Strategies to Reduce Hospital Acquired Infections

Strategies to Reduce Hospital Acquired Infections REVIEW OF LITERATURE When we think about hospital, one thing comes to our mind is â€Å"Hospital is the place for cure†. This revolutionary idea of treating the patients under the same roof was considered to ease the job of healing. But due to lack of knowledge of sterilization and antisepsis, it turned wrong in Pre- Listerian era leading to gangrene and death of patients which were suffering from wounds. Due to this reason a new discipline was emerged called as senics which was mainly dealing with the Hospital Acquired Infection (Nosocomial Infection). Semmelwis in 1861 with the help of medical officer and students observed the association of Puerperal sepsis in patients. Thus by the introduction of hand washing with chlorinated lime, he was successful to bring dramatic reduction in infection rate. Hospital acquired infection (HAI) are infections acquired during hospitalization, which are not present at eh time of admission (Atata et al, 2006). According to Baveja in 2002, the term hospital acquired infection, hospital- associated infection, hospital infection or nosocomial infection(nosocomion,meaning hospital) is defined as infection developing in patients after admission to the hospital ,which was neither present nor in the incubation period at the time of hospitalization . Such infections may become evident during their stay in the hospital or sometimes after their discharge. Due to its increased mortality and morbidity in the hospital patients these HAIs are of significant cause. HAIs are also caused due to prolonged hospital stay which are inconvenient for the patient and constitute economic burden on health care (Malhotra S, et al 2014). Dancer in 1999, depicts that microorganisms which are associated with hospital acquired infection displays two important characteristics, firstly those are the pathogens of well-established medical importance and secondly they also can withstand the hospital environment which benefits them outside temperature. Thus providing an appropriate environment niche for their survival until they transfer back to patients. Some pathogens originate from patients own flora especially those who are immunocompromised whereas others can survive in human tissues and thus rely upon person to person spread in order to disseminate. The patients who are immunocompromised due to underlying diseases, medical or surgical treatment, age are typically affected by nosocomial infections. In pediatric ICU, the hospital acquired infections are approximately three times higher than elsewhere in hospitals (Weistein 2006). Pathogen transference occurs most commonly by presence of bacterial or fungi in inanimate surfaces and equipment or between the hands of health professionals and patients (Kayabas et al., 2008). The transmission of microorganisms from hands of health care workers, medical equipment and surfaces which has become contaminated with a wide variety of pathogenic and nonpathogenic organisms has become a significant proportion of hospital environment infection which ultimately results in crosscontamination (Sehulster et al., 2003). When compared to other hospital patients, the patients who are hospitalized in ICUs are 5-10 times more likely to acquire nosocomial infection. The risk of infection and the frequency of infection vary by infection site. The increasing incidence of infection is caused mainly by antibiotic-resistant pathogens leading to seriousness of hospital acquired infection (Weber 2006). Some of the common human pathogens like, Staphylococcus aureus, Acinetobacter spp, En ­terococcus spp and Escherichia coli can survive for longer periods of time on the hospital surfaces or formites that can potentially transmit infectious organisms (Kramer et al., 2006). The primary sources of indoor air contamination are the microorganisms. When compared to outside air environment, the indoor air environment can potentially place patients a greater risk because enclosed spaces can confine aerosols and allow them to build up to infectious level. The relative humidity and/ or the moisture content of the materials determine that to what extent different micro-organisms are able to grow on indoor or outdoor materials (Dhanasekaran et al., 2009). Adebolu and Vhriterhire in 2002 reported that magnitude of hospital acquired infection is dependent upon the number and type of visitors, mechanical movement within the enclosed space, quality of hospital systems and level of hygienic conditions in hospital environment. Sites where infections acquired in hospitals and other healthcare facilities. To be classified as a nosocomial infection, the patient must have been admitted for reasons other than the infection. He or she must also have shown no signs of active or incubating infection. Depending on the hospital involved, 1 to 10 percent of the patients affected die as a result of the nosocomial infection (George Krucik 2014). Most of these infections can be prevented