Category: Infection

Introduction

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

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

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

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

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

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

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

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

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

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

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

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

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

Principles and objectives of clinical governance

Objectives

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

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

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

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

Principles

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

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

Education and training

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

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

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

Clinical effectiveness

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

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

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

Clinical audit

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

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

Research and development

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

Risk management

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

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

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

Openness

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

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

Information management

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

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

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

Plan for reducing infections in wards using clinical governance principles

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

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

Rationale for the plan

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

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

The role of staff

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

The plan

Effective resource utilization

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

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

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

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

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

Use of health surveillance systems

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

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

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

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

Deployment of risks mitigation strategies

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

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

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

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

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

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

Investment in IT

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

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

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

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

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

Conclusion

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

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

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

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

Introduction

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

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

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

Data Presentation

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

Improvement of Proposed Solutions

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

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

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

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

Preferred Solution

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

How Will the Change Be Sustained?

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

Conclusion

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

References

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

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

Bell, T., & OGrady, N. (2017). Prevention of central lineassociated bloodstream infections. Infectious Disease Clinics of North America, 31(3), 551-559. Web.

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

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

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

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

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

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

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

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

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

References

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

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

Prerequisites for a Successful Training Plan

To develop a successful training plan, it is important to incorporate the principles of leadership as a part of the implementation agenda. It is a general opinion that leadership is the process of leading in decision making in an organization. Involving proactive leadership will create a smooth transition to the desired changes in the process of implementation (Stephenson, 2013). It is crucial to explain the desired needs for accreditation and certification to ensure that the implementers are directly and proactively involved in the process of training. It can be achieved through teaching leadership traits needed for quality reporting and feedback tracking in the multifaceted healthcare environment.

Steps Involved in Educating Bedside Healthcare Providers

The first step involves constitution of offices or institutionalization of the entire training process for ease of information flow (Kulbok, Thatcher, Park, & Meszaros, 2014). In this scenario, it would be prudent to appoint an infection control unit to meet the set standards of control and prevention. The office can coordinate training, implementation, and follow-up of any event during and after training for optimal impact (Stephenson, 2013). The office will guarantee that the entire training program covers the topics of the plan to ensure success in the short and long-term time period. The office should participate in regulations and diverse reflections on the progress of the program.

Communication and Active Participation

There is a need to create a communication matrix for the plan to be authentic and pro-intentional. The matrix will ensure that the obstacles to effective assimilation of the training programs are identified and correctly dealt with (Hiatt, 2011). For instance, the infection prevention office may identify the key leadership figures to create a framework for the support and prevention program. In this scenario, it would be ideal to utilize the roles of the leader nurse, the bedside nurse, and the physician to lead the change process. The role of leadership in this scenario is to create a smooth transition at every stage of training. It also ensures discipline and control in a work environment since each stakeholder takes his or her role and responsibility.

Change Process Management Through Continuous Training

Since change is a dynamic process, there is a need to proactively manage any possible resistance. It is necessary to introduce all the stakeholders to the current practicing standards and their defects before introducing the improved practice standards. This is achievable through a continuous and participatory training process (Hiatt, 2011). It is important to encourage participation and brainstorming sessions for the change process to face minimal resistance. Once there is a general acceptance, it is advisable to document the training modules as a part of emphasis for optimal impact. The positive impact will ensure that the proposed training program is self-sustaining and effective.

Management Perspective in the Change Process

Once compliance is achieved, it is necessary to incorporate organization culture in the change process. Basically, compliance manages the negative energy that might arise from sharing past experiences or distractions arising from different standpoints. It is necessary to ensure that the change dynamics are positive and beneficial to the stakeholders and the healthcare institution (Hiatt, 2011). This process is achieved through highlighting the right values to obtain the attention of the stakeholders. For instance, catching compliance is achieved through a strategic and systematic decision-making process. The goal is to understand the needs of the stakeholders and align them with the change process.

Promoting Sense of Program Ownership and Responsibility

It is vital to encourage such traits as accountability and program ownership to ensure optimal compliance and change acceptance (Hiatt, 2011). For instance, it would be prudent to play teamwork games such as an interview on compliance perception. The questions could be framed on the acceptable infection disease control standards highlighted in the WHO safe injection and hygiene practices. Through such interaction, each stakeholder will be in a position to keep their counterpart accountable at the stage of implementation. The appointed office can act as a regulator for commitment and constructive observation to improve compliance (Hiatt, 2011). In the implementation process, the leadership offices will observe, note down, and adjust any training module that is challenging.

