Healthcare-associated infections (HAIs) Essay

BACKGROUND wellnessc be-associated transmission systems (HAIs) atomic number 18 bacterial transmittable diseases acquired during a forbearings arrest in a wellness care institution.  It imposes a huge consequence on wellnesscare institutions, costing billions of dollars for additional care costs as well as a pro ready fraction of lost lives (Houghton, 2006).  authentic estimates depict that approximately 2 million unhurrieds acquire health care-associated transmission systems (HAIs) or nosocomial transmission systems sever ally year, of which 90,000 to 100,000 diligents die (Houghton, 2006), making HAIs not only a internal health problem, moreover a global threat as well.  greenness HAIs accommodate hematological, surgical site, dermatological, respiratory, urinary and gastroin assayinal systems.  In order to ope array the increase in number of healthcare-associated infections, it is fundamental to identify key factors that recognize healthcare institutions susceptible to much(prenominal) outbreaks.  There is a penury to prize the sensitivity and efficiency of healthcare institutions to healthcare-associated infections in order to prevent next outbreaks.PROBLEM STATEMENT            This work bequeath investigate the sensitivity of spotting and efficiency of reporting healthcare-associated infections to the infirmary nerve, in the context of providing measures in improving the current surveillance program in the outlandish.  The guide passs to identification of a healthcare associated infection allow be evaluated through personal interactions with healthcare proles development questionnaires which depart be designed apply a quadruplicate option onslaught.CONCEPTUAL/THEORETICAL FRAMEWORK             This consume is establish on the occupy to dole out the current epidemic of healthcare-associated infection tha t is emerging approximately the world.  ahead an good solution to the problem is designed, it is essential that shortcomings in the ideal procedures of healthcare institutions be place.  This whitethorn be do by determining the originate of sensitivity of healthcare personnel to symptoms of healthcare-associated infections, as well as wise to(p) what are the first set of actions to be done once an infection is confirmed indoors a healthcare institution.  This turn over may table service as the first measurement dent that addresses these aspects of the global epidemic. RESEARCH dubiousness/HYPOTHESIS            This investigation aims to address the question of whether the current infirmary administration is sensitive enough to detect and substanti completelyy efficient to report to healthcare institutions either incidents of healthcare-associated infections.  This exit be directly evaluated use survey entropy collections from retrospective campaigns of particular health institutions as related to dates of hospital admission, tick of infection and give-and-take eon. SIGNIFICANCE OF THE STUDY            There is a select for an effective surveillance and sustain program for healthcare-associated infections that are ground on current settings in a healthcare institution.  Through surveys that inquire on common practices and results of healthcare workers, any shortcomings or avoidable gaps in the hospital system may be re represented, which in turn pull up stakes salve the spread of infection in the healthcare institutions.  Review of checkup spirits and interviews with be healthcare personnel give be performed in order to t each(prenominal) whether there are certain discrepancies and gaps in the healthcare protocol that avail contaminant and further spreading of infectious microbials around the healthcare institution.  This shoot may facilitate the identification of key factors that influence the increase in frequency of nosocomial infections in hospitals.  The results of this investigation may positively perform as a tool to healthcare workers such as nurses and science laboratory technicians.STATEMENT OF THE PURPOSE (OBJECTIVES)            This research provide determine the sensitivity and response direct of healthcare workers to healthcare-associated infections.  This proposal aims to develop a measurement tool that go forth determine the sensitivity for identification, efficiency of reporting and the response swan to a healthcare-association infection, with the aim of designing a cost-effective and quick right smart of attendling and ultimately eradicating the healthcare-related problem.  LITERATURE REVIEW            The prevention and learn of HAIs requires a c osmopolitan approach that addresses as many pathogens as possible (Wiseman, 2006). urinary tract infections (UTI) associated with catheter use are the most common HAIs, with hospital-acquired pneumonia having the highest mortality prize (Houghton, 2006).  