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Infection Control

Infection Control/Workplace Safety (Grades 11 & 12)

Dr. Brad WagnerApplicable to Courses: Allied Health II, Medical Sciences II, Health Occupations

Description of Students' Roles and Problem Situation: Students are nurse managers in a hospital and are faced with an infection control crisis. They are to examine the feasible ways to solve and control the problem.

Educational Goals: Students will utilize technology, language arts, trade and industry, and the health occupations curriculum. The goal is for the students to solve the problem and learn new skills.

Submitting Teacher: Debbie Wagner, Fuquay-Varina High School, 201 Bengal Blvd., Fuquay-Varina, NC 27526. BradWagner@msn.com


MEET THE PROBLEM DOCUMENT

FUQUAY-VARINA MEDICAL CENTER

To: Nurse Managers of Units 1A, 2A, ICU, Obstetrics, and Surgery
From: Deborah K. Wagner RN,C Infection Control Nurse
Date: August 23, 1999
Re: Increase in Nosocomial Infections for the past quarter

As I compiled the nosocomial infection rates of our patients for the past quarter it became evident that we have a breach in infection control as the rates more than doubled from the usual of 10% to 25%. I have listed below a breakdown of the categories and their corresponding rates.

Having a high rate evokes many problems—our patients are not receiving the care they deserve, the length of stay is increased for the patients, this could result in decreased profits due to DRG losses, and we could lose our JCAHO accreditation.

By August 30, 1999 I expect you to have had meetings with all of your employees to discuss this crisis and report back to me with solutions. We will meet in my office at 10AM that day. Since we are in a budget-crunch there are no monies allotted for overtime. You are to meet with your employees and prepare a plan without any increase of paid man-hours.

Please contact me if you have any questions at (919) 555-2111. Thank you in advance for responding to this most urgent matter.

NOSOCOMIAL INFECTION RATES FOR 2ND QUARTER (4/1-6/30/99):

E.coli 3% (10 patients)

MRSA 2% ( 6 patients)

Wound Infections post Surgery 3% (12 patients)

TB 3% ( 2 patients)

Athlete’s Foot 1% (3 patients)

Pseudomonas 3% (8 patient)


CURRICULUM ALIGNMENT

RUDIMENTARY RUBRIC FOR CURRICULUM ALIGNMENT

Technology Curriculum:
  • Acquire general technological literacy.
Language Arts Curriculum:

Edits written work for errors in sentence formation, usage, mechanics and spelling.
Trade and Industry Curriculum:

  • Provide instruction in such areas as human relations, safety and health, positive work habits, and employability skills.
Health Occupations Curriculum (Allied Health II):
  • Apply patient/client protective devices.
  • Apply terminology related to clean and safe environments.
  • Apply "Universal Precautions" and OSHA regulations to protect the health team member.

STUDENT CHARACTERISTICS---11TH AND 12TH GRADERS:

  • Want to be independent—yet can be childlike
  • Are critical toward society
  • Very conscious of "blending in", do not want to be different
  • Have difficulty talking to adults
  • Have hesitancy and difficulty in making preliminary phone calls—especially to adults

SAMPLE KNOW AND NEED TO KNOW BOARDS

Know

  1. There is an increase in the nosocomial infection rate for the past quarter of the year.
  2. All nurse managers are to have meetings with their staff to discuss this.
  3. There are no monies in the budget to provide for an increase in paid man-hours.
  4. There is a breach in infection control
  5. Our patients are not receiving the care they deserve.
  6. The length of stay for the patients is increased.
  7. Increased DRG's could lead to a loss in profit for the hospital.
  8. If our nosocomial rate stays increased the hospital could lose its JCAHO accreditation.
  9. At 10am, 8/30/99, all nurse managers are to meet with the Infection Control Nurse to discuss solutions.
  10. We know which categories of infection are increased.

Need to Know

  1. A breakdown of which nursing units are involved.
  2. What categories of patients are on which nursing units?
  3. What employees have been taking care of these patients?
  4. Is there any pattern between the categories of patients and their caregivers?
  5. Have the patients not been receiving the care they deserve?
  6. How are the various categories of infections transmitted?
  7. What measures can be instituted to prevent further outbreaks?
  8. How can these measures be taught to the employees?
  9. Are the employees then able to demonstrate the skills needed to not further infections?

