Infection Control - Research Paper Example

?Introduction and Significance of the problem Infection control is one of the major medical problems around medical profession. It is among many complications affecting patients in this era and time. This paper will seek to explore empirical literature that has handled the problem in the past. It will try to identify some of the discussions presented; implications and suggestions arrived at to be able to get the picture behind the problem. The essay will explore some of the infections, their related causes and how as a medical facility can arrive at prevention of the infection. Infection control has been a topic in discussion for many years. It has been identified that infants and patients under surgical procedures suffers the highest risk of infection hence making surgical wound infection the second largest category of hospital related infections. For example, Craven et al. (1988) found out that in most of Surgical Intensive Care Units (SICU), urinary tract infection, bacteremias and wound infections were major infections around patients. This is due to the antibiotics therapies given to patients, endotrachea tubes, arterial lines, central venous lines, and catheters they are attached to while still in SICU. Many experiments have been conducted to establish causes and magnitude of infections in hospital related infections. The studies have estimated that a quarter of the hospital-acquired infections involve ICU patients and about three quarters are related to microorganisms resistant to antibiotics. Depending on the type of infection, their frequencies, which are directly related to the effects it has on patients, differ. This difference is highly associated with mortality rate, cost of treatment and danger posed on the practitioners and the patients. Burke (2003) found that, urinary tract infections have the highest frequency of occurrence, lowest mortality rate, and lowest cost. This is followed by surgical sites infections in frequencies but third in cost, and finally pneumonia and bloodstream infections take the lowest frequency with the highest cost and mortality rate. However, frequencies and the magnitude of effect on mortality and cost keep on changing with time. For example, different studies have proved that urinary tract and surgical- site infections have been on decline. This could be due to increased surveillance and reduced stay in hospitals for the patients. Such studies gives a reason as to why the topic on infection control should be looked at more seriously if the world is to acquire minimum hospital-acquired infections. According to Burke (2003), infection control is a significant part of ensuring patient safety. This is because it ensures surveillance in the programs that are directly linked with the infections. The type of surveillance involved has been known to help medical practitioners as well as the patients to be aware of some of the dangers around them. This is attainable when policies on best practice in the medical field are changed to meet the demands of each exposure to infections. For example, policies like patient isolation to prevent nosocomial transmission need to be put in place if a minimum level of hospital related infections would be arrived at. Educating and protecting nurses, preventing transmissions of blood borne disease-causing organisms, ensuring the highest level of hand hygiene and providing practitioners with protective equipments also serves as part of the protective practices. It is important to look at the environment around which the patients receive treatment; they should be free from any infections through regular disinfection of patient care items. Empirical Review Among the infections that have been widely discovered, bloodstream infections (BSI), urinary tract infections (UTI), surgical wound infection (SWI), nosocomial pneumonia, nosocomial bacteremia and surgical sites infection (SSI) take the lead in the order mentioned. They all occur in different frequencies and symptoms though there are some that occur without observable symptoms. For example, a patient is infected of UTI if he/she has pain, frequent urination, and burning on urination. These symptoms are different in skin infections whose symptoms are pain and swellings combined with redness of the tissues (Rhinehart & Friedman, 1999). Arrangements of surveying cases of infections have been done by many researchers as part of infection control. Infection epidemiology which is the study of the frequency of disease occurrence and the causative agents of an infections have been conducted to establish the part of bacteria, viruses and other pathogens in patients. For example, pneumonia, surgical site infection, urinary tract and bloodstream infections, have different disease causing organisms. Some of them have single pathogenic pathways while others have multiple pathogenic pathways. For example, pneumonia is an infection from one or more bacterial species. Therefore, this explains why pneumonia leads to a quarter of the infected patient’s deaths hence posing a great threat to both the patients and the practitioners. Weinstein, Gaynes and Edwards (2004) are among the researchers that delved deep