Introduction to Healthcare-Associated Infections (HAIs)
Question:
Discuss about the Aureus Rates and Accreditation Scores.
The clinical problem or issue selected here is the “Healthcare-Associated Infections” (HAIs), and the Standard three has been chosen to help address this issue/clinical problem. The HAIs denotes the infections that the sick get when they are being treated for the surgical and medical conditions, and a significant proportion of such infections are preventable. The contemporary healthcare applies several kinds of devices (invasive) and procedures when treating patients and to assist their patients to recover. However, the infections can be attributed to procedures such as surgery alongside the devices utilized in the medical procedures like catheters/ventilators (Chandrananth, Rabinovich, Karahalios, Guy & Tran, 2016).
The HAIs remain significant causes of both mortality and morbidity and are linked to a considerable surge in healthcare costs every year. At any given time, the Australians who are hospitalized are affected by a HAIs. The HAIs takes place in each kind of care context. These include acute care hospitals, ambulatory surgical centres, dialysis facilities, outpatient care as well as long-term care facilities. The common types of HAIs include pneumonia, bloodstream infections, surgical infections, catheter-associated urinary tract infections and Clostridium difficile (Choi et al., 2015).
The HAIs is a critical clinical problem or issue due to many reasons. HAIs are substantial sources of complications crossway a continuum of care. These infections can be transmitted between various healthcare facilities. Nevertheless, the latest research indicates that the implementation of current prevention practices can culminate in up to 70% reduction in some HAIs. Similarly, the newest modelling data indicate that significant reductions in the resistant bacteria including MRSA can be accomplished via the coordinated tasks between the healthcare facilities in a particular region.
The financial benefits of employing the prevention and control practices are approximated to be about 25 to 32 billion dollars in the cost saved that would otherwise be spent on medication. The HAIs risk factors can be categorized into three primary categories. These include medical procedures alongside antibiotic use; organizational elements as well as patient features. The healthcare practitioner behavior alongside their interactions with the healthcare system further influences the HAIs rate (Mathot, Duke, Daley & Butcher, 2015).
Research has shown that correct education coupled with training of healthcare workers surges compliance with as well as the adoption of best practices like infection control, attention to safety culture, hand hygiene as well as antibiotic stewardship can help prevent HAIs. Because of the magnitude of the health risk to patients, there is a need for the practitioners to adopt the following best practices (Grammatico-Guillon, Rusch & Astagneau, 2015). These include careful insertion, maintenance as well as the prompt elimination of catheters and the careful utilization of antibiotics. The other best practice is decolonization of patients with the evidence-based technique to decrease the MRSA transmission in the hospitals.
Why are HAIs a Critical Clinical Problem?
The objectives of Healthy People 2020 measure the progress in Australia and globally towards the reduction of CLASBSI incidences alongside invasive MRSA infections. Nevertheless, the new wok is called for to ensure effective implementation of the Standard 3 to prevent and control HAIs effectively (Farmer & Mitchell, 2010). Besides, there are additional main kinds of HAIs which Hospital Healthcare System must work to avoid. These other types include the HAIs triggered by antibiotic-resistant pathogens (Graves et al., 2016). They include catheter-associated urinary tract infections, surgical sites infections, ventilator-associated events or ventilator-associated pneumonia as well as Clostridium difficile infections.
The studies have indicated that several of such infections remain preventable. Attempts are underway to expand not only the implementation of Standard 3 but also other strategies proven to prevent the HAIs better, advance useful prevention tools’ development, as well as explore the new-fangled approaches to prevention (Ezzatzadegan, Chen & Chapman, 2012). A significant share of strategies and energies to prevent HAIs have been directed towards acute contexts. Delivery of healthcare, increasingly, including the complicated procedures, is already being moved towards outpatient setting like ambulatory surgical centres, long-term care facilities as well as end-phase renal illness facilities (Mitchell, Shaban, MacBeth, Wood, & Russo, 2017).
