The Nurse’s Role in Prevention of Nosocomial Infection

Question

The Nurse’s Role in Prevention of Nosocomial Infection

Despite having the best intentions at heart, health professionals on several occasions act as vectors of diseases, passing on a new infection among unsuspecting patients. Nosocomial infections take place globally and normally affect both resource-poor nations and developed ones. These kinds of infections are among the common causes of death as well as increased morbidity among hospitalized patients. Nosocomial infections have grown to be a significant burden and trouble for general public health and patients.

According to a survey carried under auspices of the World Health Organization in fifty-five hospitals in 14 countries that represent Europe, Western Pacific, Eastern Mediterranean, and South-East Asia, an average of 8.7% of hospitalized patients have acquired nosocomial infections. The gravity of this situation is affirmed by the fact that more than 1.4 million people globally suffer from infectious complications acquired while in hospital. South East Asia regions and Eastern Mediterranean feature the highest frequencies of nosocomial infections.

It has come to light that factors are influencing the development of nosocomial infections. They include exposure of the patient to a microbial agent, patient susceptibility, bacteria resistance, and environmental factors such as health care setting, patients with infection, and crowded conditions. With definite knowledge of the causes, it is thereby possible to enact programs to contain nosocomial infections. Having a full comprehension of chain infection and the way of breaking the chain can be quintessential in infection prevention, and abiding by the definite role of nurses identified in this review would be important in preventing unwanted financial and medical distress to patients.

Introduction

A nosocomial infection, also known as ‘hospital-acquired infection,’ refers to an infection a patient acquires while in hospital, though being admitted for treatments of a completely different infection. In other words, it is an infection occurring in a patient during his/her duration in a health care facility with the infection being absent during admission but incubated afterward. Infections coming about more than forty-eight hours following admission are regarded as nosocomial. It also includes those infections that are acquired right inside the hospital, but only featured and noticeable after the patients have been discharged as well as occupational infections affecting the hospital staff.

Numerous findings have brought to light several factors promoting infections among hospitalized patients. They include: transmission of bacteria characterized to be drug-resistant among a crowded population within the hospital, decreased patients’ immunity, poor practices employed in infection control, and increasing invasive techniques and medical procedures for determining potential routes of infection (Mayon-White, 1988). The most prevalent nosocomial infections infect surgical wounds, lower respiratory tract, and urinary tract. Preventions of this kind of infection are the work of individuals in health care. Therefore, this paper aims at ascertaining and highlighting the active role of nurses in the prevention of nosocomial infection.

Roles of Nurses in This Case

Nurses are instrumental in the prevention of nosocomial infection not just by ensuring all the dimensions of nursing practice are based on credible evidence, but also through patient education and nursing research. The nursing staff is charged with the implementation of patient care practices geared towards infection control in hospital facilities. It implies that nurses have to be familiar with common practices of preventing the spread of infection and the occurrence of infection and maintain the right practices for patients at all times in the hospital.

The senior nursing administrator is charged with a series of responsibilities oriented towards the prevention of nosocomial infection. They include;

1. Taking part in the Infection Control Committee
2. Facilitating improvement and development of nursing techniques as well as a continual review of aseptic nursing policies that have been certified and approved by the Infection Control Committee
3. Creating training programs for all the members of the nursing team
4. Overseeing the implementation of different techniques used in the prevention of infections in specific areas such as the maternity unit, operating suite, and newborns and intensive care unit
5. Watching nursing adherence to policies
6. Overseeing the responsibility of nurses in charge of the wards

One of the outstanding activities that nurses are mandated to engage in is the maintenance of hygiene consistent with what is outlined in hospital policies as well as good nursing practice in the ward. Monitoring aseptic techniques that include the use of isolation and handwashing/using alcohol rub is quintessential. Even though handwashing may be seen as a simple procedure, it is an effective preventive measure.

It is important to note that hand washing is the single most important measure towards reducing risks associated with the transmission of skin microorganisms from one party or site to another on the same patient. Hand washing promptly and thoroughly before a patient makes contact and after with secretions, blood, excretions, body fluids, equipment, or even pieces of the article that are contaminated acts as a useful component of isolation precautions and infection control.

The spread of this kind of infection among immune-compromised patients is linked with contamination of the hands of health care workers in about 40% of all cases, thus being a monstrous challenge in contemporary hospitals (Gould, Wilson-Barnett, & Ream, 1996). Alcohol rub removes germs of hands not more than 30 seconds faster than while washing hands. The main purpose of hand hygiene is to eliminate transient flora with the proper and careful performance of handwashing by alcohol-based gels and a variety of soaps (both antiseptic and normal).

Nevertheless, one of the most common problems noted in the practice is linked to the lack of enough sinks and the amount of time consumed while washing hands. This can be resolved by the use of hand rubs soaked in alcohol since it is a faster application than the correct washing of hands. Nurses are also tasked with ensuring that the simple process is performed correctly. Thereby, the nurses must put in extra efforts on constantly reminding visitors and practitioners of the best procedures to comply with responsible hand washing.

On the same note, nurses must also elevate the practice of wearing gloves. Gloves complement hand washing, but can never be an alternative since they are important in the reduction of risks of passing on microorganisms. Wearing gloves is done for 3 good reasons in the hospital environment.