into gram-negative bacilli as a causative agent of the mentioned infections. Through their research, they arrived at reliable statistics on definition of gram-negative bacilli effect on four main hospital acquired infections. Their research concluded that by 2003 gram- negative bacilli was connected with 23.8% of BSIs, 65.2% of Pneumonia, 33.8% of SSIs and 71.1% of UTIs. Hospital acquired infections vary in magnitude from pneumonia to surgical site infection (SSI), to urinary tract infection (UTI), to bloodstream infection (BSI). However, they can be controlled if healthcare facilities are improved and infection control practices are looked at keenly. This will reduce gram-negative bacilli relation with infections associated with the hospital. According to Weinstein, Gaynes and Edwards (2004), with time, the frequency of infection on each of the mentioned 4 hospital acquired infections change. For example in the study conducted by Weinstein, Gaynes and Edwards (2004), gram negative bacilli kept on changing. During the experiment pneumonia and UTI, the bacteria remained stable throughout the study; this was different with SSIs and BSIs since they kept on decreasing. However, BSIs were associated with gram-positive bacteria pathogens rather than gram-negative ones. Therefore, it would be okay to conclude that gram-negative bacilli represent the highest level of infections associated with the four hospital- acquired infections. This level of infection exposes a need for serious infection control since infection control has become a major public health concern. The type of procedures performed and the care given to patients in ICUs should be enhanced especially with abdominal procedures. According to Richards, Edwards, Culver, and Gaynes (1999), pediatric ICUs expose patients to greater risks than adult ICUs. Due to their low immunity level, such patients are exposed to bloodstream infections, pneumonia and urinary tract infections. The invasive devices used increase the distribution of infection cites hence making disease causing organisms differ with age. The older the patient the less the chance of being infected with the four hospital acquired infections. However, this does not go unnoticed since noninvasive ventilation (NIV) is a solution to that problem. Use of NIV has been proved to reduce risk of nosocomial infections at any age hence improving survival of patients with breathing problems (Girou et al., 2000). NIV as per the experiment conducted on critically ill patients proved to lower nosocomial infections, less antibiotic use, shorter ICU stay, and lower death rates as compared to mechanical ventilation (Girou et al., 2000). In almost every research done, hand washing practices have been widely discussed as an infection control. This is because the skin on the hands carries disease-causing microorganisms divided into resident and transient microorganisms. For transient microorganisms, which only survive for a short while, hand washing with just soap and water can avoid them from spreading (Rhinehart & Friedman, 1999). Resident microorganisms that are in the superficial skin layers can only be removed by not only using soap and water but also using antimicrobial agents that get deep into the epidermal layers (Rhinehart & Friedman, 1999). Steere and Mallison (1975) highly expounded on the fact that personnel’s are at the highest risk of carrying disease causing organisms through their hand s after an interaction with excretion, secretion or blood (Steere and Mallison, 1975). Their exposure to such infections exposes most vulnerable patients like newborns at greater risks. Therefore, hand washing with either antiseptics or just water and soap is a prudent exercise that will not only prevent infections to the personnel, but will also protect the patients from getting infections through their hands. The mentioned empirical reviews for infection control provide converging evidence that the study is valid now. It is evident that both the practitioner and the patients are at risk. The practitioner is at risk of contacting infections from the patients and the patients are at risk of contacting infections from the practitioners. To be able to protect each one of them fully, both of them need to be aware of the risks involved in their interaction hence taking necessary precautions become a prerequisite. According to Elliott (2009), a psychosocial approach yields better results as compared to just taking physical approach. This approach yields long-term results since they affect the way individuals think of infection control and the standard precautions. Some of the precautions mentioned for infection control are; There is a great need for both the practitioner and the patient to recognize the need for adopting the precautions. Such recognition brings change to how an individual thinks about infection control hence helping them to take necessary measures especially for the medical practitioners. It is only through recognition of the importance of infection control that an individual can be able to adhere to the set guidelines concerning the problem. Hand hygiene process, which should not be confused with hand cleansing hubs, is another precaution