A STUDY ON HOSPITAL ACQUIRED INFECTIONS AND PREVENTIVE STRATEGIES

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A STUDY ON HOSPITAL ACQUIRED INFECTIONS AND PREVENTIVE STRATEGIES

Abstract

Hospital-acquired infections (HAIs) pose a significant threat to patient safety and public health. This study aims to investigate the prevalence, types, and risk factors associated with HAIs in a tertiary healthcare setting. Additionally, it explores the effectiveness of existing preventive strategies and proposes evidence-based recommendations for enhancing infection control measures.

The research employs a mixed-methods approach, combining retrospective analysis of medical records, surveys, and interviews. Data will be collected from patients with documented HAIs, healthcare providers, and infection control teams. The study will assess the microbial profile of infections, identify common transmission routes, and analyze patient-specific and institutional risk factors contributing to HAI development.

Preventive strategies currently in place, including hand hygiene protocols, antimicrobial stewardship, and environmental cleaning practices, will be evaluated for compliance and effectiveness. The study will also consider the impact of organizational culture, education programs, and surveillance systems on infection prevention.

Chapter One:

Introduction

1.1 Background

Hospital-acquired infections (HAIs), also known as nosocomial infections, continue to be a pervasive challenge in healthcare settings worldwide. These infections, acquired during the course of medical care, pose a substantial threat to patient well-being, prolong hospital stays, and escalate healthcare costs. Despite advancements in medical science and infection control measures, the incidence of HAIs remains a critical concern for healthcare providers, policymakers, and patients.

Hospital acquired infections (HAIs) refer to infections associated with the delivery of healthcare in hospitals, longterm facilities, home care, ambulatory settings, and other clinical environments. HAIs are unrelated to the original illness and are defined to appear 48 hours or more after hospital admission or within 30 days from discharge.⁴ These infections are the most frequent adverse event in health care delivery worldwide, leading to multiple cases of morbidity and mortality.

The emergence of HAIs dates back centuries ago; however, wide-scale recognition of the problem did not come about until the 1950s when penicillin-resistant Staphylococcus aureus infections caught the public’s attention. Unfortunately, this issue was taken lightly until it became an epidemic. Ten years later, hospitals in the United States began hospital-based infection control, and later in the 1990s, HAI control programs were established in virtually all hospitals across the nation.

Although the emergence of HAIs are unknown, there are many explanations to how they came about and are still thriving to this day. The first problem is that hospitalized patients tend to be more susceptible to infections due to their weakened immune systems. Second, because they are usually grouped together in confined areas of the hospital, the exchange of infections can occur more frequently between individuals. Third, staff members must move quickly from one patient to another, allowing cross contamination to occur if standard regulations are not met. Other explanations for the emergence of HAIs include the use of medical procedures that bypass the body’s natural protective barriers, improper sterilization of equipment, routine use of antimicrobials allowing for the emergence of resistant strains, and inadequate sanitation protocols regarding washing of hands and self. Despite these reasons, the rise of these infections can be easily reduced if healthcare providers and patients put in the extra effort. If done correctly, hand hygiene can help decrease the spread of HAIs by a significant amount. Because the hands are the main pathway for contact transmission of pathogens in healthcare, proper hand hygiene is an important measure to help avoid and prevent the spread of HAIs. Some factors that contribute to poor compliance of hand hygiene include lack of knowledge, understaffing, overcrowding of patients, poor access to hand washing or sanitizing facilities, irritant contact dermatitis of clinicians’ hands, and lack of organizational commitment to appropriate hand hygiene.

1.2 Statement of the Problem

The occurrence of HAIs is associated with a myriad of factors, including microbial resistance, compromised immune systems, and lapses in infection prevention practices. The consequences of HAIs extend beyond individual patient outcomes, impacting the broader community by contributing to the spread of antibiotic-resistant strains and increasing the burden on healthcare systems. Understanding the prevalence, types, and underlying causes of HAIs is essential for developing effective preventive strategies.

1.3 Purpose of the Study

The primary purpose of this study is to comprehensively investigate the landscape of HAIs within [Name of the Hospital], a tertiary healthcare facility. The research aims to achieve the following objectives:

Assess the prevalence and types of HAIs among patients admitted to [Name of the Hospital].

Identify the microbial profile of infections and potential sources of transmission.

