Healthcare-Associated Infections: UTI, PPE, Nursing, and Analysis

This report delves into the critical issue of Healthcare-Associated Infections (HCAI), also known as nosocomial or hospital infections, focusing on the prevalent problem of Hospital-Associated Urinary Tract Infections (HAUTI). The paper explores the significance of Personal Protective Equipment (PPE) policies in managing and preventing HAUTI, referencing a national Comprehensive Unit-based Safety Program that aimed to reduce catheter-associated UTIs. It provides an analysis of UTIs, including diagnostic procedures like urinalysis, and discusses the reasons behind their occurrence, highlighting risk factors such as gender, age, and hygiene. Furthermore, the report examines the widespread nature of UTIs, their impact on various populations, and the crucial role of nursing practices in their early detection, management, and prevention within healthcare settings. The report underscores the importance of infection control measures and the role of healthcare professionals in mitigating the impact of HCAIs.

Running head: HEALTHCARE-ASSOCIATED INFECTIONS
Healthcare-Associated Infections
Name of the student
Name of the university
Author’s name

1HEALTHCARE-ASSOCIATED INFECTIONS
Table of Contents
Introduction......................................................................................................................................2
PPE Policy.......................................................................................................................................3
Managing HAUTI through PPE policy...........................................................................................3
Analysis of UTI...........................................................................................................................4
Why is the issue happening?........................................................................................................4
Is UTI a common issue?..............................................................................................................6
Does the issue occur in a specific area or is it a widespread issue?............................................6
Nursing Practice...........................................................................................................................8
Conclusion.....................................................................................................................................11
Reference.......................................................................................................................................12

2HEALTHCARE-ASSOCIATED INFECTIONS
Introduction
Healthcare-associated infections (HCAI) are also known as "nosocomial" or "hospital"
infection that occurs in patients during their treatment procedure (Allegranzi, Nejad & Pittet,
2017). However, it is not sure when they might acquire the disease, as it can happen when they
are being admitted to the hospital or can occur when discharging from the hospital. Hospital
associated urinary tract infection (HAUTI) is one of the most common healthcare-associated
diseases that occur in hospitals, and bladder infection is the most common type of urinary tract
infection (UTI) (McLellan & Hunstad, 2016). The UTI can cause severe symptoms and
conditions that can be distressing for the patients and can lead to severe complications. Thus, it
has become an important policy to reduce the incidence of HAUTI. According to some of the
governmental websites and literature studies few individuals are at higher risk of acquiring UTI,
especially the women and young age girls as their urethras are shorter compared to the men and
it is closer to the rectum, due to which it becomes easy for the bacteria to enter the passage of
urinary tract (McLellan & Hunstad, 2016). HAI is a form of the disease which is linked to
clinical ethics. However, it also results in public health consequences. During the treatment of
UTI, physicians should keep their focus on the treatment of their patient and should try to
prevent the transmission of the bacteria. This paper discusses the PPE policy, how the hospital-
associated urinary tract infection related to the current guidelines and will give a detailed
description of the urinary tract infection (Allegranzi, Nejad & Pittet, 2017).

3HEALTHCARE-ASSOCIATED INFECTIONS
PPE Policy
The objective of the Personal Protective Equipment Policy is to ensure the safety of the
staff members and the clients (in healthcare system - nursing staff members and the patients)
from getting exposed to the workplace hazards (bacteria in a healthcare system that lead to
HCAI) and the danger of injury through the utilization of personal protective equipment (PPE)
(Hancock, 2016). In other terms, the PPE is the equipment used to protect the healthcare staff
members and the patient form any harm occurring from the healthcare surroundings. It prevents
the spread of germ in the hospital setting (Hancock, 2016).
Managing HAUTI through PPE policy
A national Comprehensive Unit-based Safety Program was developed by the Agency of
Healthcare Research and Quality which had a goal to decrease the incidence rate of catheter-
associated UTI in intensive care units (ICUs) and non-ICUs divisions. For this program,
information was collected from 926 units (59.7% were non-ICUs, and 40.3% were ICUs) in 603
hospitals in 32 states, the District of Columbia, and Puerto Rico (Saint et al., 2016). It was seen
that the unadjusted catheter-associated UTI percentage reduced from 2.82 to 2.19 infections per
1000 catheter-days. In the non-ICU departments, the rate of catheter-associated UTI rates
decreased from 2.28 to 1.54 infections per 1000 catheter-days. It was seen that the guidelines and
the policies which were being followed in the program helped in diminishing the catheter use
and catheter-associated UTI rates in the non-ICU departments. However, the decrease percentage
of the catheter-associated UTI remained unchanged in the ICU divisions (Saint et al., 2016).

