Infection Control in Healthcare: Literature Review and Analysis

This assignment is a comprehensive analysis of infection control within healthcare settings, focusing on the critical evaluation of research articles. The student begins with an introduction to the significance of infection prevention and control (IPC) in healthcare, highlighting the risks of hospital-acquired infections (HAIs). A literature review explores the prevalence of HAIs, the role of pathogenic microorganisms, and the importance of preventative measures. The student then selects and critically analyzes two research papers using the CASP framework: one qualitative study by Shah et al. (2015) examining the impact of staff behavior and organizational policies on IPC, and a quantitative study by Borg et al. (2015) investigating the influence of organizational culture on infection prevention. The analysis includes the methodologies, findings, and discussions of each paper, providing a detailed assessment of the strengths, weaknesses, and applicability of the research. The assignment concludes with a final discussion summarizing the key insights and implications for healthcare practice.

Running head = INFECTION IN HEALTHCARE
0
Infection in healthcare
IPC implementation on health care
Student Detail
[Pick the date]

Infection in healthcare 1
Contents
Introduction......................................................................................................................................2
Literature review..............................................................................................................................2
Selection of the literature.................................................................................................................4
Critical analysis...............................................................................................................................4
Introduction to the qualitative paper by (Shah et al., 2015).........................................................4
The methodology of the study:....................................................................................................5
Sampling...................................................................................................................................5
Recruitment..............................................................................................................................6
Interview of the participant and data analysis..........................................................................6
Results and discussions............................................................................................................7
Introduction of the quantitative paper (Borg et al., 2015)...........................................................7
The methodology applied in the paper.....................................................................................8
Duration and participant of the survey.....................................................................................8
Result and discussion of the study...........................................................................................9
Final discussion...............................................................................................................................9
Conclusion.....................................................................................................................................10
References......................................................................................................................................11

Infection in healthcare 2
Introduction
Infection control is an integral part of any health care system and the rigorous rehearsal that is
carried out is very significant in keeping up a sheltered domain for everybody by lessening the
danger of the potential spread of ailment (Suleyman & Alangaden, 2016), (Taylor, 2015). These
practices are intended to decrease the danger of emergency clinic related contaminations and to
guarantee a protected and sound medical clinic condition for patients, social insurance suppliers,
and guests. Medicinal services related diseases can grow either as an immediate consequence of
human services mediation, (for example, clinical or surgical treatment) or from being in contact
with an area associated with the medical service (Lawes et al., 2015), (Kanamori et al., 2015). In
a clinical setting, an infection causing agents are in no way, shape or form extraordinary. This is
the reason every single clinical expert avoid potential risk to keep them from spreading. A
portion of these insurances incorporate incessant hand washing, utilizing cleaning splashes, and
getting seriously sick patients far from different patients (Leaper et al., 2015), (Tschudin-Sutter
et al., 2018). Indeed, even with these safety measures set up, it isn't outlandish for an infection-
causing agent to spread and make others infected. The present report provides a brief overview
of the importance of infection prevention and infection control in health care services. The work
conducted by (Borg et al., 2015) and (Shah et al., 2015) were critically analyzed based on the
CASP framework.
Literature review
The literature review was primarily focused on the infections which are generally associated with
the hospitals and other health diagnosis and recovery places. A hospital-acquired infection is
generally diagnosed within the two days’ time of patient admission in the healthcare service or
within a 3-day time interval since the patient is discharged from the hospital (Lewis et al., 2019),
(Seale et al., 2015). There are different range of the pathogenic microorganisms that are highly
resistant to most of the antibiotic have been associated as the agent for hospital-acquired
infection (Murni et al., 2015). Therefore it is very important that the staff should be aware and
uses precautionary measures to prevent the spreading of any infection to the patient and among