These infections are a great dealen problematic to treat due to the fact that the microorganisms mixed pretend bugger off tolerant to antibiotics (Broadhead, Parra and Skelton, 2001). Recent media insurance coverage of meticillin-resistant staphylococci aureus (MRSA) has change magnitude the awareness of healthcare professionals to the threat of this particular microbe.  S. aureus infections can result in cellulitis, osteomyelitis, septic arthritis and pneumonia, and virtually of the systemic diseases such as food poisoning, scalded uncase syndrome and toxic shock syndrome (Zaoutis, Dawid and Kim, 2002).            MRSA and vancomycin-resistant Enterococcus (VRE) are th e primary causes of nosocomial infections and are significant factors in increase morbidity and mortality judge. These microbes are currently endemic disease in many healthcare institutions, particularly problematic in intensifier care wholes (intensive care units) (Furuno, et al. 2005).  VRE infections bind become prevalent in U.S. hospitals over the hold up decade, increase in incidence 25-fold (Ridwan et al., 2002).  Vancomycin is the antibiotic frequently apply to treat infections caused by MRSA, but recent days ease up seen the proceeds of Staphylococcus aureus infections that drive floor high-resistance to vancomycin, which makes the future effectiveness of this drug questionable (Furuno et al., 2005). all known variants of the vancomycin-resistant Staphylococcus aureus (VRSA) isolates ware possessed the vanA gene, which carries with it resistance to vancomycin.  This development is believed to fetch been acquired when the MRSA isolate conjugated with a co-colonizing VRE isolate (Furuno et al., 2005, p. 1539). This mode that endurings who suffer co-village from MRSA and VRE drive home an increased risk of infection for colonization and infection by VRSA (Furuno et al., 2005). Furthermore, Zirakzadeh and Patel (2006) stated that VRE has become a major concern due, in part, to its ability to transfer vancomycin resistance to separate bacteria, which includes MRSA.            Infection of susceptible patients typically go throughs in environments that have a high rate of patient colonization with VRE, such as ICUs and oncology units (Zirakzadeh and Patel, 2006).  In these healthcare settings, VRE has been known to survive for extensive periods and research has as well ob seed that VRE has the ability to contaminate virtually every surface (Zirakzadeh and Patel, 2006). Efforts to control HAIs, such as VRE, have centeringed on prevention, such as through hand hygienics, as the f irst line of defense.            Hand hygienics has been improved by using user-friendly, alcohol-based hand cleansers, but there neverthe little remains the goal of achieving consistently high levels of compliance with their use (Carling et al., 2005, p. 1).  Screening-based closing off practices have likewise improved transmission rates of MRSA and VRE however, logistic issues and the cost-effectiveness of these practices are still being analyzed (Carling et al., 2005). Additionally, despite isolation practices, outbreaks and instances of environmental contamination have been documented in regards to MRSA, VRE and Clostridium difficile, which cannot be screened with any practicality (Carling et al., 2005).            The many obstacles that exist in regards to effective screening practices suggest that a digest on improving existing modify/cleanseing practices may prove to be more effec tive in halting the spread of HAIs (Carling et al., 2005). Studies over the coating several decades have shown that there is often contamination of surfaces in and around the patient, as pathogens associated with the hospital environment have been known to survive on surfaces for weeks or even months (Carling et al., 2005). Significant rates of contamination with Clostridium difficile have been connected with symptomatic and asymptomatic patients (Carling et al., 2005).            In 2002, the CDC issued guidelines that called for hospitals to complete(a)ly clean and disinfect environmental medical checkup equipment surfaces on a regular ass (Carling et al., 2005, p. 2). different organizations have followed suit and stressed repeatedly the need for healthcare provides to centralise on environmental cleaning and disinfecting activities, yet these guidelines have not provided directives that address precisely how healthcare providers can either evaluate  their ability to obey with professional guidelines on this topic or ensure that their procedures are effective (Carling et al., 2005).  