NURS5041 Staphylococcus Aureus Infections in Clinical Settings Assignment Sample

• Subject Code : NURS5041
• University : Curtin College My Assignment Services is not sponsored or endorsed by this college or university.
• Subject Name : Nursing

Leadership for the Clinical Context

Introduction to Healthcare-Related Infections

Healthcare-related infections are infections that are caught in a healthcare facility while receiving care and are caused by microorganisms such as viruses, bacteria, fungi, or any other parasites (Health.gov, 2020). While infections related to healthcare can be caused by numerous sorts of pathogens, the most common source of healthcare-related infections is bacteria (Health.gov, 2020). The microorganisms causing these infections are referred to as germs or bugs. Multiple kinds of infection can be caught while getting healthcare assistance if proper safety measures are not followed, such as wound infections, chest infections, and bloodstream and/or urinary tract infections (Healthy People.gov, 2020). Therefore, every healthcare facility must have control measures and policies for keeping their patients from getting any sort of infection, making sure that all the staff members are taking every possible precaution required to avoid the spread of infections (Wisconsin Department of Health Services, 2018).

This paper focuses on the analysis of a similar case study based on the alleviating demand for the health services provided by the local integrated health service (LIHS) because of multiple factors including the increasing rate of Staphylococcus aureus infections in patients. As the accreditation survey is due in the next six months, the LIHS needs to improve the quality of services received by their patients in order to prevent the decrease in funding it receives from both the government and private health providers. Thus, there will also be an analysis of the factors that are most likely to contribute to the existing issue. Furthermore, the development of certain plans to change healthcare practices to promote healthy environments will also be discussed.

Risk Factors Associated with Healthcare-Related Infections

Although every individual who is being admitted to a healthcare facility, such as a hospital, is at some risk of getting an infection, people who have recently had surgery or who are sick are at a higher risk of contracting an infection (Department of public health, n.d.). Moreover, other people who have greater vulnerability towards catching an infection include sick children and premature babies, frail individuals such as older people (Zhao et al., 2019), people with pertaining medical conditions such as diabetes, and people having their immune system compromised, for example, people getting chemotherapies and steroid treatments. Moreover, there are multiple risk factors that can increase a person’s chances of acquiring an infection. An individual’s prolonged stay in a hospital especially when they are suffering from complex multiple sicknesses can be attributed to their increased risk of contracting an infection.

Certain surgical procedures such as the duration and kind of surgery can also increase a person’s risk, for instance, an invasive procedure in which a person’s skin, which is the normal preventive layer of the body is bypassed can expose the body to infections, for example, the insertion of an IV cannula, an indwelling urinary catheter and respiratory equipment (Premier, n.d.). Additionally, people having severed skin having wounds, surgical incisions, ulcers or burns are at a greater risk than people having intact skin. Furthermore, inadequate safety practices such as improper hand hygiene followed by the staff as well as patients can also increase the risk of contracting infections.

Staphylococcus Aureus

Staphylococcus aureus (S. aureus), also known as golden staph is a bacterium commonly found colonising on the skin and inside the nose of around thirty percent human beings (CDC, 2019a). Other places where golden staph resides include axilla (armpits), under the folds of the skin, and in groins. In most of cases, S. aureus does not impart any harm, causing certain infections that are treatable, such as boils or pimples and few other skin conditions, but in healthcare settings, infections caused by S. aureus can be serious and even fatal (CDC, 2019a). These serious infections caused by S. aureus include infections of membranous lining of the brain (meningitis), bones and bone marrow (osteomyelitis), lungs (pneumonia), veins (septic phlebitis), and the valves of the heart (endocarditis). S. aureus can spread through direct contact of contaminated surfaces with the skin. Improper personal hygiene and keeping the wounds uncovered can promote the chances of S. aureus infections (CDC, 2019a). While most of the infections can be treated with antibiotics, there are a few known strains of staph that have resistance against antibiotics known as beta-lactams including common antibiotics such as amoxicillin, penicillin and oxacillin, and methicillin. These include methicillin-resistant S. aureus (MRSA), methicillin-susceptible S. aureus (MSSA), and more (CDC, 2019c).

MRSA frequently causes very severe and potentially life-compromising infections in patients staying in healthcare settings (CDC, 2019c). These life-threatening infections are troublesome to cure as the bacteria are resistant to antibiotics. Furthermore, people with colonised MRSA strain bacteria and showing no symptoms, usually healthcare workers, can transfer them from their contaminated hands to other people who might not have enough immunity to survive those infections, leading to their sepsis or death (CDC, 2019b). The people having a higher risk of MRSA fatal infections thus include patients of chronic diseases such as cancer, lung diseases and diabetes, and the individuals taking drugs via injections. People in healthcare settings, commonly intensive care units (ICUs), having immune systems compromised, or having undergone surgeries are at the greatest risk of catching staph infections. From the year 2005 to 2012, the rate of bloodstream infections caused by MRSA was reduced by 17.1% every consecutive year (CDC, 2019b).

