Abstract
My inspiration for this essay is from a critical incident that occurred in my practice. Mrs. O. was admitted to the ward with complaints of Shortness of breath, chest pains, and syncopal episodes. A diagnosis of NSTEMI (Non-ST-elevation myocardial infarction) was given after an ECG (Electrocardiogram) and blood cardiac protein levels were checked. she was then swabbed for coronavirus disease-2019 (COVID-19) and as well as methicillin-resistant staphylococcus aureus (MRSA) which is an admission pre-requisite for all patients coming into the ward (this is to better inform care, precaution, prevention, and isolation). Her swabs came back negative, and she was put in a bay of 4 patients. It is also compulsory for patients in the hospital to be swabbed for COVID-19 on their day1, day3, and day5 of admission. Mrs. O had all these swabs taken and they were negative as well as those in her bay. By day 10 of admission, Mrs. O. spiked temperatures and was noticed to be coughing as well as having symptoms of Shortness of Breath. As required by hospital policy, she was swabbed for COVID-19 but this time it came back positive.
This left us pondering on how she got infected knowing that she was the last to be admitted into that bay and visitors are not allowed into the ward but the only people she could have encountered were staff and other fellow patients. An investigation ensued into the mode of transmission for this infection as all precaution was followed. All members of staff of the ward were swabbed for COVID-19 as well as patients to find out the cause of the outbreak. It is possible that someone who is a reservoir of the infection (although maybe asymptomatic) may have carried it through either by direct contact or indirect contact. Mrs. O was then isolated in a bay as she was symptomatic of the infection. Drawing from the chain of infection framework, the most applicable link of the chain is the mode of transmission (this is because she was infected either through direct or indirect contact)
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There are several infection prevention and control (IPC) guidelines and protocols already in place to help guide and guard our daily activities in healthcare settings. In order to critically appraise IPC protocols in this essay, I will be considering contemporary issues and debates in this field. I will emphasize on the washing of hands as well as the control of infection in a clinical setting and even the community at large.
Introduction
The impact of an infection outbreak is enormous. An outbreak of MRSA for example in a bay can lead to the closure of that bay or unit entirely until a deep clean has occurred leading to delay in care and admission as well. An outbreak also predisposes patients and staff caring for them to sickness. A simple technique such as handwashing is proven to lessen the risk of infection spread (Pratt et al, 2007). The Health Act (2006) required lawfully mandatory obligations on the National Health Service (NHS) trust including providing ample hand washing resources as well as hand rub points and directing a rolling appraisal and auditing of hand hygiene which was also implanted into the framework for local clinical governance.
Discussion
Hospital-acquired infections (HAIs) can be very harmful in any health and social care setting because of patients who are highly vulnerable to disease. These infections are those that a patient gets after or during when healthcare was received which is dangerous as developing an infection while getting health care from an unconnected problem could pose a worsening effect on the patient when compared to the reaction on a healthy individual.
Patients in health care settings and hospitals have heightened susceptibility so are subsequently receptive to ill-causing germs due to cases like diminished immunity or a portal of entry like an open wound. Therefore, proper procedures and precautions need to be in place to make sure the occurrence of cross-infections is prevented. It is therefore essential for health workers to understand the way infections spread in order to act on and consider the major consequences that can ensue when proper preventive measures are not adhered to hence the essence of having the knowledge of the chain of infection.
Health care providers place the control of infection high because of its importance as it protects patients, the public as well as staff providing care. It also promotes safe practice and environment as well as indicating the quality of health care provided. It is essential to emphasize on regulation that applies to the NHS like the NMC (Nursing and Midwifery Council) code of conduct as well as the Constitution of the. Care, competence, and Communication are part of the 6Cs of care factors in how controlling infection is being managed in the NHS.
Hand washing is arguably the most common practice that can be applied to reduce the risk of cross-infection in hospitals (Bennett, Brachman, and Jarvis, 2007). Understanding the chain of infection framework is important as well as applying the proper infection prevention technique at every link. The framework streamlines how germs spread and cause infection. germs are referred to as infectious agents because of their ability to infect the body as they appear to be clustered in some parts called reservoirs (Pittel et al, 2000).
