The Importance of Infection Control - Essay Example

?INFECTION CONTROL Introduction Healthcare is provided to patients in different settings throughout the world. Whether the patients receive medical attention in makeshift clinics or in technologically advanced hospitals, there are chances that they may get infected by disease spreading micro organisms. These infections cause discomfort to the patient and hinder the recovery process and in severe cases may even cause death. As the cost of treatment also increases, the hospital acquired infections are actually a burden on the government as well. The extended stay of the patient results in the loss of work thereby depleting his/her financial resources. Ever since the hospital acquired infections were identified, steps have been taken to control them and over the years the frequency of occurrence has largely decreased. The hospital staff, especially the nursing unit, actively participates in keeping the infection occurrence down to ensure a speedy recovery and better quality of healthcare. One of the important duties assigned to me as a staff nurse is to prevent hospital acquired infections among patients. Infections prolong the stay of the patient by impeding the recovery process and they may also affect other patients and the hospital staff. According to Nemerow, Agardy and Salvato (2009, p. 156) the data collected over the years shows that fifty percent of the infections are preventable if proper measures are taken. It is therefore mandatory for a staff nurse to educate the patients and their visitors about the dangers of infections and their prevention. Though all the wards in the hospital are susceptible to hospital acquired infections, in this essay I will mainly focus on respiratory ward where I work as a staff nurse. The respiratory ward in a hospital provides full range of treatment to patients suffering from various respiratory diseases such as asthma, lung cancer, sleep apnoea, cystic fibrosis, bronchiectasis, TB (tuberclosis) and COPD (Chronic Obstructive Pulmonary Disease). The staff at the respiratory ward comprises of a team of consultant doctors, nurse consultants and specialist nursing teams as well as health professionals for respiratory physiology and physiotherapy among others. Like other wards in the hospital, nursing team is the backbone of the respiratory ward. The Nursing Team Nurse consultants are highly experienced registered nurse who work directly with the patients and ensure that the best medical services are conveniently available to them and that they (the patients) benefit from the best nursing skills. The nurse consultants also contribute towards the education and training of colleagues and are responsible for evaluating care delivered to the patients (Freshwater et al (eds.) 1994, p. 400). In the respiratory ward the nurse consultant supports respiratory patients and their families through primary and secondary care interface (Clancy 2007, p. 28). The nurse specialist is a nurse with a master’s degree in an advanced clinical area and work for the improvement of the quality of life of the patient (Lundy and Janes 2009, p. 1068). They are supported by staff nurses; staff nurses take complete care of the patients assigned to them in a hospital (Peate 2012, p. 29). The duties of a staff nurse revolve around clinical activities, administrative activities, educative activities, supervisory activities and communication activities. Infection prevention is the top most priority in the respiratory ward where I work. Being a nurse I can play an important role in reducing the possibility of hospital acquired infections. This is because during training the nurses are imparted the necessary knowledge and equipped with the essential skills to help patient recover swiftly as well as lowering the chances of hospital acquired infections (Goldrick 2006, p. 380). Nosocomial infections or the hospital acquired infections are those infections that develop within the hospital; usually within forty eight to seventy two hours (Qayyum, Sattar and Waqas 2010, p. 168). The occurrence of hospital acquired infections is a common phenomenon and exists in hospitals the world over. Besides being a burden to patients and public health, hospital acquired infections cause morbidity in hospitalized patients and in certain cases has proved to be fatal as well (Ichhpujani and Bhattia 2002, p. 266). Research shows that at an average ten percent of the patients develop hospital acquired infections (Kurait 2009, p. 92). In USA alone the number of patients contacting the infections per year is two million with the cost of treating them estimated at eleven billion dollars. The number of deaths due to hospital acquired infections is said to be eighty five thousand per year (Kurait 2009, p. 92). What causes hospital acquired infections Hospital-acquired infections are mostly by bacteria, viruses, fungi, or parasites (Francis and De Souza 2000, p. 330). These microorganisms which cause infections are called pathogens and are likely to be present in the patients’ body at the time of admission or the patients may get them from the environment, contaminated hospital equipment, the staff or other patients (Ruwanpura, Mohamed and Lee (eds.) 2010, p. 1382). As the body’s defense mechanism is already weak, these microorganisms face little resistance. The microorganisms are resistant to anti-biotic and the common infections a patient can suffer from are respiratory infections, surgical wound infections, gastrointestinal infections and urinary tract infections. The patients can come in contact with the microorganisms either directly or indirectly. The direct contact is through hands of the staff or visitors and indirect contact includes the involvement of a piece of equipment; it may also be due to ingestion (eating contaminated hospital food), air borne route in droplet nuclei or by inoculation (through blood transfusion) (Inglis 2007, p. 191). Sources of Indirect Transmission Hospital Equipment Sources of indirect transmission are usually hospital equipment such as respiratory therapy equipment, bronchoscope (in respiratory ward), endoscopes, IV Lines, suction catheters and endo-tracheal tubes (Damani 2003, p. 5). Airborne Transmission Improper ventilation can also be a source of transmission of