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Hand

Correct

associated infections ( HCAIs ). Exposure to environmental contamination with spores of C . difficile is one example of this . While this can occur in the home as well as in healthcare environments , nurses rarely are able to manage the risk outside clinical settings .

Many micro-organisms can be identified from patients ’ environments and these usually reflect bacteria carried by patients or staff . Staff contact with the immediate patient or a contaminated environment can also be a route for transmission of micro-organisms .

High standards of cleanliness will help to reduce the risk of cross-infection . A number of methods are available for cleaning in inpatient or care home environments , which include traditional cleaning with cloths and detergent or microfibre technology . Pre-prepared detergent or disinfectant wipes are occasionally used for some items of equipment where these are used with more than one patient .

Additional technologies are also available for specialist use in hospital settings after outbreaks of infection or as part of a routine environmental decontamination programme . These include hydrogen peroxide vapour .

hygiene and care Since the onset of the pandemic , regular handwashing has become second nature to all those working in nursing . Hand hygiene is an effective way to protect yourself and patients .

Glove use has increased also considerably during the pandemic . When used correctly and in the right circumstances , gloves are a valuable element of PPE . But inappropriate and overuse of gloves carries its own risks , not only of infection but also damage to the hands .

Taking some simple steps can help with the prevention of infection linked to glove use , as well as reduce the risk of work-related dermatitis . With millions of examination gloves used in health and care each year , these steps can also make a vital contribution to sustainability .

The steps include : only using gloves when needed and removing them as soon as possible after the care task is complete ; only using gloves for an interaction with a patient when really necessary ; and using emollient creams after handwashing to protect the hands .

disposal of sharps It is not uncommon for staff to be injured due to the unsafe or poor practice of others . For example , cleaners can sustain injuries as a result of sharps being placed in normal waste bins . Sharps injuries are preventable and learning should take place following incidents to avoid future instances .

In a recent RCN survey , 15 % of respondents said they had suffered a ‘ sharps injury ’ in 2020 . This compares with 10 % in 2008 . ³

The reasons for the rise revealed in the survey included fatigue induced by the pandemic , low staffing levels , a lack of training and poor availability of safer sharps and sharps bins .

Clearly , contact with used sharps also carries the risk of infection and exposure to bloodborne pathogens . To reduce this risk , it is vital that sharps are used safely and disposed of carefully , following your workplace ’ s agreed policies . Education and guidance should be available through your employer on how to manage sharps .

References 1 UN . Sustainable Development Goals . New York : UN , 2015 . sdgs . un . org / goals 2 Courtenay M et al . Development of consensusbased national antimicrobial stewardship competencies . Journal of Hospital Infection 2018 ; 100:245-256 . bit . ly / 34ziQFM 3 RCN . Pressures of pandemic and lack of training see 50 % rise in sharps injuries . London : RCN , 2021 . bit . ly / 3yMfJbH

Resources RCN Tools of the trade : glove use and the prevention of work-related dermatitis . bit . ly / 2Rcwrju

RCN . Skin health toolkit . bit . ly / 2RRKxHt

DHSC . UK 5-year action plan for antimicrobial resistance 2019 to 2024 . bit . ly / 3fDCmaP

Management

Nutrition

Communication

of indwelling devices Indwelling devices – for example , urinary or central venous catheters and IV cannula – are common in all healthcare settings . When used appropriately , they are a valuable element of patient care and contribute to positive outcomes .

However , their use carries a risks of infection as , by their very nature , they bypass the body ’ s natural defence mechanisms such as the skin and mucous membranes .

Prevention of infection with these devices is complex , and good practice is required at all stages of their use . This includes , but is not limited to , insertion and ongoing management .

Day-to-day management of the device is important in order to assess patency ( that the device is open and unrestricted ) and to detect any signs or symptoms of infection .

As with insertion principles , staff must follow local policies / guidance , which should include a daily review ( at a minimum ) to assess the continuing need for the device , regular documented checks for patency , signs of infection and status of dressing . These should be matched with good hand hygiene before and after any contact with the device or associated administration sets .

and hydration considerations Malnutrition is a significant public health challenge . It is estimated to cost an annual £ 23.5bn in the UK , which equates to around 15 % of the total expenditure on health and social care .

A person who is malnourished will have an impaired immune response as well as fatigue and reduced muscle strength . This may increase the likelihood of a chest or urinary tract infection , or even an acute kidney injury due to dehydration .

No matter what the setting – acute , community or social care – supporting good hydration and nutrition is a fundamental element of nursing care . By being vigilant for early signs of malnutrition and dehydration , using assessment skills and sound clinical judgement , nurses will help to prevent infection in patients under their care .

Patient and public anxiety about HCAIs , including those caused by MRSA and C . difficile , often centres on the risks of infection and the precautions required to prevent transmission .

Nursing staff can do a great deal to allay fears by communicating effectively , without breaching confidentiality .

For example , nurses can make available information for patients , visitors and staff and answer any questions that may arise from this . You could also display notices that describe the precautions needed if a patient is in isolation , and talk to patients about how they can help themselves and support staff in preventing infection .

Reporting of concerns We all learn from best practice and it is important that if you see things happening that could create an infection risk , you report them . If bad practice goes unchecked , it carries the risk of being repeated .

It ’ s in everyone ’ s interest , especially employers , to take steps to prevent this from happening . Identifying early warning signs and addressing issues at an early stage is really important .

Summer 2021 nursinginpractice . com