Infection Control Essay

This essay will explore the subject Infection Control and how Healthcare Professionals control and prevent nosocomial or hospital acquired infections (HCAI’s), defined as an “infection whose development is favoured by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff” Oxford Dictionary (2008).

Common nosocomial infections include; urinary tract infections (UTI), surgical wound infections, as well as causative agents which are coagulase-negative meticillin resistant staphylococcus aureus (MRSA), Escherichia Coli (E-Coli), Extended-Spectrum Beta-Lactamases (ESBL’s), Diarrhoea and vomiting (D&V) and Clostridium Difficile (C. Diff) to mention a few.

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I plan to explore this subject matter to inquire into and evaluate the evidence proposed by published research articles and published literature, alongside that of Government guidelines for the effectiveness and practicability in reducing the frequency of nosocomial infections and nosocomial colonisation and infection within a hospital setting.

By evaluating the nursing procedures followed to control and prevent nosocomial infections, I believe that after cautious examination of research can offer Healthcare Professionals, a better understanding of how an action, such as that of the best course of treatment or drug affects and targets a nosocomial infection. By reading and researching my chosen subject I hope to increase and improve my learning, which will allow me to practice and contribute to evidence based-practice as suggested by….

My data will be sampled on adult Service User’s only, as this will allow me to reflect on my own experience through my current nursing placement. For all Healthcare Professionals to understand how to prevent and control nosocomial infections, they must understand that they all have an individual responsibility to follow their own local Trust’s infection and control guidelines of which they work for, as well as that set by the local Department of Health Authorities, as this will reduce and theoretically minimise the risks towards Service Users, themselves and others alike.

Current legislation which are in place and that are related to the prevention and control of infections are; The Health and Social Care Act (2008), Getting Ahead of the Curve (2008), Winning Ways (2003) and Essential Steps to Safe Clean Care: reducing health care associated infection (2006), however these are just a selected few.

All of these mentioned provide significant information on exactly how to move in the direction of compliance with policies and evidence based -practice. Despite the fact that hospitals use recommended sterilisation techniques as well as disposable materials, nosocomial infections still remain a constant problem, specifically to those service users that are weaker, and in addition to the chain of transmission within the hospital setting itself.

Hand hygiene should be one of the first priorities of minimising infection control and is considered the most effective and cost-effective means of prevention as suggested by Gould et al (2006), as hands are one of the most common ways of which micro-organisms predominantly that of bacteria, of which many are becoming increasingly resistant to antibiotics that are commonly used to treat such nosocomial infections. For instance, the bacterial strain of MRSA which was first identified in the 1880s as the most common cause of infected surgical wounds and could cause serious or occasionally fatal disease.

With the introduction of penicillin in the 1940s, it initially helped challenge such infections, however after sometime the strain became resistant to the antibiotic and by approximately 1959 about ninety to ninety five percent, as documented by Health Protection Agency (HPA) (2011) of staphylococcus aureus strains isolated a service user with nosocomial infections and were resistant to penicillin, and therefore making MRSA progressively more difficult to treat. Due to the staphylococcus aureus strains becoming antibiotic-resistant towards penicillin alternative reatments were developed, meticillin, cloxacillin and flucloxacillin, from using penicillin as its base and are able to treat such infections. A service user who may be considered as compromised are those individuals that are more vulnerable and therefore at a greater risk to infection, an example of which is a service user with reduced immunity. These said service users or individuals would make it far easier for pathogens to enter the body than it would of a healthy individual.

Another factor that would make it far easier for these pathogens to enter would be the use of an invasive device and/or procedure that bypasses the body’s normal and first line of defence, which is the skin. For instance, a ventilator or catheter, which is a flexible tube inserted through a narrow opening into a body cavity, duct or vessel. An example of this is when a catheter is used within the bladder to allow drainage and elimination of fluid, therefore diligent hand hygiene is the most proficient way in reducing transmission of nosocomial infections during the provision of care to such service users.

