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Basilica Arockiaraj

October 7, 2016
Period 1
Annotated Source List

Agwuna, Ruth. Interview. 20 Oct. 2016.

Dr. Ruth Agwuna is a pediatric doctor in both Dorsey Hall Drive and Georgia Avenue.
She is a member of the MedStar Harbor hospital and is fluent in both English and Bulgarian. She
completed medical school in 1983 at Higher Medical Institute and her internship in 1985 at the
University of Nigeria Teaching Hospital. She finished her residency in 1993 at the District of
Columbia General Hospital and the United Hospital. As a doctor, she is certified by the American
board of pediatrics and is a member of the American Academy of Pediatrics, the Maryland State
Medical Society, and Maryland Association of Nigerian Physicians. She has received many
awards including the Humanitarian & Culture Award, the Physician Recognition Award, the
Distinguished Service Award, and the West African Women Leadership Gold Award.

Askarian, Mehrdad, and Farideh Kouchak. "Nosocomial Infections: The Definition

Criteria." Iranian Journal of Medical Sciences, vol. 37, no. 2, June 2012,
pp. 72-73, Accessed 30 Sept.

The article Nosocomial Infections: The Definition Criteria" in the Iranian Journal of
Medical Sciences gave the basis and background information to what nosocomial infection was
and why classifying it could lead physicians to better understanding how to diagnose their
patients and give the correct treatments for that infection. The article defined nosocomial
infection as any systemic or localized conditions that result from the reaction by an infectious
agent or toxin. The area where nosocomial infections occur the most are in the intensive care
unit (ICU) because that is where the most serious problems go to for care. The authors classify
nosocomial infections by the pathogenesis, or how the disease developed, and the carrier status
criterion. Sometimes the classification and definition of the infection leads physicians to
incorrectly diagnosis their patients which then leads to the wrong treatment of the infection.
Their study in Iran showed that the best way to right the wrong comparison and control the
spread of nosocomial infection would be to use international standards of what the infection is.
They recommend that admitted patients are compared in diagnosis, burdens of diseases in the
community, health care workers concern about the origin of infection, various precautions and
use of various diagnostic techniques.
This source helped me understand nosocomial infection better and the vagueness in the
idea, because it explained how many physicians misunderstand what it is and that leads them to
misdiagnose it when they see the infection on a patient. Although it gave me a basis, it did not
delve much further than that because it merely skimmed over the tops of the ideas. I would have
to do additional research to understand it more, but I found it very helpful as it was the first
article I read on my topic. The most helpful part of the article would most likely be the list of
references that was included in the last page of the article, because the other sources they
mentioned in their article went more in depth on the topic and will help build up my knowledge
on the subject.

"Association for Professionals in Infection Control and Epidemiology." APIC, Accessed 1 Oct. 2016.

The website for the Association for Professionals in Infection Control and Epidemiology
shows the associations staff and their vision and goals for the future in their Bout tab. The
website has a tab for consumers in which the consumers are given monthly alerts and are given
patient safety resources. They also have a tab for Professional Practice where they mention the
overview of their work, the guidelines, and the research they conducted. The research they have
done over the years was collecting surveys so they can improve patient safety. The tab on
Education and Certification focused on events, conferences, and promoting education in the field
of epidemiology, while the tab for Public Policy informed others on their positions on certain
matters having to do with legislative and regulatory proposals. They try to protect patients and
promote evidence-based policies. The last tab, Resources, provides online texts to read more on,
a frequently asked questions category, consulting services, and topic specific infection
prevention. The final significant feature on the website was the search box where someone can
type in the keyword and many articles based on that word or phrase would appear.
This website is very useful as a guide to finding other sources to research. I have already
tested the search box and have found many articles on the topic. Those articles are also in PDF
form, which make the research process much easier. The website is a reliable source of people as
well, and give a list of members in the association that I can contact about my topic. They even
had a section on who to contact if people had any general questions. Most of the information on
the website would not benefit me or the topic I am pursuing, but there are some aspects of the
site that makes finding it very helpful.

Manuvel, Jeyanthi. Interview. 20 Oct. 2016.

Jeyanthi Manuvel is a registered nurse at Union Memorial Hospital. She began her
nursing career at age 21. In the year 1993, Jeyanthi graduated from and completed her residency
in the Christain Medical College and Hospital in Vellore, India. She received a diploma in
nursing. In the CSI Jeyaraj Annapackiam Mission Hospital, Jeyanthi worked in the cardiology,
rehabilitation, hematology, and medical surgical departments for 6 years. She is fluent in both
Tamil and English. In 2007 she came to America and joined the medical surgical unit in Seventh
Day Adventist Hospital in Gaithersburg. She then transferred to MedStar Union Memorial
Hospital in Baltimore and worked in the orthopedic unit to this day.

"MedStar Health Research Institute." Medstar Health, #q={}.

Accessed 30 Sept. 2016.
This website gives me information on the organization behind Union Memorial Hospital.
The tabs on this site are about us, research areas, clinical trials, scientific services, and research
support. Their about us page covered their history, their core services, and their mission and goal.
Research areas explained what MedStars specialties were, which include oncology, diabetes,
and endocrinology. Clinical trials was about what clinical trials are and what the benefits that
being part of a clinical trial can have. Scientific services was about the different science centers
they have to offer and the background information for that. Lastly, research support was there to
provide people with helpful resources to find funding and grants for their projects. The website
informs people on upcoming events like the Diabetes to Go program and the MedStar Health
Associate Giving Campaign that they funded. The website also provides news of scholarships
they gave or breakthroughs in the research they have been working on.
This website was helpful for me because it introduced me to the place that I will soon
intern at. By going through this website, I have learned their specialties and the services that they
provide for their patients. I know their mission and vision and will stay true to that goal when I
volunteer there. What was most helpful for me in that website was the search box, because I
searched nosocomial infection and a doctor Glenn Wortmann showed up as one of the search
results. After reading his biography, I learned that Dr. Wortmann is well-renowned speaker in the
MedStar sphere and he often speaks about nosocomial infections amongst other issues. He has
also published many articles and one of his research interests are in fact, nosocomial infections.
Through that biography, I found a link to all of Dr. Wortmanns article publications on PubMed.
This website has allowed me to find this doctor and now, I can use his articles as part of my
research and when I get further into studying my topic, I could possibly find a way to contact
him and interview him about my topic.

Topal, Jeffrey, et al. "Prevention of Nosocomial Catheter-Associated Urinary Tract Infections

through Computerized Feedback to Physicians and a Nurse-Directed Protocol." American
Journal of Medical Quality, vol. 20, no. 3, May-June 2005, pp. 121-26.

Through this article from the American Journal of Medical Quality, I was able to learn
more about catheter-associated urinary tract infections which are the most common nosocomial
infection. They also mentioned ways of reducing the percentage of people affected by
nosocomial infections through many methods and then went on to explain how effective they
were. They used technology through prompts in the computer system and hand-held bladder
scanners, along with staff education and nurse empowerment to reduce the number of incidents
of catheter-associated urinary tract infection (CAUTI). The longer the duration of the
catheterization, the risk of infection grows as well. Because of this, the Centers for Disease
Control and Prevention (CDC) recommended the use of catheters only when indicated and
necessary, coupled with proper insertion and maintenance techniques. They also advice prompt
removal whenever the catheter is no longer needed. The authors defined nosocomial CAUTI
based on the criteria of the CDCs National Nosocomial Infection Surveillance System. They
provided charts and tables to support their trials and tests of whether their blend of technology
and staff education would help reduce the number of reported CAUTI. After the trials, they came
to the conclusion that by reducing the number of days the catheter is inserted, the relative risk for
infection decreases in a parallel fashion. For staff education, rather than blaming a specific part
of the staff or the other, they chose to promote shared accountability and responsibility between
the disciplines. In addition to the higher percentages of safer and CAUTI free patients, cost
savings were also significant due to the fact that the patients were staying less days and healthier.
They conclude their article by noting their success in reducing the risk for CAUTI and for
creating a safer environment for the patients.
The article proved to be incredibly helpful to me because of the valuable information in
it. This focused specifically on catheter-associated urinary tract infections for nosocomial
infections, but I am not completely set on a specific topic of nosocomial infections so it was
good for me to read about the most common type and go from there. It provided me with
statistics of the cost/effects of nosocomial infections as well as general statistics of how many
people are affected each year and other questions like that. The article also provided visual aids
in the form of charts and tables. The statistics and the tables will be useful for me when I have to
do the school and county-wide presentations and I can use a statistic as my opener and some of
the tables as visual aids in my PowerPoint. I can use those pictures and statistics to further my
points and provide a deeper understanding of my topic. In the article, they also talk about the
Center for Disease Control and Prevention and the research and information they have
discovered and noted, and that has inspired me to go and visit their website and see if there is
anything useful for me relating to the topic of nosocomial infection.

