Nosocomial Infections in a Clinical Setting - Term Paper Example

NUR3020 Assignment 2 Introduction Nurses are supposed to always have a critical view of nursing practice when providing nursing care in a clinical setting. Therefore, nurses have the responsibility to always critically analyse all aspects of nursing care. This paper will specifically focus on nosocomial infections in a clinical setting. The paper will start by providing a description of nosocomial infections and then reviewing literature on the topic. Lastly, a critical analysis of the literature in relation to practice will be provided. Description of a practice Nosocomial infections refer to infections that patient acquire when they undergoing treatment for medical or surgical conditions (Dandagi, 2010). I observed that healthcare providers performed various techniques to decrease transmission of nosocomial infections by wearing protective gears such as gloves and performing hand hygiene constantly; prior to every patient contact, after every patient contact, after coming into contact with environmental surface and equipments and before wearing glovesI opted to question this practice because nosocomial infections have become a common complication in hospitals and they are a leading cause of death for many patients. In my opinion, even though nosocomial infections signify a very grave health problem, they can be prevented. This is because practically, for instance when healthcare providers adhere to hand hygiene, nosocomial infections reduce. However, the issue is still unresolved because evidence indicates that methods of controlling nosocomial infections have not been effective because for example hand hygiene is low. I have read in literature that nurses play a big role in preventing nosocomial infections but I have observed that nurses hardly adhere to infection control techniques. In order to prevent nosocomial infections, nurses and other healthcare providers tried as much to wear protective gears and perform hand hygiene whenever necessary. It was the responsibility of all healthcare providers to prevent infections; nonetheless, nurses provided care at the bedside and thus they had the capacity to directly impact infection prevention. Nurses served as the main infection transmitters because while providing nursing care they had occupational exposure to microorganisms (Dandagi, 2010). In addition, nurses had high rates of exposure to microbes, for instance through: needlesticks, hand contamination with blood, exposure to air-transmitted microorganisms. Even though most nurses tried to comply to hand hygiene and other standard precautions, at times I observed that they did not always perform hand hygiene. Review of Literature According to Edmond et al (2011), nosocomial infections include all infections that are not allied to the patient’s original diagnosis during hospital admission. They can be caused by microorganisms such as bacteria, viruses or parasites that come from the hospital setting, contaminated equipment, healthcare providers or other patients. The most commonly found types of nosocomial infections are; surgical wound infections, chest infections, in addition to urinary tract infections (Edmond et al, 2011). Sanchez et al (2004) argues that successful infection control can eliminate nosocomial infections and this can be achieved through the following principles: removing infection sources through treatment of infections and decontamination procedures; preventing of transfer of infections through adhering to appropriate hand hygiene, aseptic procedures as well as proper isolation; and by enhancing resistance through balanced nutrition and suitable antibiotic prophylaxis (Paul et al, 2010). These principles are supposed to underline all nursing practice and are essential in preventing nosocomial infections. All hospitals are supposed to have policies that facilitate the control and prevention of infections. Accordingly, nurses and other healthcare providers should be aware of policies on hand hygiene, usage of protective equipment and clothes as well as safe disposal of waste and sharps. Other key policies that can be effective in controlling nosocomial infections include policies that lower the infection risk from usage of catheters, tubes, cannulas, also policies about prudent usage of antibiotics (Paul et al, 2010). Studies indicate that nosocomial infections happen mostly within intensive care units, acute surgical wards and orthopedic wards (Perencevich et al, 2008). This is because as per the World Health Organisation, there is a high likelihood of infections occurring in patients with high vulnerability because of old age, reduced level of immunity or underlying illnesses. Other causes of nosocomial infections include the hospital environment, bacterial resistance, exposure to pathogens and microbes in the hospital and also treatments such as chemotherapy and catheterization (Perencevich et al, 2008). According to Paul et al (2010) urinary tract infections that are allied to catheter, surgical location infections, blood stream infections as well as ventilator-assisted pneumonia account for most of the nosocomial infections. A study conducted by Sanchez et al (2004) indicated that during patients’ stay in ICU, there were 98 cases of nosocomial infections where all the patients acquired infections during hospitalization. According to the study results, there were 33 cases of urinary tract infections, 35 cases of bacterial infections, 15 cases of pneumonias, 12 cases of infections allied to central-venous-catheter, 2 sinusitides and finally 1 surgical wound infection (Sanchez et al, 2004). This clearly indicates how serious and common nosocomial infections are in hospitals and how high the risk of admitted patients is, in regard to acquiring infections