Evidence-Based Care Bundle Project to Reduce Hospital-acquired Infections (HAIs) among Hospitalised Patients-Nursing Essay Examples

Background (Evidence-Based Care Bundle-Nursing Paper Examples)

Healthcare-associated infections (HAIs) continue to pose significant challenges to healthcare globally. The potentially preventable infections lead to increased morbidity and mortality rates. High morbidity rates prolong hospitalization and increase healthcare spending for patients, healthcare facilities, and the government. Increased microbial resistance to antimicrobials poses more challenges for healthcare providers (Evidence-Based Care Bundle-Nursing Paper Examples).

The infections mostly incubate 48 hours after patient admission or may appear 30 days after healthcare delivery (Ponsford et al., 2021). Although HAIs were initially associated with admission to acute care settings, they can now affect patients in long-term care facilities such as rehabilitation and nursing homes, family care, home clinics, and ambulatory care (Evidence-Based Care Bundle Project).

Globally, HAIs affect millions of patients in developed and developing patients. Sahiledengle et al. (2020) assert that 80% of hospitalized patients are predisposed to nosocomial infections, where the risks are about 2-20 times higher in most developing countries. Consequently, the research asserts that HAIs affect one in every hospitalized patient in some Australian hospitals (Evidence-Based Care Bundle-Nursing Paper Examples).

Furthermore, in Europe, HAIs account for about 16 million more hospitalization days and an extra 7 million Euros. The magnitude of HAIs is uncertain and underestimated in developing countries due to the lack of sufficient epidemiology data (Sahiledengle et al., 2020) (Evidence-Based Care Bundle-Nursing Paper Examples).

Therefore, there is a need to conduct more research to obtain evidence-based information directed toward preventing HAIs, their complications, and the negative consequences on healthcare delivery. Moreover, nurses and other healthcare professionals should be at the frontline to curb these infections through evidence-based practice to improve the quality of care and patient safety.

Besides, this change project aims to implement an evidence-based care bundle to prevent and reduce HAIs among hospitalized patients (Evidence-Based Care Bundle-Nursing Paper Examples).

Clinical Problem Statement (Evidence-Based Care Bundle-Nursing Paper Examples)

Hospital-acquired infections (HAIs) affect different healthcare settings and patients across the globe. However, some patients are highly predisposed to infections, for instance, the elderly, young children, and persons with immunocompromised immune systems (Evidence-Based Care Bundle-Nursing Paper Examples).

Hospitalized patients in acute care settings, especially in the ICU, are also prone to HAIs from medical equipment such as ventilators, indwelling, and central line catheters. Other risk factors include prolonged hospital stays, use of medical equipment such as indwelling catheters, inadequate hygiene, and antibiotic overuse leading to antimicrobial resistance (Blot et al., 2022) (Evidence-Based Care Bundle-Nursing Paper Examples).

Surgical Site Infections (SSIs), central line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CAUTIs), Clostridium difficile infection, and Methicillin-resistant S. aureus (MRSA) are common HAIs affecting the healthcare delivery (Allegranzi & Pittet, 2019). Moreover, most of these infections are device-related, such that indwelling catheters result in CAUTIs, central-line catheters result in CLABSIs, and ventilators cause VAP (Evidence-Based Care Bundle-Nursing Paper Examples).

Central line-associated bloodstream infections result when pathogens enter the body and spread to other body parts (septicemia). VAP mainly occurs among ICU patients on ventilator support; SSIs result when pathogens affect surgical incision sites while indwelling catheters raise CAUTI risks (Evidence-Based Care Bundle-Nursing Paper Examples).

Hospital-acquired infection causes are multifactorial and require comprehensive prevention measures to address patient needs. Consequently, these factors include inadequate hand, and hospital environment hygiene, inappropriate use of antibiotics, poor infection surveillance and infection control strategies, and contaminated equipment. Moreover, Hospital-associated infections and their complications are detrimental to the quality of care, patient safety, and health outcomes. Furthermore, the effects lead to high morbidity and mortality rates, prolonged hospitalization, high healthcare costs, decreased patient satisfaction, and poor experiences (Wang et al., 2019) (Evidence-Based Care Bundle-Nursing Paper Examples).

