Background Clinical problem statement. Purpose of the change proposal in relation to providing patient care in the changing health care system. PICOT question. Literature search strategy employed. Evaluation of the literature. Applicable change or nursing theory utilized. Proposed implementation plan with outcome measures. Discussion of how evidence-based practice was used in creating the intervention plan. Plan for evaluating the proposed nursing intervention. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome. Appendix section, if tables, graphs, surveys, educational materials, etc. are created.


Recent years have seen major changes in healthcare systems, which has created new opportunities as well as challenges. One of the most pressing challenges faced by healthcare providers is the increasing prevalence of healthcare-associated infections (HAIs), which pose a significant threat to patient safety and quality of care. Patients can contract HAIs while receiving care for another condition. The major cause of mortality and morbidity from HAIs is increased healthcare costs and longer hospital stays. According to the Centers for Disease Control and Prevention, approximately one in 31 US hospitalized patients has at least one HAI. HAIs are responsible for an estimated 75,000 deaths each year.

Problems in clinical practice

This proposal addresses the clinical issue of high HAIs, in particular in ICU units. Although evidence-based infections prevention techniques are available, HAIs continue to be a problem in ICUs. Many hospitals struggle with effective strategies for preventing them.

What is the purpose of the proposed change in regards to patient care in the new healthcare system?

This proposal seeks to establish a multi-faceted infection prevention intervention for the ICU to lower the rate of HAIs. It will also improve patient outcomes. The proposal addresses the changes in healthcare by encouraging evidence-based practices and quality improvement initiatives that improve patient safety, and lower healthcare costs.

PICOT question:

How does the multifaceted prevention of infection in adult ICU patients affect HAIs incidence over the course of six months?

Population: Adult ICU patients

Intervention: A multifaceted approach to infection prevention

Comparison: Usual care

End result: Increased incidence of HAIs

Time: Six months

Strategy for literature search:

A comprehensive search of relevant databases, including PubMed, CINAHL, and Cochrane Library, was conducted using keywords related to healthcare-associated infections, infection prevention, ICU, and multifaceted interventions. This search only included studies from the United States that had been published in the past 10 years.

Assessment of the literature

There were many studies in literature reviewing that assessed the effectiveness of multi-faceted infections prevention programs in ICU settings. Multifaceted, evidence-based interventions are more effective at reducing HAI incidence in ICU patients. These studies highlighted that these strategies must be implemented using a structured approach, with all parties involved, such as patients and their families.

Nursing theory or change applicable:

Diffusion Theory will guide the proposed changes. It provides an understanding of how ideas and innovations can be adopted into a system. This theory can be applied to determine the obstacles and facilitators that prevent the implementation and adoption of the intervention, and then to create strategies for its promotion and sustainability.

Implementation plan proposed with results measures

This is the plan of implementation.

  1. Instruct ICU staff to form a multidisciplinary team that includes physicians, ICU nurses and infection preventionists.
  2. Do a baseline evaluation of infection prevention and HAI rates in ICU.
  3. Implement a multifaceted intervention to prevent infection that includes evidence-based practices such as daily hand hygiene, chlorhexidine bathing and oral care.
  4. Offer education and training for ICU staff about the new intervention, its implementation and how to implement it.
  5. Monitoring the effectiveness of the intervention is important and providing feedback for staff.
  6. Compare the incidence of HAIs during the first six months and the time after intervention to determine the effectiveness of your intervention.

The following are some of the outcomes measures

  1. Before and after intervention, the incidence of HAIs was different in ICU.

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