Topic 4 DQ 1
Mariela Miccio
Posted Date
Apr 14, 2022, 7:49 PM
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The inpatient facility where I worked implements these three risk management strategies to decrease the spread of infections:
- The use of gloves, gowns, and masks work to reduce the transmission of infections between patients. When used properly, PPE acts as a barrier between infectious materials such as viral and bacterial contaminants and your skin, mouth, nose, or eyes (mucous membranes). The barrier has the potential to block transmission of contaminants from blood, bodily fluids, or respiratory secretions (Baron, 2009)
- Hand hygiene is the single most effective action you could do to reduce the spread of pathogens and prevent infections. Wash them thoroughly with soap and water or clean them with alcohol-based hand rub (APIC guide, n.d.)
- Environmental Cleaning – Keeping the environment clean is another curcial way to prevent the spread of infection. This includes regularly cleaning surfaces, such as countertops and doorknobs, and using disinfectants to kill germs (WHO, 2021). Environmental cleaning is a fundamental principle of infection prevention in healthcare settings. Contaminated hospital surfaces play a key role in the transmission of dangerous pathogens.
In conclusion, effective infection prevention and control practices support reduced risk of infection transmission between patients, healthcare workers and others in the healthcare environment; they are an essential component of safe, quality health care. The best way to prevent infection or control infection spread is to be sure all the health care providers wash their hands before and after being in contact with a patient, change gloves between patients, and keep the work area clean.
References:
World Health Organization. (2021). Infection prevention and control during health care when coronavirus disease (COVID-19) is suspected or confirmed: interim guidance, 12 July 2021 (No. WHO/2019-nCoV/IPC/2021.1). World Health Organization.
Baron, S., K. McPhaul, S. Phillips, R. Gershon, and J. Lipscomb. 2009. Protecting home health care workers: A challenge to pandemic influenza preparedness planning. American Journal of Public Health 99(Suppl. 2):S301-S307.
APICguide hand hygiene cover-W-spine final-rev3 … – ICPSNE. (n.d.). Retrieved April 14, 2022, from https://icpsne.org/APIC_handhygiene%202015.pdf
Jared Blake
Posted Date
Apr 14, 2022, 6:59 PM
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Injection control is a vital area of focus for hospital management. Whether it is protecting vulnerable patients or hospital staff, there are ample reasons why hospitals spend so much of their time brainstorming better ways and creating committees dedicated to preventing infections. There is always more that hospitals can do to improve their practices. Three examples to enhance infection control are as follows.
- Portable hand disinfectant – A study was done on the main barriers for nursing students that prevent them from adequately using routine practices for infection control. One of the main barriers was the location of some of the handwashing stations not being in a convenient location when they are busy (Hamed et al., 2021). One of the problem-solving solutions would be to have something portable, as it is not always feasible to move the handwashing stations (Hamed et al., 2021). Over the past two years, the availability of portable hand sanitizers has shown to be in demand for everyone outside of healthcare, so it would also be an accessible solution.
- Hospitals and clinics need to launder all scrubs – Research has shown that domestic laundry machines are not as efficient as commercial-grade machines at killing microorganisms left on hospital scrubs (Halliwell, 2012). There are inconsistencies with the type of machine, soap, and temperature when scrubs are washed when hospitals allow their staff to take home their uniforms to clean.
- Isolation rooms – A lot of research has been done on the benefits of isolation rooms to stop the spread of any infection (Osbourne et al., 2021). It proved beneficial at the United States Air Force Academy, where I volunteered to help test the cadets. When someone tested positive for COVID-19, there were designated dorms where they would be assigned to isolate themselves until they were free from infection. After implementing this strategy, the academy was able to mitigate the spread effectively.
Jared
Reference
Halliwell, C. (2012). Nurses’ uniforms: off the radar. A review of guidelines and laundering practices. Healthcare Infection, 17(1), 18–24. https://doi-org.lopes.idm.oclc.org/10.1071/HI11032
Hamed, A. M., Moralejo, D., Pike, A., & Curran, V. (2021). Barriers to infection control routine practices and problem-solving strategies among nursing students and instructors — A cross-sectional survey. Canadian Journal of Infection Control, 36(4), 175–183.
