Nosocomial Infections | Report

Running head: NURSING ASSIGNMENT 1
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NURSING ASSIGNMENT 2
Table of Contents
Introduction:....................................................................................................................................2
Content analysis:..............................................................................................................................2
Selected problem: Infection control and related policies:...........................................................2
Existing policies and their implication:.......................................................................................3
Associated health status:..............................................................................................................4
Quality standard and infection control........................................................................................5
Measures to improve compliance:...............................................................................................5
Conclusion:......................................................................................................................................8
References:......................................................................................................................................9

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Introduction:
Nosocomial infections attribute to one of the leading causes of death in Australia.
According to Salmon et al. (2015), nosocomial infections can be defined as the infections
acquired within the healthcare setting. The word ‘nosocomial’ is tightly linked to the infections
that arise within a hospital setting and is also referred to as hospital acquired infections. The
causative organisms that cause nosocomial infections are usually antibiotic resistant. In other
words, a nosocomial infection is one that was not present earlier but manifested itself within the
patient post 72 hours of admission within the hospital (Hor et al., 2017). Research studies
mention that the bacterium Clostridium difficle has been identified as the primary cause of
nosocomial infections which lead to diarrhea in admitted patients within U.S and Europe (White
et al., 2015; Salmon et al., 2015). Research studies suggest that the rate of mortality on account
of healthcare associated infections can exceed 50% and the central regions where such infections
occur are in case of ventilator associated pneumonia as well as infections occurring while the
patient is linked to the central line of healing (Grayson et al., 2018; Russo et al., 2018).
Content analysis:
Selected problem: Infection control and related policies:
Another common causative organism is Methicillin-resistant Staphylococcus aureus
which belongs to the staph type of bacterial strain and is resistant to a broad spectrum of
antibiotics (Grayson et al., 2018). A large percentage of nosocomial infections within Australian
healthcare settings have been reported to be caused by Staphylococcus aureus. According to a
report published by the Australian Bureau of Statistics in the year 2019, it has been stated that
approximately 200,000 deaths occur every year due to hospital acquired infections (Russo et al.,
2018). Overall infectious disorders have enhanced the disease burden and have also enhanced the
overall healthcare costs related to patient care delivery (Russo et al., 2018). Nosocomial
infections significantly impact on the quality of the patient care and contribute to the rise in
health care costs within the Australian healthcare system. Research studies in this regard have
mentioned that the primary challenge associated with the management of healthcare associated
cost is increased rapidly by the acquired property of antibiotic resistance. In this regard, it should

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be mentioned that contaminated healthcare environment and care professionals are tightly
associated with the transmission of the microbial infection to healthy patients. The most
commonly spread infection is due to the pathogen Clostridium difficle and the challenging
property in relation to the control of the microbial organism is its prolonged action effect and
antibiotic resistant property. Considering the infection burden and the manner in which it limits
the quality of life of the patients, it is increasingly important to integrate infection control
policies that would help to control the rate of infection and at the same time ensure that quality of
life of the patients is not compromised. In light of the same, a number of core components have
been integrated within the Australian healthcare system that includes, antiobiotic stewardship,
enhanced cleanliness and hygiene maintenance of the hospital and improved compliance of hand
hygiene routine. Typically, in this regard it should be mentioned that antibiotic stewardship is
increasingly encouraged within the healthcare organizations and it covers the property of reduced
use of antibiotics so as to ensure that the infection causing microorganisms do not acquire
antibiotic resistance. The infection control strategies are specifically designed in order to prevent
the antibiotic resistance of methicillin-resistant Staphylococcus Aureus and Vancomycin
resistant Enterococcus spp. The major steps that can be taken to effectively reduce the healthcare
associated infection include; patient segregation for specific ailments such as influenza and
virulent infections and precaution against infection due to adherence to droplets by the usage of
protective personal equipment such as gloves and masks. Thorough steps need to be undertaken
while respiratory disorder associated equipment are being administered to the patients such as
nebulization kits in order to effectively reduce the probability of acquiring nosocomial infection
(Hor et al., 2017). In addition to this, effective sterilization methods such as dry heat sterilization,
radiation sterilization and chemical sterilization should be undertaken. In such methods, the
medical devices undergo extreme high temperatures, ethylene oxide treatment, bleaching agent
treatment, treatment with Hydrogen Peroxide, UV radiation, irradiation with Gamma particle or
electronic beams for the purpose of eliminating any kind of pathogenic agent that might have
survived on the medical devices which can spread and cause nosocomial infection.
Existing policies and their implication:
This has stressed on the need to implement policies so as to ensure infection control
within healthcare settings. The policies increasingly focus on adhering to infection control
protocol within the healthcare setting so as to acquire positive patient outcome. In this regard it