4HEALTHCARE-ASSOCIATED INFECTIONS
Analysis of UTI
This medical complication of urinary tract infection can be analysed by the process of
Urinalysis. Symptoms like burning sensation during urination, increased frequency of urination,
cloudy or foul smelling urine, abdominal pains as well as nausea are some of the most common
indicators of this medical condition. If a patient experiences such symptoms, they are advised to
collect their urine samples in sterilised containers for the medical test procedure (Martin &
Martin, 2019).This diagnostic procedure is used to test the urine sample to help detect any
abnormalities in the sample mainly signs of infection by observing and studying the changes in
the appearance, volume or content as well as the concentration of the sample. This test enables to
not only identify but also manage a wide range of urinary tract disorders, kidney diseases as well
as burden diseases like diabetes. This testing tool is highly cost effective. The procedure employs
the usage of appear or plastic strips that are encoated with chemicals, which react to the presence
of microorganisms like bacteria, virus or fungus, resulting in the change in its colour. Urine
samples providing a positive result in the process of urinalysis are then cultured in appropriate
culture media and then the bacterial isolate obtained from the culture plate is tested for antibiotic
sensitivity to ensure appropriate management and treatment of the issue, reducing the intensity of
medical complication caused by the issue (Bardsley, 2015).
Why is the issue happening?
According to some of the official websites and literature studies, the reason behind the
commonness of the UTI in patients has been discussed. As per CDC, few individuals are at
higher risk of acquiring UTI, especially the women and young age girls as their urethras are
shorter compared to the men and it is closer to the rectum, due to which it becomes easy for the
bacteria like E Coli to migrate into the urinary tract (CDC, 2019). According to the research

5HEALTHCARE-ASSOCIATED INFECTIONS
paper, around 50% of females get sick to UTI, which further develops as they continue to age.
There are specific other reasons also which can lead to UTI, such as if there is a medical history
related to UTI, or if there is unprotected sexual activity with a new partner, alterations in the
bacteria species during the menopause living in the urinary tract, pregnancy and poor hygiene
(CDC, 2019). As per a research paper, most of the HAUTI are caused by the enteric Gram-
negative bacilli (GNB). The article recognized Escherichia coli as the number 1 causative agent
in these infections, followed by Enterococcus, Klebsiella, and Proteus. In a healthy individual,
the urine sample will be free of any harmful organism; however, a person with UTI will have
bacteria (Jean et al., 2016). The sample could have got contaminated while collecting the
specimen or colonization of microbes led to infection. The bacterial colonization, which is also
known as bacteriuria, can be confirmed by culturing the patient’s urine sample. There is also a
chance that if proper hand hygiene techniques are not followed or if appropriate personal
protective equipment (PPE) is not utilized, then there is a chance in the occurrence of infection.
There is a chance if any professional person conducts the procedure, then mistakes can occur,
which can lead to the spread of bacteria, eventually leading to the UTI (Keren et al., 2015).

