Hospital Acquired Infection (HAI).

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Hospital Acquired Infection (HAI), or as it is sometimes referred to as Nosocomial infection; is an infection occurring in patients after admission to hospital that was neither present nor incubating at the time of admission. This student will discuss the role of the nurse in preventing hospital acquired infection while on clinical placement, define HAI, and look at the causes of HAI and how it is spread. This student will also show in order to minimise these risks, systems must in place, understood and implemented by all concerned.

Plowman (1997) claimed that, 6,000 deaths per year are caused by HAI, with significant financial costs for the NHS and personal costs for patients' families. Other factors include separation from family, anxiety, sense of isolation and stigma. Glynn et al (1997) investigated the effects on the rate of infection of certain known risk factors such as age, underlying disease, and length of hospital and the use of invasive procedures. He found that it was in the use of invasive devices, which increased the infection rate from one HAI per 100 patient's episodes to 7.2, and goes on to state "this is important for nurses because they manage invasive devices, such as urinary catheters, intravascular cannulae, epidural cannulae, nasogastric tubes, and peg tubes, which often identify the early signs of infection" (McCullach, 1998).

The (NMC 2002) states "nurses have a duty to safeguard the wellbeing of patients and have a due regard for the environment of care" Code of professional conduct. Nurses must be sure that they do not contribute to infection risks and must take care to prevent infection whenever possible. Much of this is through basic nursing care such as ensuring the patient is clean and their skin is intact, the mouth is healthy, promoting mobility, promoting continence, improving the patients' nutritional and hydration status and promoting wound care.

This can only be done if Universal precautions are adhere to, which not only protects heath care staff from infections, but also prevents transmission of organisms between patients (See routes of transmission in appendix 1). The most important and the least expensive are using good hand washing techniques at the appropriate times. Hand washing is universally considered to be the most basic as well as the most vital infection control measure, as well as the most neglected of practice. Larson and Killien, 1982 comments on the reasons for non-compliance which included "too busy", "not at risk of acquiring infections from patients ", hand washing agent detrimental to skin", "wearing gloves", and not practiced by peers". (Wolinksy et al (1960) cited by Plowman (1997), confirmed the role of unwashed hands in the transmission of Staphylococcus aureus between newborns in a nursery; other studies have shown the contamination of hands by Gram-negative organisms and its relationship to Nosocomial infections (Knittle et al, 1975; Guenther et al, 1987). "The hand of the carer, so frequently used to comfort and treat patients becomes a lethal weapon in transferring pathogens to susceptible patients" (Horton, 1995 p, 936). Thus effective hand washing can reduce the incidence of HAI in all settings. (See appendix 2 for good hand washing technique).
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Nurses must be sure that they do not contribute to infection risks and must take every step to prevent infection when ever possible. They must have a sound knowledge of using aseptic technique for wound care and invasive procedures; there must also be a range of sterile equipment for invasive devices; sterile dressings for wounds and IV sites. Replaced when contaminated and decontamination of the patients' skin before invasive devices are inserted or dressed. Many other elements of nursing care are also concerned with the prevention of infection. Once again universal precaution comes into play, which requires staff ...

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