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should be mentioned that AMR surveillance and comparisons of prescribing are important
feedback activities which when communicated to end users can help acquire positive outcome.
The evidence base suggests that stringent monitoring and implementation of these control
policies can help to reduce the rate of nosocomial infection within hospital settings. For the
maintenance of an effective infection control system, proper training and education has to be
imparted to the technical staff and clinical assistant team of the hospital. Other steps that can be
undertaken to improve patient safety can be stated as, performance of mock trial de-infection
sessions for critically ill patients, development of a training module which allows the
professionals to outline the faulty points and enables the technical staff to understand the nitty-
gritty and nuances.
Associated health status:
Research studies mention that nosocomial infections can spread to healthy patients by
means of inappropriate patient handling and transmission of contamination due to ineffective
compliance with the infection control protocol (Hor et al., 2017). As stated by Gluyas (2015),
non-compliance with effective hand hygiene is one of the major reasons that contributes to poor
patient outcome. Research studies further in this regard, reveal that nurses often fail to comply
with hand hygiene regimen and donning of proper PEP while assessing patients which in turn
enhances the risk of acquiring healthcare associated infections (Shlomai, Rao & Patole, 2015).
As stated by Shlomai et al. (2015), the five mandatory moments of hygiene that are integral for
nursing professionals to comply with include, before making skin contact with a patient, before
involving in cleaning or any aseptic procedure, after being exposed to anybody fluid, after
touching a patient and after touching the surroundings of a patient. The rationale for prioritizing
the above five moments of hygiene can be explained as minimizing the probability of
transmission of infection causing agents by means of skin contact. According to McLaws (2015),
direct skin contact or dealing with exposed body fluid or injury heightens the risk of acquiring
healthcare associated infections. The listed five moments of hygiene are extremely important for
the maintenance of infection control within a health care setting. In the words of McLaws
(2015), it has been stated that hand hygiene is the single most effective method for controlling
the rate of infection among the hospital patients. Healthcare organizations must prioritize
compliance with infection control protocol so as to effectively reduce the burden of infection

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among the patients. In order to minimize the risk of infection, infection control policies are
prioritized within healthcare organizations.
Quality standard and infection control
The standard 3 of the National Safety and Quality Healthcare standards stringently
emphasize upon the prevention and control of healthcare associated infections within the
healthcare system (Safetyandquality.gov.au, 2019). The NSQHS standard are propounded by the
governing body of ACQHS and the standard intends to describe the systems as well as strategies
for the prevention of infection occurrence and limiting the phenomenon of antimicrobial
resistance with the effective use of antimicrobials as a part of the antimicrobial stewardship
process (Safetyandquality.gov.au, 2019). Healthcare organizations are expected to observe
clinical governance so as to induce quality improvement in order to effectively prevent health
care associated infections and at the same time support antimicrobial stewardship
(Safetyandquality.gov.au, 2019). Further, it is also expected that healthcare organizations would
adapt effective measures for the prevention of infections and implement effective monitoring
systems. Further, healthcare organizations are also expected to reprocess reusable medical
devices and ensure that the equipment and instrument are up to date with the existing national
standards (Safetyandquality.gov.au, 2019). Also, healthcare service providers are also expected
to implement systems so as to effectively prescribe the use of antimicrobial stewardship program
and enhance the quality of service delivery (Safetyandquality.gov.au, 2019).
In this context, it should be noted that a number of research studies have suggested that
the primary causes that result in non-compliance with the standard infection control within health
care setting include excessive patient load and busy time schedule (McLaws, 2015; Shlomai et
al., 2015). Care professionals often skip hand hygiene protocol while dealing with attending
multiple patients and this directly increases the risk of infection transmission. It should be noted
in this context that within a healthcare setting, care professionals are required to invariable treat
patient in close proximity to one another or tackle patients that have underwent critical and
invasive procedures (Gluyas, 2015). Some of the patients also have medical devices inserted and
are administered immune-suppression therapies or broad-spectrum antibiotics which favour the
growth of infection causing agents (Gluyas, 2015).

