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This case study shall centralize on how one can reduce nosocomial infection in the hospital. This comes from the wake that repositioned there is dire need for quality improvement strategies by Memorial hospital to mitigate the high rates of Nosocomial infection due to postoperative infection. The GP in this hospital have lost faith with the surgeon and they even refers patient to other hospitals for operations and this has reduce admission for this hospital and increase their neighbouring hospitals (Nichols, 1998). This has left the surgical staff with frustration as the patients are referred elsewhere. Am here supposed to administer the situation and offer the support which can help this hospital mitigate completely this problem as an administrator.
For us to understand the scope of the study there is need to define the key words in the case; Nosocomial infection is the scientific name which refers to any kind of infection which affects the patients during his/her admission at any given health care facility. This however is accounted whether this infection was discovered during the stay or after. Postoperative infection is one major kind of the nosocomial infection which usually affects the wounds of an operated patient, this usually occurs in the tissues around any incision or area of operation. This usually is very effective and occurs during the first day after operation or may take even years, however, analyst have acclaimed that it usually occurs after surgery on the 5th and 10th day. Statistics shows that the prevalence and incidents of nosocomial infection results to 79% of the death documented from surgical cases which usually adds up to postoperative infection (Green & Wenzel, 1997).
Causes of Nosocomial
Usually one of the major documented causes of infection on the wound in the hospitals is as from the result of microbes thriving within the surgical domain which is the outcome of neglect and deprived preparation of preoperative, deprived selection of antibiotics, poor immune system of the patient, wound contamination and poor attendance of the post operatives. In majority of the incisions which are conducted contamination of the wound has been one of the major dilemmas to medical practitioners (Hughes, 1988). Another documented cause which usually delays the quick recovery of the wound posing serious contamination uses includes malnutrition, decreased oxygen and cardiac failure which results to tissue weakening and his provides room for infection to culminate.
Deoine & Sandra (2009) states that there are four category of infection of wounds this include clean wound contamination, slightly contaminated wounds (biliary or abdomen surgery cases), highly contaminated wounds (intestinal surgery) and infected wounds which are contaminated even before surgery. Few of the high risks which make infection in these cases to be rampant are surgeries which last more than 2 hours, malnutrition and contamination incision and surgeries. This are usually support by also individual poor immune system, diabetes, decline in level of blood, use of immunosuppressant’s such as steroids and deprived perfusion of tissues. Some of the attributes of the wound may also foster contamination in surgical site infection (SSI), this usually encompasses factors such as poor skin preparation, wound drains and dead tissues. Some other factors include the sanitation by the surgical staff and the room and equipment if they are not highly sterilized. Another has been misdiagnosis of antibiotics. Another issue is advancement of age usually it has been articulated that elderly patients are more prone to infection than younger generation (Chaudhuri, 1993).
As the administrator of Memorial hospital in the campaign to curb postoperative infection, these are the measures which I would implement. Research has articulated that nearly 53% of the postoperative infection can be mitigated through prevention and control. Instilling sound judgment and proper sterilized surgical procedures to the patient would most be the number one factor which would be emphasized on the surgical staff and nurses whom are in contact with postoperative patients. However, although this has been proven to be hard to quantify and apply to the staff regular check of the surgical equipment and regular assessment of how surgical procedures are carried out would compliment this implementation. Strict regulation would also be enforced to ensure that the doctors adhere to the regulations which I assert in the implementation correctional changes (Fisman & Cosgrove, 2007). Some of these correctional regulations would cover the following factors proper diagnosis of preoperative antibiotics, sterilization of all surgical equipment and rooms and considerate isolation techniques which facilitates suturing postponement of infected and contaminated wounds thus reduction of nosocomial infection would be kept at bay.
Another method would also be analyzing the procedure which the doctors are executing while operating and if they are not up to date, then more training would also be recommended to the surgical staff and the supporting nurses. From this implementation it is advised that one of the major causes of infection is due to lack of sanitation from the surgical staff (Nichols, 1998). Thus the doctors would be enforced to adhere to proper sanitary hand washing practices which would ensure that the process is safe and the insertion area and equipment are sterile. Sterilizing the insertion area would be sterile using chlorhexidine disinfectants and all inserting devices to be humidified and sterilized in the sterilizers to kill all form of microorganism and bacteria which may be in this areas and equipment. Some of the inserting devices which would be centralized on being sterilized and disinfected with chlorhexidine solutions include central venous catheters and chest tubes and all other blood transfusion apparatus as exemplified by Green and Wenzel (1997).
According to Hughes (1988) strict and proper administration of antibiotics will also lessen the chances of nosocomial infections. The best diagnosis encompasses minocycline and rifampin antibiotics which are the most effective in combating and mitigating infection and contamination of the wounds after surgery. These factors are the main stream that I would advice the hospitals to enforce so that they can adhere to reduction of infection of postoperative infection.
Limitation of the study
One major limitation which is the first cause even for infection in hospitals is lack of funding to facilitate preventive measures. The implementation that would be proposed is bound to be met with this road block because of the economic budget had not capacitated for this implementation (Fisman & Cosgrove, 2007). However, I would also encourage the administration to fund this initiative so that this may reduce morbidity and mortality rate at memorial hospital and increase admission of surgery pataints and thus generate revenues to buy more modern machines for insertion and renovate surgery areas to reduce infection chances.
The major recommendation that would be emplaced on the doctors and the supporting staff in the surgery rooms is sanitation. Proper and simple means which justify cleanliness like washing and sterilizing the equipment which major uses includes insertion would be the top agenda that the surgery staffs are emphasized upon. The hospital itself shall also have to raise the budget allocation for this division to embark on purchasing new modern equipment which would capacitate infection and sterilizing works as echoed by Nichols (2001). The budget will also purchase new initiatives and apparatus like gloves, masks, gowns, aprons, disinfectors and the hospital would also allocate the best antibiotics in this division to incapacitate infection.
Statistics have approved that intravenous line s are responsible for about 35% of the infection which involves blood stream infection. Usually the recommendation which would emplaced to the practitioners is that careful insertion and catheter care would be applied o lessen infection. The hand of the person performing this task should at all times be gloved and disinfected with alcohol composed of chlorhexidine or isopropyl alcohol. These two disinfectants should also cleanse the area of insertion and allow drying before the cannula may be inserted. Gauze dressing should at all time proffered by transparent dressing as the morbidity level of transparent dressing provides high risk of infection and ground for breeding microorganism responsible for of catheter tip infection. This can also be mitigated with the new polyurethane dressings known as Tegaderm which reduces catheter tip infection and sepsis rate. They are effective because they do not allow circulation of moisture and this limiting access of microorganism to the insertion areas (Chaudhuri, 1993).
It has been articulated that the major cause of nosocomail infection is neglect and lack of sanitary etiquettes by the surgeon staff all over the world. Analyst have qarticualted that because most of the hospitals have all facilities and implementation required to mitigate this phenomenon which claims more than 10,000 lives in a year or leaves many with permanent external or emotional scars. This can be mitigated through sanitary procedures which are less costly to the hospital. Cleanliness and sterilization of the operating room, insertion areas, surgery staff and equipment would ensure that there is not room fostering microorganism which contaminates the process and thus infects the patient. Proper diagnosis of antibiotics and disinfectant has also been another method of mitigating postoperative infection. When this simple procedures are adhered to and proper sterilizing equipment are supplied then this epidemic is mitigated.