Assignment 3 13102016

Peter Fulton: Student Number: 094107
Assignment 3: Health care-associated infections
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One of the initial attempts to create sanitary reform and to establish public health
institutions in England occurred in the 1840’s. Thomas Southwood Smith a Doctor at the
London Fever Hospital, commenced writing papers on the value of public health, and was one
of the first Doctors required to give evidence before the Poor Law Commission in the 1830’s
(Thomas 2010).
When Captain Arthur Phillip and the First Fleet landed in Sydney Cove, Port Jackson in
1788, the colony of New South Wales was formed and the history of the public hospital system
in Australia commenced as chief surgeon John White filed his first report on health of the fleet.
This singular act marked the nascent origins of a hospital-based health system in colonial
Australia. Tasmania’s first public hospital was established in 1820. When public health
management was launched in New South Wales in the 1850s, the chief concerns of the day were
infectious disease and hygiene, two issues that remain prominent in public health in the new
millennium. This essay will critically appraise the issue of healthcare-associated infections in
Australia and provide a rationale for a public policy aimed at mitigation of the issue, with
particular reference to the state of Tasmania. The essay will examine current approaches to
prevent healthcare-associated infections in Australia and evaluate an extant program of
prevention with the aim of determining the feasibility of transference of strategies to a
Tasmanian implementation.
The WHO (2013b) defines a health system as “…all the activities of whose primary
purpose is to promote, restore and or maintain health” for all people in a population, as and
where the service is needed. Although amenities vary among different countries, the
fundamentals of any health system are comprised of vigorous currency apparatuses, a skilled
workforce and trustworthy information that forms the basis of results and strategies.
Additionally, fully operational amenities and logistics to distribute excellent medicines and
technologies are required at all times (WHO 2013b).

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Healthcare-associated contagions are also referred to as nosocomial or hospital infections,
and cover all infectious pathogens and diseases acquired by or affecting patients in an infirmary
or health-care facility not current or gestating at the time of admittance. Such healthcare-
associated infections also include work-related contagions among staff and contagions
developed by patients in an infirmary or facility that appear subsequent to release (WHO 2016).
Annual Australia-wide infection rates across all healthcare facilities amount to almost
200,000 health care infections (NHRMC 2010), making healthcare-associated infections the
number one health issue affecting hospital and healthcare facility patients. Worldwide health
allied infections are the number one adverse event affecting patients (WHO 2011). Additionally,
healthcare-associated infections can result in additional, and preventable, pain and misery for
patients and their families, prolonged hospital stays and added expense to the health system
(NHMRC 2010).
Perils and contrary results relating to actions in falls, treatment mistakes and healthcare-
associated infections, resulting in longer hospital stays for patients, increased expenses to all
parties and consumption of staff time. As a results a new industry emerged with the objective
of reducing/eliminating of health care infections (Mitchell, Gardner & McGregor 2012).
A study of third-year nurses identified substandard knowledge on disease transmission-
based precautions during placement practicums, revealing a substantial gap in the standard of
education and training for nursing graduates (Mitchell et al. 2014).
The World Health Organisation ‘Clean is Safer Care’ program (WHO 2016) listed eight main
areas of concern related to the prevention of healthcare-associated infections.
Personal control measures, such as hand hygiene, safe injection practices and surgical site care,
prevention of sepsis and catheter-associated bloodstream infections are all achievable HAI
prevention methods whereas; IPC to combat antimicrobial resistance, burden of healthcare-

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associated infections, IPC country capacity building are areas outside the control of individual
Health care practitioners.
Deaths from infectious diseases in Australia have dramatically declined since the early
years of the twentieth century, due mainly to improvements in sanitation and quality of life. In
1922, deaths from infectious diseases accounted for 155 of all deaths. By 2007, however, the
rate of death due to infectious disease had reduced to just over one per cent (Australian Institute
of Health and Welfare 2010).
In comparison, infection diseases continue to be one of the major origins of bereavement
and incapacity in developing regions. In South East Asia region infectious diseases account for
40 per cent of deaths and 28 per cent of illness and disability (WHO 2005a). Developing nations
often lack the economic or capacity to provide a public health structure sufficient to manage or
prevent infectious disease (Fleming & Parker 2015).
In Tasmania during 2009 there were over 2,300 healthcare-associated infections reported,
this associates to approximately 25,800 lost beds day per annum (Cruickshank & Ferguson
2008).
Additionally, each year in Tasmanian hospitals approximately eight percent of all
hospital patients are likely to pick up a contagion while in care, some of which can possibly be
life threatening (Services 2011).
A 2014 report on healthcare-associated infections in acute care in Tasmanian hospitals
revealed an average HAI rate of staphylococcus aureus (golden staph) of 1.023 per 10,000
patient days in the period July 2009 to March 2014 (Wells et al. 2014). During the first quarter
of 2014, three of the four largest hospitals in Tasmania recorded healthcare-associated golden
staph infection rates below the 2011 national healthcare target of no more than 2 /10,000 patient
days. Tasmanian rates of healthcare-associated golden staph infections were found to be
comparable to other states and territories (Wells et al. 2014). Western Australia recorded 0.88

