The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [82]
Cohorting
When the number of patients with a particular infection or carrying a particular organism exceeds the single room capacity of a healthcare provider, they may be nursed together in a cohort. This is most often done for highly infectious conditions such as norovirus. Patients who require isolation but have different infections cannot be cohort nursed together because of the risk of cross-infection between them.
Barrier nursing
The practice of nursing a patient who is carrying an infectious agent that may be a risk to others in such a way as to minimize the risk of transmission of that agent to others.
Reverse barrier nursing
The practice of nursing an individual who is regarded as being particularly vulnerable to infection in such a way as to minimize the transmission of potential pathogens to that person.
Related theory
People who are in hospital or receiving healthcare elsewhere have an increased vulnerability to infection. There are many reasons for this, including reduced immunity and the use of invasive devices and procedures that bypass the body’s normal defences. In addition, being in hospital puts them in closer proximity to other people with infectious conditions. However, many infections acquired by patients receiving healthcare are preventable, as has been amply demonstrated by the 50% reduction in MRSA bacteraemia (bloodstream infections caused by meticillin-resistant Staphylococcus aureus) in English NHS hospitals between 2005 and 2008 (Health Protection Agency 2010a) and recent dramatic falls in the number of cases of Clostridium difficile infection in England (Health Protection Agency 2010b). These reductions have been achieved by the systematic application and monitoring of established practices for the prevention and control of infection, including diligent hand hygiene and correct aseptic technique.
Common healthcare-associated infections
The 2006 national prevalence survey of patients in hospital in England with infections identified a prevalence rate of around 8%; that is, eight out of every 100 patients in hospital at the time of the survey had an infection. The most common types of infection were gastrointestinal infections (22%), urinary tract infections (20%), pneumonia (14%) and surgical site infections (13.8%) (Hospital Infection Society/Infection Control Nurses Association 2007). Less common types of infection, for example bacteraemia (bacteria infecting the bloodstream), may be more severe, so all procedures must be carried out in such a way as to minimize the risk of any infection.
Causes of infection
Infections are normally caused by micro-organisms. These are life forms too small to see with the naked eye. In some cases, for example prion diseases such as Creuzfeldt–Jacob disease (CJD), it can be unclear if the causative agent is actually living or not, while at the other extreme, infection control precautions will be applied to prevent the transmission of visible parasites such as scabies mites or enteric worms that may be metres in length (although their eggs are microscopic). The term ‘infectious agent’ is therefore often used to describe 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.
The major groups of micro-organisms are described below. Which group an infectious agent belongs to will have significant implications for the treatment of an infected individual – for example, antibiotics target bacteria but have no effect on viral infections – but for infection prevention and control it is more important to understand the route of transmission as this will dictate if any additional, transmission-based, precautions need to be in place.
Types and classification of micro-organisms
Historically, the classification of micro-organisms was based on physical characteristics such as their size, shape or ability to retain a particular stain to make them visible under the microscope. Some of these distinctions are still useful, but classification is increasingly based