Assessing Healthcare-Associated Infections, Capstone Project Example

Summary

Healthcare Associated Infections (HAIs) is a critical public problem in the hospitals. The subject of Infection Control is very important in hospitals. In very close quarters, patients are cared for by various health care workers.  Frequently contact is made among people who have an infection or can spread one, and those people who can become easily infected.  In addition, some types of procedures can increase a patient’s risk of infection.  Preventing infections is important to help patients recover quickly and stay as healthy as possible. However, just as important are the complex reasons for the infection disease epidemic. The paper will discuss the HAIs protocols along with several areas that are affecting the infectious disease epidemic, such automated real-time reporting, lack of detailed hospital reporting, hospitals not adhering to the hand hygiene controls. Hospitals are not following the CDC’s framework for preventing infectious disease outbreaks.

Introduction

 Healthcare Associated Infections (HAIs) are causing millions of deaths in the United States and no one is ringing the alarm. The OHSA research addressed the Bureau of Labor Statistics (BLS) report of 2008, which clearly indicates, healthcare workers (HCW’s) are being exposed to infectious diseases. Based on past and present research, the Institute of Medicine reported that adverse events affect approximately 2 million patients each year in the United States, resulting in 90,000 deaths and an estimated $4.5–5.7 billion per year in additional costs for patient care (Collins, 2008). In our society today, we have the unspoken problem of Healthcare infections(HAIs) that is plaguing the nation. Healthcare-associated infections (HAIs) are various infections caused by fungi and bacteria that patients are exposed during their healthcare stay. The HAIs are causing an unprecedented number of patients at- risk of infection upon their discharge.  Nosocomial infections, or hospital-associated infections, are estimated to occur in 5 percent of all acute care hospitalizations, or 2 million cases per year (Kleinpell,Munro & Giuliano,2008).

The CDC publishes various guidelines for the prevention and control of nosocomial infections, which are also known as hospital-acquired infections. These guidelines, however, are non-enforceable due to the fact that the CDC is not a regulatory agency (Americans Mad and Angry, 2012). The OHSA study addressed the Bureau of Labor Statistics (BLS) report of 2008, which clearly indicated that healthcare workers (HCW’s) are being exposed to infectious diseases. In order to control the improvement in massive number of healthcare-associated bacterial contamination , it will be important to distinguish significant variables that can make healthcare intermediaries vulnerable to these outbreaks . There will be a global need  to take a look at the level of responsiveness and performance of medical organizations in responding to  healthcare-associated infections that will enable the world to be able to protect against potential epidemics .

According to most experts, more than half to three-quarters of all nosocomial infections could be prevented, if healthcare workers strictly followed hand-washing procedures (Americans Mad and Angry, 2012). The Centers for Disease Controls (CDC) has provided a framework for the ICC departments in hospitals to enable them to effectively prevent and control infection diseases. The CDC frame is based on three areas: (1) hospital detection and epidemiologic investigation, (2) high-impact interventions and (3) sound health policies. The hospitals are clearly not following the CDC framework for ensuring the prevention and control of infection diseases. The paper will show specific examples of hospitals not handling infection disease properly, which has caused an epidemic of infectious diseases being reported.  The infectious diseases are a serious hospital problem. It is very difficult to measure the real numbers concerning the compliance of CDC Framework protocol, because each hospital may follow the CDC Framework, but deliver differently. There are multiple examples of infection control teams responding successfully to other problems by staying engaged, gaining the compliance of clinicians, and getting the right thing to happen (Farr, B, 2000, pg. 414).

Infectious disease exposures are also due to various states having different regulations pertaining to what is considered reportable. Hospitals experiencing success in getting compliance from clinicians with infection guidelines have generally retained an infection control team that is deeply involved in surveillance and control activities (Farr, B, 2000, pg. 414). Reportable conditions are determined by laws and regulations of each state and jurisdiction, and some conditions deemed nationally notifiable might not be reportable in certain states or jurisdictions (Morbidity and Mortality Weekly Report, 2010).The reports clearly demonstrate which states or hospitals have the most infectious disease deaths. However, the hospital reports omit mention of hospital, city, or state.  The paper will discuss the HAIs practices along with several areas that are affecting the infectious disease epidemic, such automated real-time reporting, lack of hospital reporting, The Center for Disease Control (CDC) is unable to monitor and enforce non-regulatory agencies and lack of hand hygiene controls. Hospitals are not following the CDC’s framework for preventing infectious disease outbreaks.

Healthcare Associated Infections (HAI)

Healthcare-associated infections (HAIs), formerly known as, (Nosocomial Infections) are infections that patients may receive during the course of treatment for other healthcare conditions.  These infections that are related to medical care can be devastating and even deadly.  The Centers for Disease Control (CDC), as the nation’s health protection agency, is committed to helping all Americans receive the finest and safest care when they require healthcare services.  HAIs are an important public health problem.  Approximately 1 out of every 20 patients who are hospitalized will contract an HAI.  The CDC strives to understand how HAIs happen and to develop appropriate ways for interventions (Healthcare-associated Infections (HAIs): (The Burden, 2010).  Furthermore, healthcare workers can also pass these diseases or can also become infected in the workplace.  Loukides et al.(2008), Consider the amount of times that you have come to work while sick.  You may be feeling under the weather, but you have so a great deal work to do, phone calls to return, and deadlines to meet, so you come to work.  Seldom does the notion of spreading germs cross your mind.  Unfortunately, this situation is all too common and is one of the reasons infectious diseases spread so rapidly in the workplace.

Types of HAIs

Bacterial

Bacterial Infections are microorganisms that are singled celled; they thrive in several different types of environments.  Some varieties live in extremes of heat or cold, while others make their residence in people’s intestines, where they assist in digesting food.  The majority of bacteria’s cause no harm to people (Steckelberg, n.d.).

Viral

Viral Infections are much smaller than bacteria and require living hosts — such as people, plants, or animals — in order to reproduce.  Otherwise, they cannot survive.  As a virus enters your body, it invades a number of your cells and takes over the cell mechanisms, redirecting it to produce the virus (Steckelberg, n.d.).

Fungi

Various skin diseases, such as athlete’s foot, or ringworm are caused by fungi.  There are additional types of fungi that can infect your nervous system and lungs.

