Hospital Acquired Infections 

Hospital Acquired Infections 

 

Hospital Acquired Infections

Among the most important responsibilities of healthcare professionals such as nurses is to ensure that the patients are safe in the clinical environment and that the patient care services offered are to a desirable and acceptable standard. Central to achieving such a feat is making the clinical environment enabling (Karlsson et al., 2019). However, even in the face of such efforts, various clinical problems still exist, and such problems threaten the safety of patients, derail the quality of healthcare and lead to high health care spending. One of such problems is hospital-acquired infections. Hospital-acquired infections are so common in healthcare. According to WHO, the overall rate ranges from 5.1 to 11.6%. The hospital-acquired infections have various adverse impacts such as increased mortality and morbidity, longer hospital stay, and increased healthcare spending; therefore, there is a need to formulate better strategies to control them. Therefore, the purpose of this project is to present an evidence-based proposal on hospital-acquired infections. As such, various aspects will be explored, including the problem statement, organizational culture and readiness, literature review, change model, implementation plan, and evaluation plan.

The Problem Statement

As earlier indicated, hospital-acquired infections are highly prevalent in healthcare settings, and they have various causes such as fungal, viruses, and bacteria pathogens. The hospital-acquired infections come in various forms, including surgical site infections, urinary tract infections, blood infections, and pneumonia, among others (Haque et al., 2018). These kinds of hospital-acquired infections lead to various adverse outcomes among the patients affected by them, for example, prolonged hospital stay, increased expenditure, and in some cases, death. Among the strategies that have been widely applied to address the problem is handwashing, which has been considered as a standard approach in healthcare settings, largely due to the fact that handwashing is an effective way of killing and removing various disease-causing microorganisms. Hand sanitizers, water, and soap have emerged in the past and at present as suitable strategies in healthcare. However, in the current site, the impact of handwashing techniques remains unexplored. As such, this project seeks to compare the efficacy of handwashing using hand sanitizers and soap in preventing hospital-acquired infections.

The Organizational Culture and Readiness

The implementation of an evidence-based practice project requires a site or an organization where the intervention or the project is to be implemented. Therefore, it is vital to evaluate that particular organization’s culture and readiness as organizational culture has been shown to substantially impact any change implementation. Indeed, for a successful change to be implemented, the organizational culture has to be supportive, characterized by an adequate and in-depth understanding of the tasks at hand, interprofessional collaboration, teamwork, and transformational leadership. As such, during such readiness assessments, various aspects are considered, such as the nurses’ and various healthcare professionals’ readiness to embrace a potential change (Arthurs et al., 2018). Therefore, this section entails an assessment of the organizational readiness for the proposed change.

The Organizational Culture Description

An assessment undertaken revealed that the organizational culture has aspects that support the change proposal. For example, upon evaluation of the strategies used by the organization to offer services, it was noted that teamwork is at the center stage, indicating that the proposed project will effectively be implemented as it requires teamwork. In addition, it was also noted that the staff in the organization operate in a team to achieve various assignments in ensuring that the care process is efficient and that the patient care initiatives are safe and of high and acceptable quality.

The predominant leadership style in the organization also revealed that the organization is ready for the proposed change. It was noted that the transformational leadership style is the predominant leadership style in the organization hence can effectively influence the required change. Among the strengths of the transformational leadership style is that the style motivates and empowers the employees to take active roles in change initiation and implementation to improve healthcare outcomes, a feature that is critical in the implementation of an evidence-based practice project. It was also noted that the organization is ready for a change from the analysis of its mission which focuses on offering efficient, safe, and high-quality patient care. The proposed project seeks efficiency in preventing hospital-acquired infections. Therefore, it is fully supported by the organization’s mission. Besides, the organization’s mission and vision also support patient-centered care process, open communication, and patient safety, which all support a change initiative (Arthurs et al., 2018).

