Assignment 4: Planning for Evaluation

NURS 7810 : Epidemiology and Population Health

Major Assessment Overview

Major Assessment 7: Using an Epidemiological Approach to Critically Analyze a Population Health Issue

Write a 12- to 15-page paper that addresses the following:

Section 1: The Problem (developed as Assignment 2; submitted at the end of Week 6)

· A brief outline of the environment you selected (i.e., home, workplace, school)

· A summary of your selected population health problem in terms of person, place, and time, and the magnitude of the problem based on data from appropriate data resources (Reference the data resources you used.)

· Research question/hypothesis

Section 2: Research Methods (developed as Assignment 2; submitted at the end of Week 6)

· The epidemiologic study design you would use to assess and address your population health problem.

· Assessment strategies (i.e., if you were conducting a case-control study, how would you select your cases and controls? Regarding the methods and tools you would use to make these selections, how is it convenient for you as the researcher or as the investigator to use this tool?)

· Summary of the data collection activities (i.e., how you would collect data—online survey, paper/pen, mailing, etc.)

Section 3: The Intervention (developed as Assignment 3; submitted at the end of Week 8)

· An outline of an intervention you would implement to address the population health problem with your selected population based on the results of the study in Section 2. Note: If you selected a descriptive study design, you are still required to outline an intervention that might be developed based on future research on.

· A review of the literature that supports this intervention

Section 4: The Impact (developed as Assignment 3; submitted at the end of Week 8)

· An explanation of the health outcome you would be seeking and the social impact of solving this issue

Section 5: Evaluation (developed as Assignment 4; submitted in Week 9)

· An evaluation plan based upon the health outcome that you have chosen and your anticipated results

The Final Paper (with feedback incorporated) is due by Day 3 of Week 11. This serves as your Major Assessment for this course.

Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from appropriate Learning Resources and additional scholarly sources as appropriate. Refer to the Publication Manual of the American Psychological Association to ensure that your in-text citations and reference list are correct.

2

Population Health: Healthcare-Associated Infections

Name

Walden University

Class

Date

Healthcare-Associated Infections

Healthcare-Associated infections (HAI) are infections acquired by patients in the course of receiving medical or surgical care. In modern healthcare, there are many procedures and invasive techniques that are meant to improve the health of patients. However, some of these healthcare procedures may put the patients at the risk of infection. HAIs are a leading cause of morbidity and mortality in healthcare institutions in the United States (Sievert et al., 2013). Additionally, these infections have led to an increased cost of healthcare. HAIs occur in various healthcare settings such as surgical centers, acute care centers, long-term care facilities, and even outpatient centers. There is need to improve the quality of care to reduce and possibly completely eradicate HAIs to enhance the quality of healthcare. The purpose of this paper is to discuss HAIs as a population health problem and develop a research topic on this health issue.

About Healthcare-Associated Infections

Person

All people who visit healthcare facilities for medical or surgical treatment can acquire HAIs. However, there are some groups of people that are at a greater risk than others. The elderly population is at the highest risk of acquiring HAIs because of their increasing immune deficiencies (Sievert et al., 2013). The elderly people’s deteriorating immune system makes them more susceptible to infections by pathogens that are commonly found in the healthcare environment. Assignment 4: Planning for Evaluation

Place

HAIs have been reported in every state in the United States. The Center for Disease Control (CDC) has two HAI surveillance programs that track the rate of infections in all U.S. states and records the trends. According to CDC reports from 2015, at least 1 in every 25 patients acquire infections in the healthcare setting (Umscheid et al., 2011). These infections are most prevalent in specific areas of healthcare such as surgical sites and intensive care units.

Time

The occurrence of HAIs is not seasonal. Patients are at the risk of acquiring infections at any time of the year provided they are exposed to an environment containing the pathogens that could cause the infections to occur. However, patients are at a greater risk at a time when they are undergoing surgical procedures or during antibiotic use.

The significance of this Health Problem

HAI is one of the major population health issues that affect the United States healthcare system. The United States Department of Health and Human Services has reflected its objective to reduce and eventually eliminate hospital-acquired infections through the Healthy People 2020 initiative. Health People 2020 identifies some of the risk factors that increase the chances of acquiring infections while receiving medical care. These include antibiotic use and medical procedures, organizational factors, lack of handwashing among healthcare workers and individual patient characteristics (Healthy People 2020, 2014). Various preventive strategies have been developed in a bid to eliminate HAIs, but research shows that these strategies have only been effective in reducing 70% of the infections (Sievert et al., 2013). Therefore, there is still the need to make more changes to reduce the infections and the morbidity and mortality that they cause. Research shows that proper education and training of healthcare workers in one of the most important strategies that can help to reduce infections in healthcare (Umscheid et al., 2011). This strategy helps to improve the best practices for healthcare workers to enhance the quality of care that they provide to patients.

