Thomas Elliott 

Nosocomial is a term derived from two Greek words: nosus meaning a “disease”or “ailment” and komeion meaning “to take care of”. By definition, nosocomial infections are those that are acquired by patients while under direct medical care. Nosocomial infections are a major safety concern for both medical professionals and their patients and have been linked to an increase in morbidity, mortality and an increase length of stay (Mehta et al., 2014). These patients require more therapeutic and diagnostic interventions, endure preventable suffering, and occupy scarce bed-days. This has a systemic effect on our medical infrastructure, forcing hospitals to spend more. Consequently, insurance companies bridge the gap by charging more for their benefits. Nurses have the responsibility of beneficence and play a crucial role in stopping the spread of nosocomial infections. It is the foundation on which our nursing procedures and techniques are grounded. The American Nurses Association (ANA) promotes evidence-based practices that can be utilized by clinicians to prevent nosocomial infections so that, in collaboration with the Affordable Care Act, patients will have more knowledge about the care they receive, better outcomes and shorter hospital stays.

Preventing nosocomial infections in patients is a major responsibility for nurses as well as other healthcare providers because it greatly reduces patient mortality, length of stay and health care costs. I worked with a 77-year-old male patient who was recovering from multiple ailments on the intensive care floor. He contracted ventilator associated pneumonia (VAP) after being on mechanical ventilation for 30 days. Upon treatment of his pneumonia, he developed multiple drug resistant organisms from his antibiotic therapy rendering his illness virtually incurable. Ventilator associated pneumonia is a nosocomial infection and patients have a 1%-4% chance of contracting this illness for every day they are on mechanical ventilation (Chastre & Fagon, 2002). This disease is preventable and two questions have been formulated to explore strategies on its prevention: What is the most important aspect of patient care for the prevention of transmission of nosocomial infections and what patient populations are the most vulnerable?

Aseptic technique is a procedural process by which a clinician establishes an environment that is free from bacteria, viruses and other harmful microorganisms in order to provide care to a patient. This technique is required anytime that a patient’s skin is perforated or when a sterile body cavity is entered such as when providing ventilator care (Schub & Woten, 2015). It includes meticulous hand hygiene and the use of sterile attire and equipment. Approximately one third of nosocomial infections occur when aseptic technique is not followed and is transmitted from patient to patient through direct contact by a healthcare provider (Lewis et al, 2011, p. 240).  Because a large portion of nosocomial infections are transmitted by healthcare providers, proper hand washing and the use of protective equipment are the single most important measures in infection control (Saloojee & Steenhoff, 2001). The hands are the most common way microorganisms are transmitted between patients, so it is imperative for health care providers to wash their hands vigorously for 15 seconds before and after leaving the room and when moving from one task to another (Mehta et al., 2014). These guidelines are backed by evidence-based practice and are established to protect patients, especially those who are the most vulnerable to infection.

Patients receiving health care are exposed to a variety of different microorganisms from clinicians, other patients and even from hospital visitors. Susceptibility can be attributed to both intrinsic and extrinsic factors. The most important intrinsic factor that determines susceptibility towards acquiring nosocomial infections is age. Older adults and the elderly population are two to three times more likely to develop nosocomial infections than the younger population (Lewis et al, 2011, p. 240).  Typically, the elderly have more comorbidities, are more immunocompromised and have longer hospital stays which increases their chances of developing nosocomial infections. Extrinsic factors include surgical or invasive procedures such as the use of a ventilator, organ transplants, implanted foreign bodies or immunosuppressive medications and personal exposure. These extrinsic factors bypass the normal defensive barriers of the skin and mucous membranes, providing foci where organisms can flourish. Both intrinsic and extrinsic factors can be controlled by healthcare providers through the application and knowledge of evidence-based infection control practices such as aseptic technique. Patients have very little control over the factors that affect their health during hospitalization and rely on the healthcare providers to stay diligent. The Affordable Care Act (ACA) in coordination with the American Nurses Association (ANA) has implemented strategies for clinicians to both reduce the likelihood of nosocomial infections and empower patients with knowledge regarding which hospitals provide the safest practices.

The Affordable Care Act (ACA) was established to provide health insurance for all Americans and to equip them with adequate knowledge regarding the risks and benefits of where they are receiving their care. Although patients covered under the act will not need to pay out of pocket for the treatment of nosocomial infections, they will need to pay for insurance claims related to medications, follow-up care, lab work and rehab. These claims can drag on for years. Because patient safety is a top priority, the ACA has rolled out a mandate which requires hospitals to be held accountable for nosocomial infections. This includes improving infrastructure, insurance requirements as well as reduced payments from Medicare and state Medicaid programs.  The ACA has also established a uniform online reference center for the public to utilize which allows them to check the prevalence of nosocomial infections at their local hospitals. Patients can then make educated decisions on where they are likely to receive the safest healthcare. Patient perception of the environment and care they receive is tied to financial incentives for hospitals which is measured by patient satisfaction surveys. The survey includes questions that ask patients about the perceived cleanliness of the hospital, quality of care and if they would recommend the specific hospital. These elements included in the ACA are designed to protect, educate and to empower patients to make the right healthcare decisions. The American Nurses Association (ANA) as well has developed evidence-based guidelines for nurses and other healthcare providers to utilize in order to prevent nosocomial infections and improve patient outcomes.

Emergent threats to patient safety, such as nosocomial infections, during a hospital stay require nurses and other healthcare providers to be equipped and educated with the latest research to protect themselves and their patients against infection. The ANA in collaboration with the Centers for Disease Control and Prevention (CDC) have developed a specialty organization called the Nursing Infection Control Education Network (NICE Network) which provides training courses for nurses to improve adherence to infection prevention practices. This program keeps nurses up-to-date on the latest research regarding infection prevention such as vigorous hand washing for 15 seconds and the use of gloves, gown and a mask when working in a sterile environment (ANA, 2017). These measures are aimed at reducing healthcare costs for patients and for improving their outcomes. The ANA described this method of care through the use of an inverted pyramid of priorities. This model represents primary care as the foundation of our nursing practice and should be the highest priority for providing care by focusing on prevention of complications and adverse events (American Nurses Association, 2008). This shift of thinking requires nurses to assume a more holistic approach to their practice not only by focusing on the physical ailment of the patient but in caring for the entire person. In so doing, nurses reduce their risk of inadvertently transmitting nosocomial infections to their patients while providing care for another reason.

Health care is becoming less accessible and more expensive for patients so it is imperative that providers stay diligent and safe with their practices as to not deter people from seeking medical attention. Nurses and other health care providers do not intend to spread disease but unfortunately, they become the vectors and can spread infection to their patients without knowing it. This is why the ANA has implemented simple, evidenced-based preventative strategies to be taught in the form of classes to significantly reduce transmission rates and to increase compliance with and adoption of safest evidence-based practices by health care providers. The ACA has established a form of accountability for hospitals along with providing the general public with information regarding nosocomial infections at their local hospitals. These measures have been implemented to protect our patients, especially the most vulnerable from acquiring these infections and to reduce the overall rate nationwide of nosocomial infections.