Organizational Readiness Assessment

As earlier discussed, it is important to assess the organization for readiness. Such an assessment needs to be accomplished using appropriate tools. Therefore a tool developed by Buildingmovement.org was applied. This tool is effective in assessing various aspects related to change influence, including the organization’s staff, leadership and governance, and the organization’s goals, mission, and vision. The assessment accomplished using the tool indicated the readiness of the organization for the change implementation. From the mission’s perspective, it was noted that the mission statement is in sync with change strategies that promote care efficiency, quality, and safety. Besides, it was also noted that staff have an adequate understanding of the vision and mission statements and proactively undertake activities that enable their achievement. In addition, the leadership in place also engages and motivates the staff to undertake activities that promote quality and efficient service provision.

The organizational assessment was also instrumental in revealing various opportunities, weaknesses, and strengths that can be fine-tuned for better results. Among the strengths is that the organization’s vision is adequately stated, and the staff have an in-depth understanding of the same. The vision also aligns with the goals and mission. The other strength is that the organization evaluates various healthcare data to support its effectiveness in offering services for desired outcomes. In addition, it was evident that the organizational governance and leadership support and understand the strategies that can be used to effectively improve the staff performance, making the staff willing and dedicated in any attempts to meet the organization’s and community’s needs.

The assessment also revealed some weaknesses, which can be negative. For example, the organization’s leadership and governance come short in expressing actions key for enhancing efficiency and excellence. Besides, the staff also displayed inadequate awareness regarding how their actions are related to the organization’s failure or success. The assessment also revealed various barriers that could hinder the implementation of the proposed project. One of such barriers is high staff workload and inadequate knowledge among the patients. The implications of these weaknesses are that suitable strategies have to be explored by the organization to improve chances of better performance and success.

The Health Care Process and Systems

The systems within healthcare are key in enhancing cost-effectiveness, safety, and quality. However, the coming of the Covid 19 pandemic has a potential impact on the project as the nurses’ workload has substantially increased. An integration of telehealth in the intervention will appropriately help in reducing the workload as nurses can attend to the patients even remotely. In addition, the provision of services virtually or remotely also helps in eliminating patient overcrowding, which can potentially escalate the rates of infection. The use of telehealth will also offer the patients a chance to engage with the healthcare providers any time of the day hence improving care process continuity and patient-centered care. The end result is that the integration of telehealth would lower costs and improve patient safety and the quality of patient service offered (Mataxen & Webb, 2019).

Ways of Facilitating Organizational Readiness

Successful implementation of a change initiative heavily hinges on the stakeholder’s and organization’s readiness to embrace the change initiative. Therefore, it is important to facilitate their readiness for change. In facilitating the readiness for change, training the change team will be explored. For example, the nurses expected to participate in the change process will be trained regarding the change and project implementation. As such, a training exercise will boost their skills and knowledge regarding the project implementation cycle, from the planning to evaluation (Spalluto et al., 2018). The next strategy to be used is the incorporation of the change initiative into the organizations day to day routines. For example, in preparation for the comparison between the use of sanitizers and soap, hand washing will be integrated as part of the organization’s routine. Central to improving readiness is open communication. Employing open communication will help in addressing stakeholders’ and the project teams’ concerns and questions to facilitate the project’s success. (Rahmayanti et al., 2020).

The Stakeholders and Team Members

The project team members and stakeholders will be a key part of the project as they heavily influence the success of the project. The team members include data analysts, trainers of trainees, nurse leaders, and the nurse manager, with the nurses taking the lead role in implementing the project. While the nurses will recruit those who will participate and also collect the relevant data, the nurse manager and nurse leaders will play an overseeing role in the implementation process. As part of the overseeing role, they will receive important feedback from the nurses regarding the project’s progress, what is going right, what could be going wrong, and what strategies can be used to ensure that the project remains on track to achieve the desired goals. While the data analysts will use appropriate tools to analyze the collected data for interpretation and recommendation formulation, the trainers of trainees will perform the function of training the nurses regarding the whole process of project implementation.

The Information and Communication Technologies

The project implementation process will also require integrated electronic health records as it will enable the implementers to obtain the project’s appropriate data. The electronic health records contain valuable patient information penitent for the project’s course, implementation, and evaluation. The project team members will be able to assess the impact of the intervention when compared to the usual care in terms of contracting hospital-acquired infections (Luyten &  Marneffe, 2021).

