Prevention Approaches for Hospital Acquired Infections

Introduction
Advances in medicine have resulted in the further enhancement of patient outcomes in healthcare settings. It is, however, important to note that the treatment of many patients in close proximity does have some downsides. Hospital acquired infections (HAIs) are one such downside. In basic terms, HAIs are inclusive of all the infections that were not part of the original diagnosis of the patient during his or her admission at the hospital. Research studies conducted in the past have clearly indicated that HAIs are a major health care concern for not only patients, but also healthcare providers. For this reason, the relevance of reigning in HAIs cannot be overstated. Indeed, as Gupta at al. (2014) point out, taking into consideration “morbidity, mortality, increased length of stay and the cost, efforts should be made to make hospitals as safe as possible by preventing such infections” (150).
Discussion
In seeking to further conceptualize the HAI concern with an aim of recommending the relevant interventions, it would be prudent to offer a more precise definition of HAIs. The World Health Organization – WHO (2002), defines a hospital acquired infection or nosocomial infection as “an infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission” (1). In essence, HAIs could be triggered by micro-organisms including, but not limited to, parasites, fungi, viruses, and bacteria.
The primary focus of this undertaking will be inpatients receiving treatment for various conditions and illnesses. It is important to note that HAIs occur at a significant cost to both patients and the entire health care system. When it comes to their impact on patients, it should be noted that in addition to causing illnesses amongst patients and prolonging their stay in hospital, HAIs also result in extended recovery periods. On the other hand, as Schmier at al. (2016) point out, one of the most critical metrics in the evaluation of quality in hospitals are HAIs. In the words of the authors, “high scores (poor performance) can lead to penalties, such as those associated with the Hospital-Acquired Condition Reduction Program established by the 2010 Patient Protection and Affordable Care Act” (Schmier, 2016, p. 199). It therefore follows that the relevance of having in place measures aimed at minimizing instances of HAIs amongst patients in healthcare settings cannot be overstated.
Some of the more common HAIs include catheter associated urinary tract infection (CAUTI), clostridium difficile infection (CDI), ventilator-associated pneumonia (VAP), and surgical site infection (SSI). Towards this end, any intervention measures seeking to address HAIs ought to largely focus on the prevention strategies to be adopted in seeking to prevent the most common HAIs identified above. To begin with, when it comes to CAUTI, it is important to note that as Saint, Krein, and Stock (2014) point out, there is need to ensure that the aseptic technique is utilized at the time of insertion. Further, catheters ought to be secured so as to ensure that the flow of urine as well as drainage is unobstructed. Yet another measure that could be taken in seeking to prevent CAUTI is the maintenance of the urine collection system’s sterility and ensuring that the same is replaced at the appropriate time. It is also important to note that in some instances, inadequate staff training on the insertion as well as maintenance of catheters does result in catheter associated urinary tract infections. Training of staff on the appropriate insertion as well as maintenance techniques is therefore critical in seeking to rein in CAUTI.
Next, clostridium difficile infection (CDI), as Saint, Krein, and Stock (2014) observe, happens to be a leading hospital-associated diarrhea cause. As the authors further point out, patients who acquire CDI have a 2.5 times likelihood of dying from the infection than patients who do not have the infection. One strategy that could be embraced in seeking to contain the infection is the implementation of precautions with regard to contact for diarrhea cases. This calls for not only the utilization of gloves, but also the selection of a designated bathroom for infected patients. On this front, the cleaning of the hospital room also ought to be a daily affair and ought to utilize a hypochlorite solution for disinfection purposes. Diagnostics should also be swift.
Third, we have ventilator-associated pneumonia (VAP). Some of the most effective approaches in seeking to rein in VAP, as Gupta at al. (2014) observe, include: intubation avoidance whenever possible; prioritization of noninvasive ventilation; prioritization of oral intubation (as opposed to nasal intubation) except in those instances where there are contraindications; re intubation avoidance; etc. Other equally effective approaches in this case include, but they are not limited to, “daily sedation vaccination if feasible and assessment of readiness to extubate” and “daily oral care with chlorhexidine solution of strength 0.12%” (Gupta at al., 2015).
Lastly, we have surgical site infection (SSI). In basic terms, a surgical site infection occurs following surgery and essentially affects the surgical site or the actual location of the surgical procedure. According to the IOWA Department of Public Health – IDPH (2019), 1-3 persons, out of 100 surgery patients, develop SSI. To bring the severity of SSIs into perspective, it should be noted that every year, “there are approximately 300,000 surgical site infections, which accounts for 17% of all HAIs, and second only to UTI” (IDPH, 2019). There are a number of prevention approaches that could be utilized in this case. For instance, in patients undergoing procedures deemed high-risk, the relevance of decolonization for methicillin-resistant Staphylococcus aureus and Methicillin-sensitive Staphylococcus aureus cannot be overstated (Saint, Krein, and Stock, 2014). Such procedures could be inclusive of orthopaedic surgery and prosthetic cardiothoracic. The preparation of skin prior to surgery should also be done using chlorhexidine alcohol?based antiseptic solutions. This is in addition to using antimicrobial soap in hand preparation prior to surgery.
The expected outcomes of the successful implementation of the strategies highlighted would be the effective prevention of HAIs and, thus, reduced rates of mortality and morbidity as a consequence of nosocomial infections. The other likely outcome is the standardization of meaningful precautions likely to help in the reduction of infection transmission.
The proposed site for the conduction of the study would be ……………
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In the final analysis, one of the AACN DNP essentials that I would find challenging as I implement my project is scientific underpinnings for practice. This is more so the case when it comes to the utilization of scientific theories to highlight the relevant courses of action to alleviate the concerns identified herein, and thereafter assess the outcomes. I would be seeking to overcome this challenge by, amongst other things, consulting the various peer-reviewed articles that have been authored in the past regarding hospital acquired infections and the prevention mechanisms that have been shown to be effective.
Conclusion
It is important to note that in the past, healthcare institutions have reported rising rates of HAIs. These have a negative effect on patient outcomes. It is therefore clear that standard care procedures utilized in most of our health care institutions fall short of reducing or limiting the transmission of harmful micro-organisms. The proposed interventions in this case focus on infection prevention strategies particularly for HAIs. 
















References
Gupta, A., Todi, S., Myatra, SN., Samaddar, D.P., Patil, V., Bhattacharya, P.K. & Ramasubban, S. (2014). Guidelines for Prevention of Hospital Acquired Infections. Indian Journal of Critical Care Medicine, 18(3), 149-163.
IOWA Department of Public Health – IDPH (2019). Surgical Site Infections (SSI): What is SSI? Retrieved from https://idph.iowa.gov/hai-prevention/information/ssi
Saint, S., Krein, S.L. & Stock, R.W. (2014). Preventing Hospital Infections: Real-world Problems, Realistic Solutions. New York, NY: Oxford University Press.
Schmier, J.K., Hulme-Lowe, C.K., Semenova, S., Klenk, J.A., DeLeo, P.C., Sedlak, R. Carlson, P.A. (2016). Clinicoeconomics and Outcomes Research, 8, 197-205.
World Health Organization – WHO (2002). Prevention of Hospital-Acquired Infections. Retrieved from http://apps.who.int/medicinedocs/documents/s16355e/s16355e.pdf