Research Based Evidence

RESEARCH BASED EVIDENCE 1

Institution Affiliation

Section A

Clostridiumdifficile is a formidable spore-forming nosocomial germ that cancause diarrhea. Also known as C. difficile or C. diff., thebacterium affects the bowel through the release of two exotoxinsnamely toxin A and toxin B (American Gastroenterological Association,2016). It is commonly experienced among individuals that haverecently had a dose of antibiotics in the hospital (Cohen et. al.,2013). For this reason, it is also known as a common cause ofantibiotic-associated diarrhea (Burnham &amp Carroll, 2013).Clostridium difficile is regarded as one of the leading causesof hospital-associated gastrointestinal illnesses in the healthcaresystem (Surawicz et. al., 2013). It is, therefore, responsible forthe highest burdens according to the current healthcare budgetaryallocations.

Since the turn ofthe new millennium, research indicates that there has been asubstantial increase in the incidence of the C. diff. disease.The medical experts attribute this growth to the emergence of newstrains of the infection (Burnham &amp Carroll, 2013). The changeshave led to alterations in the original detection mechanisms.Initially, the diagnosis was based on enzyme immunoassays for thedetection of the C. diff toxins. However, the development ofthe other strains has made the mainstay mechanisms of diagnosisinsensitive.

Based on thestatistics from the health departments across the United States, thenumber of people affected by the rod-shaped bacterium is 500,000. Ofthose infected, approximately 347,000 (69.4%) are forced to seekmedical attention at the hospitals (American GastroenterologicalAssociation, 2016). Since the disease is considered to be anaggressive intestinal bug, it can have fatal effects on thepopulation. Currently, deaths associated with C. diff rangebetween 14,000 and 30,000 annually. In terms of revenue, the diseasecosts the United States government approximately $1 billion annually(Burnham &amp Carroll, 2013).

The infectioncontinues to have a significant effect on the entire spectrum ofhealthcare. Currently, it is considered as a pathogen capable ofcausing human suffering to an extent similar to theMethicillin-resistant Staphylococcus aureus (Surawicz et. al., 2013).C. diff is associated with an increased length of stay at thehospital ranging between additional 2.6 and 4.5 days. The financialimpact is also massive and approximated to fall between $2500 and$3500 per episode. Such costs exclude those associated with surgicalinterventions (Cohen et. al., 2013).

C. diff.is the most common infection in health facilities as well aslong-term care facilities such as nursing homes (Burnham &ampCarroll, 2013). In addition to this, it can be found in air, water,and human feces. It is estimated that more than 10% of the entirepopulation have the bacteria. However, the larger percentage has noill effects and symptoms (American Gastroenterological Association,2016). The infection can therefore easily be transferable ininstances where an individual with C. diff. fails to wash thehands after visiting the washrooms. Such people are likely tocontaminate the foods they touch as well as leave the bacteria on thethings they come into contact with (Surawicz et. al., 2013). In mostscenarios, the contaminated surfaces will contain the dormant form ofthe bacteria for several months unless such an area is thoroughlycleaned with a disinfectant. If the contaminated area is not cleaned,it is likely that another person may be infected with C. diffif they come into contact with the contaminated surface (Burnham &ampCarroll, 2013). This is because the human body may accidentallyingest the spores when the suspecting individual touches the food orthe mouth.

In this scenario,considering that the study is based on a workplace, the probabilityof being infected is relatively high. This can be attributed to thefact that workmates share various equipments such as printingmachines, photocopying machines, and even the coffee maker. In otherinstances, shaking hands or touching common surfaces may culminate inthe spread of C. diff. It is for this reason that the studyfocuses on ways of preventing the spread of C. diff at the workplace(American Gastroenterological Association, 2016).