A Reservoir for an infectious agent can be people or the environment and can also be transported from one place or area to another. Germs can be transmitted from a person by exhaling and are described as a portal of exit; these germs can then be transmitted to a patient through the air, food, contact, or even blood. A portal of entry depicts the receptive area in which these germs are then launched into a patient, these can be through an aperture in the skin, urinary tract, and mouth. (Nicol and Brooker, 2011)
Between the exit portal and the entry portal there is a possibility for cross-infection, hence the necessity for proper hand hygiene. Damani (2011) recommended that Unclean hands easily transfer these germs but washing hands properly in hospitals can avert harm to patients to some extent. This increases the significance of health workers learning the technique that will clean their hands both physically and invisibly to get rid of germs. (Clayton-kent and Storr, 2004)
There are several papers and guidelines on hand washing techniques and when to carry out the technique an example is the WHO (World Health Organisation) five moments of hand washing (2006). WHO endorses that hands are to be washed prior to coming in contact with a patient and also before any aseptic procedure as well as instantly after exposure to bodily fluids, after coming in contact with a patient or their environs to shield yourself from pathogens when carrying out healthcare activity. This also complies with the NMC`s code of professional conduct (2004) which states that a nurse must act to identify and minimize risk to patients and clients.
The hand washing technique that was first outlined by Ayliffe et al (1978) has been modified by many bodies to serve different procedures. Hands are to be wet by running water and antiseptic soap. The technique consists of forwarding and backward strokes in a motion of; palm to palm, each palm over the other`s back, palm to palm interlocked, each palm over the other hand`s back interlocked, and then a rotational scrubbing of all fingers into each palm completed by the rubbing of the wrists for a 30-second duration. The hands are then to be rinsed with running water for over 15-seconds and made dry with paper towels (Ayliffe et all, 1978).
Although this practice has a stringent timeframe the WHO opts for the time it takes to sing a Happy Birthday song twice. This has raised worries over the estimate of time as it differs individually. The technique indicated the use of running water without specifying the temperature. Hand Washing for Life (2015) recommends that the temperature of the water should not exceed 43Ìc as a rise can cause delicate tissues of the hands to be damaged. This can cause pain to the caregiver as well as aiding bacteria to trapped, thereby making it hard to remove. More so, health workers are required legally to ensure they protect themselves first, this includes protecting their hands by taking care of it. (Health and Safety at Work Act, 1974)
Dougherty and Lister (2010) gave a thorough guide to carrying out hand washing effectively, stating that the least time to scrub soapy hands is about 15 seconds. It suggested that interest should be placed on areas that can be easily missed like the thumbs, tips of fingers, and between the fingers. Damani (2011) advises that single-use towels should be used to dry hands as well as in turning off taps where hands-free control is not obtainable.
It is the responsibility of everyone to take proper consideration to the control and prevention of infection; this includes patients, their visitors, and every healthcare worker (Randle, Coffey, and Bradbury, 2009). Understanding when to wash as suggested by the WHO`s handwashing five moments makes it a norm for nurses to know when to wash their hands. It also allows the nurse to be aware of the necessity to keep clean hands. National Patient Safety Alert from 2008 states that hazards to patients are significantly lessened if health workers disinfected or washed hands whenever they need to carry out patient contact.
Cummins and Bennett, (2012) state that a nurse`s main responsibility is to care (which is part of the 6Cs), this means keeping clear of possibly preventable HAIs that can have a substantial effect to the patient`s psychological and physical state. This could further exacerbate their illness, increase stress and worry, increase suffering and pain and consequently lead to an increase in the length of hospital stay. These cause a huge impact to the economy as HAIs cost the NHS an estimate of about 1 billion pounds. (NAO, 2009)
The understanding of appropriate hand hygiene will also show competence, another of the 6Cs, as nurses can control the spread of infection confidently by applying what they have learned. Handwashing also requires commitment; a nurse can wash their hands but needs the commitment to wash them to the appropriate standard. Communication is crucial in infection control as it is everyone`s responsibility. (Randle, Coffey, and Bradbury, 2009). In every aspect of infection control communication is at the heart of the process in order to take the right precautions. Researchers and health workers must communicate with each other in order to maintain an up-to-date level of knowledge on hand hygiene. It is also essential for staff to communicate with patients to teach them on how to improve their own hygiene and to ensure the safety of themselves and those around them. Communicating with patients' relatives for them to carry out regular hygiene which is germane in infection control. Public awareness should be done to with an emphasis on its ability to reduce general illness if done adequately, thereby lessening the burden on the NHS.