Nevertheless, literature on the subject does offer some direction.            Surveillance, evidence-based infection control practices and the responsible use of antibiotics have been determined to be crucial to controlling HAIs (Wiseman, 2006).  The establishment of comprehensive surveillance programs has facilitated the creation of national entropybases the compile cases of infection which may be useable to researchers investigating progression rates and causal factors.  Evidence-based control practices may be use by distributing guidelines for aseptic hospital protocols, hospital hygiene, personal protective equipment and disposal of biohazardous sharps.  A redirect examination of unremarkably used antibiotics in terms of proper dosage and length of wo rd based on clinical evidence and best practice guidance should as well be performed.            Curry and Cole (2001) account that the medical and surgical ICUs in large inner-city teaching hospitals developed an elevated patient VRE colonization rate. A multi-faceted approach was instituted to correct this problem, which involved changing behavior by pauseing norms at multiple levels through the ICU community (Curry and Cole, 2001, p. 13). This interpellation consisted of five levels of behavioural change. These encompassed 1. intrapersonal and individual factors 2. interpersonal factors 3. institutional factors 4. community factors and 5. commonplace factors (Curry and Cole, 2001, p. 13).            Educational interventions were developed that addressed each level of influence and behavioral change was predicated on modeling, observational learning and vicarious rein push backment (Curry and Cole, 2001, p. 13). These procedures resulted in a marked decrease of VRE surveillance cultures and positive clinical isolates within six months and this decrease has been consistent over the next twain years (Curry and Cole, 2001, p. 13).            Research has shown that the nutritional status of preoperative and perioperative patients can influence their risk for acquiring a HAI (Martindale and Cresci, 2005). This is particularly true for patients who are undergoing surgery for neoplastic disease as this can commonly result in immunosuppression (Martindale and Cresci, 2005). short(p) nutrition, surgical insult, anesthesia, blood transfusions, adjuvant chemotherapy/radiation/ and other metabolic changes have been identified as contributing to suppression of the immune system (Martindale and Cresci, 2005). Furthermore, studies have excessively associated infection risk with glycemic control Maintaining blood glucose levels betwi xt 80 and 110 mg/dL vs. 180 and 200 mg/dL has been shown to result in fewer instances of acute renal failure, fewer transfusions, less polyneuroopathy and decreased ICU length of stay (Martindale and Cresci, 2005, p. S53).            Citing Ulrich and Zimring, Rollins (2004) states that getting rid of double-occupancy entourage and providing all patients with single rooms that can be adjusted to accept their specific medical needs can improve patient natural inscribeber by reducing patient transfers and cutting the risk of nosocomial infections. speckle these researchers admit that the up-front cost of private rooms is significant, this get out be contrabandist by the savings accrued through lowers rates of infection and readmission, as well as shorter hospital stays (Rollins, 2004).            A recent sphere conducted by researchers at Chicagos Rush University Medical revolve around fou nd that enforcing environmental cleaning standards on a routine basis resulted in less surface contamination with VRE, cleaner healthcare worker hands, and a significant reduction in VRE cross-transmission in an ICU ( clean c deoxyadenosine monophosphateaign, 2006, p. 30). These improvement in VRE contamination continued to be experienced even when VRE-colonized patients were continually admitted and healthcare workers compliance with hand hygiene procedures were only moderate (Cleaning c angstrom unitaign, 2006). The strategies that the researchers implemented included that theyheld in-services for house keep openers about why cleaning is importantemphasizing thorough cleaning of surfaces likely to be touched by patients or workers.increased monitoring of housekeeper performance.recruited respiratory therapists to clean ventilator control panels daily.educated nurses and other ICU staff on VRE and how they could assist housekeepers by clearing surfaces that need cleaning.conducted a hand hygiene campaign, including mounting alcohol gel dispensers in common areas, patient rooms and every room entrance (Cleaning campaign, 2006, p. 30).            