U.S. Department of Health & Human Services. "Center for Disease Control and Prevention.
CDC, Accessed 25 Oct. 2016.

On the website for the Center for Disease Control and Prevention (CDC), it features six
key features. The first is a tab that says Diseases & Conditions and under that tab is featured
many different kinds of popularly discussed diseases and conditions. When a specific condition
is clicked on, it is linked to a webpage on the website specifically focused on the topic. Those
webpages provide basic information, symptoms, diagnosis, treatment, research, data and
statistics, articles, recommendations, and free materials. They even separate the statistics into
states so the different states can be compared to each other and analyzed. The second tab,
Healthy Living, had adolescent, food, and body health tips, as well as advice for smoking and
tobacco use, and vaccines and immunizations. When clicking on the tab, it also reveals more
specific topics such as breastfeeding, sleep disorders, and physical disabilities. The third tab,
Travelers Health, talked about destinations, finding a clinic, a disease directory, and a yellow
book. Emergency Preparedness, the fourth tab, explained what to do in situations like natural
disasters, severe weather, outbreaks, bioterrorism, chemical and radiation emergencies, mass
casualties, and unaccompanied children at the border. The page keeps people updated on recent
outbreaks and incidents. For example, Zika Virus and Polio Eradication are both currently recent
outbreaks and incidents on the CDCs radar. The last tab, More CDC Topics, gives, as the title
says, more topics. It provides the site visitors with data and statistics, violence and safety,
environmental health, workplace safety, global health, Disease of the Week, publications,
social and digital tools, apps, articles, and jobs. Lastly, they provide an index in alphabetical
order the various topics that are discussed in the website. This makes searching for specific
topics much easier for people who want to navigate the site.
This website is currently very useful to me because it has allowed me to search
nosocomial infection on the website and revealed to me the many articles that are on the website
alone. They are all from the CDC, but the types of sources featured are very diverse. One is a
data report, while others are journals and articles. They also talk about programs that ae created
to help control the infectious problems. I plan on using many sources from that website in my
annotated source list and in my overall project and presentations. This website provides me with
a large database of sources that I hope to use to my advantage.

Bharwana, Saima Aslam, et al. "Mortality Rate Associated with Hospital Acquired Infections
among Burn Patients." Biomedical Research and Therapy, vol. 3, no. 9, 29 Sept. 2016,
pp. 790-99.

Mortality Rate Associated with Hospital Acquired Infections among Burn Patients
explains a study conducted in government hospitals burn wards in order to document the
antecedents affiliated with burn patients (burn injuries, hospitalization, and mortality). Their goal
was to estimate the risk of death following burn injuries and find measures to prevent and
minimize infections which is essential for the survival of burn patients. The different types of
nosocomial infection include burn wound infection, bloodstream infection, respiratory infection,
urinary tract infection, and septicemia. The most common hospital acquired infection, or
nosocomial infection, in burn patients were primary bloodstream (PBS), wound infections (WIS)
were second, next came sepsis, pneumonia, followed by eye infections, and then urinary tract
infections. Out of all of those, sepsis is the leading cause of death among hospital patients. They
observed that the longer a patient was hospitalized at the hospital and the more extensive their
injuries, the more likely they were to acquire nosocomial infections. Some factors associated
with increased duration at a hospital included age and gender of the patient, the cause of the
burn, any inhalation injuries, the specific region affected, and the total body surface area that was
burnt. They concluded that better compliance techniques, stricter control over disinfection and
sterilization practices and usage of broad spectrum antibiotics, and reduction of environmental
contamination were all key in attempting to reduce the number of hospital acquired infections
among burn patients. After giving background, the article continues onto the demographic of
people with burn wounds. They are mostly people who work in places with poor health and
safety management, people who lack the training needed for the job, and the social and cultural
stress that can lead to suicide attempts. Women burn victims were usually due to household
accidents and suicidal cases, whereas men usually received burns from industrial accidents. They
noticed that at the hospital they observed, the equipment was not usually disinfected from patient
to patient and sheets were not washed on a regular basis. Sanitation is necessary for improving
the hospitals rates of infected people. In the conclusion, the authors advised the readers on what
is necessary to avoid burns for men and women in general. Then, they continued on to discuss
improvements in the hospital that could improve mortality rates. For example, some hospital
deaths occurred because of the lack of enough ventilators, so they recommended placing more
ventilators specifically in the burn units.
This article focused very specifically on burn victims and I do not think that is what I
want to focus on for my project. For my internship, I volunteer on the seventh and eighth floor,
which are the orthopedic floors. I am planning on basing my research of nosocomial infections
on what is prevalent on that unit with people coming bed-ridden from surgery and injuries. The
floor I help on does not have many, if any, burn victims. According to one of the nurses, sepsis
can sometimes occur on their floor, so I can research that. This article introduced sepsis to me
and made me more interested in researching it. I found out basic information, but I would like to
research more on it. Sepsis is a life threatening complication of an infection. It happens when
bacteria infects the bloodstream and trigger inflammation throughout the body which can
damage organ systems and sometimes cause death. Sepsis can be treated with intensive medical
care and antibiotics.

Smith, Andrew J., et al. "Survey of Instrument Decontamination in Dental Surgeries Located in
Scottish Prisons." American Journal of Infection Control, Oct. 2009, pp. 689-90.

What was most discussed in the article was the importance of sanitation and
documentation. They started the article by describing the policies and procedures of Scottish
prisons for sterilizing equipment. They found that several key parts of decontamination including
procurement of devices, cleaning, sterilizing, testing, maintenance, quality management, and
training were extremely lacking and deficient. Their study assessed the current standards placed
on the area and the procedures presently used in the decontamination cycle. In their methods
section, they included their process of sending out letters to the Scottish prisons outlining their
study. They then designed data collection forms with questions made to investigate compliance
with documents on decontamination. The surveyors were split into groups and each team of
surveyors interviewed different staff members such as the dental practitioner and the surgery
nurse. With the staff members, they reviewed documentation and the decontamination processes.
In most of the prisons, the area for decontamination was not separated from other work areas and
many activities took place in the same area like radiograph processing, preparation of restorative
materials, air compressor, medical treatment room, food, and it acted as a general work surface.
Almost all the surgeries used manual washing as the sole method or as part of the cleaning
process, but the washing process was poorly controlled. No surgeries undertook periodic tests of
the cleaning efficacy of the ultrasonic bath nor did the vacuum bench top sterilizers undergo
appropriate daily tests to demonstrate efficacy of air removal. Documentation was poorly taken
care of as well. Only 36% of surgeries had written instructions for operations and for all the
prisons visited, no sterilizer was fitted with a chart recorder or data logger. There was not even
any documentation of staff training in the use of sterilizers. In the end, the authors recommended
that thorough cleaning of reusable medical devices in order to produce sterilized equipment
requires significant improvement. A concern they addressed was how there was a mingling of
dirty and clean equipment which could lead to the device that has not been sterilized being
reused. To solve the shortcomings, they provided cost effective solutions, like outsourcing
instrument reprocessing to the central sterile service department.
This article was not as useful as I thought it would be. I thought it would talk about
nosocomial infections and the problems that could potentially arise due to the lack of
sterilization, sanitation, and documentation. Instead, the article mostly focused on what the
prisons did wrong rather than how it affected the patients. It did speak about the importance of
quality control and the necessity for medical staff to be educated and trained on sanitation
techniques and the use of sterilizers. It did give me some information, but I do not think that this
article will help further my project.