Parasites

A tiny parasite that is transmitted by an infected mosquito bite causes Malaria; a recurring illness.  Additional parasites may be transmitted to humans from animal feces (Mayo Clinic Staff, 2011).

Ways to Acquire HAI’s

Direct Contact

There are three ways of catching an infectious disease (1) Person-to-person, (2) Animal-to person, and (3) Mother-to-unborn Child.  One of the easiest ways to catch and infectious disease is coming in contact with a person or animal that has one.

Blood Borne

Blood borne pathogens are that in which an infectious agent is present in the blood of an infected individual is transmitted by contact with the blood of a predisposed individual (Mayo Clinic Staff, 2011).

Indirect Contact

These are disease-causing organisms that can linger on inanimate objects, such as doorknobs, tabletops, or facet handles.  For example, if someone handled a doorknob and has a cold or the flu, you can pick up germs they left behind by touching the object and rubbing your eyes, nose or mouth; therefore becoming infected.  Two ways of exposure are (1) Insect bites, and (2) Food contamination (Mayo Clinic Staff, 2011).

Air Borne

Air borne pathogens, or Enteric; are more commonly caused by an infectious agent entering the body through the mouth and intestinal tract. They are typically spread through contaminated food, water, or by contact with vomit or fecal matter (Infectious Diseases:epidemiology and surveillance, n.d.).

 Standard Precautions

Standard Precautions is a set of behaviors that are mandatory in the hospital. All safety precautions must always be followed for the sake of the patients and others in the working environment. Since it is hard to recognize patients who can catch infections earlier than others, we treat all blood and body fluids as potentially harmful and infectious. Waste sorting is important because our hospital pays for medical waste disposal and is fined if medical waste is found in white or clear bags. We use the following precautions to prevent anyone from contracting any type of infection/diseases:

Hand washing

• Wash hands after touching blood, secretions, bodily fluids, contaminated items, and excretions, regardless if gloves are worn or not. Wash hands immediately after gloves are removed, and between patient contacts.
• Use a plain soap for routine hand washing.
• Use an antimicrobial agent for specific circumstances.

Gloves

• Wear gloves when touching blood, body fluids, secretions, excretions, and contaminated items. Put on clean gloves just before touching mucous membranes and non-intact skin.

Mask, eye protection, face shield

• Wear a mask and eye protection or a face shield during procedures and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions (14 Hospital hygiene and infection control, n.d.).

Gown

• Wear a gown during procedures and patient-care activities that are likely to cause splashes or sprays of blood, body fluid, secretions, or excretions.

Patient-care equipment

• Ensure that reusable equipment is not used for the care of another patient until it has been cleaned and reprocessed appropriately.

Environmental control

• Ensure that the hospital has adequate procedures for the routine care, cleaning, and disinfection of environmental surfaces.

Linen

• Handle used linen, soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, and that avoids transfer of microorganisms to other patients and environments.

Occupational health and blood borne pathogens

• Take care to prevent injuries when using needles, scalpels and other sharp instruments or devices.
• Use ventilation devices as a substitute to mouth-to-mouth resuscitation methods.

Place of care of the patient

• Situate a patient who contaminates the environment or who does not assist in maintaining proper hygiene must be placed in an isolated (or separate) room (14 Hospital hygiene and infection control, n.d.).

Although anyone can catch an infectious disease, you may be more prone to get sick if your immune system is not working properly. This may occur if:

• You are taking steroids or other medications, such as anti-rejection drugs for an organ transplant that will suppress your immune system.
• You have HIV or AIDS.
• You have certain types of cancer or other disorders that affect your immune system.

Furthermore, certain additional medical conditions may predispose you to infection, including malnutrition and extremes of age, and implanted medical devices, among others (Mayo Clinic Staff, 2011).

Centers for Disease Control and Prevention (CDC)

The Centers for Disease Control and Prevention (CDC) is a federal agency of the United States under the Department of Health and Human Services headquartered in Druid Hills, in Greater Atlanta.  It serves to protect public health and safety by providing information to enhance health decisions, and to promote health through partnerships with the state health departments and other organizations.  The CDC focuses national attention on applying and developing disease prevention and control (especially infectious diseases,  microbial infections, and food borne pathogens), occupational safety and health, environmental health, and injury prevention and education activities designed to improve the health of the people of the United States.  The CDC is a founding member of the International Association of National Public Health Institutes (CDC, 2008).

The Centers for Disease Controls (CDC) has provided the critical guidelines that the hospital can follow to ensure the Infection Disease protocols are effectively delivered to the hospital populations.  According to the CDC framework, the Infectious Disease protocols are based on three areas. (1) The area is the ability for the hospital to detect Infectious Diseases with the hospital environment. (2) The second area is the hospital creating programs that address any bottlenecks in the hospitals Infection Disease guidelines (3) The hospital must have a solid foundation of healthcare internal procedures that address all infectious disease programs.  The hospitals are not following the CDC framework for ensuring the prevention and control of infection diseases. The infectious diseases are a serious hospital problem that is very difficult to measure the real numbers concerning the compliance of CDC Framework protocol because each hospital may follow the CDC Framework but they deliver differently. The is an epidemic of Infectious Disease break-outs in the United States because the hospitals are not following the CDC Framework and they hospitals continue to work alone instead of collaboration with other hospitals. The Infectious Disease outbreaks are critical in the United States and globally.  Many incidents have been report abroad that eventually found its way in the United States hospital.       The number of infectious disease breakouts in 2012 reads as follows: U.S.-Based Outbreaks (Centers for Disease Control and Prevention (CDC) :

• Meningitis – Multistate outbreak First announced October 2012
• Peanut Butter – Salmonella Bredeney First announced September 2012
• Ricotta Salata Cheese – Listeriosis First announced September 2012
• Hedgehogs – Human Salmonella Typhimurium Infections First announced September 2012
• Mangoes – Salmonella Braenderup First announced August 2012
• Yosemite National Park – Hantavirus First announced August 2012
• Cantaloupes – Salmonella Infections First announced August 2012 2012 West Nile Virus
• Pertussis (Whooping Cough) in Washington First announced April 2012
• Small Turtles – Human Salmonella Infections First announced March 2012