CDC guidelines argue that if hands are not visibly soiled, using an alcohol-based hand rub should become habitual between patient contacts. When hands are visibly soiled, use of an anti-microbial soap and water is necessary. If contact with C difficile or barn anthracis is possible, it is recommended that the healthcare provider wash with anti-microbial soap and water, as other clean agents have poor efficacy against spore-forming bacteria and the physical friction of using soap and water at least decreases the level of contamination (Houghton, 2006). scalawag (2005) indicates that the CDC has joined with the US Department of health and Human Services, the National Institutes of Health (NIH and the Food and Drug Administration (FDA) to lead a task force of 10 agencies a nd departments, which have developed a blueprint outlining federal actions to armed combat this problem. This template emphasizes the efficacy of hand washing, among other points (Page, 2005).            In 2002, the CDC issued updated hand hygiene guidelines, which address new development and research on this topic, such as alcohol-based hand rubs and alternatives to antibacterial soaps and water (Houghton, 2006, p. 2). However, while the efficacy of hand hygiene is well accepted, it is also well known that healthcare workers of all disciplines frequently fail to abide by fit hand hygiene practices (Houghton, 2006, p. 2). In fact, research has shown that adherence rates to hand hygiene guidelines are utmost in ICUs, where to the frequency of patient care contact, multiple opportunities for hand hygiene exist on a hourly basis (Houghton, 2006). According to Houghton (2006), any direct patient-care contact, which includes contact with gl oves and/or contact with objects in the immediate patient vicinity, constitutes an opportunity for appropriate hand hygiene.            This suggests that the proposed intervention should also include inquire healthcare employees at the site of the intervention to participate in a survey that examines, first of all, how closely hand hygiene protocols are followed and, if they are not followed, why not. It may be that the activity level of ICUs is so great that the practitioners feel that they cannot take sufficient term to do adequate hand hygiene. If this is the case, alternative methods of hand hygiene to that institutions handed-down policy may need to be investigated.            Just as this reading revealed factors that can be associated with non-compliance, a similar investigative effort may be called for to determine reasons why compliance may not be satisfactory for cleaning/disinfect ing environmental surfaces. Again, it may be that non-compliance hinges on factors of time.  It may be, therefore, expeditious for hospitals and other healthcare organizations to look into hiring additional personnel to uphold with cleaning/disinfecting tasks. It may also prove necessary, to cope with factors of time and efficiency, to train cleaning personnel to take a systematic approach to patient room cleaning that includes all high touch areas. As state previously, researchers at Chicagos Rush University Medical Center found that holding in-service training for housekeepers was an effective component of their overall strategy in lowering VRE related infections (Cleaning campaign, 2006). This process could be facilitated by a checklist approach or by periodically reevaluating rooms harmonize to the Carling et al. (2005) methodology.            Given these enlarge accounts of healthcare-associated infections in hospitals, it is o f significant importance that the sensitivity and response rate of health personnel be identified in order to know if there are any discrepancies and gaps in the standard hospital protocols that foster the expansion of microbials in hospitals.  This study aims to determine the level of sensitivity and response rate of healthcare institutions to the growing epidemic of healthcare-associated infections. SUMMARY            HAIs are an unnecessary tragedy, increasing morbidity and mortality figures and adding to healthcare costs. While there are ways to treat all the various HAIs, the clearest remedy for this insidious drain on healthcare resources and personnel is prevention, which begins with the simplest of actswashing ones handsbut also extends to reaching all hospital surfaces as having the potential to harbor pathogens. This means rethinking some healthcare institutional procedures. It means habitually and routinely cleaning a ll surfaces, as well as everywhere and anything that is routinely touched, whether by a bare or gloved hand.            