Al-Hazmi, Hamdan H., et al. "Hospital Acquired Blood Stream Infection as an Adverse Outcome
for Patients Admitted to Hospital with Other Principle Diagnosis." Saudi Journal of
Anesthesia, vol. 8, no. 1, Nov. 2014, pp. 84-88.

Hospital acquired infections (HAI) or nosocomial infections are a leading cause of

morbidity and mortality worldwide, affecting both developed and underdeveloped (resource
poor) countries, creating a burden for both the patient and the health care system. This study was
created to assess the HAI rate among patients diagnosed with other principle diagnosis, to
identify the causative agents of those infections, and to identify both the health related and non-
health related risk factors associates with each type of infection. According to the study, the most
common type of HAI were blood stream infections (BSI). Hospital acquired infection is defined
in the article as one that was neither present, nor incubating, at the time of admission to hospital
and which manifests itself 48 hours or more after hospital admission. Because HAI has become
an increasing world-wide problem, it is important to review and update the epidemiology and
outcome of infections. They believe that understanding these variables will help prioritize
resources, plan strategies to enhance infection control procedures, and assist infection control
practitioners in minimizing the number of infected patients. Conducted in a university hospital,
the admitted patients were checked to see if they had any sign or symptoms suspicious of
infections. Samples were then collected according to the type of infection and sent to the
microbiology lab to be examined. The patients were selected using a data collection sheets that
had sociodemographic information, the clinical condition of the patient (the diagnosis and the
length of the hospital stay), the medical history (smoking, diabetes, and hypertension), and
exposure to invasive devices or exposure to surgical procedures. Nine organisms total were
found in the different infections, Escherichia coli, Enterococcus, cons, and Pseudomonas being
the most common out of all of them. 50% of the patients with hospital acquired infections went
through the operation room, performed arterial line, or ventilated. 66% of the infected patients
had urinary catheterization, and 75% of them had a central venous line performed. Old age and
young age are vulnerable for hospital acquired infection and are most susceptible for immunity
system dysfunction.
It has been incredibly helpful for me to read the article. It has focused on blood stream
infections, but also mentioned the other kinds of nosocomial infections. It was filled with
important information that I could use for my project. The information that I learned from this
article, can be applied in my research at my internship and I can observe and look for it at my
internship. For example, many of the patients that come to the orthopedic floor have come
straight from the operating room and stay on the seventh and eighth floor for a few days to
recover from the operation. According to the article, 50% of the patients with hospital acquired
infections went through the operation room. Also, most of the patients that come to the floor I
volunteer on are elderly folks and the article says that old people are considered the vulnerable
group and the most susceptible for immunity system dysfunction. I hope to use this
information to develop more research at my internship. There were also line graphs in the article
that helps enforce what was previously stated in the article.

Kutlucan, Leyla, et al. "The Effects of Anemia and Red Cell Transfusion on the Risk of
Mortality among Geriatric and Non-Geriatric Patients with Hospital-Acquired Infections
in an Intensive Care Unit." Turkish Journal of Geriatrics, vol. 18, no. 2, 2015, pp. 104-

The research conducted in this study aimed to investigate the effects of anemia and red
blood cell transfusion on the risk of mortality in geriatric and non-geriatric Intensive Care Unit
(ICU) patients with hospital acquired infection (HAI). HAI are such a growing concern so that
they are now used as a quality indicator for hospitals. The nosocomial infections associated with
the Intensive Care Unit lead to an increase in mortality, morbidity, longer hospital stays, and
increased hospital costs. According to the World Health Organization (WHO), patients older than
65 years old are classified as geriatric patients and younger than 65 years old are classified as
non-geriatric. In patients greater than the age of 65, the risk of mortality greatly increased in
patients with anemia, a history of diabetes, patients who were intubated, patients with
neurological disorders, or patients with respiratory failure. This same relationship does not apply
to patients under the age of 65. Although for both age groups, blood transfusion did not increase
the risk of mortality. Age, multiple invasive procedures, and physical conditions are important
cause of multiple complications. In the Intensive Care Unit, most deaths are commonly caused
by cardiac disorders, neurological disorders, respiratory disorders, sepsis, and pneumonia (which
in turn increased the risk of malnutrition, chronic kidney failure, and extended hospital stay).
Anemia, another concern in the ICU, is associated with risk factors like sepsis, blood loss, a
decrease in erythropoietin production, malnutrition, hemolysis, and defective coagulation. In a
study conducted with 213 patients with septic shock showed that 90 day mortality was high
among people with low Hb levels (anemia) which decreased after blood transfusion.
I have used this article to find the definitions of many of the words that I didnt know the
specific meanings to and how it relates to the medical field. Mortality means the state of being
subject to death and morbidity is a term used to describe how often a disease occurs in a specific
area or it is used to describe a focus on death. Septic shock is a serious medical condition that
occurs when sepsis leads to low blood pressure and abnormalities in cellular metabolism. The
article also showed me that the World Health Organization has some information on nosocomial
infection and I plan on looking into their website and seeing if there is any important research
that I can use on it. This article specifically focused on nosocomial infection affecting elderly
people above the age of 65 and that is what I want to do my project on. Overall, I believe the
article will help me achieve the goals I have for my project by providing me with the information
necessary to continue on.

McFee, Robin B. Nosocomial or Hospital-acquired Infections: An Overview. 2009.

