Preventing Infection – National Patient Safety Goal 2015 Abstract

Preventing Infection – National Patient Safety Goal 2015 Abstract

PreventingInfection – National Patient Safety Goal 2015

Abstract

Forover the years, Health Care Associated Infection (HAIs) has grownwidely and further, it is estimated that it is directly associatedwith approximately 99,000 deaths. Additionally, it is estimated thatit cost about $28 to $33 billion in addition to the normal costyearly. Most of the literatures developed in this field haveindicated that most of the healthcare practitioners are oftenconscious, and they recognize that those patients under them aregenerally vulnerable to the HAIs and further that they also caninfluence the patient’s results. In spite of the fact that thereexist a wider consciousness and the existence of evidence-based HIAapproaches, there exist apparent gaps between what medicalpractitioners have suggested and what is actually put into practicethat generally tends to affect the HAIs acquisition. Therefore, themain purpose of this project is to evaluate the gaps between the HAIrecommendations and practices especially in the acute care setting,provision of various interventions aimed at addressing the existinggaps and further to impact the HAI acquisition rates and the patientresults.

Healthcare-associatedinfections for years have turned out to be one of the commoncomplications, particularly in the healthcare setting. It has beenargued that health associated infection is leading in terms of deathin the US. Most of the healthcare organizations have come torecognize the key significance of the effectual HAI prevention andhas thus placed the reduction of these infections on their agendathat focuses on the patient safety. Additionally, the HAIs preventionand the multi-Drug Organism have turned out to be one of the majorinitiatives for patient safety. There has been an increased scrutinyby both the national and state consumer groups and increased mediaand public attention that have put efforts to raise that status toall the emerging new levels as most of the organizations havesignificantly subscribed to the HAI transparency. The prevention ofthe HAI and its control has been acknowledged being a major challengeand the priority for the trust.

ProblemDescription: Amenable to Nursing Intervention

Forover the years, there has been an increased overall incidence of HAIsto about 36%. In the year 2002, the number of those patientsestimated with HAIs was in millions, and it was further associatedwith approximately 99,000 deaths in the US every year. It has beenargued that HAI is the fourth leading cause of death in the US’spatient residents. Further, in addition to the unacceptable humantoll, it has been argued that there is an enormous financial burdenthat is placed on the nation and the families used for the treatmentof the infections. It has thus been approximated that the HAIs costsranges from approximately $28-$45 billion in excess health care costevery year. This, therefore, imposes a significant social andeconomic effect of the strained financial system of the state.Despite all the cost incurred, the morbidity rates and the rates ofmortality that are associated with the HAIs, the compliance with theHAI prevention measures have remained suboptimal at best. Infectionprevention must, therefore be the responsibility of everyoneincluding the ancillary staff to the patients, clinicians, relativesand the relatives. The strategy to be implemented will focus on thestandards, the infrastructure and organization, training andeducation, surveillance and audit and communication. The targetpopulation to be used for the program will include surgicalspecialties in the national hospital. They will provide informationon patient safety particular to the surgical site infection andpossible ways to prevent infection. The significance of this problemis that it could lead to worsening of the patient’s condition andmay even lead to death.

ClinicalGuideline, Bundle, or Best Practice

Theclinical guide will contain background information for the HAIs. Theclinical guide will thus entail the model for improvement, which isthe suggested approach to the process of undertaking a particularimprovement activity. Secondly, there is the part of getting started,which covers a series of various actions, which should be worked onprior to the process of attempting to implement the changes.Therefore, this program for infection prevention is composed of twodistinct parts. The part A will entail all the actions aimed atreducing Health Care Associated Infection specifically the surgicalsite infection. It will critically focus on the appropriate use ofthe prophylactic antibiotics, maintenance of the nomothermia,maintaining the glcaemic control for the unknown patients withdiabetes and use of the recommended hair removal approaches. Theparts B of the program will focus on the ways to improvecommunication and teamwork. It will highlight the interpretation ofthe WHO surgical safety checklist. To make the program a success,there is a group in position, which is dedicated to the process ofcontrolling damage in the preoperative care.

