The Health Care Environment Provides Activities Whose Primary Purpose: Infection Prevention And Control Assignment, UCC, Ireland

INTRODUCTION

The health care environment provides activities whose primary purpose is to promote, restore or maintain health (The World Health Report 2000 – Health systems: improving performance). This includes Hospitals, primary health centers, Ambulatory services, daycare centers, long-term care centers, and social care. The quality of health care services is critical for achieving effective universal health coverage. All the countries commit to achieving Health for All, through effective, safe, and people-centered.

Patient safety is fundamental to delivering quality essential health services (WHO 2019, Patient Safety). Moreover, it is imperative that health services should be timely, equitable, integrated, and efficient for quality health care. Across the Irish healthcare system, there is a strong commitment to improving the safety and quality of care. The National Clinical Programmes implementation are central to improvements to the safety and quality of healthcare delivery and Patient safety(HSE – Patient Safety Strategy 2019-2024)

According to The Centre for Disease Control and Prevention (2004) Health, care-associated infections are defined as those that develop during hospitalization but are neither present nor incubating upon the patient’s admission to the hospital; generally, for those infections that occur more than 48 to 72 hours after admission and within 10 days after hospital discharge. Factors such as illness, age, and treatment being received can all make patients more vulnerable to infection.

Many infections are caused by micro-organisms already present in or on the patient’s own body. Such organisms only cause problems when the body’s defenses are weakened or breached by surgery or other medical procedures. Infections may also be caused by micro-organisms originating from another patient either by direct contact or through a contaminated hospital environment (NHS).

HCAI affects on average 4.9% (range up to 13%) of hospitalized patients and 3.6% (range up to 18%) of patients in long-term care facilities. While not all HCAI is preventable, recent evidence suggests that 10% to 70% of HCAI can be prevented depending on the type of infection and the baseline rate (HPSC 2017). Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine. (CDC 2019 Guidelines for prevention of CAUTI). In 2004, WHO launched a patient safety program giving importance to the safety of every patient attending the hospitals or healthcare system.

Infection prevention and control (IPC) includes all the evidence-based measures taken to prevent the spread of infection among patients and health care workers. Any IPC measures become effective when measures are done by all levels of staff in the health system in every unit. Effective IPC directly shows the good quality of care provided (WHO,2009). WHO’s first global patient safety program emphasized clean care, clean hands, clean products, clean equipment, and a clean environment, thereby promoting hand hygiene for the prevention of healthcare-associated infections. (WHO,2009).

MODE OF INFECTION TRANSMISSION

Certain conditions must be met for a microbe or infectious disease to be spread from person to person which is known as the chain of infection.  More specifically, transmission occurs when an infectious agent leaves its reservoir or host through a portal of exit, is conveyed by some mode of transmission, and enters through an appropriate portal of entry to infect a susceptible host. This sequence is called the chain of infection(CDC, Chain of Infection).

Many factors interact to contribute to the frequency and severity of CAUTI in older adults. The “Chain of Infection” is a general framework for infection prevention, which can be used to assess the main elements that lead to HAI’s and to identify modifiable risk factors for future infections (Gregory etal.2017). Host factors, including immune dysfunction and fragile skin, provide an opening for opportunistic pathogens to invade and cause an infection. Environmental factors, including contamination, provide a source of exposure for susceptible hosts.

Finally, indwelling devices provide a portal of entry for pathogenic organisms to enter a susceptible host and cause infection.  CAUTI caused by micro-organisms that are not part of the patient’s gut flora is suggestive of cross-transmission, i.e., poor infection control procedures. Being in the room with another patient with a urinary catheter has also been identified as a risk factor as has poor hand hygiene and the use of a dirty container to empty the drainage bag [Health protection Scotland 2008].

During the process of urinary catheterization without proper aseptic technique, the urinary catheter enables micro-organisms to gain direct entry to the bladder along the external catheter surface. The urinary catheter drainage system allows microorganisms to gain entry from any of the connection points if they are disconnected or opened. Once organisms have entered the urinary catheter, it can lead to infection and potentially to complete blockage of the catheter [Pratt, R.J., et al.2007].

A Microbiological survey by Smith PW et al (2000) shows that in addition to predisposing patients to infection, indwelling devices place older adults at risk of other adverse events, including overdiagnosis of infections that lead to unnecessary antibiotic use. Due in part to difficulties with diagnosis in the catheterized population, up to one-third of antimicrobials prescribed for suspected urinary tract infections (UTIs) in LTCFs are for residents with asymptomatic bacteriuria that does not merit treatment(Hooton TM et al 2010 & Nicolle T M et al 2000).

The frequent use of indwelling devices in the vulnerable population results in a significant burden to the health care system and is an important target for infection prevention and antimicrobial stewardship efforts. Fortunately, within the chain of infection that leads to CAUTI in older adults, there are multiple opportunities to implement interventions to “break the links” and reduce MDRO colonization and infections.