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Professional Nursing: Evidence-Informed Practice

Introduction to Infection Prevention Quality Indicators in Aged Care

Infection prevention is one of the main concerns, especially when the population is quite vulnerable and is at a higher risk of catching the same. Healthcare-associated infections can be quite fatal for the patient (Agarwal, 2020). The gravity of the impact of these diseases increases by multiple folds, when an elderly population sect is involved. Older individuals have a reduced immunity as compared to their younger counterparts and are thus, more prone to catch hold of healthcare-associated infections. These infections are harmful for the patient as they might increase the length of stay of hospital, prolonging the negative impact of the infections in the individual suffering from the same. It is also responsible to add to the additional medical cost incurred for treating the patient suffering from healthcare-associated infections (Tefera, 2020). The patients can get these infections either from the environment they are subjected to or from the healthcare provider working in close coordination with the patients, offering them healthcare services. These people can be inclusive of nurses, doctors, physical therapist, and medical help and so on. Keen identification of the infection in early stages is the only way out to enable early prevention of the condition. This is vital from the point of view of impeding the spread of infection and thus, reducing the risk factors largely associated with healthcare-associated infections (López, 2018).

Title

Organisation and governance of infection prevention and control in Australian residential aged care facilities: A national survey.

Abstract on Organisation and Governance of Infection Prevention and Control

The study highlights the fact that residential care facilities are at a vulnerable risk of developing healthcare-associated infections. This is directly related with the age-related changes, such as changes in physiology of the body, immunity reduces, and there are multiple comorbidities from which the elderly population suffers and last but not the least functional disability (Preshaw, 2017). The study also highlights that identification and prevention of infection and controlling it, should be considered as the top most priority as per the national health scheme. Study was based on a cross-sectional analysis based on a survey method to get an insight about the key domains of practices followed to help with the infection control and prevention. Study helped in highlighting the role of organizational structures to endure smooth facilitation of healthcare services to control and prevent the incidences and spread of healthcare-associated infections (White, 2020).

Introduction to Organisation and Governance of Infection Prevention and Control

The rate of healthcare-related infections is measured quite high as per reported in Australian hospitals. The Australian Commission on Safety and Quality in Health care has been working in close co-ordination with the various healthcare settings, trying to raise adequate funding to help in prevention of the condition (Mitchell, 2016). The study has been able to highlight the implications and effects of healthcare-associated infection on the patients, especially on the older population. Study highlights the fact that as to how a special set of guidelines were drafted under the Aged Care Act of 1997, aiming to formulate prevention and management strategies for older people. The charter also includes guidelines for infection prevention and control in aged home care facilities in order to help these individual to continue living with an independent status. The section was also able to shed light on the various gaps and unattended sections of the act, having a limited data on type of infection, use of antimicrobial and also limited access to the data on the working of these educational programs, practices and policies set in place. The study highlights on bring up the other concerns such as staffing issues, infection control services and so on (Popescu, 2019). Thus, the study will be helpful in identifying the governance and organizational gaps to help with the future implementations needed in place to rectify the current situation and maximize the output of positive healthcare outcomes.

Literature Review of Organisation and Governance of Infection Prevention and Control

Study conducted by Shaban in 2020, evaluated the scope of practice and education needs of infection prevention and control professionals in Australian residential aged care facilities. It was a cross-sectional study which was based on an online survey collection method (Shaban, 2020). The study concluded that the Australian residential aged care facilities acknowledge the importance of infection control and prevention training programs. These programs are crucial to manage and have a good surveillance on preventing the infection breakout. However, there is still a dire need of useful resources to assist in them on their efforts.

Stuart in 2015 carried out a study based on survey on infection control and antimicrobial stewardship practices in Australian residential aged care facilities. The study was based on noting down the effectiveness of the method of antimicrobial stewardship practice in the aged care facilities settings. A total of 265 surveys were carried out for the study purpose. The study concluded that only 30% of the facilities had the staffs that were trained on the infection control methods and quite few facilities had an antimicrobial stewardship prescribing restrictions in place (Stuart, 2015). The vaccination method was also carried out in most of the facilities, but in terms of pneumococcal vaccine, the numbers were considerably low.

Bennett carried out a study in 2019 on the infection prevention quality indicators in aged care: ready for a national approach. The study highlighted the importance of Accreditation board in ensuring sound standards of infections control program, to be followed in the aged care facilities. These intervention programs are based on improving the overall quality and effectiveness of these intervention strategies through the means of continuous surveillance method. The survey was carried out in the year 2016, in which healthcare professionals employed in Victorian public-health sector took part. A total of 164 participants took part in the study, engaged in a 12-hour fortnight infection prevention service (Bennett, 2019). The study was helpful in implicating a successful state-wise eight quality indicator to be implemented in the region of Victoria. The study reflected on the importance of involvement of stakeholders in strengthening the framework and monitoring the quality of improvement in public, non-profit as well as private sectors aligned with aged care and residential care facilities.

