Category: Infection

Introduction

• A dangerous and deadly Ebola virus poses a significant threat.
• The spread of the disease may be rapid.
• Mass epidemics prove the danger and need for prevention.
• Healthcare and state interventions are mandatory.
• Prevention is more important than treatment due to significant mortality statistics.
• Future safety measures include vaccination and special control at transport hubs.

Ebola virus is an extremely dangerous viral infection with a high risk of mortality. Due to the danger of rapid spread, timely preventive interventions are needed in vulnerable areas. Some massive epidemics in African regions have proven the threat of the illness and the importance of timely protection. The treatment of the disease is almost ineffective; therefore, healthcare and government interventions are mandatory. Enhanced monitoring at transport hubs and ongoing medical examinations are the essential aspects of preventive activities.

Disease Discovery

• First registered in 1976 in the Democratic Republic of the Congo (Park et al., 2015).
• Outbreaks in the northern regions of the continent were reported (Park et al., 2015).
• Later, in different parts of Africa, Ebola manifested itself.
• The origin of the virus remains unknown until now.
• Wild animals and bats are considered carriers of infection.
• In poor areas, contact with wild animals is inevitable.

The first cases of Ebola were reported in 1976 in the central region of Africa, but later, the outbreaks of the infection were identified in other areas. Researchers cannot determine the exact nature of the virus and do not have reliable data on who are the carriers of the disease. Wild animals and bats are thought to be hosts for the infection. In the areas under consideration, where the standard of living of the population is not high, contacts with fauna may be fraught with contamination.

Problem Description

• The rapid spread of the infection in case of an epidemic.
• The likelihood of stable transmission from person to person is extremely high (Park et al., 2015).
• The danger of epidemics in low-health areas.
• Both patients and healthcare providers are at risk.
• Ebola mortality rates can reach 90% (World Health Organization, 2019, para. 1).
• Infected bodies are dangerous even after death.

The Ebola threat is significant due to a number of factors, in particular, the high risk of transmission from person to person and extremely high mortality rates. Different stakeholders are at risk of infection, which creates additional challenges. Special burial principles should be applied since infected bodies pose a threat even after death due to the persistence of the virus. Poor healthcare status in some regions areas is an additional problem.

Epidemiology of the Disease

• 33 outbreaks of the disease have been reported (Martínez, Salim, Hurtado, & Kilgore, 2015).
• The virus belongs to the family of filoviruses (Martínez et al., 2015).
• The disease is rare and often fatal.
• The virus is transmitted from animals and spreads among people.
• Early supportive care promotes recovery and survival.
• Vaccination is the only possible preventative treatment.

Since the discovery of Ebola, 33 outbreaks have been reported, and they all occurred in Africa. The virus belongs to the family of filoviruses, and its strains may vary. The disease is extremely dangerous and often fatal, although recently, the vaccine against the virus has been invented to resist the threat. Early supportive care may help recover and avoid inevitable death. As one of the few treatment options, vaccination is an effective protective measure.

Transmission Methods

• Wild animals and bats are the main carriers of the virus.
• Contact with infected people will inevitably lead to the infection.
• The spread of the virus is usually within-country (Park et al., 2015).
• The sexual transmission of the illness is possible but not proven (World Health Organization, 2019).
• The disease occurs through blood and other fluids and secretions.
• The threat increases if the virus enters damaged mucous membranes or skin.

The rapid transmission of Ebola virus from person to person is one of the main threats. Also, the danger comes from infected fluids that can enter the body of a healthy person through mucous membranes and damaged skin. Sexually transmitted infection is considered one of the likely routes of Ebola transmission, but today, there is no conclusive evidence of this theory, which explains the need for further research.

Safety Measures

• Educational interventions for the population at risk.
• Training for healthcare workers in hazardous areas of Africa (Narra et al., 2017).
• Mandatory caution when transporting and burying dead bodies.
• Psychological assistance to both the target audience and medical providers (Narra et al., 2017).
• Obligatory compliance with personal safety rules.
• Mandatory vaccination as a key preventive measure.

Although Ebola is an extremely dangerous and almost incurable virus in case of progression of the disease, some safety measures may help protect both the population and medical staff, who are also at risk. Vaccination should be promoted as a mandatory procedure, and compliance with personal safety measures through special protective equipment is necessary. Also, the transportation and burial of dead bodies deserve particular attention due to the danger of the virus in corpses. All medical staff should receive special training, and interaction with psychologists is an important practice.

Disease Symptoms

• Dehydration caused by prolonged and excuriating vomiting (Narra et al., 2017).
• Diarrhea that may be accompanied by bleeding (Narra et al., 2017).
• External and internal hemorrhages requiring resuscitation (Narra et al., 2017).
• Severe fever not reduced by conventional antipyretic drugs.
• Impaired functioning of kidneys and liver.
• Frequent headache and regular sore throat.

Some Ebola symptoms are similar to fever, but in addition to high temperature, additional problems arise – regular vomiting, headaches, sore throat, bleeding, and even kidney and liver failure. Traditional medicines may be ineffective, and potent medicines are to be used to relieve symptoms. Since no interventions are effective at the late stage of the disease, if any signs of the infection are detected, immediate consultation with medical specialists is mandatory to prevent an epidemic and stop the virus from spreading.

Historic Treatment Specifics

• Historically, epidemics have occurred within one country (Martínez et al., 2015).
• The forces of domestic healthcare systems have constantly been involved.
• Isolation has been a basic principle of public protection (Martínez et al., 2015).
• Blood transfusion was used earlier to cleanse the body (Martínez et al., 2015).
• No Ebola vaccination was carried out until 2015 (Martínez et al., 2015).
• Patients received standard care based on symptoms.

Since Ebola has been known as a disease for over 40 years, certain care principles have been developed. However, some historical aspects of treatment are still promoted as basic interventions. In particular, isolating patients has always been a natural measure, and blood transfusions have been used. As a rule, an epidemic has arisen within one state, and local health authorities were involved in addressing the problem. Vaccination was not carried out, which affected high mortality rates.

Contemporary Treatment Principles

• Introducing anti-GP antibodies of monoclonal nature (Martínez et al., 2015).
• Small and interfering RNAs, or siRNAs (Martínez et al., 2015).
• “Favipirarvir is a nucleotide analog and viral RNA polymerase inhibitor” (Martínez et al., 2015, p. 374).
• Plasma administration during the recovery phase.
• Using interferons to treat the infection (Martínez et al., 2015).
• Supportive care treatment implying constant patient monitoring.

Modern methods of Ebola treatment involve using highly effective antibodies of monoclonal nature, which act on the virus and destroy it. Also, RNA-based microbodies are utilized to inhibit the development of the disease. At the stage of remission, plasma is introduced into the blood of patients to maintain their normal health, and constant monitoring is conducted. As traditional drugs, interferons are used to minimize the symptoms of the illness and relieve fever.

Prevention Techniques

• Establishing a regime of careful interaction with wild animals.
• Minimizing the risk of contracting the disease through sexual contacts.
• Constant adherence to sanitation and hygiene.
• Using sterile medical instruments and gloves.
• Food is to be cooked thoroughly (World Health Organization, 2019).
• Excluding contacts of potential Ebola patients with other people.

In order to protect oneself and one’s loved ones from Ebola infection, it is crucial to adhere to simple safety principles. When interacting with wild animals, special protection measures should be taken to exclude damage to the skin. Hygiene principles are to be respected, and any medical devices should be handled through sterile procedures. Any food made from animal protein is to be cooked thoroughly to prevent infection from entering the body. If the illness is suspected, the patient must be isolated from others.

Volunteer Help

• Engaging international volunteers is relevant and encouraged (Narra et al., 2017).
• Qualified employees prepare to work in hazardous conditions.
• Special courses are organized for volunteer program participants (Martínez et al., 2015).
• Work in both clinical and social fields is conducted.
• Volunteers involved help the medical staff and gain valuable skills.
• Healthcare authorities recruit local residents regularly.

Volunteers are often recruited to help healthcare providers conduct operations in the risky environment of the epidemic. International organizations encourage this activity and urge all concerned people to help. Special training programs are designed to help people adapt to difficult working conditions. Volunteers participate both in clinical work and in the social sector, interacting with patients and their families and providing psychological support to those affected by the illness. Assistance from local healthcare authorities is also mandatory and essential.

Healthcare Regulations

• Collaboration among healthcare organizations to provide care (Glynn & Boland, 2016).
• Joint trials to develop effective drugs.
• Creating a special unified preventive strategy.
• Appeals for blood donation and assistance to the population of the affected regions.
• Obligations imposed on local healthcare authorities.
• Sanitary and epidemiological control in different places (Glynn & Boland, 2016).

International healthcare organizations work in a single vector to create a reliable system of prevention against Ebola. Special regulations are also promoted, which contain the rules and working duties of medical specialists and volunteers in the conditions of infectious epidemics. Specific principles of sanitary-epidemiological control are developed to prevent the spread of the infection and minimize the risks of contamination. The collaboration of local medical providers with world organizations helps to constantly replenish available resources for interventions.

Current World Statistics

• Registered Ebola outbreaks in more than 10 countries since 1976 (World Health Organization, 2019).
• The largest epidemic was in Sierra Leone in 2014-2016 (14,124 cases) (World Health Organization, 2019).
• Frequent cases in the Democratic Republic of Congo.
• Mortality rates vary and reach 90% (World Health Organization, 2019, para. 1).
• In developed countries, several outbreaks of infection occurred.
• At the moment, the epidemic in the Democratic Republic of Congo is ongoing.

Since the discovery of the disease in question in 1976, numerous epidemics have occurred, and most of them took place in African countries – the Democratic Republic of Congo, Sudan, Gabon, Uganda, Sierra Leone, and others. At the same time, a few cases of the Ebola outbreak have also been reported in the USA, the UK, Italy, and Spain, which indicates the threat of the spread of the illness outside countries. The largest epidemic occurred in Sierra Leone in 2014-2016, but since then, several new outbreaks have been reported, and today, the disease is rampant in the Democratic Republic of Congo.

Current US Statistics

• Four reported cases in 2014 (World Health Organization, 2019).
• One death, which is 25% of all the infected (World Health Organization, 2019).
• More than five hundred trained employees to work in Africa in 2015 (Narra et al., 2017).
• Preventive measures are taken in many healthcare facilities.
• The monitoring of the public medical indicators.
• Most of the allocated funds are spent on personal protective equipment (Narra et al., 2017).

Despite the advanced US healthcare system, four cases of Ebola were reported in the country in 2014, and one case was fatal. Since then, no data have been received on new patients with such a diagnosis, which indicates the sufficient safety of the population and an effective preventive strategy. Assistance programs for affected countries develop intervention and humanitarian assistance strategies. Personal protective equipment allocated to the members of volunteer teams requires the highest costs of all the expenses.

Governmental Interventions

• Strengthening border control to prevent the virus entry (Glynn & Boland, 2016).
• Compulsory blood tests upon arrival from countries at risk (Glynn & Boland, 2016).
• The increased monitoring of large transport hubs.
• Allocating funds for healthcare organizations.
• Guidelines for checking products coming from potentially hazardous areas.
• National emergency programs are designed to respond quickly.

Based on the danger that the virus can carry, governments of different countries, including the United States, take measures to prevent this outcome. Border controls are tightened, and all passengers arriving from areas of high risk are to take a blood test immediately upon arrival. Also, national protection programs are designed to respond to any outbreak timely and to be prepared to deal with the threat of the epidemic. In addition, food products undergo mandatory certification to ensure there is no contamination.