Logistical Needs in the Change Management Plan

It is important to create a friendly competitive environment for different departments that are a part of the training program. It will create a sense of belonging and being a part of the change process and implementation. There is a need to provide the stakeholders with the necessary equipment for meeting the set objectives. For instance, provision of a special instrument tray and a manual can make a very big difference (Hiatt, 2011). However, each tool must be compatible with the set objectives to save time and improve efficiency in managing infectious diseases for the provider (Michel, By, & Burnes, 2013). The tools should be aligned to the change process to make them more dynamic and adaptable to the objectives.

Preview of the Intentions of the Training Process

It is advisable to refresh the memory of the beside providers on the intention of the control and prevention and make the preview process people oriented since its intention is to benefit the patients. It is necessary because more than 70% of infections can be avoided through improvement of infection control practices (Hiatt, 2011). When implemented, many lives can be saved through decreased morbidity. The intentions must be well defined for ease of implementation and follow-up. It is also important to generate a tracking standard for each milestone.

References

Hiatt, C. (2011). 11 strategies to address physician and staff resistance to complying with infection control guidelines.Web.

Kulbok, P., Thatcher, E., Park, E., & Meszaros, P. (2014). Evolving public health nursing roles: Focus on community participatory health promotion and prevention. The Online Journal of the American Nurses Association, 17(2), 12-38.

Michel, A., By, R.T., & Burnes, B. (2013). The limitations of dispositional resistance in relation to organizational change. Management Decision, 51(4), 761-780.

Stephenson, M.O. (2013). Considering the relationship among social conflict, social imaginaries, resilience, and community-based organization leadership. Ecology and Society, 16(1), 1-3.

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 healthcareassociated 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.

Healthcareassociated 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 patients 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 careassociated pneumonia in the intensive care unit: Guideline-concordant antibiotics and outcomes. Journal of Critical Care, 36, 265271.

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), 2737.

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 careassociated 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), 340341.

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), 581588.

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), 232238.

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.

Program Description

Over the past few months, multiple healthcare-associated infections (HAI) have been recorded in our organization. These challenges have necessitated the development of an educational program that will help address the challenge. The educational program will cover various topics such as defining HAIs, the most common types of HAIs, risk factors for HAIs, and cost of the problem, and how to manage the issue.

Rationale

An HAI outbreak entails evidence of an increase in the number of infections acquired in a hospital set up among patients or staff over the expected rate. The target audience for this program is nurses and certified nurse assistants (CNAs). These people are the target audience because they are responsible for caring for the patients (Delgado et al., 2022). These activities include monitoring their health, operating medical equipment, and collaborating to care for the well-being of patients during their stay in the hospital. The organization needs to offer this program to tackle the outbreak and the nurses and CNAs to manage and prevent HAIs for the patients. The program is crucial as opposed to others as it will cut costs for the organization on the money used to treat the HAIs and offer quality care to patients, which is the organizations main goal.

Program Learning Objectives

By the end of the program, the first objective is that the target audience will have ample information on HAIs. The second objective will be that the nurses will be able to identify the largest population who are at risk of acquiring HAIs. For the third objective, the learners will be able to know the cost and effects of the outbreak. Finally, the audience will gain knowledge on how to manage HAIs.

Learning Needs Assessment

The first objective will equip the learner with efficient knowledge of HAIs and be made aware of the existing problem and how to identify the HAIs. The second objective will give the learners knowledge of the population of the people who need the most care to treat existing HAIs and prevent future occurrence. The third objective will be significant in letting the learners know the urgency of learning about the problem and the need for change. The fourth objective will equip the learners with the knowledge and skills to manage the challenge and eliminate it after implementation.

Situation Analysis

There are no regulations on what will be taught, and any relevant information about the HAIs will be open to being shared. The nurses and the CNAs will be trained by the use online program conducted through zoom meetings. There is adequate time for the development of the program as it is simple and has sufficient resources. The program will be created online through zoom meetings as it is more cost-effective, and the learners can attend them without the need for physical space and meetings (Serhan, 2020). Constrain for this online program include time constraints for the nurses and CNAs and personal discipline to attend the meetings. Qualified instructors will be added to the program to teach and help develop the program. The nurses and CNAs of the organization are very interested and motivated to learn and gain from this program. They have identified the problem and feel the need for a change in the organization.

Program Logistics

The educational program is supposed to take place in four weeks. Timing of the program is essential to ensure that the program takes place together with other organization activities without affecting the regular schedule. There will be two classes in a week in which the various topics will be taught on the HAI, and different educators will teach the classes. Each class will take at least 45 minutes to ensure ample knowledge is passed to the target audience. This time is suitable to ensure the continuation of other activities in the organization without disruption.