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per 10,000 bed days in 2014. South Australia recorded 0.8 per 10,000 bed days during 2012,
and Canberra Hospital reported 1.72 cases per 10,000 days of patient care in 2012-2013 (Wells
et al. 2014).
From the last reporting quarter of 2013 to the first reporting quarter of 2014, Tasmanian
hospital-identified contagious disease infections increased from 5.4/10,000 to 6.3/10,000
patient days; via a real time increase of five more cases of infection in 2014 (Wells et al. 2014).
HCA-HCF CDI increased from 2.1/10,000 patient days in quarter 4 2013, to 3.1/10,000
patient days, presenting as seven more cases in quarter 1 2014 over quarter 1 2013. Interestingly,
the rates of identified contagious disease infection in Western Australian public hospitals in
quarter 3 2013 was 3.95 per bed days (Wells et al. 2014).
The development of various strains of microorganisms that have become resistant to
many of the antibiotics is creating challenges for management and treatment. One of the major
areas of concern is that while here there are a quantity of intrusions that have become very
real in reducing the amounts of healthcare-associated infections, nevertheless, these appear to
have not constantly being applied regularly or thoroughly. the whole issue of healthcare-
associated infections is not limited to Tasmania this is a global issue and is providing a great
task to health services worldwide (DHHS 2011).
The strategy for the prevention and control of healthcare-associated infections in
Tasmania 2013-2015, introduced by the Tasmanian Infection prevention and Control Unit
(TIPCU).
The strategy reveal that healthcare-associated infections will continually be an
impending risk for patients and patrons; nevertheless, there is extensive indication to show that
numerous of these infections can be prevented through vigilant attention to infection control
measures and methods. The well-being of patients/ clients is paramount while they are in care,
and to ensure this, it is critical for all healthcare staff working in Tasmanian Health

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Organisations (THO), the Department of Health and Human Services (DHHS), volunteers,
contractors, and visitors be aware and accountable for their personal responsibly in this area
(Mitchell et al. 2013).
The “Australian guidelines for the prevention and control of healthcare-associated
infections infection in Australia” (NHMRC 2010) Section B, breaks down the important
components of standard precautions and transmission-based precaution for effective
prevention practices Standard precautions are seen as the main policy for minimising the
spread of health care associated infections, this policy includes, effective hand hygiene
practices, correct use of personal protective equipment, proper handling and use of sharps,
effective routine management of the physical environment at all times, correct respiratory
hygiene and cough etiquette at all times, correct aseptic technique, ensure efficient waste
management handling at all times, ensure efficient handling of linen at all times.
Transmission–based precautions are used in conjunction with standard precautions and
include; correct contact precautions, correct droplet precautions, effective airborne precautions
and knowledge of how to put precautions into practice.
As stated in Mitchell et.al (2013) all healthcare workers, volunteers and visitors must be
aware of personal responsibility in taking the correct action to reduce healthcare-associated
infections.
Healthcare-associated infections transmitted while people are in healthcare mainly come
through human sources, including patients, employees and visitors. Individual people might be
vigorously sick, but not exhibiting signs of illness, however they may be in phases of a gestation
passé of the illness, or be momentary or prolonged movers of a contagious agents with or
without the signs. Other sources of transmission include microorganisms living in the breathing
or intestinal region, conservational resources as air, water, medications, or medical equipment
and any other device that has developed contamination (NHMRC 2010).

