A speciic protocol will be available in each area. These are general guidelines:
•
Skin that is accidentally exposed should be washed immediately with soap and water.•
If the conjunctiva or any mucous membrane is splashed the areas should be irrigated with copious amounts of water. Avoid swallowing if the splash is into the mouth, then rinse several times with cold water.•
In the event of a needlestick injury (or other percutaneous injury, e.g. a bite) the area should be encouraged to bleed (but do not suck the wound) under running water for at least 5 minutes (Boyle 2000). It should then be washed thoroughly (but not scrubbed) with soap and water and covered with a waterproof dressing (NHS 2013). The agreed local protocol should be followed; this is likely to include reporting the incident to a manager and tooccupational health, completing an incident form
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8| Chapter
Principles of infection control: standard precautions
leaving the room. Clinical waste is managed in the same way.
•
On preparing to leave the room, remove gloves (if worn) and apron, place in the clinical waste.Decontaminate hands.
•
Close the door on leaving; use antibacterial handrub once outside the room (unless enteric infection, see p. 82).•
On discharge the room is thoroughly cleaned using approved solutions; steam cleaning may be required.All furniture and equipment is washed and dried, curtains are sent to the laundry; carpeted loor should be steam cleaned.
Protective isolation
This involves protecting an individual from infection because they are in some way vulnerable or immunocom-promised. The midwife is less likely to be involved in this type of care. All unnecessary visitors are prohibited and extreme care is taken to ensure that no infection is taken into the room. A positive pressure environment is needed where clean air is drawn into the room from outside and forced out into the general ward area. Clearly, the ventila-tion systems need to be properly understood so that the opposite does not happen (Cutter & Dempster 1999).
Hands are decontaminated and protective clothing is applied before entering and removed after leaving the room.
and glass, sharps box, antibacterial soap and disposable towels, dissolvable linen sack (red in the UK), clinical waste sack, Pinard stethoscope, etc. The refuse sack is sealed in the room and then removed, but otherwise none of the equipment is removed from the room until cleaned or disposed of appropriately after the woman’s departure.
Unnecessary furniture is removed and a visible indication is placed on the door – often a colour-coded sign – to remind all staff. Instructions should be given to friends and relatives as to how to maintain the isolation principles.
•
A trolley outside the room contains items that are needed when entering the room, e.g. gloves, disposable gowns, masks, goggles, overshoes, plastic aprons and antibacterial handrub. This should not cause an obstruction.•
The midwife should recognize the value of the multidisciplinary team: the infection control nurse, microbiologist, obstetrician, and midwife will all need to work in close communication and partnership to provide appropriate care for the woman. The woman may also remain in her side room for delivery and additional precautions should be instigated accordingly.•
Ideally, speciic members of staff may be assigned to care for infected women; they should then have restricted access to other women, especially any that may be considered vulnerable to infection.PROCEDURE: entering, attending the woman, and leaving the room
•
Gather any necessary additional equipment.•
Wash and dry hands, apply apron and any other necessary protective clothing necessary for the procedure. Use alcohol handrub (apply gloves only if expecting to handle body luids).•
Knock, enter the room, and close the door.•
Complete the necessary care, containing all of the tasks within the room:■ crockery may be brought out of the room, providing that it will be decontaminated in a dishwasher
■ domestic services are required to clean the room and bathroom daily using approved cleansers and including a thorough damp dusting; other spillages should be cleaned according to standard precaution guidelines. Cleaning cloths etc. remain in the room for the duration of the stay and are only used in that room
■ used linen should be placed in the dissolvable sack in the room. This must be sealed before
ROLE AND RESPONSIBILITIES OF THE MIDWIFE These can be summarized as:
• recognizing the signiicance of standard precautions and PPE, risk assessing and utilizing them appropriately on every occasion and documenting their use accordingly
• the ability to adapt them to each area of work, maintaining safety for all
• the need to be familiar with up-to-date reports and protocols
• universal use to protect dignity and conidentiality
• the need to report and act on spillages or incidents.
SUMMARY
•
Standard precautions aim to protect all staff, women, babies and visitors from potentially serious infections.They use a range of measures including hand hygiene and PPE use. It is an important aspect of the midwife’s role.
•
The midwife works with a high-risk client group and should include a risk assessment for standard precautions and PPE use in every clinical situation.•
Source isolation aims to contain infection by carrying out all procedures within the woman’s single room, keeping all equipment and materials within that room.•
Protective isolation prevents infection from entering the room by use of protective measures before entering and after leaving; visitors are restricted.SELF-ASSESSMENT EXERCISES
The answers to the following questions may be found in the text:
1. Describe what constitutes standard precautions.
2. In which situations is a risk assessment necessary to appreciate which of the standard precautions or PPE are indicated?
3. Describe how to correctly apply a plastic apron.
4. Demonstrate how to remove soiled gloves, apron, and goggles.
5. Discuss the principles of source and protective isolation nursing.
REFERENCES
Barratt, R., Shaban, R., Moyle, W., 2011. Patient experience of source isolation: lessons for clinical practice. Contemp. Nurse 39 (2), 180–193.
Boyle, M., 2000. Blood borne infections.
Pract. Midwife 3 (7), 48–50.
Breathnach, A., Zinna, S., Riley, P., Planche, T., 2010. Guidelines for prioritization for single room use: a pragmatic approach. J. Hosp. Infect 74 (1), 89–91.
Cutter, M., Dempster, L., 1999. Cover notes. Nurs. Times 95 (31), 25–27.