Even though many hospitals have infection disease controls in place, there are several reasons the infection disease control policies are not effective (1) The hospital does not effectively following the CDC ID Framework that spells out how to prevent, recognize and control infection diseases in the hospital, (2)the hospital does not spend enough time simulating real infection diseases situations. Often, the emergency protocols in theory are quite different in real life. (3) The lack of hospital employee’s awareness and training concerning infection diseases in the hospital settings. (4) The hospital does not work in collaboration with other hospitals in the region to effectively share data and the prevention of past infectious disease events.  When hospitals cooperate and coordinate their infection control procedures. Hospitals working alone do not achieve the same level of infection control, according to the results of the study published in the October issue of the journal Health Affairs (McGrath, 2012). The hospitals do not want to document exposures of infectious disease, no matter the quantity. The industry’s desire for secrecy also obscured a disturbing trend, in which the Tribune investigators found buried within government and private healthcare records. Infection rates are soaring nationally, exacerbated by hospital cutbacks and carelessness by doctors, nurses and other healthcare personnel (Americans Mad and Angry, 2012). The CDC is accountable for providing a variety of solutions, for health for the public to prevent the spread of contagious diseases. Their primary goal is to identify any dangerous infectious diseases or epidemics that may affect the environment. There is a primary culprit in the hospital industry. The hospitals infectious disease teams are not making certain, the hospital staff follows hands hygiene protocols. Accordingly, the CDC now estimates as many as one-third of all U.S. hospitals fail to follow its guidelines for hand washing and other basic infection control precautions; even though strict adherence to clean-hand policies alone could prevent the deaths of up to 20,000 patients each year(Americans Mad and Angry,2012).

Infection Control Plan

Infections contracted in hospitals are also called healthcare-associated infections (HAIs); occur in approximately 5% of all hospital patients.  Sometimes these infections may increase time spent in the hospital and, in some cases, cause death. There are many reasons why HAIs are common; so it is important to have an Infection Control Plan (IFCP) in place and an Infection Control Committee (IFCC) within the organization.

The Infection Control Plan presents the Risk Assessment Factors within the organization as described in the following:

• Population and Community Served
• Urban population with limited socio-economic resources and location.
• Care, treatment and services provided, such as
• Hemodialysis (Clagon, 2012)
• Surgical – Inpatient and outpatient
• Medical – Surgical Intensive Care
• Emergency
• Perinatal services including level 1 nursery
• Behavioral health
• Population characteristics
• High rates of substance abuse, cancer, obesity, and hypertension.
• High rates of HIV/AIDs above national average.
• Aging population with many long-term care facilities transfer.
• Patient from Correctional facilities and Institutions.
• High incidence of patients with Diabetes, ESRD, Stroke, Heart Diseases, and potential for Tuberculosis.

The Characteristics that increase risks are:

• Patients lacking preventive health care.
• Patients have limited number of immunizations.
• The City is at risk for bioterrorism events.
• Debilitated, high-risk patients.
• Crowded ER, due to patients not having a private physician.
• Patients arrive for delivery without prenatal care.
• Aging Facility.
• Immuno-compromised patients unaware of their HIV status.
• Employees at risk for potential blood/body fluid exposures.
• Multiple potential sources of resistant organisms (Clagon, 2012).
• Potential sources of Tuberculosis (Clagon, 2012).

Infection Control Committee

In addition, the IFCP is an Infection Control Committee (IFCC) who is charged with minimizing patient and employee risks.  Although not widely recognized by patients, it plays an integral part in the care of every patient.  The IFCC is generally comprised of members from various disciplines within the facility, such as physicians, surgery and nursing staff, infection control practitioners, quality and risk management professionals, and environmental services, etc.  The goal of the interdisciplinary team is to bring individuals together with the expertise in different areas of healthcare, therefore providing insight from several angles for the best possible outcomes (Lee & Lind, 2000).  The role if the IFCC is multi-faceted.  It should be involved in planning, monitoring, evaluating, updating, and educating; setting the general infection control policy and providing input into specific control issues (Lee & Lind, 2000).  The IFCC uses the following tools to ensure patient and employee safety:

Planning

• Acquiring careful planning the IFCC is charged with the planning and implementation of new procedures that may pose as a potential infection control risk. It provides input in the selection of equipment used to process instruments and of chemicals used to manage the facility’s environment.

Monitoring

• The IFCC monitors infectious processes; track HAIs and incidents that may have the potential to cause infections. As an effort to minimize risk, identify problem areas, and implement corrective actions they review the facility’s infection control statistics.

Evaluating

• The IFCC constantly strives to improve processes within the facility, through regular review of each department’s infection control.

Updating

• This is one of the biggest challenges for the IFCC, due to constant advancement in healthcare technology and new bacterial strains that complicate and challenge older control processes (Lee & Lind, 2000). The IFCC encourages all members to stay abreast of changes within their expertise; for the continuance of providing guidance and leadership through these changes.

Educating

• An integral part of the IFCC is taking an active role in staff education. This may be a hands-on or advisory role in partnership with the facility’s education department.  At least two specific areas should be addressed in the education process: (1) that of annual general infection education and (2) communicating changes and updates to the hospital staff as emerging technologies are applied (Lee & Lind, 2000).

Strategies of Risk Management

Infectious diseases are not only spreading faster, they appear to be rising more rapidly than ever before.  Since the 1970s, emerging diseases have been identified at a rate of one or more per year. During the same year, the World Health Organization (WHO) has confirmed more than 1,100 epidemic events worldwide.  The spread of infectious disease is not just a public concern, but also a business risk (Loukides, 2008). The hospital or facility need to have a business continuity plan to addresses the recognition, prevention, and mitigation of communicable diseases; otherwise, employers will be unprepared efficiently and effectively and deal with subsequent absences, adjustments to benefit plans challenges that may arise due to the spread of an infectious disease.  The continuity plans should have the following:

• The role of government (local, state, national) during an outbreak
• The role of public health to:
• Contact Tracing
• Laboratory Testing
• Provide vaccinations and forms
• Provide support for clinics
• Control Guidelines (Loukides, 2008)

Leading Cause of Deaths HIA’s

There is an epidemic of infectious disease breakouts in the United States due to the hospitals are not following the CDC Framework. Many hospitals continue to work alone instead of collaborating with other hospitals. The U.S. Department of Health & Human Services (HHS) notes that nosocomial are among the leading causes of death in the United States, accounting for an estimated 1.7 million infections and 99,000 associated deaths in 2002(Occupational Safety and Health Administration (OHSA), 2012). The Infectious Disease outbreaks are critical in the United States and globally.  Many infectious disease outbreaks that have been reported abroad in hospitals eventually infiltrated United States hospitals.

