CLINICAL GOVERNANCE: Health Care Associated Infections

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Running head: CLINICAL GOVERNANCE
CLINICAL GOVERNANCE
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CLINICAL GOVERNANCE
Health care associated infections
Introduction
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?

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Critiquing of the literature
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

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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