Assignment: Hospital-Acquired Infections

Assignment: Hospital-Acquired Infections

Assignment: Hospital-Acquired Infections

Synthesize Course content from Weeks 1-5 according to the following sections:
Introduction: Analysis of the communicable disease (causes, symptoms, mode of transmission, complications, treatment) to include demographic break down that includes age, gender, race, or other at-risk indicators (da ta per demographics should include mortality, morbidity, incidence, and prevalence).
Determinants of Health: Define, identify and synthesize the determinants of health as related to the development of the infection. Utilize HP2020.

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Epidemiological Triad: Identify and describe all elements of the epidemiological triad: Host factors, agent factors (presence or absence), and environmental factors. Utilize the demographic break down to further describe the triad.
Role of the NP: Succinctly define the role of the nurse practitioner according to a national nurse practitioner organization ( National Board of Nursing or AANP, for example) and synthesize the role to the management of infectious diseases (surveillance, primary/secondary/tertiary interventions, reporting, data collecting, data analysis, and follow-up). This includes the integration of a model of practice which supports the implementation of an evidence-based practice.  Refer to your course textbook for models of practice examples.

ASSIGNMENT CONTENT
Category	Points	%	Description
Introduction	15	12%	Comprehensive description of the infectious disease (causes, symptoms, mode of transmission, complications, treatment) and the demographic of interest (mortality, morbidity, incidence, and prevalence). Integrate at risk aggregate populations with related descriptive epidemiology.
Determinants of Health	40	32%	Robust identification and description of the determinants of health with explanation of how those factors contribute to the development of this disease. Evidence supports background.
Epidemiological Triad	30	24%	Comprehensive review of the epidemiological triad (host factors, agent factors (presence or absence), and environmental factors).  Uses example/s, resources, to fully describe the triad.
Role of the NP	25	20%	Succinctly defines the role of the nurse practitioner according to a national nurse practitioner organization (Board of Nursing, AANP, for example) and synthesize the role to the management of infectious diseases (surveillance, primary/secondary/tertiary interventions, reporting, data collecting, data analysis, and follow-up). This includes the integration of a model of practice which supports the implementation of an evidence-based practice.
	110	88%	Total CONTENT Points=110 pts
ASSIGNMENT FORMAT
Category	Points	%	Description
APA	10	8%	All elements of the paper utilize APA Format current ed.
Spelling/grammar/ voice	5	4%	All elements of the paper correctly utilize spelling, grammar and a scholarly voice.
	15	12%	Total FORMAT Points=15 pts
	125	100%	ASSIGNMENT TOTAL=125 points

 

1. Choose a topic from the list provided to you by your course faculty.  Apply the concepts of population health and epidemiology to the topic.
2. Synthesize Course content from Weeks 1-5 according to the following sections:
   • Introduction:  Analysis of the communicable disease (causes, symptoms, mode of transmission, complications, treatment) to include demographic break down that includes age, gender, race, or other at-risk indicators (data per demographics should include mortality, morbidity, incidence, and prevalence).
   • Determinants of Health:  Define, identify and synthesize the determinants of health as related to the development of the infection.   Utilize HP2020.
   • Epidemiological Triad:  Identify and describe all elements of the epidemiological triad: Host factors, agent factors (presence or absence), and environmental factors. Utilize the demographic break down to further describe the triad.
   • Role of the NP:  Succinctly define the role of the nurse practitioner according to a national nurse practitioner organization ( National Board of Nursing or AANP, for example) and synthesize the role to the management of infectious diseases (surveillance, primary/secondary/tertiary interventions, reporting, data collecting, data analysis, and follow-up). This includes the integration of a model of practice which supports the implementation of an evidence-based practice.  Refer to your course textbook for models of practice examples.

