Stephanie Olson

Annotation
The Burden. (2010). Retrieved from: http://www.cdc.gov/HAI./burden.html
This article is advocated by the Centers for Disease Control and Prevention (CDC), and
healthcare associated infections (HAIs). The CDC makes it a point to understand how HAIs
happen and how healthcare workers can prevent the outbreak of HAIs, though they do not give
specific examples of interventions that could be taken. Stating that 1 out of every 20
hospitalized patients will contract an HAI is a shocking discover and makes one want to
investigate more as to why this is happening. Aside from providing a small amount of
information on HAI, the CDC provides a link to other articles that are associated with HAIs and
includes specific estimations of HAIs that are contracted in U.S. hospitals.
Cardo, D., Dennehy, H. P., Halverson, P., Fishman, N., Kohn, M., Murphy, L. C., & Whitely, J.
R. (2010). Moving toward elimination of healthcare-associated infections: A call to
action. American Journal of Infection Control, 31(11). doi: 10.1016/j.ajic.2010.09.001.
Cardo, et. al. provide an in depth analyzes on hospital acquired infections, and provide four ways
that hospitals can eliminate infections. The authors also provide information on seven specific
strategies that can be used to increase adherence by medical staff to stop hospital acquired
infections. This article also provides expertise information on infections from healthcare
epidemiologists, infection preventionists, infectionous disease physicians, and other clinicians
that work together to stop the outbreak of HAIs. The authors have made it apparent that the
prevention of HAIs does not solely rely on one person, but the need for all medical staff to be
complainant and work together to educate about HAI prevention. Cardo, et. al, make it very clear
that hospitals should no longer accept the unacceptable and that HAIs are preventable.
Gordon, S. & Stevenson, B. K. (2010). Policy implications of the society for healthcare
epidemiology of Americas research plan for reducing healthcare associated infections.
Infection Control and Hospital Epidemiology, 31(2). Retrieved from: http://www.sheaonline.org/Assets/files/other_papers/Policy_Commentary_on_Research_PP.pdf . doi:
10.1086/650583
Gordon and Stevenson provide information about the healthcare debt that is spent relating to
hospital acquired infections. They provide credible sources that explain the debt our healthcare
system is in. The authors make it clear that hospital acquired infections our preventable and can
be measured using standard and well validated surveillance systems throughout the hospitals.
However it is also stated that some infections are difficult to treat because of their association
with multi drug resistant organisms, but work should be done to try to prevent these anyways. It
is also clear that HAIs cannot be prevented by simply encouraging healthcare workers to follow
the rules, but that research addressing pathogenesis, epidemiology, and infection prevention can
help lead the way in preventing HAIs.

Marra, R. A., Guastelli, R. L., Pereira de Araujo, M. C., Saraiva dos Santos, L. J., Lamblet, R. L.
C., Silva, M., de Lima, G., Cal, R., Ravares Paes, A., Cendoroglo Neto, M., Barbosa, L.,
Edmond, D. M., Pavao dos Santos, F. O. (2010). Positive deviance: A new strategy for
improving hand hygiene compliance. Infection Control and Hospital Epidemiology,
31(1). Retrieved from:
http://www.jstor.org/stable/pdfplus/10.1086/649224.pdf?acceptTC=true
This article is based around a 9 month, controlled trial comparing the effects of a positive
deviance plan with compliance of hand hygiene and walks through how they performed
conducted the study. They looked at two 20 bed step-down units at a tertiary care private
hospital. After the 9 months were up, research was collected the authors had proven that
compliance with hand hygiene at all opportunities showed significant improvement with a
decrease in overall incidences of hospital acquired infections. Aside from washing your hands
with soap and water, research also showed that alcohol based products also reduce the time spent
washing hands, but also helped in preventing HAIs as well.
Pittet, D. (2001). Improving adherence to hand hygiene practice: A multidisciplinary approach.
Emerging Infectious Diseases, 7(2). Retrieved from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631736/pdf/11294714.pdf
This article advocates for hand hygiene and the use of alcohol based hand rubs and compliance is
poor. The author, Pittet, looks at the barriers of medical staff not being compliant, and explains
the risk factors for noncompliance and proposes strategies for promoting hand hygiene. Pittet,
makes a shocking discover that most Intensive Care Units are below average on compliance with
hand hygiene from the years 1981 to 1999. When thinking about hand washing, most think of
soap and water, however, Pittet takes it one step further and makes it clear that is not enough and
hospitals need to look at hand antiseptic agents instead. Also making it clear that medical staff,
need to be educated about compliance which would promote a change and improve compliance
to help decrease HAIs.

Appendix A
Revised Elements of Reasoning (EOR)
Table 1
1-3 sentences describing your thoughts on the
issue related to that element
1. Purpose (all reasoning has a purpose)
As of 2010, 1 out of 20 patients who are in
hospitals will contract a hospital acquired
infection (HAI) (The Burden, 2010).
HAI are becoming the most common type of
complication that is affecting the hospitalized
patients.
I believe that improving hand hygiene is not
the only way of preventing HAI. Following
isolation precautions will also help decrease
the chances of contacting an HAI, along with a
positive deviance plan.
2. Questions at issue or central problem
Nurses and doctors get busy and sometimes
(all reasoning is an attempt to figure
forget to wash their hands, and they dont want
something out, to settle some question, to take the extra minute or two to put on the
solve some problem)
protective isolation barriers. I understand that
everyone is taking their own risk, but to
jeopardize the risk of a patients health is
unbearable. So how do we make all healthcare
personnel see the importance of going back to
the basics of starting with hand washing?
3. Point of view (all reasoning is done
If a staff member does not help control HAIs
from some point of view; think about
then the healthcare debate goes up. As of 2010
the stakeholders)
healthcare has spent $2.4 trillion dollars
annually, which represents 16% of the gross
national product. If we are spending this much
it truly makes me wonder what is really going
on in the hospitals.
According to D. Pittet who wrote Improving
adherence to hand hygiene practice: a
multidisciplinary approach (2001), hand
hygiene was noncompliant because of the
following barriers. Barriers including: skin
irritation, inaccessible supplies, interference
with worker-patient relation, patient needs
perceived as priority, wearing gloves,
forgetfulness, ignorance of guidelines,
insufficient time, and finally high workload
and understaffing. Personally I dont see how
any of these reasons make it okay for medical
staff not be compliant.
I have witness for myself nurses and doctors
who dont take the time to wash hands or put

4.