Hospital acquired infections results in unnecessary human suffering and death as well as health
care expenditures. Studies show that 1 out of 20 patients fall victim to HAI. The number of
hospital acquired infections (HAI) in the US was 1.7 million, resulting in almost 99,000 deaths.
The highest infection rates occurred in the intensive care unit (ICU) followed by high risk
nurseries. Out of all of them, surgical site infections were the most significant. The most
common sites of infections were urinary tract infections, surgical site infections, pneumonia, and
blood stream infections. Antibiotic use is a preceding catalyst especially among young and old
people. Hospital acquired infections can spread according to the clinical setting, patient
characteristics (primary diagnosis, multiple morbidities, previous procedures), health care
setting, and demographic. Nosocomial infections are so common, they actually represent the
eighth leading cause of death in the USA. However, nosocomial infections are preventable and
the most effective measures to prevent it are the most basic and easily performed. Sanitation and
lack of resources are a major factor of why rate of HAI are so high in developing countries.
Studies have shown that 50% of injections administered in a health care facility in devolving
countries are unsafe due to the fact that the needles and syringes are often reused and some of the
injections given are unnecessary. The unnecessary injections resulted in new Human
Immunodeficiency Virus (HIV) infections occurring annually in Africa and cases of hepatitis B
and hepatitis C virus occurring worldwide. The highest prevalence of HAI has occurred in
Intensive Care Units, Acute Care Surgical, and Orthopedic settings. Patient susceptibility is
increased by old age, multiple morbidities (disease severity), and decreased immunity. Poor
infection control measures and certain invasive procedures (central venous, urinary catheter
placements) are a risk factor of HAI. Failing to use proper hand hygiene is the leading cause of
HAI, the spread of multi-drug resistant organisms, and contributes to outbreaks. Proper
sanitation is inhibited by overcrowded waiting rooms and health care facilities lacking surge
capacity. Lack of hospital beds also adds to the problem. Health care workers who do not
practice good hand hygiene are contributing to the rising infection problem. Target patients for
HAI are those who are immune-compromised or those with a specific risk factor (antibiotic
exposure, burns, surgery, or trauma). Global travel can also contribute to the importation on new
pathogens to different areas of the world like avian flu (avian influenza) and severe acute
respiratory syndrome. Seasonal influenza can be transmitted in health care and long term
facilities. Pathogens that survive on surfaces and instruments are the key causes of nosocomial
infections because patients interact with the staff and the contaminated instruments. The patients
own body flora is another cause. Sometimes the patients leave the hospital and are discharged
while they are still asymptomatic and the hospital acquired infection is not yet apparent. To solve
the issue of nosocomial infection, the article recommends that caregivers must be taught and held
accountable for adhering to infection prevention strategies. Sometimes, the best solutions are the
ones with the lowest amount of technology. Even with medicine protocols, mass media coverage,
and computer technology, patients are still harmed by HAI during their time in the hospital. They
recommend that the health care facility practice hand hygiene, avoid harshly scrubbing skin,
wearing gloves, following antimicrobial stewardship protocols, avoid drugs associated with
increased HAI risk, minimize practices that disrupt the skin barrier, and practice patient spacing.
The Joint Commission on the Accreditation of Healthcare Organization has become more
aggressive in penalties for nonadherence to good infection-control practices among its members.
Low cost solutions that are much cheaper than a hospital-wide outbreak include single-use
sphygmomanometers, cuff barriers, and disposable cuffs.
This article was helpful to me because it gave me useful statistics like the fact that
nosocomial infections are the eighth leading cause of death in the USA. It really interested me to
know that the best solutions are low cost and basic, but they are the most effective. I found out
that one of the areas that have the highest prevalence of HAI is in an orthopedic setting due to
the prevalent factors. I also looked into a few words I did not know in the article and I learned
some medical vocabulary I did not know before. Neonate, people who are more susceptible to
hospital acquired infections, are newborn children or infants less than four weeks old.
Seropositive is when there is a positive result in a test of blood serum for the presence of a virus.
It has already introduced me to the Institute of Medicine and the Institute for Healthcare
Improvement which according to the article, provide many cautionary articles. I plan on looking
into their website and try to find anything I could use.

H.J. Choi et al. Five-year Decreased Incidence of Surgical Site Infections Following
Gastrectomy and Prosthetic Joint Replacement Surgery through Active Surveillance by
the Korean Nosocomial Infection Surveillance System. Journal of Hospital Infection
vol. 93, 2016, pp. 339-346.

Surveillance of healthcare-associated infection has been associated with a reduction in

surgical site infection (SSI) and the aim of the study was to evaluate the Korean Nosocomial
Infection Surveillance System (KONIS) to see the effect it had on the rate of surgical site
infections since it was introduced. The Korean Nosocomial Infection Surveillance System was
made to monitor surgical site infections after surgeries. Surgical site improvement increased
post-surgical patient morbidity, mortality, and healthcare costs. Every year, before the
surveillance started, the infection control practitioners were trained to assure standardized
practices. A surgeon would evaluate the patient for the wound site and checked up on after they
were discharged from the hospital. The result of the study was that after 5 years of the Korean
Nosocomial Infection Surveillance System, the incidences of surgical site infection decreased.
Based on the results, they concluded that consistent surgical site infection surveillance and
feedback to surgeons could lead to the decrease in surgical site infection in hospitals.
This article was not that helpful to me because it did not provide any information that I
feel like I could do with my project. I did find it interesting that some of the surveillance was
expanded to 16 categories of operative procedures and out of those, hip-joint replacement was
one of the categories that performed the longest. I found this interesting because since I work on
the seventh and eighth floor (the orthopedic floor), many of the patients I see have gone through
surgery and are recovering from a hip-joint replacement.

Gahlot, Rupam, et al. "Catheter-Related Bloodstream Infections." International Journal of

Critical Illness & Injury Science, vol. 4, no. 2, Spring-Summer 2014, pp. 162-67.
Catheter-related bloodstream infection (CRBSI) is defined as the presence of bacteremia
originating from an intravenous catheter. It is the most frequent and costly of all central venous
catheterization and also the most common cause of nosocomial infection. The consequences of
CRBSI depend on the associated organisms, underlying pre-morbid conditions, timeliness, and
the appropriateness of the treatment received. Out of all other medical instruments, central
venous catheters (CVCs) pose the greatest risk of device related infection and they are also the
main source of bacteremia and septicemia in hospitalized patients. Bloodstream infections
associated with the devices are usually low, serious infectious complications that produce a high
death rate due to the fact that there is a high frequency of the catheters used. The risk of
bacteremia increases as the duration of the patient stay increases. A potential risk factor for
CRBSI include underlying disease, the method of the catheter insertion, the site of the insertion,
the duration and the purpose of the catheterization. There are also local factors including poor
personal hygiene, occlusive transparent dressing, moisture of the site, S. aureus nasal
colonization, and contiguous infections. The source of dangerous bacteremia (CRBSI) and sepsis
(multi-organ failure) is often colonization of the tip of the intravenous catheter can be observed
in the ICU practice. It is possible to detect catheter related bloodstream infections in both clinical
and laboratory examination. In a clinic, people are diagnosed when they exhibit signs of a fever,
chills, unexplained hypotension, and no other localizing sign. Severe sepsis and metastatic
infectious complications can prolong the course of CRBSI and should be considered in patients
who do not respond appropriately to treatment. Assessment of infection has to be broad based
relying on an entire gamut of historical, epidemiological, clinical, and diagnostic parameters
along with microbiology results. Catheters should be removed from patients with CRBSI
associated with any local or systematic inflammation or immunocompromised condition. The
antibiotics given to the patient will depend on the severity of the disease, the risk factors for an
infection, and the likely pathogens associated with the specific intravascular device. Central
venous catheters should be reviewed daily. They recommend new technologies to reduce the risk
of CRBSI which includes catheters and dressings impregnated with antiseptics or antibiotics,
new hub models, and antibiotic lock solutions.
This was an average article depending on what I will be researching. Catheters are the
most common form of nosocomial infection so I was interested in researching about it. Sepsis
also plays a big part in nosocomial infections so I plan on researching more on that as well. This
article has opened my mind to the other opportunities I could look into from my broad topic of
nosocomial infection. I want it to be able to connect to my internship on the orthopedic floor, so I
will ask the workers there more about my topic and what is most common on their floor. In the
ending the authors provided solutions to the nosocomial infections including catheters and
dressings impregnated with antiseptics or antibiotics, new hub models, and antibiotic lock
solutions, so I plan on researching more about it and seeing the most effective solutions using the
newer technology. The article also provided helpful graphs, tables, and labeled pictures. I have
not seen many labeled pictures of nosocomial infections and the potential routes it can take in the
body, so seeing that would be very helpful for my research project and presentations.
Camins, Bernard C., et al. "A Crossover Intervention Trail Evaluating the Efficacy of a
Chlorhexidine-Impregnated Sponge (Biopatch) to Reduce Catheter-Related Bloodstream
Infections in Hemodialysis Patients." Infection Control Hospital Epidemiology, vol. 31,
no. 11, Nov. 2010, pp. 1118-11123.

