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Experiential Learning Portfolio Guide Along with antimicrobial resistance, the sensitivities of microorganisms must be reviewed for
appropriate antimicrobials if warranted, bug-drug mismatches, and a potential need for transmission
based precautions. Reviewing the annual antibiogram can reflect what trends a facility is seeing related
to resistance. Certain classes of antibiotics may be overused in relation to the types of pathogens
typically encountered. A collaborative approach between the Infection Prevention Department, a clinical
Pharmacist, and a Microbiology Technician is critical for appropriate use of antimicrobials as guided by
the facility’s antibiogram.

Theory Application and Best Practice

I have utilized several nursing theories during my decade long Infection Prevention Career. One of
my favorites is Florence Nightingale’s Environmental Model and how her observations teach us that
the environment greatly contributes to one’s health, and that it can also be altered in order to improve
health (Environmental). I feel that her model is applicable a century later to the field of infection
prevention as it has an environmental approach. Much of what an infection preventionist does has an
environmental component. This is reflected in such things as temperature and humidity conditions in
the Operating Room to airborne infection isolation room negative pressure proper functioning for a
tuberculosis patient, to clean and sanitary conditions of a patient room related to housekeeping services
to Legionella testing of the water in the cooling towers.
Another theory that I utilize is Lewin’s change theory. This theory involves a three-stage concept to
change management: Unfreezing, change, and refreezing. Unfreezing is the process where a method
is made possible for people to let go of an old practice that was counterproductive (Kaminski, 2011).
This is followed by the next stage of change, moving, which is a modification in thoughts, behaviors and
actions. The final stage is refreezing where the change becomes the new normal and new processes
are hardwired into practice.

Change can be a struggle in any organization. As an Infection Preventionist, I have championed several
initiatives related to improved quality patient outcomes. One of these initiatives was reducing indwelling
urinary devices. In doing this, Lewin’s change theory demonstrated that as an organization, we had
to identify that there was a problem with overuse and that we needed to change current practice. We
reviewed our device utilization with the NHSN benchmarks and recognized that we were far above
the national norms. This is Lewin’s unfreezing stage. As an organization, we then implemented the
HOUDINI protocol for determining urinary device appropriateness. This nurse-driven protocol was
developed by Barnes Jewish Hospital in Saint Louis, Missouri, and specifically lists criteria for urinary
catheters to be in place (Advisory). Lewin’s stage of moving was met through organization leaders
agreeing that a change was necessary in reducing urinary catheters as CAUTI rates were above
national benchmarks. Refreezing occurred as the organization adopted HOUDINI as our practice
protocol with a daily report out of urinary catheters in place. As a result, urinary catheter utilization has
decreased by half over the past six months.
Best practices are an expectation in infection prevention. There is usually an abundance of literature
available to guide our practice. Guidelines from the CDC, standards from The Joint Commission (TJC)
and the Association of periOperative Registered Nurses (AORN), and APIC’s Text are importance

www.americansentinel.edu

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