Osbourne Townsend, J., Morillo, A., Braithwaite, L. K., Boodoosingh, S., Neil, A., Widla, J., & Farshait, N. (2021). Identification of Candida auris in a foreign repatriated patient to Ontario, Canada and infection control strategies to prevent transmission. Canadian Journal of Infection Control, 36(4), 184–187.
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Sarah Chama
Posted Date
Apr 13, 2022, 6:50 PM
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Replies to Mariela Miccio
Healthcare-associated infections are a major threat to the safety of patients. The Two basic principles that govern the primary measures to prevent the spread of infections in healthcare facilities are: separating the infection source from the rest of the hospital and cutting off any transmission route (WHO, n.d.). Early detection of multidrug-resistant organisms is essential for any infection control program. Currently, my facility only screens newly admitted patients transferred from other facilities for MRSA. It has been proven, however, that active screening of MRSA in preoperative patients and implementing decolonization, such as with nasal mupirocin, has resulted in decreased postoperative infections caused by MRSA (Global Alliance, n.d.).
Another form of separating the infection source is as simple as proper hand hygiene. My facility has done an excellent job installing many touchless hand sanitizer dispensers within reach in every department, including at all public entrances for visitors. However, a fellow nurse friend from another facility has told me about an electronic hand hygiene badge buddy that changes color to remind the nurse to perform hand hygiene throughout the day. While this may be a more costly intervention, it should be considered a significant investment that will help reduce the morbidity, mortality, increased length of stay, and costs of HAIs every year (Mehta et al., 2014).
Another additional implementation my facility should consider in preventing the spread of infection is screening healthcare workers for COVID-19. At the moment, my facility will only consider you infectious if you show proof of a positive result. They will make your stay at home for the two weeks, even if you don’t have any symptoms. However, suppose you do not develop symptoms. In that case, there is no reason one would think to get tested but at the same time, they could be spreading it to other staff and patients themselves. If staff is not experiencing symptoms, they should at least know if they are positive so they may hold themselves accountable for protecting others and preventing the spread of infection.
Reference
Global Alliance for Infections in Surgery. (n.d.). 7 strategies to prevent healthcare-associated infections. Retrieved from https://infectionsinsurgery.org/7-strategies-to-prevent-healthcare-associated-infections
Mehta, Y., Gupta, A., Todi, S., Myatra, S., Samaddar, D. P., Patil, V., Bhattacharya, P. K., & Ramasubban, S. (2014). Guidelines for prevention of hospital acquired infections. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 18(3), 149–163. https://doi.org/10.4103/0972-5229.128705
World Health Organization (WHO). (n.d.). Hospital hygiene and infection control. Retrieved from https://www.who.int/water_sanitation_health/medicalwaste/148to158.pd
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Sara Ocampo
Posted Date
Apr 13, 2022, 5:22 PM
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Replies to Mariela Miccio
The subacute facility where I worked helped prevent the transmission of diseases by implementing these three risk management measures:
- Implement a policy of universal masking for all staff, and visitors (Joint Commission, n.d.). Additionally, my facility required that all staff take an educational course about COVID and disease transmission. Even until now, it is important that all staff and visitors wear masks at all times while in the facility. Both of these precautions significantly reduced the number of infected healthcare providers in the facility.
- Conduct regular and thorough cleaning and disinfection of all public areas, with particular attention to high-touch surfaces (Environmental Cleaning Procedures, 2020). Cleaning and disinfection of all public areas is conducted on a regular basis, with particular attention to high-touch surfaces. All staff is trained on proper cleaning and disinfection procedures through the mandatory educational course.
- Implement a comprehensive hand hygiene program, with hand washing stations located at all public entrances and exits throughout the facility (APICguide, n.d.). All staff and patients are required to frequently disinfect their hands prior to entering or after leaving a room. All staff is trained on proper hand hygiene practices, which are communicated to the patients.. A comprehensive hand hygiene program is essential to preventing the further spread of diseases such as COVID.
