Download MPH 584_Healthcare Associated Infections

Jessie Damman
MPH 584 – Community Health
Dr. Kimberly Brodie
Final Paper - Healthcare Associated Infections
December 14, 2014
Introduction
Healthcare associated infections, HAIs, are associated with individuals receiving any medical or surgical treatment. These
infections can occur in healthcare settings such as, acute hospital care, same day surgery, outpatient care clinics, nursing homes or
rehabilitation centers (Healthy People 2020, 2014). “HAIs are a big cause of mortality and morbidity, with healthcare costs being
billions of dollars yearly in the U.S. alone while tens of thousands of lives are lost on top of this (Office of Disease Prevention and
Health Promotion, 2014). More specifically, post surgical patients face the healthcare associated infections of pneumonia and
Methicillin-resistant Staphylococcus aureus. These types of infections can be developed by poor sanitation and disinfection practices,
the reuse of supplies with different patients, use of medical supplies, patient characteristics, overcrowding, lack of local and national
guidelines, poor understanding of basic infection control measures, disproportionate staff to patient ratio, layout of facility and lack of
ambulation post operatively. “Ambulatory related factors are highly associated with subsequent hospitalizations for acquired MRSA
(Agency for Healthcare Research and Quality, 2009).”
Hospital acquired pneumonia, an infection of the lung, begins developing within forty-eight hours of admission while
healthcare associated pneumonia can beginshowing ninety days after a hospitalization of two days or more, three days following any
antibiotics, chemotherapy and wound care (Cunha, 2014). Methicillin-resistant Staphylococcus aureus, MRSA or Staph is one of the
most common forms of skin infection in the United States that can be a simple infection treated with antibiotics or lead to a serious
infection in surgical sites or wounds, bloodstream or pneumonia (MRSA Research Center, 2014). This infection is usually spread
between healthcare providers by direct contact with an infected wound or contaminated hands.
Develop a VMOSA
The vision for this problem is to develop a society where people are living long and healthy lives. To decrease healthcare
associated MRSA and pneumonia, the mission would include increasing public awareness, education, provide more studies relating to
post surgical patients, gather supporting agencies to work together to decrease the rates of healthcare associated infections and use
supportive research, evaluations and data to support the change. Developing objectives to address this community health issue would
be to prevent healthcare associated MRSA and pneumonia, reduce healthcare associated MRSA and pneumonia, identify challenges
that prohibit the prevention of HAIs and eventually eliminate healthcare associated MRSA and pneumonia.
General actions to address these objectives for MRSA and pneumonia in post surgical patients would be education of hospital
staff on concepts of the use of proper sterilization and disinfection and patient education on effective wound care and ways to prevent
these healthcare associated infections prior to planned admissions. Actions that can be taken to prevent post operative pneumonia are
to perform cough-deep breath exercises with the assistance of an incentive spirometer, perform oral hygiene twice a day, ambulation
under managed pain control and allow the head of the bed to be at thirty degrees while eating (Wren, 2010). While prevention of
Staph can begin with thoroughly washing hands with soap and water or alcohol based sanitizer, cover cuts and scrapes until fully
healed, disregard contact with others wounds or bandages and refrain from sharing personal items that are in contact with the skin
(MRSA Research Center, 2014).
The generic population served is post operative/surgical patients. This population will consider any gender, sexual orientation,
age, race and ethnicity. Stakeholders involved will be at a national and local level. Those at a national level associated with working
along this community health issue would be the World Health Organization, the Department of Health and Human Services, National
Nosocomial Infections Surveillance system, American Hospital Association Survey, the Centers for Disease Control and Prevention,
National Healthcare Safety Network, Emerging Infections Program, the Agency for Healthcare Research and Quality and the National
Institutes of Health. At a local level, the local health departments, hospitals, provider offices such as infection control and specialized
surgeons and outpatient facilities contribute to the mission of this community health issue.
