Healthcare associated infections (HAIs) are quite prevalent in many healthcare settings, especially those that witness a beehive of activities as well as those that do not observe the stipulated healthcare standards. Most of the HAIs are associated with the surgical wards, particularly when the equipment used to conduct the surgeries is not cleaned thoroughly or sterilized. The surgical wards could also fail to meet the required cleanliness standards, and, therefore, they could act as breeding grounds for harmful bacteria and other organisms that could cause adverse health effects among patients. Nevertheless, the objective of the research was to establish the vulnerability of acquiring HAIs among adult patients 50 years and above who undergo surgical operations within two years after being discharged from hospital.
In particular, the aim was to compare the susceptibility of acquiring HAIs among the specified population of patients undergoing surgical operations with those not undergoing surgical operations but receiving other healthcare services. The rationale for choosing adults above 50 years is that this group is likely to present to healthcare settings for medical attention given their failing immune system and physical strength. Therefore, it would be easier to gather statistics related to this population in relation to HAIs. Secondly, it is important to address the healthcare needs of older people by ensuring that they do not acquire other diseases that may jeopardize their wellbeing. The healthcare burden suffered by this group needs to be reduced and not increased. Acquiring other healthcare conditions while in the healthcare settings may overburden this group and their close kin or dependents. Older people might only be relying on their retirement benefits or savings to survive, and it would be disheartening for them to spend all their finances dealing with additional illnesses. Therefore, the objective of the research is to investigate to susceptibility of this group of acquiring HAIs to address this problem and enhance the wellbeing of older adults.
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Methodology
Firstly, I used Google Scholar to search for the required articles. The most prominent keywords used for the search were, “Hospital associated infections” and “older adults”. The first search using these keywords provided hundreds of articles, many of which were outdated. Google scholar has a function where one can specify the year range of the articles needed, and in this case I indicated the range of “2015 to current”. More than 50 articles were available after specifying the range. I skimmed through the provided articles and selected only those which examined development of HAIs two years after being discharged from the hospital. Additionally, I only selected articles that focused on patients who are 50 years and above. Most of the articles focused on HAIs among the general population, and, therefore, would not provide the exact information needed for the research. I also ensured that all the articles I selected involved some actual research and not just qualitative analysis of other studies. These articles would provide raw information collected from the actual healthcare settings. In the end, I selected five quality articles that focus on HAIs among adults 50 years and above, and which were published within the last 5 years.
Literature Synthesis
The first study was that of Zhao et al. (2019), which investigated the vulnerability of acquiring HAIs among patients 60 years and above, in China. The study involved a total of 60,332 subjects, and out of this number 1580 individuals acquired HAIs after admission to hospital, which is a 2.62% incidence rate. The authors also established that the risk of acquiring HAIs among the subjects was associated with such factors as being admitted into the ICU, use of urinary catheter or central line catheter, and use of ventilator. The second study was that of Ali et al. (2018), which was conducted in Ethiopia and involved 1015 adult patients presenting to the hospital with various health conditions. In this hospital, the incidence rate of HAIs was established to be 28.15 per 1000 patient days and the overall prevalence was 19.41%. Additionally, the highest incidence was reported at the ICU while the lowest incidence was at the ophthalmology ward. Patients with the high risk of developing HAIs were those with history of previous hospitalization, those with chest tubes, as well as those on mechanical ventilation.
The Souza et al. (2015) study involved 11, 177 adult patients at a hospital in Brazil. From this number, 889 were diagnosed with at least one HAI where 341 patients eventually died from the HAIs. The critical units that registered high rates of HAIs in this study were the burn care ward and the ICU. The nursing ward registered the lowest rate of HAIs. The Kohler et al. (2015) study involved 10 participants, and it focused mainly on those who had undergone open-heart surgery at three European hospitals. All these patients acquired HAIs due to Mycobacterium chimaera, and these infections were associated with the unhygienic conditions of the operation room as well as the devices used in the operation. The last study was that of Cai et al (2017), which surveyed 5415 patients in 13 private and public acute care hospitals in Singapore. Out of the total sample, 646 patients presented with distinct HAIs and the common ones were pneumonia and clinical sepsis. The authors note that more than a quarter of all the hospital-acquired pneumonia and about half of all urinary tract infections were associated with the devices used within the hospital environment, just like in the previous studies.
