Professional Studies 3 – Research in Nursing

Introduction to Preventing and Controlling Health Care-Associated Infection 

Healthcare-associated infections are considered to one of the greatest burdens over the health care sector and they are acquired due to the irrelevant hospital settings. The healthcare-associated infections are directly related to the increased hospital stay and financial burden over the patient (World Health Organization, 2017). 1.7 individual in hospital setting acquires healthcare-associated infection which leads to an increase in the requirement of the health care facility and increases hospital stay. Healthcare-associated infection is also responsible for increase mortality rate which is about 98,000 patient died due to healthcare-associated infection (Haque et al., 2018). Australian Commission on Safety and Quality in Health Care (2020) proposed the standard 3that is about preventing and controlling the healthcare-associated infection. The report is going to literature review about the issue discussed in the third standard which discusses the healthcare-associated infection and the literature review is going to divide into 4 themes to increase understanding toward the topic. The four themes for the literature review include introduction and prevalence of healthcare-associated infection, a different type of healthcare-associated infection, controlling measure for healthcare-associated infection. The last theme of the review will be the different intervention that can help to reduce the rate of healthcare-associated infection.

Literature Review of Healthcare-Associated Infections

A literature review helps the researcher to analyse the different quality research over the topic that help him/her to understand the different aspect of the topic. The review is important to identify the gap in the study which can be exploited in the research to add a new perspective to the study (Snyder, 2019).

Introduction to Healthcare-Associated Infections

The healthcare-associated infections are associated with the hospital setting and individual acquire the infection during treatment. They are the most common reason for mortality in the individual and they cause the increase hospital stay, increased medical and reason for morbidity. The reason behind the healthcare-associated infection is the misbalance in the infection control measure that leads to the transmission of the pathogen which leads to amplified infection in the patient (Almeida, 2015). One of the studies conducted by Ali et al. (2018) discuses that healthcare-associated infection is associated with the increased damage to the patient in both developed and low-income country that is directly related healthcare process. Healthcare-associated infection is responsible to affect 7.6% patient in the general ward and around 15.5 per 100 patients get affected by the infection. The article describes the different reason behind the increased rate of the healthcare-associated infection includes overcrowding, limited health care force, lack of infection control and lack of skill of health care professionals. The article describes the higher rate of healthcare-associated infection is related to the patient encountered any surgery or have any indwelling device and these are infection are more systemic than localized. The prevalence of the infection varies from different ward of the hospital and intensive care unit is considered to have increased risk to acquire the infection.

According to Souza et al. (2015), there are many risk factor that is linked to causing the healthcare-associated infection. The statistical data reveals that men are at higher risk to acquire the infection that is about 41% and increased age is also one of the risk factors that is linked with a high prevalence of healthcare-associated infection. The researcher also discussed how ICU patient is at higher risk to acquire infection due to their critical health status and the surgery also lead to increased risk to acquire the healthcare-associated infection. The important aspect discussed by the researcher is an invasive procedure that also increases the rate to acquire a healthcare-associated infection that directly increases the mortality rate of the individual. Healthcare-associated infection increases the health care challenge by generating complication that is directly related to the deteriorated condition of the patient. Moreover, a study conducted by Khan et al. (2017) describes different risk factor leads to an increased prevalence of healthcare-associated infection. The first risk factor according to the researcher is the environmental condition that includes poor hygienic condition and inadequate waste disposal that increase the rate of infection. Second risk factor includes immunosuppression in the patient due to disease that directly increases the risk to acquire infection. The third risk factor is unawareness of the health care associate regarding different equipment like improper injection technique, improper use of the invasive device, unsterilized device and lack of resources.

Types of Healthcare-Associated Infections

The article presented by Haque et al. (2018) describes how healthcare-associated infection is categorized according to the transmission route and affecting organ. The first healthcare-associated infection is central line-associated bloodstream infections (CLABSIs) and is it caused when the pathogen directly enter the central line which leads to entrances in the bloodstream that lead to serious complication. The article described how an increased number of CLABSIs occurs in the outpatient haemodialysis centre and inpatient ward. The common pathogens that are associated with infection include Candida, gram-positive and gram-negative bacteria. The researcher describes the second type of infection that is surgical site infection that leads to infection at the wound site that arises after 30-90 days after surgery. The rate of surgical site infection is determined by the type of surgery and the highest rate of infection occurs in orthopaedic surgery that is followed by cardiac or intra-abdominal surgery. The organisms that are involved to cause the infection include Pseudomonas, Acinetobacter, Staphylococcus and Enterococcus.

