Interpreting Health Research And Issues

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Question:

Describe about the Interpreting Health Research and Issues?

Answer:

Outline of Problem

Healthcare management emphasizes on controlling infection within the hospital for maintaining hospital hygiene. It is evident that hospital acquired infection which is known as nosocomial infection is a major concern for the health care providers and professional (McFee, 2009). Nosocomial infection can be described as the infection which has been acquired by the patient within the hospital who has been admitted to the hospital due to another reason. Hence, it means that at the time of admission, that specific infection was absent or incubating (Asensio et al., 2006). Additionally, the infections which take place after discharging patient and the occupational infections spread among the hospital staffs are included in the Nosocomial infection. Though rapid advancement in the health care due to innovation of efficient equipments and technology, infections continue to spread among the patients who have been admitted in the hospitals as well as the hospital staffs (Fridkin, Edwards, Tenover, Gaynes & McGowan, Jr., 2001). It has been found that various factors significantly contribute in promoting infection within the hospital among the patient as they have low level of immunity. Nosocomial infection occurs across the globe and it has been identified as one of the principles causes behind increased morbidity among the patients admitted in the hospitals (Newman, 2010).

Formulation of Relevant Question

A research and clinical audit can be conducted for preventing and controlling hospital acquired infections. Relevant research question need to be formulated for addressing the discussed issue. Relevant question will be:

Positivist Approach

The positivist approach in health care research focuses on discovering the general laws regarding the correlation among distinct phenomena, especially the cause and effect. According to this approach, the clinical studies or experiments are designed for measuring as well as explaining the relationship (Holloway, 2005). Moreover, it helps in testing so that a law can be disproved. Researches who adopt positivist approach focuses on putting pain under the microscope at the time of developing and testing analgesics and analyze the physiological response of the patients. In the context of social medicine, positivist theory can take some account but tends to scrutinize the social in physical terms. For example, it focuses on expressing how estimation as well as expression of pain differs in terms of age, gender and race. Positivist approach emphasizes on the cause and effect (Pope & Mays, 2000).

Advantages

The major advantage of positivist approach has an ability to generalize the findings of a study when it has been replicated for different population. Using the quantitative techniques, positivist approach can forecast.  This approach is appropriate for studying large population and it also helps in saving time (Cohen, Manion & Morrison, 2003).

Limitations

Some limitations of positivist approach have been identified such as the methods in this approach are found to be very flexible at the same time artificial (Boyte, 2000). Additionally, positivist approach is not useful in generating and establishing new theories. Positivist approach focuses on generalization and it is not helpful in analyzing a particular context. Inaccurate data collection may lead to change the ultimate result of the hypothesis (Bowen, 2001).

Health Related Problem

Health care service providers are highly exposed to several infections.  Nosocomial infection has been a major concern for the health care management across the globe. It is basically a hospital acquired infection which was absent at the time of admission to the hospital.  Ineffective management of infectious waste has been identified as the major reason behind the nosocomial infection. Nosocomial infections are responsible for leading to functional disability along with emotional pressure on the patient as well as health care staffs. Ultimately, it leads to develop some disabling condition which declines the quality of life. Additionally, hospital acquired infection increases the hospital morbidity. It is evident that the advancement of health care technology and procedures has resulted in increasing variety of process and techniques which are responsible for creation of prospective routes for infection. Therefore, the poor infection control techniques of the hospital facilitate the transmission of different bacteria among the patients as well as health care staffs. Moreover, the organisms which cause nosocmial infection can be transmitted in the community when the patient is discharged or family members and hospital staffs. Consequently, these organisms can cause potentially harmful diseases in the community.

It is very important to take effective measures for controlling and preventing nosocomial infection. In order to eradicate or minimize hospital acquired infection, it is important to identify the root causes of this problem and therefore developing effective techniques for preventing and controlling nosocomial infection. The research questions which will address the identified health related problem is:

Potential Ethical Issues

A research study can be conducted for analyzing the major reasons behind Nosoomial infection in the hospitals and identification of effective measures for preventing as well as controlling hospital acquired infections. In this study, relevant primary information for addressing the research questions successfully. Ethical aspect has significant importance in different spheres of study. It has been found that some ethical issues are associated with the research study. First of all, the major ethical issue is associated with interviewing the patients. The confidentiality of the personal information shared by the patients need to be maintained. There is a significant risk of disclosure of the personal information of the patients. Secondly, another important ethical issue is gathering information from the patients who are yet to complete the recovery process. Interviewing them for gathering relevant information is not ethical as it could affect the physical as well as mental health of the person. Third important ethical issue is concerned with the confidential information of the hospital. It may found that some cases of nosocomial infection are not reported and registered. Accessing the information of the hospital may lead to disclosure of some confidential information. Using this information for personal use without the permission of hospital authority is not ethical. These are the major three ethical issues associated with conducting the proposed research study. The ethical issues can be ranked according to its importance in the following manner:

  • Personal information of patients
  • Interviewing ill patients
  • Confidential information of hospital

Annotated Bibliography

Weinstein, R., Gaynes, R., & Edwards, J. (2005). Overview of Nosocomial Infections Caused by Gram-Negative Bacilli. Clinical Infectious Diseases41(6), 848-854. doi:10.1086/432803

The authors have gathered as well as analyzed information from 1986 to 2003 for determining the epidemiology of the gram negative bacilli in case of the intensive care unit. The study has been conducted for the common types of Nosocomial infection such as urinary tract infection, surgical site infection, bloodstream infections and pneumonia. This study was focused on analyzing more than 410,000 bacterial isolates which are responsible for nosocomial infections in the ICU.

The study has clearly demonstrated that the gram negative bacilli is continued to be correlated with the nosocmial infection. It has been found that, for the past twenty years gram negative bacilli is the root cause of occurrence of urinary tract infection and pneumonia. Presently, it has been found that gram positive bacteria are associated with blood stream and surgical site infection. In this study each of the antimicrobial pathogen has been tested which has demonstrated the growing trend of resistance. Though it has been identified that the principle causes of nosocomial infection are same all over the world this study has indicated that the increasing antimicrobial resistance varies within a well as outside of a nation.  According to Weinstein &  Edwards (2005), gram negative bacilli, for instance, P.aeruginosa, is intrinsically resistant to the antimicrobials or it has acquired the antimicrobial resistance. Hence it can be anticipated that proportion of the gram negative bacilli has been increasing. This study has identified prevalence of multidrug resistance is the major concern for the gram negative bacilli leading to the nosocomial infections.

Hsueh, P., Chen, W., & Luh, K. (2005). Relationships between antimicrobial use and antimicrobial resistance in Gram-negative bacteria causing nosocomial infections from 1991–2003 at a university hospital in Taiwan. International Journal Of Antimicrobial Agents26(6), 463-472. doi:10.1016/j.ijantimicag.2005.08.016

Hsueh, Chen & Luh (2005) had conducted a research study for evaluating the correlation between the use of antimicrobial and antimicrobial resistance in the university of Taiwan. Data has been collected for the incidents where gram negative bacteria is responsible for leading to the hospital acquired infection in the time period of 1991 to 2003.  The researchers have evaluated the disk susceptibility data of Proteus spp, Klebsiella pneumonia, Acinetobacter spp., Enterobacter cloacae, Escherichia coli,Stenotrophomonas maltophilia, Serratia marcescens along with other gram negative bacilli causing hospital acquired infections. This study has analyzed the secondary information relating the annual patient days along with consumption per year of thee extended spectrum cephalosporins such as ceftazidime, cefpirome, ceftriaxone, flumoxef, cefotaxime etc., aminoglycosides, β-lactam–β-lactamase inhibitor combinations, fluoroquinolones, carbapenems during the period 1991 to 2003. This research paper has identified the growing trend of events of several of these bacteria which caused nosocomial bloodstream infection during 191 to 2003. Additionally, it has been identified that number of days spent by the patients in the hospitals have enhanced significantly.  However, the trend has slightly changed in the year 2003 due to significant epidemic of respiratory syndrome in the nation. The statistical analysis of the study has demostarted a significant correlation between the growing resistance for ciprofloxacin and cefotaxime in E coli and higher consumption of the carbapenems, cephalosporins, aminoglycosides, fluoroquinolones etc. among the patients admitted in the university hospital of Taiwan. The research study has reached a conclusion that the increased antimicrobial resistance of Acinetobacter spp (which is resistant to meropenem) and K. pneumonia (which is resistant to ciprofloxacin) has a significant correlation with the increasing utilization of the cephalosporins. The study has exhibited major change in the use of antimicrobial which has influenced the antimicrobial resistances in case of some specific gram negative bacteria in the hospitals.