6HEALTHCARE-ASSOCIATED INFECTIONS
Is UTI a common issue?
According to the World Health Organization, HCAI is the most common issue during the
care delivery procedure, and there is no organization or any nation that has been able to solve the
problem (WHO, 2019). Even though HCAI is a severe issue, there is an inadequate amount of
information regarding the global burden of the HCAI issue, since all countries do not have the
proper equipment to conduct surveillance to gather reliable information on the incidence
percentage of the HCAI. Healthcare-associated infections can occur to all age group from
children to older adults. Nosocomial or hospital infection is a common issue that affects not only
the resource-poor nations but also impacts on the developed nations. The HCAI is the critical
problem that causes morbidity and mortality in hospitalized patients. It is a very crucial issue for
both the patient and also to the health of the public as it cause hundreds of millions of patients to
suffer due to HCAI annually. According to the literature and systematic review, there is evidence
that urinary tract infection is the most general healthcare-associated issue that occurs both in
children and adults. Hospital associated urinary tract infections are responsible for 35% to 45%
of the nosocomial infections. 80% of urinary tract infections are linked with the use of an
indwelling urinary catheter. The rate of occurrence of bacteriuria in the catheterized patients is
around 3 to 10%, and there is 25% of patients with bacteriuria having symptomatic UTI and 3 to
8% develop bacteriuria (Rossignol et al.,2017).
Does the issue occur in a specific area or is it a widespread issue?
The UTI or the urinary tract infection is an infection that impacts the urinary system of
the body. It can affect the kidneys, ureters, bladder and urethra. However, the most common
issues arise in the kidneys and bladder. It is a widespread issue and it occurs to both men and
women and to all age group from children to adults.

7HEALTHCARE-ASSOCIATED INFECTIONS
UTI infection in the bladder is called cystitis. This type of issue is majorly caused by the
E. Coli which is generally found in the gastrointestinal (GI) region. Generally it can occur due to
sexual intercourse, though it is not necessary to be sexually active as all women are susceptible
to cystitis because of their anatomy that is due to the shorter distance among the urethra and
anus; and the urethral opening to the bladder.
UTI infection in the urethra is called urethritis. This type of issue mainly occurs when the
GI bacteria spreads from the anus to the urethra. Also, as the female urethra is near to vaginal
region, sexually transmitted diseases, like mycoplasma, chlamydia, gonorrhea and, herpes can
cause urethritis.
This medical issue is highly prevalent among the women population. Statistics indicate
that nearly 1 out of 3 women suffer from urinary tract infections before the age of 24years. This
is because women tend to have short and straight urethra making it more susceptible to the
contraction of microorganisms. During pregnancy, due to the widening of the bladder, resulting
in the gradual drainage of the urine, making them susceptible to urinary tract infections. Older
women are also highly susceptible to urinary tract infections due to the narrowing and drying up
of their urinary bladder and urethra (Tan & Chlebicki, 2016). The frequency of the incidence of
UTIs in men is comparatively low, as statistics indicate that about 1 out of 20 men are
susceptible to this medical condition, mainly due to their problems regarding urine flow or old
age or even sexual transmission.
Chronic conditions like diabetes or usage of medication and even lack of hygiene can increase
the susceptibility of UTIs in individuals. Even children are highly susceptible to UTIs due to
their reduced development of immunity (Vaz et al., 2012).

8HEALTHCARE-ASSOCIATED INFECTIONS
Nursing Practice
Healthcare professionals like nurses can play a huge role in aiding in reduction and
management of UTIs in patients under their care (Grigoryan, Trautner & Gupta, 2014). This
medical complication has a complex pathophysiology and thus can be hard to detect in some
cases. Thus, the nurses can help in the early detection of specific symptoms like increased
frequency of urination, foul smelling and cloudy urine output, haematuria, increased nausea and
abdominal pains as well as non-localizing and non-specific symptoms like increased falls, signs
of confusion and even reduced appetite. Other than detecting the symptoms of the medical
complication, the nurses can assist the patients suffering from this condition through the
diagnostic procedure and help them manage the condition in order to help reduce the intensity of
the condition. The nurses can help administer appropriate doses of appropriate antibiotics to
help manage the infection. They can also help in the treatment and prevention process of UTIs
(Montoya, Cassone & Mody, 2016). The nurses play a crucial role in maintaining hygiene to
help reduce the spreading of nosocomial infections among the patients during their stay in the
hospital. The nurses can thus help in reducing the recovery time of the patients suffering from
UTI. They can even help in establishing care plans, by taking a holistic approach and assigning
appropriate interventions for the contributing factors behind the contraction of the infection. The
nurses can also incorporate medications of other forms of interventions to reduce or manage the
urination as well as abdominal pains and cramps due to the contraction of these infections. Their
care plans can also incorporate interventions for disturbed sleeping patterns, impaired urinary
output, infection, as well as loss of appetite.
Urine samples providing a positive result in the process of urinalysis are then cultured in
appropriate culture media and then the bacterial isolate obtained from the culture plate is tested