Preparing the paper

Submission Requirements

1. Application: Use Microsoft Word™ to create the written assessment.
2. Length:The paper (excluding the title page and reference page) should be limited to a maximum of four (4) pages.   Papers not adhering to the page length may be returned to you for editing to meet the length guidelines .
3. A minimum of three (3)scholarly research/literature references must be used. CDC or other web sources may be utilized but are not counted towards the three minimum references required.  Your course text may be used as an additional resource but is not included in the three minimum scholarly references.
4. APA format current edition.
5. Include scholarly in-text references and a reference list.
6. Do not write in the first person (such as “me” “I”)

Best Practices in Preparing the Project

The following are best practices in preparing this project:

1. Review directions and rubric thoroughly.
2. Follow submission requirements.
3. Make sure all elements on the grading rubric are included.  Organize the paper using the rubric sections and appropriate headings to match the sections.
4. Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal, scientific writing.
5. Title page, running head, body of paper, and reference page must follow APA guidelines as found in the current edition of the manual. This includes the use of headings for each section of the paper except for the introduction where no heading is used.
6. Ideas and information that come from scholarly literature must be cited and referenced correctly.
7. A minimum of three (3) scholarly literature references must be used. **See above section on “Preparing the Paper”.

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Hospital-Acquired Infections

A communicable disease is an illness that develops from direct or indirect transmission of an infectious agent or its toxic products from an infected person, animal, or reservoir to a susceptible host. Hospital Acquired Infections (HAIs) are examples of communicable diseases, and one of the most common is catheter-associated urinary tract infection (CAUTI). An HAI refers to an infection that occurs in a patient in a health care setting in whom the infection was not present during admission. The purpose of this paper is to describe CAUTI, its related determinants of health, the epidemiological triad, and the NP’s role in managing the disease.

Introduction to CAUTI

CAUTI is a nosocomial UTI associated with catheter use. CAUTIs are common since about 25% of admitted patients are catheterized during their hospitalization. It is caused by the inoculation of microbes into the urinary bladder by the urethral catheter. The commonest cause of CAUTI is Escherichia coli, while Candida albicans is the second-most-common cause (Cortese et al., 2018). Symptoms of CAUTI include flank pain, bloody urine, fever, and leukocytosis. The urinary catheter creates an environment for bacterial adhesion, which causes mucosal irritation. Microbes enter the bladder during insertion of the catheter, manipulation of the catheter, or through the drainage system (Cortese et al., 2018). If CAUTI is not appropriately managed, it results in complications like cystitis, urethritis, bacteremia, calculus formation, acute pyelonephritis, and renal scarring. Treatment of CAUTI usually involves antibiotic therapy for 7-14 days, depending on the severity of the infection.  

Risk factors for CAUTI include bacteria colonization of the catheter drainage bag, long periods of catheterization, catheterization late in hospitalization, lack of antimicrobial therapy, female sex, and patient with renal insufficiency, diabetes, and immunocompromised state. CAUTIs account for about 12% of all HAIs (> 560,000), and roughly 65%–70% of CAUTIs are preventable (Anggi et al., 2019). Data from the National Healthcare Safety Network (NHSN) reveal that the pooled mean rate of CAUTI was 3.1-7.5 infections per 1000 catheter days. The highest CAUTI rates occurred in burns ICUs, inpatient medical wards, and neurosurgical ICUs. Complications linked with CAUTI are associated with an extended hospital stay of 2-4 days, reduced patients’ quality of life, increased health care costs, and increased mortality rates (Menegueti et al., 2019). Mortalities attributed to CAUTI were approximated to be over 13,000, with a mortality rate of 2.3%.

Determinants of Health

CAUTI is a serious HAI that costs the US healthcare system an estimated $340–450 million annually. Social determinants like education, income, socioeconomic status, access to healthy foods, and neighborhood and physical environment impact the prevalence of CAUTI (Daniel et al., 2018). Low education levels, lack of employment, and low household income impact the quality of treatment provided to catheterized patients. Lack of employment affects individuals’ access to healthcare due to lack of health insurance, limiting them from accessing quality and specialized healthcare services. Besides, uninsured patients who develop CAUTI may fail to access specialized services to avoid complications, resulting in poor health outcomes (Daniel et al., 2018). When patients develop CAUTI, they must adapt to reorganize their lives, which entails costly resources and access to specialized health services. The education level influences a patient’s understanding of the significance of CAUTI. Thus, a patient with a low education level may not understand the symptoms of CAUTI and may fail to report to the healthcare provider when they experience fever or flank pain.

