The Impact Of Nosocomial Infections Nursing Essay
Nosocomial infections are hospital acquired infections. A nosocomial infection can be defined as: "An infection acquired in hospital by a patient who was admitted for a reason other than that infection. An infection occurring in a patient in a hospital or other healthcare facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility." (WHO 2002)
According to Inweregbu et al. (2005); "nosocomial infections are also defined as those occurring within 48 hours of hospital admission, 3 days of discharge or 30 days of an operation. They affect 1 in 10 patients admitted to hospital." Although hospitals now have infection control policies, the amount of patient deaths and suffering from hospital acquired infections is particularly high. Nosocomial infections are different from non-nosocomial infections because they are contracted by patients or staff in a hospital setting. Other infections are attained elsewhere outside of a hospital.
In recent years, hospitals have done a lot to put measures in place to tackle the rate of infection, particularly for hospital ‘super-bugs’ such as MRSA and C. difficile, and the effort has paid off, because infection rates of these two infections in particular have dropped. In a major report compiled by the Health Protection Agency, they state that cases of C. difficile fell from 2% of patients being infected in 2006 to 0.4% in 2012, and cases of MRSA fell from 1.8% in 2006 to less than 0.1% in 2012. However other infections, caused by bacteria such as E. coli and Salmonella are on the rise. They found that the most common infections are those affecting the respiratory tract, followed by UTIs (Urinary Tract Infections) and SSIs (Surgical Site Infections). The elderly and new- born babies are the most likely to have healthcare acquired infections, and infection rates were found to be highest in ICUs (Intensive Care Units) and on surgical wards. The HPA says that measures put in place to tackle MRSA and C. difficile have driven down infection rates, but now efforts need to be made to tackle new infections whilst maintaining the improvements already seen. (NHS Choices, 2012)
Nosocomial infections are the result of the presence of microorganisms in the hospital environment, the transmission of pathogens between staff and patients, especially patients with compromised immune systems. When infection is passed from person to person, whether that is from a patient to another patient, or from a member of staff to another patient, this is called exogenous infection, or cross-infection. This could occur when, for example a nurse has been to dress the wounds of a patient and moves on to dress another patient’s wounds without washing her hands. If there were any infection causing bacteria in the wound of the first patient, she could pass on the infection to the second patient, thus spreading infection. This is why hygiene and hand washing is paramount in hospitals.
Self-infection is called endogenous infection, and is defined as "an infection caused by an infectious agent that is already present in the body, but has previously been unapparent or dormant." (Saunders, 2007) A common type of endogenous infection is UTIs, which are caused by bacteria that live in the digestive system, when the bacteria gets into the urethra and causes infection.
Environmental infection is when the microorganism is acquired from an inanimate object or substances recently contaminated by another person. This includes a whole host of ways to contract infection, including: from food, air, dust, IV (intravenous) fluids, catheters, washbowls, water, endoscopes and ventilators/respiratory equipment.
In order for microorganisms to grow and spread, they must have the right environmental factors for growth, which are: water, oxygen (if aerobic), food (or nutrients), certain temperatures, lack of light (microorganisms tend to thrive in dark environments e.g. in the body, and UV light kills some bacteria) and the correct pH. The microorganisms also have a reservoir where they live and multiply which can be in an environment, a person or an animal. To cause infection the microorganisms must have a way into the body, and in order to infect another person, it must have a way out too. Some of the portals of entry and exit for pathogens in the human body include: the respiratory tract – inhalation and exhalation; the gastrointestinal tract – ingestion and excretion; the reproductive system – sexually transmitted; the skin and mucous membranes – inoculation; the urinary tract – sexually transmitted and excretion; and the blood – congenital and trauma. (Mallik et al. 2004)
The patient or host does not always develop an infection from the microorganism; people with this trait are often called "carriers" as they carry the microorganism, and can infect other people, but don’t necessarily suffer themselves. An example of this is hepatitis B; approximately 10% of people have had the hepatitis B virus in their blood, but have shown no symptoms. (Mallik et al. 2004)
An individual’s susceptibility to infection varies, but when a person is already a patient in hospital they are more likely to have a compromised immune system and therefore will not be able to fight off infection as well as they would do when normally fit and well. Those most at risk, as stated earlier, are people at both poles of life; the very young and the very old. People undergoing chemotherapy treatment for cancer are also a high risk group for acquiring nosocomial infections, as the chemotherapy diminishes the amount of white blood cells the body has, which are used to fight infection. Some cancer patients are given antibiotics as a precaution to prevent infection, but when the signs of infection appear in a chemotherapy patient, they must be treated as soon as possible, because it can become a very dangerous infection within a few hours, as their body has little or no way of fighting it off.
