Infection Prevention and Control in Hospitals - Essay Example

Discuss the reasons why MRSA and Clostridium difficile have emerged as major causes of hospital acquired infections. Contents Contents2 Introduction 3 MRSA and Clostridium difficile 4 MRSA and C.difficile as the source of infections 6 Why are they an issue in the UK hospitals 7 Current policies 9 Conclusion 11 Reference 12 Introduction MRSA and Clostridium difficile have become the bane of healthcare facilities in the UK, as hospitals pour more resources into halting their spread and reducing infection rates. All this is important, given that MRSA and Clostridium difficile have been responsible for several deaths (Gupta 2006) that were preventable. However, the more imminent threat lies in the fact that these two organisms are becoming increasingly difficult to treat with available medication which has left hospitals with prevention as their main cure for reducing hospital acquired infections. Hospital acquired infections can result from a number of factors, however, MRSA and Clostridium difficile have been cited as the major causes in most cases and this has prompted the author to investigate the reasons behind the rise of MRSA and Clostridium difficile as the major causes of hospital acquired infections. MRSA and Clostridium difficile MRSA is also known as Staphylococcus aureas or S. aureas (Nunan and Young 2007). MRSA is a bacterium which normally resides on human beings, on their skin, in their nose or mouth but does not normally cause any harm or illness (Nunan and Young 2007). This characteristic could be down to a well-functioning immune system on the part of individuals, however (Nunan and Young 2007) has raised the possibility of other individuals being resistant to colonisation by the bacteria. Therefore, in healthy individuals MRSA is not threat, but the problem arises when individuals have open wounds or their skin is damaged, which suggests that the MRSA bacteria is in some ways opportunistic as the external body defences are sufficient to halt colonisation. When this bacterium enters the human body it has the ability to cause infections and even death through blood poisoning, heart infections and other diseases such as pneumonia (Gupta 2006). The range of medical conditions that the bacterium causes would suggest that it has an effect on the immune system and contributes to its weakening. This characteristic of the MRSA bacteria is probably the most dangerous especially in hospitals, where immune systems are already compromised. Patients prolong their hospital stay which in some ways can be seen as enabling the bacteria to spread. Clostridium difficile or C.difficile is also a bacterium, but this one causes severe gastrointestinal infection by colonising and producing toxins which damage the intestinal walls (Mid Yorkshire 2007). The patient then suffers diarrhoea as a result of this infection which can lead to death (Mid Yorkshire 2007). It is apparent that C.difficile attacks the intestines specifically, whilst MRSA can be presumed to attack or rather weaken the immune system. One could also suggest that the C.difficile infection could be attributed to poor health and safety, as well as hygiene in an environment, whilst MRSA could be attributed to poor patient personal care. The distinction between the two bacteria are also important for this essay, given that the author would like to find out why both bacteria have emerged as major causes of hospital acquired infections. Just as food poisoning is associated with areas of cooking and those that serve food, C.difficile can be also be associated with the same factor in hospital environments. This does not necessarily mean that all hospital kitchens are not up to the required standard; it simply means that where food preparation is occurring the risks of bacteria that attack the intestines or cause diarrhoea are higher. In a hospital, this is heightened by the presence of individuals who are not feeling well and some that are infectious. Likewise, MRSA seems to be associated with physical contact as it tends to infect those with open wounds. One also has to consider that nurses and other hospital staff are constantly moving throughout the hospital, and they potentially serve as transfer agents or hosts for such bacteria. This provides a brief picture of the environment that these bacteria capitalise on, and this also helps the reader to understand the following section which shall look at the major causes of hospital infections. MRSA and C.difficile as the source of infections Research conducted in the United States demonstrated that C.difficile was becoming more common due to the identification of a new strain which did not respond to the treatment available such as gatifloxacin and moxifloxacin (Alison et al 2006). This resistance to medication is particularly problematic in hospitals as it results in an increase in infections and mortalities. New strains of an organism such as C.difficile and MRSA will also pose problems in its management, as the methods of containing it may be different to the historic strain. With MRSA, it is resistant to nearly all available medication which leaves little scope for health care professionals to deal with this infection. This has implications on the infection rate as the introduction has already made the reader aware of the opportunistic tendencies of MRSA. MRSA exists on most people and only becomes a problem when the skin has been broken, however if MRSA is resistant to most available treatments it will only serve to increase the risks of both primary and secondary infections. There are other alternative treatments for MRSA that are available but they cannot be taken orally and take longer to clear an infection (Alison et al 2006). This means that infected patients prolong their hospital stay, which has knock-on effects in that the chances of spreading infection increase dramatically. The high resistance rates also become a contributing factor to increased deaths and research shows that in 2005, England and Wales recorded 1,629 deaths where MRSA was a contributing cause (Taylor 2005). Why are they an issue in the UK hospitals The causes of MRSA and C.difficile are an important issue in UK hospitals, as they have to report infection rates and preventable deaths as a result of these infections. As a result, most hospitals have implemented policies to help contain the spread of these infections. Another cause of concern in UK hospitals is the increasing rate of MRSA amongst drug users, who often have wounds and infections as a result of their habit (Nunan and Young 2007). Likewise, there are patients that get admitted to hospitals for other reasons such as car accidents, home accidents or even bruising, but such patients are now at risk