while others are unavoidable. In hospitals the contaminated surfaces are increasing the cross transmission which is shown in figure-2. Figure-2 Showing the contaminated surfaces in hospitals (source: Wikipedia). These infections occur: Up to 48 hours after hospital admission Up to 3 days after discharge Up to 30 days after an operation In a healthcare facility when a patient was admitted for reasons other than the infection. In the United States, it has been estimated that 9.2 out of every 100 patients acquire a nosocomial infection Pathogens Causing Infection According to the CDC, the most common pathogens that cause nosocomial infections are Staphylococcus aureus, Pseudomonas aeroginosa, and E. coli (C.Glen May hall 2004). Based in biological and clinical criteria, the national Healthcare Safety network (NHSN) has categorized into 50 infection sites under 13 major types for the surveillance purpose (W. Bereket et al., 2012). When choosing the test organisms that are clinically relevant to human pathogens, six different organisms are considered to be major threats. These pathogens cannot cause the most devastating illnesses but majority of them will compromise with antibiotic resistant infections that are seen in most healthcare settings. These are commonly called as ESKAPE pathogens namely Enterococcus faecium, Staphylococcus aureus Klebsiella pneumonia, Actinobacter baumanni, Paeudomonas aeruginosa and several species of Enterobacter. These (ESKAPE Pathogens) pose a biggest threat that physician face today. To fight with them we definitely need some new drugs and need some cooperation among industry and government to setup RD (research and development) infrastructure to fill the needs of new drugs tha t will tackle tomorrow’s infectious diseases threats. Escherichia Coli It is oxidase negative, Gram negative, and facultative anaerobic. It is one of the common organisms that are involved in Gram negative sepsis and endotoxin-induced shock. It is one if the leading cause of blood stream infections among all other Gram-negative pathogens. It is the fifth leading pathogen for causing blood stream infection in United States (Maazuddin t al., 2014). According to Bijay Kumar Chandra 2012, a study was concluded that Escherichia coli were most common agent found in nosocomial diarrhea. Some of the common infection caused by this organism includes wound infection, urinary infection, meningitis in neonates, pneumonia in immunocompromised hospitalized patients and E. coli associated diarrheal disease or gastroenteritis. It also possess broad range of virulence factors which are responsible for disease such as UTIs and gastroenteritis (Brooks GF et al., 2007). Enterococcus spp These are gram-positive cocci typically arranged in short chains and pairs. These grow optimally at 350C on a complex media which requires carbon such as glucose, nucleic acid base and vitamin B. when enriched with sheep blood agar, it supports the growth with large and white colonies. Enterococcus species are facultative anaerobic and are considered as a part of normal flora in genitourinary tract and gastrointestinal tract of humans. Enterococcus species have emerged as a one of the most important pathogen of hospital environment. The major enterococcal infections of humans are caused by two species namely Enterococcus faecalis and Enterococcus faecium. Enterococci are one of the most important hospital acquired pathogens. Isolates of Enterococcus faecium and Enterococcus faecalis are the third most prevalent pathogens worldwide. The most common infection produced by this organisms are intra-abdominal infection, urinary tract infection, pelvic infection, surgiclal wound infection, endocarditis, bacteremia, neonatal sepsis and rarely meningitis. Enterococcus faecalis is the most common cause of infection (80-90%) followed by Enterococcus faecium (10-15%) (Marothi YA et al., 2005). Staphylococcus aureus Staphylococcus aureus is by far the most important pathogen in the hospital environment in all the genus staphylococcus. It is non-spore forming, non-motile, gram positive, catalase positive facultative anaerobe arranged in clusters (Wahington CW et al., 2006). The indicence of nosocomial blood stream infection is more known to be caused by S. aureus (Rodrigo et al., 2012). S. aureus is rarely isolated from urinary tract infection (T.Grace et al., 1993). This S. aureus is both pathogen and commensal. Approximately 30% individuals are intermittently colonized with S. aureus whereas 20% are persistently colonized. It is one of the leading cause of hospital acquired infections. Methicillin resistance staphylococcus aureus (MRSA) are the one which causes most of the infection and its isolation is continuously increasing (S Khono et la., 2007). Infections may occur during hospital stay by streptococcus and staphylococcus species when compared to other Gram-negative bacteria. Coagulase Negative Staphylococci The coagulase-negative staphylococci (CNS) species are widely known to cause NTs specifically bacteraemia