The article also discussed the third category of the infection is Catheter-associated UTIs and they are considered to be the most common infection. Urinary tract infection arises due to the indwelling catheter that directly increases the complication of the individual. the risk factor for infection include increased duration of catheter, female, older age, diabetes and inappropriate catheter drainage system, the pathogen involved include E. coli and eukaryotic fungus. The last is ventilator-associated pneumonia (VAP) that is developed after 48 hours of the patient in a mechanical ventilator that is given by endotracheal tube. Pneumonia associated with a mechanical ventilator is the major cause of death in the ICU patient and it 9 to 27% develop a health-associated infection due to mechanical ventilator. The different microorganisms that are involved in increased prevalence of infection include Klebsiella, Serratia, Stenotrophomonas and Acinetobacter.

On the other hand, a study conducted by Mitchell et al. (2015) describes the prevalence of the different type of healthcare-associated infection by considering different aspect. The bloodstream infection rate is about 7.7 patients per 10,000 beds that directly increase the complication of the individual. The surgical site infection occurs after the patient surgery at the rate of 2.7% that lead to an increase in hospital stay of the patient. Ventilator-associated pneumonia acquires about 11.3% that directly increase the death rate of the patient and catheter-associated infection account about 1.7 %.

Control measures for Healthcare-Associated Infections

According to Mathur (2020), the care bundle method is one of the best methods that can decrease the risk of healthcare-associated infection. The care bundle approach utilizes the set rules from the evidence-based method that is collaboration lead to improve patient health by decreasing the risk for healthcare-associated infection. The researcher describes a care bundle approach is a useful approach as it allows the health care professional to utilize an evidence- based approach to improve a clinical skill that directly leads to a decrease in the healthcare-associated infection. Article presented method that can help to decrease the central line-associated bloodstream infection by utilizing care bundle approach by incorporating certain strategy which includes careful hand hygiene, minimal manipulation to central catheter, attention to aseptic technique, rigour disinfection practice. The technique that can be utilized to prevent the catheter-associated infection includes early removal of the catheter, adherence to general infection control principle, condom catheter, bladder ultrasound to avoid catheterization, bedside alert for the catheter. The article also presented techniques that can be used to decrease the ventilator-associated infection include elevation of the head of the bed, daily sedation vaccine, daily oral care and continuous monitoring of the patient. The rate of surgical site infection can be decreased by pre-operative nasal screening, double-gloving before surgical treatment, postoperative blood glucose level, administration of prophylactic antibiotics and intraoperative hair clipping immediately before the operation.

Moreover, the article presented by Brouqui et al. (2017) discussed the use of new technology in the clinical practice that will assist to decrease the prevalence of healthcare-associated infection. The first technique that can be used is the electronic hand hygiene monitoring that helps to improve hand hygiene in the health care professional. The article describes that the monitoring system alerts the health care professional to perform hand hygiene before attending the patient that directly decrease the rate of infection. The second aspect that can be used is Peripheral Venous Catheter Traceability which directly helps to reduce the unnecessary use of a catheter that increases the risk for healthcare-associated infection. Biotechnological Application of Quorum Quenching Enzymes is another method that can be used to reduce the chances of biofilm formation that is directly related to the medical equipment related to healthcare-associated infection.

Intervention Programs for Healthcare-Associated Infections

World Health Organization (2016) proposed the Infection Prevention and Control program to decrease the rate of the healthcare-associated infection. IPC intervention covers the different aspect that needs to be incorporated in the health care setting to improve the quality of care. The IPC program is conducted at two-level national and facility level to improve the health care facility which directly decreases the prevalence of healthcare-associated infection. The IPC program includes education and training that help to improve the skill of the workforce which directly reduces the omission that can occur due to carelessness of the health care workers. The next aspect of the program includes surveillance that continuous monitoring of the workforce to analyse the working practise and issue that are need to be addressed. The last aspect of the program is multimodal strategies which include coordination between the different healthcare workers to increase the strategy used for the care process by understanding different perspective that can be used to improve the quality of care.

On the other hand, the article proposed by Guimarães & Costa (2018) discussed the multifaceted intervention method that aims to decrease the healthcare-associated infection. The first aspect as per the article is a behavioural change strategy that is attained by the collaborative effort of the organizational culture and behavioural attitude that helps to improve the workforce attitude toward care. The next aspect of the intervention includes public reporting of infection rate that helps to analyse the infection rate according to the hospital that helps to understand the prevalence of the disease. Environmental cleaning is also one of the important aspects of the intervention as clean surrounding directly reduces the rate of healthcare-associated infection. One of the important aspects of the intervention is to improve the hand hygiene routine in clinical practise that directly help to reduce the infection and decrease the recovery rate. The last aspect of the intervention that will help to decrease the infection rate is Antimicrobial stewardship programs (ASP). The article proposed that that proper implication of the intervention in the hospital setting help to reframe the care facility that will directly help to decrease the rate of infection.

