Infection Control and Prevention - Essay Example

Infection control and prevention and delivering adequate care for the residents in nursing home care setting. Introduction: The profession of nursing is considered to be a noble profession as it deals with atmost care offered to a suffering human being. It involves lot of care for others, commitment to job and patience in handling the sick. A nurse inspite of being good in giving personal care to patients, must also take care of issues related to infection control, hygiene maintenance, manual handling risk to protect herself or himself and the client. This essay identifies the issues related to infection control, hygiene maintenance, risk handling, nutritional management for clients, etc. The background for this nursing care is a home care setting for the aged where each nurse is supposed to take care of five residents. The first section of the essay deals with the measures and mechanism for infection control. The next section discusses about hygiene and risk in manual handling of patients. Finally the last section relates to the nutritional requirements for patients specifically suffering from faecal incontinence ( soiling ). The discussion of the above topics are dealt in accordance with a particular floor plan of the ward. Infection control : In nursing and care, the prevention and control of infection are more important because the patients who are already sick or injured are more vulnerable to further infections. The Department of Health ( DH 2005, Health Care Commission 2005 ) emphasizes that the patients are expected to be treated and cared for only in clean environment and that they should not be infected due to the poor practice of health care by the health care workers. The consequences of the avoidable infections are enormous both personally and financially ( DH 2003, Stone, Larson & Kawar, 2002 ). Practically the methods for best practices in healthcare settings are very easy, cheap and extremely effective ( Wright 2004, Pratt et al 2007 ). The health care associated infections are generally acquired from two sources. They are the treatment of the patients and the infections acquired during personal care of the patients ( DH 2006 ). The complete elimination of this problem is quite impossible but there is a possibility of the reduction in the spreading of these infections ( Chief Medical Officer, 2003 ). The perioperative environment is a major source for infections ( Williams M , July 2008 ). The people working in the theatre and the visitors inside the theatre are the primary source of contamination. If the precautions in theatres are inadequate then the other infection control measures such as hand washing etc. are of no use ( DH 2008 ). Most of the infection control mechanisms in the preioperative environment are to prevent the infection from reaching the environment or to break the chain of the transmitting infection ( Gilmour 2005 ). The common surgical site infections are generally confined to the skin only but in some cases it may spread into the tissues and organs ( Gottrup 2005 ). The major type of infections that spread are the Meticillin Resistant Staphyllococous Aureus ( MRSA ) and the Clostridium Difficile ( C. Diff.) . MSRA is more infectious than other types of staphyllococous (NHS 2008 ) , it’s spread can be prevented by hand hygiene, proper personal protective equipment ( PPE) and safe handling and disposal of sharp equipments ( NICE 2003 ). The Clostridium Difficile is a gram positive anaerobic nosocomial pathogen. It is always present in the intestine of healthy people but starts proliferating under suitable conditions leading to Clostridium Difficile Associated Disease (CDAD ) (National Clostridium Difficile Standards Group Report, 2003 ). The spreading of these infections can be controlled by the proper design of the ward rooms and operation theatre areas. There must be ensured good ventilation and correct positioning of the ‘clean’ and ‘dirty’ zones ( Williams M , July 2008 ) . Proper air flow and correct air pressure are also required to be considered in the ward design . Good hand hygiene is another requisite for infection prevention. Also proper clothes and shoes must be worn inside the theatres to avoid airborne contaminations. There are evidences that patients wearing impermeable clothes and drapes attended by staff who are wearing clean suits acquired less perioperative wound infections. Using face mask provides additional protection for the staff and surgeon from contamination. New types of face masks include eye mask. These are very efficient in protecting the eyes of staff from percutaneous or mucocutaneous penetration of the eye by blood borne viruses ( DH 2003 ). Hygiene maintenance and manual handling risk: Hygiene maintenance is an extremely essential procedure for infection control. Evidence based hand hygiene guidelines for all situations are given by ( Pratt et al 2007 ). The challenges to hand hygiene are many. These include lack of time to wash, lack of proper protocol for hand wash, lack of paper towels and soaps. The other factors that influence improper hand washing is the inconvenient position of the hand wash sink, under staffing, skin irritation to certain soaps, forgetfulness (Vernon et al 2003 ). Research suggests that hand washing is necessary even after removing the gloves ( Pratt et al 2007 ). When hand washing is impractical with water and soap, an alcohol hand wash seems to be effective ( McDonald et al 2004 ). Evidence based on six randomized controlled trails ( by Webster and Osborne , 2004 ) show that hand washing is more important than total body wash. Other hygiene measures include using disposable ( single use ) syringes and needles rather than adopting the sterilization process, mandatory usage of gloves and other protective equipments when there is exposure to body fluids. The manual patient handling includes lifting and transferring the patients from one place to another. This daily activity of manual patient handling exposes the nurses and other nursing personnels to the risk of acquiring back injuries and