pathogens; some fine pathogens remain suspended in the air for a long time and then are circulated by air currents and inhaled thus resulting in infection. Tuberculosis, measles and varicella (chicken pox) are some diseases caused via airborne transmission (Damani 2003, p. 5). Droplet Transmission Droplet transmission occurs when a person comes in contact with contaminated respiratory secretions. A patient transmits droplet spread infections when he/she sneezes, coughs or talks thereby discharging infected secretions which are propelled through the air and then either fall on the floor or on the environmental surface (Friedman and Petersen 2004, p. 6). Whooping cough can be transmitted this way. Build Environment One factor observed by many people is that although the built environment has a strong impact on safety and health of the patients, enhancing patients’ safety and improving quality takes a back seat when the hospital buildings are being designed (Barach 2008, p. 15). Elaborating further the author says that the hazards of medical errors and rate of infection in hospitals was mainly due to the present hospital design. While designing hospitals the need for proper lighting and air ventilation is often overlooked resulting in high rate of hospital acquired infections. To make matters worse, two or more patients are placed in the same room thereby increasing the chances of infection. Cross-Contamination Another source of hospital acquired infections is cross-contamination or the transfer of pathogens between people or places. For instance pathogens pile up on stethoscopes because of their regular use (White 2012, p. 4). Infections due to Direct Transmissions Direct transmission of infections causing microorganisms is because of person to person contact. The transfer of microorganisms takes place during patient care activities such as changing dressing, bathing and insertion of invasive devices. Donaldson (2003, p. 420) has observed humans to be the major source of hospital acquired infections (patients, healthcare workers and visitors). If the gloves worn by the staff nurses or their apparel are contaminated then the chances of the transference of harmful microorganisms increase tremendously. Handshake with visitors is another way through which infections can spread. Visitors also bring along flowers and balloons which can also cause transference of microorganisms. Thus the little gesture of love instead of lifting the spirits ends up making the patient sicker. As a staff nurse, it is my duty to maintain good interpersonal relationship with patients and their relatives. I make use of the communication skills I have acquired during training to develop a friendly and trusting relationship with the patients and with their kin and kith. It is my job to inform them about the hospital acquired infections and how everyone from patients to staff to visitors can all get affected by them. I teach them simple methods through which they can contribute towards controlling the hospital acquired infections. Hand Washing The most important and effective method of preventing infections through direct transmission is by washing hands thoroughly. Hygiene plays an important part in curbing infections in hospitals. Cleanliness should be maintained in the hospital surroundings and the staff should be instructed to wash their hands frequently especially before and after coming in contact with a patient and coming in contact with body fluids, secretions, blood and equipments or articles which can be contaminated. Although hand hygiene can be carried out using alcohol sanitizer; washing hands with soap or antiseptic solutions is a better option. Being a staff nurse I not only follow the practice of washing hands religiously but instruct my juniors to do the same. As a matter of fact the Center for Disease Control and Infection Prevention has made it mandatory for all staff to decontaminate their hands before entering and after leaving the patient’s room (Hospital acquired infections n.d., p. 3). Although washing hands seems to be a simple and effective procedure but it becomes ineffective if not followed properly. As most of the visitors are unaware of the process of hand washing I demonstrate the correct method so that they can remain uncontaminated. Proper hand washing techniques include washing hands till the wrists and cleaning under the nails as well. Forearms are also washed if the hands of the staff member are grossly contaminated (Williams & Wilkins 2008, p. 163). The staff dealing with patients should also wear clean uniforms and make use of gloves, masks, aprons and head covers. If we suspect that any item of our clothing is infected, we change it immediately. Hand washing is done by us even though we wear gloves; this is to ensure that the patients under our care remain safe (Clements 2011, p. 108). Isolation Another method to prevent infections through direct transmission is “isolation”. In isolation a patient is placed in a separate room to lower the risk of spreading infection to others. It is an effective technique to reduce the possibility of both direct and indirect transmission of microorganisms. Isolation can be further categorized as source isolation in which the affected patient such as one suffering from chicken pox is separated from others and protective isolation in which patient is placed separately to protect him from harmful microorganisms. Usually patients with impaired immune system are placed in protective isolation (Dougherty and Lister 2011, p. 82). Barrier nursing was introduced in 1910 in the US with the aim of checking the transmission of the harmful microorganisms to other patients and to the hospital personnel. The barrier nursing procedures were carried out when care was provided to patients in isolation. The staff used separate gowns and gloves when caring for each patient and used antiseptic solutions to wash hands after treating each patient. The objects used by the patients were also disinfected (White 2005, p. 373). Besides gowns and gloves, the nurses also use masks and eye protection for their safety. Combating hospital acquired infections due to indirect transmission The rate of hospital acquired infections can decrease by bringing about appropriate changes in the design of the hospital. A practical