Percival / Williams / Cooper Biofilms in Infection Prevention and Control

A Healthcare Handbook
1. Auflage 2014
ISBN: 978-0-12-397751-9
Verlag: Elsevier Science & Techn.
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 394 Seiten

Biofilms in Infection and Disease Control: A Healthcare Handbook outlines the scientific evidence and rationale for the prevention of infection, the role biofilms play in infection control, and the issues concerning their resistance to antimicrobials. This book provides practical guidance for healthcare and infection control professionals, as well as students, for preventing and controlling infection. Biofilms are the most common mode of bacterial growth in nature. Highly resistant to antibiotics and antimicrobials, biofilms are the source of more than 65 percent of health care associated infections (HCAI), which, according to the WHO, affect 1.4 million people annually. Biofilms are involved in 80 percent of all microbial infections in the body, including those associated with medical devices such as catheters, endotracheal tubes, joint prostheses, and heart valves. Biofilms are also the principle causes of infections of the middle-ear, dental caries, gingivitis, prostatitis and cystic fibrosis. Importantly, biofilms also significantly delay wound healing and reduce antimicrobial efficiency in at-risk or infected skin wounds. - Provides specific procedures for controlling and preventing infection - Includes case studies of HCAI, and identifies appropriate treatments - Presents national government standards for infection prevention and control - Includes extensive references and links to websites for further information

Autoren/Hrsg.

Percival, Steven L.

Williams, David

Cooper, Tracey

Randle, Jacqueline

Leseproben

Chapter Two

Infection Prevention

Principles of Safe Practice in Healthcare

Jacqui Prieto, Claire Kilpatrick and Jacqueline Randle

The prevention of healthcare-associated infections in the United Kingdom is key to the provision of high-quality, safe healthcare. There are many opportunities for infection to spread from one person to another in the healthcare environment; they are more easily recognised when a person has a known communicable infection and measures to prevent spread have been clearly defined. Such opportunities frequently remain unrecognised, however, particularly when infection is undiagnosed or when a patient is colonised rather than infected with potentially pathogenic micro-organisms. In view of this, it is essential to use preventative measures at all times to minimise the spread of infection from known and unknown sources. It is crucial that all possible prevention and control measures be adopted and, where this is not possible and cross-infection occurs, that incidents be reported and acted on so that healthcare environments can be as safe as possible for patients, healthcare workers and others. This chapter introduces Standard Precautions to promote this outcome.

Keywords

Standard Precautions; aseptic technique; specimen collection; transmission-based precautions; safe healthcare

Introduction

The prevention of healthcare-associated infections (HCAI) in the United Kingdom and globally is key to the provision of high-quality, safe healthcare.1 There are many opportunities for infection to spread from one person to another in the healthcare environment. These are more easily recognised when a person has a known communicable infection and the measures to prevent spread have been clearly defined. However, opportunities for the spread of infection frequently remain unrecognised, particularly when infection is undiagnosed or when a person is colonised rather than infected with potentially pathogenic micro-organisms.

In view of this, it is essential to apply infection prevention measures at all times to minimise the risk of spread from known and unknown sources of infection. Patients receiving healthcare are often more vulnerable to infection because of their condition or the need for treatment, particularly when this involves an invasive procedure. At times, healthcare workers and visitors may also be at risk of exposure to infection. It is therefore important to recognise the range of measures required to protect patients, healthcare workers and visitors.

A safe, clean, fit-for-purpose care environment is also essential to minimise risks of infection transmission. At times, standards of infection prevention and control can be difficult to achieve because of the facilities available. For example, in the hospital setting the requirement to isolate a patient with a known or suspected communicable infection may not always be met in a timely manner because there are no single rooms.2 However, it is crucial that all possible prevention and control measures be adopted and that incidents where this has not been possible, and cross-infection has occurred, be reported and acted on to make healthcare environments as safe as possible for patients, healthcare workers and others.

This chapter introduces the reader to Standard Precautions. One standard precaution is hand hygiene and, because of its importance to and influence on healthcare policy.

