Effect for Develop and Utilizing the clinical practice Guideline of Nursing for the Prevention and Control of High-alert multidrug-resistant bacteria
Keywords:
Nursing practice guideline, Multidrug-resistant organisms, Infection controlAbstract
This action research aimed to study, develop, and evaluate a nursing clinical practice guideline for the prevention and control of high-alert multidrug-resistant bacterial infections at Chomthong Hospital. The participants consisted of 129 nurses from nine inpatient wards and 19 members of the development team. The study was conducted between April 2019 and March 2021.
Findings revealed that:
(1) The hospital faced structural challenges, including unclear infection control policies, insufficient staff training, and lack of ongoing monitoring. Operational limitations included incomplete patient isolation, inadequate use of protective equipment, and limited availability of cleaning materials. Result-wise, patients were infected with CRE, VRE, and A. baumannii, with some experiencing severe complications or mortality.
(2) The developed guideline, called SHIPPEE+B, consisted of seven essential nursing interventions: Single-use equipment (S), Hand hygiene (H), Isolation (I), Precaution (P), Education (E), Environmental cleaning (E), and Bathing (B). The guideline was refined through multidisciplinary workshops, trial implementation, and expert feedback.
(3) Post-implementation results indicated a reduction in the incidence of MDRO infections from 0.570 to 0.278 per 1,000 patient-days. Correct nursing practices increased significantly from 60.3% to 95.2% (P<.001), and more than 90% of nurses expressed high agreement that the guideline was appropriate, practical, and effective in reducing MDRO transmission.
References
ภาวิณี ไพศาลกิตติวัฒน์, ชลธิชา มโนมัยพิบูลย์ และจารุวรรณ กิจรุ่งโรจน์. (2562). พฤติกรรมการป้องกันการติดเชื้อดื้อยาในโรงพยาบาล: การศึกษากรณีโรงพยาบาลระดับจังหวัด. วารสารพยาบาลศาสตร์, 37(1), 45–60.
สำนักงานคณะกรรมการสุขภาพแห่งชาติ. (2560). รายงานสถานการณ์สุขภาพและการดื้อยาต้านจุลชีพของประเทศไทย. นนทบุรี: สำนักงานคณะกรรมการสุขภาพแห่งชาติ
Bero, L. A., Grilli, R., Grimshaw, J. M., Harvey, E., Oxman, A. D., & Thomson, M. A. (1998). Closing the gap between research and practice: An overview of systematic reviews ofinterventions to promote the implementation of research findings. BMJ, 317(7156), 465-468.
Brinsley, K. J., Sinkowitz-Cochran, R. L., Cardo, D. M., & the CDC Campaign to Prevent Antimicrobial Resistance Team. (2005). Assessing motivation for physicians to prevent antimicrobial resistance in hospitalized children using the Health Belief Model as a framework. American Journal of Infection Control, 33(3), 175-181.
Centers for Disease Control and Prevention. (2018). Antibiotic Resistance Threats in the United States, 2018. https://www.cdc.gov
Creedon, S. A. (2005). Healthcare workers’ hand decontamination practices: Compliance with recommended guidelines. Journal of Advanced Nursing, 51(3), 208-216.
Jacob, J. T., Klein, E., Laxminarayan, R., & Beldavs, Z. G. (2013). Vital signs: Carbapenem- resistant Enterobacteriaceae. Morbidity and Mortality Weekly Report, 62(9), 165–170.
Krein, S. L., Hofer, T. P., Kowalski, C. P., Olmsted, R. N., & Saint, S. (2012). Use of central venous catheter-related bloodstream infection prevention practices by US hospitals. Mayo Clinic Proceedings, 87(3), 243–251.
Loveday, H. P., Pellowe, C. M., Jones, S. R., & Pratt, R. J. (2006). A systematic review of the evidence for interventions for reducing transmission of meticillin-resistant Staphylococcus aureus (MRSA) in the hospital setting. Journal of Hospital Infection, 63(S1), S45-S70.
Naikoba, S., & Hayward, A. (2001). The effectiveness of interventions aimed at increasing handwashing in healthcare workers: A systematic review. Journal of Hospital Infection, 47(3), 173-180.
National Institute of Clinical Studies. (2004). Evidence-practice gaps report. Melbourne, Australia: National Institute of Clinical Studies.
Stone, P. W., Pogorzelska-Maziarz, M., Herzig, C. T., Weiner, L. M., Furuya, E. Y., Dick, A., & Larson, E. L. (2015). State of infection prevention in US hospitals enrolled in the National Health and Safety Network. American Journal of Infection Control,43(3), 214–220.
Unahalekhaka A, Jamulitrat S, Chongsuvivatwong V, Ovretveit J. (2007). Using a collaborative toreduce ventilator-associated pneumonia in Thailand. Joint Commission Journal onQuality and Patient Safety. 33:387-94.
World Health Organization. (2018). Ten threats to global health in 2018. https://www.who.int
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
