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Discuss the Following “Infection Prevention is Every Healthcare Professional’s Responsibility” Essay

This essay is to discuss the statement: ‘Infection prevention is every healthcare professional’s responsibility’. In order to identify the healthcare professional’s responsibility the author will be drawing from three different sources including documents from the Department of Health, the Nursing and Midwifery Council’s code of conduct and the Royal College of Nursing. After this, the essay will talk about two different practises that healthcare professionals can use to break the chain of infection. These will include the use of personal protective equipment (PPE) and the importance of hand washing and the impact these practises have on infection prevention. The essay will then focus on how such high standards of infection prevention can cause psychosocial repercussions on the patient and how visitors can have a compromising effect on healthcare professional’s efforts to break the chain of infection.

The Department of Health (DoH), the Nursing and Midwifery Council (NMC) and the Royal College of Nursing (RCN) all provide documents and guidelines for the public to read about the role of the healthcare professional. They are all put in place to safeguard the public, the workers, and to help professionals deliver the highest quality service to the service users. It is possible to relate a lot of these documents and guidelines to infection prevention. These services have made it clear that infection prevention is every healthcare professional’s responsibility through their policies and guidelines. In the NMC’s Code of Conduct at the chapter on keeping knowledge and skills up to date, number thirty-eight of the code states ‘you must have the knowledge and skills for safe and effective practise when working without direct supervision’ (Nursing and Midwifery Council, 2008). This is important because if the healthcare professional’s knowledge and skills were not up to date then they would not understand common illnesses, causes or the most effective way to prevent them.

This would therefore put the service users at risk and the healthcare professional could be held accountable. The RCN promotes good practise by setting eight main principles for professionals to take guidance from. Principle C states, ‘Nurses and nursing staff manage risk, are vigilant about risk, and help to keep everyone safe in places they receive healthcare’ (Royal College of Nursing, 2010). This is an important element of safe and effective care and provides an understanding for the public and workers that infection is a risk that all health care professionals must be vigilant about and it is the workers as well as the public’s responsibility to make their best efforts to control it. The Department of Health creates legislation and policy which the healthcare system have to abide by. One policy document that was published by the DoH is the ‘Prevention and Control of Infection in Care Homes’ (Department of Health, 2013). It is targeted at healthcare settings such as care trusts, and is about ‘best practise guidance’. The policy document includes information such as the chain of infection, hand washing techniques as well as asepsis and aseptic technique guidelines. The DoH has created this document to improve infection prevention by giving more responsibility to healthcare professionals and urging them to use these precautionary measures.

‘The RCN considers infection prevention and control to be a core element of quality, patient safety and governance systems and as such it is one of the RCN’s key areas of activity. Infection prevention and control is the clinical application of microbiology in practice’ (Royal College of Nursing, 2013). The chain of infection model displays the transmission of infection from one patient to another. The model has six components which if broken from the chain will prevent the infection from spreading. These components include; a causative micro-organism, reservoir, portal of exit, mode of transmission, portal of entry and susceptible host. As infection prevention is every healthcare professionals responsibility, healthcare professionals should work together to break the links in the chain of infection. A common component to break is the ‘reservoir’ link. Through employee health, environmental sanitation and disinfection. Another way to break the chain of infection is to follow standard precautions by using personal protective equipment where necessary. Personal protective equipment (PPE) are special garments or equipment used by healthcare workers and service users to help protect against infections. It includes protective clothing, gloves, respirators and more. All these are essential in the discontinuation of the chain of infection. By law, employers have to supply healthcare workers with PPE and if not worn by the workers they may be held accountable. The different type of PPE used and when to use it will be stated in the service users care plan as some service users are more high risk than others. It is therefore the healthcare workers responsibility to use personal protective equipment (PPE) to prevent the spread of infection.