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Measures to improve compliance:
A number of research studies suggest that annually the rate of recurrent hospitalization
due to hospital acquired infection as well as associated morbidity is on the rise (Hor t al., 2017;
Shlomai et al., 2015). In addition to this, a number of infection conditions require extremely
expensive medications which can diminish the financial status of the patient are result in poor
standard of life. Nurses or healthcare professionals are obliged with the quality standards as well
as the ethical responsibility of providing holistic care outcome to patients. In addition to this, it
should also be mentioned that a nurse spends the longest duration of time caring for the patient.
Therefore, it is absolutely mandatory for the care professionals to stringently abide by the
infection control protocol so as to promote patient safety and reduce the prevalence of infection
burden. Healthcare associated infection is also linked with placement of medical devices such as
catheters. It is exceedingly important for care professionals to be aware about the use of proper
methods of decontamination so as to ensure reduced prevalence of infection such that positive
patient outcome is restored. As stated by Butts and Rich (2019), a nurse must comply with the
ethical code of conduct and adhere to the ethical principle of beneficence which suggests
meaning no harm to the patient or promoting good for the patient at all times. Failure to comply
with infection control policies also results in the violation of ethical principles and as a result
both the quality of the care goal as well as the care outcome is hampered (Butts & Rich, 2019).
Therefore, on analysing the accumulated evidence-based information it can be stated that
compliance with infection control policies is integral to promote patient safety and promote
quality care outcome. However, the primary reasons identified for non-compliance included
increase in patient load, busy schedule as well as lack of awareness about the significance and
outcome related to infection control policies. A number of nursing surveys revealed that the poor
nurse to patient staffing ratio was a major problem that increased the overall patient load and
contributed to inconvenience. On an average it was witnessed that one nursing professional was
expected to handle five patients at a time. On account of the excessive patient load, nurses often
found it difficult to abide or comply with the hand hygiene protocol. Majority of the nurses
mentioned to have skipped hand hygiene during the recommended five moments of hygiene. A
few of the enrolled nurses also mentioned to be unaware about the correct protocol of hand
hygiene and donning PEP. Some of the nurses also stated that compliance to hand hygiene was
difficult on account of frequent patient handling. These instances show that there is an increased

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need to incorporate infection control programs within the healthcare setting so as to acquire
positive patient outcome and reduced infection rate within the Australian healthcare system.
In this regard, it can be stated that organizing training workshops or refreshment courses
can help to disseminate awareness among care professionals about the significance of infection
control policies (McLaws, 2015). Further, conducting one day awareness workshop or seminar
on effective hand hygiene method and PEP donning procedure can help to educate nurses about
the correct procedure of the patient safety protocol (Shlomai et al., 2015; Salmon et al., 2015).
Also, one day hands on workshop on proper hand hygiene protocol can also be commenced
within the organization and it can help to educate care professionals to appropriately comply
with the hand hygiene protocol. In addition to this, encouraging nursing professionals to browse
through the NSQHS standards online and involving care professionals in extensive research can
also help to improve compliance with infection control guidelines (Safetyandquality.gov.au,
2019). Improved adherence would promote improved patient safety and would help to reduce the
poor heath outcome associated with HAI within healthcare settings (Russo et al., 2018). Also,
healthcare organizations must integrate stringent monitoring system so as to ensure that the care
professionals appropriately comply with the infection control protocol. Also, effective leadership
and management can help foster a disciplined healthcare environment that prioritizes patient
safety. In order to encourage nursing employees to comply with the infection control guidelines,
healthcare management could integrate key performance indicators and based on the same devise
an incentive-scheme to increase adherence with infection control guidelines and promote
positive patient outcome. Implementing an appropriate incentive scheme can help to promote
intrinsic motivation among the care professionals so as to comply with the hand hygiene protocol
and this might help to reduce the prevalence rate of healthcare associated infections. A number
of research studies have shown that incentivizing infection control protocol has helped to
improve adherence with infection control strategies and have positively helped to acquire
positive patient outcome and at the same time curtail the rate of infection within a healthcare
setting. This might help to improve patient outcome and reduce the overall disease burden
related to healthcare associated infection.

