Infection prevention and control in the community

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Infection prevention and control in the community




Introduction


This chapter begins by focusing on prevention and control of infection and then elaborates on the prevention and control of infection in wound care.


Healthcare-associated infections (HCAIs or HAIs) are infections that are acquired in a hospital or other healthcare setting, such as a hospice or care home, or as a result of a healthcare intervention or procedure (Turner 2008). They pose a significant threat to the safety of patients and the public. Consequently, policies and procedures for the control of infection are a major concern to the NHS and a particular area of responsibility for all practitioners within all aspects of care. It is important to note here that this does not only apply to what may be called adult nursing placements, but those related to children’s nursing, where more children are also being cared for in the home. Patients suffering from mental health can also be at risk of infection from issues such as self harm. Students who are learning in mental health nursing placements (Stacey et al 2012) may also be called upon to administer care with their mentors for patients with mental health problems who have been discharged home following surgery. Collaborative working with the district nurse in such situations is essential to ensure holistic care of the patient.


The community nurse is responsible for the holistic care of the person at home and this includes helping to prevent and control infection. More people of all ages are discharged home earlier from hospital, many on the day of surgery and an increasing number of procedures and treatments are offered at the local health centre by their doctor (GP) and specialist nurses such as practice nurses and advanced nurse practitioners. It is now commonplace for people to receive care at home such as intravenous medication, urinary catheterisation and enteral feeding.


These various procedures emphasise the importance of the prevention and control of infection within a variety of settings in the community, including nurseries, schools, residential and nursing homes, health centres and the person’s home. The physical environment within the home can also vary markedly, resulting in the community nurse requiring considerable adaptation skills to prevent or maintain control of infection: changing a dressing in a person’s home where space is at a minimum might for example entail kneeling on the carpet or even on the bed and the community nurse must make the environment as safe as possible by implementing the same principles of infection control that would be adopted in hospital.


The Nursing and Midwifery Council (NMC) require all student nurses to demonstrate essential skills in infection prevention and control. The ‘Essential Skills Cluster: Infection Prevention and Control’, states that people can trust the newly registered graduate nurse to:





• identify and take effective measures to prevent and control infection in accordance with local and national policy


• maintain effective standard control of infection precautions and apply and adapt these to needs and limitations in all environments


• provide effective nursing interventions when someone has an infectious disease including the use of standard isolation techniques


• fully comply with hygiene, uniform and dress codes in order to limit, prevent and control infection


• safely apply the principles of asepsis when performing invasive procedures and be competent in aseptic technique in a variety of settings


• act, in a variety of environments including the home care setting, to reduce risk when handling waste, including sharps, contaminated linen and when dealing with spillages of blood and other body fluids.


NMC (2010: 124)



A variety of key personnel are specifically involved with infection prevention and control. For example, infection control nurses are specialists in infection prevention and control and provide advice on infection prevention and control in hospital and in the community.


Hospital infection control teams provide an infection control service for the hospital, which can also include community hospitals. These teams are often led by a nurse consultant in this field and a lead consultant microbiologist. Infection control link personnel are normally employees working in a surgery or care home who have completed additional training in infection control and act as a link between the workplace and the infection control nurse. Environmental health officers work for local authorities and advise on food safety, pest control and waste disposal. The Public Health departments in many community health organisations play a key role in the prevention and control of infection across the community as a whole, including areas such as child care centres (Health Protection Scotland 2012: http://www.documents.hps.scot.nhs.uk/hai/infection-control/guidelines/infection-prevention-control-childcare.pdf – accessed July 2012.)




Lawrence and May (2003) outline a checklist of questions which can help the nurse with control of infection in the home; this includes the following:



Normally, discharge from hospital will be planned and the community nurse will have been given sufficient time to make appropriate arrangements to enable continuity of care; in some cases, a home visit may have been organised for example before surgery, enabling the above questions to be addressed.



Activity


In discussion with your mentor (this applies to all field of practice pathways – adult, mental health, learning disability and children’s nursing), select a patient from their allocated caseload and with their agreement, use Lawrence and May’s (2003) checklist (or an assessment template used locally) to assess their infection prevention and control status. You should be able to follow this through by mapping your assessment against local infection prevention and control policy and discussing with your mentor where action is required to manage risk. This exercise could be used to evidence learning about infection prevention and control in the community in your portfolio and contribute to meeting the requirements of the NMC Essential Skills Cluster outcomes as well.