Stopping the spread of HAIs includes multiple factors, such as restrained and appropriate use of antibiotics. However, the first line of defense is cleaning/disinfecting procedures. This constitutes the ground zero nucleotideal line for battling HAIs and this means that all healthcare practitioners should keep the goal of reducing the spread of HAIs foremost in their minds while going about their daily routines, washing hands between each patient contact and paying attention to other sepsis concerns. In other words, the first step in stopping HAIs is simply to keep them in the forefront of practitioner consciousness.ReferencesBroadhead, J. M., Parra, D. S., & Skelton, P. A. (2001). Emerging multiresistant organisms in the ICU Epidemiology, risk factors, surveillance, and prevention. Critical Care breast feeding Quarte rly, 24(2), 20.Carling, P. C., Briggs, J., Hylander, D., & Perkins, J. (2006). An evaluation of patient area cleaning in 3 hospitals using a newfangled targeting methodology. American Journal of Infection have got, 34(8), 513-519.Centers for Disease Control and Prevention. (2006). Healthcare-Associated Infections (HAIs).   Retrieved March 17, 2007, from http//www.cdc.gov/ncidod/dhqp/healthDis.htmlCleaning campaign targets VRE transmission. (2006). OR Manager, 22(7), 30.Curry, V. J., & Cole, M. (2001). Applying social and behavioral theory as a template in containing and confining VRE. Critical Care Nursing Quarterly, 24(2), 13.Furuno, J. P., Perencevich, E. N., Johnson, J. A., Wright, M.-O., McGregor, J. C., Morris Jr, J. G., et al. (2005). Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococci co-colonization. Emerging Infectious Diseases, 11(10), 1539-1544.Harrison, S., & Lipley, N. (2006). Wipe It Out infection control initiative exten ded. Nursing Management UK, 12(10), 4-4.Houghton, D. (2006). HAI prevention The power is in your hands. Nursing Management, 37(5), 1-8.Johnson, A.P. Pearson, A. and Duckworth, G.  (2005)  Surveillance and epidemiology of MRSA bacteraemia in the UK.  J. Antimicrob. Chemo.  56455462.Lopman, B.A., Reacher, M.H., Vipond, I/.B., Hill, D., Perry, C., Halladay, T., Brown, D.W., John Edmunds, W. and Sarangi, J.  (2004)  Epidemiology and personify of Nosocomial Gastroenteritis, Avon, England, 20022003.  Emerg. Infect. Dis.  10(10)1827-1834.Martindale, R. G., & Cresci, G. (2005). Preventing Infectious Complications With Nutrition Intervention. JPEN, Journal of Parenteral and enteric Nutrition, 29(1), S53.Page, S. (2005). MRSA, VRE and CDCs plan to combat antimicrobial resistance. Vermont Nurse Connection, 8(3), 6-7.Parienti, J. J. M. D. D. T. M., Thibon, P. M. D., Heller, R. P. P., Le Roux, Y. M. D. D., von Theobald, P. M. D. D., Bensadoun, H. M. D. D., et al. (2002). Hand-rubbing with an sedimentary alcoholic aolution vs traditional surgical hand-scrubbing and 30-day surgical site infection Rates. JAMA, 288(6), 722-727.Ridwan, B., Mascini, E., Reijden, N. v. d., Verhoef, J., & Bonten, M. (2002). What action should be taken to prevent spread of vancomycin resistant enterococci in European hospitals? British Medical Journal, 324(7338), 666.Rollins, J. A. (2004). Evidence-Based Hospital Design Improves Health Care Outcomes for Patients, Families, and Staff. Pediatric Nursing, 30(4), 338.Sheff, B. (2001). Taking aim at antibiotic-resistant bacteria. Nursing, 31(11), 62.STATA 8.0. College Station (TX) STATA company 2002.Stevenson, K.B., Searle, K., Stoddard, G.J. and Samore, M.H. (2005)  Methicillin-resistantStaphylococcus aureus and vancomycin-resistant Enterococci in rural communities, Western United States.  Emerg. Infect. Dis.  11(6)895-903.Tacconelli, E. Venkataraman, L., De Girolami, P.C. and DAgata, E.M.C.  (20 04)  Methicillin-resistant Staphylococcus aureus bacteraemia diagnosed at hospital admission distinguishing between community-acquired versus healthcare-associated strains.  J. Antimicrob. Chemother. 53474-479.Wiseman, S. (2006). Prevention and control of healthcare associated infection. Nursing Standard, 20(38), 41-45.Zaoutis, T., Dawid, S., & Kim, J. O. (2002). Multidrug-resistan organisms in general pediatrics. Pediatric Annals, 31(5), 313.Zirakzadeh, A., & Patel, R. (2006). Vancomycin-resistant enterococci Colonization, infection, detection and handling. Mayo Clinical Proceedings, 81(4), 529-536.METHODOLOGY            A retrospective non-probability gang surveillance study will be performed on hospital records of ii health institutions, Assir Central Hospital and Khamis Mushait Hospital from January 2002 to December 2006.  such coverage will represent a larger population of similar environmental and socioeconomic s ettings, which may also influence the frequency of healthcare-associated infections in the area.  