Incidence
of Hospital-Acquired Infection among ICU Patients and its Association with
Selected Factors, an Outcome of Health Care Negligence.
Sasmita
Das1, Twinkle Patel2, Farzana
Begum2
1Associate Dean, SUM Nursing College, SOA University, Kalinga Nagar-8, Ghatikia,
Bhubaneswar, Odisha.
2M.Sc Nursing. SUM Nursing College, SOA University, Kalinga Nagar-8, Ghatikia,
Bhubaneswar, Odisha.
*Corresponding Author Email: das.sasmita2@gmail.com
INTRODUCTION:
"A
Hospital is no place to be sick.” -
Samuel Goldwyn
Developing
hospital acquired infection is nothing but simply certifying the quality of
care provided by the hospital. Hospital or healthcare-acquired infections (HAI)
are new infections that patients acquire as a result of healthcare
interventions to treat other conditions. some
high-income countries have national surveillance systems for HAIs, there are
fewer data available from low- and middle-income countries. Recent
systematic reviews have estimated hospital-wide prevalence of HAIs in
high-income countries at 7.6% and in low and middle-income countries at 10.1
%.( WHO, 2011).A hospital-acquired
infection, also known as a HAI
or in medical literature as a nosocomial
infection, is an infection whose development is favored by a hospital
environment, such as one acquired by a patient during a hospital visit or one
developing among hospital staff. Such infections include fungal and bacterial
infections and are aggravated by the reduced resistance of individual patients.
(Oxford dictionary, 2008).Nosocomial infections
affect about 30% of patients in ICUs. Increased risk of infection in the ICU
patients is associated with severity of illness, underlying conditions,
exposure to multiple invasive devices and procedures (endotracheal
intubation, urinary catheters, etc.) and increased patient contact with
healthcare personnel. ICU staff and the equipment used for patient care during
the hospitalization are the primary sources of cross-transmission of nosocomial pathogens.
The ICU mortality rate of infected patients
was 25%, two times more than that for non-infected patients in an international
study (Vincent JL et.al, 2009).Available data for patient population and
characteristics of ICUs are lacking in developing countries.
The prevalence of infection and mortality
rates are higher in countries with limited resources associated with the
quality of care (Dunser MW et.al, 2009). Main
problems in developing countries are understaffing, poor infrastructure in ICUs
and overcrowding. Lack of injection and blood transfusion safety is still a
problem in most African countries. (Bagheri Nejad S et.al,2011) Risk factors of infections in critically ill
patients are similar in all developed and developing countries including age, comorbid diseases, mechanical ventilation, duration of hospitalisation, length of ICU stay, immune suppression and
greater disease severity. Consequently, ICU-acquired infections have been
associated with significant morbidity, mortality and rising healthcare costs in
developing countries with limited resources. (Alp E et.al,2012).The study is
conducted to assess the incidence of Hospital-Acquired Infection among the
patients admitted in ICU, selected hospital of
Bhubaneswar, by studying the association between Hospital Acquired
Infection and various Variables e.g. prolonged indwelling catheter, Intravenous
line, wound and respiratory procedures.
OBJECTIVES:
1. To identify the incidence of
Hospital-Acquired Infection among ICU patient of IMS and SUM Hospital.
2. To identify the factors responsible for
Hospital-Acquired Infection among ICU of IMS and SUM Hospital.
3. To identify the association between
incidence of Hospital-Acquired-Infection with selected factors.
ASSUMPTIONS:
·
Micro
organisms are present everywhere, in the air, water, floor surface, whatever
stationeries we are using.
·
People
with a poor immunity easily get infection
·
By
adhering to proper infection prevention measures hospital acquired infection
can be reduced to a large extent or can be bring down to non.
METHODOLOGY:
Research
approach and design
The research approach selected for the
study is survey approach. For the present study non-experimental descriptive
research design is utilized to achieve stated objectives.
Setting
for the study
The study was conducted in SUM Hospital, Kalinga Nagar, Bhubaneswar.
Target
population
The target population in present study
consists of patients admitted in ICU of SUM hospital, Bhubaneswar.
Sample
and for the study
Sample for the present study consists of 60
ICU patients.
Sampling
techniques
For the present study Non-Probability
convenience sampling is used to collect the data, because of their convenient
accessibility and proximity to the researcher.
Description
of data collection instruments
Socio-Demographic
data (Tool-1)-
It is constructed to collect data regarding
age, sex, marital status, type of family, educational status, occupation,
previous experience of hospitalization and duration of treatment.
Structured
questionnaire on Factors of HAI-
It is constructed to know selected factors
in relation to Hospital Acquired Infection.
Validity
and Reliability
The constructed tools were subjected to
content validity by five experts. As per the suggestion and opinion of
different experts regarding the relevance, adequacy and appropriateness of the
items, the tools were modified. The reliability of the tool was tested by using
Chronbach reliability formula. The reliability value
was 7.2, thus it indicates that the questionnaire is reliable. The data were
analyzed using frequency, percentage and chi-square.
