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. Inserting central lines into the femoral vein, especially in obese clients, increases the risk of infection and is not recommended as best practice. B. Performing hand hygiene for only 10 seconds is insufficient. Current guidelines recommend washing hands for at least 20 seconds to effectively reduce the spread of pathogens. C. Daily assessment of the need for indwelling urinary catheters helps reduce unnecessary use, which in turn lowers the risk of catheter-associated urinary tract infections (CAUTIs), making this an effective quality improvement measure. D. Keeping intubated clients in the supine position increases the risk of ventilator-associated pneumonia (VAP). The head of the bed should be elevated 30 to 45 degrees to prevent infection.