The main cause of hemodialysis related infections are due to catheter-related bloodstream
infections (BSI). A catheter-related bloodstream infection is defined as having a positive blood
culture at the time the catheter was in place or within 48 hours of catheter removal along with
clinical signs and symptoms of sepsis or hypotension and no other documented primary site of
infection. The risk factors for bloodstream infections include elderly people, females, and
African Americans. A new infection is one that has not received any for the infection in the 21
days prior to the current infection. This study tested the Biopatch, a chlorhexidine-impregnated
foam dressing, to determine the efficacy of it to reduce catheter-related bloodstream infections.
They first studied the incidence of bloodstream infections per 100 dialysis sessions. They then
tested the tolerability of prolonged use of the Biopatch Antimicrobial Dressing. In the study, they
had two dialysis centers, one was the experimental group while the other was a control group.
Infection rates between the two groups were compared using chi-square analysis. After the study,
they concluded that the Biopatch did not decrease catheter-related BSI among hemodialysis
patients with tunneled central venous catheters. However, it is shown to be effective in reducing
microbial colonization of epidural catheters, but not the incidence of bloodstream infections. The
authors believe that this is due to the fact that the catheter exit site may have a reduced role in the
pathogenesis of bloodstream infections in tunneled central venous catheters. In the conclusion,
the authors mention that while the Biopatch is ineffective in decreasing bloodstream infections
among hemodialysis patients with tunneled central venous catheters, antibiotics like mupirocin
and polysporin have shown to be more effective and have provided better results. They
recommend that those antibiotics should be applied first to reduce it, although the antibiotics
prohibit long term use because they could develop a resistance to the antibiotics. In their patient
population, elderly people (people over the age of 60) had the least amount of risk for
bloodstream infection.
A Crossover Intervention Trail Evaluating the Efficacy of a Chlorhexidine-Impregnated
Sponge (Biopatch) to Reduce Catheter-Related Bloodstream Infections in Hemodialysis
Patients is very interesting although it does not give a definite answer to some of their
conclusions, they only give speculative answers based on the information they received.
Hemodialysis is when a person has a failing kidney and they go through a process where they
must clean their blood to remove wastes and extra fluid from the blood and restore the proper
balance of electrolytes in the blood. It interests me that the Biopatch, made to reduce the number
of people with nosocomial infections, does not work for patients with hemodialysis. A tunneled
central venous catheter is a catheter that is inserted in the neck or chest and is connected to vein
near the heart with one end of the catheter remaining outside of the body. I would like to use the
information to research more about how a Biopatch works, why it was not be effective with
patients going through hemodialysis, and what other factors can prevent the effectiveness of the
Biopatch and why.

"Healthcare-associated Infections." Institute for Healthcare Improvement, Accessed 28 Oct.

The website for the Institute of Health Improvement (IHI) features six tabs. The first one
is the About Us tab which gives information on their vision, mission, values, history, the
science of improvement, innovation, people, how to get involved, and finances. The institute of
Health care aims to ensure that everyone has the best care and health possible and improve health
and health care worldwide. Science of improvement and innovation explain the research and the
developments that have occurred to better enforce their vision and goals. People explains who
the board and current members are and gives a brief description of what they do. To get involved,
the IHI recommends that people be educated, go to conferences, or even get training and
working for them. Finances include their financial statement and their financial position. The
next tab is Topics, in which there is an index of medical terms that can be researched on. The
Education tab provides information on people interested in being trained for IHI. They are
allowed to go through in person training and virtual training. The next tab, Resources, give an
overview of the resources, advice on how to improve, the measures so they know how much they
have improved, changes that have happened to reach the mission of the institution, improvement
stories they have heard, and tools and publications they recommend using or reading. The
regions tab gives an overview of what areas of the world they reach and information as to what
they do in those areas. For example, in the Asia-Pacific region in the world, the Institute of
Health Improvements goal was to build awareness and the will for change, develop
improvement capability, and achieve results at scale in population health and health care
improvement. The last tab, Engage with IHI, talks about the many programs and services they
This website was more helpful than other websites I saw. I especially found the tab that
said topics very useful because one of the terms I could research more into was healthcare-
associated infections. This provided me with an article with the basic information on nosocomial
infections, but what was more helpful was the source list and recommended resources list they
provided. In that list, it was more than just book, articles, and journals, there was a list of audio
sources and a list of video sources that also went along with it. Using those sources will add
diversity to my annotated source list and give me a different form of information, one that can be
listened to or watched rather than read. I also used the search bar to look up nosocomial
infections and a few articles showed up on there and I plan on reading those as well.

"Health and Medicine Division." National Academy of Sciences, Engineering, Medicine,
25.aspx. Accessed 28 Oct. 2016.

The main page for the website for the National Academies of Sciences, Engineering, and
Medicine includes the most recent publications and the most viewed publications. It also
mentions when the next public meetings take place so that people can join them in discussing
important topics. After the home page, there are four different categories to be explored. The first
tab is about their Health and Medicine Division (HMD) of the National Academies. It mentions
their process of studying the word, their staff and leadership positions, how they use social
media, and their annual reports they have done. The next tab is called Publications and it has a
filter next to it to make words easier to find. In fact, in the Publications tab, the most common
publication is about public health. They wrote many reports and the papers they wrote the least
amount of words was about a boy. Activities shows their publications and their works. The
meeting section shows when and where public meetings are meeting around the world.
Like the other websites I viewed, the search bar provided a few articles for me that I
would not have looked at before. One of the sources I found on the list was not a real source, but
rather a source that provided an agenda list of what they talked and discussed about on a specific
subject. For example, after I searched Nosocomial Infection they showed me the agenda for the
Committee on Personal Protective Equipment for Healthcare Workers during an Influenza
Pandemic: Current Research Issues. I could possibly use it, but I do not think it is an actual
source with useable information. The articles, however, I plan on reading whenever I can.

"WHO." World Health Organization, Accessed 30 Oct. 2016.

The World Health Organization websites homepage gives information on recent

outbreaks and emergencies. They give the website in many different languages including Arabic,
Chinese, English, French, Russian, and Spanish. They explain what the organization does and
stories from different parts of the world. Health Topics discusses different issues and aspects of
the healthcare system like hospitals, themselves, to various diseases and epidemics. They are
given in an alphabetical list. The next tab, Data, gives information on the Global Health
Observatory (GHO). On that tab, they have data analysis and various charts and graphs on
different subjects. Statistics are also a big part of that page. For the next tab, Media Centre,
various forms of information is uploaded, including pictures, apps, contacts, maps,
commentaries, speeches, infographics, and videos. Publications is the next tab and it provides
the viewers with reports, journals, and regional publications. It then goes on to Countries
which provides an alphabetized list of the countries that are part of the World Health
Organization and gives a description of their statistics, health profile, mortality and burden of
disease, nutrition, and risk factors for that country. The next page, Programmes and Projects
lists in alphabetical order the programs, partnerships and other projects that the World Health
Organization participates in. After exploring Programmes and Projects, it goes on to
Governance which gives background on the World Health Organizations assembly (the World
Health Assembly) and their executive board. It features pictures of the assembly as well as a link
to the boards website. The final tab, About WHO, explains who they are, what they do, where
they work, how they are governed, who they work with, their planning, finance and
This website has been useful to me because my topic is about the healthcare system and
this is the large, worldwide organization that is encompassing my topic. As usual, I searched
nosocomial infections, but this time, I received more articles than I usually do from searching a
topic. I received 580 different sources. These sources are also from different parts of the world,
so I will be able to research the different forms of nosocomial infections in different countries
and how those infections affect developed and underdeveloped countries differently. They
provide different forms of sources including publications, fact sheets, guidelines, and news
releases. These sources can also be separated into different formats as well in PDFs, Epub, and

Weinstein, Robert A. "Nosocomial Infection Update." Emerging Infectious Diseases, vol. 4, no.
3, Sept. 1998, pp. 416-20.

