Definition
Hospital acquired infections (HAI) is also known as Nosocomial infection is an infection that is acquired in a hospital or other health care facility during hospitalization.
| COMMON SITES OF INFECTION AND PREVENTIVE MEASURES | ||
| Sites of nosocomial Infection | causes | Preventive measures |
| Urinary tract | Insertion of catheter into urethra | Catheterize only for accepted indication. Remove catheter as soon as possible. Train personnel in proper technique of catheterization. Use smallest size to promote urine flow (14-16 Fr).Consider silicone catheters for long-term use. Choose smallest balloon possible |
| Accidental and frequent opening of drainage system | Maintain closed system throughout. Follow strict aseptic technique, when connecting or disconnecting system. Prevent accidental opening of system. Train personnel, patient and relatives on hazards of open system. | |
| Improper position of drainage bag, kinking, and reflux | Position the bag below level of bladder. There should not be contact with wall, floor, or furniture. Avoid kinking or looping of tube. Clamp tube when lifting above the bladder level. Avoid over filling of bag. | |
| Lack of hand washing practices in caring for catheter | Perform proper hand washing and use of gloves before contact with patient catheter, bag, or urinal. Improve general hygienic practices. Perform catheter and perineal care with soap and water daily. | |
| Frequent flushing and irrigation | Avoid frequent flushing and irrigation unless absolutely necessary. | |
| Respiratory tract | Contaminated respiratory therapy equipment | Disinfect and clean equipment after each use. Use sterile water to fill in critical and semi-critical equipment such humidifiers. Wash hands before and after each procedure. Single use equipment should be used only once. |
| Failure to use aseptic technique during suctioning and other respiratory procedures | Follow strict aseptic technique when performing procedures. Use gloves, gown, and mask whenever needed.Restrict staff with respiratory infection to care for the patient. | |
| Failure in segregating patients who are infected | Use separate rooms for infected and noninfected patients. In case of pneumonia, tuberculosis, etc. admit patients to negative air pressure rooms with independent air supply and exhaust ventilation. Use barrier nursing technique in caring for immunocompromised patient. | |
| Improper disposal of secretions and contaminated linen | Educate patients regarding disposal of secretions. Disinfect all collecting equipment after use. Use appropriate antiseptic solution for disinfection. | |
| Surgical wound | Improper skin preparation before surgery | Clean skin using antiseptic soap and shampoo on the day of surgery. Report presence of any skin lesions at operative site. Remove hair by using safe technique (if physician prefers) without traumatizing skin. Hair should be removed as close to the time of surgery as possible. Use a broad-spectrum antimicrobial agent to disinfect skin. Permit only trained personnel to perform skin preparation in surgery. |
| Poor hand washing and aseptic technique before and after surgical wound dressing | Educate personnel on hand washing and proper aseptic techniques before handling surgical wound. Permit only trained personnel to perform surgical wound dressing. Wear sterile gloves for handling surgical wounds. Change dressings whenever required. Use sterile antiseptic solution for cleaning surgical wound. | |
| Bloodstream | Use of contaminated catheters, intravenous fluids, tubings, etc. | Select catheter type and gauge based on length of use, solution being infused and vein being used. Plastic catheters are less, such asly to introduce infection when compared to steel needles. Discontinue catheters in peripheral vein every 48- 72 hour to minimize phlebitis Risk. Discontinue IV devices when signs of phlebitis start. Use proper hand washing practices. Don sterile gloves whenever handling IV devices. |
| Contamination of infusions when adding medications and contaminated heparin locks. | Use sterile technique when adding medications. Maintain closed system of intravenous infusions. Administer medications only through medication ports in the set. Clean ports before inserting needles into it. Aseptic technique to be used in passing of IV lines. Replace heparin locks every 96 hours. | |
| Contamination and improper care of insertion site of intravenous device | Encourage good skin hygiene. Use clean linen in contact with patient. Prevent soiling of dressing site. Change soiled dressing immediately. Change dressing every 48- 72 hour. When cleaning insertion site, start from inner to outer area to prevent infection. Use sterile techniques whenever changing dressing. Do not retain IV device for longer than required period. | |
Measures to prevent Hospital Acquired Infection
- Universal precautions
- Body substance isolation
- Prevention of infection in susceptible patients
- Specific isolation practices.
