Infection Control in Hospitals: Problems and Solutions - Research Paper Example

Everywhere-present, is the term used to describe the nature of micro-organisms with regard to their distribution within the environment. Despite there being institutions like hospitals, whose work it is to curb effects of pathogenic micro-organisms, it is a huge challenge to completely eliminate them. Since several species and subtypes of pathogenic agents exist in different patients from the varied origins they hail from, it would be a health disaster if cross infections occurred, making the objective of the hospitals a distant reality. In this sense, hospitals become like a mammoth micro-organism culture environment since people gather there with various infections with a hope of getting help. Prevention and control strategies must clearly be reinforced to ensure that everyone is safe in the hospitals. Specific attention must be paid to diagnosis, isolation where necessary, effective surveillance and prevention measures must be heightened in these delicate settings. Microbiology practices when adhered to with a considerable level of compliance would significantly reduce hospital-acquired infections. This study was done in an attempt to highlight this topic using an analysis of the major hospital problems and finally addresses the solutions thereon to be adopted. Infection Control in UK Hospitals Introduction Disease causing micro-organisms such as fungi, protozoa, fungi, bacteria and other parasites occur almost in every natural and human created setting. This means that human beings can get infected with diseases wherever they are although the situation is worse under certain conditions and not others. Unhygienic conditions, for example, are a common and favourable hub for pathogenic micro-organisms which multiply faster under such environments. Infectious or transmittable diseases will easily be spread from one individual to another through different ways. One such pathway is physical contact between an infected person and another person who is uninfected. The agents that cause infection may also be transferred from one person to another through food, liquids, and contaminated objects. Yet again, they may be transmitted through vectors such as mosquitoes and through the inhalation of contaminated air. Hospitals play a significant role when it comes to the treatment of diseases and prevention of their spread between persons and regions. In many cases, sick people visit hospitals where they get diagnosed and are given medication that destroy the disease causing agents leading to their restored health. In spite of hospitals’ being considered as places for the restoration of health, they also are common grounds for the transmission of diseases. In fact, hospitals, irrespective of their locations, by virtue of being visited by people who are infected by a myriad of diseases and health conditions, are places where diseases can easily be spread. These being the case, hospitals endeavour to ensure that proper infection control measures are instituted to prevent the infection of otherwise healthy people by diseases of different kinds. The following sections will discuss infection control in hospitals and with a focus on United Kingdom hospitals. Objectives To highlight infection risks involved in the hospital setup for both health professionals and patients. To identify solutions towards reduction of nosocomial infections. Methodology Apparently, infections arising from the hospital setting are expected in an ordinary setup without considerable measures to reduce chances of infections to both the staff and visitors, whether patients of not. An overview of the major online databases on infections contracted within the hospitals and the circumstances under which they were contracted was used to make this study achieve its objective. This study also attempted to highlight possible workable solutions to the challenge of infection control with the hospital setting. Results 1. Infection problems: Most common infections acquired within the hospital setting have been identified. Several major risk areas of hospital acquired infections are identified in terms of predisposition magnitude to both the patients and the health officials. This breakdown tries to highlight some of the several risks faced by each of the said groups. Patient infections and risk factors are highlighted in the first section then followed by the health staff predisposing risks. Next in the study follows the solutions to these factors as discussed. Patients: Catheter associated U.T.Is: the use of catheters (clinical tubes that are usually inserted into the body cavity of patients to drain or inject fluids or to gain access during surgical processes) act as a major infection route for many patients. Both indwelling catheters and permcaths are susceptible channels through which pathogenic micro-organisms are introduced into the patient’s body within the hospital setting. Systematic approaches must be adopted to ensure an early diagnosis for the management and treatment of the infections after clinical procedures (Farr and Keri, 2004, pp327-334). Disinfection related infections: although the rate of sterilization achieved is dependent on the agent used, disinfection is not always possible, agent choice and drug resistance being the contributing factors to this phenomenon. Frequent disinfections may not be possible before the pathogens have proliferated to infective numbers, which remains an empirical parameter to establish, this means that disinfections rely on timing in a normal hospital setting, which could not be enough to establish whether infective quantities of the bacteria have grown again. The patients coming into the premises do not have control and knowledge over what and where have been disinfected, hence safe to pass or stay. Isolation related infections: many infections are favoured by contact between uninfected person and infected