Evaluation of Infection Control in Hospitals - Essay Example

Evaluation of Infection Control in Hospitals Introduction In the 19th century, hospitals were considered as hazardous places. At that time, there was limited knowledge on the transmission and epidemiology of hospital acquired infections. Hygiene was relatively poor in these institutions and as a consequence many died during surgery and childbirth due to infections (CAG, 2000; POST, 2005; Davis, 2005). Through the years, more understanding of the connection between hygiene and infection was obtained that led to improvements in the hospital setting which was later coupled with the introduction of the use of antiseptics during surgery. Ironically, there are reports that hospital acquired infections are resurfacing and more importantly, gaining status as a major problem for health service agencies worldwide (Davis, 2005). The National Audit Office noted in its 2000 report that nine percent of all inpatients or one in every eleven inpatients in England had hospital acquired infection at any one time. This prevalence is higher than hospital acquired infections in Denmark (8%), Spain (8%), Netherlands (7%), Norway (7%) and Australia (6%). Only France (6-10%) and USA (5-10%) had higher incidence ranges (CPSO, 2004; Davis, 2005; POST, 2005). Furthermore, this figure is equivalent to approximately 100,000 hospital acquired infections per year. The effects of hospital acquired infections to patients range from minor discomfort to mortality in around 5,000 cases. These infections are considered as contributory factors to approximately 15,000 deaths a year (College of Nurses of Ontario, 2005; POST, 2005; Davis, 2005). A report by the Nosocomial Infection National Surveillance Service from 1997 to 1999, covering 96 hospitals in England showed 47 percent of microorganisms that cause surgical site infections were staphylococci. Eighty-one percent of these were Staphylococcus aureus and 61 percent were Methicillin Resistant Staphylococcus Aureus (MRSA) (CPSO, 2004; Davis, 2005; POST, 2005). All of these occurrences are attributed to one trend: a declining level of hygiene in hospital settings. Hospital cleanliness is a crucial part in the mitigation of hospital acquired infections thus the problem rests heavily on the responsibility of hospital administrators and cleaning staff (CAG, 2000; POST, 2005). In order to know the root of the problem which is the declining level of hygiene in hospitals, the sources and possible routes of infectious materials should be identified. Gaps and loopholes for the proper handling of such infection sources and vectors should be highlighted. Next, appropriate steps should be put in place that will answer these inefficiencies together with the responsible hospital staff for each task. Lastly, monitoring and maintenance systems should be developed to ensure long-term success in these efforts with emphasis on in any areas where improvements are needed (College of Nurses of Ontario, 2005; POST, 2005; Davis, 2005). Studies and information already available for the abovementioned factors will be reiterated here. However, this paper will focus on other areas where data are lacking and further research is warranted. More specifically, the role of social workers in the proliferation and solution of hospital acquired infections will be assessed. Furthermore, research gaps in this area will be identified towards the development of qualitative and quantitative research methodologies. Epidemiology of Hospital Acquired Infections Hospital acquired infections are also referred to as nosocomial infections. These are infections that develop during the patient's stay in the hospital that were not previously present. There are two types of hospital acquired infections: autoinfection wherein the causative agent is inherently present in the patient but started to proliferate during confinement because of lowered resistance level, and cross-contamination wherein the causative agent comes from outside the patient which infects and develop during the patient's stay in the hospital (CPSO, 2004; Davis, 2005; POST, 2005). Inside hospitals, health care professionals, patients and objects can be sources of infectious agents. Infectious agents come in the form of viruses, fungi and bacteria. Salmonella spp. or Escherichia coli may contaminate foods or other materials that are ingested or make contact with patients (Health Canada, 1998; CAG, 2000; RCN, 2005). In addition to above bacteria, conventional pathogens may also be present in the hospital. These include Staphylococcus aureus, Corynebacterium diptheriae, Streptoccoccus pyogenes, hepatitis viruses and even HIV. Conditional pathogens cause diseases to patients with low levels of resistance. These include Streptococcus agalactiae, Serratia marcescens and Pseudomonas aeruginosa to name a few. Opportunistic pathogens on the other hand cause diseases in patients with very low levels of resistance. Examples are Nocardia asteroides and Pneumocystis carini (Block, 1991). These pathogens are transmitted from the source to the patients in several ways. One is through direct contact of an object or person carrying the said pathogens. Another is through the indirect movement from source to patient through vectors such as wind, water or insects (College of Nurses of Ontario, 