Student Name Capella University NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1 Prof. Name Date Change Strategy and Implementation Kidney failure is a chronic condition that is manifested by inadequate functioning of the kidneys or complete shutdown, whereby external support is needed to maintain the homeostasis and filtration of waste products. This external support is hemodialysis treatment. Long-term hemodialysis may impose various complications for the patients, which include severe morbidities and increased risk of mortality. The most common complications associated with hemodialysis are bloodstream infections.  Hemodialysis treatment increases the risk of serious infections because of the frequent penetration of needles and catheters inside patients’ bodies. These infectious agents may lead to severe infections, which if spreads throughout the body, can cause sepsis. Sepsis is one of the life-threatening conditions whereby, reduced immune system response can even result in death. According to a report, in 2020, approximately 14,000 and higher patients had bloodstream infections due to dialysis in the U.S. (Office of the Associate Director for Communication – CDC, 2023). Thus, essential strategies are needed for healthcare providers to bring change within the system for reducing the risk of infections in dialysis-dependent patients.  Data Table of Current and Desired Outcomes To evaluate the presence of infections in dialysis patients, a data table is formulated using the information from Vila Health Facility. This data table presents the current situation as well as the desired outcomes of the actual and potential systemic infections. The data is HIPAA compatible because it doesn’t reveal patients’ identities and maintains privacy and confidentiality. This data is ambiguous as it doesn’t present the role of healthcare professionals behind these infections. It is unclear if these infections are caused by hospital practices or due to patient factors. However, it is imperative to consider bringing changes in healthcare practices to minimize the risk of systemic infections.  Current Results Desired Results  Patients who undergo dialysis have an increased risk of developing Hepatitis C infections. In Vila Health, 40% of dialysis-dependent patients had developed viral Hep C infection which led to increased length of hospital stay.  Using change strategies, the rate of Hep C infection in Vila Health will decrease and patients will have minimal chances to acquire infections due to their hemodialysis treatment.  Vila Health shows poor healthcare practices especially related to infection control which becomes one of the reasons hemodialysis patients acquire hospital-led infections  By the utilization of change strategies, healthcare providers will ensure to improve their infection control practices to eradicate the risks of nosocomial infections.  Patients who are undergoing hemodialysis face various problems like increased hospital stay, financial burden, and morbidities, and some also face deaths due to dialysis-associated bloodstream infections.  Patients undergoing hemodialysis will receive quality care in terms of infection control which will reduce the chances of morbidities, ultimately decreasing hospital stay and financial burden. Moreover, reduces death rates will be observed in such patients.  Long-term Hemodialysis Treatment and Bloodstream Infections  Patients who are on long-term hemodialysis treatment are significantly impacted due the treatment they receive. One of the most common health issues in such patients is bloodstream infections (BSI). According to a study, the United States Renal Data System registry declared that infections are the second most important cause of increased mortality in end-stage renal disease patients. Furthermore, the data provided by North America reveals the rate of infections in hemodialysis patients as 0.5- 27.1 out of 100 patient months. Central Venous Catheter increases the risk of infection by ten folds as compared to other dialysis accesses (Alhazmi et al., 2019).  Since patients with end-stage renal disease receiving hemodialysis treatment are immunosuppressed,  they are more likely to interact with infections eventually developing septic states within the body. Although the exact reason is unclear in the given data, nurses and other healthcare professionals must strive together to bring changes within the healthcare systems. These changes will ensure that patients remain free of such infections due to poor healthcare practices. For this purpose, some change strategies are important to improve health outcomes and enhance quality of life.  Change Strategies to Prevent Infections in Dialysis Patients  The focus of this assessment is to improve the lives of long-term hemodialysis-dependent patients by minimizing the risks of infections and improving existing infection states among the selected population. The evidence-based strategies which are important to bring change within the healthcare system are applying standards CDC for preventing bloodstream infections, increasing the use of catheters that have a low risk of infections, patients’ self-care education, and adequate care of dialysis catheters/access.  Following the Standard Guidelines of the CDC  According to the CDC guidelines, it is essential to initially encourage the practices which will help in the prevention of the progression of the disease. Moreover, it is advised to use the types of vascular accesses which claim to have reduced risks of infections like fistulas and grafts. Lastly, it is recommended to apply proven healthcare practices to prevent infections in hemodialysis units (Office of the Associate Director for Communication – CDC, 2023).  Using Catheters with Low Risk of Infections  Catheters with a low risk of infections should be utilized for hemodialysis patients. However, certain interventions have proven to decrease the risk of catheter-associated infections in dialysis patients. The strategy of early referral to nephrologists, vascular access coordinators, and healthcare teams is significantly important. These stakeholders will provide adequate education to the patients regarding the implantation of permanent access to decrease the use of catheters ultimately, reducing the risks of infections (Fisher et al., 2019).  Patients’ Self-care Education  Patient education is important in the prevention of catheter-associated infections by self-care. This enables patients to play an active role in their self-management of the disease process. Patients must be educated about the care of catheters while they are at their homes. Moreover, instructions must be provided about the management of catheters during showers, which improves the quality of life. According to the recommendations provided by CDC, showers are permitted however, patients must be careful about the ports and hubs of the access site.