National Safety And Quality Health Service Standards

Running Head: National Safety and Quality Health Service Standards 1

NATIONAL SAFETY AND QUALITY HEALTH SERVICE STANDARDS-

Preventing and Controlling Healthcare Associated Infections

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Preventing and Controlling Healthcare Associated Infections

Introduction

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)

Background

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,

2011)

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,

2012)

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)

Conclusion

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.

References

Allegranzi, B., Nejad, S. B., Combescure, C., Graafmans, W., Attar, H., Donaldson, L., & Pittet,

D. (2011). Burden of endemic health-care-associated infection in developing countries:

systematic review and meta-analysis. The Lancet, 377(9761), 228-241.

Bain, C. A., Bucknall, T., Weir-Phyland, J., Metcalf, S., Ingram, P., & Nie, L. (2013). Meeting

National Safety and Quality Health Service Standards-The Role of the Point-of-Care

(POC) Audit Application. International Journal of e-Education, e-Business, e-

Management and e-Learning, 3(6), 507.

Boyce, J. M. (2011). Measuring healthcare worker hand hygiene activity: current practices and

emerging technologies. Infection Control & Hospital Epidemiology, 32(10), 1016-1028.

Boyd, L., & Sheen, J. (2014). The national safety and quality health service standards

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