Infection Risk Management: Fundamentals, Microorganisms, Impact, Prevention, and Antimicrobial Stewardship

Hospital-acquired infections are preventable and pose a great risk to patients, hospital staff, and the community. Infection prevention control measures and encouraging hospital staff to wash their hands would decrease these infections. Learn about the microorganisms associated with hospital-acquired infections, their impact on patients, facility, and staff, prevention methods, and antimicrobial stewardship.

INFECTION RISK MANAGEMENT 1
FUNDAMENTALS OF INFECTION RISK MANAGEMENT
Name:
Institutional affiliation

INFECTION RISK MANAGEMENT 2
INTRODUCTION
Hospital-acquired infections refer to patients acquire during their hospitalization period.
They are attributed to microorganisms which are present in the hospital equipment, health
workers may also be infected or even the patient themselves. These are among the preventable
infections affecting patients who have been hospitalized. Stringent infection prevention control
measures and encouraging hospital staff to wash their hands would decrease these infections.
INFECTION AND MICROORGANISMS
According to(Center for Disease Control and Prevention,2012) some of the
microorganisms associated with hospital-acquired infections include Clostridium difficile,
Methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella. The
prevalence rate of hospital-acquired infections in New Zealand is 10% of the patients who are
admitted to New Zealand hospitals (Baker et al,2012). This not only increases the mortality rate
but also increases the costs of healthcare burden on the patients and the country as well. It is
therefore important to ensure these rates are decreased as they pose a great risk to new
admissions, hospital staff and the community at large.
RATE AND IMPACT OF HAI ON PATIENT, FACILITY AND STAFF
(Graves, Nicholls, and Morris,2012) state that in a study conducted in Auckland District
health board Hospitals showed that the prevalence rate of HAI among patients was 9.5%. This
leads to prolonged hospital stays, increased chances of disability, high costs for the patients and

INFECTION RISK MANAGEMENT 3
unnecessary and avoidable deaths. (World Health Organization,2012) ventilator-associated
pneumonia has a mortality rate of between 7% to 30%.
Healthcare workers are in direct contact with the patient most of the time and maybe a
channel of transmitting infections from one patient to another especially if hand hygiene is not
observed. Also, healthcare workers might harbor microorganisms which might be transmitted to
the patients during their hospitalization. (Price et al,2017) conducted a study on transmission of
Staphylococcus Aureus between healthcare workers and patients and it was observed with
effective infection prevention measure the workers were rare sources of transmission. The
impact of HAI on staff is poor output while providing services especially if they are
symptomatic. It may affect their personal lives as well and spread of infection into the
community. Staff may unknowingly be transmitting HAI especially if they are not practicing the
right infection prevention measures.
Hospital facilities should be on the forefront to set policies and surveillance systems to
monitor HAI. According to a study done in a public hospital in Auckland, New Zealand out of
271 patients, 21 patients developed hospital-acquired infections ranging from urinary tract
infections, wound infections, lower respiratory tract infections and Clostridium difficile colitis
(Read & Bhally,2015). This is majorly due to overcrowding of patients causing poor hygiene and
poor ventilation increasing HAI occurrence. Understaffing also contributes to HAI in that staff
who are available have a heavy workload compromising on infection prevention standards in
order to serve all the patients. Inadequate resources such as hand washing areas strategically
positioned may also increase the chances of HAI transmission. The impact of HAI on hospitals is
increased financial costs in eliminating the infection. The hospital also faces the risk of legal

INFECTION RISK MANAGEMENT 4
implications such as being sued by a patient who acquired an infection during the course of their
hospitalization. The hospital also becomes a transmission point for hospital-acquired infection to
newly admitted patients causing a new cycle of infection.
INFECTION & CONTROL PRACTICE
Urinary tract infection is among the common hospital-acquired infections.
(Klevens,2008) states that in the United States the mortality due to urinary tract infections is
2.3% and increases to 10% when the infection spreads to the blood bacteremia. Urinary tract
infections are mostly attributed to the use of indwelling catheters. A catheter is used to relieve
urinary obstruction and can also be used for diagnostic purposes such as bladder irrigation and
collection of urine culture for laboratory investigation. Most healthcare workers, however, lack
the knowledge on the indication of inserting a catheter. According to (Jain et.al,2015) only 57%
of hospital staff in his research could identify steps to prevent catheter-associated urinary tract
infections. The catheter contributes to urinary tract infection in that during insertion septic
technique is not observed leading to the introduction of microorganisms into the urinary tract.
Also when the urine bag is full there is backflow of urine causing stasis hence change of pH and
a urinary tract infection ensues. Moreso if proper perineal care is not given a urinary tract
infection may occur. A catheter should be changed based on clinical indications such as blockage
or obstruction (CDC,2012). Also, catheters are not removed on time causing a high risk of
infection.
Nurses and physicians should have knowledge of indications of catheter insertion.
According to (Saint et al,2008) 90% of healthcare workers are aware of catheter care measures
but were not aware of measures such as the use of alcohol hand rub before and after catheter