Hospital-acquired infections cause shortness of breath, coughing, headache, and fever, while severe consequences may lead to septicemia and endocarditis. Consequently, high morbidity rates and prolonged hospitalization cause increased health expenses. Furthermore, high healthcare costs render quality care unaffordable for patients (Wang et al., 2019). Lack of quality care doubles the disease risk factors leading to ill-health communities. However, implementing evidence-based practice will improve quality care and patient safety to prevent infections (Evidence-Based Care Bundle-Nursing Paper Examples).

Purpose of the Change Proposal

Hospital-associated infections (HAIs) cause preventable burdens to patients, healthcare organizations, and the entire health sector. This change project aims to implement an evidence-based care bundle to prevent and reduce HAISs among hospitalized patients. Implementing an evidence-based care bundle will promote HAI primary prevention, infection surveillance for early detection, and management of HAI cases (tertiary prevention) while adopting implementation elements/structures such as alcohol-based sanitizers (Evidence-Based Care Bundle-Nursing Paper Examples).

Besides, the change project will identify potential causes of these infections, which will be a significant foundation for devising suitable intervention strategies. The project also aims to improve the quality of care and patient safety. Thus, the project will assess the effects of HAIs to improve care quality and patient safety through improved hygiene, antiseptic technique, and following the set standards operating procedures (SOPs) that curb infections and their transmission (Evidence-Based Care Bundle-Nursing Paper Examples).

The project also aims to improve stakeholders’ (nurses, other healthcare providers, patients, and their families) knowledge of HAIs and prevention strategies. While nurses possess the required knowledge and skills to curb infections, educating and mobilizing them toward evidence-based practice will improve patient outcomes. Consequently, educating the patients and their families about the proposed intervention will promote success (Evidence-Based Care Bundle-Nursing Paper Examples).

Furthermore, as mentioned, HAIs result from medical devices. Thus, substituting indwelling catheters with external catheters will reduce the risk of infections. Hence, proper maintenance, disinfection, and handling of these medical devices as part of care bundle elements will reduce risk factors for HAIs.

Thus, implementing evidence-based practice will translate obtained evidence into clinical practice to offer the best available practices. Moreover, the PET management guide will be utilized to implement the project (Appendix A) (Evidence-Based Care Bundle-Nursing Paper Examples).

PICOT Question

This change project aims to reduce HAIs among hospitalized patients. The PICOT question for this change project is; Among adult patients (P), do evidence-based care bundles (I) lead to reduced HAIs (O) compared to standard care (C) during Hospitalisation (T)? (Evidence-Based Care Bundle-Nursing Paper Examples)

The Population (P) is the subjects recruited for this project. Adult hospitalized patients (aged 18-60) will be recruited while excluding younger patients below 18. Besides, The recruited patient population will receive an evidence-based care bundle as the proposed intervention (I). Consequently, a Control group (C) that will receive standard care (hand washing with soap and water) will be used for comparison.

Furthermore, the expected Outcome (O) is to prevent and reduce HAIs from few to zero among recruited hospitalized patients. Consequently, hospitalization days will be the project’s allocated Time (T) (Evidence-Based Care Bundle-Nursing Paper Examples).

Literature Search Strategy Employed

This evidence-based project employed a literature search strategy to gain information concerning the topic and potential implementation strategies. Moreover, the search strategy will be vital to identify credible and valid information from credible data sources. Furthermore, scholarly and scientific databases include Web of Science, PubMed, Google Scholar, and CINAHL (Evidence-Based Care Bundle-Nursing Paper Examples).

The search was limited to peer-reviewed English articles published within the last five years to gain up-to-date information. Consequently, peer-reviewed articles are credible to obtain information reviewed by a team of experts with insights concerning the project’s topic (Evidence-Based Care Bundle-Nursing Paper Examples).

The literature search employed key terms and phrases to identify articles concerning the topic. The search used key terms such as ‘hospital-associated infections’ in the Google Scholar database, producing 3927 search results. The literature search also used phrases such as ‘Hospital-associated infections among hospitalized patients’ and produced 10493 articles (Evidence-Based Care Bundle-Nursing Paper Examples).

Moreover, ‘HAI effects on quality of care and patient safety,’ ‘morbidity and mortality rates,’ and ‘evidence-based infections intervention’ for HAIs were other search phrases utilized. Consequently, the literature search utilized vital terms and phrases interchangeably to obtain valid information concerning the topic (Evidence-Based Care Bundle-Nursing Paper Examples).

