Category: Infection

Cholera is one of the most dangerous diseases in different parts of Africa, killing hundreds and sometimes thousands of people every year. The causing agent, Vibrio cholera, is a Gram-positive and comma-shaped bacteria that cause cholera toxin during cellular infection in humans (Sack, Sack, Nair & Siddique, 2011). This toxin is lethal, initiating profuse and watery diarrhoea among the patients. This is the major aspect of the disease, which kills most of its patients. Most of the cases are found in Africa probably due to poverty, poor sanitation and poorly developed sewage treatment systems. In fact, apart from the recent fatal cases of cholera in Haiti and the Dominican Republic, most of the deadly incidents of infection are recorded in Africa.

One of the stories hitting headlines in the recent past is the death of thousands of people in West Africa, especially in coastal slums and other informal settlements along the West African coast. It is a story worth telling, especially an epidemiological perspective.

The story, titled “Cholera Epidemic Envelops Coastal Slums in West Africa”, was written in The New York Times on 22 August 2012. Adam Nossiter, the writer and the NYT’s West African reporter, specifically focused on the incidents of the disease in certain slums in various cities, including Freetown, Dakar and Conakry (Nossiter, 2012). According to Nossiter (2012), about two-thirds of the population in the three cities lack toilets, which poses a major health hazard during rainy seasons. Contamination of water supply with human faeces is common in the region (Sack, Sack, Nair & Siddique, 2011).

During the 2012 incident, more than 13,000 people were infected with the bacteria. More than 300 deaths were reported. The rate of infection in Freetown was terrible. For instance, the Sierra Leone government declared the disease a national disaster after noting the number of people dying every day. According to the article, it was obvious that the governments could not handle the problems alone, which forced them to seek international invention. The World Health Organization, the Doctors without Boarders and other international organizations were forced to intervene to save lives. Flooding made the situation worse because most people were left without a good supply of water after the floods swept human faeces and contaminated the water supply (Nossiter, 2012). In addition, it was difficult to provide the flood victims with fresh water, food, and medicine because the sprawling slums lack proper roads. In addition, the population is large, which made it difficult to reach and provide them with proper health services.

The story shows that in 2012, Sierra Leone had more than 11,600 cases of the disease, with more than 200 deaths. In addition, the city of Freetown recorded more than 1,000 new cases every week, making it a fatal incident (Nossiter, 2012). Most of the patients were the poor people living in slums and other informal settlements along the West African coast. In addition, the article reports that the actual number of deaths could have been higher than the reported because some deaths occurred unnoticed or in areas where it was not possible to reach for the victims. Therefore, such deaths were not reported.

From this story, it is evident that lack of sanitation and proper sewage disposal are a serious health problem in some West African nations, especially in slums. Although the disease is treatable, the situation in West Africa is shocking, especially because the rates of infection, as well as mortality rates, are relatively high. Therefore, proper interventions during such events are required in order to reduce the number of deaths (Sack, Sack, Nair & Siddique, 2011).

References

Nossiter, A. (2012). Cholera Epidemic Envelops Coastal Slums in West Africa. The New York Times, p. A6.

Sack, D. A., Sack, R.B., Nair, G. B., & Siddique, A.K. (2011). Cholera. Lancet 363 (9404), 223–33.

“Uncomplicated Urinary Tract Infection” is a peer-reviewed article published in New England Journal of Medicine. The paper was critically reviewed to make its publication in the mentioned journal possible. Therefore it presents common known information.

The article has a clearly stated problem and purpose. This clarity gives the reader an apparent picture and focuses on what the author is trying to achieve. According to Hooton (2012), urinary tract infection is a question that deserves medical attention today. The article presents a precise medical issue, which allows the author to be specific enough. In addition, the focus of the paper is quite narrow for the reader to follow and make an informed decision on the matter presented.

The article uses secondary data, which is why the author did not discuss data collection methods in the paper. The nature of the problem presented in the article provides a solution presented in the description and by synthesizing previous studies. The article makes use of different relevant in medical field printed materials to provide varied ways in which a medical practitioner can handle recurring urinary tract infection (UTI).

The information in the article is organised in a logical way making it easy for readers to follow. At the beginning of the paper, the author states the problem of the study that is a recurring UTI. Further, they give a preview of the different perceptions and assumptions underlying UTI (Hooton, 2012). This organisation makes it easy for the reader to develop certain curiosities, which encourages further reading.

As mentioned before, the paper contains secondary data. In the entire article, the author integrates relevant information from earlier studies to make it easy to read. Evidence-based practices are the new modes of operation in both medicine and health. For this reason, the information from other studies compiled in this article is quite relevant to finding a reasonable solution to the recurrence of UTI in women.

The article only presents the history of the medical condition and the issues underlying the urinary tract infections. For this reason, it does not provide the procedures used to achieve the results of the study because that information is not relevant in this case. However, the information provided makes it easy for any practitioner to choose the treatment suggested by the author in the recommendation part. The article presents all the upsides and downsides of various ways of handling UTI, thus making it easy to replicate the study (Hooton, 2012).

The author does not discuss the data collection method, on the contrary, he presents the results of other studies relevant to the problem. The purpose of the study was to provide the most effective solution to a recurring urinary tract infection (Hooton, 2012). For this reason, analyzing different ways of solving the matter was ideal for this research.

The interpretation of the results is agreeable because it allows the medical practitioners to reduce chances of UTI recurring in the future.

The entire article is quite informative to both the medical personnel and the public. The author provides different ways for the risk group to manage the situation at a personal level thus enhancing the health. The most interesting thing in the paper is how the researcher integrates information from various renowned studies. The major strength of the paper is in the way the author presents the information: simply, but yet covering all the relevant parts of a research. The major weakness of the paper is the author’s inability to offer new information. However, the paper is memorable as it presents a piece of significant medical information in a simple and precise way.

Reference

Hooton, T. (2012). Uncomplicated urinary tract infection. N Eng J Med, 366(11), 1028- 1039.

Summary

Respiratory tract infections represent the group of infections that cause diseases of the throat, lungs, or airways, depending on the type. Thus, respiratory tract infections are divided into upper respiratory tract infections (URTIs), which cause diseases of the throat, nose, pharynx, and larynx, and lower respiratory tract infections (LRTIs), which cause diseases of the bronchi, trachea, and lungs (Kateete et al. 2010). LRTIs are usually associated with such serious conditions as pneumonia and bronchitis. LRTIs are usually viral in origin, and the pathogens that cause pneumonia and bronchitis include S. pneumonia, H. influenza, M. catarrhalis, S. aureus, and Klebsiella pneumonia (Pesavento et al. 2010). As a result of infections, patients have problems with breathing, and they report having fever and cough among other symptoms. The acute forms of these conditions can cause even the patient’s death if the infection is not treated appropriately (Shrestha, Pokhrel & Mohapatra 2009). In its turn, influenza can affect both URTIs and LRTIs. The H5N1 subtype of the influenza virus can have the most serious negative impact on the patient’s lungs and bronchi (Mishra & Bayer 2013).

In this case, the 59-year-old male has the signs of bronchitis. It is important to note that bronchitis is categorized as the LRTI, and the treatment depends on the pathogen that causes the condition. From this point, further microbiological investigation is necessary because it is significant to determine which bacterium causes bronchitis in the patient and prescribe the appropriate antibiotics to address it while referring to the antibiotics sensitivity testing. In spite of the fact that bronchitis can be caused by a variety of bacteria, the microbiological investigation allows determining the specific pathogen causing the disease development in the concrete patient, and the expected outcome is the discussion of the bacterium and identification of antibiotics to treat the disease effectively.

Materials and Methods

In order to conduct the microbiological investigation, the following materials were used:

1. The sputum sample.
2. Three agar plates: Horse blood agar (HBA), MacConkey agar (MAC), and Chocolate agar (CHA).
3. Gram staining test.
4. Catalase test.
5. Coagulase test.
6. Deoxyribonuclease (DNase) plate with hydrochloric acid.
7. Antimicrobial susceptibility test discs.

The first step in the microbiological investigation was the culturing of the patient’s sputum sample characterized as a heavy purulent one with the help of three agar plates: HBA, CHA, and MAC. The sputum was cultured and incubated for 24 hours under aerobic condition (CO2). These plates were selected because according to Cain (2014), the use of HBA, CHA, and MAC plates contributes to the rapid growth of colonies of bacteria that can be further examined individually. Adegoke and Okoh (2014) also note that under aerobic conditions, many bacteria not only survive but also grow actively.

In 24 hours, the colonies from the three plates were examined to determine the morphology type. The colonies from the HBA plate were taken with the help of a sterile loop in order to conduct the Gram staining test. The Gram stain is important in order to identify the morphology of the bacterium or its type (Kaasch et al. 2014). The same colonies were used in order to conduct the catalase test for the purpose of distinguishing between Staphylococcus and Streptococcus. The catalase test is selected because Staphylococci usually have the enzyme catalase when it is not presented in Streptococci (Cain 2014; Chatterjee et al. 2009).

The next step was to conduct the coagulase test for the purpose of distinguishing between types of Staphylococci. The slide test was conducted in order to identify how the determined Staphylococcus can clot the plasma in order to identify Staphylococcus aureus. To confirm the presence of Staphylococcus aureus, it was reasonable to conduct the DNase test. This test is used for the detection of Staphylococcus aureus to prove the results of the previous tests because Staphylococcus aureus contains such enzyme as DNase (Wiriyachaiporn et al. 2013). The DNase plate was incubated for 24 hours.

When all tests were performed, it was necessary to conduct the antibiotics sensitivity test with the help of antimicrobial susceptibility test discs in order to determine to which types of antibiotics Staphylococcus aureus can be susceptible. Penicillin, gentamicin, chloramphenicol, oxacillin, cefoxitin, and erythromycin were selected for this test because of the high-level resistance of Staphylococcus aureus to many types of antibiotics (Sudhanthiramani, Swetha & Bharathy 2015). The results of the conducted tests are presented in the following section.

Results

The results of testing using HBA, CHA, and MAC plates under aerobic conditions indicate the presence of white and yellow colonies for HBA, white and yellow colonies for CHA, and pinky colonies for MAC (Table 1).

HBA – Horse blood agar.

MAC – MacConkey agar.

CHA – Chocolate agar.

NF – nuclear factor.

For the colonies from the HBA plate, the Gram staining test was conducted. It was found that Gram-positive cocci were presented in chains of three or four colonies or clusters similar to chains. The catalase test performed after the Gram test identified the enzyme catalase-positive bacterium. As a result, it was possible to speak about the presence of Staphylococci in the patient’s sputum sample. The coagulase test also presented a positive results, and the identified Staphylococcus was categorized as Staphylococcus aureus. This conclusion was also supported by the positive results of the DNase test because the clear zone and DNase +ve colonies were found (Table 2).

DNase – deoxyribonuclease.

The results of the Gram stain test allowed the development of the scheme for further microbiological investigation in order to confirm that the identified pathogen was of the Staphylococcus type (Figure 1).

The antibiotics sensitivity test indicated that the identified Staphylococcus aureus was resistant to penicillin, but it was susceptible to gentamicin, chloramphenicol, oxacillin, cefoxitin, and erythromycin (Table 3).

Laboratory Report

Sample Description: Sputum sample.

Notes: Purulent sputum sample, possible bronchitis.

Date: 23/4/2016.

Gram: Gram-positive cocci, chains of colonies.

Culture: Growth of Staphylococcus aureus.

Comments: Susceptible to gentamicin, chloramphenicol, oxacillin, cefoxitin, and erythromycin.

