Full Answer Section

• Financial Burden: Treating HAIs increases healthcare costs due to extended treatments, additional medications, diagnostic tests, and prolonged patient stays. This strains already limited resources in public health facilities.
• Reputational Damage: The clinic/system’s reputation can suffer due to negative patient experiences, leading to decreased patient volume and community trust.
• Staff Morale and Absenteeism: HCWs are also at increased risk of occupational infections, leading to absenteeism, burnout, and reduced morale, particularly if they perceive a lack of commitment to their safety from the organization.
• Regulatory Scrutiny: Lapses in infection control can lead to audits, sanctions, or even closure by regulatory bodies like the National Ministry of Health or the Kisumu County Health Department.

1. Identify each of the following PICO components of the clinical practice problem:

• P (Patient, Population, or Problem): Healthcare workers (HCWs) in primary care settings in Kisumu County, Kenya.
• I (Intervention): Multi-modal infection prevention and control (IPC) training and educational programs (e.g., combining workshops, practical demonstrations, and ongoing feedback).
• C (Comparison): Current standard practice (e.g., routine, less intensive, or infrequent IPC training).
• O (Outcome): Improved adherence to standard precautions, reduced rates of healthcare-associated infections (HAIs), and enhanced patient safety.

2. Develop an evidence-based practice (EBP) question based on the clinical practice problem discussed in part B and the PICO components identified in part B1.

In healthcare workers in primary care settings in Kisumu County, Kenya (P), does a multi-modal infection prevention and control training and educational program (I) compared to current standard training (C) lead to improved adherence to standard precautions and reduced rates of healthcare-associated infections (O)?

C. Select a research-based article that answers your EBP question from part B2 to conduct an evidence appraisal.

Simulated Article Selection: For this exercise, I will select a hypothetical research article that would fit the criteria.

Article Title: “Effectiveness of a Multi-Modal Infection Prevention and Control Training Program on Hand Hygiene Compliance and PPE Use Among Primary Healthcare Workers in Western Kenya: A Cluster Randomized Controlled Trial.” Authors: Onyango, A., Kimani, S., & Mutiso, R. Journal: Journal of Global Health and Infectious Diseases Year: 2023

1. Discuss the background or introduction (i.e., the purpose) of the research-based article.

The background of this research-based article highlights that healthcare-associated infections (HAIs) remain a significant challenge in low- and middle-income countries, including Kenya, contributing to increased morbidity, mortality, and healthcare costs. Despite existing national guidelines for infection prevention and control (IPC), adherence to standard precautions, particularly hand hygiene and appropriate personal protective equipment (PPE) use, is often suboptimal in primary healthcare settings. The authors emphasize that HCWs in these resource-limited environments face unique challenges, including high patient loads and inconsistent access to IPC supplies. The purpose of the study was to evaluate the effectiveness of a comprehensive, multi-modal IPC training program, incorporating educational sessions, practical demonstrations, and ongoing feedback, on improving HCW adherence to standard precautions and subsequently reducing HAIs in primary care facilities in a region representative of Western Kenya.

2. Describe the research methodology used in the research-based article.

The research employed a cluster randomized controlled trial (cRCT) design. Primary healthcare facilities (clusters) in Western Kenya were randomly assigned to either an intervention group (receiving the multi-modal IPC training) or a control group (receiving standard, less intensive IPC training). The study involved baseline and follow-up data collection over a 12-month period. Data on hand hygiene compliance and PPE use were collected through direct observation by trained independent observers. Rates of common HAIs (e.g., surgical site infections from minor procedures, catheter-associated UTIs where applicable) were retrospectively reviewed from patient records. Demographic information of HCWs and facility-level characteristics were also collected. Statistical analyses were performed to compare changes in adherence rates and HAI incidence between the intervention and control groups, accounting for the clustering effect.

3. Identify the level of evidence for the research-based article using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model.

According to the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, a cluster randomized controlled trial (cRCT) is considered Level I evidence. This is because cRCTs are a form of experimental study, providing the highest level of evidence for establishing cause-and-effect relationships, similar to individually randomized controlled trials, but accounting for interventions applied at a group level (like a clinic).

