INFECTION CONTROL 1

Background

According to various reports by the Centers for Disease Control and Prevention, a significant number of lives are lost each passing year due to the spread of infections in hospitals that could otherwise have been prevented. 3 Therefore, effort geared towards understanding infection control plays a significant role in reducing the otherwise unnecessary loss of lives. Infection control entails the power to directly prevent or determine the spread of infections with the aim of avoiding it. 4 Indeed, the pathological state resulting from the invasion of the body by pathogenic microorganisms has far-reaching consequences. While so much has been done to prevent its spread, there is still a lot more to be done. This research paper intends to focus on Healthcare-associated Infections and how it can be prevented if not eliminated altogether.

Statement of the Problem

Healthcare-Associated Infections are a common occurrence in the modern healthcare setting resulting in huge financial losses and loss of lives. According to the Office of Disease Prevention and Healthcare Promotion (ODPHP), these are infections that patients contract while receiving treatment in a medical facility. Percival, Suleman, Vuotto & Donelli, (2015) pointed out that its prevalence is as a result of the employment of invasive devices and procedures meant to treat patients and to help them recover. 6 While most of them are accidental in nature, they still remain to be seen as accidents that could have been prevented. The US government, through the establishment of Healthy People 2020 and the U.S. Department of Health and Human Services (HHS) have taken a lead role in spreading the news on infection control. To that effect, recent research reveals that there could be a 70% reduction in infections by implementing existing prevention practices. This translates to a financial benefit estimated to be $31.5 billion in medical cost savings (ODPHP, 2019). Understanding these prevention measures should, therefore, be a priority to all healthcare practitioners. That is why this research study intends to shade more light on nosocomial infections. These are infections that occur within 48 hours upon admission into a hospital. They can also occur in three days of discharge or 30 days of operation. They affect one in every 10 patients admitted in a hospital. 5, 7

The rationale for addressing the issue

Addressing this issue is important to the health sector from a political, social as well as environmental perspective. As a matter of fact, its impact will be on a short term, interim basis and long term basis. Politically, health has always been a major subject of concern as it is used by voters to determine how best an administration has taken care of their needs. Establishing an infection control unit will, therefore, be beneficial to any incumbent during the elections. Besides improvising awareness on infection control, addressing this issue will not only lead to improved safety measures to control the spread of diseases but also result in reduced cases of infections in the short run. 6 This is will be the epidemiological contribution of this research, On the other hand, it will lead to the adoption of policies on infection control in the hospital, proper designing of an infection control modes and effective preparation of infection control training manual for the health facility on the interim basis. Finally, it will lead to the elimination or significant reduction in infection-related mortality in the long run. All these will result in an infection-free health care environment.

The following are the impact statements that I intend to engage to address this problem during your 120 hours in the field.

· To find out how to prevent the transmission of germs during interactions between healthcare workers and patients.

· To evaluate the best approaches to using personal protective equipment.

· To identify approaches that minimize the role of the healthcare environment

· to find innovative strategies to protect patients by stopping the spread of germs

Foundational Competencies

These are the set of skills used in the broad practice of public health by healthcare professionals. They were developed by the council of Linkages and are categorized into three tiers and 8 domains. The framework that supports the approach taken by this study is from the first tier (Front Line Staff/Entry Level) and two domains namely the Analytical/Assessment Skills as well as the Public Health Sciences Skills. The first tier is concerned with those competencies that apply to public health professionals who are not necessarily in management positions. The approach is therefore meant to provide analytical skills on infection control to the public.

Research Methodology

There are efforts to contain the scourge of infections that happen within healthcare precincts. Apparently, there is a need for more initiatives to try and control the infections and with an ultimate goal of complete eradication. This section lays out the methodology of one of the infection control efforts whose results will, hopefully, influence key decision makers in terms of commitment and the will to face the problem. As Sessler & Imrey pointed out, research methodology is the framework that chronologically arranges the techniques that will be used to conduct a study into a specific problem. To be sure, the methodology contains specific procedures that pinpoint, gather and analyze data that is relevant to the research topic. Broadly speaking, research methodology forks into two major categories that are quantitative and qualitative analysis. While quantitative research is descriptive in nature, quantitative analysis follows an exploratory approach where the primary objective is to provide more insights into a problem. 2

The oral interview method would be used to collect responses from the practicing doctors, attending nurses, lab technicians and in-patients. This particular set of respondents should be targeted because they are the main players in healthcare-related infections. This quantitative method is useful in a quick assessment of the existing problems. Interviews are also useful in establishing a good relationship between the interviewer and the interviewee, therefore, increases the probability of open sharing due to some level of trust. Questions for the interviews should be designed to gather information on the standard operating procedures of the healthcare facility and how effectively they are implemented. A good example would be asking nurse respondents on the nursing theories mostly applied in the hospital, collection of such information would be useful in detecting the relationship between the theory applied and the emergence of infections. Lab technicians should be grilled on the methods utilized while disposing of human samples as these wastes are a common source of infections.

