DIPLOMA IN HEALTH SERVICES MANAGEMENT

DIPLOMA IN HEALTH SERVICES MANAGEMENTDHSM 202 – FACILITATING TRAINING AND DEVELOPMENTTERM 1, 2019ASSESSMENT 1: INDIVIDUAL TRAINING PROPOSALINFECTION PREVENTION AND CONTROL TRAINING(CENTRAL LINE -ASSOCIATED BLOODSTREAM INFECTION OUTBREAK)PREMITA RESELEEN CHANDYIEOOOO1WO1781594330645001749282358279009516735900EXECUTIVE SUMMARYThe healthcare staffs of intensive care unit of Auckland city hospital require infection and prevention control training. The training consists of hand washing techniques, proper waste segregation and proper use of personal protective equipment at the workplace. It is recommended that all the healthcare team members of neonatal intensive care unit attend the five days of proposed training due to the unexpected central line associated bloodstream infection outbreak among the infants admitted in the intensive care unit. At the end of this proposed training, all the members of the healthcare team will demonstrate effective practices of waste segregation, hand washing techniques and the use of proper protective equipment which are the main contributing factors of controlling and preventing central line- associated bloodstream infections. INTRODUCTION There has been an outbreak of central catheter -associated bloodstream infections in the neonatal intensive care unit of Auckland city hospital. specific laboratory investigation was done for the confirmation of the case. A speculation occurs due to the onset of continuous fever, red skin and soreness around the central line and the infected infant was irritable every time after the central line catheter insertion on first day of admission. Days after, another client on day 3 of admission with the central line exhibited the same symptoms. It has been known such infections are healthcare acquired and can be transmitted through poor infection control and prevention techniques in the specialised unit. Due to the lack of knowledge on infection prevention and control techniques, the number of affected individuals increased in the organisation. Thus, it is proposed that infection control and prevention training will control and prevent the transmission of the infection. Therefore, a request for training for all the healthcare team members of neonatal intensive care unit mainly nurses, doctors and cleaners to be conducted in the conference room of Auckland city hospital. ANALYSIS OF TRAINING NEEDS ANALYSIS AND DISCUSSION OF CENTRAL ISSUENeonatal intensive care unit is in level 9 of the Auckland city hospital. This specialised care unit (NICU) provides cares for babies that are born prematurely or that are sick at birth and require medical and nursing intervention. theses babies require extra care after birth, thus the staffs support and help the families visit their baby as much as possible. (Burns, Andrew & Bowers, Lesley & Pak, Nick & Wignall, Jean & Roberts, Sally, 2010). Sometimes mothers are ready for discharge before their baby, and this means that they will have to visit the hospital daily for feeding, cuddles and advice on caring for their new baby. (Polin, Denson and Brady, 2012)TIMELINESeptember 25, 2019 A one-day old infant A was admitted in neonatal intensive care unit, Auckland city hospitalSeptember 26, 2019 A central line was inserted to give medicines, fluids and blood products into a large central veinOctober 3, 2019 Symptoms of fever, red skin and soreness around the central lineOctober 4, 2019 Suspicion of central line-associated bloodstream infection arises, and laboratory tests was done to confirm central line-associated bloodstream infectionOctober 5, 2019 A positive result for the central line-associated infectionOctober 6, 2019 Day 3 of admission infant B with a central line also acquired the same symptoms October 7, 2019 Infant B laboratory testing was done and was positive for central line – associated infection as wellOctober8, 2019 Announcement of healthcare associated infection outbreak in neonatal intensive care unit Routine Neonatal intensive care unit admission is done on the 25th of September at neonatal intensive care unit of Auckland city hospital. An aseptic procedure was performed on the client the next day, whereby a central line was inserted so that the client receives medicines, fluids and blood products into a large vein. The following day, on the 3rd of October 2019; the client developed the symptoms of fever, red skin and soreness around the central line. The client becomes irritated very quickly, the symptoms persisted, and the healthcare providers continued to manage the neonate. On 4th October 2019, the suspicion of the central line-associated bloodstream infection arouses and a specific laboratory testing for the confirmation of the central line-associated infection. Laboratory findings reports back on October 5, 2019 a positive result for the central line-associated infection. On October 6, 2019, another client of day three of admission with a central line also acquired the similar symptoms as the previous client. specific laboratory testing was also done and confirmed positive for central line-associated infections. The organisation then informed ministry of health with the situation within the neonatal intensive unit and the ministry of health announced emergency outbreak in the neonatal intensive care unit on October 8, 2019. The infected cases were put under the