Conclusion on Healthcare-Associated Infections

Healthcare-associated infection is one of the major health care burdens that have directly increased the mortality rate of the patient. The report has reviewed the healthcare-associated infection by dividing the review into four themes. The first theme describes how the healthcare-associated infection is increasing complication of the patient and increases the financial burden. The different risk factor associated with different healthcare-infection includes overcrowding, carelessness of the health care worker and irrelevant use of equipment. The second theme describes the different type of the healthcare-associated infection which include catheter-associated urinary tract infection, ventilator-associated pneumonia, surgical site infection and central line-associated bloodstream infections. The third theme of the review discusses the many control method which can be used to decrease the rate of healthcare-associated infection like a care bundle approach and new technology. The fourth theme of the review discussed the intervention program that is utilized to decrease the rate of healthcare-associated infection which includes Infection Prevention and Control program and multifaceted intervention program. The review directly indicates that there is a need to reframe the healthcare setting to change the working practice of the healthcare associates and the strength of the review is the latest articles are utilized to understand the issue.

References for Preventing and Controlling Health Care-Associated Infection

Ali, S., Birhane, M., Bekele, S., Kibru, G., Teshager, L., Yilma, Y. & Gudina, E. K. (2018). Healthcare-associated infection and its risk factors among patients admitted to a tertiary hospital in Ethiopia: a longitudinal study. Antimicrobial Resistance & Infection Control, 7(2), 1-9. DOI: 10.1186/s13756-017-0298-5

Almeida, S.-L. (2015). Healthcare-associated infections (HAIs). Journal of Emergency Nursing, 41(2), 100–101. DOI:10.1016/j.jen.2015.01.006

Australian Commission on Safety and Quality in Health Care. (2020). Preventing and Controlling Healthcare-Associated Infection Standard. Retrieved from: https://www.safetyandquality.gov.au/standards/nsqhs-standards/preventing-and-controlling-healthcare-associated-infection-standard

Brouqui, P., Boudjema, S., Soto Aladro, A., Chabrière, E., Florea, O., Nguyen, H., & Dufour, J. C. (2017). New approaches to prevent healthcare-associated infection. Clinical Infectious Diseases, 65(suppl_1), S50–S54. DOI:10.1093/cid/cix433

Guimarães, T., & Costa, S. F. (2018). New interventions targeting healthcare-associated infections. Current Treatment Options in Infectious Diseases, 10(1), 78–89. DOI:10.1007/s40506-018-0147-y

Haque, M., Sartelli, M., McKimm, J., & Abu Bakar, M. (2018). Healthcare-associated infections - an overview. Infection and drug resistance, 11, 2321–2333. https://doi.org/10.2147/IDR.S177247

Khan, H. A., Baig, F. K., & Mehboob, R. (2017). Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine, 7(5), 478–482. DOI:10.1016/j.apjtb.2017.01.019

Mathur, P. (2018) Prevention of healthcare-associated infections in low- and middle-income countries: The 'bundle approach'. Indian Journal of Med Microbial, 36, 155-62.

Mitchell, B. G., Shaban, R. Z., MacBeth, D., Wood, C.-J., & Russo, P. L. (2017). The burden of healthcare-associated infection in Australian hospitals: A systematic review

of the literature. Infection, Disease & Health, 22(3), 117–128. DOI:10.1016/j.idh.2017.07.001

Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, 333–339. DOI:10.1016/j.jbusres.2019.07.039

Souza, E. S., Belei, R. A., Carrilho, C. M. D., Matsuo, T., Yamada-Ogatta, S. F., Andrade, G., Perugini, M. R. E., Pieri, F. M., Dessunti, E. M. & Kerbauy, G. (2015). Mortality and risks related to healthcare-associated infection. Texto & Contexto - Enfermagem, 24(1), 220-228. https://doi.org/10.1590/0104-07072015002940013

World Health Organization. (2016). Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. Retrieved from: https://www.who.int/gpsc/ipc-components/en/

World Health Organization. (2017). The burden of healthcare-associated infection worldwide. Retrieved from: https://www.who.int/infection-prevention/publications/burden_hcai/en/

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