Safety in Acute Care Settings


Safetyin Acute Care Settings

Safetyand Cleanliness in Acute Care Settings

Impactof Phenomena on Healthcare Delivery

Theimportance of the healthcare sector cannot be undermined as far asthe wellbeing and progress of any country is concerned. This isparticularly considering the fact that a large number of othersectors within the economy are primarily dependent on the healthcaresector, since only healthy persons would manage to give their all tothe economic activities. In essence, it becomes immensely crucialthat the highest level of care is taken to ensure that the healthcaresector is operating at the optimum level. Of course, immense amountsof investments have been channeled to enhancing the output of thehealthcare sector. However, one of the major components of thehealthcare sector is the acute care settings, where patients obtainactive albeit short-term treatment for severe episodes of illness andinjury, urgent medical conditions, or even in the course of recoveryfrom surgery. Unfortunately, it has been the case critical situationsin emergency and acute care make some of the most fundamentalclinical challenges. The nature of this care involves immense stress,time pressure, high stakes and uncertainty, in which case there isenhanced vulnerability to infections. In a large proportion of acutecare settings, the deficiency of proper cleanliness means that therewould be the likelihood for increased infections for patients. Thisis particularly in the case of patients in acute care and surgicalwards where infections on the new surgical incisions would be likelyto not only increase their duration of stay but also the cost for thesame.

Thesituation becomes worse as a result of the prevalence of pressureulcers, which are essentially, localized injuries or wounds on theskin and or the underlying skin often over bony prominence, resultingfrom pressure, or pressure combined with shear. Also referred to aspressure sores or bed sores, pressure ulcers usually develop on theskin covering bony areas in the body including tailbone, hips, anklesand heels among others. The individuals that stand the highest riskfor bedsores are those that have medical conditions restricting theircapacity to modify the conditions, necessitating that they usewheelchairs or are confined to bed for long durations of time. Ofparticular note is the fact that bedsores have the capacity todevelop in a rapid manner and can be immensely difficult to treat.

Underliningthe importance of this phenomenon to nursing care is the fact that itcan have a bearing on the costs that an individual incurs in ahealthcare facility. According to Cooper (2013), the development ofpressure ulcers takes place in four stages. It is noted that the costof treating stage 3 or stage 4 pressure sores can range between $5000and $50000. Unfortunately, the centers for Medicare and MedicaidServices stated that they would not be catering for any extra coststhat are incurred as a result of hospital-acquired pressure ulcers.Of course, the actual costs pertaining to pressure ulcers remainunknown as a result of the deficiency of clarity regarding the coststhat are to be included in the cost estimates including materialcosts, additional acute care days, and nursing costs that areassociated with the development of pressure ulcers.

Impactof Phenomena on Nursing Care

Itgoes without saying that the development of pressure sores in acutecare settings has a negative impact on nursing care. Indeed, it notonly causes an increase in the cost of nursing care, but also theduration of hospital. Indeed, the treatment of the pressure sores canincrease the number of days that an individual stays in aninstitution. Cooper (2013) notes that patients in an intensive careunit have a large number of factors that tend to heighten the riskfor the development of ulcers. Usually, patients have sequentialcompression devices, respiratory equipment, multiple intravenouscatheters, urinary catheters, as well as the infusion of vasoactiveagents pertaining to hypotension that have make it impossible forpatients to turn and, therefore, heightens the risk of thedevelopment of pressure ulcer. It should also be noted thatinfections are not only a possible cause but also a consequence ofpressure ulcers. Key among the concerns is the fact that theinfections may actually go beyond the individual who has beencolonized by the microorganisms especially considering that theperson may in fact contaminate the environment. This means that themicroorganisms would then be transferred to other parts of thehealthcare settings not only by the individual who is infected butalso by the visitors and individuals who come into contact with thesick person especially the healthcare workers. This underlines thefact that the infections and microorganisms that are obtained fromthese sites would cause ailments to other patients, which has anegative impact on the outcomes of nursing care.

Ofparticular note is the fact that the likelihood that environmentalsurfaces’ contamination would cause healthcare associated pathogensto be transmitted is subject to varied factors including the capacityof pathogens to remain viable in varied environmental surfaces,reservoirs’ location, the frequency of handling the surfaces, aswell as the levels of the contamination with regard to their capacityto cause transmission to the patients.


