“Infection prevention and control measures aim to ensure the protection of those who might be vulnerable to acquiring an infection both in the general community and while receiving care due to health problems, in a range of settings. The basic principle of infection prevention and control is hygiene.” (WHO, 2011).Infection control is related to quality management in patient safety, as infection is likely to affect morbidity and mortality. Infectious diseases are the second cause of death worldwide (Macias & Ponce-de-Leon, 2005).
Infection control is utilised in healthcare settings to ensure the safety of patients via the prevention of nosocomial infection.A nosocomial infection is one which:Is acquired in hospital by a patient who was admitted for a reason other than that infection.-OR-Occurs in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility (Ducel, Fabry & Nicolle, 2002, pp. 1).For this reason, a nosocomial infection may also be referred to as an HAI: hospital-acquired or healthcare-associated infection.
Infection control was first recognised in Austria in 1847 by Hungarian physician IgnazSemmelweis. In the hospital where he practiced, child-bearing women were attended in 2 wards; one attended to by doctors and medical students and the other attended to by midwives. There was a great discrepancy in rates of mortality due to puerperal fever amongst the women in one ward as compared to the other. The mortality rate amongst women delivered by midwives was 2%, while those delivered by the doctors and medical students ranged from 13-18%.Long story short, Semmelweis concluded that the higher mortality rate could be attributed to the exposure of physicians and their students to cadaveric materials and so conducted a study in which the intervention was hand-washing. The results supported his hypothesis and so a hand-washing policy was implemented. The mortality rate amongst women delivered by physicians and their students decreased to 2% (Best & Neuhauser, 2004).
So what does that mean for us in the present day?
While many infection control measures exist, for example personal protective equipment and barrier care of infectious patients, effective hand hygiene is the single most important strategy in preventing health care associated infections.” (Hand Hygiene Australia, 2012). In my own experience as a nursing student and carer, I can not think of a single thing that I do during work without the use of my hands (I even talk with them!).Since the intervention of Semmelweis, hand hygiene policies have been implemented in hospitals and health care settings world wide. Policies must be flexible to suit different situations, for example, the new problems facing infection control in the present day.These include:the ever-growing number of immunocompromised patients; the concerns about the capacity of the public health systems to deal with terrorist acts; the practice of high-risk procedures in facilities lacking trained personnel, efficient laboratories, and protective items; and gene therapy and its potential infectious complications (Macias & Ponce-de-Leon, 2005).The current accepted hand hygiene policy is one outlined by the World Health Organisation, which outlines the 5 moments of hand hygiene (WHO, 2009).
Unfortunately still, approximately 4 100 000 patients are estimated to acquire an HAI in the EU every year. The number of deaths occurring as a direct consequence of these infections is estimated to be at least 37 000 (European Centre for Disease Prevention and Control, 2011).The most frequent infections are urinary tract infections, followed by respiratory tract infections, post-surgical infection, bloodstream infections, and others including gastro-intestinal infection. MRSA is isolated in approximately 5% of all hospital-associated infection (European Centre for Disease Prevention and Control, 2011).
So what is going wrong?
The matter of barriers to effective infection control is discussed in an article published by the Americal Journal of Infection Control. After a study amongst various hospital staff, 4 barriers to effective infection control were identified; the lack of imperative or precise wording, lack of easily identifiable instructions specific to each profession, the lack of concrete performance targets, and the lack of timely and adequate guidance on personal protective equipment and other safety measures (Timen, Hulscher, Rust, Steenbergen, Akkermans, Grol, van der Meer, 2010).
Another article published in Infection Control and Hospital Epidemiology suggests that the data collection carried out for HAI’s and their risk factors detracts time and resources away from the practice of effective infection control measures and therefore may not be helpful to their prevention (Yokoe & Klassen, 2008).The same article suggests that proposed information technology methods of improving the area of infection control may not be realistic in some smaller hospitals. For example, the intervention of computerized reminders for removal of urinary catheters or management of antimicrobial prophylaxis requires advanced information technology and appropriate staff to oversee the practice, both of which necessitate allocation of adequate financial resources (Yokoe & Klassen, 2008).
