An MN504 Unit 9 practice change proposal asks one oncology unit's council to pilot chlorhexidine cloth baths for line patients, fitted to its laundry, staffing, budget and authority. Searches like "mn 504 unit 9 assignment example", "mn504 unit 9 sample" and "mn504 unit 9 example" land here.
Practice Change Proposal: A Twelve-Week Pilot of Daily Chlorhexidine Cloth Bathing for Adults With Central Lines on a 30-Bed Oncology Unit
[Student Name]
Purdue University Global
MN504: Evidence-Based Practice
Unit 9 Assignment
[Instructor Name]
[Date]
The unit, staffing figures and budget are composites written as a model document. No real hospital is described.
Executive Summary
Our unit had two central line infections last quarter and averages about 2.4 per 1,000 catheter days over the past year. Evidence from intensive care supports daily chlorhexidine bathing; evidence for bathing all patients on general units does not; and for line patients on wards it is suggestive. This proposal asks the Oncology Practice Council to approve a twelve-week pilot of daily 2% chlorhexidine cloth bathing for adults with a central venous catheter, replacing the current basin bath for those patients. It does not ask for adoption. Adoption would be a separate decision after the pilot, following the Iowa Model (Iowa Model Collaborative, 2017).
Background
The literature synthesis completed for this project organized the evidence into five claims. In adult ICUs, bathing cuts bloodstream infection (consistent). Bathing all patients on general wards has not been shown to work (consistent, from the largest trial). Line patients on wards may gain from it (suggestive, from a post hoc subgroup and an internal report). Harms are mostly minor, with resistance unresolved. Bathing can be sustained if predictable barriers are planned for. National prevention guidance treats daily bathing as essential in the ICU and is more cautious about other units (Buetti et al., 2022). The largest non-intensive-care trial found benefit only in patients with devices such as central lines (Huang et al., 2019), which is why this proposal is limited to that group.
Setting
The protocol is shaped to the unit rather than imported whole, so the unit is described first. The unit has 30 beds and an average daily census of 27. About 20 patients a day have a central venous catheter, mostly implanted ports, giving roughly 600 central line days a month. Two nursing assistants on day shift give most baths, currently basin baths with soap and water, in the morning. A moisturizing lotion is stocked at every bedside. Linens are processed by a contracted laundry that uses chlorine bleach. Many patients shower independently when they feel well, and some refuse bathing on days of severe nausea.
Intervention
Product: 2% chlorhexidine gluconate cloths, six per package. Frequency: once daily. Method: cloths applied from the jawline down, avoiding eyes, ears and mucous membranes, and left to dry without rinsing. Eligibility: adults with a central venous catheter. Exclusions: known chlorhexidine allergy and patients who decline after explanation. Patients who shower independently may use a chlorhexidine cloth after showering, with the nursing assistant supplying the cloths. The chlorhexidine bath replaces the basin bath for eligible patients, rather than being added to it.
Constraints, Owners and Proposed Answers
Laundry. Chlorhexidine residue can react with chlorine bleach and leave brown stains on linens. The laundry detail, not the evidence, is the constraint most likely to stall this pilot, because stained sheets will be noticed on the first day. Owner: environmental services. Answer: request confirmation that the unit's linens can be processed with a non-chlorine bleach during the pilot.
Bedside lotion. Some lotions reduce chlorhexidine activity on the skin. Owner: supply chain. Answer: replace the unit's lotion with a chlorhexidine-compatible product for the pilot period, from a list prepared with infection prevention.
Nursing assistant workload. Owner: nurse manager. Answer: the chlorhexidine bath replaces the basin bath and takes about the same time; a five-minute training at huddle before launch.
Patient refusal. Owner: charge nurses. Answer: a bedside script explaining the purpose, with refusals recorded rather than argued. Refusal, time pressure and supply problems are the barriers reported by nurses in other units that sustained daily bathing (Musuuza et al., 2017).
Product purchasing. Owner: nurse manager and infection prevention. Answer: the council can approve the pilot, but purchasing a new product line requires their sign-off; the budget below is for their review.
Evaluation Plan
Process measure: the proportion of eligible patient days with a documented chlorhexidine bath, with a target of at least 85 percent. Balancing measures: skin reactions per 100 patient days, linen staining reports and refusals. Outcome measure: central line infections per 1,000 catheter days, compared with the unit's previous year.
The evaluation admits a limit. At the baseline rate of about 2.4 per 1,000 catheter days and roughly 1,680 catheter days over twelve weeks, the unit would expect about four infections without any change, and about two if the rate halved. A difference of two infections cannot show whether bathing works. The pilot will therefore be judged mainly on adherence, skin reactions and acceptance by patients and staff, which determine whether a longer evaluation is worth doing.
