Journal activity 5.1
Describe the basic principles of Standard and Additional precautions, and explain why they are necessary.
Standard precautions are work practices in health center settings required to achieve basic levels of infection control, and are used in the treatment of all patients. Additional precautions are safety measures based on the mode of transmission of infection agents. They are used when patients are suspected to be infected with organisms.
Are Standard and Additional precautions applicable in all health care settings?
Both standard and additional precautions are applicable in all health care settings since transmission and contamination of infections is possible when handling patients and used medical equipment
Outline the procedure for a routine hand-wash.
- Hands washed in liquid soap water for five-ten seconds.
- Thoroughly rinsed with clean water.
- Dry with clean towel
Describe the 6 step hand washing technique and comment on which steps are often omitted by health care personnel.
- Palm to palm in which the two palms are rubbed together.
- Right palm over left dosurm and vise versa, by rubbing one palm over the back of the second hand.
- Palm to palm while interlacing the fingers
- Rubbing back of fingers against the palm of te other hand while interlacing the fingers.
- Rotational rubbing of right thumb clasped over left palm and vise versa.
- Rotational rubbing of backwards and forwards with fingers of right hand in palm of left hand and vise versa (MacCulloch, 2000). The third, fourth, fifth and sixth steps are habitually ignored due to their tediousness, and partly because hand hygiene is sometimes taken for granted.
Create a table, using the following headings: hand wash type (ie. Routine/social etc), specific technique/requirements, duration, when used, rationale
|Hand wash type
|Routine hand washing
|Rubbing of palms in liquid soap water and rinsing
|All routine procedures such as after contact with any dirty surfaces or handling dirty objects, before and after meals, after visiting the toilet etc.
|To make the hand generally clean and free from germs, avoid ingestion of germs etc.
|Hygienic hand disinfection
|Washing with antiseptic by rubbing palms and back hand sides
|During infection outbreaks, aseptic procedures and after contact with blood or body fluids
|Destroy and reduce resident micro-organisms
|Hands and forearms washed with antiseptic soap
|Minimum of 2 minutes.Dry using sterile towel
|Before invasive procedures
|Removes transient micro-organisms and has a longer effect (NSW Health Dpt)
What is the process to access hard/electronic copy of the applicable risk management standard for the health service closest to where you live?
Hard/electronic copies of risk management standard for health service are accessible in my area through online search engines and medical journal publications in local libraries.
Why is context important?
In health care settings, context is important in determining the nature of possible risks, and appropriate cautionary and prevention measures. It also helps to determine the extent to which health care workers are vulnerable to infection risks
What are the three elements essential for the transmission of infection?
The three elements essential for the transmission of infections are:
- Mode of transmission.
- Route of Transmission.
- Host susceptibility.
List the factors that increase a patient’s susceptibility to hospital acquired infections.
- Size of the facility-small size facilities that encourage close contact.
- Admission of infected patients
- Triage procedures.
- Ward crowding.
Nursing staff alert you that the rural hospital has run out of single use gloves for inpatient areas, “the quota for the month has been used there is no more available”. Prepare a case to negotiate with senior management.
Single use gloves are very essential in the daily procedures in a health care setting. There are high risks of contamination and infection through contact with body fluids, blood, mucous membrane and non-intact skin of infected patients. In this regard, this is very serious and urgent matter that deserves immediate consideration to avoid the spread of nosocomial infections
You have accepted a middle management position in a low resource health care setting. You note that after each surgical case the gloves are scrubbed, washed and reprocessed using steam sterilization. Comment on the appropriateness of this practice outlining suitable alternatives.
Scrubbing is abrasive and may cause tears. Steam sterilization is not effective for gloves since they are made of latex, which is affected by high temperatures. The appropriate alternative is to soak the gloves in a 0.5% active chlorine for 10 minutes, rinse in clean water, brush the internal and external surfaces with soap, rinse and then air-dry.
In what circumstances is double gloving appropriate?
Double gloving is appropriate in surgical operations involving sharp objects. This is to avoid perforation of the inner glove, thereby reducing risks of infection.
Accidental needle-stick injuries occur frequently in health care settings. Outline factors influencing self reporting of needle-stick injuries and suggest approaches to overcome these barriers.
Some of the factors influencing self-reporting of needle-stick injuries in health care settings include lack of adequate information among health workers on the risks involved, lack of health policies on reporting and the involvement of health workers in the sale of syringes for recycling. To overcome these barriers, educational programs should be conducted to health workers, develop an effective waste management system as well as the use of incineration and non-incineration technologies in treatment.