during their hospital stay. Additionally, studies further indicate that patients who get infected after undergoing surgeries spend averagely more 6.5days within the hospitals; are 5 more time likely to have hospital readmission after being discharged and are twice likely to die. In addition, patients who undergo surgery and develop infections have a 60% probability of necessitating admission to ICU (Bruce, 2013). Evidence indicates that nosocomial infections represent a very serious problem and since they can be avoided and prevented, it is paramount to take every necessary step to prevent them (Perencevich et al, 2008). Studies and literature further show that it is possible to prevent many nosocomial infections by strictly adhering to evidence-based best practice (Perencevich et al, 2008). The evidence based practices that can effectively prevent nosocomial infections include: healthcare professional conforming to hand hygiene by always cleaning their hand with water and soap or using alcohol based hand rubs prior to and after caring for each patient or coming into contact with fluids, soiling or any other form of contamination; healthcare providers always wearing protective equipment such as hair covers, masks, laboratory coats, gowns and gloves whenever it is necessary; using catheters only if it is essential and removing them as soon as possible; and ensuring that the surgical location or the skin where the catheter is being inserted is cleaned appropriately (Perencevich et al, 2008). According to WHO (2010) effective prevention of nosocomial infections necessitates an integrated, monitored approach that should include the following aspects: a) controlling environmental risks for infection; b) restricting transmission of microorganisms between patients during nursing and medical care by adequately observing hand hygiene, using gloves, suitable antiseptic practice, isolation tactics, and disinfection practices; c) protection of patients using suitable prophylactic antibiotics, nutrition and vaccinations; d) reducing the risk of endogenous infections through reducing invasive procedures and encouraging use of antibiotics; e) surveillance of infections and prompt identification and control of infection outbreaks; f) preventing infections in healthcare providers; g) and improving healthcare providers patient care practices as well as constantly educating staff on infection control procedures. In general, all healthcare providers who include physicians, nurses, pharmacists and other have the responsibility of infection control in hospitals (WHO, 2010). Kampf, Loffler & Gastmeir (2009) emphasize that hand hygiene is the single most important factor in controlling nosocomial infections since hands can transfer micro-organisms and pathogen from one patient to another and from one location to another very easily. Therefore, nurses and other healthcare providers should always observe hand hygiene through either hand washing with soap or using alcohol hand rubs (Kampf, Loffler & Gastmeir, 2009). Basically, evidence and the reviewed literature indicate that through preventable, nosocomial infections are among the most causes of death for the patients. Healthcare providers and especially nurses are often exposed to microorganisms which can cause serious infections. Therefore, nurses have the unique opportunity to decrease the potential nosocomial infections by wearing protective gears, adhering to hand hygiene and standards and conforming to evidence-based best practice. Integrating Theory and Practice Critical reflective Comments According to the literature, nosocomial infections refer to infections that patients acquire in hospitals yet they did not have the infection nor was the infection at incubation stage during their hospital admission (Sanchez, 2004). In line with the literature, there were cases where patients acquired new infections while in the hospital. For example, the hospital documentation showed that 3 patients had contracted infections during their stay in the hospital. It was observed that the patients contracted the infections after maybe 4 or 5 days after they were admitted in the hospital. The fact that the patients did not have these infections initially and only acquired them after their admission indicates that the patients had nosocomial infections since literature indicates that nosocomial infections are acquired during hospital stay. Just as the literature indicates that nosocomial infections are most common in the intensive care units and acute surgical wards (Dandagi, G., 2010), one of the patients who had acquired the infection was in intensive care unit while the other two patients had just undergone surgery. Theory indicates that concentration of patients greatly vulnerable to infection and patients with reduced level of immunity due to the underlying disease can result to such patients contracting nosocomial infections (Arrowsmith & Taylor, 2014). Therefore, this explains why the patient from ICU acquired the infection during his hospital stay. On the other hand, the other two patients contracted infections after their surgical procedures. Literature indicates patients may contract infections after undergoing surgery due to contamination of maybe devices which subsequently contact susceptible body sites of patients (Arrowsmith & Taylor, 2014). Therefore, these two patients might have acquired the infections due to contamination. However, as per the study carried out by (Paul et al., 2010) indicated that most nosocomial infections are urinary tract infections and bacterial infections but the three patients who acquired infections while in hospital had none of these since one patient contracted pneumonia while the other two had surgical wound infections. Literature shows that nosocomial infections can be prevented