PROBLEM STATEMENT

How can we as the nurse managers investigate the increased nosocomial infection rate in such a way that we have meetings without staff to discuss the problem, do not use any increased paid man-hours, track down the cause of the infections, and are ready to present the solutions by August 30, 1999?


PROBLEM MAP

Problem Map Nosocomial Infection


RESOURCE LIST

Nosocomial Infection Memo Resource List

Alcamo, I.E. (1994). Microbiology in action. Redwood City, CA: Benjamin/Cummings Publishing Company, Inc.

Diseases. (1993). Springhouse, PA: Springhouse Corporation.

Beaumont, E. (1997). Technology scorecard: Focus on infection control. American Journal of Nursing, 97(12), 51-54.

Carroll, P. (1998). Preventing nosocomial pneumonia. RN, 61(6), 44-47.

Centers for Disease Control-Health and Prevention Topics, http://www.cdc.gov

Colbert, B.J., Ankney, J., Wilson, J., & Havrilla, J. (1997). An integrated approach to health sciences.: Albany, NY: Delmar Publishers.

Mosby-Yearbook, Inc. (Producer). (1992). Principles for the nursing assistant [Film]. (Available from Mosby-Yearbook, Inc., 11830 Westline Industrial Drive, St.Louis, MO 63146)

Mosby-Yearbook, Inc. (Producer). (1994). Surgical asepsis, surgical technique, Minor Surgery, & Bandages [Film]. (Available from Mosby-Yearbook, Inc., 11830 Westline Industrial Drive, St.Louis MO, 63146)

Nursing Center.com, http://www.ajn.org/ajn

RN web, http://www.rnweb.com

Scott, A.S., & Fong, E. (1998). Body structures & functions. Boston: Delmar Publishers.

Sheff, B. (1998). VRE & MRSA: Putting bad bugs out of business.

Nursing 98, 28(3), 40-44.

Simmers, L. (1998). Diversified health occupations. Chicago: Delmar Publishers.

Sorrentino, S.A. (1992). Textbook for nursing assistants. St.Louis, MO: Mosby-Yearbook Inc.

Wake County Public Schools. (Producer). (1996). Bloodborne pathogens [Film]. (Available from Central Office, 3200 Wake Forest Road, Raleigh, NC 26751)


DESCRIPTION OF CAPSTONE PERFORMANCE

Based on the Meet the Problem Statement Document, students will investigate reasons why the Nosocomial Infection Rate in a local hospital has dramatically increased in the past three months.

During the process of their investigation they will utilize reading, writing, and spelling skills as well as general computer literacy as they visit the Media Center for information. Students will need to investigate medical terminology, safety and workplace precautions, and theories of asepsis. Part of this process will include return demonstrations of Universal Precautions and knowledge of OSHA regulations in a hospital setting.

Two types of group assessment will be used. As each group makes their presentation, each member of the other groups will be rating them using the Rudimentary Rubric For Nosocomial Infection Memo. Since this will be my first try at PBL I also want each student to evaluate the experience by completing the Tools for Groupwork Evaluation (appendix B) from our course pack.

Due to the fact that this is a new style of teaching for me and for my students I really want to let others know about PBL. Therefore, I will invite my immediate school administrator, as well as the members of the Fuquay-Varina High School Health Occupations Advisory Council to the student presentations. The Advisory Council is composed of health care professionals in The Fuquay-Varina area. I will also invite any outside contact the students have used, such as a local physician, etc.

Each group of students will be required to give an oral presentation lasting 15-20 minutes. During this time they are to explain their course of action used in solving the problem and to give their best solution for solving it. After the formal presentations each student will be required to demonstrate skills that are required for their CNA certification.