According to theanalysis of the risk factors, there are various factors that aretaken into consideration. However, the main cause of C. difficileinfection is the use of antibiotics. This is especially prominentamong individuals that have been taking the antibiotics for asubstantial period of time as well as those who take a “broadspectrum” antibiotic intended to kill a wide variety of bacteria.However, the risk extends to those found in the hospitals (AmericanGastroenterological Association, 2016). For example, is has beenestablished that C. difficile is common in various locationssuch as hospitals, care facilities and nursing homes and it istherefore likely that patients in these areas are affected as aresult (Surawicz et. al., 2013). Other risk factors that have beenidentified through research include those of ages above 65 years old.Additionally, individuals who have had abdominal surgery are alsolikely to be in greater danger (Burnham &amp Carroll, 2013). Thelevels of contracting the infection is also significantly higheramong those who have existing problems of the intestines that mayinclude inflammatory bowel disease and colon cancer, and those withweak immune system. The latter is caused by chemotherapy or drugsthat suppress the immune systems and AIDS (Surawicz et. al., 2013).Finally, people that have initially contracted C. difficileinfection are also at a greater risk of contracting the disease.

1. Healthcare Problem

The severity ofthe C. diff has been one of the factors behind concertedefforts to offer solutions at the workplace. The infection has beenestablished to have a substantial effect on the number of dayspatients spend in the healthcare facilities. The number of workingdays that an employee may miss at the workplace might have long termeffects on their productivity (Cohen et. al., 2013). Such is likelyto be passed on their assessment during performance evaluation.Additionally, the continuous spread of C. diff. is likely toincur huge medical bills (Burnham &amp Carroll, 2013). Consideringthe lack of health insurance cover, such infections may havesubstantial financial effects on individuals.

Controlling thespread of C. diff is also relevant to the individuals since itcontributes to the prevention of other opportunistic infections thatare likely to arise in case a person is infected C. diff.(Cohen et. al., 2013). Having identified the complications that mayarise as a result of Clostridium difficile infection, thisresearch paper focuses on offering solutions to the spread of themain disease in the first place (Burnham &amp Carroll, 2013). Someof the conditions that may result from C. diff. infectioninclude pseudomembranous colitis (PMC) and perforations of the colonin some instances (Surawicz et. al., 2013). In addition to this,other opportunistic infections that one may contract include toxicmegacolon, sepsis and in extreme instances the death of an individual(American Gastroenterological Association, 2016). It is important toestablish that death is a very rare occurrence in this regard. Theresearch problem, therefore, focuses on a series of factors aimed atensuring that evidence based practice is utilized in this researchstudy.

2. Significance of the Problem

The discussionregarding the need to identify the change in the current practiceshas been necessitated by improving the healthcare of all theemployees within the organizations (Burnham &amp Carroll, 2013).According to the existing research, it has been established that theelderly are at higher risk of contracting the C. diff infections(Surawicz et. al., 2013). In addition to this, people with specificmedical conditions are also in greater danger of contracting thedisease. By identifying the group of individuals that are at anincreased risk of contracting the infection, it is possible todetermine the most appropriate practice to be implemented in theorganization.

Moreover, being aworkplace that people come into contact frequently as well as sharevarious items, the identification of the most appropriate course ofaction and its subsequent application in the case of our organizationis very critical (Burnham &amp Carroll, 2013). Additionally, thestudy will identify the precautionary steps that can be taken by theemployees so as to control the spread of C. diff. Even thoughadditional current practices are being used by the organization suchas allowing patients with C. diff to have particular rooms inthe hospital where they are given treatment, there is need to provideevidence-based solutions. This limits the area of control to arelatively smaller section that can easily be taken care of withoutextensive effort (Surawicz et. al., 2013).

The healthcareproblem is also important since it will enable the healthcarepersonnel to be in a position to differentiate between Clostridiumdifficile colonization and Clostridium difficile infection. In theformer, the patient is known not to exhibit any form of clinicalsymptoms. However, the patient tests positive for C. diff.organisms (Cohen et. al., 2013). On the other hand, in Clostridiumdiffficile infection, the patient exhibits clinical symptoms aswell as testing positive for C. diff organisms and its toxins.The differentiation of the two concepts is important in the diagnosisof the disease and the subsequent treatments (AmericanGastroenterological Association, 2016).

3. Current Practice

In the hospital,various mechanisms have been put in place to ensure that C. diffis adequately controlled. At the location of work the medicalpersonnel also run a C. diff test once a patient starts havingloose stool (Burnham &amp Carroll, 2013). They monitor the handwashing measures using live a volunteer staff that is posted in everyunit with a log. He/or she documents staff who leave the room withoutwashing their hands or using the soap dispenser. Monthly reports arecompiled and sent to Quality Management Control Department andInfectious disease control.