This example of non-probability cluster sampling will be used because it will usefulness the split-level definition that will be followed, distinguishing normal hospital cases and healthcare-associated infections or outbreaks, based on the CDCs guidelines for healthcare-associated infections.  Ethical approval from the respective ethics review committee of each hospital will be obtained before the study will be conducted.Study population.  Th study population will includ 5,000 patints that have been admitted at the Assir Central Hospital and Khamis Mushait Hospital from January 2002 to December 2006.  These hospitals were elect in order to primarily focus on collection of reliable, high-quality info based of systematic sampling.  The hospitals administrative selective informationbase will serve as the main source of information for this study.  For purposes of anonymity, patients names will be unplowed confidential and will be replaced with a case number instead.  A retrospective non-probability sampling using patint cases will be classified according to gender, age, diagnosis upon admission, length of stay and treatment received.The treatment mob of the patients will be further characterized as surgical, respiratory, urinary, urological, obsttrical, intensive care, cardiac or trauma.  Any co-morbidities will be taken tuberosity of in every patient included in the study.  Patient records will also be reviewed to determine whether and when a healthcare-associated infection was observed afterwards admission to the hospital or during the patients stay in the hospital and will be identified as the time-at-risk, or the time when the infection has been ascertain and may most probably be contagious to the patients immediate environment.  Among the inclusion subjects are healthcare workers such as nurses, laboratory techni cians and other hospital staff appendages will be included in the study as population at risk.  excommunication subjects are those patients that were not admitted into the hospital because their stay in the hospital was not recommended during their healthcare.           The entropybase of the infection control team of each of the two hospitals will be reviewed to gather information on the study population in the hospitals.  Infection control nurses are responsible for monitoring any outbreaks in each hospital during hospital ward rounds, or are identified as the point-of-contact personnel that is alerted as soon as an HAI incident is suspected to occur in the specific ward of the hospital.  Cluster sampling will be performed when an infection does happen that fits the clinical definition of an HAI, the healthcare institution is required to report this incident to the areas or countys health protection agency.  The area or co unty health protection agency is in charge of ensuring the comprehensiveness of incident reports, monitoring data admittance and conducting analyses.  The health protection agency also collects reports during months that no infections were account to verify that no infections occurred at that time.Tools to be employed.  To determine whether a case patient has contract a healthcare-associated infection, the system definitions established by the Center for Disease Control and Preventions National Nosocomial Infection Surveillance (NNIS) will be followed, with slight modification for us in a rtrospctiv study.  Th NNIS dfinitions were dvlopd according to a prospctiv approach to hospital survillanc and ar dsignd to b quit spcific.  Bcaus clinical dcisions ar oftn not mad on th basis of survillanc dfinitions, w bliv that som cass of clinically suspctd infction would mt most but not all of th NNIS critria and thus b classifid as non-HAI, spcially on a rtrospctiv map rvi w.W designed a retrospective-based data classification scheme that follows the future(a) criteria patints who were not infctd, thos with suspctd HAI, and thos with confirmd HAI.  In gnral, patints with suspctd HAI will includ thos who have received antimicrobial thrapy for a condition that appard 148 h aftr hospital admission and who will mt all but on clinical critria for a confirmed infction.  Dfinitions for a confirmed HAI will b the sam as thos usd by th NNIS, xcpt that rcipt of appropriat antimicrobial thrapy will b xcludd as a critrion for a confirmd infction. Ths critria will b finalizd bfor chart data abstraction bgins.  Th conomic prspctiv will b usd for masuring costs incurred by th hospital, bcaus th hospital administration will b th dcision makr for instituting and financing infction control programs.Data collction.  