Research Paper on "Healthcare Associated Infection and the Iowa Model"

Research Paper 10 pages (3046 words) Sources: 10

[EXCERPT] . . . .

Tests were carried out and they ruled out pneumonia and blood infection but there was presence of an infection in the urinary tract (IOWA CAUTI). The surgeon said that it must have resulted due to the blood catheter used. After four days at home, the situation changed. The incision made inflamed tremendously and a reddish yellow fluid was being discharged. She was immediately readmitted by her surgeon to the hospital and taken to the theater to reopen the incision. The diagnosis made was a surgical site infection. Culture tested positive for the organism that was present in her urine (IOWA, CAUTI). The surgeon said that the infection could have been seeded from the infection in the urinary tract. The following months proved quite trying for Jerri -- long stays at the hospital, continuous surgeries to clean her wound up, and lastly the removal of the fresh hip. She was taken to a skilled nursing facility to wait for her wound to clean up to a level it would be safe to have a new one implanted. Depression set in and Jerri did not want to engage in physical therapy (IOWA CAUTI). She stopped eating and subsequently lost a lot of weight. A feeding tube had to be administered. After three months, at the time the surgeon replaced the hip, she wasn't the same person that came for the initial surgery. The troubles were compounded by financial problems. Her care was fully covered by neither Medicare nor the supplemental insurance, and her husband had to dig deep into their savings to foot the medical bills that had now exceeded $200,000 (IOWA CAUTI).

The story of Jerri is an example of the way healthcare-associated infections, like catheter associated urinary tract infections in Jerry's case, can affect lives. The HAIs cause a high level of morbidity, costs and mortality (IOWA CAUTI). The Centers for Disease Control and Prevention (CDC) gives an estimate of two million HAIs occurring in United States hospitals 99,000 individuals losing their lives every year due to these infections. An approximate 4.5 HAIs exist for every one hundred hospital admissions. The figure is 9.3 infections for every one thousand patient days in the ICU and two surgical site infections for every one hundred operations (IOWA CAUTI). The infections cost the nation five to six billion dollars every year, with the average incremental cost per patient being $8, 832. CAUTIs account for the highest number of HAIs in hospitals in the United States (Stone, Braccia, and et al., 2005). In 2002, almost 450,000 CAUTIs were identified in United States hospitals. With the average cost for every infection being about $1,000 in the year 2007, the total cost estimate stands at a staggering $450 million every year (Stone, Braccia, and et al., 2005).

Recommendations of a different approach

While no magic bullets exist for the easy eradication of these infections, medical literature assessments has brought about the development of guidelines that are evidence-based and that can be made use of in the coming up of best practices to prevent these infections (IOWA CAUTI). Particular guidelines that have been accepted by practitioners include the ones developed by the Centers for Disease Control and Prevention, the Society of Healthcare Epidemiology of America, the Infectious Disease Society of America and the Association for Professionals in Infection Control and Epidemiology (IOWA CAUTI).

The Goal: Guiding and supporting efforts being made in hospitals in IOWA in the development of systems for surveillance for catheter-associated urinary tract infections (IOWA CAUTI). Additionally, the project aims at supporting collaboration aimed at defining and implementing effective and efficient prevention as well as control strategies in hospitals so as to reduce catheter-associated urinary tract infections.

Project Timeline (IOWA CAUTI): The program was scheduled to run from January 1, 2010 till the end of the year 2011. Prevention collaboration in the district were to be supported by the Center for Acute Disease Epidemiology (CADE) as well as Iowa Healthcare Collaborative (IHC).

Importance and impact of problem for the organization and for the patient

The CDC supports the major strategies aimed at the elimination of CAUTIs (IOWA CAUTI):

Catheters are only to be inserted for the right indications

Catheters are to be left in place only for as long as is needed

Making sure that only the adequately and properly trained medical personnel insert and also maintain the catheters

Insertion of catheters using only the aseptic technique and by using sterilized equipment (acute care setting)

After aseptic insertion, a closed drainage system is to be maintained

An unobstructed flow of urine is to be maintained

Maintain proper precautions of standards of hygiene (or of proper isolation)

Further, CDC supports other strategies, including (IOWA CAUTI):

Considering alternatives to insertion of catheters

Using movable ultrasound machines for the assessment of volume of urine so as to ensure reduction of avoidable catheterizations

Using antiseptic-impregnated/microbial catheters

Other notable things on CAUTI are (IOWA CAUTI):

As at Jan1, 2008, centers for Medicare and Medicaid Services (CMS) had implemented a rule that had done a way with patients paying for treatment of CAUTI complications in cases where the complications are developed while undergoing treatment in the hospital.