of getting an MRSA infection, by virtue of being hospitalised. Likewise for C.difficile, it mainly affects those over the age of 65, which is an issue for both hospitals and relatives of the over-65s that are susceptible to get an infection (Alison et al 2006). At that age, a C.difficile infection could result in death in this age group, as their immunity and general health may not be able to respond more effectively to this threat. Just like MRSA, the treatment of C.difficile is being made difficult by the increasing resistance to antibiotics. Therefore one of the main issues with both MRSA and C.difficile is that hospitals commonly use antibiotics to treat a range of ailments. If these ailments fail to respond to treatment, it leads to prolonged hospital admission and the use of more resources to try and combat the spread of the infection. As mentioned earlier, treatments for MRSA and C.difficile infections that have failed to respond to treatment, can be invasive and not as comfortable to the patient. These patient regimens also increase the possibilities of secondary infections, as well as side effects. Prolonged hospital admissions is another issue for UK hospitals as it restricts their capacity to treat other patients, and can serve as an inconvenience to other patients as they may have to come daily for treatment or be moved to another hospital that is not as close. Prolonged hospital admissions also increase the risks of the infections spreading to other healthy patients, which can cause preventable deaths. The issues for UK hospitals are real and practical, and they have managed to come up with policies that combat the spread of these infections. Current policies Seeing as one of the main causes of these infections is their resistance to antibiotic treatment, which is the current treatment available, hospitals have scaled down on their use of antibiotics (Gupta 2006). A high usage of antibiotics to treat any infection only serves to breed more resistant bacteria, which is important considering the people who are most at risk of contracting MRSA and C.difficile. For instance, over-65s and drug users are considered to be most at risk (Walsh 2006). As these infections are likely to spread quickly, hospitals have had to improve on hygiene, especially hand hygiene given that health care professionals are in constant contact with patients. Hand decontamination has been introduced in most hospitals and this includes hand washing and alcohol hand rubs at every point in the hospitals (Walsh 2006). This hand washing policy has even extended to visitors to the hospitals going on wards, with alcohol hand rubs being made available at every opportunity. This is probably the most practical policy in terms of prevention, as it places responsibility on all within that environment. This is important in areas where there are patients with open wounds that could be infected with MRSA, and it is also important for kitchen and cleaning staff as they can unwittingly spread the C.difficile bacteria. These preventative measures have also extended to the use of aprons and gloves when dealing body fluids (Walsh 2006). The exposure to body and body fluids increases the risks of spreading MRSA and C.difficile, especially where needles are involved. Needle stick injuries have been reduced by the introduction of sharps bins where the needles can be discarded as soon as they have been used (Walsh 2006) and in doing so prevent the risks of infection to both staff and their patients. Changes have also been made to the way that health care professionals conduct certain aspects of their responsibilities such as wound care and the associated techniques. For instance, wound dressings were expected to be carried out with an aseptic technique or a clean technique (Walsh 2006), which would minimise the need to touch the wound dressing. However, C.difficile may present as normal diarrhoea which means its detection may be slow in a healthcare setting. As a result of this, policies in this area often advocated isolation at the earliest opportunity as C.difficile has spores which cannot be killed by the hand washing policies mentioned earlier (Alison et al 2006). This means that C.difficile has to be managed more closely as it is potentially harder to detect, and has the ability to spread rapidly. Conclusion This paper sought to discuss the reasons as to why MRSA and C.difficile had emerged as major causes of hospital acquired infections. This was carried out by defining both MRSA and C.difficile, as well as exploring their characteristics which make them deadly infections. Hospital policies were also investigated as they provided insight into why they have emerged as major causes of hospital acquired infections. As a result of these investigations, it was deduced that MRSA and C.difficile have emerged as major causes of hospital acquired infections because of their increasing resistance to antibiotics. This resistance has mainly been a result of the over-use of antibiotics in the healthcare sector. Another reasons has also been the relaxed hygiene regimens which were previously followed in the healthcare sector which made it easy for infections to spread. For instance, hand washing, sharps bins and other policies have only been recently introduced into the health care sector. the last major cause of these infections is also the increase in over-65s and drug users being admitted to hospitals, as their immune systems are already compromised and so are more likely to be susceptible to such infections. As a result of this, more of these infections are being reported as more people from these risk groups are admitted to hospitals. Reference Alison M. L., Bellantoni, M.F., Greenough, W.B., and Zenilman, J.M. (2006) "Burden of Clostridium Difficile-Associated Diarrhea in a Long-Term Care Facility" Journal of the American Geriatrics Society 54 (7) , 1068-1073 Gupta, J. (2006). in "The Infection Prevention and Control Annual Report" http://www.cnwl.org/uploads/ICR_Report_%202005.doc. Nunan, C., and Young, R. (2007). "MRSA in farm animals and meat: a new threat to human health" http://www.soilassociation.org/web/sa/saweb.nsf/librarytitles/NT00024E06.html/$file/MRSA%20report.pdf Taylor, J. (2005). "MRSA, Cleaner Hospitals Programme - progress report in light of NICE guidelines." http://www.midtrentccn.nhs.uk/EasySite/lib/serveDocument.aspdoc=19807&pgid=12663 The Mid Yorkshire Hospitals NHS Trust (2007). "Trust Board Report - Infection Prevention, Management and Control." http://www.kirklees-pct.nhs.uk/fileadmin/documents/meetings/nov07/KPCT-07-209_MYHT_Trust_Board_-_Infection_prevention_report_-_Nov_07-final.pdf Walsh, P. (2005). "The Infection Prevention and Control Annual Report" http://www.cnwl.org/uploads/ICR_Report_%202005.doc. Read More