Change Model Overview In This First Paragraph Provide An Ove

Change Model Overview In this first paragraph, provide an overview of the ACE Star model Evidence-Based Practice Process

In healthcare, the ACE Star Model of Knowledge Transformation offers a systematic approach for implementing evidence-based practice (EBP) by guiding clinicians through five stages: Knowledge Discovery, Evidence Summary, Practice Prevention, Translation, and Practice Integration (Davies et al., 2017). Nurses should utilize this model as it facilitates a structured pathway for translating research findings into clinical practice, ultimately improving patient outcomes. It emphasizes not only the importance of evidence synthesis but also the crucial steps of applying, evaluating, and sustaining change within healthcare settings, making it an essential tool for nursing leaders engaged in quality improvement initiatives.

Scope of the Practice Issue

The practice issue identified pertains to the continued prevalence of surgical site infections (SSIs) within the hospital setting, which significantly impact patient morbidity, mortality, and healthcare costs. SSIs account for approximately 20% of healthcare-associated infections (Magill et al., 2014), representing a substantial burden on hospital resources and patient recovery. The problem extends beyond individual facilities, affecting healthcare systems globally by increasing lengths of stay, readmission rates, and antimicrobial use, thereby contributing to antimicrobial resistance (WHO, 2018).

Specifically, the focus is on preoperative skin antiseptic bathing or showering, a critical measure in SSI prevention. Despite evidence supporting its efficacy, variations in practice persist due to differing protocols, patient allergies, and skin tolerances. Addressing this issue is essential to standardize preoperative skin preparation, reduce infection rates, and optimize patient safety on a broader healthcare scale.

Stakeholders

As the project leader, relevant stakeholders include perioperative nurses, infection preventionists, surgical team members (surgeons, anesthesiologists), pharmacy staff, and quality improvement coordinators. Involving pharmacy personnel is vital given their role in selecting appropriate antiseptic agents; perioperative nurses are key to patient education and protocol implementation; surgeons influence surgical practices and compliance; infection preventionists monitor infection rates; and quality improvement teams facilitate data collection and sustainability planning.

Engaging these stakeholders ensures comprehensive input, fosters collaboration, and promotes adherence to the intervention, thereby increasing the likelihood of successful implementation and sustained change.

Responsibility of Team Members

The team members were selected based on their expertise and direct involvement in perioperative care and infection control. Perioperative nurses are responsible for patient education and protocol adherence; infection prevention specialists oversee surveillance and compliance; pharmacists advise on antiseptic agent selection; surgeons provide clinical authority and endorse practices; quality improvement personnel facilitate data collection, analysis, and reporting; and administration supports resource allocation. Each role is essential for ensuring that evidence-based protocols are effectively integrated into practice, monitored for outcomes, and adapted as needed.

Evidence

An extensive internal and external evidence search was conducted, focusing on peer-reviewed systematic reviews, clinical practice guidelines, and quality improvement data related to preoperative skin antisepsis. The primary evidence source was the systematic review by Webster and Osborne (2015), which evaluated the efficacy of preoperative antiseptic bathing or showering in preventing SSIs. Additional evidence included guidelines from the Centers for Disease Control and Prevention (CDC, 2017), the World Health Organization (WHO, 2018), and expert opinion articles highlighting best practices.

The evidence obtained is strong, primarily deriving from randomized controlled trials and high-quality systematic reviews, which offer a robust basis for clinical decision-making. These sources collectively support the use of antiseptic preoperative skin preparation as an effective intervention to reduce SSI risk, although variability in antiseptic agents and protocols exists.

Summarize the Evidence

Webster and Osborne (2015) conducted a systematic review that examined randomized controlled trials comparing preoperative skin antisepsis with non-antiseptic solutions. Their findings indicate a significant reduction in SSIs with the use of antiseptic solutions such as chlorhexidine and povidone-iodine. The review consistently demonstrates that preoperative antiseptic bathing or showering decreases microbial flora on the skin, thus lowering the risk of postoperative infections. The strength of this evidence is high, due to the inclusion of multiple RCTs and rigorous evaluation methods. These findings are relevant to the clinical setting as they reinforce the importance of standardized preoperative skin preparation routines and can inform protocol development aimed at reducing SSI rates within my practice setting.