Such contexts usually have restrained capacity to oversight alongside infection control than the hospital-oriented ones. Patients with HAIs alongside those triggered by antibiotic resistance pathogens, typically move between a range of healthcare facilities types. Therefore, preventions energies have to be expanded crossways the care continuum. Furthermore, the challenges brought by antibiotic-resistant pathogens alongside C. difficile stay best tackled via coordinated actions amongst the healthcare facilities in a particular area.
It is clear that HAIs is a clinical issue or problem that needs a new raft of measures to address. The HAIs remain amongst the most common, substantial and preventable patient safety clinical issue presently. Yearly, 180,000 patients in Australia suffer HAIs thereby elongating their stay in the hospitals. This further consumes two million hospital bed days. The HAIs impact encompasses surged patients mortality and morbidity risks, elongated stay in hospitals, decreased QoL as well as extra costs for consumable products utilized in the treatment of HAIs for both system and patients. The HAIs produce a substantial economic and health burden for both health system and the patients. For instance, one Australian state discovered that additional costs linked to merely 126 surgical sites HAIs stood at more than five million. Moreover, prolonged utilization of antibiotics as the initial line of defense to a surged quantity of HIAs has culminated in the increase of antimicrobial resistant bacteria. Such bacteria remain regarded as having a significant impact on the mortality and morbidity, hospital costs as well as stay as opposed to the ones resulting from the antimicrobial infections.
Preventing and Controlling HAIs with Best Practices
The results of the review have enormous implication for clinical practice or research or the profession. First, it cements the need to understand the rationale behind the implementation of the Standard three effectively. The primary intention of the Standard 3 (S3) is to prevent patients from the acquisition of “preventable healthcare-associated infections” and efficiently manage the infections as they occur utilizing evidence-based strategies. From the synthesis of the literature, it is clear that the preventable infections can cause severe illness and even potential deaths (Mumford et al., 2015). Therefore, S3 purposes to minimize the risk for patients in the acquisition of these infections and to allow these infections to be managed efficiently immediately they take place. At least 50% of associated healthcare infections are imagined to be preventable. Both overseas and Australian studies have demonstrated that there are mechanisms that can minimize the infections rate triggered by healthcare (Shalit, 2016).
There is a need for the entire healthcare system and the innovation stakeholders to start showing the need for Standard 3 full implementation. This is because the Standard 3 has explicitly recognized the need to make HAIs a national goal. It has identified HAIs as the common and preventable patient safety risk including both health and outcomes. For such issues as hygiene of hands, the infection prevention, and control as well as prescription of antimicrobial, the Standard 3 has attempted to adddress the disparities between the “best practice, and the delivered care (Mathot, Duke, Daley & Butcher, 2015). Therefore, this Standard offers strong evidence and guideline on best practices, compliance with hand hygiene and if well implemented will ensure that optimal hygiene is achieved thereby decreasing the occurrence of HAIs and antimicrobial resistance. Standard 3 entails well-researched actions and strategies that can be applied to the system to prevent and control HAIs rates in Australia significantly. The practitioners must increasingly use coordination, the focus of effort as well as collaboration between all stakeholders via the national goal framework on HAIs thereby contributing to substantial alteration within the coming years (Si, Runnegar, Marquess, Rajmokan & Playford, 2016).
The prevention and control of infection practices are purposed at reducing the resistant infectious agents’ development and reduce the transmission risk via the isolation of those with such infectious agents. Nevertheless, because there is no single trigger of infection, no one solution exists that can prevent infections (Mitchell & Shaban, 2018). Fruitful prevention and control of infections practice call for an array of strategies crossways the healthcare system. Whereas all prevention and control programs of infections show fundamental aspects which have to be taken into account, it is anticipated that programs shall be customized to reflect the local setting and risk. Irrespective of type or size of the health facility, the implementation success of S3 relies on the clinicians as well as the executive leaders who must work cooperatively (Russo, Cheng, Richards, Graves & Hall, 2015).
