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Epidemiology: Nosocomial Infections Case Study


The case study of the epidemiological situation at the Good Health Hospital presents a case of the outbreak of Escherichia coli in Ward 10 with four individuals being contaminated so far. The responsibility of a social science researcher is to identify a pattern and the risk factors for the outbreak and provide a recommendation as per the implementation plan and nosocomial infection prevention. In general, nosocomial infections occur very often and account for a significant share of prolonged hospitalization, increased treatment costs, and disability in patients. Given such an array of adverse implications for both medical organizations and patients, the issues related to the nosocomial infection outbreaks should be tackled in a timely manner with the application of evidence-based methods and approaches.

Good Health Hospital’s Records Analysis

The outbreak of Escherichia coli in Ward 10 at the Good Health Hospital is one of the incidents of nosocomial infections. According to Ling (2019), nosocomial infections are diseases “contracted after the patient’s admission and not incubated before hospitalization” (p. 101). In other words, this group of infections includes all contamination types induced in the hospital. As the statistical data indicates, “nosocomial infections account for 7% in developed and 10% in developing countries” (Khan et al., 2017, p. 478). The outbreak of Escherichia coli might have severe outcomes, as nosocomial infections commonly do, including disability, prolonged hospitalization, and broader spread of the disease. Therefore, it is essential to estimate the scope of the outbreak, analyze the cases and put the Escherichia coli case in the context of other nosocomial diseases that have occurred in the Good Health Hospital within the past year.

The hospital is currently in the process of handling the outbreak of Escherichia coli which has originated in the tenth ward. The analysis of the infection has indicated that the most likely source of initial contamination is the cafeteria located in the hospital. In particular, the bacterium that has caused the nosocomial infection was found in cold meats and vegetables, which are commonly consumed by the staff and the patients in the hospital. There are four cases of Escherichia coli identified at the moment. In particular, there is a 23-year-old male patient, a 21-year-old female, a 15-year-old male, and a 42-year-old female. The speed of transmission is relatively high, which indicates that the number of infect4ed individuals might increase with time if proper measures are not initiated in a timely manner. Table 1 shows the parameters of the cases of nosocomial infections recorded in the Good Health Hospital within the past years, indicating the individuals’ age, gender, ethnicity, time, and place.

Table 1. Nosocomial Infections at the Good Health Hospital 2020 – 2021

Number Age Gender Ethnicity Time Place Nosocomial Disease
1 35 M White American 2020 Good Health Hospital Nosocomial post orthopedic-surgery cellulitis
2 28 F African American 2020 Good Health Hospital Nosocomial post orthopedic-surgery cellulitis
3 45 M White American 2020 Good Health Hospital Nosocomial postsurgical knee-osteomyelitis
4 39 F African American 2020 Good Health Hospital Clostridium difficile-associated diarrhea
5 55 F Hispanic American 2020 Good Health Hospital Clostridium difficile-associated diarrhea
6 23 M White American 2021 Good Health Hospital Escherichia coli
7 21 F African American 2021 Good Health Hospital Escherichia coli
8 15 M White American 2021 Good Health Hospital Escherichia coli
9 42 F African American 2021 Good Health Hospital Escherichia coli

The incidences indicate that the number of cases of nosocomial diseases in the facility is relatively low, which demonstrates effective preventative measures in place. However, the scope of the recent outbreak of Escherichia coli necessitates a clarification of the conditions under which the infection was initiated and spread. Additionally, the litigation-related issues that might be relevant in the context of the investigation of the case should be discussed and clarified.

Questions for the Health Care Administrator at Good Health Hospital Regarding Potential Litigation

When it comes to the regulation of the outcomes and the designing of the treatment plan for nosocomial infections, a litigation process is commonly initiated. In particular, hospital-acquired diseases occur due to flaws in the hospital staff performance, deficiency in protocols or organizational policies, or other inaccuracies. Therefore, several questions might be suggested to elicit answers from the health care administrator in regard to the outbreak of Escherichia coli. In particular, the questions might be listed as follows:

  • What organization or vendor performs as a permanent supplier of food products for the hospital cafeteria?
  • What is the quality assurance procedure at the hospital cafeteria?
  • How often is the procedure being updated?
  • What are the organizational policies related to the prevention of nosocomial infections?
  • What is the body or an individual responsible for the implementation of those policies?
  • Is there a nosocomial disease prevention protocol in place at the Good Health Hospital?
  • Is there a system of training available to the employees concerning the dangers of nosocomial infections in the hospital?
  • Are there records of employees’ training completion on the implementation of preventative measures, protocols, and policies?

