Nosocomial Infections at Good Health Hospital
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Nosocomial infection, also referred to as hospital-acquired infection, is an illness whose progression is favored by the environment of the hospital. It may be an illness that a patient acquires during a hospital visit or one developing among hospital staff. These infections have been noted to be rampant in Tampa bay hospitals. Among these infections are fungal, viral and bacterial diseases (Rundle, 2005). In most cases, sites of infection include the sites of surgery and the urinary tract. They are exacerbated by the diminished resistance of individual patients because of initial sickness. These illnesses are usually considered to be easy to avoid. The illnesses can however have a challenge in prevention especially in neonatal acquisition whereby the mother passes the infection to the unborn child. The major targets for hospital acquired infections are patients whose immunity are compromised due to an age extreme, young or old, surgery or another invasive medical procedure, or an underlying disease. The rate of the illness is close to three times greater in the Intensive Care Unit than it is anywhere else in the hospital.
Escherichia coli is a gram negative bacteria and it is amongst the most common causes of bacterial hospital acquired infections as noted at the Good Health Hospital. The gram negative bacilli, Pseudomonas aureginosa and Enterobacteriacea, of which E. coli belongs, are mostly responsible for the cause of about 32% of these infections. According to the records at good health hospital, Escherichia coli cases are common among the young adult patients. There are numerous cases of occurrence in patients who are in the age bracket of 20-25 years. In this category, two cases (50% of the incidences) were noted. One case equivalent to 25% of the disease incidence was noted in patients of ages 15 and 42 years. The data also depicts that these cases are the same across the gender of the patients whereby 50% of the reported cases are male and the other 50% are female.
Nosocomial infections are also associated with hygiene and patients from the ethnic group associated with poor hygiene especially due to poverty and low standard of living will always be the most affected with higher incidences. In relationship to time, when Good Health Hospital wards are overcrowded with patients, there are high cases of nosocomial infections like the respiratory or airborne infections. The opposite will be true when the hospital has fewer numbers of patients (Moellering, 2006).
For health care administrator to litigate nosocomial infections at the hospital, some questions have to be noted. The administrator should ask how hospital infections spread. Knowledge of how nosocomial infections spread is vital for its control. It is important to know that illnesses spread both through air and by touch. According to Kowalski (2007), airborne nosocomial infections mostly spread through coughing and sneezing. By touching hospital surfaces like beds and beddings, where germs can be numerous, patients are also exposed to the same infections. Knowledge of how infections spread will enable the health administrator in this hospital to educate the patients on preventive measures such as protected coughing and sneezing and carry out sterilization and decontamination of hospital facilities.
Moreover, the administrator should also ask how to limit transmission of organisms. This will ensure that the spread of the causal organism for any nosocomial infection is kept under check. The transmission organism through patients during the care of patients can be limited through proper washing of hands, use of gloves, practice of aseptic methods, strategies to isolate the causal microorganisms, practices that ensure sterilization and disinfection of equipments and facilities used in the hospital settings and laundry.
The other question is finding out if there is an availability of prophylactic antimicrobials or vaccination against the causal organism. Antimicrobials are imperative in keeping patients safe from attack by the germs that cause diseases. For instance, the systemic administration of antimicrobials is majorly applied to prevent nosocomial pneumonia.
Another question is to find out if some invasive procedures can be minimized or stopped. Operation procedures that involve activities such as insertion of catheters make one prone to germs like staphylococcus aureus which entirely causes infections. They cause or leave wounds in the areas of contacts and this is a risk factor and the cause of entry for these pathogens. Minimizing such operations limit the risks of nosocomial endogenous infections. After such operations, use of microbials should also be used optimally in circumstances whereby the procedures are unavoidable (Wladyslaw, 2007).
The health administrator should find out how surveillance and monitoring of the nosocomial infection can be done. In case infections are identified, their trend of progression should be monitored closely to ensure that they do not spread and infect high number of patients in the hospital. Most of these infections spread rapidly if not checked, especially those infections that are frequented by diarrhea as the major symptom. The health administrator should find out how to prevent infection within the members of staff in the hospital setting. This majorly can involve continued staff education and enhanced staffs to patients care practices.
Table 1: an implementation plan for handling various levels of risk infections aseptically
Infection risk asepsis antisepsis hands clothes devices Target audience
Low risk clean none Simple washing of hand/ disinfection of hand by rubbing Simple clothing Clean/ disinfected at low level Nurses and patients
Medium risk
asepsis Antiseptic products which are standard Hygienic hand washing Protection against blood and fluids from the body Disinfected at high level Nurses and patients
High risk Surgical asepsis Target major products Surgical disinfection of hands Surgical clothes, caps, dress, mask and sterile gloves High level of disinfection Doctors, nurses and patients
Table 2: Steps in final plan implementation
task time Resource /personnel Expected outcome target comment
1. Improvement of hospital capacity immediately Government To ease congestion in hospital wards. Safety gears as gloves and surgical materials Good health hospital Facilities like old beddings to be disposed off.