It is a well-known fact that hand washing significantly reduces the spread of pathogens within healthcare settings and decreases mortality rates. The Department of Health and the Association for Professionals in Infection Control and Epidemiology (APIC) regularly encourage professionals to follow guidelines they set. ‘Unhygienic practises, such as healthcare professionals not washing hands between treating patients, can spread infections’ (Parliamentary Office of Science and Technology, 2005). Studies show that regular hand washing is a fundamental procedure in the prevention of common infections such as Methicillin-resistant staphylococcus Aureus (MRSA). ‘If you make nurses wash their hands you can control 80% of [MRSA]’ Mark Enright, senior research fellow in microbiology at Bath University’ (Eaton, 2005). Furthermore, according to the US Centers for Disease Control (CDC), ‘hand washing is the single most important procedure for preventing the spread of infection’ (Walker-Barrs, 2000). The APIC has produced a clear guide to hand washing that all healthcare professionals should follow. Workers in the health industry come into contact with bodily secretions often infected with pathogens and therefore hand washing is advised to be carried out before and after seeing a patient (even if personal protective equipment is used). The APIC guide to hand washing also advises on the different types of soap to use. Signs in patient’s rooms should be placed to encourage visitors, staff and patients to wash hands regularly. It is the healthcare professional’s responsibility to place and emphasis on the importance of hand washing to prevent infection.

Common healthcare associated infections (HAI’s) can all be reduced by putting appropriate infection prevention measures in place. Methicillin-resistant staphylococcus Aureus or MRSA is a well-known common infectious pathogen commonly found in healthcare settings. It attacks people with compromised immune systems therefore hospital wards are high risk settings. This puts an emphasis on how important it is to follow appropriate infection prevention methods. However, studies have undergone to find out if single room or cohort isolation can reduce the spread of MRSA in intensive care units. The results were unexpected showing that isolating patients with MRSA doesn’t affect the chances of infection and has negative outcomes that are discussed later. ‘Moving MRSA-positive patients into single rooms or cohorted bays does not reduce cross-infection. Because transfer and isolation of critically ill patients in single rooms carries potential risks, our findings suggest that re-evaluation of isolation policies is required in intensive-care units where MRSA is endemic, and that more effective means of preventing spread of MRSA in such settings need to be found’ (Cepeda, 2005).

Infection prevention in health care settings is important, however, it can have negative effects on the patient. Single room isolation is for people with serious infectious diseases and is often necessary as contact with other people can boost the chain of infection. However, there are various psychosocial implications for the client. ‘Health-care workers are half as likely to enter the rooms of patients in contact isolation’ (Kirklanda, 1999). Barriers used to protect the spread of infection like PPE can have a negative effect on the patient. For example, wearing gloves prohibits physical contact between the healthcare worker and the patient. This could give the patient a feeling that they are ‘infected’ or ‘dirty’. Furthermore, service users that get put into protective isolation may experience feelings of depression and loneliness as it reduces their contact with friends and family. These pointers require us to think about the way we go about infection prevention, for example, it would be essential to wear PPE when dealing with a patients bodily fluids however depending the type of illness they have, it may not be necessary to wear gloves when carrying out actions such as holding a patients hand. Isolation is costly, labour intensive and inconvenient for the patient and the healthcare employees.

Additionally isolation is more likely to lead to patient neglect and error. A study investigating patient’s put into isolation for infection control was carried out. It found that: ‘compared with controls, patients isolated for infection control precautions experience more preventable adverse events, express greater dissatisfaction with their treatment, and have less documented care’ (Stelfox, 2003). Furthermore, Wilkins et al (1988) focused on ‘discovering whether isolation may induce mental illness”. He found that isolation increases feelings of boredom, loneliness and insecurity. Ward, D. (2004) looked at ‘reducing the psychological effects of isolation’ and went on to find that after ‘the questionnaires were completed by 21 patients, nine participants identified negative emotions associated with isolation’ (Ward, 2004). Therefore, infection prevention is every healthcare professional’s responsibility, however, studies have proof that some forms of infection prevention that are used today are harmful both socially and mentally.