Future of Treatment

• Experimental therapies with the development of innovative vaccines (Bishop, 2015).
• Predicting an outbreak before an epidemic spreads.
• Engaging various stakeholders, including private pharmacological companies (Bishop, 2015).
• The treatment of complicating infections to prevent the development of Ebola (Bishop, 2015).
• Complexes of drugs that perform therapeutic and supporting functions.
• Identifying the virus based on environmental assessment.

Plans for addressing Ebola and treating this infection are based on the use of highly effective drugs that block the spread of the disease. Also, the interaction of official agencies with private companies is seen as a potentially beneficial cooperation. Environmental analysis may help identify the threat of an epidemic. As medications, both blockers and supportive drugs will be offered to reduce Ebola mortality. This measure will also give an opportunity to minimize the harmful effects of the virus on a human body.

Basic Control Measures

• Full public awareness of the dangers and methods of infection.
• Avoiding contacts with body fluids of other people.
• Control over the compulsory vaccination of the population (Bishop, 2015).
• Tracking any cases of Ebola-like illnesses.
• Thoughtful logistics to ensure the safety of transport (Narra et al., 2017).
• Improved hospital transmissions to ensure patient safety (Park et al., 2015).

In order to prevent the outbreak of the Ebola epidemic and protect vulnerable populations, it is essential to provide a set of measures aimed at minimizing threats. The control over compulsory vaccination should be mandatory, and educational interventions should be part of a protective program. To prevent the transmission of the disease, all transport routes should be thought out carefully. In addition, the hospital transmission of patients with suspected Ebola should be as safe and isolated as possible.

Conclusion

• The dangerous Ebola virus requires a number of preventive principles.
• A high threat of epidemics, based on current statistics.
• Not a sufficiently clear transmission mechanism.
• Symptoms and consequences of the disease require compulsory vaccination.
• Involving various resources to prevent the virus is encouraged.
• Developing the new methods of prevention and treatment is crucial.

Ebola virus is extremely dangerous, which numerous epidemics and high mortality prove. Based on available statistics, African countries are most at risk, but several reported cases in other states explain the importance of the necessary preventive work. Today, vaccination is one of the potentially effective protective mechanisms, but personal safety measures are no less crucial. A large number of stakeholders, including volunteers and official healthcare organizations, are involved in the work to eliminate the consequences of epidemics and prevent them. Highly effective drugs are developed regularly, and future Ebola treatment may be less stressful.

References

Bishop, B. M. (2015). Potential and emerging treatment options for Ebola virus disease. Annals of Pharmacotherapy, 49(2), 196-206. doi:10.1177/1060028014561227

Glynn, R. W., & Boland, M. (2016). Ebola, Zika and the International Health Regulations – Implications for port health preparedness. Globalization and Health, 12(1), 74. doi:10.1186/s12992-016-0173-9

Martínez, M. J., Salim, A. M., Hurtado, J. C., & Kilgore, P. E. (2015). Ebola virus infection: Overview and update on prevention and treatment. Infectious Diseases and Therapy, 4(4), 365-390. doi:10.1007/s40121-015-0079-5

Narra, R., Sobel, J., Piper, C., Gould, D., Bhadelia, N., Dott, M., … Fischer, W. A. (2017). CDC safety training course for Ebola virus disease healthcare workers. Emerging Infectious Diseases, 23(Suppl 1), S217. doi:10.3201/eid2313.170549

Park, D. J., Dudas, G., Wohl, S., Goba, A., Whitmer, S. L., Andersen, K. G., … Winnicki, S. M. (2015). Ebola virus epidemiology, transmission, and evolution during seven months in Sierra Leone. Cell, 161(7), 1516-1526. doi:10.1016/j.cell.2015.06.007

World Health Organization. (2019). Ebola virus disease.

The Department of Health and Human Services (DHHS) strives to reduce cases of infections at care facilities, but with mixed results. In this study, healthcare-associated pneumonia (HCAP) was reviewed as a case of healthcare-associated infection. It was noted that it contributes largely to the increased percentage of pneumonia deaths in the US. Although guidelines for HCAP were developed in 2005, available evidence suggests that it is poorly defined, understood and may not be a suitable categorization tool for patients with multidrug-resistant (MDR) etiology. Nonetheless, it is shown that HCAP identification should be based on individual patients, local factors, and risk scoring tools for appropriate determination of HCAP and provide recommended interventions. To eliminate the current controversies, HCAP requires further studies and more evidence.

Healthcare-Associated Pneumonia

• The Department of Health and Human Services wants to eliminate healthcare-associated infections (Magill et al., 2014);
• However, healthcare-associated infections are associated with more morbidity and mortality rates;
• Some types of HAIs are difficult to eliminate.

The primary goal of the Department of Health and Human Services (DHHS) is to reduce cases of healthcare–associated infections and notably, substantial achievements in prevention have been documented for some infections (Magill et al., 2014). In this research, the focus is on healthcare-associated pneumonia (HCAP) as a healthcare-associated infection, which is poorly explored and understood.

Problem Statement

• HAIs are a major cause of death in the Unified States (Rothberg et al., 2014; Russo, Falcone, Giuliano, Guastalegname, & Venditti, 2014);
• No proper treatment guideline;
• Most doctors are also not aware of the risk factors and the clinical importance of identifying them distinctly (Bo, Amprino, Dalmasso, & Zotti, 2017).

Pneumonia is the eighth major cause of death in the Unified States with a rate of case casualty approximated between 4% and 10% (Rothberg et al., 2014). The disease can be classified by the conditions under which it is acquired:

1. Community-acquired pneumonia (CAP),
2. Hospital-acquired pneumonia (HAP),
3. Ventilator-associated pneumonia (VAP).

However, the fourth classification was introduced in 2005 by the American Thoracic Society and the Infectious Diseases Society of America (ATS/IDSA) to account for a specific group of patients with latest exposure to the healthcare services systems who are at enhanced danger of harboring multidrug-resistant organisms (MDROs) (Rothberg et al., 2014). Hence, healthcare-associated pneumonia (HCAP) was introduced to account for a poorly explored category of pneumonia, but responsible for a higher mortality rate. Based on the available evidence, patients recently in contact with the healthcare system have been identified as having increased risk of infection with MDR pathogens (Russo, Falcone, Giuliano, Guastalegname, & Venditti, 2014). However, previous studies and antimicrobial treatment recommended in guidelines for CAP did not account for HCAP. Additionally, majorities of doctors are also not aware of the risk factors associated with the HCAP and the clinical importance of identifying it from CAP.

Review of the Literature

• HAIs noted as infections a patient acquires while getting health care in a care facility (Shang, Stone, & Larson, 2015; Noguchi et al., 2015; Chalmers, Rother, Salih, & Ewig, 2014; Livorsi & Eckerle, 2014; Corrao, Venditti, Argano, Russo, & Falcone, 2014);
• Interventions are mainly vertical and horizontal strategies (Septimus, Weinstein, Perl, Goldmann, & Yokoe, 2014);
• The need for enhanced surveillance (Mitchell & Russo, 2015);
• Findings demonstrate the need for a local guideline, but not a global one for intervention.

Healthcare–associated diseases (HAIs), noted as infections a patient acquires while getting health care in a care facility, are a vital patient safety challenge (Shang, Stone, & Larson, 2015). In the US, for instance, there were about 722,000 HAIs in acute care facilities, with the greater fraction of HAIs happening outside the intensive care unit (ICU). It was also estimated that on any given day, about 1 in 25 hospital patients at least reported HAI, and every year there are roughly 75,000 hospital mortality cases attributed to HAI (Shang et al., 2015). HAIs have been linked to the increased costs of care, for instance, it costs about $9.8 billion every year. Irrespective of the health burden, most cases of HAIs are actually preventable. Therefore, lessening avoidable HAIs has turned out to be one of the critical elements of action plan of the DHHS to ensure a safer and reasonable healthcare system. Moreover, it is ranked among the top issues for hospital managers in their endeavors to curtail costs of care and enhance the quality of care (Shang et al., 2015). HCAP, for instance, presents a significant challenge to care providers.

According to Noguchi et al. (2015), the causative pathogens of HCAP are still controversial, and the application of normal samples of sputum cultivation is sometimes not suitable because of the possible contamination with oral bacteria. It is likewise at times hard to decide if methicillin-resistant Staphylococcus aureus (MRSA) is an actual causative pathogen of HCAP (Noguchi et al., 2015). From the findings of Noguchi et al. (2015), it was determined that HCAP patients had heterogeneous bacteria and high incidence of streptococci relative to that observed using cultivation techniques. Moreover, the findings of the study showed a lower rate of MRSA than already expected in HCAP patients.

Some findings suggest that HCAP is a false concept derived from low-quality evidence (Chalmers, Rother, Salih, & Ewig, 2014). Chalmers et al. (2014) conducted a systematic review and meta-analysis and determined that the healthcare-associated pneumonia classification depended on low-quality evidence reinforced by bias and did not precisely indicate antibiotic-resistant pathogens. The concept of HCAP was initially proposed in the 2005 in the guidelines (Rothberg et al., 2014; Chalmers et al., 2014). It was presented as pneumonia noted in nursing home areas, patients hospitalized for at least 2 days in the past three months, patients getting home infusion interventions or wound care, and patients visiting a hemodialysis care facility in the past 30 days (Chalmers et al., 2014). The categorization of HCAP depended on the thinking that patients with successive healthcare contacts would at first need a wide range of anti-microbial treatments since they would be at higher risk for resistant pathogens (and thus higher death rates) relative to patients with no such contacts. In any case, HCAP has been uncertain, with a few specialists scrutinizing the quality of the findings while others have noted that the HCAP concept fluctuates based on the location. Subsequently, in light of these controversies, Chalmers et al. (2014) tried to demonstrate how precisely HCAP classifies patients with resistant pathogens, to assess the nature of the HCAP research findings and their potential for bias, and to approve or invalidate the HCAP categorization. According to Chalmers et al. (2014), the findings from their study do not reinforce HCAP being a reliable clinical category. The HCAP definition was less reliable at separating between patients who required antibiotic protection for MDR pathogens and the individuals who did not (Chalmers et al., 2014). It is thus sensible to presume that treating all HCAP cases in a similar fashion would prompt over treatment in locations with low MDR microbe presence and under treatment in locations with high rates. Additionally, Chalmers et al. (2014) claimed a publication bias for some studies that had surprisingly high cases of MDR microbes. Such cases destroy evidence by overstating risk linked to HCAP. In reality, the high rate of mortality in HCAP is more probably caused by old age and co-morbidities than MDR microbes. Based on the risks of wide range antibiotic agents (such as Clostridium difficile infection, advancing antibiotic resistance) and the absence of reliable findings that such a treatment enhances outcomes in HCAP, a re-evaluation of HCAP appears justified (Chalmers et al., 2014).

The findings by Chalmers et al. (2014) offer some clinical implications for nurses. The results make a solid claim for the need to comprehend the local instances of MDR microbes and to determine the most suitable treatment regimen in areas where such prevalence is high. Accordingly, it is also imperative to determine the risk factors for MDR microbes in specific patients. For instance, the MDR pathogen risk scores can be applied to assist care providers to classify risks of these microbes objectively to determine the most appropriate antibiotic treatment. The findings from this investigation bring up vital issues about the validity of the present ATS/IDSA guidelines and support the need for a re-assessment of the HCAP category of pneumonia (Chalmers et al., 2014).