Other controlmechanisms that have been implemented at the hospital require thedoctors, nurses and the healthcare providers to clean their handswith soap and water. Additionally, alcohol-based hand rubs have beenplaced at strategic locations within the facility, and all themedical practitioners are encouraged to visit such before and aftercaring for every patient (Cohen et. al., 2013). The mechanisms ensurethat there is the prevention of C. diff and other germs frombeing passed from one person to the other through hands.Additionally, the management of the hospital facility has ensuredthat all the hospital rooms are carefully cleaned (Surawicz et. al.,2013). Through cleaning is also done to the equipment that has beenused for the treatment with C. diff. The cleaning of the roomsand the equipment ensure that the risks of contracting the diseasethrough pores in the hands and mouth are eliminated by a greatermargin (Burnham &amp Carroll, 2013).

4. Impact on Background

The spread of Clostridium difficile infection is known to havevarying effects on the patients. The government continues to providea substantial percentage of budgetary allocation to facilitate thetreatment. The symptoms of C. diff include fever, loss ofappetite, watery diarrhea and belly pain and tenderness. Variousforms of treatment can be given to person suffering from C. diff.The first one includes antibiotics whereas surgery is recommended ininstances where the conditions are severe (Cohen et. al., 2013). Itinvolves the removal of the infected section of the intestine.However, it is very rare and occurs in 1 or two out of 100 cases ofC. diff (Surawicz et. al., 2013).

B. PICO Table

Example

P (patient/Problem)

The problem in this case is based on the safety of the doctors, nurses and the healthcare providers at the hospital with regard to controlling the spread of C. diff infection. The problem is also inclusive of the patients that have been admitted at the hospital wards.

I (Intervention/Indicator)

The intervention put in place relates to diagnostic tests or best practices

C (Comparison)

Since the question is looking at the best possible practice, this section of PICO table framework does not apply in this case

O (Outcome)

The outcome from the recommended course of action is a notable decrease in spread of C. diff at the hospital. This ensures the safety of doctors, nurses and the healthcare providers at the hospital as well as the patients admitted in the hospital wards

1. PICO Question

What is the best practice with regard to the control of thespread of C. diff infection in a hospital?

C. 1. Keywords

The research revolves around the identification of the best practicein controlling the spread of C. diff infections among doctors,nurses and the healthcare providers as well as the patients at thehospital. Some of the key words that will be investigated in thisstudy include:

  • Clostridium difficile Infection (CDI)

  • Staphylococcus aureus.

  • Pathogenesis

  • Epidemiology

  • Modes of Transmission

  • Antimicrobial

  • Probiotics

  • Bacillus difficilis

2. Number and Types of Articles

In thisresearch-based evidence, twelve sources were used. The evidencelevels for the articles used ranged from level 1 to level 5. Forlevel 1, an experimental study without meta-analysis was utilized.The second document involved a systematic review of the combinationof RCTs and quasi-experimental study without meta-analysis. The levelIII sources involved non-experimental studies as well as qualitativestudies without a meta-synthesis.

Sourcesconsidered to fall under the fourth level of evidence are theopinions of respected authorities as well as nationally recognizedpanels and therefore include clinical practice guidelines as well asconsensus panels. Finally, the level V of evidence is based onexperimental and non-research evidence. They include literaturereviews, programs aimed at improving the quality of serviceprovision, case reports and the opinions of nationally recognizedexperts.

a. Research and Non-Research Evidence

This section willanalyze four of the sources of evidence used in the paper. Two of thesources will provide non-research evidence with the other twoproviding research-based evidenced.

Non-Research Evidence

American Gastroenterological Association. (2016). UnderstandingClostridium Difficile Infection and Its Treatments.

This articlepresents a broad scope of information regarding C. diff infection.It begins by defining the illness and discussing the number ofindividuals affected on an annual basis as well as the finalimplications of the disease (American GastroenterologicalAssociation, 2016). After that, the source focuses on the causes ofC. diff and how one is likely to be infected with the disease.The use of hand washing mechanism as the means of avoiding infectionis analyzed in this source too. The author of the paper provides abackground of information regarding C, diff. Some of theaspects covered in this regard include the symptoms, risk factors,diagnosis and testing, and the treatment (AmericanGastroenterological Association, 2016).

