Sep 27, 2018 in Healthcare

Public Health Issue

Introduction

Provision of quality and effective health care is a basic requirement for society as a whole. Government in conjunction with global and local health organizations gives required priority to the public access of quality health care services. The issue of providing quality health care is however limited by the fact that many patients suffer from health care associated infections leading to high mortality rates in health institutions. Therefore, it is evident that in order to reduce the mortality rates arising from various health conditions, there is a need to minimize the effect of health associated infections on patients. In the United States alone these health associated infections and high mortality rates cost the government billions of dollars (Centers for Disease Control and Prevention, 2014). A separate report by the World Health Organization (WHO) listed health associated infections as one of the key public health issues that need to be addressed in 2014 (World Health Organization, 2014). Health care associated infections have been neglected over the time. Many health professionals and institutions underestimate their weight and significance in a patient’s recovery process. Health care associated infections occur in a health facility and are normally not present, or incubating, in the patient during admission to the health facility. They may be acquired before, during or after treatment. Among such infections are bloodstream infections and surgical site infections. Symptoms of health associated infections may start to show after treatment and discharge from the health facility (Klevens, Edwards, & Richards, 2002). Health care associated infections are not limited to patients at the health facility but extend to the occupational infections that involve the staff as well. According to the world health organizations, many health facilities lack proper surveillance systems for identifying health associated infections. This coupled by a lack of a standard diagnostic criterion causes hundreds of millions of deaths annually.

Population Characteristics

Health associated infections are not limited to a specific group. They affect anyone seeking health care in a community as well as the health professionals working in these health institutions. The quality of health care is significantly lower in health institutions that are adversely affected by health care associated infections. However, health care infections are more prevalent in in-patients as compared to out-patients. In-patients are more exposed to the dangers of contracting health associated infections than out-patients. The occurrence of health care infections is also high in patients that undergo surgical operations. In 2013, surgical operations accounted for 44% of the recorded health care infections in the United States (Klevens, Edwards, & Richards, 2002). Thus, in reducing health care infections, surgical site infections need special consideration. Additionally, the health workers in various health institutions are also part of the population affected by health care associated infections. Health workers can be affected by communicable diseases from patients in the health facility. The health care environment if contaminated, might affect the health workers as well. For instance, it can cause a viral infection that requires quarantine. Surgical operations are also an avenue for contracting health care associated infections by the health workers or professionals. Patients with chronic illnesses also form a large part of the affected population. Such patients are in constant need of medical attention. They frequent the health facilities for these services and hence are in a continued risk of contracting health associated infections. The population affected by health care associated infections is broad. This issue embodies those seeking medical attention in these health institutions as well as those working in them. However it is worth noting that the risk of contracting health care associated infections is higher in some patients as compared to others.

Community Health Assessment

The issue of health care associated infections is a global public health issue. However in order to reduce the number of deaths from health care associated infections, the solutions developed have to be local. Therefore it is necessary to provide a basis for an efficient community assessment method that will help in solving this issue. The community health assessment should take the population into consideration. These include patients of the health facilities within the community and the health workers of these health facilities. Data collection should be based within the health facilities themselves. Methods of data collection that could be used include interviews, observations and analyzing hospital records as well as other relevant statistics. First of all, the population of the community needs to be established as well as the number of health facilities within the area. It will help learn how representative the local statistics are, both on the national and global level. From this the research should then go ahead to look into hospital statistics and establish the number of health related infections recorded and the resultant deaths. These statistics should then be compared to the factors of the hospital such as the condition of the health care environment. Interviews and questionnaires also need to be applied in collecting data from patients and health workers. The research should also investigate principles put in place by these health institutions as compared to global and national standards. For instance, the Australian Government has the Preventing and Controlling Healthcare Infections fact sheet 3. This document outlines the guidelines and standards that health professionals and institutions in Australia need to meet in order to reduce health care associated infections (Australian Comission on Quality and Safety in Health Care, 2010). Global standards are given in the World Health Organization Health Care Associated Infections fact sheet. On the basis of the acquired data and statistics, solutions can then be proposed to the local health facilities.

