Cornerstone of patient safety and infection control at hospitals

39

Healthcare-Associated Infections (HAIs) or nosocomial infections take a major human toll on society, and reduce public confidence in the healthcare system. It adds up to substantial economic burden to a country and given the backdrop of the current pandemic, no hospital or healthcare system will want to risk lives of million people. The current convergence of scientific, public, and legislative interest in reducing rates of HAI helps bring necessary momentum to address any issues related to patient safety and HAIs. But prior to this, it is important to understand the benefits of patient safety and infection control at hospitals, and what patients should be aware of.

The role of patient safety and infection control: According to the World Health Organization, patient safety practices aim to prevent and reduce risks, errors & harm that occur to patients during provision of healthcare. A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events. Patient safety is fundamental to delivering quality essential health services. Infection control is a byproduct of a patient safety culture. It is responsible for administering and promoting best practices to ensure the safety of our patients/ residents, visitors, and staff.

Measures that can ensure safety of patients: Here are a few aspects that need to be considered by while adhering to best practices in patient safety and infection control:

  • Optimizing antibiotic stewardship/ antibiogram
  • Prevention of catheter related blood stream infections
  • Preventing ventilator associated pneumonia/ hospital acquired pneumonia
  • Preventing urinary catheter relation infection
  • Preventing Bed sore/ prophylaxis
  • Avoiding surgical site infection/ wound
  • Fall prevention and sentential events
  • Look out for Stress Ulcer prophylaxis
  • Check for DVT prophylaxis
  • Assessment of nutritional status and prevention of protein calorie defici
  • Physiotherapy/ exercise/ stabilization/ rehab
  • Physiological support
  • Patient relative counselling

From the above-mentioned measures, I would like to highlight the significance of to two extremely important aspects of patient safety and infection control – optimizing antibiotic stewardship program and preventing Ventilator-Associated Pneumonia (VAP) which are the most common and most preventable complication of a patient’s hospital stay.

Significance of Antibiotic Stewardship Program: Optimizing the use of antibiotics is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance. Antibiotic stewardship programs can help clinicians improve clinical outcomes and minimize harms by improving antibiotic prescribing.

Preventing Ventilator-Associated Pneumonia (VAP): Given the COVID scenario, it is very critical to address the problem of VAP within hospitals. VAP’s frequency and potential adverse effects increase in critically ill patients because of impaired physiology, including a blunted immune response and multi-organ dysfunction. Traditionally, VAP rates have been measured as an indicator of quality of care. Despite recent initiatives to measure complications of mechanical ventilation and a decrease in incidence over the past few years, VAP remains an issue for critically ill adults, with mortality estimated as high as 10%.

To reduce risk for VAP, the following nurse-led evidence-based practices are recommended: reduce exposure to mechanical ventilation, provide excellent oral care and subglottic suctioning, promote early mobility, and advocate for adequate nurse staffing and a healthy work environment. Nurses are particularly well positioned to lead the healthcare team in VAP prevention. A hospital can help minimize patients’ exposure to mechanical ventilation, work collaboratively to develop a ventilator weaning protocol, and ensure implementation of evidence-based care that minimizes VAP risk.

At the end of the day, patient safety and infection control are a crucial elements of quality improvement. If healthcare providers have to build trust amongst their patients, patient centricity is the only way to go.