Organizing Content

Objective 1: Giving the target audience ample knowledge of healthcare-acquired infections

The beginning of the educational program will give the learners all the essential information they need to know about HAIs. This objective aims to ensure all learners gather adequate knowledge of the existing problem and clearly understand what we are handling. The learners will learn about the common types of HAIs, such as catheter-associated urinary tract infections, central line-associated bloodstream infections, ventilator-associated pneumonia, wound infections following surgery, and skin infections.

Objective 2: Identifying the audience at risk

Knowledge of the audience at risk is significant for the learners to know who the most affected individuals are to deal with the situation more precisely. The population at risk may include patients with different characteristics such as age, users of catheters, surgical procedure complications, preexisting conditions, invasive and indwelling medical devices, and antibiotics. Each of the people at risk will need to have a different form of care

Objective 3: Giving knowledge to the learners about the impacts of HAIs and the cost disadvantages

This information will create the need for urgency in the development of change in the organization. According to Zacher et al. (2019), HAIs affect 650,000 patients annually, and our patients do not need to be a statistic hence the need for acting upon the problem.

Objective 4: Teaching the learners how to manage healthcare-acquired infections

Steps will be offered on how to deal with this challenge effectively. The steps will involve practices such as detecting an HAI, finding and defining its cause, generating and formulating hypotheses, eliminating causes, and controlling and taking preventive measures to avoid infections.

Trainers will teach each chuck meeting of this objective within less than two lessons each. Different learning activities will be involved in the program, such as discussions, dialogue simulations, assessment and quizzes, slide-based courses, and training videos. To support these activities, resources needed include survey questions, learning videos, questionnaires, and focus groups.

Material Selection

Supporting materials for the program include the following:

• Slide videos with content for the training lessons
• Pamphlets indicating the need to stop HAIs
• Posters
• Healthy People 2020 articles related to HAIs
• Case studies to support the learning content
• Books such as Graves, N., Jarvis, W. R., & Halton, K. (2009). Economics and preventing healthcare-acquired infection.

Entry Assessment

Nurses and Nurse Assistants of all proficient levels will be viable to take the training program. The prerequisite and requirement for enrolling in this program are that an individual is either a nurse or a certified nurse assistant. All the nurses and CNAs will be involved as it is their key responsibility to ensure care for the patient is given at optimum levels. All these people interact directly with the patients; hence it will be necessary for them all to be educated about the HAIs outbreak to gather maximum help in the implementation and success of the change in the organization.

Formative Assessment

Teachers and learners utilize this type of assessment during the continuation of the process of the educational training program. The goal is to assess if the students grasp the desired disciplinary learning goals and aid them in becoming self-directed learners. I will involve several practices in the formative assessment. First, I will clarify the learning with the learners of what I want them to know and be able to do by the end of the program and gauge themselves by comparing themselves to the target to see if they have gained knowledge. Secondly, I will use questions in the class to promote learners thinking and elicit learning to eliminate errors and misconceptions in practice (Yan et al., 2021). Thirdly, providing feedback will be essential for the students performance and working with the learners to share feedback with peers and reflect on their performance and understanding of the training. Finally, I will activate learning where the learners will be involved solemnly in the class, and they will monitor their knowledge and self-assess to figure out which learning strategies work best for them.

Summative Assessments

The summative assessment will be essential to evaluate whether the learners benefited from the program. The evaluation will show whether the students have gathered the required skills and knowledge taught on healthcare-acquired infections. The program will succeed if the nurses and the CNAs can identify the present HAIs effectively and treat them. The nurses will be able to identify the population at risk and measure to prevent them from occurring. The learners will acquire knowledge on all types of the possible HAIS, and the learners will be able to manage the HAIs and ensure they do not spread any more. In the long run, the program will be a success if the organization contains the problem of the HAI outbreak.

References

Delgado, K. F., Roberson, D., Haberstroh, A., & Wei, H. (2022). Nursing Staffs Role in Detecting Urinary Tract Infections in Nursing Homes: An Integrative Review.Journal of Gerontological Nursing, 48(5), 43-50. Web.

Serhan, D. (2020). Transitioning from face-to-face to remote learning: Students attitudes and perceptions of using Zoom during COVID-19 pandemic. International Journal of Technology in Education and Science, 4(4), 335-342.

Yan, Z., Li, Z., Panadero, E., Yang, M., Yang, L., & Lao, H. (2021). A systematic review of factors influencing teachers intentions and implementations regarding formative assessment.Assessment in Education: Principles, Policy & Practice, 28(3), 228-260. Web.

