Wednesday, December 11, 2019

Nurses Role in prevention of HAIs Free-Samples for Students

Question: Why do Nurses Practice hand Hygiene and use protective gear? Is there emerging evidence that could inform changes to practice? Answer: Hospital-acquired infections, are those that one acquires within a healthcare unit and present themselves in the first 48 hours following a hospital admission; or infections that occur after 30 days following discharge from a hospital after a time of admission (Revelas, 2012). HAIs are not related to the original infections or illnesses that first bring a patient to a hospital and neither are they present in the incubation stage at the time that a patient is admitted (WHO, 2015) Several reasons have made the prevalence of HAIs in the 21st century to reach alarming rates. Some of these reasons include hospitals that have large populations within their premises who on average, are sicker and with weak immune systems; increased cases of treatment in the outpatient departments which implies that persons who are in the hospitals are on average more sick; many medical procedures which navigate around the natural protective body barriers; movement of medical staff from one patient to another which offers pathogens a vehicle for spreading; inadequate adherence to sanitation protocols with reference to equipment and uniform sterilization, washing as well as other measures for prevention which may be ignored by personnel which insufficiently isolate the patients from being infected by the disease agents; and the anti-microbial agents' routine use within hospital settings which creates pressure for emergence selection for the resistant microorganism strains (Revelas, 2 012). Occurrence of Healthcare-Associated Infections is common in both paediatric and adult patients. The most common infections among children include blood stream infections, UTIs and pneumonia while the commonly occurring infections in adults are UTIs. Among children, those that are below 1 year, babies born with very low birth weight of less than 1000 grams, and children admitted at the NICU or PICU, have the highest rates of Healthcare Associated Infections (Reed Kemmerly, 2009). This paper discusses the role that nurses can play in the prevention of HAIs and will look into four literature pieces to further expound on the topic. The research articles were searched from Google Scholar (See Appendix 1 for detailed breakdown). HAIs are spread via several routes such as surfaces (more so, hands), water, air, and oral passageways. However, there are also several interventions that are non-pharmacological and which can be used to reduce prevalence of HAIs which are often ignored by personnel. The best and most adequate intervention is the use of hand washing practice as it prevents the spread of most HAIs. However, the number of healthcare providers that actually engage in this simple exercise is surprisingly low and ranges from 20-50percent for every hospital patient that they get in contact with although some researchers have reported rates of close to 81percent. The hands of healthcare providers often carry viable pathogens and these include Clostridium dif?cile (59percent), Acinetobacter spp. (15percent), and Klebsiella spp. (17percent), Pseudomonas spp. (1.3-25percent), MRSA (16.9percent), rotavirus (19.5-78.6percent), yeasts (including Candida) (23-81percent), and VRE (1percent). Several studies have shown that frequent washing of hands can reduce HAIs rates including those of MRSA although there are those studies that have shown a negative relation. and washing solutions that are alcohol-based are considered to be generally better compared to washing hands with soap and water, Comparisons of hand washing with soap and water have shown that there are lower rates of HAIs when the soaps used are either triclosan, chlorhexidine, or alcohol based. Besides washing hands, nurses and other personnel can reduce prevalence of HAIs by wearing gloves to protect themselves and the patients from infection. There are a number of studies that have demonstrated that latex gloves have shown to be more effective in the prevention of viruses and water penetration when compared to vinyl gloves as cited by the authors. However, approximately 3-16 percent of nurses and healthcare personnel are sensitive to latex and will sometimes report severe reactions of the respiratory system. The powder free gloves are highly recommended for use in hospitals as they release latex levels that are much lower. Nurses and healthcare workers should ensure that they wear sterilized gowns when attending to patients who have infectious diseases. There is sparse data linking gown use and prevention of HAIs. However, one study as cited by the authors, showed that the use of gowns in ICU was linked to a reduction of VRE by approximately 54 percent P 0.01). The study also showed that using gowns also had an economic benefit by reducing the ICU net costs by close to $420,000 and averted 58 cases of VRE. Another study also showed that gown use was linked to insignificant and modest drop in rates of MRSA cases. The rates at which gowns are used by staff when attending to patients that have contact precautions has been reported to be 76percent among the hospital staff and only 65percent for persons visiting the patients. Besides gowns, head and shoe covers need to be used in areas that contain patients that are immunocompromised or those being prepared or undergoing surgery. Although there have been studies that the shoe covers used by healthcare staff in such scenarios do indeed collect pathogens, the spread of the same is very minimal. The authors cite one study showed that wearing shoe covers and gowns during a bone marrow surgery of a patient did not reduce the risk of the patient in a significant way as was measured by the antibiotic therapy used. Another study showed that wearing headgear during a sham surgery did not significantly reduce the probability of airborne bacteria when compared to not wearing a headgear. The four common types of HAIs as stated by the authors were surgical site, urinary tract, Pneumonia, and blood stream infections BSI (Horan, Andrus, Dudes, 2008). SSIs are linked to approximately 1/3 of all nosocomial infections, while UTIs and BSIs that are catheter associated, and VAPs account for the remaining 2/3. There are many protocols that nurses and other hospital personnel can follow besides those mentioned earlier. One such protocol discussed in the research by Tsai et al., (2014) is decolonizing personnel prior to a patient surgical procedure. In decolonizing personnel, the authors cite one study assessed its effects specifically on a surgical team (Portigliatti, Mognetti, Pecoraro et al., 2010). The study identified carriers among the surgical team which comprised of nurses, doctors, and anaesthesiologists who were subsequently treated using mupirocin administered intranasally. In retrospect, 1000 consecutive patients that had SSI were recorded as being 6%. 