8. Principles of infection control
Standard infection control precautions67
Management of spills or accidents69
Role and responsibilities of the midwife69
Having read this chapter the reader should be able to:
• discuss the nature and significance of standard precautions, indicating the midwife’s role and responsibilities
• describe source and protective isolation nursing
• briefly discuss the principles of protective isolation.
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Healthcare professionals are widely exposed to large numbers and varieties of microorganisms. Human immunodeficiency virus (HIV) and other blood-borne contagious infections have increased the need to protect both women and midwives from infection. The term ‘standard precautions’ (previously having incorporated ‘universal precautions’) refers to the measures taken universally, i.e. by all health professionals for all women and babies, all the time, (whatever the clinical environment) to achieve mutual protection. As an important area of care, the reader is required to keep up to date with developing protocols, both for self-protection and to provide the best possible care. The ‘cost’ of infection to individuals (service users and staff), the NHS and the community as a whole is large and the increasing incidence of healthcare-acquired infections (HCAIs) all mean that complacency cannot be permitted. This chapter reviews the use of standard precautions and the principles of isolation nursing.
Standard infection control precautions
Childbearing women are considered to be in a high risk category for standard precaution use because:
• unprotected sexual intercourse is likely to have taken place
• there is exposure to large amounts of blood and body fluid during care.
It is almost impossible to appreciate who may be infected and who is not. Applying precautions to everyone maintains safety and prevents any individual feeling isolated or ‘singled out’. Confidentiality might be compromised if some procedures are perceived to be used for some women and not for others. Although there might be times when wearing protective clothing is potentially disruptive to the relationship that a midwife has built up with a woman, the midwife must consider the significance of protection, both for the woman and midwife, and that of other women too.
Standard precautions should be used when there is (or expected to be) contact with blood, vaginal and seminal secretions, urine or faeces, amniotic fluid, cerebrospinal fluid, saliva, breast milk or any other bodily fluid. Sweat is the only exception. The principles need to be applied correctly and the midwife needs to be alert to the following situations:
• examination per vaginam, use of amnihook, fetal scalp electrodes, etc.
• childbirth, of whatever type
• theatre work, including suction/aspiration of body fluids
• disposal of administration sets, blood transfusion sets, etc.
• specimens, including neonatal capillary sampling
• newborn babies prior to bathing
• postnatal observations of lochia and perineum
• perineal repair
• cannulation and venepuncture.
Principles of standard precautions
This should be practised routinely and thoroughly before and after every episode of direct contact or care (before applying and removing gloves), when hands are visibly soiled and after several consecutive applications of alcohol hand rub (Pratt et al 2007) (see Chapter 9 for more detail). Hand decontamination should be subjected to regular audit.
Cuts or abrasions on the skin should be covered with a waterproof dressing that is an effective barrier to viruses and bacteria.
Personal protective equipment
Personal protective equipment (PPE), that is, gloves, gowns, aprons, masks, goggles, visors, caps and theatre footwear, should be selected following a risk assessment. Questions that should be asked include: What is the likelihood of transmission of microorganism to woman or midwife? What is the risk of the midwife being contaminated by any of the woman’s body fluids? Determining the risk will aid the midwife in their choice of protection; Nicol et al (2008) offer a flow-chart to aid selection of PPE. The items should all be readily available at the point of use.
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