Health Care Associated Infections

Nosocomial infections are defined as the diseases that result from iatrogenic means. This means that these infections or diseases are a direct result of medical or pharmacological interventions of any sort. The import of this is that these kinds of diseases are generally speaking, not the primary diseases that the patients are presented with, but they become manifest after or as a result of any form of medical intervention or therapy. They can include the following: the new infections as a result of exposure to pathogens in a hospital environment, exposure to pathogens from medical procedures, like applying central lines, use of catheters, and various surgical procedures (ADVIN, 2009). They can be the diseases acquired by the healthcare professionals as a result of exposure to the sick persons or their biological materials, simple diseases made worse by exposure to the resistant strains of the same pathogen that the patient is infected with, or difficulty in treating an infection in a patient because the patient in question and/or the causative agent of the disease/infection have been exposed significantly to a chemotherapeutic agent prior to the initiation of the new therapy regimen (CDC, 2012).

In this paper, however, I shall lay particular emphasis on the drug resistance aspect of health care associated infections paying special attention to multi drug resistant Tuberculosis (MDR-TB), methicillin resistant Staphylococcus Aureus (MRSA), as well as other drug resistant pathogens. To create an effective policy or guideline that will combat this peculiar problem, the stakeholders that include governments, ministries of health and social welfare, hospitals and their policy making boards, doctors, nurses, parents, young people, and the general public need to be brought on board. The systems theory offers the possibility to combine competencies from the various fields in the formation of a frame work to achieve a target. The understanding of the cognitive development, as well as a grasp of the ways to properly motivate any group, is of a great significance, if success is to be achieved. This theory essentially is enquiry-oriented and allows for questions to be asked by the stakeholders, answers to be agreed on, and frame works to be developed. Comparatively speaking, it is a more recent organizational theory (Laszlo, Krippner, 1998)

Antibiotics by design are meant to target a particular part of microorganisms in order to kill them and/or stop their growth and to help the body’s immune system to overcome the effects of the infection. Some drugs, like penicillin, target and destroy the cell walls of the organisms; others, like macrolides and tetracycline, target the protein synthesizing apparatus of the bacteria; DNA or RNA synthesis organelles in the microbes can also be targeted by the specific group of antibiotics.

The most important principle in chemotherapy is dose and regimen. This means that the bacteria or any organism, for that matter of which you are receiving medication, will only be killed or suppressed at a particular dose. Consequently, the patient needs to bear in mind that they should take the prescribed quantity of the drug at the right times and for the specified period of time religiously. Here lies the biggest problem with chemotherapy, particularly with outpatient or ambulatory patient treatment: many patients quite normally have an aversion to taking pills of any sort and are in a hurry to get off the therapy, once their symptoms stop or at least abate. The problem with this is that if the physician-prescribed drug regimen is not followed to the letter, the patient risks having too low concentration of the drugs in his/her bloodstream to completely eliminate the pathogen. The effect of this is that the remaining pathogens in the blood evolve or develop new biochemical pathways to metabolize the drugs either partially or completely, or they simply develop a mechanism that inures them to the bio-cidal or bio-static effects of this drug. This can be combated using the WHO’s DOT regimen, especially for the cases of tuberculosis.

Another side to it is that when a patient has had an infection of any sort, they usually go to a hospital; the doctor prescribes the tests, which include antibiotic sensitivity test. This helps the doctor to make an informed choice, on which particular drug to administer to the patient for that particular situation. The problem here is that should this condition reoccur, the possibility exists that they will take the same medication, irrespective of the sensitivity of that particular strain of the pathogen to the drug they will recommend. This particularly holds true for the people, who have had or know people that have sexually transmitted infections and are responsible drug resistant gonorrhea strains. This could be combated by making all antibiotics save the penicillin’s prescription drugs. This should be the focus of the enlightenment programs among the young people.

The above mentioned scenarios are case with tuberculosis. The causative organism of this condition, Mycobacterium Tuberculosis, has a peculiar structure that makes it particularly resistant to all, but a very select group of antibiotics, namely: Rifampicin, Isoniazid, Streptomycin, and Ethambutol to name a few. The first three of the above drugs form the first line therapy for tuberculosis treatment, as recommended by the World Health Organization (WHO). It recommends a 6 months treatment regimen for these medications and others in the cocktail of anti-tuberculosis treatment. The fact is that as with the aforementioned, the cases of MDR-TB cases that rise every year are a function a combination of the two factors. The first is patient non-compliance with regimen as prescribed by the physicians; the dose and duration of treatment. The second is physician error in drug prescription (Ormerod, 2005). The result of this is the increase in the scary possibility of development of cross-resistance in certain strains of Mycobacteria. In fact, as of today, the strains of tuberculosis have emerged that are absolutely resistant to the available drugs. This, essentially, is a death sentence for the people, who are unfortunate enough to be infected with this particular strain of tuberculosis. The need in this case for effective treatment cannot be over-emphasized.

The pathogen Staphylococcus Aureus is found normally on the skin and in the nasal orifices. In nature, this pathogen is fairly easy to eliminate, but due to the drug misuse and abuse; especially, in anti-acne topical medications and in hospital environments, where people with various strains of this pathogen are being treated simultaneously, cross-resistance has led to the strains of it that have developed a very high resistance to the drugs normally employed in their treatment. The latter are known as hospital acquired MRSA (HA-MRSA). Patients could get these resistant strains in the hospital or from the communities that they live in. The fatality from the infection of MRSA, especially with complication of sepsis, is more than 75% (Huan et al., 2006).

Governments and hospitals in particular should constantly review the treatments/prescriptions issued by the health practitioners and follow best practices. Adults and parents in particular should be strongly and vigorously discouraged from medicating themselves and their children, as this ultimately does more harm than good. Governments, City Councils, and Universities should ensure that testing for STI’s can be done surreptitiously, so as to remove the stigma attached to the diagnosis, make counseling services readily accessible to sexually active young people, heavily subsidize contraceptives, or make them free entirely.

In conclusion, people should ensure that they take the drugs as prescribed to them religiously. Avoidance of indiscriminate use of drugs is paramount, just because a prescription worked before, does not mean it will work now; the consultation is needed before taking any antibiotic. Drug resistance is a huge threat to the health of our nation. Concerted efforts should be made by all the involved parties through public enlightenment and direct supervision of health care workers to ensure that the risk for development of resistance to drugs is reduced to the barest minimum.

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