300 consecutive patients examined post intervention, had yielded 0% of SSI rate. Though there needs to be further studies done, the preliminary findings are indicative that healthcare personnel including nurses are responsible for the spread of microorganism during operation procedures. This therefore, calls for institution-wide decolonization and screening of personnel as it promises to be a successful and feasible preventive measure. There are currently very few hospitals that carry out personnel screening procedure which is in contract t the mandatory screening tha t hospitals are expected to adhere to with regard to TB screening of employees. Ventilator associated pneumonia occurs frequently among patient using mechanical ventilators and is the second most frequently occurring HAI (Sedwick, et al. 2012). The VAP mortality rates are at 29-70percent which far exceed those of other (Mietto et al., 2013). That said, nurses are tasked with ensuring that VAP is controlled within the hospital settings and this requires collaboration among all nursing staff to ensure best practice implementation is achieved through knowledge dissemination. Educational interventions are an effective way of increasing knowledge among nurses. Along with educating nurses, assessment and on-going support is necessary for the evaluation of compliance as well as in determining the patient outcome impact of the education. At the entire institute level, APRNs can develop and implement modified VAP bundle that is evidence based to initiate in the Emergency Room. Evidence shows that goal-directed early therapy is useful in improvement of patient outcomes as well as in reducing hospital costs. For the APRN to accomplish these, he/she would need to take up a temporary leadership role within a team of interdisciplinary professionals for further development, implementation, and evaluation of the modified VAP bundle. By developing the said interdisciplinary team within the ER, the institutional support will be assured with regard to initiating, piloting, and evaluating the intervention within the ER. If the VAP rates decrease, then the nurse wil have succeeded in implementing a practice change to reduce HAIs. Hand washing has been shown to be effective in reducing HAIs however; other potential means of transmission need to be focused on including, common vehicles, environment, bodily fluid, air, and droplets. By gaining an understanding of the different modes of transmission, nurses can better grasp the importance of implementing several other interventions for the control of HAIs besides just hand hygiene. It is recommended that nurses should be educated on pathogen target interventions to minimize disease outbreaks. In addition to this, the nurses need to be educated on the importance of carrying out HAIs routine surveillance as well as identifying vulnerable patients to HAIs in order to highlight problematic HAIs while reducing their transmission and outbreaks. Conclusion HAIs are preventable and it is the duty of nurses as well as other personnel, to ensure that patients are protected from nosocomial infections. Deliberate acts of prevention of HAIs such as simple hand hygiene, wearing of sterilized gowns; head gear, shoe cover, and un-powdered latex gloves should be enforced in hospital settings. In addition, other prevention and control strategies such as decolonization of personnel prior to surgical procedures ought to be adopted. Lastly, continuous education for nurses with regard to criticality of control and prevention of HAIs should be implemented in all hospital settings References Curtis, L. T. (2008). Prevention of hospital-acquired infections: review of non-pharmacological interventions.Journal of Hospital Infection,69(3), 204-219. Ferrazzano, D. M. (2014). Preventing Ventilator-Associated Pneumonia: Educating Emergency Room Nurses. (Retrieved on 28th April, 2017) https://digitalcommons.ric.edu/cgi/viewcontent.cgi?article=1039context=school_of_nursing Horan TC, Andrus M, Dudeck MA: (2008). CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control, 36: 309-332. Mietto, C., Pinciroli, R., Patel, N., Berra, L. (2013, June 1). Ventilator associated pneumonia: evolving definitions and preventative strategies. Respiratory Care Journal, 58, 990-1007. https://dx.doi.org/10.4187/respcare.02380 Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., Prisma Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLoS med,6(7), e1000097. Portigliatti Barbos M, Mognetti B, Pecoraro S, Picco W, Veglio V(2010). Decolonization of orthopedic surgical team S. aureus carriers: impact on surgical-site infections. J Orthop Traumatol, 11: 47-49. Rashleigh-Rolls, R. M. (2016).Hospital acquired infections: outbreaks and infection control interventions, a national descriptive survey(Doctoral dissertation, Queensland University of Technology Reed, D., Kemmerly, S. A. (2009). Infection Control and Prevention: A Review of Hospital-Acquired Infections and the Economic Implications.The Ochsner Journal,9(1), 2731. Revelas, A. (2012). Healthcare associated infections: A public health problem.Nigerian Medical Journal?: Journal of the Nigeria Medical Association,53(2), 5964. https://doi.org/10.4103/0300-1652.103543 Sedwick, M., Lance-Smith, M., Reeder, S., Nardi, J. (2012, August, 2012). Using evidence-based practice to prevent ventilator-associated pneumonia. Critical Care Nurse 32(4), 41-51. Tsai, D. M., Caterson, E. J. (2014). Current preventive measures for health-care associated surgical site infections: a review.Patient safety in surgery,8(1), 42. WHO (2015). Clean Care is Safer Care: The burden of healthcare associated infections worldwide. (Retrieved on 30th April, 2017). https://www.who.int/gpsc/country_work/burden_hcai/en/

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