Hospital-Acquired Infections in Michigan
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Hospital Acquired Infections (HAIs) are preventable yet are a common occurrence throughout medical care facilities in America that arise from improper sanitation of medical equipment and antibiotic resistance. This issue is of important concern since HAIs exacerbate patient symptoms, increase length of stay, raise mortality rates, and increase hospital costs through the utilization of invasive devices. HAIs have been particularly impacting Michigan, with significant rates above the national average for catheter-associated infections and predominantly affecting elderly immunocompromised patients. Preventive approaches have been implemented through training and educating medical personnel regarding infection control, and Michigan’s own Health-Associated Infection Surveillance and Prevention Plan aims to assist hospitals with limited resources on infection control and improve routine surveillance. Despite these efforts, challenges still persist with controlling incidence rates of HAIs. Some of the major factors that cause the observed accumulation of HAIs within Michigan are due to antibiotic resistance, lack of communication for mandating hospital reports regarding HAIs, and racial disparities involving language barriers. Future directions for minimizing the occurrence of nosocomial infections would call for collaborative efforts among hospitals and state health departments to reduce antibiotic resistance in emergency rooms and intensive care units, as there are limited treatments available that tackle this issue. Along with this focus, future interventions should target infection-control policies, effective vaccines and medications, educational interventions, and enhanced protective equipment for patients and medical personnel.
Keywords: HAIs, Michigan, antibiotic resistance, infection control
Among the most detrimental issues of public health, a serious health concern lies within medical care facilities. Hospital-acquired infections (HAIs) are bacterial, fungal, or viral infections that occur within a clinical setting during the course of medical treatment and create comorbid complications for patients. HAIs are caused by improper sanitation procedures of medical devices and from antibiotic resistance. Procedures such as catheter insertions, injections, and improper antibiotic use are all risk factors that can potentially increase a patient’s susceptibility for acquiring nosocomial infections. Some prominent infections that are prevalent include surgical site infections (SSIs) and catheter-associated urinary tract infections (CAUTIs) (Krein, Kowalski, Hofer, & Saint, 2012). They are intricate issues that are major causes of morbidity and mortality, yet are preventable if proper precautions are administered. With devastating impacts on health, HAIs require extensive recognition in hygiene, antibiotic resistance, surveillance reports for data collection, and formal education interventions that enable implementation throughout all aspects of care. Through the study of public health, it is essential to maintain the safety of health professionals and patients by reducing rates of HAIs.
Public Health Problem
Although some progress has prevailed through policy implementation within hospitals, many clinical settings, such as ambulatory centers and hospice care, lack effective prevention strategies to eradicate the threat of these significant problems. Michigan has reported substantial rates of HAIs higher than the national average baseline, surfacing at approximately 15% for catheter-associated infections (Centers for Disease Control and Prevention [CDC], 2016). Recent observational studies illustrate that these contaminants within Michigan are mainly due to improper sanitary conditions and insufficient regulation procedures.
The main difficulty in treating HAIs is their notoriety for developing antibiotic resistance, making these public health detriments extremely difficult to manage and reduce. The development of resistant strains of infectious pathogens from excessive use of monotherapies on patients has spread across high-density patient populations, leading to increases in morbidity and mortality associated with nosocomial infections (Knisely, Liu, Ranallo, & Zou, 2016). Common medications are unable to impact resistant pathogens, which causes worsening of symptoms. Excessive doses of antibiotics and improper routes of administration unable to penetrate sites of infection contribute to the increased resistance health care is observing today (Knisely et al., 2016). Due to increased antibiotic resistance, HAIs can worsen and increase the length of stay for patients, increase hospital costs through utilization of invasive devices, and raise mortality rates from ineffective treatment.
These issues have continued to pose serious concerns nationally. In a 2014 study, the New England Journal of Medicine discovered that 721,800 patients acquired HAIs throughout the year, and of those infected, there were approximately 75,000 deaths (Magill et al., 2014). Not only is this a prevalent issue nationally, it is a statewide occurrence as well. Michigan has seen dramatic incidence rates of HAIs in its hospitals, reporting a 22% higher national average for SSIs related to colon surgery between 2013 and 2014 (CDC, 2016). These reports may point to possible negligence from health professionals as these issues are lethal, but avoidable.
HAIs are observed more commonly in specific geographic regions and demographics of patients. The southeast region of Detroit has been linked to excessive rates of HAIs, severely burdening intensive care units and emergency rooms as these areas tend to have increased numbers of high-risk patients and a high density of biological pathogens (Figueroa, Joynt, Zhou, Orav, & Jha, 2017). HAIs have shown to predominantly affect elderly immunocompromised patients as they remain at high risk due to their inability to prepare protective bodily responses from infections (Lazarus et al., 2007). Because of the demand of patients seeking care for other issues on a daily basis within intensive care units and emergency rooms, it is essential that Public Health sectors derive solutions for reduction of HAIs and sustain protection for those individuals pursuing medical treatment.
Historical efforts to reduce the prevalence of HAIs focused mainly on acute care settings such as neonatal intensive care and urgent care centers. Treatments for infection during the early 19th century included enemas, topical rubs, phlebotomy with a focus on cleaning and sterilization of operating rooms, and the implementation of protective clothing (Smith, Watkins, & Hewlett, 2012). Despite progress, health professionals emphasized strategies that did not encompass in-depth prevention and contained no structural framework to provide surveillance reports for tracking rates of disease.
