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Combating Health Care-Associated Infections: A Community-Based Approach

Combating Health Care-Associated Infections: A Community-Based Approach

Providing quality and effective health care is a basic requirement for society. The Government prioritizes public access to quality healthcare services in conjunction with global and local health organizations. However, the issue of providing quality health care is limited because many patients suffer from healthcare-associated infections leading to high mortality rates in health institutions. Therefore, it is evident that to reduce the mortality rates arising from various health conditions, there is a need to minimize the effect of health-associated infections on patients. In the United States alone, these health-associated infections and high mortality rates cost the government billions of dollars. A separate report by the World Health Organization (WHO) listed health-associated infections as one of the key public health issues that need to be addressed in 2014. Healthcare-associated infections have been neglected over time. Many health professionals and institutions underestimate their weight and significance in patient recovery. Healthcare-associated infections occur in a health facility and are normally not present or incubating in the patient during admission to the health facility. They may be acquired before, during or after treatment. Among such infections are bloodstream infections and surgical site infections. Symptoms of health-associated infections may show after treatment and discharge from the health facility. Healthcare-associated infections are not limited to patients at the health facility but extend to occupational infections involving the staff. According to the world health organizations, many health facilities lack proper surveillance systems for identifying health-associated infections. This, coupled with a lack of a standard diagnostic criterion, causes hundreds of millions of deaths annually.

Population Characteristics

Health-associated infections are not limited to a specific group. They affect anyone seeking health care in a community and the health professionals working in these health institutions. Healthcare quality is significantly lower in health institutions adversely affected by healthcare-associated infections. However, healthcare infections are more prevalent in in-patients as compared to out-patients. In-patients are more exposed to the dangers of contracting health-associated infections than out-patients. The occurrence of healthcare infections is also high in patients that undergo surgical operations. In 2013, surgical operations accounted for 44% of the recorded healthcare infections in the United States. Thus, in reducing healthcare infections, surgical site infections need special consideration.

The health workers in various health institutions are also part of the population affected by healthcare-associated infections. Health workers can be affected by infectious diseases from patients in the health facility. If contaminated, the healthcare environment might also affect the health workers. For instance, it can cause a viral infection that requires quarantine. Surgical operations are also an avenue for contracting healthcare-associated infections by health workers or professionals. Patients with chronic illnesses also form a large part of the affected population. Such patients are in constant need of medical attention. They frequent the health facilities for these services and are at continued risk of contracting health-associated infections. The population affected by healthcare-associated infections is broad. This issue embodies those seeking medical attention in these health institutions and those working in them. However, it is worth noting that the risk of contracting healthcare-associated infections is higher in some patients than in others.

Community Health Assessment

The issue of healthcare-associated infections is a global public health issue. However, to reduce the number of deaths from healthcare-associated infections, the solutions developed have to be local. Therefore it is necessary to provide a basis for an efficient community assessment method to help solve this issue. The community health assessment should consider the population. These include patients of the health facilities within the community and the health workers of these health facilities. Data collection should be based on the health facilities themselves. Methods of data collection that could be used include interviews, observations and analyzing hospital records and other relevant statistics. First, the community’s population needs to be established and the number of health facilities within the area. It will help learn how representative the local statistics are on the national and global levels. From this, the research should then go ahead to look into hospital statistics and establish the number of health-related infections recorded and the resultant deaths. These statistics should then be compared to the factors of the hospital, such as the condition of the healthcare environment. Interviews and questionnaires must also be applied to collect patient and health worker data. The research should also investigate principles put in place by these health institutions as compared to global and national standards. For instance, the Australian Government has the Preventing and Controlling Healthcare Infections fact sheet 3. This document outlines the guidelines and standards health professionals and institutions in Australia must meet to reduce healthcare-associated infections. Global standards are given in the World Health Organization Health Care-Associated Infections fact sheet. Based on the acquired data and statistics, solutions can be proposed to the local health facilities.