RESULTS:
Description
of samples based on socio demographic variables
The finding showed that distribution of the
subjects according to age depicts 22% of the sample were in the group of <30
years,26%of sample were in the group of
30-40 years,22% were in the group of 30-50 years and 29% of sample were
>50years of age. The distribution of subjects according to sex depicts 56% of the
sample were male and 46% were female. Marital Status depicts 89% of the sample
were married and 11% were unmarried. educational status depicts 15% were
completed primary school,25% completed middle school,30% completed High school and
30% having higher education. Occupation depicts 25% of sample are business
holder, 7% are government employee,23% are from
private sector and 45% are from others. Monthly Income depicts 28% of sample
having income <5000,37% of sample having income of 5000-10,000, 20% having
income of 10,000-15,000 and 15% having income more than 15,000/- per month. Previous
Hospitalization depicts 49% of sample having previous experience of
hospitalization and 51% of sample having no experience of hospitalization.
Residence depicts 45% of sample are from rural area and 55% are from urban
area. Hospital Stay depicts that 15% of sample getting treatment for <4days,37% of sample getting treatment for 4-7 days and 48% for
>7 days.
Frequency and percentage distribution of associated factors of
hospital-acquired-infection.
The distribution of the sample according to
Hand hygiene depicts that in 16% of sample Hand hygiene done and in 84% hand
hygiene not practiced. The sample according to using sterile technique for 95%
of sample sterile Technique used before procedure and 5% sterile technique not
practiced before procedure. Tracheostomy care depicts
in 94% of sample tracheostomy care given 8 hourly
whereas 6% of sample tracheostomy care 8 hourly not
given. The distribution of sample according to PPE(personal
protective equipment) use depicts for 100% of sample PPE used before any
procedure and sample according to Oral Hygiene depicts for 100% of sample oral
hygiene done once daily. Distribution of the sample according to change I.V. canula in 72 hours depicts for 15% sample I.V. canula changed in 72 hours whereas in 85 % sample I.V canula not changed in 72 hours. pre-prepared
heparin solution depicts in 100% sample pre-prepared heparin solution used to
flush out before given any I.V.
injection. According to I.V. set nozzle closed while not in use depicts in 94%
of sample I.V set nozzle closed while not in used and in 6% of sample I.V. set
nozzle not closed while not in used. Distribution of the sample according to
daily practice catheter care depicts in 100% of sample catheter care not given.
Distribution of the sample according to change of catheter in every 15 days
depicts In 7% of sample catheter changed in every 15 days and 93% of sample
catheter not changed in every 15 days.
Association
between hospitals acquired infection with selected factors
Table-1(Association between hospitals acquired
infection with selected factors)
Area of associated factors |
Positive hospital acquired
infection |
Negative hospital acquired
infection |
D.F |
P- Value |
Chi-Square |
Inference |
Blood |
3 |
97 |
2 |
0.1653 |
3.6 |
Not significant |
Urine |
7 |
93 |
||||
Tracheal aspiration |
2 |
98 |
Table-1
Shows that, by conventional criteria, this difference is considered to be not
statistically significant. This difference among associated factors responsible
for hospital acquired infection is consider to be not statistically
significant, that means that all factors are equally responsible for hospital
acquired infection if not providing quality care
CONCLUSIONS:
The Incidence of Hospital-Acquired
Infection among patient admitted in ICU is 12% and it is due to some wrong practices
of the health care provider. The most effective technique for controlling nosocomial infection is to strategically implement quality
control measures to the health sectors, and evidence-based management can be a
feasible approach. For those with ventilator-associated or hospital-acquired
pneumonia, controlling and monitoring hospital Indore air quality needs to be
on agenda in management, where as for nosocomial rota virus infection, a hand hygiene protocol has to be
enforced and audit should be conducted regularly.
BIBLIOGRAPHY:
1.
World
Health Organization (WHO). (2011) Report on the Burden of Endemic Health
Care-Associated Infection Worldwide. A systematic review of the literature.
Available at http://www.who.int/en/
2.
"Nosocomial Infection". A Dictionary of Nursing.
Oxford Reference Online. 2008.
3.
Vincent
JL, Rello J, Marshall J, Silva E, Anzueto
A, Martin CD. International study of the prevalence and outcomes of infection
in intensive care units. JAMA 2009 Dec; 302(21):2323-9.
4.
Dunser MW,
Bataar O, Tsenddorj G, Lundeg G, Torgersen C, Romand JA. Differences in critical care practice between an
industrialized and a developing country. Wien Klin Wochenschr 2008 Sep;120(19-20):600-7.
5.
Bagheri Nejad S, Allegranzi B, Syed SB, Ellis B, Pittet D.
Health-care-associated infection in Africa: a systematic review. Bull World
Health Organ 2011 Oct;89(10):757-65.
6.
Alp E,
Kalin G, Coskun R, Sungur M, Guven M, Doganay M. Economic burden of ventilator-associated
pneumonia in a developing country. J Hosp Infect 2012 Jun;81(2):128-130
7.
Kaur Lakhwinder,
Kaur Maninder, A Textbook of Nursing Foundations, 1st Edition,
Punjab: P.K. Jain Prop. , 2009, Pp 380- 382.
Received on 25.01.2014 Modified on 15.04.2014
Accepted on 29.06.2014 ©
A&V Publication all right reserved
Asian J. Nur. Edu. & Research 4(3): July- Sept., 2014; Page 276-278