            Patients with low education levels may fail to care for the indwelling catheter appropriately. They can manipulate the catheter leading to inoculation of bacteria and ultimately causing CAUTI (Anggi et al., 2019). Poor nutritional status is associated with a high risk of CAUTI. Therefore, patients with poor nutritional status due to limited access to healthy food options and low-income levels have a higher risk of developing CAUTI. Poor environmental sanitation and health conditions are also attributed to the incidence of CAUTI (Anggi et al., 2019). Individuals living in neighborhoods with poor sanitation and accessing healthcare in hospitals located in these neighborhoods have a higher risk of contracting CAUTI than those with proper sanitation facilities.  

CAUTI Epidemiological Triad

CAUTI is caused by Escherichia coli, Pseudomonas species, Enterococcus species, Staphylococcus aureus, Enterobacter species, coagulase-negative staphylococci, and Candida albicans. The route of transmission in CAUTI is an indirect transmission. The source of microbes causing CAUTI can be endogenous, usually through meatal, vaginal, or rectal colonization (Anggi et al., 2019). It can also be exogenous through the contaminated hands of healthcare providers or equipment. Microbial pathogens enter the urinary tract through the extraluminal route; through migration along the external part of the catheter in the periurethral mucous sheath; or through the intraluminal route by the microbes moving along the internal lumen of the catheter from a contaminated collection bag or catheter-drainage tube junction (Menegueti et al., 2019). Host factors that increase their susceptibility to CAUTI include diabetes, poor nutritional status, history of previous antibiotic use, compromised immunological status, and immunosuppressive medications.

Role of the NP

The AANP defines the scope of NP practice. The NP roles include assessment; ordering, performing, and interpreting diagnostic tests; diagnosing; initiating and managing pharmacologic and non-pharmacologic treatments; coordinating care; counseling; and providing health education to patients, families, and communities (Peterson, 2018). With respect to this scope, the NP has the role of assessing patients presenting with CAUTI symptoms, diagnosing the disease, and developing treatment plans. In addition, the NP is tasked with educating patients and their families on prevention and control measures like a healthy diet and maintaining high levels of environmental hygiene.

The NP should implement secondary prevention interventions, including prescribing antibiotics to patients with signs of CAUTI. Furthermore, the NP is tasked with following up on patients with CAUTI to assess for any complications. The NP can integrate the Iowa Model for Evidence-Based Practice when recommending and implementing CAUTI preventive and control measures. The Iowa model identifies a clinical problem and has decision points with assessment feedback loops (Duff et al., 2020). It addresses the sustainability of EBP, implementation of interprofessional change, and patient-centric care for providers at all levels.

Conclusion

Communicable diseases are caused by biological agents or their products, which are transmissible from one individual to another. CAUTI is the most common HAI and is spread via indirect contact transmission. Studies show that social determinants like education, income, socioeconomic status, access to healthy foods, and neighborhood and physical environment contribute to health outcomes in CAUTI. The NP is tasked with assessing and diagnosing patients with Influenza, providing health education on prevention and control measures, and educating the community on CAUTI.

 References

Anggi, A., Wijaya, D. W., & Ramayani, O. R. (2019). Risk Factors for Catheter-Associated Urinary Tract Infection and Uropathogen Bacterial Profile in the Intensive Care Unit in Hospitals in Medan, Indonesia. Open access Macedonian journal of medical sciences, 7(20), 3488–3492. https://doi.org/10.3889/oamjms.2019.684

Cortese, Y. J., Wagner, V. E., Tierney, M., Devine, D., & Fogarty, A. (2018). Review of Catheter-Associated Urinary Tract Infections and In Vitro Urinary Tract Models. Journal of healthcare engineering, 2018, 2986742. https://doi.org/10.1155/2018/2986742

Daniel, H., Bornstein, S. S., Kane, G. C., & Health and Public Policy Committee of the American College of Physicians*. (2018). Addressing social determinants to improve patient care and promote health equity: an American College of Physicians position paper. Annals of internal medicine, 168(8), 577-578. https://doi.org/10.7326/M17-2441

Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidence-based practice environment: an interpretive description. Implementation science communications, 1(1), 1-9. https://doi.org/10.1186/s43058-020-00070-0

Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., Canini, S., Basile-Filho, A., &Laus, A. M. (2019). Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: A quasi-experimental study. Medicine, 98(8), e14417. https://doi.org/10.1097/MD.0000000000014417

Peterson, M. E. (2018). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.