Literature Review

In an effort to answer the clinical question, a literature search was conducted using various databases. Using the relevant keywords, google scholar was used in searching for the required articles. In addition, other databases applied to get the articles for literature synthesis include CINHAL, PubMed, Cochrane Library, and Trip database.

In one of the research studies, Tolera et al. (2020) conducted research to explore various factors connected with healthcare-associated infections among patients admitted in hospital specialized units. In a cross-sectional study, the researchers recruited a total of four hundred and thirty-three patients to take part in the study. The clinical and sociodemographic data were obtained from the patients who were admitted for more than two days in the pediatrics, gynecology/obstetrics, medical and surgical wards through the use of questionnaires. Upon the analysis of the data, the researchers noted that there are various factors that enhance hospital-acquired infections (Tolera et al., 2020). They include having to undergo an invasive procedure, in-hospital stay for more than four days, and cigarette smoking. The researchers, therefore, recommend that when formulating hospital-acquired infection programs, these factors should be a major focus.

Caselli et al. (2018) also conducted a study to explore whether the use of a probiotic cleaning hygiene system can influence the incidences of hospital-acquired infections. The study was a multicentre, pre-post interventional study where the usual or normal sanitation was substituted with a probiotic cleaning hygiene system, and the incidences of the hospital-acquired infections pre and post intervention compared. The analysis of the data revealed that the use of a probiotic cleaning hygiene system led to a stable decrease of surface pathogens when compared to the usual sanitation that was applied (Caselli et al., 2018). Therefore, this study showed that sanitation impacts HAI incidences and that a probiotic-based environmental intervention is key in reducing the risk of contracting hospital-acquired infections when patients are hospitalized.

According to Barker et al. (2017), hospital-acquired infections are higher in middle and low-income countries as compared to high-income countries. These researchers conducted a qualitative study to explore barriers and facilitators of effective control of hospital-acquired infections. The researchers conducted semi-structured interviews among physicians and nurses, with the study participants recruited through convenience sampling to give a total of ten doctors and ten nurses. The analysis of the interview scripts revealed various facilitators and barriers, which were divided into various levels such as organizational, task, and person. The main barriers revealed include heavy clinical workloads, language competency limitation, the time which has to be used in training new staff, and the enhanced rates of nursing staff turnover (Barker et al., 2017). On the other hand, this study revealed various facilitators, such as healthcare facilities focusing on hospital-acquired infection control and a well-crafted infection control team. Therefore, from this research, it is evident that institutional support is key when it comes to implementing various strategies for controlling infections (Barker et al., 2017). In addition, prioritization of resources that can be used in recruiting and retaining experienced and trained nursing staff is key and, therefore, worth pursuing.

Recently, Osme et al. (2020) undertook a study with the aim of analyzing the costs and burden of hospital-acquired infections in Brazil. The financial aspects were analyzed from the reimbursement data from the Brazilian government as well as direct costs incurred in intensive care units. A matched pairs case-control study was conducted among eighty-three patients with hospital-acquired infections and eighty-three without hospital-acquired infections. From the data analyzed, the study revealed that the reimbursement costs for every hospitalization of individuals with hospital-acquired infections were up to 75% higher than the costs incurred by patients without hospital-acquired infections. The major cause of the difference is the fact that the hospital-acquired infections made patients spend more time in hospitals hence increasing the costs. In addition, the direct costs of hospitalization were higher in the ICUs where patients had hospital-acquired infections. Therefore, there the researchers indicate that there is a need to formulate better methods of addressing the rates of infections and strategies of reinforcing the programs.

AL-Kerity& Naji. (2017) also carried out a study to examine the practices undertaken by the healthcare workers towards infection control. This was a descriptive study involving a total of seventy healthcare workers. The questionnaire was a major data collection tool used in collecting data about the health care workers. The analysis of the data revealed that most of the healthcare workers did not have sufficient training regarding a high level of infection control. Instead, the majority of the participants possessed a moderate level of practice and knowledge on infection control. Therefore, the development and implementation of a relevant infection program in the primary health care centers should be the major focus to ensure that the health care workers comply with the measures of infection control in the hospitals (AL-Kerity& Naji, 2017).

