Cross Infection and Risk Management in the Accident and Emergency Hospital Environment - Research Paper Example

 A REPORT ON CROSS INFECTION AND RISK MANAGEMENT IN THE ACCIDENT AND EMERGENCY HOSPITAL ENVIRONMENT PREVENTION OF HEALTHCARE ASSOCIATED INFECTIONS CONTENTS Background Introduction Methodology Findings Discussion Conclusion and Recommendations Appendix 1 – Risk Management Package References Background: For over 20 years, several “guidelines for the control of meticillin-resistant Staphylococcus aureus (MRSA) in hospitals in the UK have been published…” (Coia et al, 2006). Media interest over recent times has alerted the public and healthcare staff to the dangers of cross infection, ever present in the hospital setting. According to Wiseman (2006), in relation to Healthcare-associated infections (HCAI), “Prevalence studies show that one in ten patients in acute hospitals will acquire an infection following admission to an acute hospital….1 per cent of these patients will die as a direct result of HCAI, and 3 per cent will die from HCAI as a contribution factor.” (Wiseman, 2006 citing National Audit Office, 2000) It is not just MRSA that poses a problem, but the risk of other antimicrobial resistant infections has been identified, with Clostridium difficile being found to threaten certain groups: “older people and those who have undergone surgery, and people with serious underlying diseases, all in association with recent antibiotic use.” (Health Protection Agency (HPA), Press Release, 2005). However, their joint survey of 173 trusts also found “that cases of C. difficile are not confined to older people: 41% of trusts estimated that one out of ten cases affected people under the age of 65.” (HPA, 2005). Introduction: Taking that information and issues on HCAI in genera into account, this report will examine how cross infection can occur and look at the strategies for prevention, with particular reference to A & E. (See Appx. 1.) Several strategies, workshops, campaigns and standards have been created to address the problem. These included the Nursing Times ‘Keep it Clean Campaign’ (Crouch, 2005), which aimed for “Trusts to provide changing and uniform facilities for nurses” and “…information for visitors on good infection control practice”, amongst others. The NICE Guideline (2003) quoted four areas of action for all healthcare staff, in the Standard Principles: “hand hygiene” “use of personal protective equipment” “safe use and disposal of sharps” “education of patients, their carers and healthcare personnel” (NICE, Section 1, Summary, 2003) The Royal College of Nursing (RCN) have supported and underlined these standards with their ‘Wipe it out’ campaign (2005), setting minimum standards throughout. One particular area of interest included uniforms as follows: “Staff must presume some degree of contamination, even on clothing that is not visibly soiled.” (RCN, p.9, 2005) Methodology: A review of literature, journals, strategies, media reports, websites and national standards was undertaken, as mentioned in the Introduction. From these, the most relevant and easily applied processes were gathered and used to form the Risk Management Package (See Appendix. 1). Findings: Yet at the time of writing, the findings from a Healthcare Commission Report, publicised June 18 2007 in the media (BBC News), identified that trusts were failing to meet some of the standards of the hygiene code, with only 40% meeting all of them. (DoH, Health Act, 2006). Such findings make it all the more vital that each individual in healthcare understands what needs to be done and takes responsibility for tackling the issues. Discussion: In the A&E setting, these facts should be borne in mind and practical measures that include hand hygiene, protective clothing, robust laundering and decontamination of all reusable medical devices, be taken to prevent cross infection. The setting provides many risks, as staff will be confronted by situations, health conditions and patients that pose a high level of risk. Dealing with emergency injuries, chronic illnesses, drug and alcohol trauma, patients and families from every domain of nursing – the list goes on – managing and preventing infection is a challenge. The potential for blood, bodily fluids, viral and bacterial infections to affect staff and other patients and service users is high, and volumes, variations and unpredictability mean that stringent and consistent plans and actions must be followed. Evidence also suggests that not just hygiene but early identification of patients with MRSA and other HCAIs can contribute to the eradication, or at least, the decrease of infections. Given that assessment and history taking is carried out, as far as possible, on admission to A & E., the correct gathering and recording of patient information is a sound start in the identification and management processes. For example, if a patient has been hospitalised in the past, or has received regular antibiotic treatments, then the possibility of infection or colonization must be considered. A & E staff could be at the forefront of the first line of defence in identifying the risks. The Specialist Advisory Committee on Antimicrobial Resistance (SACAR) have revised guidelines for treatment, Coia et al (2006) suggest ”antibiotic policies should be reviewed” and HPA (2005) reported that “Over two thirds of trusts thought that the prescribing of antibiotics and the lack of facilities for isolation represented the greatest challenges to controlling infection.” By addressing the use of antibiotics, before and during a hospital stay, gathering this information during