Universal Precautions
Centers for Disease Control and Prevention (CDC) recommended universal precautions to decrease the risk of transmission of unidentified pathogens in 1987.
- Universal precautions are used in the care of all hospitalized persons regardless of their diagnosis or possible infection status.
- They apply to blood, all body fluids, secretions and excretions except sweat (whether or not blood is present or visible), non-intact skin, and mucous membranes
- Gloves should be worn while contacting with blood and body fluids, mucous membranes, non-intact skin, surfaces soiled with blood or body fluids, and for performing venipuncture and other vascular access procedures.
- Gloves should be changed after contact with each patient.
- Masks and protective eye wear or face shields should be worn during procedures that are, such asly to generate droplets of blood or other body fluids.
- Gowns should be worn during procedures that are, such asly to generate flashes of blood or other body fluids containing blood.
- Hands and other skin surfaces should be washed immediately and thoroughly, if contaminated with blood or other body fluids containing blood.
- To prevent needle stick injuries, needles should not be recapped, purposely bent, broken, or removed from disposable syringes. Used needles are to be placed in puncture-resistant containers near the work area.
- To reduce the need for mouth-to-mouth resuscitation, mouthpieces, resuscitator bags, or other ventilation devices should be used.
- Healthcare workers who have exudative lesions should refrain from all direct patient care activities and from handling patient care equipment.
Body Substance Isolation
Body substance isolation (BSI) includes isolation precautions that consider all body substances which are potentially infectious regardless of a person’s diagnosis. BSI precautions should be followed whenever coming in contact with moist body substances, mucous membranes, and nonintact skin. These include blood, blood-tinged fluids, feces, urine, wound drainage, oral secretion, vomitus, and any other substances.
Body substance isolation was first implemented by CDC in 1996 and the basic premises are:
- All individuals are prone to infections from microorganisms placed on their nonintact skin and mucous membranes.
- All people have potentially infectious microorganisms in all of their moist body sites or substances.
- An unknown portion of patients and healthcare workers will always be colonized or infected with potentially infectious microorganisms in their blood and other moist body sites and substances.
Body substance isolation requires the following to be done by healthcare personnel:
- Wear clean, disposable gloves before contact with mucous membranes, nonintact skin, and insertion sites for indwelling devices.
- Change gloves between patients and between activities with the same patient when gloves become excessively soiled.
- Wash hands for at least 10 seconds when the hands are soiled, before contact with new patient, and after gloves are removed.
- Use additional barriers, such as gowns or plastic aprons, masks, goggles, or glasses. Use hair covers or shoe covers as needed to keep moist body substances off clothing, skin, and mucous membranes.
- Discard sharp instruments and needles uncapped in a rigid puncture proof container located in the patient’s room or treatment area.
- Handle all laboratory specimens as if they are infectious.
- Transport all soiled and reusable articles in plastic bags or rigid containers.
- Secure soiled linen in bags before transport.
- Isolate patients with communicable diseases and follow appropriate isolation precautions.
Prevention of Infection in Susceptible Patient
The actions for protecting susceptible host include the following:
- Promoting basic hygiene practices, such as bathing and regular oral hygiene which can reduce the numbers of microorganisms that may enter the body.
- Ensuring ambulation of patient within limitation and deep breathing and coughing exercises to clear respiratory tract.
- Immunizations of susceptible hosts, both children and adults, based on current and accepted schedules.
- Encouraging a healthy well-balanced diet and adequate fluid intake for improving general health status and for ensuring an adequate outflow of urine.
- Promoting adequate rest and sleep and reducing stress.
