Nosocomial infections

Nosocomial infections (hospital-acquired infections) have a major impact on morbidity, mortality, and length of stay. "Research show that almost 100,000 people die each year as a result of an estimated 1.7 million nosocomial infections" (Klevens, Edwards, Richards Jr, Horan, Gaynes, Pollock & Cardo, 2007). "Hospitals are always working to limit the quantity of bacteria, germs, viruses, spores, and fungi that are transferred across institutions from patients, the public, and personnel," writes Greene (2013). Drug-resistant klebsiella pneumonia infection, urinary tract infections, bloodstream infections, MRSA, and methicillin-resistant Staphylococcus are among the infections. Hospitals have employed several measures designed to combat hospital-acquired infections such as the implementation of hand-hygiene monitoring and infection prevention systems (Richardson, 2015). This study intends to analyze the impact of nosocomial infections in patient care, discuss evidence-based practices for reducing nosocomial infections, and finally complete a gap analysis that outlines the ways of reducing such infections.

Evidence-Based Practices for Reducing Nosocomial Infections

Products

Healthcare facilities need efficient and effective equipment to reduce the rate of infections. As a chief nursing office, I would recommend the use of microfiber cleaning products to the heavy wooden handles since the former are less costly, collect and hold dust, dirt and allergens as compared to the latter. Further, hospital cleaners and healthcare staff should use personal protective equipment (PPE), for instance, high quality gloves, facemasks, face shield, protective eyewear, and gowns whilst cleaning or handling patients to reduce the transmission of bacteria from the patient to the healthcare worker and from the worker to the patient (Rosenthal et al., 2008).

Technology

Implementing effective technology can significantly reduce the rate of nosocomial infections in hospitals by 60% (Pr, 2017). St. Joseph Mercy Oakland is one of the healthcare institutions that implemented the robotic technology to do away with disease causing microorganisms in patient rooms, theatres, and cardiac catheterization labs. The hospital acquired two robots named Shelby and Lexi that use pulsed xenon ultraviolet that emit rays 25,000 times greater than those emitted by the sun effective enough to kill hidden microscopic pathogens in patient rooms (Greene, 2013). As a chief nursing officer, I would advocate for this technology in my hospital since it is an effective cleaning system. I will also implement an electronic hand-hygiene monitoring system to minimize microbial growth and an infection prevention system to shield patients from bacteria.

Patient/Family

Besides organizational-related HAIs, it is my personal responsibility as a chief nursing officer to ensure that patients and their families receive adequate education on why they should constantly remind hospital workers to wash their hands. Hands carry countless pathogens and for that reason, patients and their families should ask their healthcare providers if they have cleaned their hands before handling them. Seven years ago, Emory Hospitals and Sentara Healthcare facilities began plastering flyers on walls and writing notes on white boards for patients to remind healthcare workers to comply with hand-washing rules before handling them and they have since registered reduced nosocomial infections (Hamilton & Shepley, 2015).

Finances

Costs incurred in the treatment and payment of penalties associated with nosocomial infections amount to nearly $30billion annually in the entire nation (Richardson, 2015). However, healthcare administrators can reduce these costs by injecting adequate financial resources, for instance, adequate staffing to improve nurse-patient ratio, patient & employee training, solid infrastructural systems, and instigating control programs all designed to reduce the rate of HAIs (Greene, 2013). Although the administrators might be tempted to reduce budgets directed to such frameworks due to their high resource consumption with no financial gains, such frameworks play a primary role in reducing HAI-related penalties and costs that negatively affect the quality of care.

Community Relations

HAIs are not limited within the hospital walls. People can acquire such infections especially when patients are treated at home or in the community. Therefore, healthcare institutions need to broaden prevention frameworks beyond the hospital. Hospital-acquired Infections (2008) report recommends extending palliative, acute, postpartum, and long-term care to the community. This includes educating them on the importance taking the sick to hospitals for treatment instead of having them treated at home.

The Impact of Nosocomial Infections on Patient Care

As discussed above, nosocomial infections increase morbidity, mortality, length of stay in hospitals, and costs, which entirely affect customer satisfaction. Healthcare organizations are focusing on ways that will decrease nosocomial infections in order to reduce penalties and fines enforced by CMS. Warye & Granato, (2009) assert that all hospital patients are at a higher risk of developing HAIs and these include geriatric & pediatric patients and patients with weak immune systems. A research conducted by the CDC indicates that pediatric patients in the ICUs have an overall infection rate of 6.1%, which is quite high (Center for Disease Control and Prevention, 2017). A hospital is supposed to keep patients safe but this is compromised if patients acquire certain hospital-related infections, some adverse, in the very institutions that are supposed to ensure their safety. As a result, patients register prolonged stays and some die due infections that could have been prevented. Eventually, nosocomial infections lead to higher costs, which a patient cannot cover without a proper insurance in place.