 

ASSESSMENT INSTRUMENT FOR CAPSTONE PERFORMANCE

RUDIMENTARY RUBRIC FOR NOSOCOMIAL INFECTION MEMO

Group members________________________________________________

Circle appropriate points for each selection:

SPEECH Max. 4 points

Speaks clearly with inflection and appropriate volume 4

Only 2 of above 3

Only 1 of above 2

Did not fulfill any of above 0

EYE CONTACT Max. 3 points

Consistent eye contact with audience 3

Sometimes maintained eye contact 2

Rarely maintained eye contact 1

INTRODUCTION Max. 3 points

Present, captured attention of audience effectively 3

Only 2 of above 2

Only 1 of above 1

CONTENT/ORGANIZATION Max. 7 points

Problem stated and explained, solution stated and explained,verifying information provided, solution sound and workable 7

Only 6 of above 6

Only 5 of above 5

Only 4 of above 4

Only 3 of above 3

Only 2 of above 2

Only 1 of above 1

PRESENTATION BY GROUP Max. 3 points

Evidence of planning, summary, good response to questions 3

Only 2 of above 2

Only one of above 1

TEAMWORK Max. 3 points

Abundance of evidence of teamwork in reaching solution 3

Marginal evidence of teamwork 2

Little or no evidence of teamwork 1

TOTAL POINTS _________ (out of 23)


ALTERNATIVE SOLUTIONS

STRATEGY #1: Cross-reference infected patients with their caregivers.

Pros: See if there is a common thread.

  • No outside help needed.
  • Hospital is able to "save-face" by solving problem on their own.
  • Physicians will feel reassured that patients are receiving good care.

Cons: Very time-consuming to check patient records and cross-reference them to employees.

  • There may not be a common "thread".
  • Some of the staff will be "pulled off" their regular assignments to check charts.
  • No money in budget to pay for extra work.

Consequences:

Nurse managers are required to spend time checking charts, therefore their work does not get done and it creates a "domino" effect as the extra work trickles down.

Problem solved quickly.

STRATEGY #2: Assume poor skills are the reason for the increased infection rate.

Pros: Reeducation of hospital staff.

  • Staff is able to earn continuing education units.
  • All patients will benefit from the reeducation.
  • This is best if there is not a common thread that caused the increased rates.

Cons: Employees take offense at being accused of causing the problem.

  • Time consuming and expensive.
  • Personnel have to be trained to teach the classes.
  • No monies in budget for extra training.

Consequences:

Employees are up-to-date with their infection control training.
Employees could have a morale issue due to having mandatory reeducation.


DEBRIEFING THE PROBLEM

DEBRIEFING INSTRUMENT

Group Presentation Day—there are guests present.

Give students five minutes to get into their groups and review presentations.

Meanwhile, I will share the Nosocomial Infection Memo with the guests and briefly explain PBL.

Students in groups. Hand out Rudimentary Rubric for assessment and review criteria with the students. Answer any questions and emphasize role of fairness and being non-partial.

Oral group presentations of solutions, rubric evaluations concurrently.

Have each group write and present a brief summary of their best solution (one or two sentences) on the board.

Each student group will evaluate all the group solutions with the best being #1, etc.

Depending on the solutions generated, I may need to introduce some coaching questions at this time.

"Best Solution" is now formulated from the group solutions and new issues that have been raised.

Each group shares the Rudimentary Rubric ratings with each other via the board. This is meant to be a learning tool for all the groups of students.

I introduce any coaching questions I feel that may have been missed or I may further elaborate on any material I feel is necessary to wrap-up this PBL.

Ask if anyone has questions, thank the students for their work and the guests for their support.

On to the next PBL lesson!!!


COACHING QUESTIONS

Meeting the Problem

C 1. What seems important to the hospital?

C 2. Do you have enough facts to suggest the cause(s) of the infection?

MC 3. Have you considered culturing the employees involved?

Know/Need to Know Board

EC 4. What is at stake if this increase in infection continues?

MC 5. How can preventable measures be taught to the employees?

EC 6. What measures can be instituted to prevent further outbreaks?

Writing Problem Statements

MC 7. Does an increase in the infection rate mean that the patients are not receiving the care they deserve?

MC 8. Have you considered a pattern between the categories of patients and their caregivers?

EC 9. Are the employees able to demonstrate the skills needed for asepsis?

Information Gathering and Sharing

C 10. What have you learned about nosocomial infections?

MC 11. From the Nosocomial Infection Memo Resource List, which medical resources have been helpful to you so far?

MC 12. What, if anything, about your goals and strategies used so far to solve this hospital problem, needs to change?

Generating Possible Solutions

EC 13. To what degree of certainty do you feel that you know the correct information about the increase innosocomial infections?

EC 14. What solution fits best with the criteria in the Nosocomial Infection Memo problem statement?

C 15. Are you sure of your solution for solving this increase in nosocomial infection rates?

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