All the articles support my PICOT in the sense that all of them focus on the elderly population in relation to HAIs and raise important aspects of the hospital environment which could increase the incidence of HAIs to the identified population. Additionally, the studies present various wards of the hospital environment, and from these departments, a comparison can be made between adult patients undergoing surgical operations and those seeking other treatments. The most profound similarity among all the articles relates to the aspect of HAIs being more prevalent in intensive care units and other surgical wards where patients require specialized services such as the burn care wards. HAIs in almost all articles seem to be associated with surgical equipment and artificial implants such as chest tubes, and urinary tract catheters. However, some differences exist among the articles. For instance, while the other articles mainly investigated the general HAIs that can be acquired from hospitals, the Kohler et al. (2015) study mainly focused on one; infection caused by Mycobacterium chimaera. The Kohler et al. (2015) study also used the smallest sample. In all the articles, the greatest limitation is the lack of a clear comparison of HAIs between patients undergoing surgical operations and those undergoing other treatment procedures.
To conclude, the evidence presented in all the articles suggests that HAIs are mainly associated with intensive hospital units, such as the ICU, burn care wards, and wards where surgical procedures are performed. Therefore, older patients going for operations or surgical procedures in intensive hospital units are more vulnerable to HAIs than those seeking treatment for conditions that do not require surgical procedures. Additionally, the risk of acquiring HAIs is related to unhygienic conditions in the intensive units, negligence, and failure to follow the required standards. Further study is required to identify and define some of the common HAIs and their specific causes.
References
Ali, S., Birhane, M., Bekele, S., Kibru, G., Teshager, L., Yilma, Y., Ahmed, Y., Fentahun, N., Assefa, H., Gashaw, M., & Gudina, E. K. (2018). Healthcare associated infection and its risk factors among patients admitted to a tertiary hospital in Ethiopia: longitudinal study. Antimicrobial resistance and infection control , 7 , 2. https://doi.org/10.1186/s13756-017-0298-5
Cai, Y., Venkatachalam, I., Tee, N. W., Tan, T. Y., Kurup, A., Wong, S. Y., ... & Ang, B. (2017). Prevalence of healthcare-associated infections and antimicrobial use among adult inpatients in Singapore acute-care hospitals: results from the first national point prevalence survey. Clinical Infectious Diseases , 64 (suppl_2), S61-S67. https://doi.org/10.1093/cid/cix103
Kohler, P., Kuster, S. P., Bloemberg, G., Schulthess, B., Frank, M., Tanner, F. C., ... & Sommerstein, R. (2015). Healthcare-associated prosthetic heart valve, aortic vascular graft, and disseminated Mycobacterium chimaera infections subsequent to open heart surgery. European Heart Journal , 36 (40), 2745-2753. https://doi.org/10.1093/eurheartj/ehv342
Souza, E. S., Belei, R. A., Carrilho, C. M. D. D. M., Matsuo, T., Yamada-Ogatta, S. F., Andrade, G. ... & Kerbauy, G. (2015). Mortality and risks related to healthcare-associated infection. Texto & Contexto-Enfermagem , 24 (1), 220-228. http://dx.doi.org/10.1590/0104-07072015002940013
Zhao, X., Wang, L., Wei, N., Zhang, J., Ma, W., Zhao, H., & Han, X. (2019). Risk factors of health care–associated infection in elderly patients: a retrospective cohort study performed at a tertiary hospital in China. BMC geriatrics , 19 (1), 193. https://doi.org/10.1186/s12877-019-1208-x
