Quality Improvement Proposal

Quality Improvement Proposal
Overview of the Problem and the Setting

Nosocomial infection (NI) is a significant public health concern that affects hundreds of millions of people worldwide every year, also known as ‘hospital-acquired or health care-associated infection.’ NI is characterized as an infection that occurs in more than 48 patients admitted to health care, but without any proof that the infection was present or incubated at the time of admission (Wang et al., 2019). Nosocomial infections are a significant cause of morbidity, prolonged length of stay and mortalitty that can be avoided. It is important to avoid these infections. Therefore, continuous monitoring, auditing and hand hygiene are vital. In this context, severe medicolegal problems sometimes occur, as the patient or their relatives often blame the infection on the hospital staff and seek compensation (Khan, Baig & Mehboob, 2017). Predisposing factors such as invasive procedures, unnecessary use of antibiotics for long hospital stays, and the prevalence of serious illness contribute to NI rates in patients admitted to the intensive care unit many times much higher than evidenced in the general population of the hospital population (Khan et al., 2017). There is an increase in extended hospital stays, increased, increased socio-economic disruption, long-term disability and increased mortality rates with rising infections. Due to poorly designed monitoring systems and inexistent control procedures, spare data on the burden of nosocomial infections remains.

Value of Quality Improvement Initiative

The risk of hospital-acquired infections in poor health systems is extremely high. Therefore, resolving hospital-acquired infections demands healthcare interventions that include infection prevention, monitoring, and response and guarantee consistency in the delivery of quality treatment. Quality management serves as a preventive mechanism against nosocomial outbreaks resulting from poor-quality treatment by ensuring obedience to evidence-based practices (Alrubaiee, Baharom, Shahar, Daud & Basaleem, 2017). Therefore, quality management solves this problem by putting quality at the heart of care delivery, reflecting on how it is possible to reorganize care delivery processes to ensure that patients receives the care needed, whenever they need it. In a health system, the emergence of nosocomial infections are indicators of healthcare systems that do not operate in a way that is consistent with evidence-based practices. Notably, quality management will determine what procedures must be improved to deliver better outputs and results through knowing the inputs in addition to the processes that define quality care.

Furthermore, in the quality improvement process, changes are integrated into the health system’s procedures after finding areas of weakness in the delivery of treatment. These improvements aim to reorganize care delivery processes to improve attention to and adoption of best practices and recommendations based on evidence. In improving healthcare systems, the aim is to deliver enhanced health system outputs and outcomes. Notably, by improving conformity with best practices and recommendations in care delivery procedures, nosocomial infections due to poor quality treatment are avoided, thereby increasing the health system’s efficiency (Wang et al., 2019). Morbidity and mortality rates associated with hospital-acquired infections are reduced, highlighting yet another outcome of adopting quality improvement mechanisms. Additionally, quality improvement initiatives are essential in addressing the long length of stay associated with nosocomial infections, reducing disability and preventing socio-economic disruption.

Results of Research Supporting the Quality Improvement Initiative and Projected Outcomes

Recognizing that nosocomial may occur even in situations where high levels of quality care are provided, quality assurance goes beyond the current healthcare delivery practices and stresses the value of setting and constantly improving standards, including surveillance and prevent infection transmission (Alrubaiee et al., 2017). As healthcare delivery practices are fundamentally imperfect, there is a need for monitoring and quality improvement. Quality assurance strategies include how providers can evaluate and respond appropriately to information from their surveillance systems in addition to establishing surveillance systems. To monitor and respond to infection outbreaks, it is important to review and respond to surveillance system information, as well as to raise awareness among providers of any current problems in their healthcare delivery processes that contribute to the prevalence of nosocomial infections. The qualitative study by Khan et al. (2017) identified that the prevention of nosocomial infections in the ICU requires knowledge of infection rates and the causes, the pathogens involved, and the risk factors for infection. The frequency of nosocomial infections varies depending on the environment, such as the type of hospital or ICU, the population of patients and the particular description and screening techniques used to detect nosocomial infections. A multifaceted intervention for quality enhancement decreased nosocomial infection rates, duration of stay in the hospital, and mortality in the ICU (Murni, Duke, Kinney, Daley & Soenarto, 2015).

Steps Necessary in Implementing the Quality Improvement Initiative

Two major approaches are adopted in achieving quality improvement in addressing nosocomial infections in the ICU, and they are prevention strategies and the adoption of surveillance. As a first step towards a better infection control strategy, these results can now be used to prepare a surveillance program for nosocomial infection in our ICU environment. Additionally, the gaps in NI control measures knowledge and practices suggest the need to develop a relevant NI health care policy and introduce a regular training program to update and refresh nurses’ knowledge and practices regarding NI control measures. Signiant changes necessary include Infection outbreak prevention by ensuring quality healthcare; tracking and monitoring of infection outbreaks, continuous improvement to react adequately to outbreaks and create resilience in the health system (Murni et al., 2015). Guidelines and procedures for infection prevention have existed for many years. These protocols and procedures seek to standardize healthcare delivery and ensure that microbes are not spread via the delivery processes of healthcare. In avoiding nosocomial infections, adherence to best practices important. Quality management strategies help us recognize and track deficiencies in healthcare delivery procedures resulting in nosocomial outbreaks through surveillance and continuous improvement.

Quality management provides a straightforward approach in response to these failures that focuses on reorganizing procedures to ensure that evidence-based recommendations and best practices are implemented in the treatment provided to patients. When combined with quality enhancement, developed and practiced standards and surveillance systems improve health system resilience to infection outbreaks through their ability to track and control infection outbreaks while improving the quality of care delivery and antibiotic management processes that prevent nosocomial infections. It is important to have surveillance systems, but not all healthcare systems have surveillance systems installed in place. Surveillance systems allow for the tracking of outbreaks by providers. Quality management provides healthcare facilities with the required resources for tracking infection outbreaks through the establishment and improvement.
Evaluating Quality Improvement Initiatives

The monitoring of the rates of hospital-acquired infections or nosocomial infections may be one effective approach to evaluating the effectiveness and efficiency of the quality improvement initiatives implemented within the ICU. Additionally, monitoring and recording the rate of mortality and morbidity as a result of nosocomial infections further provides insights into the extent to which the quality improvement initiatives have been successful. Additionally, an evaluation of the length of hospital stay resulting from nosocomial infections can further provide insights into the effectiveness of the quality improvement initiatives implemented.
Variables, Hypothesis Test and Statistical Test

The variables that would be evaluated included mortality, morbidity and length of stay in ICU. In this case, the hypothesis test would be that adopting a surveillance program and implementing preventive strategies is essential in reducing the rate of nosocomial infections in the ICU. A chi-square test for association would be the most appropriate in determining if there is an association between prevention strategies, surveillance program and the rate of nosocomial infections within the ICU. These statistical tests would be effective in determining if adopting these quality improvement measures would impact the rate of nosocomial infections evidenced within the healthcare setting.

Alrubaiee, G., Baharom, A., Shahar, H. K., Daud, S. M., & Basaleem, H. O. (2017). Knowledge and practices of nurses regarding nosocomial infection control measures in private hospitals in Sana’a City, Yemen. Safety in Health, 3(1), 1-6.
Khan, H. A., Baig, F. K., & Mehboob, R. (2017). Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine, 7(5), 478-482.
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.
Wang et al. (2019). Epidemiology and risk factors for nosocomial infection in the respiratory intensive care unit of a teaching hospital in China: A prospective surveillance during 2013 and 2015. BMC infectious diseases, 19(1), 145.

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