isolation protocol for further treatment and management (Burns, Andrew & Bowers, Lesley & Pak, Nick & Wignall, Jean & Roberts, Sally, 2010).Furthermore, the organisation investigated how this outbreak occurred and found out that it resulted because of poor technique and ongoing patient care. A compulsory training program for the prevention and control of healthcare acquired infections was suggested by the ministry of health which is to be facilitated by the Auckland city hospital management for all the healthcare providers working in the neonatal intensive care unit which includes the unit nurses, cleaners and doctors. (Burns, Andrew & Bowers, Lesley & Pak, Nick & Wignall, Jean & Roberts, Sally, 2010)Stakeholders participating in the training rolesnurses Nursing care and management of the patientsdoctors Assess, diagnose and outline the treatment cleaners Keep the unit clean according to the infection control protocolB. EVALUATION OF THE IMPACTS AND EFFECTS OF THE ISSUEA central line-associated bloodstream infection (CLABSI) is usually caused by bacteria or viruses which inhibits the bloodstream via the central line and is known as the healthcare acquired serious infection. (Polin, Denson and Brady, 2012). There has been a rise in reported cases of this infection in other nations leading to a chaos to the people. Announcement of the central line- associated bloodstream infection alarms the communities leading to negative impacts on the organisation. (Lee, Cho, Jeong, Kim, Han & Song, 2018).Client quality care decreases due to the healthcare acquired infection outbreak which attacks the behaviour of the workforce unit. This outbreak will eventually lead to the financial burden in the management in terms of training need costs and supplying of the proper protective equipment’s essential to safeguard the healthcare providers and clients from spreading and getting the infection. (Lee, Cho, Jeong, Kim, Han & Song, 2018).The healthcare providers will suffer from work load because of the outbreak and its treatment would involve time consumption resulting in patient’s long-term admission. Thus, the organisational reputation is at risk and staff morale is affected. (Charalambous, Swoboda, Dick, Perl, Lipsett, 1998).C. EFFECTS OF THE ISSUE ON THE ORGANISATIONAL GOALSVision of the organisation Healthy communities, world class healthcare, achieved togetherValues of the organisation Welcome, respect, together aim highAim of the organisation To achieve the right mix of servicesTo balance the needs of people(Health point Limited, 2004-2009)Due to the outbreak of healthcare acquired infection mentioned, the organisational goals and vision is unlikely to be achieved resulting a great downfall in the ministry of health structure. As their vision and goals is to maintain healthy community and healthcare aiming to achieve the balance needs of the people, the organisations reputation is affected, and they would be facing difficulties in regaining the trust and reputation back.The solution to the incidence, besides conducting infection prevention and control training, healthcare workers need to be monitored adherence with hand hygiene recommendations and feedback given. In addition, behavioural approaches need to be implemented and the identification of barriers and facilitators for the improvement of hand washing rates. Moreover, patients and their family members need to be encouraged to remind the healthcare workers to perform hand washing techniques. (Guideline for Hand Hygiene in Health-care Settings, 2002). A strict protocol must be followed by the health care providers during the insertion of the line in order to confirm the line is kept sterile to prevent central line-associated bloodstream infection. Additionally, healthcare providers must follow strict infection control practices each time the line or dressing is being changed. METHODS USED IN IDENTIFICATION OF THE TRAINING NEEDSThe two main assessment techniques that is used to identify this need are as follows:Direct observation techniques This process is simply directly observing the targeted healthcare staffs whereby their competence in adherence to infection control practices will be monitored and assessed without disturbing them. This method is efficient since the person will be observed in their workplace. The findings and plans for the training need will be accurately recorded by the assessor.questionnaires This technique assesses the level of information about the healthcare acquired infections such as catheter-associated bloodstream infection, how it occurs and how it can be prevented through infection control and prevention practices. This method helps to give exact information provided by the participants. Their questions and answers are used to collect information about the requirement of conducting future training sessions.E. PRESENTATION OF THE SOLUTION: the best solution to minimise and eradicate the healthcare acquired infections in neonatal intensive care unit is to facilitate infection control training. the infection control practice ensures the safety of patients as it involves direct encounter of clients and healthcare staffs. upon investigation, the main cause of the outbreak was due to lack of infection control knowledge. There are no specific pre-requisites for the healthcare workers needed prior to attend the training.The criteria below will be