Читать книгу Kelly Vana's Nursing Leadership and Management - Группа авторов - Страница 84

Florence Nightingale observed that noise, food, rest, light, fresh air, and cleanliness were instrumental in health and illness patterns. Thus, she maintained, the aim of nursing was to put the patient in the best condition for nature to act upon her or him (Nightingale, 1865/1970). Nightingale also discovered the link between adverse patient outcomes and a lack of cleanliness and hand washing. Yet generations after the insights of Nightingale were first set forth, sporadic adherence by health care providers to hand washing continues. Although significant progress has been made in preventing some health care‐associated infection types, there is much more work to be done. On any given day, about one in 31 hospital patients has at least one health care‐associated infection. Three percent of hospitalized patients in the 2015 survey had one or more HAIs. There were an estimated 687,000 HAIs in U.S. hospitals in 2015. About 72,000 hospital patients with HAIs died during their hospitalizations (CDC, 2018b).

One hundred years ago, illnesses such as tuberculosis or pneumonia required lengthy hospitalizations and were often catastrophic for individuals and families. Today, such illnesses are preventable and are often easily treated. Vaccination programs have been used extensively to prevent the spread of communicable diseases. Additionally, surgical interventions in hospitals (e.g., tonsillectomies, appendectomies, and reproductive procedures) have improved to treat otherwise debilitating or mortal conditions. Health care is delivered by professional nursing and medical practitioners who are science based and who use evidence‐based practice. Health care is primarily directed at preventing and treating chronic and behavioral diseases. Health care advances have extended life expectancy, with the consequence of more elderly people requiring more health care for chronic and complex health problems. The majority of clinical care is still provided in hospitals, but length of stay is much shorter, and a variety of innovative models of care are now used to provide cost‐effective care for people with acute, community, and long‐term clinical needs (Health Workforce Solutions LLC & Robert Wood Johnson Foundation, 2008).

Health care‐associated infections currently result in increased length of stay, mortality, and health care costs. In addition, a Centers for Disease Control and Prevention (CDC, 2018) report estimates that the overall annual direct medical costs of health care‐associated infections in U.S. hospitals ranges from $28.4 to $33.8 billion. These infections are most often attributed to invasive supportive measures such as endotracheal intubation and the placement of intravascular lines and urinary catheters. Several studies have noted that health care‐associated infections can be prevented through a number of multidisciplinary, evidence‐based interventions, reducing the incidence of infection by as much as 70% (Anderson et al., 2007; Harbarth, & Gastmeir, 2003; Muto et al., 2005).