Interviews may not be applicable to all staff due to tight schedules and limited time. This should be countered by using questionnaires. Brief and precise open-ended questionnaires should be delivered to representative staff members. This should contain a flexible response time of up to two weeks giving the respondents the freedom to respond at their free time. High chances of credible responses should be expected as these individuals will respond at their own leisure. The questions in the interviews should be brief forms of those in the interviews aimed at establishing the probable origin or cause of these infections.

General observations over a guided tour of the facilities should be utilized in checking for the presence of sanitization procedure charts, taps and sinks with detergents in toilets and latrines, sterilization liquids in labs, color coded dustbins for waste sorting, emergency showers, clean dust coats and other protective gears such as gloves. Lack of these seemingly minor items could be important in increasing the chances of incidences of healthcare-related infections.

Research design

The ultimate goal of this study is to completely eradicate healthcare-associated infections. To that end, there is a need for insights into the problem and, particularly, how the infections happen and why. As such, the researcher will utilize a qualitative research design which, as per Castrodale facilitated an in-depth examination of non-numerical data to establish the best way to control, prevent and eradicate infections. 1

Procedures for data collection and analysis

Beginning the data collection and analysis process goes back to the point where the researcher identifies the appropriate sample that will aid the investigation during the study. In a qualitative analysis, the data is always in non-numerical form. To be sure, the qualitative study collects data that will aid the researcher to develop appropriate, if not accurate, ideas to facilitate the study. The best technique that can be used to collect such data is by employing questionnaires. In addition, the researcher will carry out assessments on the infection levels within the target population. This is one of the ways through which the researcher will find out the most appropriate measures that should be taken to control the infections. The key desired impacts of the study are to first determine how the transmission of germs at any point during patient-health worker interaction can be prevented. Secondly, the study will try to establish the most fitting techniques to employ protective equipment while looking for innovative ways to protect patients. While conducting the surveys, the study will keenly focus on the intended impacts such that the resulting data is relevant, reliable and impactful.

To get a sense of the data, the study will employ content analysis approach to interpret the data from surveys. In particular, the main idea is to form a solid concept that explains the behavioral aspect of the infection problem. Further, this technique will help to interpret the text of the observations recorded during the assessment exercise to determine the levels of infection within the sample. During the data analysis phase, the researcher will focus on relationships and patterns that might provide important insight into the problem. Ultimately, the idea to establish the main elements that play a significant part in the transmission of germs from the health workers to the patients.

Research objectives

1. To find out how to prevent the transmission of germs during interactions between healthcare workers and patients.

2. To evaluate the best approaches to using personal protective equipment.

3. To identify approaches that minimize the role of the healthcare environment

4. to find innovative strategies to protect patients by stopping the spread of germs

Results & Discussions

Rotational usage of antibiotics would be crucial in preventing the development of resistant forms of microorganisms. Continuous and prolonged usage of antibiotics causes the microorganisms specifically bacteria to develop resistant genes in their circular plasmids. These plasmids are later transferred to offspring generation and other bacteria through conjugation, transduction and transformation. This eventually leads to the development of a resistant population of bacteria such as VRE that are notorious in facilitating the prevalence of nosocomial infections. Rotational usage of various antibiotics can decrease the chances of resistance by up to 40%. The graph below illustrates how various bacteria display resistance sourced from CDDEP Resistance Map

Strict measures should be observed during the interaction of individuals in the hospital. Proper management of interaction between health workers with patients and patients with other patients can prove useful in reducing the transmission of germs. Healthcare workers should ensure that sterile latex gloves are worn every time while handling the patient and disposed of immediately before handling another patient. Gloves have been reported to spread infections from one patient to another by the attending nurses or doctors, therefore, it is crucial to use a different set of gloves for every patient.

Proper sanitization and hand hygiene should be observed. All main entries to major wards should contain clear charts on how to wash hands using the recommended detergents. There should be electrical hand driers triggered by a lens so as to reduce contact like that in the use of hand towels. Procured detergents for use should be properly vetted by the quality assurance officers to assert that they meet the required health specifications. Here is an example of a hand washing guideline chart by Doves hygiene;

The healthcare environment is a major contributor to the emergence of infections. Contaminated surfaces and poor ventilation are major factors. The contribution of the environment can be mitigated by; ensuring all surfaces are sterilized with a combination of 70% alcohol and 0.05% sodium hydroxide which has been proven effective in killing all surface microbes, ensuring that wards are properly ventilated for proper airflow so as to reduce chances of airborne infections by infected air droplets, door knobs and handles should be made with self-sterilizing metals such as Brass that are toxic to microorganisms and employing use of quarantine and isolated treatment for patients with nosocomial infections.