According to theevidence provided by this source, the symptoms are divided intoeither acute or less-serious sections. The latter symptoms appear atthe initial stages of infection, and they include watery diarrhealasting for two or three times a day (American GastroenterologicalAssociation, 2016). In some instances, the symptoms may last for morethan 48 hours. Additional symptoms include abdominal pain usuallycaused by the intestinal cramps as well as moderate nausea. Finally,the infected person may suffer from loss of appetite. The more severecases are experienced when the degree of inflammation in the colon isextensive and severe thereby causing bleeding as well as theformation of pus and ultimately the destruction of the lining of theintestine (American Gastroenterological Association, 2016). In thiscase, the symptoms include watery diarrhea more than ten times in aday, fever, weight loss, dehydration, and severe abdominal pain andintestinal cramping (Lefter &amp Lamont, 2015).

The diagnosis andtesting of C. diff can be accomplished in various ways (Lefter&amp Lamont, 2015). The selection of the most appropriate test willdepend on the symptoms of the patient and their medical history. Themajor types of tests include stool tests, blood tests, endoscopicexamination, and CT scan (American Gastroenterological Association,2016). The stool test is considered to be the simplest of all thetesting methods. In this case, the patient is required to provide astool sample in a sterile container provided by the laboratoryattendants. Thereafter, a series of tests will be done on the sampleto detect toxins produced by the bacteria. The results can takebetween 24 and 48 hours to be obtained. The blood tests reveal a highwhite blood cell count which is an indication of an infection to thebody (American Gastroenterological Association, 2016).

The endoscopicexamination revolves around the inspection of one’s colon bycolonoscopy. This form of tests is very rare and as such requires theservices of a medical practitioner who has specialized in thedigestive system (a gastroenterologist) to determine whether the testis necessary in the first place (American GastroenterologicalAssociation, 2016). The doctor will be in a position to examine theentire colon and rectum. On the other hand, sigmoidoscopy focuses onthe examination of the lower part of the colon and the rectum. The CTscan is conducted in instances where the doctor believes that thepatient has developed complications with C. difficile and as aresult, a computerized tomography is necessary (AmericanGastroenterological Association, 2016). This test is done to look atthe thickening of the intestinal walls. To ensure that the CT machinetakes better pictures of the intestines, an intravenous injection isadministered to the patient. In other instances, a special dye willbe utilized in the study (Lefter &amp Lamont, 2015).

The treatment ofC. diff varies depending on the cause of the infection. Forthose who are infected as a result of taking antibiotics, thesolution will demand that they quit the drug or switch to another onepromptly (American Gastroenterological Association, 2016). Thetreatment stages include stopping the antibiotics that allow thegrowth of C. difficile. However, in cases where such tests arenot successful, the doctor can recommend the use of other antibioticsfor the treatment of C. diff. The most efficient solution formild cases is metronidazole for approximately two weeks. However, forsevere cases, vancomycin is administered a similar period (AmericanGastroenterological Association, 2016). Lastly, the patient can beallowed to try fidaxomicin or rifaximin in case the first two optionsdo not achieve the desired results.

Another treatmentmechanism revolves around the use of probiotics. This is a livingmicroscopic organism that can be of benefit to the health of anindividual. They might be in the form of bacteria or yeast, andresearch has indicated that some types of probiotics can be used inthe treatment of C. diff Infection (AmericanGastroenterological Association, 2016). For example Saccharomycesboulardii reduces the frequency of relapses among individuals thathave severe bouts of C. diff. (Lefter &amp Lamont, 2015). Toachieve desirable results, it should be accompanied with vancomycin.Additionally, Lactobacillus Plantarum 299v reduces the level ofrelapses when taken with metronidazole. The probiotics prevent therelapses by competing for spaces that might be occupied by C. diffin the GI tract (American Gastroenterological Association, 2016).

Inlife-threatening circumstances, surgery may be conducted on thepatient. In this case, the affected section of the GI tract isremoved. Fecal microbiota transplantation (FMT) is also a treatmentmethod. According to the procedure, stool from a healthy donor isprocessed after which it is transferred into the colon of theinfected individual. This is done to facilitate the introduction ofhelpful organisms (American Gastroenterological Association, 2016).

National Clinical Effectiveness Committee. (2014). Surveillance,Diagnosis and Management of Clostridium difficile Infection inIreland. National Clinical Guideline No. 3.