Literature Evaluation

This capstone change project identified eight peer-reviewed articles (Appendix B). Furthermore, the articles will provide evidence-based information instrumental to implementing the evidence-based care bundle. Consequently, the research articles will determine whether the proposed intervention (care bundle) is the most appropriate strategy for HAIs. Furthermore, the literature evaluation will compare the research questions, sample population, and limitations of the identified research articles (Evidence-Based Care Bundle-Nursing Paper Examples).

Comparison of Research Questions

A cross-sectional observational study by Alharbi et al. (2020) aimed to identify potential sources of HAIs in the ICU. Moreover, the research question was, “What are the potential sources of transmitting hospital-acquired infections by routine devices in the adult ICU at Alrass General Hospital?” The question is relevant to my project as it aims to identify potential sources of HAIs crucial in devising intervention strategies. Over 80% of HAIs relate to device use among patients in hospital settings, such as ventilator-associated pneumonia, urinary tract infection, and surgical site infection (Evidence-Based Care Bundle-Nursing Paper Examples).

García et al. (2022) research question was, “What are the elements of evidence-based care bundles?” comprehension of the elements is vital to adopting the intervention to curb HAIs. Consequently, Voidazan et al. (2020) research question aimed to determine the prevalence of HAIs at public hospitals in Romania. Comprehension of the HAI prevalence aids in understanding the level of the problem posed by the HAIs (Evidence-Based Care Bundle-Nursing Paper Examples).

Furthermore, a descriptive study design by Connor et al. (2023) research question was, “How does the implementation of EBPs improve patient outcomes in healthcare settings?” The research article will be vital to implementing evidence-based intervention to improve patient outcomes through quality care and patient safety (Evidence-Based Care Bundle-Nursing Paper Examples).

Subsequently, Linda et al. (2023) research question relates to my PICOT as it aims to determine how hospital environmental sanitation and disinfection procedures aid in curbing HAIs. Moreover, hospital cleanliness is vital in improving patient safety, which is one of this project’s primary goals (Evidence-Based Care Bundle-Nursing Paper Examples).

Consequently, Verberk et al. (2021) research question was, “What are the experiences of infection control practitioners?” Understanding nurses and other healthcare professionals’ perceptions aids in implementing an intervention that they support and find effective in any EBP project (Evidence-Based Care Bundle-Nursing Paper Examples).

Moreover, Browne et al. (2023) research question aimed to evaluate how cleaning and disinfection of shared medical equipment affect HAIs. Furthermore, in a prospective cohort study, Gidney et al. (2023) research question was, “What is the clinical and economic burden of HAIs among hospitalized patients?” The research article will be vital to show the health and economic effects of HAIs. Hence, the article shows the significance of implementing the evidence-based care bundle to curb HAIs to gain stakeholders’ support (Evidence-Based Care Bundle-Nursing Paper Examples).

Comparison of Sample Populations

Alharbi et al. (2020) collected 36 swabs from three different devices used by every twelve patients in the ICU. Moreover, the sample population related to my project’s sample, which involved adult patients in the hospital setting (ICU). Consequently, García et al. (2022) sampled 3619 records with 44 eligible studies identified in Neonatal units in low and middle-income nations (Evidence-Based Care Bundle-Nursing Paper Examples).

Voidazan et al. (2020) used seven public health settings, while Connor et al. (2023) reviewed 636 studies. Moreover, Linda et al. (2023) involved 15 Midwestern Veterans Administration Hospital patients (Evidence-Based Care Bundle-Nursing Paper Examples). 

The research article was vital to understanding perceptions of patient hospital hygiene. Verberk et al. (2021) involved 33 care providers in direct patient care. Lastly, Browne et al. (2023) involved patients from 10 large hospitals in Australia, while Gidney et al. (2023) recruited 408 patients at Ayder Comprehensive Specialized Hospital. Although some of the evidence collected comprised reviews, most articles recruited patients or caregivers who provided insightful data relating to my project (Evidence-Based Care Bundle-Nursing Paper Examples).

Comparison of Study Limitations

Study limitations portray weaknesses in a research design that affect the outcomes and conclusions of the research. One of the main limitations noted in most research articles was small sample sizes. For instance, Alharbi et al. (2020) had 36, Voidazan et al. (2020) used seven, Linda et al. (2023) involved 15 patients, Verberk et al. (2021) involved 33 care providers while Browne et al. (2023) involved 10 (Evidence-Based Care Bundle-Nursing Paper Examples).