Centers for Disease Control and Prevention report that a significant number of lives are lost each passing year due to the spread of infections in hospitals that could otherwise have been prevented. Healthcare-acquired infections are becoming a common problem in the modern healthcare facilities thus leading to the losses of huge sums of money and lives. There are a number of infections which are acquired by the patients during the treatment processes (Pervical, 2015). The increase in Healthcare Acquired Infections is as a result of the increased use of invasive devices and procedures which are meant to treat patients and help them towards their full recovery. Even though some of these cases are accidental nature, some of them can be prevented.

Dealing with issues related to healthcare-acquired infections requires political, social, and environmental perspectives. Health has been a major concern within the political platform since it is being considered by the voters to help in determining how the administration has taken the needs of healthcare. The cost of treatment of the surgical site infections among other surgical procedures are increasing and are associated with comorbidities. It is therefore important for the ministry of government through the present healthcare facilities to ensure that there are effective approaches towards a reduction of the healthcare-acquired infections. Addressing this issue requires the political, social and environmental aspects. It is the responsibility of the government through the ministry of health to ensure that citizens are receiving quality healthcare services. One of the key factors, why they were voted in, is to ensure that there is an improvement in the health sector. The image of the healthcare facility should be one which is caring for the welfare and well-being of the citizens. When there are increased cases of admissions and readmissions, then it means that there is the existence of poor healthcare services to the citizens. The environment under which surgical operations are being done must always be cleaned and free from infections.

Recommendations

It is important to make an effort towards understanding infection control so that there can be a reduction in the unnecessary loss of lives. Infection control entails the power to directly prevent or determine the spread of infections with the aim of avoiding it. It is therefore important for each healthcare facility to create an infection control unit. It is important to increase awareness regarding the infection control as well as addressing some of the key issues leading to the increase in healthcare acquired infections to ensure that there are safety measures needed to control the spread of infection. Each healthcare facility needs to develop infection control policies, develop proper designing modes of infection controls, and effective preparation of the infection control training manuals. Healthcare providers should be provided with protective equipment to prevent the spread of the healthcare-acquired infections from one unit to the other or from patient to patient. It is also important for healthcare management to ensure that there is effective management of all the hazardous equipment for the healthcare providers with the view to manage and control infections which might result from the bad use of the equipment. It is also important to look at the aspects of the staffing level so that healthcare providers do not have an issue to do with burnout. It is, therefore, necessary important to have adequate healthcare providers to patient ratio.

Conclusions

Healthcare acquires infections are issues of concern which needs to be addressed urgently. Healthcare-acquired infections are common within the surgical units which are then spread to other units and from patients to patients as healthcare providers are moving from one ward to the other. Increase in infection is causing problems related to huge healthcare costs, an increase in cases of admissions and readmissions, and the mortality. Therefore, addressing the issues of infections requires effective measures from both the government through the ministry of health and efforts by healthcare organizations. It is important for every stakeholder in the health industry to play a role in ensuring that there is a reduction in infection rates. It is necessary to provide important tools which are required to help in managing infections. It is also important to have effective infections guidelines which can help in the efforts towards the reduction of health acquired infections.

Shell for reporting data

Faculty Demographics

Name of Institution
Type of Institution
Date of Assessment
Type of Assessment	On-Site	Other

Tick as appropriate using the following Likert scale of 1-5 where: 1= No Extent; 2= Little Extent; 3= Moderate Extent; 4= Great Extent; 5=Very Great Extent

Objective 1	1	2	3	4
Strategy/Approach
Strategy/Approach
Strategy/Approach
Strategy/Approach
Strategy/Approach
Strategy/Approach

Tick as appropriate using the following Likert scale of 1-5 where: 1= No Extent; 2= Little Extent; 3= Moderate Extent; 4= Great Extent; 5=Very Great Extent

Objective 2	1	2	3	4
Strategy/Approach
Strategy/Approach
Strategy/Approach
Strategy/Approach
Strategy/Approach
Strategy/Approach

Tick as appropriate using the following Likert scale of 1-5 where: 1= No Extent; 2= Little Extent; 3= Moderate Extent; 4= Great Extent; 5=Very Great Extent

Objective 3	1	2	3	4
Strategy/Approach
Strategy/Approach
Strategy/Approach
Strategy/Approach
Strategy/Approach
Strategy/Approach

Tick as appropriate using the following Likert scale of 1-5 where: 1= No Extent; 2= Little Extent; 3= Moderate Extent; 4= Great Extent; 5=Very Great Extent

Objective 4	1	2	3	4
Strategy/Approach
Strategy/Approach
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Strategy/Approach
Strategy/Approach

Graphical Analysis of the Objectives

References

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2. Hammersley M. Deconstructing the qualitative-quantitative divide 1. Mixing Methods: qualitative and quantitative research. 2017:39-55.

3. Alp, E., & Damani, N. Healthcare-associated infections in intensive care units: epidemiology and infection control in low-to-middle income countries. The Journal of Infection in Developing Countries. 2015; 9(10), 1040-1045.

4. Berríos-Torres, S. I., Umscheid, C. A., Bratzler, D. W., Leas, B., Stone, E. C., Kelz, R. R., … & Dellinger, E. P.. Centres for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA surgery, 152(8), 784-791.