- Encouraging appropriate exercise to meet physiological requirements.
- Preventing contact of susceptible host with potential source of infection.
Specific Isolation Practices
1. Strict isolation:
- Purpose: Prevents spread of highly contagious or virulent infections spread through air and by contact.
- Disease conditions: Chickenpox, diphtheria, etc.
- Room: Private/separate room.
- Protective devices:
- Gown.
- Gloves.
- Mask.
- Precautions: Discard or bag all soiled articles, contaminated with infective materials. Reusable articles to be disinfected and sterilized appropriately.
2. Contact isolation:
- Purpose: Prevents transmission of highly transmissible infections spread by close or direct contact.
- Disease conditions: Acute respiratory infections in infants and young children, impetigo, herpes simplex, and infections by resistant bacteria.
- Room: Separate room. Patients infected with same organisms may share the room.
- Protective devices:
- Gown is required if soiling is expected.
- Gloves are required when touching infected material is expected.
- Mask is required when coming in close contact with the patient.
- Precautions: Discard or bag and label articles contaminated with infective materials. Reusable articles to be disinfected and sterilized appropriately.
3. Respiratory isolation:
- Purpose: Prevents transmission of infection through air droplets.
- Disease conditions: Measles, meningitis, mumps, pneumonia, Haemophilus influenzae in children.
- Room: Separate room. Patients infected with same organism may share the same room.
- Protective devices:
- Gown-not required.
- Gloves-not required.
- Mask-required when coming close to the patient.
- Precautions: Discard or bag and label articles contaminated with infective materials. Reusable items to be disinfected and sterilized. Patients should not use same bathroom.
4. Enteric precautions:
- Purpose: Prevents infections transmitted by direct or indirect contact with feces.
- Disease conditions: Cholera, hepatitis, gastroenteritis caused by infectious organisms
- Room: Separate room if patient’s hygiene is poor. Patients infected with same organisms may share the same room.
- Protective devices:
- Gown-indicated if soiling is, such asly.
- Gloves-indicated when touching infective material.
- Mask-required if patient coughs and does not cover mouth.
- Precautions: Articles to be thoroughly cleansed and disinfected or discarded.
5. Drainage and secretion precautions:
- Purposes: Prevents transmission of organism by contact with purulent material or drainage from infected body site.
- Disease conditions: Abscess, burn infection, infected wounds.
- Room: Separate room not indicated.
- Protective devices:
- Gown-required if soiling with infective material is, such asly.
- Gloves-indicated when touching infective material.
- Mask-not indicated.
- Goggles- when there is high risk of exposure to splash.
- Precautions: Discard or bag and label articles contaminated with infective materials. Reusable articles to be disinfected and sterilized.
6. Universal blood and body fluid precautions:
- Purpose: Prevents contact with infected blood or body fluids containing blood.
- Disease condition: HIV, hepatitis B, syphilis.
- Room: Separate room if patient’s hygiene is poor.
- Protective devices:
- Gown-indicated during procedures, such asly to generate splashes of blood or body fluids.
- Gloves-indicated when touching blood or body fluids containing visible blood, mucous membranes, or nonintact skin of all patients.
- Mask-indicated during procedures, such asly to generate droplets of blood.
- Goggles-indicated if splashes/spurts are expected
- Precautions:
- Discard or bag and label articles contaminated with blood or body fluids. Disinfect and sterilize articles.
- Avoid needle sticks.
- Discard used needles in puncture-resistant container.
- Clean blood spills promptly with solution of sodium hypochlorite or bleach.
7. Care of severely immunocompromised patients:
- Purpose: Protects patients with lowered immunity and resistance from acquiring infectious organisms.
- Disease conditions: Leukemia, lymphoma, aplastic anemia.
- Room: Separate room.
- Protective devices:
- Gown-required.
- Gloves-required.
- Mask-required for all persons coming in contact with patient.
- Precautions: Use sterile gloves for open wound or burns.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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