The meta-analysis by Chalmers et al. (2014) has attracted attention from many other scholars interested in healthcare-associated pneumonia. It shows that the HCAP definition inadequately predicts the availability of resistant microbes. In view of these results, Chalmers et al. (2014) argue that interventions for HCAP should be guided by the local cases of MRD pathogens (Livorsi & Eckerle, 2014). In response to Chalmers et al. (2014), Livorsi and Eckerle (2014) conducted a study focusing on the need to develop a local syndromic antibiogram specific to HCAP using inpatients treated for pneumonia. They concurred with Chalmers et al. (2014) that local microbiologic data could be useful for providing a definition of HCAP that is more relevant than the current global one. Nonetheless, Livorsi and Eckerle (2014) recognized the challenges associated with developing a microbiologic diagnosis in the HCAP patient population, local guidelines can likewise be derived by checking clinical results in patients who meet the HCAP definition but treated empirically as though they have CAP infections (Livorsi & Eckerle, 2014).

Chalmers et al. (2014) further attracted much attention. It has been reviewed with extensive interests to determine its accuracy (Corrao, Venditti, Argano, Russo, & Falcone, 2014). In any case, few methodological issues must be addressed in that meta-analysis. First, Corrao et el. (2014) claim that it is extremely hard to evaluate the primary endpoint of this systematic study on the grounds that no research has been particularly intended to differentiate microbiology cases of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP). Indeed, across all cases, causative microbes have been identified just in a small number of cases (Corrao et al., 2014). Just as critical is the concept that intrusive diagnostic procedures, such as bronchoscopy, have not yet been methodicallly included to verify etiologies. Therefore, it is observed that information presented in the available systematic research does not absolutely reveal whether the HCAP factor is a test for determining resistant microorganism etiologies (Corrao et al., 2014). Still, Corrao et al. (2014) note that they do not know whether HCAP itself is the most proper instrument to isolate patients with the multidrug-resistant etiology, but reliable findings show that a fraction of patients with the community-acquired pneumonia has a multidrug-resistant infection, and in most of these cases, patients satisfy the HCAP definition. The varying etiology of infections in patients exposed to care facilities have been plainly shown in different kinds of infections, including bacteremia, endocarditis, unconstrained bacterial peritonitis, and urinary tract diseases. However, pneumonia remains an uncertain issue due to the poor evidence currently available in published studies (Corrao et al., 2014).

Determinants of Healthcare-Associated Pneumonia (HCAP)

• Hospitalization for 48 hours or more in the preceding 90 days;
• Residence in a nursing home or extended care facility;
• Home infusion therapy (including antibiotics and chemo);
• Hemodialysis within 30 days;
• Home wound care (Russo, Falcone, Giuliano, Guastalegname, & Venditti, 2014);
• Local factors should be patient-centered;
• HAIs common in resource-limited settings (Pathak, Singh, Jain, Dhaneria, & Lundborg, 2014).

Currently, the healthcare system has witnessed tremendous changes, which have transferred multiple aspects of care from hospital settings to community settings. Consequently, the known variations between hospital-acquired infections and community-acquired infections have become less clear. For this, more successive contacts with care facilities, patients, particularly the fragile elderly patients, have increased risks of multidrug-resistant (MDR) colonization and to acquire more serious pneumonia, with an actual risk to get ineffective empiric antibiotic treatments and, in this way, to have a severe outcome (Russo et al., 2014).

HCAP refers to pneumonia that is developed either within or outside care facilities based on the availability of risk factors for multidrug-resistant (MDR) microbes due to earlier contacts with care facilities. Specifically, risk factors have been identified as “hospitalization in the previous 90 days, residence in a nursing home, home infusion therapy, chronic dialysis, and contact with a family member harboring MDR pathogens” (Russo et al., 2014, p. 5387). Recent evidence also suggests not all HCAP patients may have increased risk of infection with MDR microbes, and the same patients may also have microbes that overlap with CAP microbes, but other do not based on the availability of risk factors. Pneumonia observed in patients following admission because a recent contact with the care facility is different from other types of pneumonia and has been classified as a distinct category, which requires a completely different approach when choosing empiric antibiotic therapies (Russo et al., 2014).

The Effectiveness of Clinical Prevention Interventions

• HAI patients tend to have outcomes that are worse than other forms of infections (Rothberg, et al., 2014).
• Some findings do not demonstrate improved outcomes among ICU patients with HAIs who received GC-HCAP therapy (Attridge et al., 2016).
• The IDSA guidelines recommend extended-spectrum antibiotic treatment and other antibiotics (Webb, Dascomb, Stenehjem, & Dean, 2015).
• An accurate, adequately validated prediction score is needed (Webb et al., 2015).

According to Rothberg et al. (2014), HCAP patients had results that were more serious than results obtained for CAP patients, even after controlling for comorbidities and demonstrating seriousness of condition, in spite of the fact that the variation looked less as other findings have shown.

Recent findings have failed to show enhanced results when guideline-concordant (GC) antibiotics are given to patients with HCAP (Attridge et al., 2016). The study by Attridge et al. (2016) was intended to assess the relation between patient outcomes and GC treatment in patients admitted to an intensive care unit (ICU) with HCAP. The study major outcome was 30-day patient mortality, and risk factors for the major result were evaluated and the findings did not show enhanced outcomes in ICU patients with HCAP who received GC-HCAP treatment (Attridge et al., 2016).

HCAP was based on the 2005 ATS/IDSA guidelines, which recommended an extended-spectrum antibiotic treatment for patients meeting HCAP criteria (Webb, Dascomb, Stenehjem, & Dean, 2015). In any case, the prescient value of the HCAP model is constrained, and evidence shows that outcomes are not enhanced following the use of HCAP guideline-concordant treatment and, thus, improved techniques to anticipate risk of CAP are required (Webb et al., 2015). Further improvement and validation of prediction scores derived from risk factors that are more thorough for CAP are required. Once a precise, satisfactorily certified prediction score is provided, its clinical importance will be assessed.

Patient-centered Strategies

• Identify vulnerable patients from the community;
• Use risk factor calculators to quantify risk for MDR pathogens;
• Determine the right antibiotic therapy (Restrepo & Aliberti, 2014);
• Evaluate patients with HAIs separately (Komiya, Ishii, & Kadota, 2015);
• Interventions should address unique needs of a patient, such as language, patient education, family engagement.

For effective patient-centered strategies, it is recommended that possibilities of pneumonia patients from the community to care facilities and have a MDR versus non-MDR pneumonia should be determined. Risk factor tools can help physicians to determine the exact risk for MDR microbes to choose the most effective antimicrobial therapy. Nonetheless, risk factor tools should be individualized to account for local epidemiology. It ought to be evident that a risk factor assessment, a microbe analysis, and a decision on the correct treatment are only few considerations for averting mortality in pneumonia patients. All assessments should be linked to specific therapies centered on stabilization of the patient’s immune response and effective management of comorbidities (Restrepo & Aliberti, 2014).

It is imperative to recognize that guidelines for pneumonia are developed based on scientific evidence and, therefore, physicians who administer therapies should account for cultural issues of their patients. HCAP may overlap with aspiration pneumonia. Hence, it is imperative to identify patients to account for HCAP sufficiently to ensure that patients with obvious repeated cases of aspiration pneumonia do not interfere with results (Komiya, Ishii, & Kadota, 2015).

The aim of patient-centered care is to account for unique needs of patients. In this case, patient education, patient knowledge, engagement of family members to ensure safety, and any concerns associated with the care provision should be sufficiently handled. Patients should also be allowed to bring their own unique perspectives and care agendas. Such engagement is advanced by developing an effective rapport and providing different instructive materials to facilitate patient involvement in care provision.

Clinical Prevention Concepts

• Based on increased risk for infection with antibiotic-resistant organisms;
• Identify risk for MRSA, multidrug-resistant pathogens, or both (Russo et al., 2014);
• Use therapeutic interventions focused on stabilization of the immune response (Restrepo & Aliberti, 2014);
• Adopt risk-scoring tools (Shorr & Zilberberg, 2015).

By developing a new guideline for HCAP pneumonia, the ATS/IDSA recognized that HCAP patients are at elevated risk for infection with MDR pathogens and the lack of antibiotic treatment or cover contributes to increased mortality. Risk factors for the advancement of pneumonia and the rise of pneumonia from medication-resistant microbes, basically methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, are not similar among the category of patients with HCAP. For instance, dialysis patients face various risks relative to nursing home patients (Shorr & Zilberberg, 2015). Besides, there is relevance heterogeneity of risk factors for HCAP within the HCAP subgroups because of differences in local factors, for example, local microbiology and strategies for providing care and differences in individual risk components, for example, status or earlier antibiotic contacts. Additionally, it is imperative to evaluate evidence for other causes of HCAP, such as possible risk factors for cases of pneumonia drug resistance. Thus, the intervention should always focus on patients at greater risk for HCAP. Still, within the scope of pneumonia infections, care providers should always ensure that they account for different types of pneumonia based on types of risk, including MRSA and possible resistance to drugs.

Researchers have developed different risk scoring devices to categorize patients based on the probability that their infection has emanated from pathogen, for example, methicillin-resistant S. aureus or P. aeruginosa (Shorr & Zilberberg, 2015). Results from the scoring tools give accurate means to isolate patients on the premise of the possible recuperation from resistant microbes than does the HCAP infection. The vast majority of these risk-scoring tools are simple to compute and use, and a few have been independently tested for validity (Shorr & Zilberberg, 2015). Overall, effective care requires care providers to consider using these instruments in their strategies to handle patients with HCAP pneumonia infections.

Conclusion

• Healthcare-associated infections are major causes of deaths;
• Risk factors indicate that patients are at higher risks for mortality;
• Significant improvements have been noted, but enhanced surveillance, horizontal and vertical intervention strategies are required;
• Patient-centered treatment and the use of risk-scoring tools to stratify patients are imperative for effective interventions.

Pneumonia is among the major killers in the US, and it is among the most common healthcare-associated infections. For HCAP, the ATS/IDSA recognized deaths related with it and in 2005, it developed guidelines to ensure quality care and outcomes. However, certain findings show that HCAP is controversial because of its definition and supporting evidence. Hence, it is not an appropriate category of pneumonia, but some results have supported this category of pneumonia. Nonetheless, HCAP requires further studies to support its classification, patient-centered care, effective interventions, and reliable risk assessment tools.

References

Attridge, R. T., Frei, C. R., Pugh, M. J., Lawson, K. A., Ryan, L., Anzueto, A., . . . Mortensen, E. M. (2016). Health care–associated pneumonia in the intensive care unit: Guideline-concordant antibiotics and outcomes. Journal of Critical Care, 36, 265–271.

Bo, M., Amprino, V., Dalmasso, P., & Zotti, C. M. (2017). Delivery of written and verbal information on healthcare- associated infections to patients: Opinions and attitudes of a sample of healthcare workers. BMC Health Services Research, 17, 66.

Centers for Disease Control and Prevention. (2016). HAI Data and Statistics. Web.

Chalmers, J. D., Rother, C., Salih, W., & Ewig, S. (2014). Healthcare-associated pneumonia does not accurately identify potentially resistant pathogens: A systematic review and meta-analysis. Clinical Infectious Diseases, 58(3), 330-339.

Corrao, S., Venditti, M., Argano, C., Russo, A., & Falcone, M. (2014). Healthcare-associated pneumonia and multidrug-resistant bacteria: Do we have a convincing answer? Clinical Infectious Diseases, 58(8), 1196-1197.

Komiya, K., Ishii, H., & Kadota, J.-i. (2015). Healthcare-associated pneumonia and aspiration pneumonia. Aging & Disease, 6(1), 27–37.

Livorsi, D., & Eckerle, M. K. (2014). Developing local treatment guidelines for healthcare-associated pneumonia. Clinical I nfectious Diseases, 59(4), 609-610.

Mitchell, B. G., & Russo, P. L. (2015). Preventing healthcare-associated infections: The role of surveillance. Nursing Standard, 29(23), 52-58.