Ibrahim, E. H., Sherman, G., Ward, S., Fraser, V. J., & Kollef, M. H. (2000). The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest Journal118(1), 146-155.

This study has been conducted with the aim of evaluation of the correlation between the competence of antimicrobial treatment for one of the most common nosocomial bloodstream infection and the results among the people who require to get admitted in the intensive care unit. The study has been designed in a prospective cohort study for 492 patients in a hospital. In this study primary data has been collected through patient surveillance.

The research study has demonstrated that 29.9% of the sample population has received insufficient antimicrobial treatment in case of the hospital acquired bloodstream infection. Additionally, the study has analyzed the mortality rate of the patients admitted in the hospital having a nosocomial bloodstream infection. It has been found that the patients receiving sufficient antimicrobial treatment has lower mortality rate in comparison to the patients receiving insufficient antimicrobial treatment. The statistical analysis conducted in this research has recognized the insufficient antimicrobial treatment in the hospital as the independent determinant of the hospital mortality. Moreover, this study has also identified the principle causes of bloodstream infections. The common pathogens include Staphylococcus aureus (resistant to oxacilin), Pseudomonas aeruginosa, enterococci (resistant to vancomycin), coagulase-negative staphylococci, Candida species. This study has provided an insight regarding the administration of the insufficient antimicrobial treatment for the victims of nosocomial bloodstream infection which has a significant association with the hospital mortality. The study has concluded that the hospitals must focus on putting significant effort in order to minimize inadequacy in terms of antimicrobial treatment.

Rosenthal, V. D., Maki, D. G., Salomao, R., Moreno, C. A., Mehta, Y., Higuera, F., . & Leblebicioglu, H. (2006). Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Annals of internal medicine,145(8), 582-591.

The research study has emphasized on analyzing the role of the medical devices in spreading nosocomial infection. It is evident that the medical devices in the intensive care units of the hospital are a major issues related to the patient safety. The major aim of this study is to find out   the incidents of nosocomial infection generated from the medical devices in the intensive care units of the developing nations.

In this study, 46 hospitals of developing countries such as Brazil, India, Morocco, Colombia, Argentia, Peru, Mexico etc have been considered for conducting the study. The study has found that during 2002 – 2005, the 14.7% patients in the ICU of the studied hospitals had been suffering from hospital acquired infection caused by the medical devices. This study has implied that the patients have greater risk of ventilator associated pneumonia.  Ventilators account for almost 41% device related nosocomial infections.  Additionally, it has been found that the patients are highly vulnerable to the bloodstream infections which are associated with the central venous catheter. Urinary tract infections are related to catheter which has been found to be very common in case of the ICUs of the studied hospitals. The findings of the research included that most of the infections related to Staphylococcus aureus has been leaded by methicillin resistant strains.  This research study has concluded that the intensive care units of the developing countries are exposed to significant risk related to the medical devices which is considered to be a significant threat associated with the patient safety. This study has recommended that active control as well as prevention program must be designed and implemented for offering high range of patient safety.

Ouderkirk, J., Nord, J., Turett, G., & Kislak, J. (2003). Polymyxin B Nephrotoxicity and Efficacy against Nosocomial Infections Caused by Multiresistant Gram-Negative Bacteria. Antimicrobial Agents And Chemotherapy47(8), 2659-2662. doi:10.1128/aac.47.8.2659-2662.2003

The principle objective of this paper is to find out the effectiveness of the systematic colistin therapy for treating the nosocomial infections which has been caused due to the Pseudomonas aeruginosa and Acinetobacter baumannii which are multi drug resistant. Additionally, this paper has been focusing on the scrutinizing the relevant incidents which are adverse in terms of outcomes.