Analysis of The Issues Related to The Case Study

In the provided case study, the local integrated Health services (LIHS), which was established in the year 2014 is now experiencing negatively influencing media reports due to several reasons. Moreover, the infection rates in the LIHS are now double that of any other healthcare service in that region leading to patients cancelling their surgeries because they are afraid of getting severe infections. These infections include Staphylococcus aureus infections, which were reported increasing from the past three years i.e. from the year 2017 to 2019. Twenty four S. aureus infection cases per 10,000 days of patient care were reported in 2017, which rose to 58 in the year 2018 and 65 in the year 2019. In addition to this, the infection rates at the surgical site, which was 17% in 2017, grew to 26% in 2018 and 32% in the year 2019. The compliance to hand hygiene was seen decreasing consecutively in the past three years, i.e. 82% in the year 2017, 62% in 2018, and only 56% in the year 2019. Therefore the decreasing compliance to hand hygiene can be attributed to the increasing rate of S. aureus infection in both clinical and surgical settings. All the healthcare providers must comply with the hand hygiene standards in order to ensure the provision of the best possible care to their patients (CDC, 2020). However, not only the healthcare service providers but also the patients themselves should follow good hand hygiene practices for their own safety (Chadwick, 2019), alongside asking their visitors as well to clean their hands (CDC, 2020).

The clinical services as shown in the case study indicated that for the years 2017 to 2019, the number of patients has been continuously decreasing in both general medicine and paediatrics departments. The people undergoing surgeries were also lesser in 2019 than in 2018, which were again lesser than in the year 2017 because a lesser number of people were being referred for surgery from the general practice to LIHS. This decrease can be attributed to the corresponding decrease in the staff members available for providing care to the patients in the years 2017, 2018 and 2019, as the number of healthcare workers lost days have also increased consecutively in these years, as a result of both absenteeism and injuries to healthcare workers. It is highly likely that in the presence of fewer staff members and heavy workload, the healthcare providers available for providing facilities have been taking less care for maintaining proper hygiene practices, including hand hygiene, leading to the transfer of Staphylococcus aureus from the asymptomatic staff members to their patients. Additionally, in the case study, the turnover of the LIHS staff members had also shown aggravated from 5% in the year 2017 to 28% in the year 2018 and further to 40% in the year 2019. Furthermore, there was no authority to make sure that all the hygiene practices were being followed by all the available staff members in the clinical areas as the quality department of the local integrated health service had no authority over the clinical department, this can also be attributed to the increasing rate of infection (Richmond Premium Dental and Medical Products, 2019).

Strategies for The Amelioration of Clinical Facilities in the LIHS

Considering all the loopholes that are currently present in the management system of LIHS clinical setting and as a part of my ethical duties as a nurse that includes the ethical principle of beneficence, which states that the nurses should make their best efforts in every situation in order to provide best possible care to their patients (Registered Nursing.org, 2020), I will take all the possible steps to improve the quality of care that the patients can get in the LIHS. Firstly, in order to prevent the infections related to S. aureus, the healthcare staff members in the LIHS have to be made well acquainted with the importance of washing their hands thoroughly along with appropriate housekeeping practices, including damp dusting (Chadwick, 2019). Moreover, they will have to be made aware when do they need to perform the hand hygiene practice, including prior to and following contact with a patient, right after coming in contact with any body fluid such as blood, or a patient's severed skin or mucous membranes even when gloves were worn while contacting and following the removal of gloves. In addition, during the client care, while moving to clean sites from contaminated sites, following contacting with medical equipments or objects in the close proximity to the patient, prior to eating something and after using the restroom as well as following sneezing or coughing (into a tissue as a routine breathing hygiene practice) (Wisconsin Department of Health Services, 2018).

Furthermore, patients will have to be encouraged by the staff members to follow hand hygiene practices (Chadwick, 2019), and when to necessarily do so, i.e. before and after touching their nose, eyes or mouth, prior to eating and after touching things such as doorknobs, bed rails and remotes, and following sneezing, coughing and using restrooms (CDC, 2020). In addition to telling the staff and patients about when to follow hand hygiene, telling them how to do so is also necessary, using both soap and water and alcohol-based hand sanitizers/rubs (WHO, n.d.). Moreover, the spread of S. aureus related infections have to be taken care of at the surgical sites also, thus proper preventive measure will have to be implemented before and after critical surgical procedures (CDC, 2019d). For instance, proper screening of patients at high risk of MRSA infections followed by the required core and supplemental strategies such as the use of intranasal anti-staph antibiotics or antiseptics (iodophor or mupirocin) and chlorhexidine wash/wipe before performing a high-risk surgical procedure on a patient (CDC, 2019d).