Tounderstand the aim of the program clearly, there was the need tounderstand the current state of the situation at hand or the currentstate of surgical site infection. The clear understanding of thecurrent state will be necessary for the purposes of setting arealistic timeframe for the program’s goal. For instance, the aimof the program would be to reduce the preoperative harm byapproximately 3 percent within a period of 18 months. This can onlybe attained through the process of execution of patient safetyintervention that will focus on the prevention of SSI and at the sametime improving the teamwork and communication. There is further theneed to measure improvement, which is believed to be the only way tounderstand whether a particular transformation will representprogress. To achieve this, there is the need to create theoperational definition of the program’s aims. It is important thatthe team will have to determine a set of criteria that they will usein the process of defining a surgical surface infection. For therationale of this program and movement, the Centers for DiseaseControl and Prevention concept definition will thus be employed.

Froma general definition, a surgical wound infection is defined simply asthe existence of pus in addition to either one or two signs ofsymptoms as given: redness, pains, and localized swelling.

Therefore,with this in place, all the stakeholders and the team members will,therefore, share a common understanding of what may need to be takeninto consideration to qualify as a surgical surface infection andwhat does not. Additionally, the group will establish its ruling outcriterion to be used. There was also the need to determine themeasure that will inform the team of its progress and ways they willuse in collecting them. In the process of defining and measuring thepreoperative harm, it was necessary that it be carried out throughan analysis of the various reported occurrences and the existingsuitable activators. For instance, all the organizations that weretaking part in the Patient Safety First movement will be carrying outa random case by the use of the Global Trigger Tool in addition tothe reporting data on various harm occurrences each month. Theeconomy of preventing HAI is often described in a general term.HAIgeneral uses the limited health sector funds and this so by extendingthe patient’s hospital stay. Therefore, an effectual infectioncontrol strategy will release these strained funds for other vitalapplication. Cost saving is thus derived when the infection controlmechanism leads to saving on resources that will have a worth in thealternative application. For most of the hospital infections, thecost for their prevention is often lower than the values of the fundsthat are released.

ResearchEvidence

Theobjective of Kallen et al. (2010) was to illustrate thetransformations in the levels of invasive health care−associatedMRSA infection from the year 2005 – 2008 amongst the inhabitants of 9US regions. The study focused on Methicillin-resistant Staphylococcusaureus (MRSA), which is a bacterium of public health significanceMRSA control programs that may influence MRSA spread andcontamination have become more and more general in the healthcaresectors. A vigorous, population-based surveillance that was aimed forthe invasive MRSA in the nine regions that covered approximately 15million individuals. It was found out that all the reports from theselaboratories indicated incidences of invasive MRSA infections fromthe years 2005- 2008 were assessed and later on arranged according tothe setting of the positive cultures and the availability of healthcare experience. Further, it is evident that health care–relatedinfections, which contributed to 82% of all the infections, were alsoincorporated in the study. The result showed that from the year 2005-2008, there were approximately 21 503 incidents of invasive MRSAinfection and that 17 508 were actually related to health care.Therefore, the prevalence rates of invasive MRSA infection was about1.02 per 10 000 population in the year 2005 and reduced by 9.4%yearly. Further, the prevalence of health care–relatedcommunity-onset infection was about 2.20 per 10 000 residents in theyear 2005 and reduced further by 5.7% yearly.

Theobjective of Naimi et al. (2003) was to typify the variousepidemiological and the microbiological distinctiveness of thecommunity-related MRSA cases and then contrasted with the healthcare–related MRSA cases. The MRSA has traditionally had beenregarded as one of the health care–related bacterium among thepatients with recognized factors that are considered risky. A cohortstudy of patients with MRSA infections was selected at 12laboratories in Minnesota to contrast community-related with healthcare–related MRSA cases. The result showed that of 1100 MRSA ratesof infections, about 131 were actually community-associated.