Zacher, B., Haller, S., Willrich, N., Walter, J., Sin, M. A., Cassini, A., & Eckmanns, T. (2019). Application of a new methodology and R package reveals a high burden of healthcare-associated infections (HAI) in Germany compared to the average in the European Union/European Economic Area, 2011 to 2012.Eurosurveillance, 24(46), 1900135. Web.

Infectious diseases are widely spread from one person to another through either direct or indirect contact. The causative agents of such contagious infirmities include viruses, bacteria, parasites, and fungi. The common types of illness associated with such ailments are malaria, measles, and respiratory diseases. Reports indicate that 9344 people have contracted HIV since the 1980s in Ireland (HIV in Ireland, 2018). Therefore, reviewing reports of Irelands infection rate helps the country prepare to observe safety and universal health care to patients and medical workers. This essay demonstrates the importance of various aspects linked to work safety and health.

Direct Contact Methods of Infection Transmission

Person to person direct contact is the primary form of infection transmission. These infectious diseases are spread when an individual comes into direct contact with another persons bodily fluids. These infections can be contracted, especially when one is not aware of the ailment. Sexually transmitted diseases (STDs) are spread by this mode of transfer  direct contact. Furthermore, pregnant women are potential agents of infectious illness to unborn children through the placenta. STDs such as gonorrhea are transferred from the mother to the child during childbirth. Besides, the disease can be spread directly by means of mouth droplets.

The infection is scattered when one is either coughing or sneezing. It can be transmitted when one speaks with somebody. In this case, researchers have claimed that mouth droplets usually fall to the ground within a few feet and increase the chances of catching infections (Horowitz, 2017). Healthy people must keep a distance from infected people even if they are not coughing or sneezing.

Indirect Methods of Contracting Infections

Indirect methods of transmission can either be through air or by other mechanisms such as insect bites. An example of indirect methods is through airborne transmission, where the infectious agents can travel over long distances and be trapped in the air for an extended period. For instance, one has a high risk of contracting the measles infection if they enter a room with infected people. Diseases associated with food or drinking water are usually spread when one eats or swallows contaminated food or water. For instance, E. coli is commonly transmitted in case of improperly prepared food or undercooked meat. Therefore, it is advisable to consume well-cooked food or drink well-treated water.

Since infection can be spread through direct or indirect contact, nobody is safe from infectious illnesses. People are at risk of contracting an illness when they come closer to individuals suffering from infections. Contagious diseases can be prevented, for example, by washing hands thoroughly with soap and by using an alcohol-based sanitizer. Other means of prevention include avoiding sick people, refrigerating perishable food and leftovers, and thoroughly cooking raw meat and vegetables. Avoiding contaminated food and taking proper precautions while choosing food can help reduce the spread of infectious diseases.

In addition, most people working at healthcare facilities are at higher risks of getting contagious diseases than those in their homes. Individuals at the hospital can touch surfaces with droplets of coughs and sneezes from patients. Some deferment of causative agents of airborne diseases could be suspended in the air if patients are in proximity with healthy people.

Accidents

A medical accident can be described as the patients injuries emanating from a physician or nurse error. They commonly occur during the delivery of health care with defects latent in the hospital system. However, medical accidents are not random events but are proceedings resulting between human error and the systems fault. It is worth noting that accidents are the primary causes of death and disability. In general, approximately 14,000 people lose their lives in the United Kingdom, and the majority of them are reported to be in England, and about 700,000 were severely injured in England alone (Common sources of accidents in health and social care settings, 2020). The four common types of accidents include falling, poisoning, cuts, and bumps. Therefore, to prevent poisoning, chemicals, and medicines should be kept out of sight and reach.

In my view, in case of a fall, the following measures will be observed. Firstly, I will ensure proper use of the stair gates and supervising patients having the hardship to use the stairs. Secondly, I will not allow children under the age of 5 years old to sleep on top of the bunk bed. I will also ensure that the floor is not damaged or worn-out of floor tiles. Finally, I will pay close attention to anything that can fall or harm the patients.

Workplace

In Ireland, the Health and Safety Authority (HAS) is mandated to perform administration, Medicare enforcement, and safety at work. HAS is responsible for monitoring compliance with legislation at the workplace and has a responsibility to enforce action. In Ireland, HAS is a national center that is a source of health safety information and advice to employers, employees, and self-employed individuals about health and safety matters (Higuera, 2017). Finally, the HSA also participates in training and research in health and safety.

The safety healths role is devoted to continually advancing the institutions safety measures to prevent harm from infection. The safety office forms vital programs to ensure personal safety, prevent accidents and avoid injury. Finally, it also spearheads the promotion of wellness and ensures compliance with environmental, health, and safety laws and regulation.