This is also a non-research source of evidence used in the paper. Itfocuses on three major areas of research namely the surveillance,diagnosis, and management of Clostridium defficile. Thissource is important since it facilitates the analysis of theessential elements of the prevention of the C. diff infections(National Effectiveness Committee, 2014). It provides thegovernance structures that have been implemented in Ireland to ensurethat standard precautions are taken with regards to the detection andtreatment of the disease (Public Health Agency of Canada, 2016).

The document alsoprovides extensive analysis of the prevention of C. diff infection.In this case, it identifies the antimicrobial stewardship measuresthat should be integrated into the prevention and control programsrelating to the C. diff control programs (National EffectivenessCommittee, 2014). Additionally, the patients and residents that maybe at risk of being infected with C. diff and the risk factorsthat can be modified. The risk factors according to this sourceinclude the severity of the disease, the age of the patient,increased in co-morbidities, antimicrobial use and cognitive andfunctional impairments. Other variables include gastrointestinalsurgery and nasogastric intubation, exposure to other patientsinfected with CDI and length of hospital stay (National EffectivenessCommittee, 2014). Finally, the source discusses the roles ofacid-suppressing medications, cancer chemotherapy, and HIV infectionas other risk factors.

The concept ofproton pump inhibitors (PPIs) in increasing the risk of C. diffinfection is also discussed in this source as well the specificgroups of the society that need to be educated on the most efficientways of preventing the spread of C. diff infections (NationalEffectiveness Committee, 2014). Moreover, the source discovers therole of asymptomatic carriers in the transmission of the disease inthe healthcare facilities in addition to the risks that thehealthcare workers (HCWs) face with regards to the contraction of C.diff infections at their workplaces. Other concepts discussed inthe source include surveillance, laboratory diagnosis, and themanagement of outbreaks and clusters (National EffectivenessCommittee, 2014).

Research Evidence

Wilcox, M. (2013). Updated guidance on the management andtreatment of Clostridium difficile infection. Public Health England.

This sourceprovides clinical practice guidelines for the treatment ofClostridium difficile and as such is a level III source of evidence.This article focuses on the management and treatment of C. diff bylaying an emphasis on the evidence base, agents and treatmentalgorithms. It begins by analyzing the evidence base that is dividedinto three sections namely mild disease, moderate disease, and severedisease (Wilcox, 2013). For the patients with mild disease, there isno particular C. diff antibiotic treatment. As such, variousforms of oral antibiotics can be administered to the patients. On theother hand, the moderate disease has a 10-14 day treatment that canbe applied to them. The most efficient form of treatment is oralmetronidazole. It is preferred because it is cheaper than other typesof treatment such as oral vancomycin. Moreover, there are increasingconcerns that overuse of vancomycin may result in the selection ofvancomycin-resistant enterococci (Wilcox, 2013).

Severe disease, on the other hand, requires a more sophisticated formof treatments. To begin, patients with severe form of C. diff need tobe given an oral dose of vancomycin (Wilcox, 2013). The choice oftherapy can be attributed to the fact that metronidazole has shownhigh rates of failure in the recent past (Public Health Agency ofCanada, 2016). Additionally, there is a relatively slower clinicalresponse to metronidazole in comparison to oral vancomycin treatment.Moreover, vancomycin preparation for injection is authorized by lawin addition to the fact that it is cheaper as compared to thecapsules (Wilcox, 2013).

The article alsodiscusses agents other than metronidazole, vancomycin, andfidaxomicin. Of these agents, probiotics have failed to demonstratestatistically significant efficacy in the treatment and prevention ofC. diff infection (Wilcox, 2013). Saccharomyces boulardii has beenstudied extensively with conflicting results. However, according tosubset analysis results, there are possible benefits in some chroniccases. Intravenous immunoglobulin is considered to be an appropriatetreatment for severe or recurrent C. diff infection. Otheragents discussed in the article include Anion exchange resin,Non-toxigenic C. difficile (NTCD), Faecal transplant, Fusidic acid,Rifampicin, and Rifaximin (Wilcox, 2013).