Accordingto Klevens et al., (2007), the rationale of this research was tooffer a nationwide approximation of the numbers of all the HAIs andmortalities in hospitals in the US. HAI was simply defined as auniversal state that often originates from a critical response to theincidence of a communicable agent that takes place in a hospitalenvironment, and further meets the body site-precise criterion.Further, patient-days were also defined simply as the sum number ofall days that the patients spend in the hospital. The study used datafrom about 283 participating from NNIS hospitals in the year 2002 andcontributed to about 2.3 million patient-days of data from about 678ICU. The study result approximated about 274,098 SSI all through theUS residents. Further, 244,385 SSI were among the adults and childrenwho were all outside of the ICUs. It was further approximated thatfor both adults and children who were outside the ICU, there wereabout 424,060 urinary tract infections, 129,519 pneumonia cases,133,368 bloodstream infections, and 263,810 other forms ofinfections.

Planfor Implementation

Thestrategy timescales of this project for the development of a trainingprogram is 2015. Therefore, in order to support the training programthat is aimed at developing and implementing a strategy, there is theneed to come up with a training program that is aimed at developingan infection control expertise that will be directed to all thestaffs. The practice protocol will include the establishment of theHAI prevention leadership and collaborate with local partners. Thereare ten the identification of a particular HAI prevention target.Secondly, there will be the establishment of HAI prevention andcontrol program team. Then there is the integration of all thelaboratory activities with HAI prevention and control efforts.Lastly, there would be the facilitation of the use of a standardbased format. The Infection Control Committee will be in charge ofthe identification and agreement of all the developed directoratepriorities and activities of the implementation plan.

Onthe other hand, generally reporting on the level infection controland management will be a major feature of the Directorate performancereviews. The trust infection control team will take the role ofadvising on various aspects of prevention and in controlling ofinfection in the hospitals. The infection control team will thuscomprise of about two infection control doctors and three nurses.There are three consultant microbiologists, who will provide adviceon infection control to the population. The team will therefore besupported by the microbiology laboratories at the Princes of WalesHospital. It is evident that the government often places a strongemphasis on the importance and need for all the healthcare employeesto fully understand and discharge their assigned roles andresponsibilities towards the prevention of infection within itsoutline clinical governance and the risk management framework. Theprogram for the prevention of HAI will be built on the existingcoordinated federal, partner, and the state organization.

The framework for the program is generally based on the collaborativepublic health approach. This will therefore entail the surveillance,outbreak response, the research, training and education and theimplementation of prevention practices. It is evident that a timelyand accurate process of monitoring always remains vital to gaugingthe progress towards the elimination of HAI. An increasedparticipation in various systems including National Healthcare SafetyNetwork is believed to promote the reduction of the HAI. Therefore,the implementation of this program of infection prevention will lowerthe risk of patients contracting the infections hence promotingsafety. With the reduced number of infection, it would imply that thecost of treatment would go down hence provoking it to be costeffective.

Integrationof Evidence and Theory

Anevidence-based strategy is vital in the identification of practicesthat will improve the safety of patients. These practices are arguedto target a diverse array related to safety problems. The studyargues that those practices that have strong supporting evidence arethe clinical intervention that often reduces the risks that areassociated with surgery, hospitalization, and critical care. Thestudy suggests that there is the need to have an appropriate use ofprophylaxis that will prevent thrombolism in those patients who are arisk. Antibiotic prophylaxis should also be used in surgical patientsto prevent postoperative infection (Rockville, 2001).

Accordingto Pittet (2005), the HAI has turned out to be a major issue when itcomes to the safety of a patient. The study indicates that asignificant number of patients have a complication in terms of caredeliveries as a result of infections and further added to the burdenof funds spend and may lead to unanticipated death. Therefore, it hasbeen proved that early infection control is successful and should beimplemented. The study thus advocates for the use of a computerizedpatient records epidemiology, evidence-based recommendations, healthcare system trends, and the modification of the behaviors ofhealthcare workers.

