Preventing Hospital-Acquired Infections: Strategies and Outcomes

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 carry some downsides. Hospital-acquired infections (HAIs) are one such downside. In basic terms, HAIs encompass all infections that were not part of the original diagnosis of the patient at the time of his or her admission to the hospital. Research studies conducted in the past have clearly indicated that HAIs are a major healthcare concern for not only patients, but also healthcare providers. For this reason, the importance of reining in HAIs cannot be overstated. Indeed, as Gupta et 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" (p. 150).

Defining HAIs and Their Impact on Patients and Healthcare Systems

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" (p. 1). In essence, HAIs can be triggered by micro-organisms including, but not limited to, parasites, fungi, viruses, and bacteria.

The primary focus of this paper is inpatients receiving treatment for various conditions and illnesses. HAIs occur at a significant cost to both patients and the entire healthcare system. In addition to causing illness and prolonging hospital stays, HAIs also result in extended recovery periods. As Schmier et al. (2016) point out, one of the most critical metrics in the evaluation of hospital quality is HAI rates. 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 et al., 2016, p. 199). It therefore follows that having measures in place aimed at minimizing instances of HAIs amongst patients in healthcare settings is of the utmost importance.

Common HAIs and Evidence-Based Prevention Strategies

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). Any intervention measures seeking to address HAIs ought to focus largely on prevention strategies for these most common types.

When it comes to CAUTI, Saint, Krein, and Stock (2014) emphasize the need to ensure that aseptic technique is utilized at the time of catheter insertion. Further, catheters ought to be secured so as to ensure that the flow of urine and drainage remains unobstructed. Another measure that can help prevent CAUTI is maintaining the sterility of the urine collection system and ensuring it is replaced at the appropriate time. Inadequate staff training on the insertion and maintenance of catheters can also contribute to CAUTI. Training staff on appropriate insertion and maintenance techniques is therefore critical in seeking to rein in this type of infection.

As Saint, Krein, and Stock (2014) observe, Clostridium difficile infection (CDI) is a leading cause of hospital-associated diarrhea. The authors further note that patients who acquire CDI are 2.5 times more likely to die from the infection than patients who do not have it. One strategy that can be embraced in seeking to contain the infection is the implementation of contact precautions for diarrhea cases. This calls for not only the use of gloves, but also the designation of a specific bathroom for infected patients. Daily cleaning of the hospital room using a hypochlorite solution for disinfection is also essential. Swift diagnostics are equally important in managing CDI.

Some of the most effective approaches to reducing VAP, as Gupta et al. (2014) observe, include: avoiding intubation whenever possible; prioritizing noninvasive ventilation; prioritizing oral intubation over nasal intubation except where contraindications exist; and avoiding re-intubation. Other effective approaches include "daily sedation vacation if feasible and assessment of readiness to extubate" and "daily oral care with chlorhexidine solution of strength 0.12%" (Gupta et al., 2015).

A surgical site infection occurs following surgery and affects the surgical site or the location of the surgical procedure. According to the Iowa Department of Public Health (IDPH, 2019), 1 to 3 persons out of every 100 surgery patients develop SSI. To put the severity of SSIs into perspective, "there are approximately 300,000 surgical site infections" annually, "which accounts for 17% of all HAIs, and second only to UTI" (IDPH, 2019).

There are a number of prevention approaches that can be utilized in this case. For patients undergoing high-risk procedures, decolonization for methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus is of great importance (Saint, Krein, and Stock, 2014). Such procedures may include orthopaedic surgery and prosthetic cardiothoracic procedures. Skin preparation prior to surgery should be performed using chlorhexidine alcohol-based antiseptic solutions, and antimicrobial soap should be used in hand preparation prior to surgery.

Conclusion

In the past, healthcare institutions have reported rising rates of HAIs, which have a negative effect on patient outcomes. It is therefore clear that standard care procedures utilized in most healthcare institutions fall short of reducing or limiting the transmission of harmful micro-organisms. The proposed interventions focus on infection prevention strategies particularly targeting the most common HAIs. Implementing evidence-based measures consistently across healthcare settings remains essential to protecting patients and improving overall healthcare quality.

References

Gupta, A., Todi, S., Myatra, S. N., 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