Infection in healthcare 3
themselves also (Mocanu et al., 2015), (Mu et al., 2016). The present review was conducted
keeping the following points in consideration:
I. The standard database will provide many relevant and trustworthy results, rather than
direct search on the internet which could result in false results. Hence, for the present
research Google Scholar and PubMed were primarily used for the search of the article.
II. The keywords mostly used for the search in the present study were infection, healthcare,
and nursing. The use of Boolean operators “and” was mostly used to refine the search for
example “hospital infection and nursing”. To narrow down the search item from the vast
array of results time frame window was selected for the year 2015 to 2020.
III. The above-mentioned search criteria used in PubMed to get the results and a total of 4389
hits of the topic were observed. In the context of Google scholar search the same
keywords resulted in a total of 44,100 hits.
IV. To further increase the specificity of the results the article that had either two keywords
from hospital, infection or nursing.
Based on the search strategy mentioned above, a brief literature review was conducted and
briefly presented in the following paragraph. The study conducted by (Mody et al., 2017)
reported that approximately two million people are reported with some sort of hospital-acquired
infection costing about four billion dollars cost of health care. It was observed that a 54 %
decrease in the infection rate was observed over a year with intervention in catheter removal. The
study conducted by (Cassone & Mody, 2015)has reported the multi-drug resistant organism as
the primary source of infection at the nursing homes also a major cause for mortality or lifetime
diseases due to infection. The study conducted by (Tartof et al., 2015) presented the scale of
infection in a nursing home due to Clostridium difficile , it was observed that out of 401,234
patient admitted in 14 hospitals over a period of 2011 January to 2012 December, 2,368 were
infected with Clostridium difficile . The study also indicated that the rate of occurrence of
infection increased with the increase in age and exposure with different classes of antibiotics. In
the review published by (Zingg et al., 2015) reported that approximately 37, 000 deaths every
year have been associated with the infection that, the patient has acquired due to the visit at a
health care facility, the review also pointed out various components that were primarily
associated with hospital infection such as bed occupancy, workload along with the availability of

Infection in healthcare 4
the required materials. Also, the review suggested that the rate of hospital-acquired infection
could be changed based on the some of the good managerial practice could be followed at the
health care facility along with continuous training of hospital staff for the safety management
that would result in positive change in the attitude of the staff towards the hospital-associated
infections. The study conducted by (Shah et al., 2015) showed the importance of management
and training for the hospitals to prevent various infectious diseases. The study conducted by
(Borg et al., 2015) showed that the organization culture was one of the major driving forces
behind infection prevention and infection control behavior.
Selection of the literature
Out of the different literature studded it was observed that most of the literature was targeted
over any single micro-organisms and its hospital-associated infection property, however in the
section of prevention technology the role of the hospital staff was mentioned in almost all the
literature studied. Hence it was established that along with the various hygiene protocol
implemented in a hospital for the prevention of hospital-associated infection, the role of medical
staff is as important as the policy for infection prevention (Tajeddin et al., 2016), (Gould et al.,
2016). Therefore these two papers were selected to study the impact of various managerial staff
and hospital policy in the prevention from hospital-associated infection, moreover, the work
carried out by the researches was related to the current trends in the healthcare sector in the UK.
The paper published by (Shah et al., 2015) provided a qualitative framework regarding the co-
dependence of the overall behavior of the employee and the policy created by the organization in
terms of prevention from hospital-associated infection. The study conducted by (Borg et al.,
2015) provided a quantitative framework regarding the impact of organizational culture as one of
the primary driving factors for the prevention of infectious diseases in hospital-associated
diseases. A step wise strategy for the selection of two articles is given in Figure 1.

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Figure 1 Selection strategy
Selection of articlesBased on the literature it was established
that for implementation of IPC, the role
of medical staff is very important.
Therefore the two articles selected for the
study that provided framework for
improvememt of work culture.
Article studied for the study
After studying the abstract and conclusions of different hits a total of 15 articles were
selected for detailed study.
Total number of articles from the database
PubMed database showed a total of 4389
hits
Google Scholar provided a total 44,100
hits
Duplicate removalTime constraints were set
for the study for the time
interval of 2015 to 2020.
Titles of the paper were
searched from the serarch
tab of both the database.
The articles that were
present in both the
databases were removed
from consideration.
Operator used in the study
Hospital infection and
nursing
The keyword for the study
was Hospital, infection ,
nursing
Boolean operators used =
and
Database studied
PubMed Google Scholar

Infection in healthcare 6
Critical analysis
Introduction to the qualitative paper by (Shah et al., 2015)
The paper for critical analysis was published in the year 2015 in the peer-reviewed “Journal of
Hospital Infection”. There was a total of 5 authors of this paper out of the 5 authors, N. Shah, E.
Castro-Sa´nchez, E. Charani, A.H. Holmes were from Imperial College London, UK and L.N.
Drumright was associated with the University of Cambridge. The title of the paper was quite
long which resulted in the distraction of interest, in the place of abstract a summary of the whole
work was provided by the author. The summary consisted of a short background for the basis of
research and the challenge associated with the implication of infection prevention and control
policy. The summary also includes the aim of the study, methodology applied for the study and
findings. The aim of the study was divided into three parts, first part relates to the behavior of
staff towards the infection prevention and care (IPC), the second part involves the main
challenges regarding the IPC compliance and third is the study of the impact of the working
environment regarding the discrepancies in IPC implementation. The introduction of the paper
was brief and precise regarding the problem associated with the earlier studies reported by
various researchers regarding the lack of study in terms of behavioral change of health care
workers (HCW) (Cioffi & Cioffi, 2015). Also, the introduction points out the problem associated
with earlier studies regarding the pattern of study as of the studies were mostly targeted on the
behavior, not on the circumstantial effect on behavior. The author also emphasized that a
qualitative approach will provide evidence for the identification of regarding the IPC policies
and its values in the context of the behavioral pattern of HCWs’.
The methodology of the study:
The workers in the field of the healthcare sector at National Health Service UK were interviewed
from December 2010 to July 2011. The interview was semi-structured and the people involved in
the interview were mostly in the interaction with the patients and antimicrobials, also who were
ready to participate in the study.
Sampling
The primary participant for the study was recognized by the list delivered by the respective
human resource department. The list of the employee was used to maximize the randomization
of the data; the selection was based on the profession, not by their profession. This criteria of

