Hospital acquired infections
Hospital acquired infections (HAIs) also known as health care associated infections encompass almost all clinically evident infections that do not originate from a patient's original admitting diagnosis (Nguyen 2009). The risk factors for the invasion of colonizing pathogens are:
- Iatrogenic: This includes infections acquired from medical personnel, invasive procedures, antibiotic use and prophylaxis
- Organizational risk factors: Infections can be acquired from contaminated air conditioning, water systems etc
- Patient risk factors: it includes the severity of illness, underlying immuno-compromised state, length of stay, etc (Nguyen 2009).
According to World Health Organization (2002), HAIs are caused by viral, bacterial and fungal pathogens and the most frequent nosocomial infections are infections of surgical wounds, urinary tracts and lower respiratory tracts.
EPIDEMIOLOGY OF HOSPITAL ACQUIRED INFECTIONS
Nosocomial infections are estimated to occur in 5% of all acute care hospitalizations and the incidence rate is 5 infections per 1000 patient days. Based on 7000 acute care institutions in the United States, the incidence of HAIs is more than 2 million cases per year. They also result in 26,250 deaths and expenditure in excess of 4.5 billion dollars (Nguyen 2009).
In another study conducted by the department of health in 2004, it was found that 6-10% of patients who go to hospital in the United Kingdom acquire an infection. In addition, it has been estimated that 9% of in-patients acquire an infection; this according to experts is equivalent to at least 300000 infections per year.
The World Health Organization (2002) also reported that at any given time, over 1.4 million people worldwide suffer from infectious complications acquired in the hospital.
A comprehensive study commissioned by the department of health and undertaken by the London school of hygiene and tropical medicine and the central public health laboratory in 1995 suggests that HAIs may be costing the NHS as much as 1 billion pounds a year (Bourne 2001).
HOSPITAL INFECTION CONTROL PROGRAMMES
Infection control programmes are effective, provided they are comprehensive and include surveillance and prevention activities as well as staff training (WHO 2002).
The infection control team usually comprise one doctor, one or two nurses and a microbiologist if he or she is not the infection control doctor. The team is responsible for the day to day aspects of infection control and for preparing and implementing the infection control programme and policies. It is also responsible for surveillance of infection, auditing, monitoring of hospital hygiene, investigating and advising on control outbreaks and training all hospital staff in infection control. (Bourne 2000).
COMPONENTS OF INFECTION CONTROL CAMPAIGN
There are several components of effective infection control however this literature will focus on the following:
- HAND HYGIENE AND STANDARD PRECAUTIONS:
- SCREENING AND ISOLATION OF INFECTED PATIENTS:
- EDUCATION AND TRAINING:
- ANTIBIOTIC STEWARDSHIP:
- CLINICAL AUDIT OF INFECTION CONTROL MEASURES:
- SURVEILLANCE INITIATIVES:
The single most effective way of combating HAIs is to improve hygiene in health settings especially hand hygiene. Hand hygiene involves the use of an alcohol based hand rub, washing with soap and water and the use of protective hand gloves (Bourne 2000).The 2004 WHO guidelines for infection control emphasized that standard precautions for infection control should include the use of standard protective equipments, prevention of needle stick injuries, environmental cleaning, sterilization, disinfection, appropriate handling of wastes, good environmental management practice etc.
Evidence to the House of Lords select committee on science and technology in 1998 proves that isolation of patients is an expensive but effective form of infection control. Isolation involves putting patients in isolation wards, physically segregating infected patients in one part of the ward with nursing by designated staff and the use of single bedded rooms.
Education is necessary to inform staff of the merits of infection control measures in the hospital. There should be continual training of food handling staff, nurses, doctors, and students etc on good infection control practices as well as periodic infection control updates on current issues in the hospital. There is a need for the hospital to have written policies, procedure and guidelines for the prevention and control of infection and this should be reviewed regularly.(Bourne 2000)
Hospital acquired antibiotic resistant bacteria is a great challenge to the healthcare system. Antibiotics stewardship programs encourage the proper use of antibiotics to prevent bacterial resistance. The rise in antibiotic resistant strains is due to increased and unnecessary antibiotic use, self medication with left over antibiotics against fresh infections, incomplete intake of prescribed dose, etc
Audit is a key function of infection control teams. Infection control audit should include audits of infection control policies in wards and departments and microbiological safety audits of the health care environment (Hay 2006).In this regard, the team according to Bourne (2000) can identify a need for specific training to re-emphasize the importance of various infection control activities such as sharps policy, isolation practice, antibiotic prescribing etc.
Surveillance is a key component of infection control programme and the effectiveness of prevention, detection and control measures is improved if they are underpinned by an effective surveillance strategy. Research (Bourne 2002) shows that surveillance involving data collection, analysis and feedback of results to clinicians is central to detecting infections, dealing with them and ultimately reducing infection rates. In the year 2000, the department of primary care and public health laboratory services have been working together to develop a national surveillance scheme. The aim of the scheme is to improve patient care by providing information to assist NHS trust to reduce rates and risks of HAIs and to provide national statistics on specific types of infection for comparison with local results. (House of Commons 2003).
The main objectives of surveillance are:
- To detect unusual levels or changes in the incidence of infection.
- To identify hazardous or highly antibiotic resistant organisms to enable early investigation and application of control measures.
- To assess the efficacy of control measures
- To prevent and detect outbreaks in order to allow timely investigation and control.
- To assess infection levels over time in order to determine the need for preventive and control measures. (House of commons 2003)
Aseptic techniques in invasive procedures should be observed. There should be monitoring in relation to cleaning, housekeeping, disinfection, sterilization, safe collection and disposal of clinical waste, standardization of diagnostics tests and procedures, kitchen hygiene among others. There should also be specific documented arrangements for dealing with infections including outbreak control, targeted screening and isolation of patients (Bourne 2000)
This study concludes by identifying health as a major priority for any society whereas hospital acquired infections remain a leading cause of death globally. Hospital Acquired infections are Is add to functional disability and emotional stress of the patient and may lead to disabling conditions that reduces quality of life of affected individuals hence the necessity of good infection control. This study identifies hai as a possible leading cause of death globally. Hai
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