Develop Recommendations for Change Based on Evidence

Based on the accumulated evidence, the recommendation is to implement a standardized protocol mandating preoperative antiseptic bathing or showering for all surgical patients. The protocol should specify the antiseptic agents to be used, preferably chlorhexidine or povidone-iodine solutions, due to their proven efficacy. The intervention should be administered at least the night before surgery to maximize microbial reduction. Staff training and patient education are vital components to ensure compliance and understanding of the importance of the practice. Regular audits and feedback will be necessary to maintain adherence and evaluate effectiveness in reducing SSIs.

Translation Action Plan

The implementation plan involves establishing a multidisciplinary team to develop and review the protocol, train staff, and educate patients. The steps include staff education sessions within the first month, distribution of educational materials, and integration of antiseptic bathing instructions into preoperative routines. The timeline anticipates full protocol adoption within three months, with ongoing monitoring through SSI surveillance data. Evaluation will assess compliance rates and infection rates at baseline, three months, and six months post-implementation. Feedback from staff and patients will guide adjustments, ensuring a sustainable practice change.

Process, Outcomes Evaluation and Reporting

The primary outcomes are the reduction in SSI rates and increased compliance with preoperative antiseptic bathing. Data collection will involve reviewing infection surveillance reports, patient adherence logs, and staff compliance audits. Outcomes will be analyzed using descriptive and inferential statistics to assess the effectiveness of the intervention. Findings will be shared in quarterly quality improvement meetings and summarized in reports to stakeholders. A formal presentation at departmental meetings and summaries in the hospital newsletter will ensure internal dissemination. External communication may include presenting results at conferences or publishing in relevant nursing journals.

Identify Next Steps

Following successful pilot implementation, the next step is to extend the protocol to other surgical units and outpatient procedures. To ensure sustainability, ongoing staff education, periodic audits, and incorporation into hospital policy are necessary. Feedback loops and continuous quality improvement cycles will further embed the practice into routine care, promoting long-term adherence. Engagement of leadership and ongoing resource allocation are critical to scaling and maintaining the initiative across the facility.

Disseminate Findings

Results will be communicated internally via detailed reports, staff debriefings, and presentations at clinical meetings. External dissemination will include submitting findings to peer-reviewed journals, presenting at professional conferences, and sharing best practices through hospital networks. Collaborating with regional or national infection control organizations can help promote adoption of effective protocols beyond the facility, potentially influencing broader standardization of SSI prevention strategies.

Conclusion

The persistent challenge of surgical site infections necessitates evidence-based interventions such as preoperative antiseptic bathing or showering. Utilizing the ACE Star Model provides a structured pathway to assess, implement, and sustain best practices in infection prevention. The evidence supports routine preoperative skin antisepsis as an effective measure to reduce SSIs, thereby enhancing patient safety, decreasing healthcare costs, and improving quality outcomes. By engaging stakeholders, standardizing protocols, and evaluating outcomes, hospitals can foster lasting change and elevate standards of surgical care.

References

• Centers for Disease Control and Prevention. (2017). Surgical Site Infection (SSI) Event. CDC; Atlanta, GA.
• Davies, B., McNeill, L., & Allard, S. (2017). The ACE Star Model of Knowledge Transformation: Application in Nursing Practice. Journal of Nursing Scholarship, 49(2), 164-172.
• Magill, S. S., et al. (2014). Multistate Point-Prevalence Survey of Healthcare-Associated Infections. New England Journal of Medicine, 370(13), 1198-1208.
• Webster, J., & Osborne, S. (2015). Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database of Systematic Reviews, (2), CD004985. http://doi.org/10.1002/14651858.CD004985.pub5
• World Health Organization. (2018). Global Guidelines for the Prevention of Surgical Site Infection. WHO Press.
• Horan, T. C., et al. (2017). CDC/NHSN Surveillance Definitions for Specific Types of Infections in Healthcare. Centers for Disease Control and Prevention.
• Al Maqbali, M. A. (2013). Preoperative antiseptic skin preparations and reducing SSI. British Journal of Nursing, 22(21), 1227.
• Jakobsson, J., Perlkvist, A., & Wann-Hansson, C. (2011). Searching for evidence regarding using preoperative disinfection showers to prevent surgical site infections: A systematic review. Worldviews on Evidence-Based Nursing, 8(3), 138-147.
• Cowperthwaite, L., Holm, R. L., & Cowperthwaite, L. (2015). Guideline implementation: Preoperative patient skin antisepsis. AORN Journal. https://doi.org/10.1016/j.aorn.2014.11.009
• Magill, S. S., et al. (2014). Multistate point-prevalence survey of healthcare-associated infections. New England Journal of Medicine, 370(13), 1198–1208.