Information (all information is based

on data, information, evidence,
experience, research)

5. Concepts and ideas (all reasoning is

expressed through, and shaped by,
concepts and ideas)

6. Assumptions (all reasoning is based on

assumptions-beliefs we take for
granted)

on protective barrier. I believe that HAIs will

be around no matter what we do, but we do not
need to stop looking for ways to prevent HAIs
or to decrease it from occurring today.
The information I plan to provide is looking at
the CDC and how many patients are now
contracting an HAI on our watches. I also plan
to research information on how patients are
contracting HAIs. I plan to research possible
solutions that were used in the past and show
evidence how they do not work alone and why
my positive deviance plan will provide a more
measurable outcome. .
Patients should not have to worry about
contracting an HAI while in the hospital.
Patients along with healthcare staff should be
educated on the importance of decreasing
HAIs. I understand that some professionals
will be against what I propose but that
shouldnt stop them from going back to the
basics. Hand washing is not the only factor in
patients obtaining HAIs there are other factors,
such as not wearing protective gear, or
performing a procedure properly, however
hand washing is the basic and it starts there.
My positive deviance plans starts at the
beginning with proper hand hygiene to all
medical staff, and yes even promoting it to our
patients and their families. Medical staff needs
to attend classes or seminary to promote and
reiterate how important hand hygiene is to
healthcare. Also in my plan we need to
promote adherence to evidence based practices
through partnering, educating, implementing,
and investing in seminars or educational
classes for medical staff. We also need to
educate the public about hospital acquired
infections.
I understand that everyone believes that they
wash their hands and have never touched a
patient without doing so but when you actually
sit down and think about it we all have done
this. I am also going to assume that people
think that using hand sanitizer is as good as
washing their hands. Hand sanitizer can be
used to wash hands, but not all of the time. I

7.

Implications and consequences (all

reasoning leads somewhere. It has
implications and when acted upon, has
consequences)

8.

Inference and interpretation (all

reasoning contains inferences from
which we draw conclusions and give
meaning to data and situations)

assume that there will be other ideas and

factors that come into play when looking at
HAIs but I cannot stress enough that our basic
tools will be the start of preventing HAIs. This
is a serious matter, and one that I believe is
taken for granted and we need to start looking
at risks we put our patients in because we dont
want to put on isolation protection or wash our
hands because we are only in the room for a
minute.
If we do not take a serious look at HAIs we our
letting down not only our healthcare system
but our patients as well. Not only will hospitals
lose money because they are not getting
reimbursed but patient care will diminish in my
eyes.
I hope to conclude that HAIs can be decrease.
We need to work together to get the message
across, and I hope that with my plan which is
stated above, other nurses will help and start to
implement it in their own practice.

Stephanie Olson
Reflection on the EBPP
How did the planning process, where you thought about what you wanted to change,
prepare you for the EBPP.
I knew right away what I wanted to change, and that was preventing hospital acquired infections
(HAIs). Knowing what I wanted to do prepared me for the EBPP because it is something I am
passionate about, and the EBPP helped me put all my thoughts together and organize them. It
also made me think about how this was going to change how people thought about HAIs and
help in preventing them if I could show that going back to the basics and being conscious about
the basics really worked and protected our patients.
How did the peer evaluation process prepare you for the EBPP.
I liked the peer evaluation, even though I only had one person evaluate my work. My peer helped
make sure that my ideas where clear and that people understood what I meant by a positive
deviance plan, because I was unsure of where to state it in the EBPP. I wish that I would have
had more peers evaluate my work.
Do you feel you are prepared to elicit change in your practice with your proposal?
How does it fit into quality health care.
Honestly I am very nervous to make this change in my practice. I am compliant with hand
hygiene, and wearing isolation protective clothing, but making sure that my fellow staff
members and doctors follow it is a scary to me. I still feel like I am a student and I should not tell
doctors to wash their hands or use alcohol rub, for the fear of getting yelled at. However, I think
it needs to be done, because we are trying to protect and care for our patients not make them
sicker. It is not just looking out for the wellbeing of our patients but for ourselves as well, we
dont know what we could contract if we dont take the time to protect ourselves with hygiene,
so yes this practice fits into the quality of health care.
What could you have done better.
I think I could have gone more in depth about other ways to prevent hospital acquired infections,
but I feel it starts with the basics and then we can move on from there. I did find an article that
explain how Medicare and Medicaid will stop reimbursing hospitals if a patient contracts a HAIs
and how they will not pay for the patients medical expense should they need to be in the
hospital longer.
How well do you think you are using the EOR? Do they make sense to you (why or
why not).
I believe I am using the EOR well, and it makes sense to me of what to put in each category. The
EOR helped me in putting my thoughts together, and looking not only at my problem that I want
to change but also what assumptions other might have about my proposal. I also think that I
explained everything that was asked of me, and when my peer reviewed it I made changes per
request. I do admit at first it was a little bit confusing but after looking at the sample it made
sense. Overall it helped to put my thoughts in order and organized them well.