The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [90]
Indications
Infection prevention and control precautions must be taken with all patients, regardless of whether or not they are known to be carrying any particular infectious agent that may cause a hazard to others. This is because it is impossible to guarantee whether or not any given individual is free of any particular infectious agent and because many common micro-organisms may cause infections in some circumstances. The indications for additional infection control precautions are that an individual is particularly vulnerable to infection because of some deficiency in their normal defence mechanisms or that they are known to be infected or colonized with an infectious agent that may pose a particular risk to others.
Contraindications
As mentioned previously, precautions to prevent the spread of infection must be based on a risk assessment that takes in all the relevant factors. In some cases precautions will need to be modified because of a patient’s physical or psychological needs. Isolation, for example, has been demonstrated to have an adverse psychological effect on some individuals (Morgan et al. 2009).
Anticipated patient outcomes
The anticipated outcome is that no patient will acquire micro-organisms from any other individual during the course of healthcare or suffer an avoidable infection.
Legal and professional issues
In England, the Health and Safety at Work, etc. Act 1974 is the primary piece of legislation relating to the safety of people in the workplace. It applies to all employees and employers, and requires them to do everything that is reasonable and practicable to prevent harm coming to anyone in the workplace. It requires employers to provide training and appropriate protective equipment and employees to follow the training that they have received, use the protective equipment provided, and report any situations where they believe inadequate precautions are putting anyone’s health and safety at serious risk. This dovetails with the requirements of the Nursing and Midwifery Council (NMC 2008a) for nurses to promote and protect the well-being of those in their care and to report their concerns in writing if problems in the environment of care are putting people at risk.
The requirement to protect individuals from healthcare-associated infections is further emphasized in England by the Health and Social Care Act 2008. This legislation is monitored and enforced by the Care Quality Commission, which assesses care providers against the requirements of the Code of Practice for health and adult social care on the prevention and control of infections and related guidance (DH 2010a). Often referred to as the Hygiene Code, this has been applied to NHS hospitals in England, in one form or another, for some years but from October 2010 applies to all providers of health or adult social care. Each provider must be registered with the Care Quality Commission and declare compliance with the ten criteria of the Hygiene Code. These criteria are summarized in Table 3.4.
Table 3.4 Criteria of the 2010 Hygiene Code of Practice
Compliance criterion What the registered provider will need to demonstrate
1 Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and consider how susceptible service users are and any risks that their environment and other users may pose to them
2 Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections
3 Provide suitable accurate information on infections to service users and their visitors
4 Provide suitable accurate information on infections to any person concerned with providing further support or nursing/medical care in a timely fashion
5 Ensure that people who have or develop an infection are identified promptly and receive the appropriate treatment and care to reduce the risk of passing on the infection to other people
6 Ensure that all staff and those employed