Gap Analysis

Causes of Nosocomial Infections

HAIs become apparent after at least 2 days after hospitalization hence considered hospital-related. The causes of nosocomial infections are divided into three areas: iatrogenic, institutional-based, and patient related. Iatrogenic causes include the use of antibiotics, prophylaxis, and invasive processes. Institutional-based causes relate to the healthcare environment, for instance, contaminated water & air conditioners, understaffing (low nurse-to-patient ratio), and the physical design of the facility (overcrowded wards). Patient related causes may include low immunity, length of stay in the healthcare facility, and the level of severity of the illness (Horan, Andrus & Dudeck, 2008).

Effect of stakeholder Roles, Responsibilities and Relationships of Patient Outcomes

The primary stakeholders include the patients, the providers (healthcare staff), the payers, and the employers. Providers are tasked with delivering high quality and accurate services to the patients. Conversely, payers focus on minimizing costs so they want the providers to follow a clear process to reach an accurate diagnosis with few patient visits and tests involved. On the other hand, the patient wants the employer to provide and fund a variety of health insurance programs with the least cost being shifted to the employee (patient). In contrast, employers want to minimize the costs of operation by lowering their cost of contribution to such schemes (Hearld, Alexander, Beich, Mittler & O'Hora, 2012). Therefore, each stakeholder has specific responsibility and the analysis indicates that patient outcomes are heavily reliant on the three stakeholders (employer, payer, and the provider). A patient will be in a position to access the best care possible only if they can pay for it. Thus, the payer relies on the employers while the provider depends on both stakeholders. If employer provides the best schemes then the patient will be in a position to access the best care.

Roles & Relationships of Infection Control and Education Within the Organization

The primary purpose of infection control procedures and policies is to avert the multiplication of pathogens among patients, patient to staff, and staff to patient. Patients in many hospitals receive treatment in enclosed places, which are favorable grounds for breeding of pathogens. Staff members are exposed to such patients thereby increasing the risk of spreading infections to other patients (McKibben et al., 2005). Staff education on infection control procedures is vital to the reduction of nosocomial infections and that is the reason the two elements are strongly related. The hospital staff will comprehend and implement the standard procedures required to prevent the spread of infections despite a patient’s infectious status.

Strategy to Combat the Increase of Nosocomial Infections

Organizational related infections can be reduced injecting financial resources towards training and developing staff on infection control procedures, for instance, constant washing of hands and wearing guards to prevent possible contagion (McKibben et al., 2005). Further, the healthcare facility can minimize nurse-patient ratio (reduce burnout), which is one of the elements that fuels infections, by utilizing medical students working under internship programs. Additionally, congested hospital beds should be discouraged since they create a fertile habitat for pathogens. The healthcare facility should have an effective cleaning crew equipped with sophisticated cleaning technology to maintain high-level cleanliness in the entire facility, especially areas prone to nosocomial infections such as theatres and intensive care units (ICUs) (World Health Organization, 2017). The healthcare facility’s administration should have a committee in place to ascertain if the infection prevention policies and procedures are being upheld as well as ensure compliance to the required level of cleanliness in the organization. In addition, the committee ensures that adequate financial resources are allocated towards employee training & development and ensuring maintenance of optimum staff levels in the healthcare entity. A reduction in HAIs will be reflected in patient records and improved satisfaction (Horan, Andrus & Dudeck, 2008).

Reducing Nosocomial Infections for each of the areas below:

Products

Products range from protective guard, cleaning equipment, and treatment drugs. Nurses and physicians should be equipped with high quality protective guard when handling patients to minimize the possibility of an infection. Further, the cleaning equipment should be effective enough to reduce dirt and dust while cleaning. Microfiber cleaning products are the best. Drug-resistant bacteria bring most of the nosocomial infections so to administer the right drugs, healthcare practitioners should stay informed on the infections affecting the population they are treating and ensure the obtain an effective antibiotic to treat the disease.

Technology

Obtaining robots that use pulsed xenon ultraviolet rays will aid in eliminating the microscopic pathogens. This is the most effective technology that will ensure hospital rooms are kept clean and free from dangerous microorganisms. Robotics have proved effective for hospitals that have implemented the technology and some have registered a significant decrease in nocosomial infections. Additionally, hands carry many germs, which can easily be transmitted to other patients so having an electronic hand-hygiene monitoring system in place will destroy bacteria hence minimizing possible microbial growth.