Safety in the Healthcare Environment

Healthcare stakeholders should ensure safety in a facility. Scholars have claimed that diverse workplaces that offer employment practices that are non-discriminatory lead to an improvement in performance (Jolly et al., 2018). The following are the strategies that promote a safe and healthy environment: ensuring support and encouragement of professional development, identification and removal of barriers to optimum health, and finally ensuring staff turnover is low.

The primary goal of practical housekeeping is to eliminate the hazards from the workplace. Lack of housekeeping techniques commonly can result in accidents. For instance, risks occur due to negligence of littering papers, debris, clutter, and spills. Thus, it is vital to observe water housekeeping because it may reduce patient accidents at clinics.

Housekeeping is not only about cleaning, but it also entails maintain the office neat and tidy and ensuring that the halls and floors do not slip. Housekeeping also provides the removal of waste material and other fire hazards from the workplace. As per my healthcare experience, if my colleagues attempt to move patients incorrectly under my watch and seek my help, I will reprimand them and shift the patients properly. In facilitating the patients transfer, I will ensure that the established health and safety guidelines are followed to avoid any unintentional accidents happening to them.

Reference List

Common sources of accidents in health and social care settings (2020). Web.

Higuera, V. (2017) How are diseases transmitted? Web.

HIV in Ireland (2018) Web.

Horowitz, H. (2017) Infection control III: infection prevention and control as mediators, American Journal of Infection Control, 45(5), pp. 519-520. Web.

Jolly, J. et al. (2018) Qualitative evaluation of an educational intervention to reduce medicolegal risks for medical doctors experiencing significantly more cases than their peers in the UK and Ireland, BMJ Open, 8(4), pp. 1-11. Web.

Introduction

Infection control remains one of the most important aspects of any modern healthcare facility. The high hospital-acquired infections (HAIs) incidence rates and the presence of multiple negative outcomes demonstrate the need for an effective measure that will help to minimize the threat and ensure patients recovery. A UK-based survey suggests that 6.4% of inpatients at acute care hospitals acquire HAIs, with pneumonia (22.8%), urinary tract infections (17.2%), and surgical site infections (15.7%) accounting for the majority of the healthcare-associated infections (National Institute for Health and Care Excellence, 2016). Around 4 million people in Europe acquire HAIs and 37,000 die, as a result, each year (UK Government, 2016). For this reason, the existing Guidelines on Infection Control Practice in the Clinic Settings of the Department of Health (2017) state that the implementation of these practices is the key to positive outcomes and patient satisfaction. The existence of infection control coordinators emphasizes the unique role that this issue plays in a modern healthcare setting as their major task is to gradually increase the level of awareness surrounding the discussed problem (Steinkuller, Harris, Vigil, & Ostrosky-Zeichner, 2018). Some effective methods offered by the guidelines include hand hygiene, personal protective equipment, and other methods that can be helpful in eliminating infection risk.

These measures are introduced to reduce the incidence of the most common types of HAIs which are a catheter-associated urinary infection (CAUTI), central line-associated bloodstream infection, surgical site infection, and ventilator-associated event (ECDC, 2013). The existence of these health risks significantly deteriorates the quality of patients lives and outcomes. Consequently, it is critical to adhere to the proposed regulations and guarantee that no undesired effects will emerge.

Case

A case study is described to illustrate the increased importance of the existing guidelines and regulations related to disease prevention. The setting is an outpatient clinic with the case discussed as a personal experience by the author of this paper who is a senior RN. After surgical intervention, the patient feels good and gradually recovers. He visits a doctor to determine future treatment and dietary recommendations. However, in three days his physical state worsens, and he has a fever. Additional diagnosing discovers that he has influenza, which complicates the surgery recovery and weakens the immune system of the patient. In three days, the patient acquired complications at the surgical site as a result of HAI. The in-depth analysis of the case emphasizes that the major factor of this incident was the disregard of the basic rules of prevention. A nurse responsible for the provision of care to the patient was not informed about the cough etiquette and how it can impact patients with various complications after surgeries (Preparedness plan for an influenza pandemic, 2014). Additionally, there was no infection control coordinator responsible for the explanation of basic rules and measures that should be used by health specialists with the primary aim to avoid deterioration of the situation.

Learning Process

Reflecting on the given case, it is possible to say that it helps to acquire important information about the role infection disease prevention plays in the modern healthcare setting. The high levels of HAIs among various patients mean that health workers should be especially careful while working with clients in different states (Damani, 2004). For instance, observation of simple cough etiquette, protection tools, and hand hygiene could help to save patients with weak immune systems or others from being infected by influenza.