The number of infectious disease breakouts in 2012 reads as follows: U.S.-Based Outbreaks (Centers for Disease Control and Prevention (CDC) :

• Meningitis – Multistate outbreak First announced October 2012
• Peanut Butter – Salmonella Bredeney First announced September 2012
• Ricotta Salata Cheese – Listeriosis First announced September 2012
• Hedgehogs – Human Salmonella Typhimurium Infections First announced September 2012
• Mangoes – Salmonella Braenderup First announced August 2012
• Yosemite National Park – Hantavirus First announced August 2012
• Cantaloupes – Salmonella Infections First announced August 2012 West Nile Virus
• Pertussis (Whooping Cough) in Washington First announced April 2012
• Small Turtles – Human Salmonella Infections First announced March 2012

Even though many hospitals have infection disease controls in place, there are several reasons the infection disease control policies are not effective (1) The hospital does not effectively following the CDC/ ID Framework that spells out how to prevent, recognize, and control infection diseases in the hospital, (2) hospitals do not spend enough time simulating real infection diseases situations. Often, emergency protocols in theory are quite different in real life. (3) The lack of hospital employee’s awareness and training concerning infection diseases in the hospital settings. (4) hospitals do not work in collaboration with other hospitals in their region to effectively share data and the prevention of past infectious disease events.  CDC/HICPAC states, “several observational studies have shown limited adherence to recommended practices by healthcare personnel (Occupational Safety and Health Administration (OHSA), 2012). Hospitals should hospitals cooperate and coordinate their infection control procedures. Hospitals working alone do not achieve the same level of infection control, according to the results of the study published in the October issue of the journal Health Affairs (McGrath, 2012). There are enough documented hospital cases that did not prevent or detect infection disease threats. In hospitals of this type, the small fraction of colonized patients with clinical infection may be placed in isolation, but staff frequently violates the isolation guidelines, perhaps because they recognize that nothing is being done to prevent exposure (Farr, B, 2000, pg. 414).  Many health care settings have poor infection control and fewer infection control programs, giving rise to transmission of infections in hospital settings.   The significance of the problem to be explored is addressed.

Global Infectious Disease Controls

The CDC has recognized that the Infectious Disease Controls is a global issue, not just in the United States. The global effects of Infectious Disease Control are important to research because, all hospitals should be reporting the origin of the infectious disease. The best example is the infectious disease, AIDS. The epidemic of AIDS was already rampant in Europe before the United States acquired enough information about the deadly impact of AIDS. The list below clearly shows that the global diseases that eventually made its way to the United States. The mosquito infectious disease started abroad, however after a few months, the United States began reporting explained number of deaths due to mosquito bites. However, there is some correlation to outbreaks in other countries Centers for Disease Control and Prevention (CDC), 2012:

Epidemic on the Rise

In our society today, hospitals are recording, some the highest cases of infectious disease episodes in history. Hand hygiene still remains as the simplest, most effective measure for preventing nosocomial infections. Despite advances in infection control and hospital epidemiology (CDC, 2012, pg. 231).  If hospital employees follow the CDC framework for infectious diseases, and when they see the first indication of a strange and unknown illnesses, act accordingly and follow CDC framework guidelines. There would be fewer occurrences of infectious diseases. When the numbers of outbreaks are not being fully reported means, it is hard to correctly track infectious diseases.

In 2006, the Association for Professionals in Infection Control and Epidemiology (APIC) reported, 14 States have mandatory public reporting, and 27 States have other related legislation under consideration. Participation in public reporting has not been regulated by the Federal sector at this time (Collins, 2008).  Many times, school systems take the initiative to close schools when an unknown infectious disease occurs on campus. A study of adherence to CDC finds respiratory infection control practices examined 653 healthcare workers in primary care clinics and emergency departments of five medical centers and found significant gaps in compliance (Occupational Safety and Health Administration (OHSA), 2012). The hospitals are the last to report to the CDC while the public is making the decision to tempo­rary close the education facilities and suspend classes. Although the state health officials take accountability for suspending classes, it should have been reported by the hospitals to the CDC. What is a hospitals dentition of an epidemic? A hospital epidemic is the occurrence of lack of hygiene protocols that can affect the health of the hospital staff, patients, and the community. In the largest hospital-wide survey ever conducted, predictors were detected of noncompliance with hand hygiene during routine patient care (CDC, 2012, pg. 233). Many times hospitals will not report the epidemic; however, legislation is working on making at change. Many times the hospital will call an infectious disease pandemic, because they do not want to report they are responsible (for example a children’s flu virus). A recent Institute of Medicine report identified a high alert for patient safety concern and recommended immediate and strong mandatory reporting of other adverse health events, suggesting that public monitoring may hold health care facilities more accountable to improve the quality of medical care and to reduce the incidence of infections (Collins, 2008).  The term outbreak might be used when a single case of an unusual disease occurs. CDC/HICPAC has also noted that HCWs generally reported greater self-adherence to infection control practices than was actually reported in observational studies (Occupational Safety and Health Administration (OHSA), 2012). A pandemic is an epidemic that spreads through human populations worldwide. Because there have been previous situations where a pandemic influenza has happened, public health officials are engaged in ongoing efforts to prepare for this type of a situation. Improvement in infection control practices requires questioning basic beliefs, continuous assessment of the stage of behavioral change, interventions with an appropriate process of change, and supporting individual and group creativity (CDC, 2012, pg. 237). When a strange type of illness occurs, or an unusual number of individuals develop an illness or symptom, the situation may be an outbreak, an epidemic, another type of infectious disease emergency, an environmental issue, or an incident of bioterrorism. However, it is still the hospital responsibility to report the breakout as infectious disease.

Comparisons

The Consumer Reports.Org (2012) provided the data showing whether hospitals were following safety procedures to protect the community and hospital employees. The hospital report compared five hospitals: United Medical Center, Washington Hospital Center, Georgetown University Hospital, Children’s National Medical Hospital, and Howard University Hospital. The hospital report was informative providing accreditation information, number of beds, mortality rates, discharge, and each hospital safety score but the results indicated the district of Columbia hospitals do not report safety scores information to the state nor the public.

