Many healthcare problems that harm patients are related to system deficiencies or the unsatisfactory performance of specific hospitals. For example, a lack of professionals creates a work overload for staff, leading to medical errors. At the same time, the solution to this problem requires systemic changes at the state level in education, healthcare, and social affairs. However, other issues arise at the organizational level of facilities and can be corrected by hospitals’ administration. This paper will look at one of the facilities’ problems, such as hospital-acquired infections, as well as structural and organizational changes that contribute to their prevention.
Hospital-acquired infections are a common problem in all countries, regardless of their level of development. Hospital-acquired infection is an infectious disease that manifests itself at least 48 hours after admission to an inpatient facility (Monegro et al., 2020). The most common types are bloodstream infections, catheter-associated urinary tract infections, surgical site infections, hospital-acquired pneumonia, ventilator-associated pneumonia, and clostridium difficile infections (Fernando et al., 2017). At the same time, 15% of patients worldwide suffer from hospital-acquired diseases, and 4-56% are fatal depending on their type (Khan et al., 2017). For this reason, global health associations and national amentia have developed prevention protocols and recommendations to avoid infections; however, levels remain high due to varying degrees of compliance by hospitals.
The leading causes of hospital-acquired infections are related to facilities’ organizational and procedural aspects and the lack of patients and staff education. First, staff, especially nurses, are the main carrier of infection as they work with many patients, and particles of biological material can remain on their clothes, hands, and hair. However, despite the mandatory wearing of gloves, masks, uniforms, and handwashing, sometimes the medical staff neglects these measures due to workload, distractions, or a frivolous attitude towards the rule. A similar factor is also improper sorting of medical waste, which is hazardous in 10-25% of cases (Khan, 2017). Other violations are improper disinfection of reusable instruments, re-use of single-use equipment, or waste segregation in disregard of safety rules that lead to blood infections.
Another factor is poor organization and equipment of hospital premises, since overcrowded wards, public toilets, and showers increase the risk of infection, and lack of regular cleaning, medical waste containers, and sanitizers hinders the implementation of preventive actions. In addition, insufficient education of staff and patients leads to inappropriate care. For example, patients may not wash their hands or remove the catheters without help, and a nurse may not know about the need to turn the patient connected to ventilation every two hours (Wosti et al., 2017). Thus, these reasons demonstrate that hospital-acquired infections are a consequence of improper hospital organization.
Moreover, it should be noted that the main reason for the violation of the rules is the lack of procedures and organizational culture to ensure a safe environment. For example, if the administration does not provide its hospital with disinfectant for cleaning, or tanks for sorting medical waste, personnel cannot take precautions. Another example is the disregard of personal hygiene rules violations, as well as neglect of these standard safety procedures by senior staff or encouragement of its silencing. This hierarchy and the lack of lectures and safety education also discouraged staff from taking preventive measures.
The problem of hospital-acquired infections also negatively affects the health and safety outcomes and a hospital’s performance. First, the length of patients’ stay in the hospital increases due to the need to treat the acquired infection in addition to the primary diagnosis. This factor also influences hospital overload and staff workload. Second, patient satisfaction is diminished due to low quality of care. In addition, the hospital may suffer legal and financial consequences if, as a result of the hospital-acquired infection, the patient dies or remains impaired (Pyrek, 2016). Therefore, the problem of hospital-acquired infections requires a solution for the benefit of patients and the hospital.
Required Changes and Perceived Outcomes
The policy and rules for the prevention of hospital-acquired diseases are recommended or required by the world and national health institutions. For this reason, a high rate of hospital-acquired infections most often indicates weaknesses in the management and organizational problems of hospitals. Consequently, the main changes should be aimed at the hospital’s organizational culture, material maintenance, and the creation of procedures and safety rules.
First, an organizational culture that encourages adherence to ethical rules and principles must be adopted at all levels of the hierarchy. Senior staff should enforce rules and inspire, and junior employees should not be intimidated to note a mistake or complain to managers. Nurses have a critical role in this process as they can trace the infection source, such as surgery or poor hygiene practices by nurses or patients, and intervene. In addition, this organizational culture will encourage the education of staff to avoid infections, as well as motivate nurses to educate patients as they have the closest interaction with them. However, hospital administrators must provide facilities to maintain basic hygiene practices such as adequate supplies of gloves, soap, antiseptics, waste containers, and room disinfectants.
It is also vital to establish hospital policies and procedures for staff based on general standards of care and hospital features. These rules should include wearing uniforms, masks, new gloves for each patient, hand washing, disposal of medical waste, and practices for specific procedures such as catheterization or ventilation. These measures have proven their effectiveness and are simple for implications (Khan, 2017; Fernando et al., 2017). Knowing these rules and the penalties for not following them helps staff build a strong culture of safe care. In addition, these policies can also include ethical issues and situations, which facilitate decision-making for personnel. Thus, a moral and safe organizational culture will be a “pull factor” for staff, and sanctions will become “push factors” (Prakash, 2015). Consequently, patient safety and health outcomes will improve.
Moreover, since adherence to the rules will reduce hospital-acquired infection, this trend will also be reflected in a hospital’s performance. An ethical organizational culture promotes compliance with other policies, for example, the relationship between patients and staff. These changes will also reduce treatment costs, length of stay, lawsuits against the hospital, and increase patient satisfaction. Simultaneously, these steps have an equal priority, and their parallel implementation does not require significant investments.
Therefore, the analysis of the hospital-acquired infections problem demonstrates that its sources are most often the organizational deficiencies of institutions. Affordable and simple prevention methods, such as handwashing and wearing protective clothes, are widely studied. However, staff’s non-compliance with rules due to lack of equipment or adverse organizational culture leads to harmful consequences for patients and hospitals. Consequently, major changes should aim to promote a safe organizational culture that motivates employees to use simple preventive measures. The policies and rules directed at reducing implementation, as well as penalties for violating them, are necessary for this process. In addition, ensuring the resources to perform safety procedures is a critical aspect of preventing hospital-acquired infections and improving health and safety outcomes.
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