Healthcare-associated infections (HAIs) Essay

BACKGROUNDHealth bursting charge-associated transmissions (HAIs) ar bacterial infections farmd during a diligents bind in a health c be invention. It imposes a huge burden on healthc atomic number 18 bases, costing billions of dollars for special c ar costs as good as a indicationifi dropt disunite of lost lives (Houghton, cc6). Current estimates depict that approximately 2 million diligents acquire health care-associated infections (HAIs) or nosocomial infections to severally one year, of which 90,000 to 100,000 long-sufferings die (Houghton, 2006), making HAIs non further a matter health problem, precisely a global nemesis as well. Common HAIs include hematological, functional site, dermatological, respiratory, urinary and gastrointestinal administrations. In night club to guarantee the increase in number of healthcare-associated infections, it is fundamental to notice key factors that make healthcare institutions susceptible to much(prenominal) outbreaks. on that point is a pick up to esteem the sensitiveness and efficiency of healthcare institutions to healthcare-associated infections in social club to preclude future outbreaks.PROBLEM STATEMENT This choose exit tail assemblyvass the sensitivity of staining and efficiency of insurance insurance coverage healthcare-associated infections to the hospital administration, in the consideration of providing measures in improving the trustpricey surveillance program in the country. The guide termination of businesss to appellation of a healthcare associated infection ordain be evaluated by means of in the flesh(predicate) interactions with healthcare workers utilisation questionnaires which allow be designed victimisation a bigeminal choice approach.CONCEPTUAL/THEORETICAL FRAMEWORK This study is base on the need to address the current epidemic of healthcare-associated infection that is emerge close to the world. Before an effective solution to the problem is designed, it is essential that shortcomings in the standard procedures of healthcare institutions be determine. This whitethorn be through by determining the direct of sensitivity of healthcare personnel to symptoms of healthcare-associated infections, as well as knowing what are the first set of actions to be done once an infection is substantiate within a healthcare institution. This study whitethorn serve as the first measurement tool that addresses these aspects of the global epidemic.RESEARCH QUESTION/HYPOTHESIS This investigation purports to address the question of whether the current hospital administration is sensitive enough to detect and substantially cost-efficient to report to healthcare institutions either incidents of healthcare-associated infections. This pull up stakes be directly evaluated apply survey selective information compendiums from retrospective matters of particular health institutions as relate to dates of hospital admission, s tandation of infection and treatment cartridge holder.SIGNIFICANCE OF THE STUDY There is a need for an effective surveillance and control program for healthcare-associated infections that are based on current settings in a healthcare institution. through with(predicate) surveys that inquire on green practices and solutions of healthcare workers, any shortcomings or avertable gaps in the hospital system whitethorn be reformed, which in arise lead alleviate the dispersed of infection in the healthcare institutions. brush up of aesculapian records and interviews with attending healthcare personnel impart be performed in order to teach whether in that respect are certain discrepancies and gaps in the healthcare protocol that facilitate defilement and further mete outing of infectious microbials around the healthcare institution. This study whitethorn facilitate the identification of key factors that sour the increase in frequency of nosocomial infections in hospitals. Th e outcomes of this investigation whitethorn supremely serve as a tool to healthcare workers much(prenominal) as nurses and laboratory technicians.STATEMENT OF THE PURPOSE (OBJECTIVES) This research entrust determine the sensitivity and response rate of healthcare workers to healthcare-associated infections. This proposal aims to develop a measurement tool that bequeath determine the sensitivity for identification, efficiency of reporting and the response rate to a healthcare-association infection, with the aim of designing a cost-effective and quick way of controlling and ultimately eradicating the healthcare-related problem.LITERATURE REVIEW The measure and control of HAIs requires a comprehensive approach that addresses as many pathogens as possible (Wiseman, 2006). Urinary tract infections (UTI) associated with catheter use are the most common HAIs, with hospital-acquired pneumonia having the highest mortality rate (Houghton, 2006). These infections are frequently problemat ic to treat collect to the fact that the microorganisms involved defecate become resistant to antibiotic doses (Broadhead, Parra and Skelton, 2001). Recent media coverage of meticillin-resistant staph aureus (MRSA) has increased the awareness of healthcare professionals to the threat of this particular microbe. S. aureus infections can result in cellulitis, osteomyelitis, septic