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