Healthcare for Nosocomial Infections-Free-Samples for Students

Question: Write a Literature Review on Knowledge Gaps Of Healthcare Professionals In Preventing Nosocomial Infections. Answer: Introduction Healthcare associated infections pose a major problem to healthcare officials in all medical settings. The most virulent microorganisms that can cause nosocomial infections to susceptible patients in the hospital include methicillin resistant Staphylococcus aureus (MRSA), Escherichia coli, Pseudomonas aeruginosa, Klebsiella, Enterococcus and Acinetobacter species (Brown et al. 2012). These microorganisms are able to survive for days on the surfaces of hospital equipments, beds, among others. These organisms are found on other objects, apart from hospital equipments. These include the doctors coat, identity badges, and stethoscopes, among others (Longtin et al. 2014). Moreover, other objects like thermometers, bronchoscopes and even cell phones show the presence of these pathogenic microorganisms. Various studies have shown that there is a direct connection between microbial colonization of hospital objects, transmission of these pathogenic microorganisms by healthcare professionals a nd the subsequent development of nosocomial or hospital acquired infections (Morgan et al. 2012). There is a significant knowledge gap among healthcare professionals in the prevention of hospital-acquired infections. Hand hygiene is an important issue that causes transfer of infections to patients and this practice is lacking among the healthcare officials (Kirkland et al. 2012). Physicians though are familiar with the rules and guidelines associated with hand hygiene but there are still vast gaps in knowledge. There are clear gaps between the recommendations provided in the guidelines and those, which are practiced. This greatly impacts and in turn increases the acquisition of hospital acquired infections (Mortel 2012). This report describes the various knowledge gaps of healthcare officials regarding the use of effective practices to prevent hospital-acquired infections. Necessary recommendations are also provided that can increase the knowledge of the healthcare officials to prevent such nosocomial infections. Summary of contemporary evidence Safdar et al. (2014) has identified various knowledge gaps of healthcare officials. These are associated with the measurement and assessment of hospital acquired infections. These knowledge gaps are associated with surveillance, improvements of risk adjustments, lack of data about infection burdens in settings other than the acute care settings, research gaps to prevent hospital acquired infections, poor understanding of pathogenesis and epidemiology of infections, among others. To understand the impact of the outcomes, surveillance measurements include collecting data and subsequent reporting. Definitions of subjective elements are a primary concern with the surveillance of healthcare associated infections. Knowledge gaps associated with ventilator associated pneumonia or VAP include nonspecific nature of the symptoms, poor interpretation of the diagnostic findings, variations in sampling methods, among others. Knowledge gaps associated with central line associated bloodstream infec tions (CLABSI) include the validity and reliability of the surveillance definitions. Another major limitation is that a large proportion of these infections are not reported since they are recognized to other sites. Surveillance of surgical site infections are also challenging as it involves a variety of surgical procedures, the various settings and the subsequent follow-ups. Moreover, there are also considerable knowledge gaps regarding the differentiation of clinical infection from asymptomatic bacteriuria in association with catheter associated urinary tract infection (CAUTI). To improve the risk adjustments of hospital acquired infections, identification of factors other than quality of care can influence the risk of infection. Current risk adjustment efforts include the use of multivariate risk models and procedure specific models that incorporate patient factors, which can help to identify the necessary risk factors that could give rise to surgical site infections. However, ad ditional research is needed to improve the ability to carry out risk adjustments for hospital acquired infections without the increase in efforts on data collection. There is also lack of knowledge regarding the epidemiology, pathogenesis and prevention of hospital acquired infections in settings other than acute care is limited. Pediatric facilities face severe challenges in association with prevention of hospital acquired infections. However, less emphasis is placed on identifying epidemiology of these infections in association with child care units. These infections include those caused by Clostridium difficile and multidrug resistant organisms. Less importance is also placed on the critical analysis of new technology and prevention interventions in pediatric care units. Substantial knowledge gaps also exist in understanding the pathogenesis and epidemiology of hospital acquired infections. Even after tremendous efforts to promote the influenza vaccination of healthcare officials , the rates of vaccinations among these individuals are very low. Moreover, this study also reports that pertussis infection is a huge concern in the United States and the healthcare officials pose the major problems because they can acquire the infection and can transmit it other critically ill patients. However, the misconceptions associated with pertussis vaccine are highly common among the healthcare officials. According to Aftab et al. (2015), there are knowledge gaps among healthcare officials regarding the spread of infection via fomites and the necessary practices to minimize such spread. Objects that become colonized by pathogenic microorganisms are called fomites and they serve as effective vectors for their transmission (Khanna and Pardi 2012). Pathogens are shed after the course of an infection and contaminates