Robert A. Weinstein who wrote the Nosocomial Infection Update believes that to
prevent nosocomial infections, people need to increase national surveillance, "risk adjust"
infection rates, develop more noninvasive infection-resistant devices, and work with health-care
workers on better implementation of existing control measures such as hand washing. Shorter
inpatient stays has actually increased the rate of nosocomial infections per 1,000 patient days and
has also made it difficult to track nosocomial infections by site, although it is noted that
bloodstream infections and pneumonia frequencies have increased. Weinstein then goes on to
explain who is affected by nosocomial pathogens. Nosocomial infections typically affect patients
who are immunocompromised because of age, underlying diseases, or medical or surgical
treatments. The aging of the population and increasingly aggressive medical and therapeutic
interventions have created a cohort of people vulnerable to nosocomial infections. Because of
this, the highest infection rates are in intensive care unit (ICU) patients. The sites of infection and
the pathogens involved are directly related to treatment in ICUs. There are three major forces
involved in nosocomial infections. The first one is antimicrobial use in hospitals and long-term
care facilities because the use of antimicrobial drugs has created a large reservoir of resistant
strains in nursing homes. The second force is that many hospital personnel fail to follow basic
infection control (hand washing) between patient contacts. The final force is that patients in
hospitals are increasingly immunocompromised. The readers are then told how nosocomial
infections can be prevented and controlled in a cost-effective manner. In fact, Weinstein explains
that studies show that approximately one third of nosocomial infections are preventable. He
recommends that people need to improve national surveillance of nosocomial infections so that
they have more representative data, assess the sensitivity and specificity of the surveillance, and
develop systems for surveillance of "nosocomial" infections that occur out of the hospital, where
much health care is also given. In the conclusion it is speculated that hospitals will become more
like the ICUs and more routine care will be delivered on an outpatient basis. Weinstein believes
that it is better to attempt at improving technology rather than attempting to improve or change
human behavior. In order to maintain valid evaluations, infection control measures will need to
pass the test of the "four Ps" which answers the questions if the recommendations are
biologically plausible, if they are practical (affordable), if they are politically acceptable, and
lastly, if personnel will follow them. The major advances in overall control of infectious diseases
have resulted from immunization and improved hygiene, specifically hand washing. Lastly,
people must work with hospital personnel on better implementation of existing infection control
so that they will not need to rely only on technologic advances as preventative measures for
nosocomial infections.
This article has provided an excellent overview of nosocomial infections, not only
covering what nosocomial infections are, but also why they are emerging, who are affected by
them, and how to prevent and control them. I enjoyed reading this because I was provided with
many statistics and facts, about how nosocomial infections have changed through the years and
there are many comparisons as to why, it has become more prevalent now than ever. The article
also provides two tables that could be useful to me. The first table showed nosocomial infections
in the United States (patient days, length of stay, and nosocomial infections) and the second table
showed sites of nosocomial infections. It interested me to know that although nosocomial
infections has decreased, the number of nosocomial infections per 1,000 patient days has actually
increased. I plan on researching more about that.

"National Nosocomial Infections Surveillance (NNIS) System Report." American Journal of

Infection Control, Oct. 2004, pp. 470-85.

This source is a report and a summary of the data collected and reported by hospitals
participating in the National Nosocomial Infections Surveillance (NNIS) System from January
1992 through June 2004. The National Nosocomial Infections System is a system where selected
hospitals in the United States routinely report their nosocomial infection surveillance data into a
national database. The data is collected using standardized protocols, called surveillance
components where infections are categorized into major and specific infection sites using
standard Center for Disease Control (CDC) definitions that include laboratory and clinical
criteria. The site specific infection rates are calculated by using the number of patients at risk,
patient days, and days of indwelling urinary catheterization, central vascular cannulation (central
line), or ventilation. A record on every patient undergoing the selected procedure is generated
that includes information on risk factors for surgical site infections (SSI) such as wound class,
duration of operation, and an American Society of Anesthesiology (ASA) score. By using a
composite index for predicting the risk of SSI after operation, the rates by the number of risk
factors present can be calculated.
This source was different from my other sources because while the other sources
provided research and study, this source provided raw statistics, data, and evidence. It was
interesting to look over the many charts and tables provided as well as the explanations of how
the statistics and rates are calculated. Going through the data, I plan on using a few of them like
the percentiles of the distribution of SSI rates by operative procedure and risk index category.
This is because they went into hip and knee prosthesis and that is what the floor I volunteer helps
patients recover from after surgery, among other surgeries.

Gopal, Jay. Interview. 29 Oct. 2016.

Dr. Jay J. Gopal is doctor at Union Memorial hospital. He speaks both English and Tamil
fluently. He completed his fellowship program at the University of Maryland Medical Center in
1986, his internship programs at the Madras Medical College Hospital in 1977 and at Howard
University Hospital in 1982. He graduated medical school in Madras University in 1977 and
completed his residency program at Madras Medical College Hospital in 1978 and Howard
University Hospital in 1984. He has three practices, two in Baltimore and one in Ellicott City as
well as his practice in Union Memorial Hospital. He has had 35 years of experience and is
certified by the board. He has been awarded and recognized for Compassionate Doctor
Recognition in 2014, top 10 doctor in the Baltimore in 2014, the On-Time Doctor Award in
2014, and Patients' Choice Award in 2015.

One Is Too Many: Viewing Infection Data from the Patient's Perspective. Narrated
by Rosemary Bartel, 2012.

This source was a video on nosocomial infections and a patient who had to go through
the whole process of recovering from surgical site infection. She went in for a routine knee
replacement to get her stitches out and started to feel something different. After knee replacement
surgery, Rosie Bartel was told she had contracted a methicillin-resistant Staphylococcus
aureus (MRSA) infection. She had to go through 11 surgeries, an amputation, and is currently in
a wheelchair. This was her fifth surgery and she did not expect this to happen to her. The doctor
told her that she had a 30% chance of surviving. She said that people have heard of these
problems, but they dont know about it and they dont understand it. Rosie Bartel lost her right
leg because of surgical site infection. Ms. Bartel had to leave her home and rent because her
current home was too small for her to get through since she had an amputated leg, she became
financialy unstable, she lost her dream job because she could no longer travel, and she lost all her
independence and had to depend on her husband to take her everywhere. Not only her life has
changed, but her husbands life has changed. She feels like a burden to him and its hard for her
to feel like she cannot do anything on her own. Rosie Bartels story convinced people to create a
week long study of improvement on joint surgery and surgical site infection. As an educator, she
feels that when you put a face on situations, you touch their hearts and eventually you reach their
minds and convince them that change is necessary.
I found this video through the Center for Disease Control (CDC) website and it was
incredibly touching, because my other sources were just statistics and data, but what Rosie Bartel
went through, was real and it affected her life far more and deeply than simply what the statistics
say. She was articulate and explained very clearly what she went through. I liked what she said
about putting a face behind a problem because when I read the statistics, I knew it was a
problem, but I did not feel a connection until Ms. Bartel explained how her entire life changed
because of it. I was very touched and am now seeing nosocomial infections in a new way.

Beggs, C., et al. "Environmental Contamination and Hospital-acquired Infection:

Factors That Are Easily Overlooked." Journal of Indoor Air, vol. 25, 2015,
pp. 462-74.