arthritis and pneumonia, and approximately of the systemic diseases such as food poisoning, scalded skin syndrome and toxic shock syndrome (Zaoutis, Dawid and Kim, 2002). MRSA and vancomycin-resistant Enterococcus (VRE) are the primary causes of nosocomial infections and are significant factors in increased morbidity and mortality judge. These microbes are currently endemic in many healthcare institutions, particularly problematic in intensive care units (intensive care units) (Furuno, et al. 2005). VRE Infections have become prevalent in U.S. hospitals over the last decade, increasing in relative in cidence 25-fold (Ridwan et al., 2002). Vancomycin is the antibiotic frequently used to treat infections caused by MRSA, tho recent years have seen the emergence of Staphylococcus aureus infections that have high- confrontation to vancomycin, which makes the future effectiveness of this drug questionable (Furuno et al., 2005).All know variants of the vancomycin-resistant Staphylococcus aureus (VRSA) isolates have possessed the vanA gene, which carries with it immunity to vancomycin. This development is believed to have been acquired when the MRSA isolate conjugated with a co-colonizing VRE isolate (Furuno et al., 2005, p. 1539). This inwardness that patients who suffer co-village from MRSA and VRE have an increased attempt for colonization and infection by VRSA (Furuno et al., 2005). Further more than, Zirakzadeh and Patel (2006) stated that VRE has become a major concern due, in part, to its baron to transfer vancomycin resistance to otherwise bacteria, which includes MRSA. I nfection of susceptible patients typically occurs in environments that have a high rate of patient colonization with VRE, such as ICUs and oncology units (Zirakzadeh and Patel, 2006). In these healthcare settings, VRE has been known to survive for massive periods and research has besides detect that VRE has the ability to contaminate virtually e really surface (Zirakzadeh and Patel, 2006). Efforts to control HAIs, such as VRE, have focused on prevention, such as through hatful hygienics, as the first line of defense. Hand hygiene has been repaird by employ user-friendly, intoxicant-based hand cleansers, but there still remains the goal of achieving consistently high directs of meekness with their use (Carling et al., 2005, p. 1). Screening-based closing off practices have likewise improved transmission range of MRSA and VRE however, logistic issues and the cost-effectiveness of these practices are still being study (Carling et al., 2005). Additionally, despite isolation practices, outbreaks and instances of environmental befoulment have been documented in regards to MRSA, VRE and Clostridium difficile, which cannot be screened with any practicality (Carling et al., 2005). The numerous obstacles that exist in regards to effective screening practices show that a focus on improving existing cleaning/disinfecting practices may prove to be more effective in halting the spread of HAIs (Carling et al., 2005). Studies over the last several decades have shown that there is often contamination of surfaces in and around the patient, as pathogens associated with the hospital environment have been known to survive on surfaces for weeks or even months (Carling et al., 2005). Significant rates of contamination with Clostridium difficile have been connected with symptomatic and asymptomatic patients (Carling et al., 2005). In 2002, the CDC issued guidelines that called for hospitals to good clean and disinfect environmental medical equipment surfaces on a cease less founding (Carling et al., 2005, p. 2). Other organizations have followed suit and stressed repeatedly the need for healthcare provides to focus on environmental cleaning and disinfecting activities, yet these guidelines have not provided directives that address precisely how healthcare providers can either evaluate their ability to comply with professional guidelines on this topic or visualise that their procedures are effective (Carling et al., 2005). Nevertheless, literature on the subject does offer some guidance. care, evidence-based infection control practices and the responsible use of antibiotics have been determined to be crucial to controlling HAIs (Wiseman, 2006). The establishment of comprehensive surveillance programs has facilitated the creation of national databases the compile cases of infection which may be useful to researchers investigating advance rates and causal factors. Evidence-based control practices may be implemented by distributing guidelines for aseptic hospital protocols, hospital hygiene, personal protective equipment and disposal of biohazardous sharps. A review of comm tho used antibiotics in terms of proper sexually transmitted disease and distance of treatment based on clinical evidence and trump out practice guidance should also be performed. Curry and Cole (2001) inform that the medical and surgical ICUs in large inner-city teaching hospitals developed an rare patient VRE colonization rate. A multi-faceted approach was instituted to correct this problem, which involved changing behavior by shifting norms at multiple levels through the ICU conjunction (Curry and Cole, 2001, p. 13). This intervention consisted of five levels of behavioral