The Hospital Safety Score organization had the closest information for overall rating of hospitals including their Infection Disease Controls and adherence to CDC hygiene protocols. The results indicated that all the hospitals received a C report grade, including United Medical Center. However, after evaluating the overall different in the numbers for each hospital, the differences were miniscule however; there was some presentation of how hospitals are preparing to prevent infectious diseases. The safety scores represent a complete picture from the hospital compliance, hospital hygiene, customer perception of the cleanliness and the important grading. The reports indicated that most of the hospitals are attempting to operate in the District of Columbia within the confines of the Infectious Disease Control guidelines (see Appendix 1 to 2)

Limitations and Assumptions  

The limitations are the measurement of the Center for disease control and Prevention (CDC) hospital outbreaks because they base the event on national or local outbreaks. However, the study that concentrates on why the outbreak happens gets lost in the translation from the hospital to the CDC. There are a number of reasons the information is gray due to hospital exposures for hospital infectious diseases. There is a rising cost of the medical malpractice lawsuits due to hospitals not taking necessary precautions to avoid or control infectious diseases. Hospitals agree and collaborate that infectious disease was caused the lack of hygiene protocols by the hospital workers. However, clear logic indicates that if the hospitals follow the CDC protocols along with collaborating with other agencies the infectious disease outbreaks are preventable. Infection control professionals should promote and conduct outstanding research and provide solutions to improve health-care worker adherence with hand hygiene and enhance patient safety (CDC, 2012, pg. 237).

Hospitals are spending more time ensuring they are not liable, that pertinent information on the infectious disease events is being lost forever.  The secondary limitation is the reported data on how many infectious diseases were caused by the hospital after surgery .Many infectious diseases are contributed to hospital works not following proper safety protocol. Observed adherence to universal precautions (now part of standard precautions) ranged from 43% to 89%, with even greater variability reported recommended infection control practices (e.g., glove use).\16\ (Occupational Safety and Health Administration (OHSA), 2012).According to Dudeck, et.al (2010). The hospital facilities should use the infectious disease data from the National Healthcare Safety Network (NHSN) to determine where the hospital falls in relation to prevention of infection disease using the percentiles as a gauge of performance of reducing infectious disease events in the hospital. Hospitals provide infection disease information, which is collected by the National Healthcare Safety Network (NHSN) from participating hospitals in the Washington DC area from January through December 2010. The CDC has created aggregated data from these reports to reflect the following data reports:

• Collection of infectious disease data on hospital facilities that report Infection Diseases
• Collections of data from hospitals that are complying to the CDC Framework number of events
• Collections of infectious disease based trend patterns that may pinpoint epidemics/outbreaks
• Collection of hospital quality control data concerning infectious disease facility comparisons
• Collection of analysis based on assisting hospitals with detection and prevention and interventions
• Collection or studies concerning the infectious disease strategies best benchmarking

The primary limitations of the data is the reports only capture the percentiles which does not give a clear indication of how well or how bad any hospital is doing in the area of infectious diseases reporting and preventions. There are some reports from LeapFrog that address the safety records of the hospital but the reports do not give specific information on each hospital Infectious Disease incidents. Once again, the research has limitations in providing the detail information on each hospital performance with Infectious Disease. That limitation is apparent with the CDC Hospital reports that indicate how the hospital is performing concerning Infectious Diseases; however, the limitations are the CDC reports do not give specifics on which hospital is in non-compliance.

CDC Frame Protocol

In order to determine if hospitals are following the proper CDC framework for compliance, the CDC provides the statistics for hospitals that are compliant. More importantly, how does a hospital know if they are following the National Guidelines for Infectious Disease Controls? The CDC has a webpage that is dedicated to hospital protocols for prevention of infectious disease outbreaks. The CDC provides an extensive guide for Infection Control of Hospital Personnel that can be accessed 24/7 even if the employee does not have the information during the event. The CDC hospital guidelines follow the Prevention and Control of Nosocomial Infections. The CDC has developed these guidelines in a direct response of hospital and other medical professionals. Some type of central reference is needed for health professionals since they are at constant risk for infection disease within the hospital. The CDC recommendations are based on historical data, which is easily accessible for the hospital personal. It should be emphasized that these guidelines represent the advice of CDC on questions commonly asked of the hospital infections program, but are not intended to have enforce the law or regulations. These guidelines can be expected to change in response to the acquisition of new knowledge (CDC Wonder, 2012).

Previous Research

The Agency for Healthcare Research and Quality (AHRQ) has lead research to improve infection safety in the healthcare industry. There several areas of previous research such as Barriers and Challenges for  Preventing HAI’s 34 hospitals, Initiatives Examines Tools and Interventions to Assist with Reducing HAI;s and Hand Hygiene is Important for Preventing HAI’s. The Hand Hygiene research was gathered and reported HAI’s rates in the Prevention of Healthcare Associate infections. The researchers reviewed 64 studies that reported HAI rates. Based on this research the researchers suggested that the industry need to implement education training using Web and Video based training to improve knowledge levels on HAIs. Multidisciplinary teams at 34 participating hospitals are using AHRQ-supported evidence-based tools for improving infection safety to facilitate changes in clinician behaviors and habits, care processes, and the safety culture (Agency for Healthcare Research and Quality (AHRQ), 2010). There is previous research presented by the CDC concerning the continue outbreak of infectious diseases in the United States. The Center for Infectious Disease Research and Policy (CIDRAP), founded in 2001, is a global leader in addressing public health preparedness and emerging infectious disease response. Part of the Academic Health Center at the University of Minnesota, CIDRAP is led by Michael Osterholm, PhD, MPH, director and professor, Division of Environmental Health Sciences, School of Public Health, an adjunct professor in the Medical School, and an internationally renowned expert in public health(CIDRAP,2012).  The CDC said today in its fungal meningitis outbreak update that the number of infections linked to NECC’s contaminated methylprednisolone acetate has risen to 404, 18 more than reported.  More patients have died, raising that total to 29(CIDRAP, 2012).  This previous research is critical because CIDRAP provides studies on each infectious disease by categories. In addition, the research gives specific reports on infectious disease cases such as 386 cases of fungal meningitis. The research provides a clear history concerning infectious diseases in the past that have been controlled in the new century along with solutions, resources and experts that are willing to help with new and improved research.

