The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [80]
Infection Prevention and Control
Definitions
‘Infection prevention and control’ has been defined as the clinical application of microbiology in practice (RCN 2010). More simply, it is a collective term for those activities intended to protect people from infections. Such activities are carried out as part of daily life by most individuals; for example, people wash their hands before eating to protect themselves from infection. The term is most often used in relation to healthcare, in particular with reference to preventing patients acquiring those infections most often associated with healthcare (such as wound infection) and preventing the transmission of micro-organisms from one patient to another (sometimes referred to as cross-infection).
Defined in Box 3.1 are some other terms used when discussing infection prevention and control. Confusion may sometimes arise because some of these terms are synonymous or have meanings which overlap, or are used in different ways by different people or organizations and this has been highlighted wherever possible.
Box 3.1 Terms used when discussing infection prevention and control
Infectious agent
Anything that may be transmitted from one person to another, or from the environment to a person, and subsequently cause an infection or parasitic infestation. Infectious agents are most often micro-organisms such as bacteria or viruses.
Pathogen
A micro-organism that is capable of causing infection. Many micro-organisms are opportunistic pathogens; that is, they will cause infection in vulnerable individuals but not, normally, in healthy adults.
Colonization
When micro-organisms are present on or in a person but not currently causing any harm, that person is said to be colonized with those organisms. For example, human beings are normally colonized with huge numbers of several different species of bacteria.
Healthcare-associated infection (HCAI)
Any infection acquired as a result of a healthcare-related intervention or an infection acquired during the course of healthcare that the patient may reasonably expect to be protected from. For example, a person may acquire viral gastroenteritis in many circumstances but if they acquire it in hospital from another patient, it should be regarded as healthcare associated. This has replaced the term ‘hospital-acquired infection’.
Cross-infection
Cross-infection is one term given to the transmission of infectious agents between patients within the healthcare setting. It may be direct transmission from one person to another, or indirect, for example via an incorrectly cleaned piece of equipment.
Universal precautions
Correctly called universal blood and body fluid precautions, these are the precautions that are taken with all blood and ‘high-risk’ body fluids. They are based on the principle that any individual may be infected with a bloodborne virus, such as HIV or hepatitis B, and so pose a risk of infection; no individual can be regarded as completely ‘risk free’. They are incorporated within standard precautions.
Standard precautions
The phrase ‘standard precautions’ is sometimes used interchangeably with ‘universal precautions’ (see above) but is used in this chapter and elsewhere (e.g. Health Protection Scotland 2009, Siegel et al. 2007) to describe the actions that should be taken in every care situation to protect patients and others from infection, regardless of what is known of the patient’s status with respect to infection. Standard precautions include:
hand hygiene at the ‘5 moments’ described by the WHO (2009), including before and after each patient contact
care in the use and disposal of sharps
the correct use of personal protective equipment for contact with all blood, body fluids, secretions and excretions