Chapter 1. Infection Control

1.8 Summary

Infection control and prevention practices are a critical component of patient safety in the health care environment. In order to protect the public and cut health care costs, all health care professionals must take part in preventing infections before they occur. The use of routine practices, effective hand hygiene techniques, additional precautions, and sterile procedures contribute to enhancing patient safety and eliminating significant health care risks such as health care-associated infections. If effectively applied, infection control and prevention practices will prevent and minimize transmission of infections in health care settings.

Key Takeaways

  • Hand hygiene is the single most important part of infection prevention and control practices in the health care setting.
  • Plan your care: each health care worker is responsible to perform a risk assessment before every contact with a patient and/or patient’s environment to ensure the proper control measures are in place to prevent transmission of infections.
  • The most common sites for HAIs are the urinary tract and the respiratory tract. It is vital to implement preventive measures at all times during patient care or during procedures related to these areas.
  • Be aware of potential risk factors of patients that make them more susceptible to infections. Susceptible patients include very young children; patients who are elderly, nutritionally deficient, or chronically ill; patients undergoing medical treatments such as chemotherapy or taking medications such as high doses of steroids; and individuals who are already ill or have open wounds (Perry et al., 2014).
  • Be aware how the chain of infection works and implement ways to break the chain of infection in practice.
  • Practise strict adherence to the principles of sterile technique to prevent and minimize infections during sterile and invasive procedures.

Suggested Online Resources

1. BC Centre for Disease Control: Blood and body fluid exposure management. This resource outlines risk assessment and guidelines for potential exposures of percutaneous, permucosal, and non-intact skin to HIV, hepatitis B, and hepatitis C.

2. British Columbia: Home and community care – Policy manual. This manual offers guidelines for working in the community and residential care.

3. Centers for Disease Control and Prevention: Antibiotic/antimicrobial resistance. This resource covers common viruses/bacteria found in the health care setting, such as:

  • Clostridium difficile infection (CDI)
  • Carbapenemase-producing organisms (CPO)
  • Multi-drug-resistant organisms (MDRO) or antibiotic-resistant organisms (ARO): MRSA/VRE
  • Severe acute respiratory syndrome (SARS)
  • Middle East respiratory syndrome (MERS)
  • Ebola virus disease (EVD)

4. Centers for Disease Control and Prevention: Guidelines for disinfection and sterilization in healthcare facilities. The goal of this document is to reduce the rates of health care associated infections. Each recommendation listed is categorized according to scientific evidence, theoretical rationale, and applicability.

5. Infection and Prevention Control Canada. (IPAC): Evidence-based guidelines. This website offers the latest reports, guidelines, standards, and policies related to infection control issues. U.S. and international resources are also provided. These documents may be used to support your own documentation practice and best practices.

6. Ontario Agency for Health Protection and Promotion: Routine practices and additional precautions. This excellent  resource provides routine practice and additional precautions in all health care settings. These were developed by the Ontario Provincial Infectious Disease Advisory Committee (PIDAC) on Infection Prevention and Control (IPC).

7. Provincial Infection Control Network of British Columbia (PICNet): BC infection control and hand hygiene module. This course teaches the basic principles of infection control in the health care system, sharps management, hand hygiene, blood and body fluid exposure and cleanup, the proper use of personal protective equipment, and isolation precautions.

8. Provincial Infection Control Network of British Columbia (PICNet): Infection control guidelines.Providing health care to the client living in the community.
PICNet Educational Links.This document is intended to provide guidance in the writing of policies pertaining to infection prevention and control within community health care, and home care programs and settings.

9. Public Health Agency of Canada: Hand hygiene practices in healthcare settings. This excellent Canadian resource covers infectious disease prevention and control policies.

10. World Health Organization: Clean care is safer care. This website provides links to the five moments in hand hygiene, diagrams on hand washing and hand rubs, and leaflets for teaching.

References

Accreditation Canada. (2013). Infection prevention and control. Mentum Quarterly, 5(4). Retrieved on Feb 28, 2015, from: http://www.accreditation.ca/sites/default/files/qq-spring-2013.pdf

American Academy of Allergy, Asthma and Immunology. (2015). Latex allergies: Tips to remember. Retrieved on Feb 28, 2015, from: http://www.aaaai.org/conditions-and-treatments/Library/At-a-Glance/Latex-Allergy.aspx

ATI. (2015a). Traditional hand scrub method. Retrieved from ATI Nursing Education. Surgical Asepsis. Retrieved on Oct 10, 2015, from http://atitesting.com/ati_next_gen/skillsmodules/content/surgical-asepsis/viewing/attire-tradscrub.html

ATI. (2015b). Open-gloving technique. Retrieved from ATI Nursing Education. Surgical Asepsis. Retrieved on Oct 10, 2015, from http://atitesting.com/ati_next_gen/skillsmodules/content/surgical-asepsis/viewing/glove-open.html

ATI. (2015c). Setting up a sterile field. Retrieved from ATI Nursing Education. Surgical Asepsis. Retrieved on Oct 10, 2015, from http://atitesting.com/ati_next_gen/skillsmodules/content/surgical-asepsis/equipment/field.html

Barratt, R. L., Shaban, R., & Moyle, W. (2011). Patient experience from source isolation: Lessons from clinical practice. Contemporary Nurse, 39(2), 180-193. doi: 10.5172/conu.2011.180

Bartlett, G. E., Pollard, T. C., Bowker, K. E., & Bannister, G. C. (2002). Effect of jewellery on surface bacterial counts of operating theatres. The Journal of Hospital Infection, 52(1), 68-70.

