Review of the Literature

Multimodal Approach

Studies have established that the adoption of more than one intervention is effective in preventing hospital-acquired infections. Mody et al. (2015) conducted a study to determine the impact of a multimodal evidence-based targeted infection prevention intervention in averting clinically defined CAUTIs. The intervention comprised “preemptive barrier precautions, active surveillance for infections and MDROs, hand hygiene promotion, and structured infection prevention education” (p. 8).  Therefore, for patients with indwelling devices, health care providers should use comprehensive and technically simple approaches to control infections. Al Kuwaiti (2017) affirmed the perspective taken by Mody et al. (2015), and hence, confirmed the effectiveness of the multicomponent intervention in improving compliance with infection control strategies, such as hand hygiene and reducing the rates of nosocomial infection.

The implementation of a multimodal approach combines various interventions aimed at preventing hospital-acquired infections. Martínez-Reséndez et al. (2014) used a pre-post intervention combining different strategies, including bathing with CHX-impregnated wipes and hand hygiene to test the effect of the approach in reducing the rate of hospital-acquired infections. The rate of infection before the intervention was higher compared with the rate after implementation, which suggests the effectiveness of the intervention.

Hand Hygiene

Hand hygiene is an integral part of all comprehensive multimodal interventions for the prevention of hospital-acquired infections. According to Amine, Helal, and Bakr (2014), intervention is generally known to be an essential part of infection prevention in hospital settings. The study was based on the CDC support for the concept of hand hygiene as a critical measure to control and prevent hospital-acquired infections. As a result, researchers proposed the need for the inclusion of hand hygiene compliance as part of care bundles implemented to avoid hospital-acquired infections. Gupta et al. (2018) affirmed that hand hygiene knowledge and compliance are critical in reducing hospital-acquired infections in a healthcare setup. Similarly, Fox et al. (2015) established a positive effect of nurses’ hand-washing compliance in preventing central catheter-associated bloodstream infection and catheter-associated urinary tract infection in hospitalized patients.

In general, consistent hand hygiene is a necessary mechanism in the prevention of Hospital-acquired infections (HAIs). According to McCalla et al. (2018), hospitals should monitor hand hygiene compliance to reduce the rates of HAIs in their settings and ensure positive patient outcomes. They should have hospital infection control staff to assess and enhance compliance through education. The study proposes the implementation of automated hand hygiene compliance system (HHCS) to guarantee effective monitoring of hand hygiene compliance.

Proper Catheter Use

Besides hand hygiene in the use of catheter as part of standard treatment for critically ill patients, appropriate catheterization plays a vital role in preventing hospital-acquitted infections such as central catheter-associated bloodstream infection. Barbadoro et al. (2015) revealed the importance of a suitable setting for catheter insertion in the prevention of CAUTIs. More importantly, proper aseptic insertion methods help in preventing the onset of infections. Kachare, Sanders, Myatt, Fitzgerald, and Zervos (2014) established that besides catheter bundle and hand hygiene compliance, decreased catheter use played a decisive role in the prevention of catheter-related hospital-acquired infections. The study was based on early Foley catheter removal policy, which suggested the need for minimal catheter use and removal at the earliest convenience. Galiczewski and Shurpin (2017) recommend the implementation of the institution’s standard insertion algorithm to reduce hospital-acquired infections associated with catheter use. Nurses should use the standard insertion procedure because lack of proper use is the core reason for the infections. Therefore, they should be trained on the appropriate ways to insert and manage the catheter as part of routine treatment in hospital settings.

Educational Interventions

Although various strategies have been established, which have a positive impact on the prevention of hospital-acquired infections, they work better when health care providers are trained in their use. Al Kuwaiti (2017) revealed that active educational intervention has a positive relationship with low rates of nosocomial infection. Education is critical in improving compliance with other interventions among healthcare staff. After all, education is the basis for the suitable implementation of infection prevention strategies. Amine, Helal, and Bakr (2014) support the significance of health education, such as presentations, posters, and videos in promoting hand hygiene compliance in hospital settings. In their study, the intervention was revealed to improve compliance rates from 0% before to 37.5% after implementation of the educational and multimodal strategy.

Recommendation for Prevention of Hospital-Acquired Infections

Research establishes the importance of implementing effective interventions towards the prevention of different types of hospital-acquired interventions, such as central catheter-associated bloodstream infection and catheter-associated urinary tract infection in hospital settings. Some of the researchers have established the need for multimodal interventions that include adequate training of nurses about the standards and evidence-based mechanisms to prevent hospital-acquired infections (Mody et al., 2015; Al Kuwaiti, 2017). Hand hygiene compliance emerges, in most of the studies, as being a critical part of care bundles for hospitalized patients (Amine, Helal, & Bakr, 2014; Gupta et al., 2018). Therefore, the hand hygiene protocol has the potential for positive outcomes, regarding hospital-acquired infections.