Research Question

Does handwashing education among healthcare workers compared to lack of handwashing education help to reduce the rate of healthcare-associated infections among the elderly population in healthcare facilities within a year?

P: Elderly population within healthcare facilities

I: handwashing education

C: lack of handwashing education

O: reduce the rate of healthcare-associated infections

T: a year

Conclusion

In spite of the many strategies in place to improve the quality of healthcare, HAIs are still a great population issue affecting medical institutions in the United States. Many strategies have been put in place to eliminate these infections, but there are still patients who are affected while in the course of treatment for other medical issues. There is need to create and improve more strategies that will enable the complete eradication of HAIs. Assignment 4: Planning for Evaluation

References

Healthy People 2020 (2014). Healthcare-associated Infections. Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/healthcare-associated-infections

Sievert, D. M., Ricks, P., Edwards, J. R., Schneider, A., Patel, J., Srinivasan, A., … & Fridkin, S. (2013). Antimicrobial-resistant pathogens associated with healthcare-associated infections summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infection Control & Hospital Epidemiology, 34(1), 1-14. Doi: https://doi.org/10.1086/668770

Umscheid, C. A., Mitchell, M. D., Doshi, J. A., Agarwal, R., Williams, K., & Brennan, P. J. (2011). Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infection Control & Hospital Epidemiology, 32(2), 101-114. Doi: https://doi.org/10.1086/657912

1

2

Defining the Problem and Research Methods

Name

Walden University

Class

Date

Defining the Problem and Research Questions

The Problem

Many strategies have been implemented in the United States health care system to improve the quality of care that patients receive. Many of these strategies have been successful in improving patient outcomes. However, healthcare-acquired infections (HAIs) are still a significant issue affecting the health care system. HAIs are infections that are acquired by patients in the course of receiving surgical and medical care. There are many invasive treatment options in the current health care systems that are designed to improve the health of patients, but in some cases, they put them at the risk of acquiring various types of infections (Healthy People 2020, 2014). HAIs are a serious public health issue because they are one of the leading causes of mortality and morbidity in the United States healthcare institutions (Sievert et al., 2013). In addition to the increased rate of mortality and morbidity, HAIs have also increased the United States’ cost of health care. Therefore, there has been dire need to enhance the quality of healthcare delivery in medical institutions to minimize the rate of the infections that occur in the course of receiving treatment. Eradicating HAIs can help not only to reduce patient deaths but also to reduce the cost of healthcare. The purpose of this paper is to examine the problem of HAIs in the United States and develop a research strategy that can help to devise techniques to be used in reducing the rate of infections in the course of patient care. Assignment 4: Planning for Evaluation

Environment

The environment that is the problem is based on the healthcare setting. HAI is a population health problem that affects people who are in healthcare institutions receiving care for various other issues. HAIs may occur across multiple healthcare environments such as acute care centers, surgical centers, outpatient centers, and long-term care facilities.

Healthcare-Acquired Infections

The following is a summary of HAIs as a population health problem regarding epidemiologic factors of person, place, and time.

Person

Every person who visits a medical institution is at the risk of acquiring an infection because this environment is usually rich in various pathogens. However, some populations have a higher risk of HAIs than others because of their unique characteristics. The elderly community is one of the population groups that have the highest risk of acquiring HAIs because of their deteriorated immune capabilities (Sievert et al., 2013). The older adults usually have a lower immune system because of the reduced capabilities of the body’s organs; hence, they stand a higher chance of them being infected by the disease-causing pathogens present in the hospital environment.

Place

HAIs do not have a specific location of occurrence, as long as it is a healthcare facility. Cases of HAI have been reported in all the states in America. The Centers for Disease Control (CDC) tracks the HAI infection using two surveillance programs which help to record the trends and monitor the rate at which people are getting infected while receiving treatment. According to the CDC reports, at least one in every 25 patients in the healthcare setting acquire some infection originating from this environment (Umscheid et al., 2011). The most common areas where diseases are acquired are in various hospital units such as the intensive care units, and surgical centers. Assignment 4: Planning for Evaluation

Time

Healthcare-acquired infections are not seasonal as they can be acquired at any time of the year provided that the patient is exposed to the organisms causing the infection. However, the patients tend to be a higher risk when they are undergoing procedures that increase the risk of infection such as surgical care.