person where body fluids and secretions are likely to cause disease whether in small quantities or large. Based on the type of transmission involved, there are mainly three types of isolations that can be performed, which include, air-borne transmission, droplet isolation, draft isolation and contact isolation. In most of the cases, it is not possible to perform the isolations due to technical nature of the requirements that these isolations demand. Draft isolation for instance requires that immuno-suppressed individuals obtain complete isolation from contact with ordinary air which has a high likelihood of containing several pathogens. This is because the compromising nature of their immune system cannot withstand the harsh pathogen containing environmental air without coming down with diseases. Single patient room for more susceptible patients is sometimes not practical since the underlying requirement would be argued out to be sterilization of air which can be done in shared rooms. Understanding the principal provisions of science behind isolation would ensure the consideration of all the three factors namely; agent, host and environment to come up with efficient isolation, which is usually rare (Friedman and Rhinehart, 2006, p134). Hand hygiene: washing of hands with soap considerable reduces the chances of contracting diseases within the hospital setting. This mostly affects the patients since they don’t follow a certain rule to observe hygiene especially after visiting the hospital where they are likely to collect infectious micro-organisms. Nosocomial infections through hand contamination are considerably high on the patients than health officials, because nowadays they often observe hygiene protocols. Antimicrobial agents are not always available to them; otherwise, ignorance of the importance to wash hands is a contributing factor. Intravascular device related infections: intravascular devices result in bloodstream infections if the necessary measures to ensure safety are not followed. Surgical and other related clinical equipment safety always depends on the state of their storage, sterilization, education and training of the practitioners as well as proper impregnation with antiseptics or antibiotics. However, even the most stringent compliance always gets some rare departure form the expected results. Surgical sites related infections: According to National Institute for Health and Clinical Excellence (NICE), several areas may get infected by virtue of performing a surgical procedure on a patient and necessary measures must be taken in advance. Such areas as the nasal cavity harbours several strains of bacteria which become pathogenic and virulent when they are exposed to surgical openings o n the other parts of the body. Such strains as Staphylococcus aureus become drug resistant and when they gain entrance to the surgical openings, it is a serious clinical issue to solve. Other areas include: post surgical wound dressings which need extra care if infections have to be kept at bay. Differences occur in the effectiveness of the various types of wound dressing to be used, regarding their efficiency. Skin complications that would attract possible pathogenic invasion are also other areas of infection that surgical sites are faced with. Health Professionals Environment and working surface sanitation: While environmental sanitation factors appear to be cutting across the stakeholders, health officials remain for longer in the hospital premises and their interaction with pathogenic micro-organism in this environment is big risk. Working surfaces may not be thoroughly sterilized, which do not only involve those in the theatres but also in the offices. Some stubborn pathogens may hide in places hard to easily identify and sterilize. This becomes a major cause of infection for the medical professionals. Air contamination is another route through which hospital staff get their nosocomial infections, a complex issue that sterilization almost always can not solve (Chang and Leun, 2006, pp17-23). Surgical glove failure: barrier methods of infection control may sometimes fail as is the case with glove protection failure. Fluid-borne infectious pathogens are therefore a cause of infection transmission between the patient and the health professional. Whereas gloving is a major control practice, it is therefore not adequate in ensuring safety and alternative solutions must be sought to supplement it (Korniewicz and Rabussay, 1997, pp867-88). Immunizations: health workers are required to ensure that they are immunized against the diseases that they encounter during their practice to eliminate chances of contracting diseases that they treat. The most common infections among the infectious diseases that health workers should seek immunization for are Hepatitis B, Influenza, Meseals, Mumps, Rubella, Vuricella, and TB among others. The rest for which immunization may be sought are Hepatitis A, Meningococcal disease, Pertussis, Typhoid and Vaccinia. When the health worker is immunocompromised, it is strongly recommended that they take the correct measures to avoid their bodies picking up infections. Maintenance of strong immunity status for the health workers is of paramount importance since they interact with possible infections in their day to day life during their clinical practice. Medical facilities always fail to ensure these immunizations as standard practices in their operations, partly due to resistance by the health workers and among other factors. Until efficient immunization is facilitated by the health facility, these diseases continue to be a major threat to the health of the health workers. Biosafety in microbiology practice: there is a delicate protocol to be observed by clinical personnel while working with microorganisms. These rules are always hard to follow due to the voluminous requirements that should be followed. Health workers fall victims of breaking these rules which are sometimes as minor as they appear but the implications and consequences thereon are very serious. It follows that the protocols are fixed on the walls in large printouts for the health workers to familiarize themselves, even in due course of their practice. Even in such measures, flouting one simple rule which may be forgotten is a danger to the health of the health workers. It is important that the disease control solutions below are followed, failure to which serious infections could arise. 