Discussion

Bronchitis can be provoked by S. aureus, S. pneumonia, H. influenza, and M. catarrhalis among other bacteria. In 59-year-old patients, as well as elderly patients, the risks of developing complications associated with non-treated bronchitis increase, and it is important to identify the bacterium that causes the disease in the particular case (Kitara et al. 2011). Acute bronchitis is frequently caused by Staphylococcus aureus when the bacteria pass from the pharynx to bronchi, and the organism’s reaction to the bacteria is the inflammation with the production of mucus (Wiriyachaiporn et al. 2013). In order to identify whether bronchitis is caused by Staphylococcus aureus or other bacteria, it is necessary to examine the sputum sample and conduct a variety of tests.

In this case, the Gram stain test indicated that the bacteria were Gram-positive cocci that are typical of both Staphylococcus and Streptococcus, and they resembled both clusters and chains of colonies. Therefore, additional testing was necessary to distinguish between Staphylococcus and Streptococcus. The catalase test indicated that the bacteria are catalase–positive, and this condition is typical of Staphylococcus rather than Streptococcus. Moreover, this condition is characteristic of Staphylococcus aureus. In order to support the assumption about the morphology of the bacterium, it was necessary to conduct the coagulase and DNase tests. These tests allowed speaking about the bacteria as coagulase-positive. They contributed to creating clear zones. Therefore, the conclusion was that the male patient’s bronchitis was caused by Staphylococcus aureus.

In the 59-year-old patient, Staphylococcus aureus can also cause pneumonia; therefore, it was necessary to conduct the antibiotics sensitivity test in order to identify antibiotics that are most appropriate to be used in the patient’s case. Mishra and Bayer (2013) state that individual sensitivity can influence the effectiveness of using gentamicin, chloramphenicol, oxacillin, cefoxitin, and erythromycin in order to treat bronchitis in elderly patients. From this point, it is important to note that patients aged 59 years old and older are in the group of people who are usually affected by Staphylococcus aureus because of the lowered immunity (Kitara et al. 2011).

Public health considerations related to the treatment of persons with Staphylococcus aureus include the prescription of appropriate antibiotics. It is also important to focus on the isolation of patients during the period of treatment and the decrease of risks associated with the further possible infecting or spread of the untreated Staphylococcus aureus in the organism. Much attention should be paid to avoiding the auto-infection and monitoring the symptoms in the patient during the treatment.

Reference List

Adegoke, A & Okoh, 2014, ‘Species diversity and antibiotic resistance properties of Staphylococcus of farm animal origin in Nkonkobe Municipality, South Africa’, Folia microbiologica, vol. 59, no. 2, pp. 133-140.

Cain, H 2014, Microbiological laboratory techniques manual, University of Melbourne, Melbourne.

Chatterjee, S, Ray, P, Aggarwal, A, Das, A & Sharma, M 2009, ‘A community-based study on nasal carriage of Staphylococcus aureus’, Indian Journal of Medical Research, vol. 130, no. 6, pp. 742-748.

Kaasch, A, Barlow, G, Edgeworth, J, Fowler, V & Hellmich, M 2014, Staphylococcus aureus bloodstream infection: a pooled analysis of five prospective, observational studies’, Journal of Infection, vol. 68, no. 3, pp. 242-251.

Kateete, D, Kimani, C, Katabazi, F & Okeng, 2010, ‘Identification of Staphylococcus aureus: DNase and Mannitol salt agar improve the efficiency of the tube coagulase test’, Annals of Clinical Microbiology and Antimicrobials, vol. 9, no. 1, 1-10.

Kitara, L, Anywar, A, Acullu, D, Odongo-Aginya, E & Aloyo, J 2011, ‘Antibiotic susceptibility of Staphylococcus aureus in suppurative lesions in Lacor Hospital, Uganda’, African Health Sciences, vol. 11, no. 3, pp. 34-39.

Mishra, N & Bayer, 2013, ‘Correlation of cell membrane lipid profiles with daptomycin resistance in methicillin-resistant Staphylococcus aureus’, Antimicrobial Agents and Chemotherapy, vol. 57, no. 2, pp. 1082-1085.

Pesavento, G, Ducci, B, Comodo, N & Nostro, 2010, ‘Antimicrobial resistance profile of Staphylococcus aureus isolated from raw meat: a research for methicillin-resistant Staphylococcus aureus (MRSA)’, Food Control, vol. 18, no. 3, pp. 196-200.

Shrestha, B, Pokhrel, B & Mohapatra, T 2009, ‘Phenotypic characterization of nosocomial isolates of Staphylococcus aureus with reference to MRSA’, The Journal of Infection in Developing Countries, vol. 3, no. 7, pp. 554-560.

Sudhanthiramani, S, Swetha, C & Bharathy, S 2015, ‘Prevalence of antibiotic-resistant Staphylococcus aureus from raw milk samples collected from the local vendors in the region of Tirupathi, India’, Veterinary World, vol. 8, no. 4, pp. 478-481.

Wiriyachaiporn, S, Howarth, P, Bruce, K & Dailey, L 2013, ‘Evaluation of a rapid lateral flow immunoassay for Staphylococcus aureus detection in respiratory samples’, Diagnostic Microbiology and Infectious Disease, vol. 75, no. 1, pp. 28-36.

Introduction

After reviewing current records, it has been noted that the infection rate of Nosocomial infections is on the rise at LHAC. After thorough research, it has been identified that this is due to failure of our sterilization processes and equipment as well as very unorthodox health practices by some of our staff coupled with improper allocation of bed space to potentially infectious patients.

Root Cause

The root cause of the rise in the rates of nosocomial infections was found to be improper allocation of bed space to patients closely followed by the failure of our sterilization procedures and equipment. The levels of nosocomial infections rose by an appalling 24% the last year, a whooping 10% more than the levels recorded by Chicago Hope the same year.

Outcome

It is in this light that we have decided to develop more special wards, and more accurate screening services. We identified Pseudomonas as a particularly troublesome and notorious organism therefore we decided to be segregating any patients with such infections in their own wards as well as applying more stringent infection procedures. As for the problematic sterilization process we decided to procure a new autoclaving machine, and use new disinfectants that couldn’t be inactivated by body fluids just incase the ones we had weren’t effective.

Equipment

The problem of having inadequate and old equipment has led to sharing of certain equipment by patients, as the staff employ some unorthodox methods of sterilization that are ineffective leading to transfer of infection from one patient to the next.

I therefore suggested that:

• More state of the art equipment be bought
• The members of staff undergo mandatory courses on Infection control and safe practice.

Outcome

The suggestion on procurement of equipment was taken very positively by the management, with the only hindering problem being the acute lack of funds in the hospital’s account.

Most of the staff felt that they were being undermined, as they said they were conversant with infection control procedures, in light of this, very few willingly undertook the course leading to lower morale amongst those who were forced by management to undertake it.

These unsatisfactory results, led to my developing alternative options like, sourcing donors for the procurement of equipment in return for some free workshops and health drives. As for motivation of staff I suggested that some kind of sitting allowances be paid to the employees who participated in the infection control course.

Benchmarking Partner

I chose PriceWaterHouseCoopers as my benchmarking partner; this was because they are an established audit company with already established channels and procedures as well as being very professional.

The next time I will take a collaborative approach to benchmarking and involve more companies.

Process Improvement Strategy

I chose to use the CMMI model of process improvement, as it adopts an approach that is continuous and allows for constant improvement and picking of subsequent areas that need improvement.

The outcome of the process improvement strategy wasn’t immediately evident but the process is still continuous, and currently I am intending to begin the reassessment of the problem areas.

Summary & Conclusions

The problem of nosocomial infections is a worldwide problem, that try as we may, may never be completely dealt with, this is due to the fact that nothing infected patients who are not yet symptomatic may be very difficult. This simulation showed that striving to achieve excellence is a continuous process that begins with the identification of problem areas followed by change then evaluation and the process begins all over again. This simulation also shows that no status quo or way of doing things should be taken as the best, and that there is always room for improvement.

References

Camp, R. (1989). The search for industry best practices that lead to superior performance, Productivity Press.

Introduction

Bloodstream infections (BSIs) are common and life-threatening despite being preventable. BSI’s, also known as sepsis, are associated with many morbidities and mortalities amongst patients. Yearly, a third of all mortalities that occur amongst patients can be related to BSIs. They lead to far-reaching effects on patient care (Aliyu et al., 2018). Some of the effects include prolonged hospital stay, high hospital costs, poor clinical outcomes, and reduced patient satisfaction (Viscoli, 2016). The implications are profound in patients with low immunity, such as newborns, the elderly, and immunocompromised due to other underlying conditions. BSI is extensively experienced by patients whose skin integrity is impaired, such as those suffering from chronic dermatitis, renal failure, and malignancies.

Bloodstream infections can occur due to the spread of local disease or the introduction of microorganisms into the blood system (Banik et al., 2018). As showed in Figure 1 above, bacteria play a significant role in the causation of blood steam infections as compared to other organisms such as fungi, viruses, and bacteria. Interference with skin integrity through trauma or burns creates the microorganisms that can get into the body’s blood system. Clinical activities, including the use of invasive devices during patient care, can develop through which microorganisms get into the blood system leading to BSIs.

.

Blood stream infections form a significant percentage of the acquired infections in the hospital settings. According to Franco-Paredes (2016), BSIs account for up to 15% of real cases. Most poof, the affected patients are admitted staying more than 48 hours in the hospital setting. BSI’s that are community-acquired can also occur as shown in Figure 1, which highlights various risk factors that could predispose an individual to acquiring BSIs. Some of the issues that can contribute to contracting of BSIs include old age, low immunity, hospitalization, improper practices during catheter use, during dialysis if aseptic technique is not followed, among many others. Usually, the prognosis for individuals with bloodstream infections is poor (Hallam et al., 2018). As shown in Figure 2, mortalities have been reported amongst patients related to BSIs. The outcomes are worse in case of late diagnosis, wrong interventions, underlying conditions. BSIs can lead to systems making the individual situation critical to be managed in regular wards. Most patients admitted to the ICU have community-acquired infections, especially bacteremia.

Data Presentation

The data will be presented to the rest of the class physically through a class video conferencing. Additionally, a softcopy material will be shared on the classroom online forum. The presentation can also be transferred to other class members through the class official email before the actual presentation. The class members will be expected to participate in the presentation actively and react by seeking clarification, asking questions, and/or commenting on the presentation’s findings.

Improvement of Proposed Solutions

Sepsis can be a threat to an individual’s life, hence, it requires early recognition and appropriate intervention. Despite it being common amongst patients, it is preventable with right precautions (Bell & O’Grady, 2017). BSIs are caused by either localized spread of infections or introduction of microorganisms into the surrounding blood system. Mostly, invasive devices such as intravenous cannulas, central lines, urinary catheters, and hemodialysis catheters can be the infection source. The use of invasive devices contributes to a larger percentage of BSI experienced by patients, especially in the clinical setting. Septic procedures during insertion and maintenance of the instruments lead to allowing microorganisms to access the blood system, hence causing infection.

Prevention of BSIs is a teamwork process, which requires educating the care providers and patients on marinating aseptic surroundings while handling invasive devices is necessary to prevent blood system infections. According to Bell and O’Grady (2017), whenever an invasive device is involved in patient care, the spread of sepsis increases. Therefore, training individuals on invasive devices to reduce blood infections will work efficiently towards achieving the mission (Vijayan & Boyce, 2018). The concerned members will ensure appropriate precautions are put in place to prevent occurrence of the infections.

Most of the infections are related to exposure to unsafe clinical environment and physiological factors. According to Franco-Paredes (2016), sepsis occurs as a result of underlying complications. Usually, it originates from other conditions, mostly localized infections within the body systems, such as the urinary tract, skin, lungs, or abdomen. Once the infection spreads, the immune system responds by activating septic reaction, which is life-threatening. Various microbes, such as fungi, viruses, and bacteria, can cause sepsis, but bacteria are the common cause. This aspect makes early recognition and treatment of infections essential in avoiding BSIs.