The 6Cs would influence a nurse in hand hygiene as a nurse would think about caring for the patient, giving a commitment to safe care as well as being competent in this task. Electing the most effective hand washing technique must be done to successfully remove pathogens so as not to transmit it from one patient to another or one area to another. The techniques discussed vaguely circle around the same routine with differences in times, in clinical practice these would all influence the nurse whilst performing hand hygiene, but the standard practice would be used as it is the technique enforced by the NPSA adapted from the WHO.
The most recently updated hand hygiene method by the NPSA includes the use of alcohol gels, these should not be used as a constant alternative as they would lead to build-up and therefore not effective for removing harmful microbes and are not suitable in some cases as they would not remove dirt or organic materials, cause a risk of ignition when handling medical gas cylinders and would not be effective against Clostridium difficile and Norovirus. (Brekle and Macqueen, 2012) Therefore this would influence workers in clinical practice as alcohol gels should only be used in these circumstances.
This demonstrates that there will always be constant reviews of infection control, so it is important to keep up to date on the latest information on practice available and to comply with the NMC code of conduct. A nurse must take part in additional learning or training to develop competence in hand hygiene practice and to constantly review on their development in order to assess what they could do to improve (Department of Health, 2019).
Randle, Coffey, and Bradbury (2019) suggest that ongoing training will always be required in this area of practice. This personal and professional development relates to the NMC Code, developing and understanding the appropriate hand hygiene procedures for personal and professional practice is important to comprehend so that the nurse can continue to care of the patient as their first concern. Caring for a patient means to not worsening their health by transmitting infection which could be preventable as by washing hands.
It is immensely important for nurses to act within their competencies which includes being able to competently hand wash appropriately to control infection as it is vital in performing any act of physical care to patients. (Dougherty and Lister 2011). Another section of the NMC code specifies that a nurse should administer care based on the best available evidence or best practice. All nurses must strive and aspire to remain on top of the developing and constantly modifying information and research on infection control.
This also relates significantly to the NMC code which represents that all nurses must maintain and improve their knowledge and skills based on the most up-to-date information throughout their working lives. Providing high-quality infection control always applies to the NMC code because it means that the nurse is complying with always providing a high standard of practice and care. The NHS constitution also states the rights and commitments to patients, the public, and the staff. (Department of Health, 2013). The constitution is the integral law to which the NHS strives to stand by and infection control is constantly high on the agenda for the NHS to improve upon. The constitution expresses that the NHS aims to provide the highest standards of excellence and professionalism and provide a high caliber of care that is safe, effective, and focused on the patient. The terms safe and effective relationships to hand hygiene as nurses must follow hand hygiene procedures so that the care given is not hindered by the possibility of passing infection.
The constitution also gives the values of the NHS, which include the value to improve lives. The NHS commits to improving lives and not decreasing the health of the patient due to HAIs and so it is paramount that infection control procedures are followed to lessen the risk of infections occurring whilst receiving healthcare. More so it is the right of the patient to be treated with a professional standard of care which is to be administered by a qualified professional. Service users of the NHS also have the right to expect the quality of healthcare to be monitored and improved continuously, which includes safety, so the hand hygiene of workers should be continuously reviewed to make sure it is up to the standard that will ensure safety. The NHS Constitution commits to establishing a safe and hygienic setting that is fit for purpose which directly involves the matter of hand hygiene because of its importance in infection control which promotes a safe and clean environment. (Department of Health, 2013)
Conclusion
Transmitting infectious diseases can be reduced if staff, visitors, and patients wash their hands prior to and subsequently after any task, a routine hand hygiene technique cannot be stressed enough as it is paramount for all staff to adhere to so that the spread of infection can be kept at bay. It is now valued that hand washing is not only important when hands are visibly contaminated but is also vital that they are washed when it is not visible that they are contaminated due to the microscopic pathogens hidden on the skin. More so, hand hygiene techniques influence all nurses because of the strong link to many of the 6Cs and the vast importance to the health of all patients.
This knowledge is essential to be passed on to all those who flow through a healthcare setting so that education can be continued on infection control. With this given, it is key that communication skills are overly efficient at voicing and helping in infection control with caring for the patients at the heart the education. With continued education and observations in this area, more people would be able to show acceptable handwashing and therefore reduce the risk of infection.
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