Clinical Decisions

Moreover, speaking about clinical decisions and other issues related to the problematic situation, one should consider the unique importance of prevention and infection control measures regarding the current complex situation in the given sphere. For instance, the introduction of a hand-hygiene monitoring tool will help to significantly reduce the threat associated with the transmission of various diseases among health workers and patients (Qiao, Huang, Zong, & Yin, 2018). At the same time, additional training preconditioning cough etiquette and provision of information about other measures can also help to achieve better outcomes among workers of the health unit.

Causes

Unfortunately, in the given case and many other situations, the lack of resources, poor guidelines, and inappropriate infrastructure became the main causes for the emergence of the problem and the development of severe consequences. In general, statistics show that these three aspects critically deteriorate outcomes in many hospitals and increase incidence rates of HAIs (Alp, Leblebicioglu, Doganay, & Voss, 2011). The use of effective equipment to improve monitoring and prevention practices and continuous training will help to achieve better results.

Solutions

In such a way, the possible solutions for better infection control should include the creation of new guidelines and the introduction of education and training programs for health workers. The primary goal of these courses is to increase the level of knowledge about HAIs, their major causes, and how they are transmitted in hospitals. Moreover, research shows that the use of this tool remains a potent approach to increasing the effectiveness of existing infection control methods (Kilpatrick, Prieto, & Wiggelsworth, 2008).

Future Needs

The information mentioned above and findings formulated after analyzing the course are important for my future career and achievement of desired goals. First of all, after the completion of the Infection Control Practice course, I will continue my education in the sphere and pursue an advanced practice control certification. That is why the improved understanding of relevant prevention and control practices is critically important for the achievement of success and becoming a qualified specialist. Moreover, the experience generated through the analysis of appropriate cases is fundamental to avoid the same mistakes in my workplace and promote patients recovery.

Conclusion

Altogether, the modern healthcare industry faces a serious problem of HAIs and their high prevalence despite significant measures being taken. Therefore, infection control and prevention are top priorities for health providers and agencies as an effective approach to improving the situation and minimizing the risk of being infected by other diseases that can be found in healthcare settings. It should be given attention to avoid further deterioration of the situation.

References

Alp, E., Leblebicioglu, H., Doganay, M., & Voss, A. (2011). Infection control practice in countries with limited resources. Annals of Clinical Microbiology and Antimicrobials, 10(36), 1-4.

Damani, N. (2004). Manual of infection control procedures (2nd ed.). New York, NY: Cambridge University Press.

Guidelines on infection control practice in the clinic settings of department of health. (2017). Web.

ECDC. (2013). Core competencies for infection control and hospital hygiene professionals in the European Union. Web.

Kilpatrick, C., Prieto, J., & Wiggelsworth, N. (2008). Single room isolation to prevent the transmission of infection: Development of a patient journey tool to support safe practice. British Journal of Infection Control, 9(6), 19-25.

National Institute for Health and Care Excellence. (2016). Healthcare-associated infections. Web.

Preparedness plan for influenza pandemic. (2014). Web.

Qiao, F., Huang, W., Zong, Z., & Yin, W. (2018). Infection prevention and control in outpatient settings in ChinaStructure, resources, and basic practices. American Journal of Infection Control, 46, 802-807.

Steinkuller, F., Harris, K., Vigil, K., & Ostrosky-Zeichner, L. (2018). Outpatient infection prevention: A practical primer. Open Forum Infectious Diseases, 5(5), 1-8.

UK Government. (2016). Healthcare associated infections (HAI): Point prevalence survey, England. Web.

Salmonella was discovered in the XIX century and was named after an American veterinarian Daniel Elmer Salmon who discovered it. Salmonella is divided into six subspecies, and salmonella enterica is one of them. Salmonella enterica is a bacterium of the genus Salmonella. As a rule, it is contained in raw food, specifically in hen or geese eggs, or other food that contains them as ingredients if the preparation procedures were violated. Salmonella enterica has a shape of flagellate, rod-shaped, a Gram-negative, a facultative anaerobic bacterium (Salmonella enterica). Salmonella enterica does not have any specific areas of distribution and is common to all parts of the planet.

Internal and External Structures

Salmonella enterica does not have a shaped nucleus, and its DNA is preserved in an unclearly structured nucleoid. The bacterium also has such organelles as ribosomes, cellular fluid, and other ones that are responsible for storing energy and protein (Cui et al.). When it comes to the external structure of Salmonella enterica, it is necessary to state that it has such organelles as flagella and sensory organelles. Flagella are used for moving, and sensory organelles help the bacterium measure the temperature and the chemical nature of the extracellular space (Salmonella enterica). Salmonella enterica can form strong binds to host organisms and their cells because it contains a lot of fimbrial and non-fimbrial adhesins that ensure stable and almost unbreakable binding.