Small sample sizes lead to uncovering bias as it is difficult to determine whether various outcomes are valid findings. Verberk et al. (2021) study was prone to underrepresentation since only 18% of all Dutch general hospitals participated (Evidence-Based Care Bundle-Nursing Paper Examples).

In García et al. (2022), there might have been a selection bias in screening the research articles since only random samples of 20 abstracts were screened independently in the initial stages. Voidazan et al. (2020) lack adequate case reports of HAIs, such as patients’ conditions upon discharge. Linda et al. (2023) focused on patient satisfaction, while the surveys focused on patients’ perceptions of cleanliness (Evidence-Based Care Bundle-Nursing Paper Examples).

Browne et al. (2023) had limitations since hospital policy or practice changes would affect the study outcomes. Gidney et al. (2023) were conducted in a single center. Thus, generalizations of the outcomes will not be accurate. The study estimated direct medical and economic burdens while costs related to illness and loss of productivity were not measured, which may underestimate the total costs incurred (Evidence-Based Care Bundle-Nursing Paper Examples).

Nursing Theory

Continuous quality improvement implements changes required to improve care quality and patient safety. Furthermore, healthcare professionals promote continuous quality improvement by replacing their existing knowledge to improve their knowledge, skills, and competency by acquiring new evidence-based information. However, the implemented changes should align with organizational goals, missions, and vision to attain success (Evidence-Based Care Bundle-Nursing Paper Examples).

On the other hand, this project will use Lewin’s theory to implement this evidence-based project (Appendix C). Consequently, the three-step model is easy and straightforward to follow and has unfreezing, change, and refreezing stages (Adelman-Mullally et al., 2023) (Evidence-Based Care Bundle-Nursing Paper Examples).

The unfreezing step prepares for the change by identifying care practice gaps and creating strategies to initiate change. This step will entail the identification of healthcare burdens caused by HAIs. A literature search will obtain evidence-based information to determine the most appropriate intervention to remedy the identified problem. The stakeholders will also be informed about the proposed change and implementation strategies.

The second stage entails implementing the proposed intervention by adopting care bundle elements to improve care quality and patient safety. After implementing the care bundle, the refreezing stage allows the stakeholders to work towards sustaining the implemented change. A summative evaluation will be conducted to make improvements required to sustain change (Evidence-Based Care Bundle-Nursing Paper Examples).

Proposed Intervention and Outcome Measures

This evidence-based project aims to implement care bundles to reduce hospital-associated infections among hospitalized patients. The facility’s nurses and other healthcare professionals should implement evidence-based care bundle elements to achieve desired outcomes. The care bundle comprises primary prevention, early detection, and tertiary prevention through case management and implementation structures such as alcohol-based sanitizers to improve hospital hygiene (García et al., 2022) (Evidence-Based Care Bundle-Nursing Paper Examples).

Primary prevention will entail hygiene measures through alcohol-based sanitizers, disinfection and antiseptic techniques, and alternative medical devices, such as replacing indwelling catheters with external catheters. Secondly, early detection through screening and surveillance promotes early identification and management. Tertiary prevention will be vital to managing advanced HAI cases through interdisciplinary healthcare teams. Finally, the implementation will entail physical equipment and structure modification, such as hand hygiene infrastructure and supplies, such as antibiotics and sanitizers (Evidence-Based Care Bundle-Nursing Paper Examples).

Creation of Intervention Plan

Evidence-based information was used to create the intervention plan. The literature search identified eight articles to obtain evidence-based information concerning the topic. The information will also determine whether the care bundle is the most appropriate intervention to reduce HAIs. The evidence collected revealed that an evidence-based care bundle had improved outcomes towards preventing HAIs (Evidence-Based Care Bundle-Nursing Paper Examples).

For instance, care bundle elements prevent HAIs through strategies such as hand hygiene with alcohol-based sanitizers before and after handling patients (García et al., 2022). Secondly, sterilization of medical equipment will curb HAIs. Evidence-based information was also vital for identifying measurable outcomes to evaluate whether the proposed intervention was successful. The obtained information also offered insights into the nursing theory utilized in implementing the intervention (Evidence-Based Care Bundle-Nursing Paper Examples).