The Government responded by introducing the ‘CleanYourHandsCampaign’ (CYHC) in partnership with the National Patient Safety Agency in 2005, throughout the England and Wales, however is no longer active but still remains a useful archive for information and tools and its sole purpose was to achieve consistent, evidence-based practice in hand hygiene. This campaign was introduced into England and Wales due to the established success of a similar methodology used by Pittet et al. n Geneva and its objective was to ensure NHS healthcare workers were performing hand hygiene correctly and at the right time and place, which would contribute to preventing nosocomial infections. This recommendation involved ensuring that alcohol-based products were available and positioned at every bedside and ward entrance. Posters and other publicity materials were used to encourage and remind healthcare workers and service users to use alcohol gels.

The compliance of the CYHC was exhilarated through repeated audits and feedback and yet evidence suggests that the mortality rate from MRSA has increased over the last ten years in the UK and is higher in comparison to other European countries, as documented within the research article ‘The CleanYourHandsCampaign: critiquing policy and evidence base’. This may be due to the more aggressive approaches used to prevent nosocomial infections.

Gould et al (2006) has advised that the Netherlands used a ‘search and destroy’ approach to dramatically reduce the number of occurrences of MRSA. This approach included an increase in agreement with hand hygiene protocols and involved a multifaceted approach in ensuring healthcare workers do not forget or neglect hand hygiene. Alongside the CYHC, the Department of Health (DoH) made a further recommendation in 2007, with the published guidance; Uniforms and workwear: An evidence base for developing local policy, which is now broadly known and referred to as ‘bare below the elbows’.

This advocates hands and wrists should be free of any jewellery, as jewellery inhibits good hand washing of which dirt and bacteria can remain beneath jewellery even after good washing, and can act as a route of transmission of microorganisms as a result poor evidence-based practice. As well as uniforms being short-sleeved, as cuffs can equally become heavily contaminated and are highly possible to come into contact with service users and is regarded within the healthcare industry as good evidence-based practice.

Hands should be washed with preferably a liquid antimicrobial soap (those containing chlorhexidine or povidone-iodine PVP-I) and clean water or alternatively alcohol-based hand gel, however the alcohol hand gel is not the best form of decontamination as the alcohol gel evaporates quickly before it has had time to cover all of the hand surfaces, although I believe these alcohol hand gels were introduced to increase hand hygiene at busy frequencies, but yet still not as effective as antimicrobial soap and water.

Hand hygiene should take place for at least 15 seconds to 3 minutes; however this will depend on the level of hand hygiene being performed. For example any surgical procedures would have a higher level of hand hygiene guidelines due to increased risk of infectious disease being transferred to an open wound.

This initial stage should be followed prior to any service user contact, as this will in effect decontaminate or neutralise and protect the service user against any potential harmful germs on the hands being transferred from service user to servicer user or undeniably another part of the service user’s body, and is recommended by the World Health Organization (WHO) guidelines (2009). It has also been suggested by Kozier et al (2004) that hands of nursing professionals and that of the service user should be ashed at the following times to help prevent the spread of microorganisms; before eating, after the use of bedpans, commodes or toilet, and if hands come in to contact with any secreted bodily fluids, such as sputum, blood, semen; nevertheless as previously mentioned it is essential that any healthcare worker wash their hands before and after providing care of any kind. With all of these mentioned guidelines, it begs the question of ‘If these guidelines are all fully adhered to, why do we still see so many nosocomial infections within a hospital setting?

My personal opinion is could it be due to the financial cuts that are being placed on NHS hospitals by local Government bodies, therefore leading to lack of resources or alternatively purchasing cheaper and poor evidence-based materials, such as alcohol gels or can it be due to the pressure now put on healthcare workers to take on extra duties than before and as a result guidelines are not always fully adhered to and therefore cutting corners in order to achieve other deadlines.

I also feel that the negative press and media coverage that is placed on healthcare workers and the NHS itself for these nosocomial infection outbreaks and therefore leading to low morale within the healthcare workforce. All this being said and yet the Nursing & Midwifery Council (NMC) Code of Conduct (2008) clearly states ‘provide a high standard of practice and care at all times’,.

The National Audit Office have established that it could be highly possible to decrease nosocomial infections by fifteen percent, which is equivalent to approximately ?150 billion through better application of current policies and procedures, but is this really possible with such cuts, only time and research will convey.