Volumesof research and literary works have been written in an effort toexplore every aspect of pressure ulcers in acute care settings. Theseare not only aimed at providing proper and all-inclusivecomprehension of the causes and risk factors pertaining to thecondition but also coming up with the appropriate and effectivestrategies that would be used in the treatment and prevention of thecondition in acute care. Of course, this should not undermine theimportance of comprehending the factors that cause the condition inhealthcare settings.

Accordingto Mwabeza et al (2014), pressure ulcers are a major complicationpertaining to long periods of hospitalization particularly in casesinvolving poor nutrition and heightened moisture on the skin,compromised sensory stimuli, as well as prolonged pressure. Indeed,the condition may increase the costs incurred in hospitalization,increase the mortality and morbidity rates of patients, as well asplay a crucial role in spreading infections within the clinicalareas. This underlines the importance of stopping or preventing thegrowth of the condition right at an early stage, as this would have asignificant impact on the resource expenditures.

Dorneret al (2009) seems to agree that there is a connection between thelevel of nutrition and the prevalence of bed sores or pressureulcers. While there exists limited evidence-based research, there isgeneral agreement on the fact that nutrition is a crucial element ofthe comprehensive care plan for the treatment, as well as theprevention of pressure ulcers, which underlines the importance ofaddressing nutrition in all people who have pressure ulcers. Indeed,it should be noted that good nutrition comes as fundamental for thedevelopment and sustenance of a healthy skin. Patients who haveproper nourishment and persistently have good nutrition in thehealthcare centre have less likelihood for developing pressure ulcerscompared to patients who have nutritional deficits. Compromisednutritional status including undernutrition, unintentional loss ofweight, dehydration deficits and protein energy malnutrition havebeen seen as risk factors for the development of pressure ulcers.Similarly, there may be an increase in the risk of development ofpressure ulcers with regard to nutrition as a result of factors suchas low Body Mass Index, decreased consumption of food, as well asimpaired capacity to consume food autonomously. Under-nutrition mayhave a negative impact on the healing process of pressure ulcers.Situations that may cause problems with nutrition may include highdependence on other people, problems with chewing and swallowing,unintentional loss of weight, advanced age, as well as decreased oralconsumption of fluid and food. It is noted that undernutrition cancause a decrease in the capacity of the body to fight infections, aswell as have a negative impact on the healing of pressure ulcers.Varied tools may be used in evaluating the risk of undernutritionincluding the Mini-Nutritional Assessment (MNA), as well as MNAScreening Form and Malnutrition Universal Screening Tool (MUST).Others include the Braden Risk Assessment Scale which predicts therisk of pressure ulcers and incorporates a nutrition subscale thatgenerates additional data that may be utilized in the screening andassessment process for nutrition. It is imperative that individualsare re-evaluated after there is a modification of a condition forinstance, intravenous fluid therapy, NPO Status and even surgery.Once the results of the nutrition screening have been obtained, athorough nutritional assessment would be completed for every personand recommendations made for management and treatment. Of particularnote is the fact that there is no universal nutritional treatment forthe condition as the nutritional predisposing factors for thecondition are divergent. In essence, a distinctive nutritionalregimen would be given subject to the conditions of the patient andthe nutritional needs. For instance, where an individual has beengiven a nutritional diagnosis to the effect that he has “insufficientfluid and food intake associated with less than 50% intake of mealsas demonstrated by the presence of non-healing stage IV pressureulcers, as well as 5-pund weight loss within two weeks”, thepatient and the healthcare professionals would collaborate indeveloping individualized and appropriate interventions, which wouldthen be monitored and assessed for any necessary modification to thenutritional intervention. An example of an intervention is theprovision of regular diet incorporating fortified foods during everymeal, as well as a 6-ounce nutritional supplement provided at aparticular time of the day. Nevertheless, given that pressure ulcersare primarily indicated by the presence of wounds on the skin, theutilization of dietary supplements such as vitamin C, Zinc andprotein is imperative as they have been demonstrated to increase thespeed of wound healing. In instances where the individual diet isdeficient of these minerals and vitamins, the skin would beconsiderably more vulnerable or stand a higher risk for thedevelopment of pressure ulcers. Of course, a dietician would becrucial in developing or coming up with an appropriate dietary planfor an individual.