Nursing Intervention Evaluation

This capstone project’s evaluation will engage the stakeholders (healthcare professionals, patients, and their caregivers) to promote success. The evaluation will help to identify potential gaps in healthcare practice to devise improvements and sustain the change (Dopp et al., 2021). As such, the project should be transparent and have a defined purpose. The stakeholders should know whether the evaluation results will eliminate or support the project. A comprehensive project description informs the stakeholders whether the proposed intervention will be successful (Evidence-Based Care Bundle-Nursing Paper Examples).

The project evaluation will collect data on the rates of HAIs among hospitalized patients in the facility. The information will be collected from patient’s records before and after the implementation of the care bundle. Open-ended surveys will determine the stakeholders’ knowledge and perception of the evidence-based care bundle. The evaluation results will be conveyed to the stakeholders through face-to-face presentations to obtain immediate feedback and responses from the stakeholders (Evidence-Based Care Bundle-Nursing Paper Examples).

Barriers and Implementation Strategies

The potential barriers to the implementation of the project may include a lack of support from relevant stakeholders. The facility’s healthcare staff and management team may portray resistance toward change. Healthcare staff may lack knowledge and confidence in adopting implemented care bundles and evidence-based practice. However, having a strategic plan is vital to promote implementation. The project will create awareness about its significance in obtaining stakeholders’ support (Evidence-Based Care Bundle-Nursing Paper Examples).

Continuous professional development will ensure the healthcare staff supports EBP and current and future changes (Kavanagh, 2021). The change project may also be costly to implement and sustain. However, creating a strategic plan will ensure maximization of resources. The plan will also be vital to obtain funding from the hospital management team and the government to implement the project. Poor communication may also hinder the implementation of the project. In this case, stakeholder collaboration will promote communication and improve decision-making (Evidence-Based Care Bundle-Nursing Paper Examples).

Conclusion (Evidence-Based Care Bundle-Nursing Paper Examples)

Healthcare-associated infections (HAIs) pose significant challenges to healthcare globally. The potentially preventable infections lead to increased morbidity and mortality rates. High morbidity rates prolong hospitalization and increase healthcare spending for patients, healthcare facilities, and the government (Evidence-Based Care Bundle-Nursing Paper Examples).

This change project aims to implement an evidence-based care bundle to prevent and reduce HAISs among hospitalized patients. Implementing an evidence-based care bundle will promote HAI primary prevention, infection surveillance for early detection, and management of HAI cases (tertiary prevention) while adopting implementation elements/structures such as alcohol-based sanitizers (Evidence-Based Care Bundle-Nursing Paper Examples).

Lewin’s theory will be used to implement the evidence-based project as it is straightforward. The literature search strategy identified peer-reviewed articles to obtain evidence-based information to create the intervention plan. An evaluation will be vital to assess the project’s success while devising improvement strategies. While the project may encounter potential financial constraints, creating a strategic plan and collaboration among the stakeholders will promote success (Evidence-Based Care Bundle-Nursing Paper Examples).

References

Adelman-Mullally, T., Nielsen, S., & Chung, S. Y. (2023). Planned change in modern hierarchical organizations: A three-step model. Journal of Professional Nursing, 46, 1-6.

Alharbi, R. D., Ali, A. H. M., Almatroudi, A., & Mohamed, S. (2020). The potential sources of transmission of hospital-acquired infection by routine devices in the adult ICU in Alrass General Hospital. Journal of Biosciences and Medicines, 8(4), 69-80. https://www.scirp.org/journal/paperinformation.aspx?paperid=99511

Allegranzi, B., & Pittet, D. (2019). Role of hand hygiene in healthcare-associated infection prevention. Journal of Hospital Infection, 101(4), 301-314. doi 10.1016/j.jhin.2018.09.020

Blot, S., Ruppé, E., Harbarth, S., Asehnoune, K., Poulakou, G., Luyt, C. E., … & Zahar, J. R. (2022). Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive and Critical Care Nursing, 70, 103227.