Bennett in 2018 carried out another study which was based on identifying the prevalence of infections and antimicrobial prescribing in Australian aged care facilities. The study helped in evaluation of modifiable and non-modifiable determinants of the same. Main objective of the study was to identify the resident and facility level factors associated with infection and antimicrobial prescribing in Australian aged care residents. Data was captured by the means of national point-prevalence survey. It helped in identifying risk and protective factors determined with the assistance of multivariate Poisson regression. A total number of 292 residential facilities were taken into consideration for the study purpose (Bennett, 2018). Study suggested that priority should be given to implementing UTI management guidelines and prevention of infection in residents having an indwelling catheter. Study also reflected on the needs for enhanced monitoring and prevention strategies for the residents admitted to hospitals pertaining to catching these infections.

Methodology of Organisation and Governance of Infection Prevention and Control

Study was based on a cross-sectional survey method (Wang, 2019). The study was conducted in 2018 with a help of simple survey collecting data from residential and aged care facilities across all Australian States and Territories.

Sampling & Ethics

Ethical approval for the study was granted by Avondale College of Higher Education Human Research Ethics Committee (Russo, 2019). For the study purpose all residential and aged care facilities were included. The study was based on random sampling method. The details on contacts were collected from a database managed under the Australian government. Invitation and promotional material were sent to all of the participants through the medium of post and mail. In case of multicentre residential and care facility, only the primary location was considered for the study purpose. Online survey was provided to the participants to choose as per their individual convenience. For the study purpose 158 Australian residential and aged care facilities were taken into consideration. A survey comprising of 42 questions, having a key five domains related to infection prevention and control were included. The five domains were namely, governance, education, practice, surveillance, competency and capability were undertaken in 2018.

Data Collection Strategies of Organisation and Governance of Infection Prevention and Control

Data was collected through the means of web-based, cross-sectional survey method. The survey was drafted through the means of standardized instrumentation method which was used prior in various studies conducted in USA and UK. Two research members who had previously completed these programs were involved in developing a suitable tool similar to the programs used before. These programs had been previously used in various Australian hospitals. The survey was divided into various sections including the following:

  • Person responsible for infection control.
  • Details on education and polices associated with infection control.
  • Detailed surveillance of the infection control strategies and services.

The personal details of the participants were not collected in the study. The invitation letter to each of the participants allocated from residential and aged care facilities, were encoded with a unique code to help the researcher identify the particular participant while collecting the details during the procedural events of the survey data collection.

Data Analysis of Organisation and Governance of Infection Prevention and Control

The data was analysed using the SPSS statistical software program (Kaya, 2019). After refining the data by filtering it, descriptive statistics and frequencies of all of the valid variables were collected and then calculated. Fisher’s exact test was used in the method which helped in calculating additional 95% confidence interval. Mean full-time equivalent was also calculated for the staff supporting the infection control activities. Full time equivalent staff was presumed to be working for 38 hours a week. A word cloud was created using an online software package named WordArt. This helped in illustrating the frequency of common work undertaken by the designated infection control staff, engaged in various infection prevention and control activities.

Limitations of Organisation and Governance of Infection Prevention and Control

The study had multiple limitations and they were as follows:

  1. It was a cross-sectional study and thus, it was able to focus on a single point at a given timeframe.
  2. There was potential bias while selecting from various residential and aged care facilities to participate in the study.
  3. The agency through which the data was collected for the participants to be recruited were cross checked again. These agencies were no longer to be found on eth database. Rather different agency’s names came up after searching for the results.
  4. The response rate of this study when compared to other similar studies remains limited.
  5. The data collected was done through the means of survey method. Survey method is a self-reporting method of data collection and hence, the reliability and legitimacy of the data collected can not be trusted upon (Brick, 2017).
  6. The study was able to provide with the ways to improve infection control. However, the study only provided with a small insight of the current infection control policy arrangements.
  7. Only two ways of supporting residential and aged care facilities in infection control was highlighted in the study. However, these ways were also formulated on the basis of perceived challenges and priorities as per the residential care facility staff and not on the basis of actual limitation of the infection control and prevention plan.

Conclusion on Organisation and Governance of Infection Prevention and Control

Residential and aged care facilities provide the individual with a vital source of health and social care benefits. Despite the lack of intervention management strategies and also with the lack of guidelines available, the residential and aged care facilities have been able to provide overwhelming support for prevention of healthcare-associated infections. These residential facilities are more equipped in delivering these prevention strategies, along with complying with their own individual guidelines as well. They have therefore, been successful in meeting their individual needs and specific concerns. However, there is a dire need of extensive research in an effort to highlight on eth areas where these residential and aged care facilities can be helped, to improve their overall effort in reducing the incidence of healthcare-associated infections and thus, helping in preventing the same. There is also lack of guidance in these residential and aged care facilities, to get them with par with the hospital standards. Quality residential and aged care facilities free from healthcare- associated infections require formal structure and organizational strategies to manage the functioning of the system in a more profound manner. This will help in ensuring not only identification and prevention of healthcare-associated infections but will also be helpful in reducing the negative impact of these conditions on the individual.