Overall, the implementation of these measures has contributed greatly to a reduced number of infections at the workplace. Additionally, through the risk management steps taken at my facility, the healthcare services that are provided to each patient have improved, as more individualized attention is provided as a result of the COVID precautions. The implementation of risk management programs, like the one present in my own, across multiple healthcare facilities could contribute to better quality care and safer interactions between providers and patients.
References:
APICguide hand hygiene cover-W-spine final-rev3 … – ICPSNE. (n.d.). Retrieved April 12, 2022, from https://icpsne.org/APIC_handhygiene%202015.pdf
Centers for Disease Control and Prevention. (2020, April 21). Environmental Cleaning Procedures. Centers for Disease Control and Prevention. Retrieved April 11, 2022, from https://www.cdc.gov/hai/prevent/resource-limited/cleaning-procedures.html
Universal masking statement – joint commission. (n.d.). Retrieved April 12, 2022, from https://www.:jointcommission.org/-/media/tjc/documents/covid19/universal-masking-statement-04232020.pdf
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Nicholas Derkowski
Posted Date
Apr 13, 2022, 1:06 PM
Replies to Mariela Miccio
Little parts of a machine all do their part to solve a larger problem, such is the case with infection control. We wash our hands, clean our stethoscopes between rooms, and in the OR we put on clean gowns each morning. All these parts make up the broad bulwark of infection prevention. Without these measure hospital acquired infections would overwhelm the healthcare system with non-reimbursable care being required.
Linens
With about 5% of patients acquire hospital acquired conditions (HACs)(Dunn, 2022). HACs cost organizations billions of dollars every year (Dunn, 2022). A new avenue of infection prevention I had just read about was focused on the linens throughout the hospital and more specifically in the surgical unit. Usually my thoughts about linens consist of which blanket to grab out of the warmer or if I should wheel the linen bucket to the room or if I can get away with walking the short distance to the hall to the hamper (I could improve!). Nevertheless, this is a serious place for improvement.
In a sample of 50 curtains on a surgical unit 21 (44%) were found to have VRE and 11 (22%) were found to have MRSA on them (Dunn, 2022). Close monitoring of chemical mixtures, temperatures, and time of washing are important to ensure infectious organisms are destroyed or brought to an acceptable level (Dunn, 2022).
COVID Debriefing
Personally I would hope there have been high level meetings regarding COVID with infection control stakeholders throughout my organization. COVID come on fast and quickly evolved from one emergency to another not giving organizations enough time to evaluate the interventions. By going through a debriefing hospitals could cement the effective infection control measures and streamline the implementation for next time. With the world becoming smaller through globalization a new pandemic could already be brewing.
Although in clinical studies of medications including ivermectin, iota-carrageenan, and bromhexine hydrochloride little was found to decrease symptoms and the spread of Covid I think there are other nonpharmaceutical practices hospitals could put into place to decrease the risk (Jafari et al., 2022).
Hand Washing
No infection prevention writing would be complete with out a mention of hand washing! So here I am to plug hand washing and write out hand washing as many times as possible so the term sticks in my head like those HEAD-ON APPLY DIRECTLY TO THE FOREHEAD commercials from years ago. There always improvement in hand washing to be made since everyone, organization wide and visitors, could and should be washing their hands. In every article I looked at to write this post there were mentions of hand washing. From the CDC, JC (Joint Commission not Jesus Christ, but I’m sure Jesus would be spearheading the hand washing movement), and CMS, all had a blurb, a mention, or an article about hand washing. So was your hands!
As the example above says hand washing stations could be placed at the entrance. Maybe we could have doors that wouldn’t open unless you had used the hand soap dispenser (Possibly a fire risk, but who’s counting?).
