PATIENTS FIRST

Patient Safety: Our Duty & Responsibility

Infection Control

Acknowledgments
o World Health Organization
The World Health Organization is committed
to promoting healthy outcomes for all of the
worlds people.
This lecture is primarily based on the World
Health Organization Patient Safety
Curriculum Guide retrieved from
http://www.who.int/patientsafety/educatio
n/curriculum/en/index.html

Learning Objectives
1. Recognize patient safety as an important
nursing responsibility in global health care
systems.
2. Apply required knowledge in preventing
and/or minimizing infection.
3. Perform appropriate behaviors required to
prevent health care associated infections.
4. Demonstrate required competence to provide
patients with safe care.

Introduction to Patient Safety:

Definition
o Patient safety is a discipline in the health care
sector that applies safety science methods
toward the goal of achieving a trustworthy
system of health care delivery. Patient safety is
also an attribute of health care systems; it
minimizes the incidence and impact of, and
maximizes recovery from, adverse events
(Emanuel et al., 2008) .

Introduction to Patient Safety:

Background
o Adverse medical events are widespread and
preventable (Emanuel et al., 2008) .
o Much unnecessary harm is caused by healthcare errors and system failures.
Ex. 1: Hospital acquired infections from poor
hand-washing.
Ex. 2: Complications from administering the
wrong medication.

Introduction to Patient Safety:

Goal
o Prevent and/or minimize the adverse events
and eliminate preventable harm in health care.
o All health care professionals including nurses
are responsible for ensuring patient safety

Introduction to Patient Safety:

This unit of patient safety will

focus on Infection Control

Global Infection Problems

According to WHO (2005),
o On average, 8.7% of hospital patients suffer
health care-associated infections (HAI).
o In developed countries: 5-10%
o In developing countries:
Risk of HAI: 2-20 times higher
HAI may affect more than 25% of patients
o At any one time, over 1.4 million people
worldwide suffer from infections acquired while
in hospital.

Health Care-Associated Infections

(HAI)
According to WHO:
o HAI is also called nosocomial.
o HAI is defined as:
an infection acquired in hospital by a patient
who was admitted for a reason other than
that infection.
an infection occurring in a patient in a
hospital or other health-care facility in whom
the infection was not present or incubating
at the time of admission.

Impacts of Health Care-Associated

Infections (HAI)
HAI can:
o Increase patients suffering.
o Lead to permanent disability.
o Lead to death.
o Prolong hospital stay.
o Increase need for a higher level of care.
o Increase the costs to patients and hospitals.

Preventing infections
Requires health care providers who have:
Knowledge of common infections and their
vectors
An attitude of cooperation and commitment
Skills necessary to provide safe care

Required Knowledge
o Knowledge of the extent of the problem;
o Knowledge of the main causes, modes of
transmission, and types of infections.

Required Attitudes
Being an effective team player.
Commitment to preventing HAIs

Required Skills
o
o
o
o
o

Apply universal precautions*

Use personal protection methods
Know what to do if exposed
Encourage others to use universal precautions
Report breaks in technique that increase
patient risks
o Observe patients for signs and symptoms of
infection

One more important thing!

Protect Yourself
Be sure you have been immunized against
Hepatitis B since it is very easy to transmit!

Main Sources of Infection

o Person to person via hands of health-care
providers, patients, and visitors
o Personal clothing and equipment (e.g.
Stethoscopes, flashlights etc.)
o Environmental contamination
o Airborne transmission
o Hospital staff who are carriers
o Rare common-source outbreaks

Campaigns to Decrease Infection Rates

o WHO Clean hands are safer hands campaign
o Centers for Disease Control and Prevention
(CDC) prevent antimicrobial resistance
campaign in health-care settings
o Institute for Healthcare Improvement (IHI)
5 million lives campaign
Developing country focus

Main Routes for infections

o Urinary tract infections (UTI)
Catheter-associated UTIs are the most frequent,
accounting for about 35% of all HAI.
o Surgical infections: about 20% of all HAI
o Bloodstream infections associated with the use of
an intravascular device: about 15% of all HAI
o Pneumonia associated with ventilators: about15%
of HAI

Types of Infections

Burke J Infection control-a problem for patient safety New Eng Journal
of Medicine (February 13, 2003)

Four Ways to Prevent HAI

1. Maintain cleanliness of the hospital.
2. Personal attention to handwashing before and
after every contact with a patient or object.
3. Use personal protective equipment whenever
indicated.
4. Use and dispose of sharps safely.