The Change Model

The change model or framework is one of the most fundamental aspects of change implementation as it supports the effective implementation of the quality improvement or evidence-based practice project. These models or frameworks are sources of theoretical underpinnings upon which various change aspects hinge on. Therefore, this section explores a relevant change model and how the implementation of this proposed project will depend on it. The chosen change model is related to the application of various strategies to ensure that the adverse effects resulting from hospital-acquired infections are addressed.

The chosen change model to guide the implementation of this project is Kurt Lewin’s change model. This model is composed of three distinct steps that can be applied as a practice model to understand and guide a change project (Hussain et al., 2018). According to the theory, a successful change in any organization is triggered by an adequate understanding of why the change is necessary and needed, which then leads the change implementers to identify the targeted behaviors and how to make the desired behaviors the norm.

Lewin’s change model has been shown to be effective in facilitating a successful modification of behaviors among the healthcare staff to result in the required organizational behavior change (Hussain et al., 2018). As such, the nursing staff in various departments such as the ICU will use the desired behaviors to facilitate the achievement of the targeted results, such as lowering the rates of hospital-associated infections.

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The Stages of Lewin’s Change Model

As earlier indicated, this model has three main stages, including unfreezing, change, and refreezing. The unfreezing stage is the first phase and perhaps the most crucial as every organization that must undergo change has to pass through it. This phase entails an evaluation of the current organizational behaviors and why change is necessary (Hussain et al., 2018). It is worth appreciating that people like the status quo and, in most cases, are naturally predisposed to resist change, especially those who do not understand the importance of change. Therefore, in the unfreezing stage, the change implementers have to find a way of motivating people that the targeted change will yield better results, and so, it should be embraced. As such, the implementers may use various ways, such as effective communication and motivation, while explaining the potential benefits of the proposed change to trigger acceptance of the proposed change.

The second phase, which is the change stage, sometimes known as the transition stage, entails the process of implementing the proposed change to achieve the targeted results. Therefore, relevant activities and careful planning are key at this stage as they ensure a successful implementation. In addition, this phase of the model entails the teaching of the individuals within the organization concerning the new behaviors and ensuring that adequate support is offered to the staff throughout the stage (Hussain et al., 2018). The employees also need constant reminders on why the change is worth pursuing.

The final stage of the model is the refreezing stage. In this phase, the change implementers reinforce, solidify, and standardize the targeted change and improvements. Therefore, the stage ensures that the staff does not go back to the older behaviors which were in place before the change implementation. Central to the standardization of the improvements and integrating the same into the organizational culture is the use of individual acknowledgments and a reward system (Hussain et al., 2018). This phase is also enhanced by formulating supporting structures and policies that can guide employee behavior.

Application of the Change Model in the Implementation of the Proposed Project

The three-phase change model offers vital steps in the implementation of the project. In the freezing stage, the nursing staff and other health practitioners determine the need for making a change which is to reduce the rates of hospital-acquired infections. Besides, during the stage, the nurse collects necessary information and data from the health care team and the facility, supporting the need for change and coming up with the most appropriate strategy that can be applied in improving outcomes and reducing possible change resistance (Helmold, 2021).

In the second phase, the change implementers formulate ways of facilitating effective communication that helps in bringing every stakeholder on board for the success of the program. Again, the healthcare workers in the ICU will be engaged to ensure that uniformity underlines the process. In the last stage, adequate training is accomplished, and stakeholders are supported to improve familiarity. The refreezing stage will also entail sustaining the change, which is the use of hand sanitizers and soap to lower the levels of hospital-acquired infections.

The Implementation Plan

Another aspect of evidence-based practice project implementation is an adequately formulated implementation plan (LoBiondo-Wood & Haber, 2021). As such, the implementation plan should include various materials, finances, and the human resources required for successful implementation. As part of the implementation plan, various aspects will be explored, including addressing potential barriers and minimizing such barriers.

The Study Setting and Access to the Potential Subjects

The plan is to accomplish this project in a hospital setting with the study subjects majorly drawn from the medical wards. The site has been chosen since it will allow easy access to the targeted study subjects. The use of hospital-acquired infection prevention practices such as handwashing is predominant in this setting. Therefore, it will be easier to explore hospital-acquired infections and handwashing techniques’ cause-effect relationships. The approval will have to be obtained from the facility to allow the accomplishment of the project.