through hand hygiene and wearing protective equipment (WHO, 2010). All nurses in the hospital wore personal protective equipment such as gloves whenever they had any physical contact with the patients. At no single point, did nurses handle patients and deliver nursing care without wearing gloves. Since evidence singles out hand hygiene as the single most way of preventing nosocomial infections, most nurses and other healthcare providers tried to always observe hand hygiene (Kampf, Loffler & Gastmeir, 2009). Healthcare providers would ensure they cleaned their hand before and after getting into contact with the patients. This was done either through hand washing with soap or by using alcohol hand rubs. Nonetheless, it was observed that in the wards where there were no alcohol hand rubs and healthcare providers had to use water and soap to clean their hands, adherence to hand hygiene was relatively low when compared to wards that had alcohol rubs even at the patients’ bedside. A report from the hospital surveillance showed that nurses adhered to hand hygiene more when using alcohol hand rubs. Other ways in which healthcare providers tried to prevent infections include avoiding urinary catheterization whenever possible. This is because as the literature indicates, catheters should only be used if it is absolutely necessary because they are a major source of urinary tract infections (WHO, 2010). Additionally, nurses always conducted thorough hand washing and aseptic technique when inserting and taking care of urinary catheters. Implications Nurses play a very important role in prevention of nosocomial infections by ensuring that all aspects of their nursing practice is evidence based (Arrowsmith & Taylor, 2014). Evidence suggests that nurses should always adhere to hand hygiene and wear protective apparatus whenever handling patients. Since nurses are patients’ advocates, they are in a position to impact changes in order to improve patient care standards. Nurses have several tools available for creating a safe environment for patients by; observing universal precautions whose purpose is preventing transmission of blood borne pathogen during delivery of healthcare and by adhering to hand hygiene which is the most effective nursing intervention of preventing infections (Arrowsmith & Taylor, 2014). Hospital management can cultivate a safe environment for patients by creating and supporting an open and non-punitive atmosphere where it is possible to report errors and near misses. This can assist a healthcare institution in determining how the system can be improved and how future errors can be prevented from occurring. In addition, organisations and management have the responsibility of providing the necessary resources to support a safe environment in order to prevent nosocomial infections (Arrowsmith & Taylor, 2014). Recommendations The hospital management should implement preventative strategies aimed at preventing nosocomial infections. All hospitals should develop specific plans for assessing and promoting good health care, suitable isolation, sterilization, personnel training as well as epidemiological surveillance (Edmond et al, 2011). Hospitals should provide adequate resources for supporting all programmes and strategies aimed at preventing nosocomial infections (Edmond et al, 2011). Alcohol hand rubs should be used for hand hygiene instead of hand washing unless there is visible soiling of the hands because evidence indicates that adherence to hand hygiene is much higher when healthcare providers use alcohol hand rubs (Kampf, Loffler & Gastmeir, 2009). The relevant authorities such as NUM should ensure that hospitals implement infection control policies and procedures. Conclusion As the paper indicates, nosocomial infections are very common in hospitals and pose great health risks. It is therefore important to have the appropriate infection control measures to prevent them. Some infection measures that have proved to be effective in preventing nosocomial infections include hand hygiene, using protective gears such as gloves and caps and sterilisation. Nurses have the responsibility of delivering safe nursing care while hospital management have the responsibility of developing the appropriate strategies and providing the required resources to prevent nosocomial infections. Bibliography Arrowsmith, VA; & Taylor, R., 2014, Removal of nail polish and finger rings to prevent surgical infection, The Cochrane database of systematic reviews, 8: CD003325. Bruce N., 2013, Improving Compliance with Healthcare Associated Infection (HAI) Practice Guidelines to Reduce the Acquisition of HAIs, Capstone Projects, Paper 30. Dandagi, G., 2010, Nosocomial pneumonia in critically ill patients, Lung India, 27(3): 149–153. Edmond B et al., 2011, Nosocomial Bloodstream Infections in Brazilian Hospitals: Analysis of 2,563 Cases from a Prospective Nationwide Surveillance Study, J Clin Microbiol, 49(5): 1866–1871. Doi:  10.1128/JCM.00376-11. Kampf G, Loffler H & Gastmeir P, 2009, Hand Hygiene for the Prevention of Nosocomial Infections, Dtsch Arztebl Int, 106(40): 649–655. Doi:  10.3238/arztebl.2009.0649. Paul M., et al., 2010, Effectiveness and safety of colistin: prospective comparative cohort study, J. Antimicrob. Chemother, 65:1019–1027. Perencevich E. N., et al., 2008, Summer peaks in the incidences of gram-negative bacterial infection among hospitalized patients, Infect. Control. Hosp. Epidemiol, 29:1124–1131. Lung India. 2010 Jul-Sep; 27(3): 149–153. Doi:  10.4103/0970-2113.68321. Sanchez P, Benjamin D, White R, Bloom B, Powers R & Clark R., 2004, Nosocomial infection in the NICU: a medical complication or unavoidable problem? J Perinatol, 24(6):382-8. World Health Organisation (WHO), 2010, Prevention of hospital-acquired infections, Geneva: WHO. Read More