CLOSTRIDIUM DIFFICILE INAPPROPRIATE TESTING
Clostridium Difficile Inappropriate Testing: Executive Summary
American Sentinel University
Clostridium difficile Inappropriate Testing: Executive Summary
Hospital-acquired infections are among the significant causes of morbidity and mortality among patients and lead to many challenges for clinicians. Patients receiving healthcare are at risk of contracting infections due to their compromised state of health and the medical conditions with which care is given. They are also exposed to infections when they get into contact with health care interventions such as diagnostic testing, invasive devices or during surgery. The tools used in hospitals can also be contaminated with virus and bacteria, increasing the chances of infections for patients in a hospital. Healthcare setting offers an ideal condition for the transmission of microorganisms from patients to care providers. The close contact between a provider and a patient contribute to increased high rate of infection transmission from either side (Al-Tawfiq & Tambyah, 2014). Besides, some of the surfaces in healthcare facilities have high levels of contamination compared to other; therefore, infection prevention and control require control so that the level of microorganisms can be minimized. To minimize contact contamination, nurses are urged to use gloves and gowns to avoid infection transmission from patient to patient from patient to provider. According to the Centers for Disease Control, the common pathogens that cause infections in healthcare are Staphylococcus aureus, Pseudomonas aeruginosa and E. coli (Mehta et al., 2014). In this project, Clostridium difficile will be identified alongside with its background, and in particular, the purpose, timeline, budget, proposed implementation, data analysis, and nursing theory will be included as part of the project to make it complete.
Problem and Its Background
Healthcare-associated infections are among the major complications in the contemporary healthcare system. Clostridium difficile is among the healthcare-related infections likely to be transmitted from one patient to another. Clostridium difficile infections have been increasing day -in day-out causing morbidity and mortality at a high level. Inappropriate testing for Clostridium difficile can be expensive to healthcare systems and understanding symptoms of such diseases and modes of transmission can save on cost as well as the length of stay for patients. A study by Al-Tawfiq & Tambyah (2014) revealed the reason for increasing healthcare-associated infections as the aging of patients, complexity of care, increased utilization of invasive devices as well as poor usage of antimicrobial therapy. Annually, the United States report more than 250,000 new cases of Clostridium difficile with 14,000 deaths emanating from the cases (Scott, 2009). The researches added that multiple factors lead to Clostridium difficile and understanding each of them is the key to implementing relevant preventive measures. What is more, Clostridium difficile infections increase healthcare costs, hence a significant concern in the contemporary healthcare systems.
According to CDC, most of the hospital infections are transmitted from patient to patient and some extent, they are also contracted from poorly disinfected hospital surfaces (Mehta et al., 2014). Annually, at least 2.3% to 14.4% of people die due to hospital-acquired infections. Environmental factors and the architectural layout of a hospital facilitate infection transmission and more so Clostridium difficile therefore; they are a target in this quality improvement hospital. Preventing Clostridium difficile inappropriate cost is the key to providing quality and safe care while reducing healthcare costs associated with inappropriate testing. Mehta et al. (2014) asserted that infection prevention starts with the identification of a source of organisms so that the problem can be solved from the root. Room ventilation, decontamination, cleaning, wearing of protective clothing, as well as special care for food given to patients, are among the things that registered nurses should do to prevent transmission of Clostridium difficile from one patient to another. Since Clostridium difficile is a contagious disease, patients with the condition should be separated from the rest of the population to avoid transmission or reinfections.
According to Murni, Duke, Kinney, Daley & Soenarto, (2015), the irrational use of antibiotics, as well as transmission of infections between patients and care providers, are preventable using various programs; therefore they should not be a concern to the current healthcare system. Murni, Duke, Kinney, Daley & Soenarto, (2015) added that implementation of multifaceted infection control and facilitating stewardship program dealing with antibiotics are among the ways which will prevent hospital-acquired infections. Since Clostridium difficile occur due to continuous use of antibiotics, minimizing infections that require consumption of antibiotics is among the ways to reduce healthcare costs and prevent transmission of C. diff. Also, the use of recommended antibiotics is advised by the World Health Organization (WHO) which will fight common hospital infections.
Purpose
This quality improvement project is to eliminate C. diff inappropriate testing. On average, 0.5 incident of C. diff inappropriate testing occurs daily increasing the cost of care. Due to high mortality and morbidity rate among children and adults in hospitals due to C. diff, implementing the training program for C. diff inappropriate testing will be essential to curb the increased costs and mortality rate associated with the infections likely to occur during nursing practice. Nurses are exposed to workplace-pathogens due to their close contact with patients and their poor working conditions (WHO, 2005). This will ensure that patients are protected from infections and reinfections and promote a safe working environment for both providers and patients. The intervention program will be multidisciplinary so that it can cover all the probable causes of C. diff in the healthcare set up. With well-implemented infection prevention programs, infections in hospitals will be minimized, and there will be a healthy environment for both patients and providers. The intervention program will ensure nurses, and other care providers are trained on safe hand washing practices and the importance of wearing protective gear before attending different patients.
