Nurses Themselves Can Be a Barrier to Effective Infection Control Precautions - Literature review Example

Nurses Themselves can be a Barrier to Effective Infection Control Precautions Name: Course: Tutor: Date: Healthcare environments across the world are perceived as a source of wellness, where patients go to receive treatment for their ailments. However, the fact that the healthcare facilities are visited by people with different infections could also mean that one can catch an infection from the same place, especially if no precautions are taken by the health facility to prevent infectious diseases from spreading. Through their role of handling multiple patients, nurses are required to comply with set standard procedures that are meant to ensure that the nurse himself/herself is protected from contracting the infectious diseases from patients, but also to ensure that the nurse does not act as a mode of disease transmission, whereby pathogens from one patient are transferred to another through the nurse’s hands. In a research conducted by Picheansathian, Pearson and Suchaxaya (2008, pp. 315-321), it was discovered that lack of proper hand hygiene is one of the main contributing factors that made nurses a barrier to effective infection control. After studying the spread of nosocomial infections in 42 Thailand hospitals, the three researchers found out that patient to patient transmissions of the same infection largely occurred through the hands of healthcare workers. After reviewing earlier researches conducted on the same subject, Picheansathian et al. (2008, p. 316) further discovered that even though healthcare workers knowing that their hand hygiene was necessary in reducing patient-to-patient infection rates, only the compliance rate to the same rarely exceeded the 50 percent mark. This was even lower for nurses who registered less than 30 percent compliance. Some of the reasons cited by nurses for not complying with the hand-hygiene requirements include perception by nurses that their hands were not contaminated; skin irritation from too much use of the hand-hygiene products; little or no knowledge regarding hand-hygiene requirements; multi-tasking between patients; lack of enough time especially during medical procedures; continuous care provision to one patient; and forgetfulness. Other nurses also argued that wearing gloves when handling patients makes it unnecessary for constant washing of hands (Picheansathian et al., 2008, p. 317). A similar research was conducted among Turkish nursing students by Akpinar et al. (2009, pp. 426-430). In this case however, the researchers extended their survey beyond hand hygiene to cover the presence of nasal flora among the surveyed sample. The researchers found out that healthcare workers acquire resident and transient flora from direct patient contact or from contaminated surfaces in the healthcare facility. Transient flora was especially found to be a significant cause of infections transferred from one patient to another through healthcare workers. By nature, transient flora is attached on the upper layer of a person’s skin and can be easily removed by proper hand hygiene. In findings that disagreed with the opinion held by nurses that some activities do not contaminate hands as discovered by Picheansathian et al. (2008, p. 317), Akpinar et al. (2009, p. 427) found out that nurses’ hands can be contaminated during activities considered as con-contaminating. Such include moving a patient, taking his or her pulse rate, measuring a patient’s blood pressure, taking his or her oral temperature or examining a patient’s body parts. Other places considered as possible sources of transient pathogens include walls in the health facilities, doors, patient files, desks, pens, treatment tables and the telephone receiver handles (Bonassoli & Svidzinski, 2002 cited by Akpinar et al., 2009, p. 428-9). In conclusion, Akpinar et al. (2009, p. 429) found out that nosocomial infections transmitted from one patient to another through the contaminated hands of nurses could be drastically reduced if “proper and frequent hand-hygiene practices” were adopted by all healthcare workers. In addition, awareness regarding the importance of not only cleaning hands but also wearing sanitary gloves should be enhanced in order to reduce cases of infections resulting from nurses’ handling of patients. As observed by Leaver and Gregorian (2008, p. 4) some patients perceive protective clothing worn by nurses as distressing. In an attempt to reduce the stress and anxiety caused by such clothes, some nurses opt not to wear them. However, considering that there has been evidence in earlier researches (such as Korniewicz et al., 1998, cited by Leaver and Gregorian, 2008, p.4) that protective clothes act as a barrier against health care workers contracting infectious pathogens, protective clothes need to be used whenever the need to do so arises. But how then should a nurse know which case to wear protective clothes for? According to Leaver and Gregorian (2008, p.4), nurses and other health workers must learn how to conduct a risk assessment before taking up any clinical activity. In the assessment, the nurse should consider the nature of the healthcare task, amount of physical contact between him and the patient and probability of contamination from body fluids such as blood or mucous membranes. Should the nurse establish that from the named