5. Khan, H. A., Baig, F. K., & Mehboob, R. Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine, 2017; 7(5), 478-482.

6. Percival, S. L., Suleman, L., Vuotto, C., & Donelli, G. Healthcare-associated infections, medical devices and biofilms: risk, tolerance and control. Journal of medical microbiology. 2015; 64(4), 323-334.

7. Suleyman, G., & Alangaden, G. J. (2016). Nosocomial Fungal Infections: Epidemiology, Infection Control, and Prevention. Infectious Disease Clinics of North America, 30(4), 1023-1052.

8. Tacconelli E, Cataldo MA, Dancer SJ, De Angelis G, Falcone M, Frank U, Kahlmeter G, Pan A, Petrosillo N, Rodríguez‐Baño J, Singh N. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug‐resistant Gram‐negative bacteria in hospitalized patients. Clin Mic Inf. 2014 ;20:1-55.

9. Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team5: Infection Control and Management of Hazardous Materials for the Dental Team. Els H S; 2014.

10. Rosenthal VD, Maki DG, Mehta Y, Leblebicioglu H, Memish ZA, Al-Mousa HH, Balkhy H, Hu B, Alvarez-Moreno C, Medeiros EA, Apisarnthanarak A. International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007-2012. Dev-Assoc mod. Ame joul inf cont. 2014;42(9):942-56.

11. Saiman L, Siegel JD, LiPuma JJ, Brown RF, Bryson EA, Chambers MJ, Downer VS, Fliege J, Hazle LA, Jain M, Marshall BC. Infection prevention and control guideline for cystic fibrosis: 2013 update. Infe Cont & Hosp Epide. 2014 ;35(S1):s1-67.

12. Tängdén T, Giske CG. Global dissemination of extensively drug‐resistant carbapenemase‐producing E Enterobacteriaceae: clinical perspectives on detection, treatment and infection control. Intern Med. 2015;277(5):501-12.

13. Dingle KE, Didelot X, Quan TP, Eyre DW, Stoesser N, Golubchik T, Harding RM, Wilson DJ, Griffiths D, Vaughan A, Finney JM. Effects of control interventions on Clostridium difficile infection in England: an observational study. Lant Infect Dise. 2017;17(4):411-21.

14. Cao-Lormeau VM, Blake A, Mons S, Lastère S, Roche C, Vanhomwegen J, Dub T, Baudouin L, Teissier A, Larre P, Vial AL. Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lan. 2016 ;387(10027):1531-9.

15. De Angelis G, Cataldo MA, De Waure C, Venturiello S, La Torre G, Cauda R, Carmeli Y, Tacconelli E. Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients: a systematic review and meta-analysis. Anti Chem. 2014; 69(5):1185-92.

16. Brusaferro S, Arnoldo L, Cattani G, Fabbro E, Cookson B, Gallagher R, Hartemann P, Holt J, Kalenic S, Popp W, Privitera G. Harmonizing and supporting infection control training in Europe. Hosp Inf. 2015 ;89(4):351-6.

17. Wood AM, Moss C, Keenan A, Reed MR, Leaper DJ. Infection control hazards associated with the use of forced-air warming in operating theatres. Hosp Inf. 2014; 88(3):132-40.

18. Parani M, Lokhande G, Singh A, Gaharwar AK. Engineered nanomaterials for infection control and healing acute and chronic wounds. ACS. 2016 ;8(16):10049-69.

19. Rand KH, Tremblay EE, Hoidal M, Fisher LB, Grau KR, Karst SM. Multiplex gastrointestinal pathogen panels: implications for infection control. Diagn microb. 2015;82(2):154-7.

20. Khosravi A, Yáñez A, Price JG, Chow A, Merad M, Goodridge HS, Mazmanian SK. Gut microbiota promotes hematopoiesis to control bacterial infection. Cell microbe. 2014;15(3):374-81.

21. Jeong SY, Kim OS, Lee JY. The status of healthcare-associated infection control among healthcare facilities in Korea. Dig Conv. 2014;12(5):353-66.

22. Sopirala MM, Yahle-Dunbar L, Smyer J, Wellington L, Dickman J, Zikri N, Martin J, Kulich P, Taylor D, Mekhjian H, Nash M. Infection control link nurse program: an interdisciplinary approach in targeting healthcare-acquired infection. A j infe C. 2014 ;42(4):353-9.

23. Halboub ES, Al-Maweri SA, Al-Jamaei AA, Tarakji B, Al-Soneidar WA. Knowledge, attitudes, and practice of infection control among dental students at Sana’a University, Yemen. intern oral H: JIOH. 2015;7(5):15.

24. Karkar A, Bouhaha BM, Dammang ML. Infection control in hemodialysis units: A quick access to essential elements. S J K DT. 2014;25(3):496.

