Mandating Action for the Prevention of Nosocomial Infections

Problem
From the onset, it is important to note that nosocomial or healthcare-acquired infections (HAIs) happen to be rather common in our healthcare settings. In basic terms, nosocomial infections could be defined as the all those infections that are acquired or contracted within the healthcare environment. To be more specific, the World Health Organization – WHO (2020) defines the said infections as all those infections that “affect patients in a hospital or other health-care facility, and are not present or incubating at the time of admission.” Further, according to WHO (2020), this category of infections could also be inclusive of infections acquired by hospital staff in the course of executing their functions within a healthcare facility. This is the definition that will be adopted in this policy brief. As the Centers for Disease Control and Prevention – CDC (2018) observes, at least 1 out of a total of 31 hospitals across the country report a minimum of 1 nosocomial infection on a daily basis. The impact this has on the general wellbeing of patients and hospital staff is significant. Indeed, according to WHO (2020), “hundreds of millions of patients are affected by health care-associated infections worldwide each year, leading to significant mortality and financial losses for health systems.” Towards this end, the relevance of suggesting policy measures to help address this particular problem cannot be overstated.
Background
CDC (2018) points out that although some progress has been made in efforts to reign in HAIs, there is still a lot of work to be done. This is an assertion echoed by Stone et al. (2015) who note that although there are plenty of laws – both federal and state - that have been enacted in an attempt to reign in HAIs in our healthcare institutions, significant progress is yet to be made. Some of the laws enacted on this front relate to the public reporting of nosocomial infections. For instance, the US has in the past enacted strict reporting laws targeting healthcare institutions. For instance, a total of 37 states have specific laws requiring healthcare institutions to furnish NHSN with the relevant HAI data from time to time (CDC, 2020). At the federal level, it ought to be noted that as per Public Law 111–148, Medicare is permitted to make payments to healthcare institutions on the basis of their reporting of quality measures (Stone et al., 2015). However, in the words of the authors, “the federal laws apply across all 50 states and provide incentives only; these interventions do not mandate action” (Stone et al., 2015). It is on this basis that a proposal is made for the formulation of standard preventive measures that would be applied across the board in an attempt to reduce nosocomial infections in our hospitals.
What is the Law?
The suggested law would lay down specific organizational and administrative measures that each healthcare institution ought to adhere to in attempts to minimize instances of nosocomial infections. To be specific, a total of two (2) measures have been highlighted/listed below:
1. Hospitals to ensure that all staff take the recommended viral and bacterial vaccines. This is particularly important given that recent studies have found that “historic and current vaccines have already contributed to reductions in healthcare-associated infections, and future vaccines have the potential to reduce these infections further” (McIntosh, 2018, p. 20).
2. Hospitals to have in place formal education and training programs for staff on the prevention of nosocomial infections. This would ensure that both new and existing staff have the relevant skills and capabilities to prevent HAIs in the hospital environment – thereby helping bring down the rate of nosocomial infections.
Other Policy Options
There are other policy options which also ought to be considered. These have been listed below:
1. Formulation of architectural and layout regulations targeting ICUs. This is a valid proposal given that as Andersen (2019) points out, one of the major contributors to infection spread happens to be the physical environment. Thus, suggestions in this case would ordinarily be inclusive of the utilization of antimicrobial materials, minimization of points of touch, ensuring adequate ventilation, putting in place visual cues to encourage staff to embrace desired behaviors, etc.
2. Have laid down Intensive Care Unit protocols for the prevention of HAIs. This is also an important policy consideration given that as Despotovic et al. (2020) point out, nosocomial infection rates happen to be very high in ICUs. As the authors further point out, “acquisition of Hospital-acquired infections (HAIs) in intensive care units (ICUs) predispose patients to higher mortality rates and additional adverse events” (Despotovic et al., 2020, p. 1212).
What’s Next?
There is need for the measures implemented to minimize HAIs to be proactive. This is more so the case given that as it has been pointed out elsewhere in this text, Stone et al. (2015) are convinced that the interventions that have been put in place at both the state and federal levels do not mandate action. Instead, as the authors point out, “they provide incentives only” (Stone et al., 2015, p. 639). The policy suggestions highlighted above are meant to mandate action. This is to say that they are designed to push for deliberate organizational and administrative courses of action to reign in nosocomial infections in healthcare facilities.
References
Andersen, B.M. (2019). Prevention and Control of Infections in Hospitals: Practice and Theory. New York, NY: Springer.
Centers for Disease Control and Prevention – CDC (2018). HAI Data. Retrieved from https://www.cdc.gov/hai/data/index.html
Centers for Disease Control and Prevention – CDC (2020). States with HAI Reporting Mandates. Retrieved from https://www.cdc.gov/hai/state-based/required-to-report-hai-nhsn.html
Despotovic, A., Milosevic, B., Milosevic, I., Mitrovic, N., Cirkovic, A., Jovanovic, S. & Stevanovic, G. (2020). Hospital-acquired infections in the adult intensive care unit—Epidemiology, antimicrobial resistance patterns, and risk factors for acquisition and mortality. American Journal of Infection Control, 48(10), 1211-1215.
McIntosh, D.G. (2018). Healthcare-associated infections: potential for prevention through vaccination. The Adv Vaccines Immunother., 6(1), 19-27.
Stone, P.W., Pogorzelska-Maziarz, M., Reagan, J., Merrill, J.A., Sperber, B., Cairns, C. …Skillen, E. (2015). Impact of laws aimed at healthcare-associated infection reduction: a qualitative study. BMJ Qual Saf., 24(10), 637-644.
World Health Organization – WHO (2020). Health care-associated infections FACT SHEET. Retrieved from https://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf?ua=1