The following aspects of Standard Precautions are addressed here:

• Use of personal protective equipment (including glove and apron selection and face, eye, nose and mouth protection)

• Respiratory hygiene/cough etiquette

• Safe management of used linen

• Safe disposal of clinical waste

• Safe handling and disposal of sharps, including safe injection practice

• Occupational exposure management, including sharps injury

• Management of blood and other body fluid spillages

Also addressed are the broad principles of:

• Maintaining asepsis using an aseptic technique

• Safe collection of specimens

• Transmission-based precautions

Standard Precautions

Standard Precautions are the minimum measures applied routinely when performing healthcare and social care activities in order to minimise the risk of spreading micro-organisms, from both known and unknown sources of infection, to patients, healthcare workers and visitors. This includes preventing micro-organisms from colonising a patient at a vulnerable site on that person, such as through a mucous membrane or non-intact skin, or via an invasive medical device.

The key principal underpinning Standard Precautions is that body fluid or moist body site may contain infectious micro-organisms that pose a risk of infection. The measures included in Standard Precautions are known under other names such as ‘Standard Infection Control Precautions’, ‘Standard Principles’, ‘Standard Practice’ and ‘Safe Working Practice’. This reflects the ongoing evolution of the concept of Standard Precautions, the evidence base for which has recently undergone review in both the United Kingdom3 and the United States.4

Use of Personal Protective Equipment

Personal protective equipment (PPE) is the specialised disposable clothing or equipment used by healthcare workers or visitors to protect themselves from exposure to infectious substances. This includes disposable gloves, aprons/gowns, goggles/visors and masks/respirators.

For healthcare workers in the National Health Service (NHS), it is important to remember that the NHS has a responsibility to provide appropriate PPE. All healthcare workers should be educated in the its use to prevent injury or harm.5 The importance of PPE as an essential component for reducing cross-infection is emphasised by Slyne et al.6 However, they summarise studies which have shown that there is no consistent approach towards the use of PPE and there is confusion as to which item to wear and when.

Therefore the decision to use PPE should be based on an assessment of the risk of a task or situation (Table 2.1). PPE should be donned at the start of a procedure before exposure/contamination might occur. When gloves and an apron are worn primarily to protect the wearer, the importance of their prompt removal between tasks on the same patient or between patients may be overlooked, giving rise to the possibility of cross-contamination/infection.

Table 2.1

Risk Assessment for the Selection of PPE

The need to remove or change contaminated PPE during, as well as after patient care, must be considered to avoid cross-contamination/infection. Likewise, hand hygiene should always be performed following removal of PPE, given the potential to contaminate the hands. Personal protective equipment should be changed when damaged and/or torn or soiled and, in the case of surgical masks, if wet with moisture, including from breath. A wide variety of PPE is available, and it is essential that the type used be the most appropriate for the care activity to be undertaken.

Key Point

• Uniforms are not classified as personal protective equipment.

Glove Selection

Gloves suitable for healthcare purposes are made from various materials, including chlorethene polymer, neoprene and vinyl. Polythene gloves are not suitable for healthcare use.7 Gloves made from this material possess different properties; it is therefore important to select the appropriate glove for any given task,8 remembering that not all gloves can protect the wearer and/or the patient during all healthcare activities.7

Figure 2.1 summarises the properties and recommended uses of different types of disposable glove based on the approach adopted by Health Protection Scotland.9 The problem of allergy, both to latex proteins and the chemical accelerators used in latex glove manufacture, has increased substantially in recent years; it influences glove choice for those with an allergy, including the wearer and the patient receiving care. Specifically, Social Care and Social Work Improvement Scotland8 identifies the best evidence-based practice as being when healthcare workers decontaminate their hands and wear a pair of clean, non-sterile gloves before certain patient activities, and decontaminate their hands after removing them.

Figure 2.1 Glove use and selection. Health Protection Scotland.9

Gloves can only protect the wearer and do not remove the contaminant from the environment, so they should not replace hand hygiene.7,10 The limited evidence base in this area is contradictory, with some research suggesting that glove use decreases hand hygiene compliance and other research suggesting that it improves it.10 Importantly, Hakko et al.11 find that the belief that glove use prevents the spread of infection is widespread; however, gloves are not a substitute for hand hygiene.

Apron/Gown Selection

A disposable plastic apron should be worn when there is a risk that clothing may be exposed to blood or body fluids, secretions or excretions.12 When there is a risk of significant splashing (e.g., in the operating...