylor et al., 2017). However, the negative impact of all these factors can be decreased by adherence to existing hand hygiene guidelines.
Appropriate infection control practices are given significant attention from various researchers as one of the effective tools to struggle against the infection. For instance, Burke and Lamont (2014) are sure that the success of the struggle against C. diff depends on the ability to create and follow relevant hygiene guidelines that will provide both patients and health workers with needed information about the disease and risk factors.
Under these conditions, collaboration becomes one of the possible approaches to prevention. Johnson (2018) emphasizes the idea that the cooperation of clinical nurse leaders, specialists, and patients will help to create the framework characterized by the existence of effective guidelines regarding the prevention of C. diff via enhanced hand hygiene practices as one of the most promising approaches.
Trying to find more information related to the issue, Legenza et al. (2018) conduct a study devoted to C. diff prevention. Interviewing physicians about possible barriers to the improvement, the authors come to the conclusion that gap in knowledge and disregard of existing hand hygiene parties can be considered the central areas that needed enhancement to achieve the desired goal and provide care effectively.
The importance of preventive measures is evidenced by other authors. For instance, reviewing the relevant literature related to the problem of HAIs including C. diff, Shafer, Alison, Hogue, and Huntington, (2019) assume that control of all pathogens and bacteria can be performed via the observation of all guidelines created on the basis of all information available to regulatory agencies at the moment as it will help to achieve better results.
Similar results are achieved by Turner et al. (2019). Evaluating the literature to prove the effectiveness of the multidisciplinary approach they summarize that a significant reduction of HAIs incidence can be achieved via the improvement of existing hygiene practices and better monitoring tools (Turner et al., 2019). For this reason, they state that the introduction of new strategies will alter the situation.
Ananji, Walker, and Christian (2017) conduct another quantitative systematic review to collect data about the effectiveness of hand hygiene and the necessity of education to formulate conclusions about the possible solutions to the problem of HAIs. They state that hand hygiene can be an effective approach if the major risk factors and systematic issues are considered.
Finally, in an observational study, Musu et al. (2017) evaluate the hand hygiene compliance among health workers in intensive care units. The researchers conclude that there is still a need for improvement as the current level of knowledge can be not enough because of existing gaps and poor understanding of how various HAIs including C. diff might emerge in patients.
Altogether, the given literature review proves the increased importance of the problem of C. diff in the modern healthcare setting as there is a significant number of patients affected by it. Regarding the scope of the issue, there are multiple attempts to reduce its incidence by creating appropriate and effective guidelines describing hand hygiene practices that can be used to avoid the spread of infection.
Theoretical Framework
The nature of the selected problem and the involvement of both health workers and patients presupposes the choice and utilization of Orem’s Self-Care deficit theory. In accordance with this theory, people should be self-reliant, responsible for their care, and possess an improved knowledge about particular problems to promote self-care behaviors (Orem, 2001).
In other words, all stakeholders of the treatment process can contribute to the achievement of positive results by their own efforts engaging in activities that will improve the quality of lives and avoid significant deterioration of health, which is one of the main goals of modern medicine. Additionally, in accordance with this paradigm, nursing becomes a form of action aimed at the provision of care and knowledge needed for clients to recover and enjoy outcomes (Orem, 2001). This information is critical for the whole process as it becomes the key to achievement.
Considering the fact in the majority of cases, C. diff emerges because of the disregard of prevention activities aimed at the reduction of the incidence, the selected paradigm becomes critical for the EBP project. Adhering to the basic assumptions of Orem’s theory, it is possible to achieve better results by providing patients with information on how to wash their hands and how to ensure that there will be no infections or other pathogens that can deteriorate their health and precondition undesired results.
Additionally, Orem’s framework presupposes education for both nurses and patients with the primary aim to engage in self-care activities which is critical for improved outcomes regarding C. diff and its negative impact on the functioning of health units. That is why the preference is given to self-care deficit theory as one of the best possible theoretical frameworks.
Methods
Research Design
The nature of the selected problem presupposes utilization of a qualitative methodology to conclude about the effectiveness of hospital hand hygiene protocols and their contribution to the decreased incidence of HAIs and C. diff. Additionally, it is supported by design presupposing the separation of participants into two focus groups with the primary aim to compare results and conclude about the advantages or disadvantages of one or another method. The utilization of this methodology will help to collect credible data and formulate an informative conclusion.