change. These encompassed 1. intrapersonal and individual factors 2. interpersonal factors 3. institutional factors 4. community factors and 5. public factors (Curry and Cole, 2001, p. 13). Educational interventions were developed that addressed each level of influence and beh avioral change was predicated on modeling, observational learning and vicarious reinforcement (Curry and Cole, 2001, p. 13). These procedures resulted in a marked decrease of VRE surveillance cultures and positive clinical isolates within six months and this decrease has been consistent over the nigh dickens years (Curry and Cole, 2001, p. 13). Research has shown that the nutritional status of preoperative and perioperative patients can influence their risk for acquiring a HAI (Martindale and Cresci, 2005). This is particularly true for patients who are undergoing surgery for neoplastic disease as this can commonly result in immunosuppression (Martindale and Cresci, 2005). Inadequate nutrition, surgical insult, anesthesia, origin transfusions, adjuvant chemotherapy/radiation/ and other metabolic changes have been place as contributing to suppression of the insubordinate system (Martindale and Cresci, 2005). Furthermore, studies have also associated infection risk with glycemic control Maintaining blood glucose levels between 80 and 110 mg/dL vs. 180 and 200 mg/dL has been shown to result in fewer instances of acute nephritic failure, fewer transfusions, less polyneuroopathy and decreased ICU length of stay (Martindale and Cresci, 2005, p. S53). Citing Ulrich and Zimring, Rollins (2004) states that get rid of double-occupancy get ons and providing all patients with single rooms that can be adjusted to meet their specific medical needs can improve patient safety by reducing patient transfers and cutting the risk of nosocomial infections. While these researchers admit that the up-front cost of private rooms is significant, this result be offset by the savings accrued through lowers rates of infection and readmission, as well as shorter hospital stays (Rollins, 2004). A recent study conducted by researchers at Chicagos heraldic bearing University aesculapian Center found that enforcing environmental cleaning standards on a routine rump resulted in less surface contamination with VRE, dry-cleaned healthcare worker give, and a significant reduction in VRE cross-transmission in an ICU ( make clean campaign, 2006, p. 30). These improvement in VRE contamination continued to be see even when VRE-colonized patients were continually admitted and healthcare workers compliance with hand hygiene procedures were only moderate (Cleaning campaign, 2006). The strategies that the researchers implemented included that theyheld in-services for housekeepers about why cleaning is heavyemphasizing thorough cleaning of surfaces likely to be refered by patients or workers.increased monitoring of housekeeper performance.recruited respiratory therapists to clean ventilator control panels daily.educated nurses and other ICU staff on VRE and how they could assist housekeepers by clearing surfaces that need cleaning.conducted a hand hygiene campaign, including mounting alcohol gel dispensers in common areas, patient rooms and every room entrance (Clean ing campaign, 2006, p. 30). CDC guidelines indicate that if hands are not visibly soiled, using an alcohol-based hand rub should become habitual between patient contacts. When hands are visibly soiled, use of an anti-microbial soap and water is required. If contact with C difficile or Bacillus anthracis is possible, it is recommended that the healthcare provider wash with anti-microbial soap and water, as other antiseptic agents have poor talent against spore-forming bacteria and the physiological friction of using soap and water at least decreases the level of contamination (Houghton, 2006). Page (2005) indicates that the CDC has joined with the US Department of Health and tender Services, the National Institutes of Health (NIH and the Food and Drug Administration (FDA) to lead a task force of 10 agencies and departments, which have developed a pattern outlining federal actions to beleaguer this problem. This template emphasizes the efficacy of hand laundry, among other point s (Page, 2005). In 2002, the CDC issued updated hand hygiene guidelines, which address young development and research on this topic, such as alcohol-based hand rubs and alternatives to antibacterial soaps and water (Houghton, 2006, p. 2). However, while the efficacy of hand hygiene is well accepted, it is also well known that healthcare workers of all disciplines frequently fail to abide by adequate hand hygiene practices (Houghton, 2006, p. 2). In fact, research has shown that adherence rates to hand hygiene guidelines are lowest in ICUs, where to the frequency of patient care contact, multiple opportunities for hand hygiene exist on a hourly basis (Houghton, 2006). According to Houghton (2006), any direct patient-care contact, which includes contact with gloves and/or contact with objects in the immediate patient vicinity, constitutes an opportunity for appropriate hand hygiene. This suggests that the proposed intervention should also include asking healthcare employees at the si te of the intervention to embark in a survey that