Browne, K., White, N., Tehan, P., Russo, P. L., Amin, M., Stewardson, A. J., … & Mitchell, B. G. (2023). A randomized controlled trial investigating the effect of improving the cleaning and disinfection of shared medical equipment on healthcare-associated infections: the CLEaning and Enhanced disinfection (CLEEN) study. Trials, 24(1), 133. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9944767/

Connor, L., Dean, J., McNett, M., Tydings, D. M., Shrout, A., Gorsuch, P. F., … & Gallagher‐Ford, L. (2023). Evidence‐based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review. Worldviews on Evidence‐Based Nursing, 20(1), 6-15. https://sigmapubs.onlinelibrary.wiley.com/doi/pdf/10.1111/wvn.12621

Dopp, A. R., Kerns, S. E., Panattoni, L., Ringel, J. S., Eisenberg, D., Powell, B. J., … & Raghavan, R. (2021). Translating economic evaluations into financing strategies for implementing evidence-based practices. Implementation Science, 16(1), 1-12. https://implementationscience.biomedcentral.com/articles/10.1186/s13012-021-01137-9

García, A. M., Cross, J. H., Fitchett, E. J., Kawaza, K., Okomo, U., Spotswood, N. E., … & Lawn, J. E. (2022). Infection prevention and care bundles addressing healthcare-associated infections in neonatal care in low-middle income countries: a scoping review. EClinicalMedicine, 44, 101259

Gidey, K., Gidey, M. T., Hailu, B. Y., Gebreamlak, Z. B., & Niriayo, Y. L. (2023). Clinical and economic burden of healthcare-associated infections: A prospective cohort study. Plos one, 18(2), e0282141. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9949640/

Kavanagh, J. M. (2021). Crisis in Competency: A Defining Moment in Nursing Education. Online Journal of Issues in Nursing, 26(1).

Linda, M., Kelsey, B., Rosie, B., Mark, F., & Nasia, S. (2022). Engaging veterans in identifying key environmental cleaning and disinfection elements for preventing healthcare-associated infections: A qualitative study. American Journal of Infection Control, 50(2), 148-154. https://www.sciencedirect.com/science/article/abs/pii/S0196655321006799

Ponsford, M. J., Jefferies, R., Davies, C., Farewell, D., Humphreys, I. R., Jolles, S., … & Barry, S. (2021). The burden of nosocomial covid-19: results from the Wales multi-center retrospective observational study of 2518 hospitalized adults. medRxiv, 2021-01.

Sahiledengle, B., Seyoum, F., Abebe, D., Geleta, E. N., Negash, G., Kalu, A., … & Quisido, B. J. E. (2020). Incidence and risk factors for hospital-acquired infection among pediatric patients in a teaching hospital: a prospective study in southeast Ethiopia. BMJ open, 10(12), e037997.

Verberk, J. D., van der Kooi, T. I., Derde, L. P., Bonten, M. J., de Greeff, S. C., & van Mourik, M. S. (2021). Do we need to change catheter-related bloodstream infection surveillance in the Netherlands? A qualitative study among infection prevention professionals. BMJ open, 11(8), e046366. https://bmjopen.bmj.com/content/bmjopen/11/8/e046366.full.pdf

Voidazan, S., Albu, S., Toth, R., Grigorescu, B., Rachita, A., & Moldovan, I. (2020). Healthcare-associated infections—a new pathology in medical practice? International Journal of environmental research and public health, 17(3), 760. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036829/

Wang, Y., Yang, J., Qiao, F., Feng, B., Hu, F., Xi, Z. A., … & Yuan, Y. (2022). Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis. American Journal of Infection Control, 50(5), 563-571.

Appendix A: PET Management Guide

Appendix B: Literature Evaluation Table (Evidence-Based Care Bundle-Nursing Paper Examples)