musculoskeletal disorders ( De Castro, Handle with care, 2004 ). It is said that due to this manual handling of the patients, the nurses are more prone to back injuries than construction laborers. Efforts to reduce injuries due to manual patient handling have been based on personal experience and tradition instead of scientific evidence. Evidence show that the education and training on body mechanisms are inefficient (Nelson & Baptise, Evidence-Based Practices for Safe Patient Handling and Movement, 2004). There are some engineering based solutions for this problem. Unfortunately here again the staff are not trained properly to use the patient handling equipment. New models of education are required to promote staff competence when using patient handling equipment. Also the injury to the patient must also be avoided while handling them. The improper handling of the patients must not lead to further complications to the already ill patient. Nutritional management specific to faecal incontinence : Faecal incontinence is a common problem among the aged people due to weakening of the anal muscles. In this care setting there is a client named Maria Swartzkoph who is 85 years old. She stays in bed 1 in room 1 which is next to the wall . She appears distressed because of faecal incontinence. Her care plan shows that she is usually continent. She needs attention in terms of some medication and proper nutrition. The cause for such incontinence may be improper diet, constipation or in few cases it may be Irritable bowel Syndrome . In the case of this client, the problem may be due to aging and improper nutrition. Diet is the main reason for incontinence . To avoid incontinence the diet must be balanced with proper food and fluid balance (Dr Laurence Knott , 2007). Factors like malnutrition, hard stools must be considered in diagnosing the reason for incontinence. Sometimes the ‘non- fat fat’ called olean or olestra may be the reason for the incontinence. This must be avoided in food. A basic medication must include anti - diarrhoeal drug like loperamide hydrochloride less than 2 mg. Sometimes even constipation may be the reason for incontinence in which case, there is faecal discharge from the bowel around the hardened stool. The food must include more fibrous intake if the incontinence was due to constipation. So based on the reason for the incontinence, the diet must be proposed for this client. Moreover the client may be shifted to a single room ( room 3 according to floor plan of the ward ) , so that there is less possibility of infection to other patients. Conclusion : In the above essay issues related to infection control in a home care setting was discussed in relation to personal care, perioperative environment, safety measure like personal protective equipment ( PPE ), etc.. The hygiene maintenance was discussed in relevance to hand hygiene and handling of others instruments, needle disposal, etc. Later the risks involved in the manual patient handling was explained and some remedies were suggested. In the last section issues related to nutrition were discussed in relevance to a specific client who suffers from faecal incontinence. Though there are various training and discussions related to health and hygiene, it is the proper practice and compliance to these guidelines that is highly important in avoiding infections and hygiene related problems. References : 1. Chief Medical Officer 2003, Winning Ways : Working Together to Reduce Health care Associated Infection in London, England. Department of Health. 2. De Castro, Handle with care, 2004 from Overview and summary Nurse Safety: Have We Addressed the Risks? Carol A , September 30, 2004 from < www.allnurses.com > Accessed 7 September 2008. 3. Department of Health 2006, The Health Act 2006, A Code of Practice for the prevention ad Control of Healthcare Acquired Infections, London, Department of Health. 4. Department of Health 2008, Clean, Safe Care. Reducing Infections and Saving Lives, London . Department of Health. 5. Dr Laurence Knott, Faecal Incontinence, Patient – UK, 2007, < www.patient.co.uk > Accessed 7 September, 2008. 6. Gilmour D, 2005, Infection Control Principles : A Textook of Perioperative Practices. Woodhead K, Wicker P ( Eds.) London. Elsevier Churchill Livingstone. 7. Gottrup F, Melling A, Hollander D 2005. A Overview of Surgical site Infections : aetiology, incidence and risk factors. < www.worldwidewounds.com ∕ 2005 ∕ September ∕ Gottrup ∕ Surgical-site-Infections- Overview.html > Accessed 6 September 2008 8. Healthcare Commission 2005, A Snapshot of Hospital Cleanliness in England London, Healthcare Commission. 9. McDonald A, Dinah F, Mckenzie D, Wilson A, 2004. Performance feedback of hand hygiene, using alcohol gel as the decontaminant reduces the number of inpatients newly affected by MRSA and antibiotic costs. Journal of Hospital Infection 56 (1) 10. National Clostridium Difficile Standards Group 2003, Report to the Department of Health.. < www.ric.org.uk > Accessed 6 September 2008 11. National Institute for Health and Clinical Excellence 2003. Infection Control – Prevention of Health care associated infections in primary and community care . < www. nice.org.uk. > Accessed 6 September 2008. 12. Nelson & Baptise, Evidence-Based Practices for Safe Patient Handling and Movement, 2004, from Overview and summary Nurse Safety: Have We Addressed the Risks? Carol A , September 30, 2004 from < www.allnurses.com > Accessed 7 September 2008. 13. NHS Direct 2008 : MRSA. < www.hsdirect.hs.uk > Accessed 6 September 2008 14. Pratt R , Pellowe C , Wilson J , et al 2007, epic 2 : National Evidence Based Guidelines for preventing healthcare associated infections in NHS hospitals England. Journal of Hospital Infection. 65S S61 – S64. 15.Stone P, Larson E, Kawar L, 2002, A Systematic Audit of Economic Evidence Linking nosocomial infections and infection control interventions 1990 – 2000, Association of Professionals in Infection control and epidemiology 30 ( 3 ), 145 – 152. 16.Vernon, M.O., Trick, W.E., Welbel, S.F. et al. 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