Infection Prevention and Control in Defence Healthcare - Essay Example

?  Infection Prevention and Control in Defence Healthcare of the of the Infection Prevention and Control in Defence Healthcare I. Introduction Wherever there is injury, there are chances of infection that must be prevented. As the old adage goes, prevention is better than cure, and this is most definitely true of infection prevention and control. In fact medical science in general and the nursing profession in particular have given much attention in recent years to this oft neglected area of clinical practice. This paper will discuss not only the nature and causes of infections, but also the efforts for infection prevention and control with special reference to defence healthcare. Present and important theories on infection control and prevention will be discussed, as well as the best practices in vogue today. II. What Is an Infection? An infection in medical terms may be defined as the susceptibility of the human body or an area of the human body to be vulnerable to germs (www.cqc.org.uk). These germs enter the body and multiply, causing disease and subsequent discomfort. Infection may be caused by a debilitating disease such as cancer or diabetes, or even be the side effects of treatments being provided to cure or lessen other impacts of life threatening diseases and maladies. In fact, diabetes, cancer, arthritis, Alzheimer’s and other such conditions in the elderly may cause them to fall and thus result in wounds and infections that if not cared for properly and effectively lead to partial or even permanent immobility. An infection may also be defined as the invasion of foreign cells that cause harm to the host organism. Bacteria, viruses, fungi and parasites can invade the human body at a susceptible location and cause harm to it. Engaging in combat as defense personnel do put them in the front lines of battle and can easily lead to injuries and wounds which can get infected as well. That is why it is important that persons dealing with infection prevention and control such as doctors, nurses, paramedics and surgeons not only have first hand knowledge of the most common types of infections but also how to prevent them or control their spread in the human body. They must not only know the best practices but also take proper and adequate measures when dealing with injured patients who have already contracted infections to prevent them from causing further harm to themselves or the patients (RCN, 2005). III. Kinds of Infections & Their Causes As stated above, there may be many causes of infections. An infection may be caused by viruses, bacteria, fungi or any other kind of parasite. Strep throat infections, urinary tract infections, E.coli and tuberculosis are caused by infections of the lungs and other parts of the body. Bacterial infections include strep throat and impetigo, a skin condition that can be treated with antibiotics that have been created to combat and destroy the specific bacteria causing the infection. Viruses are typically smaller than bacteria and often work by infecting a specific part of a healthy cell, preventing it from doing its work and causing sickness. Influenza and the common cold are two types of common infections caused by bacteria. Sometimes it is worth remembering that bacterial infections occur in coordination or secondary to viral infections, in which case the antibiotic prescribed works to prevent the infection from spreading, while the body is healed through its natural mechanism. The most common types of fungal infection include nail infections, ringworm, athlete’s foot and vaginal yeast infections. Fungal infections are caused either by certain conditions in the body or as a result of coming into contact with a person who is so infected. The usual treatment prescribed in this case is oral medication or the application of anti-fungal creams. IV. The Need and Importance of Infection Control We have looked at the different causes of infections and also how they may be spread. The usual method of spreading disease or infection is either through bodily contact, a sharing of blood, semen or syringes and other medical instruments that have not been properly sterilized or disinfected before use. It is therefore extremely important for a doctor, surgeon or other medical practitioner who is coming into contact with the patient to take proper and adequate precautions to prevent being infected themselves. There is always a risk that blood or other bodily fluids or inadvertently touching an infected part of the body may contaminate parts of gloves or protective clothing, where the infectious agent lies dormant until it comes into contact with skin, blood or saliva whereby it can spread to healthy persons and affect their body’s immunity. It is thus important for every medical practitioner whether a doctor, nurse or ward assistant to take measures to prevent and minimize the chances of infection while dealing with wounded or diseased patients carrying infections. Proper and standard operating procedures regarding previous preparation, and even what to do if inadvertently infected are supremely important. No one wants to contact a disease or infection if they can help it. Infection can also be spread by air, water, sharing utensils with a patient, eating in a previously used un-sterilized utensil or vessel for food and water. Insect bites are another way that infectious diseases can be spread. In the operating room, lack of adequate precautionary measures and improperly sterilized medical and surgical equipment are the major causes of the spread of infections in today’s world (McIntyre et al, 2008, 57). V. Best Practices for Infection Control It is important at the outset to distinguish between infection prevention and infection control. The former deals with stopping the spread of infection before it