Outline the Australian standards management of a staff member incurring a sharps injury during a minor surgical procedure. The sharp was contaminated with the patient’s blood and they are a known intravenous drug user with negative HIV status. What is the supporting evidence?
The standard management is to remove gloves, clean the wound with a detergent and apply antiseptics to kill pathogens and avoid skin infection. Evidence of intravenous drug usage include skin popping due to drug injection into the skin’s fatty layer and extravasations due to seepage of drugs into the skin tissues.
Outline the responsibilities and risks associated with implementing additional precautions.
Implementing additional precautions require the provision of extra facilities such as single rooms, personal toilets and extra protective clothing. It also requires strict quarantine/isolation measures to avoid the spread of infections. The major risk associated with additional precautions is the possibility of psychological disorders on the isolated patients.
List the factors influencing staff compliance with implementing isolation appropriate to additional precautions required.
Factors that influence staff compliance with implementing isolation measures include:
- The need to avoid the stigmatization of the patient.
- To avoid situations of anxiety and other isolation-related psychological disorders in patients.
- To avoid depersonalization effects by emphasizing on the physical care while ignoring psychological aspects of nursing.
Positive pertussis serology from a staff member employed in the nursery of the maternity unit has been notified to the Infection Control Team by the local public health unit.
Outline the response by the Infection Control Team.
__The response of the Infection Control Team is to restrict the particular ward to avoid further infections, carrying out serology tests for persons in the pediatric ward and finally carrying out an isolation exercise. Linen and medical equipment in the ward will be disinfected and sterilized, and nurses handling patients in the ward e required wearing protective clothing.
Discuss the ethical issues.
__The ethical issue is the stigmatization that will result from the isolation of infected patients. The two competing values are whether to restrict the movement of a patient with a resistant infection which will affect him psychologically, or to priotize the well being of others who might get infected if isolation is not carried out. The overriding factor, however, is to strive to maximize good outcome while minimizing possible harm (Herwaldt, 1998).
Journal activity 5.2
Describe how you would sterilize a single-use only needle in a resource-poor setting.
- Pre-disinfection by immersing in a detergent mixed with clean water.
- Careful brushing of the instrument, especially at the pointed extreme.
- Rinse thoroughly in clean water to remove detergent.
- Dry with a fluff-free towel.
- High disinfection by immersing in a 0.1 % active chlorine solution for 20 minutes.
- Sterilizing using saturated steam sterilization process. (Connell 2010).
Describe the steps in managing a spill of blood or body fluids in Australia.
- Wear protective gear to avoid risks of body contact with blood pathogens.
- Cleaning the spills with detergents and warm water thoroughly. Sodium hypochlorite may be used if necessary.
- Disinfecting the whole area.
How would you sterilize instruments used in a neurosurgical operation on a suspect Crutzfeld-Jacob Disease patient?
Such instruments may contain infection agents that are resistant to steam sterilization. In such cases, a chemical sterilant should be used to kill pathogenic agents.
List of References
Department of Health and Ageing. Infection control guidelines for the
prevention of transmission of infectious diseases in the health care setting. Canberra, 2004
Gammon, J. The psychological consequences of source isolation: a review of
the literature. Journal of Clinical Nursing1999;8:13-21.
Herwaldt, L., M. D. Decker, Eds. A Practical Handbook for Hospital
Epidemiologists, Chapter 8 Ethical Aspects of Infection Control 1998.
McCulloch J. Ed. Infection Control. Science, Management and Practice.
London, Whurr Publishers Ltd. 2000
MSF. Infection Control in Health care settings. 2006. Retrieved August 12,
Mujeeb, S.A., M.M. Adil, A. Altaf, Y. Hutin, S. Luby. Recycling of Injection
Equipment in Pakistan. Infection Control & Hospital Epidemiology 2003;24(2):145-146.
New South Wales Health Department. Resources Packages: Hand Washing.
2010. Retrieved August 12, 2010 <
Whitby, R. M. and M. L. McLaws. Hollow-bore needlestick injuries in a tertiary
teaching hospital: epidemiology, education and engineering. Medical Journal of Australia 2002;177:418-422.
Speare, R., Connell, J. Infection Control in Healthcare Settings. School of
Public Health, `Tropical Medicine, JamesCookUniversity, Townsville, 2010.
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