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Safety in nursing
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Abstract
Secondary infection is a significant problem within the treatment facility setting. It
affects all stakeholders, since they are all vectors for infection that can be harmless to one
demographic but cause substantial complications with others. For example, paediatric and
geriatric wards are especially susceptible to problems resulting from secondary infection.
However, the sources of and solutions to secondary infections problems within the treatment
facility environment can be traced to a lack of policing of proper procedure, and can be
carefully measured in order to best isolate the root cause of particular infections and infection
cycles.
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Part I: Root Cause Analysis of secondary infection vectors
Health and safety problem: Identification
The problem under discussion is the transfer of secondary infections to patients while
they are in treatment facilities. This consists of a group of sentinel events, depending on the
particular stakeholder, but should be treated as a single event due to the single problem –
patients receiving secondary infections while in treatment environments.
This is increasingly becoming a problem, and the significance of that problem is
likely to worsen over time as a greater variety of germ resistant bacteria such as MRSA
evolve within hospital conditions, and as increases in population density make it harder and
harder to control the germ environment of treatment facilities. As a result, this health and
safety issues has implications for all stakeholders in the treatment environment, from the
cleaners and canteen staff to doctors, visitors, and the setup of sanitation facilities around the
treatment centre.
Health and safety problem: definition
The problem under investigation is the transfer of germs both internal and external to
the treatment facility, and the ways in which this transfer can be minimised at all points of
contact between wards and between the treatment facility and the outside world. This will
include a different causal path, and therefore recommendation path, depending on the vector
of the particular transmission.
The behaviour and the event
For each stakeholder within the treatment facility, there are slight differences between
the particular behaviour and event that is of concern. Some of these events can be relatively
easily controlled through proper training, and others can only be remediated by changes in
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the treatment environment and its particular sanitation facilities and policed procedures and
rules.
In all cases, the event is identical; a patient currently undergoing care within a clinical
environment has their condition degrade due to a secondary infection carried by either
another person – either a patient, visitor, clinician, or non-clinical staff member. For each of
these stakeholders, the particular behaviours associated with this event, since their
transmission vectors vary. These vectors also vary within their trajectories.
For example, clinical staff are more likely to spread infection within specific wards,
since their duties keep them relatively geographically confined but involve close contact with
many patients in that environment. However, since they spend their time primarily within a
small clinical environment or their own homes, they are less likely to be the cause of
secondary infection transmission from the general population or between wards.
In contrast, non-clinical staff are the most likely vector for transmission between
wards, since they visit all parts of the treatment facility during their daily routines. They are
not in prolonged close contact with patients or clinical staff, and so do not have the same
likelihood of acting as a disease vector, but their movements increase the risk of transmission
across a broad area.
Visitors are the vector by which diseases that are otherwise not present within the
treatment facility are carried. These visitors are the primary way in which new infections can
arise within hospitals, since they are likely to come from an extremely broad demographic
and geographical and professional range. They are also much less likely to follow proper
sanitati0n procedures such as washing their hands, and as such are more likely to act as
vectors than the non-clinical staff.
Finally, patients themselves are often the cause of secondary behaviour. Because they
spend prolonged amounts of time in group settings within wards, the probability of cross-
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contamination is extremely high/ This is also increased when patients are allowed free access
to the treatment facility facilities, since this essentially means that spread cannot be easily
localised to quarantined; by the time a significant spread of secondary infection has occurred
it is quite likely that it will have spread across all but the most isolated areas of a treatment
facility.
Literature review
Secondary infections are a serious problem in any treatment facility, but these
problems become critical when one of three factors is in place. First, if the treatment facility
is in a high-density area, such as within mainland China or India. Secondly, if the area has a
high amount of mobility, with a population that is frequently going abroad, such as in New
York or London. Thirdly, if there are new germs that are resistant to the existing sanitation
measures, allowing them to spread quickly in environments that are assumed to be sterile or
at least clinically safe. In cases where all three of these factors attain, secondary infection
quickly becomes a serious problem. There are many case studies of situations such as these.
For example, in Saudi Arabia and the Middle East, a substantial problem is presented by
Dengue fever. This is investigated in Khan et al (2008)...