Healthcare professionals understand that medical devices subject patients to various risks, such as hospital-acquired infections, which undermine their well-being. Healthcare-associated infections (HAIs) are a common occurrence among patients who receive surgical procedures and use medical devices, such as urinary and intravenous catheters. This paper presents a root cause analysis of HAIs to investigate potential causes and develop comprehensive strategies for addressing them to improve patient safety and quality outcomes. Root cause analysis (RCA) has been applied widely in healthcare settings as a structured and systemic procedure for examining sentinel events that are harmful to patients (Liepelt et al., 2023).

Analysis of the Root Cause

Many patients, especially those in long-term care hospitals, have a higher risk of acquiring healthcare-associated infections (HAIs) at any stage of the care process (Sunkwa-Mills et al., 2023). The most prevalent HAIs include ventilator-associated pneumonia, catheter-associated urinary tract infections (CAUTIs), hospital-acquired pneumonia, surgical site infections, and others (Sartelli et al., 2023). The rising cases of mortality and morbidity due to HAIs show that there is a need to develop and implement measures to enhance patient safety. Healthcare professionals acknowledge the challenge of managing HAIs and related complications because of the growing resistance of bacteria to antibiotics. The risk of antimicrobial resistance (AMR) is still a major concern that also continues to threaten public health globally. The World Health Organization developed an AMR Global Action Plan and a framework called infection prevention and control (IPC) for mitigating the effect of HAIs and improving patient safety in healthcare settings (Kubde et al., 2023).

Given the risk of mortality and morbidity associated with HAIs, a root cause analysis was performed to investigate the problem in order to develop and implement a safety improvement plan. Nurses at the organization reported 36 cases of HAIs over the past year at the long-term care department at the facility and other areas of care, including inpatient wards and emergency departments. The goal of this root cause analysis was to comprehend and identify factors causing it to be able to implement the plan. A multidisciplinary team conducted the root cause analysis and consisted of a nurse manager, physician, registered nurse, nurse case manager, public health authorities, infection control experts, and pharmacist (Kubde et al., 2023). The team reviewed annual data on HAIs recorded at the organization and specific areas or departments where they were reported. Nurses also determined that intensive care units (ICUs) had one or more instances of HAI. Surgical patients had the highest risk of acquiring HAIs due to environmental factors. The team reviewed each case and highlighted possible causes and why they may have occurred.

While implementing this root cause analysis, the team collaborated with patients, infection control experts, and authorities from the public sector to develop a comprehensive list of factors and ways of preventing infection transmission (Kubde et al., 2023). Healthcare professionals determined, based on the data on 36 cases of HAIs, that patients were exposed after being admitted, and the symptoms appeared within 48 hours after hospitalization. The multidisciplinary team also found that leading factors that contributed to HAIs in all these cases were invasive medical procedures, improper hygiene/sanitation practices, patients with compromised immunity, and exposure to pathogens that have developed resistance to antibiotics (Kubde et al., 2023). In addition, 11 cases of surgical patients and those with indwelling medical devices were indirectly or directly in contact with infected patients, while 6 others contacted contaminated equipment or materials. Other cases were suspected to be due to poor patient management after placement or insertion of medical devices, such as urinary and intravenous catheters.

It became clear that HAIs were a complex problem in the organization and required an urgent solution. Generally, 5 to 10% of patients in healthcare settings acquire HAIs, while those in ICUs face an elevated risk of 9 to 37%, with a 12 to 80% mortality rate (Shulakova et al., 2023). Severe cases of HAIs found by the interprofessional team consisted of CAUTIs, central line-associated bloodstream infections (CLABSIs), methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, and ventilator-associated adverse events (Sands et al., 2023). Some risk factors for acquiring these HAIs in vulnerable patient populations include touching the surroundings or belongings of patients, unhygienic or aseptic procedures, contact with body fluid, interfering with indwelling medical devices, and lack of management of catheters post-insertion.

Application of Evidence-Based Strategies

HAIs are complex and have far-reaching consequences; thus, studies recommend multiple strategies or combinations of solutions to alleviate this problem. A multimodal strategy has been proposed as an effective technique for improving infection prevention control practices. It consists of multiple approaches that nurses and other healthcare professionals can use to inspire behavior change among healthcare workers, enhance patient outcomes, and change the culture in the organizational setting (Sartelli et al., 2023). An example of a multimodal strategy that the hospital can implement is to promote hand hygiene practices among healthcare workers in addition to other evidence-based recommendations that can ensure change in the behaviors of workers.