APIC. (2008). Guide to the Elimination of Clostridiumdifficile in Healthcare Settings. Washington

This articleprovides a guide to the elimination of Clostridium difficilein healthcare settings. It suggests the quality improvements in thehealthcare settings with regards to eliminating C. diff infectionsin the healthcare facilities (APIC, 2008). It, therefore, satisfiesthe criteria for level IV evidence. The research conducted and thesubsequent findings and recommendations are related to this casesince this paper discusses the control of C. diff amongmedical practitioners. It discusses the pathogenesis as well as thechanging epidemiology of C. diff Infection (CDI).Additionally, it identifies the CDI bundle that includes variousactivities such as the early recognition of the disease (APIC, 2008).This can be achieved by utilizing the most appropriate surveillancecase-finding methods as well as microbiologic identification. It alsoinvolves antimicrobial stewardship, offering administrative support,education of the health workers, hand hygiene measures, and patientand family education (APIC, 2008).

The articleprovides statistics relating to the C. diff infection in thepediatric population and the modes of transmission. With regards tothe latter, the document advocates for the analysis of three majorconcepts (Public Health Agency of Canada, 2016). To begin with, itacknowledges that C. difficile can survive in the hospitalenvironment and surfaces during which it assumes its spore form.Secondly, both healthcare workers and patients can contract thedisease from contact with the contaminated surfaces as vegetativecells and spores. Finally, transmission occurs via a fecal-oral routeand as such any form of action that involves contact with the mouthneeds to be addressed as a prevention mechanism (APIC, 2008).

In diagnosis, thearticle discusses the number of times one should be tested andfrequency by which such tests should be conducted. It also analyzesthe collection and transport of stool for C. difficiletesting. Finally, it performs a comparison analysis of thelaboratory-based diagnosis tests for C. diff infection (APIC,2008) as shown in the table below:

, L. (2015). Probiotics for the Primary and Secondary Prevention ofC. difficile Infections: A Meta-analysis and Systematic Review.Antibiotics 2015, 4, 160-178

Laboratory Test

Pros

Cons

Toxin enzyme immunoassay (EIA)

Less ExpensiveFaster

Less sensitive in comparison to cytotoxicity assay

Some only test for toxin A

Cell cytotoxicity assay

Relatively more sensitive than toxin EIA assays

A limited number of laboratories able perform the test.

Glutamate dehydrogenase assay

Sensitive RapidInexpensiveCan be used as initial screen

Not specific (detects non-toxigenic C. difficile and other bacteria).

Stool culture for C. difficile

Most sensitive test Provides C. difficile isolates.

Not specific (detects non-toxigenic C. difficile) Can take more than72 hours for results Labor intensive.

D. Evidence Matrix

Authors

Journal Name/ WGU Library

Year of Publications

Research Design

Sample Size

Outcome Variables Measured

Level (I-III)

Quality (A, B, C)

Results/Author’s Suggested Conclusions

McFarland

Antibiotic

2015

Review

Small individualized sample sizes

Probiotics as a means preventing C. diff Infections

III

A

Of all the analyzed pribiotics, none improved the prevention of secondary CDI

Cohen, H. Gerding, Johnson, Kelly, Loo, McDonald, Pepin &amp Wilcox.

The Society of Healthcare Epidemiology of America

2013

Semi-experimental

Simple random sample

Prevention measures for health care worker and patients

II

B

Recommended that Probiotics should not be used in the primary prevention of CDI

Burnham &amp Carroll

Clinical Microbiol Review

2013

Review

Small individualized sample sizes

Diagnosis and Prevention of CDI

III

A

Acknowledged the existence of new strains of C. diff Infection

Surawicz, Brandt, Binion, Ananthakrishnan, Curry, Gilligan, McFarland, Mellow &amp Zuckerbraun

The American Journal of Gastroenterology

2013

Semi-Experimental

Simple random sample

Epidemiology and risk factors

I

B

The healthcare providers should incorporate barrier precautions such as the use of gowns and gloves

Daniel Leffler &ampThomas Lamont

The New England Journal of Medicine

2015

Descriptive

Small individualized sample sizes

III

A

Fecal microbial transplantation is the standard care for chronic infections

E. Recommended Practice Change

Based on theinformation contained in the Evidence Matrix, it indicates that theorganization should consider the implementation of the best practicein relation to the preventing the spread of C. diff within thehospital. The current practice has revolved around the cleaning ofhands with soap and water as well as well as alcohol-based hand rubs.Additionally, the health facility advocates for extensive cleaning ofthe rooms occupied by patients diagnosed with C. diff infections.Even though such practices have yielded the necessary results byreducing the spread of the disease within the healthcare facility,there is need to implement a best practice to eliminate the risksfaced by the medical practitioners.