Moreover, healthcare professional’s efforts are undermined when visitors contaminate the healthcare setting with pathogens from outside. ‘The Centers for Disease Control and Prevention (CDC) has estimated that, nearly 2 million patients each year acquire an infection that is linked to a hospital visit. Of those, about 90,000 result in death’ (Davis, 2006). Despite hand gels, wash basins and personal protective equipment being provided as well as signs to encourage usage, visitors still do not understand the risk they are taking upon the service users when they do not acknowledge the importance of these measures. Visitors act as the ‘mode of transition’ within the chain of infection and influence the spread. As we cannot stop the public from visiting their friends and loved ones, it is the healthcare staff’s responsibility to encourage visitors to use appropriate precautions when entering and leaving the healthcare environment. The healthcare staff may feel that there is no point in making infection prevention their responsibility if their efforts are simply disregarded and undermined by the public. To stop the spread of pathogens, visitors should be encouraged to wash their hands as often as possible, stay at home if they are unwell and ensure their immunisations are up to date. Additionally, limiting visitors will decrease the chance of the spread of infection. An article titled ‘Limit Visitors to Help Cut Hospital Infections’ states that ‘Chris Beasley said “visitors increase the risk of hospital-acquired infections” (HAIs) and that she is thinking of ways to reduce the number of non- patients in hospitals’. The article then goes on to suggest ‘patients undergoing elective surgery could have to identify their key visitors’’ (Harrison, 2005). The ‘key visitors’ idea proposed by England’s chief nursing officer provides a means to cutting the spread of infection by visitors. Consequently legislation putting this idea into place would support their role of healthcare professional making infection prevention their responsibility.

Through the course of this essay it has been proven that infection prevention is every healthcare professional’s responsibility and is backed up by policies, legislation and guidance from the Department of Health, the Nursing and Midwifery Council and the Royal College of Nursing. They have published guidance on hand washing and the use of personal protective equipment but most importantly they have set a foundation for good healthcare practise to safeguard the public. In the NMC code of conduct, numbers thirty-eight to forty-one are focuses on keeping knowledge and skills up to date. Good knowledge and skills are essential in the awareness of common illnesses such as MRSA and without them the healthcare professional is not making infection prevention their responsibility. Even though it has been proven that high levels of infection prevention can cause negative effects to the service healthcare professionals provide, there are actions we can implement to conquer them, for example only using personal protective equipment when necessary as well as using single room isolation as a last resort.

Cepeda, A. (Jan 2005). Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two centre study. The Lancet. 365 (9456), p295-296. Davis, S. (2006). Breaking the Chain – Eight Strategies for Reducing Risk of Hospital Acquired Infection. Environmental Sciences. 19 (12), p43-45. Department of Health and Health Protection Agency (2013). Prevention and Control of Infection in Care Homes. London: Department of Health and Health Protection Agency. P1-16. Eaton, L. (April 2005). Hand washing is more important than cleaner wards in controlling MRSA. Available: http://www.bmj.com/content/330/7497/922.3. Last accessed 18th October 2013. Harrison, S. (2005). Limit visitors to help cut hospital infections. Nursing Standard. 19 (41), p6. Kirklanda, K. (1999). Adverse effects of contact isolation. The Lancet. 354 (9185), p1177-1178. Nusing and Midwifery Council (2008). The Code: Standards of conduct, performance and ethics for nurses and midwives. London: NMC. p6.
Parliamentary Office of Science and Technology. (July 2005). Infection Control in Healthcare Settings. Postnote. 247, p2. Royal College of Nursing. (2010). The Principles of Nursing Practise. Available: http://www.rcn.org.uk/development/practice/principles/the_principles. Last accessed 2nd November 2013. Royal College of Nursing. (2013). Infection Prevention and Control. Available: http://www.rcn.org.uk/development/practice/infection_control. Last accessed 20th October 2013. Stelfox, H. (2003). Safety of Patients Isolated for Infection Control. The Journal of the American Medical Association. 290 (14), p1. Walker-Barrs, A. (July 2000). Hand washing: Breaking the Chain of Infection. Available: http://www.infectioncontroltoday.com/articles/2000/07/handwashing-breaking-the-chain-of-infection.aspx. Last accessed 18th October 2013. Ward, D. (2004). Infection control: reducing the psychological effects of isolation. Available: http://www.internurse.com/cgi-bin/go.pl/library/article.cgi?uid=5527;article=BJN_9_3_162_170;format=html. Last accessed 2nd November 2013.

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