Review of Literature

The literature from the CDC provides a solid foundation for hospitals to tailor their infection disease protocols. A CDC Framework for Preventing Infectious Diseases: Sustaining the Essentials and Innovating for the Future—CDC’s ID Framework—was developed to provide a roadmap for improving our ability to prevent known infectious diseases and to recognize and control rare, highly dangerous, and newly emerging threats, through a strengthened, adaptable, and multi?purpose U.S. public health system (Frieden, T. & Khabbaz, R, 2010).

The CDC Framework literate is significant to support the papers assumptions because the CDC ID Framework literature provides a systematic protocol for the prevention or detection of an infection disease. In addition, the literature provides information that is difficult to locate the chronological events of past infection diseases from 2000 to present. The literature provides examples of cases concerning infection diseases that made it into the population. In other words, the CDC ID Framework gives the hospital real life infectious disease events to assist hospitals with building the best infection disease program. The literature provided by Americans Mad and Angry, 2012 supported the assumptions about the hospitals not complying with the CDC Framework guidelines. This forum provided the specific statistics on how many Americans have died because of Infectious Disease exposure. Incredibly, hospital infection deaths represent the fourth leading cause of death among Americans (behind heart disease, cancer and strokes), and nosocomial infections kill more people in our country each year than car accidents, fires and drowning combined(Americans Mad and Angry, 2012. The literature was short but gave specific dates, statistics, data, and sources that indicated that the Infectious Disease hospital non-compliance program needs to be addressed before the epidemic reaches catastrophic results which is not too far into the future.

The Occupational Safety and Health Administration (OHSA). (2012) literature provides a unique snapshot by providing the number of hospital workers exposed to injury due to Infectious Disease accident of some kind hidden behind the other accidents at the hospital. This study provides the specific statistics that clearly show that the hospital non-compliance and no regulatory body to enforce the Infectious Disease guidelines are leading to catastrophic results.

Operational/Evaluation Questions

The question remains concerning the lack of hospitals utilizing real time simulation.  Majority of the hospitals follow a similar protocol that outlines the procedures, policies, and accountability of the staff when the red alert is sounded for an infectious disease breakout. According to McGrath, 2012,” The hospital created an infection disease simulation for all the hospitals in the Orange County district, as a result over 75 percent of hospitals responded appropriately. The simulation used real data from previous hospital infection disease episodes.” The hospitals have several agencies that already have the resources, training, and documentation to assist hospitals with revamping or adjusting polices to meet National Standards.  The best example is CIDRAP An international, collaborative center drawing on a wide range of expertise and real time data, CIDRAP  (2012) “focuses on emerging global challenges to public health and those demanding immediate attention, striving to create solutions targeted for the greatest impact. The center’s current work focuses on four main areas:

• Pandemic influenza preparedness in public and private sectors, including research on influenza viruses with pandemic potential

• Infectious Disease Preparedness and response
• Internet-based infectious disease reporting and publishing
• Education

There is no reason why any hospital should not be able to remain complaint with the CDC Framework because you have many agencies like the CIDRAP that already has the programs ready for the hospital use and implementations. CIDRAP (2012) programs:

• Consensus building: Convening experts to assess problems, analyze available information, and develop effective public policy recommendations and guidance. Consulting with and catalyzing policy makers, business leaders, and the medical and public health communities to act.
• Research: Conducting and facilitating targeted research on the detection, epidemiology, ecology, and transmission of infectious diseases, as well as on policies and practices that advance effective public health responses.
• Information synthesis: Conducting critical review and analysis of available scientific and public policy information on selected topics and generating authoritative, accurate, and current Web-based content.
• Communication: Making current information widely available to educate and inform healthcare providers, public health professionals, business leaders, students, opinion leaders, policymakers, the media, and others across the nation and around the world.
• Interdisciplinary partnerships: Working collaboratively with a wide range of public health, environmental, veterinary and medical researchers and experts, as well as philanthropic groups and foundations, throughout the world to develop and support new initiatives.
• Education and training: Providing education and training opportunities (such as classroom teaching, mentorship, workshops, online training, and exercises) targeted to a wide range of audiences, including CIDRAP staff, university students at all levels and professionals in public or private sectors domestically and internationally.

Methodology

The methods for addressing the Hospital Infectious Disease compliance utilize the doctors and hospitals statistical rates to determine which hospitals are preventing infectious disease outbreaks and which hospitals are underperforming. According to the Doctors and Hospital Consumer Report, 2011, “These so-called central-line infections account for about 15 percent of all hospital infections but are responsible for at least 30 percent of the 99,000 annual hospital-infection-related deaths, according to the best estimates available.” This method analysis of hospital performance was utilized because the study consisted of 1000 hospitals across the country. In addition, to 5000 acute-care hospitals and 3300 intensive care units (ICU).

This information was collected by the Leapfrog (2010) located in Washington, D.C that collects and disseminates hospital information. The method of qualitative data was used because the data was unbiased information, with the mission to share and educate as their mission versus the Leapfrog group being controlled by another hospital group; that wanted the information presented in more friendly or acceptable way that would prevent lawsuits. The Leapfrog Group is since opening their doors in 2000 has been recognized as an agency that collects hospital data without making judgment on the hospital operations or bottlenecks.

The Leapfrog Groups have built a database of collected survey information for all hospitals to improve the overall functions of the hospital in the healthcare industry. Leapfrog’s public reporting initiatives offer valuable benchmarking capabilities to hospitals, as well as providing consumers and purchasers of healthcare with the information they need on the quality and safety of their hospitals (LeapFrog, 2012). The CDC has morbid death rates by infectious disease in which the method utilized to analyze this data was based on open exposures at the hospital level. The number of new cases gives a clear indication that the hospitals are not following the CDC protocol for new and well-known diseases means the methodology is accurate for this case.

