During my time on placement I assisted with the care of a very premature baby who had contracted an infection whilst recovering from lengthy operation. A new care plan was produced which included a recommendation to move the infant into a side room, as recommended by the Leeds Teaching Hospitals Trust policy for infection control in suspected gastrointestinal infections (2000). Isolating the patient helps to prevent the transmission of the infectious organism to any of the other children whilst also providing an extra barrier to help to protect the patient against any other strains of infection that other children may be carrying. The care plan also included instructions to test the infant to formally identify what the infectious organism was so that the correct treatment could be given. Before this incident I had not realised the impact that an infection could have on the health of an already sick child and felt like I may have overlooked the importance of infection prevention measures. After this experience I was able to identify the signs of infection, such as a fever or a rash (Hockenberry et al, 2003) and I am confident that if a similar situation were to arise I would be able produce a new care plan with appropriate suggestions such as testing the patient to identify any infectious agents and moving the patient to a side room.
The guidelines in place to protect the susceptible patients rely on effective bed management and production of suitable care plans, and are very successful because they recognise that some hospitals may struggle to implement the infection control guidelines due to lack of available space and resources and therefore the policies often include recommendations as to what to do if the necessary facilities are unavailable. As an example it is recommended that each patient with a suspected gastrointestinal infection should be placed in a side room with en suite facilities (Leeds Teaching Hospitals Trust, 2000) however if an en suite is unavailable the policy recommends that the patient is allocated a separate commode or toilet which is cleaned after each use (Leeds Teaching Hospital Trust, 2000). If guidelines such as these are adhered to patients will be much better protected and the risk of transmission will be reduced.
As mentioned previously the susceptible host is arguably the hardest link in the chain to control because hospitals are designed to house very ill and therefore very susceptible patients. Whilst assessment, positioning and careful planning can help to protect the patient, it is important that healthcare professionals tightly control the two remaining links in the chain, that is the infectious organism (and its source) and the means of transmission, in order to protect their patients.
Most nosocomial infections are caused by bacteria and viruses, although infections resulting from fungi are also becoming more widely identified (Huband and Trigg, 2000). An important part of preventing healthcare associated infections from spreading is quick identification of the organisms accompanied by a good understanding of the organism (Hockenberry 2005). There are certain characteristics of infection causing organisms that healthcare professionals need to be aware of so that they can produce the best care plan for their patients. Huband and Trigg (2000) recognise these characteristics as the pathogenicity, infectivity, invasiveness and virulence of the organism. If an organism were determined to have a high virulence it would mean the organism would be able to produce a much more severe illness than an organism with a low virulence. This extra information would allow healthcare workers to produce plans and set up measures to prevent transmission that are appropriate to the level of threat the organism presents.
There are many different potential sources of infectious organisms which are routinely found in hospitals including food, water, medical equipment and laundry. These only become sources of hospital acquired infection when hospital’s procedures that are put in place to protect patients against nosocomial infections are not followed, for example wards are overcrowded, medical equipment is not properly maintained or sterilised, or when healthcare workers fail to adhere to infection control guidelines (Huband and Trigg, 2000). There are many guidelines in place to prevent the colonisation of pathogenic organisms in hospitals thus preventing hospitals, and hospital equipment becoming a source of infection. An example of one such guideline is the Food Safety General Regulations document (DoH 1995 cited in Kenworthy et al 2002) which gives details as to how to prepare food that is safe for consumption and includes a recommendation of training for food handlers.
During my time in my placement there were a number of times when I was asked to go and prepare drinks for my patients and whilst I was in the kitchen I was able to observe some of the Department of Health’s food safety guidelines (1990, cited in Kenworthy et al 2002) being practised. I noticed that the kitchen staff washed their hands prior to touching any of the food or equipment, they also wore gloves, aprons, hairnets and I saw that to cover up any cuts on their hands the kitchen staff used bright blue plasters. I later discovered that the reason that the plasters are so brightly coloured is so that if the plaster fell of and landed into the food it would be easy to see and the food would be disposed of (DoH 1990, cited in Kenworthy et al 2002). All of these precautions are in place to prevent pathogens being transferred to the food where they could potentially colonise causing the food to become the source of the pathogens.
Whilst there are many precautions in place to prevent pathogens from colonising within the hospital environment, such as procedures for the disposal of clinical waste and sharps, cleaning of bed linen and sterilisation of medical equipment (Kenworthy et al 2002), it is important to realise that many organisms that have the potential to become disease causing are routinely found in various parts of the human body. They become pathogenic when the organism is transferred to a foreign site of the body (Mallik et al, 1997) and therefore it is important healthcare professionals bear this in mind as it suggests that one of the biggest sources of infectious agents are humans and therefore it is possible that it is the patients, staff or visitors who may be the sources.
