Hospital Infection Prevention and Control

This assignment delves into the critical topic of hospital infection prevention and control. It discusses various types of infections prevalent in hospitals, outlining their transmission routes and potential consequences. The document emphasizes the importance of implementing robust infection control measures, such as hand hygiene, environmental disinfection, and appropriate use of personal protective equipment. Furthermore, it explores challenges associated with infection control, including antimicrobial resistance and inadequate adherence to protocols. Finally, the assignment highlights best practices and strategies for minimizing hospital-acquired infections, ultimately aiming to enhance patient safety and well-being.

Running head: CRITICAL APPRAISAL
CRITICAL APPRAISAL ON HEALTH CARE ASSOCIATED INFECTION
Name of the Student
Name of the university
Author’s note

1CRITICAL APPRAISAL
Introduction
Medical advances have given life saving care to the patients, yet one of the main risks
associated to health care safety is the risk of infections. The unanticipated risks of infections may
develop during the course of a surgical treatment a may deteriorate the condition of the patient.
According to the consensus a large number of deaths are caused daily due to the HAI (Moore et
al.2012).
HAI may bring about unwanted mortality and may increase the time of the hospital stay.
The HAI necessitates additional costs and can increase the overall cost of the hospital stay.
Preventing HAIs is critical to patient. The risk of infection lies with any patient. Risk of infection
depends upon the immune capacity of a particular person, presence of invasive medical devices
such as catheter tubes and use of antibiotics. Proper preventive measures can help in mitigating
the chance of the HAI (Weber et al.2013)
Patients admitted in the health settings are subjected to risks of infections. From exposure
to microorganisms that are transmitted between the clinical staffs and the patients.
Overuse of antibiotics has increased the problems of HAI by giving rise to the antibiotic
resistant microorganisms. This paper aims to critically analyze three papers; a qualitative study, a
quantitative study and literature review related to the health care associated infections and their
nursing interventions (Polin et al.2012).
The NSQSH standard 3, refers to the prevention of the health care associated infections,
and has presented with guidelines to prevent the nosocomial infections in the inpatients (Moore
et al.2013).

2CRITICAL APPRAISAL
According to the guideline, prevention strategies like proper surveillance, application of proper
disinfection and sterilization techniques, antimicrobial steward ship and proper communication
between the patients and the carers can mitigate the possibilities of the health care associated
infections.
Critical appraisal
The CASP tool has been chosen for the critical appraisal of the three papers. CASP tools
are appropriate to help the individuals to make sense of research evidence and help them apply to
evidence based practice. CASP tools are normally used to appraise a paper critically and thus
help to solve the vagueness of any article. A critical research makes sure that all the ethical
considerations of the study have been met or whether the research has any beneficial
implications over mankind.
The Paper by Jackson et al (2012) is an interpretative qualitative study that will discuss
about the hospital acquired infections and the insufficient compliance of the guidelines by the
health care workers. This study uses vignettes to enquire the nurses about their initiative to
prevent the Health care associated infections. In this study twenty semi structured interviews
were being undertaken using vignettes and a topic guide. One of the limitations of this paper is
that it is a self practiced study, as most of the participants were keen to develop a good
impression and present themselves as responsible registered nurses. Therefore it can be
acknowledged that the practice of self report is biased. This strength of this study is due to the
use of the vignettes which can lessen the socially desirable responses. By allowing the nurses to
talk about their practice and the vignette character, some of the disparities between the subjective
and the objective data can be removed. For this study the formulation of the research questions,

3CRITICAL APPRAISAL
data collection methods were appropriate. All the ethical issues have been granted by the King's
college London. The research had been valuable as it actually proved how the irresponsible
behavior of the health care workers is related to nosocomial infections.
The literature review by Weber et al. (2013) reviews the role of the contaminated hospital
surfaces in the spread of the communicable diseases. The paper also demonstrated the how
scientific interventions can decrease the risks of microbial contamination and the HAIs.
MEDLINE, CINAHL databases have been brain stormed to search the literatures associated with
this issue. All the literature used in this study is pertinent to the topic of HAIs. The results
obtained from all the studies form all the studies were quite similar. Al most all the studies
concluded that enhanced education, checklists and procedures to evaluate the effectiveness of
room cleaning along with the immediate feedback to the in charge can lead to the mitigation of
the HAIs.
The quantitative study by Anderson et al (2012), aims to identify and prioritize the risks
and hazards in the surgical wards and the possible recommendations to prevent the sentinel
events. Seventy hours of observations have been done and the severity and the frequencies of the
severity of the surgical infections have been identified and documented. The strength of this
paper is that this was the first systematic proactive analysis of the surgical wards. In this paper
the exposures were subjected to minimum bias. All the confounding factors have been addressed
properly. Ethical clearance has been received. The time period for the follow up was enough for
the assessment.