Oxygen and Temperature Needs

Salmonella enterica pertains to the group of anaerobic bacteria, which means that it does not need oxygen to live and develop. Moreover, they are unable to grow in the presence of oxygen (Cui et al.). Salmonella enterica can survive after drying and may live in dry places and food for years. This group of bacteria cannot be destroyed by freezing, but ultraviolet radiation boosts the process of their destruction. Salmonella enterica dies after being heated to 55-60 °C for ninety minutes or more. To protect from salmonellosis, doctors and scientists recommend heating and boiling food to at least 75 °C.

Infection and Its Symptoms

The disease caused by salmonella enteric and other types of bacteria of the group is called salmonellosis. It is dangerous since if not properly treated, the infection may boost the risk of the development of colorectal cancer (Silbergleit et al., 136). The most common characteristics of the disease are:

• spasmodic pains in the stomach,
• vomiting,
• diarrhea.

As a rule, they appear after 12-72 hours after being infected. As a rule, the majority of patients with salmonellosis recover in four days or a week as maximum, but in case of severe diarrhea, the patient may need hospitalization.

Prevention

There are no specific preventive measures for this infection for every person because it is impossible to visually or by other characteristics to establish whether food or water contains the bacteria. In the case of salmonellosis prevention, it is a matter of sanitary and epidemiologic service concern. It needs to liquidate the infection in animals, control farms and their products, as well the quality of tap water. For general citizens, it is necessary to follow the rules of storing food products and to be attentive and careful during the process of its preparation. Apart from that, people should pay attention to personal hygiene and the hygiene of the house since salmonella enterica may be contained not only in food but in tap water as well.

Works Cited

Cui, Luqing et al. Virulence Comparison of Salmonella enterica Subsp. enterica Isolates from Chicken and Whole Genome Analysis of the High Virulent Strain S. Enteritidis 211. Microorganisms, vol. 9, no. 11, 2021.

Salmonella Enterica, Microchem Laboratory, n.d. Web.

Silbergleit, Matthew et al. Chapter Five  Oral and Intestinal Bacterial Exotoxins: Potential Linked to Carcinogenesis. Progress in Molecular Biology and Translational Science, vol. 171, 2020, pp. 121-193. Web.

Introduction

Salmonella is a type of gram-negative bacteria that can lead to typhoid fever, food poisoning and paratyphoid fever. These species can cause the production of hydrogen sulfide and are motile. Their name is derived from that of an American veterinary pathologist, Daniel Elmer Salmon. Along with Theobald Smith, who was also a renowned pathologist and epidemiologist, Salmon discovered the organism which causes hog cholera, Salmonella enterica var. Choleraesius (Ryan & Ray, 2004).

Main text

A research published in 2008 provided documented proof about the presence of Salmonella antibodies in Malawi children as researchers succeeded in identifying an antibody which acts as a protecting agent against bacterial infections of the blood caused by Salmonella. Results of research involving 352 children at Blantyres Queen Elizabeth hospital showed that infants and children till the age of two develop antibodies that help in eliminating the abovementioned bacteria. This was positive news for researchers as with this knowledge, they are one step closer to the prospect of a Salmonella vaccine (MacLennan et al., 2008)

Salmonella is present in many turtles and a large number of other reptiles as well. The culture mediums on which it is isolated in clinical laboratories are MacConkey agar, XLD agar, XLT agar or DCA agar. Salmonella can cause infections in the intestine and in a healthy bowel, the number of bacteria normally present is much greater than their amount. Because of these reasons, a selective medium is necessary for primary isolation, and CLED agar or another type of comparatively non-selective medium is generally not used (Ryan & Ray, 2004).

Often, the quantity of salmonella is so low in clinical samples that enrichment culture has to be carried out, in which selenite broth or Rappaport Vassiliadis soy peptone broth is used as a selective broth medium in which a small volume of stool is incubated in, overnight. These media have properties that hinder the growth of the microbes which are generally present in the healthy human bowel, while at the same time they make it possible for salmonellae to increase their quantity. Then, salmonellae can be recovered by immunizing the enrichment broth on either one or more than one of the primary selective media (Ryan & Ray, 2004).