25. Osman MF, Askari R. Infection control in the intensive care unit. Surg Clin. 2014; 94(6):1175-94.

26. Mitchell BG, Hall L, MacBeth D, Gardner A, Halton K. Hospital infection control units: staffing, costs, and priorities. AJIC. 2015;43(6):612-6.

Annotated Bibliography

Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, Morgan S, Solomkin JS, Mazuski JE, Dellinger EP. Centres for disease control and prevention guideline for the prevention of surgical site infection, 2017. JA sur. 2017;152(8):784-91.

The cost of treating surgical site infections and the number of surgical procedures is increasing. These are associated with complex comorbidities. This paper provides not only new but also updated evidence-based recommendations for preventing surgical site infections. It used the grading of recommendations, Assessment, development, and evaluation (GRADE) technique to assess the strength of recommendation and the quality of evidence and to provide the relationship between the two. The guideline is intended to provide an updated and a shred of new evidence-based recommendations for preventing surgical site infections and incorporates it into quality improvement programs with the view to improve patient safety. The paper explains the proper ways to carry out various surgical operations such as cesarean procedures, skin preparation, surgical incision, and other surgical operations. 4

Tacconelli E, Cataldo MA, Dancer SJ, De Angelis G, Falcone M, Frank U, Kahlmeter G, Pan A, Petrosillo N, Rodríguez‐Baño J, Singh N. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug‐resistant Gram‐negative bacteria in hospitalized patients. Clin Mic Inf. 2014; 20:1-55.

These guidelines are provided to enable the management of infection control measures to minimize the transmission of multidrug-resistant gram-negative bacteria in hospitalized patients. The corresponding author E. Tacconelli, is the in the division of infectious diseases in the department of internal medicine at the Tubingen University Hospital in Germany. The paper asserts that multidrug-resistant Gram-negative bacteria cause healthcare infections which are known to be the leading causes of morbidity and mortality in the whole world. The guidelines have been produced after a thorough review of other published studies on infection control. It provides evidence-based guidelines which are defined in accordance with the GRADE approach, describing the level of strength for and evidence for each and every recommendation. 8

Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team5: Infection Control and Management of Hazardous Materials for the Dental Team. Els H S; 2014.

This is a book that can be used by both undergraduates and graduates in infection control and management of harmful materials for the dental team. The book covers various areas of infection control such as development of infectious diseases, emerging infectious diseases, the microbial world, rationale and regulation of infection control, immunization, hand hygiene, greener control, concerns, OSHA inspection, cross-contamination between work and home, waste management, preventing sharps injuries, aseptic techniques, personal protective equipment, oral and respiratory diseases, and laboratory and radiographic asepsis. The book explores the management of all the hazardous equipment for the dental team with the view to manage and control infections which might result from the bad use of the equipment. It begins with the microbial world, explaining the characteristics of microorganisms with the view to understand infections and hence find out how to control them. 9

Rosenthal VD, Maki DG, Mehta Y, Leblebicioglu H, Memish ZA, Al-Mousa HH, Balkhy H, Hu B, Alvarez-Moreno C, Medeiros EA, Apisarnthanarak A. International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007-2012. Dev-Assoc mod. Ame joul inf cont. 2014;42(9):942-56.

This is a report on infection control carried out by an international Nosocomial Consortium (INICC). The reports span between January 2007 to December 2012. The report represents 43 countries where 503 intensive care units were tested. The report details nosocomial infection, central line bloodstream associated infection, ventilator-associated pneumonia, urinary tract infection, details of resistance of Pseudomonas and their relationships with amikacin, imipenem, and the isolation of pneumoniae to ceftazidime. The reports detail comparison of these infections in the intensive care units and the INICC. Furthermore, the report details the disparities of these infections in developed and developing countries. The report explains the challenges faced in overcoming these infections in limited resources countries or low-income countries. The report details the ways to curb the infections in developed countries too. 10

Saiman L, Siegel JD, LiPuma JJ, Brown RF, Bryson EA, Chambers MJ, Downer VS, Fliege J, Hazle LA, Jain M, Marshall BC. Infection prevention and control guideline for cystic fibrosis: 2013 update. Infe Cont & Hosp Epide. 2014 ;35(S1):s1-67.

This is a guideline for control and prevention of infection for Cystic Fibrosis. It is a 2013 update of the original 2003 version. The guideline is updated following the changes that occurred between 2003 and 2013 which include new knowledge and new challenges with the increased population. The guidelines explain the need to integrate all the relevant recommendations from the 2003 evidence-based guidelines, and the emerging pathogens that have emerged in our expanded population. The guidelines explain the various control measures for infections majorly the Cystic Fibrosis infection. The paper also provides guidelines for the prevention of various infections resulting from pathogens. The pathogens include influenza and severe acute respiratory syndrome coronavirus. It has also included the implementation of science and its benefits, adherence monitoring, and principles of feedback. 11

Tängdén T, Giske CG. Global dissemination of extensively drug‐resistant carbapenemase‐producing E Enterobacteriaceae: clinical perspectives on detection, treatment and infection control. Intern Med. 2015;277(5):501-12.