in patients with prosthetic implants and catheter and also in patients who are immunocompromised. Staphylococcus epiermidis and Staphylococcus haemolyticus are the teo well known species and occur most common in CNS species (C.Geary et al., 1997). Coagulase negative staphylococci, Staphylococcus aureus and Enterococcus are the three most widely isolated pathogens which tends to cause blood stream infections. After hospitalization of the patient, the CNS usually takes 19 days to cause bacteraemia. The mortality rate of CNS is less when compared to some other pathogens (Aldof et al., 200). For the colonization of CNS, the main reason is its antimicrobial resistance. This CNS isolates is resistant to Oxacillin or nafcillin and methicillin (T Grace et al., 1993). Pseudomonas aeruginosa It is a Gram-negative with mucoid polysaccharide capsule typically arranged in pairs. It is a well known cause of pneumonia, endophthalmitis, conjunctivitis, sepsis and also associated with high mortality rates. Potential reservoirs include humidifiers, equipment, incubators, sinks, tap water and hands of health care workers. The identification of this pseudomonas aeruginosa is mainly based on simple biochemical test and colony characteristics. It colonizes the respiratory and gastrointestinal tracts of the hospitalized patients. When normal defense mechanism is impaired, the pathogenesis by this organism is initiated. Pseudomonas aeruginosa attaches and colonizes the mucous or skin and invades locally to produce systemic disease. This process is mediated by different virulent factors like enzymes (proteases, elastases, phospholipase C), Pili and toxins (endotoxin A). P. aeruginosa produces infection such as blue-green pus, urinary tract infection, meningitis, and necrotizing pneumon ia (Contreras GA et al., 2008). Many contemporary studies showed that, the antibiotic resistance among the gram-negative bacteria is increasing especially of pseudomonas aeruginosa. The rate of resistance towards ceftazidime and imipenem by Pseudomonas aeruginosa was increasing dramatically. Prevention of Infection There are number of simple care practices that can reduce the probability of developing a Hospital acquired infection. Some of them include sterilization of resuscitation bags and masks, elimination of overcrowding, decreasing number of heal sticks, use of sterile suctioning technique, careful preparation and storage of infants formulas, using single dose administration of medications and avoiding drugs associated with increased risk of nosocomial infection. Infection Control Committee The infection control committee is a board which deals with the preventionof hospital acquired infections. It involves multidisciplinary personals like pharmacists, physicians, clinical microbiologists and others. This committee works on co-operation, information sharing principles and inputs. It has many different tasks to perform for the eradication and prevention of hospital acquired infection. It has to review and approve the surveillance data when needed. It has to examine and encourage the infection control practices and provide proper staff training in infection control safety. It also need to assess the new devices used in the hoapital for their risk in violating infection control stratergies and slso to communicate and co-operate with the hospital control committees for information. According to infection committee statistics, the infection rate were increased from 13.8- 22.1 per 1000 catheter days (Jeffery et al., 2005). Therefore infection control committee plays a key rol e in preventing the nosocomial infection. Hand Hygiene Hand hygiene has been considered to be the most important tool in nosocomial infections control. One of the significant contributors to the outbreaks of this hospital environment infection is failure to perform appropriate hand hygiene. Resident and transient microorganisms are known to be the natural microflora of the skin of hands. The resident microorganisms survive and multiply on skin and does not cause any harm to human flora whereas transient microorganisms represent recent contamination of hands which is acquired from colonized or infected patients/clients or contaminated environment or equipment. These transient microorganisms are not isolated consistently from most of the persons. When compared to resident microorganisms, the transient microorganisms which are found on the hands of health care personnel will become as a primary source of infections. Gram negative coliforms and Staphylococcus aureus has been known to be the most common transient microorganisms (Sarmad et al. , 2009). Appropriate hand washing results in reduced incidence of both nosocomial and community infection (Kampf et al., 2004).An estimated 40 percent of nosocomial infections are caused by poor hand hygiene (WHO). Hospital staff can significantly reduce the number of cases with regular hand washing (Figure-8). They should also wear protective garments and gloves when working with patients (James Chin 2000).