Research Question/Hypothesis

Does hand washing education among healthcare workers compared to lack of hand washing education help to reduce the rate of healthcare-associated infections among the elderly population in healthcare facilities within a year?

P: Elderly population within healthcare facilities

I: hand washing education

C: lack of hand washing education

O: reduce the rate of healthcare-associated infections

T: a year

The Research Methods

Epidemiologic Study Design

The epidemiologic study design selected for this study is a case-control study. A case-control is a type of observational study that evaluates two different groups of the population, one with the intervention and the other without, to determine the differences in the outcomes based on a given causal attribute (Kleinbaum, Sullivan & Barker, 2013). These two groups which include the control group, where the intervention is not administered, and the case group where the intervention is included. Assignment 4: Planning for Evaluation

This study seeks to investigate the impact of hand washing education for nurses in a healthcare facility on reduced healthcare-acquired infections. The nurses who receive the hand washing education will be considered as the intervention group while those who do not receive the education will be the control group. It is expected that there will be a difference in the outcome of hospital-acquired infections for both groups (Friis & Sellers, 2014). This design is based on the assumption that the case group and the control group will yield different results because of the difference in the administered intervention. Therefore, this will help to determine whether nurses’ education really has an impact on reduced rates of infections on patients in the course of care.

Assessment Strategies

In this case-control study, both the case and the control groups are nurses. The only difference between the two is that the case group is expected to receive education on handwashing while the control group is not expected to receive the education on hand washing. A criterion for the inclusion of the case and the control group will be developed to ensure that the results are valid. First, the case and control groups will both come from the United States health care facilities with access to almost similar kinds of medical resources. This will help to ensure that in each facility there is a similarity with the types of risks of infections that the patients face. It will also minimize the impact of other confounding factors that could impact the rates of infections such as poor management. A group of nurses from one of the medical facilities will go through a six weeks’ education program teaching them techniques of enhancing handwashing hygiene to minimize the transfer of pathogens to the patients under their care. On the other hand, the control group will continue handling their care without receiving the education program.

Data will be collected on the rate of HAIs in both the case and the control group’s areas of work before the education program. After the education program, the data will be collected on the new rate of HAIs in the respective areas of case and control to measure the differences in the rates before and after the education program in each of the groups. The results will later be compared to show the difference between the rates before and after the education for the case group in comparison with those of the control group. Assignment 4: Planning for Evaluation

The assessment strategies that have been selected above are convenient for this study because they minimize the impact of external factors on the case and control group. The data will also be easy to collect because each of the medical facilities is expected to keep a record of the hospital-acquired infections.

Summary of Data Collection Activities

The data for this study will be collected from the databases of the respective hospital where the research will be done. Each medical facility in the United States keeps a record of the hospital-acquired infections. With the consent of the facilities included in the study, a history of the HAIs from the beginning of the study to its maturity will be collected for analysis to determine the impact of the intervention on the case group and the lack of intervention on the control group. The patient identities from the data collected will be kept private according to the HIPAA guidelines.

The data will be collected three times in the course of the research. First, the data will be collected at the beginning of the study before the education program is administered. The data will also be collected six months after the education program to assess the immediate impact that the program had on the rates of HAI infections. Lastly, the data will be collected a year after the education program to follow up on the impact of the education program after an extended period.

Conclusion

HAIs are significant public health problems that affect the United States health care system. Even though many strategies have been implemented to eradicate hospital infections, there is still a significantly large percentage of patients who acquire infections in the course of care. Therefore, there is a need for more research to determine new strategies that can reduce HAIs further or possibly eradicate them. This research seeks to investigate whether nurses’ education on hand washing can help to reduce infections among the elderly population in a period of one year. Case-Control study design has been recommended for this study because it will help to investigate the difference between the infection rates in the case population and the control population. If this study is successful, it can help to reduce the rates of HAIs among the elderly community in healthcare facilities, which has a higher risk than other population communities. Assignment 4: Planning for Evaluation

References

Friis, R. H., & Sellers, T. A. (2014). Epidemiology for public health practice (5thed.). Sudbury, MA: Jones & Bartlett.

Healthy People 2020 (2014). Healthcare-associated Infections. Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/healthcare-associated-infections

Kleinbaum, D. G., Sullivan, K. M., & Barker, N. D. (2013). Epidemiologic Study Designs. In ActivEpi Companion Textbook (pp. 37-66). Springer, New York, NY.

