Background – There is a high risk of developing HAIs in persons in various RACFs (Residential and Aged Care Facilities) across Australia, because of factors such as, weak immune system of the elderly population, presence of comorbid conditions and other forms of physical disability. This paper highlights the challenges in healthcare sector and methods of infection prevention and control (IPC) in RACFs in Australia.
Aim and/ or Objectives of the literature review – The aim of the research is to identify and resolve the issues pertaining to increase HAIs in the RACFs in Australia.
Methods – An online cross-sectional Survey of all RACFs within Australia was used. Data was acquired from the Australian Government database. The tool used was SPSS to analyse the data and deduce the findings (Ong & Puteh, 2017; Babbie et al., 2018).
Results – The results revealed the biggest challenge in clinical governance of HAIs was lack of awareness as well as interest of the elderly population in the IPC activities and lack of interest in IPC service providers towards the RACF facilities, which was 39 percent and 36 percent respectively. Results also indicated that the residents wanted increased access to IPC care providers and increased support for the assigned IPC person (Vaske, 2019).
Findings – The findings point toward ineffective clinical governance due to the reporting of IPC services into government arrangements other than ACSQHC (Australian Commission on Safety and Quality Healthcare) which is responsible for activities for controlling HAIs in all hospitals.
Relevance to clinical practice - Identification of risk factors for increased HAIs, may result in decreased rate of morbidity and mortality in aged patients of RACFs in Australia.
Conclusions - The role of clinical governance is of utmost importance for reducing the risk of HAIs in RACFs. The research is suggestive of required reformation in the framework of IPC by engaging more professionals designated exclusively to perform responsibilities of the IPC.
Many efforts have been made for advancements in the area of healthcare associated infections, however, it still remains a debatable and challenging issue for the elderly residing in the residential aged care facilities. Various studies conducted in Europe highlighted the importance of how well-structured organizational components which can be helpful in reducing the risk and incidence prevalence of HAIs. The key driving factors are, “increasing awareness among the aged population, reforming policies of IPC, increasing the staffing within the facilities, increase in the availability of the IPC person and providing sufficient resources, such as proper medical kits.” The reason for which the RACF residents are at a high risk of HAIs due to enumerable factors such as age, comorbid illness, functional disabilities, decreased immunity, and use of invasive devices (catheters, oxygen support pipes, cannulas, and others). The other factors involve issues in clinical governance and inadequate surveillance (Stone et al., 2012). This article presents critical evaluation of the research articles based on HAIs and in-depth discussion of the articles in relation to the methodology used, critical analysis of themes of the articles, results and findings as well as detailed review analysis of the literature.
The main aim of the paper is to identify the risk factors involved in the prevalence of healthcare associated infections and the challenges faced by RACFs across Australia for preventing the occurrence of the same. It also aims to highlight the opportunities to control the infection. The article provides conclusion which is consistent to the aim of the research. The research focuses on addressing the gap in the literature studies available on the topic.
The researcher used an online cross-sectional Survey of all RACFs within Australia. The survey entailed questions pertaining to participants demographics, probable factors which lead to infection, the awareness of policies and education related to nosocomial infections, and questions related to services of infection control. Data was acquired from the Australian Government database. SPSS statistical tool was used, to analyse the data (Chakraborty et al., 2016). It is used for quantitative analysis. PubMed, CINHAL and Google Scholar search engines were used to search for articles.
Key Words used: Healthcare associated infections; Hospital acquired infections, Elderly population; nursing homes.
Inclusion Criteria: Articles from year 2013-2020 were included; abstract screening was done to short list 3 out of 10 peer-reviewed articles. The articles which were in ENGLISH language were included. This helped in providing latest evidence-based study and increased the reliability of the research.
Exclusion Criteria: The articles older than 2013 were excluded; also, those articles which were not in English language and did not comply with the standard of research were excluded.
The researchers used a well-structured and broad range of literature based on evidence to connect valid dots for the readers and was able to withdraw appropriate conclusion. The success of a HAI program is based on its ability to incorporate strategies and monitoring of the implementation of those strategies with the help of infection control professionals (ICPs). The writer of the article highlights the disparities in the clinical governance of hospital setting and that of the RACFs (Residential Aged Care Facilities). In RACFs, the national guidelines for infection prevention and control differ, the care is RACFs I provided by approved professionals under the Aged Care Act 1997. The research data base is limited; however, it is important to understand the crucial elements such as clinical governance policies and procedures which are used to control infection in the RACFs. The author of the article investigated that, designated infection-control personnel was assigned to nearly 91% of RACFs, and, among these only 31% of had a reliable degree or certification pertaining to infection control.
On the other hand, on the report of National Health and Medical Research Council (2017), it was stated that the prevalence of HAIs in RACFs was mainly due to living conditions such as shared accommodation, prolonged hospital stays and frequent visits to the hospitals for acute care due to ongoing medical conditions, lack of immediate access to diagnostic facilities, delayed diagnosis and poor clinical outcomes. The research conducted by Mitchell et al. (2019) also discovered this issue in similar researches, which supported that there were minimal qualified staffs for activities of infection control in aged care facilities. The author of the article cites the research of Stuart et al. (2015), who revealed that about 44% of staff conducting IPC support services was not qualified for the designation and 60% weren’t affiliated with a professional body for IPC. A study based on the point prevalence method was conducted by Mitchell at el, (2016) for identifying the roots of increased HAIs in the residential care institutions in Australia.