The stakeholders who will be impacted by the project include all patients, nurses, nursing managers, senior administrators, providers, and all casual workers in a healthcare facility. According to Dancer (2014), nurses and healthcare providers are greatly affected by the project because they are the likely people to breach infection control practices and that can increase the risk of transmission of hospital-acquired infections. Reduced infections rate and reinfections for patients will also be prevented by the project especially with controlled use of antibiotics. The ultimate result of the project will be increasing patients’ satisfaction due to high quality and safe services.
Timeline
Infection preventionists who supposed to manage, implement, and follow up the project will need leadership approval. The project is expected to be initiated from January 2019 and completed in June 2019. Data collection for a baseline of the project will be collected from hospitals which will be used by the senior leadership to implement relevant intervention programs for infection control. The duration will be enough for planning the activities to be conducted, baseline assessment of the hospitals, training nurses and healthcare providers, executing the decided plan, assessing the impact of the plan and sustaining the implemented program for long-term service. Preparation of the action will be done by senior facility managers. Assessment of the hospital will be conducted by a team responsible for assessing the condition of the hospital and whether the providers and nurses are following the expected safety practices. The implemented intervention program will be expected to educate staff on safety practices during patient encounter and promote a conducive working environment for nurses and other healthcare practitioners (Scott, 2009).
Budget
The projected cost of this project is $7656.75. This includes the cost of training healthcare providers on how to use the implemented project, and this will take approximately two weeks after the project is implemented, the education will be conducted as an annual competency. The project goal is to eliminate C. diff inappropriate testing. On average, 0.5 incident of C. diff inappropriate testing occurs daily.
Total cost savings from reduced inappropriate testing is as follows:
Cost for C. diff PCR test= $230
$230 x 0.5 (average daily C. diff inappropriate testing occurrence) x 365 day = $41,975
Total cost savings = $41,975 – $7656.75 = $34,318.25
Proposed Implementation
The intervention program will educate nurses and other medical providers as well as developing and implementing healthcare algorithms. The program will be implemented after it is approved by the senior hospital leadership. The first step will be combining all the prerequisites that require addressing so that nothing will be omitted during the project implementation. The second step will be a baseline assessment of the current situation of the hospital and comparing it to 2017 hospital data. Baseline data will be collected using interviews and group discussions with a senior manager so that the current situation of the hospital can be identified. During the assessment, the strengths and weaknesses of the project are highlighted together with the expected outcomes after the project is completely implemented (Cohen et al., 2010). After the assessment, the program will be executed and implemented according to the expected outcomes.
The results of the baseline assessment will be used during the implementation of the project so that they guide on the interventions required to minimize hospital infections and consumption of antibiotics that cause C. diff. Plan execution will occur in April 2019 through piloting in some departments, and the implemented project will be assessed for effectiveness for the two months after which it will completely be implemented in all departments. After complete implementation, the project of infection prevention control will be used to improve the quality of care and help answer relevant questions regarding patient safety in healthcare (Dancer, 2014). A review will be conducted after some months to assess whether the project improved patient satisfaction, promoted patient outcome and reduced on healthcare costs. Besides, education intervention program will be made mandatory to healthcare facilities where it will be offered on an annual basis and will include nature of the disease, indication of testing, symptoms, indication for testing as well as the communication necessary when the disease is detected.
Evaluation and Data Analysis
During the evaluation of the project, data will be collected from the hospital which will be compared to the data collected during the assessment before the project was implemented. Nurses will be expected to prove competency in the symptoms of C. diff, the transmission methods when the diseases require urgent attention, the preventive measures and the education relevant to patients. The compared data will be analyzed to assess nursing compliance rate with the new infection prevention and control program and patient satisfaction as a result of the implemented program. Analysis of the collected data will assist in the evaluation of the project success, and the project will be assumed to be successful if it promotes patients outcome if it increases patient satisfaction as well as reducing nurse turnover rate (Scott, 2009). The project main aim is to eliminate C. diff inappropriate testing by training nurses and other healthcare providers on instances to test for C. diff. Nurses and other care providers will also be expected to prepare extensive documentation on patients’ rounds as well as maintain proper strategies to prevent information loss. This will also reduce hospital infection rate as a result of contact and unsanitary working conditions during patients’ rounds. Therefore, reduced hospital infections and increased patient satisfaction are the baselines for successful project implementation.
Nursing Theory and QSEN Standards
This project will align with Jean Watson Theory of Human Caring where the quality improvement project is believed to not reward patients, but also the nurses and other providers (Watson & Woodward, 2010). Nurses embrace the theory which helps them to acquire positive energy employed in the control of infections and pathogens from the surfaces will minimize transmission of the infections from patients to patients as well as from patients to providers (Watson & Woodward, 2010). They are also expected to increase competency on C. diff transmission, symptoms and ways to prevent it so that they can avoid inappropriate testing. Also, providing patients with a safe environment while admitted in a hospital is part of care shown to patients without discrimination. Although the infected patients with C. diff can be separated from the rest of the patients, that is part of care aimed to protect the rest of the patients from transmission since the disease is highly infectious. The theory assisted in the identification of the relevant interventions required to reduce hospital-acquired infections.
