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Report on Consequence of Breach in Infection Control, reflected on the unsafe injection practices of the physicians

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Consequence of Breach in Infection Control

Introduction:

 

The case study has reflected on the unsafe injection practices of the physician James Peters aged 63 while infecting 55 of his patients with the hepatitis C. health care associated infections are increasing in the alarming rate and therefore it is important to take proper care of the patients. Such of the unanticipated infections can occur during different health care treatment and therefore it is the responsibility of the physician to take proper care of the patients. Instead in this case the doctor has deliberately made the mistake and therefore strong legal action against him is necessary. 

This report has described breach in the infection and associated chain of transmission based on this scenario. Along with this it has also identified ethical and legal implications of this particular scenario. This report has elucidated identification process of patient at risk; failure of the process is discussed along with offering brief personal reflection. 

The breach in infection and the associated chain of transmission in this scenario:

 

Healthcare associated infections are those people generally acquire in the context of healthcare setting while receiving treatment (Septimus & Schweizer, 2016). It can be acquired wherever healthcare is being delivered including those of impatient hospitals of acute care, outpatient related setting and facilities for long-term care. In this case severe breach is being made through the unsafe injection practices. Safe practices of injection are designed for preventing the transmission of disease from healthcare worker to the patient and patient to that of patient. Absence of the visible signs off blood or the contamination signs in the used syringe, vial of multi-dose medication, IV tubing and monitoring device for blood glucose cannot mean that such item is totally free from the potential agents of infections( Shabot, et al., 2016). Though there remains no other visible proof of the contamination it is possible that the microbes and other bacteria are already present in it. All of the materials and supplies of used injections are contaminated potentially and must be discarded. 

Safe injection practices are the steps like not using similar needle in more than the one patient which is not at all followed in this case. These necessitates including the measures for performing the injections in the manner which is safe for the providers and patients. The doctor should have maintained standard infection prevention practices for enduring the patients are safe from the attack of any unwanted disease. Due to breaching safe injection practices has lead here the women to be infected by the diseases as they have already been in vulnerable estate, referral of the provider to those of listening boards in the context of disciplinary actions and different suits of multiple being filed by the patients.

 In this case breach has occurred due to the usage of similar syringe to himself and the patients to whom he was treating. In this case the mishap has occurred because of the accessing medication to the patients with a syringe that has already been used by the doctor and failure in proper usage of aseptic techniques in terms of preparing as well as administering the injections. Similar case has occurred at Naveda in the 2008 outbreak of the hepatitis C at the clinic of endoscopy as syringes have been used for accessing the medication vials being used for different patients (Septimus & Schweizer, 2016). Southern Neveda Health District has estimated that of total costs of public health comprising of testing, medicalcounseling and investigation. In this case due to the breach of safe injection practices 54 women has been infected with Hepatitis C because of his carelessness. Investigation has happened to be highly time consuming, costly and necessitates the testing, notification and counseling of the numbers of patients. 

 

The legal and ethical implications of this scenario:

 

Addressing the infection prevention along with control necessitates facility wide program as well as it is also the responsibility of each individual for offering patient that safe environment and taking care of them. Healthcare facilities and physicians have the legal responsibilities for offering the safe work environment, safe work systems and safe environment for the patients along with the visitors. The doctor in this context has not put the safety of patients first and handled them with negligence. Even beefier the physician,Dr.James Peters who was suffering from Hepatitis C has been addicted to the painkiller Fentanyl and has injected drug into himself earlier to use similar syringe on the patients. Based on the code of risk management, it is the duty of this doctor to put the needs of his patients’ first through participating in the systems of the quality improvement and quality assurance. It has also stated that it is the responsibility of the physician to practice and provide healthcare in such a manner for the development of the patient safety, reducing error and supporting the colleagues raising necessary concerns regarding the patient safety. Here the doctor has not taken care of the safety of the patients and has injected the patients with infected syringe which should not be done (Chantal, et al., 2017).