The Project Timeline

The project has been planned to be accomplished within three months. Within these three months, necessary and relevant data will be collected to support the proposed project. In addition, the period is projected to be enough in promoting the desired healthcare quality and patient safety through the use of the necessary strategies to help lower the rates of infections.

The Budget and Resource List

Resources are required to help in the project’s successful implementation; therefore, it is important to budget for adequate resources. The total cost of the implementation has been estimated to be $5000. This budget will be applied in facilitating various activities such as data analysis, data collection, training of the staff, and performing the needs assessment. The detailed specifics of the budget have been included in the appendix sections. Part of the resources needed for adequate implementation is the human resources such as unit nurse managers, data analysts, and registered nurses. In addition, materials that will be required include writing materials, educational brochures for patients, hand sanitizers, soap, and water. A detailed resource list has been added in the appendix section.

The clinical Tools or Process

In efforts to help answer the clinical question, patients will have to be divided into groups. One group will be recruited to use sanitizers, while the other group will be required to use soap and water. Nurses will help in distributing the patients into the two groups mentioned. To enhance their competence, they will be trained on data collection strategies to collect the necessary data that can be used to determine the efficacy of the intervention.

The Study Design

The quantitative design will be implemented in the study since a large sample is targeted and will also help in gaining more insight into the relationship that exists between the study variables. Statistical analysis will be key in determining the impact of the proposed intervention (LoBiondo-Wood & Haber, 2021). The statistical analysis will be key in revealing the impact of handwashing using either sanitizers or soap and water in controlling hospital-acquired infections.

Methods and Instruments

This project plans to use simple data collection methods and tools. One of the most vital tools that will be used is the questionnaire which will be key in obtaining the relevant information on patients, such as the number of patients that have been impacted by the hospital-acquired infections. One advantage of questionnaires is that it helps in obtaining objective data that are necessary to the project. In addition, the costs of administering questionnaires are relatively low, and the data is easier to organize and analyze (Dang & Dearholt, 2018).

The Intervention Delivery Process

The delivery of the intervention is projected to follow a structured project (LoBiondo-Wood & Haber, 2021). The first step to being performed by the nurses is to select the participants and assign them to either the group that uses hand sanitizers or that uses soap and water. The nurses will then identify the patients who go on to develop hospital-acquired infections. The rates of infections will then be compared between the groups. Again, it is important to offer the nurses adequate training to ensure that they have enough skills and knowledge to help them carry out all the assigned duties.

The Stakeholders

The stakeholders form an integral part of the project implementation since their input is considered to be key (LoBiondo-Wood & Haber, 2021). As earlier indicated, they include nurse leaders, nurse managers, and registered nurses. The nurse leaders will help in allocating the resources for the project implementation, while the registered nurses will help in enrolling and educating the patients in each of the groups. In addition, the nurse managers will be responsible for overseeing the whole implementation process by ensuring that the project uses the right process, such as data collection, intervention implementation, and selection of participants.

The Potential Barriers

Various barriers can hinder the success of the project; therefore, it is important to identify them and come up with ways of addressing them. A potential barrier is the lack of enough institutional support, as the institution may fall short of offering the needed resources for the project’s success. There could also be a potential change resistance among the nurse staff, which can be caused by a lack of knowledge and inadequate skills regarding the project (Jolley, 2020).

The Strategies to Overcome the Barriers

The barriers should be addressed to ensure successful implementation. Among the strategies is involving the nursing staff in the change process from the onset since they play a critical role in every phase of the project. Such an approach is likely to minimize potential resistance to change. Training will also be offered to the nursing staff to ensure that they have enough knowledge and skills regarding the proposed project (Melnyk&Fineout-Overholt, 2019). Therefore, when these strategies are used, then there are higher chances that the project will be implemented successfully.

The Evaluation Plan

Evaluation is the final phase of this proposed project to help in assessing the effectiveness of the processes and the intervention used in solving the clinical issue. Therefore, various aspects of evaluation will be explored, including expected outcomes, data collection tools, statistical tests, strategies, and plans.

