Article Review: Infection in Acute Care: Evidence for Practice

The article chosen is Infection in Acute Care: Evidence for Practice,which focuses on treating and preventing three common infections. Some complications may arise from receiving treatment for other infections in hospital and healthcare environments. While scientific advances have resulted in life-saving treatments for many illnesses, they have also raised the danger of healthcare-associated complications. This article analyzes three common infections patients may get when receiving acute care: pneumonia, gastrointestinal tract infection, and surgical site infection. The purpose of reviewing the article is to reflect on the recommendations for preventing and controlling the mentioned infections. However, a few concepts might not be effective for some people, including children, pregnant women, and immunocompromised patients.

Discussion

A study conducted by the Centers for Disease Control (CDC) indicated that for about 12,000 patients treated in 2015, more than 3.2% of patients admitted they had some form of infection associated with healthcare (Houghton 24). The most common infections were pneumonia at 25.8%, surgical site infections at 16.2%, and GI tract infections at 21.3% (Houghton 25). Patients on immunosuppressive medication and individuals with deficiencies in their immune systems are exposed to higher risks of infections when receiving treatment in hospitals. During the last century, various antibiotics were developed, significantly reducing infection-related mortality rates. However, as these medications have grown more widely used, pathogens of all types have evolved progressively, becoming resistant to their effects, resulting in the emergence of multidrug-resistant organisms (MRDOs). MDROs are established in practically any care situation, but are most prevalent in acuity.

Community-acquired pneumonia (CAP) was recently discovered as the sixth most common finding at the time of admittance to the hospital and is the eighth leading death-causing disease alongside influenza in the United States (Houghton 25). Pneumonia that develops during hospitalization is called Hospital-acquired pneumonia (HAP). Patients hospitalized for more than two days, as surgical patients, are at a higher risk of getting HAP. The most critical variance between HAP and CAP is the increased hazard of MDRO pneumonia in hospitalized patients. Ventilator-associated pneumonia (VAP) progresses when an individual is placed under mechanical ventilation for a duration exceeding two days.

More than 20% of infections acquired in hospitals are from surgical site infections (SSIs). Threat elements may be either procedure or patient-induced (Houghton 28). Patient causes may be categorized into two groups: Patient-determined factors, including non-modifiable factors such as smoking, alcohol, and obesity, and modifiable factors such as radiotherapy, age, and patient history. Infections may present themselves through edema, fever, and increased white blood cell count. It is sometimes difficult to differentiate between a normal postoperative surgical wound and an unhealthy surgical site. Examining the location regularly, typically by the same individual, can be beneficial.

Pseudomonas, Streptococcus, and Staphylococcus are the most common bacteria that infect surgical wounds. The bacteria infect surgical wounds through contact with unsterilized equipment, a contaminated care provider, or when they already exist in the patient's body. Surgical site infections typically appear thirty days after the surgery. The CDC classifies them into Deep incisional SSI, Organ, and superficial incisional SSI (Ilies et al.). Deep incisional SSI occurs when the infection happens under the incised region in the tissues and muscles. Organ SSI occurs when organs and regions other than the skin or the tissue that underwent surgery become infected. It may include the space between organs. Superficial incisional SSI occurs when the infection occurs in the incised skin region.

C. difficile infection (CDI) rates in community and inpatient populations have gradually and drastically increased over the last 20 years (Banks and Phillips 729). CDI is mainly caused by exposure to bacteria, antibiotics, and, in extreme cases, comorbidities. The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) have announced new guidelines that advocate testing individuals who have more than three unformed stools in a duration of 24 hours without using laxatives.

C. difficile is spread mostly through the fecal-oral channel, although new evidence suggests it could also be airborne (Banks and Phillips 729). Most people remain asymptomatic despite C. difficile being cultured in their stool. Disrupting flora in the gut through the use of antibiotics may lead to infection. C. difficile produces toxins that harm the intestinal lining, destroying cells, causing the decaying of cellular debris, and making patches of inflamed cells or plaque. Severe cases of C. difficile may cause colon enlargement, sepsis, and inflammation of the intestines.

Reflective Commentary

To prevent HAP and VAP, high levels of hygiene should be practiced in hospitals, especially hand hygiene. Hospitals should provide antiseptics near patient beds to ensure increased hygiene compliance levels. High levels of oral care should also be practiced. Quiet inhalations into the intrathoracic airway are common in healthy people, although they are more common in the elderly and those who are neurologically impaired (Kollef 1403). Hospitals should also position their beds strategically, ensuring that airflow is sufficient. Mobility programs could aid in reducing VAP and HAP in hospitals.

Preventing surgical site infections involves hospitals maintaining extremely high standards of hygiene. Handwashing should be highly encouraged before and after surgical procedures. Before carrying out any procedure, the skin should be cleaned using an antiseptic. The surgical team must always use sterile drapes and clothing. Antibiotics must be used an hour before making any incision and stopped 24 hours after the surgery. The wound should be adequately cared for with proper dressing, while open wounds should be sterilized.

Finally, to inhibit C. difficile infections, high hygiene levels should be practiced at home and in the hospital. Hand washing should be done often with soap and water. All surfaces must be kept clean. Medical personnel should wear protective gear when handling patients and any samples provided. The gear should be disposed of appropriately after use in closed-lid bins, preventing further transmission of infections. Surface disinfectants such as chlorine, hydrogen peroxide, and peracetic acid should be used when cleaning, especially in hospitals. The article Infection in Acute Care: Evidence for Practice adequately explains three of the most common infections patients may acquire when receiving acute care. All are preventable and controllable if hospital personnel, patients, and caregivers pay attention to hygiene and proper care.