A nurse manager is evaluating a quality improvement initiative for reducing health care-associated infections. Which of the following findings indicate the initiative is effective?

A. Clients who are intubated are kept in the supine position: Keeping intubated clients in supine position increases the risk of ventilator-associated pneumonia. Elevating the head of the bed to 30-45 degrees is recommended to prevent aspiration and reduce the risk of infections. B. Central lines are inserted into the femoral vein for clients who are obese: Inserting central lines into the femoral vein is generally avoided because it increases the risk of infection and complications, especially in obese clients. The jugular or subclavian veins are preferred. C. Clients who have an indwelling urinary catheter are assessed daily to determine if it is still needed: Regular assessment of the necessity of an indwelling urinary catheter is an evidence-based practice to reduce catheter-associated urinary tract infections (CAUTI). D. Nurses perform hand hygiene for 10 seconds before completing tasks: The recommended duration for hand hygiene is at least 20 seconds to effectively remove pathogens. A 10-second duration is insufficient to prevent the transmission of infections.