This journal describes the dissemination, clinical prevention, treatment and infection control of carbapenemase-producing Enterobacteriaceae (CPE) The paper explains the prevalence of carbapenem-resistant Gram-negative bacilli, its worldwide rise, its resistance, and its possibility of reaching to a level of community untreatable infection. The paper describes the bacterial that carry these resistances, the determinants of resistance and treatment options. It describes the difficulty experienced in detecting carbapenemase-producing-Enterobacteriaceae. It also explains the current clinical evidence for treatment and the issues associated with them such as insufficient information on treatment options. The paper also explains regimes such as colistin, carbapenems, aminoglycosides, and finally fosfomycin. The paper further describes strict infection control measures and management information for supporting patients infected with CPE. 12

Dingle KE, Didelot X, Quan TP, Eyre DW, Stoesser N, Golubchik T, Harding RM, Wilson DJ, Griffiths D, Vaughan A, Finney JM. Effects of control interventions on Clostridium difficile infection in England: an observational study. Lant Infect Dise. 2017;17(4):411-21.

This paper explains the challenge experienced in the control of Clostridium difficile infections. It describes the role of the national policy in the check of the infections. It also illustrates the effects of increasing or reducing antibiotic on the prevalence of the diseases. The paper further describes the circumstances that reduced the infections such us the general improvement in infection control hospitals. It explains in details the importance of restricting antibiotics such as fluoroquinolone on the prevalence of the diseases. The paper uses England as a case study describing the challenges experienced in the control of the infections. The document uses both regional and national data to explain the challenges faced in solving the quest to control the diseases. 13

Cao-Lormeau VM, Blake A, Mons S, Lastère S, Roche C, Vanhomwegen J, Dub T, Baudouin L, Teissier A, Larre P, Vial AL. Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lan. 2016 ;387(10027):1531-9.

The paper is a control case study, describing the outbreak of Zika virus in France. The document describes the link between the Zika virus and the Guillain-Barre’ syndrome which occurred during the same time. the paper describes the role of Zika virus in the development of Guillain-Barre’ syndrome. The document provides evidence for the cause of Guillain-Barre’ syndrome which is the Zika virus infection. Furthermore, the paper describes the integrative biology of the various emerging infectious diseases. The document explains the neutralizing antibodies against the virus, a transient illness associated with the infection, the rapid evolution of diseases, glycolipid, respiratory problems and assistance, glycoarray, history of past dengue virus, and acute motor neuropathy. The document describes the major cause of the Zuka virus in individuals most of which are related to the infections mentioned above. 14

De Angelis G, Cataldo MA, De Waure C, Venturiello S, La Torre G, Cauda R, Carmeli Y, Tacconelli E. Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients: a systematic review and meta-analysis. Anti Chem. 2014; 69(5):1185-92.

This paper describes Vancomycin-resistant enterococci (VRE) and the issues associated with it. The document further explains the measures for effective control and prevention that may reduce the spread of VRE. The paper described the estimated pooled risk ratio. The document illustrates the many factors that reduce the prevalence of VRE such as the implementation of hand hygiene and contact precautions. Furthermore, the paper describes the potency of hand hygiene and contact precaution on reducing the spread of VRE. The document failed to describe surveillance screening, cleaning of the environment and interventions for antibiotic formulary. Furthermore, the paper notes that it did not study the effectiveness of isolation of staff and patients. The document explains the issues associated with the available measures to treat the spread of VRP in hospitals. 15

Brusaferro S, Arnoldo L, Cattani G, Fabbro E, Cookson B, Gallagher R, Hartemann P, Holt J, Kalenic S, Popp W, Privitera G. Harmonizing and supporting infection control training in Europe. Hosp Inf. 2015 ;89(4):351-6.

This paper explains the support and harmonization of infection control. It explains healthcare-associated infections (HCAI), the safety of patients, and bringing together related programs and policies. The paper explains the needs for training in infection control. It also describes healthcare workers training for infection control. The document demonstrates HCAI prevention and commitment. It illustrates several barriers to the harmonization of training in infection control and the promotion of the training. The paper explains the qualification requirement for nurses, the resources available, and the sustainability of the programs in the healthcare systems. It illustrates the core competencies for control of infection and general hygiene in the hospitals and a methodology that is agreed upon by nations for a collective control of disease in the larger region of Europe. 16

Wood AM, Moss C, Keenan A, Reed MR, Leaper DJ. Infection control hazards associated with the use of forced-air warming in operating theatres. Hosp Inf. 2014; 88(3):132-40.