The impact of hospital acquired infections is no doubt a burden on the NHS in terms of cost, morbidity and mortality. According to Bourn (2000), around one in eleven patients at any one time has an infection caught in hospital, there are at least 100,000 hospital infections a year, they cost the NHS hundreds of millions of pounds a year and they can mean several extra days in hospital. Nosocomial infections not only cost the NHS financially and affect services, but they also have a profound impact on the patient and their families. If a patient who goes into hospital for a routine operation contracts a hospital born infection, it can affect many parts of their life, for example their family will be affected by grief and worry, and the patient (if they work) will have to take more sick leave from employment, affecting their income and possibly other family members such as their partner having to manage household bills without them. It could also affect the patient’s children, as childcare would need to be taken care of whilst they are in hospital, and it could also affect the mental well-being of the patient. They may become more stressed about their current situation, or feel low and depressed about being more ill than they were when they initially entered hospital care.
Although nosocomial infections still do present a problem for many hospitals in the UK, there are measures which can be taken to prevent the spread of infection. These range from the very basics of hand washing, to the more complicated processes of surveillance of hospital infections. Hand hygiene is top priority in healthcare settings, as it has been now recognised that the healthcare professional could be a vector for infection, whereas in early medicine this was unknown. Most hospitals and even GP surgeries in the UK now have alcohol hand gel dispensers widely spread throughout buildings. The government has even backed the need for hand hygiene in recent years with nationwide campaigns such as the "catch it, bin it, kill it" campaign to reduce flu infections. Other methods of preventing the spread of nosocomial infections include: good practice in disinfection, proper management of medical waste, isolation precautions, prevention of catheter infections, infection control in ICUs, personal hygiene (staff and patients), regular disinfection and sterilisation, hospital environmental cleaning and good antibiotics practice.
Nosocomial infections are becoming an increasingly important issue in public health, as there is an increasing amount of bacteria resistant to antibiotics. This, teamed with the sheer numbers of people in hospitals, most of whom have vulnerable immune systems and the fact that there has been a discovery void of new antibiotics since the 1980’s spells out a dangerous threat to the future health of the UK. In an article for the BBC by Walsh (2013), Dame Sally Davies describes this issue as a "ticking time bomb" and warns that "routine operations could become deadly in just 20 years if we lose the ability to fight infection." In the article Davies goes on to say other infections are on the rise, E. coli and Klebsiella both having risen by two thirds in recent years. They are both gram negative bacteria and are carried in the bowels, however they have a high risk of entering the blood stream and when they do they are likely to cause septicaemia. Many strains of these two bacteria are antimicrobial resistant, and the current death rate is double if you have an antimicrobial resistant strain than if you don’t, but the death rate is still significant for those without the resistant strain, at 15% of patients with the infection die. In England, Wales and Northern Ireland, 99,000 cases of blood stream infections were reported in 2011-12, and E. coli alone accounted for 36% of the cases compared with just 1.6% due to the hospital superbug MRSA.
The World Health Organisation (2002) states: "While progress in the prevention of nosocomial infections has been made, changes in the medical practice continually present new opportunities for the development of infection." Therefore it is vital that all individuals at the forefront of the healthcare profession take responsibility for ensuring the prevention of nosocomial infections. This can be achieved if staff on all levels (from higher management to healthcare assistants) work co-operatively to reduce the risk of infection. By adhering to infection control policies in their area of work, for instance on wards and in surgical theatres, they will help to keep nosocomial infections to a minimum. Such policies are most effective when thorough staff training is provided and measures are taken to ensure the completion of surveillance and prevention activities.