Magill, S. S., Edwards, J. R., Bamberg, W., Beldavs, Z. G., Dumyati, G., Kainer, M. A., . . .Fridkin, S. K. (2014). Multistate point-prevalence survey of health care–associated infections. The New England Journal of Medicine, 370(13), 1198-208.

Noguchi, S., Mukae, H., Kawanami, T., Yamasaki, K., Fukuda, K., Akata, K., . . . Yatera, K. (2015). Bacteriological assessment of healthcare-associated pneumonia using a clone library analysis. PLoS ONE, 10(4), e0124697.

Pathak, A., Singh, P., Jain, S., Dhaneria, M., & Lundborg, C. S. (2014). Incidence and determinants of health care associated blood stream infections at a neonatal intensive care unit in Ujjain, India: Results of a prospective cohort study. International Journal of Infectious Diseases, 21(S1), 48.

Restrepo, M. I., & Aliberti, S. (2014). Healthcare-associated pneumonia: Where do we go next? Clinical Infectious Diseases, 58(3), 340–341.

Rothberg, M. B., Haessler, S., Lagu, T., Lindenauer, P. K., Pekow, P. S., Priya, A., . . . Zilberberg, M. D. (2014). Outcomes of patients with healthcare- associated pneumonia: Worse disease or sicker patients? Infection Control and Hospital Epidemiology, 35(S3), S107-S115.

Russo, A., Falcone, M., Giuliano, S., Guastalegname, M., & Venditti, M. (2014). Healthcare-associated pneumonia: A never-ending story. Infectious Disease Reports, 6(2).

Septimus, E., Weinstein, R. A., Perl, T. M., Goldmann, D. A., & Yokoe, D. S. (2014). Approaches for preventing healthcare-associated infections: Go long or go wide? Infection Control and Hospital Epidemiology, 35(7), 797-801.

Shang, J., Stone, P., & Larson, E. (2015). Studies on nurse staffing and healthcare associated infection: Methodological challenges and potential solutions. American Journal of Infection Control, 43(6), 581–588.

Shorr, A. F., & Zilberberg, M. D. (2015). Role for risk-scoring tools in identifying resistant pathogens in pneumonia: Reassessing the value of healthcare- associated pneumonia as a concept. Current Opinion in Pulmonary Medicine, 21(3), 232–238.

Webb, B. J., Dascomb, K., Stenehjem, E., & Dean, N. (2015). Predicting risk of drug-resistant organisms in pneumonia: Moving beyond the HCAP model. Respiratory Medicine, 109(1), 1-10.

Summary

Urinary tract infection (UTI) is a urinary system infection involving the bladder, urethra, kidney, and ureters. Most of the UTIs acquired in the hospital are connected to urinary catheters, especially when there is prolonged use. The infections are obtained through poor insertion techniques and unnecessary use that may introduce bacteria (Atkins et al., 2020). The health professional should standardize urinary catheter insertion to address the Catheter-Associated Urinary Tract Infection (CAUTI).

Moreover, there should be the maintenance of bundles based on well-known evidence-based procedures. Ideally, the medical worker should be monitoring compliance with urinary catheter bundles by providing timely feedback. Other frontline health caregivers must collaborate in designing and measuring patient outcomes related to applicable CAUTI rates and catheter use. Education awareness campaigns and periodic in-service competency is significant. Furthermore, it should be based on the training of healthcare caregivers and prompt coaching by clinical resource nurses (CRNs).

Effective Handwashing in Prevention of Catheter-Associated Urinary Tract Infection

Hand hygiene (HH) and infections are inversely interconnected, whereby adherence is a critical step in preventing healthcare-linked infections. Hand washing is an essential intervention method, but it is ignored mainly by healthcare personnel in hospital settings (Al Kuwaiti, 2017). The multicomponent intervention is efficient in the improvement of HH compliance so that hospital staff can avoid CAUTI. Measures in preventing the infections are categorized into programs aimed at deterring catheter-associated urinary tract infections when applied by medical personnel.

The intervention methods fall under World Health Organization (WHO) point’s strategy. An increase in availability and easier access to water supply and alcohol-based rub and holding is recommended. More training events on handwashing and infection control to curb infection are critical. Seemingly, the provision of education and support with frequent assessment and feedback analysis should be a priority. On the other hand, the presentation of visual displays to motivate handwashing increases the chances of CAUTI prevention. My current perspective and direction were prompted by the high number of CAUTIs in healthcare facilities, which is draining resources and impacting patients’ health.

References

Al Kuwaiti, A. (2017). Impact of a multicomponent hand hygiene intervention strategy in reducing infection rates at a university hospital in Saudi Arabia. Interventional Medicine and Applied Science, 9(3), 137-143. Web.

Atkins, L., Sallis, A., Chadborn, T., Shaw, K., Schneider, A., & Hopkins, S. (2020). Reducing catheter-associated urinary tract infections: A systematic review of barriers and facilitators and strategic behavioral analysis of interventions. Implementation Science, 15(1). Web.

• Infection control is the process through which health care organizations prevent diseases from spreading.
• All health care facilities are required to prevent nosocomial infections.
• This are infections contracted by staff members and patients in the healthcare facility during admission or incubation.
• There are specific procedures and policies used by organizations to control nosocomial infections.

Introduction

Infections obtained in the hospitals is among the major causes of deaths globally. About 2 million preventable infections occur every year, which result to more than 90,000 deaths annually [Centers for Disease Control and Prevention (CDC), 2020]. For this reason, all health care workers should be proactive in disease control in their jobs. This infection control and training program addresses issues related to the spread of nosocomial infections within the settings of health care. Examples of nosocomial infections well known are ventilator-associated pneumonia, Methicillin Staphylococcus aureus, Vancomycin-resistant Enterococcus, Candida albicans, Clostridium difficile, Acinetobacter baumannii, Tuberculosis, Urinary tract infection, and Legionnaires’ disease. Currently, COVID-19 joins the list of infectious disease that can be obtained in the hospital (World Health Organization (WHO), 2020). Prevention of these infections alludes to the procedures and policies used to minimize the possibility of their spread in hospitals and other health care facilities.

Objectives of this Infection Control and Training Program

• To understand basic concepts used in infection control.
• To know the causes of nosocomial infections.
• To understand the rules, policies, and regulations to be followed in avoiding the spread of COVID-19 virus.
• To comprehend the components of this infection control program and training.
• To know the importance of a committee in control of infections.

The categories of workers eligible for this training program include nurses, doctors, medical laboratory technologist, and the cleaning staffs. Generally, all workers in healthcare facilities should have basic understanding and knowledge of corona virus infection and prevention principles.

The training program will be tailored to the needs of each department.

Importance of Infection and Training Program

The hospital needs this infection and training program because:

• Infections acquired in hospitals are common.
• The training aspect of this program will produce skilled IPC practitioners, whose role is to ensure that infection control is practiced in the healthcare facility.
• Currently, there is covid-19 pandemic, which should be stopped from spreading.
• About 9,000 health care workers in the US have contracted the COVID-19 virus (Center For Disease Control and Prevention [CDC], 2020).
• Healthcare workers are at the more risk of contracting corona virus in the workplace.

The prevalence of infections acquired in hospitals is 9% globally (World Health Organization, 2020). There is a need for infection control because the cost of healthcare of a patient increases when one contract a disease in the healthcare facility. Nosocomial infections aggravates antimicrobial resistance.

The cost of medication increases in presence of hospital acquired diseases. The government incur a lot of losses in terms of revenue as a result of this infections. The world Bank studies estimated that 50% of health care budgets in two-thirds of developing countries is used in treating hospital acquired infections. Therefore, operative infection and training programs are beneficial because they reduce the rate of nosocomial infection spread as well as mortality, morbidity and health care cost.

The trained workers will co-ordinate develop, audit, revise, and implement policies to be used in control of COVID-19 infections.

COVID-19 Virus

• COVID -19 is a respiratory disease caused by SARS-CoV-2 virus.
• The virus easily spread from one person to another.
• It is transmitted through droplets, aerosols, and contact with the virus.
• Currently, it is a deadly epidemic in all parts of the world.

Droplet are respiratory secretions released into the air when sneezing and coughing. They land into the eyes, nose, and mouth when causing an infection. Aerosol are liquid droplets or solid particle that are suspended in the air. In regards to contact, one obtains the virus after touching a surface with SARS-2 virus and thereafter touching nose, mouth, or eyes. Corona virus poses a higher risk to people with underlying health conditions such as asthma, heart disease, diabetes, and Suppressed immune systems.

New cases of Corona virus is reported each day. Thus, there is a need for this infection prevention and control program.

Infection Control Committee

• The goal of the infection control committee is to prevent corona virus infection spread in the healthcare facility and community.
• It consist of doctors, Infection control nurses, and representatives from all organization departments.
• The functions of this committee are:
  • To receive and manage critical virology data and information concerning COVID-19. This includes surveillance data;
  • Address visitation policies, critical patient care practices, disinfection procedures, and workplace safety;
  • Develop policies.

The doctors in the committee will include general physician, surgeon, infectious disease specialist, and a virologist. Departments such as housekeeping, laboratory, administration, pharmacy and central supply will have two representatives in the committee.

Functions of the committee

• Investigating and recognizing outbreaks in the hospital and community.
• Educating and training all health care workers about prevention measures.
• Create policies that prevent COVID -19 spread in the health care facility.

Impacts of individuals and their roles

• The individual roles of persons involved in infection control committee include:
  • Doctors-recommend and develop polices, and surveillance and identification strategies;
  • Nurses-direct intervention when dealing with patient and community outreach, they also implement preparations and precautions in health care settings;
  • Departmental representatives educate members of staff in their respective sections.
• The impacts of individuals involved are:
  • Doctors are increasing infection control rates in the hospitals and the community by identifying areas that need change;
  • Nurses have facilitated reduction of infection in the community, they have lowered the risk of patients contracting the disease in hospitals;
  • The departmental staff have created a safe and healthy environment in the sections to avoid spread of COVID-19.

Doctors develop and recommend informed policies and practices pertaining to COVID -19 control to the infection control committee, which are later discussed and implemented.

They also recognize and investigate the COVID -19 outbreak in the community by offering screening services. Nurses intervene directly when dealing with patients to prevent infections, they also teach patients prevention measures through health education promotion. They cover aspects such as a safe environment , canceling group meetings, avoiding touching the eyes, nose, and mouth, early detection of infections, social distancing, and personal hygiene when nursing patients.

Optimum Infection Control Practices in Healthcare Facilities

• Distancing (no hand shaking)/ separation / restriction of movement and of visitors.
• Waste management.
• PPE: gloves, masks, gowns, and eye-protection.
• Hand hygiene.
• Discharge of patients.
• Staff health management.
• Cleaning, disinfection and sterilization.

Control of COVID -19 spread

Transmission of most respiratory disease occurs when sick people are close to each other. Therefore, in hospitals, a distance of about 1 meter should be maintained between patients and all other staffs. In regards to respiratory etiquette, one is required to wear mask when dealing with a sick person. In addition, both the staff and the patient is required to sneeze and cough into a sleeve or a scarf and wash their hands thereafter.

Transmission of COVID-19 increases with direct contact, close contact, touching infected surfaces, and performing aerosol generating procedures such as nasopharyngeal aspiration, endotracheal intubation, and swabbing.

In this COVID -19 pandemic era, all patients reporting to facilities of health care with acute respiratory signs and symptoms such as shortness of breath, fever, and cough should be separated from other patients. This implies that a different waiting area should be created in the health care facility. At hospital entrance, all sick people visiting the hospital must be triaged, before being directed to the appropriate waiting area.