2. Infection Control Solutions Different definitions of infection control abound. The Medical Dictionary (nd) defines the term as those policies and procedures that are implemented to limit or ultimately eliminate the risk of spreading infections, more so in animal and human healthcare facilities including hospitals. Other quarters have described the term as the discipline that deals with the prevention of health-associated, hospital acquired, or nosocomial infection. Yet again, the term has been defined as the protection of hospital workers and patients from infection in healthcare settings in a cost effective way. The definitions given above may well be generalized to describe infection control as every activity that is done or every measure taken to prevent infection of patients and hospital workers especially in the health care setting. From the definition given above, it is beyond doubt that the main objective behind infection control is to limit the chances of infectious diseases occurring. Infectious diseases as previously briefed can be spread through animal-human contact, human-human contact, through airborne transmission, through contact with infected objects, liquids and food. According to statistics, about five percent of all patients in hospitals get infected with hospital-derived infections. This is a condition that should not be the case given that it goes squarely against what hospitals have as their core missions – giving people back to people good health. Nosocomial infections as a matter of fact have led many patients under the care of health workers to stay longer in the journey to full recovery. Such infections have also led to the deaths of countless patients who otherwise would not have succumbed to their initial infections. In other words, hospital-acquired infections can easily complicate the original conditions of patients while also exposing health care providers to great risks. Issues like glove failure during clinical practice can be corrected by a variety of approaches including: integrity of glove monitoring, use of better glove quality, optimization and modification of surgical techniques in use, clinical equipment and instrument improvement, teamwork improvement, proper glove standard selection, use of double gloving techniques as well as routine glove changing during clinical procedures. Touch (feel), use of colour-puncture indicators and electronic glove monitoring devices can be adopted to establish integrity of gloves. Quality checks should be availed to establish in- use conditions of the gloves. Other control measures may involve a glove rating system and procurement stringency to ensure accountability on deliveries which would work towards quality assurance over time (Korniewicz and Rabussay, 1997, p1043). Some stubborn infections that occur amid extensive compliance can be eliminated on evidence based interventions for improved results in intravascular devices related infections (O’Grady et al, 2002, pp476-489). According to the National Institute for Health and Clinical Excellence, proper care should be taken to ensure both the patient and the health care giver are sufficiently safe during clinical procedures. There should be deliberate attempts towards improvement of management of infections within the hospitals. These should include disease surveillance to ensure possible infections are taken care of in good time. Isolation of patients whose diseases are infectious should be streamlined at the entry point to the hospital before spreading to the other patients. Outbreaks should be handled at a special section of the hospital, to facilitate efficient tackling of emerging disease and manage those that appear after a number of decades. Traditionally, medical professionals should ensure that they do not spread diseases form one patient to others by some practices which only need optimization in some instances. These include among others the few discussed items. The medical professional should wash their hands soon after handling a patient and materials that may act as a means of transmission of the pathogens to eliminate chances of possible infections. Prior planning on the clinical procedure to be carried out on a patient significantly reduces possibility of transmission of the pathogens in a particular patient to the other through the professional clinician. It is also possible to prevent contraction of the infection by the professionals themselves by planning in advance. After identifying a patient arriving at the hospital, the hospital staff should not allow contact of the patient by other patients as this considerably increases cross infections. Patients should be guided to a different location and should never come into contact, for purposes of isolation and disease control. Aseptic techniques recommended in microbiology should be observed while dealing with any specimens obtained from the patients. Highly efficient mouth covers or masks should be used while dealing with a patient. Airborne diseases are considerably lowered when masks are utilised to cover the faces by medical staff. The mask should be used only once and discarded in a safety receptacle. While in use, the health care giver should refrain from touching the mask. Where soiling is expected, a safety lab coat or gown should always be put on. Only sterile gowns are supposed to be used in clinical settings to avoid further infections. Dirty clinical wear should be put