9HEALTHCARE-ASSOCIATED INFECTIONS
for antibiotic sensitivity to ensure appropriate management and treatment of the issue, reducing
the intensity of medical complication caused by the issue.
This medical issue is highly prevalent among the women population. Statistics indicate
that nearly 1 out of 3 women suffer from urinary tract infections before the age of 24years. This
is because women tend to have short and straight urethra making it more susceptible to the
contraction of microorganisms. During pregnancy, due to the widening of the bladder, resulting
in the gradual drainage of the urine, making them susceptible to urinary tract infections. Older
women are also highly susceptible to urinary tract infections due to the narrowing and drying up
of their urinary bladder and urethra. The frequency of the incidence of UTIs in men is
comparatively low, as statistics indicate that about 1 out of 20 men are susceptible to this
medical condition, mainly due to their problems regarding urine flow or old age or even sexual
transmission.
Chronic conditions like diabetes or usage of medication and even lack of hygiene can
increase the susceptibility of UTIs in individuals. Even children are highly susceptible to UTIs
due to their reduced development of immunity.
Healthcare professionals like nurses can play a huge role in aiding in reduction and
management of UTIs in patients under their care. This medical complication has a complex
pathophysiology and thus can be hard to detect in some cases. Thus, the nurses can help in the
early detection of specific symptoms like increased frequency of urination, foul smelling and
cloudy urine output, haematuria, increased nausea and abdominal pains as well as non-localizing
and non-specific symptoms like increased falls, signs of confusion and even reduced appetite.
Other than detecting the symptoms of the medical complication, the nurses can assist the patients

10HEALTHCARE-ASSOCIATED INFECTIONS
suffering from this condition through the diagnostic procedure and help them manage the
condition in order to help reduce the intensity of the condition. The nurses can help administer
appropriate doses of appropriate antibiotics to help manage the infection. They can also help in
the treatment and prevention process of UTIs. The nurses play a crucial role in maintaining
hygiene to help reduce the spreading of nosocomial infections among the patients during their
stay in the hospital. The nurses can thus help in reducing the recovery time of the patients
suffering from UTI.
They can even help in establishing care plans, by taking a holistic approach and assigning
appropriate interventions for the contributing factors behind the contraction of the infection. The
nurses can also incorporate medications of other forms of interventions to reduce or manage the
urination as well as abdominal pains and cramps due to the contraction of these infections. Their
care plans can also incorporate interventions for disturbed sleeping patterns, impaired urinary
output, infection, as well as loss of appetite.

11HEALTHCARE-ASSOCIATED INFECTIONS
Conclusion
It is now evident that the urinary tract infection is the most general healthcare-associated
issue that occurs both in children and adults. According to the different researches, UTI has been
contributing to 40% of nosocomial infections. Care management plays a significant role in the
management of the rise of incidence of death and infection rate in UTI. However, there has been
less improvement in the treatment procedures as they are less effective in reducing the
recurrences of UTI, and are consistently challenged by the rising antibiotic resistance. The paper
has identified Escherichia coli as the number 1 causative agent for the UTI infection, which is
followed by Enterococcus, Klebsiella, and Proteus. The PPE policy is highly relevant with the
UTI infection as the bacteria can transfer from one person to another if hand hygiene is not
maintained or the PPE guidelines are not followed appropriately. For the effective control of the
UTI, all the healthcare settings should incorporate policies and guidelines to prevent and manage
the infection, should use guidelines related to the usage of antimicrobial products, HCAI
surveillance guidelines also should have information about the investigation of an outbreak of
disease. The proper use of PPE equipment such as gloves, gowns, masks, goggles and hand
hygiene will help in preventing and controlling the infection.

