Nosocomial Infections
Sarah Hammer
DEA 453
Phase B
Table of Contents
Analysis
Synthesis
19
Invention
33
Bibliography
45
ANALYSIS
9This section includes a discussion of the literature describing the
importance of a reduction in the occurrence of nosocomial
infections and the benefits of hand hygiene in healthcare settings.
9Statistics and the significance of the research findings are
presented.
Analysis
Analysis
Nosocomial Infections
What are they?
Hospital-acquired infections
Infections which are a result of treatment
in a hospital or hospital-like setting, but
secondary to the patient's original condition
(Wikipedia, 2006)
Analysis
Nosocomial Infections
Why the focus?
2 million U.S. hospital patients are affected
In 1995, nosocomial infections
Cost $4.5 billion
Contributed to more than 88,000 deaths
Analysis
(Yalcin, 2003)
Analysis
Type of
Nosocomial
Infection
Pneumonia
Blood Stream
Surgical Site
Urinary Tract
0
10
15
20
25
30
Analysis
Type of
Nosocomial
Infection
Pneumonia
Blood Stream
26
28
30
32
34
36
Mortality Percentage
Analysis
10
11
Type of
Nosocomial
Infection
$10,000
$20,000
$30,000
$40,000
Cost
>Pneumonia: $4,947
Analysis
12
Analysis
13
Analysis
14
Hand Washing
Why the focus?
Analysis
15
Hand Washing
Even though we know that:
The most common way infections are spread is by staff
members touching a patient or contaminated piece of
equipment with their hands, then touching another patient
without washing their hands (Van Enk, 2006),
AND
The Centers for Disease Control and Prevention clearly
mandates that all healthcare personnel decontaminate their
hands as they enter a patients room and as they leave the
room (CDC, 2003),
Compliance of healthcare workers with recommended
handwashing practices remains unacceptably low, often in
the range of 30% to 50% (Boyce, 1999).
Analysis
16
Hand Washing
So why arent they washing?
Risk Factors for Noncompliance with Hand Hygiene
Being a physician or nursing assistant rather than a nurse
Being male
Working in an intensive care unit
Wearing gloves or a gown
Heavy workloads
Performing activities with high risk of cross-transmission
Having many opportunities for hand hygiene per hour of patient care
(Pittet, 2001)
Analysis
17
Hand Washing
So why arent they washing?
Perceived Barriers to Hand Hygiene: Reasons Reported by Healthcare
Workers for Not Washing their Hands
Skin irritation
Inaccessible supplies
Interference with worker-patient interaction
Wearing gloves
Forgetfulness
Ignorance of guidelines
Insufficient time
High workload and understaffing
Lack of scientific knowledge demonstrating benefits
Inconveniently located or insufficient number of sinks
Disagreement with guidelines
Analysis
(Pittet, 2001)
18
SYNTHESIS
9Presentation of a case study on Surgicare, part of the Cayuga Medical
Center, including data obtained through observation.
9Were any of the previously mentioned risk factors or barriers associated
with noncompliance with hand hygiene observed at Surgicare?
9Were additional factors observed?
Synthesis
19
Surgicare
entrance
Post-operative
suite: view of
bays 2-5.
Synthesis
20
21
Surgicare Stats
2 foot-pedal sinks
1 in pre-op; 1 in post-op; both
located outside of dressing rooms
Synthesis
ABHR
Dispenser
Lotion
Dispenser
Sink
23
Observation Results
Observed Hand Washing
12
10
8
# of times
6
used
4
2
0
ABHR
Sink
Method of Cleansing
Synthesis
36-45
45+
Age of Nurse
24
Observation Results
Where the Nurse Came from Just Before
Washing
7
6
5
# of Hand 4
Washings 3
2
1
0
6
# of times 5
Nurse
4
Came from
3
Bay and
2
then
Washed 1
0
Bay 1 Bay 2 Bay 3 Bay 4 Bay 5
Bay #
# of Bays Occupied
Synthesis
25
26
Check out
all of that
red!
Based on these
observations,
compliance rate
was only 20%!
Synthesis
27
Synthesis
Limitations
Because of patient privacy, there was no way to observe the activities that took
place in the bays when the curtains were closed. This fact has at least two
implications:
1.
It is impossible to tell whether or not the nurse used the ABHR dispenser
located in the bay upon entering and/or exiting. When nurses were
observed exiting the bay and then failed to wash their hands, it is possible
that they had already washed their hands with the ABHR dispenser inside of
the bay. This would make the actual rate of compliance higher than the
observed rate of compliance.