Guidelines for Preventing COVID -19 Spread in Health Care Settings

• High infections rate among healthcare workers has been reported (Ng et al., 2020).
• Therefore, employers should ensure that equipment, training, and procedures undertaken are fully protective.
• The guidelines to be utilized are from the State Health Department and CDC.
• The CDC site contains advice for home care, infection control, clinical care, and evaluating people under investigation.

Policies to Prevent Infection Spread

The policies to be adjusted in this health care organization include:

• Utilizing teleconferences, phones, and emails rather than physical contact when communication with co-workers.
• Conducting meetings using zoom or Skype.
• Encouraging the staff to stay at when unwell.
• No staff should fear loss of benefits or pay and other benefit when ill.

The above policies promote social distancing. It also reduces the contact with corona virus patients and surfaces with SARS-COV –Virus .

Workers Protection

Workers should be protected by starting with the highest hierarchy in the pyramid. Engineering control requires protection of workers from risks, this is achieved by ensuring that the workplace is well ventilated. Additionally, plastic shield, sneeze guards, biological safety cabinet, and UV irradiation systems are engineering controls needed in the healthcare facility laboratory.

The administrative controls involves alteration of organization policies and the way of carrying out duties. In this case, work from home policies will be established for the staffs not involved in healthcare deliveries such as secretaries. Furthermore, sick employees will be allowed to work at home.

Personal Protective Equipments (PPEs)

• According to OSHA standard, employers are required to: train employees on how to wear and use PPEs effectively.
• Provide appropriate PPEs without deducting from the employees salary.
• Train the staff to store, maintain, and replace PPEs.
• Undertake assessment on the PPEs.
• PPEs include gowns, face mask, gloves, and eye protectors.

In the OSH Act both the employee and the employer have a responsibility to make work environment friendly.

The employers are required to provide a healthy and safe environment. On the other hand, the workers should take part in the creation and implementation of health and safety policies. The involvement of both workers and employers in this act ensures that the law is implemented suitably.

Plan for this Program Implementation In The Healthcare Facilities

• Participation of the employer and employee in leadership.
• Risk identification and management.
• Prevention, communication, and control of risk.
• Evaluation of the System.

Training Technique:

• The training will be hands on;
• Drilling will be conducted;
• Trained observer will be included to reduce accidents;
• Specific processes such as decontamination procedures will be practiced.

Program design:

• The program will be Interactive;
• It is designed for workers;
• It involves approach to all workplace hazards;
• Structured materials from training will be provided.

The success of the program will be monitored by the infection and control committee.

The program will successful if:

• Covid-19 transmission cases among healthcare workers in the hospital is greatly reduced.
• All health care workers apply the hospital infection control policies.
• The staff practices matches the rules, guidelines, and standards set by the government.

This infection control and training program enlightens and protect employees from COVID -19 virus.

The process of this program implementation include: training the employer and the employee, collecting COVID-19 spread data, analyzing and presentation of data result to the formed committee. Lastly, policies and actions plans are formulated according to the data results.

Additional materials to be used in the training include CDC website—protocols, Engender Health training program—web-based, an instructor guide, NIEHS training program, and ICAT tools. In the training a drilling opportunity will enable the trainee to wear the PPEs appropriately.

References

Centers for Disease Control and Prevention. (2020). Characteristics of health care personnel with COVID-19. Web.

Maps and trends (2020). New Cases of COVID-19 in World Countries. Web.

National Institute of Environmental Health Sciences.(2020). NIEHS COVID-19 response training tool: Protecting yourself from COVID -19 in the workplace. Author.

Ng, K., Poon, B. H., Kiat Puar, T. H., Shan Quah, J. L., Loh, W. J., Wong, Y. J., & Raghuram, J. (2020). COVID-19 and the risk to health care workers: A case report. Annals Of Internal Medicine,172(11), 766-767.

World Health Organization. (2020). Coronavirus disease 2019 (COVID-19) situation report. Web.

Introduction

A new public health issue plagues communities every day, making it one of the most pressing matters facing modern civilization today. Furthermore, it has been found that the Coronavirus Disease (COVID-19) infection is a widespread public health issue that can affect people of all ages and genders in today’s global society (Gorna et al., 2021). This study critically evaluates a qualitative research article by Roberts et al. (2021). It discusses the prevalence of COVID-19 infection in the population, the physical and psychological happenings, and how social isolation can benefit and harm those living with the virus. This discussion board posting attempts to evaluate a qualitative study critically using the Critical Appraisal Skills Program’s (CASP) checklist. The critical evaluation gives health professionals the ability to assess evidence in studies properly to avoid presuming that all study published in scientific periodicals has worth and validity. Healthcare professionals make well-informed judgments about patients ‘ values and care using the most current evidence, clinical expertise, and patient preferences.

CASP Tool’s Critical Assessment of Qualitative Research

Roberts et al. (2021) explored the fundamentals of living with COVID-19. Their study aimed to understand what it is like to be infected and live with the disease. Nurses and other health care workers should be responsive to the experiences of the hospitalized and those who do not need hospitalization to adequately aid persons infected with COVID-19.

Yes, the qualitative technique of the study was suitable. Qualitative research aims to understand better the perspectives and experiences of people involved in the study. This form of analysis could only be conducted in the humanities and social sciences until recently. Qualitative research is currently precious in other fields, such as medicine (Sawatsky et al., 2019). Developing themes, experiences, viewpoints, and tales from qualitative research provides a deeper insight into the world than can be acquired by statistical analysis. When it comes to putting theory into action, ‘life experiences’ like these are invaluable. Theoretical frameworks are like the foundation of a home; without a basis, the structure itself cannot be supported. The researchers explained the methodology of the study in a manner that eases its understanding. Siedlecki (2020) found that the qualitative method is appropriate for discussing human experiences and perspectives on a specific topic. As a result, phenomenology research is an excellent tool for gaining insight into participants’ brains.

The research design was suited to the purpose of the study. The researchers employed a phenomenology study approach to learn more about how the effects of COVID-19 feel. According to the research by Dodgson (2019), in a qualitative study approach, understanding the opinions of the participants and researchers is quite important. In this procedure, phenomenological analysis is instrumental since it allows the researchers’ interpretive views to be combined with the facts from their participants. Even on the level of measurement, the tested methodology does not allow for the collection of numerical data. In other words, drawing concepts from statistical information is not a good idea.

Yes, the study’s aim necessitated an adequate recruitment approach, and the researchers determined the best way for selecting participants. Snowball sampling proceeded until all of the data had been gathered, at which point it was considered complete (Roberts et al., 2021). Participants were able to share their personal stories through the snowball technique. Only the sort of sample method used was mentioned in the paper, which did not go into further detail. Furthermore, the publication did not define the sample setting. The sample was presumably taken from a hospital in a facility center with inpatient and outpatient patients in the same building. Within the first phase of the COVID-19 epidemic, the researchers employed a phenomenological study approach and interviewed 14 people aged 18 and older.

Thirteen non-hospitalized COVID-19 patients and a hospitalized patient who was not on oxygen therapy were interviewed for the data analysis (Roberts et al., 2021). Attributable to a continuing intervention, the participants may draw on their own experiences (presumptively from the qualitative method). Some participants choose not to participate, and it is not clear why. Because the manner of selecting the sample was a snowball approach, it is assumed that all participants knew each other. Current participants invite new contributors to join the study through a referral-type program in this method. The study’s inclusion of the vast majority of the general hospital’s patients has additional ramifications. Participants who elected not to participate were presumably unknown to those who participated (and therefore not invited). They were probably newly admitted to the hospital or had not yet been integrated into its usual patient population.

Yes, all the necessary information was gathered to tackle the research problem. An in-depth interview strategy was used to collect all the data needed to understand the encounter of those infected with COVID-19 (Roberts et al., 2021). The researchers conducted semi-structured interviews with participants as a part of this study. Colaizzi’s phenomenological descriptive analysis method was employed for the qualitative technique in this study. Because of the COVID-19 restrictions, telephone discussions were used to interview adults with COVID-19 who were 18 years of age or older. Their feedback was transcribed, and open-ended interview queries on the experience were issued before inquiries about the data (Roberts et al., 2021). The research ranged from 20 minutes to an hour in length for the interviews.

The subjects completed a demographic questionnaire where only gender and age were included in possible risk factors. All data was encoded to safeguard the anonymity of the participants, ensuring the confidentiality of the study. Data from phenomenological studies were analyzed using Colaizzi’s technique (Roberts et al., 2021). Participation by a peer debriefer ensured the data was accurate in the analysis. Authenticity was guaranteed with member-checking by the participants. The team sifted through the data until a few common threads emerged. Study participants shared physical experiences that affected their health and perception of well-being. There was a feeling of overwhelming exhaustion, a loss of smell and taste, and neurological/muscular problems. The available research corroborates the claimed experiences.

The researchers and participants have established a clearly defined relationship. In light of this, it is fair to say that the researchers spent a significant amount of time getting to know the participants before beginning the interview procedure. The researchers started the study after the data saturation point had been reached to reduce study bias. According to Assarroudi et al. (2018), qualitative content analysis can be done in three ways: conventionally, directed, or summative. Because a framework was used to guide the information analysis in this study, the strategy used is the directed approach. The article outlines the data sources used by the researchers during their investigation.

The Institutional Review Board and the ethical committees of the necessary institution and the hospital did not give their approval to the research proposal or the data collection method. However, each subject was allowed to provide their informed consent. All participants’ names were kept private and secret during their participation in the study’s duration. The privacy law mandates that study participants’ discretion and confidentiality be protected. The ethics committee and the institution that shortlists the subjects should also provide their consent before any human study may begin (Weinhardt, 2020). As a result, it is possible that the authors did not adhere strictly to the research’s ethical standards.

The data analysis procedure was described in detail; it was adequately rigorous. With Colaizzi’s technique, detailed interviews conducted per a semi-structured consultative guide yielded qualitative data (audio recordings). Selecting a striking statement as a theme has been covered in full in this article. According to Aguas (2022), the data analysis approach developed by Colaizzi aids in the impartial interpretation of qualitative research findings. Thus, the authors were able to describe the data analysis in detail. However, the researcher neglected to use a tabular representation of concept generation, preventing a quick overview of theme generation. The study’s reliability and validity were improved by conducting independent analyses of each theme related to patients’ experiences.

Yes, the researcher offered a clear statement of the findings. In addition, the researcher discussed the validity and triangulation of the participants’ responses. More than one researcher carried out data analysis and the creation of themes, ensuring triangulation and decreasing the risk of bias (Siedlecki, 2020). It was decided to return to the original study question to discuss the findings. The findings were based on the research purpose and fitted within the study’s scope.

People who have COVID-19 report similar emotional, psychological, and physical symptoms. According to current research findings, as the disease control methods, isolation and quarantine can have both positive and negative results (Roberts et al., 2021). Covid-19’s lived experience, as discussed in this study, is consistent with previous research. Such studies show that social isolation can have long-term psychological and physical impacts, including anxiety and sadness; well-documented in the scientific literature. The psychological impacts of seclusion, sense of helplessness, and embarrassment can severely impact patients’ coping capacity and self-esteem when they contract a highly infectious new virus. Neuromuscular repercussions resulting from the unique virus’s bodily impact have necessitated the compassionate understanding of carers.

Caregivers can offer a range of techniques to lessen the virus’s lasting effects. This encompasses evaluating the ability to exercise in a safe and comfortable environment and exposure to environmental and sensory stimulation, including radio, TV, computers, and other digital devices (Roberts et al., 2021). Virtual visits with loved ones might help alleviate feelings of loneliness and isolation.