2005; POST, 2005; Davis, 2005). Airborne pathogens are easily dispersed through airconditioning systems and closed ventilation conditions. These are released through expiration, sneezing or coughing and may stay in the air for a while (Gardner & Simmons, 1983). Vectors are generally found in hospitals with premises frequented by insects, rodents and other organisms that come in contact with food, water and other objects given to patients. Feces and secretions from patients which normally contain pathogens may come in contact with these organisms which can freely move and transfer these pathogens (CAG, 2000; POST, 2005). Direct contact constitutes health worker to patient transmission of disease agents while indirect contact occurs when infected patients touch objects and hospital walls or doors which may also come in contact with other patients. Of the four routes of infection, direct infection by health worker of patients seemed to be the most frequent case in the hospital setting (College of Nurses of Ontario, 2005; POST, 2005; Davis, 2005). Proper hygiene is therefore a controversial issue among healthcare professionals. In order to prevent transmitting pathogens from one patient to another, a health care practitioner must meticulously clean and disinfect body parts and garments that may come in contact with patients. Of particular importance are the hands since apart from wearing gloves, practitioner and other personnel should observe proper hand washing to thoroughly rid their hands of microorganisms. Various soaps and chemicals are recommended to achieve this. These include alcohol, chlorinated solutions, glutaraldehyde and other disinfectants which have been studied for efficiency and safety of use. Data are already available in the percentage and type of pathogens these reagents can eradicate as well as their weaknesses particularly the risks these pose to patients and health workers (CPSO, 2004; Davis, 2005; POST, 2005). Prevention of Hospital Acquired Infections Prevention of hospital acquired infections involves two major principles. The first concerns the separation of infection source from the other elements of the hospital setting. The other is through elimination of the transmission routes from source to patients (College of Nurses of Ontario, 2005; POST, 2005; Davis, 2005; CAG, 2000). Separation of infection sources from the hospital involves not only the putting up of barriers between infection sources such as patients but also all other possible sources such as objects, health care personnel and visitors. This implies the identification of potential sources of infection and designating these objects or persons to areas where they cannot be of frequent contact with vulnerable patients. This may also involve transferring or moving objects or persons out of particularly susceptible areas (Block, 1991). Objects, in particular, should be handled with extra caution. Excreta, secretions, and other substances from patients normally come in contact with instruments, furniture, tools and garments. All objects should be disposable especially those used for patients. After contact with patient body parts these must be sterilized and disposed of properly. If these objects or containers are reusable, a thorough cleaning, washing, disinfection and sterilization are warranted before reuse (CAG, 2000; POST, 2005). Isolation of patients is the most commonly performed and recommended protocol for preventing patients from infection sources. Very strict isolation measures are applied for highly infectious diseases such as hemorrhagic fever and diphtheria. Relatively strict isolation measures are on the other hand followed for relatively less infectious diseases such as tuberculosis and diarrhea. Some blood borne diseases also require isolation of patients to prevent transfer to health care personnel and other persons visiting the patient in the room (CPSO, 2004; Davis, 2005; POST, 2005). Cleaning involves the use of detergents and soaps for the removal of fluids and dirt where pathogens thrive. Sterilization is the process of rendering places or objects free from microorganisms. This is achieved through the use of various chemicals ranging in strength for inactivating pathogens (Health Canada, 1998; CAG, 2000; RCN, 2005). The three most common chemicals used are alcohol, chlorine and hydrogen peroxide. Alcohol was shown to be very active for various types of pathogens, while chlorine was only as active as hydrogen peroxide (CAG, 2000; POST, 2005). Stronger disinfectants such as formaldehyde, glutaraldehyde, phenolic compounds and ammonium compounds are also used for specific purposes. These were deemed very active in killing microorganisms but can only be used in inanimate objects and are not advisable for skin surfaces since these are corrosive and toxic to people (Block, 1991). Formulation of Research Questions Knowing the above information regarding the source and transmission of infection in the hospital setting leads to the evaluation of all factors that may be involved in these processes and the appropriate action or steps on which improvement can be anchored. In the part of the health care personnel, several groups can be identified. One of them are the social workers. Social workers are also hypothetically contributory to a portion of the hospital acquired infections