the fomites by contact with body secretions or soiled hands. These fomites then help in the transfer of these infectious agents from one object to another. In patient infections are usually caused by cross infections from healthcare personnels. These infections occur when the healthcare officials come into contact with contaminated fomites and eventually transmit them to the patients. Various medical or non medical objects like thermometers, bronchoscopes, stethoscopes, beds, tables, that are handled by healthcare officials harbor various pathogens. This study involved a cros s-sectional study among healthcare officials to determine the knowledge of the individuals regarding mode of transmission of infection via fomites and the necessary prevention strategies. A questionnaire based survey was carried out. The results of this study revealed that medical students had poor knowledge about fomite based transmission and the necessary attitudes required to prevent such transmissions. However, nurses scored better than the physicians and medical students to carry out practices regarding prevention of fomite based infection spread. Although 95% of the healthcare officials scored more than 50% on the knowledge of fomite based infection spread but only 32.3% individuals scored more than 50% in the necessary practices to prevent such infection spread. The study also reveals that contaminated surfaces of computers in intensive care units to be a major source of infections caused by methicillin resistant Staphylococcus aureus, Enterococcus and Enterobacter species. O nly, 49.9% of healthcare personnels had identified these surfaces to be potential sources of infection. Cell phones are also very good sources of infection transmission and 54.1% of the officials identified the role of cell phones in infection spread. Although 60.6% of the officials identified stethoscopes as potential modes of infection spread but the number was not as high as would be required. This study therefore identified the gaps associated with knowledge and the implementation of necessary practices to prevent fomite based infection spread among the healthcare officials. The study also provides recommendations to prevent such transmission by promotion of hand hygiene among the healthcare officials and disinfection of hospital environments to prevent contact based transmission. The study also proposes the participation of these individuals in academic sessions and workshops to spread awareness and minimize infection spread via fomites. Poor hospital hygiene, particularly the hygiene maintained by medical students is a serious concern that gives rise to subsequent infection spread and appearance of disease symptoms. Medical students are exposed to the hospital environment and activities that increases their chances of contracting infections and their subsequent transmission to other patients in the hospital. Transmission of hospital borne infections is usually associated with droplets or aerosols or by transmission through food and water (Cowling et al. 2013). Exposure to pathogenic microorganisms are the most important occupational hazard faced by the healthcare workers and medical students. Early intervention or training programs are needed to educate these individuals about the importance of good hospital hygiene and the necessary practices to prevent transmission. According to Ojulong, Mitonga and Iipinge, (2013), maintenance of hand hygiene is a serious concern among the healthcare officials. These individuals are provided with rules and guidelines to carry out proper hand sanitization, but still there are significant knowledge gaps. Proper maintenance of hand hygiene can significantly reduce the risk of nosocomial infection spread but these rules are not strictly followed by the healthcare workers. This study involved determining the knowledge and attitudes of medical students regarding infection control and prevention. Emphasis was placed on the knowledge of standard precautionary measures like hand hygiene. The survey revealed that 24.1% of the participants gave correct answers regarding air, inert surfaces and water to be the major sources of bacteria causing nosocomial infection. On the topic of hand hygiene, only 33.9% properly identified the use of alcohol hand rubs, 42% of the healthcare officials identified the use of gloves to prevent infection spread to hands after contact with body or blood fluids. The overall mean score for infection prevention and control among the healthcar e officials and medical students were low. The study also reveals the importance of carrying out seminars and group discussions to improve the hand hygiene practices among healthcare workers. The healthcare associated infections usually occurs within 48hours following hospital admission. It can also occur 30 days after an operation (Emerson et al. 2012). This occurs mainly due to the use of non-sterile instruments, untrained and lack of awareness and knowledge among the healthcare workers. Millions of people die as a result of such nosocomial infections, thereby increasing the mortality rates and financial losses. The healthcare worker has the duty to help the patient in the recovery process, but sometimes they can even act as sources of transfer of pathogenic microorganisms to the patients. According to Zaidi et al. (2016), the knowledge of healthcare workers is adequate but the implementation of the necessary practices are lacking. A cross-sectional study was carried out to determine the gaps in basic knowledge and necessary practices among healthcare officials regarding healthcare associated infections. Questionnaires were provided to participants and the resulting dat a was analyzed. The results revealed that that approximately 94% of the participants had good knowledge about hospital acquired infections, however, only 47% used gloves during the handling of critically ill patients and 94% took preventive measures. 95% of the participants used personal protective equipments but a staggering 87% of the healthcare workers had no knowledge about the national guidelines regarding infection prevention and control. 