This journal describes the infections control hazards associated with the use of forced-air warming in operating theatres. It is a review representing both clinical and experimental research to prevent the occurrence of hypothermia which might result from the infections. The study describes the use of ultra-clean ventilation. It explains all the synergies ultra-clean ventilation has on various types of patient warming. Furthermore, the paper describes an increase in risks related to surgical site infections. The document describes the effects of forced air warming on ultra-clean air ventilation and the increased risk of surgical site infection. It illustrates the need for surgeons to use alternative patient warming systems especially in places where the operative field must not be contaminated. 17

Parani M, Lokhande G, Singh A, Gaharwar AK. Engineered nanomaterials for infection control and healing acute and chronic wounds. ACS. 2016 ;8(16):10049-69.

This paper describes the use of engineered nanomaterials in the treatment of wounds without infections. The document illustrates the use of nanomaterials for disease control and the treatment of chronic injuries. The paper describes in details nanoengineered biomaterials. It explains the increase in the use of nanoengineered biomaterials in the check of disease and in accelerating the healing of wounds. It describes the various developments that are shaping the use of nanoengineering in the field of medicine and control of infection. It further outlines the potential applications of nanomaterials in the healing of wounds. It describes the various nanomaterials developed recently for the control of diseases. The paper describes the current state of engineered nanomaterials for wound healing and the future perspective of using nanomaterials in infection control. 18

Rand KH, Tremblay EE, Hoidal M, Fisher LB, Grau KR, Karst SM. Multiplex gastrointestinal pathogen panels: implications for infection control. Diagn microb. 2015;82(2):154-7.

This paper describes the implications for the control of infection resulting from gastrointestinal pathogens. The document describes the diseases resulting from diarrheal and their possible regulators for inpatient services. The paper describes the possibility of an inpatient having an infection resulting from diarrhoea. The document describes the various causes of such disease to reach the patients. Furthermore, the paper describes possible ways of avoiding the spread of such an infection. It outlines possible ways to prevent the disease from spreading. The document describes all for the case of acute care where a wide variety of factors can cause both infectious and noninfectious diarrhoea. The paper recommends various techniques to be used with the aim of controlling and preventing the spread of the infections which include patient isolation and to reduce nosocomial transmission. 19

Khosravi A, Yáñez A, Price JG, Chow A, Merad M, Goodridge HS, Mazmanian SK. Gut microbiota promotes hematopoiesis to control bacterial infection. Cell microbe. 2014;15(3):374-81.

The paper describes the control of bacterial infection. The document centers on the check on Gut Microbiota and its impact on disease-causing bacteria. It illustrates the influences of the commensal microbiota on the various immune cell. The paper describes the consequences of being germ-free. It explains the impacts of microbes on yolk sac and the development of the individual myeloid cell. The document illustrates the importance of microbiota in the resisting of bacterial infection. Furthermore, the paper describes the negative impacts of oral antibiotics on myelopoiesis and their general role in suppressing an individual’s immune system. The paper, therefore, explains the consequences of living without a germ such as the microbiota which is found to be useful in providing resistance to various infections. 20

Jeong SY, Kim OS, Lee JY. The status of healthcare-associated infection control among healthcare facilities in Korea. Dig Conv. 2014;12(5):353-66.

The paper describes the infection control and its status among the Korean healthcare facilities. The paper describes the various factors that contributed to the increase or the decrease in the cases of infection and these were found to include, the mean number of beds in the hospitals in relation to the populations, the presence of infection committee in the healthcare facilities, the number of infection control practitioners in the healthcare facility, the gender of the infection control practitioner, the level of education of the practitioners, their levels of experience, availability of necessary facilities, the number of health care providers with respect to the size of the hospital, the general organization of the health care facility, and availability of facilities such as computer programs, and negative pressure room. 21

Sopirala MM, Yahle-Dunbar L, Smyer J, Wellington L, Dickman J, Zikri N, Martin J, Kulich P, Taylor D, Mekhjian H, Nash M. Infection control link nurse program: an interdisciplinary approach in targeting healthcare-acquired infection. A j infe C. 2014 ;42(4):353-9.

This document describes infection control through the link nurse program. The paper describes the link nurse program in detail. It explains the role of nurse education and training in alleviating the spread of infections. It details the tasks of providing nurses with clearly defined goals in reducing the spread of infectious diseases. The document describes the importance of using various tools such as hand soap in minimizing the spread of infections. Furthermore, the paper emphasizes the importance of hand hygiene compliance in decreasing the spread of diseases. The document compares the changes that occur after a period of time while taking the time in which the interventions were set to be the baseline. The paper notes the impact of having defined goals and continued education for nurses in reducing the spread of infections. 22

Halboub ES, Al-Maweri SA, Al-Jamaei AA, Tarakji B, Al-Soneidar WA. Knowledge, attitudes, and practice of infection control among dental students at Sana’a University, Yemen. intern oral H: JIOH. 2015;7(5):15.