The best methodbeing recommended is the use of contact prevention as the means ofpreventing C. diff from spreading to other patients within thefacility as well as the medical personnel that is in constant touchwith the patients on a daily basis. Contact precaution, in this case,will involve numerous practices such as having patients with C.diff to share a single room. Additionally, patients sufferingfrom C. diff can only share a room with patients sufferingfrom a similar infection. In order to protect the healthcareproviders, they will be required to put on gloves in addition towearing a gown over their clothing whenever they come into contactwith patients suffering from C. diff. Visitors within thefacility may also be required to wear the gowns and gloves. Finally,after completing their shifts, the healthcare providers will beneeded to remove their gowns and gloves when leaving the rooms. Theyare then required to wash their hands. These are a series of changesthat are being recommended to facilitate the achievement of thedesirable objectives. The organization has deemed it fit to introducethe new practices as a means of ensuring the safety the safety of thepatients and healthcare providers.

Another reasonthat may have necessitated the change is due to human errors amongthe active volunteer staffs that are posted at every unit with a log.Failure to follow instructions may culminate in the spread of C.diff. The new practices are aimed at ensuring that human error iseliminated. As such, it will be mandatory for everyone within theunits of the patients suffering from C. diff to put on thegloves and gowns so as to comply with the rules and regulations. Thevolunteer staff will undergo a training program to equip them withthe necessary knowledge with regards to managing the new practicewithin the hospital.

F. 1. Key Stakeholders

Theimplementation of this program will involve various stakeholders.They will be drawn from different departments. The management willplay the greatest role in this case. This is because they have toensure the availability of the gloves and the gowns that the medicalpractitioners will be expected to put on whenever they come intocontact with the patients suffering from C. diff. Morespecifically, the hospital’s Chief Operating Officer (COO) will beexpected to submit the proposed changes to the board of directors andthe management committee of the organization. The COO plays asignificant role in this process because he is the one to convene theemergency meeting to present the changes to the relevant managementteam. Additionally, the operations officer is expected to approve allprojects in the organization before they are implemented. As such, hewill be required to evaluate the viability of the proposed changesbefore appending his signature to the changes.

Other keystakeholders will be IT department under the tutelage of the chieftechnologist. According to the proposed changes, the gowns to be wornby the healthcare providers will have a key card. This is aimed atensuring that only the individuals wearing the dresses can gainaccess to the rooms that have been reserved for patients sufferingfrom C. diff infections. Therefore, they have to be includedin the process since their expertise will be required in thedevelopment of the key cards that will guarantee access to the wardsto be used by the patients diagnosed with C. diff Infections.

The finalstakeholders to be involved in the decision-making process are thehealthcare providers themselves. Despite the final decision restingwith the management of the hospital, the new practice can only be asuccess if the medical practitioners are well conversant with the newrules. Since they are the channel through which the implementation ofthe new strategy depends on, it is necessary to ensure that they areinformed of the expected standards of operations within the medicalfacility.

2. Barriers

Theimplementation of the best practice is likely to face variouschallenges that must be addressed for the project to achieve thedesired outcomes (Clegg Kornberger &amp Pitsis, 2016). The firstmajor obstacle to the implementation of the program is the lack ofsufficient funds. The purchase of the extra gloves and gowns to beused by the healthcare providers will require more resources. Inaddition to this, the IT team will need more resources to facilitatethe development of the key cards to be attached to the gowns. Ininstances where the organization may lack the capacity to produce theexpected security features on the key cards, the next viable optionwould be to outsource the services of experts. This would incuradditional expenses to the hospital.

Additionally,another barrier may arise in the form of employee dissent(Ichniowski, 2012). In most instances, most employees tend to resistchanges to the existing practices. Some of the healthcare providersmay be satisfied with the current methods that involve washing handswith soap and water and other alcohol-based hand rubs. They may,therefore, be skeptical about having to cooperate with the proposedchanges (Levkoff, 2006). Since the implementation success of theprogram massively depends on the corporation of the hospitalpersonnel, it will be important that they accept the proposed changesby the hospital management.