BC Centre for Disease Control (BCCDC). (2014). Hand hygiene. Retrieved on Feb 21, 2015, from: http://www.bccdc.ca/prevention/HandHygiene/default.htm

BC Centre for Disease Control (BCCDC). (2015). Communicable Disease Control. Blood and body fluid exposure management. Retrieved on Nov 6, 2015 from
http://www.bccdc.ca/NR/rdonlyres/E6AF842F-A899-477F-BC90-5BFF6A4280F6/0/CPS_CDManual_BBFExpMangt_20150715.pdf

Berman, A., & Snyder S. J. (2016). Skills in clinical nursing (8th ed.). Upper Saddle River, New Jersey: Pearson.

Bissett, L. (2007). Skin care: An essential component of hand hygiene and infection control. British Journal of Nursing, 16(16), 976-981.

Braswell, M. L., & Spruce, L. (2012). Implementing AORN recommended practices for surgical attire. AORN Journal, 95(1), 122-140. doi: 10.1016/j.aorn.2011.10.017

Centers for Disease Control and Prevention (CDC). (2007). Part III: Precautions to prevent the transmission of infectious agents. Retrieved on Oct 10, 2015, from http://www.cdc.gov/hicpac/2007IP/2007ip_part3.html

Centers for Disease Control (CDC). (2012). Frequently asked questions about Clostridium difficile for healthcare providers. Retrieved on Feb 27, 2015, from http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html

Centers for Disease Control (CDC). (2014). Types of healthcare-associated infections. Retrieved on Feb 27, 2015, from http://www.cdc.gov/HAI/infectionTypes.html

Infection Control Today. (2000). Asepsis and aseptic practices in the operating room. Retrieved on Oct 10, 2015, from http://www.infectioncontroltoday.com/articles/2000/07/asepsis-and-aseptic-practices-in-the-operating-ro.aspx

Kampf, G., & Loffler, H. (2003). Dermatological aspects of a successful introduction and continuation of alcohol based hand rubs for hygienic hand disinfection. The Journal of Hospital Infection, 55(1), 1-7.

Kennedy, L. (2013). Implementing AORN recommended practices for sterile technique. AORN Journal, 98(1), 14-26.

Longtin, Y., Sax, H., Allegranzi, B., Schneider, F., & Pittet, D. (2011). Hand hygiene. New England Journal of Medicine, 34(13) 24-28. Retreived on Feb 27, 2015, from http://www.nejm.org/doi/pdf/10.1056/NEJMvcm0903599

Operating Room Nurses Association of Canada (ORNAC). (2011). Standards, guidelines and position statements for perioperative registered nursing practice. Retrieved on Oct 10, 2015, from http://flex5114.weebly.com/uploads/1/4/5/1/14518934/ornac_standards.pdf

Patrick, M., & Van Wicklin, S. A. (2012). AORN recommended practice for hand hygiene. AORN Journal, 9(4), 492-507. doi; 10.1016/j.aorn.2012.01.019 492

Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2014). Clinical skills and nursing techniques (8th ed.). St Louis, MO: Elsevier-Mosby.

Provincial Infectious Diseases Advisory Committee (PIDAC) (Ontario Agency for Health Provincial Infectious Disease Advisory Committee). (2012). Routine practices and additional precautions in all health care settings (3rd ed.). Toronto, ON: Queen’s Printer for Ontario. Retrieved on Feb 20, 2015, from http://www.publichealthontario.ca/en/eRepository/RPAP_All_HealthCare_Settings_Eng2012.pdf

Poutanen, S. M., Vearncombe, M., McGeer, A. J., Gardam, M., Large, G., & Simor, A. E. (2005). Nonsocomial acquisition of methicillin-resistant Staphylococcus aureus during an outbreak of severe acute respiratory syndrome. Infection Control Hospital Epidemiology, 26(2) 134-137.

Public Health Agency of Canada (PHAC). (2012a). Hand hygiene practices in healthcare settings. Retrieved on Feb 26, 2015, from http://publications.gc.ca/site/eng/430135/publication.html

Public Health Agency of Canada (PHAC). (2012b). Routine practices and additional precautions for preventing the transmission of infection in healthcare settings. Retrieved on Feb 26, 2015, from http://www.phac-aspc.gc.ca/nois-sinp/guide/ summary-sommaire/tihs-tims-eng.php

Public Health Agency of Canada (PHAC). (2013). The Chief Public Health Officer’s report on the state of public health in Canada: Infectious disease, the never ending threat. Retrieved on Feb 26, 2105, from http://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2013/infections-eng.php#a8

Rothrock, J. C. (2014). Care of the patient in surgery. St. Louis, MO: Mosby Elsevier.

Siegel, J. D., Rhinehart, E., Jackson, M., & the Healthcare Infection Control Practices Advisory Committee (HICPAC). (2007). Guidelines for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Centers for Disease Control. Retrieved on Feb 17, 2015, from: http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf

World Health Organization (WHO). (2009a). WHO guidelines for hand hygiene in health care: First global patient safety challenge. Retrieved on Feb 6, 2015, from http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf?ua=1

World Health Organization (WHO). (2009b). Five moments for hand hygiene. Retrieved on March 1, 2015, from: http://www.who.int/gpsc/tools/Five_moments/en/

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