In this paper, Ouderkirk, Nord, Turett & Kislak, (2003), a research report of the study which was conducted in the university hospital of Tunisia has been presented. The study was conducted on 75 people who had been suffering from seventy eight hospital acquired infections due to P. aeruginosa and A. baumannii which are resistant to multidrug. This study was conducted for the patients admitted in the intensive care units and primary data was collected. The research method focused on conducting a practical intervention for preventing and controlling nosocomial infection. In this study, the patients were treated with colistin sulphomethate sodium. The procedure was administrated intravenously. Additionally, the dosage of the colistin sulphomethate sodium was adjusted as per the renal function of the patients. In this study, thee researchers have used statistical methods such as linear regression that has been utilized for analyzing the correlation between the chosen variables. From this study it can be inferred that colistin is safe and can be used for treating the patients suffering from nosocomial infections due to the multi drug resistant. Hence, this study has recommended use of colistin as a salvage therapy for the patients where the hospital acquired infection is severe and the infections caused by the multi drug resistant.

Jain, M. (2006). Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change. Quality And Safety In Health Care15(4), 235-239. doi:10.1136/qshc.2005.016576

Previous studies have identified that in the intensive care units, hospital acquired infections take place for almost 10% patients. Some research studies have demonstrated that an initiative for enhancing quality can contribute in declining the infections which are acquired within the hospital, mortality rate along with the cost. On the basis of the past studies, Jain (2006), has conducted a study in a hospital which is situated in the northern region of Mississippi. It has been found that the average occupancy rate of the intensive care unit of the hospital having 28 beds is 95%.

An initiative was adopted by the researcher for improving the rate of infections which have been acquired in the hospitals declining the number of adverse incidents in ICU along with decreasing the tenure of stay in ICU. In this research, four changes were implemented and the first is facilitation of multidisciplinary rounds which had been led by the physicians. A flow meeting was conducted daily for assessing the availability of bed.  “Bundles” refers to the third change that refers to the set of evidences which are based on the best practices. Cultural changes have been facilitated where the emphasis was given on the team decision making.

The research study has demonstrated significant impact of the change implemented by Jain (2006). It has been observed that the rate of nonsocial infection such as blood stream infection, ventilation related pneumonia and urinary tract infection has declined.  The study has clearly implied that adoption of a systematic approach for improving the settings in the intensive care units can exhibit significant result. It has been found that the multidisciplinary team has contributed in enhancing the communication and the bundles have offered consistency of evidence based practice. The flow meeting was found to be effective as it assisted in prioritization of the tasks and developed a new culture for decision making empowered by the members of the team.

Urrea, M., Pons, M., Serra, M., Latorre, C., & Palomeque, A. (2003). Prospective incidence study of nosocomial infections in a pediatric intensive care unit. The Pediatric infectious disease journal22(6), 490-493.

This study has been conducted for analyzing the incidents of nosocomial infection in case of the intensive care units for pediatrics. It is evident  that the infections acquired within the hospital lead to the mortality, morbidity or elongated hospital stay in the in case of the intensive care units of pediatrics department. The study was based on surveillance and it was conducted in the university hospital in Bercelona. The study aimed to scrutinize the epidemiologic profile of the hospital acquired diseases.  In this study, for describing the nosocomial infection, the definition provided by Centres for Diseases Control and Prevention has been used a standard. Primary data was collected for identification of the external risk factors which is related to the nosocomial infection.

This study has found that, during that six month period almost 15.1% patients were suffering from nosocomial infections. The findings of the study stated that the incidence of nosocomial infection is 1.5% in the pediatric intensive care units.  The patients with cardiac surgery are found to be highly vulnerable to the nosocomial infections. Additionally, this study had focused on identification of the common types of hospital acquired infections.  Bacteremia has the highest rate of occurrence in the pediatric intensive care units. Moreover, urinary tract infection and respiratory infections are the most common nosocomial infections. It has been found that these nosocomial infections have a significant correlation with the utilization of the invasive devices.  This study has been able to isolate two most common organisms Pseudomonas aeruginosa and Coagulase-negative staphylococci. The duration of staying in the hospital for the patients with nosocmial infection is 22.5 days and 9 days for the patients without infections.

Levin, A., Levy, C., Manrique, A., Medeiros, E., & Costa, S. (2003). Severe nosocomial infections with imipenem-resistant Acinetobacter baumannii treated with ampicillin/sulbactam. International Journal Of Antimicrobial Agents21(1), 58-62. doi:10.1016/s0924-8579(02)00276-5

In the hospitals, Acinetobacter baumannii leads to various infections such as bloodstream infection, urinary tract infection, meningitis and pneumonia. Across the world issues resistant to multidrug has been identified as the major problem which is growing concern of the health care providers. Acinetobacter has been found to be resistant to all the antimicrobials that are commercially available.  This study conducted by Levin, Levy, Manrique, Medeiros & Costa (2003) focused on scrutinizing the clinical competence of the combination of ampicillin and sulbactam for treating the infection caused by the Acinetobacter baumannii.

Primary data was collected for this study for gathering information regarding the infection caused by the Acinetobacter baumannii which is multidrug resistant. In this study the patients were treated with the combination of sulbactam and amplicillin. It has been observed that the Acinetobacter baumannii leaded to death of 80% of the patients having different nosocomial infections. However, patients with urinary tract infections have survived. Most of the patients considered in this study were at the terminal stage and they did not have any other therapeutic option. According to Levin, Levy, Manrique, Medeiros & Costa (2003) ,  this study has implied that treating the patients with nosocomial infection caused by Acinetobacter baumannii is effective. Hence, from this study it can be inferred that combination of sulbactam and amplicillin is safe as well as effective therapeutic option for treating severe infection that has been caused due to the Acinetobacter baumannii.

Segers, P., Speekenbrink, R., Ubbink, D., van Ogtrop, M., & de Mol, B. (2006). Prevention of Nosocomial Infection in Cardiac Surgery by Decontamination of the Nasopharynx and Oropharynx With Chlorhexidine Gluconate, A Randomized Controlled Trial. JAMA296(20), 2460. doi:10.1001/jama.296.20.2460

This paper aims to identify a prevention mechanism for nosocomial infection in case of the cardiac surgery. Past research studies have identified nosocomial infection as a significant cause behind mortality and morbidity after cardiac surgery. Therefore, this study has been conducted by Segers, Speekenbrink, Ubbink, van Ogtrop & de Mol (2006), for determining the effectiveness of the perioperative decontamination of the oropharynx and nasopharynx in order to reduce nosocomial infection after the cardiac surgery.

A double blind, randomized, prospective and placebo controlled clinical trial had been conducted by the researchers on the patients who have been undergoing cardiothoracic surgery.  The major intervention of this clinical study is use of nasal ointment which will contain placebo or chlorhexidine gluconate. The findings of the study implied that the use of chlorhexidine gluconate has helped in declining the rate of respiratory tract infection along with severe surgical site infections. Additionally, in order to prevent nosocomial infection, the patients were treated with chlorhexidine gluconatein have demonstrated notable reduction in rate of Staphylococcus aureus nasal carriage. Additionally, the study has indicated that the use of chlorhexidine gluconatein has helped in shorten the duration of stay in hospital. Hence, the major findings of the study clearly implies that one of the most effective prevention mechanism of nosocomial infection is to decontaminate oropharynx with nasopharynx along with chlorhexidine gluconate after occurrence of cardiac surgery.

Leone, M., Garnier, F., Dubuc, M., Christine Bimar, M., & Martin, C. (2001). Prevention of Nosocomial Urinary Tract Infection in ICU Patients *. Chest120(1), 220. doi:10.1378/chest.120.1.220

One of the most common nosocomial infections in intensive care unit is urinary tract infection. The principle purpose of the clinical research study is to indentify whether utilization of a complicated closed drainage system or the two chambered open drainage system can help in differentiating the rate of acquisition of bacteriuria which is responsible for urinary tract infection.  In this study, complex closed drainage system refers to the drip chamber, antireflux valve and a pre-attached catheter and provision of iodine releasing cartridge.

The design of the study is nonrandomized and prospective and a controlled trial has been conducted to find a preventive mechanism for nosocomial urinary tract infection for the patients admitted in the intensive care unit.  The researcher has conducted the study in the medical and surgical ICU of the university hospital for 224 patients. Two types of complex closed drainage system were applied to evaluate the difference. The findings of statistical analysis were not been able to demonstrate any significant difference between the rates of bacteriuria acquisition between these two groups. Two individual studies have been conducted for comparing the efficiency of complex closed drainage system and the two chamber open drainage system for preventing the urinary tract infection in ICU. As no significant difference has been noted between these two urinary drainage systems, complex closed drainage system will not be selected as the cost is higher in this case. According to Leone, Garnier, Dubuc, Christine Bimar & Martin (2001) it is not justified to bear higher cost without any significant implication.

