Good Example Of Applications Of Epidemiology: A Case Study. Case Study

The situation at Good Health Hospital has become a bit overwhelming ever since the outbreak of E. coli in Ward 10 on the second floor. It appears that there are six (6) cases of the disease. To better understand the situation, communication with the CDC has revealed that this particular bacterium can be found in many everyday items. The CDC recommends that investigation begins in the hospital kitchens, since E. coli can be transmitted via contaminated vegetables, as well as delicatessen meats such as salami and other cold cuts. The following table shows the number of cases identified so far:
After meeting yesterday with chief administrator Joe Wellborn, it has been decided that the litigation issues with one (1) of the patients may need further information to determine if the patient was already symptomatic with the bacteria prior to admission. Research has indicated that hospitals operating in the Tampa Bay area have been known to have cases of E. coli contamination. This substantiates the need for further investigations by the County Health Department. Due to the severity of the cases, and the potential for further spread, it is recommended that the hospital seek alternate vending services since the present suppliers cannot verify sanitation protocols for their products. In conclusion, the study done at Good Health Hospital has indicated that the E. coli outbreak was in fact caused by spoil food from the cafeteria. As a social science researcher working for a regional hospital, you are placed in charge of contacting the DOH from your home state, as well as the CDC for statistical data on nosocomial diseases that frequently cause illness at your health care facility. Using information from both agencies, evaluate the data on common nosocomial diseases and compile a treatment contingency plan for dealing with the hospital infections.
1. Analyze Good Health Hospital’s records and itemize recent nosocomial infections that occurred within the past year. In your report, categorize the different parameters (i.e., person, time, place, ethnicity, and gender) used in the compilation of data into the information summative. 
So far, there are only 4 identified cases: two males and two females. They are all young, working-aged people. Sadly, no more information about these patients have been provided so far. Nevertheless, E. coli infections commonly cause Catheter-Associated Urinary Infections, or CAUTIs, which are nosocomial infections that occur when urinary catheters are not put correctly, not kept clean, or are left for too long in a patient without changing it, then bacteria such as E. Coli travel through it causing bladder and kidney infections. The U.S. Standardized Infection Ratio (SIR) of CAUTIs was 1.06, and North Carolina had a 14% higher SIR when compared to the National baseline. Furthermore, North Carolina reported no significant change in terms of CAUTIs between 2012 and 2013 (Centers for Disease Control and Prevention, 2015).
2. Propose at least six (6) questions for the health care administrator at Good Health Hospital, regarding potential litigation issues with infections from the nosocomial diseases. Rationalize, in your report, the logic behind your six (6) questions. 
a. Do you keep electronic or physical medical records for all admited patients to the Hospital?
This may seem like an obvious question, but it could be also one of the first asked during a litigation process, as the medical record of every patient is a legal document that could be used in court. Taking into account Bradford-Hill’s criteria for causation (Schünemann, Guyatt & Ahmed, 2011), medical records are usedful to establish temporality between the admission diagnosis and status of the patient, and the alleged health-associated infection.
b. Do you provide continuing education programs to your staff regarding health-associated infections?
The answer to this question might show the degree of commitment from the Hospital administrators with educational prevention strategies directed to the Hospital staff. Continuing education programs are part of the infection surveillance strategies to minimize health-associated infections in hospital settings (Vincent, 2003). These programs allow e.g. physicians to better choose state-of-the-art antibiotics at optimal doses to prevent future antimicrobial resistance, and nurses to stay alert at aseptic and antiseptic techniques while performing proceedures.
c. Does your staff use personal protective equipment while on duty?
The U.S. Center for Disease Control and Prevention has recommended the use of personal protective equipment to minimize nosocomial infections (Daugherty, Perl, Needham, Rubinson, Bilderback & Rand, 2009), especially in case of Influenza. However, this idea might be extrapolated to other diseases and other staff within a hospital setting, i.e. kitchen staff. By using gloves, hats, and masks, the spread of diseases decreases, both in relation to the staff and the patients.
d. Does your staff comply with handwashing protocols?
Another very useful strategy to prevent health-associated diseases is compliance with handwashing protocols. The best recommended technique is the use of alcohol-based hand-rub products, and avoid the use of rings (Vincent, 2003).
e. Does your staff ensure cleaning and disinfection of equipment and the environment in the different Hospital departments?
Appropriate cleaning and disinfection of equipment may also reflect the degree of commitment of the staff regarding the prevention of health-associated diseases, and has been suggested by the U.S. Centers for Disease Control as one of the prevention strategies against nosocomial infections (Yokoe et al., 2008).
f. Have you established a multidisciplinary Infection Control Committee in the Hospital?
