Nursing Plays a Major Role in Infection Control

March 5th, 2012

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By , 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:

  • Infectious agent – A microbial organism with the ability to cause disease. The greater the organism's virulence (ability to grow and multiply), invasiveness (ability to enter tissue) and pathogenicity (ability to cause disease), the greater the possibility that the organism will cause an infection. Infectious agents are bacteria, virus, fungi, and parasites.
  • Reservoir – A place within which microorganisms can thrive and reproduce. For example, microorganisms thrive in human beings, animals, and inanimate objects such as water, table tops, and doorknobs.
  • Portal of exit – A place of exit providing a way for a microorganism to leave the reservoir. For example, the microorganism may leave the reservoir through the nose or mouth when someone sneezes or coughs. Microorganisms, carried away from the body by feces, may also leave the reservoir of an infected bowel.
  • Mode of transmission – Method of transfer by which the organism moves or is carried from one place to another. The hands of the health care worker may carry bacteria from one person to another.
  • Portal of entry – An opening allowing the microorganism to enter the host. Portals include body orifices, mucus membranes, or breaks in the skin. Portals also result from tubes placed in body cavities, such as urinary catheters, or from punctures produced by invasive procedures such as intravenous fluid replacement.
  • Host – A person who cannot resist a microorganism invading the body, multiplying, and resulting in infection. The host is susceptible to the disease, lacking immunity or physical resistance to overcome the invasion by the pathogenic microorganism.

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:

  1. Incubation period – The time interval between the invasion of the pathogen into the body and the first signs and symptoms of infection (length of time varies).
  2. Prodromal stage – The time interval between the onset of nonspecific signs and symptoms (malaise, achiness in joints) to more disease specific signs and symptoms. The disease is communicable and it is recommended that the patient take precautions to prevent the spread of the infection.
  3. Illness stage – The time during which the disease specific signs and symptoms are present. The nurse knows that this is the acute illness stage and patient will need added rest, increased fluids, medication, treatment and probably a modified diet.
  4. Convalescence – That time between the disappearance of the acute signs and symptoms of infection and full recovery.

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.

Nosocomial Infections

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.

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