Infection in healthcare 7
selection resulted in narrowing the possibility of the diversity of the subjects in terms of their
specialty. To form groups of the staff it was considered to use job title and their working area
along with their level of experience.
Recruitment
The recruitment process for the study started with the invitation through the electronic mail, after
that the recruitment was conducted until the set data saturation point was achieved. At the end of
the recruitment process, a total of 10 doctors, 10 pharmacists, 18 nurses, and one midwife were
selected for the study. The experience of each of the individuals participated in the study and
their association with their respective organization was tabulated in the research as it provides an
idea regarding the expertise of each individual in their respective fields.
Interview of the participant and data analysis
The protocol for the interview and the study was sanctioned by the National Research Ethics
Service of the United Kingdom (Charles et al., 2016), for the study purpose-written consent was
taken from the participant before starting the interview (Beedholm et al., 2015). The questions of
the interviews were framed after the discussions with the expertise in the subject of IPC and
based on the extensive literature study carried out by the authors in the field related to
healthcare-associated infections, antimicrobial prescribing, catheter management and IPC. For
the interview purpose, the participant was named in coded variables to maintain the anonymity
of the data (Behaghel et al., 2015). The primary topic of the interview was regarding the work
routine, individual perspective in terms of IPC management in common terms, the various
obstacles or support individual gets for the implication of infection control and guidelines, their
respective knowledge regarding the vascular access, impact and effect of antibiotics what are the
facilitator and barriers in the context of antibiotic prescription, the kind of communication
involved and any other issue if left that a participant wanted to include in the study. For the
analysis purpose, the thematic code induction based on the answers provided by HCWs’ was
carried out and the deduction was carried out using data indexing. The indexing of the data was
carried out using three categories vascular access, Standard IPC practice and a prescription for
antimicrobial. The data analysis was carried out by three individual researchers separately which
were a great approach for the qualitative analysis of the data. Each of the researchers was

Infection in healthcare 8
provided whole reports and based on their knowledge and extensive discussion among the three
researchers provided the analysis of the results.
Results and discussions
The analysis of the interview provided results that could be classified under three basic
categories. It was observed that most of the participants were attributing responsibility to others'
working class. The need for implementation of IPC in the working environment was agreed by
almost every participant; however, most of the participants reported that due to a shortage of
resources it was not possible to prioritize implementation of IPC. One of the major challenges
observed in the results was the hindrance of implementation of IPC due to the influence of senior
staff that does not follow the correct protocol (Li et al., 2018), (El-Hosany & Sleem, 2015). The
findings of the questioner described that one of the major challenges between the medical staff
regarding the communication of IPC implementation is the lack of knowledge regarding the
responsibility of each other. The results also indicated that behavioral intervention is required to
generate personal responsibility among all the hierarchy at the workplace (Dawson & Guare,
2018). The lack of resources was also one of the major blockages for proper implementation of
IPC, which resulted in the implementation of selective IPC protocols based on the resource and
time availability to the HWSs’.
Introduction of the quantitative paper (Borg et al., 2015)
The paper was written by M.A. Borg, B. Waisfisz and, U. Frank and the corresponding author
M.A. Borg working in infection control department of Mater Dei Hospital, Msida, Malta, the
other two authors were from The Hofstede Centre, Helsinki, Finland and Heidelberg University
Hospital, Heidelberg, Germany respectively. The paper published by (Borg et al., 2015), was a
quantitative paper majorly based on the organizational culture assessment in terms of its relation
with IPC. The title of the paper was appropriate providing information regarding the context of
the paper. The article had a summary at the start of the paper in the place of the abstract, it was
published in a peer-reviewed journal with an impact factor of 3.354. The summary of the paper
was very vague, provided broad-spectrum information regarding the study as it was conducted in

