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I need two separate responses to student 1 and student 2s discussion posts. I attached both of the
posts and the original assignment. They only need to be 1 to 2 paragraph response each. This post
should provide constructive commentary, beyond “I agree”, “Good post”, etc. Simply rephrasing
another student’s post is not acceptable. Dont dog on the student either.
Dont really need outside sources on these
Problem-Solving Application
Hospitals and Nursing Homes Collaborate to Combat
Common Foes
The Foes MRSA (methicillin-resistant Staphylococcus aureus) and CRE (carbapenemresistant Enterobacteriaceae) are two especially resistant and dangerous bacteria, and
although you can catch these bugs anywhere, the most common and problematic places
are hospitals and nursing homes. When patients are infected in these facilities they are
referred to as health care-associated infections (HCAIs). Some patients enter both types
of facilities with these infections which need to be treated. But it also is increasingly
common for patients to be infection free when admitted and then catch one of the bugs
while a patient. This major problem is made even worse when infected patients are then
transferred from one facility to another along with their super bugs. This means health
care facilities are not islands with independent challenges contained within, but instead
they are interconnected and literally share their problem bugs. And once the bugs are in
a facility they spread, often rapidly and mercilessly.74
Costs and Responsibilities The Centers for Disease Control estimates
approximately Page 326 15 percent of hospital patients and 65 percent of nursing home
patients carry resistant bacteria (not all will develop infections), which result in more
than 23,000 deaths.75 Medicare is increasingly rewarding or punishing hospitals based
on performance outcomes, like infection rates and readmissions. Hospitals and nursing
homes therefore have both moral and financial incentives to act.76
Causes and Solutions Besides rampant misuse and overuse of antibiotics, which is
the fundamental cause for resistance in the first place, the transfer from facility to
facility and patient to patient is largely attributed to insufficient hygiene—clinician
handwashing, patient bathing, and facility cleanliness, all of which can be controlled by
health care personnel, but obviously any effort needs coordination, collaboration, and
commitment. One nurse may be meticulously clean, but those efforts are undermined
by the first/next one that isn’t so conscientious.
Many efforts and programs have been initiated to combat the spread of HCAIs,
including some in Southern California and Illinois. In fact, fifty facilities (hospitals and
nursing homes) are implementing a new protocol funded by the CDC in which patients
are bathed with a particular antimicrobial soap, one proven to kill MRSA, CRE, and
some of the other most resistant bugs.77
Such collaborations are unusual and difficult, as in many cases the facilities in a
particular area compete daily for patients and health care dollars.
Put antibiotic prescribing practices aside, assume you are a chief nursing officer in
a metropolitan hospital. Apply the 3-Step Problem-Solving Approach to help mitigate
the problem of HCAIs.
Apply the 3-Step Problem-Solving Approach
Step 1: Define the problem(s) confronting hospitals and nursing homes.
Step 2: Identify the major causes of the problem(s).
Step 3: Make your recommendations. Provide details.
Step 1:
Hospitals and nursing homes in America face MRSA (methicillinresistant Staphylococcus aureus) and CRE (carbapenem-resistant
Enterobacteriaceae). The problem with the two resistant bacteria
is growing due to it easily being contracted by patients. As
patients are transferred from one care facility to another, such
as a hospital to a nursing home, if not treated quickly, the
bacteria can spread quickly to others, leading to the patient
dying. As hospitals and nursing homes are rewarded or
punished for their patient’s care, the goal is not to have
returning infected patients. The impact of the patients returning
for medical care has increased medical costs. It makes the
bacteria more difficult to treat as they become more resistant to
the antibiotics used to heal the person. Simultaneously, the CDC
has made recommendations to the care facilities to combat the
growing problem; not all care facilities have the allocated
personnel for continuous care.
Step 2:
While the CDC has allocated specific funding for the care
facilities to handle the growing problem, it will take some time
to allocate the teams and headcount. To keep these facilities
operational, they are still running a business and ensuring
patient volume is seen. Both types of facilities are also faced
with nearby competition from other similar places.
Step 3:
My recommendation to combat the two bacteria and continually
operating to keep patient infection rates minimum is to form a
team using Tuckman’s five-stage model. They could also
collaborate with other care facilities for support and training
during the first two stages before becoming a norm.
Furthermore, it takes a continuous effort to ensure all patients
are bathed and continually cleaned while the bacteria exist. They
could utilize the CDC funding to aid in their efforts.
Problem: Rampant spread of drug resistant bacteria MRSA
(methicillin-resistant Staphylococcus aureus) and CRE
(carbapenem-resistant Enterobacteriaceae) in hospitals that have
both moral and financial implications to hospitals, nursing
homes, and other healthcare facilities. Also lots of unnecessary
death for patients which is problematic to the public in general.
Causes: The biggest cause would be over-reliance on antibiotics
which is implied in the names of the infections. Hygiene for
patients and practitioners would also seem to be a major issue.
This issue is exacerbated when you have patient transfers from
different facilities with different standards for hygiene and
facility cleanliness.
Recommendations: Incentivize the behavior for the desired
outcome. Rather than punish or reward the facilities for
outcomes, incentivize the hospitals that are not overprescribing antibiotics. These healthcare facilities should also
set an agreed upon standard for cleanliness and hygiene.
Ongoing training and oversight can be done to ensure the
standard is being met. Transfers from facilities that meet these
standards can be more seamless and create a better patient
experience. If patient transfers are coming from facilities not
meeting the standard, then steps should be taken to ensure the
patient is cleaned in a designated place prior to entering the
“clean” portion of the facility. Staff that do the cleaning should
also wear protective gear to be removed before coming back to
the “clean zone”.

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