4CRITICAL APPRAISAL
Critical analysis
The qualitative study by Jackson et al. (2012) indicated that the behavior of the nurses
and other clinical workers to the prevention of the HAIs were quite harmful. although the
clinical staffs present themselves that they desire to protect the safety of the patient, but the
underlying facts supports that one of the driving factor for the spread of the infections are due to
lack of compliance with the guidelines. According to the study, spread of infection is associated
with the lack of understanding among the health care staffs. Studies have shown that in most of
the cases the health care staffs does not have any guidelines regarding the hand washing
procedures and practice. As per the study by Weber et al. (2013) it is necessary to maintain
cleanliness in the hospital surfaces as infections can also spread through them. According to
Moore et al (2013) Inadequate hand and hygiene, improper disposition of the used apron and
gloves and any equipment that can be moved from bed to bed bear high risks of infection.
Polin et al. (2012) have emphasized on the following that it is important to disinfect the
surgical instrument and clean the site of the surgery to prevent infection to the next patient.
According to Otter et al.(2013) the operating theatres should be cleaned with wet vacuum and
clean air should be supplied with the help of the high efficiency particulate air filters (HEPA).
According to Wunderink et al. (2012) infections can also spread while the meeting of the staffs
in hand during the changeover of shifts.
Huttner et al. (2013) have emphasized on the "No-touch" methods of surface disinfection.
Hospital rooms can be disinfected by using Ultraviolet lights or hydrogen peroxides, both of
them have bactericidal effects (Otter et al. 2013). According to Carling (2013) self disinfecting
surface can be created by coating the surfaces with metals such as silver or copper, both of which

5CRITICAL APPRAISAL
have microbicidal properties. It has been seen that coated surfaces in hospital settings have
reduced the risk of the HAIs that spread through contaminated surfaces.
Reports suggest that despite of the education and training among the workers, there lacks
self motivation among the staffs (Wunderink et al. 2012). It has been argued that self protection
in the staffs can be called upon as a motivating factor for the prevention of infection among the
patients and the workers. It has been found that in most of the cases the nurses rationalize their
own behavior by finding flaws in other's practice. This study reveals that the patients often fail to
change their gloves while attending different patients.
Hence it can be concluded that Education in the clinical staffs, use of effective antimicrobial
substances in hospital surfaces and the surgical sites, effective disposition of the used substances,
maintenance of hand and hygiene and self education in patients can reduce the rates of mortality
and morbidity due to HAI.

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Summary table
Author/s,
(year)
Country
Aims Sample/
Setting
Designs/
methods
Main Findings Strengths
and
limitation
of study
1 Jackson et
al. 2014
United
Kingdom
To understand
the relation
between the
health care
associated
infections and
problems in
the clinical
staffs
regarding the
lack of
compliance
with the
guidelines.
The
registered
nurses
working in
the hospital
settings.
Qualitative
study.
20
interviews
were
conducted
using a
vignette and
a topic guide
The findings shows the
clinical staffs did not
comply by the
guidelines of hygiene.
Strengths:
Use of the
vignettes
which can
lessen the
socially
desirable
responses.
Limitations:
practice of
self report is
biased
2 Weber et al.
2013
United
States
Role of the
contamination
of the hospital
surfaces in the
transmission
of the
Literature
review on
publications
searched
from
MEDLINE
Literature
review on a
recent
literature
that is
related to
Vancomycin-resistant
Enterococcus spp
(VRE),Staphylococcus
aureus (MRSA), ,
Clostridium difficile,
norovirus and
Strengths:
Minimum
bias, wide
spread
literature
search,

7CRITICAL APPRAISAL
pathogens and
the possible
interventions
to reduce the
chance.
and
CINAHL
the topic. Acinetobacter spp, can
spread through
contaminated surface.
Improved disinfection
and surface cleaning
can reduce the
transmission of the
harmful pathogens.
Ethical
approval
received.
Implications
in the
environment.
Limitations:
The number
of articles
taken has not
been
mentioned.
3 Anderson
et al.2012
United
Kingdom
To determine
and prioritize
the hazards
due to
infections in
the surgical
wards and the
interventions.
Seventy
hours of
observation
has been
conducted in
the surgical
wards. The
mode of the
health care
failure and
effect
analysis was
performed .
Quantitative
study. A risk
assessment
survey was
performed
between
fifty nine
patients and
staffs.
Among the hazardous
events, the 5 most
hazardous event was
related to hand
hygiene, isolation of
infections and disposal
of surgical wastes.
Strengths:
It was the
first study to
conduct a
systematic
risk
assessment of
the surgical
wards. The
results are
supported by
other's
reports.
Ethical

8CRITICAL APPRAISAL
approval
received.
Limitations:
All the
sentinel
events were
not recorded
and the
sample size
was not
adequate.

9CRITICAL APPRAISAL
References
Anderson, O., Brodie, A., Vincent, C.A. and Hanna, G.B., 2012. A systematic proactive risk
assessment of hazards in surgical wards: a quantitative study. Annals of surgery, 255(6),
pp.1086-1092.
Carling, P., 2013. Methods for assessing the adequacy of practice and improving room
disinfection. American journal of infection control, 41(5), pp.S20-S25.
Huttner, A., Harbarth, S., Carlet, J., Cosgrove, S., Goossens, H., Holmes, A., Jarlier, V., Voss, A.
and Pittet, D., 2013. Antimicrobial resistance: a global view from the 2013 World Healthcare-
Associated Infections Forum. Antimicrobial resistance and infection control, 2(1), p.31.
Jackson, C., Lowton, K. and Griffiths, P., 2014. Infection prevention as “a show”: a qualitative
study of nurses’ infection prevention behaviours. International journal of nursing studies, 51(3),
pp.400-408.
Moore, G., Muzslay, M. and Wilson, A.P.R., 2013. The type, level, and distribution of
microorganisms within the ward environment: a zonal analysis of an intensive care unit and a
gastrointestinal surgical ward. Infection Control & Hospital Epidemiology, 34(5), pp.500-506.
Otter, J.A., Yezli, S., Perl, T.M., Barbut, F. and French, G.L., 2013. The role of ‘no-
touch’automated room disinfection systems in infection prevention and control. Journal of
Hospital Infection, 83(1), pp.1-13.