Clinical cases of healthcare-associated infection identified by the clinical laboratories of the two fighting(a) hospitals will be compile d.  Demographic, medical history and other epidemiologically relevant data on each reported case will be roll up.  The microbiology laboratory of the hospital may also contribute information to the data collection.  The patients medical record will serve as the primary source of information for this study.  The data collected will be recorded in a standardize data collection form.  In addition, outbreak or infection abridgment forms that were previously completed by infection control nurses and reported to health protection agencies as a healthcare-associated infection will be collected and integrated into the study database.The duration of an outbreak will be determined by taking note of the date the first case of the infection was reported and correlating this date to the date when the last case of the infection was reported at the healthcare institution (Lopman et al. 2004).  All data will reckon from patint mdical rcords of the healthcare facility.&nb sp Intrratr rindebtedness will not b masurd, bcaus ach abstractor will b focusd on rcording a singl lmnt of data for ach patint, similar to an assmbly lin.  All data meeting will b dirctly suprvisd by a member of the research program.  Patints with suspctd or confirmd HAI will b idntifid on th basis of thir vital signs, laboratory and microbiology data, and clinical findings documntd in the respective physicians progrss and consultation nots.To improve the validity of the collected data, the following approaches (Stevenson et al. 2005) will be employed  1) a data dictionary and trading operations manual will be created with explicit instructions for completion of the data collection forms 2) the data collection protocol will be discussed during convocation calls along with frequent one-on-one communication and 3) anomalous data in the data reports will be routinely searched for and corrected.  The definitions employed in this study will concentrate on the locatio n of the patient at the time of microbiological hearing for infection diagnosis, and the presence or of exposure to the healthcare environment. The study will emphasize the time of response of any member of the healthcare institution to the definitive diagnosis of the healthcare-associated infection (Johnson et al. 2005).  Each identified HAI case will be further analyzed for its causative agent, such as MRSA or VRE.  All included in this study were HAI cases with any prior history of hospitalization, out-patient surgery, residence or care in a home/health agency with documented healthcare-associated infections in the last 6 months.  Examples would include former out-patient cases with post-operative infections.  Other coexisting factors that may be associated with healthcare-associated infections such as diabetes mellitus, immunosuppression, renal failure and other antimicrobial drug treatments, will also be included in the data collection form.The incidence r ates of each type of healthcare-associated infection will be calculated for each hospital from January 2002 to December 2006.  Any patient cases that could not be ascertained to be completely reported in the medical records will not be included in the analysis.  The incidence rates will be expressed as the number of healthcare-associated infections per 10,000 patient-days or number of community cases per 10,000-person-years, based on county population (Taconelli et al. 2004).Instruments including reliability and validity.  A data collection form will be designed for use in this investigation.  Essential entry data will include case number (patient name is kept confidential), hospital name, date of admission, diagnosis upon admission, treatment regime, date of detection of healthcare-associated infection, treatment of healthcare-associated infection, date of admission of treatment of healthcare-associated infection, identification of HAI etiological agent, resistance of HAI etiologic agent and date of patient discharge.  The healthcare institution personnel that have attended to the patient will also be noted, such as attending physician, consults, nurses, technicians and technologists.          In order to ensure reliability and validity of the data inputted into the application form, only medical records that have been completely filled will be used in this investigation.  In addition, there will be questions in the application form that will determine whether the patient has undergone any previous exposure to any hospital for outpatient or inpatient hospital or nursing facility in the last 6 months.  