examines, first of all, how closely hand hygiene protocols are followed and, if they are not followed, why not. It may be that the action at law level of ICUs is so great that the practitioners feel that they cannot take sufficient time to do adequate hand hygiene. If this is the case, alternative methods of hand hygiene to that institutions traditional policy may need to be investigated. fair(a) as this study revealed factors that can be associated with non-compliance, a standardized investigative effort may be called for to determine reasons why compliance may not be satisfactory for cleaning/disinfecting environmental surfaces. Again, it may be that non-compliance hinges on factors of time. It may be, therefore, expeditious for hospitals and other healthcare organizations to look into hiring additional personnel to aid with cleaning/disinfecting tasks. It may also prove necessary, to oversee with factors of time and efficienc y, to train cleaning personnel to take a doctrinal approach to patient room cleaning that includes all high touch areas. As noted previously, researchers at Chicagos Rush University health check Center found that holding in-service training for housekeepers was an effective component of their boilers suit strategy in lowering VRE related infections (Cleaning campaign, 2006). This process could be facilitated by a checklist approach or by periodically reevaluating rooms jibe to the Carling et al. (2005) methodology. Given these detailed accounts of healthcare-associated infections in hospitals, it is of significant importance that the sensitivity and response rate of health personnel be identified in order to know if there are any discrepancies and gaps in the standard hospital protocols that foster the expansion of microbials in hospitals. This study aims to determine the level of sensitivity and response rate of healthcare institutions to the growing epidemic of healthcare-asso ciated infections.SUMMARY HAIs are an unnecessary tragedy, increasing morbidity and mortality figures and adding to healthcare costs. While there are ways to treat all the various HAIs, the clearest remedy for this insidious drain on healthcare resources and personnel is prevention, which begins with the simplest of actswashing ones handsbut also extends to considering all hospital surfaces as having the likely to harbor pathogens. This means rethinking some healthcare institutional procedures. It means habitually and routinely cleaning all surfaces, as well as over and anything that is routinely touched, whether by a bare or gloved hand. lemniscus the spread of HAIs includes multiple factors, such as restrained and appropriate use of antibiotics. However, the first line of defense is cleaning/disinfecting procedures. This constitutes the ground zero foundational line for battling HAIs and this means that all healthcare practitioners should keep the goal of reducing the spread o f HAIs foremost in their minds while going about their daily routines, washing hands between each patient contact and paying circumspection to other sepsis concerns. In other words, the first step in lemniscus HAIs is simply to keep them in the forefront of practitioner consciousness.ReferencesBroadhead, J. M., Parra, D. S., & Skelton, P. A. (2001). Emerging multiresistant organisms in the ICU Epidemiology, risk factors, surveillance, and prevention. Critical Care Nursing Quarterly, 24(2), 20.Carling, P. C., Briggs, J., Hylander, D., & Perkins, J. (2006). An evaluation of patient area cleaning in 3 hospitals using a clean targeting methodology. American Journal of Infection Control, 34(8), 513-519.Centers for sickness Control and Prevention. (2006). Healthcare-Associated Infections (HAIs). Retrieved March 17, 2007, from http//www.cdc.gov/ncidod/dhqp/healthDis.htmlCleaning campaign targets VRE transmission. (2006). OR Manager, 22(7), 30.Curry, V. J., & Cole, M. (2001). Applying s ocial and behavioral theory as a template in containing and confining VRE. Critical Care Nursing Quarterly, 24(2), 13.Furuno, J. P., Perencevich, E. N., Johnson, J. A., Wright, M.-O., McGregor, J. C., Morris Jr, J. G., et al. (2005). Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococci co-colonization. Emerging infectious Diseases, 11(10), 1539-1544.Harrison, S., & Lipley, N. (2006). Wipe It Out infection control scuttle extended. Nursing Management UK, 12(10), 4-4.Houghton, D. (2006). HAI prevention The power is in your hands. Nursing Management, 37(5), 1-8.Johnson, A.P. Pearson, A. and Duckworth, G. (2005) watch and epidemiology of MRSA bacteraemia in the UK. J. Antimicrob. Chemo. 