The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [94]
Assessment and recording tools
Assessment for infection prevention and control should take place at every level in an organization providing healthcare, from completing an assessment of infection risks (both to and from the patient) as part of the care planning process to the audit of compliance in a team, unit or hospital (DH 2010a). As mentioned previously, the Care Quality Commission assesses care providers in England against the requirements of the Hygiene Code. Other external assessors may also require evidence that procedures are in place to reduce the risk of healthcare-associated infection. Such evidence may include audits of compliance with hand hygiene against the WHO ‘5 moments’ when hand hygiene should be performed at the point of care (WHO 2009) or audits to demonstrate that all the elements of a procedure that carries a particular risk of infection have been carried out. Such procedures are sometimes referred to as ‘high-impact interventions’ because the risk of infection is such that improving adherence to good practice when they are carried out can have a significant impact on an organization’s infection rates. The English Department of Health’s Saving Lives toolkit (DH 2007a) is a collection of guidelines for high-impact interventions in the form of care bundles, and audits of those care bundles that can be used both for practice improvement and as evidence of good practice for internal and external assessment. All nurses should know which of these tools are being used in their workplace and actively participate in their completion.
At the level of individual patients, all additional precautions for infection prevention should be documented within the patient’s individual plan of care, which should include regular reassessment and changes as necessary as the patient’s condition alters. For example, a patient given antibiotics for a chest infection may be at risk of developing Clostridium difficile infection; if they develop diarrhoea, they will need to be isolated immediately but if the diarrhoea settles following treatment, they will no longer require isolation once they have been free of symptoms for 48 hours (DH/HPA 2008). When a procedure is carried out that requires additional precautions, for example aseptic technique, it should be documented in the record of that procedure that those precautions were adhered to or, if not, the reasons why they could not be implemented.
Specific patient preparations
Education
All patients should be informed about the risks of healthcare-associated infection and the measures that are known to reduce the risk of infection. In particular, patient education programmes that encourage the patient to ask healthcare workers ‘Did you wash your hands?’ have been demonstrated to increase compliance with hand hygiene (McGuckin et al. 2001). In addition, patients who are infected or colonized with infectious agents that require additional precautions to be implemented to reduce the risk of infection to other patients must be clearly told the nature of the infectious agent and its mode of spread, the risk to others, the details of the precautions required and the rationale behind them. Patients are likely to suffer anxiety if they are infected or colonized by such agents and this can be alleviated through being provided with clear information. Similarly, there are adverse psychological effects of isolation and other precautions (Gammon 1998) and these are more likely to be mitigated if the patient has a clear understanding of why they are being implemented (Ward 2000).
Procedure guideline 3.1 Handwashing
Essential