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Program Intervention to Reduce Health Care Associated Infection Within a ICUChapter Writing

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Intervention to Prevent and Reduce Health Care-Associated Infections in ICU

The objective of this study is to implement a new practice intervention using the chlorhexidine 2% gluconate bath cloth combined with Mupirocin nasal antibiotic ointment to reduce and prevent the healthcare associated infections such as VRE, MRSA, and CLABSI in the adult ICU (intensive healthcare unit). (Peterson, Beaumont, & Robicsek. 2008). HAI (Healthcare-associated infection) is one of the leading causes of morbidity, mortality, and preventable illness in the United States often result in the illness from the bacteria colonization, which overcomes the body defenses. Sydnor, & Perl, (2011) define the healthcare-associated infections as the type of infections acquired within an ICU where there is an absence of evidence that the infection is incubating, or present at the time of the hospital admission. However, the definition has undergone changes; modern medical healthcare is becoming invasive and associated with a high risk of infection complications. (Robicsek, Beaumont, Paule, et al. 2008). The AIDS epidemic, aging population, a growing rate of transplant population, and growth of chemotherapeutic for cancer patients have increased the risks of HAI. (Stone, Glied, McNair, 2010).

MRSA (methicillin-resistant Staphylococcus Aureus) is one of the pathogens that causes the healthcare associated infections in the ICU. MRSA, as well as VRE (vancomycin-resistant Enterococcus), are the drug resistance pathogens within a healthcare setting. The immunocompromised or critically ill patients have a high risk of acquiring the VRE or MRSA infections that may prolong their hospital stays as well as increasing in-patient burden. Both VRE and MRSA have been identified as the serious health problems where a prevalence of MRSA is more than 60% and 30% for VRE in the intensive care units in the United States. (Kallen, Mu, Bulens, et al. 2010). Some healthcare workers also face the risks of cross-transmission through a hand contamination. (Chen, Li, Lianhong, et al. 2013, Huang, Septimus, Kleinman, et al. 2013).

Typically, HAIs are ranked as the sixth leading cause of death in the United States, and their underlying capital costs across the country are between $28 and $45 billion annually. In the U.S. healthcare setting, more than 2 million patients develop HAIs yearly leading to 36% of hospital admissions. In the last 10 years, the U.S. has recorded 36% increase in HAIs causing an estimated 100,000 HAIs associated death per year. Moreover, more than 80,000 cases of MRSA invasive infections were reported in 2011 leading to 11,000 deaths. Consequently, MRSA can be cultured from the basin baths in the intensive care unit leading to a secondary contamination, and colonization of patients' skin. Thus, HAIs prevalence has forced several states in the United States to mandate more MRSA surveillance. Moreover, federal legislation mandates all ICUs to report their HAI rates. (Sydnor, & Perl, 2011, CMS, 2007).

B: Personal and Professional Interest

I am a nursing professional working at the Hospital Surgical Intensive Care Unit providing care for the sick patients. However, the last thing patients require is to be infected with the preventable infections such as CLABSI, MRSA, and VRE. My professional experiences have enhanced my greater understanding about the rates the patients acquire the HAIs after hospitalization. It is very sad to view patients admitted to the hospital with no infection, and catch up infections after the hospitalization. The issue can extend patients' hospital stay, complicate their sickness, and increase the costs of hospitalization. My main goal is to recommend policies that will prevent the infection rate in the intensive care unit. Application of the policy is essential because approximately 90,000 deaths per year are associated with HAIs adding to the costs of patients care of nearly $5.7 billion annually. Thus, my policy recommendation aims to prevent HAI within the ICU and to reduce the associated costs of treating patients at the intensive care units. (Vernon, Hayden, Trick et al. 2006).

Identification of the Intervention to address the Problem

In my ICU working environment, the bathing procedure is ineffective leading to an increased risk of infection among patients. Based on the absence of preoperative bathing, our ICU has become a breeding ground for pathogens and spread of antimicrobial resistance bacteria. (Webster. & Osborne, 2012). Factors influencing the disease transmission include colonization pressures and low rates of hand washing among the hospital personnel that leads to the adjacent spread of bacteria. ( Petlinn, Schallom, Prentice et al. 2014). The burden of the HAI for the ICU is high, consequently, aggravate the illness of patients, and increase the cost of hospitalization within the ICU. The absence of skin antiseptics or preoperative bathing protocol often increase the rate of readmissions and increase the average medical costs of between $10,000 and $20,000 per SUI (surgical site infection). Thus, the study recommends the use of chlorhexidine 2% bathing protocol to prevent and reduce an incidence HAIs.