can take hold of a patient, while the latter deals with stopping the effects after they have materialized in a patient. It is far better to prevent than to control infections, as they might have already done their worst in a host patient and debilitated him or her, making the patient vulnerable to further diseases and side effects. Some commonly observed symptoms and signs of infection in a patient include fever, swelling or redness, and pain in a certain part of the body. Unfortunately due to the various modes of spreading infections, it is not always possible to prevent them infecting you. Using basic hygienic practices such as washing your hands frequently, covering your mouth with tissues while sneezing or coughing, and wearing of protective gloves and surgical masks while coming into contact with a patient having infection are some of the ways in which spread can be minimized. Inadvertent splashing of bodily fluids while operating on a patient or while stitching a wound are to be guarded against, and procedures for decontamination followed as laid out in the hospital’s manual of surgical operating procedures. According to LeTextier (2000), although hand washing is the principal method used to prevent infection, yet in the medical setting of today, the effectiveness of even this precaution can be compromised since medical professionals are often required to deal with loads of patients in very short periods of time, paving the way for infection possibilities. According to the Centers for Disease Control in the USA, the cost of not following this simple prevention method using soap and water is a staggering US$1.3 billion per year, with around 2.4 million people getting infected and resulting in between 30,000 primary and 70,000 secondary deaths per year. This is quite alarming when one considers it can easily be prevented. The problem is that soap and water have limited or no effectiveness against antibiotic resistant organisms (AROs) such as MRSA and VRE and therefore it has been agreed that antiseptic based cleanser is more preferable to plain soap and water (LeTextier, 2000). According to the Centers for Disease Control, there are five types of healthcare associated infections or HAI’s. These may be classified as (i) central line associated bloodstream infections (CLABI); (ii) clostridium difficile infection (CDI); (iii) Surgical site infection (SSI); (iv)catheter associated urinary tract infection (CAUTI) and (v) ventilator associated pneumonia infection (VAP) (CDC, 2010). CLABI is caused by a tube that healthcare providers place in a large vein such as the neck, arm or chest area to give blood to the patient. CDI occurs due to a bacterium that is associated with antibiotics and may cause diarrhea, colitis and other gastrointestinal infections. SSI refers to infections that may develop from improper precautionary procedures while handling an infected patient in the operating room- these include superficial skin cuts or more serious errors such as handling an infected area during surgery. CAUTI infections are caused by handling the catheter used to drain urine. VAP is a lung infection developed in a patient using a ventilator for breathing, Germs can enter the tube and infect the patient’s lungs. Anyone dealing with the tube or the patient runs the risk of infection. VI. Infection Prevention and Control in Defense Healthcare We have just recollected the different types of infections and their causes as well as discussed some precautionary procedures. Understanding how infection and disease is caused leads to thinking about how infections can be prevented. An audit of precautionary procedures and manual of operating procedures used in the defense industry in the UK gives one a good picture of the state of readiness regarding this very important issue and also the real state of affairs on the ground. When soldiers or indeed any kind of military personnel are exposed to combat situations like in Iraq and Afghanistan, a periodic audit is an invaluable aid in calculating the state of readiness and ability to respond in case of infections, as well as the updating of one’s knowledge in this very important area of clinical practice (WHO)oo. VII. Need and Rationale for Periodic Audit A medical or clinical audit is defined as a quality improvement process that concerns itself with the standards of delivery of healthcare to ensure that best practices are being used (Pearce, 2006). This has been part of the NHS since being recommended in a White Paper in 1989. According to a report published in the Western Journal of Medicine as far back as 1976, medical audits and continuing medical education have now become mainstays of quality assurance in hospitals (Sanazaro, 1976, 241-252). An audit is thus a check on the principles and procedures being followed and is an indicator of the degree of quality standards that are being maintained. Patients can be assured treatment according to approved standards of medical practice, with fewer complications. The advanced purpose of an audit is also to pinpoint causes of patient complaints and lapses in care, seeking a scientific analysis and determining the relationship between cause and effect. The performance and judgment of medical staff in the defence industry can thus be measured against these principles and rules of practice (Damani et al, 2003, 149). VIII. Objectives of the Audit and Choice of Audit Tool The medical audit described was taken at the Army Primary Healthcare Services (APHS) Centre in the UK. The primary objective of the audit was to look at the procedures and practices being followed at the centre in the use of Personal Protective Equipment (PPE). These may be defined as everything from eyewear to face and skin coverage and the means of protecting the body from infection from head to toe. The audit covered the current materials and methods used at