Additionally, the presence of an optimum number of staff members in also required in any clinical setting in order to make sure that the patients and their needs, as well as complaints, are appropriately addressed and proper balance between competency towards hygiene practices and available workload is being maintained (ANM Healthcare, 2017, February 19). This includes the factors related to the increasing staff turnover in the LIHS, such as the presence of psychological burnout in the nurses and other medical practitioners (Costa & Moss, 2018). Lastly, since ensuring adequate quality and safety in the clinical settings plays an important role in improving patient outcomes and their satisfaction (Health IT.gov, 2019), the quality department should be given authority over the clinical department of the LIHS. As a nurse leading change towards improving patient outcomes in the LIHS, I will make sure to implement all the aforementioned preventive measures before the next clinical audit.

Conclusion on Staphylococcus Aureus Infections

Healthcare-related infections are the infection that a patient contracts while receiving care in a clinical setting and these infections can be moderate to life-threatening, caused mostly because of bacterial infections such as Staphylococcus aureus infection. The infection caused by the antibiotic-resistant strains of S. aureus i.e. MRSA (methicillin-resistant S. aureus) usually leads to serious complications including deaths. This paper focussed on a case study based on a clinical setting where the infection rate due to Staphylococcus aureus was seen increasing consecutively in the past three years. Therefore, the analysis of factors associated with this increasing rate was done such as decreasing compliance with hand hygiene. Furthermore, certain preventive measures to be taken before the clinical audit that will happen after six months were also discussed in order to prevent the cutting of funding from both government and private healthcare providers. These measures include adequate compliance with hand-hygiene, proper quality checks in the clinical settings, and more.

References for Staphylococcus Aureus Infections

ANM Healthcare. (2017, February 19). Three ways healthcare staffing boosts patient satisfaction. https://www.amnhealthcare.com/latest-healthcare-news/three-ways-staffing-leads-to-patient-satisfaction/

CDC. (2019a). Diseases and organisms in healthcare settings. https://www.cdc.gov/HAI/organisms/organisms.html#staph

CDC. (2019b). Methicillin-resistant Staphylococcus aureus (MRSA). https://www.cdc.gov/mrsa/healthcare/index.html CDC. (2019c). MRSA. https://www.cdc.gov/hai/organisms/mrsa-infection.html CDC. (2019d). Staph BSI prevention strategies. https://www.cdc.gov/hai/prevent/staph-prevention-strategies.html

CDC. (2020). Clean hands count for safe healthcare. https://www.cdc.gov/patientsafety/features/clean-hands-count.html#:~:text=Hand%20hygiene%20is%20a%20great,patients%20on%20any%20given%20day.

Chadwick C. (2019). Infection control 4: good hand- hygiene practice for hospital patients. Nursing Times, 115(9), 27-29. https://www.nursingtimes.net/clinical-archive/infection-control/infection-control-4-good-hand-hygiene-practice-hospital-patients-29-08-2019/

Costa, D. K., & Moss, M. (2018). The cost of caring: emotion, burnout, and psychological distress in critical care clinicians. Annals of the American Thoracic Society, 15(7), 787-790. https://doi.org/10.1513/AnnalsATS.201804-269PS

Department of public health. (n.d.). Why people are at risk for healthcare associated infections (HAIs). https://portal.ct.gov/DPH/HAI/Why-People-Are-at-Risk-for-Healthcare-Associated-Infections-HAIs Health IT.gov. (2019). Clinical quality and safety. https://www.healthit.gov/topic/clinical-quality-and-safety Health.gov. (2020). Health-care associated infections. https://health.gov/our-work/health-care-quality/health-care-associated-infections

Healthy People.gov. (2020). Healthcare-associated infectionsNew. https://www.healthypeople.gov/2020/topics-objectives/topic/healthcare-associated-infections

Premier. (n.d.). Healthcare associated infections (HAIs).

Registered Nursing.org. (2020). Ethical practice: NCLEX-RN. https://www.registerednursing.org/nclex/ethical-practice/

Richmond Premium Dental and Medical Products. (2019). The importance of infection prevention and control (IPC). https://www.richmonddental.net/library/the-importance-of-infection-prevention-and-control-ipc/ WHO. (n.d.). Clean care is safer care. https://www.who.int/gpsc/clean_hands_protection/en/

Wisconsin Department of Health Services. (2018). Infection control and prevention – Standard precautions. https://www.dhs.wisconsin.gov/ic/precautions.htm

Zhao, X., Wang, L., Wei, N. Zhang, J., Ma, W., Zhao, H., & Han, X. (2019). Risk factors of health care–associated infection in elderly patients: a retrospective cohort study performed at a tertiary hospital in China. BMC Geriatrics, 19(193). https://doi.org/10.1186/s12877-019-1208-x

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