Introduction
Hospital-acquired infections (HAIs) include catheter-associated urinary tract infections, methicillin-resistant Staphylococcus aureus (MRSA) infections, surgical site infections, and gastrointestinal infections. The control of hospital-acquired pathogens causing these infections continues to be an unresolved issue for many US hospitals. HAIs are responsible for developing significant complications for patients, including increased length of hospital stay and a high probability of readmission after discharge, not to mention deterioration in the quality of life and a higher risk of mortality. The identified population health intervention to address HAIs is the use of barrier precautions, such as mask, gown, or gloves, as control measures for MRSA infections by healthcare workers.
Video Transcript
Hi, I am (your name), a DNP practice scholar. In today’s video, I am going to discuss the acute problem of public health, which is hospital-acquired infections. First, let us define what hospital-acquired infections are. So, hospital-acquired infections are infections acquired in a hospital or other healthcare facility. Did you know that people can get infections during their medical care while they are being treated for something else? On any given day, one in twenty-five hospital patients has an infection caused by their medical care. Approximately 45% of these patients are older than 65 years (Schmier et al., 2016, p. 198). Infections are usually associated with the devices used to deliver care, such as ventilators or catheters. Examples of such hospital-acquired infections are catheter-associated urinary tract infections and central line-associated bloodstream infections. However, the infection may also be spread by healthcare staff or some infected patient. Besides, there are infections that occur in that part of the body where the surgery took place.
It has been estimated that 1.7 million infections are acquired in US hospitals annually (Arefian, Vogel, Kwetkat, & Hartmann, 2016, p. 1). HAIs can occur in various types of healthcare settings, including but not limited to medical centers, nursing homes, outpatient care, and acute care hospitals. It should be noted that hospital-acquired infections place a major economic burden on both healthcare organizations and patients. The overall costs of hospital-acquired infections incurred by hospitals are equal to 9.78 billion dollars (Schmier et al., 2016, p. 200). The five major healthcare-associated infections are catheter-associated urinary tract infections, surgical site infections, ventilator-associated pneumonia, central line-associated bloodstream infections, and clostridium difficile infections.
Catheter-associated urinary infections have an overall cost of 0.03 billion dollars, which is 0.4% of the total costs. Surgical site infections have an overall cost of 3.3 billion dollars, which is 33.7% of the total costs. Ventilator-associated pneumonia has an overall cost of 3.09 billion dollars, which is 31.6% of the total costs. Central line-associated bloodstream infections have an overall cost of 1.85 billion dollars, which is 18.9% of the total costs. Clostridium difficile infections have an overall cost of 1.51 billion dollars, which is 15.4% of the total costs. At the same time, direct per-case costs of HAIs incurred by hospitals range from $1,000 to $44,000 (Schmier et al., 2016, p. 199). The highest charges are attributable to ventilator-associated pneumonia, and the lowest charges are attributable to catheter-associated urinary tract infections.
Now, let us look at some social determinant risk factors for hospital-acquired infections. These are economic and social conditions that account for an increased probability of getting an infection while receiving medical care. It is worth mentioning that correct identification of the main risk factors for healthcare-associated infections is hindered by the differences in individual susceptibility to the acquisition of a certain infection. Some hospital services and procedures, gender, age, ethnicity, long hospital stay, overuse of antibiotics, as well as admission diagnosis and its severity are among significant risk factors for HAIs (Wang, Zhou, Chen, Yu, & Feng, 2019).
Top three social determinant risk factors for hospital-acquired infections are the availability of resources for hospitals, medical staff education, and socioeconomic conditions. Hospitals that have sufficient resources and finances are generally more successful at preventing healthcare-associated infections. At the same time, there is a correlation between staff education in infection control and the rate of HAIs. It is important that healthcare workers receive adequate training to identify the biggest infection risks. Socioeconomic conditions may also impact the risk of acquiring healthcare-associated infections. For example, HAIs occur more often in rural areas, whereas rates of HAIs in urban areas are lower.