Literature Review

Past efforts have been made in order to curb the effect of health care associated infections on both global and local scale. The efforts have proved fruitful but there is a need for further inquisition into the matter in order to arrive at long-lasting and more effective solutions. For instance, the National Plan to Prevent Health-Care Associated Infections: Roadmap to Elimination is an initiative by the United States government aimed to reduce and ultimately eliminate health care associated infections throughout the country (Centers for Disease Control and Prevention, 2014). Such projects have recorded a measure of success. The aforementioned one has recorded a 20% decrease in the nationwide Standardized Infections Ratio (SIR). Surgical site infections have also decreased by 15% across the United States by the year 2008 (Klevens, Edwards, & Richards, 2002). The project however lacks focus on particular infections such as bloodstream infections, urinary tract infections and Clostridium Difficile Infections among others (Centers for Disease Control and Prevention, 2014). This project among others focuses on a broader picture of general health care associated infection reduction. However in order to realize the set goals of such projects, it is necessary for health professionals to develop specific solutions. The proposed solutions need to be tailor-made for the various causative-agents and infection avenues. Most of such projects roll out a single plan of action for the entire problem. Often this does not include all the infection avenues. In addition there is negligence when it comes to infections affecting health care workers. The projects initiated by the CDC, WHO and others focus mainly on health care associated infections that affect patients. In order to improve the situation and provide quality medical health care, solutions developed should be related to the health care associated infections as well. According to the World Health Organization, health care associated infections are a major concern causing millions of deaths annually (World Health Organization, 2014). The measures put in place by the various stakeholders have been fruitful but they need to address the aforementioned shortcomings in order to yield better results.

Community Health Education

Community health education involves promotion of community health and prevention of diseases by employing theoretically-based approaches. This field involves studying a certain community and developing solutions to the health issues faced by them. The analysis carried out and the solutions obtained should focus on a specific health issue such as the prevalence of health care associated infections. In doing so, the solutions proposed will specifically suit the needs of that particular community. In addition, community health education specialists are tasked with the responsibility of influencing decisions, policies, practices and behaviors of the community members in order to foster a healthier lifestyle. Therefore it is important that an appropriate community health education theory is selected; one that is in line with the project goals. The transtheoretical model is best suited for this project. This model is geared towards permanent behavioral change; a concept which can be married to the project objectives. The community and health facilities should change their practices in order to ensure a reduction in the number of reported health care associated infections. As discussed earlier, practices by health professionals and the general work ethic within these health institutions contribute greatly to the reduction of health care associated infections reported annually as well as the resultant deaths. A paradigm shift is also necessary on the part of the patients as well. Many of the members of the public need to be informed on the symptoms of health care associated infections. This is crucial in order to reduce post-treatment infections. Therefore one can argue that the project initiates a behavioral change of some sort from the parties involved and hence the transtheoretical model is best suited. The transtheoretical model is based on a five-stage process that describes the stages to behavioral and attitude change. The processes are; pre-contemplation, contemplation, preparation, action and maintenance. Individuals in the pre-contemplation stage are characterized as uninformed or under-informed about the risks and consequences of their behavior. This is can be compared to the public which is ignorant on the matters dealing with health care associated infections. This is the initial stage before execution of the project. Therefore there is a need for massive community information and involvement. Additionally, pre-contemplation can be applied in the health facilities and among the health professionals as well. They might not realize the impact of their actions and the set standards that relate to curbing health related infections. Informing these parties moves the project into the next stage which is the contemplation stage. In the second stage the parties involved are now more informed on the matter. They are more informed about the issue and are in a better position to make informed decisions. This can only be achieved by sensitization of the public as provided for in the project structure. The next stage after this is the preparation stage in which the concerned parties make immediate adjustments to effect the change. These are usually minor adjustments that have an immediate effect. In relation to the project, such changes might include changing of the practices by health professionals and health institutions. Long-term effects such as expansion of in-patient housing facilities are embodied within the fourth stage; the action stage. The actions taken are usually gradual but have a long-term effect geared towards the desired change. The last stage is maintenance. Preventing relapse helps in cementing the changes made in the previous stages. Additionally, evaluation is done in order to assess the behavior change process. This can be linked to the evaluation part of the project. In this stage, the outcomes of the project are compared to the initial objectives. By doing so, the success or failure of the project can be determined.

Project Objectives

The general objective of such a community based project is to ultimately reduce the impact of health care associated infections on the community. In doing so the project aims at improving the conditions of the various health care facilities in the community. This is the basis for reducing health care associated infections pertaining to patients or health workers. This is because research shows that the number one cause for health care associated infections is deteriorative conditions of health care facilities coupled by lack of proper surveillance. Solutions provided should be geared towards providing quality health care in suitable environments and this will be one of the key objectives of the project. The project should use already existing standards and incorporate its own suggestions as well. A time frame of not less than 6 months needs to be given for the health facilities to incorporate these solutions. However, the nature of the solution also dictates the amount of time for implementation. For instance expansion of certain in-patient housing facilities could be a possible solution. Such a proposal needs to go through the appropriate channels and can take about 2-3 years before being implemented. Apart from improving the conditions of health facilities, the aim of the project should also be to advocate for practices that reduce the risk of acquiring health care associated infections. For instance, competent surgical practices as well as proper diagnosis and treatment of surgical site infections should be included as part of the project goals. Additionally, the public ought to be educated on the dangers of health care associated infections. Many of these infections occur during post-treatment. In order to seek timely medical attention patients need to know the signs and symptoms of these infections.