Literature Review

Past efforts have been made to curb the effect of healthcare-associated infections on both global and local scales. The efforts have proved fruitful, but there is a need for further inquisition into the matter to arrive at long-lasting and more effective solutions. For instance, the National Plan to Prevent Health-Care Associated Infections: Roadmap to Elimination is an initiative by the United States government to reduce and ultimately eliminate healthcare-associated infections nationwide. Such projects have recorded a measure of success. The one mentioned above has recorded a 20% decrease in the nationwide Standardized Infections Ratio (SIR). Surgical site infections have also decreased by 15% across the United States by 2008. The project, however, needs more focus on particular infections such as bloodstream infections, urinary tract infections and Clostridium Difficile Infections, among others. This project focuses on a broader picture of general healthcare-associated infection reduction. However, to realize the set goals of such projects, health professionals must develop specific solutions. The proposed solutions must be tailor-made for the various causative agents and infection avenues. Most such projects roll out a single action plan for the entire problem. Often this only includes some of the infection avenues. In addition, there is negligence regarding infections affecting healthcare workers. The projects initiated by the CDC, WHO and others focus mainly on healthcare-associated infections that affect patients. The solutions developed should also be related to healthcare-associated infections to improve the situation and provide quality medical health care. According to the World Health Organization, healthcare-associated infections are a major concern causing millions of deaths annually. The measures put in place by the various stakeholders have been fruitful, but they need to address the shortcomings above to yield better results.

Community Health Education

Community health education involves the promotion of community health and the prevention of diseases by employing theoretically-based approaches. This field involves studying a certain community and developing solutions to their health issues. The analysis and solutions should focus on a specific health issue, such as the prevalence of healthcare-associated infections. In doing so, the solutions proposed will specifically suit the needs of that particular community. In addition, community health education specialists are tasked with influencing decisions, policies, practices and behaviors of the community members to foster a healthier lifestyle. Therefore an appropriate community health education theory must be selected that aligns with the project goals. The transtheoretical model is best suited for this project. This model is geared towards permanent behavioral change, a concept that can be married to the project objectives. The community and health facilities should change their practices to ensure a reduction in the number of reported healthcare-associated infections. As discussed earlier, practices by health professionals and the general work ethic within these health institutions contribute greatly to reducing healthcare-associated infections reported annually and resulting in deaths. A paradigm shift is necessary on the part of the patients as well. Many members of the public need to be informed about the symptoms of healthcare-associated infections. This is crucial to reduce post-treatment infections. Therefore, the project initiates a behavioral change of some sort from the parties involved; hence, the transtheoretical model is best suited. The transtheoretical model is based on a five-stage process describing behavioral and attitude change stages. The processes are; pre-contemplation, contemplation, preparation, action and maintenance. Individuals in the pre-contemplation stage are characterized as uninformed or under-informed about the risks and consequences of their behavior. This can be compared to the public, who is ignorant of healthcare-associated infections. This is the initial stage before the execution of the project. Therefore there is a need for massive community information and involvement.

Additionally, pre-contemplation can be applied in health facilities and among health professionals. They might need to realize the impact of their actions and the set standards for curbing health-related infections. Informing these parties moves the project into the next stage, which is the contemplation stage. In the second stage, the parties involved are now more informed. They are more informed about the issue and better positioned to make informed decisions. This can only be achieved by sensitization of the public as provided for in the project structure. The next stage after this is the preparation stage, in which the parties make immediate adjustments to effect the change. These are usually minor adjustments that have an immediate effect. Concerning the project, such changes might include changing the practices of health professionals and health institutions. Long-term effects, such as expanding in-patient housing facilities, are embodied within the fourth action stage. The actions are usually gradual but have a long-term effect on the desired change. The last stage is maintenance. Preventing relapse helps in cementing the changes made in the previous stages.

Additionally, evaluation is done to assess the behavior change process. This can be linked to the evaluation part of the project. The project’s outcomes are compared to the initial objectives in this stage. By doing so, the success or failure of the project can be determined.

Project Objectives

The general objective of such a community-based project is to ultimately reduce the impact of healthcare-associated infections on the community. In doing so, the project aims at improving the conditions of the various healthcare facilities in the community. This is the basis for reducing healthcare-associated infections of patients or health workers. This is because research shows that the number one cause of healthcare-associated infections is healthcare facilities’ deterioration coupled with a lack of proper surveillance. Solutions provided should be geared towards providing quality health care in suitable environments, which will be one of the project’s key objectives. The project should use existing standards and incorporate its own suggestions. A time frame of at least 6 months needs to be given for the health facilities to incorporate these solutions. However, the nature of the solution also dictates the amount of time for implementation. For instance, expanding certain in-patient housing facilities could be a possible solution. Such a proposal must go through the appropriate channels and can take about 2-3 years before implementation. Apart from improving the conditions of health facilities, the project aims to advocate for practices that reduce the risk of acquiring healthcare-associated infections. For instance, competent surgical practices and proper diagnosis and treatment of surgical site infections should be included as part of the project goals.
Additionally, the public should be educated on the dangers of healthcare-associated infections. Many of these infections occur during post-treatment. To seek timely medical attention, patients need to know the signs and symptoms of these infections.