history taking, recording findings, healthcare staff would be alerted to the risks. The following recommendations support this process of assessment, alongside essential hygiene standards that minimise and manage risks in the A&E setting and the hospital at large. “Labelling medical records….so that they are recognized immediately on admission. Electronic labelling of patient database Ready access to database of known affection patients in the admissions and Accident and Emergency departments” (Coia et al, 2006) In addition, Department of Health (DoH) Standards (2006, Appx. 2) regarding decontamination of reusable medical devices, urged that records be kept on the decontamination process and on to identify those patients who had used the devices. Conclusion and Recommendations: A & E might be understood as the first line of defence in taking up the challenge. The situation is still at a dangerous level, and only by education and continuously assessing and reviewing policies and processes, can a reduction occur. The hand hygiene campaigns may be considered effective; the public and staff are fully aware of the implications. The importance of cleaning in hospitals has been an issue for government and been addressed by the matrons’ role in managing cleaning services and by the colour coding system (healthservicetalk, 2006). But the application of standards and correct procedures are still dependant on individual action and responsibility; from the moment a patient arrives in A & E, every aspect of risk management must be considered and applied. The package suggested in Appendix 1 attempts to summarise the key issues that could go towards prevention and management of the spread of HCAIs. Local circumstances could dictate which are more valid than others, but all are considered to be necessary in decreasing risks. Given that it contains actions that can be immediately put into practice, it has been a useful tool in keeping to good hygiene standards and for improving history taking and record keeping. Appendix 1 – Risk Management Package Education and Information: Ensure all staff and service users are aware of hygiene practices regarding hands, uniforms, protective clothing, sharps and medical devices. Policies and standards to be displayed and readily available. Infection Control Team/Champion: A named individual/individuals to be in place to survey, advise, guide and review processes with staff. They must communicate with all related staff and other departments and report outbreaks to HPA. Assessment, History Taking and Records: All relevant staff to take full history, screen patients and check for infection. Steps to be taken to inform Infection Control Team and all other health professionals. All records to be clear, accessible and up to date, while maintaining patient confidentiality. Minimize Risks in Practice: Hand and equipment hygiene, antiseptic and alcohol washes available for appropriate use (e.g. decolonisation). Disinfect environment, prevent airborne contamination (careful use of fans), keeping linen and all supplies clean and free from airborne contamination. Use laboratory for analysis of strain. Inform and involve patients and family in hygiene procedures, isolate patients and where applicable, remove invasive devices. Use of antibiotics should be appropriate to the recommended practice of British National Formulary. * These points may be applied throughout the hospital setting and in particular to any high risk area, and to any HCAI, including MRSA. Reference List BBC News 18 June 2007 – “Struggling trusts: A report…failing to comply with basic hygiene standards” Available from: http://www.news.bbc.co.uk/1/hi/health/6764153.stm [cited 19 June 2007] Coia, J.E., et al 2006. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. Journal of Hospital Infections, Vol 635 1- 44. Available from: www.sciencedirect.com [cited 19 June 2007] Crouch, D. 2005. Outside Influence: Contracting out cleaning services to the private Sector has been a controversial move. Nursing Times Vol 101 (12) Department of Health 2004b. Towards Cleaner Hospitals and Lower Rates of Infection: A summary of Action. The Stationery Office, London. Department of Health 2006. The Health Act 2006: Code of Practice for the Prevention And Control of healthcare associated infections. Available from: http://www.dh.giv.uk/en/Publicationsandstatistics/Publications/PublicationsPolicy andGuidance/DH_4139446. [cited 19 June 2007] Health Protection Agency 2005. Press Release: Healthcare agencies urge the NHS to Step up measures to minimise risk of patients contracting Clostridium difficile. Available from: http://www.hpa.org.uk/hpa/news/articles/press_releases/2005/ 051221_c_difficile.htm. [cited 19 June 2007] Healthservicetalk 2006. [online] Colour coded hygiene wipes offer peace of mind. Editorial. Available from: http://www.healthservicetalk.com/news/msz/msz100.html [cited 19 June 2007] NICE 2003. Infection Control: Prevention of Healthcare-associated infections in Primary and community care. Summary. Available from: http://www.nice.org.uk/pdf/infection_control_full_guideline.pdf. [cited 19 June 2007] Royal College of Nursing 2005. Campaign –‘wipe it out’ RCN Campaign on MRSA. Available from: www.rcn.org.uk/MRSA. [cited 19 June 2007] Specialist Advisory Committee on Antimicrobial Resistance 2005. UK Template for Hospital Antimicrobial Guidelines. Available from: http://www.advisorybodies.doh.gov.uk/sacar/hospital-antimicrobial-guidelines- template-May05.rtf. [cited 19 June 2007] Wiseman, S. 2006. Prevention and Control of healthcare-associated infection. 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