For people who have been diagnosed with COVID-19, nurse practitioners (NPs) can help them find resources and provide continuing support for them and their families. For individuals with COVID-19 or those who have suffered COVID-19, NPs can aid in establishing systems that enable access for patients and access to care for health care professionals. Moreover, among patients with COVID-19, NPs can use telemedicine as a safe substitute for traditional in-person care (Roberts et al., 2021). Patients with COVID-19 who are confined to their homes may benefit from services such as episodic care, psychological counseling, wellness evaluations, and education. Individuals, households, and communities can benefit from NPs’ knowledge of the COVID-19 virus and the steps they can take to combat its effects.

Even though the study’s findings and value are only of limited use in clinical settings, they are crucial in nursing practice. There is a growing consensus among health care experts that the concepts and environments in which care is provided can promote both harmful and positive patterns of care. The study also acknowledges that most medical students are reluctant to criticize unfavorable care cultures in their practice areas (Roberts et al., 2021). It was agreed upon that there are theoretical connections between the values of compassion, adaptability, and emotional intelligence in nursing education. The study did not address whether the research may be applied to other medical sectors besides nursing.

A peer debriefer was used in this study to verify the authenticity and reliability of the data. After each data collection interval, analysis and discussions were performed to see if data saturation had been achieved. Saturation in data collection is reached when the research scientist is no longer getting new information and has decided to stop collecting data (Guest et al., 2020). One of the study’s drawbacks, according to the authors, was the tiny sample size. As saturation approaches in qualitative research, the sample size is not known. There is no way of knowing whether the uniformity of the study’s sample affected the results. Despite the researchers’ claims that their findings might be generalized, this was an anticipated study limitation.

According to the researchers, study findings will help policymakers better create treatment and management policies for COVID-19. From the viewpoint of this particular phenomenon, the used PARIHS (Promoting Action on Research Implementation in Health Services) model is sound. Although the study did not include all of PARIHS’s sub-categories, it went beyond the framework’s foundations to find and propose more sub-groups. The results show that people diagnosed with COVID-19 can alleviate their unpleasant feelings by additional treatments (Roberts et al., 2021). The findings sparked further studies into the paradigm itself as a model for knowledge translation.

The study was conducted when the epidemic was in its early stages. Potential participants were reluctant to participate in the study due to their apprehension of being interviewed. The fear of social stigma and the embarrassment of being diagnosed with COVID-19 made people hesitant to confess they had been diagnosed (Roberts et al., 2021). Nurses who treat patients infected with COVID-19 will benefit from the participants’ experiences. In the future, researchers should do a follow-up study on health care providers who have been infected with COVID-19 and the protracted effects of the condition on their mental health.

The Worth of the Research Study

Negative caring behaviors are expected in medical settings, and patients have complained about a lack of professionalism in their care. Nurses can learn from this study’s findings what contributes to subpar patient care and what they can do to improve it. Patients and family members expect compassionate treatment when they are in the hospital and rely on others to look after them (Su et al., 2020). As a result, nurses should exhibit behavior and attitudes that demonstrate compassion and optimism. One of the nursing tenets has been that those who cannot care for themselves should be treated with kindness and respect.

Caring begins the moment the patient and the caregiver come into contact. To arrive at an accurate diagnosis and the most suitable course of treatment, nurses who exhibit a caring and conscientious demeanor build trust with their patients (McClelland & Vogus, 2021). The study is useful in nursing since it aims to define and explain nurses’ caring behaviors. It has been shown that the following methods are effective in fostering healthy working relationships: being friendly, chatting, and schmoozing patients on a personal level, encouraging them, and reassuring them while still maintaining professional standards.

Conclusion

In today’s global society, COVID-19 infection is a common public health problem affecting people of all ages and genders. This discussion board post critically evaluates a qualitative study using the CASP checklist. Healthcare professionals make well-informed decisions about patients ‘ values and care using the most current evidence, clinical expertise, and patient preferences. Patients infected with COVID-19 should be helped by nurses and other health care workers who are sensitive to their experiences. The snowball sampling in the study was considered finished when all of the data had been collected. For this study, researchers spoke with 13 patients who were not hospitalized for COVID-19 and 1 hospitalized patient who was not receiving oxygen therapy. NPs can assist those diagnosed with COVID-19 by pointing them in the direction of available resources and offering ongoing support to them and their loved ones. NPs’ knowledge of the COVID-19 virus and the steps they can take to combat its effects can benefit individuals, households, and communities. Future studies should look at the long-term effects of COVID-19 on the psychological wellbeing of health care workers who have been infected.

References

Aguas, P. P. (2022). Fusing approaches in educational research: Data collection and data analysis in phenomenological research. The Qualitative Report, 27(1), 1-20. Web.

Assarroudi, A., Heshmati Nabavi, F., Armat, M. R., Ebadi, A., & Vaismoradi, M. (2018). Directed qualitative content analysis: The description and elaboration of its underpinning methods and data analysis process. Journal of Research in Nursing, 23(1), 42-55. Web.

Dodgson, J. E. (2019). Reflexivity in qualitative research. Journal of Human Lactation, 35(2), 220-222. Web.

Gorna, R., MacDermott, N., Rayner, C., O’Hara, M., Evans, S., Agyen, L., Nutland, W., Rogers, N., & Hastie, C. (2021). Long COVID guidelines need to reflect lived experience. The Lancet, 397(10273), 455-457. Web.

Guest, G., Namey, E., & Chen, M. (2020). A simple method to assess and report thematic saturation in qualitative research. PloS One, 15(5), 1-17. Web.

McClelland, L. E., & Vogus, T. J. (2021). Infusing, sustaining, and replenishing compassion in health care organizations through compassion practices. Health Care Management Review, 46(1), 55-65. Web.

Roberts, M. E., Knestrick, J., & Resick, L. (2021). The lived experience of COVID-19. The Journal for Nurse Practitioner, 17(7), 828–832. Web.

Sawatsky, A. P., Ratelle, J. T., & Beckman, T. J. (2019). Qualitative research methods in medical education. Anesthesiology, 131(1), 14-22. Web.

Siedlecki, S. L. (2020). Understanding descriptive research designs and methods. Clinical Nurse Specialist, 34(1), 8-12. Web.

Su, J. J., Masika, G. M., Paguio, J. T., & Redding, S. R. (2020). Defining compassionate nursing care. Nursing Ethics, 27(2), 480-493. Web.

Weinhardt, M. (2020). Ethical issues in the use of big data for social research. Historical Social Research, 45(3), 342-368. Web.

Introduction

Screening and prevention play a significant role in combating the spread of Sexually Transmitted Infections (STIs). Last year the US Preventative Services Task Force (2020) updated their recommendations for screening for hepatitis B virus (HBV) contagion in adult and adolescent persons at increased risk of having diseases related to human immunodeficiency viruses (HIV). Although STIs affect all populations within the life span, they are particularly prevalent among adolescents.

It is due to social, biological, and economic factors (STDs in adolescents and young adults, 2019). The health care institution must protect these and all other categories of the population. This work aims to analyze and discuss one of the recent measures, namely the new guidelines, taken by the US Preventive Services Task Force to prevent the spread of HBV infection.

Teenagers and Adults with Hepatitis B Virus Screening Recommendations Outline

Here are the current guidelines for screening for hepatitis B virus in teenagers and adult persons:

• Screening should be offered and provided to adolescent and adult populations suspected of HBV infection within them.
• The service’s target populations are asymptomatic, non-pregnant, and even vaccinated teenagers and adults with a higher chance of being HBV infected.
• The first stage of the screening procedure should be performed using hepatitis B surface antigen tests.
• The second stage is a confirmatory test for the virus.
• Clinicians should pay special attention to:
  • People from countries of Africa, Asia, South America, and the Pacific Islands.
  • Unvaccinated people from the United States (US).
  • Persons with (HIV).
  • People who use injected drugs.
  • Homosexual biological men with active sex life.
  • Individuals who have household or sexual contact with HBV-positive persons.
• Clinicians should perform screening procedures periodically.

Analysis of the Evidence-Based Grade

US Preventative Services Task Force gives the recommendation a Grade B. It means that the organization recommends this service and strongly advises medical practitioners to provide it to patients (Grade definitions, 2018). Based on the description of the supporting evidence, it is safe to say that the level of evidence for these guidelines is 2a. The evidence of the 2a category is assigned to a “systematic review of (homogeneous) cohort studies” (Evidence-based medicine: Levels of evidence, 2021, para. 2).

US Preventive Services Task Force (2020) notes that they “examined evidence from new randomized clinical trials and cohort studies” (p. 2418). A related article, namely Screening for Hepatitis B Virus Infection in Nonpregnant Adolescents And Adults: Updated Evidence Report And Systematic Review for the US Preventive Services Task Force by Chou et al. (2020), follows the same methodology. Description of study selection is proof of it.

Guidelines and Its Implementation

For recommendations to be effective, they must be followed by medical professionals. Over the past decade, several of the largest US health care organizations have released new guidelines for screening teenagers and adult persons. They are “The CDC, the American College of Physicians, and the American Association for the Study of Liver Diseases” (US Preventive Services Task Force, 2020, p. 2421).

It can be said that health care providers are currently following recommendations. Moreover, in 2018 Centers for Disease Control and Prevention (CDC) “funded three programs to develop hepatitis B testing and linkage-to-care programs serving non-US-born persons during 2014–2017” (Harris et al., 2018, p. 541). One can say that this shows a new and comprehensive approach to combat the spread of HIV infections in the US.

References

Chou, R., Blazina, I., Bougatsos, C., Holmes, R., Selph, S., Grusing, S., & Jou, J. (2020). Screening for hepatitis B virus infection in nonpregnant adolescents and adults: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA, 324(23), 2423-2436. Web.

Evidence-based medicine: Levels of evidence. (2021). Stony Brook University Libraries. Web.

Grade definitions. (2018). U.S. Preventive Services Task Force. Web.

Harris, A. M., Link-Gelles, R., Kim, K., Chandrasekar, E., Wang, S., Bannister, N., Pong, P., Chak, E., Chen, M. S., Jr., Bowlus, C., & Nelson, N. P. (2018). Community-based services to improve testing and linkage to care among non–US-born persons with chronic hepatitis B virus infection—three US programs. Morbidity and Mortality Weekly Report, 67(19), 541-546. Web.

US Preventive Services Task Force. (2020). Screening for hepatitis B virus infection in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA, 324(23), 2415-2422. Web.

Introduction

Nosocomial infections denote hospital-acquired contagions that were not existing during admission and acquired during hospitalization as the patient receives medical attention. Urinary tract infection signifies the commonest hospital-acquired contagion in developing nations. It emanates from blood and microorganisms that get into the space around the urethra via perineum or urinary catheter. Urinary tract infections comprise over 41% of nosocomial contagions in the US each year, with most of them linked to catheterization (Mong et al., 2021). The rising rate of urinary tract infections in the acute care unit is influenced by a vast proportion of catheterization, regular contact with caregivers, and high resistant microorganisms. Hospital-acquired infections cause augmented morbidity and mortality, in addition to extended hospital stay following contagion.

Reason for Choosing the Topic

This topic was selected attributable to rising cases of nosocomial infections in intensive care units for patients having a catheter than those who did not have. Such infections affect sections of the urinary system, encompassing the bladder, ureter, and urethra. Among all the hospital-acquired urinary tract infections, about 75% are linked to having a catheter (Eckert et al., 2020). The catheter is a tube that is put in the bladder via the urethra for urine drainage. Approximately 20% of hospitalized patients have the catheter inserted in the course of the hospital stay. The major risk aspect in the development of catheter-related infections is extended use, for example, over six months. Consequently, catheters should only be inserted for suitable signs and removed once they are no longer essential.