56455462.Lopman, B.A., Reacher, M.H., Vipond, I/.B., Hill, D., Perry, C., Halladay, T., Brown, D.W., John Edmunds, W. and Sarangi, J. (2004) Epidemiology and Cost of Nosocomial Gastroenteritis, Avon, England, 20022003. Emerg. Infect. Dis. 10(10)1827-1834.Martindale, R. G., & Cresci, G. (2005). Preventing Infectious Complications With Nutrition Intervention. JPEN, Journal of Parenteral and Enteral Nutrition, 29(1), S53.Page, S. (2005). MRSA, VRE and CDCs plan to combat antimicrobial resistance. Vermont Nurse Connection, 8(3), 6-7.Parienti, J. J. M. D. D. T. M., Thibon, P. M. D., Heller, R. P. P., Le Roux, Y. M. D. D., von Theobald, P. M. D. D., Bensadoun, H. M. D. D., et al. (2002). Hand-rubbing with an aqueous alcoholic aolution vs traditional surgical hand-scrubbing and 30-day surgical site infection Rates. JAMA, 288(6), 722-727.Ridwan, B., Mascini, E., Reijden, N. v. d., Verhoef, J., & Bonten, M. (2002). What action should be taken to prevent spread of vancomycin resistant enterococci in European hospitals? British Medical Journal, 324(7338), 666.Rollins, J. A. (2004). Evidence-Based Hospital Design Improves Health Care Outcomes for patients, Families, and Staff. Pediatric Nursing, 30(4), 338.Sheff, B. (2001). Taking aim at antibiotic-resistant b acteria. Nursing, 31(11), 62.STATA 8.0. College Station (TX) STATA Corporation 2002.Stevenson, K.B., Searle, K., Stoddard, G.J. and Samore, M.H. (2005) Methicillin-resistantStaphylococcus aureus and vancomycin-resistant Enterococci in rural communities, westbound United States. Emerg. Infect. Dis. 11(6)895-903.Tacconelli, E. Venkataraman, L., De Girolami, P.C. and DAgata, E.M.C. (2004) Methicillin-resistant Staphylococcus aureus bacteraemia diagnosed at hospital admission distinguishing between community-acquired versus healthcare-associated strains. J. Antimicrob. Chemother. 53474-479.Wiseman, S. (2006). Prevention and control of healthcare associated infection. Nursing Standard, 20(38), 41-45.Zaoutis, T., Dawid, S., & Kim, J. O. (2002). Multidrug-resistan organisms in common pediatrics. Pediatric Annals, 31(5), 313.Zirakzadeh, A., & Patel, R. (2006). Vancomycin-resistant enterococci Colonization, infection, detection and treatment. Mayo Clinical Proceedings, 81(4), 529-536.METHO DOLOGY A retrospective non-probability cluster surveillance study entrust be performed on hospital records of two health institutions, Assir Central Hospital and Khamis Mushait Hospital from January 2002 to declination 2006. much(prenominal) coverage leave behind symbolise a larger race of similar environmental and socioeconomic settings, which may also influence the frequency of healthcare-associated infections in the area. This type of non-probability cluster sampling result be used because it testament benefit the split-level definition that result be followed, distinguishing normal hospital cases and healthcare-associated infections or outbreaks, based on the CDCs guidelines for healthcare-associated infections. Ethical approval from the respective(prenominal) ethics review committee of each hospital leave be obtained onward the study will be conducted.Study population. Th study population will includ 5,000 patints that have been admitted at the Assir Central Hospita l and Khamis Mushait Hospital from January 2002 to December 2006. These hospitals were chosen in order to primarily focus on appealingness of reliable, high-quality data based of systematic sampling. The hospitals administrative database will serve as the main source of instruction for this study. For purposes of anonymity, patients realizes will be kept confidential and will be replaced with a case number instead. A retrospective non-probability sampling using patint cases will be classified according to gender, age, diagnosis upon admission, length of stay and treatment received.The treatment category of the patients will be further characterized as surgical, respiratory, urinary, urological, obsttrical, intensive care, cardiac or trauma. Any co-morbidities will be taken note of in every patient included in the study. Patient records will also be reviewed to determine whether and when a healthcare-associated infection was observed after admission to the hospital or during the p atients stay in the hospital and will be identified as the time-at-risk, or the time when the infection has been ascertained and may most probably be contagious to the patients immediate environment. Among the inclusion subjects are healthcare workers such as nurses, laboratory technicians and other hospital staff elements will be included in the study as population at risk. Exclusion subjects are those patients that were not admitted into the hospital because their stay in the hospital was not recommended during their healthcare. The database of the infection control team of each of the two hospitals will be reviewed to gather information on the study population in the hospitals. Infection control nurses are responsible for monitoring any outbreaks in each hospital during hospital ward rounds, or are identified as the point-of-contact personnel that is alerted as soon as an HAI incident is hazard to occur in the specific ward of the hospital. Cluster sampling will be performed wh en an infection does happen that fits the clinical definition of an HAI, the healthcare institution is required to report this incident to the areas or countys health protection office. The area or county health protection agency is in charge of ensuring the comprehensiveness of incident reports, monitoring data entrance and conducting analyses. The health protection agency also collects reports during months that no infections were account to range that no infections occurred at that time.Tools to be employed. To determine whether a case patient has contracted a healthcare-associated infection, the system definitions established by the Center for Disease Control and Preventions National Nosocomial Infection Surveillance (NNIS) will be followed, with slight modification for us in a rtrospctiv study. Th NNIS dfinitions were dvlopd according to a prospctiv approach to hospital survillanc and ar dsignd to b quit spcific. Bcaus clinical dcisions ar oftn not mad on th basis of survil lanc dfinitions, w bliv that som cass of clinically suspctd infction would mt most but not all of th NNIS critria and thus b classifid as non-HAI, spcially on a rtrospctiv chart rviw.W designed a retrospective-based data classification scheme that follows the following criteria patints who were not infctd, thos with suspctd HAI, and thos with averd HAI. In gnral, patints with suspctd HAI will includ thos who have received antimicrobial thrapy for a condition that appard 148 h aftr hospital admission and who will mt all but on clinical critria for a confirmed infction. Dfinitions for a confirmed HAI will b the sam as thos usd by th NNIS, xcpt that rcipt of appropriat antimicrobial thrapy will b xcludd as a critrion for a confirmd infction. Ths critria will b finalizd bfor chart data abstraction bgins. Th conomic prspctiv will b usd for masuring costs incurred by th hospital, bcaus th hospital administration will b th dcision makr for instituting and financing infction control progra ms.Data collction. Clinical cases of healthcare-associated infection identified by the clinical laboratories of the two participating hospitals will be compiled. Demographic, medical history and other epidemiologically relevant data on each reported case will be pile up. The microbiology laboratory of the hospital may also contribute information to the data collection. The patients medical record will serve as the primary source of information for this study. The data collected will be recorded in a standardized data collection form. In addition, outbreak or infection summary forms that were previously completed by infection control nurses and reported to health protection agencies as a healthcare-associated infection will be collected and integrated into the study database.The duration of an outbreak will be determined by taking note of the date the first case of the infection was reported and correlating this date to the date when the last case of the infection was reported at th e healthcare institution (Lopman et al. 2004). All data will abstracted from patint mdical rcords of the healthcare facility. Intrratr rliability will not b masurd, bcaus ach abstractor will b focusd on rcording a singl lmnt of data for ach patint, similar to an assmbly lin. All data gathering will b dirctly suprvisd by a member of the research program. Patints with suspctd or confirmd HAI will b idntifid on th basis of thir vital signs, laboratory and microbiology data, and clinical findings documntd in the respective physicians progrss and consultation nots.To improve the hardihood of the collected data, the following approaches (Stevenson et al. 2005) will be employed 1) a data mental lexicon and operations manual will be created with explicit instructions for termination of the data collection forms 2) the data collection protocol will be discussed during conference calls along with frequent one-on-one communication and 3) anomalous data in the data reports will be routinely searched for and corrected. The definitions employed in this study will concentrate on the location of the patient at the time of microbiological testing for infection diagnosis, and the presence or of exposure to the healthcare environment.The study will emphasize the time of response of any member of the healthcare institution to the definitive diagnosis of the healthcare-associated infection (Johnson et al. 2005). individually identified HAI case will be further analyzed for its causative agent, such as MRSA or VRE. All included in this study were HAI cases with any prior history of hospitalization, out-patient surgery, residence or care in a home/health agency with documented healthcare-associated infections in the last 6 months. Examples would include former out-patient cases with post-operative infections. Other coexisting factors that may be associated with healthcare-associated infections such as diabetes mellitus, immunosuppression, renal failure and other antimicrobial dr ug treatments, will also be included in the data collection form.The incidence rates of each type of healthcare-associated infection will be mensural for each hospital from January 2002 to December 2006. Any patient cases that could not be ascertained to be completely reported in the medical records will not be included in the analysis. The incidence rates will be expressed as the number of healthcare-associated infections per 10,000 patient-days or number of community cases per 10,000-person-years, based on county population (Taconelli et al. 2004).Instruments including reliability and validity. A data collection form will be designed for use in this investigation. indwelling entry data will include case number (patient name is kept confidential), hospital name, date of admission, diagnosis upon admission, treatment regime, date of detection of healthcare-associated infection, treatment of healthcare-associated infection, date of admission of treatment of healthcare-associated in fection, identification of HAI etiologic agent, resistance