3. Strategies for Barriers

The success ofthe proposed changes will benefit the healthcare providers and thepatients since there will be reduced cases of C. diff infectionswithin the health facilities. Having identified the potentialbarriers to the implementation of the project, it will be necessaryto develop strategies to tackle the obstacles (Ichniowski, 2012). Inreference to the financial barriers that may be faced in theimplementation of the proposed changes in the organization, themanagement of the hospital will seek additional funds from thefederal government. Additionally, funds will also be raised throughthe provision of additional services within the medical facility.Finally, there will be a series of events aimed at raising capital tofinance budgetary deficits. This can be in the form of charity walk,charity run and contributions from donors.

The healthcareproviders will also be educated on the importance of the proposedchanges. This is aimed at reducing dissents among them. A comparisonanalysis will be conducted on the current practices and the proposedchanges to highlight the additional benefits that the health careproviders will derive from adherence to the recommended practices.

4. Indicator to Measure Outcome

This sectionrefers to the evaluation of mechanisms that have been put in place bythe hospital to ensure that the desirable results have been achieved.In this case, the hospital will practice all the necessary infectioncontrol measures. Additionally, an individual has been assigned thetask of patrolling the unit and using a compliance tool to recordwhen employees leave patient`s room and whether they wash their handsor not. Additionally, the entry system will ensure that only thosewearing gowns are granted access into the unit of those sufferingfrom C. diff infection (CDI).

G. References

Top of Form

Bottom of Form

Top of Form

Bottom of Form

Top of Form

American Gastroenterological Association. (2016). UnderstandingClostridium Difficile Infection and Its Treatments. Retrieved from:http://www.gastro.org/info_for_patients/2013/10/24/understanding-clostridium-difficile-infection-and-its-treatments

APIC. (2008). Guide to the Elimination of Clostridium difficile inHealthcare Settings. Washington

Burnham, C. &amp Caroll, K. (2013). Diagnosis of&nbspClostridiumdifficile&nbspInfection: an Ongoing Conundrum for Clinicians andfor Clinical Laboratories. Clinical Microbiology Reviews, Vol.26 (3): 604-630. Retrieved from:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719497/

Clegg, S., Kornberger, M., &amp Pitsis, T. (2016).&nbspManaging &amporganizations: An introduction to theory and practice.

Cohen, S., Gerding, D., Johnson, S., Kelly, C., Loo, V., McDonald,C., Pepin, J. &amp Wilcox, M. (2013). Clinical Practice Guidelinesfor Clostridium difficile Infection in Adults: 2010 Update by theSociety for Healthcare Epidemiology of America (SHEA) and theInfectious Diseases Society of America (IDSA). Infection Controland Hospital Epidemiology, Vol. 31 (5).

Ichniowski, C. (2012).&nbspThe American workplace: Skills,compensation, and employee involvement. Cambridge: CambridgeUniversity Press.

Leffler, D. &amp Lamont, T. (2015). Clostridium difficile Infection.The New England Journal of Medicine 37216.

Levkoff, S. (2006).&nbspEvidence-based behavioral health practicesfor older adults: A guide to implementation. New York: Springer Pub.

McFarland, L. (2015). Probiotics for the Primary and SecondaryPrevention of C. difficile Infections: A Meta-analysis and SystematicReview. Antibiotics 2015, 4, 160-178

National Clinical Effectiveness Committee. (2014). Surveillance,Diagnosis and Management of Clostridium difficile Infection inIreland. National Clinical Guideline No. 3.

Public Health Agency of Canada. (2016). Clostridium DifficileInfection. Canada.gc.ca

Surawicz, C., Brandt, L., Binion, D., Ananthakrishnan, A., Curry, S.,Gilligan, P., McFarland, L., Mellow, M. &amp Zuckerbraun, B. (2013).Guidelines for Diagnosis, Treatment, and Prevention of Clostridiumdifficile Infections. The American Journal of Gastroenterology,Vol. 108:478-498. Retrieved from:http://gi.org/wp-content/uploads/2013/04/ACG_Guideline_Cdifficile_April_2013.pdf

Wilcox, M. (2013). Updated guidance on the management and treatmentof Clostridium difficile infection. Public Health England.

Bottom of Form