measure that every practitioner should put in place. This is because hand-cleansing rubs only does short term decontamination. Therefore, hand-washing process should be put in place since it facilitates prevention and reduction of hospital-acquired infections (Elliott, 2009). The process should be done before and after any contact with a patient to reduce risk of infection to the practitioner and the next patient he/she is likely to attend to. Medical practitioners especially the ones involved in the emergency department’s faces a high risk of infection from soiled linens. Part of the preventive measures for such should be to follow policies and procedures set for handling soiled and contaminated cloths. Practitioners should ensure that when handling such cases, they are in proper protective clothing to avoid cases of cross infection. At this era of technology and industrialization, the environment has been so much contaminated. Cleaning of health facilities should not only be left to the designated cleaners only, it should be the responsibility of each person to ensure that they operate in a clean environment. Therefore, regular and thorough cleaning practices should be upheld as part of the infection control practice. For the medical facility, providing disposable aprons and gloves is essential as part of infection control precaution measures. Such coverings are known to provide some protection to the person wearing it which translates to protection to the next patient they will be attending to. The facility should consider ensuring that there are sufficient aprons and gloves for every practitioner at all times especially for situations where the practitioner is handling body fluids and contaminated substance materials. Failure to using them could lead to infections to not only the next patient but also to the medical practitioner. It is recommended that eyes, ears and mouth should be protected where there is potential risks of flying objects or splashes of harmful substances (Elliott, 2009). This is because the mentioned parts are at highest risk of infection when exposed. Depending on the level of exposure, individuals should determine when to wear the protective devises and nobody should come around in protest against such a determination. It is good practice for everybody to be responsible for his or her own mess. For example, if anybody gets involved in any spillage, it is a good precaution measure to clean up for not only his or her health but also of those around him or her. The spilled substance should be disposed in a way that would not posse further risks to anybody. In conjunction with spillage, every waste material should be handled with care due to the different hazards they posse on different conditions. Each person should endeavor to follow the set guidelines for disposal of waste materials to reduce risks of infection to the people involved. As part of precaution, food handling either at personal or social level needs caution. There are several cases of cross infections that have been recorded on failure to observe measures around the commodity. At all times, protective clothing for food handlers and following hand hygiene routine should be observed to avoid contamination that lead to infections. “Skin trauma, which is common in the medical field, should be dealt with in accordance to employer’s policies and procedures (Elliott, 2009, pp. 6). Regardless of how minor the trauma may look, the wound should be cleaned and well dressed to avoid contamination. Necessary authorities should be notified of the accident to avoid further injuries as well as allow enough time for healing. This precaution is applicable to both the practitioner and the patients since both are at great risks of skin trauma as long as they interact with sharp objects. Finally as per Elliott discussion, personal hygiene for both the caregiver and the recipient is an essential part of minimizing infection (2009). They both should look into it that they are hygienically upright to avoid cases of cross infection. The necessary measures in this case may involve taking a regular bath, keeping nails short and clean and ensuring that they operate in clean and hygienic environments. Prevention of hospital-acquired infections As the saying goes “prevention is better than cure,” it is important for both the patient and the practitioner to be aware of the risks factors involved to be able to make interventions. For urinary tract infections, replacing invasive devices with condom catheters and shortening duration of devise use for mechanical ventilation patients will prevent infections (Burke, 2003). Surgical sites infections can be prevented by use of equipments and needles with safety features. Anesthesia equipments and practice should be designed to prevent infections besides surveillance and early reporting of infections to relevant authorities. Another way of ensuring reduced cases of infection is conducting epidemiologic analysis. Such an analysis can work best if there is a case to study on a particular infection. A case in point could involve a patient with urinary tract infection. Studying how it happened by close examination of the urinary drainage will help identify the