44% of staff members did not carry out aseptic techniques when handling patients with surgical wounds post operation. The various factors that prevent the healthcare officials to carry out hand washing or wearing gloves include skin irritation and dryness, absence of hospital guidelines, lack of knowledge and experience. The study highlights the need for carrying out training sessions to educate the healthcare workers on infection prevention along with effective supervision and monitoring. Clinical indicators are defined as periodic or continuous measurement of variables and identifying the characteristics of a given system or process. These indicators help to thoroughly assess the healthcare services meted out to patients (Loveday et al. 2014). National recommendations has identified the importance of carrying out nosocomial infection prevention programs in hospitals, but the evaluation system does not involve measurement, interpretation and qualifications of such evaluations, which is in turn necessary to determine the quality of care practices provided to the patients. The objective of the study carried out by Menegueti et al. (2015) was to investigate the programs related to nosocomial infection control in hospital settings. The results revealed that there was significant lack of knowledge regarding the evaluation of the hospital guidelines and evaluation of control and prevention activities regarding nosocomial infections. Evaluation of hospital guidelines reveale d poor compliance with standards for the use of antiseptic or germicidal solutions, control and prevention of bloodstream associated infections, collection of culture materials and proper sanitization of clothing. The study revealed that despite having knowledge about the prevention measures, there was a large gap in knowledge regarding the importance of the prevention strategy implementations. As a result, a large gap was observed between the necessary recommendations and the practices. Recommendations Hospital acquired infections are a major cause of concern among healthcare officials as well as the patients. Prevention of such infections are to be kept in mind in association with morbidity, mortality, increased hospital stay and financial costs (Zimlichman et al. 2013). Research is needed to address the knowledge gap regarding prevention of transmission of multidrug resistant bacteria in health care environments, implementation of effective strategies in order to ensure the supervision of antimicrobial practices, preventive measures against MRSA spread in hospitals, development of strategies that ensure the utilization of proper hand sanitization standards and development of strategies to prevent C. difficile infections in hospitals (Kwon, Olsen and Dbberke 2015). It is necessary to carry out international collaborations with various institutes consisting of a wide mix of staff from nonacademic centers, long-term care giving facilities, long term acute care hospitals (LTACHs), mo bile surgical units, pediatric hospitals, dialysis centers, outpatient practices, among others. It is also necessary to streamline the institutional review board to identify issues regarding emerging infections and securing infrastructure to carry out pilot projects for addressing serious healthcare issues. Though healthcare workers possess sufficient knowledge, however, the implementation of the necessary practices are limiting. It is important to include the importance of necessary practices for the prevention of infection transmission to the training and education of medical students (Alessandro et al. 2014). The promotion of proper hand hygiene and disinfection of hospital equipments including non-medical devices like laptops, computers, cell phones among healthcare workers is essential to prevent transmission of infections to surroundings and subsequently to patients (Badr, Ibrahim Badr and Ali 2012; Catano, Echeverri and Szela 2012). Recommendations regarding hand washing should include the use of soaps and the time of hand washing, which should be at least 15 seconds. Hands should be dried using disposable towels. Various training and academic sessions as well as workshops can be carried out to promote the knowledge and importance associated with hand hygiene and promotion of han d sanitization by the use of alcohol rubs like 0.5% chlorhexidine along with the se of 70% ethanol. Standard precautionary measures for healthcare officials should include the use of gloves during surgical procedures, use of gowns to prevent soiling of clothes, mask and eye protection gears, shoe and head masks and proper sterilization of reusable equipments (Mehta et al. 2014). Hospitals are required to provide institutional guidelines to healthcare workers regarding infection control. Teaching methods directed towards medical students and other staffs should be improved to increase knowledge of infection control and necessary prevention strategies. Conclusion Hospital acquired infections are a serious concern as it results in increased rates of morbidity, mortality and subsequently becomes a financial burden to the healthcare settings. Hospital acquired infections generally involve the transmission of pathogenic microorganisms from one individual to another. These individuals could be the healthcare workers and the patients. The pathogens are transmitted in the form of droplets or aerosols or by direct contact with other contaminated surfaces or individuals. The healthcare workers are in constant contact with patients and it is necessary for them to carry out effective precautionary measures to prevent transmission of infection to patients. However, the increased incidences of nosocomial infections indicate the lack of updated knowledge among the healthcare workers. Although they have the necessary knowledge, they lack in the ability to carry out necessary interventions to prevent the spread of infections. 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