Any hospitalized patient is vulnerable to contracting a hospital-acquired infection. Some of the patients who are at high risk include the elderly, little children, and people with problems in their immune systems. Other risk aspects include prolonged hospitalization, failure of caregivers to wash or sanitize their hands properly, the insertion of indwelling catheters, and lengthy use of antibiotics. The Centers for Disease Control (CDC) approximates that in the US health facilities alone, there are about 2 million hospital-acquired infections and approximately 100,000 deaths every year. In addition, 32% of all infections are urinary tract contagions because of having a catheter during a hospital stay (Mong et al., 2021). Although urinary tract infections are linked to low morbidity compared to other hospital-acquired contagions, they sometimes result in bacteriaemia and death.

The PICOT Question

The PICOT question chosen for this study is: in acute care hospitals (poverty areas), how does having a catheter during hospital stay compared with not having one affect hospital acquired infections over 6 months? The high prevalence of catheter-linked urinary tract contagion in the acute care unit in poverty areas is more than twice when compared to not having one. Furthermore, this infection has been associated with extended hospitalization and an increase in ensuing medical costs (Mong et al., 2021). This signifies that the insertion of the catheter only when highly needed, shortened hospital stays, and decreased periods of catheter use might reduce the rate of nosocomial urinary tract infections.

Possible Integration of Evidence in Clinical Practice

Insertion of urinary catheters denotes the highest risk aspect associated with the acquisition of nosocomial infections. The choice to insert the urinary catheter ought to be made with the awareness that it entails the risk of causing infections with a prolonged hospital stay. Most of the catheters are introduced in the emergency room, devoid of an adequately documented arrangement. In about 25% of all cases, doctors do not know that the patient has a catheter (Eckert et al., 2020). Sadly, there is a rising tendency to insert indwelling urethral catheters in acute care hospitals (poverty areas), which worsens the problem. While 40% of hospital-acquired infections arise in the urinary tract, over 80% of them are attributable to indwelling urethral catheters. Luckily, most catheters are not left indwelling for a long time. The period of catheterization is proportionally associated with the occurrence of bacteriuria, hospital-acquired infection, and likely bacteriaemia with sepsis.

A low proportion of patients get infections during their few days of hospitalization if the sterilized procedure and appropriate care of a closed system are accomplished. Bacteria could develop in the urine and rise along the lumen, or pathogens in the biofilm outside the catheter might cause infections in the bladder. Although external sources of pathogens on or close to the patient might cause infections, most microorganisms emanate from patients’ intestinal flora (Mong et al., 2021). The main morbid occurrences related to having a catheter are fever and probable development of bacteriaemia with sepsis. Timely detection of infections and prevention of their progress, particularly in high-risk individuals, is paramount. There is a need for increased research to establish practices of averting infection past the sterilized closed system.

Methods to Evaluate the Effectiveness of Implementation

With increased research, numerous measures have been established to prevent hospital-acquired infections. Such practices encompass the establishment of nosocomial infection control boards, regular culture from varying hospital units, training and development for all health professionals, application of enhanced infectious waste disposal practices, and sterilizing hands before surgical operations. However, hospital-acquired infections have continued to generate countless complications during treatment, encompassing extended hospital stay, augmented use of medication, and high lab costs (Eckert et al., 2020). Diversity of pathogens, increased medical interventions, prolonged use of a broad scope of antibiotics, and rising significance of prevention, diagnosis, and treatment are some of the significant factors behind intensified research concerning hospital-acquired infections. Patients should be advised to alert doctors whenever they feel that the catheter might be blocked or when they start passing considerably significant elements of debris or grumes. The risk of hospital-acquired infection rises by about 5% to 10% with each day of catheter usage. Therefore, it is essential to check the aseptic method during catheterization carefully, think about substitutes to catheterization, and minimize the period of catheter use.

Conclusion

Nosocomial infections designate hospital-acquired contagions that were not extant during admission and developed during hospitalization as the patient gets medical attention. They cause augmented morbidity and deaths, in addition to lengthy hospital stays following contagion. Insertion of urinary catheters represents the highest risk aspect linked to the acquisition of nosocomial infections. The catheter is a conduit that is put in the bladder via the urethra for urine passage. This topic was chosen attributable to rising instances of nosocomial infections in acute care units for patients having a catheter than those who did not have. Among all nosocomial urinary tract infections, about 75% are associated with having a catheter. The critical risk aspect in the development of catheter-connected infections is prolonged usage, for example, more than six months. With improved research, several measures have been established to avert hospital-acquired infections.

References

Eckert, L., Mattia, L., Patel, S., Okumura, R., Reynolds, P., & Stuiver, I. (2020). Reducing the risk of indwelling catheter–associated urinary tract infection in female patients by implementing an alternative female external urinary collection device: A quality improvement project. Journal of Wound Ostomy & Continence Nursing, 47(1), 50-53.

Mong, I., Ramoo, V., Ponnampalavanar, S., Chong, M. C., & Wan Nawawi, W. N. F. (2021). Knowledge, attitude and practice in relation to catheter‐associated urinary tract infection (CAUTI) prevention: A cross‐sectional study. Journal of Clinical Nursing, 1(1), 1-10. Web.

Introduction

Nosocomial infection is one of the most aggressive medical factors, which continuously complicates nurses’ workflow, diminishes care quality, and undermines patient safety, consequently. Moreover, these bacteria place a tremendous financial burden on both a distinct individual’s pocket and the local and federal budget overall. This paper aims to explore the impact of nosocomial infections on patient safety and the quality and cost of care and the influence of state board nursing practice standards and governmental policies on this problem. The paper also offers different mitigating strategies that improve patient safety and the quality of care and reduce care costs.

One-Year Contract

Nosocomial infections, or Healthcare-associated infections (HCAIs), present the significant healthcare concern that severely threatens patients during hospital stays or can exacerbate their illness course. For example, patients who become contaminated via surgery spend an average of 6.5 extra days in the medical facility (“Healthcare-acquired infections,” n.d.b). On the national scale, as the Centers for Disease Control and Prevention (CDC) states, approximately 1.7 million cases of nosocomial infections occur in the USA, which totally results in more than 98,000 deaths each year (Haque, 2018). In other words, one in 20-30 hospitalized patients has at least one nosocomial infection on any given day.

It is also worth noting that patient safety is primarily impended by the adverse quality of HCAIs, namely, their resilience to most antibiotics. About 50 percent of surgical-associated infections, especially Staphylococcus aureus and gram-negative bacilli, are antibiotic-resistant (“Infection prevention and control,” n.d.). Herewith, according to the CDC, in 2017, Clostridium difficile, exceptionally resilient to antibiotic medication and comprising half a million infections, caused 13 thousand deaths in the USA (“Clostridioides difficile,” 2019). In this regard, healthcare professionals should place the central focus on antimicrobial stewardship since it decreases microbial resistance development and infection spread.

HCAIs also result in substantial annual healthcare expenditures associated with treatment, preventable procedures, and antibiotic provision and stewardship. The five most prevalent hospital-acquired infections (HAIs) cost $10 billion every year; herewith, surgical site infections (SSI) cost is the highest, accounting for $3.3 billion (“Overall and unit costs,” n.d.). In addition, central line-associated bloodstream infections are the most expensive for patients, comprising almost $46.000 per case (“Overall and unit costs,” n.d.).

It is worth adding that the federal efforts to combat HCAIs also require a big budget. For instance, the 58 percent reduction of dangerous central line-associated bloodstream infections (CLABSIs) between 2001 and 2009, which led to around saved 6,000 lives, cost $1.8 billion (Haque, 2018). Therefore, state and federal governments should follow and develop cost-effective prevention strategies.

State Board Nursing Practice Standards and Governmental Policies

In the United States, every state and territory has a specific licensing and regulatory body known as the Board of Nursing (BON), which supervises nursing practice through established nursing standards within the assigned jurisdiction. Currently, 59 BONs exist, formulating the National Council of State Boards of Nursing (NCSBN), a not-for-profit organization where governmental agencies counsel together concerning safety and welfare, public health, and nursing licensure examinations.

Nursing boards focus on four main areas, such as practice, education, licensure, and discipline. Regarding these agencies’ effectiveness, the findings of the study by Winstead and Moore (2020) examined The North Carolina Board of Nursing (NCBON) and supported its activities on implementing regulatory workshops. Such workshops can enhance participants’ expertise, knowledge, and intent to implement nursing practice changes. Overall, by guaranteeing that only quality care is delivered by licensed, qualified nurses, these regulatory bodies empowered by the Nursing Practice Act protect public health and significantly improve patient safety.

Besides state boards of nursing practice, the US Department of Health and Human Services (HHS) also established definite preventive initiatives on HCAIs as one of the primary tasks. In particular, its Steering Committee, together with scientists and other leading national organizations, adopted the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (HAI Action Plan).

This plan provides a cohesive, consistent framework for preventing nosocomial infections in ambulatory surgical centers, hospitals, and long-term facilities and directing antibiotic stewardship efforts. For instance, HAI plans require adopting relevant laws and forming the state HAI advisory council or multidisciplinary group to cooperate with local partners, including academic organizations, clinics, and professional societies.

Plans also include onsite public health infection control assessments that appeared to be adequate to train healthcare staff in containment activities and isolation (“State HAI plans,” 2020). Finally, they suggest implementing the Antibiotic Resistance Laboratory Network (ARLN) to detect high-concern and novel resilient organisms. Overall, the HAI Action Plan resulted in considerably improved federal and state coordination attempts to prevent HAIs by sharing resources, best practices, and lessons retrieved from collective clinical experience.

Effective Strategies

Realizing the grave threat of nosocomial infections, national and local authorized organizations develop different elaborated strategies that eliminate or, at least, alleviate the problem’s effect. These strategies are primarily directed at realizing effective preventive methods, infection control, antimicrobial stewardship, research, and reporting. The primary prophylactic measure is frequent, careful handwashing, especially after each contact with patients, equipment, body fluids, and excretions.

For example, a systematic review by Doronina et al. (2017) states that hand hygiene is the most effective practice to avert HAIs, but nurses’ compliance with this practice is still low, indicating the need for education and continuous feedback. Another study by Azor-Martinez et al. (2018) has revealed that hand hygiene programs can reduce respiratory infections, absent days, and antibiotic prescriptions. Another precaution that proves its effectiveness is hospital sanitation which requires providing the safety of clinical rooms, personnel’s uniforms, and equipment for patients. This also implies appropriate hospital waste management, that is, the separate disposal of diagnostic laboratories and waste contaminated with sputum and blood.

Additional preventive practices include personal protective equipment, immunization or vaccination, injection safety, and medication storage and handling. Moreover, medical facilities can also use various available advanced technologies, such as hydrogen peroxide vapor (HPV) and ultraviolet light devices (UV). HAI prevention practices’ financial benefit ranges from $25 billion to $31 billion in healthcare cost savings (“Healthcare-Associated Infections,” n.d.a).

Besides, the benchmark for HAI of Mayo Clinic Hospital at Rochester, a leading national clinic, exceeds the national standard on almost all main infections, including CLABSI, CAUTI, SSI, and Clostridium difficile (“Mayo Clinic,” n.d.). This result has been achieved due to strict adherence to the best preventive strategies and the application of modern technologies that protect medical staff and patients from pathogens.

National and state governments, along with healthcare organizations and hospitals, should pay attention to nurses’ adequate compliance with antibiotic stewardship policies, norms, and standards on antibiotic application and consumption. Research conducted in 88 countries, including the United States, discovered that among all hospitalized patients taking at least one antibiotic either for treatment or prophylaxis, only 54 percent had proven bacterial infection (Getahun et al., 2020). The research by Ho et al. (2020) emphasizes the importance of proper antibiotic stewardship since the infection rate for C. difficile was increased due to antibiotics overuse, especially in developed countries. Hence, it is critical to enhancing hospitals’ provision of testing means and medical professionals’ awareness of this issue to improve the antibiotic application.