Standard infection control precautions


The practice of standard infection control precautions aims to prevent the transmission of infection. Potential sources of infection include blood and body fluids or excretions and any equipment in the care environment that could become contaminated. Figure 7.1 outlines the ways in which infection can spread. It is important that you learn about this process and most importantly, the physiological aspects of infection and its causes and outcomes.



It is essential that all practitioners carry out standard infection control precautions at all times, irrespective of whether infection is present or not and irrespective of the setting in which they are caring for their patients. However, compared with the hospital setting, it can be challenging to practise all standard infection control precautions to the same high standard and in some community contexts, the risks are very different. For example, risks such as cross-infection between people in close proximity as in a hospital ward are significantly reduced in the home but it is also more difficult to control the environment when it is a person’s home. The elements of standard infection control precautions are listed in Table 7.1. It is also important to include the patient’s family and/or immediate carer in any risk assessment of infection and how to prevent it happening. Patient education will often include the family member or carer, especially when the patient is unable to undertake any procedure necessary.



Lectures covering standard infection control precautions such as hand decontamination, personal protective clothing and safe handling of sharps will have been included in your preparation for practice learning and will also form an essential part of your practice assessment (formative or summative) in many placements.



Hand hygiene


Handwashing is an essential component in the prevention and control of infection and regular careful handwashing is vital when you are looking after someone at home. However, within someone’s home, hot and cold running water might not always be readily available. Community nurses therefore carry alcohol hand rubs/alcohol hand gel and tissues to address this problem but it must be remembered that this must be accompanied by an appropriate hand decontamination technique. (See an online example of this technique at the CETL website: http://www.cetl.org.uk/learning/hands/hand-washing/data/downloads/print-sheet.pdf – accessed October 2012.)


In your initial preparation for clinical practice, you will have received specific instructions on how to wash your hands, covering all the surfaces of your hands including the tips of your fingers, your thumbs and the areas between the fingers. It is essential to explain the risks associated with poor hand hygiene to service users and carers and educate them to undertake effective hand hygiene, particularly within the home setting, when an informal carer may be delivering the majority of nursing care. (See an example of information for patients and carers to use in the home at the Stroke4Carers website: http://www.stroke4carers.org/?p=5086 – accessed October 2013)




Personal protective equipment


The main purpose of protective clothing is to prevent the spread of potentially pathogenic micro-organisms to another client, preventing contamination of the nurse’s uniform or clothing (NICE 2003). It is important that you adhere to the local policy and protocols regarding protective clothing such as gloves and aprons.





Sharps management


One of the potential hazards facing nursing staff is the potential risk of needle stick injury. Safe practice should be maintained at all times, as it is not always possible to know who is infected by bacteria or viruses. Within the community setting, it may be difficult to reach local occupational health or accident and emergency departments if needle stick injury occurs, therefore you should always check local policy regarding the procedure if this occurs. Practices to prevent injury are similar to hospital practice and include:



Remember also that inoculation can also occur if abrasions, cuts or scratches are exposed to blood or body fluids. Within their everyday work, nurses risk exposure to dangerous viruses such as hepatitis as a result of needle stuck injury (RCN 2009).


You must become acquainted with the local guidelines and policies in relation to needle stick injury and sharps management. However, most protocols regarding needle stick injury will follow the same general guidelines which include:



• Encourage bleeding from the inoculation site and wash under running water


• Cover with a waterproof dressing and report to a senior member of staff on duty


• Record the incident


• Inform occupational health, GP (or visit accident or emergency) and client’s carer


• Assess risk of hepatitis B and C or HIV


• Obtain relevant blood samples from source and recipient with informed consent


• Seek specialist advice if there a need for post-exposure prophylaxis or follow-up for Hepatitis B and C or HIV?




Clinical waste management


Clinical waste is any waste such as swabs, dressings, syringes, needles, which have been in contact with tissue, blood or body fluids. The increasing number of complex treatments being delivered within the home and other community settings has increased the amount of clinical waste requiring safe disposal. Local policies and guidelines must be adhered to by community staff and collaborative working may be required with the local infection control nurse and local council to arrange appropriate disposal and removal of clinical waste from people’s homes.


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Feb 19, 2017 | Posted by in NURSING | Comments Off on Infection prevention and control in the community

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