As previously discussed, we carry an enormous number of microorganisms on and in our bodies.
Add to that the fact that many people with a blood borne virus (BBV) infection are asymptomatic carriers and are unaware of their carrier status/infectivity (see Chapter 24), and it is easy to see how important the application of standard precautions is during everyday patient contact.
When patients who are known to be colonised or infected with microorganisms die, care of the body (last offices) and removal to the mortuary generally only requires the application of standard precautions. This may include the requirement for the patient to be placed into a body bag (i.e.
invasive group A streptococcal disease, Norovirus), but body bags are generally not required as a rule. However, there are some microorganisms that may pose significant infection risks to mortu- ary staff and others who subsequently handle the body. These ‘high-risk’ microorganisms belong
Box 11.4 Management of negative-pressure rooms
•
Doors must not be left open or wedged open.•
Walls must not be damaged (this will affect the pressure control).•
Damage to the door seals must be avoided.•
Rooms must be re-validated yearly.•
The pressure should be 10 pascals between the entrance lobby and the corridor; this should be monitored and recorded at least daily.If the pressure fails, Nursing staff must:
•
Check that the doors are shut and/or that they have not been left open for a prolonged period.•
Contact the Estates Department once the above checks have been made, in order that the ventilation plant can be inspected.•
Contact the IP&CT.•
Record the time of alarm, and any instructions given and actions taken.172
Further resources are available for this book, including interactive multiple choice questions. Visit the companion website at:
www.wiley.com/go/fundamentalsofinfectionprevention
Chapter summary: key points
•
Standard precautions must be used for all patients in all healthcare settings all of the time on the assumption that all contact with blood, body fluids, secretions and excretions (with the exception of sweat), non-intact skin and mucous membranes, along with contact with the healthcare environment, may result in the transmission of infectious microorganisms.•
The purpose of isolation is to isolate or contain the organism and its mode of transmission, rather than the patient.•
The patient’s overall condition and his or her safety have to be taken into consideration when isolation is required – where isolation is not possible, a risk assessment must be made, documented and then reviewed each shift or daily.•
Patient care and rehabilitation must not be compromised.•
If standard precautions are stringently implemented, cross-infection should not occur.to ‘hazard group 3 biological agents’ (see Chapter 6, Specimen Collection) and include (amongst others) avian influenza, CJD, dysentery, viral encephalitis, hepatitis B and C, HIV, malaria, leprosy, paratyphoid fever, plague, novel coronavirus and respiratory tuberculosis.
It is a Health and Safety Excecutive (HSE) requirement that all organisations have a Policy for the management of ‘high-risk cadavers’, that covers deceased patients who die in hospital and who are brought into the mortuary from the community. Where patients are suspected or known to be ‘high risk’, a ‘danger of infection’ label should be attached to the outside of the body bag and any accompanying paperwork completed as per Policy. When ‘community death’ bodies are brought into hospital premises, for example when a thorough medical assessment of the patient has not been undertaken, the body should be treated as ‘high-risk’.
173
References
Abad C., Fearday A., Safdar N. (2010). Adverse effects of isolation in hospitalised patients: a systematic review. Journal of Hospital Infection. 76 (2): 97–102.
Barrett R. (2010). Behind barriers: patients perceptions of source isolation for meticillin-resistant Staphylococcus aureus. Australian Journal of Advanced Nursing. 28 (2): 53–59.
Department of Health (2010). Code of Practice on the Prevention and Control of Infections and Related Guidance. Department of Health, London.
Interdepartmental Working Group on Tuberculosis (1998). The Prevention and Control of Tubercu- losis in the United Kingdom: UK Guidance on the Prevention and Control of Transmission of HIV-related Tuberculosis and Drug-resistant, including Multiple-drug Resistant, Tuberculosis.
Department of Health, London.
Healing T.D., Hoffman P.N., Young S.E.J. (1995). The Infection Hazards of Human Cadavers. CDR Review. Volume 5, review number 5. 28th April 1995.
Health and Safety Executive (HSE) (2003). Safe Working and the Prevention of Infection in the Mortuary and Post-Mortem Room. HSE, London.
Health and Safety Executive (HSE) (2004). Advisory Committee on Dangerous Pathogens. The approved list of biological agents. HSE, London.
Health and Safety Executive (HSE) (2005). Controlling the Risks of Infection at Work from Human Remains: A guide for those involved in funeral services (including embalmers) and those involved in exhumation. HSE, London.
Loveday H.P., Wilson J.A., Pratt R.J., Golsorkhi M., Tingle A. et al (2013). EPIC3: National Evidence- Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England.
(Draft). Richard Wells Research Centre, University of West London, 2013.
National Clinical Guideline Centre (2012). Partial Update of NICE Clinical Guideline 2. Infection:
Prevention and Control of Healthcare Associated Infections in Primary and Community Care.
National Clinical Guideline Centre, London.
Pratt R.J., Pellowe C.M., Loveday H.B., Robinson M., Smith G.W. and the EPIC Guidelines Develop- ment Team (2001). The EPIC Project: developing national evidence-based guidelines for pre- venting healthcare associated infections. Journal of Hospital Infection. 47 (Suppl.): S1–S82.
Pratt R.J., Pellowe C.M., Wilson J.A., Loveday H.P., Harper P.J., Jones S.R.L.K., McDougall C., Wilcox M.H. (2007). EPIC2: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. http://www.epic.tvu.ac.uk/Downloads/ (accessed 26 February 2013).
Skyman E., Sjostrom H.T. (2009). Patients experiences of being infected with MRSA at a hospital and subsequently source isolated. Scandinavian Journal of Caring Sciences. 24 (1): 101–
107.
Contents
Fundamentals of Infection Prevention and Control: Theory and Practice, Second Edition. Debbie Weston.
© 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd. Companion Website: www.wiley.com/go/fundamentalsofinfectionprevention
Hand hygiene
12
Ignaz Semmelweis 175
The microbial flora of the skin 176 How cross-infection via the hands occurs 177
Hand hygiene 178
Hand decontamination at the point of
care – the 5 Moments for Hand Hygiene 180
Hand hygiene: patients and the public 187
Care of the hands 188
Chapter summary: key points 188
References 189
175
Introduction
In 2005, the World Health Organization (WHO) launched the First Global Patient Safety Challenge, Clean Care Is Safe Care, to promote best practice in hand hygiene globally and to emphasise the importance of hand hygiene in reducing healthcare-associated infections. This was followed in 2009 by the publication of new evidence-based best-practice Guidelines on Hand Hygiene in Health Care (WHO, 2009a). A recent research study evaluating the success of the national Cleanyourhands campaign in England and Wales, which looked at the procurement of soap and alcohol hand rub within NHS Trusts, its usage and rates of Clostridium difficile infection and meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia found that rates of both infections fell, and although there were other national key drives, a national campaign to raise awareness regarding the importance of hand hygiene was undoubtedly a significant factor (Stone et al., 2012).
This chapter explains the difference between resident and transient microorganisms on the skin and hands; how cross-infection via the hands occurs; when hand washing with soap and water, and hand decontamination with alcohol-based hand rubs or gels, should be undertaken; the advantages and disadvantages of each method, and the importance of undertaking hand hygiene and hand decontamination at the point of care in accordance with the 5 Moments for Hand Hygiene.
Learning outcomes
After reading this chapter, the reader will be able to: