Executive summary
The main aim of every patient in the rehabilitation center is to learn to correct previous mental and psychological trauma that had changed their lives in one way or the other. These patients have hopes of repairing their already tarnished lives into a brand new one and any chance of contagious infection may negatively affect their healing process or expose them into a new problem as they go out to start their new lives. The current procedures that are allowed in the rehab which includes permitting the patients who have tested positive for MRSA and VRE infections to interact with other institution residents poses a threat of spreading this bacteria that is impossible to decolonize to the healthy residents (Arias, 2010) . The infection is mostly worse if the patient has open or dressed wounds or urinary infection with Foley catheter assistance in passage of urine.
This means that adopting isolation method whereby all the patients with the contingent infection are put in a private resident will ease the spread of the infection. The process involves conducting a routine purcpolymerase chain reaction test and all those testing positive for the antibiotic resistance bacteria whether infected or from previous colonization are put in isolation from the rest of the residents. The main reason for adopting isolation method is to prevent infecting the health patients and the visitors who comes into contact with those suffering from the infection. The process will include purchase of additional gloves, gowns and masks both for the patients and the medical personnel responsible for administering antibacterial medicine, wounds dressing and catheter treatments for the isolated patients.
Problem statement
This proposal focuses on the ways in which the issue of increased spread of bacterial infections in the long term health institutions as a result of contaminations from patients with antibiotics resistant infections would be regulated. Rehabilitation centers is a form of long term health institution of patients from diverse situations, some suffering from burns, cuts or other severe injuries and the rate of multiple bacterial infections is relatively high. A patient suffering from antibiotic resistant organisms particularly VRE (Vancomycin Resistant Enterococci) and methicillin resistant staphylococcus aereus (MRSA) which is mostly transmitted though physical contacts, respired or excreted in urine puts the people they are in contact with at a risk of infection (Brady, 209). This means that sometimes a patient suffering from MRSA or VRE with an open or dressed wound which has not been fully treated by taking antibacterial medicines is likely to infect other people he/she comes into contact with.
The current procedures adopted in the rehab permits the patients with dressed wounds or have undergone catheter treatment to interact with the fellow patients or the visitors as long as the wound is not open. This has facilitated spread of MRSA and VRE bacterial infections within and even outside the institution (Arias, 2010). As a way of reducing the spread of contaminations found in wounds, urine, nasal or skin contacts, it is necessary to change the current program practiced in health institutions especially in the rehabilitation centers which is a long term establishment for the patients by adopting a new strategies of addressing the issue of when a patient testing positive for the above antibacterial infections should be allowed to interact with other people in case they have a wound regardless of whether it is open, dressed or whether they have a Foley catheter.
Proposed change
The current measure includes frequent screening and treatment of patients with antibiotics resistant infections particularly Vancomycin Resistant Enterococci, VRE and methicillin resistant staphylococcus aereus, MRSA. However, according to a research conducted by the United States Health Protection Agency (2008), physical contacts between people is the major form of transmission staphylococcus bacteria regardless of whether the patient is taking antibiotics or not. This means that as long as those patients testing positive for HRSA or VRE in the rehab are allowed to interact with other people within the institution, there is likelihood that the bacteria will be spread to other potential host.
In an effort to reduce the spread of these antibiotics resistance infections which are contagious and hard to treat, the most likely proposal to handle the issue is adopt an isolation strategy for patients tested positive. Rehabilitation center is an long term care institution and the nature of patients present have various psychological issues that might inhibit them from taking precautions of infecting other people they come in contact with particularly managing body fluid discharge such as pus, mucus and saliva. This includes frequent hand washing with disinfectants, sneezing and coughing measures that control the spread of the bacteria. A process of isolating all the patients with the infection is the primary step to reducing this tremendous spread whereby those tested positive are put in a secluded place with strict surveillance by the medical practitioners until they finish taking the appropriate antibiotics prescribed to them for decolonizing the organism.
Isolation procedure includes giving patients private residential rooms with fully equipped sanitation facilities, isolated dining area and utensils and recreation facilities. This ensures that the bacteria are not spread during these critical times which all the rehab patients have to undergo while in the institution. In addition to decolonization, patients in isolation should be provided with dry clothing and gowns to reduce the growth of the bacteria. This is necessary for patients with a Foley catheter, open or dressed wound which especially is caused by MRSA or VRE infection or colonization (Singh, 2010). Apart from isolating patients with the antibiotic resistant bacteria, those medical practitioners and caretakers should also be separated in such a way that they isolate the items they use in these patient in isolation (Chen, 2010). Items such as gloves, gowns and washing machines used in the isolation area should not be mixed with other items within the institution to reduce the risk of contaminating other residents’ clothing.
The institution should also provide a permanent isolated resident for patients who have been permanently colonized with the bacteria. Although colonization is less harmful to the patient, the bacteria can be transmitted to other people the patient comes in contact with even without their knowledge.
Justification
The main reason for this idea is due to the rising MRSA and VRE bacterial infection rate in the rehabilitation centers both to the visitors, other patients, medical care providers and other care givers and residents within the institution. Isolation strategy is the best way of protecting these people from potential infections. The rate of infection from skin and nasal contamination to health people contributes to 25-30 percent. Also the process of isolation, although it has high initial cost of purchasing the necessary protective clothing and additional buildings, will ease the institution from purchasing expensive decolonization antibacterial medicine for treating all the infected residents.
Anticipated cost
There are several additional materials necessary for the process among which includes protective gowns, gloves, masks and addition linen for the isolated patients.
Gloves per pair $ 8.45
Gowns $ 30.21
Masks $ 108.50
Medical shoe covers $ 18.05
Disinfectants and other necessities $ 115.00
Total cost per person $ 280.21
Budget for 100 patients $ 28, 021.00
Collaborators
The program needs the institution’s management and stakeholders’ approval for it to be effective. The relevant collaborators include the ministry of health, government to assist in funding and the NHS. The NHS is required for further research on the effectiveness of the isolation proposal and the benefits of its adaption.
Isolation is the suitable way of preventing further infections of the bacteria in the long term healthcare facilities such as the rehabs and if properly utilized, the cases of infected or colonized MRSA and VRE cases will be reduced tremendously.
References
Arias, M.K. (2010). Outbreak Investigation, Prevention, and Control in Health Care. New York, Routledge.
Brady, R. et al (2009) A prevalence screen of MRSA nasal colonization amongst UK doctors.
Chen, P. (October, 2010). Putting Barriers between Doctor and Patient. Vol 6. retrieved from www.blogs.nytimes.com
Deleo, F. R et al (2010). Community-associated meticillin-resistant Staphylococcus aureus. Lancet Press.
Lautenbach, E. ET al. (2010). Practical Healthcare Epidemiology. (3rd Ed). University of Chicago Press.
Singh, D. (2010). Effective Management of Long Term Care Facilities. Oxford Press.