Quality and Safety Education for Nurses is aimed to meet the challenges nurses are expected to meet during the future of nursing practice. The future of nursing requires that all nurses continuously improve the quality and safety of care, and with nursing education and training, the goal will become a reality. The six QSEN standards include safety; Patient-centered care, Evidence-Based Practice, Quality Improvement, Teamwork and Collaboration and Informatics (World Health Organization, 2005). The standard that informed this project is a Quality improvement which enhanced the writer’s knowledge on the development of quality improvement standards. Also, it equipped the writer with knowledge on whether a quality improvement project is successful after implementation. Therefore the standard is useful in promoting quality improvement in a healthcare facility by increasing nursing compliance with the standards.
Conclusion
The infection intervention program was implemented so that it could protect patients and healthcare providers from contracting Clostridium difficile disease and control inappropriate testing of the disease which is expensive to a healthcare system. Control of C. diff inappropriate testing will save on healthcare cost largely and increase knowledge on when to test for the disease. Clostridium difficile disease is common and has led to deaths of many patients and increased the length of stay as a result of reinfections from one patient to another. Therefore, patients with highly infectious diseases should be separated from the rest of the patients to avoid the transmission of infections. Also, nurses and healthcare providers should adhere to infection control practices by wearing gloves and other protective gear as well as ensuring that the working places are regularly disinfected to avoid hospital-acquired infections. They should also understand when to conduct C. diff test so that they can minimize on healthcare cost.
References
Al-Tawfiq, J. A., & Tambyah, P. A. (2014). Healthcare associated infections (HAI) perspectives. Journal of Infection and Public Health, 7(4), 339-344.
Cohen, S. H., Gerding, D. N., Johnson, S., Kelly, C. P., Loo, V. G., McDonald, L. C., … & Wilcox, M. H. (2010). Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infection Control & Hospital Epidemiology, 31(5), 431-455.
Dancer, S. J. (2014). Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clinical microbiology reviews, 27(4), 665-690.
Mehta, Y., Gupta, A., Todi, S., Myatra, S. N., Samaddar, D. P., Patil, V., … & Ramasubban, S. (2014). Guidelines for prevention of hospital acquired infections. Indian Journal of Critical Care Medicine: Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 18(3), 149.
Murni, I. K., Duke, T., Kinney, S., Daley, A. J., & Soenarto, Y. (2015). Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study. Archives of Disease in Childhood, 100(5), 454-459.
Scott, R. D. (2009). The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention.
Watson, J., & Woodward, T. K. (2010). Jean Watson’s theory of human caring. Nursing theories and nursing practice, 3, 351-369.
World Health Organization. (2005). Practical guidelines for infection control in health care facilities (No. Regional Publication No. 41). WHO Regional Office for South-East Asia.
Appendices
Appendix 1
Timeline
Date
Assignment
January-2019
Identify how many patients have undergone inappropriate testing
Identify cases of inappropriate antibiotic use
Obtain C Diff. Infection rates and patients outcome
February-2019
Present proposed Quality Improvement Plan to senior leadership for approval: CFO, CNO and CMO
March-2019
Develop educational material for 30minute education sessions regarding recommended practice
April-2019
Complete 30 education sessions for providers, RNs and CNAs
May-2019
Review inappropriate testing rate, compliance data, and C. diff infection rate to compare with pre-implementation readings.
June-2019
Review the C. Diff rates on a quarterly basis
Appendix B
Budget
Activity
Cost $
Cost for C. diff PCR test
41,975
Training cost
7,656.75
Total Cost Saving
34, 318
Total
7656.75
Appendix C
Proposed Quality Improvement Intervention
The quality improvement project is aimed to educate nurses and providers on new care algorithms for both nurses and the providers. The project is expected to reduce the rate of hospital acquired infections by preventing and controlling Clostridium Difficile. The project entails implementation of infection prevention and control program that will guide nurses on safe practices to prevent transmission of infection. The project will be implemented in sections and after it’s proven to be successful, it will be implemented in the whole healthcare facility. Data collection will be done using interviews and group discussions from patients and the information will be used to assess the current hospital condition. The information will be analyzed and used for reviews of the project after implementation.
Appendix D
Evaluation Tool(s)
Evaluation of the project will be done by comparing the assessment data before the project is implemented to review data after the project is implemented. The reviewed information will be data on nursing competency, patient satisfaction, reduced rate of transmission as well as increased nursing compliance to safety practices. The nurses should demonstrate their understanding of symptoms of the disease
To determine the success of the project, the following are expected to happen. There should be increased staff compliance and competency with the new infection control program. Also, increased patient satisfaction will translate to a successful project. The last measure will be if the project will last longer.