Criteria	Article 1		Article 2	Article 3	Article 4
Author, Journal (Peer-Reviewed), and   Permalink or Working Link to Access Article	Alharbi, R. D., Ali, A. H. M., Almatroudi, A., & Mohamed, S. (2020). The potential sources of transmission of hospital-acquired infection by routine devices in the adult ICU in Alrass General Hospital. Journal of Biosciences and Medicines, 8(4), 69-80. https://www.scirp.org/journal/paperinformation.aspx?paperid=99511		García, A. M., Cross, J. H., Fitchett, E. J., Kawaza, K., Okomo, U., Spotswood, N. E., … & Lawn, J. E. (2022). Infection prevention and care bundles addressing healthcare-associated infections in neonatal care in low-middle income countries: a scoping review. EClinicalMedicine, 44, 101259.	Voidazan, S., Albu, S., Toth, R., Grigorescu, B., Rachita, A., & Moldovan, I. (2020). Healthcare-associated infections—a new pathology in medical practice? International Journal of environmental research and public health, 17(3), 760. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036829/	Connor, L., Dean, J., McNett, M., Tydings, D. M., Shrout, A., Gorsuch, P. F., … & Gallagher‐Ford, L. (2023). Evidence‐based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review. Worldviews on Evidence‐Based Nursing, 20(1), 6-15. https://sigmapubs.onlinelibrary.wiley.com/doi/pdf/10.1111/wvn.12621
Article Title and Year Published	The potential sources of transmission of hospital-acquired infection by routine devices in the adult ICU at Alrass General Hospital 2020		Infection prevention and care bundles addressing healthcare-associated infections in neonatal care in low-middle income countries: a scoping review 2022	Healthcare-associated infections—a new pathology in medical practice? 2020	Evidence‐based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review.  2023
Research Questions (Qualitative)/Hypothesis (Quantitative)	What are the potential sources of transmitting hospital-acquired infections by routine devices in the adult ICU at Alrass General Hospital?		What are the elements of evidence-based care bundles?	What is the prevalence of HAIs in public hospitals in Romania?	How does the implementation of EBPs improve patient outcomes in healthcare settings?
Purposes/Aim of Study	To determine the potential sources of transmitting hospital-acquired infection by routine devices in the adult ICU in Alrass General Hospital.		This scoping review aimed to synthesize published literature on infection prevention and care bundles addressing neonatal HCAI in LMICs and to construct a Classification Framework for their components.	The purpose of this study was to analyze the cases of HAI identified from the public hospitals at the county level through the case reports sheets as they are reported according to Romanian legislation.	This scoping review provided a thorough summary of published literature on implementing EBPs on patient outcomes in healthcare settings.
Design (Type of Quantitative or Type of Qualitative)	an observational and cross-sectional study		Descriptive study design	Cross-sectional study design based on the case law of the data reported to the Mures Public Health Directorate.	Descriptive study design
Setting/Sample	Adult ICU in Alrass General Hospital		3619 records were screened, with 44 eligible studies identified. Neonatal units in low and middle-income nations	Seven public health settings	636 studies were included in the review
Methods: Intervention/Instruments	Three swabs were taken from the surfaces of an indwelling urinary catheter, mechanical ventilation device, and central venous catheter.		Qualitative content analysis was used to build a classification framework to categorize bundle elements, and the classification groups’ contents were then described quantitatively.	Tracked hospital-acquired infections reported for 2017–2018	A comprehensive librarian-assisted search was done with three databases, and two reviewers independently performed title/abstract and full-text reviews within a systematic review software system.
Analysis	Microsoft Excel Software		Qualitative content analysis to construct the Classification Framework	Statistical Package for Social Sciences (SPSS. version 20. Chicago, IL, USA).	Microsoft Excel Software
Key Findings	Indwelling catheters were the most contaminated device		Most care bundle elements were primary prevention interventions focused on central line catheters and mechanical ventilators.	1024 cases of HAIs were identified from the seven public health settings	EBPs on infection prevention were the most implemented projects  and were linked to improved patient outcomes
Recommendations	Effective evidence-based infection control practices and effective strategies to control antibiotic-resistant bacteria should be applied.		More research to be conducted on the elements of evidence-based care bundles	Improvement of data reporting systems  to identify and track HAIs	Further incorporation of EBP in all healthcare settings to improve the quality of care and patient safety
Explanation of How the Article Supports EBP/Capstone Project	The article discusses sources of HAIs in the ICU.		The article supports my project by studying the elements of evidence-based care bundles.	The articles study the cases of HAIs in healthcare settings and will be used to provide the prevalence of HAIs.	The articles review how EBP projects are linked with patient outcomes. The article will be vital in the implementation stages of my capstone change project.
Criteria		Article 5	Article 6	Article 7		Article 8
