Increased Rate of Infections in the Acute Care Setting

Rey Albert Tablazon
Kim Harper

Healthcare associated infections develop in a patient as a result of their exposure to healthcare facilities or procedures. They include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), C. difficile and other infections caused by bacteria and viruses encountered in healthcare facilities (CUPE, 2009). Hospital acquired infection can result in prolonged or permanent disability and some hospital acquired infections prove fatal (Taylor, Plowman, & Roberts, n.d.).The rates of these hospital acquired infections in the acute care setting have increased especially in Alberta. For example, in 2007, a preliminary surveillance report on MRSA in patients from 47 Canadian acute-care sentinel hospitals found that the MRSA rate was 8.62 per 1000 admissions (AHW, 2011). Also, since reporting began in 1999, a cumulative total of 1,241 VRE infected cases were reported to the Public Health Agency of Canada (Agency) through December 31, 2011 (PHAC, 2013). With the incidences of these super-infections occurring in the acute care setting, the health of the individuals being admitted in the hospital is further placed at risk. The individuals at risk include mostly children and the elderly. According to the population projections of the Alberta Treasury Board and Finance (2013), the number of Albertans aged 80 years and older would more than triple from the current level of about 115,000 in 2012 to over 383,700 by 2041 (p. 3). This means that more and more elderly individuals will be at high risk for infections such as MRSA which according to the report by AHC (2011), have infection rates highest in the elderly (70 years and older). Acquiring infections in the acute care setting can have a great impact on the affected person’s life. This might mean he can no longer go to work while being treated in the hospital which would mean financial losses which not only affect the individual, but also his family. Furthermore, treating super infections in a hospital care setting can significantly impact the country’s economy. A survey of Canadian hospitals (reported in 2000) estimated the direct costs of hospital acquired infections in Canada to be approximately $1 billion annually. In 2007, MRSA alone was estimated to be costing Canada’s healthcare system $200-250 million per year (CUPE, 2009).

Identifying Solutions to Prevent Super-infections

Super-infections can be costly to treat and most often than not, prove fatal for the individuals afflicted with such. However, over the years, methods have been developed to further prevent individuals admitted to in an acute care setting from contracting such infections. Such methods involve adding more healthcare cleaning and infection control staff with proper training. Knowing how to deal with a situation where infection occurs can greatly reduce the risk of certain infections from spreading further among individuals in an acute care setting. Hospitals in Canada and Europe have demonstrated that investment in more cleaning and infection control staff, training and workforce stability has brought infection rates down (CUPE, 2009). Most infections acquired in the acute care setting can be transferred through direct contact. It can either be direct contact with an infected individual or an object that has come into contact with an infected individual. Transfer of infectious bacteria can be prevented through proper hand washing. Hospitals nowadays tend to have hand sanitizers placed strategically over the entire hospital. While antimicrobial soap and water are still recommended for hands that are visibly soiled or have been exposed to bodily fluids, alcohol-based gels or rubs are now preferred for routine decontamination of hands after most patient contact. These products rapidly kill bacteria and most viruses, and actually are gentler on the hands than repeated use of soap and water (IHI, 2012). The nurse’s role is to educate, not only the individuals being admitted into an acute care setting, but also the visitors coming in and out of the hospital to wash their hands properly.

Nursing Care Plans

There are three nursing care plans that were drafted from this scenario which may apply to potential high risk individuals involved. First nursing diagnosis is an actual problem, fear/anxiety (see Appendix A for a breakdown of the care plan). Second nursing diagnosis is a potential problem, risk for infection (see Appendix B for a breakdown of the care plan). The last nursing diagnosis is an educational need, knowledge deficit (see Appendix C for a breakdown of the care plan).

Conclusion

Preventing the spread of super-infections involves team effort. Not only is this limited to the health care workers, but also extends to families and visitors in an acute care setting. The addition of more staff that are trained and knowledgeable in dealing with infection prevention certainly helps keep such infections at bay. Most of these infections are acquired through direct contact; therefore, proper hand washing should be performed before and after coming into contact with an individual or any object that is present in the hospital. Not only will it reduce the risk of contracting a super-infection towards oneself, it will also prevent the spread towards other individuals.

References

Albert Health and Wellness, (2011). Methicillin Resistant Staphylococcus Aureus (MRSA) – 2010 AHW Report. Retrieved from http://www.health.alberta.ca/documents/MRSA- Alberta-Report-2006-2010.pdf

Alberta Treasury Board and Finance, (2013). Alberta population projection. Retrieved from http://www.finance.alberta.ca/aboutalberta/population-projections/2013-2041-alberta- population-projections.pdf

Canadian Union of Public Employees, (2009). Health care associated infections: a backgrounder. Retrieved from http://cupe.ca/health-care/health-care-associated- infections

Doenges, M.E., Moorhouse, M.F., Murr, A.C., (2006). Nursing care plans. Guidelines for individualizing client care across the life span 7^th ed. USA. F.A. Davis Company

Elsevier, (n.d.). Infection, risk for universal precautions; standard precautions; CDC guidelines; OSHA. Retrieved from http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/

Constructor/gulanick33.html

Institute for Healthcare Improvement, (2014). Reducing MRSA Infections: Staying One Step Ahead. Retrieved from http://www.ihi.org/knowledge/Pages/ImprovementStories/ ReducingMRSAInfectionsStayingOneStepAhead.aspx

Nanda Nursing Interventions, (2012). Nursing diagnosis knowledge deficit – gestational diabetes mellitus. Retrieved from http://nanda-nursinginterventions.blogspot.ca/2012/08/nursing- diagnosis-knowledge-deficit.html