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Possibly the most alarming issue surrounding healthcare-associated infections is hand
hygiene, evident in the research the understanding, intents, and opinions on infection
prevention and control in nurse graduates (Mitchell et al. 2014). Mitchell et al. surveyed 349
final year nursing students from various Australian universities, signified 21 per cent of nurses
graduating in Australia. The results showed that knowledge of standard precautions indicated
that 88.9 per cent of the questions were replied to correctly, however, the same students when
answering the questions relating to transmission-based questions resulted in 27.2 per cent of
the questions being answered correctly which amounts to a substandard level of knowledge
(Mitchell, et al. 2014).
Devotion to effective hand hygiene from all healthcare workers is measured to be the
foremost precautionary priority concerning HAI (Pittet et al. 2011),interestingly the greater
quantity of writings speak to patient –centred focus on hand hygiene (Landers et al. 2012).
Landers et.al is strongly supported by (McGuckin & Govednik 2013).
The above results must raise concern and questions re the level of what students are being
taught in their nursing studies regarding healthcare-associated infections and also the levels of
supervision and training they are receiving on their placements. While healthcare-associated
infections are a major health issue not only in Tasmania but worldwide then maybe it is the
right time to introduce a more detailed course at all levels providing more detailed knowledge
on healthcare-associated infections and best prevention practices to reduce healthcare-
associated infections at all levels (Wells et al. 2014).
Hand hygiene compliance in Tasmania between March 2009 and March 2014 has
significantly increased from a baseline of 35.5 per cent to 78.3 per cent. This result reveals that
hand hygiene levels in Tasmania as being similar to most of Australia, during the third statistics
gathering quarter of 2013, distributed hand hygiene proportions in Victoria was 78.2 per cent,
Western Australia 77 per cent while the national average was 79 per cent (Wells et al. 2014).

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The deterrence of infection necessitates a multifaceted tactic at all levels as infectious
carriers can be transmitted to a susceptible host by a variety of methods, including the direct
spread of hands of workers, carried on equipment, and through airflow (Mitchell et al. 2014).
Numerous studies have highlighted the inadequacy of many undergraduate programs
which effectively train and equip students of various clinical disciplines which can and will
impact healthcare-associated infections. This result raises the question of the connection
between University nursing undergraduate courses and the failure of compliance to IPC policy
(Kennedy & Burnett 2011).
Additionally, research conducted by (Barnett et al. 2014), argues that hand hygiene is
one of the keys to reducing the risk of healthcare-associated infections, however for this to be
successful requires a higher commitment to compliance amongst all hospital and health care
facilities, currently in some places compliance rate have been under 50 per cent.
Knowledge is the precursor to change entrenched attitudes on healthcare-associated
issues and many studies have stated the importance of both these component’s to bring about
a sustainable behavioural change amongst clinicians. (Cabana et al. 1999).
Higher education standard for all healthcare workers is the key strategy in the reduction
of HAI’ through IPC programs. The ACSQHC states better education as the central tenet in
effective IPC strategies.(Quality).
It is the writer’s view that greater emphasis is required in all nursing education,
commencing at universities on infection control as well as in all hospitals and health care
facilities, data in this study has raised the question of final year nurses lacking knowledge on
key aspects of healthcare-associated infections. Additionally is also raise the question of
supervision in the workplace during their placements, is their supervisor training and equipping
the nurses properly in their quests to become professional nurses.

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To raise the standard of training in this area may include a separate Diploma/ Graduate
Certificate level course for all nursing students at nursing schools in conjunction with their
Batchelor’s degree, additionally more detailed supervision in the workplace while on
placement is required, these steps will, in time, assist in the reduction of healthcare-associated
infections Australia wide not only in Tasmania.
A study was undertaken by (Wyer et al. 2015) on involving patients in understanding
hospital infection control using visual methods states if healthcare workers are wanting to
reduce infection rates they must start to consider patients as active participants to infection
control.
Healthcare workers should engage patients about practices and pay particular attention
to patient’s feedback about infection risk and control. The benefit is two-edged, it will assist
the workers’ understanding of infection control risks and behaviours as well as assist them to
aid suitable patient self-care behaviour.
In recent years, the whole nursing profession has acknowledged mentoring to be a vital
link to professional practice. Nurse wanting to increase their knowledge and careers will seek
answers that will keep them abreast in their fields but will also pass that on to develop others
in their growth in the profession and find fulfilment in doing that (Kanaskie 2006).
A specific approach to setting up new healthcare workers across all facets of healthcare
with a mentor/ buddy for a period of three to twelve months with a significant focus on the
reduction and prevention of healthcare associated infection, this may well bring positive results
over the long term.
The literature highlights that successful mentoring relationships may well be the key to
many nurse’s success in practice and is also linked to professionalism and gaining plus
maintaining quality standards (Ronsten, Anderson & Gustafsson 2005).

