clinical focus
Hand hygiene must travel
Keeping clean outside the controlled environment of the hospital is a challenge that must be met.
Linda Raymond interviewed by Dallas Bastian
20 agedcareinsite. com. au
With companion animals and cluttered workspaces to deal with, infection control in the community can be challenging. Still, nurses and community-care workers must not lose sight of the importance of hygiene practices.
This is one of the key points raised by Linda Raymond, regional wound management clinical nurse consultant with Latrobe Community Health Service, in a recent editorial in the Australian Nursing and Midwifery Journal.
Writing on behalf of the Regional Wounds Victoria( RWV) collaborative, which is funded by the Commonwealth and Victorian governments under the Home and Community Care program, Raymond stated:“ While the environment is not controlled and home hygiene standards are not usually at a hospital standard, this does not mean that care in the community should be compromised.”
Aged Care Insite sits down with Raymond to discuss the unique challenges health professionals working in community settings face when it comes to hand hygiene and what must be done to ensure workers and clients are supported in this and related areas.
ACI: You said that over the past 20 years there has been a shift in healthcare provision, with an increasing proportion of complex care previously undertaken by healthcare workers in acute care settings now being provided in the community. What impact does this shift have on the importance of keeping on top of infection control? LR: Healthcare workers in community settings often work alone and usually have to make quite swift decisions and risk assessments. The push for hospitals to discharge patients earlier means more complex care is being attended to in the community. Also, as we know, we have an ageing population, and with the advances in healthcare we have an increasing number of people requiring care in the community. Healthcare workers are now attending to more complex and invasive care. We have IV therapy and ventilation and catheterisations. Many clients are not only elderly but also terminally ill, or are recovering from major surgery, they’ re immunocompromised, [ they’ ve had ] chemotherapy, and have chronic diseases. Nurses have to carry more equipment to be able to attend to all of these needs. How this is transported and cleaned is a major infection-control issue, along with basic hand hygiene. It’ s become far more complex.
What are some of the other unique challenges health professionals working in community settings face when it comes to hand hygiene? We visit clients’ homes, which is always a privilege to be able to do, so we are going in as a guest; however, we still have a job to perform and we need to do that well. These homes can be anything from palatial to small caravans. Some nurses and community health workers attend to people who live on the streets, although I haven’ t done that.
Some of these homes are kept fastidiously clean. I’ ve been into some homes where you could eat off the floor, [ but you can also ] go into absolute squalor.
How does the healthcare worker attend to a procedure in this environment when it’ s even difficult to devise a sterile or even clinically clean workplace? Does the risk assessment that’ s completed before we’ re meeting this client address being able to do what your service is required to do safely in this home?
OH & S comes into play as well. Healthcare workers don’ t have a lot of ability to raise beds as you do in the hospital. They don’ t have bariatric equipment or hoists, or anything like that. You’ re also having to do this procedure in a difficult position. You might be on a low bed or on a chair, or it might involve attending in a double bed and having to reach across it. These obstacles come into play.
You described a scenario in which a nurse was attempting to dress a foot wound while contending with a front gate, dogs running about, and working in a restricted space. What are some of the common infection-control issues that may slip to the back of workers’ minds in particularly challenging situations? What thoughts should be front and centre?