As you probably know, Healthy People 2020 is aimed at attaining high-quality lives and enhancing the overall level of patient care. Healthy People 2020 established several goals related to the high incidence and prevalence rates of healthcare-associated infections. One of such goals is to prevent, reduce, and ultimately eliminate hospital-acquired infections. This goal reflects the urgent need for the US healthcare system to improve the rates of nosocomial infections in various types of healthcare settings. The global initiative mainly concentrates on central line-associated bloodstream infections (CLABSIs) and methicillin-resistant Staphylococcus aureus (MRSA) infections.
Let us focus on MRSA infections which are caused by a hospital-acquired pathogen which increases mortality and morbidity and is resistant to many antibiotics. In fact, MRSA is very contagious. You can get this type of infection not only through direct contact with an infected wound but also through contact with contaminated linens. Unfortunately, MRSA can transmit to the hands and clothes of healthcare professionals even when there is no direct contact with bodily fluids. That is why there is a strong need for the adoption of prevention practices to decrease the transmission of this infection.
The use of barrier precautions, such as mask, gown, or gloves, as control measures for MRSA infections is the evidence-based intervention that can be integrated into the routine practice of healthcare workers. It has been proven that the use of disposable gloves and washable gowns by healthcare workers can prevent transmission of MRSA by protecting their hands and clothes from being contaminated by methicillin-resistant Staphylococcus aureus (Albrecht, Croft, Morgan, & Roghmann, 2017). In turn, the use of masks could prevent the spread of the infection through the air (López-Alcalde et al., 2015). The use of masks and gloves is especially recommended for high-risk care activities that are targeted towards patients with pressure injuries. It is important that this evidence-based intervention is accompanied by education of healthcare staff and patients.
The measurable objective to address the Healthy People 2020 goal is the reduction of the standardized infection ratio of MRSA infections by fifty percent. The current standardized infection ratio stands at 1.0, and the desired standardized infection ratio is 0.5 (Office of Disease Prevention and Healthcare Promotion, 2018). The target standardized infection ratio can be reached by utilizing the best current evidence-based practices for the prevention of the spread of MRSA infections and staff education.
In summary, hospital-acquired infections are infections that patients get while receiving medical treatment. Despite the fact that HAIs are mostly preventable, a large number of patients acquire them every year. Healthy People 2020 is, among other things, committed to reducing and eliminating healthcare-associated infections. The identified public health intervention related to the practice problem of HAIs is the use of gowns, masks, and gloves by medical staff.
References
Albrecht, J. S., Croft, L., Morgan, D. J., & Roghmann, M. (2017). Perceptions of gown and glove use to prevent methicillin-resistant staphylococcus aureus transmission in nursing homes. Journal of the American Medical Directors Association, 18(2), 158–161.
Arefian, H., Vogel, M., Kwetkat, A., & Hartmann, M. (2016). Economic evaluation of interventions for prevention of hospital acquired infections: A systematic review. PLOS One, 11(1), 1–15.
López-Alcalde, J., Mateos-Mazón, M., Guevara, M., Conterno, L. O., Solà, I., Nunes, S. C., & Cosp, X. B. (2015). Gloves, gowns and masks for reducing the transmission of meticillin-resistant staphylococcus aureus (MRSA) in the hospital setting. Cochrane Database of Systematic Reviews, 16(7), 70–87.
Office of Disease Prevention and Healthcare Promotion. (2018). Healthcare-associated infections. Web.
Schmier, J., Hulme-Lowe, C., Semenova, S., Klenk, J., Deleo, P., Sedlak, R., & Carlson, P. (2016). Estimated hospital costs associated with preventable health care-associated infections if health care antiseptic products were unavailable. ClinicoEconomics and Outcomes Research, 8(1), 197–205.
Wang, L., Zhou, K., Chen, W., Yu, Y., & Feng, S. (2019). Epidemiology and risk factors for nosocomial infection in the respiratory intensive care unit of a teaching hospital in China: A prospective surveillance during 2013 and 2015. BMC Infectious Diseases, 19(145), 1–9.