The World Health Organisation has outlined some core components of improving infection control.Evidence and rationale support the notion that the participation of trained infection control professionals in IPC programmes is associated with better results.The ratio of infection-control professionals, particularly nurses, to the number of beds (or admissions or any other indicator of workload) of a health-care facility has been associated with success in IPC programmes. There are numerous studies that demonstrate successful interventions for the prevention and control of endemic HAI and outbreaks, such as provision of basic organizational structure and building infrastructure, promoting a culture of safety, implementation of evidence-based interventions guided by surveillance findings, reinforcement of leadership and performance feedback (WHO, 2008).
Infection control is the responsibility of all those who enter a hospital or health care facility, including:Management, Physicians, Microbiologists, Pharmacists, Nursing staff, Sterilization staff, Food, laundry and housekeeping services, Visitors (Ducel & Fabry, 2002).“Hand hygiene practices have been universally poor among health care workers.” (Hand Hygiene Australia, 2012).Ultimately, effective hand hygiene is consideredthe single most important strategy in preventing health care associated infections (Hand Hygiene Australia, 2012). All those responsible for maintaining effective infection control standards must follow accepted policies in all situations to prevent the spread of infection (Ducel & Fabry, 2002).
Infection control... Protection of those vulnerable to infection Hygiene basic principle (Image taken from Clipart).
Nosocomial infection Acquired in hospital or health-care setting AND: Patient admitted for reason other than that infection Infection was not present or (Image taken from Clipart). incubating at time of admission
20–30% of hospital-acquired infections are considered preventable by utilising hygiene and control programmes!!!! (European Centre for Disease Prevention and Control, 2011).
The literature... the lack of imperative or precise wording The lack of easily identifiable instructions specific to each profession the lack of concrete performance targets the lack of timely and adequate guidance on personal protective equipment and other safety measures
A little more literature... Skills and curriculum for training of infection- control professionals Ratio of infection-control professionals to workload Strategies for implementation
Where does the responsibilitylie? Management Infection control teams Physicians Microbiologists Pharmacists Nursing staff Sterilization staff Food, laundry and housekeeping services Visitors
References Best, M., & Neuhauser, D. (2004). Ignaz Semmelweis and the b irth of infection control. Quality safety health care, 13, 233-234. Ducel, G., Fabry, J., & Nicolle, L. (Eds.). (2002). Prevention of hospital-acquired infections: A practical guide (2nd ed.). Geneva, Switzerland: World Health Organisation. European Centre for Disease Prevention and Control. (2011). Healthcare-associated infections. Retrieved from http://www.ecdc.europa.eu/en/healthtopics/Healthcare- associated_infections/Pages/index.aspx Hand Hygiene Australia. (2012). What is hand hygiene? Retrieved from http://hha.org.au/AboutHandHygiene.aspx Macias, A., & Ponce-de-Leon, S. (2005). Infection control: Old problems and new challenges. Archives of medical research,36, 637-645. Timen, A., Hulscher, M., Rust, L., Steenbergen, J., Akkermans, R., Grol, R., & van der Meer, J. (2010). Barriers to implementing infection prevention and control guidelines during crises: Experiences of health care professionals. American journal of infection control, 38(9), 726-733. World Health Organisation. (2008). Core components for infection prevention and control programmes. Retrieved from http://whqlibdoc.who.int/hq/2009/WHO_HSE_EPR_2009.1_eng.pdf World Health Organisation. (2009). WHO guidelines on hand hygiene in health care: First global patient safety challenge clean care is safer care. Geneva, Switzerland: Author. World Health Organisation. (2011). Infection control. Retrieved from http://www.who.int/topics/infection_control/en/ Yokoe, D., & Klassen, D. (2008). Improving patient safety through infection control: A new healthcare imperative. Infection control & hospital epidemiology, 29(1), 3-11.