Infection prevention and control
The prevention of infection is a core element of safe and effective midwifery practice. Midwives and other healthcare professionals should consider the development of infection as an ‘adverse’ event, and monitor and investigate all infections as part of their organisation’s patient safety systems and learning culture. Box 1.1 indicates how infections may occur.
As knowledge of microbiology and the epidemiology of multiresistant organisms has increased, prevention now also includes the avoidance of colonisation of bacteria of clinical importance including (but not limited to):
- Staphylococcus aureus (including PVL strains)
- Meticillin-resistant Staphylococcus aureus (MRSA)
- Pseudomonas aeruginosa
- Multidrug-resistant Gram-negative bacteria (MDR GNB) such as Klebsiella pneumonia and Escherichia coli (E. coli)
- Mycobacterium tuberculosis
- Fungi and yeasts.
Viruses can also be problematic, in particular blood-borne viruses (hepatitis B and C, HIV) and chickenpox.
Box 1.2 provides examples of common infections associated with pregnant and postnatal women.
A number of different practice interventions are described supporting the midwife to prevent or interrupt the development of infection or colonisation, which may lead to risks specifically in-patient care setting. They are:
- The use of standard precautions (see Chapter 4)
- Knowledge and compliance of organisational infection prevention and control policies and guidance
- Active laboratory surveillance and reporting of cases of infection
- Screening of women/babies
- Vaccination of staff, women and babies
- High standards of cleanliness
- Education and information on hygiene, infection and prevention methods.
Many women and babies who develop an infection recover well; a small proportion go on to develop sepsis, a potentially life-threatening condition (Chapter 5). The importance of sepsis as a cause of maternal death has been recognised in reports such as MBRRACE UK.
Sepsis cannot be transmitted from person to person. It is a condition that occurs due to overwhelming infection, resulting in an immune cascade leading to septic shock. It can affect both mothers and neonates. Information on neonatal sepsis is detailed below. See Chapter 5 for the management of sepsis in adults.
Isolation: Physical (source) isolation has traditionally been used to separate people receiving hospital care from others due to a risk of spread of infection. In midwifery and neonatal care, isolation may be through the provision of single room accommodation (for mother or mother and baby) or an incubator/cot in the neonatal setting.