Evidence-based practice (EBP)

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Evidence-based practice (EBP) has become the standard in nursing care. It has helped to incorporate new, and researched skills and methods in caring for patients. These adaptations create positive outcomes in patient care. One are of nursing practice that has had improved patient outcomes because of EBP is foley catheter insertion. In the hospital that I work in, we were seeing an increase in the rates of CAUTIs, or catheter induced urinary tract infections. The California Department of Public Health states that 600,000 patients developed a hospital-acquired UTI per year. 80% of these infections were urinary catheter associated. Research has also found that about half of the patients surveyed did not require a catheter (CDPH, 2013). According to the Hartford Institute of Geriatric Nursing, research has shown that “29-69% of CAUTIs are preventable through the application” of EBP strategies. Some of these techniques include avoiding catheters all together, but if necessary, ensuring proper care, correctly surveillance and educating staff, and ensuring timely removal of the catheter (Hartford Institute of Geriatric Nursing, 2012) Because of these studies, physicians and nurses are becoming more aware and cautious about inserting catheters, their reasons for insertion, and about care of the catheter. These finding have changed my practice. In the ER, we have also found that ensuring that two trained staff members are present for catheter insertion helps to reduce the risk of possible contamination. The reasons for catheter insertion are also closely reviewed, so that a patient does not get a catheter if they do not need one.
Hand hygiene is another practice that most people don’t really think about as being apart of EBP. When some people think of hand hygiene, they think about washing their hands. In nursing, hand hygiene also includes hand sanitizer. Alcohol-based hand sanitizing products are throughout facilities so that a quick, accessible, and effective method of hand hygiene is available. Research reported by the British Medical Journal showed how effective hand hygiene could be at reducing transmission of Hospital Acquired Infections. Several studies found that an as more alcohol hand rub was used associated with “reduced incidence of healthcare associated infection and evidence that it was associated with reduced healthcare associated methicillin resistant Staphylococcus aureus (MRSA) infection.” An Australian teaching hospital found that when hand hygiene increased from 21% to 42%, their rates of MRS declined by 40% after 36 months of hygiene. Because of this research, I incorporate hand hygiene between every patient. There are alcohol rubs in every room, so I make sure to use it when entering and exiting each patient’s room, unless it is a patient with Clostridium Difficile or my hands are visibly soiled (Luangasanatip, et. Al, 2015).
References:
California Department of Public Health. (2013.) Catheter-Associated Urinary Tract Infection (CAUTI) Prevention. Retrieved from http://www.cdph.ca.gov/programs/hai/Documents/Slide-Set-2-CAUTI-Prevention.pdf.
Hartford Institute of Geriatric Nursing. (2012.) Prevention of catheter-associated urinary tract infections. In: Evidence-based geriatric nursing protocols for best practice. Retrieved from https://www.guideline.gov/summaries/summary/43936
Luangasanatip, N., et. al. (2015.) Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. Retrieved from http://www.bmj.com/content/351/bmj.h3728