Timeline
Weeks minus 4 to minus 1: environmental services confirms the laundry process; supply chain stocks compatible lotion and cloths; infection prevention finalizes the audit form; nursing assistants and nurses complete the huddle training. Week 1: launch, with the clinical nurse specialist on the unit each morning to answer questions. Weeks 1 to 12: daily bathing, weekly adherence audit and weekly tally of skin reactions, staining reports and refusals. Week 6: midpoint review by the project team, with any protocol adjustment recorded. Week 13: data analysis. Week 14: report to the council.
Risks and Stopping Rules
The pilot carries modest risks, and the team will stop or pause it under stated conditions. If skin reactions exceed 2 per 100 patient days, or if any reaction is more than mild, bathing will pause while infection prevention and the unit's dermatology consultant review the cases. If the laundry cannot confirm a non-chlorine process before launch, the start date will move rather than accept stained linens, which would undermine staff and patient acceptance on the first day. If adherence falls below 60 percent in any two consecutive weeks, the team will meet with the nursing assistants to find the cause before continuing. Every other practice change on the unit during the pilot, such as a new dressing product or a change in line-care policy, will be recorded, so that the results can be read with those changes in mind.
Budget
Cloths: about 600 patient days a month for three months, at roughly 3 dollars per package, about 5,400 dollars. Compatible lotion: about 400 dollars. Training time: two huddles, no additional cost. Laundry change: to be confirmed by environmental services. Estimated total: about 5,800 dollars, offset in part by basin bath supplies not used.
Request
The Oncology Practice Council is asked to approve a twelve-week pilot of daily chlorhexidine cloth bathing for adults with central lines, beginning after environmental services and supply chain confirm the laundry and lotion changes, with results reported to the council at the end of the pilot for a separate decision on adoption.
References
Buetti, N., Marschall, J., Drees, M., Fakih, M. G., Hadaway, L., Maragakis, L. L., Monsees, E., Novosad, S., O'Grady, N. P., Rupp, M. E., Wolf, J., Yokoe, D., & Mermel, L. A. (2022). Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 update. Infection Control and Hospital Epidemiology, 43(5), 553-569. https://doi.org/10.1017/ice.2022.87
Huang, S. S., Septimus, E., Kleinman, K., Moody, J., Hickok, J., Heim, L., Gombosev, A., Avery, T. R., Haffenreffer, K., Shimelman, L., Hayden, M. K., Weinstein, R. A., Spencer-Smith, C., Kaganov, R. E., Murphy, M. V., Forehand, T., Lankiewicz, J., Coady, M. H., Portillo, L., ... Platt, R. (2019). Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial): A cluster-randomised trial. The Lancet, 393(10177), 1205-1215. https://doi.org/10.1016/S0140-6736(18)32593-5
Iowa Model Collaborative. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223
Musuuza, J. S., Roberts, T. J., Carayon, P., & Safdar, N. (2017). Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran's Hospital by examining nurses' perspectives and experiences. BMC Infectious Diseases, 17(1), 75. https://doi.org/10.1186/s12879-017-2180-8
How this MN504 Unit 9 example is structured
Setting comes before intervention, the proposal's defining choice: the unit's staffing, supplies and contracts are described first so the bathing protocol can be shaped to them rather than imported whole. The laundry problem goes to environmental services with a request to confirm a non-chlorine process for the unit's linens; the bedside lotion goes to supply chain with a list of CHG-compatible alternatives, since some lotions reduce chlorhexidine activity; the assistants' workload is addressed by replacing, not adding to, the basin bath. Authority is explicit: the council can approve a pilot, while purchasing a new product line needs the nurse manager and infection prevention. Evaluation admits a limit: at the baseline rate the unit would expect about four infections in twelve weeks, and about two if the rate halved, so the pilot is judged on adherence, skin reactions and acceptance.
Get an MN504 Unit 9 example written to your instructions
Describe the unit where your change would happen, its staffing, supplies and who approves pilots, and attach the Unit 9 prompt and rubric with the synthesis it builds on. The proposal comes back fitted to those constraints, with owners named and measures sized to the pilot's length. First custom sample free; allow 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN504 Unit 9 questions, answered
How specific should the setting description be?
Specific enough that a reader could tell this proposal apart from one written for another unit. Bed count, staffing pattern, patient mix, relevant supplies and who holds decision authority normally belong. Exact figures can sit in brackets where they are estimates. Identifying details, such as the hospital's name or any patient information, should be left out or disguised.
Why propose a pilot instead of a full change?
Because the evidence for a particular setting is often suggestive rather than conclusive, and a pilot tests feasibility before an organization commits. It also fits how many translation models, the revised Iowa Model among them, separate trying a change from adopting it. A pilot with clear measures and a decision date is usually easier for a council to approve than a permanent change.
What are process and balancing measures?
A process measure checks whether the change is actually happening, such as the share of eligible patients bathed with chlorhexidine each day. A balancing measure watches for unintended harm elsewhere, such as skin reactions or time taken from other care. Together with an outcome measure they show whether a change was carried out, whether it helped, and what it cost.