Author, Journal (Peer-Reviewed), and   Permalink or Working Link to Access Article		Linda, M., Kelsey, B., Rosie, B., Mark, F., & Nasia, S. (2022). Engaging veterans in identifying key environmental cleaning and disinfection elements for preventing healthcare-associated infections: A qualitative study. American Journal of Infection Control, 50(2), 148-154. https://www.sciencedirect.com/science/article/abs/pii/S0196655321006799	Verberk, J. D., van der Kooi, T. I., Derde, L. P., Bonten, M. J., de Greeff, S. C., & van Mourik, M. S. (2021). Do we need to change catheter-related bloodstream infection surveillance in the Netherlands? A qualitative study among infection prevention professionals. BMJ open, 11(8), e046366. https://bmjopen.bmj.com/content/bmjopen/11/8/e046366.full.pdf	Browne, K., White, N., Tehan, P., Russo, P. L., Amin, M., Stewardson, A. J., … & Mitchell, B. G. (2023). A randomized controlled trial investigating the effect of improving the cleaning and disinfection of shared medical equipment on healthcare-associated infections: the CLEaning and Enhanced disinfection (CLEEN) study. Trials, 24(1), 133. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9944767/		Gidey, K., Gidey, M. T., Hailu, B. Y., Gebreamlak, Z. B., & Niriayo, Y. L. (2023). Clinical and economic burden of healthcare-associated infections: A prospective cohort study. Plos one, 18(2), e0282141. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9949640/
Article Title and Year Published		Engaging veterans in identifying critical elements of environmental cleaning and disinfection for preventing healthcare-associated infections: A qualitative study 2022	Do we need to change catheter-related bloodstream infection surveillance in the Netherlands? A qualitative study among infection prevention professionals.  2021	A randomized controlled trial investigating the effect of improving the cleaning and disinfection of shared medical equipment on healthcare-associated infections: the CLEaning and Enhanced disinfection (CLEEN) study. 2023		Clinical and economic burden of healthcare-associated infections: A prospective cohort study. 2023
Research Questions (Qualitative)/Hypothesis (Quantitative)		How does environmental cleaning and disinfection prevent HAIs in hospitals?	What are the experiences of infection control practitioners?	How does enhanced cleaning and disinfection of shared medical equipment affect the rate of HAIs in a tertiary hospital setting?		What is the clinical and economic burden of HAIs among hospitalized patients?
Purposes/Aim of Study		To engage patients in achieving patient-centered care and examine patient perspectives on environmental cleaning work systems in healthcare.	To explore the experiences of infection control practitioners (ICPs) and medical professionals with the current CRBSI surveillance in the Netherlands and their suggestions for improvement	Assess the effectiveness of improving the quality and frequency of cleaning and disinfection of shared medical equipment in reducing HAIs.		To assess the clinical and economic burden of HAIs in hospitalized patients at Ayder Comprehensive Specialized Hospital.
Design (Type of Quantitative or Type of Qualitative)		Qualitative descriptive study	Qualitative study using focus group discussions (FGDs)	Stepped wedge randomized controlled		Prospective cohort study design
Setting/Sample		15 patients from Midwestern Veterans Administration Hospital.	24 infection control practitioners and 9 health professionals  Basic, teaching and academic hospitals in the Netherlands	10 wards of one large Australian hospital over 36 weeks		408 patients, 204 with HAIs and 204 without HAIs in hospital settings
Methods: Intervention/Instruments		Semi-structured interviews to collect that data	Used focus group discussions (FGDs) with ICPs and medical professionals separately, followed by semi-structured interviews to investigate whether the points raised in the FGDs were recognized and confirmed by the interviewee	The intervention will consist of 3 additional hours per weekday for the dedicated cleaning and disinfection of shared medical equipment in each ward.		Medical records, interviews, and patient bills were reviewed to extract the necessary information.
Analysis		Rapid qualitative inquiry (RQI) analysis	Thematic analysis was used	A generalized linear mixed model (GLMM) with a logit link function or primary outcome  and a binomial generalized linear mixed model with a logit link function for secondary outcome		STATA 14.1 (STATA Corporation, Texas, USA) Descriptive analysis for quantitative variables
Key Findings		Patients expected room cleaning to improve their health outcomes	Infection surveillance was valuable in monitoring care	Cleaning of medical equipment reduces the rate of HAIs		In-patient mortality, lengthy hospitalizations, and high health costs were the significant effects of HAIs
Recommendations		In further evaluation of unique patient populations and needs, researchers should develop and evaluate interventions to address patient-identified barriers.	Increased automation of the infection surveillance process	Provision of adequate medical equipment to  prevent sharing the increased risks of HAIs		Adoption of EBP to curb HAIs and their consequences in healthcare settings
Explanation of How the Article Supports EBP/Capstone		The articles focus on environmental cleaning and disinfection to mitigate HAIs	The article offers insights on infection surveillance to improve care quality and patient safety.	The article will offer guidance on education on how to clean medical equipment to prevent HAIs		The articles provide insights into the impact of HAIs and will be vital to devising strategies to improve patient outcomes through HAI prevention in hospital settings.

Appendix C: Lewin’s Change Model