Gathering Instruments

The Leapfrog database was user friendly allowing the researcher to pull comparison information on the infectious disease controls of hospitals. It also allowed the measurement of internal effectiveness of preventing the spread of an infectious disease. The Leapfrog database has large amounts of data; which is important to gather numbers of infectious disease causes, Ambulatory Data, Summary of Notifiable Diseases all provide some form of insight to determine if the hospitals are using the CDC Framework protocols. The database was searchable by city and state providing the important data required to compare any Infectious Disease reports. The data base gives the user different criteria’s to search for hospital information such as type of facility, program location, program target(hospital), hospital performance metrics, public reporting, and financial profiles.

LeapFrog is a national and global leader in reporting unbiased hospital information to the public. LeapFrog is one the most reliable resources because they do not cater to any focus groups nor do they skews the results to improve the hospitals ratings. The LeapFrog company is a totally independent not-for-profit organization that was established 10 years ago by the industries best healthcare experts (LeapFrog, (2012). The primary goal of Leapfrog is to promote safety and quality for consumers seeking medical care at any hospital in the United States. Their mission is to provide a platform for hospitals to share critical data that will prevent infection disease outbreaks, accidents, or medication errors. The nationally recognized surveys collect hospital data from over 1100 hospitals who release this information freely to Leapfrog (LeapFrog. (2012).

The surveys and reporting from the LeapFrog safety measurements monitor and score information from each hospital including hygiene compliance infectious diseases, medical care, and patient medications and nursing ratio to patient information. The information is target to the patient population when deciding which hospital may have the best performance. This further substantiates the accuracy of the report because the audience is not intended to appease the hospital population, but allow the patient make an informed decision. Leapfrog collects the data from the hospital including process, structural and outcome measures from each hospital. The areas that are measured are Patient Safety Indicators (PSI), Hospital Acquired Conditions (HACs), Surgical Care Improvement Project (SCIP), Safe Practices per hospital, Physician Staffing and Computerized Physician Order Entry. The most important data to evaluate is the HAC) Hospital-Acquired Conditions because it addresses the hospital performance of internal Infection Disease Controls. In addition, the Centers for Medicare and Medicaid Services (CMS) rely heavily on the scores for patient and public safety (LeapFrog. (2012).

 Results/Evaluation Method

The most glaring omissions was the hospitals unwilling to provide information about medical safety at the hospitals in Washington, D.C. The hospitals did not provide the information about the mortality rates in relation to infectious diseases. The George Washington University Hospital, Howard University Hospital, Providence Hospital of Washington, Sibley Memorial Hospital, United Medical Center, and Washington Hospital Center all decline any questions concerning the hospitals infectious disease protocols and effectiveness.

The research found by the Occupational Safety and Health Administration (OHSA), 2012, found that hospitals are following the simple Hand Hygiene protocols in hospital settings. The surveys came from physician and nurses that clearly responded that the hand hygiene protocols for infectious diseases were not being following in the hospitals. It also classified many previously identified clusters of infectious diseases that are most likely to occur because of normal random fluctuations (Huang, et al, 2010). The research indicated that one of the reason for infectious disease exposures are due to each state having different regulations about what is considered reportable. Reportable conditions are determined by laws and regulations of each state and jurisdiction, and some conditions deemed nationally notifiable might not be reportable in certain states or jurisdictions (Morbidity and Mortality Weekly Report, 2010). The reports do clearly show which states or hospitals have had the most infectious disease deaths. However, some reports do omit pertinent information such as which hospital, city, or state.

SWOT Healthcare Organizations

The healthcare organizations SWOT analysis is critical to understand the hospital and healthcare relations issues. The SWOT analysis examines an organization, the environment, and the way the organization interacts internally and externally. This important tool is commonly used by hospitals and healthcare agencies. A SWOT ANALYSIS is an effective way of identifying strengths and weaknesses, and of examining the opportunities and threats that are faced (Pearce, 2007). The SWOT will discuss the Strengths, Weaknesses, Opportunities, and Threats. Here some possible question of the healthcare SWOT analysis: Possible questions to ask concerning the healthcare organization, when trying to determine the strengths and weaknesses. These questions are critical to the corporate office to get a clear snapshot.

What are some of the healthcare organizations strengths? The healthcare organizations provide support to the healthcare system with quality care, building relationships and providing choices for consumers. In this study, a quantitative SWOT analysis has been newly proposed to identify relationships among SWOT factors systematically and to formulate competitive strategy on the basis of identified relationships (Shinno, Yoshioka, Marpaung, & Hachiga, 2006).  The healthcare organization does an excellent job of providing the consumer healthcare. The healthcare organizations do an excellent job communicating with the public using marketing, seminars, TV advertisements, and offer mailings. The healthcare organizations provide information about the hospitals that are in their network and how they choose the best hospitals for the patient to choose from during their search for local medical care. The healthcare organizations have become more involved with tracking infectious diseases using proactive programs, which address the hospitals when a diagnosis clearly represents some type of infection disease. Carrying out an analysis using the SWOT framework will help you and your teams focus your activities on where you are strongest, and where your greatest opportunities lie (Pearce, 2007).

The healthcare organization will promptly send out a questionnaire and a phone call to ensure their patient was not exposed before being released from the hospital. The hospital questionnaire would ask:

• What do we do well? The healthcare organization does an excellent job of working with hospitals on addressing the payment and expediting any claims that are considered an infectious disease. The healthcare organizations does an excellent job of tracking healthcare diseases using their own managed-care reports to determine is their healthcare clients are receiving the best care in the community in which they live. SWOT-CM analysis is basically what is missing for or what makes a management team to reach an

agreement, by engaging for the implementation of long-term actions (Briciu, Capusneanu, & Topor, 2012).  (The healthcare companies do an excellent job of posting any communicable disease that may affect patients in any regions where the healthcare organizations operates. Overall, the healthcare organizations do a great job in keeping the consumer informed and keeping the hospital informed on any infectious disease trends observed from a patient care standpoint.

• What advantages do we have? The healthcare organizations have advantages because they have resources to respond to any healthcare event with hours to assist the hospital with any clean-up or preventive measures. The healthcare organizations have the power to reach out to politicians or hospitals, or consumers to make changes in healthcare policy or laws pertaining to hospital care.
• What relevant resources do we have access to? The healthcare organizations shares resources with the hospital that can be utilize to help with clinical situations.

What do others see as our strengths? The other strengths are the healthcare organization ability to join forces with the hospitals with prevention programs for employees as well as patients. This technique can be used in various situations including business planning, team building and away days, as well as when you review the work of your team, during change management processes and even in  personal career planning(Pearce,2007).

