Infection prevention and control - Royal Marsden Manual of Clinical ...

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 signifi cant impact on an organization’s
infection rates. The English Department of Health’s Saving
Lives toolkit ( DH 2007a ) is a collection of guidelines for highimpact
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
Procedure guideline 3.1 Handwashing
Essential equipment
■ Hand wash basin
■ Liquid soap
■ Paper towels
■ Domestic waste bin
Preprocedure
Action Rationale
1 Remove any rings, bracelets and wristwatch still worn
and roll up sleeves. (Note: It is good practice to remove
all hand and wrist jewellery and roll up sleeves before
entering any clinical area and the English Department
of Health has instructed NHS trusts to implement a
‘bare below the elbows’ dress code.)
2 Cover cuts and abrasions on hands with waterproof
dressing.
Infection prevention and control
chest infection may be at risk of developing Clostridium diffi
cile 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.
Specifi c 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 ).
Jewellery inhibits good handwashing. Dirt and bacteria
can remain beneath jewellery after handwashing. Long
sleeves prevent washing of wrists and will easily become
contaminated and a route of transmission of microorganisms
( DH 2010c, C ).
Cuts and abrasions can become contaminated with bacteria
and cannot be easily cleaned. Repeated handwashing can
worsen an injury ( WHO 2009 , C ). Breaks in the skin will
allow the entry of potential pathogens.
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