Sample
The needed amount of participants is 100 as they will be separated into a comparison and control group to determine the effectiveness of selected interventions. The sample size is justified by the need to collect numerical and qualitative evidence of suggestions about how discussed methods work. The main inclusion criteria will be diagnosis (C. diff), hospitalization, and adherence to selected hand hygiene patterns. The participants will be recruited via the convenience sample of patients who have the investigated state and are ready to participate.
Setting
It is planned to conduct the study in the urban setting, in the health unit of Miami, Florida. The main reason for the selection is explained by the fact that the majority of similar facilities across the USA face the same problem. For this reason, it is essential to conduct the investigation using the same environment as in the majority of research works devoted to it. Additionally, using this setting, we will be able to acquire relevant and credible data critical for the conclusion.
Research Protocol
All participants should provide their informed consent to be included in the research. Their real names should be hidden to guarantee the confidentiality of data and the preservation of complete anonymity. The planned intervention is the adherence to two types of hand hygiene protocols offered by the selected hospital and CDC (CDC, 2002). Two groups will use these guidelines, and their results will be compared using the statistical data about the incidence of C. diff. The demanded time frame for implementation is three days as data portions will be taken after the first 48 hours or after three midnights of patients’ hospital stay. Prior to conducting this research, IRB approval from Keiser University and the facility should be acquired
Data Analysis
Data can be analyzed by comparing information provided by two groups of participants. The graphs to demonstrate the reduction or increase of C. diff’s incidence can be created to visualize results and ensure that they are understandable for the audience. The acquired portions will be discussed assessing the difference in the number of ill and healthy patients to evaluate the effectiveness of proposed measures. Finally, data can be incorporated in tables representing the results of each group and making their comparison easier to discuss and analyze.
References
Ananji, J., Walker, J., & Christian, R. (2017). Effectiveness of formal hand hygiene education and feedback on healthcare workers’ hand hygiene compliance and hospital-associated infections in adult intensive care units: A systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 15(5), 1272-1279. Web.
Burke, K., & Lamont, J. (2014). Clostridium difficile infection: A worldwide disease. Gut and Liver, 8(1), 1-6. Web.
Center for Disease Control and Prevention (CDC). (2002). Guideline for hand hygiene in health-care settings. Recommendations and Reports, 51(PR-16). Web.
Center for Disease Control and Prevention (CDC). (2018). HAI data. Web.
Dinleyici, M., & Vandenplas, Y. (2019). Clostridium difficile colitis prevention and treatment. Advances in Experimental Medicine and Biology. Web.
Haque, M., Sartelli, M., McKimm, J., & Abu Bakar, M. (2018). Health care-associated infections – an overview. Infection and Drug Resistance, 11, 2321-2333. Web.
Johnson, S. (2018). Combating hospital-acquired C. diff. Nursing Management, 49(3), 16-22. Web.
Legenza, L., Barnett, S., Rose, W., Safdar, N., Emmerling, T., Peh, K., & Coetzee, R. (2018). Clostridium difficile infection perceptions and practices: A multicenter qualitative study in South Africa. Antimicrobial Resistance and Infection Control, 7, 125. Web.
Musu, M., Lai, A., Mereu, N., Galletta, M., Campagna, M., Tidore, M., … Coppola, R. (2017). Assessing hand hygiene compliance among healthcare workers in six Intensive Care Units. Journal of Preventive Medicine and Hygiene, 58(3). Web.
Orem, D. (2001). Nursing concepts of practice. New York, NY: Mosby.
Shafer, C., Alison, J., Hogue, A., & Huntington, M. (2019). Infectious disease: Health care-associated infections. FP Essentials. Web.
Taylor, K., McHale, M., Saenz, C., & Plaxe, S. (2017). Diagnosis and treatment of Clostridium difficile (C. diff) colitis: Review of the literature and a perspective in gynecologic oncology. Gynecologic Oncology, 144(2), 428-437. Web.
Turner, M., Behrens, S., Webster, W., Huslage, K., Smith, B., Wrenn, R., … Mantyh, C. (2019). Multidisciplinary approach to Clostridium difficile infection in adult surgical patients. Journal of the American College of Surgeons, 228(4), 570-580. Web.