What are some of the healthcare organizations Weaknesses?

• What aren’t we doing well? The healthcare organizations weaknesses are the inability to provide the patients with support during the infectious disease events. The patient will only receive support after the event has been concluded or resolved.
• What can we improve? The healthcare organization can improve their relationship with agencies that are advocates that protect patients from unnecessary exposures. Many times the healthcare organizations only get involved at the high level but never at the patient level.
• What should we avoid? The healthcare organizations should avoid any political pressure not to get involved with patients complaints about exposures. The healthcare organization should be a major resource for patients that need assistance, especially patients with disabilities or serious illnesses. The political machines have different agendas such as the pharmaceutical company that provide the drug prevent infection during surgery, may get involved to ensure they are not named as part of the Infectious Disease event.

What are some of the healthcare organizations Opportunities?

• Where are good opportunities facing us? The healthcare organizations have the opportunity to reach out to patients and improve hospitals relationships with all the healthcare changes. Most of the Fortune 500 companies are using this as an opportunity to see what the patients’ needs will be in the future.
• What trends might be helpful to observe? The primary trend will be the cost of healthcare and the changes in the pricing structure. The hospitals and physicians will not be able to change expensive prices that vary from state to state, city to city, hospital to hospital and physician to physician.

What are some of the healthcare organizations threats?

• What obstacles do we face? The healthcare organizations will face the threat of new healthcare policies that may cause the healthcare companies to cut back on spending because the reimbursement rates will change.
• Is technology changing faster than we are adapting to the changes? The healthcare organizations will have make certain changes with medical coding; changes that impact the hospitals and all healthcare organizations because changes may require purchasing a new hospital or healthcare system. The healthcare organizations will have to change their healthcare systems to adapt to the change of codes and diagnosis that will change the face of how healthcare information will be delivered to the public. The government is making mandatory that every person in America must be covered with healthcare without understanding the implications for the increase technology for the healthcare organizations to be able to deliver the same level of healthcare we have come accustomed.

Discussion/Conclusions/Recommendations

One the preventive programs the hospitals can implement is offering Web-based learning courses to focus on how to decrease the incidents of  HAIs while providing an educational format that is easily accessible by hospital employees. In order for hospital to improve their measurement of the risk of infections after surgery, they must implement a zero tolerance approach to avoidable  infections along with continue improvement of internal procedures and to implement  sensitivity programs for upper management to determine, if the management team has the tools to detect any incidents of healthcare-associated infections. When it comes to HAIs, the healthcare industry needs to revisit the ineffective institutional policies and procedures addressing HAIs . This means reeducation on sterilizing all surfaces in the hospital and reinforcing the compliance of washing your hands after touching anything regardless if you touch it bare handed or with a glove.  One of the nation wide solutions should be a shared Infection Disease databases that require hospitals to enter pertinent information about infectious disease lead by the requirements of the CDC. Hospitals will be forced to fill in requirement information such as cause, location, protocols used, when was it reported, who was infected, was the community informed, and any other information they would not normally provide unless the hospital was asked. I t should be mandatory for hospital to keep this database current. Hand washing is one of the simplest forms of infectious disease control. Hospitals continue to make the same mistakes due to lack of information about a specific infectious disease because they wait until after the event to determine the prevention or spreading of the deadly virus. Some hospitals have started cooperating to control hospital-acquired infections.

In California, the Safety Net Initiative is building learning collaborative among California public hospitals to reduce such infections. The Pittsburgh Regional Health Initiative has successfully created a culture of change to improve overall patient safety. Similar programs in Iowa, Michigan, Nebraska, New York, South Dakota, and Wisconsin also have successfully reduced hospital-acquired infections (McGraph, 2012).

The reporting of infectious diseases from hospital must undergo some type of reform that requires the hospital to answers specific questions about infectious diseases and accounting. Health officials in California will attempt to collect data in a different manner because a recent hospital infection study has serious limitations, The Associated Press reports (Benson, 2011). Today, the surveillance and control of communicable diseases are mostly reported by the hospital to the CDC, which includes reports of infectious diseases that have been submitted, by hospitals, hospital physicians, hospital laboratories, and other hospital agencies required the law.

The hospitals should have mandatory test by the CDC to ensure they are following the CDC Framework. The upper management must be held accountable for these yearly test and certifications for the hospital to continue to operate and receive any type of government funding. The effectiveness of this solution would be groundbreaking because you start affecting the city, state, and federal funding to the hospital for not completing the testing and certifications for the CDC Infectious Disease protocols, the hospitals will comply immediately.

The CDC FastStats should be utilizing more by other agencies to determine some of the problems within the hospitals. The FastStats (2012) indicate that the United States has over 100,000 new cases of infectious disease reported. The FastStat data is collected from several sources such as health department, CDC reporting, hospitals, clinics and other medical agencies that track Infectious Disease events. The recommendation would be that a committee is developed at the State Level to review this FastStat data and requesting that hospitals respond to the epidemic of new cases of known Infectious Diseases such as the spread of tuberculosis. According to FastStats (2012), there were 11,545 new cases of tuberculosis being released within a hospital. The committee must take swift and immediate action to ensure the hospital does not cover up or water down the spread of the tuberculosis cases regardless of the how many exposures.

This automated method has the potential to provide valuable real-time guidance both by identifying otherwise unrecognized outbreaks and by preventing the unnecessary implementation of resource-intensive infection control measures that interfere with regular patient care (Huang, et al, 2010). The entire nation should follow the University of Pittsburgh’s RODS report system that automatically records the hospital infectious disease data in real time. The RODS also classifies major complaints, syndromes, and aggregate data that analyze data for possible infections disease outbreak patterns. This approach to cluster detection has the potential to be more comprehensive than current surveillance systems and save substantial amounts of infection control resources (Huang, et al, 2010).

The government would have to spend a limited amount of funding because the ROD system is already functional and working for the hospitals in Pittsburg. The implementation would be a simple addition of cities, states, and counties to the database, which is automatically gathering the information. In conclusion, Hospitals need to take infection control more seriously. Hospital staff is not washing their hands. Infectious diseases can be controlled if all protocols are followed. Hospitals must be governed closely in the areas of infectious diseases.

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