Infection Control Committees should be established by health administrators in case of local outbreaks and to perform infection surveillance (Ducel, Fabry & Nicole, 2002). The multidisciplinary feature allows for work-team and different points of view to be taken into account, in aims of synergist models agains health-associated diseases. The establishment of such Committees show responsibility and leadership from the health administrators.
3. Identify a targeted audience within Good Health Hospital, and prepare an implementation plan based on your hypothetical meeting with the hospital health care administrator. Propose four (4) steps that will be useful in the final implementation plan.
The target audience for this implementation plan will be the Hospital staff (health administrators, epidemiologists, physicians, nurses, kitchen, cleaning and maintance personnel). The first step will be to establish or re-gather a multidisciplinary Infection Control Committee. This Committee will provide leadership for the rest of actions, establish a timeframe, and will report periodically to the competent authorities on the progress of disease prevention. The second step will be to gather and analyze data from the current infection situation at the Hospital, in aims of establishing baseline characteristics before other intervention strategies are implemented. This analysis will include data on morbidity and mortality, along with demographic characteristics of the treated patients, admission, re-admission and discharge rates, complications, etc. The third step will be training of personnel by continuing education programs and educational campaigns, especially in the previously analyzed data on health-associated infections, the use of personal protective equipment, handwashing proceedures, cleaning and disinfection of equipment, etc. The fourth step will be to use work-place reminders, in order to improve compliance rates with the new preventive measures. As an extra step, evaluation and feedback should take place at regular intervals of time, to check whether or not the implemented strategies have any effect, and if subtle or drastic improvements should be made.
4. Suggest at least five (5) recommendations to your department head based on the steps taken in the implementation plan. Provide rationale for your suggestions.
As the steps from the implementation plan relate to primary and secondary prevention of health-associated infections, the same strategies can and should be applied to any other healthcare facility. The specific suggestions would be: 1. To establish a multidisciplinary Infection Control Committee within our own Hospital, mainly due to reasons previously explained, 2. Implement a continuing education program along with positive reinforcement techniques to those who participate (award certificates, provide recognition, allow for collaboration on the workshops, have the meetings at different places, e.g. restaurants, hotels, etc.), 3. Place alcohol-based hand-rub antibacterial products at strategic places in the different departments (emergency and operating rooms, intensive care units, outpatient areas, etc.), 4. Place posters and elaborate audiovisual campaigns to play at the hospital screens regarding prevention of health-associated infections such as handwashing, use of personal protective equipment, etc., 5. Provide and evaluate the use of protective personal equipment in all hospital areas and from all hospital staff, especially in the kitchen.
5. Using these approved recommendations, design a safety protocol itinerary that must be placed in public access areas of the hospital.
The safety protocol itinerary will be a graphically-appealing infographic poster that must be placed in public access areas of the hospital, and will include al relevant information about the implementation plan agains health-associated infections. It will also serve as a reminder to all hospital staff about the most important preventive measures against nosocomial infections. It will show expected goals, set within the decided timeframe. It will contain reminders about handwashing techniques, use of personal protective equipment, being specific about the use of antibiotics on patients and recording that information, cleaning and disinfecting equipment and areas, etc. It will also contain contact numbers, webpages and e-mail addresses from the hospital epidemiologist, public health department, health administrator, local and national Department of Health, U.S. Centers for Disease Control, and World Health Organization. A hierarchical tree of decisions might also be appropriate. This itinerary might be updated regularly to include achieved goals (e.g. percentage reduction of health-associated infections, increased rates of compliance to handwashing techniques, etc.).

References

Centers for Disease Control and Prevention. (2015) National and State Healthcare-Associated Infections Progress Report. Available at www.cdc.gov/hai/progress-report/index.html.
Daugherty, E. L., Perl, T. M., Needham, D. M., Rubinson, L., Bilderback, A., & Rand, C. S. (2009). The use of personal protective equipment for control of influenza among critical care clinicians: a survey study. Critical care medicine, 37(4), 1210-1216.
Ducel, G., Fabry, J., & Nicolle, L. (2002). Prevention of hospital acquired infections: a practical guide. Prevention of hospital acquired infections: a practical guide, (Ed. 2).
Schünemann, H., Hill, S., Guyatt, G., Akl, E. A., & Ahmed, F. (2011). The GRADE approach and Bradford Hill's criteria for causation. Journal of epidemiology and community health, 65(5), 392-395.
Vincent, J. L. (2003). Nosocomial infections in adult intensive-care units. The Lancet, 361(9374), 2068-2077.
Yokoe, D. S., Mermel, L. A., Anderson, D. J., Arias, K. M., Burstin, H., Calfee, D. P., & Classen, D. (2008). A compendium of strategies to prevent healthcare‐associated infections in acute care hospitals. Infection control and hospital epidemiology, 29(S1), S12-S21.