Salmonellae from moist colonies on blood agar, their diameter being about 2 to 3 mm. if the cells are grown for a longer period of time at a temperature ranging between 25 and 28°C, they will produce a biofilm, which is a group of cellulose, proteins and complex carbohydrates. This characteristic, that is the ability to produce the said biofilm, is a sign of dimorphism. Dimorphism is the name given to the ability of one genome to produce numerous phenotypes when exposed to certain external environmental conditions. Salmonellae generally produce hydrogen sulfide, and do not ferment lactose. The hydrogen sulfide they produce when exposed to media containing ferric ammonium citrate, reacts to turn into a black spot in the center of the creamy colonies (Ryan & Ray, 2004).

As far as classification of salmonella is concerned, there are two species namely S. bongori (previously subspecies V) and S. enterica (formerly called S. choleraesuis) which are further classified into six subspecies. These are: I: enterica, II: salami, IIIa: Arizona, IIIb: Arizona, IV: houtenae, V: obsolete (now designated S. bongori), VI: India (Ryan & Ray, 2004).

Within both these species, S. bongori and S. enterica, there are also over 2500 serotypes or serovars, that are found in many different types of environments and are linked with a disparate variety of diseases. More than 99.5% of human isolates are from the subspecies S. enterica. To reduce complexity, the Centers for Disease Control and Prevention recommends that the serovar Salmonella Typhi is used to refer to Salmonella species, instead of the technically correct, but longer name, Salmonella enterica subspecies enterica serovar Typhi (Giannella, 1996).

In terms of serology classification, the main division in salmonella is first by the somatic O antigen, then by flagellar H antigens. The latter are further sub-categorized into phase 1 and phase 2, and H antigens belonging to both phases are required to completely identify an isolate but the norm has become such that routine labs will leave this part to Reference Laboratories (Giannella, 1996).

Aside from typhoid and paratyphoid, salmonellosis is an infection is not related to blood, contrary to what is popular belief regarding it. Examples include Salmonella Enteritidis (1,9,12:g,m)  where the O antigens found are 1, 9 and 12; with the H antigens being g and m. Another example is Salmonella Typhi (9, 12, Vi;d ) where the O antigens are 9, 12; with the H antigen being d and the Vi antigen is called so because of its link with the bacterial capsule and its role as a Virulence factor. Recommendations by the Health Protection Agency include regular testing of the following antigens: O antigens: 2 4 6.7 8 9 and 3.10; phase 1 H antigens: a b d E G i r Vi; phase 2 H antigens: 1,2 1,5 1,6 1,7 (Ryan & Ray, 2004).

To guard against Salmonella as the food disease and illness it brings with it, it is crucial that food and food contact surfaces are clean and sanitary. Alcohol serves as an effective topical sanitizer. Quaternary ammonium is also often used with alcohol because it acts as a sanitizer that provides long-lasting protection. To prevent salmonella, surfaces are also kept clean by using non-flammable alcohol vapor in chlorine bleach or by using the safe and environmentally method developed in Japan i.e. carbon dioxide NAV-CO2 systems (Giannella, 1996).

Salmonellosis is the name given to an infection as a result of salmonella bacteria. The salmonella species which cause diseases are today known as a single species, names Salmonella enterica. Subtypes include salmonella typhi which is responsible for typhoid fever. Food poisoning which is often the result of salmonellae is caused by their presence in poultry, and raw eggs (because of which it is crucial that foods containing raw eggs are thoroughly cooked before consumption).

Often, food which is not eaten fresh but is frozen for extended periods of time also results in foodborne illness. Diarrhea, vomiting, fever, and cramps are often indications of this possible condition. In a large number of cases, 3 to 7 days is the time span of the infection. The need for antibiotic treatment and/or hospitalization does usually not exist in the majority of non-typhoidal strains linked with food-borne infection, however, complications may occur in cases of certain serovars (for example, Typhi) in which case the need arises for serious treatment.

Dehydration caused by diarrhea might require administration of intravenous fluids and medications to remove the symptoms such as fever. A problem arises in the common uses antibiotics in beef as well as poultry industries, which has led to the development of antibiotic resistance in a strain of salmonella (Ryan & Ray, 2004).

Summary

Another way of catching Salmonellosis is by physically coming into contact with reptiles like turtles or iguanas. Cases of gastrointestinal illness as a result of salmonella were also reported in 2003 and 2004 as a result of physical handling of pet rodents (Ryan & Ray, 2004).

References

Ryan K. J. & Ray C. G. (eds). (2004). Sherris Medical Microbiology. 4th ed. McGraw Hill.

Giannella, R. A. (1996). Salmonella in Baron S. et al (eds.): Barons Medical Microbiology. 4th ed. Univ of Texas Medical Branch.

MacLennan, C. A. et al. (2008). The neglected role of antibody in protection against bacteremia caused by nontyphoidal strains of Salmonella in African children. The Journal of Clinical Investigation, 118 (4), 1553-1562.