References for Infection Prevention Quality Indicators in Aged Care

Agarwal, M., Dick, A. W., Sorbero, M., Mody, L., & Stone, P. W. (2020). Changes in US nursing home infection prevention and control programs from 2014 to 2018. Journal of the American Medical Directors Association21(1), 97-103. DOI https://doi.org/10.1016/j.jamda.2019.10.020

Bennett, N. J., Bradford, J. M., Bull, A. L., & Worth, L. J. (2019). Infection prevention quality indicators in aged care: Ready for a national approach. Australian Health Review43(4), 396-398. DOI https://doi.org/10.1071/AH18052

Bennett, N., Imam, N., James, R., Chen, C., Bull, A., Thursky, K., ... & Worth, L. (2018). Prevalence of infections and antimicrobial prescribing in Australian aged care facilities: Evaluation of modifiable and nonmodifiable determinants. American Journal of Infection Control46(10), 1148-1153. DOI https://doi.org/10.1016/j.ajic.2018.03.027

Brick, J. M., & Tourangeau, R. (2017). Responsive survey designs for reducing nonresponse bias. Journal of Official Statistics33(3), 735-752. DOI https://doi.org/10.1515/jos-2017-0034

Kaya, E., Agca, M., Adiguzel, F., & Cetin, M. (2019). Spatial data analysis with R programming for environment. Human and Ecological Risk Assessment: An International Journal25(6), 1521-1530. DOI https://doi.org/10.1080/10807039.2018.1470896

López-Mestanza, C., Andaluz-Ojeda, D., Gómez-López, J. R., & Bermejo-Martín, J. F. (2018). Clinical factors influencing mortality risk in hospital-acquired sepsis. Journal of Hospital Infection98(2), 194-201. DOI https://doi.org/10.1016/j.jhin.2017.08.022

Mitchell, B. G., Hall, L., Halton, K., MacBeth, D., & Gardner, A. (2016). Time spent by infection control professionals undertaking healthcare associated infection surveillance: A multi-centred cross-sectional study. Infection, Disease & Health21(1), 36-40. DOI https://doi.org/10.1016/j.idh.2016.03.003

Popescu, S., & Leach, R. (2019). Identifying gaps in frontline healthcare facility high-consequence infectious disease preparedness. Health Security17(2), 117-123. DOI https://doi.org/10.1089/hs.2018.0098

Preshaw, P. M., Henne, K., Taylor, J. J., Valentine, R. A., & Conrads, G. (2017). Age‐related changes in immune function (immune senescence) in caries and periodontal diseases: A systematic review. Journal of Clinical Periodontology44, 153-177. DOI https://doi.org/10.1111/jcpe.12675

Russo, P. L., Stewardson, A. J., Cheng, A. C., Bucknall, T., & Mitchell, B. G. (2019). The prevalence of healthcare associated infections among adult inpatients at nineteen large Australian acute-care public hospitals: A point prevalence survey. Antimicrobial Resistance & Infection Control8(1), 114-120. DOI https://doi.org/10.1186/s13756-019-0570-y

Shaban, R. Z., Sotomayor-Castillo, C., Macbeth, D., Russo, P. L., & Mitchell, B. G. (2020). Scope of practice and educational needs of infection prevention and control professionals in Australian residential aged care facilities. Infection, Disease & Health. 42(2), 102-113. DOI https://doi.org/10.1016/j.idh.2020.06.001

Stuart, R. L., Marshall, C., Orr, E., Bennett, N., Athan, E., Friedman, D., ... & Members of RACRIG (Residential Aged Care Research Interest Group). (2015). Survey of infection control and antimicrobial stewardship practices in Australian residential aged‐care facilities. Internal Medicine Journal45(5), 576-580. DOI https://doi.org/10.1111/imj.12740

Tefera, G. M., Feyisa, B. B., Umeta, G. T., & Kebede, T. M. (2020). Predictors of prolonged length of hospital stay and in-hospital mortality among adult patients admitted at the surgical ward of Jimma University medical center, Ethiopia: Prospective observational study. Journal of Pharmaceutical Policy and Practice13(1), 1-11. DOI https://doi.org/10.1186/s40545-020-00230-6

Wang, Z., Wang, S., Zhang, Y., & Jiang, X. (2019). Social media usage and online professionalism among registered nurses: A cross-sectional survey. International Journal of Nursing Studies98, 19-26. DOI https://doi.org/10.1016/j.ijnurstu.2019.06.001

White, N. M., Barnett, A. G., Hall, L., Mitchell, B. G., Farrington, A., Halton, K., ... & Gericke, C. A. (2020). Cost-effectiveness of an environmental cleaning bundle for reducing healthcare-associated infections. Clinical Infectious Diseases70(12), 2461-2468. DOI https://doi.org/10.1093/cid/ciz717

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