Studies reveal that almost 40% of doctors attending to patients who had unnecessary urinary catheters still in them were not aware the patients still had the devices in them.

The risk for a patient being infected by a CAUTI is between 3% and 7% everyday the device is left inside the patient.

Studies reveal that CAUTI patients stay longer in hospitals by half a day to one day and the cost is $1,000 for every case -- even more if the patient has a resistant organism or develops complications.

12% to 25% of patients hospitalized will use an indwelling urinary catheter and almost half of these put without the existence of valid reasons.

CAUTI is linked to increased mortality and morbidity, and can cause surgical site infections. It is second among most common causes of bloodstream infections.

The Strategy (IOWA CAUTI)

Have CAUTI rate decreased by 25% in the participating health facilities.

The Team:

It is important to note that every project and organization is unique in its own way. There are no similar units and the same goes for project teams. Team members can be given definitive names that represent the roles they play like Clinical Champion, Project Team Leader, Data Manager, Day-to-Day Leader or process experts (IOWA CAUTI). Teams may bring on other members from time to time during the project's life. The members of the team can be people from marketing, finance, patient education, among others. How the team is structured for the project is dependent on the available resources as well as the scope of the project being handled (IOWA CAUTI). Teams that are effective have certain characteristics. They, for instance, have members possessing three key areas of expertise: project leadership, organizational leadership and technical or clinical expertise. As was noted above, every organization is unique and the uniqueness should be considered in choosing team members. There will never be two same units. Neither will there be two similar project teams (IOWA CAUTI).

How the Goal Will Be Achieved (IOWA CAUTI):

There will be formation of partnerships so as to encourage collaboration to help support all project areas. The partners will be requested to contribute expertise and resources unique to the nature of the organizations they are from. Those sponsors for the collaborative are the Iowa Department of Public Health (IDPH), Iowa Healthcare Collaborative (IHC) and Center for Acute Disease Epidemiology (CADE).

The hospitals participating in this program will get expertise on improving preventive measures. This will be achieved at the state levels. They will be given help in the development of the required cultural elements to help support as well as sustain the gains made. The hospitals choose one or more units (e.g. surgical unit, intensive care unit, rehabilitation unit, etc.) to channel their energies to during the collaborative. The team from the hospital will go on to develop and also redesign their care processes to ensure the prevention of CAUTIs and measure the resulting effectiveness in data reports made to National Healthcare Safety Network (NHSN). After the development of reliable and sustainable processes, the teams will be tasked with the development of spread plans so that their processes can be incorporated in other areas.

References

1)

Iowa Department of Public Health Center for Acute Disease Epidemiology Healthcare-associated Infection Prevention Plan. (2010, January 1). Retrieved January 18, 2015, from http://www.cdc.gov/hai/pdfs/stateplans/Iowa.pdf

2)

Healthcare-associated Infections (HAIs). (n.d.). Retrieved January 18, 2015, from http://www.cdc.gov/HAI/vap/vap.html

3)

Bauer, C. (2010). Evidence-Based Practice: Demystifying the Iowa Model. Oncology Nursing Society Metro Detroit Chapter,25(2). Retrieved January 18, 2015, from http://metrodetroit.vc.ons.org/file_depot/0-10000000/0-10000/8013/folder/62252/Spring 2010 Volume XXV Issue 2.pdf

4)

Pape. (2003). Evidence-based nursing practice: To infinity and beyond. The Journal of Continuing Education in Nursing,,34(4), 154-161.

5)

Ciliska, DiCenso, Melnyk, & Stetler. (n.d.). Using models and strategies for evidence-based practice. (pp. 185-219). Philadelphia, PA:: Lippincott… READ MORE

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