Patient/family

The hospital should place charts, flyers, and white boards to remind patients and their families on the benefits of washing hands immediately after handling a patient. The message is for them to remind the healthcare staff handling them and this will immensely reduce the rate of infection.

Finances

The healthcare organization is required to allocate a percentage of its annual budget towards the prevention of nocosomial infections. The funds are channeled towards internship programs, purchase of new cleaning equipment, and constant staff education.

Community relations

The healthcare facility should embark on training the immediate community on ways of handling patients in their homes to minimize the spread on HAIs in the households. The institution may also extend palliative, acute, postpartum, and long-term care to the community especially after discharge.

Solutions to the Gap, Anticipating Potential Challenges

Best Practice

Best Practice Strategy

Barriers/Challenges to Best Practice Implementation

Will Implement Practice (Yes/No; Why Not?)

Stakeholder Roles and Responsibilities to Implement Best Practices

Technology

Acquisition of modern technology for cleaning hospital rooms

Costly- the healthcare facility will spend more on acquisition and maintenance

Yes: Because it is the most effective tool in reducing nosocomial infections

The hospital administration needs to positive about this particular strategy for it to be implemented. Further, the staff should be ready to learn and embrace new technology.

Finances

Source funds from donors, well-wishers, government and patients

Lack of adequate funds to achieve this particular goal and the objective does brings no financial benefit to the institution

Yes: will begin with small budget allocations and this will be increased gradually

The hospital administration and the state government should offer financial support towards this initiative.

6a. One Solution from part C6 to Combat Nosocomial Infections

The best solution is finances though they have their pros and cons. The positive side of finance is that it can be used to purchase the best technology the healthcare facility needs to reduce nosocomial infections. In addition, it can be used to train & develop staff as well as hire more staff to enhance staff-to-patient ratio. The disadvantage is the difficulty of acquisition. Sourcing for adequate funds to run this particular department is challenging and failure to meet the required target might lead to budget cuts in other departments thereby reducing the level service delivery in those areas.

References

Center for Disease Control and Prevention. (2017). HAI Data and Statistics. Retrieved from https://www.cdc.gov/hai/surveillance/index.html, July 3rd, 2017.

Greene, J. (2013). Hospitals go high-tech in their fight against hospital-acquired infections. Crain's Detroit Business, 29(50), 0024.

Hamilton, D. K., & Shepley, M. M. (2015). Design for critical care: An evidence-based approach. Routledge.

Hearld, L. R., Alexander, J. A., Beich, J., Mittler, J. N., & O'Hora, J. L. (2012). Barriers and strategies to align stakeholders in healthcare alliances. American Journal of Managed Care, 18(6), S148.

Horan, T. C., Andrus, M., & Dudeck, M. A. (2008). CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. American journal of infection control, 36(5), 309-332.

Hospital-acquired Infections. (2008). H&HN: Hospitals & Health Networks, 82(10), 55-65.

Klevens, R. M., Edwards, J. R., Richards Jr, C. L., Horan, T. C., Gaynes, R. P., Pollock, D. A., & Cardo, D. M. (2007). Estimating health care-associated infections and deaths in US hospitals, 2002. Public health reports, 122(2), 160-166.

McKibben, L., Horan, T., Tokars, J. I., Fowler, G., Cardo, D. M., Pearson, M. L., ... & Healthcare Infection Control Practices Advisory Committee. (2005). Guidance on public reporting of healthcare-associated infections: recommendations of the Healthcare Infection Control Practices Advisory Committee. American journal of infection control, 33(4), 217-226.

Pr, N. (2017, January 12). Hospital Acquired Infection Treatment Market - Global Industry Analysis, Size, Share, Growth, Trends, and Forecast 2016 - 2024. PR Newswire US.

Richardson, D. (2015). Reducing HACs. Managed Healthcare Executive, 25(7), 17-20.

Rosenthal, V. D., Maki, D. G., Mehta, A., Álvarez-Moreno, C., Leblebicioglu, H., Higuera, F., ... & Navoa-Ng, J. A. (2008). International nosocomial infection control consortium report, data summary for 2002-2007, issued January 2008. American journal of infection control, 36(9), 627-637.

Warye, K., & Granato, J. (2009). target: zero hospital-acquired infections. Hfm (Healthcare Financial Management), 63(1), 86-91.

World Health Organization. (2017). Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. Retrived from http://www.who.int/gpsc/ipc-components/en/, July 3rd, 2017.