Sievert, D. M., Ricks, P., Edwards, J. R., Schneider, A., Patel, J., Srinivasan, A., … & Fridkin, S. (2013). Antimicrobial-resistant pathogens associated with healthcare-associated infections summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infection Control & Hospital Epidemiology, 34(1), 1-14. Doi: https://doi.org/10.1086/668770

Umscheid, C. A., Mitchell, M. D., Doshi, J. A., Agarwal, R., Williams, K., & Brennan, P. J. (2011). Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infection Control & Hospital Epidemiology, 32(2), 101-114. Doi: https://doi.org/10.1086/657912

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2

Developing an Intervention and Determining its Impact

Name

University

Class

Date

Developing an Intervention and Determining its Impact

Infections acquired by patients within the healthcare setting are a significant problem affecting the United States health care system. Healthcare-acquired infections mainly occur when the pathogens are transferred to the patients. Therefore, a significant intervention to reduce infections is one that limits the transfer of pathogens. The following is a hand-washing intervention for nurses that can help to reduce the transmission of germs to patients; hence, reducing the acquisition of infections.

Outline of the Intervention

The proposed intervention for healthcare-acquired infections is a handwashing education program for nurses. Nurses play an essential role in the continuum of care. There are various instances when the nurses come into contact with the patients in the process of administering care. During the process of patient caring, there is a possibility of the transfer of pathogens from one patient to another or from the general health care environment to a patient. Therefore, this intervention includes an education program that teaches nurses the vital information on handwashing so that they can have a better chance at sterilizing when taking care of the patients. There are many nurses’ education programs that have already been carried in a significant number of healthcare institutions, but there are still some cases of infection that have been presented. Therefore, this education program will be specifically altered to include factors that will enhance its effectiveness in improving nurses’ hygiene. Assignment 4: Planning for Evaluation

First, the education program will be carried out for six months. It is expected that nurses’ undergoing an extended period of training will enable better results by enhancing the possibility of maintaining the lessons that have been learned in training. Additionally, this training program will focus mainly on compliance rather than spreading the knowledge on handwashing. This component of the intervention training has been included on the assumption that the nurses already understand the knowledge of hand hygiene and the techniques of hand washing. Hand hygiene is a big part of nursing training and also training for other medical professions. Medical professionals are often taught the importance of maintaining sterility when dealing with patients to minimize transfer of pathogens. In spite of this training, there is a significant percentage of healthcare professionals who still fail to maintain the required standards of hand washing. Thus, this handwashing training program will mainly focus on training the nurses on compliance to the standards of handwashing. The training will be offered in the practice setting rather than in a theoretical model so that it can be easier to identify the mistakes that the nurses make in the handwashing process and develop strategies to improve them.

Review of Literature Supporting the Intervention

A multitude of literature has been written on the effect of training healthcare professionals on handwashing hygiene on the spread of infections within the healthcare setting. According to Al-Khawaldeh, Al-Hussami & Darawad (2015) nurses beliefs, attitudes, and knowledge on handwashing compliance directly affects their hand sanitation practices. This conclusion was made based on a cross-sectional study done with nursing students as the subjects. The study found that knowledge, attitudes, and beliefs on hand sanitation were significant variables affecting the nurses’ compliance with the hand washing guidelines provided to them. Therefore, this study recommended that training is used as a technique for promoting hand washing knowledge and promote positive beliefs and attitudes on sanitation among the nurses. Sopjani, Jahn, and Behrens (2017) evaluated the impact on handwashing training on the knowledge and practices of undergraduate nurses on Kosovo. This study analyzed the knowledge level for the participants before and after they underwent an education program for hand cleanliness in the healthcare setting. The study results showed that there is a significant difference between the nurses’ knowledge level before and after the training. After the training, the subjects were more likely to understand more about the importance and techniques of maintaining sanitation in the healthcare setting. The study maintained that training could help to maintain a satisfactory level of knowledge that will improve nurses’ practices with regards to hygiene.