covered during the training:Infection control techniques Brief oulinesWaste segregation All wastes obtained from the unit will be disposed on an appropriate bin with colour coding.Hand washing techniques Moments of hand washing will be discussed and its importanceProper protective equipment Types of protective equipment’s, its uses and the importance At the end of the proposed training, all the healthcare workers should be able to demonstrate effective practices of waste segregation, hand washing techniques and the use of proper protective equipment. These are main contributing factors of controlling and preventing catheter lines associated infections. therefore, quality healthcare services will be provided by the organisation fulfilling all the goals and vision. This will help sustain the re-establishment of the organisation reputation in the bigger context. RESEARCH SUPPORTAccording to (Charalambous, Swoboda, Dick, Perl, Lipsett, 1998), an important cause of deaths and illness is the catheter line infections. As per studies, performance improvement reveals the direct focus in a review of hospital practices. It is suggested that breakage in the method during catheter insertion and maintenance of care would lower the risk of central line infections. Results of the study also included other risk factors of central venous catheter infections which includes infection establishment elsewhere in the body. Due to increasing risk of venous catheter colonisation, catheter duration is the main risk factor causing central line infections. Thus, the effective method to decrease the central line infections is the removal of central line catheters if it is not needed for the patient care. A highly effective systemic approach to address the requirement for continued catheter use is suggested by the observational case studies. This includes nurses’ protocols and daily goals sheet incorporation. The study also reveals that it is advisable to remove the catheter if there is suspicion of unexplained fever, bloodstream infection and signs of sepsis. (Bell & O’Grady, (2017).(Cho & Cho, 2018), states that high risk patients susceptible to infections are new born infants including preterm infants. Furthermore, central line infections are most common type of healthcare acquired infections in this population. the most important preventative strategy for central line or catheter line infections is the ongoing training and education of medical staffs. The effective measures to minimise the occurrence of catheter line or central line infections is the use of preventable approaches and checklists during the insertion of central catheters.Based on the study by Burns, Andrew & Bowers, Lesley & Pak, Nick & Wignall, Jean & Roberts, Sally, (2010), it was investigated how this outbreak occurred and found out that it resulted because of poor technique and ongoing patient care. A compulsory training program for the prevention and control of healthcare acquired infections was suggested by the health boards which is to be facilitated by the hospital management for all the healthcare providers working in the neonatal intensive care unit which includes the unit nurses, cleaners and doctors. Summary of cost analysis of the training programInfection prevention and control training programDuration 5 daysparticipants 15 nurses, 8 doctors and 5 cleanerslocation Auckland city hospitalvenue Conference room Date October 21 to October 25, 2019Guest lecturer Infection control doctor from ministry of healthequipment Projector, laptop, learning manual, snacks, soap, hand sanitizer and personal protective equipment’sDay and time Monday to Friday from 9am to 3pmBudget NZD 1,890CONCLUSIONInfection prevention and control training is the main solution for the central line- associated bloodstream infection which will also help the organisation to achieve its goals and visions leading to a successful organisation under the ministry of health structure.REFERENCESLee, K. H., Cho, N. H., Jeong, S. J., Kim, M. N., Han, S. H., & Song, Y. G. (2018). Effect of Central Line Bundle Compliance on Central Line-Associated Bloodstream Infections. Yonsei medical journal, 59(3), 376–382. doi:10.3349/ymj.2018.59.3.376Burns, Andrew & Bowers, Lesley & Pak, Nick & Wignall, Jean & Roberts, Sally. (2010). The excess cost associated with healthcare-associated bloodstream infections at Auckland City Hospital. The New Zealand medical journal. 123. 17-24.PolinRA, Denson S, Brady MT. Strategies for prevention of health care–associated infections in the NICU. Paediatrics. 2012 Apr 1;129(4): e1085-93.Charalambous C, Swoboda SM, Dick J, Perl T, Lipsett PA. Risk Factors and Clinical Impact of Central Line Infections in the Surgical Intensive Care Unit. Arch Surg. 1998;133(11):1241–1246. doi:10.1001/archsurg.133.11.1241Health point Limited (2004-2019). Auckland city hospital. Retrieved from https://www.healthpoint.co.nz/auckland-city-hospital/Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.Bell, T., & O’Grady, N. P. (2017). Prevention of Central Line-Associated Bloodstream Infections. Infectious disease clinics of North America, 31(3), 551–559. do: 10.1016/j.idc.2017.05.007Cho, H. J., & Cho, H. K. (2019). Central line-associated bloodstream infections in neonates. Korean journal of paediatrics, 62(3), 79–84. doi:10.3345/kjp.2018.07003

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