Their Research also revealed that there was poor surveillance of infections in the residential care institutions or facilities, especially in case of urinary tract infections. It also leads to increase in frequency of hospital admissions and further increasing the risk of sepsis. Therefore, targeted catheterization techniques should, mainly intermittent catheterization instead of continuous catheterization, as excessive catherization may cause catheterization acquired urinary tract infection (CAUTIs) in the elderly population and add to consumable costs. The research done by Bennet et al. (2016), highlights the fact that the residents at the residential aged care facilities have higher incidence rate of recurrences of HAIs, owing to many reasons, for instance, age, comorbid illness, functional disabilities, decreased immunity, and use of invasive devices (catheters, oxygen support pipes, cannulas, and others). They led to variety of HAIs, which were mainly comprised of urinary tract infection, respiratory infection, mucosal infections as well as soft-tissue infections. These HAIs were re-defined as per the revised McGeer Criteria which encompassed new set of infection surveillance definition, especially to be clinically useful for long term care facilities or LTCFs. The basis of revised McGeer Criteria was a structured literature and addition of norovirus gastroenteritis and clostridium difficile infection and new basis for diagnosis was established.
Findings: Critical analysis of three main articles identify with important themes in clinical practice, such as on clinical governance issues related to inadequate staffing of professional IPC personnel’s , lack of adequate knowledge and education to the patients/staff and inadequate surveillance of the infections occurring in residential care institutions and utilization of the updated version of McGeer Criteria for identification of healthcare associated infections. The first finding reveals lack of professional degrees for the staff by the committee, which causes misses in care. The second finding reveals inadequate surveillance of infections and inability to identify the root cause of infections which shows poor quality and delivery in the method of facilitating care to the patients and management of residents in RACFs, thereby increase in the incidence rate of HAIs.
The third important theme identifies the infections based on revised McGeer criteria, which was done based on well-structures, latest, evidence-based literature. It helps in conducting effective surveillance of infections. The researcher Bennett et al, (2016) highlights that majority of RACFs did not use the revised Criteria and failed to effectively diagnose the infection and meet the requirement of the patient, resulting in decrease standard of care due to poor infection control & management. Furthermore, the researcher also stated that prolonged use of antibiotics in elderly makes them resistant to the drugs making them more vulnerable to infections. Thus, surveillance of prescribed drugs from time to time is also necessary to help reduce the incidence rate of HAIs in the aged care residents.
Relevance to clinical practice: The study provides valuable insights into the alarming situation of increase in the rate of HAIs in the residential care institutions. It is crucial that identification of the factors leading to the increase the risk of nosocomial or healthcare associated infections in aged care institutions for improving the quality of healthcare delivery and to ensure safe health care practices to improve the treatment outcomes in the patient. The research identifies the key factors responsible in the current scenario which impacts the health of the residents and they are, poor clinical governance by IPC personnel, lack of adequate surveillance, missed nursing care, lack of enough knowledge and education to the patient. By recognizing the potential hazards causing infection, targeted methods of infection control can be implemented in the RACFs and LTCFs (Long-term care facilities). Therefore, this study is very vital for all health care professionals to understand and implement strategies to meet the needs of the patient in a safe and secure way.
The aged care facilities are faced with the double challenge in terms of providing quality care to the elderly population by enhancing their life saving and survival skills and striving for functional independence and on simultaneously to protect them from chronic and acute infections to which they are exhibit high vulnerability. Increase in the rate of prevalence of HAIs in elderly are due to multiple factors. They include- weak immune system of the elderly population, presence of comorbid conditions and other forms of physical disability. However, the research reveals factors such as clinical governance issues related to inadequate staffing of professional IPC personnel’s, lack of adequate knowledge and education to the patients/staff and inadequate surveillance of the infections also an active role in contributing to increase rate of HAIs in the aged care facilities. Therefore, it is crucial to implement clinical strategies to rectify the issues identified in this research by providing adequate staffing, providing proper education and training to the staff and using current criteria for effective diagnosis and management of infection to improve healthcare or treatment outcomes in the residents.
Babbie, E., Wagner III, W. E., & Zaino, J. (2018). Adventures in social research: Data analysis using IBM SPSS statistics. Sage Publications.
Bennett, N. J., Johnson, S. A., Richards, M. J., Smith, M. A., & Worth, L. J. (2016). Infections in Australian aged-care facilities: Evaluating the impact of revised McGeer criteria for surveillance of urinary tract infections. infection control & hospital epidemiology, 37(5), 610-612.
Chakraborty, N. M., Fry, K., Behl, R., & Longfield, K. (2016). Simplified asset indices to measure wealth and equity in health programs: a reliability and validity analysis using survey data from 16 countries. Global Health: Science and Practice, 4(1), 141-154.
Mitchell, B. G., Fasugba, O., Beckingham, W., Bennett, N., & Gardner, A. (2016). A point prevalence study of healthcare associated urinary tract infections in Australian acute and aged care facilities. Infection, Disease & Health, 21(1), 26-31.
Mitchell, B. G., Shaban, R. Z., MacBeth, D., & Russo, P. (2019). Organisation and governance of infection prevention and control in Australian residential aged care facilities: A national survey. Infection, disease & health, 24(4), 187-193.
Ong, M. H. A., & Puteh, F. (2017). Quantitative data analysis: Choosing between SPSS, PLS, and AMOS in social science research. International Interdisciplinary Journal of Scientific Research, 3(1), 14-25.
Stone, N. D., Ashraf, M. S., Calder, J., Crnich, C. J., Crossley, K., Drinka, P. J., ... & MacCannell, T. (2012). Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infection control and hospital epidemiology: the official journal of the Society of Hospital Epidemiologists of America, 33(10), 965.
Vaske, J. J. (2019). Survey research and analysis. Sagamore-Venture. 1807 North Federal Drive, Urbana, IL 61801.
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