A researcher has developed and administered a survey that addresses clients\' re

Question

A researcher has developed and administered a survey that addresses clients' reactions and responses to being diagnosed with nosocomial (hospital-acquired) infections while inpatients. The researcher has subsequently completed and submitted a manuscript that proposes a theory around the clients' perceptions of infection control in the hospital setting. The researcher's actions most clearly represent a potential deficit in which of the following criteria?

A) Veracity B) Individuality C) Transferability D) Credibility

Explanation / Answer

Nosocomial Infection

The term nosocomial infection is synonymous with hospital acquired infections. An infection is considered nosocomial if it develops in a patient who has been hospitalized for 48 to 72 hours and was not incubating the infection at the time of admission. Currently, in the United States, nosocomial infections affect more than 1.6 million patients annually leading to an overall annual cost of about $ 4.5 billion. The CDC (Centers for Disease Control and Prevention) estimates that nosocomial infections contribute to 0.7 to 10.1% of deaths and cause 0.1 to 4.4% of all deaths occurring in hospitals. Ten to thirty percent of patients admitted to hospitals and nursing homes in India acquire nosocomial infection as against five percent in the West, according to members of Hospital Infection Society (HIS), India. This alarming situation is attributed to hospitals reluctance to invest in infection control, lack of awareness and improper waste management. In a study, conducted in intensive care units of seven Indian cities shows that the central venous catheter-related bloodstream infection (CVC-BSI) rate was 7.92 per 1000 catheter-days; the ventilator-associated pneumonia (VAP) rate was 10.46 per 1000 ventilator-days; and the catheterassociated urinary tract infection (CAUTI) rate was 1.41 per 1000 catheter-days.2

The distribution of pathogens for NI and their resistance pattern has been changing constantly and for effective management of NI constant surveillance of the organism responsible for hospital acquired infection and local sensitivity pattern is important. Moreover, hospitals provide a breeding ground for drug-resistant bacteria which can be transmitted due to poor infection control practices in the hospital.

PREVENTION OF NOSOCOMIAL INFECTIONS

Patient is exposed to variety of microorganism during hospitalization. The infection may be caused by micro organism acquired from another person in hospital (cross-infection usually by hand) or may be caused by patients own flora (endogenous). Some organism may be acquired from an inanimate object or substance recently contaminated from other human source. The patient susceptibility is also important in causation of NI. Important patient factors include: age (extremes of age), immune status, and underlying disease (diabetes mellitus, leukemia, HIV, neoplasia), diagnostic and therapeutic interventions.3 Prevention of nosocomial infections is the responsibility of all individuals and services providing health care. Everyone must work cooperatively to reduce the risk of infection for patients and staff. Infection control programs are effectively provided they are comprehensive and include surveillance and prevention activities, as well as staff training. An “Infection Control Committee” provides a forum for multidisciplinary input and cooperation, and information sharing. This committee should include wide representation from relevant disciplines, e.g. management, physicians, other health care workers, clinical microbiology, pharmacy, central supply, maintenance, housekeeping, training services. The committee must have a reporting relationship directly to either administration or the medical staff to promote program visibility and effectiveness

Infection Control Professionals (Infection Control Team)

Health care establishments must have access to specialists in infection control, epidemiology, and infectious disease including infection control physicians and infection control practitioners (usually nurses). In some countries, these professionals are specialized teams working for a hospital or a group of health care establishments; they may be administratively part of another unit, (e.g. microbiology laboratory, medical or nursing administration, public health services). The optimal structure will vary with the type, needs, and resources of the facility. The reporting structure must, however, ensure the infection control team has appropriate authority to manage an effective infection control program. The infection control team or individual is responsible for the day-to-day functions of infection control, as well as preparing the yearly work plan for review by the infection control committee and adminis-tration. These individuals have a scientific and technical support role: e.g. surveillance and research, developing and assessing policies and practical supervision, evaluation of material and products, control of sterilization and disinfection, implementation of training programs.

Hand Washing

Hand washing is the single most important preventive strategy and remains the cornerstone of infection control. The normal microbial flora of the skin helps to prevent colonization of hospitalacquired microorganisms. Skin flora is composed of resident and transient micro-organisms. In general, resident microorganisms tend not to be highly virulent but can cause infections in patients who are immuno-compromised or who have implanted foreign devices.

Isolation

The CDC has recently proposed two levels of Isolation Guidelines for Hospitalized Patients: Standard and Transmission-Based Precautions.5,6 This new system replaces the previous disease-specific systems and has integrated universal precautions and body substance isolation. Standard Precautions states that blood; all patients’ body fluids (except sweat), secretions, and excretions; mucous membranes; and non intact skin be treated as potentially infectious. The components of Standard Precautions include: hand washing, wearing gloves, wearing mask, eye protection, face shield and gowns when appropriate, cleaning patient-care equipment, enforcing environmental control, cleaning linen, enforcing occupational health and blood borne pathogen protocols and cohorting patients. Transmission-Based Precautions are used for infected or colonized patients (confirmed or suspected) with transmittable microorganisms. These precautions should be used in conjunction with Standard Precautions. However, in resource limited situation the patients can be stratified based on risk of acquiring NI and appropriate antiseptic measures could be followed based on the risk categorization

Cleaning, Disinfecting, and Sterilizing Patient Care Equipment

Cleaning: All items to be sanitized or disinfected should first be completely cleaned to expel all natural issue (blood and tissue) and other buildup. Signs for sanitization and abnormal state sterilization: Critical therapeutic gadgets or patient care hardware that enters ordinarily sterile tissue or the vascular, framework or through which blood streams ought to be subjected to a sanitization strategy before each utilization. Laparoscopes, arthroscopes, and different extensions that enter ordinarily sterile tissue ought to likewise be subjected to a sanitization technique before each utilization; if this isn't doable, they ought to get at any rate highlevel cleansing. Hardware that touches mucous layers, e.g., endoscopes, anesthesia breathing circuits, and respiratory treatment gear, ought to get abnormal state sterilization.

Antimicrobial Control

It is estimated that 23 to 40% of hospitalized patients receive systemic antimicrobial agents at any given time, and about 40 to 50% of their use is inappropriate. The following principles are of use in formulating a policy for antibiotic use

MANAGEMENT OF Nosocomial Infection

Treatment of nosocomial infections is three-fold. First, a high index of suspicion must be present. Second, appropriate source control is paramount, such as the removal of infected lines or an infected abscess. Third, antimicrobial therapy that covers the likely infecting organisms and local resistance patterns should be commenced promptly. Early and regular microbiological consultation helps to ensure an optimal clinical outcome, controls the emergence of resistance and reduces costs. The most appropriate empiric treatment is best achieved on the basis of resistance surveillance. The choice of empiric antibiotic therapy for the treatment of any NI before microbiology is available requires.

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