example is that of Bronson Methodist Hospital located in Kalamazoo, Michigan (Barach 2008, p. 15) where the rate of infection dropped by eleven percent with the inclusion of private rooms and especially located sinks in the design of the hospital. The healthcare staff can control cross contamination through stethoscope by occasionally cleaning its diaphragm and bell with alcohol or any other antiseptic (White 2012, p. 4). One method of decontaminating equipment is by cleaning it with antiseptic solution. Sterilization and asepsis are two methods adopted in the hospitals to keep the equipment free of the infection producing microorganisms. Total cleansing can be achieved with sterilization which involves treating the equipment with heat or chemical agents. Instruments used in surgeries are always sterilized. However sterilization is a costly process which is also difficult to maintain. Also because of the sensitive nature of some equipment especially those used in respiratory care, asepsis is a better option (White 2012, p. 4). The hospital management should also make sure that the hospitals are protected from insects as insects can also carry pathogens from one patient to another. The hospital management should see that no violation of the infection control practices takes place and that no non-sterile or unclean procedures are practiced. The hospital management should also provide a clean environment and must make hand hygiene mandatory as most infections take place because of hand contact. Regular screening of hospital employees especially those dealing with patients 24/7 should also be done. The specimen collected from patients should also be sent to the laboratory to identify the infection if any at an early stage. In wards where two or more patients are placed in a single room, screens must be used to separate them. Also the hospital authorities should see that the patient is not kept in the hospital unnecessarily as this increase the chances of infection. The hospitals must carry out infection surveillance procedures regularly to identify and consequently control the infections from spreading. The role of staff nurse in clinical epidemiology Epidemiology is generally the study of the factors that determine the occurrence and distribution of disease in a population. Epidemiology studies and researches the origins of health problems in a community especially due to the presence of infectious agents, human behavior and the social and psychological state of the community. Clinical epidemiology is based on more or less the same pattern and focuses on the prevention and treatment of hospital acquired infections inpatients already undergoing treatment in a healthcare facility (Jekel 2007, p. 3). Because of the communicable nature of infections in my settings, it is important that I predict and prevent the presence of infections. As most of the respiratory infections are spread by contaminated hands and airborne transmission and droplet transmission such as coughing and sneezing, I follow barrier nursing procedures such as use of gloves and masks. Patients with communicable diseases are placed in isolation and infectious visitors are denied contact with patients. Other policies and procedures to prevent and control the infections followed in my place of work (respiratory ward) are antibiotic control, screening of patients, cleaning of the environment and installation and maintenance of water heating and air conditioning system. As respiratory ward is one of the sensitive areas in a hospital and so if I suspect an offset of infection in any of the patients under my care, I report immediately to the attending physician. If an attending physician is not available, I order culture specimens from suspected patients and place them in isolation if necessary. I may also limit the exposure of patients to infections from staff, visitors and hospital equipment. For example I instruct the visitors that the flowers they bring for the patients can actually serve as a medium for transmitting harmful microorganisms. Summary The hospital acquired infections have become a global problem especially in the developing countries where the quality of health care is poor and hospitals are overcrowded with patients and understaffed. Controlling hospital acquired infections has become a significant part in hospital management. These infections are not present at the time of admission to the hospital and generally surface within or after forty eight hours. The infections developed in hospitals are anti-biotic resistant and can be serious and in some cases fatal. Hospital acquired infections are caused by microorganisms such as parasites, bacteria and fungi that are transmitted to the patients either directly or indirectly. These microorganisms can cause a number of infections such as urinary tract infection, respiratory infection, infections in blood, skin and bones and wound infections. The financial burden which the infections cause and the physical pain and discomfort an already sick person goes through calls for effective methods of controlling hospital acquired infections. Various measures of infection control such as sterilization of equipment, proper disposal of certain materials like syringes etc and provision of a clean and healthy environment are being carried out in hospitals. Proper air circulation and lighting is also essential for patients’ health as it cheers them up. The nursing staff has always been at forefront in preventing the spread of infections among patients, visitors and healthcare staff and carries out its duties diligently to make the hospital environment safe for everyone. Studies have shown that hand contact is the single most common source of direct transmission of harmful microorganisms. The nurses play a pivotal role in preventing hospital acquired infections by following the universal precautions defined to check infections and by educating patients about the risks of infections. Hand washing is the most effective technique to combat infections. The nurses wash their hands with antimicrobial soaps before and after treating the patients. They also make use of barrier precautions such as masks, gloves and gowns to keep themselves and the patients under their care safe. 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