The Expected Outcomes

Among the expected outcomes is a lower incidence of hospital-acquired infections upon the use of the intervention. Even though both soap and water and the use of sanitizers have been shown to be effective, recent research shows that soap and water are more effective. However, it is expected that both strategies will yield positive results. The other outcome is adoption and increased use of the intervention in the facility. It is also expected that the project will be sustainable through the effective use of resources and promoting patient quality care and safety.

The Data Collection Tools

Central to the collection of data in this project is the use of questionnaires which will be administered pre and post-intervention. During the pre-intervention, the questionnaires will be key in determining the patient’s predisposition to the HAI. A quantitative study design has been selected for the project as it will allow the effective collection of data and mathematical models application in data analysis (Zammitti et al., 2021).

The Statistical Test

Analysis of the project’s data will be key in answering the clinical question. Therefore, paired T-test will be used. This statistical test will be key in testing the difference occurring between variables obtained from the same population. As such, it will help in determining the rates of infection before and after the implementation of the intervention to offer an accurate evaluation of the impact of the intervention used in both groups (Kim et al., 2020).

The Methods Applied On Data Collection

In ensuring that the data is not biased, a check for completeness will be performed before ordering and coding. An analysis software will be used to analyze the data, which will then be interpreted to determine the impact of the intervention (Kim et al., 2020). Such data will be used in formulating the report and implication for practice.

Strategies and Plan

In case the outcomes obtained are not the desired ones, then the interventions will be re-examined. Re-analysis will also be done to find out about any weaknesses and areas that need improvement (LoBiondo-Wood & Haber, 2021). The project timeline will also be extended to correct any mistakes. In case the project yields positive impacts and is cost-effective, then it will be maintained. If no substantial conclusions can be made, then more time will be used to obtain sufficient data. If the project causes harm to patients, hence compromising safety, then it will be discontinued.

Conclusion

Hospital-acquired infections are common in healthcare settings, and they lead to various adverse outcomes which endanger patients’ safety and life. Therefore, there is a need to come up with better ways of controlling or preventing infections. This project seeks to explore the efficacy of the use of soap and water and the use of sanitizers in washing hands to prevent hospital-acquired infection. As such, various sections of the proposal have been presented.

References

AL-Kerity, S. H. F., & Naji, A. B. (2017). Evaluation of Healthcare workers’ Practices Concerning Infection Control Measures at Primary Health Care Centers. http://sjomr.org.in/index.php/SJOMR/article/view/35/35.

Arthurs, K., Bell-Gordon, C., Chalupa, B., Rose, A. L., Martinez, D., Watson, J. A., & Bernard, D. P. (2018).A culture of nursing excellence: A community hospital’s journey from Pathway to Excellence RG to Magnet RG recognition.Journal of Nursing Education and Practice, 8(5).

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Barker, A. K., Brown, K., Siraj, D., Ahsan, M., Sengupta, S., & Safdar, N. (2017). Barriers and facilitators to infection control at a hospital in northern India: a qualitative study. Antimicrobial Resistance & Infection Control, 6(1), 1-7. https://doi.org/10.1186/s13756-017-0189-9

Caselli, E., Brusaferro, S., Coccagna, M., Arnoldo, L., Berloco, F., Antonioli, P., … & SAN-ICA Study Group. (2018). Reducing healthcare-associated infections incidence by a probiotic-based sanitation system: A multicentre, prospective, intervention study. PLoS One, 13(7), e0199616. https://doi.org/10.1371/journal.pone.0199616.

Dang, D., &Dearholt, S. (2018). Johns Hopkins Nursing Evidence-based Practice: Model and Guidelines.Sigma Theta Tau International

Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Health care-associated infections–an overview. Infection and drug resistance, 11, 2321. https://dx.doi.org/10.2147%2FIDR.S177247

Helmold, M. (2021). Change Management as the Trigger for New Work. Management for   Professionals, 31-43. https://doi.org/10.1007/978-3-030-63315-8_3

Hussain, S., Lei, S., Akram, T., Haider, M., Hussain, S., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002

Jolley, J. (2020). Introducing Research and Evidence-based Practice for Nursing and Healthcare Professionals. Routledge.