infection as a catheter-associated urinary tract infection. Such a study will expose the issues and create a high rate of caution hence reducing chances of considering infections as inevitable (Burke, 2003). However, it is important to note that some guidelines that had been given before as preventive measures have been tricky to employ. This includes suggesting that use of antibiotics and health care workers education would stand out as preventive measures. For example, it has been proved that very few health care workers keep to the behavior change of hand hygiene. Majority of the workers fail to adhere to this simple routine despite the fact that it is considered the simplest and most important method of infection control (Burke, 2003). To be able to identify how effective infection control has been, a medical facility should consider surveillance of their practices and measures put in place towards the same. This will help in identifying adaptable risk factors hence detecting the direction of infection control in the facility. For example, surveying a surgical process right from the timing of antibiotic prophylaxis before surgery to the end of the procedure will help in identifying risk factors that are important in spot system problems. This will reduce risk of infections since the results obtained out of the surveillance will be used to improve measures in the procedure. Definite patient-care practices will be implemented, adapted, and improved hence providing the lowest-risk care in the facility. Conclusion From the discussions above, it is evident that infection control is a thing to consider. It is the only way medical practitioners can ensure they are safe from infections as well as their patients. To achieve infection control, there has to be first an identified need to do so. Both the medical practitioners and the patients should see it necessary to take precaution as a prevention measure. It is good practice to ensure that they are protected from sharp objects that may cause skin trauma. In case of any injury or infection, the involved persons should notify the relevant authorities to ensure that necessary measures are taken. It is important to realize that infection control is a problem that should be addresses in the medical field. Educating and protecting nurses, preventing transmissions of blood borne disease-causing organisms, ensuring the highest level of hand hygiene and providing practitioners with protective equipments is part of the protective practices. It is important to look at the environment around which the patients receive treatment; they should be free from any infections through regular disinfection of patient care items. This is because failure to address the issues leads to high mortality that could otherwise be avoided. Among the infections that have been widely discovered, bloodstream infections (BSI), urinary tract infections (UTI), surgical wound infection (SWI), nosocomial pneumonia, nosocomial bacteremia and surgical sites infection (SSI) comprise the highest level of infection. They have a very close relationship with pathogens like gram-negative bacilli transferred through hands hence posing a significant threat to both medical practitioners and the patients. To avoid cases of contamination through contact, it has been widely discovered that hand washing stands as prerequisite. Medical practitioners should wash their hands before and after having contact with any patient. The medical facility should look into it that patients are protected from possible infections by establishing policies on infection control. It is the responsibility of every party involved to ensure that both the patients and the practitioners are well covered against preventable infections. References Burke, J. P. (2003). Infection Control- A problem for Patient Safety. The New England Journal of Medicine, 348, 651-656. Craven, D. E., Kunches, L. M., Lichtenberg, D. A., Kollisch, N. R., Barry, M. A., Heeren, T. C., McCabe, W. R. (1988). Nosocomial Infection and Fatality in Medical and Surgical Intensive Care Unit Patients. Archives of Internal Medicine, 148 (5), 1161-1168. Elliott, P. (2009). Infection Control: A Psychosocial Approach to Changing Practice. Abington, Oxon: Radcliffe Publishing Ltd. Girou, E., Schortgen, F., Delclaux, C., Brun-Buisson, C., Blot, F., Lefort, Y., Lemaire, F., and Brochard, L. (2000). Association of Noninvasive Ventilation with Nosocomial Infections and Survival in Critically Ill Patients. The Journal of the American Medical Association, 284 (18), 2361-2367. Rhinehart, E., & Friedman, M. M. (1999). Infection control in home care. Gaithersburg, Maryland: Aspen Publishers, Inc. Richards, M. J., Edwards, J. R., Culver, D. H., and Gaynes, R. P. (1999). Nosocomial Infections in Pediatric Intensive Care Units in the United States. Pediatrics, 103 (4), e39. Steere, A. C. & Mallison, G. F. (1975). Handwashing Practices for the Prevention of Nosocomial Infections. Annals of internal Medicine. Retrieved from: http://www.annals.org/content/83/5/683.short Weinstein, R. A., Gaynes, R., and Edwards, J. R. (2004). Overview of Nosocomial Infections Caused by Gram-Negative Bacilli. Oxford Journals, 41 (6), 848-854. Read More