Standard Three Implementation to Prevent HAIs
The implementation of this Standard arises from the gaps already identified in the NHMR 2010. Therefore, there is a need to address these disparities and priorities by having the departments and groups in health facility working collaboratively to accomplish enhanced outcomes thus supporting the quality alongside safety of patients, workforce as well as consumers. Effective governance together with management systems for the “healthcare-associated infections” must be implemented as well as maintained to achieve the S3.
The inherent need for measuring the HAIs and illness burden or surveillance is central to the attempts to prevent and control HAIs. Australia lacks a national HAI surveillance framework or system, and this makes it profoundly challenging to assess HAIs systematically and subsequently report on the HAIs burden. There is a growing trend or need for Australia to have a reliable and credible estimate of HAIs incidence. This is a period of finite health resources (Mitchell, Shaban, MacBeth, Wood & Russo, 2017). Thus such an estimate will be helpful in prioritizing prevention and control strategies for this HAIs.
Further, having such a reliable estimate will offer the best benchmark against which the future targets and accomplishments are measured as well as evaluated. This estimate will further allow the healthcare industry and the associated stakeholders in innovations to enjoy a more reliable data to invest in commodities and research. It will also assist in the determination of essential resources for the prevention and control of HAIs relative to additional health issues.
Also, on the eve of the “post-antibiotic” period, the need for a systematic and coordinated national surveillance alongside reporting of HAIs and known contributing factors, including antimicrobial resistance alongside antibiotic utilization is of great significance. Therefore, it is believed that three parallel strategies are essential to address such a disparity. First, there is a need for the state together with national government agencies to determine and act to accomplish consensus definitions, approaches to surveillance as well as transparent regular reporting. This must take place simultaneously with the national HAIs surveillance program establishment.
There have been increased calls for a national centre illness control, specifically a national HAIs surveillance initiative might be integrated into this centre. There is a need for a national point study on prevalence to give useful insights in the short run on the HAIs burden in Australia. Provided that the latter doesn’t need a sophisticated research design and offers descriptive outcomes, it has never been preferably bolstered by funding agencies. Whereas such suggested recommendations have till now failed to eventuate, the stakeholders in HAIs surveillance are urged to work together to publish data in the literature.
Collaboration and Coordination to Succeed in Preventing HAIs
Conclusion
Standard 3 remains an essential standard in addressing HAIs which are the most common complication that affects the patients in different healthcare facilities. In Australian healthcare context, a significant number of patients are undergoing treatment under proximity to one another. These patient go through invasive procedures whereby the medical devices are inserted in them as well as receiving vast-spectrum antibiotics/immunosuppressive therapies. Such conditions avail ideal opportunities for spread and adaptations of pathogenic, infectious organisms (Ezzatzadegan, Chen & Chapman, 2012).
The HAIs increasingly complicate the recovery process and surge costs of healthcare by prolonging the hospital stays’ length, alongside desired treatment and care. Moreover, increasing problem of such organisms being resistant to present antimicrobial treatments have been noted. Many HAIs remain preventable. Thus, infections and control practices like hand hygiene, personal protective equipment use, disinfecting equipment, cleaning environment and vaccination are acknowledged as desired part of the efficient response to infection prevention and control alongside resistant to antimicrobials.
This has been provided by the Standard 3 which includes the utilization of surveillance data in the identification of resistant organism and proper prescription of the antimicrobial thereby decreasing the resistant organisms’ development (Cruickshank & Murphy, 2009). There is a need for a collaborative approach to ensure successful infection control and prevention coupled with an array of strategies crossway all health service organization levels. Such approaches and strategies have been described in Standard 3.
With full implementation of Standard 3, systems to support as well as promote HAIs control and prevention will be availed. Systems for safe and suitable prescription and utilization of antimicrobial which is an integral part of antimicrobial stewardship will be avail (Worth, Spelman, Bull, Brett, & Richards, 2016). It will also help in the prompt identification of patients at high risk of HIAs at global, national and local level hence receiving proper management alongside treatment. The Standard three will also ensure clean organization and reprocess re-cycled medical devices, instruments as well as equipment that are consistent with appropriate present national standards as well as instructions of manufacturers.
