Systematic Reduction Of Nosocomial Infections In Healthcare Settings

Literature Review

Discuss About The Systematic Reduction Associated Infections.

Nosocomial infections are the type of infections that are acquired from exposure to pathogens in the hospital. These kinds of infections can spread from one patient to another in a short stretch of time (Ott et al 2013). The World Health Organization has provided a list of precautions to be undertaken by healthcare professionals to prevent hospital-acquired infection (Luangasanatip et al 2015). Nurses play an important role by providing care to the patients for a major part of the time the patient is in the facility. It is very important that they maintain a certain level of hygiene as they deal with numerous patients throughout the day (Kirwan Matthews. and Scott 2013). Hand washing is the most important aspect for maintaining hospital hygiene. Most of the nosocomial infections occur due to exposure of absence of hand washing. It is important for nurses have knowledge about the repercussions of the issue (Rosenthal et al 2013). The aim of this paper is to provide an in depth overview of the problem and commence interventions to evaluate the rate of incidence of the infection is healthcare settings.

PICO Question- Does (knowledge of effective hand washing) (I) in (nursing staff) (P) (decrease the incidence of nosocomial infections) (O) in comparison to (nurses who are not aware of the habit) (C) over subsequent period of time?

The intensive care unit generally serves severely critical patients who require the best care and constant monitoring. However, it is observed that patient in the ICU also suffer the risk of nosocomial infection (van Vught et al 2016). The rate of the morbidity and mortality associated with this risk in constantly increasing with time. Many reports suggest that the incident rate of nosocomial infections in patients are almost twice to five times more susceptible in the ICU unit rather than the general units (Salama et al 2013). A paper published by the Indian Journal of Critical care Medicine, in 2015, showed that risk of such hospital acquired infections and analysed their consequences. The nursing education was performed which would determine the efficacy of the intervention in the ICU attending nurses (Dasgupta Das Chawan and Hazra 2015). Systematic Reduction Of Nosocomial Infections In Healthcare Settings Discussion Paper The authors researched by conducting an observational study in a combined medical and surgical ICU unit in a hospital setting in eastern India. 242 participants were selected for the studies who were admitted in the hospital who were stationed in the unit for over forty-eight hours. The collected data comprised of details about the illness, severity of the patient condition and indication of risk factors or infection. Other factors that were noted were the length of stay in the hospital, initial cause of hospitalisation and status of survival were kept for collection of data and background history of the patients. The authors conducted a logistic regression analysis. The common identified pathogen prevalence were Enterobacteriaceae, a gram-negetive pathogen and P. Aeruginosa. The morbidity associated with nosocomial infections in ICU patients were more prevalent in patients who stayed for longer.

It is crucial to maintain the safety of neonates as they are exposed to the environment without complete development of the immune system. Hospitals have a separate setting for prevention of diseases complications (Hamdan 2013). However, incidences have been reported where the neonates have acquired nosocomial infections in the neonatal intensive care unit itself. The risks of such hospital-acquired infections in the neonates are from the care givers like nurses who do not undertake proper hand hygiene. The most commonly identified infection to be the root of these nosocomial infections are coagulase-negative staphylococci bacteria (CoNS) (Marchant Boyce Sadarangani and Lavoie 2013). A paper published in the Hindawi Publishing Coroporation in 2013, shows immunological and epidemiological risk factors that accompany the CoNS in neonates. The authors also reviewed the factors that would help to diagnose, prevent and treat the neonates with such a condition. Sepsis in the neonates occurs within the first 28 days of their live and the continue up to 4 weeks after the delivery. The authors pointed out that the best possible method for the prevention of such condition is practice of effective hand washing. This is also a very cost effective method to reduce the risk of nosocomial infection. However, it is very difficult to control the compliance of these techniques in the healthcare workforce. Care and strict supervision need to be carried out to prevent the spread of such infections and prohibit the spread of intravenous infection, overuse of antibiotics.

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Catheter insertion is a very critical technique that requires skilled professional expertise associated with the closed drainage systems, structured daily care plan and interventions (Gould et al 2010). However, the risk of catheter-induced infection and other urinary tract infections still cannot be controlled and many people suffer the effect of the aforementioned disease. The group of researchers investigated the issue to arrange an interventional study across a hospital to observe the procedure of catheter insertions and the role of supervisors. The paper was published in Elsevier in the year 2013, where an interventional study was conducted to improve the community teaching of the hospital regarding the insertion of catheter veins (Parry Grant and Sestovic 2013). The primary focus of the authors’ was to promote the practice of catheter removal on direction of a nurse. The direction of the removal was similar to that of the prescribed insertion procedure by the practitioner. The considerations of the catheter insertion criteria was considered, progress chart, observation as well as maintenance of the rate of catheter use. The measurement of catheter rates was done specifically in accordance to the unit in a multidisciplinary environment. The authors arranged for a surveillance interventions to monitor the activities of the program to find out the hygiene of the hands of the nurses were the root cause next to the sterility of the catheter veins. They set up an education program for the nurses which would help development of better skills for hygiene maintenances and insertion or removal techniques. The result was achieved for about 50% reduction in the use of unsterilized catheter and the 70% reduction in the catheter induced UTI over a period of 36 months.