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Perils and contrary results linked with proceedings such as falls, drugs errors and
healthcare-associated infection have produced a complete new commerce charged with
endeavoring to save people from the threats of healthcare infections (Mitchell, Gardner &
McGregor 2012).
This has been necessitated by the large number of healthcare-associated infections, not
just in Tasmania but the rest of Australia and worldwide.
For approaches providing successful outcomes for preventing or reducing healthcare-
associated infections will involve the application of a risk management agenda to manage
‘human’ and systems’ features that are linked to the transmission of infectious agents. Just as
important when recommendations have applied all hospital and health care facility workers
must contemplate the danger of transmission of contagion and implement presenting to their
precise situation and conditions (NHRMC 2016).
NHRMC (2016) paragraph above is strongly supported by Mitchell et.al (2013), where
they write the ongoing well-being of patients, clients, visitors is paramount while they are in
care, and to ensure this, it is critical for all health care staff working in Tasmanian Health
Organisations (THO), the Department Health and Human Services (DHHS), including all
employees, volunteers, contractors, and visitors be aware and accountable for their personal
responsibilities in this area.
Every year across Tasmanian hospitals approximately eight percent of patients will pick
up some form of infection, some of which will be life threatening (DHHS 2011).
Effective hand hygiene appears to be a major issue in healthcare-associated infections. A
study conducted by (Mitchell et al. 2014) on nursing graduates from Australian universities on
their understanding, intents, and opinions on infection prevention and control, amazingly the
overall results in transmission based-precautions were substandard. Even in hospitals and aged
care facilities effective hand hygiene appears to be an issue, therefore there is a strong case to

10
be made for more professional development in the expanse of healthcare associated contagion
deterrence and regulator.
Devotion to rigorous, effective hand hygiene from all clinicians is acknowledged to be
the most important step in preventative measures against healthcare-associated infections
(Pittet et al. 2011). Interestingly, the far greater volume of literature addressing patient-centred
roles, focus on hand hygiene (Landers et al. 2012). This is strongly supported by (McGuckin
& Govednik 2013).
Even though progress in the reduction of healthcare associated infections has been made
the medical profession needs to stay focussed to decrease these incidents further through more
education and professional development.
References:

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Australian Institute of Health and Welfare 2010, 'Australia's health 2010', Australia's Health
no. 12, Australian Institute of Health and Welfare, Canberra.
Barnett, AG, Page, K, Campbell, M, Brain, D, Martin, E, Rashleigh-Rolls, R, Halton, K,
Hall, L, Jimmieson, N, White, K, Paterson, D & Graves, N 2014, 'Changes in healthcare-
associated staphylococcus aureus bloodstream infections after the introduction of a national
hand hygiene initiative', Infect Control Hosp Epidemiol, vol. 35, no. 8, p. 7. pp. 1029-1036,
doi: 10.1086/677160
Cabana, M, Rand, C, Powe, N, Wu, A, Wilson, M, Abboud, P & Rubin, H 1999, 'Why don't
physicians follow clinical practice guidelines? A framework for improvement', JAMA, vol.
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Cruickshank, M & Ferguson, J, Ed 2008, 'Reducing harm to patients from healthcare
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<www.dhhs.tas.gov.au/tipcu>.
Fleming, ML & Parker, E 2015, Introduction to Public Health 3e, 3rd edn, Elsevier Australia,
Chatswood Sydney NSW.
Kanaskie, M 2006, 'Mentoring - A Staff Retention Tool', Critical Care Nursing Quartely,
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Kennedy, M & Burnett, E 2011, 'Hand hygiene knowledge and attitudes: comparisions
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Landers, T, Abusalem, S, Coty, M & Bingham, J 2012, 'Patient-centred hand hygiene: the
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NHRMC, (2011) Part B:Standard and Transmission-Based-Precautions
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healthcare-2010/part-b-standard-and-tran

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NHMRC 2016, Australian Guidelines for the Prevention and Control of Infection in
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<http://www.nhnrc.gov.au/guidelines-publications/cd33>.
Pittet, D, Panesar, S, Wilson, K, Longtin, Y, Morris, T, Allan, V, Storr, J, Cleay, K &
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Management, vol. 13, p. 9.
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Assignment 3 13102016

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