Infection in healthcare 9
7 hospitals in the European region with the help of Hofstede’s model and a relation between the
occurrence of methicillin-resistant Staphylococcus aureus (MRSA) and hospital determinant
score was observed and presented (Cadena et al., 2016). The introduction of the paper was very
short and briefly discussed the relationship between organizational culture and implementation
of IPC and factors affecting IPC. In terms of review of literature conducted by the authors, it was
very less and could be subjected to insufficient in terms of information provided for the basis of
the paper and the why the methodology was used in the paper, was only supported by one paper.
Therefore it could be said that the paper introduction should have been more elaborative
regarding the introduction section for a better understanding of the theme of the paper and
purpose of the research.
The methodology applied in the paper
The study conducted by the authors was a part of other projects (DG Sanco) and the tool for the
analysis and evaluation was the Quickscan survey tool (Dick et al., 2017). The primary principle
of the tool is Hofstede’s model on the organization culture, the tool required minimum of 20
response to provide a validate information regarding any particular situation and it contains
seventy-six online questions that should be answered under the prescribed time limit the answers
were converted as scores with the help of a computer-oriented algorithm. To study the process
and relation 7 hospitals from 4 countries in Europe were selected that had a minimum of two
hundred and fifty beds. They evaluated the MRSA occurrence and the definition provided by the
European health authority for MRSA proportion from the total strain of Staphylococcus
aureus captured from Petri plate culture each for every patient in 2011. The study also studied
the impact of the implementation of IPC and the reduction in MRSA proportion. However, some
hospitals reported that MRSA as endemic with more than 25 % cases of MRSA.
Duration and participant of the survey
The survey of the research was conducted in the month of July and August of 2012, and the
participant of the survey was nurses and doctors working in the intensive care unit of the
hospitals. The study was primarily concentrated in five major areas such as insight of trust,

Infection in healthcare 10
assurance of job stability, the fear of being used as a scapegoat, the ease of change and assistance
of change. The score of -100 to +100 was provided to each of the parameters.
Result and discussion of the study
The results indicated that a broad range of variation was observed for the readiness to change it
was in the range of + 95 to – 73. The result also indicated that the hospital with fewer cases of
MRSA had the high score in ease of change and providing assistance for the change along with
the trust factor. The hospital with a greater number of MRSA had a low score in all the three
aforementioned factors but they had a high score in job security. There are strategies involved in
for the implementation of IPC in a hospital but its success is highly dependent on the
organization culture. The result provided critical insight into the relationship between various
factors involved in organizational culture and their impact on policy implementation. The
importance of management of the change has been emphasized in the paper. The result also
indicates the need for the study of change management in organizational culture before the
implementation of IPC as it has been observed the implementation of the same IPC program
could result in success in one hospital and could be a failure in the other hospital. The high
number of MRSA cases and the sense of job security in that hospital indicate the lack of
consequence for the current fail in IPC implementation. The research conducted had several
limitations such as the participation of only 6 staff group from 7 hospitals, which indicate that
the study was not coordinated properly with the participant. The study was spread over a wide
range of countries; however, the cultural impact was neglected in the study, which is a major
factor in determining organizational culture.
Final discussion
The study conducted by (Shah et al., 2015) provided a qualitative view of the problem associated
with the implementation of IPC in hospitals some drawbacks were observed in the study. The
number of participants included in the study was very less in comparison to the amount of
workforce involved in the healthcare sector to form a generalized idea regarding the situations
(Freund et al., 2015). The category of the participant was reduced to the doctor, nurses, and
pharmacists; however, in the health sector many other participants are involved hence their point

Infection in healthcare 11
of view should be included. In the second study conducted by (Borg et al., 2015) had several
limitations such as the participation of only 6 staff group from 7 hospitals, which indicate that
the study was not coordinated properly with the participant (Tschudy et al., 2017). The study was
spread over a wide range of countries; however, the cultural impact was neglected in the study,
which is a major factor in determining organizational culture.
Conclusion
IPC practices are intended to decrease the danger of emergency clinic related contaminations and
to guarantee a protected and sound medical clinic condition for patients, social insurance
suppliers, and guests. Medicinal services related diseases can grow either as an immediate
consequence of human services mediation, (for example, clinical or surgical treatment) or from
being in contact with an area associated with the medical service. The impact of IPC can be
studied from the literature which conveyed a 54 % decrease in the infection rate was observed
over a year with intervention in catheter removal. The two studies selected for the qualitative and
quantitative analysis presented the impact of organization policy, culture and behavior of the
employees on the implementation and success of IPC

Infection in healthcare 12
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