Challenges faced with this community health issue is educating the population of the severity of the issue. The rate of HAIs is
affecting one in every twenty patients (California Department of Health, 2013). While education may also be given to this population
prior to surgical procedures and their understanding is verbalized, actions may take a different course following the procedure. For
instance, an orthopedic patient was seen in the office prior to the operation to discuss the risk factors of this procedure which includes
infection(s); full consent and understanding of behaviors needed following the procedure are given and once the patient’s operation is
complete pain is uncontrolled which inhibits them from ambulation and in turn after two days post surgical hospital acquired
pneumonia is developed. Or with the same scenario the patient is completely ambulatory per surgeons protocol but returns to the
office two weeks later to discuss redness around the incision site due to improper wound care by not changing the bandage
appropriately and leaving it uncovered while it is still healing. As of 2011, 44% of the reported number of infections by hospitals
included pneumonia and surgical site infections (CDC, 2014).
Literature review
“Hospital acquired pneumonia is the second most common infection in hospitals and the most prevalent in surgical intensive
care units with accounting for fifty percent of the antibiotics administered in the hospital setting (Cunha, 2014).” Research studies
conducted can conclude that 10.7% of patients with abdominal surgery acquire pneumonia, women are two times more likely to
develop pneumonia and mixed or minority races are 4.4 times more likely to develop pneumonia compared to Caucasians with results
varying with the type of surgical procedure that occurs (Thompson et. Al, 2006).” Further analysis of this report could show that
women may have a lower pain tolerance than men which inhibit them from ambulating and minority races may have certain beliefs or
lifestyle behaviors where they do not participate in medication.
Staph infections in this population are vital as this type of bacteria cannot be treated with antibiotics and infections in the
bloodstream can lead to death and wound infections can lead to improper healing or amputations. “MRSA that began in hospitals
dropped by fifty-four percent between the years of 2005 and 2011 with 9,000 less deaths in 2011 compared to 2005 (CDC, 2014).”
Staph is an infection that may be carried but signs or symptoms may not be apparent as one in three are carriers while two in 100 are
carriers of MRSA (CDC, 2014). It is reported that the number of Staph infections overall has decreased but hospital acquired
infections is still a major healthcare concern with the ultimate goal being able to completely eliminate them. While it is important that
MRSA infections have significantly decreased over the years, completely eliminating this infection through the healthcare system is a
big goal for stakeholders as liability falls onto medical providers and revenue is not supported by this community health issue.
An appropriate model to use for this community health concern would be to enforce ecological perspectives. Ecological
perspectives allow for effective interventions to be influential on a variance of levels because overall health is shaped by family,
community, workplace, beliefs, traditions, economics, and the physical and social environment (U.S. Department of Health and
Human Services, 2002). This theory best work best as a logic model for practice as there are many components to eliminating
healthcare associated infections. Hospital acquired infections have many risk factors in which they can occur therefore the best use of
theory is the ecological perspective which relates specifically to a single living being and the relationship to the physical environment
(McLaren et. Al, 2005). With many levels of individuals being involved, a behavior theory is also important to understand and
consider as there may be religious, spiritual, family or physician practices that influence the population affected.
The challenges faced with this community health issue are engaging primary care physicians to identify any barriers that may
limit or prevent following the recommendations provided by the CDC and addressing the risk factors associated with healthcare
associated MRSA and pneumonia. While practices may be in place for preventative measure unexpected occurrence can happen
leading to inadequate staff for patient ratio or lack of necessary supplies. Therefore, supportive of this approach is proper education
and training of health care workers will increase the compliance of best practices to prevent HAIs (Healthy People 2020, 2014).
“Proper hand hygiene is a key component during patient care that is the most important means for preventing health care associated
infections (Pincock et.al, 2012).”
For the purpose of infection control staff, health care epidemiologists, health care administration, nurses, health care providers
and any others that are actively working to develop, implement and evaluate infection control programs in health care systems a model
and theory for behavior is important. This model for behavior can begin to explain where gaps in healthcare are beginning and where
change can start. Once change begins to occur, re-evaluating the community health concern periodically will signify whether
additional modifications need to be made or if the same path of can be continued. The importance of addressing healthcare associated
infections is understanding individual behaviors and patterns. This factor can determine how a specific population type, dependent
upon age, race or ethnicity, can access the healthcare system or education needed. For instance, an important factor to know would be
if a population is predominately lower socioeconomic status and the understanding of healthcare materials is a struggle due to their
comprehension level but comprehension of healthcare related terms can be difficult for anyone.
