The Nurse's Role in Preventing Hospital-Acquired Infections
Nurses play a pivotal role in preventing hospital-acquired infections (HAI), not only by ensuring that all aspects of their nursing practice is evidence based, but also through nursing research and patient education.
As patient advocates, nurses are in the unique position to affect change to improve patient care standards. The nurse has many tools available to create a safe environment for patients. Universal precautions are the cornerstones of a safe environment that is free of infection. According to the Center for Disease Control and Prevention (CDC, 2010) universal precautions are designed to prevent the transmission of blood borne pathogens when providing first aid or healthcare. They apply to a wide variety of body fluids, including blood, cerebrospinal fluid, amniotic fluids, semen and vaginal secretions. They do not apply to nasal secretions, sputum, saliva, sweat, tears, urine, feces or vomit unless these fluids contain visible blood. Under the universal precautions rule, nurses must wear personal protective equipment when coming into contact with the specified body fluids.
Hand washing is another potent weapon in the nurse’s arsenal against infection, and is the single most important nursing intervention to prevent infection. Effective hand washing may be accomplished with antimicrobial soap and water, and specific guidelines are provided by the CDC for the use of alcohol-based hand rubs as acceptable substitutes.
There are many other ways in which nurses can prevent infection at the bedside. Avoidance of urinary catheterization is recommended whenever possible. If it is not clinically feasible to avoid catheterization, intermittent catheterization is another preferable option. For patients who require long-term catheterization, supra-pubic catheters should be considered. Scrupulous hand washing and aseptic technique is vitally important in the insertion and care of urinary catheters, as well as accurate and precise documentation.
Irrigating cutaneous wounds thoroughly between dressing changes, debriding necrotic material effectively and dressing a wound appropriately to absorb exudates, are all ways in which nurses can protect patients from HAIs.
Neutropenic patients should receive frequent oral care, including teeth brushing and gentle flossing, or receive oral antimicrobial rinses when gingivitis or poor hygiene is noted.
Intravenous therapy is a huge area of concern with HAIs. Nurses can make a huge contribution in this war against infection by using full barrier precautions (sterile field, caps, gowns, masks and gloves) when preparing for the insertion of central venous catheters. All catheters, regardless of site, should always be placed aseptically. A two percent chlorhexidine preparation is the preferred cleansing agent of catheter sites and injection ports and diaphragms of multidose vials should be cleansed with 70 percent alcohol prior to accessing (CDC, 2010). Catheters should be removed promptly when deemed unnecessary.
Catheter dressings should be replaced immediately when damp, soiled or loosened. IV administration sets, extensions and secondary sets should be replaced every 72 hours, unless infection is suspected or documented.
In addition to practical bedside interventions, nurses can foster a safe environment for patients by creating an open, non-punitive environment where errors and near misses can be reported. This approach helps an organization determine how to improve the system and prevent future errors from occurring. Become familiar with your organization’s error reporting policies, procedures and keep in mind the following general tips:
- Adopt a safety-minded attitude. Safety is everybody’s job! Make prevention a part of your work habits.
- Focus on the task at hand.
- When “noise” in your environment is distracting, you and others are at risk for accidents.
- Noise” might include your own thoughts that are unrelated to the task at hand, an interesting conversation going on nearby, or anything that breaks your concentration.
- Identify “noise” and take actions to limit the source.
- Develop a personal list-making or note-taking system to keep your thoughts focused.
Nurses in all roles and settings can demonstrate leadership in infection prevention and control by using their knowledge, skill and judgment to initiate appropriate and immediate infection control procedures. Practice diligently and keep your patient safe. For additional infection control guidelines you can use to protect your patient, visit the CDC’s website at: http://www.cdc.gov/ncidod/dhqp/guidelines.html
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