This is done to make sure that the source of the HAI is determined, whether it is coming from within the hospital or from another healthcare institution.Data Analysis.  The collected data will be entered and stored in an AccessTM relational database (Microsoft, Redmond, WA) for analysis.  A ccessTM is a database management system that is very useful for handling and manipulation of data that are designed in the examination format.  It provides the analyst an easier way to extract data from the database according to selected fields or variables, as well as equation or combine two variables at one time.Data analyses will be performed using Microsoft ExcelTM and Stata 8.0 (2002).  Proportions of heart cases meeting specific epidemiologic criteria will be calculated, and characteristics of each home will be compared by using Fisher exact testing.  To compare means, the t-test will be employed, and to compare proportions, the 2 test will be used.  All continuous data will be analyzed using linear regression.  To assess linear correlations between two variables, the Spearman rank test will be used.  Census data and ages of patients in each category will be compared using the Kruskal-Wallis equality of populations rank test.  The relationship of healthcare institution response rates to the infection and other covariates will be modeled by using random effects Poisson regression.Each hospital will be taken into account as a unit and treated as a random effect.  During th initial phas of data collection, dscriptiv statistics will be used to dscrib and summariz th data obtained in th study.  Th scond phas of analysis will focus on th us of multivariat analysis to dtrmin th rlationship btwn variables such as length of stay and the severity of infection.  This will b conductd through th us of cross tabulation of nominal data btwn slctd variabls in th study.  Statistical significanc is to b st at an alpha lvl of 0.05 ANOVA will b usd to xamin th variation among th data. Along with it, ordinary last-squars (OLS) rgrssion will b usd to tst for linar rlationships btwn variables tested.  Suspctd HAI, confirmd HAI, and admission to ICU will b codd as dummy variabls, with th valus of 1 that will b deputed for pati nts with th attribut and 0 for thos without it. Whn prsnt, ths dichotomous variabls act as intrcpt shiftrs but do not chang th slop of th stimatd rgrssion lin.Limitations of the study.  Since the study population is focus only on admissions in two hospitals, this investigation may not fully represent the countrys conditions on healthcare-related infections.  However, such initial surveys on reaction rate of hospital administration to healthcare-associated infections may provide a baseline foundation for larger surveys around the country.  Ethical considerations.  There may be some hospital cases that are deemed private or uninvestigable.  These will not be included in the investigation.  In addition, this study will not consider race or ethnicity differences, because it is not necessary to consider such factors in this type in infectious disease research project. Feasibility of the backcloth of this study.  This investigation is feasible to condu ct given the resources and time available to the detective because it is a retrospective study that will only deal with medical records.  Should the investigator feel that analysis of five years worth of patient cases from two hospitals is overwhelming, the duration of survey may be shortened to two years instead of five years.  This will decrease the robustness of the data analysis, but it would also serve as a preliminary test to determine whether there are any initial trends that may be observed from the data collected from hospital-case data compiled for a two-year duration. succinct assessment.  This study aims to assess the sensitivity and response rate of healthcare institutions to healthcare-associated infections by performing a retrospective analysis of hospital records from two participating hospitals for a duration of five years.  Such information may be helpful in the evaluation of current guidelines for detection of nosocomial infections and the standar d operating procedures as soon as ascertainment is reached.Recommendation.  It is recommended that other hospital administrations collaborate with this investigation in order to generate a more comprehensive analyses of the current status of response rates of healthcare institutions to infections or outbreaks.  Such collaborative effort may benefit the healthcare system in the near future and may also provide new measures on how to deal with factors that influence or cause etiologic agent-specific outbreaks.