since they can serve as mobile vectors through hands, clothing and belongings coming into contact with patient harboring infectious pathogens. Several studies have been undertaken to assess the impact of hygienic practices of physicians, anesthesiologists and nurses (College of Nurses of Ontario, 2005 p. 3; POST 2005; CAG, 2000; Davis, 2005), but there is an apparent lack of data regarding the role of social workers in the incidence and control of hospital acquired infection. The following research questions are formulated to append this information gap regarding social workers and hospital acquired infections. First is "What proportion of hospital acquired infections is attributed to social workers" Second is "What are the main steps social workers can take to prevent hospital acquired infections" Third is "How can social workers be evaluated for hygiene in the practice of their profession" Lastly, "What will be the impact of social workers' improvements in hygiene on the overall hospital performance regarding nosocomial infections" For the question "What proportion of hospital acquired infections is attributed to social workers" the following data will be gathered. For qualitative data, survey questions will be disseminated to major hospitals in the country. Patients, health care professionals and hospital administrators will be asked for the perceived incidence of hospital acquired infections associated with the practice of social workers. For quantitative data, statistics correlating the number of social workers, visiting hours and patients to the incidence of hospital acquired infections will be obtained from hospital records and health agency databases. For the second question, "What are the main steps social workers can take to prevent hospital acquired infections" the following information will be collected. For qualitative data, hospital staff including social workers will be interviewed to rank cleaning and disinfection methodologies according to perceived efficiency. For quantitative data, figures regarding the use of particular methods by social workers for cleaning and disinfection will be measured for efficiency in preventing contamination and infection. For the third question, "How can social workers be evaluated for hygiene in the practice of their profession" the following data will be obtained. For qualitative data, hospital staff including social workers will be given evaluation forms for the performance of social workers related to maintaining hygienic environment in the practice of their job. For quantitative data, hospital administrators will be provided tally forms for the number of patients attended to by social workers and the incidence of hospital acquired infections in these patients. For the last question, "What will be the impact of social workers' improvements in hygiene on the overall hospital performance regarding nosocomial infections" the following information will be gathered. For qualitative data, hospital staff and patients will be interviewed for the level of improvements in social workers with regard to hygienic practices and for the overall performance of the hospital related to the problem. Equivalent performances will be graded either as "exemplary," "satisfactory," "poor," or "very poor." For quantitative data, numerical grading will be based on the number of social workers, number of cleaning methods practiced, time allocated for each method, number of hospital acquired infections in patients and total for each hospital. In summary, information on the correlation of hospital acquired infection and social workers are of limited scope if not nonexistent. A study satisfying the above four research questions would fill up this gap and contribute to the comprehensive elucidation of the issue for the improvement of hygiene and cleanliness in the hospital setting. Reference List Block, S.S. (1991). Disinfection, sterilization, and preservation, 4th ed. Philadelphia, Lea & Febiger. College of Nurses of Ontario. (2005). Practice standard: Infection prevention and control. Available from [Accessed 22 July 2007]. College of Physicians and Surgeons of Ontario (CPSO). (2004). Infection control in the physician's office. Available from [Accessed 22 July 2007]. Comptroller and Auditor General (CAG). (2000). The management and control of hospital acquired infection in acute NHS trusts in England. National Audit Office. Available from [Accessed 22 July 2007]. Davis, S. (2005). Hospital contract cleaning and infection control. Global Political Economy School of Social Sciences. Cardiff University. Available from [Accessed 22 July 2007]. Garner, J.S. and Simmons B.P. (1983). CDC Guideline for isolation precautions in hospitals. Infection control, 4:245-325. Health Canada. (1998). Infection control guidelines: Hand washing, cleaning, disinfection and sterilization in health care. Laboratory Centre for Disease Control, Bureau of Infectious Diseases, Nosocomial and Occupational Infection. Volume 24S8. Available from [Accessed 23 July 2007]. Parliamentary Office of Science and Technology (POST). (2005). Infection control in healthcare settings. Available from [Accessed 22 July 2007]. Royal College of Nursing (RCN). (2005). Good practice in infection prevention and control. RCN Wipe it Out Campaign. Available from [Accessed 23 July 2007]. Read More