Scholarship & Research
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Item Certification of reprocessing standardization: preventing endoscopy associated infections(Montana State University - Bozeman, College of Nursing, 2023) Ranck, Aaron Thomas; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughBackground: Between 2012-2015, 25 outbreaks were linked to contaminated duodenoscopes worldwide due to human error or negligence during reprocessing. A standardized education and training reprocessing program is necessary to address nationally increasing Endoscopy Associated Infections (EAIs). Problem: A Montana endoscopy unit committed to adopting national standards. An unmet objective was the certification of endoscopy reprocessing (CER) requirement. This pilot project sted in developing a mandatory CER protocol to optimize infection control. Methods: A Plan-Do-Study-Act (PDSA) quality improvement method was employed, with pre- and post-intervention design to evaluate infection incidence and risk. This involved patient chart review and duodenoscope reprocessing log review. An aggregate comparison was made between a CER participant and eight non-CER technicians. To inform future program development, a survey was conducted to collect data on CER participant motivation, preparation, and perception of recommended educational materials. Intervention: A pilot study involving a single participant attempting to obtain nationally recognized CER was conducted. The facility manager shared the facility's intention of mandatory certification and via endoscope technician meeting, including incentives. Created certification-benefit video presentation and exam preparation materials were provided one month before the exam. Results: Zero infections occurred during pre- and post-intervention. Pre-intervention, the average infection risk scores per endoscope reprocessing were 12.2 relative light units (RLUs) for the unit and 11.1 RLUs for the CER participant. Post-intervention phase, these numbers were 15.7 RLUs by non-CER technicians and 2.8 RLUs by the CER participant. Conclusion: This study highlights the effectiveness of mandatory CER in reducing the risk of patient infections. Maintaining infection prevention and control in endoscopy procedures requires ongoing education, training, and motivation. Informing employees of the benefits of standardization may improve motivation.Item Nurse-driven catheter-associated urinary tract infection (CAUTI) prevention project(Montana State University - Bozeman, College of Nursing, 2021) Gaskin, Katelyn Dawn; Chairperson, Graduate Committee: Susan LuparellAn indwelling urinary catheter (IUC) is a tube that is placed into the bladder through the urinary tract, left in place and connected to a closed system drainage bag. Catheter placement in the urinary tract increases the risk of bacteria ascending the catheter and causing an infection, known as a catheter-associated urinary tract infection (CAUTI) (Center of Disease Control [CDC], 2019; Fekete, 2020). Healthcare-associated infections (HAI) are the most common complication of healthcare treatment and are a major cause of mortality and morbidity. CAUTIs are the most common and preventable HAI, making up over 30% of the HAI in the United States (Agency of Healthcare Quality and Research [AHRQ], 2015; CDC, 2019; Centers for Medicare & Medicaid Services [CMS], 2008). CAUTIs cause increase pain and discomfort, and increase patients' hospital length of stay (AHRQ, 2017; CDC, 2019). IUCs are frequently placed without appropriate indication and remain in longer than medically necessary (CDC, 2019). Problem statement: Critical care patients are most vulnerable to acquiring a CAUTI from an IUC due to their weakened immune systems and underlying co-morbidities (CDC, 2019). The intensive care unit (ICU) setting has the highest reported rates of CAUTIs (CDC, 2019). Purpose statement: The purpose of this project was to reduce CAUTIs by implementing a nurse-driven algorithm to avoid IUC insertion, decrease IUC duration, and strengthen existing CAUTI prevention measures. Methods: Kotter's change management theory combined with the Plan-Do-Study-Act (PDSA) model served as the project's framework. The project was designed to foster a collaborative approach to reduce CAUTI incidences by empowering nurses to work at the highest level of their scope of practice, standardizing care, and strengthen existing CAUTI prevention. Results: CAUTIs were measured pre/post-implementation, and an absolute reduction from 2 to 0 was observed. The standard infection ratio (SIR) decreased to 0 post-implementation and the standard utilization ratio (SUR) decreased by 2.17%. ICU nurses were very likely (92%) to implement the algorithm into practice, and 81% indicated they implemented the algorithm on 75% of their patients. Conclusion: Although many studies have looked at reducing CAUTIs and have shown the benefit of avoiding insertion and using alternatives, there are few that have examined the standardization and combination of alternative measures, appropriate indications, and acute urinary retention measures into one nurse-driven algorithm. This quality improvement project implemented evidence-based practice in a nurse-driven algorithm and observed a decrease in CAUTI incidence.Item Smoking and non-surgical MRSA skin infections : is there a link?(Montana State University - Bozeman, College of Nursing, 2010) Finn, Susan Ann; Chairperson, Graduate Committee: Karen ZulkowskiMethicillin-Resistant Staphylococcus Aureus (MRSA) skin infections are becoming increasingly common and are the result of nearly 20,000 deaths in the United States each year. Although smoking has been linked to numerous infections including those that occur post-operatively, no one has ever linked the exposure to cigarette smoke to these types of infections. This study intended to examine the relationship between the two. Data was collected from patients in an Emergency Department with a history of non-surgical MRSA skin infections to determine what percentage of them smoked, smoked at the time of their infection or were exposed to smoke on a regular basis. Because of a small sample size and a flawed study design, a statistical analysis was not possible. However, it was discovered that over 63% of those with the infection were exposed to cigarette smoke in one form or another. The remaining 37% were nonsmokers or were not exposed to smoke on a regular basis. This indicates there may possibly be a link between the two but more research is needed in the area in order to establish a relationship.