Setting up rules and regulations that govern the avoidance and provision of standard guidelines on BSIs can work well towards the reduction of BSIs. Some health care facilities across the nation have developed, adopted, and even implemented quality practices geared towards reducing BSIs (Viscoli, 2016). Evidence-based practices, such as suitable training, provision of required equipment and resources have positively helped achieve the goal. Additionally, research activities based on BSIs also improve the quality of care (Hallam et al., 2018). Through studies, real situations are visualized forming the basis for evaluation and change. The findings are also used in making crucial decisions regarding acquisition of the appropriate resources and equipment for reducing BSIs.

Preferred Solution

Based on the impact on the desired outcome, solutions are prioritized. In this situation of BSIs, research activities are given more credit. The corresponding insights before implementation of the interventions are crucial in addressing the functional challenges. It also assists in determining the root cause of the problem and the most appropriate solution. Research findings also form the basis for evaluation after a specified period. Therefore, one can identify resources needed for completion of the mission, BSIs reduction. Therefore, it is through exploration that one can determine which strategy can be applied to yield the nest results as expected. Evidence-based practices on the prevention and management of BSLs cases will be acquired and adopted through research activities.

How Will the Change Be Sustained?

For the change to be sustained, it has to be part of the corporate culture. The change can be included in the organizational policies and guidelines of practice making it compulsory for individuals practicing under the umbrella of those policies to follow. Therefore, the organization administrative personnel, departmental leaders, and any other team that may be appointed to oversee the change will be responsible for reinforcement of set rules and regulations. In this case, conducting research activities pertaining to BSIs, implementation of findings, and evaluation will be a culture for care providers. Cooperation, teamwork, and commitment from every member will be ultimate expectations, as the whole team remains focused on the betterment of practices, especially about BSIs.

Conclusion

Blood Stream infections are one of the common epidemiological burdens to the health care system. The conditions are expected with poor medical prognosis despite being preventable. BSIs have to increase morbidities, mortalities, prolonged hospital stay, and increased medical costs. The quality of life is reduced, and some factors associated with BSIs include old age, hospital, ratio, use of invasive devices during patient care, and lost skin integrity. Ensuring sterility when handling invasive devices, provision of education on BSIs, and conduction research activities are some of the identified ways to reduce BSIs.

References

Aliyu, S., Cohen, B., Liu, J., & Larson, E. (2018). Prevalence and risk factors for bloodstream infection present on hospital admission. Journal of Infection Prevention, 19(1), 37– 42. Web.

Banik, A., Bhat, S. H., Kumar, A., Palit, A., & Snehaa, K. (2018). Bloodstream infections and trends of antimicrobial sensitivity patterns at Port Blair. Journal of laboratory physicians, 10(3), 332. Web.

Bell, T., & O’Grady, N. (2017). Prevention of central line–associated bloodstream infections. Infectious Disease Clinics of North America, 31(3), 551-559. Web.

Franco- Paredes, C. (2016). Core concepts in clinical infectious diseases (CCCID) (1st ed.). Elsevier Science.

Hallam, C., Jackson, T., Rajgopal, A., & Russell, B. (2018). Establishing catheter-related bloodstream infection surveillance to drive improvement. Journal of infection prevention, 19(4), 160 — 66. Web.

Kell, D. B., & Pretorius, E. (2015). On the translocation of bacteria and their lipopolysaccharides between blood and peripheral locations in chronic, inflammatory diseases: The central roles of LPS and LPS-induced cell death. Integrative Biology, 7(11), 1339-1377. Web.

Tsuzuki, S., Matsunaga, N., Yahara, K., Gu, Y., Hayakawa, K., Hirabayashi, A., & Ohmagari, N. (2020). National trend of blood-stream infection attributable deaths caused by Staphylococcus aureus and Escherichia coli in Japan. Journal of Infection and Chemotherapy, 26(4), 367-371. Web.

Vijayan, A., & Boyce, J. M. (2018). 100% use of infection control procedures in hemodialysis facilities: Call to action. Clinical Journal of the American Society of Nephrology, 13(4), 671-673.

Viscoli, C. (2016). Bloodstream infections: The peak of the iceberg. Virulence, 7(3), 248-251. Web.

The debate revolving around the benefits and drawbacks of inpatient and outpatient forms of treatment has been now triggering many practitioners and patients due to the inability to define the most appropriate method between the two. To begin with, it is of crucial importance to define what is represented with each of the notions for the sake of further clarity. The concept of inpatient treatment is related to the patient’s stay on the hospital premises during the process of therapy and diagnostics. The latter form, on the other hand, is a synonym to the notion of ambulatory treatment, making it possible for the patient to spend the time outside the hospital if there is no direct necessity. Thus, the primary purpose of the following paper is to outline the level of safety in each case when it comes to infection contraction probability during both inpatient and outpatient surgeries on the basis of evidence recorded within the last decade.

Over the past years, a rapid increase in the cases of patients choosing an outpatient surgery created a demand to take a closer look at its actual benefits when compared to more “traditional” surgery conductions with patients having to spend a night after the interference at the hospital. Thus, in 2017, the first explicit attempt to conduct a comparative analysis was made on the example of total ankle arthroplasty surgery. According to the study, while the question of infection safety was not that radical in terms of inpatient treatment, as medical employees were to observe the patients overnight, the question of outpatient surgery was tackling the practitioners all over the world (Mulligan & Parekh, 2017). However, the results claimed the absolute majority of cases to result in success, claiming no evidence of increasing post-surgical infection risks. Another study, focused on the examination of arthroplasty procedures, displayed no major difference between both settings. The researchers implied that ambulatory treatment was a completely safe procedure even in the context of surgeries, preventing patients from contacting an infection during the hospital stay (Darrith et al., 2019). Thus, the overall analysis of the secondary data contributes to the fact of outpatient treatment having more advantages in terms of patient safety.

However, taking into consideration the reality of today’s healthcare segment and its countless challenges and areas that require improvement, the situation might not be as optimistic. In fact, many aspects of patient safety in modern hospitals are, for the most part, correlated with the notion of overall medical competence and sanitary norms within an establishment. Thus, it is of crucial importance to secure these issues before making a choice preferring one of the options more than others. This preventive aspect especially concerns the notion of outpatient care, as it is more trustworthy among the patients at the moment.

References

Darrith, B., Frisch, N. B., Tetreault, M. W., Fice, M. P., Culvern, C. N., & Della Valle, C. J. (2019). Inpatient versus outpatient arthroplasty: a single-surgeon, matched cohort analysis of 90-day complications. The Journal of Arthroplasty, 34(2), 221-227.

Mulligan, R. P., & Parekh, S. G. (2017). Safety of outpatient total ankle arthroplasty vs traditional inpatient admission or overnight observation. Foot & Ankle International, 38(8), 825-831.

A reasonable problem

The occurrence of nosocomial infections transmitted by all staff within a Skilled Nursing Facility is the issue, which makes many people bothered. To make sure that it can be prevented by the implementation of preventative alert and pause systems, the literature review in the sphere should be conducted to understand what is known about the issue, which the rate of the infection occurrence is and what the level of the danger is in case the patients are infected.

3 or more appropriate symptoms or pieces of evidence of the problem identified

The nosocomial infections are believed to be important in the modern society as according to the research conducted by Šuljagić et al. (2011) the problem effects people with chronic diseases that makes the issue worse. Yen, Lu, Huang, Chen, Chen, & Lin (2010) are also sure that the delivery of the infection from the patients to the staff in clinics may cause the epidemics. The chances for such development of the affairs should be reduced to minimum. Navarro-Zarza, Álvarez-Hernández, Casasola-Vargas, Estrada-Castro, & Burgos-Vargas (2010) conducted a research on the basis of the patients with systemic lupus erythematosus who were infected with nosocomial infections in hospitals and dwelt upon the complications while treatment. Therefore, the problem is urgent and the ways of the infection elimination should be searched for.

7 keywords to use to punch into the computer and a precise description of the modification of keyword searches

Nosocomial, infections, hospital, staff, microorganisms, prevention, and epidemics are the main keywords which have been used for searching for the appropriate information. When the keywords did not work effectively, the combination of the words was applied to, for example nosocomial infections, hospital infections, infections prevention, epidemics prevention, etc. The more complicated keyword phrases such as nosocomial infection prevention gave the best results as the relevant sources were listed for consideration.

2 or more appropriate resources for references

EBSCO and PubMed databeases were used for searching for the appropriate information as these resoueces are reliable and contain only credible sources.

CARS checklist

The sources under consideration are scholarly articles, therefore, they do not have limitations as being reviewed by the professional PhD editors, the sources were gathered from reputable databases and can be trusted. Professional nurses or scientists who have a great experience in the sphere are the authors of the research. The information is considered to be useful as the practical implementation of the research results may reduce the cases of the nosocomial infection in clinics.

A complete annotated bibliography for 10 sources

Šuljagić, V., Jevtić, M., Djordjević, B., Romić, P., Ilić, R., Stanković, N., &… Jovelić, A. (2011). Epidemiology of nosocomial colonization/infection caused by Acinetobacter spp. in patients of six surgical clinics in war and peacetime. Vojnosanitetski Pregled: Military Medical & Pharmaceutical Journal of Serbia & Montenegro, 68(8), 661-668.

The research is based on the comparative analysis of the spread of the nosocomial infection in clinics during the war and in peacetime period. The research has shown that at the wartime men were more infected with the bacteria, while at the peacetime more people with chronic diseases were subjected to the disaster. The usefulness of the research is explained by the reference to the people with chronic diseases. The timeline is considered as the limitation as the wartime was reviewed when other principles of medication were used. The audience of the research is the medical staff. I suppose the information from the source may be applied in practice and more attention should be paid to people with chronic diseases.

Yen, M., Lu, Y., Huang, P., Chen, C., Chen, Y., & Lin, Y. E. (2010). Quantitative evaluation of infection control models in the prevention of nosocomial transmission of SARS virus to healthcare workers: Implication to nosocomial viral infection control for healthcare workers. Scandinavian Journal of Infectious Diseases, 42(6-7), 510-515.

The research is subjected to the impact of the nosocomial infection on the patients with the infection of the nervous system and the outcome of such infection. The study is devoted to “clinical and epidemiological characteristics of nosocomial infections in ICU treated patients with ACNS infections” (p. 277). At the same time, the restriction of the research material is the limitation in this case as only some particular aspects and diseases are covered. Still, the awareness that the problem affects people with nerves diseases. The author concludes that people with nerves diseases should be paid more attention in the relation to nosocomial infections to avoid being infected.

Navarro-Zarza, J. E., Álvarez-Hernández, E. E., Casasola-Vargas, J. C., Estrada-Castro, E. E., & Burgos-Vargas, R. R. (2010). Prevalence of community-acquired and nosocomial infections in hospitalized patients with systemic lupus erythematosus. Lupus, 19(1), 43-48.

Being the most spread causes of morbidity and mortality in systemic lupus erythematosus, infections should be eliminated. The hospital infections are the most possible ways for getting ill. The ways how the infecting may be eliminated are discussed in the article. The main limitation of the research is the discussion is conducted in general, without particular data that reduces its value in the scientific world. Thus, the audience of the article may be any person interested in the issue. I believe that the problem does not bring any innovation in the sphere.

Gajović, O., Tomović, M., Stanarcić, J., Canović, P., Todorović, Z., & Lazić, Z. (2011). Clinical characteristics of nosocomial infections of patients with acute central nervous system infections treated in ICU. Medicinski Glasnik, 8(2), 277-279.

The problems people have when they are infected are numerous and the risk for mortality is higher for those who suffer from acute central nervous system infections. The research does not consider the cases of other diseases and the level of mortality there that is the limitation for this case. The audience is the medical staff and the author concludes that these people are to pay more attention to patients with the problem.