 Mastretta, E., Longo, P., Laccisaglia, A., Balbo, L., Russo, R., Mazzaccara, A., & Gianino, P. (2002). Effect of Lactobacillus GG and Breast-feeding in the Prevention of Rotavirus Nosocomial Infection. Journal Of Pediatric Gastroenterology And Nutrition35(4), 527-531. doi:10.1097/00005176-200210000-00013

Several past research studies have proved that Rotavirus is one of the most common etiologic agents which lead to nosocomial infection among children. Therefore, it is evident that it is very important to develop effective preventive measures.  One research study has found that Lactobacillus GG can be very effective in treating the rotavirus infection. However, there is only one evidence for supporting the prevention mechanism of Lactobacillus GG. Hence, Mastretta et al., (2002) decided to undertake a study for providing additional support to the previous study. Additionally, there is a strong conflict regarding the role of breast feeding for preventing the nosocomial infection caused by rotavirus. The major aim of this study is to analyze the effectiveness of the Lactobacillus GC along with the role of breast feeding in order to prevent nososcomial infection caused by rotavirus.

Mastretta et al., (2002) had conducted a double blind; placebo controlled and randomized study on two hundred twenty children. They were treated with Lactobacillus GG everyday and test was performed for finding the presence of rotavirus every day even after discharge. The results of the study have not been able to find any significant impact of the Lactobacillus GG in preventing the infection caused by rotavirus. Moreover, an important implication of the study is found in case of the role of breast feeding. The study has indicated that the attack rate of rotavirus has been significantly lower in case of children who were breast fed in comparison to the children who were non breast fed. Hence, Mastretta et al., (2002) has clearly identified Lactobacillus GG was not efficient for prevention of the nosocomial infection caused by rotavirus. However, it can be concluded that breast feeding is more effective in order to prevent attack of rotavirus among children.

Lam, B. (2004). Hand Hygiene Practices in a Neonatal Intensive Care Unit: A Multimodal Intervention and Impact on Nosocomial Infection. PEDIATRICS114(5), e565-e571. doi:10.1542/peds.2004-1107

Nosocomial infections are persistent in the intensive care units for neonatal. It has been indentified that hand hygiene plays a major role in prevention of the nosocomial infection.  However, the health care workers across the world have demonstrated poor hand hygiene compliance. The major aim of this study is to analyze nature as well as frequency of the patient contact in case of the intensive care units of neonatal.  Additionally, the study aimed to observed the techniques as well as compliance of the hand hygiene among the health care workers before and after implementing an intervention program.

Lam (2004) had observed the frequency and the nature of the patient contacts along with compliance with hand hygiene as well as the techniques of washing hands were observed clearly. It significantly helped in reflecting the baseline compliance. Additionally, it focused on investigation of the factors for noncompliance.  The intervention focused upon problem based as well as task oriented hand hygiene education. It emphasized on enhancing the minimal handling protocol and clustering it with the nursing care, up gradation of the factors for the non-compliance, provision for alcohol based antiseptic, regular hygiene audit along with implementation of surveillance of health care related infections.  The result of the study has depicted significant result. It has been found that the overall hand hygiene compliance have been enhanced from 40% to 53%. Hence, it can be implied that task oriented as well as problem oriented education system can help in improving the hand hygiene compliance. Increasing the minimal handling along with clustering the nursing processes can assist in reducing the total patient contact which will contribute in overcoming the major barrier of time constraint.

 Evaluative Summary

Literature review helps in getting an insight to the past studies and research findings which are relevant to the present research topic. Annotating literatures on the causes and prevention of nosocomial infection, significant knowledge has been acquired regarding the topic. This section will emphasize on summarizing the principal understandings and ideas of the literature.

