Infection Control Health Article

Hand-washing indications

Health care workers should wash their hands:

• after removing gloves
• when coming on duty
• when hands are soiled, including after sneezing, coughing, or blowing the nose
• between patient contacts
• before medication preparation
• after personal use of the toilet
• before performing invasive procedures
• before taking care of particularly susceptible patients, such as those who are severely immunocompromised and newborns
• before and after touching wounds
• before and after eating
• after touching inanimate objects that are likely to be contaminated with pathogenic microorganisms, such as urine-measuring devices and secretion collection apparatuses
• after taking care of infected patients or patients who are likely to be colonized with microorganisms of special clinical or epidemiologic significance; for example, bacteria that are resistant to multiple antibiotics

Preparation

Routine hand-washing is accomplished by vigorously rubbing together all surfaces of lathered hands followed by thorough rinsing under a stream of water. This should take 10-15 seconds to complete. The hands should be dried with a paper towel. Immediate recontamination of the hands by touching sink fixtures may be avoided by using a paper towel to turn off faucets.

Universal precautions recommend that all health care workers who come into contact with a patient's blood or body fluids that contain visible blood should wear an appropriate type of barrier to prevent the spread of blood-borne pathogens. Other body fluids for which barrier protection is recommended include semen, vaginal secretions, cerebrospinal fluid (CSF), synovial fluid, pleural fluid, pericardial fluid, and amniotic fluid. The type of exposure determines the specific barrier that should be used. Universal precautions are designed to augment, not replace, standard infection control procedures such as hand washing and the use of gloves when touching obviously infected materials.

Adequate routine cleaning and removal of soil should be the environmental sanitation procedure for all healthcare facilities. Microorganisms are normal contaminants of the environment. A healthcare facility's environmental services department should maintain schedules for routine cleaning in all rooms and include equipment and working surfaces. General and infectious wastes are disposed of on a regular schedule. All departments, though, are responsible for implementing infection control policies.

Complications

Health care workers must not be complacent about implementing their facility's infection control policies. Perhaps due to long-time exposure to occupationally acquired infections, they have the tendency to minimize or ignore the ramifications. Infections oftentimes go undetected, underreported, or overlooked by health care workers.

Results

If infection control programs are successful, the result will be a reduction in the risk of infection and related adverse outcomes in the healthcare setting, achieved in a cost-efficient manner.

Health care team roles

Much of the responsibility for infection control rests on the shoulders of the clinical staff providing care at the bedside. Because nurses are close to the patient physically, they are able to prevent the spread of infection, but they can also be a means of transmitting infection. Therefore they need to foster compliance with infection control policies to ensure a high quality outcome for the patient. Infection control practices should have a positive effect on not only the clinical staff, but the patient as well.

BOOKS

Jennings, J., and F. Manian. APIC Handbook of Infection Control. Washington, D.C.: Association for Professionals in Infection Control and Epidemiology, 1999.

PERIODICALS

Barrs, A. "Infection Control Across the Board." Nursing Homes Long Term Care Management 49, Issue 11 (November 2000):38.

Henderson, D. "Raising the Bar: The Need for Standardizing the Use of "Standard Precautions" as a Primary Intervention to Prevent Occupational Exposures to Bloodborne Pathogens." Infection Control and Hospital Epidemiology 22 (February 2001):6.

Heseltine, P. "Why Don't Doctors and Nurses Wash Their Hands?" Infection Control and Hospital Epidemiology 22 (April 2001):4.

Hood, R., and D. Olesen. "Re-evaluating the Role of the Clinical Nurse in Minimizing Health Care Related Infection." Australian Nursing Journal (8 October 2000):1.

Rello, J. "Impact of Nosocomial Infections on Outcome: Myths and Evidence." Infection Control and Hospital Epidemiology 20 (June 1999):6.

"Requirements For Infrastructure and Essential Activities of Infection Control and Epidemiology in Hospitals: A Consensus Panel Report." Infection Control and Epidemiology 19 (1998):114-124.

Shimkins, J. "Making the Grade." Health Facilities Management 1 (January 1999):18.

Stratton, C. "Occupationally Acquired Infections: A Timely Reminder." Infection Control and Hospital Epidemiology (January 2001):22.

ORGANIZATIONS

Hospital Infections Program. Center for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA 30333. <http://www.cdc.gov/ncidod/publications/brochures/hip.htm>.

OTHER

Infection Control: Hand-Washing and Antisepsis. Johns Hopkins University. 2001.

René A. Jackson, RN