Advertising and Program Materials

In order to ensure the success of the project adequate information on health care associated infection needs to be passed out to members of the community. In doing so, they will understand the weight of health care associated infections and hence see the need to address this public health issue. Advertising is helpful in creating awareness and promoting public participation in the project. The first way to advertize a local event is by word of mouth. Members of the research team can go from house to house educating the public on the impact of health care associated infections and in the process collecting information about the state of health facilities around them. Another way is by holding events that are bent on informing the public as well. These events should be coupled with entertainment activities such as family fun days in order to increase attendance. The program can also be boosted through posters and inclusion of articles in local newspapers. If possible, a website could be created. It should contain information related to health care associated infections. Members of the public will be able to visit this website in order to get detailed information on the subject. Local radio stations are also a perfect avenue for advertising a community project such as this one. Program materials that need to be drafted include interview questions, questionnaires as well as handouts and booklets. The interviews and questionnaires are an important part of data collection both within and outside the health facilities. The handouts and booklets will be used to disseminate information about health care associated infections to the public and health officials. In general all advertising should be geared towards community involvement because it is a crucial part of any community health education program.

Project Evaluation

Project evaluation is a necessary part of any community based project in order to gauge its success and failure. The success and failure of any project should be reflected using its initial objectives. The main objective of this project as aforementioned is to reduce the impact of health care associated infections on the community. This main objective is encompassed in each of the three stated project objectives. These are aimed to increase public awareness, promote competent practices by health professionals and increase the quality of health facilities within the community as well as the health care they offer. It is on the basis of these objectives that we can determine whether the project met its designated goals. In evaluating public awareness on the issue of health care associated infections, the research team can conduct interviews and offer questionnaires to certain group of people. The collection of data should be structured in a way that it gauges the public’s awareness. Additionally, the data collected from the project evaluation should be compared to the data collected before the implementation of the project. From this the research can determine whether the project succeeded as far as increasing public awareness is concerned. The project success can also be measured in terms of the condition of the health facilities within the community. Have the conditions improved? Do they meet the national and global standards? Feedback from patients and health officials can be used to check whether health professionals are upholding the principles and practice guidelines given by the project team. Lastly, the main objective can be assessed by looking into current statistics in terms of reported health care associated infections as well as the resultant deaths. These statistics should be compared with the statistics of previous years. These four parameters should prove useful in gauging the overall success of the project in the community.

Potential Barriers

Implementing such a project within a community is associated with challenges. The first hindrance to the success of the project is ensuring community participation. The issue addressed in the project is a technical medical issue. Thus convincing members of the public of its importance might prove difficult. The public need to realize the weight of this matter in order to participate in addressing it. Reaching out to the public on such a matter is one of the challenges that the project is likely to face. Another challenge is lack of co-operation with health facilities and health professionals. The said parties may refrain from participating in the project for various reasons. For instance, health professionals may refuse to be interviewed or questioned about their practice due to the fear of being labeled incompetent. The local health facilities may also refuse to participate in the proposed solution plans for various reasons such as cost of implementation. Additionally, some proposed solutions may take a long time to be implemented such as expansion of patient housing facilities. Consequently, it will be difficult to evaluate the success of the project due to incomplete solutions. Another setback would be cost of project execution. Certain aspects of the project require financial input in order to succeed. For example, the advertising, events, posters and website development would cost the research team a lot of money. Therefore, the research team needs to pitch their project idea to sponsors including local authorities. Adequate funding will ensure that the project is executed swiftly.

References

  1. Australian Comission on Quality and Safety in Health Care. (2010). Preventind and controlling health care infections standard 3: FACT SHEET.
  2. Centers for Disease Control and Prevention. (2014, May 22). Healthcare-associated infections (HAI). Retrieved from Centers for Disease Control and Prevention (CDC 24/7: Saving Lives Protecting People).
  3. Klevens, M., Edwards, J., & Richards, C. (2002). Estimating health care-associated Infections and deaths in U.S. hospitals. Public Health Reports, 122, 160-166.
  4. World Health Organization. (2014). Health care-associated infections: FACT SHEET.

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