Accordingto Gaynes et al. (2001), described the Centers for Disease Controland Prevention`s National Nosocomial Infections Surveillance system.The study argues that there are certain elements that should be usedto reduce infection rates including, identification of high-riskpopulation, adequately trained infection control professionals and tohave a link between the prevention efforts and the monitored rates.The author argues that infection is one of the major cause of deathsin most hospitals hence calls for the need to have a strategy thatwill lead to its prevention. This will in the process save the hugeamount used fin the treatment of infections and reduces the deathrates that are caused by infections.

According to Yokoe (2008), the study focuses on the preventable HAIthat s prevalent in the US hospitals. Therefore, the prevention ofinfections has turned out to be a national priority and haveinitiatives that are led by health organizations, the government, andthe professional associations. There is the need to develop anevidence-based approach to preventing HAI. The study states that thisapproach is efficient and focuses on a set of most fundamental HAIprevention approaches in addition to unique strategies to be used inhospitals where infection are not controlled using basic practices.The study further recommends that the accountability for theimplementation of infection prevention should be given to a specificindividuals or groups.

Thestudy analyzes the existing proof of the existing connection betweenthe interventions of hand hygiene and the incidences of HAI,particularly in the acute care. The hand hygiene practices generallyentailed an initiation of a multimodal hand hygiene program and theuse of alcohol hand sanitizers. It focused on studies that examinedhand hygiene compliance with the intent of reducing infections. Itfurther highlights possible costs related to infections about the useof hand washing approach. The study states that the cost of treatinginfection is huge compared to the cost of prevention. This type ofinfection has been ranked to be one of the leading cause of deathparticularly among children hence the need to have an evidence-basedapproach that will result in prevention of hand related infections(Backman, 2008).

Infectionprevention, particularly in nations that have inadequate resources,will generally affect healthcare sectors in all countries. It statesthat infectious ailments have significantly increased throughout theworld powerfully however the prevention strategies have laggedbehind. Therefore, the control of HAI is considered one of thegreatest successes globally. This is because it is associated withreduces level of sickness and deaths hence saving patient’sresources. The global health constraints that are believed to haveaffected the infection control entail the inadequate financialresources, especially in the health care. There is also a malfunctionof facilities to make use of established control approaches inaddition to insufficient preparation for nurses (Lynch et al., 2007).

Accordingto Cohen et al. (2010), there are significant changes that have beenexperienced in the epidemiology and the treatment of Clostridiumdifficile infection. This infection is one of the main causes ofhealthcare associated diarrhea hence it has turned out to be vital asa community pathogen. The author argues that these types of infectionhas lead to massive deaths in hospitals and add to the existing moneyon strained resources. There is thus the need to have anevidence-based approach that will ensure that the rates of infectionsare low.

References

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Cohen,S. H., Gerding, D. N., Johnson, S., Kelly, C. P., Loo, V. G.,McDonald, L. C., … &amp Wilcox, M. H. (2010). Clinical practiceguidelines for Clostridium difficile infection in adults: 2010 updateby the Society for Healthcare Epidemiology of America (SHEA) and theInfectious Diseases Society of America (IDSA). InfectionControl,31(05),431-455.

Gaynes,R., Richards, C., Edwards, J., Emori, T. G., Horan, T.,Alonso-Echanove, J., … &amp Tolson, J. (2001). Feeding backsurveillance data to prevent hospital-acquired infections. Emerginginfectious diseases,7(2),295.

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

Lynch,P., Pittet, D., Borg, M. A., &amp Mehtar, S. (2007). Infectioncontrol in countries with limited resources. Journalof Hospital Infection,65,148-150.

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Yokoe,D. S., Mermel, L. A., Anderson, D. J., Arias, K. M., Burstin, H.,Calfee, D. P., … &amp Classen, D. (2008). Executive summary: acompendium of strategies to prevent healthcare-associated infections in acute care hospitals. InfectionControl,29(S1),S12-S21.