In 2013, the Lancet journal published a paper depicting the World Health Organization’s multimodal strategy to improve the hand hygiene on a global scale. The effort was to prevent the diseases transmission of diseases and improve the hand hygiene among healthcare professionals across five different counties. A quasi-experimental study was carried out in Costa Rica, Italy, Mali, Pakistan and Saudi Arabia from 2006-2008. The strategies undertaken by the research group were questionnaire, skills, knowledge. The transmission of nosocomial infection is one of the most commonly observed acquired infections in the healthcare settings. Millions of people are affected by the nosocomial infections on a yearly basis as reported by WHO. The high-income countries have 7% patients who suffer from nosocomial infections and middle-income countries have up to 15% casualties. Billions of money is invested in countries like UK and USA to treat such conditions per year (Allegranzi et al 2013). The authors validated that the incidence of  observance of health-care workers with finest practices ranges between the facility and the country, but is usually short and inadequate to guarantee patient safety. The research group selected 55 departments in 43 healthcare settings across five countries to ensure the change in the system procedure by implementing alcohol based hand sanitiser usage and to be the preferred method of hand hygiene. The author implemented training sessions to improve the nursing education about the repercussions of poor hand hygiene. They also set up intervention for the healthcare workforce to maintain the provision of performance and feedback. The authors encouraged use of visual reminders to make sure that the nurses are constantly reminded to wash or sanitize their hands. The authors also aimed to maintain the safe environment for the hospital and its patient.

The Cambridge University Press and The society for Healthcare and Epidemiology of America published a document to highlight the strategies to maintain efficient hand hygiene in the healthcare workforce (Ellingson et al 2014).  The authors referred to the previous published guidelines to formulate an idea for the strategy and provide a concise format of the strategies. This document intending to point out some practical references in a brief plan. It also bring up-to-date recommendations with scientific proof and explain topics that permit clarification. Moreover, this document is planned to support facilities available in healthcare in putting on improvement programs of hand hygiene adherence. It also includes determination to enhance usage of hand hygiene product, screen and revert the data of hand hygiene adherence, and promote change in behavior.

It is important for the nursing workforce to maintain the efficiency in their skills. The practice of hand hygiene is important for providing the patient better health outcome and lowers the risk of hospital readmissions (Huis et al 2013). Additionally as noted in the literature review the prevalence of nosocomial infections is lowered with this practice.

The study can be conducted in the local hospital to find out about the incidence of nosocomial infection and ask the patients about the safety and hygiene procedures. Observational studies can be done to physically note the practice procedures of the nurses. If the collected data would suggest that, the clinical malpractice of hand hygiene is prevalent in the hospital then interventional strategies can be undertaken to supervise the nursing practice. Training sessions can be conducted to include the nurses and teach them about the repercussions of low hand hygiene. The evaluation committee can be formulated with the help of professors, practitioners and higher authorities.

The data collection procedure can be done by noting the prevalence of hand hygiene and helping the supervisory committee. The collected data will be then analyzed to evaluate the process of the intervention. Consent of the patient needs to be taken to ask about the nurses (Butcher et al 2018). The interview sessions and educational training sessions can be evaluated by the positive outcome in the nurses.

Analysis of the interview sessions will be evaluated by measuring the positive and negative responses. Based on the threshold value of the negative responses the nurses will be intervened and analyzed (Lewis 2015). The positive outcome of the interventions will be evaluated based on the positive outcome of the nursing habit.

The research finding would be suggestive of the lower rates of nosocomial infection in the patients and signify the improved hand hygiene of the nursing staff. Evaluation of the training and educational interventions will provide better patient safety and less susceptibility to hospital acquired infection. The knowledge and the practice of effective hand washing in nursing staff  thus may decrease the incidence of nosocomial infections. This can be compared with the negative outcome of the responses that was found during data analysis. The comparison between positive outcome of the evaluation and the nurses who are not aware of the habit may infer that the positive outcome is responsible for lowering the rate of nosocomial infection over subsequent time period.

Reference

Allegranzi, B., Gayet-Ageron, A., Damani, N., Bengaly, L., McLaws, M.L., Moro, M.L., Memish, Z., Urroz, O., Richet, H., Storr, J. and Donaldson, L., 2013. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. The Lancet infectious diseases, 13(10), pp.843-851.

Butcher, H.K., Bulechek, G.M., Dochterman, J.M.M. and Wagner, C., 2018. Nursing Interventions classification (NIC)-E-Book. Elsevier Health Sciences.

Dasgupta, S., Das, S., Chawan, N.S. and Hazra, A., 2015. Nosocomial infections in the intensive care unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 19(1), p.14.

Ellingson, K., Haas, J.P., Aiello, A.E., Kusek, L., Maragakis, L.L., Olmsted, R.N., Perencevich, E., Polgreen, P.M., Schweizer, M.L., Trexler, P. and VanAmringe, M., 2014. Strategies to prevent healthcare-associated infections through hand hygiene. Infection Control & Hospital Epidemiology, 35(8), pp.937-960.

Gould, C.V., Umscheid, C.A., Agarwal, R.K., Kuntz, G., Pegues, D.A. and Healthcare Infection Control Practices Advisory Committee, 2010. Guideline for prevention of catheter-associated urinary tract infections 2009. Infection Control & Hospital Epidemiology, 31(4), pp.319-326.

Hamdan, M., 2013. Measuring safety culture in Palestinian neonatal intensive care units using the Safety Attitudes Questionnaire. Journal of critical care, 28(5), pp.886-e7.

Huis, A., Schoonhoven, L., Grol, R., Donders, R., Hulscher, M. and van Achterberg, T., 2013. Impact of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: a cluster randomised trial. International journal of nursing studies, 50(4), pp.464-474.

Kirwan, M., Matthews, A. and Scott, P.A., 2013. The impact of the work environment of nurses on patient safety outcomes: a multi-level modelling approach. International journal of nursing studies, 50(2), pp.253-263.

Lewis, S., 2015. Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), pp.473-475. Systematic Reduction Of Nosocomial Infections In Healthcare Settings Discussion Paper