Issue Related to Health Service Standards



Select an issue related to one of the Health Service Standards (Hospital-associated Infection) reflect on safety and reflect on their clinical experience to date and with reference to the National Safety and Quality Health Service Standards.




Hospital-acquired or nosocomial infections appear in the admitted or visiting patients, who have come down for the treatment other than infection under healthcare organization. These infections now became a worldwide phenomenon in developed and developing countries. As the nosocomial infections develop during hospitalization, which may bring about the extended hospital stay, disability, mortality, and financial burden. Generally, predominant infections are mostly associated with the central line, ventilator, catheter, and surgery practices; and common pathogens include fungal parasites, bacteria, and viruses. Care of patients is given in clinical setting varying from simple medical clinics with fundamental equipment to substantial advanced exceptionally furnished healthcare organizations with the conditions of the craft innovation. Regardless of advancement in public health and healthcare setting, diseases related to infections keep on developing in hospitalized patients and furthermore in healthcare staff. In hospitalization, the infection can be transmitted to the patients through various sources like from hospital environment and waste materials, from healthcare nurses and staffs, or from infected patients. However, prevention of transmission should be restricted to decline the incidences of infection. The present literature review will highlight the prevalence of nosocomial or hospital-acquired infections; also discuss the significance of prevention and control practices guided by WHO along with the effectiveness of surveillance system to accomplish the aim for the elimination of interims.

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The World Health Organization (WHO) addressed hospital-acquired infections a noteworthy reason for mortality and inability among patients. A study on HAIs uncovers that whenever, more than 1.4 million individuals worldwide are experiencing diseases obtained during hospitalized conditions, with an expected 80,000 passing in every year. The factual ratio fluctuate from 5%-10% of gross patients admitted to advanced hospitals or clinics on the developed countries and nearly 25% in developing nations (Nazir & Kadri, 2017). The European Centre for Disease Prevention and Control outlines that in European countries a normal predominance of Hospital-acquired infection ratio is 7.1%. The prolonged ICU treatment also increases the risk of developing an infection for patients. The hospitalized patients can be acquired infections from a variety of microorganism sources such as cross-infection or sometimes from endogenous pathogens; other than that utilization of invasive apparatus, specifically ventilators, urinary catheters etc. can also cause infections to the patients (Zingg et al., 2017; Magill et al., 2015).
The hospital acquired infection related accessible data are somewhat limited in case of the developing countries; however, a current investigation by WHO depicted that the risk of “hospital” infection in developing countries is more frequent in comparison with developed countries. Whenever the predominance of “hospital” infection differs in the vicinity of 5.7% and 19.1% in low as well as middle-income nations. The ratio of ICU-acquired infections among patients varied from 4.4%-88.9% and around two to three times higher than the developed countries. Besides, in few developing nations, the recurrence of contaminations related with the utilization of central lines, intrusive equipments, and ventilators conceivably comparable equal to nineteen times greater than the developed countries (Bammigatti et al., 2017). However, infection in surgical site is considered as the principal contamination especially in case of the normal patients in developing countries; while, the affected patient’s proportion is 9 times greater in developing countries compared with developed countries (Plowman et al., 2001; Zingg et al., 2017). 
The hospital-related infections related to patient’s safety concerns as well as make further distress in terms of long-term functional disability, which sometimes, prompt incapacitating conditions that decrease the quality of life; it can enhance anti-microbial resistance, emotional stress, longer hospital stays; which in turn not only cause huge financial burden for the patients and their respective families but also, increase futile mortality rates (WHO, 2016; Osterholm et al., 2000). 

Review of the Literature: 

As hospital-acquired infections are known to be the reason for diseases and demise; so, it should be prevented by applying standard measures with the goal that their spread can be regulated. According to several literature reviews, prevention of infection needs a comprehensive and integrated program; additionally incorporate monitoring, prevention measures, and training of healthcare staffs. Environment plays an important role regarding the prevalence of infection. Within the hospital setting, air, water, and foodborne pathogens can be transmitted to the patients. It is crucial to implement policies to guarantee the proper cleaning of healthcare surroundings, along with the sterilization of medical devices. To eliminate airborne microorganisms’ both appropriate ventilation and fresh filtration of air are principal methods to be used in the healthcare setting. In general patients’ wards, the routine monitoring of filters and ventilation along with operating theatres and ICUs should be kept up and recorded. To prevent infection from waterborne microorganisms, checking up and analysis of water is important. The inappropriate way of dealing with food may lead to infections; so, hygiene of the area and standard of the food quality ought to be maintained (Dellinger, 2016; Mehta et al., 2014). Infections can be transmitted from healthcare workers. Prevention of hospital-acquired infections considered to be the accountability of the healthcare service providers and staffs. Everybody should work in a simultaneous manner to decrease the risk of infection for the admitted patients and hospital workers. Individual cleanliness is essential for everybody so healthcare workers ought to look after it. Routine hand washing is required with antimicrobial agents before and after being in contact with inanimate sources and contaminated patients. In high-risk health care settings, maintenance of proper cleanliness such as utilization of sterilized invasive devices and aseptic practice; also utilization of gloves, hand coverings, eye protection, face shield, and appropriately disinfected uniform is basic requirement to deliver healthcare services (Loveday et al., 2015; Zingg et al., 2015; Ellingson et al., 2014). Waste management in the healthcare setting is another potential strategy to prevent infection. Potentially infectious and hazardous healthcare waste ought to be put away in the zone with the confined accession. Waste including a huge amount of heavy metals and infectious body fluids like blood, sputum, secretions, excretions, and mucous membranes; along with wastes from surgeries and diagnostic laboratories should be discarded distinctly. The staffs and cleaners must be well-informed about the health hazards and appropriate management of waste materials (Tunkel et al., 2017; Berríos-Torres et al., 2017). 