of HAI etiologic agent and date of patient discharge. The healthcare institution personnel that have attended to the patient will also be noted, such as attending physician, consults, nurses, technicians and technologists. In order to ensure reliability and validity of the data inputted into the application form, only medical records that have been completely fill will be used in this investigation. In addition, there will be questions in the application form that will determine whether the patient has undergone any previous exposure to any hospital for outpatient or inmate hospital or nursing facility in the last 6 months. This is done to make sure that the source of the HAI is determined, whether it is coming from within the hospital or from another healthcare institution.Data Analysis. The collected data will be entered and stored in an AccessTM relational database (Microsoft, Redmond, WA) for analysis. AccessTM is a data base management system that is very useful for handling and manipulation of data that are designed in the query format. It provides the analyst an easier way to extract data from the database according to selected palm or variables, as well as compare or compound two variables at one time.Data analyses will be performed using Microsoft ExcelTM and Stata 8.0 (2002). Proportions of total cases meeting specific epidemiologic criteria will be calculated, and characteristics of each category will be compared by using Fisher incubate testing. To compare means, the t-test will be employed, and to compare proportions, the 2 test will be used. All continuous data will be analyzed using linear regression. To assess linear correlations between two variables, the Spearman commit test will be used. Census data and ages of patients in each category will be compared using the Kruskal-Wallis equality of populations rank test. The kind of healthcare institution response rates to the infection and other covariates will be modeled by using random effects Poisson regression.Each hospital will be taken into account as a unit and treated as a random effect. During th sign phas of data collection, dscriptiv statistics will be used to dscrib and summariz th data obtained in th study. Th scond phas of analysis will focus on th us of multivariat analysis to dtrmin th rlationship btwn variables such as length of stay and the severity of infection. This will b conductd through th us of cross tabulation of nominal data btwn slctd variabls in th study. Statistical significanc is to b st at an of import lvl of 0.05 ANOVA will b usd to xamin th variation among th data. Along with it, ordinary last-squars (OLS) rgrssion will b usd to tst for linar rlationships btwn variables tested. Suspctd HAI, confirmd HAI, and admission to ICU will b codd as dummy variabls, with th valus of 1 that will b assignd for patints with th attribut and 0 for thos without it. Whn prsnt, ths dichotomous vari abls act as intrcpt shiftrs but do not chang th slop of th stimatd rgrssion lin.Limitations of the study. Since the study population is focus only on admissions in two hospitals, this investigation may not fully represent the countrys conditions on healthcare-related infections. However, such initial surveys on response rate of hospital administration to healthcare-associated infections may provide a service line foundation for larger surveys around the country.Ethical considerations. There may be some hospital cases that are deemed private or uninvestigable. These will not be included in the investigation. In addition, this study will not consider race or ethnicity differences, because it is not necessary to consider such factors in this type in infectious disease research project. feasibility of the scope of this study. This investigation is feasible to conduct given the resources and time on hand(predicate) to the investigator because it is a retrospective study that will only deal with medical records. Should the investigator feel that analysis of five years worth of patient cases from two hospitals is overwhelming, the duration of survey may be cut down to two years instead of five years. This will decrease the cogency of the data analysis, but it would also serve as a approach test to determine whether there are any initial trends that may be observed from the data collected from hospital-case data compiled for a biyearly duration.Summary assessment. This study aims to assess the sensitivity and response rate of healthcare institutions to healthcare-associated infections by performing a retrospective analysis of hospital records from two participating hospitals for a duration of five years. Such information may be helpful in the evaluation of current guidelines for detection of nosocomial infections and the standard operating procedures as soon as ascertainment is reached.Recommendation. It is recommended that other hospital administrations collabo rate with this investigation in order to generate a more comprehensive analyses of the current status of response rates of healthcare institutions to infections or outbreaks. Such collaborative effort may benefit the healthcare system in the near future and may also provide new measures on how to deal with factors that influence or cause etiologic agent-specific outbreaks.