In some circumstances personal protective equipment (PPE), masks, non-latex disposable gloves and single-use disposable gowns should be worn and readily available in a clinical area as recommended by Pratt et al (2007) and in particular where regular use is expected, to act as a barrier to bodily fluids and micro-organisms, thus providing protection to both healthcare workers and service users.

However use of PPE equipment alone is insufficient, therefore good hand hygiene should also be adhered to and carried out before placing non-latex disposable gloves on the hands, when hands are visibly soiled; after contact with contaminated materials such as linen and soiled protective wear (pads), when performing any surgical or aseptic techniques, prior to handling food and after leaving a ward as recommended by Parker (2002) and correctly disposed of according to clinical waste management guidelines that will be discussed later within this essay.

A UK simulated live exercise was conducted in selected north-west England hospitals during 2008, over a twenty four hour period by teams of infection control nurses and documented by Phin et al (2008), to observe and record health care workers behaviour, practice and attitudes towards PPE, as well as to identify operational issues and to quantify PPE usage. It had been documented that there was an increase in gloves and surgical masks used than expected, which proved to be excessive compared to that of WHO recommendations.

This simulated exercise took place on four acute medical wards and the amount of PPE worn was recorded hourly and in conclusion of their findings found that the majority of healthcare workers lacked in confidence and even more so in infection control measures, when knowing when to use PPE and the correct disposal even though all healthcare workers receive training and guidance for the use of PPE. This exercise also provided and gathered data from self-administered questionnaires to discover the thoughts and feelings of healthcare workers on wearing PPE.

Twenty-one ward staff (thirteen nurses, four healthcare assistants (HCAs), three domestics and one ward clerk) out of twenty-three (91%) completed questionnaires provided. Of these, seventeen staff (81%) said that duties took longer and the biggest problem arising being extra time taken up by more frequent emptying of clinical waste bins. Although this study has provided to be of an insight, it does highlight some weaknesses and limitations.

This study was conducted on respiratory medical wards and was conducted throughout an influenza pandemic, therefore although very insightful not necessarily completely accurate data recordings, as it would have been conducted when infection control measures would be at an increase level. It would have been more accurate to have had this exercise in hospitals when there was not a pandemic influence and thus providing more general data findings.

Prior to this simulated exercise the proposal was discussed with the Chair of the hospitals research ethics committee who agreed and was satisfied, that the exercise did not fall within the remit of the committee. Key managers and clinicians were involved in meetings and all healthcare workers were made aware of the planned exercise. Service users and their visitors were provided with written information about the purpose of the exercise and in addition, a member of staff was at the ward entrance throughout the exercise to provide information.

Therefore, I feel that infection control measure would have been enlightened and increased and all healthcare workers and service users alike were made aware prior to the start of the exercise and so data collected may not be of a true account of such a situation. Instead, I feel that perhaps this type of exercise would be best suited to an anonymous observation to gather a true and accurate account of PPE usage, when healthcare workers are not aware they are being observed. PPE and hand hygiene is of a great importance when it comes to those service users and individuals that are barrier nursed on within isolation.

To define barrier nursing is to contain yet prevent an infectious source from being transferred to other service users and healthcare workers alike and therefore would ideally be isolated and nursed in preferably separate rooms compared to that of the common bays seen in hospital settings at present. There are two types of barrier nursing, which are the first and generally the most common barrier nursing itself, and this is the practice of nursing to a service user known or thought to be carrying a HCAI or contagious disease.

The second type is reverse barrier nursing which is the practice of nursing an individual who is considered to be vulnerable and at greater risk to infections and as a result are nursed in this manner to reduce and minimise the risk of potential infections an example of which MRSA, C. diff and E-Coli. As already mentioned, preferably an affected or vulnerable service user would be nursed in a separate room and all medical equipment (i. e. commode, bed pan, sliding sheets etc. would remain with the service user until discharge, when all medical equipment can be sterilised to prevent cross-infection. All PPE equipment should be worn prior to entering the barrier room, and disposed of accordingly within the affected room prior to leaving, ensuring the waste management guidelines are followed. This goes alongside the safe management of all used linen, to prevent cross-infection. Hand hygiene, according to the 6 stages are vital before and after each patient contact and disposal of all PPE, and especially after leaving a barrier room.