Regulation of hospital-acquired infection:

Utilization of antimicrobial agents ought to legitimize the correct clinical diagnosis or the infection producing microorganisms. According to the Centers for Disease Control and Prevention (CDC), around half of the antibiotic courses prescribed by the doctors are superfluous (Sikkens et al., 2016; MacGowan & Macnaughton, 2017). The physicians must prescribed antimicrobials medicine on the basis of the resilience of the patient; additionally, identification of the infection and causal microorganisms is also important. The purpose of antimicrobial therapeutics is to utilize the prescribed medicine, which is specifically dynamic against in all likelihood microorganisms and to the least extent liable to develop resistance and antagonistic impacts. Antimicrobial prophylaxis ought to be utilized at proper timing like before surgery to minimize the occurrences of postoperative complications and surgical site infection (Dresser et al., 2017; Potter, 2018).
Although compelling attempts apply to prevent hospital-associated infections; yet more effort needed to manage these contaminations. Implementation of control programs and infection prevention is required to ensure the well being of the patients as well as healthcare staffs. Organization, staffs, people admitted or visiting healthcare facility must consider such projects to assume their part in the counteractive action of contaminations. The analysis of several literature review demonstrated that healthcare organizations, which implemented infection control program that included reconnaissance and control segments, could lessen HAIs by 32% contrasted and those healthcare institutes that did not implement this sort of program or the basic elements (Nazir & Kadri, 2017; Danasekaran et al., 2017). 
The infection control and prevention program at the healthcare facility is an arranged, methodical way to deal with screen and assess the quality and suitability of infection control methodology and process. The program is the strategy of functioning which is assigned to distinguish contaminations, which develop in admitted patients and healthcare workers that have the potential for transmission of infection, recognize possibilities for the decrease of hazard for infection transmission, and suggest risk minimization methods by incorporating standards of vigorous infection control management in patient care; also provide training and instruction to the healthcare staffs, distillation and sterilization proceedings at healthcare services and control and surveillance by in-house reviews and different recording appliances. The primary point of the disease control program is to bring down the danger of a contamination amid the time of hospitalization. This kind of control initiative can forestall 33% of hospital-acquired contaminations (Khan et al., 2015; Li et al., 2017; Ziaee et al., 2017; Kalenic & Budimir, 2009).

Infection Control Team management in Hospital:

WHO patient safety response currently working towards setting up successful methods for enhancing worldwide medicinal services and protect lives of patients mislaid due to healthcare-acquired infections. In WHO patient safety, “Clean Care is Safer Care program” is intended for lessening healthcare related infection all-inclusive and has established the enhancing hand cleanliness processes to accomplish the absolute goal. WHO Patient operates in association with different WHO programs, including local and nation workplace advocating the State members, to lessen healthcare-associated infections by helping with the evaluation, outlining, and execution of infection prevention as well as policies and procedures, well-timed activities at national as well as organizational levels (World Health Organization, 2016). 
Establishment of Infection control organization is a necessary part of the infection prevention program. Though, the ideal organizational structure will fluctuate according to the requirements, type, and resources of the healthcare institutes. The team should have a direct reporting connection to either management or the healthcare workers to facilitate perceptibility and efficacy. It is currently a worldwide acknowledged aspect that the infection control team is playing the role of policymaker for the infection control program in every healthcare organization.  This committee incorporates all-inclusive embodiment from pertinent departments such as management, physicians, nursing staffs, health care workers, clinical microbiology, maintenance, pharmacy, medical representatives, housekeeping members. The committee is responsible for the planning of policies regarding the prevention and control of infection. Team members of Infection control committee embrace the daily functions of infection control, along with developing and evaluating policies regarding infection control, preparing yearly work plan for surveillance and prevention, giving counsel and direction in regards to infection control proceedings, review surveillance data, identification and investigation of epidemic conditions, promotion of awareness activities within healthcare facility, provide proper education and training of staff (Ziaee et al., 2017; National Nosocomial Infections Surveillance System, 2004; Balarabe et al., 2015; Núñez-Núñez et al., 2017).

Surveillance of Healthcare-associated or Nosocomial infection:

Despite the fact that the infection prevention, as well as the control program, is designed to annihilate healthcare-associated contaminations yet surveillance report for the presentation of advancement of execution is as yet required to achieve the goal. The productive surveillance techniques incorporate accumulation of information from various proveniences via competent information authorities; data ought to incorporate authoritative information, statistical risk factors, patient’s diagnostic reports and history, and approval of information. Next step includes extraction and investigation of gathered data ought to be done which incorporates the illustration of principles, dissemination of contaminations, and contrast of prevalence ratios. Assessment and reviews after investigation ought to be proclaimed through infection control committees, administration, and labs maintaining the privacy of patients. The assessment of the believability of surveillance frameworks is needed for effective intercessions also its congruity. Predominantly, the endeavor of information at general interims for support of the effectiveness of surveillance frameworks ought to be made necessary (Collins, 2008). 


With the enhanced hospital-acquired infection is has turned out to be troublesome for healthcare organizations along with infection prevention and control committees to achieve the objective for the minimization epidemic incidences and elimination of the nosocomial infections. Nevertheless, by practicing safe and robust methods for the delivery of healthcare planned by the infection control management, regulating infection transmission applying proper techniques for antimicrobial usage can be helpful for the elimination of nosocomial pathogens effectively. An effective surveillance technique by following the WHO recommended guidelines can support healthcare organizations to formulate infection control programs; also, appropriate training of hospital workers regarding the bio-safety measures, legitimate waste management, standardize care delivery, and increasing general awareness about these infections can likewise assist in the decline of hospital-acquired infection. 


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