Infection control in National Health Service

Infections can be acquired in the hospital and when thus acquired they are referred to as nosocomial infections. It is therefore important to control infections and thus stop the transmission of diseases which are communicable to other patients or healthcare staff (Hassan, Aftab and Riffat, 2015). Effective prevention of transmission of infections require an understanding of the epidemiology of the disease, what makes the patients prone to infections and an understanding of the treatment methods that can potentially lead to infections. The epidemic of infections has been elevated by the inappropriate usage of broad spectrum antibiotics in hospital settings leading to antimicrobial resistance (Chiller, 2019).

There are thirteen infection sites in the body, among these the most common are; urinary tract infections, respiratory tract infections, surgical and soft tissue infections, meningitis and gastroenteritis infections. Nosocomial infections are caused by microorganisms including protozoans, viruses fungi, mycobacteria and bacteria. Bacteria cause 99%of all the infections while the rest of the microbes only causes only one percent of infections. The microbial agents responsible for causing infections include; Staphylococcus aureus (S. aureus) Streptococcus spp. Pseudomonas aeruginosa (P aeruginosa), Acinetobacter spp., Legionella enterococci, Bacillus cereus (B. cereus and coagulase negative staphylococci. (Borges et al. 2016; (Pogue and Kaye, 2015); (Zhang et al. 2016). The agents which play the greatest role in creating infections among these are enterococci, S. aureus, P. aeruginosa, and E. coli. E. coli is mainly found in urinary tract infections. Enterococcus spp. is mainly found in infections of surgical sites but is rarely found on respiratory tract infections (Khan, Ahmad, and Mehboob, 2018). The

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coagulase-negative staphylococcus aureus is the main causative agent of blood bone infections. The S. aureus is found in many other sites of infections in the body but is rarely found in urinary tract infections. , P. aeruginosa is found to be distributed in body sites evenly and causes a tenth of all the infections (Borges et al. 2016).

Healthcare associated infections are a significant burden on delivery of healthcare services. This has made it a priority to the National Health Service (NHS). The reduction of these infections has however proved difficult owing to a number of reasons such as patient case mix, the environment, the diagnostic and treatment methods, the management of the antimicrobials, the patterns of healthcare delivery and type of microbe present at the infection site (Sanchez et al. 2015). The microbes causing the infection could come from the microbial flora of the patient themselves or from other patients who are infected through transmission by air for airborne infections or from the contaminated hands of workers in the hospital or contaminated surfaces such as taps. The transmission can be spread from ward to ward through the movement of staff members or patients. The infection can also come from outside the hospital (Hassan, Aftab and Riffat, 2015).

The methods used to control infections are grouped into standard and transmission based precautions. The standard precautions are hand hygiene, use of appropriate personal protective gear when handling any body fluids, using aseptic technique when deemed necessary, ensuring any reusable equipment’s are reprocessed appropriately, handling any sharp objects which could be potentially infectious in a safe manner and disposing them appropriately, handling linen and wastes carefully and effective management of the environment including cleaning and management of spills (Suleyman and Alangaden, 2016). When a patient is either suspected or has been confirmed to be infected with an organism of concern additional precautions known as transmission based precautions are put in place to manage the spread of the infection and are dependent on the path of transmission of the infection whether it is airborne, or transmitted by contact (Zhang et al. 2016). These include the use of single rooms or isolation, the use of respirators for respiratory protection, use of gloves and gowns which are disposable and protection of the eyes when entering the isolation rooms (Hassan, Aftab and Riffat, 2015).

A study which investigated how to control infections caused by meticillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile-associated diarrhoea (CDAD) has revealed that for MRSA proper hand hygiene on the side of all hospital users including staff, patient and visitors reduce the infection rates (Hassan, Aftab and Riffat, 2015). The rates of infection increased because of the inability of trusts to isolate infected patients because of lack of other rooms. The audit of the practices for prescribing antimicrobials led to better control of CDAD (Khan, Ahmad, and Mehboob, 2018). Providing a clean environment such as clean toilets was associated with lower levels of infections caused by CDAD. Proper management of hospital beds and their allocation to patients leads to lower levels of infections resulting from both MRSA and CDAD (Hopkins et al. 2017). When infection control was incorporated into appraisal and personal development plans staff responded positively and there was a reduction in the rate of infections. For Infections caused by MRSA hand hygiene was found to be more important than the cleanliness of the ward (Borges et al. 2016).