The effectiveness of training nurses on handwashing has been established by many studies. However, some researchers have questioned the sustainability of this intervention, transfer of germs is still an issue even though many training programs have been conducted. A study by Doronina et al. (2017) evaluated the effectiveness of interventions that have been used to improve handwashing compliance among nurses working in healthcare institutions. The researchers, in this case, conducted a systematic review of six studies evaluating different types of interventions that have been used to promote hand hygiene in healthcare institutions. Among the studies assessed, three were randomized control trials, one was a controlled before-after study, and one was an interrupted time series. In the studies that evaluated the impact of education as an intervention technique to promote hygiene, it was found that the teaching was effective. However, this meta-analysis shows that education was effective but not sustainable because most healthcare professionals fail to maintain the compliance for a long time after the intervention. Assignment 4: Planning for Evaluation

A study by Gould et al. (2017) evaluated the impact of observing hand hygiene in the practice setting. Instead of just theoretically training nurses on maintaining hand cleanliness, this study investigated the effect of practically watching the nurses’ hygiene behaviors while they practice. In a literature review, this study examined the impact of the Hawthorne effect, which is the alteration of behavior due to the understanding that they are being observed. This study suggests that most positive results of the positive interventions in investigations of the effectiveness of handwashing interventions have been affected by this effect. Therefore, the research indicates that the researchers investigate the efficacy of interventions for an extended period after the intervention has been administered. This helps to take into account the practices of the subjects after the Hawthorne effect is no longer in occurrence. Based on the suggestions of Gould et al. (2017) it is likely that having an intervention based in the practice setting for an extended period will have a better chance at determining the actual effect of the intervention.

Luangasanatip et al. (2015) conducted a meta-analysis comparing the efficiency of various hand hygiene interventions for nurses. This study evaluated 41 types of research on hand hygiene intervention. Among various other factors, time was found to be one of the variables that affect the effectiveness of these interventions. The interventions that were applied over an extended period were more likely to yield positive results. Therefore, this study demonstrates that conducting an education program for an extended period is more likely to have a more significant impact on improved hand sanitation by nurses.

The Impact of the Intervention

The proposed nurses’ education program is expected to have a positive impact on improving nurses’ practices when delivering care. The nurses who will undergo this intervention will be trained for six months on knowledge and compliance of hand washing while their methods are observed to identify the possibility of limitations that reduce the sanitation in the healthcare environment. It is expected that by the end of the training, the nurses will have learned the proper application of hygiene standards as part of their daily practices and not just for the study. This intervention focuses on compliance more than the knowledge, even though both components are included. The focus on compliance will help to enhance the sustainability of the intervention. The nurses are expected to maintain the changes caused by the training for an extended period because the intervention requires them to practice for six months.

The change in the nurses’ behaviors is expected to have a positive impact on the reduction of the risk of healthcare-acquired infections. With more nurses being hygienic, there will be reduced transfer of disease-causing pathogens, which cause the life-threatening infections that are currently a population health issue. Patients in the process of receiving care will have a higher chance of having positive outcomes because of the reduced risk of getting infected by germs available in the healthcare environment. In general, the effectiveness of this intervention strategy will help to improve the overall quality of care.

Conclusion

Healthcare-acquired infections are one of the top ten population health issues affecting the United States. A majority of the infections in the healthcare setting are caused by problems that could have been avoided. The nurses are the health care professionals who spend the most time with the patients. Therefore, they have a high risk of being agents transferring pathogens to the patients under their care. This is why an intervention on training for hand-hygiene compliance is recommended as the best strategy for reducing the occurrence of infections. Studies have shown that improved education on hand hygiene has been an excellent strategy for improving nurses’ practices. However, maintaining compliance for an extended period is still a problem. This intervention attempts to address this problem to enhance the effectiveness of training programs. Assignment 4: Planning for Evaluation

References

Al-Khawaldeh, O. A., Al-Hussami, M., & Darawad, M. (2015). Influence of nursing students handwashing knowledge, beliefs, and attitudes on their handwashing compliance. Health, 7(05), 572.

Doronina, O., Jones, D., Martello, M., Biron, A., & Lavoie‐Tremblay, M. (2017). A systematic review of the effectiveness of interventions to improve hand hygiene compliance of nurses in the hospital setting. Journal of Nursing Scholarship, 49(2), 143-152.

Gould, D. J., Creedon, S., Jeanes, A., Drey, N. S., Chudleigh, J., & Moralejo, D. (2017). Impact of observing hand hygiene in practice and research: a methodological reconsideration. Journal of Hospital Infection, 95(2), 169-174.

Luangasanatip, N., Hongsuwan, M., Limmathurotsakul, D., Lubell, Y., Lee, A. S., Harbarth, S., … & Cooper, B. S. (2015). Comparative efficacy of interventions to promote hand hygiene in hospital: a systematic review and network meta-analysis. BMJ, 351, h3728.

Sopjani, I., Jahn, P., & Behrens, J. (2017). Hand Hygiene Training and Its Impact on the Knowledge of Undergraduate Nursing Students in Kosovo. Global Journal of Health Science, 9(4), 142.