considerations that indeed wearing protective clothing is necessary, he or she should then decide which types of protective clothes to wear based on the efficacy of the same. Leaver and Gregorian (2008, p. 8) also observe that wearing of protective clothing by nurses does not automatically mean that they cannot catch an infection from a patient or even pass the same to another patient. For starters, the two researchers note that nurses who wear the same protective clothes while handling different patients can still transmit infections. As such, they recommend that items such as gloves, masks, aprons, eye and face protectors should be removed immediately a clinical procedure on each patient is concluded. More to this, nurses must always be cautious when removing the protective gear in order to avoid contaminating their hands. As a precautionary measure is that hands should be cleaned after removing the protective clothing, before handling a patient, and after handling the patient. Inasmuch as nurse health educators stress on the need of adopting practices that would reduce nurses acting as agents of infection, Madeo (2004, p. 1018) notes that healthcare workers often have preconceived notions about the same. For example, it was noted that nurses would wear gloves when handling open wounds or where there is a possibility of having contact with body fluids, but would fail to wear the same when performing venepuncture, often assuming that the latter is less contaminating. This happens in spite of the fact that infection control guidelines stipulate that gloves should be worn during such a procedure. According to Madeo (2004, p.1018), most nurses find gloves cumbersome since once worn they reduce the dexterity of one’s hands. More so, most nurses are not informed about the risk of transmitting infections through their hands and therefore fail to pay the needful attention to the same. Gamon, Morgan-Samuel and Gould (2007, pp. 157-167) on the other hand establish that healthcare practitioners (nurses included), are well aware of the universal precautions (UPs) that they should take in order to control the spread of infections. Nurses also comprehend the importance of adhering to the precautions especially since doing so would protect them and the patients. However, they are either ignorant or selective on how they adhere to the practices. According to Gammon et al. (2007, p. 158), UPs are also known as Standard Precautions (SP) in some countries. Their role is to “promote basic infection control practices aimed at reducing the transmission of organisms”. According to Gammon et al., the UPs/SPs encourage nurses and other health workers to avoid direct contact with body fluids, to use protective equipment when handling patients, to decontaminate their hands before and after handling patients, to safely use and dispose medical equipment and to decontaminate the re-usable equipments and the healthcare environment. Despite the fact that it has been established that nurses and other healthcare workers know and comprehend UPs/SPs, Gammon et al. (2007, p. 158) found out that the level of adoption and application of the same was way too low. Worse still, the authors observe that interventions meant to improve healthcare workers’ compliance did not have a significant or lasting effect. Gammon et al (2007, p. 159) concluded that non-compliance with UPs/SPs mainly occurred because nurses do not fully appreciate the crucial role that observing the precautions would have on their well-being as well as the patients’ health. Overall, it is indeed true that nurses themselves can be a barrier to the effective control of infections by failing to observe the Standard Precautions. By failing to observe the precautions, nurses increase the risk of cross infecting patients through contaminated hands or through airborne pathogens. This means that nurses can aid to increase infections that occur in healthcare facilities, spreading from one patient to another and even to the healthcare workers themselves. While Gammon et al. (2007, p. 164) note that awareness creation through educative forums has been the main method used in the past to encourage compliance, it is quite apparent that this method is not having the desirable effect. As such, there is an increasing need to adopt a different strategy in order to encourage more nurses to adopt precautions that will lessen the risk of spreading infections within healthcare facilities. References Akpinar, R., Celebioglu, A., Uslu, H & Uyanik, H 2008 ‘An evaluation of the hand and nasal flora of Turkish nursing students after clinical practice,’ Journal of Clinical Nursing, Vol.18, pp. 426-430. Gammon, J., Morgan-Samuel, H & Gould, D 2007, ‘A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions,’ Journal of Clinical Nursing, Vol. 17, pp. 157-167. Leaver, L & Gregorian, L 2008, ‘Policy for Standard/universal infection control precautions and the use of protective clothing,’ Brent NHS, Issue 02, ICC10, pp. 1-13. Madeo, M 2004 ‘Commentary on Bennett G. & Mansell I. (2004) universal precautions: A survey of community nurses’ experience and practice,’ Journal of Clinical Nursing, vol. 13, pp. 1017-1019. Picheansathian, W., Pearson, A & Suchaxaya, P 2008, ‘The effectiveness of a promotion programme on hand hygiene compliance and nosocomial infections in a neonatal intensive care unit,’ International Journal of Nursing Practice, vol. 14, pp. 315-321. Read More