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Introduction

Healthcare-associated infections are those that affect a patient at the time of or after treatment of another infection or disease at the health care centre. According to the Centre for Disease Control Prevention (CDC), healthcare associated infections are those that occur when an individual is hospitalized, but were not present before, neither incubating in the patient when being admitted. In addition they occur more than 48-72 hours after the patient is admitted and for a period of within 10 days after discharge. They were previously referred to as nosocomical infections but the name changed in order to relate to infections that infect the patient at the healthcare environment. The infections may result to serious illness or even death. For them to occur there must be the microorganism, the susceptible host and the transmitting medium. Vulnerable patients are colonized and infected by resistant, micro-organisms through contact with healthcare staff, other patients, visitors to the hospital, and other colonized places. Noscomical organisms include bacteria, fungi, viruses, and protozoa (Williams & Wilkins, 2008, p.902). The infections can be passed from health care staff, other patients or the people visiting, with the most common being the individual patient, equipment used, the environment, the health staff, and contaminated food.

Historical perspective

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The mode of transmitting the microorganisms may be through direct or indirect contact, respiratory droplets e.g. influenza, airborne e.g. tuberculosis and smallpox, and vector borne which include transmition from insects or parasites. In the US healthcare, associated infections comprise the top ten causes of death and about 2million  patients are affected annually, while in the European Union, 7% of the patients in acute treatment procedures have healthcare-associated infections. Annually, there is a reported high mortality of patients linked directly to HAI’s. The cost of treatment in the US is estimated at $4.5-5.7 billion annually. Studies done in 1991 indicated that the major forms of HAI’s included; drugs, noscomical infections and complications after surgery. In the last years, HAI’s have been on the rise generally attributed to rise in cases of patients with acute illness and general increase in number patients over staff ratio, and inadequate resources at the hospitals (Joint Commission Resources, 2009 p.5).

The measures that can help prevent HAI’s include following strict control procedures; early outbreaks identification and taking required procedures while in the meantime eliminating unnecessary procedures that cause the infections which may include isolation of patient; ensuring proper hygiene, keeping people with general symptoms of transmition away, and special caring of the vulnerable.

All hospitals have to address catheter associated urinary tract infections, bloodstream infections, community and health care associated pneumonia, skin and soft tissue infections and surgical infections in order to curb the healthcare associated infections. They generally occur due to inadequate hygiene, transmission of multidrug resistant organisms (MDROs), inadequate personnel, affected or immuno-compromised personnel, and technological infections (Joint Commission Resources, (2007 p.19).

In 1985 a project known to study the Efficacy of Nosocomial Infections Control (SENIC), was established, an initiative that reduced the infections of HAI’s with a 32% margin for those hospitals that followed the plan but those that did not implement the plan had an increase of 18% this occurred over a 5 year period. It included strict surveillance and control of activities, training sessions, staff regulations, and monitoring the effects (Gorbach, Bartlett, & Blacklow, 2004, p.79). Another program was the Infection Control Personnel (ICP); it emphasized the role of staff in preventing infections and medical errors. Improved training of the personnel was also practiced with the Occupational Safety and Health Administration, nurses, and other personnel involved in the training including evaluations for patient safety. Prevention strategies involved included patient variability, the mode of patient care variation, administrative variance, and technological variance to see which contributed most in HAI’s (Joint Commission Resources, 2007 p.22).

Strategies

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Environmental hygiene was also emphasized with effective environmental cleaning being taken seriously. Removal of the active chemicals was also emphasized in order to get rid of parasites e.g. mosquitoes, that cause HAI’s. Leadership from the side of the health care practitioners was also core to reduce the cases of HAI. The staff dedicated most of their time in caring for the patients medical needs, and monitoring the patients for improved healing.

Proper use of personal protective gear like gloves gowns, masks, eyewear, and face shields was also emphasized and included in training. This was meant to reduce occupational infections from being transmitted from the patients. They protected their skin, eyes, nose, mouths, and hands from deadly microorganisms that caused the HAI’s. Proper use of the gear was a must in order to minimize the transfer of the microorganisms from one patient to another or re-infecting the patient. Policies involving reductions of HAIs include the National Patient Safety Goal (NPSG) which is aimed at reducing the impacts of MDROs. There has been community associated MDRO’s which pays more attention to Methicillin/oxacillin-resistant Staphylococcus aureus. Good hand hygiene is also being stressed upon to personnel, in the fight towards patient safety, risk management, and quality management (Williams & Wilkins, 2008 p.901).

Key steps in the fight against HAI’s include proper hand hygiene, antibiotic stewardship programs, policies to assure personnel who are suffering, surveillance programs which look at patterns in various infections, areas of occurrence and proactive strategies too prevent infections. The best hand hygiene steps include; washing hands with plain soap and water at all times, antiseptic hand rubbed liquids at the surfaces of the facility, and surgical antiseptics to wash hands to avoid bacterial, fungi, protozoan, or other infectious agents. The CDC and the WHO has also launched a safety procedure in the health environment to reduce HAI’s including look-alike, sound alike medication names, patient identification, communication during handing over of patients, correct procedure on collect body organ, control of concentrated electrolyte solutions, assuring medication accuracy, avoiding catheter and tubing misconnections, using single devices for injections, and  proper hygiene. The formation of the joint commissions, Infections Prevention and Control Standards and Requirements, has also helped fight the HAI’s (Joint Commission Resources, 2009 p.4).

There has been a law since 2002 in four states of Florida, Illinois, Missouri, and Pennsylvania which require all health care organizations to shed light (to the public) on the HAI’s affecting them. The Association of Professionals in Infectious Control and Epidemiology (APIC), made 14 states to report to the public on their HAI’s and to date, 27 other states have related laws being considered. Proper respiratory hygiene and cough etiquette was also emphasized though precautions were taken (Gorbach, Bartlett, & Blacklow, 2004 p.82). Occupational health policies were also important to guide the staff if any infection occurred to them. For coughs, there needed to be posted visual alerts where the authority would be notified incase of any respiratory infections; proper etiquette of the patient and the staff of covering the nose and mouth while coughing; using tissue and disposing them well after use, hand hygiene to clean the respiratory infections, quarantine or use of masks while respiratory illnesses increase, and proper use of gear by personnel when examining patients. The reduction of preventable HAI’s should be the main aim in order to maximize patient safety, reduce risk, and offer quality health care.

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Conclusion

The management of healthcare associated infections in the early days has been effective in curbing the infections. The goal of the policy makers aimed at reducing the number of HAI’s occurring in hospitals which has so far been achieved as fewer case of infections are being reported unlike in the past. The staff is the one who need to take the first step to protect themselves since; if they cannot protect themselves then they cannot protect the patients. The authority of the hospitals should be sensitive to provide the necessary equipment and training to the staff in order to minimize the deaths and infections caused by HAI’s. Doctors should unite against this menace that seems to be a silent killer and embrace better hygiene procedures, good monitoring and having the interest of the patient at heart and upholding his levels of service. The effectiveness of this will help reduce the cases of HAI’s to ass low as possible.

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