Research Review on Hospital-Acquired Infections (HAIs)

Research Review on Hospital-Acquired Infections (HAIs)

Nursing research has previously been carried out on different topics of clinical problems. Among those topics is the hospital-acquired infections. Research indicates that HAIs are a major challenge to healthcare institutions, healthcare professionals and to patient safety. HAIs are a major challenge to clinicians because they have been found to be the major cause of morbidity and mortality. The fact that HAIs lead to high mortality, morbidity and increased costs due to prolonged hospital stay, efforts should be made to make healthcare facilities as safe as possible to prevent the infections. This article provides a summary of knowledge about hospital-acquired infections, a step-by-step explanation of how nursing practice can be improved based on research findings and a description of how the protocol plan can be implemented in a healthcare institution.

Summary Knowledge on Hospital-Acquired Infections

A hospital- acquired infection (HAI), also referred to as a nosocomial infection is an infection that is acquired in a healthcare facility by a patient that was admitted there for other reasons other than that infection (McCarthy, 2015). It is an infection that was not present when the patient was being admitted in that healthcare facility. HAIs include infections that the patient acquired in the hospital and those that appeared after discharge, as well as occupational infections that are among the staff within the facility. 

The causes of nosocomial infections are bacterial, viral and fungal pathogens. Nosocomial infections that are found to frequently occur include urinary tract infections, lower respiratory tract infections and surgical wounds. In addition, bloodstream infections and pneumonia (such as ventilator-associated pneumonia) are acquired in the hospitals. Research studies by WHO and other researchers indicate that the highest prevalence of the infections occur in acute surgical, intensive care units and orthopedic wards. The rates of infections are more in patients with high susceptibility as a result of an underlying disease, chemotherapy or old age. For an infection to be referred as HAI, it must have occurred within 48 hours after healthcare facility admission, three days after discharge, 30 days following an operation and in a hospital where an individual was admitted for other reasons other than the infection (Dellinger, 2016). Symptoms for HAIs may include fever, difficulty urinating or burning urination, headache, vomiting, nausea, diarrhea, discharge from wounds, shortness of breath or coughs. New symptoms keep developing as patients continue staying in the hospital. 

According to Durani (2012), HAIs occur globally and they affect both resource-poor and developed nations. HAIs have been found to be a burden for public health and patients. In a prevalence survey that World Health Organization (WHO) conducted in 55 healthcare facilities in 14 nation that represent 4 WHO areas (Western Pacific, Eastern Mediterranean, Europe and South- East Asia), 8.7 percent of patients in hospitals were found to have nosocomial infections (McCarthy, 2015). At any given time, more than 1.4 million individuals globally have infectious complications that they acquired in health care facilities. According to the survey highest frequencies of HAIs were reported from healthcare facilities in South-East Asia and Eastern Mediterranean regions (10% and 11.8% respectively) where the prevalence was 9% and 7.7% in Western pacific and European regions.

HAIs add to emotional stress and functional disability of the patient and sometimes leads to disabling conditions which reduce life quality. Apart from being the leading cause of death, the infections lead to considerable costs. A study by Dellinger (2016) showed that the average increase in hospitalization duration for patients with infections resulting from surgical wounds was eight days. The days ranged from three days for gynaecology, 10 days for general surgery and 20 days for orthopedic surgery. Prolonged hospital stay not only increases direct costs to payers and patients but also indirect costs as a result of the work lost. In addition, drugs are used more, patients have to be isolated and there is more use of diagnostic and laboratory studies. All these lead to increased costs. HAIs are one of the leading causes of imbalance between primary and secondary care resource allocation because they divert funds to conditions that can be prevented. 

Protocol Plan to Improve Nursing Practice Based on Findings on HAIs Research

As antibiotic resistance increases and medical care becomes complex, HAIs cases will keep increasing. However, HAIs can be prevented and avoided in major healthcare institutions. A good protocol plan that can prevent HAIs and improve nursing practice would be one that addresses the root cause of the infections. This can be done by addressing the factors that influence development of nosocomial infections.  These factors include microbial agents, patient susceptibility, environmental factors and bacterial resistance.

The first step in this protocol plan would be to reduce or eliminate microbial agents that cause the infections. Findings from research indicate that patients are exposed to a wide variety of microorganisms during the process of hospitalization (Gould, 2015). The contact between the microorganisms and the patient does not necessarily result to infection development. Factors such as the frequency and nature of HAI may lead to infection development. The amount of infective substance, the intrinsic virulence and resistance to antimicrobial agents increase the likelihood of exposure to viruses, bacteria, parasites and fungi causing infections. Use of antibiotics kills the microbial agents and prevents them from spreading from one patient to others.