4. Summarize how the researcher analyzed the data in the research-based article.

The researchers analyzed the data using both descriptive and inferential statistics. Descriptive statistics (means, standard deviations, frequencies, percentages) were used to characterize the baseline demographics of HCWs and facility characteristics in both groups, as well as to summarize adherence rates and HAI incidence. Inferential statistics involved mixed-effects regression models to compare the post-intervention changes in hand hygiene compliance, PPE use, and HAI rates between the intervention and control groups, while controlling for baseline differences and the clustering effect of facilities. This approach allowed them to determine the statistical significance of the intervention’s impact on the outcomes, accounting for the hierarchical nature of the data (HCWs within facilities). They also performed sensitivity analyses to check the robustness of their findings.

5. Summarize the ethical considerations of the research-based article.

The research-based article outlined several key ethical considerations.

• Institutional Review Board (IRB) Approval: The study confirmed that ethical approval was obtained from relevant IRBs in Kenya and the collaborating international institution.
• Informed Consent: All participating healthcare workers provided written informed consent after being fully informed about the study’s purpose, procedures, potential risks, and benefits, and their right to withdraw at any time without penalty.
• Confidentiality and Anonymity: Measures were taken to ensure the confidentiality of participant data and patient records. HCW observations were anonymized, and patient data related to HAIs was de-identified.
• Minimization of Harm: The intervention itself (IPC training) was considered beneficial, thus posing minimal risk. The researchers ensured that no HCW was penalized for non-compliance observed during the study, as the observations were for research purposes only.
• Equity and Benefit Sharing: The control group eventually received the intervention after the study period, ensuring equitable access to potential benefits of the training program.
• Cultural Sensitivity: The research team ensured cultural sensitivity in their approach to data collection and interactions with local healthcare staff and communities.

6. Identify the quality rating of the research-based article according to the JHNEBP model.

Based on the description of the methodology (cluster randomized controlled trial), the clear background, ethical considerations, and robust data analysis, this article would likely receive a Quality A rating according to the JHNEBP model. A Level I study with strong methodology and reporting typically warrants a Quality A rating, indicating that the study is consistent, generalizable, and has sufficient sample size with definite conclusions.

7. Analyze the results or conclusions of the research-based article.

The study concluded that the multi-modal IPC training program significantly improved hand hygiene compliance and appropriate PPE use among healthcare workers in the intervention group compared to the control group. Specifically, hand hygiene adherence increased by 35% in the intervention group (p < 0.001), and consistent PPE use (gloves, masks, gowns) increased by 28% (p < 0.001). Furthermore, the intervention group demonstrated a statistically significant reduction in the incidence of common healthcare-associated infections, with a 20% lower rate of reported HAIs compared to the control group (p = 0.012). The authors concluded that multi-modal IPC training is an effective strategy for enhancing adherence to standard precautions and improving patient safety outcomes in resource-limited primary healthcare settings in Kenya.

a. Explain how the article helps answer your EBP question.

This article directly helps answer my EBP question: “In healthcare workers in primary care settings in Kisumu County, Kenya (P), does a multi-modal infection prevention and control training and educational program (I) compared to current standard training (C) lead to improved adherence to standard precautions and reduced rates of healthcare-associated infections (O)?”

The study provides strong Level I (Quality A) evidence that such an intervention (multi-modal IPC training) does lead to the desired outcomes. It shows a statistically significant improvement in adherence to standard precautions (hand hygiene and PPE use) and a significant reduction in HAIs in a relevant population (primary healthcare workers in Western Kenya, a context similar to Kisumu County). The findings suggest that investing in and implementing such programs can effectively mitigate the clinical practice problem of poor adherence to standard precautions, leading to enhanced patient safety.

D. Select a non-research-based article from a peer-reviewed journal that helps to answer your EBP question from part B2 to conduct an evidence appraisal.

Simulated Article Selection: I will select a hypothetical non-research article.

Article Title: “Strengthening Infection Prevention and Control in Resource-Limited Primary Care: A Quality Improvement Initiative in Kisumu County.” Authors: Atieno, J., & Wafula, D. Journal: African Journal of Primary Healthcare and Family Medicine