A study has been conducted by the gram negative bacilli for identifying its role in nosocomial infection. Most common type of nosocomial infections includes pneumonia and urinary tract infection, surgical site infection and blood stream infection. .  According to Weinstein &  Edwards (2005), gram negative bacilli, for instance, P. aeruginosa, is intrinsically resistant to the antimicrobials or it has acquired the antimicrobial resistance. Proportion of the gram negative bacilli has been increasing.  Weinstein & Edwards (2005) has clearly identified that the resistance of the gram negative bacilli towards multi drug is a major concern.  Hsueh, Chen & Luh (2005) had conducted a research study for evaluating the correlation between the use of antimicrobial and antimicrobial resistance in the University of Taiwan. It has been found that the use of antimicrobial which has influenced the antimicrobial resistances in case of some specific gram negative bacteria in the hospitals. The research study has demonstrated that it has increased antimicrobial resistance of Acinetobacter spp (which is resistant to meropenem) and K. pneumonia (which is resistant to ciprofloxacin) has a significant correlation with the growing utilization of the cephalosporins. Another study has been reviewed for evaluating the association between the effectiveness of the antimicrobial treatment in case of hospital acquired bloodstream infection (Ibrahim, Sherman, Ward, Fraser, & Kollef, 2000). It has been found that administration of the inadequate antimicrobial treatment for the nosocomial bloodstream infection can help in lowering the rate of hospital mortality caused by nosocomial infection.

Various studies have been found that nosocomcial infection has a strong association with the medical devices used in the intensive care units. According to Rosenthal, Maki, Salomao, Moreno, Mehta, Higuera & Leblebicioglu (2006), the infections caused by Staphylococcus aureus is spread within the intensive care unit through medical devices. In case of the developing countries, the study has demonstrated that the patients are exposed to high risk of urinary tract infection.  In the pediatric intensive care unit, occurrence of the nosocomial infection hav been studied by various researchers. According to Urrea, Pons, Serra, Latorre, & Palomeque, (2003), Pseudomonas aeruginosa and Coagulase-negative staphylococci are the most common organisms leading to nosocomial infection in the intensive care unit of pediatrics department. It has been found that the duration of the hospital stay is significantly higher in case of the patients with infection in comparison to the patient without infection. Past research studies have found that bloodstream infection, urinary tract infection, meningitis and pneumonia are caused by Acinetobacter baumannii.

Some study has focused on developing prevention methods for nosocomial infections. From the study conducted by Ouderkirk, Nord, Turett & Kislak, (2003), it can be implied that use of colistin is safe and can be used for treating the patients suffering from nosocomial infections due to the multi drug resistant. Hence, the use of colistin is considered as a salvage therapy for the patients where the hospital acquired infection is severe and the infections caused by the multi drug resistant. According to Rosenthal, Maki, Salomao, Moreno, Mehta, Higuera & Leblebicioglu (2006), effective prevention and control system need to be designed as well as implemented in order to offer superior patient safety. As significant studies have indentified the frequent occurrence of the nosocomial infections in the intensive care units, Jain (2006) have put an effort on the declining the infection rate through enhancing quality, better team work and change in culture. The research study has demonstrated significant impact of the change implemented by Jain (2006). It has been observed that the rate of nonsocial infection such as blood stream infection, ventilation related pneumonia and urinary tract infection has declined.  Reviewing the literature it can be concluded that adoption of a systematic approach for improving the settings in the intensive care units can exhibit significant result. It has been found that the multidisciplinary team has significantly helped in improving the interaction and the bundles have offered reliability of evidence based practice. The flow meeting was found to be effective as it assisted in prioritization of the tasks and developed a new culture for decision making empowered by the members of the team. A study conducted by Levin, Levy, Manrique, Medeiros & Costa (2003) has demonstrated that treating the patients suffering from nosocomial infection can be treated with the combination of sulbactam and amplicillin as it has been found to be effectual as well as safe. According to Segers, Speekenbrink, Ubbink, van Ogtrop & de Mol (2006), decontamination of oropharynx with nasopharynx along with chlorhexidine gluconate after occurrence of cardiac surgery will be helpful in preventing nosocomial infection. On the other hand, literature review has also helped in getting an insight regarding the prevention mechanism of Nosocomial Urinary Tract Infection in ICU Patients. A study was conducted by Leone, Garnier, Dubuc, Christine Bimar & Martin (2001) for comparing the effectiveness of complex closed drainage system with the two chamber open drainage system in preventing urinary tract infection.

Various research studies have been conducted in order to prevent and control nosocmial infection for children.  The study of Mastretta et al., (2002) has clearly identified Lactobacillus GG was not efficient for prevention of the nosocomial infection caused by rotavirus. On the other hand, it can be concluded that breast feeding is has been found to be effective for preventing hospital acquired infection for infants. Lam (2004), has focused on analyzing the importance of hand hygiene in prevention of nosocomial infection for the neonatal in the intensive care units.

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