2.
The point of observation made it impossible to see into the nourishment room,
which featured a sink. The nurses were observed using this room very
frequently, but there was no way for the observer to know whether or not she
used the sink to wash her hands.
Synthesis
29
30
31
32
INVENTION
9 This section presents the current methods for solving the problem of
noncompliance. It also provides the results of these attempts to improve
hand hygiene.
9 The current methods for increasing compliance along with the results of
the case study help to create a solution that would increase the occurrence
of hand washing by the staff at Cayuga Medical Centers Surgicare facility.
Invention
33
Invention
34
Invention
35
36
37
Results Of Interventions
In a Pittet et al (2000) study that monitored overall compliance with hand hygiene
before and after the four interventions mentioned in the previous pages, a
sustained improvement in compliance with hand hygiene was found which also
coincided with a reduction in nosocomial infections.
Compliance with Hand Hygiene
20
70
60
50
40
Percent
Com pliance 30
20
10
0
15
Percent
10
Infection
5
0
Before Intervention After Intervention
Invention
Before Intervention
After Intervention
Results Of Interventions
The Clean Your Hands Campaign was also a multi-modal campaign consisting of the
previously mentioned strategies in order to improve compliance in a hospital in
England (Randle et al., 2006).
Compliance with Hand Hygiene
70
60
50
Percent
40
Com pliance 30
20
10
0
ABHR dispenser
use increased by
184%
Before
Interventions
After Interventions
Invention
39
Invention
40
Invention
41
Invention
42
Cross Transmission
Invention
43
Conclusion
Nosocomial infections are a significant burden on us all. They
cost significant amounts of money, and they also claim lives. There are
many ways that we can design healthcare environments to reduce the
occurrence of these types of infections. Improving compliance with
hand hygiene remains the single most important measure to prevent
nosocomial infections (Pittet, 2000).
Although these campaigns aimed at increasing hand washing
are costly, they are well worth the time, effort, and money spent. Most
importantly, lives will be saved and we will be able to erase nosocomial
infections from the list of leading causes of death. We will be able to
uphold the cardinal rule of medicine: First, do no harm. The
significant amount of money that will be saved can be put to better
uses: hospitals will be built or renovated, the latest technology will be
purchased, and patients will be attracted.
Invention
44
Bibliography
Author Unknown (2000). Surgicare. Retrieved on November 25, 2006 from
http://www.cayugamed.org/services/surgicaldetail.cfm#Surgicare
Author Unknown (2006). Nosocomial Infection. Retrieved on November 20, 2006
from http://en.wikipedia.org/wiki/Nosocomial_infection
Boyce, J. M. (1999). It is Time for Action: Improving Hand Hygiene in Hospitals.
Annals of Internal Medicine, 130 (2), 153-155.
Centers for Disease Control and Prevention (2003). Guidelines for Environmental
Infection Control in Health-Care Facilities: Recommendations of CDC and
the Healthcare Infection Control Practices Advisory Committee (HICPAC).
MMWR 52 (No. RR-10).
Institute of Medicine (2000). To Err is Human: Building a Safer Health System.
Washington, DC: National Academy Press.
Institute of Medicine (2001). Crossing the Quality Chasm: A New Health System for
the 21st Century. Washington, DC: National Academy Press.
Jarvis, W. R. (1996). Selected Aspects of the Socioeconomic Impact of Nosocomial
Infections: Morbidity, Mortality, Cost, and Prevention. Infection Control
and Hospital Epidemiology, 17 (8), 552-557.
45
Bibliography
Marberry, S. O. (Ed.). (2006). Improving Healthcare with Better Building
Design. ACHE Management Series, Health Administration Press.
Pittet, D. (2000). Effectiveness of a Hospital-Wide Programme to Improve
Compliance with Hand Hygiene. The Lancet, 356 (9238), 1307-1312.
Pittet, D. (2001). Improving Adherence to Hand Hygiene Practice: A
Multidisciplinary Approach. Emerging Infectious Diseases, 7 (2), 234238.
Randle, J., Clarke, M., Storr, J. (2006). Hand Hygiene compliance in Healthcare
Workers. Journal of Hospital Infections, 64, 205-209.
Van Enk, R. A. (2006). Modern Hospital Design for Infection Control.
Design Magazine, September 2006.
Healthcare
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