Prevention in Hospitals and

Clinics
o Studies show infections are minimized when
hospitals/clinics:
Are visibly clean;
Use increased levels of cleaning during
outbreaks;
Use hypochlorite and detergents during
outbreaks.

Prevention through Handwashing

o Handwashing: the single most important
intervention before and after patient contact.
o Required knowledge and skills:
How to clean hands
Rationale for choice of clean hand practice
Techniques for hand hygiene
Protect hands from contaminants
Promote adherence to hand hygiene guidelines

Five moments for hand hygiene

o Before patient contact
o Before an aseptic task
o After body fluid exposure even if wearing
gloves!
o After patient contact
o After contact with patient surroundings

Your 5 moments for HAND HYGIENE

How to Clean Hands

o Remove all wrist and hand jewelry.
o Cover cuts and abrasions with waterproof
dressings.
o Keep fingernails short, clean, and free from nail
polish.

Effective Handwashing Technique

o Wet hands under tepid running water
o Apply soap or antimicrobial preparation
solution must have contact with whole
surface area of hands
vigorous rubbing of hands for 1015 seconds
especially tips of fingers, thumbs and areas
between fingers
o Rinse completely
o Dry hands with good quality paper towel.

How to use waterless handrub

o
o
o
o
o

Apply a palmful of product in cupped hand

Rub hands palm to palm
Right palm over left hand with interlaced fingers
Palm to palm with fingers interlaced
Backs of fingers to opposing palms with fingers
intelocked
o Rub between thumb and forefinger
o Rotational rubbing, backwards and forwards with
clasped fingers of right hand in left palm and vice versa
o Once dry your hands are safe.

Resources for Correct Handwashing

Procedures
o Your Five Moments for Hand Hygiene
o http://www.who.int/gpsc/tools/5momentsHandHygiene
_A3.pdf

o How to handrub? How to handwash?

o http://www.who.int/gpsc/tools/GPSC-HandRub-Wash.p
df

Personal Protective Equipment

o Gloves, aprons, gowns, eye protection, and
face masks
o Health care workers should wear a face mask,
eye protection and a gown if there is the
potential for blood or other bodily fluids to
splash.

Personal protective equipment 2

o Masks should be worn
if an airborne infection is suspected or
confirmed
to protect an immune compromised patient.

Gloves
Gloves must be worn for:
o
o
o
o

all invasive procedures

contact with sterile sites
contact with non-intact skin or mucous membranes
all activities assessed as having a risk of exposure to
blood, bodily fluids, secretions and excretions, and
handling sharps or contaminated instruments.

Hands should be washed before and after gloving

Safe Use and Disposal of Sharps

o Keep handling to a minimum
o Do not recap needles; bend or break after use
o Discard each needle into a sharps container at
the point of use
o Do not overload a bin if it is full
o Do not leave a sharp bin in the reach of
children

Required Performance
Nursing students need to:
o apply universal precautions
o be immunized against Hepatitis B
o use personal protection methods
o know what to do if exposed
o encourage others to use universal precautions

Act to Minimize
Spread of Infection-1
Before contact with each and every patient:
clean hands before touching a patient
clean hands before an aseptic task

Act to Minimize
Spread of Infection-2
After contact with each and every patient:
clean hands after any risk of exposure
to body fluids
clean hands after actual patient
contact
clean hands after contact with patient
surroundings

Encourage Others to Participate in

Infection Control
Students may routinely observe staff who:
apply inadequate technique in handwashing
fail to wash hands
routinely violate correct infection control
procedures

Be Sure
o Educate patients and families/visitors
about clean hands and infection
transmission.
o Ensure patients on precautions have same
standard of care as others:
frequency of entering the room
monitoring vital signs

References
o World Health Organization. (2010). WHO Patient Safety Curriculum
Guide for Medical Schools.
o World Health Organization. (2010). Topic 1: What is patient safety?
o World Health Organization. (2010). Topic 9: Minimizing infection
through improved infection control.
o Emanuel, L., Berwick, D., Conway, J., Combes, J., Hatlie, M.,
Leape, L., Reason, J., Schyve, P., Vincent, C., & Walton, M. (2008).
What exactly is patient safety? Advances in Patient Safety, Vol. 1:
Assessment. Retrieved from
http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=aps2v1&par
t=advances-emanuel-berwick_110
o Burke, J. P. (2003). Infection control A problem for patient
safety. The New England Journal of Medicine, 348, p. 651-656.