TOPIC:

HOSPITAL-ACQUIRED INFECTION PREVENTION IN INTENSIVE CARE UNIT PATIENTS

INTRODUCTION:

Hospital-Acquired Infections (HAIs) are those infections, which are not present at the time of
admission and acquired during the course of hospital settings manifested 48-72 hours after admission,
more prevalent in critical care settings. World Health Organization (WHO) reported over all 5.1-11.6%
prevalence rate of HAIs in high-income countries (HICs). The impact of HAIs ranged from increase of
morbidity and mortality to more hospital stay, laboratory procedures, chances of antibiotic resistance
that culminate in sickening financial burden on patients, families and health care systems. As per WHO,
HAIs directly contribute to an estimated 1,400,000 deaths with economic impact. Blood stream
infections and ventilator associated pneumonia have more deleterious effects on health outcomes and
costs. National surveillance data on HAIs from low – and middle – income countries are mostly
unavailable; hospital-based studies reported much higher rates compared to HICs. Infection control
practices and importance of compliance to standard precautions are the responsibility of all health care
professionals. Primary care physicians are the first point of contact with the patients in the community.
They play crucial role in the continuum of care of diverse prehospital care to hospital-based care
spectrum. Critical conditions in the family medicine practices entail collaborative outpatients and in-
patient’s domains with follow-up and domiciliary care after discharged. Considering the importance of
HAIs, this study was conducted to find out the impact of hand hygiene compliance among health care
workers on catheter – associated urinary tract infections (CAUTI), Central – line associated blood stream
infections (CLABSI), ventilator – associated pneumonia (VAP), and surgical site infections (SSIs).

A hospital – acquired infection also known as a nosocomial infection, is an infection that is acquired
in a hospital or other healthcare facility. To emphasize both hospital and non-hospital settings. It is
sometimes instead called a healthcare – associated infection. Such an infection can be acquired in
hospital, nursing home, rehabilitation facility, outpatient clinic, diagnostic laboratory or other clinical
settings. A number of dynamic processes can bring contamination into Medical Intensive Care Unit,
Surgical Intensive Care Unit and other areas within nosocomial settings. Infection is spread to the
susceptible patient in the clinical setting by various means. Health care staff also spread infection, in
addition to the contaminated equipment, bed linens, or air droplets. The infection can originate from the
outside environment, another infected patient, staff that may be infected, or in some cases, the source
of the infection cannot be determined. In some cases, the microorganisms originate from the patient’s
own skin microbiota, becoming opportunistic after surgery or other procedures that compromise the
protective skin barrier. Though the patient may have contracted the infection from their own skin, the
infection is still considered nosocomial since it develops in the health care setting. Nosocomial infection
tends to lack evidence that it was present, when the patient entered the health care setting, thus
meaning it was acquired post – admission.

Hospital – Acquired infection are common in hospitalized patients, impacting 7 to 10% of patients
globally. In lower – and middle-income countries, the risk is 15% with surgical site infection being most
common. In higher – income countries, health care – associated infection affects up to 30% of Intensive
Care Unit (ICU) who are vulnerable because of underlying comorbidities and immuno suppression and
the presence of invasive catheters and devices. In this review, we summarize current evidence – based
strategies for health – care associated infection prevention in ICU patients. Healthcare – associated
infection risks factors, treatment, and severe acute respiratory.

For the last few decades, hospitals have taken the hospital – acquired infections seriously.
Several hospitals have established infection tracking and surveillance systems in place, along with robust
prevention strategies to reduced the rate of hospital – acquired infection. Identifying patients with risk
factors for hospital – acquired infections is important in the prevention and minimization. The infections
are monitored closely by agency of the Center for Disease Control and Prevention (CDC). This
surveillance is done to prevent HAI and improve patient safety. HAI infections include central line –
associated blood stream infections (CLABSI), catheter – associated urinary tract infection (CAUTI),
surgical site infections (SSI), hospital – acquired pneumonia (HAP), ventilator – associated pneumonia
(VAP).

STATEMENT OF THE PROBLEM:

• This study aimed to assess the impact of Hospital – Acquired Infections Prevention in
Intensive Care Unit Patients.

• Specifically, it sought answers to the following questions:

1. What is the demographic profile of the respondents in terms of:

1.1 age ; ;
1.2 gender;
1.3 educational attainment;
1.4 hospital affiliated;
1.5 department / section;
1.6 no. of working hours;
2. What is the effect of Hospital – Acquired Infections Prevention in Intensive Care Unit
Patients in terms of?
2.1 Supply Chain on needed equipment and medical supplies;
2.2 Health work force management
2.3 Efficiency of service;
2.4 Medical, diagnostic and surgical procedures assessed by nurse’s; and; physicians;
2.5 Work of the respondents;
3. Why are patients in Intensive Care Units are at high risks for HAI?
4. Do nurses have good practice for hospital – acquired infection prevention?
5. Who is responsible for infection control practices?
RESEARCH METHODOLOGY

This chapter in the study discussed the research design and methodology used in realizing the
aims of this study. This includes population and sample, research instruments its preparation, validation,
administration. The data gathering procedure and retrieval done by the researchers.