Clinical governance has referred the system where each of the manager and clinician in the health care facility is responsible for sharing responsibility and are responsible for taking care of the patients. In this context it is also important to mention that healthcare workers carrying blood borne virus like Hepatitis C must indulge in modified patient care duties while performing the procedures that are prone to exposure and posing potential risk to the patients along with other staff (Wendorf, Kay, Baliga, Duchin, & Eckmann, 2015). Healthcare workers carrying the blood borne virus must be obliged legally for declaring their status of infection which is not at all done in that case besides suffering from Hepatitis C the physician has work negligently towards the patients (Wendorf, Kay, Baliga, Duchin, & Eckmann, 2015). Besides that patient have also the rights of being treated with skill and care by the provider of healthcare.

Patients at risk of infection would be identified and the investigative process required: 

Infection control program is considered as an effective practice in this context.  In assessment of health risk infection of the patients, infection control programs have the most significant role to play. The most significant elements related to infection control program include executing organized control and the surveillance activities. Both the health care workers and the hospital administrators have the task of demonstrating the effectiveness of the programs of infection control, assuring enough training to the staffs in the context of infection control, confirming the results of the surveillance are connected with the developments of performance measurement, evaluating that of the changing priority programs depending on that of ongoing evaluation of the risks, confirming enough numbers off the competent practitioners related to infection control and performing the evaluations of program with the use of the development tools. It is the responsibility of both the hospital workers and the physicians for interpreting effectivenessrelated to the programs of infection control, confirming enough training of staff in the purpose of the infection control, assuring that the results of surveillance are connected with the developments of performance measurement, evaluation of the changing priorities depending on that of ongoing assessment of the risks, confirming introducing or appointing enough numbers of the practitioners in infection control and conducting the program evaluation with the use of indicated development tools(Wendorf, Kay, Baliga, Duchin, & Eckmann, 2015). 

It has been seen that individual in infection control play the most significant role in the prevention of health care worker and patient infections and reducing different forms of the medical errors. Infection control could be appointed for maintaining ongoing surveillance related to the infections for particular wards, calculating the rates of infection and reporting such data to the important personnel, conducting the staff education, and training, implementing and responding to those of outbreak measures of control and consulting on the issues of employee healthcare. Such specialty practitioner is responsible for gaining the expertise through education comprising of the infection control, infection surveillance as well as epidemiology from the present science publications along with the courses of basic training offered by the healthcare institutions. Healthcare workers and the physicians remain at the frontline in terms of applying practices related to daily infection control for preventing the infections and organism transmissions to the other patients (Wendorf, Kay, Baliga, Duchin, & Eckmann, 2015). Though Occupational Safety and Health Administration are responsible for offering the training to prevent blood borne exposures of pathogen annually yet the clinical nurses as well as other staffs in healthcare must receive the additional training in infection control and periodical assessments of the aseptic care in the context of the activity of planned patient safety. 

Steps for investigating infection include recognizing the infection and initiating the preliminary investigation through development of the case definition, identifying pathogen, site and the affected patients. It is also necessary to determine the problem magnitude and considering whether the immediate measure of control is required. If this is necessary then control measures like cohering or isolation of the infected cases must be implemented and asepsis and strict hand washing must be applied. Next step is associated with notifying and engaging proper departments, personnel along with the hospital administrators. The next step is searching for the additional cases through examination of microbiological and clinical records, conducting line listing for each of the case, patient details, time and place of the occurrence and development of the infection details (Merli, et al., 2016). It is also important to develop an epidemic curve based on the time and plavce of the occurrence and developing the infection details. In the next step particular control measures are required to be implemented with the identification of the cause of the infection. It is also necessary to monitor further cases along with the effectiveness of the control measured to be performed. Immediate control measures include strengthening the practice and policies of sterilization and disinfection, strict hand washing, commitment to the aseptic protocols and inclusion of infection control committee. Infection control program possesses objectives like minimizing infection risks to the patients, visitors and healthcare workers, formulating local guidelines as well as standard operating procedures for preventing along with control of the infection, training and educating health care workers, and recommending policy of antimicrobials for the hospital. Safe infection control practicing is one of the most significant aspects in infection control program. Taking care of the patients with the communicable diseases and the care of building the patients, protection related to the immune-comprised and immune-suppressed patients, isolation processes and protocols. 