Finally, it is worth highlighting the importance of research and reporting in the strategy of fighting nosocomial infections. In particular, noticeable research gaps still exist concerning different issues, such as the precise cost of HCAIs on national and local levels, financial benefit of infection prevention, morbidity and mortality, and many others. These gaps mainly stem from inadequate reporting caused by the shortage of testing and healthcare professionals’ neglect of reporting. In this regard, one of the effective solutions can be implementing the Health Information System (HIS) that will document all incidents of HCAIs and provide actual, precise information for researchers.

Conclusion

In summary, the paper has examined the influence of nosocomial infections on patient safety and the quality and cost of care and state board nursing practice standards and governmental policies on this problem. HCAI presents a severe healthcare concern undermining patient safety and complicating nurses’ workflow. The problem is exacerbated by nosocomial infections’ resilience to most antibiotics. As a result, the cost of HCAI accounts for billions of dollars per year and a considerable number of preventable deaths and disabilities. Nevertheless, all states have their Boards of Nursing that regulate nursing practice via established nursing standards and licensure procedures.

Additionally, the federal obliges state governments to realize and update HAI Action Plans that provide laws, norms, and health infection control assessments. Finally, the most valid strategies include infection precaution practices, infection control, antimicrobial stewardship, advanced technologies, research, and reporting.

References

Azor-Martinez, E., Yui-Hifume, R., Muñoz-Vico, F. J., Jimenez-Noguera, E., Strizzi, J. M., Martinez-Martinez, I., Garcia-Fernandez, L., Seijas-Vazquez, M. L., Torres-Alegre, P., Fernández-Campos, M. A., & Gimenez-Sanchez, F. (2018). Effectiveness of a hand hygiene program at child care centers: A cluster randomized trial. Pediatrics, 142(5), e20181245. Web.

Clostridioides difficile infection. (2019). CDC. Web.

Doronina, O. D., Jones, D., Martello, M., Biron, A., & Lavoie‐Tremblay, M. (2017). A systematic review on the effectiveness of interventions to improve hand hygiene compliance of nurses in the hospital setting. Journal of Nursing Scholarship, 49(2), 143-152. Web.

Getahun, H., Smith, I., Trivedi, K., Paulin, S., & Balkhy, H. H. (2020). Tackling antimicrobial resistance in the COVID-19 pandemic. Bulletin of the World Health Organization, 98(7), 442 – 442A. Web.

Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Healthcare-associated infections: An overview. Infection and Drug Resistance, 11, 2321-2333. Web.

Healthcare-Associated Infections: Overview. (n.d.a). Health People. Web.

Healthcare-acquired infections (HAIs). (n.d.b). PatientCareLink. Web.

Ho, J., Wong, S. H., Doddangoudar, V. C., Boost, M. V., Tse, G., & Ip, M. (2020). Regional differences in the temporal incidence of Clostridium difficile infection: A systematic review and meta-analysis. American Journal of Infection Control, 48(1), 89-94. Web.

Infection prevention and control. (n.d.). WHO. Web.

Mayo Clinic Hospital Rochester: Complications & deaths. (n.d.). Medicare. Web.

Overall and unit costs of the five most common hospital-acquired infections (HAIs) in the US. (n.d.). The Center For Disease Dynamics, Economics & Policy. Web.

State HAI plans. (2020). CDC. Web.

Winstead, J., & Moore, C. M. (2020). Outcomes and impact of a nursing regulatory orientation workshop for nurse leaders. Journal of Nursing Regulation, 10(4), 22-29. Web.

Introduction

For health care professionals, in order to address uncertainties that may appear in clinical practice, it is essential to ask relevant clinical questions. Answers to them frequently provide guidance on the most appropriate ways of health care delivery with regard to patients’ needs. The most common format of guidelines for evidence-based practice uses the acronyms PIO, PICO, PICOS, or PICOT (Polit & Beck, 2018). In them, P stands for patients or population, I is an intervention or influence, C is comparison, O means outcomes of the intervention, S is for settings, and T refers to time. In order to answer these questions, researchers should search for evidence clinical practice guidelines, systematic reviews, and other preprocessed reliable sources.

Rationale of the Study

The topic chosen for research is the efficiency and rationale of antibiotic treatment for patients with upper respiratory infections as there are specific concerns in this area. On the one hand, upper respiratory infections may be regarded as a common health disorder, however, if left untreated, it may lead to severe complications, especially in older adults, infants, and people with pre-existing immune system disorders. In this case, appropriate treatment, including antibiotics therapy, is necessary. At the same time, there are multiple studies that indicate inappropriate use of antibiotics for the treatment of upper respiratory infections that may lead to antibiotic resistance in the future. The seriousness of this issue is determined by the fact that due to antibiotic resistance, the treatment of particular infectious diseases becomes less effective.

PICOT Question

Thus, in order to examine the rationale of antibiotics’ use for the treatment of upper respiratory infection, it is necessary to form a PICOT question on a first-priority basis. It will be the following: In patients with upper respiratory infections, does antibiotic treatment for 10 days clear infection faster than if patients had no antibiotics? where P means patients with upper respiratory infections, I – antibiotics treatment, C – absence of antibiotic treatment, O – faster improved state without infection, and T – the period of 10 days. Evidence will be detected in reliable peer-reviewed articles and clinical guidelines that will be searched in databases, including Medline, CINAHL, PubMed, and Google Scholar on the basis of keywords related to this topic (“upper respiratory infection,” “antibiotics,” “antibiotic resistance”).

Literature Review: Results

According to the results of the literature review, the expediency of antibiotics’ use for the treatment of upper respiratory infections is determined by their type. According to Yoon et al. (2017), upper respiratory infections may be both bacterial and viral. Respiratory viruses include adenovirus, influenza virus, rhinovirus, parainfluenza virus, echovirus, coxsackievirus, coronavirus, metapneumovirus, and respiratory syncytial virus (Yoon et al., 2017). When upper respiratory infection is caused by a virus, the use of antibiotics that aim to affect bacteria will be inefficient and may cause complications, including antibiotic resistance. In the case of infection caused by a respiratory virus, symptomatic treatment may be applied for the first 10 days.

Antibiotics treatment is necessary for patients with acute pharyngotonsillitis caused by bacteria especially when they have comorbidities or other complications (Yoon et al., 2017). Additional factors that presuppose the use of antibiotics include the duration of illness (more than 10 days), age (infants younger than 6 months old), and the severity of symptoms that may indicate the affection of other organs (Plitcher et al., 2018).

At the same time, there is multiple research that indicates the significance of appropriate use of antibiotics treatment as inappropriate use may lead to antibiotic resistance. According to Chokshi et al. (2019), fundamental causes of antibiotic resistance in developing nations include the lack of resistant development surveillance, clinical misuse, poor quality of antibiotics, and the high availability of this kind of medication. For developed countries, the major contributors to an increasing antibiotic resistance are excessive use of antibiotics in farming and a low level of control over antibiotic use in healthcare facilities (Chokshi et al., 2019). The evidence of the inappropriate use of antibiotics is supported by the study of Pulia et al. (2018) who state that inappropriate antibiotic use was identified in almost 81% of outpatient clinic prescriptions, 73.3% of emergency department initiations, and nearly 56% of NH prescriptions.

All authors emphasize the significance of this issue as antibiotic resistance is developing faster than before. In this case, some researchers aim to examine the ways of treatment for patients with existing antibiotic resistance. For instance, according to Durdu et al. (2019), a combination of tigecycline and trimethoprim-sulfamethoxazole may be regarded as an efficient therapy for patients with resistance.

Conclusion

Answering the PICOT question, it is possible to conclude that it requires particular improvement to provide a reliable answer. In patients with upper respiratory infections, it is necessary to identify an infectious agent first. In the case of viruses, antibiotic treatment is not necessary and inefficient – with symptomatic treatment, infection will clear within 10 days. However, when infections are caused by bacteria, a patient is younger than 6 months old or has complications or long-lasting symptoms, antibiotic treatment is essential regardless of the time. These precautions are determined by growing antibiotic resistance due to inappropriate antibiotic treatment, especially when it was not required.

References

Chokshi, A., Sifri, Z., Cennimo, D., & Horng, H. (2019). Global contributors to antibiotic resistance. Journal of Global Infectious Diseases, 11(1), 36-42. Web.

Durdu, B., Meric Koc, M., Hakyemez, I. N., Akkoyunlu, Y., Daskaya, H., Sumbul Gultepe, B., & Aslan, T. (2019). Risk factors affecting patterns of antibiotic resistance and treatment efficacy in extreme drug resistance in intensive care unit-acquired Klebsiella Pneumoniae infections: A 5-year analysis. Medical Science Monitor, 25, 174-183. Web.

Piltcher, O. B., Kosugi, E. M., Sakano, E., Mion, O., Testa, J. R. G., Romano, F. R.,… & Tamashiro, E. (2018). How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an expert panel. Brazilian Journal of Otorhinolaryngology, 84, 265-279.

Polit, D. F., & Beck, C. T. (2018). Essentials of nursing research: Appraising evidence for nursing practice (9^th ed.). Wolters Kluwer.

Pulia, M., Kern, M., Schwei, R., Shah, M., Sampene, E., & Crnich, C. (2018). Comparing appropriateness of antibiotics for nursing home residents by setting of prescription initiation: a cross-sectional analysis. Antimicrobial Resistance & Infection Control, 7(1), 1-8. Web.

Yoon, Y. K., Park, C. S., Kim, J. W., Hwang, K., Lee, S. Y., Kim, T. H.,… & Kim, S. W. (2017). Guidelines for the antibiotic use in adults with acute upper respiratory tract infections. Infection & Chemotherapy, 49(4), 326-352. Web.

The patient is an 84-year-old female who was admitted to the hospital due to delirium and a urinary tract infection and demonstrated the presence of anemia, hypokalemia, hyponatremia, anxiety, and depression. At the same time, as discussed in the article “The management of urinary tract infections in older patients within an urgent care out-of-hours setting,” the causes of diseases can be different, including flora and problems with the kidneys. There is an ongoing problem that older people in primary and secondary care are being prescribed antibiotics as a popular treatment. However, antibiotics are a serious stress for the body, and it seems that their number should be reduced in dealing with this health problem.

The article considers the possibility that the lack of preventive or timely treatment of infections in the urinary tract leads to the fact that patients experience sepsis. The problem of infections is one of the most important, as it can have serious consequences. An increase in the number of elderly and senile people leads to an increase in the number of diseases. Thus, a challenge arises for some nurses in out-of-hours care to perform a range of tasks. At the same time, the concept of autonomous practical nurses is being popularized. They can legally examine patients, diagnose diseases, prescribe certain medications, and provide treatment. Symptoms may not be apparent in older patients or may include an urge to urinate, dysuria, decreased appetite, and pain in the lower abdomen and lumbar region (Dexter & Mortimore, 2021). With inflammation of the kidney, systemic symptoms and a septic reaction can be observed.

In conclusion, for evaluation, the national early warning score system is often used, which is based on physiological parameters. The article’s authors found that the presence of infections increases the level of delirium. Moreover, recommendations are given for the analysis of elderly patients through studying the background of diseases, as well as that it is optimal to conduct a full analysis before prescribing treatment. It is highlighted that the role of the nurse in communication to convey information is important.

Reference

Dexter, J., & Mortimore, G. (2021). The management of urinary tract infections in older patients within an urgent care out-of-hours setting.British Journal of Nursing, 30(6), 334-342.