Informative Speech Essay

Attention Getter: Mothers day is coming up, and there is a few options for you to use as gifts. 1. You can spend fifty dollar on flowers just to watch them die in a week. 2. You can buy her chocolates even though most of us are constantly trying to cut back. 4. You can do nothing and look like a jerk. 5. Or can simply spend a dollar at a thrift store, and create a desk ornament using only an old book. Topic Sentence: Recently I’ve made a few of these and have gotten a really great response from family and friends. I suppose I’d call it book-origami, but I’m not sure if there’s a proper title for this sort of thing. My purpose tonight is to teach you how to make one of these. Credibility / goodwill: After I made my first book, I got several compliments on it. Afterward, I came to the conclusion it might make a great mantelpiece, or even a desk ornament. Itsinthestars.com/us shows a survey taken in 2012 that states â€Å"The average person ends up purchasing 16 gifts or more a year.† Gift buying can add up quickly so I have found that it is nice to have a backup plan in case you’re broke at the time. Surely some of us in this very room have come to this dilemma so I am hoping to provide an idea for such an occasion. Thesis: Tonight I will teach you how to make one of these decorations by first teaching you what type of books are best to use, secondly I will tell you how to prepare the process of getting started, and lastly I will be teaching you a few of the folding techniques. Body: (Chronological = steps in a process) I. The First step in making one of these book decorations is to find the right kind of book to work with A. Through trial and error, I have found that it is best to use a hardcover book. 1. The way I have been making these has been without the use of any glues or starches, and the hardcover frame seems to help the book hold its shape naturally. B. When choosing your book you will also need to consider the number of pages that it has. 2. This was actually my first book, and it has about two hundred fifty pages in it. My second book actually has over 550 pages in it. The choice you make depends on your taste, but personally I think the thicker book has a much fuller and professional look. C. You should also consider the size of the cover of your book. 1. I believe that a someone smaller book makes for the best decoration because it doesn’t take up much room. Transition: Now that you have chosen a book to work with, you are ready to divide your book in sections. A. In my first book I didn’t take a whole lot of time, and just approximately divided the book into 3 sections. 1. You might not be able to tell at first glance but one side actually has around 15 pages more using the first folding style. B. If you want to go for a truly symmetrical look, I would suggest counting out each page individually. It will take more time this way, but you will probably be happier with the end result. 1. After you have decided how much you want in each section, I would recommend marking each sections beginning and end with a bookmark. Transition : Now that you have sectioned off your book, you’re ready to start folding. (please excuse my lack of technical terms, but this is really just something I’ve been experimenting with and was not actually taught anything about origami. A. I like to start off each book with several simple corner folds. 1. After each page, you should alternate between folding the top corner down, and folding the bottom corner down. 2. The reason I start the book this way because it is a really easy technique, and it also seems to help the book expand quite a bit. B. Another fold I use quite a bit I would call an airplane fold. I call it this because it is how I remember starting off paper airplanes, again this isn’t a technical lesson. 1. This technique is done simple by folding the top and bottom edges into the middle of the page. 2. I tend to use this technique for the middle section because again, it is very easy to do, and it helps the book to stand up. C. What I have used for the outer-middle section here is actually just a variation of the airplane fold. 1. After folding both edges in, you then take the middle point of the page and fold it to either the upper or lower portion, again alternating with each following page t o get this accordion look. Conclusion: Thesis: Tonight I have taught you how to make one of these decorations by first teaching you what type of books are best to use, secondly telling you how to prepare the process of getting started, and lastly I taught you a few of the folding techniques. Closure: Now you’re ready to make one of these for yourself. I’ve only been doing this for a few months, and I have found that most of the fun comes from trying new techniques. I’ve only shared with you a couple of the techniques that I’ve used. I would highly encourage you to try some of your own ideas, get creative . You could try ripping or cutting the edges of certain pages to give them a rough look, or you could add paperclips to portions of the book to give it a specific hold. Maya Angelou once said in the book Conversations with Maya Angelou printed in 1989 â€Å"You can’t use up creativity. The more you use, the more you have† I’ve always agreed with that. I have found this to be a fun, creative and cheap idea for a gift. Mothers day is Sunday the 12th of May this year, so you should get started.

Intro to Business Essay

FRANCHISE Case Study Questions: 1) Discuss the benefits and drawbacks of opening a franchise. (6 marks) The benefits of opening a franchise is that the franchisor would provide support, assistance and training; they would have a recognized name and products and; opening the franchise would be a reduced risk to the franchisee. The drawbacks of opening a franchise is that there would be restrictions on operations as the franchisee would have to follow the franchisor’s rules and regulations; must pay franchise fees and the percentage of sales to the franchisor and; there would be a loss of management control, prices, wages or even innovation. 2) Evaluate the benefits and drawbacks of running this franchise with a partner rather than doing it on your own. The benefits/advantages of running this franchise with a partner would be; It would be fairly easy to start the partnership with an agreement between two people; It would be easier to raise more capital than a sole proprietorship; We would have greater skills and expertise with two of us as partners and; flexibility to support and help each other. The drawbacks/disadvantages of running this franchise with a partner would be; there could be conflicts or disagreements with a partner; we would be sharing the profits and; there could be difficulty in leaving or ending the partnership. 