The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [111]
2 Exclude any visitor who has had symptoms of infection or been in contact with a communicable disease in the previous 48 hours. Individuals may be infectious both before and after developing symptoms of infection (Chadwick et al. 2000, E).
3 Educate all visitors to decontaminate their hands before entering the isolation room. Hands carry large numbers of potentially pathogenic micro-organisms that can be easily removed (WHO 2009, C).
4 Visiting by children, other than very close relatives, should be discouraged. Children are more likely to have been in contact with infectious diseases but are less likely to be aware of this, and are more likely to develop infections because they have less acquired immunity. E
Prevention and management of inoculation injury
Related theory
Healthcare workers are at risk of acquiring bloodborne infections such as human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS), hepatitis B and hepatitis C. While the risk is small, five episodes of occupationally acquired HIV infection had nonetheless been documented in the UK up to 2002 (Health Protection Agency 2005). In 2006–7, 914 incidents of occupational exposure to bloodborne viruses were reported, of which between one-fifth and one-third could have been prevented through proper adherence to universal precautions and the safe disposal of hazardous waste (Health Protection Agency 2008). An understanding of the risk of infection and the preventive measures to be taken is essential in promoting a safer work environment (UK Health Departments 1998).
Bloodborne viruses are present in both the blood and other high-risk fluids that should be handled with the same precautions as blood. High-risk fluids include:
cerebrospinal fluid
peritoneal fluid
pleural fluid
pericardial fluid
synovial fluid
amniotic fluid
semen
vaginal secretions
breast milk
any other body fluid or unfixed tissue or organ containing visible blood (including saliva in dentistry).
Body fluids that do not need to be regarded as high risk, unless they are bloodstained, are:
urine
faeces
saliva
sweat
vomit.
The most likely route of infection for healthcare workers is through the percutaneous inoculation of infected blood via a sharps injury (often called a needlestick injury) or by blood or other high-risk fluid splashing onto broken skin or a mucous membrane in the mouth, nose or eyes. These incidents are collectively known as inoculation injuries. Blood or another high-risk fluid coming into contact with intact skin is not regarded as an inoculation injury. It carries little or no risk due to the impervious nature of intact skin.
Evidence-based approaches
If the guidance in Box 3.2 is followed, it has been shown to reduce the risk of sharps injuries.
Box 3.2 Actions to reduce the risk of inoculation injury
Do not re-sheath used needles.
Ensure that you are familiar with the local protocols for the use and disposal of sharps (e.g. location of sharps bins) and any other equipment before undertaking any procedure involving the use of a sharp item.
Do not bend or break needles or disassemble them after use: discard needles and syringes into a sharps bin immediately after use.
Handle sharps as little as possible.
Do not pass sharps directly from hand to hand; use a receiver or similar receptacle.
Discard all used sharps into a sharps container at the point of use: take a sharps container with you to the point of use if necessary. Do not dispose of sharps into anything other than a designated sharps container.
Do not fill sharps bins above the mark that indicates that it is full.
Sharps bins that are not full or in current (i.e. immediate) use should be kept out of reach of children and with any temporary