Healthcare professionals may develop and maintain hospital infection control to shield patients and workers from acquiring and/or transmitting infection to vulnerable patient populations (Tuma et al., 2023). For instance, evidence supports that thorough washing of hands by healthcare workers should be encouraged using methods, such as posters with visual and text information on the benefits of handwashing, where to wash hands, and antiseptic items for hand hygiene. Hand hygiene may be based on the “Five Moments” model developed by the WHO to encourage hand hygiene before and after contact with a patient, before cleaning wounds or performing aseptic procedures, after contact with body fluid, and following contact with the environment or patients’ belongings (Kubde et al., 2023). Healthcare workers are also encouraged to acquire and use proper PPEs to protect themselves from infections or transmitting pathogens to vulnerable patients.

HAIs can be prevented using several other evidence-based strategies, including education and training, electronic patient monitoring, antimicrobial surfaces, technology, electronic hand hygiene monitoring, ultraviolet (UV) disinfection systems, environmental cleaning, sterilization and disinfection, and surveillance and reporting (Kubde et al., 2023). For instance, healthcare personnel should continue to advance education in patient safety to have current knowledge of best practices and strategies for preventing HAIs and other infections. Education and training teach them about ways of implementing standard precautions, modes of transmission, and risks of infection. After wearing appropriate PPE, healthcare workers must also conduct environmental cleaning to make people feel safe and reduce the risk of transmitting diseases (Kubde et al., 2023). Environmental cleaning should go hand in hand with sterilization and disinfection, which ensures that medical equipment used to treat patients are free from pathogens.

Improvement Plan with Evidence-Based and Best-Practice Strategies

A three-fold implementation plan is the most appropriate solution that can help healthcare professionals address HAIs, enhance patient safety, and achieve better quality outcomes. The first dimension of the plan is to conduct thorough and routine environmental cleaning to minimize the risk of exposure to HAIs. This is a multimodal strategy called Researching Effective Approaches to Cleaning in Hospitals (REACH). The first stage of this approach is to conduct a risk assessment before nurses and other healthcare workers embark on a thorough exercise that will see the organization implement an environmental cleaning program (Sartelli et al., 2023). The initial phase of the plan is identifying potential risks of HAIs at the organization and patients using a three-stage procedure. First, nurses must examine the risk profile of each individual patient. Secondly, it is important to assess the risk profile of equipment, materials, and surfaces within the healthcare setting. Thirdly, nurses should examine the risk profile of pathogens responsible for HAIs. Healthcare professionals should conduct cleaning by creating a team of trained workers to remove debris, dirt, or oils using appropriate equipment and detergents to ensure the surface is sparkling clean (Sartelli et al., 2023). The cleaners can also use disinfectants to eradicate or alleviate pathogens that can infect wounds and harm patients.

The second part of this quality improvement plan is driven by top management to ensure that there are organization-wide infection prevention and control programs and practices. This plan acknowledges that organizational and structural arrangements have a critical role in enhancing safety in hospital settings (Puro et al., 2022). The leadership at the organization will play a part in communicating the commitment of the hospital to alleviate HAIs and AMR. This initiative might have a wide range of activities that top management must perform, including budgeting, expressing the need to reduce these issues through a shared and signed piece of paper, apportioning resources, and defining the goals (Puro et al., 2022). Resource allocation seeks to reinforce key areas, such as staffing, equipment, and project implementation.

The last part of the plan is through the development and implementation of guidelines. The hospital should encourage strict adherence to guidelines to alleviate unwarranted practices and ensure that healthcare workers follow evidence-based practices (Sartelli et al., 2023). Organizations heavily rely on safety and quality guidelines; therefore, the clinical staff should use guidelines to educate and train others about HAIs, AMR, infection prevention, and other related topics. It is possible to standardize clinical practices to ensure staff use them to treat and manage patients. Some of these guidelines might include checklists, nurse-driven protocols, posters, discharge sheets, and others.

Existing Organizational Resources

This plan will leverage existing organizational resources to ensure the successful implementation and accomplishment of the initiative to prevent and reduce HAIs in order to improve safety and quality. Human resources will be the first and most important organization resource that this plan will leverage and includes utilizing skills and experience to implement the plan and evaluate its success. For instance, nurses and physicians will oversee the cleaning activities to ensure that surfaces do not contain harmful pathogens. Case nurse managers will review patient cases to determine their risk profile. Top management will be used to allocate resources and supervise the implementation of the entire plan. Nursing education and training initiatives within the organization will be used in skills development. Healthcare resources that will support this plan include PPE, gloves, detergents, posters, and other materials.

Conclusion

HAIs present complex challenges to hospitals and the health system. Healthcare professionals face challenges managing vulnerable patient populations because of the elevated risk of hospital-acquired infections and accompanying complications. With about 36 cases of HAIs over the past year, the organization should implement the above plan to alleviate causal factors, such as poor hand hygiene, environmental issues, and contact with other people or materials. Healthcare professionals should use the above three-fold plan to enhance quality and safety by preventing and alleviating HAIs.