The modern treatment of HAIs has seen significant positive changes by expanding prevention approaches in ambulatory centers, long-term care facilities, and child labor settings. Nationally, strategies include training and education of medical personnel through lectures and online modules regarding infection control. To receive medical licenses, physicians are now required to participate in simulation-based training workshops, targeting hand hygiene protocols and sanitation of catheter devices (Krein et al., 2012). The expansion and application of proper training procedures for cleanliness is essential for HAI prevention as it has reduced rates of infection nationwide (Krein et al., 2012).
Michigan has also taken initiative to reduce nosocomial infection rates within its health care system by launching the Healthcare-Associated Infection Surveillance and Prevention Plan in March 2004. This project, a subset of MHA Keystone ICU, has saved nearly 1,500 lives and a net worth of US$165.5 million in health care costs (PR Newswire, 2006). This infection control network is a collaboration among community hospitals and public universities that is monitored by Michigan health departments. The network’s primary goal is to assist hospitals with limited resources on infection control and conduct data analysis through surveys and observational studies to improve infection control efforts. Operation of this network is managed through Michigan health departments where they leverage infection surveillance data through communications with local hospitals and suggest prioritization of specific infection preventive measures. Academic institutions involved within the network are responsible for managing the research behind data collection. An example of this program in action is the collaboration of the Detroit Medical Center and Wayne State University, engaging in infection preventive strategies to enclose this outbreak.
These achievements reflect the components of Public Health system through state health departments, clinical care delivery systems, and educational institutions. State health departments and academic institutions are highlighting the assessment aspect of Public Health by implementing data collection plans and evaluating the effectiveness of educational interventions. Hospitals attempting to improve routine surveillance of nosocomial infections, medical-device sanitary procedures, and infection control educational interventions are applying evidence-based methods to target the source of infections. A strong occurrence of preventive efforts is now overlapping with treatment in tackling this public health problem.
Despite preventive efforts, challenges exist both nationally and at the state level. Antibiotic resistance poses the highest level of threat for HAIs in the United States due to its complexity of reduction and severity of impact. More than 70% of the etiologic infectious pathogens for HAIs are now displaying increased resistance to at least one or more common antibiotic treatments (CDC, 2001). It is essential to control the increasing resistance as it can drive rising hospital costs and mortality rates. Health professionals have begun to investigate the role of vaccines and their ability to decrease antimicrobial usage; however, scientific challenges revolving around success of treatment impede successful developments and licensing due to inefficient effectiveness and emergent harmful side effects (Knisely et al., 2016). Michigan’s difficulty in responding to the HAI crisis lies in its lack of transparency for mandating hospital reports regarding HAIs. Three percent of the nation’s penalized hospitals surround southeast Detroit, causing a delay in communications of infection rates due to carelessness and insufficient acknowledgment of this serious issue (Figueroa et al., 2017).
Within the challenges presented, racial disparities are also a contributing factor to the issue. A study in 2011 reported that Asian and Hispanic patients had significantly higher rates of HAIs than White non-Hispanics (Bakullari et al., 2014). Black patients also indicated slightly higher odds of infection than their White counterparts. Language barriers and unconscious bias from physicians are some of the leading factors contributing to this disparity because a proportion of non-White patients are categorized as immigrants with lack of English abilities (Bakullari et al., 2014). Many physicians lack supplementary language skills besides English, creating a gap for patient and physician understanding. Due to miscommunication from both parties, it can lead to failure in responding to patient concerns and manipulation of catheter device protocols that increase infection. These challenges reflect components of the Public Health system as clinical care delivery systems fail to implement strategies that reduce health inequities prevalent among minority groups in the population.
Although the previous challenges listed persist in health care today, one action that can be taken to prevent rising HAI rates nationally and within Michigan would be a call for a coordinated approach to reduce antibiotic resistance in emergency rooms and intensive care units. Collaborative efforts among hospitals and state health departments focused on tackling Clostridium difficile bacteria, a prominent pathogen known to have developed genetically resistant strains from excessive antibiotic administration, can significantly reduce transmission of antibiotic-resistant infections and reduce the prevalence of HAI rates (Slayton et al., 2015). There are limited treatments available aimed at reducing the prevalence of antibiotic resistance, and there have been increased numbers of patients within high-density population health care facilities who have developed untreatable infections. Among this coordinated approach, injection treatments that aim to penetrate resistant strains within the bacteria have been tested for effectiveness and have shown promising results as high as 55% reduction in infection rates (Slayton et al., 2015). The CDC has estimated that an immediate implementation of qualified versions of these injection treatments could prevent more than 500,000 antibiotic-resistant HAIs within the next 5 years (Slayton et al., 2015).
Many efforts have been executed to minimize the impact of the harmful effects HAIs create. However, further preventive actions must be called to action as disparities and additional medical innovations remain in Michigan and the entire nation. Future Public Health interventions should target infection control policies, additional and specific evidence-based educational interventions, effective vaccines and medications, and enhanced protective equipment for patients and health care staff to ensure proper administration of medical treatments.
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