RUNNING HEAD: Evidence Based Approach to HAI 1

Clinical Assignment: Evidence Based Approach to Prevent Hospital Acquired Infection

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Evidence Based Approach to HAI 2

Evidence Based Approach to Prevent Hospital Acquired Infection

It is estimated that about 10% of hospitalized patients experience a healthcare-associated

infection (HAI) every year, resulting in significant morbidity and mortality (HHS, 2013).

Prevention of Hospital Acquired Infections is of great economic and public health concern and as

such is a top priority for the U.S. Department of Health and Human Services (HHS), and

Hospital Acquired Infections are the focus of a host of national and disease prevention

initiatives. Healthcare providers owe a great deal of legal responsibility of care to their patients

and must exercise that level of care and skill in the levels that could be expected of a prudent

practitioner. They also owe their patients the responsibility to act in the best interest of the

patient as set out in various ethics of practice in health care. In the same vein, health care

institutions have an obligation of providing a safe environment that facilitates healing and

recovery to keep their patients off harm’s way in the course of receiving care. Health care

institutions have "a duty not only to establish necessary systems and protocols to promote patient

safety but [they] must also take reasonable steps to ensure that ... staff (including medical staff)

comply with these protocols." (Picard and Roberts 1996).

Considering the issue described here, it is most likely the case that the patient has

acquired an HAI which can be traced to the failure of the care providers to follow evidence-

based practices which in this case has amounted to medical negligence, predisposing the patient

to the following three risk factors and eventually coming down with an infection which includes

Patient Risk Factors which is the length of the period of the patient's stay in a clinical setting, the

severity of the illness or injury which brought about the admission, and the functionality of the

patients’ immune system as at the time of visit and hospitalization, then organizational risk

factors which include the aseptic status of the hospital and treatment applications in general,
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including the, the concentration of patient beds, cleanliness of water systems, sterility of medical

devices etc., and finally the iatrogenic risk factors which include how careful and prudent the

care providers are in discharging their duty, their hand hygiene routines, use of antibiotics, and

especially care used during invasive procedures such as intubation, and urine catheterization.

While it may be difficult to ascertain exactly the source of the infection, it can’t be denied

that the damage has been done and like every other case of medical errors, silence does not

prevent litigation, it promotes it. My response to the family members of the patient is to

apologetically explain the risk factors that predisposed the patient to HAI, let them know of the

extent of damage done and possible interventions in line with the active disclosure policy of the

hospital, and then assure the patient that the issue has been reported to the quality assurance

committees of the hospital which will monitor the incidence and make steps to improve the

quality of care provided in the facility, thus enhancing patient safety and learning from past

mistakes.

One strategy I employ in my clinical practice to reduce the spread of infection during

patient care is the hand hygiene technique according to the WHO directives (Bolton, &

McCulloch, 2018). This is particularly of great importance in taking care of ICU patients, in

patients of prolonged hospital stay, in patients with weak immunity like the aged, the infants and

the immune-compromised. I clean my hands by rubbing them thoroughly with an alcohol-based

formulation, as the preferred mean for routine hygienic hand antisepsis if my hands are not

visibly soiled. It is faster, more effective, and better tolerated by my hands than washing with

soap and water. I wash my hands thoroughly with soap and water when my hands are visibly

dirty or visibly soiled with blood or other body fluids or after using the toilet. If exposure to

potential spore-forming disease-causing organisms is strongly suspected, I wash my hands with

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soap and water (Bolton, & McCulloch, 2018).. To rub my hands for hand hygiene, I apply a

palmful of the product in a cupped hand, covering all surfaces. I rub my hands palm to palm,

right palm over left dorsum with intersected fingers and vice versa, palm to palm with fingers

intersected, backs of fingers to opposing palms with fingers interlocked, rotational rubbing,

backwards and forwards with clasped fingers of right hand in left palm and vice versa. Once dry,

my hands are safe. I wash my hands when visibly soiled by applying enough soap to cover, I rub

my hands palm to palm, all hand surfaces, I make my hands wet with water, right palm over left

dorsum with intersected fingers and vice versa, palm to palm with fingers intersected, backs of

fingers to opposing palms with fingers interlocked, rotational rubbing backwards and forwards

with clasped fingers of right hand in left palm and vice versa. Then I rinse my hands with water,

dry my hands thoroughly with a single-use towel, and then use a towel to turn off the faucet, my

hands are now safe.

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References

U.S. Department of Health & Human Services (2013): National Action Plan to Prevent Health

Care-Associated Infections: Road Map to Elimination. Retrieved from

http://1.usa.gov/1KycQcM

Picard and Roberts (1996). Legal Liability of Doctors and Hospitals in Canada, 3rd ed. (p. 370).

Thomson Canada Ltd.

Bolton, P., & McCulloch, T. J. (2018). The evidence supporting WHO recommendations on the

promotion of hand hygiene: a critique. BMC Research Notes, 11(1), 899.

https://doi.org/10.1186/s13104-018-4012-3