References
Chandrananth, J., Rabinovich, A., Karahalios, A., Guy, S., & Tran, P. (2016). Impact of adherence to local antibiotic prophylaxis guidelines on infection outcome after total hip or knee arthroplasty. Journal of Hospital Infection, 93(4), 423-427.
Choi, J. Y., Kwak, Y. G., Yoo, H., Lee, S. O., Kim, H. B., Han, S. H., … & Lee, H. (2015). Trends in the incidence rate of device-associated infections in intensive care units after the establishment of the Korean Nosocomial Infections Surveillance System. Journal of Hospital Infection, 91(1), 28-34.
Cruickshank, M., & Murphy, C. (2009). Reducing harm to patients from healthcare associated infections: An Australian infection prevention and control model for acute hospitals. Sydney: Australian Commission on Safety and Quality in Health Care.
Ezzatzadegan, S., Chen, S., & Chapman, J. R. (2012). Invasive fungal infections after renal transplantation. International journal of organ transplantation medicine, 3(1), 18.
Farmer, T., & Mitchell, C. (2010). Australian Infection Control Guidelines: preventing and managing infection in health care. Healthcare Infection, 15(4), 101.
Grammatico-Guillon, L., Rusch, E., & Astagneau, P. (2015). Surveillance of prosthetic joint infections: international overview and new insights for hospital databases. Journal of Hospital Infection, 89(2), 90-98.
Graves, N., Page, K., Martin, E., Brain, D., Hall, L., Campbell, M., … & Barnett, A. G. (2016). Cost-effectiveness of a national initiative to improve hand hygiene compliance using the outcome of healthcare associated Staphylococcus aureus bacteraemia. PloS one, 11(2), e0148190.
Mathot, F., Duke, T., Daley, A. J., & Butcher, T. (2015). Bacteremia and pneumonia in a tertiary PICU: an 11-year study. Pediatric Critical Care Medicine, 16(2), 104-113.
Mitchell, B. G., & Shaban, R. Z. (2018). Infection, Disease & Health for today, tomorrow, and the future.
Mitchell, B. G., Shaban, R. Z., MacBeth, D., Wood, C. J., & Russo, P. L. (2017). The burden of healthcare-associated infection in Australian hospitals: A systematic review of the literature. Infection, Disease & Health, 22(3), 117-128.
Mumford, V., Reeve, R., Greenfield, D., Forde, K., Westbrook, J., & Braithwaite, J. (2015). Is accreditation linked to hospital infection rates? A 4-year, data linkage study of Staphylococcus aureus rates and accreditation scores in 77 Australian acute hospitals. International Journal for Quality in Health Care, 27(6), 479-485.
Russo, P. L., Cheng, A. C., Richards, M., Graves, N., & Hall, L. (2015). Healthcare-associated infections in Australia: time for national surveillance. Australian Health Review, 39(1), 37-43.
Russo, P. L., Cheng, A. C., Richards, M., Graves, N., & Hall, L. (2015). Variation in health care-associated infection surveillance practices in Australia. American journal of infection control, 43(7), 773-775.
Shalit, N. (2016). Healthcare-associated infections in Australia: is it time for national surveillance?. Australian Health Review, 40(4), 475-475.
Si, D., Runnegar, N., Marquess, J., Rajmokan, M., & Playford, E. G. (2016). Characterising health care-associated bloodstream infections in public hospitals in Queensland, 2008–2012. The Medical Journal of Australia, 204(7), 276.
Worth, L. J., Spelman, T., Bull, A. L., Brett, J. A., & Richards, M. J. (2016). Epidemiology of Clostridium difficile infections in Australia: enhanced surveillance to evaluate time trends and severity of illness in Victoria, 2010–2014. Journal of Hospital Infection, 93(3), 280-285.
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