Hand Washing
Hand Washing
Reference
Dunn, D. (2022). Linen: The New Frontier in Infection Control and Prevention. AORN Journal, 115(4), 310–324. https://doi.org/10.1002/aorn.13643
Jafari, Y., Yin, M., Lim, C., Pople, D., Evans, S., Stimson, J., Pham, T. M., LSHTM CMMID COVID-19 working group, Read, J. M., Robotham, J. V., Cooper, B. S., & Knight, G. M. (2022). Effectiveness of infection prevention and control interventions, excluding personal protective equipment, to prevent nosocomial transmission of SARS-CoV-2: a systematic review and call for action. Infection prevention in practice, 4(1), 100192. https://doi.org/10.1016/j.infpip.2021.100192
Shyra Lovingood
Posted Date
Apr 13, 2022, 11:03 AM
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Replies to Mariela Miccio
Working in the OR it’s practically a clean and sterile environment. When patients gets infections it’s questionable if all staff members are following protocols to help prevent infections from happening. During surgeries, especially orthopedics, there is limitations on entering and exiting the or suite due to the high risk of infections. The hospitals health organization can implement better practices than can reduce the infection rates.
There are many staff members in the OR department from nurses to surgical techs and janitorial to name a few. The amount of people can help the function of the department but can also harm the department by having many high traffic areas. The bigger the OR department, the more staff and equipment accumulates. The surgical equipment, such as tables, specialty chairs etc., are stored in the tightest areas. Some are stored in a closet and some are stored in the hallways due to the lack of spacing. Which are close to sterile equipment. In a article I’ve read that sterile items should not be placed by any cleaning disinfectant or stored in high traffic areas Mitchell S, & Denholm B. (2008). Another measure that could be re-evaluated is the amount of vendors having full access to the OR. Walking wherever they want, whenever they want and not having the qualifications to understand the full concepts of sterility is an issue. lack of knowledge is one of the barriers for the practice of infection prevention and control, due to only 28% health workers that have sufficient knowledge about infection control principles, Usman, S. (2022). It created more unnecessary movement in and out of OR suites. Lastly, ensuring that all personnel is committed to routinely hand washing. Hand washing is a huge infection prevention. Our hands hold billions of germs and bacteria that is easily transmitted to surfaces and people. This measure should be implemented more often.
In conclusion, HAI’s will continue to increase if measures are not implemented correctly and frequently. These causes other issues in patients that could have been prevented. Storing of surgical equipment, slowing down the amount of vendors allowed to have full OR access, and most importantly hand washing. These measures are small changes that has a huge impact on infection reduction.
References:
Mitchell S, & Denholm B. (2008). Clinical issues. Sterile storage. AORN Journal, 87(5), 1000–1001. https://doi-org.lopes.idm.oclc.org/10.1016/j.aorn.2008.04.008
Lailawidar, sahputra, I., Usman, S., Nurjannah, & Martoenis. (2022). Health Workers Compliance Towards Infection Prevention and Control in Indonesia. International Journal of Nursing Education, 14(1), 88–98.
Best Regards,
Shyra L.
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Shaina LaCount
Posted Date
Apr 12, 2022, 10:44 AM
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Replies to Mariela Miccio
Hello,
Infection prevention is very important in all health care facilities. I work at an ambulatory outpatient center with multiple locations and some that are ambulatory surgery centers. Our infection controls are pretty standard to most – hand hygiene protocols, PPE protocols. etc. We have sinks with appropriate soap, and wall sanitizers in every exam room, and nurses station. When looking for ways to further prevent infection other than the standards we have in place, I came across some good ideas.
- Increase the number of sanitizer and hand washing stations available to patients and staff. In an article by, (Vogel, 2019) an example used was of a teaching medical center that had began designing a 740,000 sq ft. ambulatory center that would be scheduled to open in 2018. Along with architects, engineers, medical staff, was also the infection prevention and control (IPC) team. They took the angle of where and how to effectively use space to increase the number of sanitation stations. Putting sanitizer stands by elevators, by entrances of bathrooms, randomly throughout the waiting areas would all be good ideas. Creating nooks by the entrance to bathrooms to provide a hand washing station would be a good idea as well.