Makmor-Bakry, M., Mustafa, S., & Omar, M. (2011). Antimicrobial therapy in critically ill patients with nosocomial infections. International Journal of Pharmacy & Pharmaceutical Sciences, 3(4), 340-342.

The basis for the research is the antimicrobial therapy for clinic patients who were subjected to the nosocomial infection. The research is directed both at staff in hospitals and patients to make sure that hey are aware of the possible ways of treatment. However, too limited duration of the research may be the limitation in the study even though the author concludes that this way of treatment is effective. Moreover, the author concludes, and I absolutely agree, that there are ways which may prevent the infection and the antimicrobial therapy for clinic patients will be unnecessary.

Control and prophylaxis of gram negative nosocomial infections in the intensive care units. (2011). HealthMed, 5(3), 639-642.

The prevention strategies for eliminating the hospital infections is discussed in detail. The researchers offer several ways which may be used for preventing the epidemics, however, the list of the measures is not full that is the research limitation. Moreover, the reasons of the infection and the ways of treatment are not correlated which seems inappropriate for me. The author concludes that each of the mentioned methods may be applied in various situations, however there are more successful and efficient methods. The patients and hospital staff are the audience for the research results consideration.

Vandijck, D., Labeau, S., Vogelaers, D., & Blot, S. (2010). Prevention of nosocomial infections in intensive care patients. Nursing In Critical Care, 15(5), 251-256.

The research in this article is devoted to the prevention of nosocomial infections. However, the specific focus is provided on the catheter-related bloodstream infections. Moreover, the researchers offer the strategies aimed at nurses which work in critical care environments. The author concludes that it is possible to prevent the infection if appropriate measures are taken. Moreover, I agree that people with various diseases should be treated differently. The audience for the article is the medical staff and students who study the issue.

Rosner, F. (2007). Handwashing and Infection Control. Mount Sinai Journal of Medicine, 74(1), 33-35.

This article offers the reasons for hand washing as the main restriction and infection spread prevention. Washing hands as often as possible and after visiting each of the patients is the way to avoid nosocomial infections. The general audience is the focus as the information should be used by anyone. The research does not bring any academic value as hand washing as the disease prevention is the universally known fact. Therefore, this is the limitation as the research just supports already known data.

Jain, S., Persaud, D., Perl, T., Pass, M., Murphy, K., Pisciotta, J., &… Sullivan, D. (2005). Nosocomial malaria and saline flush. Emerging Infectious Diseases, 11(7), 1097-1099.

The delivery of the infection between the patients who shared one room is researched and the results prove that the possibility of such delivery is high. The patients are the audience who are to be aware of the issue. The attention should be paid conclusion of the article where the authors stress on the high spread of the infection. Moreover, the attention should be paid to academic level of the research which is not scientific.

Klevens, R., Edwards, J. R., Richards, C. r., Horan, T. C., Gaynes, R. P., Pollock, D. A., & Cardo, D. M. (2007). Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002. Public Health Reports, 122(2), 160-166.

The research offers the statistics related to the number of deaths caused by the hospital infections. It should be mentioned that the number of the deaths because of this reason is high and the author concludes that something should be doe. The study’s audience is the research professionals in the sphere who are to base their further research on the results. The author concludes that the high rate of deaths is caused by low attention to the problem.

Reference List

Control and prophylaxis of gram negative nosocomial infections in the intensive care units. (2011). HealthMed, 5(3), 639-642.

Gajović, O., Tomović, M., Stanarcić, J., Canović, P., Todorović, Z., & Lazić, Z. (2011). Clinical characteristics of nosocomial infections of patients with acute central nervous system infections treated in ICU. Medicinski Glasnik, 8(2), 277-279.

Jain, S., Persaud, D., Perl, T., Pass, M., Murphy, K., Pisciotta, J., &… Sullivan, D. (2005). Nosocomial malaria and saline flush. Emerging Infectious Diseases, 11(7), 1097-1099.

Klevens, R., Edwards, J. R., Richards, C. r., Horan, T. C., Gaynes, R. P., Pollock, D. A., & Cardo, D. M. (2007). Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002. Public Health Reports, 122(2), 160-166.

Makmor-Bakry, M., Mustafa, S., & Omar, M. (2011). Antimicrobial therapy in critically ill patients with nosocomial infections. International Journal of Pharmacy & Pharmaceutical Sciences, 3(4), 340-342.

Navarro-Zarza, J. E., Álvarez-Hernández, E. E., Casasola-Vargas, J. C., Estrada-Castro, E. E., & Burgos-Vargas, R. R. (2010). Prevalence of community-acquired and nosocomial infections in hospitalized patients with systemic lupus erythematosus. Lupus, 19(1), 43-48.

Rosner, F. (2007). Handwashing and Infection Control. Mount Sinai Journal of Medicine, 74(1), 33-35.

Šuljagić, V., Jevtić, M., Djordjević, B., Romić, P., Ilić, R., Stanković, N., &… Jovelić, A. (2011). Epidemiology of nosocomial colonization/infection caused by Acinetobacter spp. in patients of six surgical clinics in war and peacetime. Vojnosanitetski Pregled: Military Medical & Pharmaceutical Journal of Serbia & Montenegro, 68(8), 661-668.

Vandijck, D., Labeau, S., Vogelaers, D., & Blot, S. (2010). Prevention of nosocomial infections in intensive care patients. Nursing In Critical Care, 15(5), 251-256.

Yen, M., Lu, Y., Huang, P., Chen, C., Chen, Y., & Lin, Y. E. (2010). Quantitative evaluation of infection control models in the prevention of nosocomial transmission of SARS virus to healthcare workers: Implication to nosocomial viral infection control for healthcare workers. Scandinavian Journal of Infectious Diseases, 42(6-7), 510-515.

Introduction: Pathophysiology of H. Pylori

• H. pylori: a helical, Gram-negative, rod-shaped bacterium.
• H. pylori colonizes the gastric mucosa.
• World spread: nearly 50% of people are affected.
• In the USA: 30-40% of the population is impacted (Fashner & Gitu, 2015).
• Four steps of pathogenesis.

H. pylori is reported to be present in 70% of patients suffering from gastric ulcers and in 95% of individuals having duodenal ulcers (Fashner & Gitu, 2015). The common way of transmission of this bacterium is through the fecal-oral route. The transmission starts in early childhood and then persists for decades. H. pylori is a widely known agent of duodenal and gastric ulcers. Also, the bacterium is a common risk factor for gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma (Fashner & Gitu, 2015). Upon the bacterium’s entering the stomach, four steps of pathogenesis are identified: surviving in the acidic stomach, moving toward epithelium cells, attaching to host cells through the receptor or adhesin interaction, and damaging tissue by the release of toxins (Kao, Sheu, & Wu, 2016).

Pharmacodynamics of H. Pylori Treatment

• A similar treatment regimen for gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD).
• All approaches involve a combination of antimicrobial therapy and proton pump inhibitors (PPI).
• Antimicrobial agents: amoxicillin, clarithromycin, levofloxacin, tetracycline, and metronidazole (Woo, 2016).

Pharmacodynamics of H. pylori treatment is almost the same both for PUD and GERD. Antimicrobial agents are prescribed in a triple or quadruple drug regimen that involves bismuth subsalicylate (Woo, 2016). A combination of the antimicrobial and the PPI leads to acid suppression that promotes the alleviation of ulcer-related symptoms. Additionally, such treatment helps to heal gastric mucosal inflammation and may sometimes improve the efficacy of antimicrobial agents against H. pylori at the mucosal surface (Woo, 2016).

Treatment Regimen: First-Line

• First-line regimen:
  • Standard triple therapy;
  • Sequential therapy.

Standard triple therapy includes PPI, amoxicillin 1 g, and clarithromycin 500 mg two times daily. The duration of this treatment is 7-10 days, but it may be prolonged up to 14 days. This is a preferred therapy, and the eradication rate of H. pylori constitutes 70-85% (Fashner & Gitu, 2015). Another variation of standard triple therapy is PPI, clarithromycin 500 mg, and metronidazole 500 mg two times daily from 10 to 14 days.

Sequential therapy, which requires validation in the USA, is divided into two regimens. The first one involves PPI and amoxicillin 1 g two times a day. The second regimen includes PPI, clarithromycin 500 mg, and metronidazole or tinidazole 500 mg twice daily (Fashner & Gitu, 2015). This treatment guarantees up to 84% eradication rate of H. pylori.

Treatment Regimen: Second-Line

• Second-line regimen:
  • Non-bismuth based quadruple therapy (concomitant treatment);
  • Bismuth-based quadruple therapy;
  • Levofloxacin-based triple therapy (Fashner & Gitu, 2015).

Non-bismuth based quadruple therapy includes PPI, clarithromycin 500 mg, amoxicillin 1 g, and metronidazole or tinidazole 500 mg two times daily (Fashner & Gitu, 2015). The duration of treatment is 10 days, and the eradication rate is 90%. This approach is simpler than sequential therapy while presenting a similar eradication level.

Bismuth-based quadruple therapy includes (1) PPI two times daily and (2) bismuth subsalicylate 525 mg or subcitrate 300 mg, tetracycline 500 mg, and metronidazole 250 mg four times a day (Fashner & Gitu, 2015). The treatment period is 10-14 days, and it can be used in case first-line therapy fails.

Levofloxacin-based triple therapy is used as a salvage approach only and requires validation in the USA.

Antimicrobial Agents: Pharmacodynamics

• The effect of most antimicrobial agents is concentration-dependent.
• The breakpoint for susceptible strains:
  • In clarithromycin: 0.25 μg/mL;
  • In levofloxacin: > 1 μg/mL;
  • In metronidazole: > 8 μg/mL (Yang, Lu, & Lin, 2014).
• The effect of amoxicillin: time-dependent.
• The breakpoint for susceptible strains in amoxicillin: >0.5 μg/mL.
• Resistance: changes in properties of penicillin-binding proteins (Yang et al., 2014).

The efficacy of most antimicrobial agents is related to their plasma concentration. In some agents, such as amoxicillin, the effect is time-dependent (Yang et al., 2014). What concerns resistance, the most common mechanism is the alteration in the penicillin-binding protein’ properties. Another amoxicillin-resistance process is the reduced membrane permeability that may cause the low accumulation of amoxicillin (Yang et al., 2014). For clarithromycin, the point mutation in the 23S rRNA gene is the major resistance mechanism. The most frequent mutation occurs at A2143G (69.8%) (Yang et al., 2014).

Nursing Implications

• The major goal: the eradication of H. pylori.
• Other implications:
  • Oincreasing the intragastric pH;
  • Opreventing the development of other related diseases;
  • Oassuring the best treatment outcome.

It is highly crucial to eradicate H. pylori since it can lead to serious complications. To reach this aim, combinations of antimicrobial and antisecretory agents have been offered as first-line or second-line approaches (Yang et al., 2014). The increase in the intragastric pH is necessary for the beneficial effect of antibiotics. Additionally, healthcare professionals are concerned with the effective pharmacological management of H. pylori because this bacterium can cause the initiation of other serious conditions. It is vital to select the most suitable treatment regimen since many patients are resistant to some agents (Yang et al., 2014). The successful treatment of H. pylori enables patients to avoid adverse events.

References

Fashner, J., & Gitu, A. C. (2015). Diagnosis and treatment of peptic ulcer disease and H. pylori infection. American Family Physician, 91(4), 236-242.

Kao, C.-Y., Sheu, B.-S., & Wu, J.-J. (2016). Helicobacter pylori infection: An overview of bacterial virulence factors and pathogenesis. Biomedical Research, 39(1), 14-23.

