Critical Evaluation of Adverse Events in the Acute Environment

The aim of this essay is the critical evaluation of adverse events in the acute environment. Adverse event (AE) can be defined as an unattended and harmful effect which is caused by healthcare management that has or may cause harm to patient/s and result in prolonged hospital stay, disability or death (Wyeth, 2014). AE impose a huge financial burden on the healthcare system HCS and question the quality of care of the patients. AE is not caused by the mistake done by a single person who is involved with the direct cares of a patient but might be the conditions in the whole system that let the AE to occur (Raftar et al., 2014). Falls, medication errors, pressure sores and infections are different types of AEs that put patients at risk and place a huge burden on the HCS to resolve these issues (Kang, Kim, & Lee, 2014). AE chosen for this essay is hospital acquired infection (HAI). This essay will also talk about the prevalence of HAIs in healthcare and how it effects the patients, their families and the HCS itself. Two strategies involving interprofessional practice to prevent HAI in the hospital setting are also going to be explained in this essay. This essay will also show light on some of the barriers in the achievements nursing strategies to prevent HAI in the hospital setting and discuss the various approaches to overcome such barriers and prompting patient safety.

HAI is also known as nosocomial infection that is the major safety concern for patients admitted in hospital and results in morbidity, increase in deaths and put health care system into financial pressure. There are approximately 200,000 HAIs occur in Australian hospitals each year that shows it is the most common complication effecting patients (Mitchell, Shaban, Macbeth, Wood, & Russo, 2017). HAI is defined as an infection acquired by a patient during the hospital stay when he/she admitted in the hospital for another reason rather than infection. These infections appear after hospital discharge and also occupational among hospital staff. (Kadri, 2014). Different types of HAIs are urinary tract infections, surgical site infections, bloodstream infections, lower respiratory infections to name a few. HAIs occur because of microorganisms transmit from an infected person to a non-infected person through personal contact, air droplets, contaminated food, medicines, equipment, water and so on (Fernando, Grey, & Gottlieb, 2017).

Patients and their families often get emotional stress caused by HAIs lead to prolonged hospital stay, disability, reduced quality of life, readmissions, loss of job and fear of death (Kadri, 2014). Medicare costs are increased by HAIs both during hospital admission and subsequent health care that leads to financial stress as Medicare may not cover when a patient has consumed a specific coverage threshold (Coomer & Kandilov, 2016). Surgical infection is one of the HAI occurs up to two years of surgery is mostly acquired during the surgery cause suffering to the patients and leave negativity impact on their lives. Devices used to drain fluid from the surgical wounds in these cases can be socially embarrassing for the patients (Moore, Blom, Whitehouse, & Gooberman-Hill, 2015). Depression and anxiety can also be seen among the patients who are on contact or isolation precautions. Patients feel neglected and discriminated when they have less contact with nurses and family members (Landelle, Pagani & Harbarth, 2014).  In the situation of loss of physical function patients become dependent on partner or family members that put burden on the caregivers that brings psychological stress to the patient like loss of dignity and independence. Loss of income because of sudden disabilities as a result of HAIs put the patients in financial difficulties (Moore et al., 2015). Antibiotic treatment of HAIs cause side effects like diarrhea, allergic reaction and vomiting may lead to social isolation due to embarrassment and humiliation (Guillemin et al., 2014).

Infection Prevention and control (PAC) is a continual struggle as medical treatment has become more invasive and ageing and immune comprised population continue to increase. There is financial burden on HCS due to allocating resources and the funds to treat patients from HAIs and to make strategies to prevent HAIs (“Australian Safety and Quality Goals for Health Care | Safety and Quality”, 2018). Surgical site infections, central venous catheter associated infections and catheter associated urinary infections are the most common infections causing financial burden on the hospitals. Different types of costs include medical service, medications, material and compensations to the patients due to the unintentional harm caused in the form of HAIs (Fernando, Gray & Gottlieb, 2017)

The role of nurses is very important in PAC of infections in their daily activities when they look after patients. It is the responsibilities of nurse to make sure that quality care is being provided to the patients by following the appropriate practices to save the patients from HAIs. According to the National Competency Standards for the Registered Nurses in Australia, a nurse should have basic competencies on skills, knowledge and attitude to provide safe and competent care (Liu, Curtis, & Crookes, 2014). Two nursing strategies involving inter-professional practice for this essay are hand hygiene (HH) and the use of Personal Protective Equipment (PPE) for PAC of HAIs. Inter-professional practice includes different healthcare professional such as physician, nurses, dieticians, pharmacists, environment physicians, physiologist, nutritionists and so on that are involved in the patient care for various reasons or care needs during their hospital stay. So, the role of their inclusion       is important for effective Infection PAC strategies (Nester, 2016).

It is recommended by the World Health Organization (WHO) that HH is the effective way to prevent HAIs. HH is defined as any action of cleaning of hands. Hands are common source of transmission of organisms and therefore HH is a significant approach to prevent infection passing from one person to another. HH is washing hands with soap and water, use of alcohol-based hand rub (ABHR), no artificial nails, trimmed fingernails with no nail polish and avoiding wearing long sleeve clothing to prevent infection transmission through hands (Mehta et al., 2014). The presence of microorganism is reduced when HH is performed correctly and it also promotes infection prevention. Five moments of HH recommended by WHO guides healthcare professionals to when, why and how to perform HH (Wyeth, 2014).