RESEARCH METHOD USED

The research design that was used in this study is the descriptive – correlational research design.
This was the most appropriate design to use in the study because it draws information without making
any changes to the study subject.

According to Beck (2012), descriptive correlational research aimed to described the relationship
among variables rather than to infer – and – effect relationships.

The researchers were primarily interested in describing relationships among variables without
seeking to establish a casual connection. It tended to described certain phenomena and their respective
relationships.

POPULATION FRAME AND SAMPLING SCHEME

The researchers selected the population that was to be used in the study through purposive
sampling technique. Purposive sampling, also known as judgmental, selective, or subjective sampling, is
a form of non – probability sampling in which researchers rely on their own judgement when choosing
members of the population to participate in their surveys. Participants from one of the government
hospitals in the Province of Apayao were purposively selected, and the selection was presented in the
table here in this chapter

TABLE 1. The Population and Sampling Scheme

TARGETED HOSPITAL NUMBER OF PARTICIPANTS

FAR NORTH LUZON GEN. HOSPITAL AND 16
TRAINING CENTER
TOTAL TARGETED PARTICIPANTS 16

Using the total population of the participating hospital in the study shown in the table above,
the researchers focused on participants that were physically reporting during the course of health care
operations in their respective health institution, hence purposive sampling, also known as judgmental,
selective, or subjective sampling, was the sampling technique used. It is a form of non – probability
sampling in which researchers rely on their own judgement when choosing members of the population
to participate in their surveys.
DESCRIPTION OF THE PARTICIPANTS

The researchers conducted this study in the province of Apayao as the location of the study in
which it is a level II government hospital catering primary and major health care services from the
province of Apayao and Cagayan.

The study was participated by a total of 16 participants, the researchers conducted the data
gathering with the consultants or the Internal Medicine Doctors, Nurses and Nursing attendants who are
all staff in the Intensive Care Unit.

RESEARCH INSTRUMENT

In gathering data for this study, the researchers prepared the questioner after the statement of
the problem was formulated. The researcher’s questionnaires were composed of two parts. The first
portion included the demographic profile of the participants. The second one is what is effect of hospital
– acquired infections prevention in intensive care unit patients. The researcher’s questionnaires were
validated by competent statisticians and experts in research and dissertation writings. The
questionnaires were distributed to the selected participants. The items were developed and modified
appropriately to the given indicators and to suit the level of understanding of the selected respondents.

The questionnaire was validated with certification with a validator coming from the faculty of
Lyceum of Aparri, College of Health to establish content validity and reliability.

Using reliability test, it was made possible to distinguish between valid and non – valid items
(Maida, 2017). The reliability test was carried out in this study by comparing the R count value with the R
table value. Cronbach’s Alpha was utilized. When the alpha value of a variable is more than 0.60, the
variable can be deemed to be trustworthy (Riyanto, 2019). A three-part questionnaire was sent to 16
employees from the nursing and medical department; and the remaining 10 employees were coming
from the administrative department. These employees who participated the pilot study were not the
actual respondents of the study and it also aimed to establish reliability of the survey questionnaire. The
agreeableness scale consisted of 10 to 11 items (.65), the management subscale consisted of 10 items
(.82), and the overall agreeable subscale consisted of 71 items (.88).

The assessment scoring key is show in Table 2 below. The study is descriptive type; therefore
it can easily be qualified because the participant will answer the level of agreement or disagreement per
items written in the survey questionnaires form. Further the 5 points.

Likert Scale was used to evaluate the HOSPITAL – ACQUIRED INFECTIONS PREVENTION IN INTENSIVE
CARE UNIT PATIENTS
 Table 2 Scoring Key

SCALE VERBAL INTERPRETATION

10 STRONGLY AGREE
7 AGREE
4 NEITHER AGREE NOR DISAGREE
0 DISAGREE
0 STRONGLY DISAGREE

Table 3. Range Scale and Verbal Interpretation

VERBAL INTERPRETATIO
SCORE RANGE VERBAL INTERPRETATION (Effects of Hospital – Acquired
Infections Prevention in
Intensive Care Unit Patients)
9.25 – 10.00 STRONGLY AGREE VERY STRONG EFFECT
6.25 – 7.10 AGREE STRONG EFFECT
5.30 – 6.25 NEITHER AGREE NOR DISAGREE NEUTRAL EFFECT
1.25 – 2.20 DISAGREE WEAK EFFECT
1.10 – 1.90 STRONGLY DISAGREE VERY WEAK EFFECT

Table 3. Shows the range scale and the verbal interpretation of the study. The participants choose the
answer using the scoring key. The average weighted mean was computed based on the answers and it
has a corresponding verbal interpretation. The study used a verbal interpretation to measure the Effect
of Hospital – Acquired Infections Prevention in Intensive Care Unit Patients.