Karlsson, A. C., Gunningberg, L., Bäckström, J., & Pöder, U. (2019). Registered nurses’ perspectives of work satisfaction, patient safety and intention to stay–A double‐edged sword. Journal of nursing management, 27(7), 1359-1365. https://doi.org/10.1111/jonm.12816.

Kim, M., Mallory, C., & Valerio, T. (2020).Statistics for Evidence-Based Practice in Nursing. Jones & Bartlett Learning

LoBiondo-Wood, G., & Haber, J. (2021).Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice.Elsevier.

Luyten, J., &Marneffe, W. (2021). Examining the acceptance of an integrated Electronic Health Records system: Insights from a repeated cross-sectional design. International Journal of Medical Informatics, 150, 104450. https://doi.org/10.1016/j.ijmedinf.2021.104450

Mataxen, P. A., & Webb, L. D. (2019).Telehealth nursing: More than just a phone call. Nursing2022, 49(4), 11–13. https://doi.org/10.1097/01.NURSE.0000553272.16933.4b.

Melnyk, B. M., &Fineout-Overholt, E. (2019).Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice.Wolters Kluwer.

Osme, S. F., Almeida, A. P. S., Lemes, M. F., Barbosa, W. O., Arantes, A., Mendes-Rodrigues, C., … & Ribas, R. M. (2020). Costs of healthcare-associated infections to the Brazilian public Unified Health System in a tertiary-care teaching hospital: a matched case-control study. Journal of Hospital Infection, 106(2), 303-310. https://doi.org/10.1016/j.jhin.2020.07.015

Tolera, M., Marami, D., Abate, D., & Dheresa, M. (2020). Are invasive procedures and a longer hospital stay increasing the risk of healthcare-associated infections among the admitted patients at Hiwot Fana specialized university Hospital, eastern Ethiopia?. Advances in preventive medicine, 2020. https://doi.org/10.1155/2020/6875463.

Zammitti, A., Magnano, P., & Santisi, G. (2021). The concepts of work and decent work in relationship with self-efficacy and career adaptability: Research with quantitative and qualitative methods in adolescence. Frontiers in Psychology, 12, 856.

Appendices

Appendix IBudget

Item	Cost
Training	$1000
Data collection and analysis	$500
Purchase of materials	$2500
Miscellaneous	$1000
Total	$5000

Appendix II: Resources

Nursing staff

Data analyst

Soap, water, and hand sanitizers

Educational brochures

Writing materials

Appendix III Data Collection Instrument

Patient Code

Patient Group: Soap and Water [        ] Hand Sanitizer [        ]

Patient’s diagnosis:

Patient’s gender: Male [          ] Female [        ]

Age: 18-24 years [      ] 25-30 years [             ] 31-35 years [             ] 36-40 years [             ]

Above 40 years [         ]

Type of hospital-acquired infection:

Outcome: Recovered [            ] Died [            ]

For this assignment, you will synthesize the independent evidence-based practice project proposal assignments from NUR-550 and NUR-590 into a 4,500-5,000-word professional paper.

Final Paper

The final paper should:

Incorporate all necessary revisions and corrections suggested by your instructors.
Synthesize the different elements of the overall project into one paper. The synthesis should reflect the main concepts for each section, connect ideas or overreaching concepts, and be rewritten to include the critical aspects (do not copy and paste the assignments).
Contain supporting research for the evidence-based practice project proposal.
Main Body of the Paper

The main body of your paper should include the following sections:

Problem Statement
Organizational Culture and Readiness
Literature Review
Change Model, or Framework
Implementation Plan
Evaluation Plan
Appendices

The appendices at the end of your paper should include the following:

All final changes or revisions for the drafts that will be included in the appendices of your paper.
Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as the final appendix at the end of your paper. In each preceding course you have been directed to the Student Success Center for assistance with APA style, and have submitted the APA Writing Checklist to help illustrate your adherence to APA style. This final paper should demonstrate a clear ability to communicate your project in a professional and accurately formatted paper using APA style.
General Requirements

You are required to cite 10-12 peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.