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Infections in Hospitals: Barriers to Prevention

Infections in Hospitals: Barriers to Prevention

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iv catheter associated infectionsThese are 8 reasons why it is difficult to control infections in hospitals.

  1. All medical staff do not wash their hands when they should. The single most important and effective means for preventing infections is proper hand hygiene. Unfortunately this is a challenge for healthcare staff because of the demands of constant patient care. The advent and scientifically proven value of waterless alcohol-based hand gels, foams, and liquids has added a powerful weapon to the arsenal of effective hand hygiene products.
  2. There could be a delay in diagnosing the infection. Many hospitals may not analyze their own laboratory tests and thus the facility may “outsource” these services by sending the specimen to the laboratory. There can be a delay in obtaining the laboratory results when outsourcing specimens. “Stat” laboratory results may not be obtainable. While bacterial culture results are usually available within about forty-eight hours, gram stains can be done and read in a matter of minutes. This provides acute care infection control efforts with more rapid results. Gram staining, however, does not provide definitive results. The final culture needs to be reviewed, and if necessary a change in treatment may be initiated.
  3. There could be a delay in starting the right antibiotic. Often treatment is initiated based on the usual causal organisms. Once these culture results are available and reviewed by the physician, a treatment plan will be reevaluated. Some organisms are resistant to certain antibiotics. If organisms are resistant to the antibiotic used as treatment, a change in antibiotic is indicated. Resistance is defined as when the antibiotic does not slow or kill the organism. When an organism is sensitive to an antibiotic, this organism will be affected by the antibiotic. Some providers do not order the correct antibiotic or the correct dose because of lack of knowledge or not checking the culture and sensitivity report when it is available.
  4. There are strains of bacteria and viruses that are not killed by antibiotics. The “super bugs” may invade a patient’s body and cause death. Antibiotics are lifesaving and at the same time lead to the development of microbial resistance to these drugs.
  5. There are multiple opportunities for staff (or the patient) to transmit the organism from the patient to someone else. Accommodations can be made for those patients who require isolation in the hospital setting. A hospital stay is recognized as temporary, which makes it possible to confine patients to their rooms when controlling communicable diseases. Even hospitals have to face the necessity of the infected patient leaving the room for therapy, diagnostic tests, and surgery. In some instances patients may leave to visit other patients, go to the lounge, or even the cafeteria. Thus, patient transport to other locations complicates the ability to control infections.
  6. Treatment of infections is expensive. Another barrier includes the costs of medical care, which have risen at the same time payments for care provided have declined. Coincidentally, patients in hospitals today tend to be much sicker; and people living longer increases subjection to chronic diseases, often requiring more sophisticated and costly care. This conundrum demands greater resource availability, yet less is available.
  7. Staffing for most infection control departments is limited and can be another major barrier to fighting infections. For years the infection control community has unsuccessfully attempted to identify the proper infection control specialists and epidemiologist-to-patient ratio, as health care is in constant flux.
  8. The art and science of acute care infection control is far more complex than it was in the 1960s, even when taking into account that era’s hospital-acquired infections of penicillinase-producing staphylococci. Intensive care units did not exist in most hospitals then. Hospitals now have numerous intensive care units filled with critically ill susceptible patients. Patients are living longer and acquiring diseases or treatments that diminish the effectiveness of the immune system. Sophisticated medical diagnostic techniques and interventions are double edged as they may save and prolong life but not without risk of adverse consequences such as infections.

Modified from “Infections in Hospitals and Nursing Homes” in  Nursing Malpractice, Fourth Edition 2011

  • Do you want to sharpen your skills in understanding liability issues of hospital-acquired infection cases?
  • Are you a legal nurse consultant or attorney who is asked to evaluate an infection case for liability, causation, and damages?
  • Are you a clinician interested in understanding the medical and legal implications of these infections?

Med League provides medical expert witnesses to trial lawyers. Please call us at (908)788-8227 or contact us today to discuss your next case.

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