Whilst in placement I found that it was a ward requirement that everyone entering the ward used an alcohol gel to clean their hands as recommended by the NICE guidelines on infection control (2003). This helped to eradicate any of the organisms that staff and visitors may be unknowingly carrying. Unfortunately regular use of the alcohol gel causes dry skin and after a day or so on placement my hands were becoming really sore and dry. The NICE guidelines on infection control (2003) recommend using an emollient hand cream to prevent dryness caused by the alcohol gel and when I returned to placement I noticed that there were indeed moisturiser dispensers situated near the sinks. Providing the moisturiser is one way to improve adherence to hand washing procedures as it minimises the costs of using the alcohol gel by preventing dryness and irritation of the hands.
Alcohol gel cannot always be used because a more thorough cleaning is regularly required, this is because not only are hands sometimes the source of the infectious agent they are responsible for almost every transfer of infectious agents between patients and healthcare workers (Borton and McCleave, 2000).
In cases where a more thorough cleaning is required there are numerous guidelines on the correct procedure. The NICE guidelines on Infection Control (2003) recommend using tepid water and soap and using a three step approach: preparation, washing and rinsing and then finally drying. Huband and Trigg (2000) develop the washing and rinsing stage slightly further and suggest 6 precise movements designed so that not a single part of either hand is missed and the risk of transmitting infection is reduced even further.
Whilst working on placement I had to wash my hands using this procedure repeatedly every day and found that many of my colleagues either did not spend the recommend 10-15 seconds rubbing the soap into their hands (NICE 2003), replaced the frequent hand washes with a couple of squirts of the alcohol gel or in some cases did not wash their hands at all. Although at first I was surprised, soon I became acutely aware of just how busy my colleagues were and how inconvenient thorough hand washing was for them. For busy healthcare workers hand washing can easily be seen as a procedure that could be ‘cut out’ to save time. Whilst this is understandable it is important that this way of thinking is changed; healthcare workers need to be well educated in infection control so that they better understand the reasoning behind the procedures to prevent infection which in this case is the importance of good hand hygiene in preventing infection. Borton and McCleave (2000) recognise the importance of hand washing and suggest that teaching the hospital staff the importance of thorough hand washing and the correct way to wash their hands should be a top priority for the hospital’s infection control practitioners.
Of course it is not just the hands that are responsible for the transfer of infectious agents; transmission is also possible through other routes such as droplet and airborne transmission (Hockenberry et al 2003). Ways to prevent transmission by these methods include simple measures, such as teaching children to cover their mouth and nose when they sneeze (Hockenberry 2005), to more extensive measures such as specialised ventilation for children who are suffering with a very infectious and virulent infection (Hockenberry et al 2003). On reflection I now fully understand why patients with infections are placed in side rooms rather than just nursed on the ward using universal standard precautions. It is because infections can be passed through numerous routes and so simply using universal standard precautions to prevent contact transmission is sometimes not enough to prevent an infection from being transmitted. Therefore it is recommended that patients with infections are placed in separate rooms to also reduce the risk of airborne and droplet transmission (Leeds Teaching Hospital Trust, 2000).
In conclusion, for a nosocomial infection to occur there must be a susceptible host, a source of the infectious agent and a means of transmission (DoH, 2003), these components put together are often referred to as the chain of infection (Huband and Trigg 2000). This essay has examined the procedures and practices in place to break the chain of infection at each of the different points in order to prevent a nosocomial infection from occurring. Examples from practice have also been included in order to unearth the advantages as well as the difficulties associated with each practice or procedure.
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Reference list
Borton, D. and McCleave, K. (2000) Infection Control (Chapter 9) in Springhouse. 3rd Edition Nursing Procedures. Pennsylvania: Springhouse.
Department of Health (2003) Winning Ways: Working together to reduce Healthcare Associated infection in England. Available from the World Wide Web:
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Hockenberry, M.J. (2005) Wong’s Essentials of Pediatric Nursing. 7TH Edition. St Louis: Elsevier Mosby.
Hockenberry, M.J, Wilson, D. Winkelstein, M.L, and Kline, N.E. (2003) Wong’s Nursing Care of Infants and Children. 7TH Edition. London: Mosby.
Huband, S. and Trigg, E. (Eds.) (2000) Practices in Children’s Nursing: Guidelines for Hospital and Community. Edinburgh: Churchill Livingstone.
Kenworthy, N. Snowley, G. and Gilling, C. (Eds.) (2002) Common Foundation Studies in Nursing. 3rd Edition. Edinburgh: Churchill Livingstone.
Mallik, M. Hall, C. and Howard, D. (Eds.) (1997) Nursing Knowledge and Practice: a Decision Making Approach. London: Baillière Tindall.
National Institute for Clinical Excellence (2003) Infection control: prevention of healthcare associated infection in primary and community care. Available from the World Wide Web: [Accessed 19th December 2005].
The Leeds Teaching Hospitals NHS Trust (2000) LTHT Infection Control Policies: Gastrointestinal Infections. Available from the World Wide Web:
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