Woo, T. M. (2016). Gastroesophageal reflux and peptic ulcer disease. In T. M. Woo & M. V. Robinson (Eds.), Pharmacotherapeutics for advanced practice nurse prescribers (4th ed.) (pp. 1021-1034). Philadelphia, PA: F. A. Davis Company.

Yang, J.-C., Lu, C.-W., & Lin, C.-J. (2014). Treatment of Helicobacter pylori infection: Current status and future concepts. World Journal of Gastroenterology, 20(18), 5283-5293.

An 86 year old male patient was admitted to the hospital-based on the diagnostic complaints of fall and urosepsis. He was admitted as he was suffering from post-fall due to Urinary tract infections (UTI) complications with septic stock. The associated clinical conditions observed were a multi-organ failure, and atrial fibrillation with the repetitive ventricular response (RVR) complicated with non-ST elevation myocardial infarction (NSTEMI), functional decomposition, iatrogenic bladder perforation, and anemia.

UT I occurs due to infections of various parts of the urinary tract that involves the bladder, kidneys, ureters, and urethra(Urinary tract infection, 2008). It was described that patients who had a history of a fall also develop UTI In addition (Rhoads, Clayman & Nelson, 2007). Similarly, patients with UTI are likely to develop acute coronary syndrome where non–ST-elevation MI is common (Sim et al.,2005). The present 86 year old male patient had a medical history that is in agreement with the complications studied in the research evidence.

Need

To provide care to the patient, there should be awareness on investigation approaches which is lacking about the UTI case conditions relevant to this patient. I felt the need to provide some teaching-based resource assistance to the patient analogous to an expert clinical practitioner. The basis for this strategy is the problem the patient has been confronted with. In older people, urinary tract infections (UTI) are the most frequent infections that occur in long-term care settings and at the community level. The variety of UTIs ranges from symptomatic bacteriuria to bacteremic infection. In the older individuals, UTI with bacteremia has high mortality in the older population, at a rate of 5% for 28 days.

Diagnosis of UTI was very often done without considering the clinical history and signs and as result, 40% of older individuals have become hospitalized (Beveridge et al., 2012) In addition, the absence of specific evidence-based practice criteria for UTI has also contributed to the misdiagnosis of the older population with UTI. The present patient is in the hospital as he needs a remedy from UTI-associated complications that are seriously making him frail. He needs to be taught from the teaching perspective. The patient needs are more relevant to treatment and complications, improving the quality of life, medication awareness, living activities, feelings about condition, skincare, and community follow-up (Bostrom et al., 1994). His selection is the major determinant of learning outcomes.

We identified the learning needs of the patient by observing him for clinical symptoms and through questionnaires. To better accomplish this, the assistance of baccalaureate program students proved very influential. The attitude of students was judged by giving the work assignment on client selection and their interest to work with the older adults. Their positive set of mind and level of gerontological knowledge were additional key factors.

Based on Kogan’s Attitude Toward Old People Scale, the students were categorized into groups. Palmore’s Facts on Aging Quiz was used to measure the knowledge of students. A 50% of students were familiar with the elderly population (Greenhill & Baker, 1986). These students were utilized for approaching the older patients and understanding their needs. The patient was in an urge to talk to the intervening student group and reveal the problems he has been confronted with. He needs a precise diagnostic remedy such that he could return home.

As such, students were being given a chance to become acquainted and flexible in dealing with the old patients. This was done to enhance their awareness levels on the aging process and implement that knowledge within the domain of nursing, by recognizing the vital components of development utilized in the health assessment of the old patients (Ross, 1985). Hence, motivation from the student group seemed very important to better prepare the client and make him ready

Principals of Motivation and Readiness

Initially, the conditions surrounding the patient were made positive by advising the patient to withstand the negative beliefs, assumptions, and expectations eliminating the failure contributing components of the learning environment. This was made feasible by developing a congenial ad conducive atmosphere that facilitates prolonged efforts and constructive spirit towards learning. The patient was shown certain posters, booklets that serve as visual aids to draw his curiosity and attention for motivation. Occasionally, the patient was subjected to receive incentives in the form of praise and privilege from the students which was determined by the teacher. This could be because in the absence of rewards self-motivation would fail. Motivational interviewing was done to enable the patient learn novel skills of behavior.

This was mostly focused on open-ended questions, reflective listening, affirmation, and summarization in order for the patient to tell his opinion about change (Miller,2010). It was observed that through the course of time, the patient has shown readiness which made the teacher to promote its development. An expected change, at the earliest moment, in the behavior of patient was supervised to guarantee its occurrence. Very often, when the patient was not ready to learn and unreliable in assimilating the given instructions, he was supervised and the instructions were said again (General principles of motivation, n.d.).

The patient was exposed to a neatly organized instructional material by making the information appear lucid at his level. Here, specific tasks were given in relation to the already familiar ones, assessment was made of the expected outcomes and the patient was finally advised to make comparison of old and new ideas. During the readiness, the patient was not feeling well and emotionally upset with anxiety. It was understood that learning may induce variations in behavior and beliefs and leads to mild anxiety. So, the patient was regularly monitored for the identification of anxiety and its impact on the learning process.

To lessen the anxiety, the patient was not given any unclear and unrealistic goals of high level (General principles of motivation, n.d.). This has strengthened a report that described the reliability of written and verbal information on health while during patient communication on care issues and hospital discharge. Satisfied care in a standard format is the outcome expected from the combination of written and verbal health information.

In addition this approach enhances knowledge not only in patients but also in care providers. The literacy level of the patient determines the communication approach of motivation and needs thorough evaluation (Johnson, Sandford &Tyndall, 2003). In the present context, the information imparted or instructed to the patient was in agreement with his literacy level. It is essential to understand that the motivation strategies implented for the present client may coincide with the research evidence provided through studies on other age groups, very often. Hence, while implementing the principles of motivation, a balance was maintained between the

patient’s active participation stimulation and respecting his autonomy in the care. More probably, face-to-face coaching sessions has worked out regardless of written materials (Wetzels et al., 2007). On the whole benefit derived was more in the patient identification of needs.

Objectives

Next, the patient admitted to the hospital needs some behavioral change about improved self-care (Alywahby, 1989). So, identifying certain behavioral objectives is a new challenge. The present old patient with UTI is having falls as an important associated complication. Patients with falls are at risk of serious injuries and need some rehabilitation care. In the rehabilitation care center, the old patient was suspected to receive an improper and undiagnosed UTI, and the resulting infection was likely associated with catheter use. A questionnaire was conducted by students in a nursing format about the use of catheters and their removal.

The students were showing interest in deciding about the use of catheters and supporting the patient (Romito, Beaudoin & Stein, 2011). A measurement approach was utilized at baseline and after treatment on urinary parameters like bladder voiding efficiency (BVE), postvoid residual urine volume (PVR), and Q-max, average flow rate (Q-ave) (Hiroo et al., 2009). The screening of old UTI patients for measurable objectives was performed daily for one month.

Especially, this routine screening made the student to learn about the connection between UTI and the amount of post-void residual urine (PVR). In detail, the students measured the PVR with portable ultrasound. It was found that incidence rate correlated with the level of function. The students concluded that good amounts of PVR and decreased functional level are risk factors for prevalence and incidence of UTI in elderly patients in a rehabilitation day-hospital.

Therefore, it was concluded that routine measurement of parameters in UTI patients was important in a rehabilitation setting (Hershkovitza et al., 2002).Fall management is another objective in the UTI risk measurement. It can be overcome by training inbalance and strength related to Tai Chi and Otago Exercise Programme, supplementation of Vitamin D, review of medications to minimize the psychotropic medications, correcting vision defects and its assessment and monitoring of home hazards (Falls in older people,2011).The patient when used the drug phenazopyridine developed side effects like skin rash and unusual tiredness or weakness.

The impact of medication side effect was also considered during rehabilitation care and appropriate monitoring was also done.VI. Teaching/Learning Principals: The patient was able to learn best from the teaching strategies focused on verbal and written communications. He was regularly assessed through questionnaire and feedbacks. Students enrolled for the job are kept under constant surveillance by the teacher. The aged UTI patient may have some barriers to learning.

It was reported that problems related to vision, hearing, memory deficits occur gradually and become unavoidable in older individuals. As such, the principles of teaching are emphasized on assessing and overcoming the interference of these barriers by teaching the client to achieve objectives. This is to expect an enhanced self care and functioning in the elderly patient (Alywahby,1989). Videos that boost the patient’s confidence have been shown to the patient daily for one hour followed by related colorful pamphlets. Videos involve clips on the patient active participation in the UTI management program. Likewise the pamphlets involved cartoons that reflected patient participation.

Overall,the environment provided to the patient was very conducive to learning.

Teaching Plan

The teaching plan of nearly 28 days, proceeded from studying the physical appearance of patient, reviewing the personal medical record, identification of patient problems in the first week; interaction with the patient, motivational interviewing –which is a style of counseling

based on client for invoking a change in behavior by making them discover and solve the uncertainties they encounter in their life (Motivational interviewing,2006), showing patient friendly organized materials for motivation, post analysis of behavior and outcome in a rehabilitation style from second week to fourth week.

Evaluation

Finally, the teaching strategy was evaluated fro several perspectives. Firstly, the identification of patient’s symptom was difficult. It was done through careful monitoring of behavior in relation to the developed symptoms and medication use. The patient was very anxious and emotionally upset in the initial stages of the teaching based intervention. He was appreciated and gradually monitored which made him perfectly fit for the participation. He was ready to move to a new location and hardly needs the interference of care providers. The patient was discharged and at home, the student group used to visit the patient and feedback was obtained. The patient problems have almost subsided and he was able to perform routine tasks of movement.

Differently, I could have concentrated more on the previous history of the patient.An investigation of the conditions that led to UTI might have given much more information like diabetes, hear ailments, reproductive disorders etc. Medication history could have been sought in detail like the dose regimen, any changes in the treatment plan or doctor change. Family members might have approached and questionnaires would have been conducted to find out the actual care provided to the old patient, his behavior, symptom and societal interaction. An evaluation of previous medical visits of unrelated UTI complaints could have been sought to find an association between the previous medical problems and the current UTI. Severities of UTI infection coud have been assessed by the utilization of specific biochemical or modern genetic markers. Nurse care provided to the patient in the past could have been reviewed to asses the actual medical aid he received in the past.

Handout

• Need – There need was to provide some teaching-based resource assistance to the patient analogous to an expert clinical practitioner. The rationale for the need was the UTI problem the patient has been confronting with. The patient needs are information on treatment and complications, quality of life improvement, medication awareness, living activities, feelings about condition, skincare, and community follow-up.
• Principles of Motivation/Readiness: The principles of motivation are more emphasized on looking for the readiness in patients to participate in UTI management intervention led by the teaching staff. For a better outcome, motivational interviewing was applied to enable the patient to learn novel behavior skills and express his thoughts.
• Objectives: The measurable and behavioral objectives for the patient involve looking for the baseline and after treatment analysis of parameters like postvoid residual urine volume and assessing fall severity and movement-oriented tasks by training in balance and strength related to Tai Chi and Otago Exercise Programme.
• Teaching/Learning Principles: The principles of teaching have been emphasized on enabling the patient to achieve goals to expect changes related to vision, hearing, memory deficits that might interfere in the aging old patient with the UTI and become an obstacle to learning.
• The Teaching Plan: It involves patient observation about his physical behavior and mental keenness to cope with the intervening group and review of his past medical history in the initial first week. Implementing motivational interviews and measuring objectives/ clinical parameters in the second week. Analysis of outcome and behavioral change in a rehabilitation model.
• Evaluation: This task involves the assessment of all strategies beginning from the identification of learner’s needs, subsiding symptoms, gain in endurance and strength which were declined due to the combined effect of UTI and fall and behavior change.

References

Alywahby, N.F. (1989). Principles of teaching for individual learning of older adults. Rehabil Nurs, 14(6), 330-3.

