March 5th, 2012
By Jennifer Olin, BSN, RN
“Dirty Surgical Tools Put Patients at Risk” and “Legionnaire’s Disease Outbreak at MVH Draws Lawsuits” are just two recent headlines we've seen related to unsterile or unclean conditions in hospitals. As patients we expect our hospitals and other healthcare facilities to be more than clean—and as nurses we are directly involved in providing biologically safe environments for our patients. That means everything from hand washing to sterilizing our surgical instruments falls, at least partially, under the RN’s scope of practice.
The nurse plays a critical role in preventing and controlling infectious disease. From day one nursing students learn about and are expected to participate in the infection prevention process. An important component in preparing for clinical nursing practice is an understanding of the infection process and prevention techniques.
The Nature of Infection
The straightforward definition of an infection is the entry and multiplication of an infectious agent in the tissue of a host. In other words, an infection is an overgrowth of bad bacteria. The infectious agent is called a pathogen.
The presence of a pathogen does not mean that an infection will necessarily begin. The development of an infection happens in a cycle that depends on all elements of the cycle being present. There are six elements in the chain of infection:
An infection will only develop if this chain stays intact. As nurses we follow infection prevention and control practices to break the chain so that infection will not develop.
The Infectious Process
By understanding the chain of infection, the nurse can intervene and stop an infection from developing. The chain can be broken at any link. However, should an infection develop, they all follow the same progressive course:
Infections can be of two types, localized or systemic. A localized infection may be means it develops only in one place on the body. A systemic infection is spread throughout the body by the bloodstream.
Course of Care
The course of an infection influences the level of nursing care that is needed. The RN is responsible for giving the prescribed antibiotics and monitoring the patient’s response to the drug therapy. Other supportive therapies include providing adequate nutrition and rest to bolster the client’s defenses against the infectious process. The complexity of care required is dependent on the body systems affected by the infection.
No matter whether the patient’s infection is localized or systemic, the nurse plays a critical role in minimizing its spread. For example, the organism causing a simple wound infection can spread to involve an intravenous (IV) needle insertion site if the nurse uses improper technique during the IV dressing change.
Nurses must be particularly careful, as well, to protect themselves. If you have a break in your own skin you can acquire those same infections from your patient. It can’t really be said enough, always wash your hands before and after caring for any patient and always wear gloves when dealing with an infection.
Patients being treated in healthcare settings like hospitals, long, and short term care facilities have an increased risk for acquiring infections. Nosocomial or hospital acquired infections result from delivery of health services in a healthcare facility. A hospital is one of the most likely places to “catch” an infection because they harbor a high population of microorganisms that may become resistant to antibiotics. Unfortunately, healthcare workers transmit many nosocomial infections.
The number of health care workers who have direct contact with a patient, the type and number of invasive procedures, the therapy received, and the length of time the client spends in the hospital all influence the risk of infection. The most common sites for hospital acquired infections include surgical or traumatic wounds, urinary and respiratory tracts, and the bloodstream.
Nosocomial infections significantly increase the costs of healthcare. Extended stays in healthcare facilities, increased disability, increased costs of antibiotics, and prolonged recovery times all add to the client’s and healthcare facility’s expenses. And, now, Medicare and Medicaid are withholding payment from non-federal hospitals for preventable nosocomial infections. Private insurance companies are following suit.
Nurses play a key role in infection prevention…this is where we started. To be even more specific, nurses play a key role in infection prevention, the health, and well being of their patients and the financial health of their employers.