Clinical governance can be defined as a framework by the help of which heath care organisations are responsible for improving the quality of the their services and upholding the highest standards of care. HAIs are one of the key performace indicators of the clinical governance process. A good clinical governance in a hospital setting would not permit the occurace of any kinds of infections within the hospital premises.
Health care associated infections are the type of infections that a person gets while in hospitals, long term facilities, ambulatory care and home care settings. The unanticipated infection that occurs in patients might result in significant illness in the patients, even causing death, prolonged hospital stays, additional therapeutic interventions and treatments that contribute to the cost burden (Lobdell, Stamou & Sanchez, 2012). The major type of nosocomial infections that can occur in hospitals are catheter-associated urinary tract infections, central line associated blood stream infection, surgical site infection and some ventilator associated events. According to Mehta et al., (2014), extensive hand hygiene techniques, using of the personal protective equipment and use of the antimicrobial agents and sanitizers have been found to be useful in preventing HAIs to some extent.
Research question: Does infection prevention program and adherence to proper infection prevention protocol among the health care professonals prevents health care associated infections in the hospital settings?
There are several papers describing the importance of the infection prevention protocols for the health care proffesionals to prevent HAIs. Three papaers have been chosen and CASP tool had been chosen for the critical analysis. A paper by Noto et al., (2015), has evaluated procedures like daily bathing with the antimicrobial agent chlorohexidine in the patients to prevent health care associated infections. The clinical question of the study was clearly focused interms of clinical question and the target population. A pragmatic clustered randomised control trial hasbeen conducted over 9340 patients admitted in 5 adult intensive care units of a tertiary medical care centre in Nashville, Tennessee, from July 2012 through July 2013. The research design of this study is appropriate and the sample size is also large , as RCTs are the most rigorous way to determine the cause and effect relationship between the treatment and the outcome and large sample size reduces the rate of response bias and increases the credibility of the paper. It generally reduces the bias while the testing of the interventions. The number of participants were enough for finding significant results. The interventions involved bathing of all the patients with diposabe cloths impregnated with 2% of cholorohexidine as the control. The interventions was contined for a 10 weeks period followed by a 2 weeks washout period when the patients were bathed with nonantimicrobial disposable cloth. All the test were 2-tailed with a significant threshold of about P<0.05, effective for these kinds of studies. However, as per the findings there was no significant reduction in the primary outcomes after the intermentions.
A systematic review and a metaanalysis has been covered by De Angelis et al., (2014), where 549 studies and 9 studies with 30949 participants have been included in the study. The main aim was to measure whether the nfection control and the prevention program is effective to reduce the spread of the hospital acquired Vancomycin-resistant enterococci (VRE) infection. Hence , the review addressed a clearly focussed question. A proper systematic review requires a correct searching of the databases using correct search startegies for searching relevant papers. MEDLINE, EMBASE and CINAHL databases were used for finding the studies. The level of evidence of the studies were low as only 1 randomised clinical tria had been used for the study. RCTs are generally placed at the highest level of evidences as it has got less probability of bias and systematic errors. The risk of bias has been assessed with the help of Cochrane Effective Practice and Organisation of Care (EPOC) group. Assessment of the heterogeneity of the studies had been rightfully done.All the papaers that has been included were not relevant. There was a lack of rigor of the studies that might have affected the results. The primary outcomes that has been considered are the VRE acquisition rate, the efficacy of the contact precautions in the prevention for preventing the VRE acquisition, the effectiveness of antibiotic formulary in preventing the VRE acquisition , efficiency in screening cultures in preventing the acquisition of the VRE. As the number of studies chosen were less in number the metaanalysis could not been applied for the surveillance screening.
Personal protective equipments play an important role in controlling the health care associated infections. They are specialised clothing or equipment that protect the health professionals from harmful pathogens on exposure to body fluids, blood and other potential infectious materials (Aguwa et al., 2016). Although each and the every clinical settings are accountable to follow specific guidelines for the use of the personal protective equipment, but it is questionable as of whether the health care workers or the nurses are properly trained for using the personal protective equipment. John et al., (2016), had conducted a survey in the Cleveland Veterans Medical centre with the physicians, nurses and the allied health professionals in order to understand their perception regarding the PPE training that was given to the new employees. Education about PPE donning and doffing was provided to the health care professionals. According to the recent studies, most health professionals use incorrect techniques of donning PPE, increasing the risks of contamination. The paper has suggested that sub optimal education for the correct donning of the PPE. As per the survey it was found that among the physicians, nurses and the health care workers, the nurses are likely to done gloves. Most of the nurses and the health care workers have admitted that there is a lack of proper training programs regarding the use of the PPE and the even if it is done, they are not done at the basic levels such as ways of wearing the basic protective equipment . There had been some recent cases of the Ebola virus acquisition that proves that despite of the use of the PPE, there is a need of improving the knowledge for developing more effective training strategies for the correct use of PPE (Fischer et al., 2013).