The rationale for the first three questions is that the information about the products that have been identified as contaminated and provoking the outbreak of Escherichia coli should be investigated to identify the guilty party. It will allow for obtaining more information on where the contaminated products came from and stop the process of disease spread. Moreover, the data on the supplier and quality assurance procedures will help identify possible flaws in the hospital’s cafeteria’s functioning that might need improvement. Furthermore, the rest of the questions are justified by the need to eliminate the drawbacks in the currently applied policies and plans in order to improve them. The identification of flaws that have caused the outbreak will allow for effective improvement of prevention measures. Moreover, it will provide the basis for the development of a treatment plan.

Target Audience and Implementation Plan

The target audience of the Good Health Hospital includes a diverse population of patients comprised of primarily White and African Americans aged between 18 and 50 years. The patients are admitted to surgical and intensive care units, which exposes them to a high level of nosocomial infection contamination. Given the current situation with Escherichia coli, the following steps within an implementation plan should be considered:

  • Elimination of contaminated products from the cafeteria and sterilization of the facility.
  • Limiting the mobility of patients between wards without urgent need.
  • Initiation of wearing protective masks and suits when in the ward.
  • Intensification of personal hygiene for all staff working in the ward.
  • Review and borrow common treatment methods for community-acquired Escherichia coli (Ling, 2019).
  • Administer antibiotic treatment for a patient with reference to evidence-based procedures on nosocomial infection treatment (Glasset et al., 2018).
  • Updating a protocol for intravenous medication administration (Tchouaket et al., 2021).

Recommendations to the Department Head

Given the implementation plan steps, the recommendations that might be given to the head of the department might include the following:

  • Isolate patients that have the signs of Escherichia coli.
  • Ensure limited access of staff to the ward with infected patients.
  • Initiate sterilization of cafeteria and elimination of all contaminated products.
  • Control staff’s hygiene by disseminating requirements as per hand washing and sanitizing.
  • Ensure updating medical tools’ sanitizing procedures.
  • Update and promote invasive procedures performance, especially intravenous medication administration

The rationale behind these recommendations is that they are aimed at reducing the risks for further spread of the diseases, as well as preventing new cases of other nosocomial infections.

Safety Protocol Itinerary

The safety protocol itinerary displayed in public spaces of the hospital should include the following guidelines for the staff to prevent infection spread:

  • Always wash hands thoroughly using soap and effective hand-washing techniques.
  • Eliminate unnecessary contact with surfaces in the ward.
  • Utilize single-use items immediately after using; utilize properly with safety in mind.
  • Clean medical tools after each patient.
  • Ensure sterile conditions for intravenous procedures.

These safety protocol elements will help staff remain cautious during the outbreak. Moreover, the reminders to follow the basic rules of hygiene and health care procedures will increase the likelihood of safety for patients. Since these guidelines are of a universal application, they might be effective for different preventive types of nosocomial infections, which commonly occur in hospital wards. Using these simple rules, the safety, health, and lives of many people admitted to the Good Health Hospital will be ensured.


Glasset, B., Herbin, S., Granier, S. A., Cavalié, L., Lafeuille, E., Guérin, C. (2018). Bacillus cereus, a serious cause of nosocomial infections: Epidemiologic and genetic survey. PLoS ONE 13(5): e0194346. Web.

Khan, H. A., Baig, F. K., & Mehboob, R. (2017). Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine, 7(5), 478-482.

Ling, H. W. (2019). Is it possible to treat community-acquired and nosocomial infections with the same method, without the use of antibiotics. Journal of Applied Microbiological Research, 2(2), l01-13.

Tchouaket, E. N., Sia, D., Brousseau, S., Kilpatrick, K., Boivin, S., Dubreuil, B., Larouche, C., Parisien, N., Dubois, C. A., Brousselle, A., & Borgès Da Silva, R. (2021). Economic analysis of the prevention and control of nosocomial infections: Research protocol. Frontiers in Public Health, 9, 883.

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