Advertising and Program Materials

To ensure the project’s success, adequate information on healthcare-associated infection needs to be passed out to community members. In doing so, they will understand the weight of healthcare-associated infections and hence see the need to address this public health issue. Advertising helps create awareness and promote public participation in the project. The first way to advertise a local event is by word of mouth. Members of the research team can go from house to house educating the public on the impact of healthcare-associated infections and, in the process collecting information about the state of health facilities around them. Another way is by holding events that are bent on informing the public. These events should be coupled with entertainment activities such as family fun days to increase attendance. The program can also be boosted through posters and the inclusion of articles in local newspapers. A website could be created. It should contain information related to healthcare-associated infections. Public members will be able to visit this website to get detailed information on the subject. Local radio stations are also a perfect avenue for advertising a community project such as this one. Program materials that need to be drafted include interview questions, questionnaires, handouts, and booklets. The interviews and questionnaires are important to data collection within and outside the health facilities. The handouts and booklets will disseminate information about healthcare-associated infections to the public and health officials. All advertising should be geared towards community involvement because it is crucial to any community health education program.

Project Evaluation

Project evaluation is necessary for any community-based project to gauge its success and failure. The success and failure of any project should be reflected using its initial objectives. As aforementioned, this project’s main objective is to reduce the impact of healthcare-associated infections on the community. This main objective is encompassed in each of the three stated project objectives. These are aimed at increasing public awareness, promoting competent practices by health professionals and increasing the quality of health facilities within the community and the health care they offer. Based on these objectives, we can determine whether the project met its designated goals. The research team can conduct interviews and offer questionnaires to certain people to evaluate public awareness of healthcare-associated infections. Data collection should be structured to gauge the public’s awareness.

Additionally, the data collected from the project evaluation should be compared to those collected before implementation. From this, the research can determine whether the project succeeded in increasing public awareness. The project’s success can also be measured in terms of the condition of the health facilities within the community. Have the conditions improved? Do they meet national and global standards? Feedback from patients and health officials can be used to check whether health professionals are upholding the principles and practice guidelines given by the project team. Lastly, the main objective can be assessed by looking into current statistics regarding reported healthcare-associated infections and resulting deaths. These statistics should be compared with the statistics of previous years. These four parameters are useful in gauging the project’s overall success in the community.

Potential Barriers

Implementing such a project within a community is associated with challenges. The first hindrance to the success of the project is ensuring community participation. The issue addressed in the project is a technical, medical issue. Thus convincing members of the public of its importance might prove difficult. The public must realize the weight of this matter to participate in addressing it. Reaching out to the public on such a matter is a challenge the project will likely face. Another challenge is the need for cooperation with health facilities and health professionals. The said parties may refrain from participating in the project for various reasons. For instance, health professionals may refuse to be interviewed or questioned about their practice due to the fear of being labeled incompetent. The local health facilities may also refuse to participate in the proposed solution plans for various reasons, such as the cost of implementation.

Additionally, some proposed solutions may take a long time to implement, such as expanding patient housing facilities. Consequently, it will be difficult to evaluate the project’s success due to incomplete solutions. Another setback would be the cost of project execution. Certain aspects of the project require financial input to succeed. For example, the advertising, events, posters and website development would cost the research team a lot of money. Therefore, the research team must pitch their project idea to sponsors, including local authorities. Adequate funding will ensure that the project is executed swiftly.

📎 References

1. Australian Comission on Quality and Safety in Health Care. (2010). Preventind and controlling health care infections standard 3: FACTSHEET. Retrieved from http://www.safetyandquality.gov.au/wp-content/uploads/2012/01/NSQHS-Standards-Fact-Sheet-Standard-3.pdf
2. Centers for Disease Control and Prevention. (2014, May 22). Healthcare-associated infections (HAI). Retrieved from Centers for Disease Control and Prevention (CDC 24/7: Saving Lives Protecting People): http://www.cdc.gov/hai
3. Klevens, M., Edwards, J., & Richards, C. (2002). Estimating health care-associated Infections and deaths in U.S. hospitals. Public Health Reports, 122, 160-166.
4. World Health Organization. (2014). Health care-associated infections: FACT SHEET.