Nosocomial Infections and Infections

Nurse burnout is a common occurrence. This can exacerbate an ongoing problem that is seen in hospitals, nosocomial infections. Nosocomial infections remain prevalent for patients with extended hospital stays like those in intensive care units. An infection that starts roughly 48 hours after admission, those in intensive care units (ICUs) experience a continued rate of infection leading to increase length of stay, mortality, and morbidity. The number of patients that develop a nosocomial infection are from 7 to 10% internationally (Dasgupta, Das, Hazra, & Chawan, 2015). As such, hospitals have decided to classify nosocomial infection sites based on clinical and biological criteria.

Research has led to the discovery of several bacterial strains that involve the formation of nosocomial or hospital acquired infections. "The agents that are usually involved in hospital-acquired infections include Streptococcus spp., Acinetobacter spp., enterococci, Pseudomonas aeruginosa, coagulase-negative staphylococci, Staphylococcus aureus, Bacillus cereus, Legionella and Enterobacteriaceae family members, namely, Proteus mirablis, Klebsiella pneumonia, Escherichia coli, Serratia marcescen" (Khan, Ahmad, & Mehboob, 2015, p. 509). These pathogens can be transmitted via infection individuals, contaminated food and water, person to person, environment, contaminated healthcare personnel's skin, and contact from shared surfaces/items. The kinds of multi-drug resistant pathogens are: "methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Pseudomonas aeruginosa and Klebsiella pneumonia, whereas Clostridium difficile shows natural resistance" (Khan, Ahmad, & Mehboob, 2015, p. 509).

With 90% of the infections stemming from bacteria, the potential mistakes made by burned out or overworked nurses regarding hygiene could further progress the problem. Those in ICUs often stay there for an average of one week or more and may experience infection via several ways. Two of which are catheter and length of stay. The most frequent nosocomial infection experienced in ICUS is pneumonia. "Pneumonia was the most frequently detected infection (62.07%), followed by urinary tract infections and central venous catheter associated bloodstream infections. Prior antimicrobial therapy, urinary catheterization and length of ICU stay were found statistically significant risk factors associated with nosocomial infection" (Dasgupta, Das, Hazra, & Chawan, 2015, p. 14). Although the data used came from a hospital in Eastern India, many research articles note that length of stay and catheters lead to increased rates of nosocomial infection.

Increased rates of nosocomial infection can be prevented if nursing science is applied. Meaning, research suggests nurse staffing could have a potential link to the occurrence and prevention of nosocomial infections. With annual nosocomial infections reaching 7 million affected, nurses facing increased workloads and burnout are more likely to commit errors that can lead to higher rates of infection. In fact, some researchers state the reduction of nurse burnout can lead to reduction in nosocomial infections.

There was a significant association between patient-to-nurse ratio and urinary tract infection (0.86; P = .02) and surgical site infection (0.93; P = .04). Hospitals in which burnout was reduced by 30% had a total of 6,239 fewer infections, for an annual cost saving of up to $68 million (Cimiotti, Aiken, Sloane, & Wu, 2012, p. 486).

Cimotti, Aiken, Sloane, & Wu share the link between patient satisfaction, suboptimal care, and nurse job-related burnout. As the nursing shortage reaches critical in many areas of the country and the world, the nurses working often have increased workloads, having to treat a higher number of patients daily. The constant shifts, increased number of patients, and limited break time can leave a nurse stressed and overworked. Nurses can suffer from mental and emotional exhaustion leading to cognitive and emotional detachment (Cimiotti, Aiken, Sloane, & Wu, 2012). This is when nurses may make more mistakes in terms of hand hygiene, delivery of medications, and most importantly, catheter removal.

The population is patients in intensive care units and the identified health risk is nosocomial infections. The CDC gave Hospital Acquired Infections (HAI) statistics from 2011 and stated the highest occurrence of infection was pneumonia, with an estimated 157,500 cases reported in 2011. The second are gastrointestinal illness with 123,100, followed by urinary tract infections with 93,300. The 4th, 5th, and 6th major sites of infection are primary blood stream infections (71,900), surgical site infections from inpatient surgeries (157,500), and other types of infections (118,500), for a total of 721,800 estimated reported cases of nosocomial infections (CDC, n.d.).

Some progress has been made at reducing nosocomial or HAI infections from 2008 and 2014. Specifically, central-line associated bloodstream infections have witnessed a 50% decrease in occurrence (CDC, n.d.). A 13% decrease has been identified in MRSA related infections from 2011 to 2014. However, catheter-associated urinary tract infections (CAUTI) have remained the same from 2009 to 2014. This demonstrates the need for CAUTI to be recognized as a continued and primary source of nosocomial infections. Below is SPSS data that correlates with the information presented along with potential brief look through at the progress and lack of progress made regarding nosocomial infections.

Source: (Ohara et al., 2013).

Catheters have been identified as a main component of nosocomial infections in intensive units (Dasgupta, Das, Hazra, & Chawan, 2015). The reason why they generate infection is because they are left in patients longer than needed. Nurses may forget to take out the catheter early on, or they may decide the patient's catheter should not be removed. The more time a catheter is in a patient's urethra, the better chance for a urinary tract infection (UTI).

Another potential obstacle that may hinder implementation of methods that reduce nosocomial infections is lack of nursing staff available to reduce existing nurse's workload. As previously mentioned, nurses suffering burnout are more likely to commit mistakes like keeping a catheter in place for longer than necessary. If nursing shortages continue to be the norm, there is no means of alleviating the workload for existing nurses. This becomes the main obstacle in implementation.

One potential solution is benchmarking data for training purposes. If data is available that can allow for the effective training of new nurses, this can lead to a potential solution for a nursing shortage. The problem here is the lack of ability of those performing the data analysis to assess accurately all the patient risks within a heterogenous population. "The main challenge to external benchmarking is accounting for differences in patient risks and surveillance methodologies" (El-Saed, Balkhy, & Weber, 2013, p. 326).

Should information be properly collected and used to standardize certain practices, this may also lead to a reduced workload for nurses. Nurse burnout can occur purely from a lack of experience in treating and caring for patients (Khan, Ahmad, & Mehboob, 2015). The nurses that receive adequate information to perform proper job-related functions will have reduced likelihood of committing errors and improve their patient-care abilities.

Certain stakeholders that can assist in the process of training new and existing nurses are nurse managers and nurse educators. Nurse managers are the ones responsible for managing the workload for nurse practitioners and can provide the administrative support needed to implement positive changes. (Cheng, Bartram, Karimi, & Leggat, 2016). In fact, transformational leadership (TL), may lead to a purposeful and beneficial impact on nurse burnout and intention to leave, resolving some of the current problems with nursing shortage. "Results illustrate that social identification appears to be the psychological mechanism through which TL impacts important employee outcomes, including perceived quality of patient care" (Cheng, Bartram, Karimi, & Leggat, 2016, p. 1200).