Beveridge Louise, A., Davey Peter, G., Phillips Gabby, & McMurdo Marion E,T. (2012). Optimal management of urinary tract infections in older people.Clin Interv Aging, 6,173–180.

Bostrom, J.,Crawford-Swent, C., Lazar, N., Helmer, D. (1994). Learning needs of hospitalized and recently discharged patients. Patient Educ Couns, 23(2), 83-9.

Falls in older people: causes and prevention. (2011). Web.

General principles of motivation. (n.d.). Web.

Greenhill, E.D., & Baker, M.F.(1986). The effects of a well older adult clinical experience on students’ knowledge and attitudes. Nurs Educ, 25,145-7.

Hershkovitza Avital, Belooseskyc Yichayaou , Pompa Nitzchia, & Bril Shai. (2002). Is routine screening for urinary tract infection in rehabilitation day-hospital elderly patients necessary? Archives of Gerontology and Geriatrics,34,(1)29–36.

Hiroo Miyazaki, Takafumi Suda, Atsushi Otsuka, Masao Nagata, Seiichiro Ozono, Dai Hashimoto., ….. Kingo Chida. (2009). Tiotropium does not affect lower urinary tract functions in COPD patients with benign prostatic hyperplasia. Pulmonary Pharmacology & Therapeutics, 21(6), 879-88.

Johnson, A., Sandford, J.,& Tyndall, J. (2003). Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home. Cochrane Database Syst Rev, 4, CD003716.

Miller, N.H. (2010). Motivational interviewing as a prelude to coaching in healthcare settings.J Cardiovasc Nurs, 25(3),247-51.

Motivational interviewing. (2006). Web.

Rhoads,J., Clayman, A., &Nelson, S. (2007). The relationship of urinary tract infections and falls in a nursing home. Director,15 (1),22-6.

Romito, D., Beaudoin, J,M., & Stein, P. (2011). Urinary tract infections in patients admitted to rehabilitation from acute care settings: a descriptive research study. Rehabil Nurs, 36,216-22.

Ross, MM. (1985). The impact of client selection on clinical teaching. Adv Nurs, 10,567-73.

Sims John, B., de Lemos James, A., Maewal Param, J.,Warner John, J., Peterson Gail, E., McGuire Darren, K. (2005). Urinary tract infection in patients with acute coronary syndrome: A potential systemic inflammatory connection. American Heart Journal, 149 (6) 1062-1065.

Urinary tract infection – adults. (2011). Web.

Wetzels, R., Harmsen, M., Van Weel, C., Grol, R, & Wensing, M. (2007). Interventions for improving older patients’ involvement in primary care episodes. Cochrane Database Syst Rev,1, CD004273.

Introduction

Formally, New Zealand embraced clinical governance for the first time in the year 1999. Since then, all New Zealand healthcare organisations have recommended its implementation. In New Zealand, the concepts of clinical governance are also widely embraced. Application of concepts of governance in the healthcare setting entangles the setting of frameworks through which organisations are checked for accountability through fostering continuous improvement in quality of healthcare service delivery coupled with safeguarding and provision of healthcare of high standards. This deliverable has been possible via creation and management of an environment in which care delivery can flourish.

From this fundamental approach in clinical governance, the paper focuses mainly on the role of clinical governance in enhancing cute clinical care, which leads to better control of infections in wards in New Zealand. Due to valid healthcare needs for various groups of people, the paper holds that patients’ needs in New Zealand form the primary concern of healthcare professionals for prevention of infections in New Zealand wards to materialise.

It provides an extensive analysis of the literature on the roles of clinical governance in prevention and control of infections in wards in New Zealand. It also holds that any clinical governance strategy applied to the management of health conditions of New Zealand people with valid and diverse healthcare also needs to have the concerns of the healthcare givers at heart. This plan keeps the staff motivated. It eliminates or reduces substantively cases of occurrence of burn out among healthcare staff.

The paper proposes that extensive and magnificent provision of information related to perceptions of health risks in wards can work as an incredible strategy tied within the umbrella of clinical governance for reduction of infections in wards. When appropriate risk management principles are applied within clinical healthcare settings, healthcare professional working in wards becomes aware of the risks presented by inappropriate management of an environment that would form subtle breeding grounds for infections in wards, both on healthcare professionals and on the chief client of clinical healthcare facility: patient.

Consequently, the paper infers that, while the professionals attempt to reduce or even prevent completely the risk of infections on their part while working in wards, the patients also are shielded from contracting infections. Another vital plan of reducing infections is fostering optimal resource utilisation in clinical facilities. The paper also proposes that incorporation of information technology in clinical information management can amount to a substantial aspect of quality improvement. Hence, it can incredibly aid in realisation of aims and objectives of clinical governance coupled with application of its principles in reduction of infections in wards in New Zealand healthcare facilities.

Roles and Significance of application of clinical governance in prevention of Infection in wards in New Zealand

A statutory responsibility goes to the clinical facilities to make sure that the guidelines of clinical governance deliver quality healthcare to the clients-patients. Prior to adoption of the clinical governance across New Zealand, the main concern of accountability in healthcare facilities revolved around healthcare institutions management capacity to balance financial books. A similar approach was also evident in New Zealand.

However, clinical governance altered this emphasis and focused it on the patients as the real priority (Pellowea et al, 2002, p.375). In this context, clinical governance had the immense responsibility of enhancing magnificent quality care within healthcare organizations in New Zealand (Good Hands Report 2006, p.3). Arguably, from this perspective, it is upon maintaining of high quality standards in the clinical healthcare service delivered to all patients that infections can cease taking place in wards.

The success of any healthcare infections prevention and control program is largely dependent on the capacity of all healthcare stakeholders to understand the various modes and means through which transmissions of infections can take place within clinical healthcare facilities including wards. The responsibility of control and prevention of infections transmissions in wards is a noble duty for all persons visiting and or working in healthcare facilities such as the patients, staff, caregivers and even the administrators (Ham, 2003, p.1979).

Therefore, success in reduction and prevention of infections in New Zealand wards enormously depends on ability to apply cutely various concepts of risk management in the attempt to manage both system and human factors, which have close association with person-to-person agents of infections transmission. This way, infectious agents, either which are common such as gastrointestinal virus, or even the evolving ones such as influenza among others can be managed effectively. Inculcation of measures to curb infections in wards is not an issue of not only clinical healthcare management concern, but also an issue of concern in the public domain.

This is because effective strategies of preventing infections coupled with their control is a key indicator of the quality of New Zealand healthcare delivered to patients coupled with likely indication of the capacity to provide working environments that are safe in healthcare clinical settings (Hahn, Cummings & Michalek, 2002, p.527). Application of clinical governance approaches in management of infection in wards is immensely significant upon consideration of the harm that permitting opportunities for infections to take place can cause. For instance, Beggs, Kerr, and Noakes (2008) approximate that in Australia, there are about 200, 000 cases of infections associated with acute healthcare facilities (p.253).

Arguably, healthcare-associated infections in New Zealand entangle the most notable complications afflicting patients, especially when such patients appear in common areas such as hospital wards. Apart from giving birth to pains that are unnecessary coupled with sufferings on the part of the patients together with their families, healthcare associated infections leads to prolonged stays in hospital. Hence, they can be expensive to the entire healthcare system.

Indeed, the challenge of infections in healthcare settings does not only pose health risks to workers and patients. They can take place in any other clinical healthcare setting such as dental and even in general practice clinics without negating care facilities providing long term healthcare services. This implies that any person who accesses any New Zealand healthcare facility is at risk of infection. However, amid all this dangers posed by healthcare associated infections, such infections are significantly reducible to manageable limits by incorporation of strategies of effective control and prevention of infections as stipulated in the clinical governance strategies and principles.

Principles and objectives of clinical governance

Objectives

Clinical governance, as a concept that can proactively facilitate in reduction of infections in wards, is deeply ingrained in the foundations of the need to reorient the organisational culture to indebt in working collaboratively in enhancing quality healthcare that is subtle for forging and inducing partnerships between care providers and patients that are meaningful (Elcoat, 2000a, p.622). Indeed, clinical governance was an additional mechanism of facilitation of strategies for achievement and improvement of quality clinical care. It was vital for modernisation of New Zealand clinical services (Department of Health, 1997, p.34: Department of Health, 1998, p.13).

For realisation of the proper inclusion of the principles of clinical governance in the managerial approaches of the healthcare facilities, the objective of the clinical governance needs to be at the forefront of any program deemed substantive for delivery of quality healthcare to patients.

Firstly, clinical governance in New Zealand has the objective of ensuring that quality data is availed to aid in monitoring clinical care with regard to both the commissioned and provider services. Secondly, it endeavors to foster improvement of quality assessment processes, for instance the process of clinical audit and for taking appropriate actions with response to the feedback obtained from the users and patients. The third objective is to set priorities and indentify the myriads of education coupled with development needs of the clinical healthcare staff with the aim of ensuring that the staff is appropriately skilled.

Additionally, clinical governance has the objective of putting in place programs that facilitate professional development. In the endeavor to promote continuous quality healthcare delivery, clinical governance objects to ensure early identification of challenges of poor performance and deal with them accordingly before they escalate to higher magnitude and hence affect negatively the levels of healthcare quality delivery. Moreover, it objects to ensure promotion of fair and open-ended blame culture. This sort of organisational culture is critical since outward incidents coupled with near misses go through a precise detection and then investigation. Arising lessons can then be available among all staff followed by fostering of quality healthcare.

Principles

Upon the introduction of clinical governance, many medical scholars in New Zealand became cynical about its ability to produce change and ensure that quality healthcare goes to all patients. One of the significant counterargument was that clinical governance had numerous unwritten rules that acted only to place more emphasis on the status quo (Garratt, 2000, p.63). This means that new ideas on organisational change including New Zealand and clinical audits fell on stony grounds (Miller, 2001, p.87). On the other hand, many healthcare professionals, upon scrutiny of the principles of clinical governance disagreed with its core aims’ capacity to boost the quality of health care in clinical settings.

This is perhaps evident since many doctors, long before the introduction of clinical governance principles, had been practicing it unknowingly when they strived to deliver utmost quality care, though in fragmented, introspectively and in haphazard manner (Millward, Barnett & Thomlinson, 1993, p.219). The main principles of clinical governance constitute seven elements. These elements are education and training, clinical effectiveness, clinical audit, research and development, information management, openness, and risk management.

Education and training

After qualification, continuing education is crucial. Clinicians needs not abstain from it. This is because many of the things learned during the foundational training have the tendency of becoming obsolete. Consequently, professionals have the due duty of ensuring that they remain up to date (Squire, 2001, p.1332). On the other hand, the trust has a noble responsibility of ensuring the clinicians participate in professional development forums. Arguably, continuous education and training ensures the development of clinical governance in accordance to the complexities of differing organisations.

Various organisations subscribe to differing organisational beliefs, values, relationships, structure and even management styles. All these diversities should be in harmony for the caregivers to deliver quality healthcare in clinical settings. Basic education embraces the minimum standards upon which people can be gauged for placement in any clinical facility (Chambers & Boath, 2001, p.137). Indeed, it is impossible for basic education to address the diversities of every clinical facility. Consequently, on job education and training is critical for the clinicians to gain system understanding and communication processes which results in better service output.

Creation of cute system awareness is particularly significant since system awareness enable healthcare workers to come into acquaintance with the various parts of the organisation that can function uniquely or as a function of the whole organisation in the endeavor to bring about quality improvements. “System thinking identifies organisational problems and obstacles to quality improvement and encourages creative responses to these issues” (O’Neill, 2001, p.1074). Without proper understanding of the system, it is impossible for the workers to utilise all the resources available in the organisations in enhancing their delivery of quality care to the patients. Understanding of the system is only achievable through continuous education and training.

