Nursing care for patients with a nephrostomy is a highly demanding activity accompanied by many complicated medical procedures and various problems with a tube, including misplacement or occlusion. In this regard, nurses should possess the necessary knowledge and skills concerning the appropriate management of patients with a nephrostomy to minimize readmissions and infection risk. This paper aims at examining the situation related to infection control concerning nephrostomy based on evidence from the Agency for Healthcare Research and Quality (AHRQ) and giving respective recommendations.
In every healthcare facility, infection control represents a fundamental issue that requires persistent and careful consideration and substantial efforts to be addressed since hospital-acquired infections (HAIs) are associated with increased mortality and morbidity. For example, according to the Agency for Healthcare Research and Quality, one out of every twenty hospital patients contracts at least one HAI (“Eliminating CAUTI,” 2013). Clostridioides difficile, catheter-associated urinary tract infection (CAUTI), Staphylococcus aureus, and line-associated bloodstream infection are among the most widespread contagions. In particular, the Centers for Disease Control and Prevention calculated that, in 2011, C. diff comprised approximately half a million infections and produced 29 thousand deaths within 30 days from the initial diagnosis (“AHRQ safety program,” 2017). In the case of nephrostomy, the foreign body puncturing the kidney exposes patients to a high risk of developing pyelonephritis causing acute kidney inflammation. In this regard, an individual can have symptoms of sepsis, loin pain, fever, elevated temperature, and even purulent urine output leading to a severe deterioration of vital signs. In addition to considerable harm to health, contracted infection imposes a massive financial burden on the budget of consumers, their families, and the healthcare system.
The worst problem is that many HAIs not only can spread rapidly in a hospital setting but also acquire antibiotic resistance, especially when misused. For instance, each year in the United States, of over two million nosocomial infections, about 50-60 percent are induced by antibiotic-resistant organisms (Babcock & Fraser, 2003). Six bacteria related to CAUTI and surgery, namely Staphylococcus aureus, Enterobacteriaceae, multi-drug resistant pseudomonas, extended-spectrum ß-lactamases, and multi-drug resistant Acinetobacter, are determined as the most lethal antibiotic-resistant bacteria (“Making Health Care,” 2016). Numerous factors can contribute to growing antibiotic resistance, such as severe immunosuppression, prolonged length of hospital stay, inadequate or incorrect application of insulation and barrier measures, and excessive use of empiric and prophylactic antibiotics (Babcock & Fraser, 2003). It is worth noting that antibiotic treatment with broad-spectrum agents and at an early stage demonstrates the highest effectiveness in managing HAIs.
Recommendations for Infection Control
In this regard, to prevent infection transmission, clinicians, nurses, and patients should follow precaution guidelines established by WHO together with other organizations, such as the Centers for Disease Control and Prevention. These guidelines consist of standards and recommendations for hand and respiratory hygiene and cough etiquette, barrier protection, decontamination, antibiotic stewardship, environmental cleaning, and waste disposal, among others. Currently, as mentioned-above statistics show, most healthcare providers, especially in developing countries, fail to ensure precaution against infection measures, which results in adverse consequences for patients and the nation’s safety overall.
For this reason, the international and national governments should primarily focus on developing appropriate and valid antibiotic stewardship policies that include norms and standards regarding antibiotic application and consumption. Moreover, the spread of infections, particularly during outbreaks, is mainly caused by the insufficient adherence to the rules of personal hygiene and disinfection of surfaces often touched. Thus, it is recommended to advance proper hygiene practices and decontamination strategies among healthcare providers and consumers. Finally, hospital managers should pay close attention to organizational and human-related factors, especially clinical workloads. For example, in their study, Hugonnet et al. (2007) concluded that staffing is a critical factor of HAI dissemination and that the maintenance of nurse staffing at a higher level could prevent this phenomenon. Training new staff and language competence can also be both facilitators and obstacles to ensuring compliance to infection control policies.
Comprehensive Unit-based Safety Program
In this context, it should be indicated that the AHRQ, along with the US Department of Health and other federal organizations, has developed the Comprehensive Unit-based Safety Program (CUSP). The program targets enhancing antibiotic use in long-term acute ambulatory care conditions by promoting the appropriate antibiotic stewardship in daily clinical practice via Four Moments of Antibiotic Decision Making (“Antibiotic Stewardship Toolkits,” 2019). In particular, the first moment implies that clinicians should determine the relevance of initiating antibiotic therapy by reviewing all necessary clinical and laboratory data. The second moment indicates the importance of ensuring that relevant cultures are gathered before antibiotic therapy is begun. The third moment highlights the necessity of estimating the pertinence for continuing antibiotic therapy over some time of the treatment. The final moment can be applied after the definition of a patient’s diagnosis and recommends utilizing the shortest efficient antibiotic duration for treating the infectious process.
In summary, the paper has explored the situation associated with infection control in the context of nephrostomy based on evidence from the Agency for Healthcare Research and Quality (AHRQ) and given respective recommendations. The critical problem of infection management is principally conditioned by both the fast spread of HAIs in hospital settings and the quality of bacteria to acquire resistance to specific antibiotics. The primary barriers are related to the lack of healthcare providers’ competence to ensure compliance with precaution infection measures, resulting in adverse consequences for patients and nation safety overall. In this regard, different healthcare organizations, including the AHRQ, developed guidelines and programs facilitating adequate antibiotic use in long-term acute ambulatory care conditions by advancing the appropriate antibiotic stewardship.
AHRQ safety program for improving antibiotic use. (2017). Agency for Healthcare Research and Quality. Web.
Antibiotic stewardship toolkits. (2019). Agency for Healthcare Research and Quality. Web.
Babcock, H. M., & Fraser, V. J. (2003). Inappropriate antibiotic use. Agency for Healthcare Web.
Eliminating CAUTI: Interim data report. (2013). Agency for Healthcare Research and Quality. Web.
Hugonnet, S., Chevrolet, J. C., & Pittet, D. (2007). The effect of workload on infection risk in critically ill patients. Critical Care Medicine, 35(1), 76–81.
Making health care safer: Protect patients from antibiotic resistance (2016). The Centers for Disease Control and Prevention. Web.