Nursing Care Plan, (n.d.). Nursing care plan. Retrieved from http://wps.prenhall.com/chet_ perrin_criticalcare_1/98/25168/6443016.cw/content/index.html

Nursing Care Plan, (2012). Nursing care plan for deficient knowledge. Retrieved from http://nanda-nursing-care-plan.blogspot.ca/2012/02/nursing-care-plan-for-deficient.html

Public Health Agency of Canada, (2013). Vancomycin-resistant enterococci infections in Canadian acute-care hospitals: Surveillance Report January 1, 1999 to December 31, 2011. Retrieved from http://www.ammi.ca/media/55895/cnisp_vre_surveillance_report_ 1999_to_2011-en.pdf

Taylor, K., Plowman, R., Roberts, J.A., (n.d.) The challenge of hospital acquired infection. USA. Stationery Office

Appendix A

Nursing Diagnosis

Fear/Anxiety related to threat of acquiring an infection as evidenced by client’s expressed feelings of concern and restlessness

Planning

Client Goals:

Client will have decreased feelings of fear and anxiety

Expected Outcomes:

Within 8 hours of my shift, client will have reported decreased fear and anxiety reduced to a manageable level as evidenced by verbalization of feeling less anxious or exhibit a relaxed state.

Interventions

Validate source of fear. Provide accurate factual information (Doenges, Moorhouse, & Murr, 2006)
Orient patient to the environment and new experiences or people as needed (Doenges, Moorhouse, & Murr, 2006).
Acknowledge awareness of patient’s anxiety (Doenges, Moorhouse, & Murr, 2006).

Rationale for Interventions:

Identification of specific fear helps client deal realistically with it (Doenges, Moorhouse, & Murr, 2006).
Orientation and awareness of the surroundings promote comfort and may decrease anxiety (Doenges, Moorhouse, & Murr, 2006).
Acknowledgment of the patient’s feelings validates the feelings and communicates acceptance of these feelings (Doenges, Moorhouse, & Murr, 2006).

Evaluation

Achievement of Expected Outcomes and Goal

Goal totally achieved. Within 8 hours of my shift, client reported a decrease in level of fear and anxiety as evidenced by appearing to be in a relaxed state and verbalizing “I don’t feel so anxious or afraid anymore after all the information you have presented to me”

Based on your Assessment Critical Analysis above:

Goal was met because the client was able to overcome fear and anxiety by appearing calm and relaxed and verbalizing that the level of fear and anxiety was reduced after appropriate nursing interventions were rendered.

Appendix B

Nursing Diagnosis

Risk for infection related to possible exposure to a contaminated area in the acute care setting

Planning

Client Goals:

Client will be free of infection while admitted in an acute care setting

Expected Outcomes:

Within 8 hours of my shift, The client will be free of infection as evidenced by negative cultures.

Interventions

Teach patient or caregiver to wash hands often, especially after toileting, before meals, and before and after administering self-care (Elsevier, n.d.).
Use strict aseptic technique when handling invasive lines and equipment (Nursing Care Plan, n.d.).
Limit use of invasive devices/procedures when possible. Remove lines/devices when infection is present and replace if necessary (Doenges, Moorhouse, & Murr, 2006).

Rationale for Interventions:

Patients and caregivers can spread infection from one part of the body to another, as well as pick up surface pathogens; handwashing reduces these risks (Elsevier, n.d.).
To decrease risk of nosocomial infection (Nursing Care Plan, n.d.).
Reduces number of sites for entry of opportunistic organisms (Doenges, Moorhouse, & Murr, 2006).

Evaluation

Achievement of Expected Outcomes and Goal

Goal totally achieved. Within 8 hours of my shift, client did not acquire an infection as evidenced by vital signs being normal and reported negative cultures from lab.

Based on your Assessment Critical Analysis above:

Goal was met. After interventions were rendered and being extra careful in dealing with the client and the environment, the client was free from infection by the end of my 8 hour shift.

Appendix C

Nursing Diagnosis

Knowledge deficit in preventing spread of infection related to lack of information as evidenced by client verbalizing “I don’t know how infection is transferred”

Planning

Client Goals:

Client verbalizes understanding of desired content

Expected Outcomes:

Within 8 hours of my shift, the client will verbalize understanding of how infection is transferred in the acute health care setting.

Interventions

Determine client’s learning style especially if client had learned and retained new information in the past (NCP, 2012).
Instruct client/family in disease process, progression, what to expect, and answer all questions honestly (NCP, 2012).
Discuss recognize the signs of infection (Nanda Nursing Interventions, 2012).

Rationale for Interventions:

Some persons may prefer written over visual materials, or they may prefer group versus individual instruction. Matching the learner’s preferred style with the educational method facilitates success in mastery of knowledge (NCP, 2012).
Promotes optimal learning environment when client shows willingness to learn (NCP, 2012).
It is important to seek medical attention early to avoid complications (Nanda Nursing Interventions, 2012).

Evaluation

Achievement of Expected Outcomes and Goal

Goal totally achieved. Within 8 hours of my shift, client was able to verbalize understanding of how infection is transferred from one person to another as evidenced by client verbalizing “I should really wash my hands more often if infection is easily transferred through direct contact with contaminated objects in the area”

Based on your Assessment Critical Analysis above:

Goal was met. After interventions were rendered the client was able to understand how infection is commonly transferred in the hospital and how to reduce the risk of contracting them.