Therefore, providing education to the population with health literacy in mind is essential to completely eliminate this
community health concern. Including religious or spiritual practices is also important as some may not believe in practices associated
with reducing or preventing healthcare associated infections, such as the use of specific hospital equipment to decrease pneumonia
chances or pain regimes to insure ambulation post surgery. Socioeconomic status effects the behavior theory as well as many
generations, this gap in healthcare can be a struggle to address as you are trying to manage altering a learned behavior, whether it is
individual, family, provider or hospital. Any change can be difficult, as one practice may have been in place for a century. In
summation, the theory of behavior is the most relatable to the overall community behavior change.
To support the efforts behind intervention and a program designed for decreasing healthcare associated infections evidence
based practices can be enhanced through public reporting, advisory councils, training promoting adherence of materials, financial
incentives to healthcare workers and ensuring patient safety (Astho, 2011). State policies placed for HAIs include public reporting,
financial support, financial incentives and facility licensure/training to increase education on infection control recommendations
(Astho, 2011). The state policies in place are supportive of community health issues as they provide a gateway into developing
changes and providing the services needed to address the issue at hand.
With this community health issue relating back to hospitals, the biggest incentive for a change in this area is that hospitals or
healthcare providers will not be allowed to receive payment from insurance providers once a patient is readmitted for a healthcare
associated infection. “Medicare will no longer pay hospitals for the additional costs associated with the care and treatment of hospital
acquired conditions (U.S. Department of Health and Human Services, 2013). As a former healthcare provider, this is by far one of the
biggest incentives to fully engage in policies/recommendations enforced by providers and the hospital board. While this also allows
for a gateway for education for staff, clinicians or providers to dedicate to their training and education materials for others.
Evaluation
The proposed logic model will assess the further evaluation and reassessment of HAIs to eventually work towards complete
elimination of MRSA and pneumonia associated with healthcare.
Program: _Eliminating HealthCare Associated Logic Model
Situation: HAIs of MRSA and Pneumonia
Inputs
O
u
t
c
o
m
e
s
I
m
p
a
c
t
Outputs
Activities
Participation
Short
Medium
Long
Federal Agencies
World Health Organization
Department of Health and
Human Services
Centers for Disease
Control and
Prevention
Agency for Healthcare
Research and Quality
National Institutes of
Health
National Healthcare Safety
Network
Emerging Infections
Programs
National Nosocomial
Infections
Surveillance system
American Hospital
Association Survey
Local Agencies
Health departments
Hospitals
Hospitalists
Nurses
Certified Nurse Aides
Provider offices
Infection control
Specialized surgeons
Assumptions
1. Develop an advisory
board
2. Develop local, state,
and national policies
3. Develop a
comprehensive
surveillance system
4. Identify challenges
1. Patient education
prior to operation
2. Healthcare provider
education
3. Increase in wound
education
External Factors
1. Use of proper
sterilization and
disinfection
2. Increase in
patient ambulation
3. Increase in
patient use of
incentive
spirometer
4. Increase in
patient deep
breath/cough
exercise
1. Increase in hand hygiene
measures
2. Increase in quality
scores/measures
3. Decrease in patient rehospitalization
4. Decrease in hospital
associated pneumonia
5. Decrease in hospital
associated MRSA
6. Re-evaluation of standards
and policies of healthcare
associated infections
7. Review of data analysis
Elimination of healthcare associated MRSA and pneumonia with the coordination
and collaboration of all participating stakeholders
To consider implementing a nation wide surveillance system and educational
training.
Innovation
The advantage to this approach for healthcare associated MRSA and pneumonia is that many practices and policies are in place
and further research, evaluation and development are left to fully eliminate this community health issue. While MRSA and pneumonia
can lead to mortality, the positive outlook is that healthcare associated infections are preventable and with proper measures taken the
rate of these infections will decrease.
The advantage to this program are to ensure the overall safety of patients and minimize health care associated infections that
can be controlled. The response of this program can ensure that facilities have the minimum requirements to reduce infections, core
components of infection control are implemented beginning at a national level and moving into specific health care settings, staff
education is mandatory and they are held accountable for the material, surveillance protocols are standardized across the board and
utilize patients in research to determine their involvement for making changes, reporting of HAIs and control of developing a HAI.