Another step in this plan would be to determine patients who are susceptible to HAIs in order to provide them with extra care. According to Durani (2012), patient factors that influence their acquisition of infections include immune status, underlying disease, age and therapeutic and diagnostic interventions. Studies indicate that the extremes of life, old age and infancy, decrease resistance to infections. Also, patients that have chronic diseases like leukemia, renal failure, malignant tumors or AIDS are susceptible to infections caused by opportunistic pathogens. Irradiation or immunosuppressive drugs also lower resistance to HAIs. Skin injuries or mucous membrane interferences bypass body’s defense mechanisms. A majority of modern therapeutic and diagnostic procedures like endoscopic examinations, biopsies, and intubation / ventilation, catheterization and suction increase infection risks. Knowledge of those patient factors would enable health professionals accord patients more care.

The next step of the plan would be to consider the environmental factors that lead to the spread of infections. Health care facilities are environments where those at the risk of infections and those that are infected meet. Patients who are infected or those that are carriers of pathogens, and are admitted in heal care facilities are potential sources of HAIs for both staff and patients. In this step, the management is supposed to ensure that the infected and patients who are carriers of pathogens are isolated from the others in rooms where they receive care. In addition, more care should be taken so that when health care professionals are in their day-to-day work they do not spread the infections. Research shows that crowding in hospitals, frequent transfers across units and concentration of susceptible patients aid in development of HAIs (Gould, 2015). 

The last step in this protocol would be to discourage the use of antibiotics when it is not necessary in order to prevent development of multidrug-resistant bacteria strains. Findings from research indicate that antibiotics promote emergence of bacteria that are resistant to various drugs (McCarthy, 2015). The resistant strains become an endemic in health care facilities since they are not suppressed by the mostly used antibiotics. 

Implementation of the Protocol Plan

Implementation of the plan protocol will involve all staff working within a particular health care facility. The medical management (administration) will provide leadership and support for an infection program that will be created. The management will create an infection control committee, identify appropriate resources to monitor infections and ensure all staff are educated and trained on how to prevent infections through sterilization and disinfection techniques. In addition, the management will delegate hospital hygiene (nursing, maintenance, housekeeping and clinical laboratory) to the appropriate staff. It will be the role of management to review, approve and implement policies that control HAIs. 

Physicians will control and prevent HAIs by use of practices which minimize infections while providing direct patient care; isolating, handwashing and following appropriate hygiene; protecting their patients from those staff and patients that maybe infected; and notifying HAIs cases to infection control team and admitting patients that are infected. Physicians will also advise visitors, staff and patients on techniques they should use to prevent transmission of infections. They will also be required to institute treatment that is appropriate and prevent the infections that they may be having from spreading.

Nursing staff spend most of their time with patients. They will prevent HAIs by maintaining hygiene in tandem with facility policies, monitor aseptic techniques as well as isolation and handwashing; report to the physician any evidence of HAI; limit the exposure of patients to infections that maybe transmitted by hospital staff, visitors, equipment used in treatment or from other patients; and maintenance of adequate supply and safe ward supplies and equipment. In addition, nurses who handle patient specimens should follow guidelines that have been established for collection, handling and transporting them. Nursing staff would also be monitoring disinfection, sterilization and the environment where appropriate. 

In conclusion, hospital- acquired infections or nosocomial infections are acquired in a healthcare facility by a patient that was admitted there for other reasons. The infections are caused by bacterial, viral and fungal pathogens. HAIs are a burden to patients and healthcare professionals since they lead to increased morbidity and mortality rates apart from increased healthcare costs. The infections affect resource-poor and developed nations as well. HAIs can be prevented and avoided in major healthcare institutions. This can be done by addressing the factors that influence development of nosocomial infections, which include microbial agents, patient susceptibility, environmental factors and bacterial resistance. An effective protocol plan is one that ensures that all the services and individuals providing health care within the institution are involved. All staff, including care providers and the management should cooperatively work to reduce risks of infection.

References

Dellinger, E. (2016). Prevention of Hospital-Acquired Infections. Surgical Infections, 17(4), 422-426. http://dx.doi.org/10.1089/sur.2016.048

Durani, D. (2012). Hospital Acquired Infections due to Gram Negative Bacteria Related to Endotracheal Tube at Tertiary Care Hospital. International Journal of Scientific Research, 3(7), 361-362. http://dx.doi.org/10.15373/22778179/july2014/109

Gould, D. (2015). Hospital Acquired Infections – Power Strategies for Clinical Practice Hospital Acquired Infections – Power Strategies for Clinical Practice. Nursing Standard, 21(44), 31-31. http://dx.doi.org/10.7748/ns2007.07.21.44.31.b642McCarthy, M. (2015). Hospital acquired infections are falling, CDC reports. BMJ, 350(jan16 4), h296-h296. http://dx.doi.org/10.1136/bmj.h29