Clinical effectiveness

In the context of clinical governance, clinical effectiveness embraces a measure of extent to which certain inventions functions to enhance increased quality care delivery. Although the measure is ardently important on its own, other additional factors affect decisions to particular strategies to enhance the effectiveness of clinical service delivery to patients. Such factors include “whether a certain intervention is precise and appropriate representation of money value” (Taylor, Plowman & Roberts, 2000, p.28).

Stemming from this argument, concepts of clinical governance hold that, current healthcare services in clinical settings need being refined to reflect the emerging substantive evidence of effectiveness without negating efficiency aspects coupled with safety in healthcare facilities from the dimension of both the wider community and individual patients. Certainly, from this perspective, clinical effectiveness entails the approaches an organisation or a service institution deploys in order to both develop and make use of desired outcomes and agendas (McSherry & Pearce, 2002, p.23).

Thus, agenda setting to reflect on the patient focused model of clinical management is critical for enhancing the clinical effectiveness. On the other hand, the principle of clinical effectiveness maintains that such a model needs being porous to the traditional organisational demarcations. This is because “preventing infections is every one’s business and because microorganisms do not acknowledge such boundaries” (Taylor, Plowman & Roberts, 2000, p.30). Ideally, this means that infections control and prevention services and trusts have immense things to learn from each other and harmonise them into a single strategic plan.

Clinical audit

Clinical audit entangles “reviewing the clinical performance, refinement of various clinical practices and performance measures against the datum of accepted and agreed upon standards” (Taylor, Plowman & Roberts, 2000, p.29). Arguably then, clinical audit amounts to cyclical clinical care improvement process. For increasingly many number of year, clinical audit has constituted one of the pronounced methodology of measuring good clinical practices.

The only challenge of the traditional clinical audit is that it over-emphasised on the financial accountability and negated central consideration of the quality of care delivered to the patients in its premises. Although, systems of clinical governance such as New Zealand have included clinical audit as one of the requirements, opposed to traditional approach, clinical audit competes with other priorities vital for enhancement of quality care delivery. This means that in primary care, audit is only encouraged since its time competes with other priorities.

Research and development

Any professional practice needs to have immense supply of evidence acquired from a broad body of research. In this end, clinical governance endeavor to make introduction of shortened time lags coupled with related morbidity. This accomplished through conducting research coupled with implementation of results acquired from the research in enhancing the quality of clinical service delivery to the patients. To make this a realty, tactics such as “project management, critical appraisal of various literatures garnered from the research, and also developments of various guidelines, strategies of implementation and protocols” (Taylor, Plowman & Roberts, 2000, p.37) are akin and central to the process of creating a superfluous model of clinical governance.

Risk management

A perception of risks is one of the central and key principles of clinical governance. It involves consideration of a number of elements, which can foster quality care delivery while well balanced. Among these elements, the risk on the patients’ part is the most significant main issue for consideration. To mitigate such risks, good clinical governance policies encourages incredible compliance with statutory regulations (Department of Health, 2001, p.5). Another way of reducing risks to patients is through putting in place mechanisms for checking the conformance of the system to standards on regular basis. Where irregularities are evident, queries arise.

A good example of system check for conformance is through conducting critical audit events and endeavoring to gather, analyse and learn from patients and other noble stakeholders’ complaints. In this context, the system is ran through feedback mechanism in which the main plan and strategies for improving quality care delivery are derived from the consumer‘s demand requirements. Furthermore, use of medical moral and ethical standards contributes greatly in maintenance of appropriate public and patient safety. Another element of risk that is an important component of a good clinical governance program is the risks to the practitioners. Clinicians need to “be immunised against various forms of infectious diseases, should work in safe and well protected environment and are aided in getting updated with various requirements and essential elements of quality assurance” (Taylor, Plowman & Roberts, 2000, p.30).

An organisation may also be at risk. Hence, it is in the risks principle of clinical governance. One of the substantive coercion to any organisation is underprivileged eminence. Hence, the organisation needs to be mitigated from it. In this end, apart from striving to curtail risks to patients and practitioners, organisations need also to develop risks resilience. One the subtle ways of achieving risks resilience is to deploy high quality practice of employment. Such a practice encompasses reviewing and thorough scrutiny of both team and individual performance portfolios and locum procedures. Other mechanisms include designing working and favorable public involvement policies and making provisions of safe working environments.

Openness

Closed doors can serve as crucial breeding culture medium for poor practice and poor performance of healthcare organisations. Clinical governance acts to open up these closed doors to ensure openness of the health facilities’ practices for the scrutiny by the public. This happens upon considering the significance of both practitioners and patients respect of individual confidentiality. However, justification of the confidentiality in an open environment is critical element of good quality assurance under the concerns of clinical governance. Under the pillar of sincerity, as an indispensable code of clinical control, deliberations and procedures have to be crucial attributes in the organisational quality frameworks.

Therefore, any association that ardently claims that it offers good quality healthcare needs to demonstrate that it has the capacity and the will to cater for the myriad of demands of its target population. For instance “health needs assessment and understanding of the problems and aspirations of the community requires the cooperation between any relevant organisation, public health departments, local authorities and community health councils” (Scally & Donaldson, 1998, p.63). This implies that all stakeholders and interest groups in the performance of an organisation should have an opening for accessing the levels of quality of service delivered by any clinical service. This may help in determining whether an organisation embraces good clinical governance in its management practices.

Information management

Information management in the healthcare setting involves proper collection of the records of the patients’ (about their clinical information, demographic and socioeconomic information), its management, and appropriate use of the garnered information within the system of healthcare. The extent of precise accomplishment of this task, aids in determining how effective the healthcare system is in conducting its noble roles of health problems detection, priorities definition, identification of solutions that are incredibly innovative coupled with how the organisation allocates resources aimed at improving the outcomes of health interventions of the patients.

Communication of the collected information is also critical in fostering delivery of cute healthcare. Hence, effective communication of clinical information is part of the realm of the principles of information management in the clinical governance approaches. In this line, Pratt and Pellowea et al (2001) hold, “ the effectiveness of infection prevention and control practice and the potential of clinical governance to derive quality improvements largely depends on communication skills, specifically people’s ability to first understand others and then to move people from understanding to involvement and commitment” (p.332).

This insight proves that without proper enhancement of good information management through good communication, alignment of the concerns of various stakeholders of clinical healthcare organizations cannot be achieved. Hence, quality of care delivered to the patient suffers some blows.

Plan for reducing infections in wards using clinical governance principles

Objective of the plan and how achievement of the objectives can be determined

The main objective of the plan proposed in this section is to provide a theoretical proposal of strategies of preventing infections in wards in New Zealand. This plan entails making use of the principles of resource management and risks management in curtailing the spread of infections in wards. The capacity of the plan to achieve this objective can be determined through statistical comparisons of infection rates data before and after the plan is implemented.

Rationale for the plan

The rationale behind the choice of this area of concern in healthcare setting is based on the fact that, in ward, patients are always in close vicinity with each other and hence chances of spreading of infectious diseases are imminently high. Since clinical governance aims at ensuring delivery of high quality clinical care (Good Hands Report, 2006, p.2) and that the main concern of the plan discussed in this section is on enhancing quality clinical care through prevention of infections in wards, its principles are widely applicable in reduction of infections in New Zealand wards. Quality in clinical services delivery is essential for enhancing reductions of infections in wards.

In this context, clinical governance may be the concept that revolves around improving the quality of healthcare delivery in clinical settings. In this section, principles of clinical governance are in terms of prevention and control of infections in wards discussed as a specific area of application of the principles of clinical governance in nursing practice.

The role of staff

A plan of incorporating the principles of clinical governance in practice entails the deployment of concepts of risk management coupled with cute resource management as two subtle mechanisms of reducing infections in wards. To realise this plan, the professionals must play their roles in making the principles of clinical governance practical. This is because “If clinicians are to be held to account for the quality outcomes of the care that they deliver, then they can reasonably expect that they will have the powers to affect those outcomes” Good Hands Report, 2006, p.3. This implies that staff must get empowered to aid in setting the direction for the myriads of services they deliver; make decisions on the resources used in clinical facilities; and to make decisions on various people with high probabilities of being exposed to infection risks in wards.

The plan

Effective resource utilization

In order to make the principles of clinical governance practical, splendid consideration of effectiveness of resource utilisation to curb infections in wards is necessary. This responsibility mainly falls under the basket of the clinical facilities leadership. Since high quality services are predominantly resource effective, and clinical governance is all about hiking the quality of services rendered in clinical facilities, effectiveness in utilisation of resources is of paramount importance. This follows because “waste and failure of poor quality can add up to 10 percent to 35 percent to the costs of healthcare (Elcoat, 2000b, p. 880).

For example, for the case of New Zealand, adverse effects that harm patients costs it about two billion pounds every year with about 400 million pounds paid for clinical negligence claims every year (Department of Health, 2000 a, p.17). Arguably, infections in wards entangle one of such expensive adverse effects that occur in clinical facilities. Juran (1964) likened quality to “gold situated in mines” (p.79). The concept can also incorporate infections prevention and control strategy in the wards. One can explain the manner in which this concept may help in improving quality in wards and hence contribute in infections control and prevention by an example of application of clinical governance in England and New Zealand.

For instance, in England, health associated infections cost New Zealand about one billion pounds every year (Plowman et al, 1999, p.103) with 15 percent to 30 percent of the infections being potentially preventable (Department of Health, 2000a, p.23). In case people get it right for the very first time in subsequent times (Donaldson and Gray, 1998, p.41), it is possible to save about 150 to 300 million pounds every year. Such saving depicts that resources are purposely used appropriately for the good cause.

This argument points at basing the effectiveness of resource utilisation on the existing evidence of mechanisms of saving funds that can in turn be utilised in handling other critical conditions that may favor spread of infections in wards. Such conditions include poor hygiene and ventilations without negating the efforts to facilitate availing of protective gadgets and devices to the caregivers who handle differing patients and in the cause of doing their work, they may end up acting as subtle agents of spreading infections. Focusing the intervention of infection control and prevention on evidences of effectiveness of resource utilisation is one major avenue leading to achievement of high quality clinical care with the cost factors bared in mind.

Unfortunately, in the field of clinical care, in many interventions, such evidence is normally widely non-existent and if available, it is weak. Consistent with this line of thought, Masterton and Teare (2001) argue, that “even when good evidence is available, practitioners remain unaware of it and thus fail to incorporate it into clinically effective practice” (p.25). However, specialised practitioners for instance, IPCP normally undertake initiatives to acquire evidence on effectiveness of clinical care service delivery. Consequently, they act as enormous resource to other practitioners. Therefore, the plan of effective utilisation of clinical healthcare resources for the utmost good of the patients can reach every practitioner. Hence, the plan can greatly aid in reducing infections in New Zealand wards.

Use of health surveillance systems

Apart from looking at the effectiveness in resource utilisation from the dimension of cost saving so that to have optimal service delivery, surveillance systems can also play proactive roles in aiding to monitor the patterns of health associated infections in wards. The decision to install such systems lies squarely on the clinical facilities leadership and management. Hence they are the ones charged with this aspect of the overall plan of reducing infections in New Zealand clinical healthcare wards. In particular, health-monitoring system may significantly aid in inculcation of feedback approached in handling the concerns of patients in wards.

Through such an approach, health care providers become motivated to carry out thorough investigation of situations that run out of control. Armed with the information garnered, plausible interventions and remedies are instituted. This way, infections can be controlled and prevented in wards. One way of doing this is deploying charts of process variations. These charts have proved infective (Curran et al, 2001, p.15). The argument here is that any effective approach of curtailing infections in New Zealand wards needs amicable information and evidence on the effectiveness of other possible approaches that can also be deployed to yield similar results. Arguably, this argument is significant since clinical governance essentially deploys bottom-up approaches in the effort to achieve quality health care.