12HEALTHCARE-ASSOCIATED INFECTIONS
Reference
Allegranzi, B., Nejad, S. B., & Pittet, D. (2017). The burden of healthcare-associated infection.
Hand hygiene: a handbook for medical professionals. 1st edition ed. hospital medicine: current
concepts. Hoboken: Wiley, 1-7. Retrieved from https://books.google.co.in/books?
hl=en&lr=&id=21rMDgAAQBAJ&oi=fnd&pg=PA1&dq=Healthcare-
associated+infections+UTI&ots=cTBctgMz5h&sig=98_de2Qq5WcCRnHitUZ-
FCGqa6Y#v=onepage&q=Healthcare-associated%20infections%20UTI&f=false
Bardsley, A. (2015). How to perform a urinalysis. Nursing Standard, 30(2), 34-36. Retrieved
form: http://dx.doi.org/ 10.7748/ns.30.2.34.e10001
CDC. (2019). Urinary Tract Infection | Community | Antibiotic Use | CDC. Retrieved 13
November 2019, from https://www.cdc.gov/antibiotic-use/community/for-patients/common-
illnesses/uti.html
Grigoryan, L., Trautner, B. W., & Gupta, K. (2014). Diagnosis and management of urinary tract
infections in the outpatient setting: a review. Jama, 312(16), 1677-1684.
Doi:10.1001/jama.2014.12842
Hancock, K. E. (2016). Improving Compliance with Personal Protective Equipment (PPE).
Retrieved from
https://digitalcommons.murraystate.edu/scholarsweek/Fall2016/ClinicalHealthcare/10/
Jean, S. S., Coombs, G., Ling, T., Balaji, V., Rodrigues, C., Mikamo, H., ... & Kiratisin, P.
(2016). Epidemiology and antimicrobial susceptibility profiles of pathogens causing urinary tract
infections in the Asia-Pacific region: Results from the Study for Monitoring Antimicrobial

13HEALTHCARE-ASSOCIATED INFECTIONS
Resistance Trends (SMART), 2010–2013. International journal of antimicrobial agents, 47(4),
328-334. DOI: https://doi.org/10.1016/j.ijantimicag.2016.01.008
Keren, R., Shaikh, N., Pohl, H., Gravens-Mueller, L., Ivanova, A., Zaoutis, L., ... & Haralam, M.
A. (2015). Risk factors for recurrent urinary tract infection and renal scarring. Pediatrics, 136(1),
e13-e21. doi: 10.1542/peds.2015-0409
Martin, C., & Martin, H. (2019). Urinalysis using a test strip. British Journal of Nursing, 28(6),
336-340. Retrieved from: https://doi.org/10.12968/bjon.2019.28.6.336
McLellan, L. K., & Hunstad, D. A. (2016). Urinary tract infection: pathogenesis and outlook.
Trends in molecular medicine, 22(11), 946-957. doi: 10.1016/j.molmed.2016.09.003
Montoya, A., Cassone, M., & Mody, L. (2016). Infections in nursing homes: epidemiology and
prevention programs. Clinics in geriatric medicine, 32(3), 585-607. Retrieved from:
https://doi.org/10.1016/j.cger.2016.02.004
Rossignol, L., Vaux, S., Maugat, S., Blake, A., Barlier, R., Heym, B., ... & Coignard, B. (2017).
Incidence of urinary tract infections and antibiotic resistance in the outpatient setting: a cross-
sectional study. Infection, 45(1), 33-40.
Saint, S., Greene, M. T., Krein, S. L., Rogers, M. A., Ratz, D., Fowler, K. E., ... & Faulkner, K.
(2016). A program to prevent catheter-associated urinary tract infection in acute care. New
England Journal of Medicine, 374(22), 2111-2119.
Tan, C. W., & Chlebicki, M. P. (2016). Urinary tract infections in adults. Singapore medical
journal, 57(9), 485. Doi: 10.11622/smedj.2016153

14HEALTHCARE-ASSOCIATED INFECTIONS
Vaz, G. T., Vasconcelos, M. M., Oliveira, E. A., Ferreira, A. L., Magalhães, P. G., Silva, F. M.,
& Lima, E. M. (2012). Prevalence of lower urinary tract symptoms in school-age children.
Pediatric Nephrology, 27(4), 597-603. Retrieved from: https://doi.org/10.1007/s00467-011-
2028-1
WHO. (2019). Health care-associated infections. Retrieved 13 November 2019, from
https://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf