National Safety and Quality Health Service Standards

Running Head: National Safety and Quality Health Service Standards 1
Preventing and Controlling Healthcare Associated Infections
Preventing and Controlling Healthcare Associated Infections
One of the emerging issues in healthcare, is the ability of health facilities to provide a
safe environment for treatment. This is done by preventing the transmission of health-related
infections to other patients in the facility (Fauci & Morens, 2012; Boyd & Sheen, 2014). Hence,
it requires healthcare providers to be proactive and prevent the occurrence of diseases and
infections within their facilities of service. (Vaz, et al, 2010; Geiger-Brown & Lipscomb, 2011;
Carpman & Grant, 2016). The aim of this review is to evaluate the causes of healthcare related
infections, their effect on the individual health outcomes and the healthcare sector in general;
prevention and control standards, and mechanisms to reduce the chances of patients getting
infected while undergoing treatment. This will be achieved by reviewing the available literature
on this topics and the National Safety and Quality Health Service Standards (NSQHSS)
The need to establish quality healthcare standards led to the drafting of the National
Safety and Quality Health Service Standards by the Australian Commission on Safety and
Quality in Health Care (ACSQHC) in collaboration with medical practitioners, health care
providers, specialists, consumers, patients, manufacturers of health products and equipment
amongst many other stake holders. . The primary objective of these standards is to safeguard the
public from harm, prevent the occurrence of conditions that require medical attention and ensure
quality of personalized health care. (Groves, et al, 2011; Boyd & Sheen, 2014) These safety and
quality service standard requires health care leaders and senior administrators in institutions that
provide health care services, to develop and implement mechanisms that prevent the prevalence
of conditions and infections that occur within healthcare centers hence leading to more harm to
patients rather than recuperation. (Groves, et al, 2011; Fauci & Morens, 2012) One the National
Safety and Quality Health Service Standards is the need to need to prevent healthcare related
infections. These are infections that occur with a healthcare setting. (Geiger-Brown & Lipscomb,
Risk of Infection and Outcomes
In order to tackle infections appropriately it is important to understand the elements of
infection. For an infection to occur there must be a source of the pathogenic agent where it
resides, a host that is susceptible to the micro-organism and a viable mode of transmitting the
disease-causing germ from its source to the host. According to Bain, et al, 2013, healthcare
workers and patients are the most common sources of pathogenic organisms. They are also the
most vulnerable hosts for contamination by these infectious agents. (Carpman & Grant, 2016).
The diseases that arise in a healthcare setting can be transmitted through inhaling air with
pathogens, drinking water or eating food that is contaminated, contact with persons that are
infected and through body fluids such as sweat, mucus, saliva and blood. Infectious micro-
organisms reproduce and colonize the host at a very fast rate.
The recovery outcomes on an individual that is infected at a health care facility is highly
dependent on the resilience of the immune system as at the time of exposure. According to
Kallen, et al, the risk of the patient having an aggravated condition is higher especially if he or
she is under irradiation treatment or immunosuppressive medication which lowers the activity of
the immune system significantly. Other factors that affect the outcomes of patients infected
within a healthcare setting include: age (the elderly and neonate patients tend to have a less
effective immune system hence a higher susceptibility), the virulent nature of the pathogenic
agent and the health status of the patient. Open wounds, surgical procedures or medical treatment
that involves the insertion of equipment such as a catheter provide entry points for infectious
agents. (Vaz, et al, 2010; Fauci & Morens, 2012)
Prevention and Control Strategies
Strategies and systems for the control and prevention of healthcare related complications
must be compliant with the set standards of policy and practice such as the Australian Guidelines
for the Prevention and Control of Infections in Health Care. Management of the risks of infection
can be implemented by adopting safe procedures and policies such as those set out in these
guidelines published by the National Health and Medical Research Council amongst other
protocols and practice rules. (Fauci & Morens, 2012; Roca, et al, 2015) The provisions of this
policy provide directions on the best practices of preventing infections from occurring in
healthcare facilities. These guidelines set out the following key areas of focus in taking standard
precaution based on best available evidence and consensus among healthcare stakeholders: hand
hygiene, wearing of personal protective equipment to minimize occupational hazards that may
occur in the process of handling patients and substance, diligence in the storage, use and disposal
of sharp objects, routine environmental cleaning and the process of re-using medical instruments
and equipment, regular reporting, assessment, data collection and response mechanisms. (Ryan,
et al, 2012)
Occupational Hazards
Healthcare workers run a high risk of infection in their ordinary course of business. Most
of the infections to health workers are as a result of the use or disposal of sharp objects.
(Chartier, 2014) Chartier, further proposes that this can be avoided through proper training on
proper use of needle stick equipment and safe disposal practices for sharp objects. Another
intervention that reduces needle-stick injuries significantly is the use of safety engineered
devices. These are equipment that are manufactured in such a way as not to reduce the chances
of injury when handling them. Research has shown that improved technology and safety
engineering is associated with reduced risks of occupational harm. (Tosini, et al, 2010) However,
safety devices are not very common in facilities in Australia due to the cost involved in
procuring them and the amount of resources required in training the workforce on how to use
them. Tosini et al argue that most medical practitioners prefer to use ordinary devices instead of
safety equipment due to their ease of use. However, safety engineering has received a huge
mandate within countries in the European Union, United States of America and Canada. (Boyd
& Sheen, 2014)
Protective Gear for Health Workers
Wearing of protective gear mitigates the chances of exposure to infection by health
workers. Treating patients with highly contractible conditions such as Hepatitis B, HIV or
lymphotropic virus is a highly risky procedure that requires protective gear. (Carpman & Grant,
2016) There is legislation and policy guidelines that specifically provide for the wearing of
personal protection gear in certain medical procedures such as the National Code of Practice for
the Control of Work- related Exposure to Hepatitis and HIV, published by the National
Occupational Health and Safety Commission. Under this guidelines, health workers are required
to wear protective gear such as a surgical mask to alleviate the chances of contracting a
respiratory infection that can be transmitted by the patient when coughing or sneezing. (World
Health Organization, 2014).
Similarly, using sterile gloves when touching infected parts reduces the susceptibility to
contracting an infection or transmitting it through contact. It is also important to protect the eyes
when observing infected parts at close range or administering medication that involves spraying
or splashing. (Geiger-Brown & Lipscomb, 2011) Wearing goggles that are coated with anti-fog
material provides reliable protection from infection at all angles. Use of personal contact lenses
or eye glasses is not considered as adequate protective gear. (Geiger-Brown & Lipscomb, 2011)
For specialized operations that requires microscopic observance, safety glasses are more
appropriate that goggles. Geiger-Brown & Lipscomb, opine that the use of protective gear should
be accompanied by safety protocols of removing the gear and disposing it without being exposed
to pathogenic organisms. (Fauci & Morens, 2012)
Design and Construction of Health Facility
A study conducted by Carpmanm and Grant in 2016, revealed that the general outline and
design of a health facility can influence the susceptibility of occupants to infections. Therefore,
project managers in consultation with the healthcare providers should design and construct
structures that reduce the risks of patients developing complications while undergoing treatment
or medical consultation and facility. (Carpman & Grant, 2016; Geiger-Brown & Lipscomb,
2011) This includes the surfaces, fittings furniture and equipment that is installed in the facility.
Some of the recommended designs under the Australian Guidelines for the Prevention and
Control of Infection in Healthcare include: surfaces that can be easily cleaned and maintained
(i.e. walls, floors, fittings, fixtures and platforms); efficient ventilation with adjustable air
conditioning, and standard water systems and cooling towers; proper partitioning that allows for
the isolation of patients to avoid transmission of pathogens. (Carpman & Grant, 2016; Groves, et
al, 2011; Boyd & Sheen, 2014)
The health facility can be designed to have negative pressure rooms for patients with
airborne diseases such as Tuberculosis and positive pressure rooms that are fitted with an air
filtration devices for patients whose immune system has been compromised for medication. The
waiting bays can also be designed to separate patients to avoid infection. According to Carpman
and Grant, the facility should also have an efficient work flow design that allows for efficient
and procedural cleaning, access to hand sanitization or cleaning points, accessible and adequate
storage for all items needed in patient care and efficient waste disposal protocol.
Criteria of Implementation
The Australian Commission on Safety and Quality in Health Care (ACSQHC) establishes
a criteria that is to be applied in achieving the goals of prevention and control of diseases. This
criteria involves: establishing effective systems of management and solid governance to
spearhead the process of surveillance, assessment, control and prevention of infections. It also
inculcates the process of developing evidence-based strategies in preventive health care practices
by identifying infected patients at an early stage and recommending them for treatment and
appropriate management of their conditions. (Cardo, et al, 2010) Workers are also required to
maintain a high level of hygiene and safety by properly disinfecting, sterilizing and cleaning
equipment used in medical procedures and disposing waste in a safe way that is friendly to the
environment and risk-free. (Allegranzi, et al, 2011) The implementation criteria also outsets the
need to establish transparent communication between patients, service providers and care-
providers in order to acquire useful information and feedback on service delivery. (Ryan, et al,
Emerging Challenges
One of the emerging challenges in implementing disease control and prevention
strategies is the constant mutation of disease causing organisms that become resistant to
microbial treatment. (Roca, et al, 2015) For example, Staphylococcus aureus (MRSA) bacteria is
resistant to methicillin and enterococci (VRE) bacteria is resistant to vancomycin treatment.
Another challenge is the influx in patient population at health facilities leading to a higher risk of
contamination. (Fauci & Morens, 2012; Sievert, et al 2013)
Due to the close proximity between patients and high population in the health care
facilities patients infect each other with communicable diseases through contact or air
contamination. (Groves, et al, 2011; Geiger-Brown & Lipscomb, 2011)The occurrence of
infections at health care facilities compounded with an increase in the number of patients seeking
health care services leads to a decline in the quality of service offered. Moreover, the increased
use of health facilities by patients leads to patient influx, and impacts pressure on the medical
workforce. These leads to a depreciation of facilities, equipment and fatigue on the part of the
workforce. With such conditions, the quality and safety standards of health care are bound to
deteriorate. (Boyd & Sheen, 2014)
Mechanisms of preventing the occurrence of infections aim at reducing the adaption of
disease causing pathogens that are resistant to conventional medicine, minimizing the risks of
spread by isolating the micro-organisms causing the infection or the infected patient. These can
be achieved through set standards of hygienic practices, wearing protective gear, avoiding
occupational hazards and designing health care facilities appropriately to avoid the occurrence of
infections. These procedures are targeted at taking standard precautionary measures in an attempt
to safeguard the public from infection.
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Bain, C. A., Bucknall, T., Weir-Phyland, J., Metcalf, S., Ingram, P., & Nie, L. (2013). Meeting
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workers at the University Hospital of the West Indies, Jamaica. The international journal
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