In such an approach supply of information from the ground- clinical wards, is vital as the information garnered aids the managerial arm to make appropriate decisions and put in place the right measure to curtail undue conditions that may lead to more pronounced infections. This is opposed to the authoritarian approach in that authoritarian managerial approach results to dissonance and is largely unforeseeable.

In this context, Robinson (2002) posits, “trying to police so many different teams and professionals would require huge resources” (p.23). Consequently, the plan of effective resource utilisation as a key way of reducing infections in ward becomes impaired. From this perception, monitoring of progress of the programs put in place to enhance quality service delivery in wards at both teams and departmental level coupled with at individual level is critical in enhancing the effectiveness of professional caregivers in ensuring appropriate incorporation of strategies of reducing the dangers infection risks in wards.

Deployment of risks mitigation strategies

This plan stems from the realisation of the fact that the current health care systems are predominantly complex. Hence, mistakes occur emanating from the organisation, human errors or even technological errors. For instance, physical equipments that help in ventilation and or in air circulation within a ward may fail. This may amplify the risks of infections. Therefore, risk management concepts are central to infection control and prevention in healthcare settings including wards. Every person who has accessibility to clinical wards has the noble responsibility of ensuring that he or she acts in a manner that would reduce chances of being infected. In actual sense, all people in clinical facilities are charged with implementation of this plan in one way or another in New Zealand.

Failure to control and manage risks may result to consequences that are disastrous to not only the organizational but also even the patients (Taylor, Plowman & Roberts, 2000, p.87). Risk management process deserves being a continuous process entangling incorporation of proactive measure to assess and evaluate risks. Various methods of controlling such risks can then be employed. To curtail situations providing subtle breading culture of infections in wards, a system of reporting errors and adverse situations and near misses effectively (Taylor, Plowman & Roberts, 2000, p.89) need to come in the process of identification of various risks coupled with differing responses to risks of infections in wards.

Most paramount to note is that, in health care interventions, risks are real. For instance, according to Meers et al (1981) “the prevalence of healthcare associated infections has hardly declined in the New Zealand hospitals over the last decade, affecting approximately 9 percent of all hospitals in-patients” (p.7). In case the number of patients suffering from infectious diseases is reduced, the risk of infection in wards can also be reduced significantly.

For this reason, health surveillance programs can incredibly reduce healthcare associated infections and hence risks to both in-patients and their healthcare providers in wards. Indeed, majority of the risks of infection can immensely get reduced through employment of strategies for safety and quality healthcare theories including; methodologies of quality improvement as stipulate by the guidelines of clinical governance, creation of culture of safety in wards and also through incorporation of system thinking culture. Therefore, for success of these theories, any endeavor to reduce risks of infections in wards needs being ardently derived from information arising from the health surveillance systems (Skoutelis, Westenfelder & Beckerdite et al, 1994, p.212).

According to Centre for Diseases Control, health surveillance system entangles “the ongoing, systematic collection, analysis, interpretation and dissemination of data regarding a health related event for use in public heath action plan to reduce morbidity and mortality and improve health (2001, p.43). Considering the immense role of surveillance in reducing healthcare associate infections, it is evident that surveillance can lead to embracement of effective interventions that can lead to reduction of infections in the healthcare wards.

For example, through monitoring hygiene, compliance coupled with bloodstream infection rates (Cosgrove & Carmeli, 2003, p.885) and then ensuring that the information goes across the entire health facility, improvement of hygiene practice is achievable. The repercussion is better management of infections with healthcare facilities including wards. Infections risk in wards call for use of technological interventions to solve them. Thus, technology encompasses an additional plan for helping to reduce the risks of infections in wards in the endeavor to improve the quality of healthcare delivery as postulated by principles if clinical governance.

Investment in IT

For success of the capacity of clinical governance to facilitate in reduction of healthcare associated infections in wards in New Zealand, it is crucial that investment in technological development is considered. This is because dependence on unrewarding and laborious data collection and cases review is largely not sustainable. However, this does not mean that substantial investment in healthcare management systems has not been incorporated in the healthcare facilities. In fact, “fully integrated patient management system already exist in many general practices and are being introduced in most hospitals in the near future” (Cosgrove & Carmeli, 2003, p.884).

The proposal here is that such opportunities needs being embraced with both hands in the endeavor to speed up the decision making processes coupled with implementation of strategies of reducing hazardous situations in wards. Although, in the modern day practices there is an incredible volume of information being feed in computer data bases in the endeavor to pace up the rate of analysis of information and hence the rate of decision making, more work needs being done in improvement of both validity and consistency in coding information upon collecting it. Consistent with line of view, Pratt, Pellowea, and Wilson (2007) posit, “Key indicators should be agreed by individual teams and departments for regular feedback of performance” (p.65). By doing this, quality indicators can be derived.

While the practitioners attempts to comply and perhaps surpass the preset quality indicators, utmost mitigation of risks of infection can be realised. Accessibility to clinical information at high speed is also critical in enhancing prevention and control of infections in wards. Many situations, upon diagnosis, patients and caregivers are not immediately acquainted with the health conditions of the patients. During the periods of admission to diagnosis and immediately before results are acquired chances of infections are eminently high. Technology can reduce these times by great extent. Hence, it is anticipated that chances of infections can also be reduced by equal or even greater magnitudes.

In this context, information technology contributes to improvement of accessibility of clinical information prompting appropriate action in the shortest time possible. In fact, knowledge databases can directly link with the libraries of clinical rooms and wards in the network. Consequently, before the caregiver offers help to the patients no matter how needy such help may be, it is possible to access the clinical information of that particular patient.

The caregiver would then offer aid bearing in mind the extent and level of risk encountered in the due cause of offering the service on the part of other patients and him/her. Recognition of perceived risks is in this context vital since the practitioner, under normal circumstances, would make decision that would minimize risks on his or her part first. Consequently, other patients likely to get the attention of the same practitioner are placed and milder risks of infection.

Conclusion

Based on the expositions made in the paper, it is evident that clinical governance is a subject that the health sector needs to give attention. Without proper governance in the field of clinics, then the target people, patients, are at risk. Therefore, establishment of a strategy that boosts this area is crucial if patients are the main agenda in the field of clinics. Quality of healthcare is the focus of the clinical governance principles. The paper reveals how the application of various concepts of clinical governance revolves around establishment of frameworks for checking the accountability of a healthcare organisation in terms of delivering quality health care to the chief client: patient.

Quality healthcare is realised when the culture of providing high standard healthcare is embraced and sufficiently safeguarded. This is possible via creation and management of an environment in which care delivery can flourish. Additionally, the paper argues that the principles of clinical governance embrace seven critical elements or pillars. They include education and training, clinical effectiveness, clinical audit, research and development, information management, openness and risk management.

However, before discussing of the principles and how they can be applied in reduction of infections in wards, an attempt was made to scrutinise the objectives of clinical governance. The paper recognised that, in wards, risks of infection are real. Consequently, it proposed the plan of reducing risks of infection in wards through deployment of information and technology in the management of patients’ clinical information, and optimal resource utilisation coupled with the plan of reducing infection through surveillance system and creation of risks awareness.

Reference List

Beggs, B. Kerr, G., & Noakes J. (2008). The ventilation of multiple-bed hospital wards: review and analysis. Journal of Infection Control, 36(4), 250–259.

Centre for Diseases Control. (2001). Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group. MMWR, 50 (2), 1–51.

Chambers, R., & Boath, E. (2001). Clinical Effectiveness and Clinical Governance Made Easy. Oxon: Radcliffe Medical Press Ltd.

Cosgrove, E., & Carmeli, Y. (2003). Studies of bloodstream infection outcomes: reading between the lines. Infection Control Hospital Epidemiology, 24(12), 884–886.

Curran, T, Benneyan, C., & Hood, J. (2001). Controlling methicillin resistance to Staphylococcus aureus: a feedback approach using annotated statistical process control charts. Infection Control and Hospital Epidemiology, 23(1), 13-18.

Department of Health. (1997). The New NHS Modern, Dependable. London: Department of Health.

Department of Health. (1998). A First Class Service: Quality in the new NHS. Department of Health. London: Department of Health.

Department of Health. (2000). An Organization with a Memory. London: Department of Health.

Department of Health. (2001). Controls Assurance Infection Control Standard. London: Department of Health.

Donaldson, J., & Gray, M. (1998). Clinical governance: a quality duty for health organisations. Quality in Health Care, 7(2), 37-44.

Elcoat, C. (2000a). Clinical governance in action Part 1: Key issues in clinical effectiveness. Professional Nursing, 15(10), 622-623.

Elcoat, C. (2000b). Clinical governance in action Part 5: Resource effectiveness. Professional Nursing, 16(2), 880-881.

Garratt, B. (2000). The Learning Organisation. London: HarperCollins.

Good Hands Report. (2006). Transforming Clinical Governance in New Zealand. New Zealand: Task Group.

Hahn, T., Cummings, M., & Michalek, A. (2002). Efficacy of high-efficiency particulate air filtration in preventing aspergillosis in immune-compromised patients with hematologic malignancies. Infection Control Hospital Epidemiology 23(9), 525–531.

Ham, C. (2003). Improving the performance of health services: the role of clinical leadership. Lancet, 361(9373), 1978–1980.

Juran, M. (1964). Managerial Breakthrough. New York, NY: McGraw-Hill.

Masterton, G., & Teare, L. (2001). Clinical governance and infection control in the United Kingdom. Journal of Hospital Infection, 47 (3), 25-31.

McSherry, R., & Pearce, P. (2002). Clinical Governance: A Guide to Implementation for Healthcare Professionals. Oxford: Blackwell Science.

Meers, D., Ayliffe, A, Emmerson, M., & Leigh, A. (1981). Report on the national survey of infection in hospitals 1980. Journal of Hospital Infection, 2(1), 1-11.

Miller, J. (2001). Clinical Governance. NT Monographs No. 56. London: Emap Healthcare.

Millward, S., Barnett, J., & Thomlinson, D. (1993). A clinical infection control program: evaluation of an audit tool used by infection control nurses to monitor standards and assess effective staff training.” Journal of Hospital Infection, 24 (3), 219-232.

O’Neill, S. (2001). Clinical governance in action Part 8: Systems awareness.” Professional Nursing, 16(5), 1074-1075.

Pellowea, M., MacRae, D., Loveday, P., & Reid, P. (2002). The scope of guidelines to prevent healthcare-associated infections. British Journal of Community Nursing, 7(7), 374-8.

Plowman, R. (1999). The Socioeconomic Burden of Hospital acquired Infection. London: Public Health Laboratory Service and the London School of Hygiene and Tropical Medicine.

Pratt, R, Pellowea, M., & Wilson, A. (2007). National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection, 5(3), 65-81.

Pratt, R., & Pellowea, M. (2001). The epic Project: Developing National Evidence-based Guidelines for Preventing Healthcare associated Infections. Phase 1: Guidelines for Preventing Hospital-acquired Infections. Journal of Hospital Infection, 47 (3), 332-339.

Robinson, B. (2002). “A PEST analysis of the role of clinical governance in hospital infection control. British Journal of Infection Control, 3(1), 22-25.

Scally, G., & Donaldson, J. (1998).Clinical governance and the drive for quality improvement in the new NHS in England. Oxford: Oxford Press.

Skoutelis, T., Westenfelder, O., & Beckerdite, M. (1994). Hospital carpeting and epidemiology of Clostridium difficile. Journal of Infection Control, 22(4), 212–217. Ownership. Professional Nursing, 16(9), 1332-1333.

Squire, S. (2001). Clinical governance in action Part 11: Encouraging a Sense of Taylor, K., Plowman, R., & Roberts, J. (2000). The Challenge of Hospital Acquired Infection. London: National Audit Office.