Hart, S., 2008. Barrier Nursing. In:
Doughty, L., Lister, S. (Eds.), The Royal Marsden Hospital Manual of Clinical Nursing Procedures Student Edition. Wiley Blackwell, Oxford, pp. 117–204.
Hubner, N., Goerdt, A., Mannerow, A., et al., 2013. The durability of examination gloves used on intensive
care units. BMC Infect. Dis. 13 (226), 1471–2334.
Loveday, H., Wilson, J., Pratt, R.J., et al., 2014. epic3: National Evidence-Based Guidelines for Preventing Healthcare – Associated Infections in NHS Hospitals in England. J. Hosp. Infect 86 (Suppl. 1), S1–S70.
Martirani, R., Weaving, A., 2011. Infection prevention & control. In: Doughty, L., Lister, S. (Eds.), The Royal Marsden Hospital Manual of Clinical Nursing Procedures, eighth ed. Wiley Blackwell, Chichester, (Chapter 3).
pp. 79–128.
NPSA (National Patient Safety Agency), 2011. It’s ok to ask. Available online: <http://www.npsa.nhs.uk/
cleanyourhands/about-us/faqs/>
(accessed 5 March 2015).
NHS EO (National Health Service European Ofice), 2013. Protecting healthcare workers from sharps
injuries Brieing 13. The NHS Confederation, Brussels.
NHS (National Health Service), 2013.
NHS Choices: What should I do if I injure myself with a used needle? Available online: <http://
www.nhs.uk/chq/Pages/2557.aspx
?CategoryID=72> (accessed 23 January 2015).
RCN (Royal College of Nursing), 2012.
Tools of the trade. RCN, London.
Available online: at <www.rcn.org.uk>
(accessed 5 March 2015).
WHO (World Health Organisation), 2009. WHO Guidelines on Hand Hygiene in Health Care. WHO, Geneva, pp. 101, 102, 123, 140, 141.
Wilson, J., Loveday, H., 2014. Does glove use increase the risk of infection?
Nurs. Times 110 (39), 12–15.
Wyeth, J., 2013. Hand hygiene and the use of personal protective equipment.
B. J. Nurs 22 (16), 920–925.
Principles of infection control: hand hygiene
Chapter
This chapter focuses on the principles of hand hygiene, an important means of infection control. Hand hygiene encompasses both hand care and hand decontamination;
hand decontamination includes both handwashing and the use of alcohol handrub (NICE 2014). Hand hygiene is the most effective, least expensive way to prevent healthcare-associated infections (HCAIs) and one of the most important approaches to patient care (Kilpatrick et al 2013, Spruce 2013).
Transient microorganisms colonize the supericial layers of the skin; usually they do not multiply, although they occasionally survive and multiply but can be removed by hand decontamination. Colony forming units (CFUs) of bacteria on the hands range from 3.9 × 104 − 4.6 × 106 CFU/cm2 but can be much higher in the perineal and inguinal areas (WHO 2009). Up to 106 skin squames containing viable microorganisms can be shed each day from normal skin causing contamination of clothes, bedding, furniture, etc.; thus it can be easy to contaminate hands during ‘clean’ procedures such as taking vital signs, assisting with changing clothes. Microorganisms survive for differing time periods on the hands in the absence of hand decontamination, e.g. only 50% of Escherichia coli are killed in 6 minutes (WHO 2009). WHO (2009) advise that microorganisms such as staphylococci, enterococci, and Clostridium difficile are more resistant to desiccation and thus more likely to be the cause of contamination. Resident lora are attached to the deeper layers of the skin and are more resistant to removal but are also less likely to be a cause of a HCAI. Cross-contamination can also occur from hands to paper, including medical records (Hübner et al 2011).
Approximately 30% of the population is colonized with Staphylococcus aureus on their skin or in their nose with
9
CHAPTER CONTENTS
Learning outcomes 81
General hand care 82
Hand decontamination 82
Cleansing agents 82
Alcohol handrub 83
Indications for hand decontamination 83 Principles of hand decontamination 84 PROCEDURE: medical/social scrub 84
PROCEDURE: surgical scrub 86
Role and responsibilities of the midwife 86
Summary 86
Self-assessment exercises 86
References 86
LEARNING OUTCOMES
Having read this chapter, the reader should be able to:
•
discuss why hand hygiene is important•
discuss the principles of general hand care•
discuss the beneits of alcohol handrub and when it should be used•
identify the occasions when the midwife should undertake hand decontamination and what should be used•
describe the main differences between ‘medical/social’ and ‘surgical’ scrub
•
discuss the role and responsibilities of the midwife in relation to hand hygiene.water as its irst ingredient and contain no anionic-based chemicals or petroleum.
•
Be bare from the elbows down when providing direct patient care (Loveday et al 2014, NICE 2012).Long sleeves can be easily contaminated and make handwashing less effective (Martirani & Weaving 2011, NICE 2012). If exposure of the forearms is unacceptable for religious reasons, the sleeve should not be loose or dangling and must be rolled/pulled back securely during handwashing and direct patient care (NICE 2012).
•
Rings, bracelets, and watches should not be worn (Loveday et al 2014). Rings (particularly stoned rings) increase the number of microorganisms found on the hand; jewellery and watches also make it dificult to clean the hands thoroughly, apply AHR and put gloves on (Hautemaniere et al 2010, Khodavaisy et al 2011). Hautemaniere et al (2010) suggest that wearing a lat band wedding ring does not interfere with hand decontamination, a view supported by Al-Allah et al (2008) who found that the wearing of a lat band wedding ring did not provide a source of increased bacterial load following a surgical scrub and suggest they may be kept on for this form of handdecontamination.