- Increase the number of isolation rooms. This is also a very good idea. In the article, the IPC team would routinely walkthrough the facility offering suggestions of where and how to put in infection controls, and increasing the number of isolation rooms for sick or patients suspected of having a communicable disease could be seen without exposing other patients and staff. (Vogel, 2019) My office currently has 1 dedicated isolation room, but every provider has 3 exam rooms allotted to them, and if need be, we just turn 1 into an isolation room and will disinfect and reuse the room after the required timeframe.
- Explore Patient Motivational Dialogue (PMD) This concept comes from a place of empowering the patient to hold health care professionals accountable to exercise proper infection control. (Grota et al., 2020) Many infection control/hand hygience protocols at health care facilities dictate that some sort of hand disinfection process is to be done prior to donning gloves, after using gloves, after contact with a patient, before contact with a patient, etc. Patients a lot of time do not realize that health care providers are supposed to disinfection even prior to putting on gloves, and think that the gloves are enough. (Grota et al., 2020) By encouraging patient to politely ask for additional hand washing or sanitation, this can help increase infection control rates.
-Shaina
reference:
Grota, P. G., Eng, T., & Jenkins, C. A. (2020). Patient motivational dialogue: A novel approach to improve hand hygiene through patient empowerment in ambulatory care. American Journal of Infection Control, 48(5), 573–574. https://doi-org.lopes.idm.oclc.org/10.1016/j.ajic.2019.11.024
Vogel, R. (2019). Infection Prevention and Control’s Role in the Design and Construction of a new Ambulatory Care Center. Lessons Learned. American Journal of Infection Control, 47, S26. https://doi-org.lopes.idm.oclc.org/10.1016/j.ajic.2019.04.049
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Yasmany Aguiar Alvarez
Posted Date
Apr 11, 2022, 5:30 AM
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Replies to Mariela Miccio
Although the environment acts as a reservoir for a wide range of microorganisms, it is only seldom implicated in disease transmission unless in immunocompromised people. Accidental exposure to opportunistic pathogens in the environment (e.g., Mycobacterium tuberculosis and varicella-zoster virus) can result in illnesses with considerable morbidity and/or mortality. Likewise, noncompliance with established norms and guidelines (e.g., water quality in dialysis, sufficient ventilation for specialized care areas such as operating rooms, and correct disinfectant use) can adversely affect patient outcomes in health care institutions. The goal is to create an environmental infection-control guideline that examines and reinforces measures for preventing environmental-mediated infections, especially among health care personnel and immunocompromised patients. When possible, the recommendations are evidence-based.
Conducting systematic monitoring and control efforts, a certified infection control physician, an infection control nurse for every 250 beds, and a method for providing infection rates to clinical care personnel were essential components of efficient infection control programs. In addition, these programming components have remained consistent over time. Accordingly, they are incorporated into the Joint Commission’s infection control criteria (formerly the Joint Commission on Accreditation of Healthcare Organizations, JCAHO) as stated by (Mehta, Pandit, & Shukla, 2019).
PPE must be used, worn, and removed correctly to provide optimal protection to the health care worker. However, PPE may not be completely protective, particular work methods \/may expose workers (e.g., needlestick injury), PPE breaches may occur, and some violations may go unnoticed. Therefore, when exiting the patient care area, all PPE should be removed (Kwon, et al., 2017).
References
Kwon, J. H., Burnham, C. D., Reske, K. A., Liang, S. Y., Hink, T., Wallace, M. A., . . . Cass, C. (2017, June 13). Assessment of Healthcare Worker Protocol Deviations and Self-Contamination During Personal Protective Equipment Donning and Doffing. Infection Control & Hospital Epidemiology, 38(9), 12-15. Retrieved July 19, 2021, from https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/abs/assessment-of-healthcare-worker-protocol-deviations-and-selfcontamination-during-personal-protective-equipment-donning-and-doffing/6A084D32113D9286AF7C9DE025EE
Mehta, N., Pandit, A., & Shukla, S. (2019, December). Transforming healthcare with big data analytics and artificial intelligence: A systematic mapping study. Journal of Biomedical Informatics, 100(1), 103311. Retrieved July 19, 2021, from https://www.sciencedirect.com/science/article/pii/S1532046419302308