This paper describes knowledge, practices, and attitudes on infection control for senior dental students’ procedures. The document describes the probability of a dental student to be vaccinated for hepatitis B and post-hepatitis B immunization serology test. The paper describes the importance of wearing gloves during a dental operation. It illustrates the percentage of dental students who wear gloves during a procedure. Furthermore, the document describes the importance of wearing face protection during a procedure and records down the number of dental students who wear eyewear face masks during a procedure. The document further describes the attitudes of students towards their work especially for the treatment of a patient with infectious disorders. The paper explained the need to improve knowledge attitude and practices as far as infection control is concerned for dental students. 23

Karkar A, Bouhaha BM, Dammang ML. Infection control in hemodialysis units: A quick access to essential elements. S J K DT. 2014;25(3):496.

This journal describes the control of infection in a hemodialysis unit. The document describes the impact of the disease on hospitalization rates and mortality. The paper describes the possible consequences of infection both HD patients and the dialysis staff. It illustrates the potential cause of infection in an HD unit. It explains the role of different international organizations in controlling the spread of infectious diseases in an HD unit. The document provides guidelines on improving hemodialysis units to alleviate infections. The paper outlines the guidelines that center on reducing the spread of disease to promote global outcome in the HD units. The paper facilitates access, increases awareness and encourage implementation among HD providers through viewing, extracting and comparing all the necessary guidelines and recommendations. 24

Osman MF, Askari R. Infection control in the intensive care unit. Surg Clin. 2014; 94(6):1175-94.

This paper explains the importance of understanding and recognizing the adverse impacts of having infections in the intensive care unit (ICU). The article describes the overwhelming nature of the clinical, economic, and social expenses that patients incur in hospitals. The study regards multiple ways to remove infections in intensive care units which include taking infection control measures, implement, and enforce them. The paper notes down various guidelines that have been developed by other researchers for the control of infection in intensive care units. The guidelines cover infection control and prevention committees, antimicrobial stewardship programs, assessments on a daily basis, identifying risk factors and minimizing them, and educating the staff. The paper finally notes down the advancement and the evolution of infection control in the ICU and its unlimited future possibilities. 25

Mitchell BG, Hall L, MacBeth D, Gardner A, Halton K. Hospital infection control units: staffing, costs, and priorities. AJIC. 2015;43(6):612-6.

This article describes the prevention and control of infection by professionals. It illustrates various relevant matters such as staffing levels, outcomes of patients, and the generally associated costs for limiting and controlling the disease. The paper describes hospital demographics, services of the infection control unit, infection prevention, control outputs, patient outcomes, and infection control priorities. The study provides further information concerning the number of bed in hospitals, staffing costs and the need to increase access to support for both public and private hospitals. The paper describes the disparities in private and public hospitals in controlling and managing the infection. The article mentions further the advantage of enhanced information technology in the process of alleviating disease and hence in the process of ensuring quality health. 26

Logic Model

RESOURCES

OUTPUTS

OUTCOMES-IMPACT

PROBLEM

Participation

Long-Term

Interim

Short-Term

Activities

The financial resources available include that available for establishing an infection control department, payment of the employees and purchasing of supplies.

The materials are antiseptics, alcohol-based hand rubs, sterile gloves and caps for the employees and preventive masks. For catheter patients antimicrobial and antiseptic-impregnated catheters.

The personnel required include a trained infection control physician, infection control nurse, and clinical care staff

Infections are common in the hospitals especially when the right sterilization is not used. Nosocomial infections are most common because they occur within 48 hours upon admission into a hospital. They can also occur in three days of discharge or 30 days of operation. They affect one in every 10 patients admitted in a hospital.

Improved awareness of infection control

Improved safety measures to control infections

Reduced cases of infections per ward

Increased use of hand washing and antiseptics

Adoption of policies on infection control in the hospital

Designing of an infection control model

Preparation of infection control training manual for the health facility

Improved record keeping in matters of infection.

Reduction or elimination of infection cases in the health facility.

Reduced infection-related mortality

Improved handling of infections in the hospital as well as documentation

This program intends to reach out to the patients to enhance their knowledge of proper hygiene. It will incorporate the hospital staff on matters such as hand washing and sanitization.

The patient families will be included to educate them on how to avoid infecting the patients

To increase awareness on infection control, activities such as workshops to train the staff on infection control measures. Recruiting an infection control practitioner to carry out surveys. Carrying assessments on levels of infections and compare those to determine the best measures that should be taken.

Strategy/Approach Chosen Objective 1 Objective 2 Objective 3 Objective 4 4.3 2.5 3.5 4.5 Strategy/Approach Chosen 2 Objective 1 Objective 2 Objective 3 Objective 4 2.4 4.4000000000000004 1.8 2.8 Strategy/Approach Chosen 3 Objective 1 Objective 2 Objective 3 Objective 4 2 2 3 5

Strategy/Approach Chosen Objective 1 Objective 2 Objective 3 Objective 4 4.3 2.5 3.5 4.5 Strategy/Approach Chosen 2 Objective 1 Objective 2 Objective 3 Objective 4 2.4 4.4000000000000004 1.8 2.8 Strategy/Approach Chosen 3 Objective 1 Objective 2 Objective 3 Objective 4 2 2 3 5