2. Patients education continuous Health practitioners.
Government Awareness to be created on proper hygiene measures like simple hand wash Patients admitted at Good Health hospital.
Patients to be educated through public lectures.
3. Health care givers
education continuous Government Care givers to be enlightened on ways of avoiding infections from patients. All the care givers Capacity building of health care givers through short courses
Recommendations to the head of department
Medical doctors and nurses should have an on job training to acquire skills which will help them remain safe while giving treatment to patients and to minimize introduction of nosocomial infections to their patients. This will help ensure that the help practitioners acquire knowledge on how serious infections from the patients can be prevented from infecting the caregivers.
The hospital administration should improve the physical facilities of Good health hospital like improving the bed capacities to avoid overcrowding.
Admitted patients should be taught on ways of avoiding contamination for example, through hand washing.
Only necessary medical operations should be done to patients to avoid introduction of endogenous germs which are acquired from the external environment of the hospital.
Operations involving High risk infections should only be done by highly qualified specialists to avoid unnecessary deaths arising from failures of such procedures.
Safety Protocol
Use of good hospital principles; reduce infections by offering single bed rooms and improve air infiltration system.
Reduce shift periods for medical staff. This is because acute and chronically tired medical residents are prone to making mistakes. Residents who perform duties on 30-hour shifts should only handle patients for up to 16 hours and should have a five-hour protected sleep period
Patients’ education on use of blood thinners; after operation, wrong use of blood thinners can cause severe bleeding of patient. The blood thinners are always inserted after operations and they are important for ensuring that clotting of blood is achieved. They are therefore critical for post operative healing and patients cannot do without them. A right patient’s education on their management is hence very critical.
In the managing of infections of the urinary tract, enclosed catheters can be removed if it can be possible, to avoid continuity and reoccurrence of illness. In certain situations, catheter removal may result to spontaneous bacteriurial resolution. Administering empiric antibiotics and antifungal therapy can be considered as being in a position to prevent a patient from developing major medical ramifications, which can include pyelonephritis, infections of the blood stream and damage of the kidney. The period of treatment is a point of argument and is not well defined. Most medical practitioners however recommend not less than ten to fourteen days of treatment for children who are experiencing sepsis, pyelonephritis, or abnormality of the urinary tract, (Randle, 2005).
Surgical-site infections should be managed with a combination of surgical care and antibiotic therapy to prevent occurrences of nosocomial infections occurring from post operative procedures. The coverage of antibiotics may be altered when culture outcomes are available (Kowalski, 2007). In cases of these kinds of infections, provision of antibiotics only may not work as a regimen for the infection.
Additional infections which are associated with healthcare: Rotavirus which invades the gastro-enteric region is an illness which limits itself. Such illnesses only need proper and adequate supportive care by both the caregivers and the patients as part of the management regimen. Medical management should put a lot of emphasis on preventing dehydration, which can be a very serious cause and spread of nosocomial diarrhea.
Restructuring of hospital discharges. Potentially preventable readmissions can be lowered by assigning a medical staff member to work in close contact with patients and other staff to reconcile medical regimens and program important follow-up of medical appointments (Kowalski, 2007). The health administrator at the Good Health Hospital should create a simple, precise and easy-to-understand plan of discharge for each patient, containing a medication schedule, a record showing all upcoming medical appointments, and names personal contact details like phone numbers of a staff to be contacted in case of any problem which may arise. These steps will eventually lower cases of readmission by two thirds, equivalent to 30%.
References
Kowalski, Wladyslaw. (2007). Airborne Superbugs: Can Hospital-Acquired Infections Cause Community Epidemics? Research & Development Journal, 3(42), pp 28-32. Retrieved from http://patients.about.com/sitesearch.htm?q=Airborne+Superbugs%3A+Can+Hospital-Acquired+Infections+Cause Community epidemics?
Kowalski, Wladyslaw. (2007). Air-Treatment Systems for Controlling Hospital-Acquired Infections. Heating/Piping/Air Conditioning Engineering: HPAC, 1 (79), pp 33-48. Retrieved from http://search.proquest.com/business/publication/publications_24945?accountid=45049.
Moellering, R.C. (2006). The Growing Menace of Community-Acquired Methicillin-Resistant Staphylococcus aureus. Annals of Internal Medicine, 144(5), pp 368-370. http://search.proquest.com/docview/1263031431/1431E4417476179E06D/1?accountid=45049
Rundle, Rhonda. (2005). Pennsylvania Finds High Toll In Hospital-Acquired Infections. Wall Street Journal. Retrieved from http://search.proquest.com/docview/399042115?accountid=45049.