1. First, they are meant to set up protective barriers and also to prevent any form of cross-contamination of hands when a nurse touches secretions, mucous membranes, blood, non-intact skin, excretions, and blood. For instance, in the United States of America, a mandate has been issued by the ‘Occupational Safety and Health Administration’ for gloves to be worn to reduce the common risk of blood-borne pathogens.
2. The second reason for wearing gloves is to reduce the likelihood of transmitting microorganisms found on the hands of personnel to patients at the time of invasive or different patient-care procedures involving non-intact skin and mucous membranes of patients.
3. Thirdly, gloves are worn to reduce the chances of the hands of health personnel or a nurse being contaminated with any harmful micro-organism from a patient or even fomites from being passed on to another patient. In regards to this, it is proper for gloves to be changed continually between patient contacts and hands must be washed each time following the removal of gloves.

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Besides, it is important to note that wearing gloves does not become an alternative for washing hands since gloves may have small, unapparent defects, or even may get torn while being used leaving hands contaminated during removal (Girard & Savey, 2002).

Nurses prevent the risk of nosocomial infection by putting on aprons or gowns most of the time, especially when interacting with a patient. On the same note, gowns help in keeping infectious materials away from the clothing. Two studies have asserted that staff gowning while in the neonatal intensive care unit is not a suitable activity. This is because wearing gowns hardly reduces neonatal colonization, mortality rates, or infection. In some instances, the white coats are the source of contamination because of pockets and cuffs, hence it is recommended that a plastic apron is donned after the removal of the coat.

Nurses also have the responsibility of implementing standard precautions. These are set control measures used in the prevention of transmission of blood-borne pathogens such as HepB and HIV whereby bodily fluids and blood from all patients are normally considered infected with blood-borne pathogens regardless of the performed diagnosis. Such measures have to be applied to all broken skin, blood, bodily fluids, and mucous membrane regardless of whether the sample contains blood.

Standard precaution measures employed in preventing transmission of diseases include the use of eye shields, gloves, protective equipment, masks, and other barriers used in reducing the common risk of exposure of nurses or other healthcare personnel. The measures must be implemented while interacting with patient equipment at the time of environmental disinfection in instances involving patient care procedures where there are bodily fluids, discarding contaminated sharp instruments, and during injection as well as while working with soiled linen (Glynn, Ward, & Wilson, 1997).

The nurses are important in these scenarios since they utilize critical thinking skills in determining whether isolation precautions have to be implemented. In addition, other responsibilities of nurses in charge of wards include:

1. Issuing prompt reports to physicians in attendance on available evidence containing relevant information on the patient’s infection under the care of the nurse.
2. Ensuring patient isolation and asking for culture specimens from any patient with signs of communicable disease at the time when a physician cannot be at service.
3. Restricting patients from being exposed to any infections from visitors, other patients, hospital staff, or used equipment for diagnosis.
4. Ensuring there is a constant supply of drugs, equipment, and patient care supplies to the ward.

The nurse overseeing infection control is a part of the control team hence responsible for the identification of infections, investigating the exact type of infection and the causative organism, taking part in the training of personnel, and monitoring hospital infections. They also play a participatory role in the investigation of outbreaks, coming up with infection control review and policy, and approving patient care policies that concern infection control. On the same note, these nurses ensure total compliance with both local and national regulations, liaising with public health, and providing consultative advice of an expert to other staff as well as regulating other hospital programs in matters associated with the transmission of infections.

It is the utmost responsibility of nurses in the hospital to know the factors that are due to an increase in the susceptibility of patients to any infection. Some of the factors that must be added to knowledge include drug therapy, age, underlying disease, and whether a patient is supposed to undergo surgery. This allows nurses to be able to carry out a correct assessment of the patients who are greatly at risk for them to develop care plans, hence determining if there is needed extra care or precaution that must be taken as well as protocols to follow. A study suggests that a proper assessment of the risk of infection of a patient to another in care plans before the commencement of any procedure is a fundamental principle to be adhered to in infection control.

Nurses are in a critical position to facilitate change in improving patient care standards more so because they have many tools at their disposal for creating a safe environment for patients to thrive in. One of the cornerstones nurses build on in ensuring a safe environment free of infection is enacting universal precautions, which are specifically designed to prevent the possible transmission of blood pathogens in the provision of healthcare and first aid. They apply universal precautions to a variety of body fluids, which include semen, cerebrospinal fluid, blood, amniotic fluids, and vaginal secretions.

Such precautions are not applied to nasal secretion, tears, saliva, sputum, feces, urine, and vomit unless it is noticed that the fluids contain visible blood. Nurses are also helpful in numerous ways in preventing infection at the bedside. They do this by avoiding urinary catheterization. In the case where the situation is not clinically feasible, intermittent catheterization is the most preferred option.

In addition to bedside interventions, nurses can ensure a safe environment for patients by the creation of an open, non-punitive environment in which near misses and errors can be noted and included in the reports. This approach is helpful for organizations in determining the way of improving the system and preventing future errors from taking place (Glynn, Ward, & Wilson, 1997).

Conclusion

In conclusion, nurses play a quintessential role in the prevention of nosocomial infection because they normally have close interaction with patients. Nurses in all settings and roles can demonstrate great leadership in the prevention and control of infections by employing skills, knowledge, and right judgment in initiating appropriate and immediate procedures for infection control.