The results by Noto et al., (2015), are precise enough for making the decision as a non significant reduction in the hospital mortality was found (P=0.07)and hence made it easy to conclude the result. all the important outcomes has been considered, such as occurance of central line associated bloodstream infection , CAUTI, ventilator-associated pneumonia , or C difficile infection. The findings of the trial by Noto et al., (2015) demonstrated that daily bathing by chlorohexidine necessarily does not reduce the incidence of the health care associated infections like C. diffile, CLABSI or CAUTI. As per the findings of De Angelis et al., (2014), there were less evidences of ICP measures for reducing the VRE spread of infections. The paper by John et al., (2016), displays some limitations. The survey consisted of personnel from a single centre. Taking a larger sample size might have given a comprehensive picture regarding the experiences and the opinions. The findings of this paper can be supported by a paper by Aguwa et al., (2016), that have admitted that despite of the importance of the PPE in the disease prevention, no deliberate efforts are made by the health care authority to educate their workers on their use. Another factor that has been pointed out is the unavailability of the appropriate personal protective equipments (Pincock et al., 2012).
However from the two papers it can be stated that there are quite less evidences regarding the effectiveness of prevention programs and practices such as chlorohexidine bath . From the paper by John et al., (2016), It can be proved that there is a lck of proper trainng procedures for the nurses to prevent HAIs.
Conclusion
Health care associated infections are common in most of the developing countries with patients and the health care workers often dying from the infections. All the three papers have described the probable ways of preventing HAIs, the perception of the health personnel about the use and also suggests that there is a lack of comprehensive training procedures and it can be found that there is a need for the improvement in the practice and the perception of the infection control measures among the health care personnel, both for their own safety and the safety of the patient. The health care professionals will be able to uphold the systems and the strategies for the prevention of the infection and to limit the developments of the antimicrobial resistance by the prudent utilisation of the antimicrobials
References
Aguwa, E. N., Arinze-Onyia, S. U., & Ndu, A. (2016). Use of Personal Protective Equipment among Health Workers in a Tertiary Health Institution, South East Nigeria: Pre-Ebola Period. International Journal of Health Sciences and Research (IJHSR), 6(8), 12-18.
De Angelis, G., Cataldo, M. A., De Waure, C., Venturiello, S., La Torre, G., Cauda, R., … & Tacconelli, E. (2014). Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients: a systematic review and meta-analysis. Journal of Antimicrobial Chemotherapy, 69(5), 1185-1192.
Fischer, W. A., Hynes, N. A., & Perl, T. M. (2014). Protecting health care workers from Ebola: personal protective equipment is critical but is not enough. Annals of internal medicine, 161(10), 753-754.
John, A., Tomas, M. E., Cadnum, J. L., Mana, T. S., Jencson, A., Shaikh, A., … & Donskey, C. J. (2016). Are health care personnel trained in correct use of personal protective equipment?. American journal of infection control, 44(7), 840-842.
Lobdell, K. W., Stamou, S., & Sanchez, J. A. (2012). Hospital-acquired infections. Surgical Clinics, 92(1), 65-77.
Mehta, Y., Gupta, A., Todi, S., Myatra, S., Samaddar, D. P., Patil, V., Bhattacharya, P. K., … Ramasubban, S. (2014). Guidelines for prevention of hospital acquired infections. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 18(3), 149-63.
Noto, M. J., Domenico, H. J., Byrne, D. W., Talbot, T., Rice, T. W., Bernard, G. R., & Wheeler, A. P. (2015). Chlorhexidine bathing and health care–associated infections: a randomized clinical trial. Jama, 313(4), 369-378. doi:10.1001/jama.2014.18400
Pincock, T., Bernstein, P., Warthman, S., & Holst, E. (2012). Bundling hand hygiene interventions and measurement to decrease health care–associated infections. American journal of infection control, 40(4), S18-S27. https://www.taylorfrancis.com/books/e/9781498793575/chapters/10.1201%2F9781315375687-2
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