Examine patient-specific and institutional risk factors contributing to the development of HAIs.

Evaluate the compliance and effectiveness of existing preventive strategies in place.

1.4 Research Questions

To guide the study, the following research questions will be addressed:

What is the prevalence and microbial profile of HAIs among patients at [Name of the Hospital]?

What are the common transmission routes and risk factors associated with HAIs in this healthcare setting?

How effective are existing preventive strategies, including hand hygiene protocols and antimicrobial stewardship, in reducing HAIs?

What recommendations can be proposed for enhancing infection control measures based on the study findings?

1.5 Significance of the Study

This study holds significance for multiple stakeholders within the healthcare system. Understanding the dynamics of HAIs at [Name of the Hospital] will contribute valuable insights for healthcare providers, administrators, and policymakers. By identifying areas of improvement in preventive strategies, the study aims to enhance patient safety, reduce healthcare costs associated with prolonged hospital stays, and inform evidence-based practices that can be applied across healthcare settings.

1.6 Scope of the Study

The study will focus on patients admitted to [Name of the Hospital] within a specific timeframe. Both quantitative and qualitative methods will be employed to gather data on the prevalence, types, risk factors, and preventive strategies related to HAIs. The research will also consider the perspectives of healthcare providers and infection control teams.

1.7 Significance of the study

Stated earlier, HAIs are the most frequent adverse event in healthcare worldwide and create numerous problems and risks to patients affected. The impact of HAIs include additional suffering to the individual, expensive treatments leading to high medical costs, expensive surveillance, prolonged hospital stays, long-term disability, increased resistance to antibiotics, and unnecessary deaths. The most recent study from the CDC in 2011 shows than an estimated 722,000 individuals were affected by HAIs in acute care hospitals in the United States.⁵ Of these cases, 99,000 resulted in death.⁴ In 2009, the annual direct medical cost of HAIs in the U.S. ranged from 28-45 billion dollars.⁴

The HAI type that causes the highest morbidity and mortality is ventilator associated pneumonia, or VAP.² This infection is one of the top three concerns of clinicians today and can account for up to 60% of all deaths from HAIs in the U.S.² If death does not occur, VAP can increase patient time in the intensive care unit by four to six days and is estimated to generate increased medical costs of 20,000 to 40,000 dollars.² VAP is an increasing concern world-wide, as there is evidence of an increase of transmission in ICU patients in Germany, France, and the United Kingdom.² Because there is a great risk of pneumonia in patients receiving continuous ventilation, most of the research on HAIs have been focused on VAP.

Another major site of infection that affects around 158,000 out of 722,000 HAI infected patients are surgical site infections.⁵ Any breach of skin can lead to a surgical site infection. These invasive procedures can then lead to additional or extended treatment, resulting in up to 10 billion dollars in treatment costs every year in the U.S. alone.²

In addition to these concerns, there are many factors that put patients at risk for HAIs. First, distinct settings create specific patient populations. The risk of acquiring HAIs in developing countries is 2 to 20 times higher than in developed countries.² Therefore, factors that place patients at greater risk for HAIs in settings with limited resources can include poor environmental hygienic conditions and waste disposal, poor infrastructure, insufficient equipment, understaffing, overcrowding of patients, poor knowledge and application of basic infection control measures, lack of procedure, lack of knowledge of injection and blood transfusion safety, and absence of local and national guidelines and policies.³ In developed countries, the factors that put patients at greater risk consist of prolonged or inappropriate use of invasive devices and antibiotics, high risk procedures, weakened immune systems, and inappropriate application of standard isolation precautions.³ When looking at overall circumstances that place a patient at risk, one could examine patient characteristics (age and/or underlying conditions that compromise the immune system), presence of invasive medical devices (catheters, breathing tubes), complications from surgical procedures, and antibiotic use.³

Another factor contributing to HAIs are antibiotic resistant microorganisms, particularly bacteria. Overuse of medication can promote the emergence of antibiotic resistant organisms that cause these infections and limit treatment options. Studies show that up to 50% of antimicrobial use in hospitals is unnecessary, inappropriate, and contribute to the overgrowth of resistant Clostridium difficile infections.⁵ C. difficile infections are currently at historically high levels and can cause severe diarrhea, fever, and abdominal pain.

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