Limitations
The limitations with the approach to this community health issue is the underdevelopment in acquired data. However, with the
development and implementation of this program, national, state and local organizations and agencies can collectively coordinate
reports and gather statistics to fully understand the number of HAIs as these numbers are underreported to the National Nosocomial
Infections Surveillance system. “The rates from hospitals using NNIS could vary from other hospitals, these hospitals are affiliated
with academic institutions while a higher rate of infections might result in an overestimate of infections.(Klevens et.al, 2007) These
hospitals could include KU Research or KU Med that are associated with the University of Kansas in Lawrence, KS but would not
include reports from Lawrence Memorial Hospital as it is non-profit.
Providing a unified program to prevent, decrease and eliminate healthcare associated infections would provide a single
standardized criteria for diagnosing these specific hospital acquired infections as well as allow for public awareness when there are
epidemics, where currently this system does not exist but occurs separate based on individual organizations or countries/states.
References
Agency for Healthcare Research and Quality. (October 2009). AHRQ’s Efforts to Prevent and Reduce Health Care-Associated
Infections. Retrieved on November 26, 2014 from http://www.ahrq.gov/research/findings/factsheets/errors-safety/hairflyer/index.htm
Astho. (2011). Effective State Policy Interventions for the Prevention of Healthcare Associated Infections. Retrieved on November 26,
2014 from http://www.astho.org/Programs/Infectious-Disease/Healthcare-Associated-Infections/Poster--Effective-State-PolicyInterventions-for-the-Prevention-of-Healthcare-Associated-Infections/
California Department of Health. (27 November, 2013). Healthcare Associated Infections. Retrieved on November 26, 2014 from
http://www.cdph.ca.gov/programs/hai/Pages/HealthcareAssociatedInfections.aspx
Centers for Disease Control and Prevention. (3 April, 2014). General Information about MRSA in Healthcare Settings. Retrieved on
December 9, 2014 from http://www.cdc.gov/mrsa/healthcare/index.html
Centers for Disease Control and Prevention. (15 September, 2014). Data and Statistics. Retrieved on November 26, 2014 from
http://www.cdc.gov/hai/surveillance/
Cunha, B. (10 June, 2014). Nosocomial and Healthcare-Associated Pneumonia. Retrieved on December 8, 2014 from
http://emedicine.medscape.com/article/234753-overview#aw2aab6b5
Healthy People 2020. (8 December 2014). Healthcare Associated Infections. Retrieved on November 2, 2014 from
https://www.healthypeople.gov/2020/topics-objectives/topic/healthcare-associated-infections
Klevens, R., Edwards, J., Richards, C., Horan, T., Gaynes, R., Pollock, D., and Cardo, D. (2007). Estimating Health Care-Associated
Infections and Deaths in the U.S. Hospitals, 2002. Retrieved on November 26, 2014 from
http://www.ncbI.n1m.gov/pmc/articles/PMC1820440/
McLaren, L, and Hawe, P. (January 2005). Ecological Perspectives in Health Research. Retrieved on December 13, 2014 from
www.ncbI.nih.gov/pmc/articles/PMC1763359/
MRSA Research Center. (2014). Frequently Asked Questions about MRSA. Retrieved on December 9, 2014 from http://mrsaresearch-center.bsd.uchicago.edu/patients_families/faq.html
Office of Disease Prevention and Health Promotion. (26 November, 2014). Healthcare Associated Infections. Retrieved on November
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Pincock, T., Berstein, P., Warthman, S. and Hoist, E. (May 2012). Bundling hand hygiene interventions and measurement to decrease
health care associated infections. Retrieved on November 26, 2014 from http://www.ncbI.n1m.nih.gov/pubmed/22546269
Thompson, D., Makary, M., Dormon, T., and Pronovost, P. (April 2006). Clinical and Economic Outcomes of Hospital Acquired
Pneumonia in Intra-Abdominal Surgery Patients. Retrieved on December 9, 2014 from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448956/
U.S. Department of Health and Human Services. (1 November, 2013). Efforts to Reduce Healthcare Associated Infections. Retrieved
on November 26, 2014 from http://www.hhs.gov/asl/testify/2013/09/t20130923.html
U.S. Department of Health and Human Services. Physical Activity Evaluation Handbook. Atlanta, GA: US Department of Health and
Human Services, Centers for Disease Control and Prevention; 2002, Appendix 3, pg. 43.
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Wren, S. (30 November, 2010). A Strategy to Prevent Postoperative Pneumonia. Retrieved on December 9, 2014 from
http://www.physiciansweekly.com/a-strategy-to-prevent-postoperative-pneumonia/