Inaddition, the treatment of pressure ulcers would have to involvetaking care of the wounded areas subject to the stage of the ailment.Areas where there is unbroken skin close to the bedsore would have alubricant or protective film applied so as to protect them againstinjury. This often necessitates the utilization of debridementprocess where the dead tissue is removed from the ulcer so as toassist in the stimulation of the healing process. In instances wherethere exists a small amount of dead tissue, specially designeddressings and paste may be used, while larger amounts of dead tissuecan be eliminated by the use of mechanical means. An alternativemethod of eliminating the dead skin or debridement is maggot orlarvae therapy. This involves the utilization of maggots on thewounded areas as they are known to feed on the infected and deadtissue without injuring the healthy tissue. Further, maggots fightinfection through releasing substances that kill bacteria and triggerthe process of healing. In the course of maggot therapy, maggots arecombined into the wound dressing and the wounded region covered usinggauze. The dressing would be removed after some time and the maggotsremoved. As much as maggot therapy may seem off-putting research hasindicated that it could actually be more effective in treating thewounded area compared to other techniques of debridement.

Onthe same note, scholars have acknowledged that pressure ulcers arenot always easy to heal in which case it may become necessary toundertake a surgical procedure so as to heal the wound, and avert thepossibility of any further tissue damage. Surgical treatment wouldinvolve proper cleaning of the wound and closing it through directclosure where the edges of the wound are brought together or using atissue that is derived from a close part of the body. This treatmenttechnique may pose challenges to the individual particularlyconsidering that the person is already in a poor health state, not tomention the additional risks such as infection, muscle weakness,blisters, blood poisoning, internal bleeding, recurrence of pressureulcers, as well as abscesses.

Whilecleaning the wounds would be imperative in the treatment of pressureulcers in acute care settings, it is equally important that theenvironment within which an individual lives is properly cleaned.Scholars have acknowledged that acute care providers like hospitals,long-term care facilities and nursing homes often set a high bar withregard to the cleaning needs of the facility (Rothwell et al, 2011).Indeed, it is immensely crucial that a healthy environment isprovided to the staff, visitors and patients. As earlier noted, thecleanliness of the acute care settings not only has a bearing on thehealthcare outcomes for patients within such environments but alsothose that are in other areas within the same facilities and beyond.This is especially considering that the individuals who come intocontact with the patients in such settings are also likely to comeinto contact with other people in the other parts of the healthcarefacilities. This underlines the need for clean and infection-freeenvironments (Rothwell et al, 2011). In this case, it has becomeimperative that certain guidelines and standards are utilized in theelimination of the possibility of infections in healthcare facilitiesand particularly in acute care settings.

Conclusionand further research

Ofcourse, it is evident that proper cleanliness in acute care settingsis not optional rather it is a fundamental requirement for anyinstitution that aims at enhancing the quality of its outcomes. Inthis regard, it is imperative that these guidelines are adhered to inorder to ensure that the possibility of contamination and infectionis eliminated. Indeed, it has been acknowledged that the achievementof cleanliness has a bearing on the outcomes of the healthcareinterventions. Pressure ulcers often occur as a result of a myriad ofissues pertaining to acute care settings including the fact thatthere is limited change of posture and position. In essence, theutilization of a combination of prevention strategies would go a longway in enhancing the treatment of the ailment.

Futureresearch could focus on the effectiveness of a combination of theinterventions and prevention strategies in tackling the problem. Areparticular strategies more effective than others? What are theconditions that influence the success and effectiveness of atreatment procedure? Can these factors be manipulated to enhance thesuccess and effectiveness of the strategies?


Cooper,K.L (2013). Evidence-Based Prevention of Pressure Ulcers in theIntensive Care Unit. CriticalCare NurseVol 33, No. 6

Dorner,B., Posthauer, M.E &amp Thomas, D (2009). The Role of Nutrition inPressure Ulcer Prevention and Treatment. NationalPressure Ulcer Advisory Panel White Paper.

Mwebaza,I., Katende, G., Groves, S &amp Nankumbi, J (). Nurses’ Knowledge,Practices, and Barriers in Care of Patients with Pressure Ulcers in aUgandan Teaching Hospital. NursingResearch and Practice.Volume&nbsp2014&nbsp(2014), Article ID&nbsp973602, 6 pages

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RothwellM, Jukka C, Lum E, Mitchell C &amp Kyriakides P (2011).Retrospective Analysis of Emergency Readmissions to Rural andRegional Hospitals. Journal of Pharmacy Practice and Research. 41(4) 290-294