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Conclusion:
Therefore, to conclude it can be stated that healthcare associated infections attributes to a
leading cause of morbidity and mortality in Australia. The poor healthcare status can be changed
by assuring improved compliance with the infection control guidelines within the healthcare
settings. The primary reasons resulting in poor compliance have been evaluated to be poor
education and awareness about the significance of infection control guidelines, excessive patient
load as well as busy schedule. It can be stated in this regard that integration of educational
workshop and seminars on infection control and patient outcome can help to improve
compliance and improve the quality of healthcare service delivery. In addition to this, it should
also be stated that an improved understanding about the NSQHS quality standards can help to
acquire positive patient outcome and reduce the prevalence of infection within the healthcare
environment. Compliance with infection control guidelines aligned to the NSQHS guidelines can
help to improve positive patient outcome and acquire an improved standard of living. This can
help to reduce the morbidity and mortality associated with healthcare associated infection.

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References:
Butts, J. B., & Rich, K. L. (2019). Nursing ethics. Jones & Bartlett Learning.P.90
Gluyas, H. (2015). Understanding non-compliance with hand hygiene practices. Nursing
Standard (2014), 29(35), 40.
Grayson, M. L., Stewardson, A. J., Russo, P. L., Ryan, K. E., Olsen, K. L., Havers, S. M., ... &
National Hand Hygiene Initiative. (2018). Effects of the Australian National Hand
Hygiene Initiative after 8 years on infection control practices, health-care worker
education, and clinical outcomes: a longitudinal study. The Lancet Infectious
Diseases, 18(11), 1269-1277.
Hor, S. Y., Hooker, C., Iedema, R., Wyer, M., Gilbert, G. L., Jorm, C., & O'sullivan, M. V. N.
(2017). Beyond hand hygiene: a qualitative study of the everyday work of preventing
cross-contamination on hospital wards. BMJ Qual Saf, 26(7), 552-558.
McLaws, M. L. (2015). The relationship between hand hygiene and health care-associated
infection: it’s complicated. Infection and drug resistance, 8, 7.
Russo, P. L., Stewardson, A., Cheng, A. C., Bucknall, T., Marimuthu, K., & Mitchell, B. G.
(2018). Establishing the prevalence of healthcare-associated infections in Australian
hospitals: protocol for the Comprehensive Healthcare Associated Infection National
Surveillance (CHAINS) study. BMJ open, 8(11), e024924.
Safetyandquality.gov.au (2019). [online] Safetyandquality.gov.au. Available at:
https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-
Quality-Health-Service-Standards-second-edition.pdf [Accessed 27 Aug. 2019].
Salmon, S., Pittet, D., Sax, H., & McLaws, M. L. (2015). The ‘My five moments for hand
hygiene’concept for the overcrowded setting in resource-limited healthcare
systems. Journal of Hospital Infection, 91(2), 95-99.

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Shlomai, N. O., Rao, S., & Patole, S. (2015). Efficacy of interventions to improve hand hygiene
compliance in neonatal units: a systematic review and meta-analysis. European Journal
of Clinical Microbiology & Infectious Diseases, 34(5), 887-897.
White, K. M., Starfelt, L. C., Jimmieson, N. L., Campbell, M., Graves, N., Barnett, A. G., ... &
Brain, D. (2015). Understanding the determinants of Australian hospital nurses’ hand
hygiene decisions following the implementation of a national hand hygiene
initiative. Health education research, 30(6), 959-970.