The other aspect of standard infection PAC strategies is PPE. PPE are the equipment used to protect self and to minimise the risk of transmission infectious organism in the healthcare setting. Gloves, apron, facemask, gowns, shoe covers, goggles and eye protecting items are included in PPE (Lamb, 2013). HCPs should have the knowledge about PPE items when caring patients with various health conditions to prevent infection. Nurse and other healthcare professionals are expected to follow the hospital guidelines to prevent PAC infection at the time of cleaning body fluids and blood spills, specimen collection, collecting and handling used equipment and instruments. To follow the correct sequence of putting on and removing PPE is highly important to reduce the risk of unintentional exposure to microorganism causing infection (Liu et al.,2014). Educating the staff to help assessing the risk associated to the task and select appropriate PPE wisely will save from potential exposure to the infectious agents and promote self and patient safety

(Wyeth, 2014.) Provision of PPE such as gowns, mask and gloves outside the patient’s rooms who are isolated or are under contact precautions, clear signage of using appropriate PPE on the doors of the rooms and educating visitors to use appropriate PPE like mask for the patients under droplet precautions can help in infection PAC (Barker et al., 2017). Providing education to the staff about appropriate positioning of PPE in the clean dry places and using PPE dispensers, avoid decanting PPE will save decontaminating of PPE and prompt safety (Lamb, 2014).

There are some barriers in implementing the above two chosen strategies for PAC of HAIs that includes lack of knowledge in basic infection PAC practices, inexperienced staff, incorrect use and disposal of PPE, lack of hand washing bays, language proficiency, nurse to patient ratio and so on (Barker et al, 2017). There is not enough awareness among the nurses about the standard precautions like HH and PPE. In previous study majority of nurses expressed that the use of gloves replaces hand washing. The reason of this perception could be lack of work experience and previous trainings (Kang, Kim, & Lee, 2014). Inappropriate use and disposal of PPE increase risk of infections among staff and patients. Barriers for HCPs being non-compliant in using PPE includes incorrect fitting, insufficient knowledge, availability of PPE, skin reactions, workload and so on (Wyeth, 2014). Another barrier in infection PAC strategies such as HH and PPE is language. Limited language proficiency and experience issues to understand terminology used in health care setting are seen in the HCPs from non-English speaking countries (Travers et al., 2015). Studies have shown that the terminology related to HH has been interchangeably used like hand disinfectant, hand washing, hand rub ABHR and hand sanitizer which can be confusing for the HCPs with limited language skills (Pires, Tartari, Bellissimo-Rodrigues, & Pittet, 2017). Another barrier is nurse to patient ratio that affect to carry out routine infection PAC strategies because of excessive work load (Traver et al, 2015).There are also some other barriers in infection PAC to minimise HAIs such as lack of hand washing bays and unavailability of ABHR (Mehta et al., 2014).

To overcome the above barriers there are different methods which can be helpful to infection PAC such as on job education and training to the new staff, provision of  basic knowledge about HH such as HH Australia handout explaining five moments of  HH with written and visual description and access to  infection control units to obtain required information. Another strategy is to educate hospital staff about how and when to use PPE and appropriate method to remove and disposal of gloves (Lamb, 2013).The role of hospital management staff is also very important to address the issues like provision  of more sinks and ABHR dispensers, sufficient supply of HH and PPE products, fast access to dermatologist in case of skin reaction, monitor staff work load to ensure the staff get enough time to comply with hygiene policies. Posters and signage at various locations tokens of appreciation like cups, water bottles, officials notice, and emails can help to motivate staff for HH and PPE use (White et al., 2015). Empowering patients to participate in their care can also be beneficial for infection PAC strategy. National Patient Safety Agency initiated Cleanyourhands campaign and the aim of this campaign used to encourage patients to ask healthcare professionals if they have performed HH before providing them care is a good example of patient empowerment (Seale et al., 2015). There are also other strategies such as pictures, colour coded messages clear and simpler readings and educational sessions will help HCPs from diverse cultures, languages and different educational levels to develop their knowledge about HH and the use of PPE (Travers et al., 2015).

To conclude it can be said that this essay fulfilled the aim of critically evaluating the adverse events in the acute environment. The chosen adverse event in this essay is HAI and the prevalence of HAI in Australian hospital setting is discussed as well. This is also highlighted how an AE affects the patient and their families in terms of emotional stress because of prolonged illness or disability caused by HAIs, change in physical appearance and financial burden. Besides of that, it has also been discussed how the healthcare system bear the financial burden resulted from HAIs such as facing legal complaints lodged by patients and their families, cost of prolonged treatment of patients and use of resources. Critical evaluation of the chosen two strategies of HH and PPE is also discussed in this essay. The role of the Interprofessional practice and the barriers to implement these strategies are also identified. The different strategies to overcome these barriers to promote patient safety are also presented in this essay.


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