the APHS Centre and commented on the standards followed. The Audit Tool used was the APHCS Infection Prevention and Control Tool 3.1 PPE, Version 1, prescribed as of April 2011. The audit standards for the use of this tool ensure that clinical practices will be based on best practice and reflect infection control guidance to reduce the risk of cross infection to patients’ whilst providing appropriate protection to staff (Wilson, 1998; Wilson, 2006). The audit took place over one week observing medical professionals carrying out related tasks and procedures at the APHCS Medical Centre. The staff consisted of 3 Nurses, 2 Doctors and 5 Combat Medical Technicians. A total of 18 questions were selected from the APHCS Audit Tool 3.1: PPE. The results of the audit are summarised in the following section. IX. Findings and Recommendations The audit found that adequate structures were in place to ensure compliance and monitoring of all policies and practice which include the use of Personal Protective Equipment (PPE). Further, all staff have been trained in the use of PPE as part of local induction processes. Over 70 percent of the time, adequate arrangements for PPE such as surgical gloves conforming to EU standards were available in all clinical areas. An alternative to natural rubber latex gloves were also on hand for those with NRL sensitivity at least 40 percent of the time. Over 80 percent of the time, gloves of proper size and quality were available at points of care. Unfortunately, the same could not be said for aprons which were available only 50 percent of the time. Invasive procedures saw the use of gloves in 60 percent of cases. Some lapses were also noted in the use of gloves for procedures involving contact with mucous membranes and exposure to bodily fluids. This needs to be corrected as it is a bit alarming. On the positive side, gloves were primarily used once and disposed of, while hands were decontaminated 50 percent of the time prior to putting on the gloves, compared to only 30 percent of the time following their removal. Gloves were worn immediately before an episode of patient contact or treatment, when appropriate, and removed as soon as the activity is completed. Another area of lapse was in the use of plastic aprons, especially when it was foreseen that splash of bodily fluids could pose risk to the body- in such cases, aprons were worn only 50 percent of the time. Furthermore, plastic aprons were inclined to be used in more than one such encounter. There was also no evidence of face masks or protective eyewear being used in case there was danger of splashing of fluids in the face or eyes. Among the key recommendations are the following: 1. Further teaching and monitoring needs to be done to ensure that all medical staff is aware of compliance for all PPE. 2. Alternatives to NRL gloves should be made available in all consulting rooms (Hoffman et al, 2004). 3. Consulting rooms need to be stocked with all sizes of gloves. 4. Aprons of both cloth and plastic type need to be made available in all rooms. 5. An IP&C link nurse needs to be available and in the absence of a link structures need to be in place for staff to access information when required (Hawker et al, 2005, 77). 6. The medical audit needs to be repeated every 6 months to ensure that staff training and processes and procedures followed at the APHS Centre are up to the mark (Weston, 2008, 37). X. Conclusion In this paper we have looked at the kinds of infections and the PPE that needs to be worn to combat and minimize infection. While this is not always possible, a committed and proper adherence to standard and best practices will prevent needless risk and ensure better quality of care for patients admitted to the APHS Centre. References 1. Army Primary Healthcare Services website. Accessed on 18 Sep 2011. 2. Care Quality Commission website. Accessed on 18 Sep 2011. 3. Department of Health Centers for Disease Control: Healthcare Associated Infections, 2010. Accessed on 18 Sep 2011 at http://www.cdc.gov/HAI/infectionTypes.html 4. Damani, N. & Emerson, A.: Manual of Infection Control Procedures (2nd ed). Cambridge Univ. Press, 2003. 5. Hoffman, P.; Bradley, C. & Ayliffe, G.: Disinfection in Healthcare, 3rd ed. Blackwell, Oxford 2004. 6. Horton R. & Parker, L..: Informed Infection Control Practice, 2002. 7. Infection Control Nurses Association: Hand decontamination guidelines, 2002. 8. Infection Control Nurses Association: Reducing sharps injury: prevention and risk management, 2003. 9. Hawker, Blegg, Blair et al: Communicable Disease Control Handbook, 2005. 10. Healthcare Commission: Report of Defence Medical Services: A Review of the Defence Medical Services in the UK and Overseas, 2009. 11. McIntyre, J. et al: Infection Control in Primary Care, 2008. 12. Website of the National Medical Council. 13. NICE: Infection Control: Prevention of Healthcare Associated Infections in Primary and Community Care, 2003. 14. Practice Nurse: Infection Control Procedures, 2009. 15. Pratt, R.J.: 'The Epic Project: Developing National Evidence Based Guidelines for Preventing Healthcare associated infections.' Journal of Hospital Infection 47s S3-S4. 16. Royal College of Nursing (2005) Good Practice in Infection Prevention Control. 17. Sanazaro, Paul J.: Medical Audit, Continuing Medical Education and Quality Assurance. Western Journal of Medicine, September 1976, Volume 125, Issue 3, pp 241-252. 18. Wilson, J.: Infection Control in Clinical Practice, 1998. 19. Wilson, J.: Infection Control in Clinical Practice, 2006. 20. Weston, D.: Infection Prevention and Control: Theory and Clinical Practice for Healthcare Professionals, 2008. 21. British Journal of Nursing. 22. Journal of Hospital Infection. 23. Nursing Times. 24. Pearce: Ten Steps to Managing Change. Nursing Management Journal, 2006. 25. WHO: Standard Precautions on Healthcare. Read More