INFECTION RISK MANAGEMENT 5
care. These indicate the need for continuous medical education for hospital staff regarding
evidence-based protocol for catheter insertion, catheter care, and catheter removal.
Control practice involves policies designed to reduce catheter-associated urinary tract
infection. Use of the catheter-associated urinary tract infection bundle. This bundle comprises of
handwashing before and after insertion of the catheter, ensuring insertion of the catheter is done
in a sterile procedure, avoiding unnecessary insertion of urinary catheters, use of standards
guidelines in the maintenance of the catheter, daily assessment of catheter and earliest removal
of the catheter. The bundle also involves the use of an ultrasound to determine if there is a
necessity of inserting the catheter. According to (HanCHett& Rn,2012) CAUTI bundle also
involves maintaining unobstructed urine flow, the drainage bag should be below the bladder
level and the catheter should be secured to prevent irritation of the bladder. This intervention is
applied simultaneously would prevent the rates of infection since they focus on assessing the
need of a catheter insertion, hand hygiene before insertion of the catheter, aseptic technique
while inserting the catheter, care of the catheter and prompt removal of the catheter. The bundle
is relevant since it is an all-around approach that considers the patient as the primary focus who
should be discharged from the hospital infection free. The bundle is easily applicable as its steps
can easily be grasped and retained by health care workers. According to (Clarke et.al,2013)
CAUTI bundle is simple and cost effective therefore can easily be assimilated in hospitals. Also,
this bundle comprises several interventions put together and therefore makes it easier to
implement. CAUTI bundle is important since its prevention would save the economic burden of
treating the infection. According to (Simmering et.al,2011) the cost of treating hospitalizations
due to UTIs was $2.8 billion.

INFECTION RISK MANAGEMENT 6
IMPLICATIONS OF ANTIMICROBIAL STEWARDSHIP
Antimicrobial stewardship refers to various measures set in place to reduce unnecessary
dispensing of antibiotics in an effort to reduce antibiotic resistance and cut down the costs.
According to (Gardiner, Pryer& Duffy2017) antimicrobial stewardship programs in hospitals in
New Zealand has been positive. Some of the microorganisms causing hospital-acquired
infections are drug-resistant for example carbapenem-resistant Enterobacteriaceae, Enterococcus
faecalis, Staphylococcus aureus and Enterococci. Increased use of antibiotics causes the
production of strains of microorganisms resistant to antibiotics. This complicates treatment and
management of such infections. Appropriate use of antibiotics promotes optimal patient
outcomes. (Neidell et.al ,2012) antibiotic resistance is among the major consequences associated
with hospital-acquired infections. Antibiotic stewardship which involves a diagnosis of a
bacterial disease, consideration of nonantibiotics and judicious administration of antibiotics and
would slow down the rate of antibiotic resistance. Antibiotic resistance refers to the persistence
of an infection despite treatment using the first line drugs indicated for the infection. This may
cause the physician to then prescribe second line or third line drugs which comes with
consequences such as severe drug side effects and a high and extra cost of treating an infection.
Antimicrobial stewardship would foresee a smooth successful treatment in hospital-
acquired infections since causative microorganisms would be sensitive to first-line treatment.
Laboratory investigation of samples before administering an antibiotic would enhance the
administration of the right antibiotics. According to (Doron and Davidson,2011) treatment of
infections with the right drug would decrease antimicrobial resistance and easier management of
hospital-acquired infections.

INFECTION RISK MANAGEMENT 7
INFECTION PREVENTION METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS
The Ministry of Health in New Zealand recommends isolation of patients suspected to be
positive with MRSA before admission in hospital. Hospital staff who are expected to be in
contact with patients should also be screened for MRSA. The management of patients with
MRSA includes hand hygiene before and after contact. The patient with MRSA should be
isolated in his own room with a full suite while if there are multiple patients they should be in a
single unit but consideration of their comorbidities put in place to prevent cross infection. Use of
protective equipment such as gowns and masks are highly recommended.
International guidelines according to the center of disease control and prevention include
hand hygiene regardless of whether gloves were worn or not. The use of gloves is recommended
and a change of gloves after procedures ensuring no hand contamination. There should be proper
handling of laundry since they can transmit infections caused by MRSA. The CDC recommends
that while transporting a patient with MRSA infected areas should be covered. There should be
the use of disposable items specific for the patient and in cases where this is not possible the
equipment should be properly disinfected before the next use. If the patient is for dialysis it
should be done a few stations away from others. The patient should be isolated in a private room
and if this is not possible the single unit with other patients with MRSA should not have other
infections. Finally, the patient’s environment should be disinfected regularly while using
personal protective equipment.
CONCLUSION
Hospital-acquired infections are not only devastating to the patient but also to the
healthcare workers and community in general. They are further complicated by antibiotic