in isolation bags and clearly labelled “isolation”, to avoid chances of contaminations and infections. High quality gloves should always be worn while attending patients and every time a pair is used, it should be discarded accordingly. Double gloving is advised in some clinical procedures that require higher protection levels. Needles and other clinical equipment should always be handled with a lot more care, especially for the sharp tools and equipment. Contaminated infectious droplets should be controlled by a variety of ways which include instructing patients to use a handkerchief in covering their noses and mouth during coughing or sneezing and wrapping their waste tissue paper together and discarding. The hospital should have adequate ventilation and air circulation in and out of the rooms. A buffer area should be created at the door to ensure that outside air is not in a continuous flow and doors kept closed all the time. Outbreaks policy should be in form of a clear protocol highlighting the management of dangerous outbreaks, waiting the development of a vaccine or while monitoring response to vaccines. There is a requirement that all health workers dealing with outbreak victims should vaccinated before handling the patients. Those health care givers who take part in international research on certain diseases should equally be vaccinated against those diseases. While it is in line of duty that health workers are likely to encounter the particular infections, it is highly recommended that every health worker undertakes to disclose all exposure to risky diseases. This would ensure that enough care is taken on them to prevent development of the dioceses. If exposure occurs, leaves are recommended while proper attention is given to such health workers. Health workers should be equipped with the relevant resources to enable them pursue their work with few or no mistakes. Reminders of when to attend patients with catheters for instance should be integral in the delivery of services with minimum incidents of patient nosocomial infections that could arise in delays. Blood and other specimens should safely be collected and stored in the microbiology laboratory facility and entry should be regulated to minimise infections. Attire worn in the lab should be handled with a lot of caution so that infection chances are considerably brought down. The type of specimen involved determines the nature of caution to be exercised on them. A serious statement should always be made to the health workers that infections should not necessarily be detectable; therefore ignoring the control protocol is upon the individual, which trickles down to all other stakeholders. The first rule being hygiene and sterility, personal effort by every health professional should be centred on maintenance and observance of this simple breakdown. Use of common sense and improvisation of applicable infection control measures is the duty of all clinicians. With commitment and responsibility in their line of duty, the clinical professionals can substantially reduce the level of nosocomial infections. Conclusions From the above study, it is apparent that nosocomial infections are a reality in the hospitals and that solutions can be arrived at if proper measures are effected towards overcoming them. Infections that occur within the hospitals may affect both the health worker and the patients. Apart from general personal hygiene and safety measures, patients may not control nosocomial infections due to lack of information regarding the topic. Patients may get nosocomial infections from other patients or from health workers during interactions in the hospital. However, healthcare workers can considerable reduce their chances of infections by upgrading their practice knowledge and team work. There are a number of immunizations that could considerably reduce nosocomial infections for health workers. Use of current trends in technological advancement for clinical practise could enhance control and management of nosocomial infections to both patients and health workers. Health institutions must put into account of their responsibility to ensure compliance with various state accreditation requirements towards achieving safety for the people frequenting them. Streamlining control of infections in hospitals should be heightened to ensure low morbidity, reduced stay at the hospitals and reduced risks of exposure by health workers. References Chan A. and Leung M., (2006). “Control and Management of Hospital Indoor air Quality”, Medical Science Monitor, 12(3):17-23. Farr B. and Keri H., (2004). “Diagnosis and Treatment of Long Term Central Venous Catheter Infections”, Journal of Vascular and Interventional Radiology, 15(4):327-334. Friedman M. M. and Rhinehart E., (2006). Infection control in home care and hospice, New York, Jones & Bartlett Learning. Harris D. A., Kim W. P., Perenncevich E. N. and Roughmann M. C., (2003). “Rates of Hand Disinfection associated with Glove use, Patient Isolation and Changes between Exposure to Various Body Sites”, American Journal of Infection Control, 31(2):97-103. Korniewicz D. M. and Rabussay D., (1997). “Improving Glove Barrier Effectiveness”, Association of periOperative Registered Nurses Journal, 66(6):1043 Korniewicz D. M. and Rabussay D., (1997). “The Risks and Challenges of Surgical Glove Failure”, Association of periOperative Registered Nurses Journal, 66(5):867-888. Medical Dictionary (nd) Infection Control, viewed 23rd August, 2010http://medical-dictionary.thefreedictionary.com/infection+control National Institute for Health and Clinical Excellence report number 74, Surgical site infection: prevention and treatment of surgical site infection, Clinical Guideline: 89-103, 2008 O’Grady N. P., Raad I. Issam., Randolph A. and Weinstein R. A., (2002). “Guidelines for the Prevention of Intravascular Catheter-Related Infections”, American Journal of Infection Control,30(8):476-489. Read More