Definition and History of Chlorhexidine 2% Bathing

The chlorhexidine 2% bathing consists of 2% chlorhexidine gluconate impregnated clothes is an established clinical procedure to reduce the rate of HAIs infections. The 2% chlorhexidine gluconate can reduce the rate of infection by 82%, kill germs in patient's skin, and help in preventing germs from entering into the patients' blood. (Vernon, Hayden, Trick, et al. 2006). Sydnor, & Perl, (2011) traced the history of chlorhexidine 2% Bathing to 1847 when Ignaz Semmelweis discovered that a pathologist died from a sustained injury after he performed an autopsy on patients suffering from puerperal sepsis. To address a further occurrence of this case, Semmelweis made a policy to use chlorinated lime hand washing, and the strategy reduced the rate of maternal mortality. Afterward, Semmelweis postulated the theory of transmission recommending a health intervention to prevent the development of HAIs through the hand hygiene.

In the 1970s, public health officials made a campaign mandating all hospitals to implement the surveillance and infection program. In 1974, the CDC evaluated the infection surveillance program across the United States to reduce the rate of HAIs. Despite the effort of the policy makers to reduce the incidence of HAIs, MRSA transmission continues to increase. The investigation carried out revealed that hospital bath basin was the source of contamination, and a 4-year study across 88 hospitals in the U.S. and Canada showed that 62% of the basins of the sampled hospitals were contaminated with harmful bacteria, 45% of basins were contaminated with the gram-negative bacteria, 35% with VRE and more than 3% with MRSA. All the traditional strategies to increase the staff compliance to reduce the infection transmission through the basin management failed.(Rafuse, 2014). Thus, the CHG bathing has become a novel idea, and 2% CHC cloths are recommended based on its efficacy in reducing MRSA and VRE. The Joint Commission International reveals, "2% CHG impregnated washcloths may be a simple, effective strategy to decrease the rate of primary BSIs." (Rafuse, 2014 p 12). Moreover, the 2% CHG assists in reducing MRSA infections. For example, SAGE ABC (Antiseptic Body Cleanser) yield 43% reduction of MRSA, and ABC reduced BSI by 87%.

"Chlorhexidine gluconate is a water-soluble antiseptic preparation with broad activity against bacteria, yeasts, and viruses. Recent investigations of whole-body skin decolonization with chlorhexidine in medical ICU patients have demonstrated a reduction in the acquisition of MRSA and VRE, and decrease the incidence of CRBSI." (Evans, Dellit, Chan, et al. 2010 p 240).

Effectiveness of routine Cleansing with 2% Chlorhexidine Gluconate

Rafuse, (2014) demonstrates the effectiveness of routine cleansing with 2% chlorhexidine gluconate by carrying out the experiment on randomly selected patients. The outcome of the experiment reveals that patients using the 2% SAGE CHG Impregnated Cloth record a 28% lower of MDRO incidence. The author concludes that daily bathing with the CHG washcloths reduces the development of HA-BSI and risk of the MDROs transmissions. Evans et al. (2010) provide a similar result after carrying an experiment to demonstrate the effectiveness of 2% chlorhexidine gluconate. The outcome of the experiment reveals that the incidence of MRSA reduces significantly in the ICU with the use of the 2% chlorhexidine gluconate. However, Chen et al. (2013) suggest that consecutive day's application of a skin antisepsis assists in reducing the microbial counts. Moreover, daily bathing with the CHG is an effective medical strategy to "eradicate the colonization of high-risk pathogens including MRSA and VRE, thus decreasing the acquired risk for transmission between healthcare workers and patients." (Chen et al. 2013 p 518). However, Climo, Sepkowitz, Zuccotti et al. (2009) argues that decolonization of bacteria are not enough to eradicate MRSA. The authors suggest that the whole body bathing using the CHG is an effective alternative to prevent and reduce the multi-sites' colonization. Moreover, the CHG cleansing assists in persistence reduction of the microbial skin colonization as being compare with water and soap bathing.

Targeted Colonization v. Universal Colonization in MRSA

The targeted colonization is the screening of MRSA carriers in isolation; however, the universal colonization involves no screening and colonization of patients. (Yoo, Shin, Cha, et al. 2006). Rafuse, (2014) carries out an experiment to evaluate the difference in the effectiveness of universal and targeted colonization. The results… [END OF PREVIEW]

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