Analyzing where the process failed and what could be done to prevent this in future:

Safe injection practices have not been followed in this particular case. The physician James Peters has been considered as guilty because of infecting 55 women with Hepatitis C. The doctor here has used the same syringe that has been used by him for injecting women and therefore contamination has occurred and spread eventually. Here the doctor has not maintained code of conduct and different legislations related to patient safety. It is utmost important for the doctor to maintain hygiene and considering new syringe for each patient which is not at all maintained. The doctor is obligated to use sterile equipment for injection like using the sterile syringe along with needle for each of the infection and reconstituting each of medication unit (Chantal, et al., 2017). It is recommended to use single-use and new needle and syringe, inspecting the packaging in terms of breaches in the barrier integrity, discarding the syringe or needle if package gets punctured, damaged or torn. If the single-used syringe is not all available it is recommended to use the equipment designed for that of steam sterilization. Different recommendations are also provided for preventing the injection equipment contamination and the medication (Smith, et al., 2017). Preparing each of the injection in the clean and designated area is important where it is unlikely to spread the contamination from the body fluid or blood, using vials of single-dose other than those of multi-dose vials. If the multi-dose vials are going to be utilized then it is important to pierce the septum with that of the sterile needle. It is also important to strengthen laws and legislations for safe hygiene practices. 

Reflecting upon personal values and professional responsibilities in this scenario:

In this scenario the doctor has been suffering from Hepatitis C and has been diagnosed with the disease in the year 1997. In that year he has been suspended by Medical Board of Victoria for abusing the opiates and medical board has permitted him to return to the work. He has been taking painkillers and knowingly has infected patients with the same syringe leading to their infection. In this case the doctor is bound to follow safe injection practices and other codes and legislations for ensuring safety of the patients. On the contrary, he has expressed attitude of negligence towards his own students leading to their poor condition. Medical board was not supposed allow him to practice medication in this case and due to such permission such mishap has occurred (Chantal, et al., 2017). The physician should have kept under strong vigilance.

The victims in this context are totally innocent people who have nothing to do with this. The doctor should have maintained ethical and legal practices and the hospitals must have taken necessary measures against him earlier. If such measures would have taken then such mishap could be avoided(Chantal, et al., 2017). The physician could have practiced safe injection practices in the context of using the needles, replacing needles or intravenous delivery systems, using the antiseptic technique for avoiding the contamination of the sterile equipment of inject. Not administrating the medications from single syringe to the multiple patients, using the fluid infusion as well as administration sets, using the single-dose vials for the parental medications. Strict rules and legislations must be imposed in case of further violation of code of conduct and negligently handling matters of patient safety. 

Justice Paul Cohen must consider taking strong actions against the doctor in order to endure that situations never occur in future. It is also important to confiscate license of the doctor to prevent doctor from private practice. In future it is important to strengthen rules and regulations related to practice of safe injection and ensure people violating these rules to be given strict punishment. Only in this way it is possible to avoid such practices in future. 

Conclusion:

 

Based on this case study, it is important importance of safe injection practices is understood. Health associated infections are considered as the most unavoidable circumstances of the life-saving interventions or as the failures of system resulting out of the inadequate resourcing. It is found that health-care associated infections are the major economic and clinical issues in the Australian hospitals. Failure of protecting the patients from the avoidable harm has the most significant legal and ethical implications reflecting the failure of the organization and non-compliance of that of the healthcare workers with the policies based on evidence. It is important to implement this with proper safeguards and bundles of infection control including sanctions for the poor policies of compliance with the safe injection practices along with the other practices of infection control.

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