The article Environmental Contamination and Hospital-acquired Infection: Factors That

Are Easily Overlooked addresses the ongoing debate about the reasons for and factors
contributing to healthcare-associated infection (HAI). Different solutions have been proposed
over time to control the spread of HAI, with more focus on hand hygiene than on other aspects
such as preventing the aerial dissemination of bacteria. However, this article states that there is a
need for a more pluralistic approach to infection control that reflects the complexity of the
systems associated with HAI and involves multidisciplinary teams. This study reviews the
knowledge base on the role that environmental contamination plays in the transmission of HAI,
with the aim of raising awareness regarding infection control issues that are frequently
overlooked. From the discussion presented in the study, it is stated that many unknowns persist
regarding aerial dissemination of bacteria, and its control through cleaning and disinfection of
the clinical environment. There is a need for carefully designed studies to determine the impact
of environmental contamination on the spread of HAI. Environmental contamination plays a role
in nosocomial infections, but because it is hard to trace, people have a tendency to rely on single-
measure strategies rather than taking a more holistic approach, which is not sufficient. It is
plausible that duct cleaning could reduce HAI risk but there is very limited evidence and
research done on this topic, so there is a need for studies linking duct cleaning with health
outcomes. The impact of hospital cleanliness is easily ignored because of how difficult it is to
quantitate. The author recommends introducing patient screenings, more careful use of
antibiotics, improving placement and management of intravenous lines and catheters, improving
management of ventilated patients, ward deep cleaning, and placing a greater emphasis on
hospital cleanliness (including hand hygiene). This has led to a dramatic fall in MRSA and C.
difficile infection rates.
This article does not provide me with any helpful information because it discussed how
there is no quantitative data and that there is a need for more research but does not provide any
research of its own that I could use. I found it interesting that they mentioned that hand hygiene
is not the only way to prevent nosocomial infection and that it was limited in its usefulness, when
every other source I have read states that person hygiene and hand hygiene was the best way to
prevent nosocomial infection. I do not think I will be using this article in my research, although it
was different to get a new perspective on the use of hand hygiene in the prevention of hospital-
acquired infection.

Bhambri, Alka, and Nisha Pandey. "Nosocomial Infections in NICU: Profile and Risk
Factors." National Journal of Integrated Research in Medicine, vol. 7, no. 3, May-June
2016, pp. 30-33.

Nosocomial infections (NIs) in Neonatal Intensive Care Unit (NICU) are one of the
leading causes of mortality and long term morbidity in developing countries. In this study, they
analyzed data of NICU patients and discovered that eye infection and umbilical sepsis was the
most common infection followed by systemic blood infection. Nosocomial infections increase
the cost of health care delivery by increasing the resource consumption and prolonging the
hospital stay. Although NIs occur universally, they are more prevalent in developing countries.
Newborns are the most vulnerable population in pediatric age group, especially those requiring
NICU admission, where the use of therapeutic interventions, antibiotics and immature immune
system increase the risk of nosocomial infections. Effective surveillance is important to evaluate
the risk factors associated with NIs. Infection was more common in males compared to females
and most of them were premature neonates and had a low birth weight. In the study low birth
weight and prematurity were the most important risk factors for NIs. These babies have an
immature immune system and are more exposed to various therapeutic interventions, exposing
them to higher risk of nosocomial infections.
While this article provided conclusive data, it was done about nosocomial infections in
the Neonatal Intensive Care Unit and focused on babies receiving nosocomial infections and
nothing else. This might not be able to help me because I am not focusing on babies and the
information was targeted for babies. I learned the risk factors and statistics for babies, but I do
not know if it applies to babies. I did read in another article that elderly people and babies were
both the most susceptible to nosocomial infections because their immune system is most weak at
that age, so I could compare those two.

Dziewa, Agnieszka, et al. "Nurse Care Quality and Hospital-acquired Infections: Adhering to
Aseptic Techniques." Journal of Public Health, vol. 125, no. 3, 2015, pp. 133-36.

According to the article, the quality of medical services can be regarded as an indication
of the changes being implemented at a given moment. But, improving the care quality is
essential, regardless of the given moment. This makes upgrading employees skills a necessity to
be able to prevent undesired events, like the common hospital acquired infections. This study
aimed to measure the quality of nursing care delivered to patients who contracted a hospital-
acquired infection, with special attention paid to the adherence of aseptic procedures. They
concluded that there is a 10% deficit in terms of adherence to aseptic procedures and constant
supervision and upgrading of the nursing staff skills is essential. Assessing the changes in social
awareness and the level of the patients expectations or requirements are reasons why there is a
constant need for skill upgrading by the nursing staff. Fawcett-Henessy states that quality
should not only become another trend recommended by various organizations, but rather be
rooted in a common initiative of all healthcare employees, hoping to improve the quality of
services and making care available to anyone who needs it. The standards of preventing
hospital-acquired infections should make patients, hospital managers, and healthcare providers
aware of what high quality care is and what role they should play in improving the care
efficiency and for preventing and controlling hospital-acquired infections. The social
expectations put an emphasis on the health care delivered at the moment. This requires hospitals
to introduce effective measures improving the care quality and put patients first. The ability to
prevent hospital-acquired infections is the most important care quality indicator. Understanding
hospital-acquired infections requires knowledge in the fields of epidemiology, infectious
diseases, microbiology, and economy or management. The study showed that usually when the
staff did not adhere to aseptic standards was when they washed or disinfected their hands
improperly and did not use gloves in the right way. Gloves should defend healthcare
professionals against blood, body fluids, secretion, excreta or contaminated instruments. To
conclude the study, they speculated that proper education of the staff (developing the right
hygiene and epidemiological habits) can greatly help the adherence to aseptic standards. Tackling
hospital-acquired infections means a quality improvement and lowering the treatment costs.
This article helped show the nurses side of hospital acquired infection and what needs to
improve with them so that they can reduce hospital-acquired infection. This reminded me of
when I volunteered at Union Memorial for the first time and I was delivering water to each of the
patients rooms. I had to go in for one second, set it on their table, and leave, but I was told that
every time I entered and exited the room, I had to sanitize my hands. They had a hand sanitizer
station next to every single one of the patients rooms and I used all of them. I thought it was
overused and redundant; I thought I just had to use it once or maybe once in a while, but after
reading this article, I understand why it is necessary to do that. This article gave me a good quote
and good information that I hope to incorporate into my final project.

Bakunas-Kenneley, Irena, and Elizabeth A. Madigan. "Infection Prevention and Control in Home
Health Care: The Nurses Bag." American Journal of Infection Control, vol. 37, Oct.
2009, pp. 687-88.

Home healthcare nursing is an independent practice so infection control policies and

practices vary widely. Existing clinical guidelines set for long-term care settings have been used
to bridge the gap to the home healthcare setting, but the practice dimensions are different that
questions regarding their use in home health care have arisen. Standard precautions and hand
hygiene guidelines apply to all patients in all situations including patients receiving care in the
home, but some agencies suggest that the clinician carry their own paper towels and the use of
waterless antiseptic products are necessary when there is no available area for handwashing.
Gloves are to be worn at all times and should be changed and hands cleansed between
procedures, after touching highly contaminated items. Home health care nurses bags are
containers that are used to transport supplies necessary for patient care. The nurses bag
technique is the process of placing a newspaper under the nurses bag during the home visit to
serve as a barrier to protect against contamination. This study was conducted to determine
whether there is greater risk associated with positive cultures on the inside of the nurses bags
when the outside of the nurses bags has positive cultures. The outside of the nurses bags
indicated that 83.6% of the bags were positive for human pathogens and the inside of nurses bag
cultures resulted in 48.4% positive for human pathogens. Nurses bags with leather surface
material were considerably less contaminated than cloth nurses bags. Because of this, the
authors recommend the use of less porous surface materials for the optimal nurses bags.
Research showed that the use of institutional cleaners that contain sodium hypochlorite as the
active ingredient worked best to decrease bacterial contamination rates and the outside of the
nurses bags optimally should be cleaned on daily or at least weekly intervals.
This was interesting because it explained how inanimate objects can be contaminated as
well and pose risks for nosocomial infections. Although this focused on healthcare outside of the
hospital, I believe I can still apply how the pathogens from outside the nurses bags were found
inside them as well. Hand hygiene is important, but it is not the only thing that can be
contaminated. However, it is not that connected with my topic and this could be applied to my
project if I was studying how the contaminations affect a person outside the hospital, once they
were in it.

Perla, Rocco J., et al. "Health Care-associated Infection Reporting: The Need for Ongoing
Reliability and Validity Assessment." American Journal of Infection Control, vol. 37,
2009, pp. 615-18.

