The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [91]
7 Provide or secure adequate isolation facilities
8 Secure adequate access to laboratory support as appropriate
9 Have and adhere to policies designed for the individual’s care and provider organizations that will help to prevent and control infections
10 Ensure, so far as is reasonably practicable, that care workers are free of and are protected from exposure to infections that can be caught at work and that all staff are suitably educated in the prevention and control of infection associated with the provision of health and social care
From DH (2010a) © Crown copyright. Reproduced under the terms of the Click-use Licence.
Nurses need to be aware of the measures that are in place in their workplace to ensure compliance with the Code of Practice. For example, many hospital trusts have a programme of regular visits to clinical areas by senior staff who will carry out an inspection against the criteria of the Code as if they were an external assessor. This programme ensures that senior staff are familiar with the Code and that everyone is familiar with the inspection process. In addition, nurses may need to carry out activities to promote compliance and provide evidence of assurance, such as audits of hand hygiene performance or compliance with aseptic technique. One such set of audits in place in many hospitals in England is the package produced by the Department of Health (2007a) and known collectively as Saving Lives. These are discussed in more detail later.
In addition to healthcare-specific requirements, items of legislation and regulation have also been devised with the objective of reducing the risk of infection in any situation that apply to healthcare as much as they do to any other business or workplace. These include legislation and regulation relating to food hygiene (Food Safety Act 1990), water quality (Health and Safety Commission 2001), waste management (Hazardous Waste Regulations 2005) and other issues that are peripheral to healthcare but must be taken into account when developing policies and procedures for an NHS trust or other healthcare provider.
Competencies
The NMC Code (NMC 2008a) states that all nurses must work within the limits of their competence. This means not carrying out aseptic procedures, for example, without being competent and confident that they can be carried out without increasing the risk of introducing infection through lack of knowledge or technique. However, there are some procedures for infection prevention and control that must be carried out as part of every care activity, and so all nurses must be competent in these if they are to provide any level of physical care at all. These include:
hand hygiene
use of personal protective equipment such as gloves and aprons
appropriate segregation and disposal of waste, in particular used sharps items and other equipment designated as single use
appropriate decontamination of reusable equipment after use.
Preprocedural considerations
Equipment
All infection prevention and control measures have the objective of preventing the transmission of infectious agents, whether by removing them from items that may be contaminated (hand hygiene and cleaning) or establishing a barrier (personal protective equipment and isolation). There are therefore some items that should be available for effective infection prevention and control in any situation where healthcare is provided.
Equipment for hand hygiene
It is essential that wherever care is provided, there are facilities for hand hygiene. Hand wash basins in clinical areas should have taps that can be turned on and off without using the hands; that is, they should be non-touch or lever operated (DH 2006b). Basins used solely by clinical staff for hand hygiene should not have plugs (to encourage hand washing under running water) or overflows because they are difficult to clean effectively and can be a reservoir for organisms such as Pseudomonas that may cause infection in vulnerable