England has succeeded in reducing the burden caused by meticillin-resistant Staphylococcus aureus (MRSA) by 80%. This stunning improvement was achieved through a multiple interventions which targeted different aspects of the infection and levels of healthcare. The senior managers and clinicians were mandated to ensure that interventions to control infections were a priority and that there was a zero tolerance to MRSA. The healthcare system was required to build a new culture of managing infections which focused on proactive and not reactive surveillance. In addition to this practice audit was required from every healthcare institution. Hygiene was improved by ensuring handwashing using alcohol hand gels at all points where patients come in contact with their environment. There was also prudent use of antimicrobials (Duerden et.al 2015).

Due to antimicrobial resistance infections continue to be a menace. Alternative treatments for infections are continuously being sought. One method which has been reported to be effective for infectious diseases is antimicrobial photodynamic therapy (aPDT). The Mechanism of Antibacterial Photodynamic Therapy involves the use of photosensitizers which can be uptaken preferentially by bacterium. The photosensitizers accumulate inside the bacteria and in its cytoplasm membranes. The next step is the exposure of the photosensitizer to an appropriate wavelength of light so that it can take up a certain photon of light. The photosensitizer now in an excited state now releases light energy to molecular oxygen found in the bacteria thus splitting it up to form free oxygen radicals. These free radicals are toxic to cells and destroys them causing elimination of bacteria. and attract a photon. Then, the photosensitizer transferal energy from light to molecular oxygen to produce singlet oxygen and free radicals that are cytotoxic to cells. (Mahmoudi et al. 2018).

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References

Bezuidenhout, M.B., van Staden, A.D., Oosthuizen, G.A., Dimitrov, D.M. and Dicks, L.M., 2015. Delivery of antibiotics from cementless titanium-alloy cubes may be a novel way to control postoperative infections. BioMed research international, 2015.

Borges, A., Abreu, A., Dias, C., Saavedra, M., Borges, F. and Simões, M., 2016. New perspectives on the use of phytochemicals as an emergent strategy to control bacterial infections including biofilms. Molecules, 21(7), p.877.

Chiller, T.M., 2019. Infection control/public health issues in fungal infections. Pathology, 51, pp.S61-S62.

Duerden, B., Fry, C., Johnson, A.P. and Wilcox, M.H., 2015, March. The control of methicillin-resistant Staphylococcus aureus blood stream infections in England. In Open forum infectious diseases (Vol. 2, No. 2, p. ofv035). Oxford University Press.

Hassan, K.A., Aftab, A. and Riffat, M., 2015. Nosocomial infections and their control strategies. Asian Pacific Journal of Tropical Biomedicine, (7), pp.505-509.

Hopkins, L., Brown-Broderick, J., Hearn, J., Malcolm, J., Chan, J., Hicks-Boucher, W., De Sousa, F., Walker, M.C. and Gagné, S., 2017. Implementation of a referral to discharge glycemic control initiative for reduction of surgical site infections in gynecologic oncology patients. Gynecologic oncology, 146(2), pp.228-233.

Kaye, K.S. and Pogue, J.M., 2015. Infections caused by resistant gram‐negative bacteria: epidemiology and management. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 35(10), pp.949-962.

Khan, H.A., Ahmad, A. and Mehboob, R., 2015. Nosocomial infections and their control strategies. Asian pacific journal of tropical biomedicine, 5(7), pp.509-514.

Mahmoudi, H., Bahador, A., Pourhajibagher, M. and Alikhani, M.Y., 2018. Antimicrobial photodynamic therapy: An effective alternative approach to control bacterial infections. Journal of lasers in medical sciences, 9(3), p.154.

Sanchez, J.L., Cooper, M.J., Myers, C.A., Cummings, J.F., Vest, K.G., Russell, K.L., Sanchez, J.L., Hiser, M.J. and Gaydos, C.A., 2015. Respiratory infections in the US military: recent experience and control. Clinical microbiology reviews, 28(3), pp.743-800.

Suleyman, G. and Alangaden, G.J., 2016. Nosocomial Fungal Infections: Epidemiology, Infection Control, and Prevention. Infectious disease clinics of North America, 30(4), pp.1023-1052.

Zhang, S., Palazuelos-Munoz, S., Balsells, E.M., Nair, H., Chit, A. and Kyaw, M.H., 2016. Cost of hospital management of Clostridium difficile infection in United States—a meta-analysis and modelling study. BMC infectious diseases, 16(1), p.447.

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