3) List 6 key characteristics that you and your partner will have to display in order to be successful in this entrepreneur endeavor. The key characteristics that my partner and I would have to display to be successful in our entrepreneur endeavor would be, to be: Ambitious, committed, self-confident, energetic, passionate, creative, passionate, determined and risk takers. 4) List 6 stakeholders and discuss how they are impacted by your business. 1.Employees – my business would create jobs Customers – my business would be a convenience of another franchise available Suppliers – my business would give suppliers more business Government – my business would pay taxes (business and employee, etc) to help the economy Local Community – to create a better local economy of having a business Environment – to be environmentally responsible by using reduce, reuse and recycle FRANCHISE Case Study 1: Intro to Business 5) Using your knowledge of demand and supply theory. Draw a market for Dominos Pizza with demand (BLUE Line) and supply (RED Line) equilibrium assuming the average price customer pays for a Domino’s pizza is $9 and sells an average 500 units a week. (2 marks) Dominos Pizza – Supply and Demand in One (1) Week UNITS The pizza market is highly competitive and competitors prices impact and demand. On your diagram, draw the shift in demand that will result from new low price $5 hot and ready pizza offer by its competitor Little Caesar’s. Discuss the impact on Domino’s (in terms of its price and profits) . (2 marks) Due to the low price of the competition (Little Caesars) means Dominos pizza’s Demand Curve will DECREASE (GREEN Line) which means the profits will decrease along with the demand for Domino’s higher priced pizza. 6) As a local franchise, using your knowledge of the promotional mix, describe 4 tactics/strategies from the promotional mix that you could use to promote your local store. Be sure to explain how it will increase sales. (4 marks) 1. Personal Selling – to use a sales person to assist customers in making a purchase 2. Advertising – using different media channels to build awareness of the product 3. Public Relations – to create a good image of the company & product through publicity and sponsorship 4. Sales Promotion – to stimulate sales through coupons, discounts, contests & special offers 7) Make 2 recommendations to Domino’s Pizza Corporate on how the marketing mix could be changed in order to meet customer needs and continue to grow the company. (4 marks) The Marketing Mix is a blend of product offering, pricing, promotional methods and distribution system that brings a specific group of consumers superior value. My two recommendations to Dominos Pizza Corporate would be concerning the ‘Product’ to make smaller personal sized pizzas and my second recommendation would concern ‘Pricing’ to have a special introductory low price to attract customers, to the new personal sized pizza. My recommendations would meet the more ‘healthy = smaller sized portions’ of food to the healthy minded customer – and this would help with the growth of the company.

Iron Cage - Max Webers Theory of Rationality

One of the theoretical concepts that founding sociologist Max Weber is best known for is the iron cage. Weber first presented this theory in his important and widely taught work,  The Protestant Ethic and the Spirit of Capitalism. But since he  wrote in German Weber never actually used the phrase himself. It was American sociologist Talcott Parsons who coined it, in his original translation of Webers book, published in 1930. In the original work, Weber referred to a  stahlhartes Gehà ¤use, which literally translated means housing hard as steel. Parsons translation into iron cage, though, is largely accepted as an accurate rendering of the metaphor offered by Weber, though some recent scholars lean to the more literal translation. Roots in Protestant Work Ethic In  The Protestant Ethic and the Spirit of Capitalism, Weber presented a carefully researched historical account of how a strong Protestant work ethic and belief in living frugally helped foster the development of the capitalist economic system in the Western world. Weber explained that as the force of Protestantism decreased in social life over time, the system of capitalism remained, as did the social structure and principles of bureaucracy that had evolved along with it. This bureaucratic social structure, and the values, beliefs, and worldviews that supported and sustained it, became central to shaping social life. It was this very phenomenon that Weber conceived as an iron cage. The reference to this concept comes on page 181 of Parsons translation. It reads: The Puritan wanted to work in a calling; we are forced to do so. For when asceticism was carried out of monastic cells into everyday life, and began to dominate worldly morality, it did its part in building the tremendous cosmos of the modern economic order. Simply put, Weber suggests that the technological and economic relationships that organized and grew out of capitalist production became themselves fundamental forces in society. Thus, if you are born into a society organized this way, with the division of labor and hierarchical social structure that comes with it, you cant help but live within this system. As such, ones life and worldview are shaped by it to such an extent that one probably cant even imagine what an alternative way of life would look like. So, those born into the cage live out its dictates, and in doing so, reproduce the cage in perpetuity. For this reason, Weber considered the iron cage a massive hindrance to freedom. Why Sociologists Embrace It This concept proved useful to social theorists and researchers who followed Weber. Most notably, the  critical theorists associated with the Frankfurt School  in Germany, who were active during the middle of the 20th century, elaborated on this concept. They witnessed further technological developments and their impact on capitalist production and culture  and saw that these only intensified the ability of the iron cage to shape and constrain behavior and thought. Webers concept remains important to sociologists today because the iron cage of technorational thought, practices, relations, and capitalism—now a global system—shows no signs of disintegrating anytime soon. The influence of this iron cage leads to some very serious problems that social scientists and others are now working to solve. For example, how can we overcome the force of the iron cage to address the threats of climate change, produced by the very cage itself? And, how can we convince people that the system within the cage is  not  working in their best interest, evidenced by the shocking wealth inequality that divides many Western nations?