The identification, reporting, and reduction of HAIs has become a priority for patients,
healthcare providers, and state health departments and as demands for public reporting of
infection rates escalate, data accuracy becomes increasingly important. Reliability is described as
the lack of distortion or precision of a measuring instrument or the probability of performing an
intended function for a specified interval under stated conditions. Reliable measures tells
someone that they are measuring something consistently or precisely. Validity is whether or not
they are measuring what they intend to measure. The potential sources of invalidity and poor
reliability are numerous. Standardized reliability and validity checks are currently absent from
hospital-acquired infection (HAI) data collection models and systems. This includes the National
Healthcare Safety Network (NHSN). The NHSN is an online risk-adjusted system that provides a
means for HAI identification and comparisons among hospitals in the United States that evolved
from the National Nosocomial Infections Surveillance System. The NHSN does not currently
provide participant hospitals with methods to gauge the ongoing reliability and validity of HAI
case identification among epidemiologists and infection control professionals (ICPs). The NHSN
and Healthcare Infection Control Practices Advisory Committee documents do stress the need for
periodic reliability and validity checks. One specific suggestion for improving the current HAI
surveillance system is to develop a Web-based proficiency testing module on the NHSN data
submission website that includes a vignette. The goal of the vignette is to highlight aspects of
clinical situations that are linked to specific learning needs and to conduct various assessments of
clinical understanding and judgment. Clinical vignettes are standardized and allows participants
to respond to the same stimulus, it allows for greater control of nonrandom and confounding
variables, the designer can control the variable and modify the degree of exposure and the
degree of the presence or absence of features, and they are a quick way to gather data on process
and outcome measures and to study what factors are associated with erroneous decisions and
reports. A main challenge in the vignette development process is to try and create vignettes that
are as realistic as possible. True accountability and improvement cannot be achieved if the
information driving change is not reliable or valid. The benefits of standardized and consistent
reliability and validity checks for HAI surveillance and detection are increasing data quality and
an ongoing assessment of HAI reliability and validity that will facilitate continuous improvement
and optimization of ICP judgments.
In this article, they covered what was necessary for a reliable and valid interpretation of
HAI rates. They suggested using a website with a vignette. I did not find this useful, because
they were discussing how to improve it, but there was no research conducted saying it was
effective. I also believe that this article has very little to do with my topic and what I plan to do
with my project. I am interested in researching surgical site infections and this did not give much
information on the topic.

Dahmardehei, Mostafa, et al. "Effect of Sticky Mat Uage in Control of Nosocomial Infection in
Motahary Burn Hospital." Iranian Journal of Microbiology, vol. 8, no. 3, June 2016, pp.

Infection is the most common cause of death among burnt patients and infection control
decreases the rate of mortality. The use of the sticky mat can control contamination by
preventing the entrance microorganisms into the hospital wards. This study evaluated the sticky
mats effect in reducing a microorganisms entry by personnel shoes to the burn intensive care
unit (BICU). They tested outer soles of personnels shoes with swap and cultured them before
and after sticky mat contact in the entrance of BICU and then analyzed the results. They
discovered that the effect of the sticky mat in removing the microorganisms was 56%. It
confirms the effectiveness of the sticky mat in controlling the infection and reducing the amount
of hospital contamination. The prevention of burn injuries is not only more efficient but also
reduces costs, than to treat it. The most common cause of death in the burn patients in developing
countries was sepsis and the wound infection was the most common source of sepsis whereas, in
developed countries, pneumonia was the most common cause of infection. Hospital renovations
also increase the risk for nosocomial infection because of the dust and air particles that come out
of it, but with adhesive mats, contamination control flooring, and shoe covers, there was a
decrease in the presence of microbial agents on holding room floors and footwear. They
concluded that the sticky mat needs further studies with more samples to reevaluate the role of
those mats in hospital infection control, especially in ICUs and burn wards. They end the article
by stressing the importance in reconsidering the use of the mats at hospital wards.
The sticky mat is used in the burn wards to help prevent the entry of microorganisms into
the wards and to decrease contamination. It is similar to what the Biopatch does for the skin. I
found this article to be very interesting because this study was done as a re-evaluation for the
sticky mat, because it was declared unnecessary before, but this time, they found out that it does
help prevent contamination. This shows that multiple studies and multiple trials are necessary to
receive a good answer. I found it interesting that sepsis was the bigger problem in developing
countries, but pneumonia was the problem for developed countries. I could research more into
that as well.

Arefian, Habibollah, et al. "Economic Evaluation of Interventions for Prevention of Hospital

Acquired Infections: A Systematic Review." PLoS ONE, vol. 11, no. 1, 5 Jan. 2016.

This review was created to assess the costs and benefits of interventions preventing
hospital-acquired infections and to evaluate methodological and reporting quality. Hospital
acquired infections (HAIs), also called nosocomial infections, are a serious public health
problem, a major cause of morbidity and mortality, and can prolong the length of hospital stays
and increase costs for healthcare systems. The annual financial losses due to HAIs in the United
States (direct costs only) is approximately $6.5 billion. The most frequent HAIs are urinary tract
infections, surgical wound infections, ventilator-associated pneumonia, and primary bloodstream
infections. A study showed that central lineassociated bloodstream infections have the highest
costs ($45,814) and surgical wound infections are the next highest ($20,785). In the conclusion,
the authors state that HAI prevention interventions yield very positive cost-benefit estimations,
but also mention that the quality of economic evaluations should be improved to provide better
information to healthcare policy makers and clinicians. They predicted that international
standardization of cost estimations for HAIs would enable economic evaluation studies to
perform more precise assessments of economic benefits and cost changes associated with HAI
prevention programs.
Almost every article I have read on nosocomial infections mentions how nosocomial
infections increase hospitals costs and are economically detrimental to both the healthcare
system and the patient, but after reading this article, I have a better idea on just how much
nosocomial infections affect the healthcare system financially. This article provides a good
reason as to why this is a serious issue and needs to be addressed. I think it is important to
evaluate and understand how taking precautionary measures is actually cheaper than doing
nothing and waiting for the consequences.

DAngelo, John, et al. "A Partnership to Reduce Deaths from Sepsis." WIHI, 24 Jan. 2014, Accessed 31
Oct. 2016. Interview.

This was an hour long podcast that featured guests all from the North Shore-Long Island
Jewish Health System who have significantly reduced its sepsis mortality rate and are currently
in a partnership with the Institute for Healthcare Improvement (IHI) to maintain and further these
gains. The guests are Dr. John DAngelo, Dr. Martin E. Doerfler, Darlene Parmentier, Andrea
Kabcenell, and Diane Jacobsen. The podcast began by mentioning New York governor, Andrew
Cuomos, proposal of the new regulations to improve the timely diagnosis and treatment of
sepsis for more targeted actions. This was because of the reactions to the sepsis related death of a
12 year old that happened recently in New York. There are known steps to reduce sepsis if the
focus is on the top of the medical peoples mind, they are able to quickly investigate the
situation, and if the healthcare facilities know it and know how to take care of it. In sections,
sepsis remains a big problem in developing countries. Problems are resulting from the body
trying to eradicate the bacteria using inflammatory methods. Any patient with a bacterial
infection can have the inflammatory mechanism spring up to injure the bodys normal organs and
functions. The solution for this includes engaging different departments and staff, using
multidisciplinary methods, and enforcing early identification and early antibiotics for timely
This was a new source for me because I have never used a podcast before. The podcast
was created by the Institution of Healthcare Improvement and allowed me to listen and take
notes. I found it intriguing that the governor created the regulations after the girls death and it
reminded me of the video with Rosie Bartel and how the medical facility began to work on
improvements in joint surgery after they put a face behind surgical site infection. People heard
about sepsis before, but it was not until there was the face a 12 year old that made the situation
seem more real and more human. I believe that I will be using this source in my project and will
be listening to this many more times later for more information. This also introduced me to the
Surviving Sepsis Campaign and their website and I plan on visiting that site and seeing what they
have to say and what they have done regarding reducing the number of incidences involving