INFECTION RISK MANAGEMENT 8
resistance and comorbidities. It is therefore important to prevent their occurrence and prompt
management when they occur. Health care workers should also be involved in making policies
that are can easily be implemented

INFECTION RISK MANAGEMENT 9
REFERENCES
Baker, M. G., Barnard, L. T., Kvalsvig, A., Verrall, A., Zhang, J., Keall, M., ... & Howden-
Chapman, P. (2012). Increasing incidence of serious infectious diseases and inequalities in
New Zealand: a national epidemiological study. The Lancet, 379(9821), 1112-1119
Centers for Disease Control, & Prevention (US). (2012). Morbidity and mortality weekly report:
MMWR (Vol. 38, No. 53). US Department of Health, Education, and Welfare, Public Health
Service, Center for Disease Control.
Clarke, K., Tong, D., Pan, Y., Easley, K. A., Norrick, B., Ko, C., ... & Stein, J. (2013). Reduction in
catheter-associated urinary tract infections by bundling interventions. International Journal
for Quality in Health Care, 25(1), 43-49.
Doron, S., & Davidson, L. E. (2011, November). Antimicrobial stewardship. In Mayo Clinic
Proceedings (Vol. 86, No. 11, pp. 1113-1123). Elsevier.
Gardiner, S. J., Pryer, J. A., & Duffy, E. J. (2017). Survey of antimicrobial stewardship practices in
public hospitals in New Zealand district health boards. Infection, 20, 100.
Graves, N., Nicholls, T. M., & Morris, A. J. (2012). Modeling the costs of hospital-acquired
infections in New Zealand. Infection Control & Hospital Epidemiology, 24(3), 214-223.
HanCHett, M., & Rn, M. (2012). Preventing CAUTI: A patient-centered approach. Prevention, 43,
42-50.
Jain, M., Dogra, V., Mishra, B., Thakur, A., & Loomba, P. S. (2015). Knowledge and attitude of
doctors and nurses regarding indication for catheterization and prevention of catheter-

INFECTION RISK MANAGEMENT 10
associated urinary tract infection in a tertiary care hospital. Indian journal of critical care
medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine,
19(2), 76.
Klevens, R. M., Edwards, J. R., Richards Jr, C. L., Horan, T. C., Gaynes, R. P., Pollock, D. A., &
Cardo, D. M. (2008). Estimating health care-associated infections and deaths in US hospitals,
2007. Public health reports, 122(2), 160-166.
Neidell, M. J., Cohen, B., Furuya, Y., Hill, J., Jeon, C. Y., Glied, S., & Larson, E. L. (2012). Costs of
healthcare-and community-associated infections with antimicrobial-resistant versus
antimicrobial-susceptible organisms. Clinical Infectious Diseases, 55(6), 807-815.
Price, J. R., Cole, K., Bexley, A., Kostiou, V., Eyre, D. W., Golubchik, T., ... & Llewelyn, M. J.
(2017). Transmission of Staphylococcus aureus between health-care workers, the
environment, and patients in an intensive care unit: a longitudinal cohort study based on
whole-genome sequencing. The Lancet Infectious Diseases, 17(2), 207-214.
Read, K., & Bhally, H. (2015). 'Real-time'burden of community and healthcarerelated infections in
medical and rehabilitation patients in a public hospital in Auckland, New Zealand. The New
Zealand Medical Journal (Online), 128(1426), 69.
Saint, S., Kowalski, C. P., Kaufman, S. R., Hofer, T. P., Kauffman, C. A., Olmsted, R. N., ... &
Krein, S. L. (2008). Preventing hospital-acquired urinary tract infection in the United States:
a national study. Clinical Infectious Diseases, 46(2), 243-250.
Simmering, J. E., Tang, F., Cavanaugh, J. E., Polgreen, L. A., & Polgreen, P. M. (2017, January).
The increase in hospitalizations for urinary tract infections and the associated costs in the

INFECTION RISK MANAGEMENT 11
United States, 1998–2011. In Open forum infectious diseases (Vol. 4, No. 1). Oxford
University Press.
World Health Organization. (2012). Prevention of hospital-acquired infections: a practical guide.