Infection Control: Protocol, Risk, And Compliance

Why infection control is important in healthcare facilities

Risk Management: Because the status of all person regarding blood-borne infections are unknown, spills of biological fluids (blood and body fluids) must be considered to have the potential for infection transmission. To prevent the possibility of infection transmission, spills need to be dealt with promptly and effectively.

Equipment:

• Blood spill kit for biological spills (containing Bio-waste absorbent)
• Gloves, protective glasses and impermeable gown
• Dust pan and scoop
• Hazard signs
• Paper hand towels
• Neutral detergent
• Mop and bucket
• Infectious waste bag

Method:

• Biological spills are cleaned immediately
• Collect spill cleaning kit
• Don protective apparel from kit, including gloves, plastic apron, protective glasses
• Place hazard signs around the spill
• Pour Bio-waste infectious waste absorbent sparingly onto spill, wait until it turns into a jelly consistency
• Remove as much of the spill as possible with the dustpan and scoop and dispose it immediately into infectious waste bag
• Use more paper towel to wipe- up spill completely
• Clean the spill site with hot water and neutral detergent
• Place all materials used in infectious waste bag, including gloves
• Seal waste bag, and place in appropriate waste storage area
• Wash hands
• The person who found and attended to the clean-up of the spill is responsible for restocking the spill kits and notifying the Infection Control Practitioner if additional equipment is required.
• Complete Incident Report form
• Chlorinated disinfection is only to be used for a highly infectious case, e.g. Avarian flu, CJD, gastro-enteritis.

It is likely that all products that can clean spills of blood on carpets will cause damage to the carpet.

• Clean immediately
• Place Hazard signs around the spill
• Collect Spill Kit from pan room, decontamination room in theatre, east pan room in Residential Care and in the store room at Oncology Centre.
• Remove as much of the spill as possible with the dustpan and scoop and dispose it immediately into infectious waste bag
• Other body fluids spill shall be removed with an approved carpet cleaner or detergent in the same manner as non-carpeted areas
• If staining of the carpet or upholstery is likely, notify the Nurse Unit Manager / After Hours Clinical Co-ordinator who will organise a professional cleaner as soon as practicable
• Complete Incident Report form
• Chlorinated disinfection is only to be used for a highly infectious case, e.g. Avarian flu, CJD, gastro enteritis
• The person who found and attended to the clean-up of the spill is responsible for restocking the spill kit and notifying the Infection Control Practitioner if additional equipment is required.

• Isolate spill and using signs keep area clear
• Response will vary depending on the chemical
• Relevant Material Safety Data sheets are available from the MSDS folder in the work area
• Immediately notify the Environmental Services Manager or for afterhours contact the After Hours Clinical Co-ordinator
• Complete Incident Report form.

• Protective clothing shall be worn
• Pick up waste with a dustpan and scoop and place in green waste bag
• Mop area with hot water and neutral detergent.

Ms. Pam Albert is a recently joined housekeeping staff at VCHN Regional Health. Mr. Ian Murdock is an EN and a member of Infection Control Committee (Better Practice Advisors) at this facility. Ian is delegated to monitor Ms. Pam’s work practices as part of quality and compliance monitoring.

Ian supervised Ms. Pam while she was attending to a general waste spill (heavily soiled incontinence pads on the floor) in a medical ward. The following are the observations made by Ian on Pam’s work practices.

• Pam used dustpan and scoop to pick up waste and placed in green waste bag.
• Pam mopped area with hot water and neutral detergent.
• Pam did not wear any protective clothing other than gloves while managing the general waste.
• Pam did not use hazard signs while mopping the floor.

Infectious agents can be transmitted to other wards of the hospital as Pam did not use any signs of keeping the area clear. Someone can walk past that area and may transmit the germs via shoes or socks. Improper disposal of the infectious wastes may cause drug resistant diseases (Nhmrc.gov.au. 2018). Infections spreading to neonatal wards may be fatal.

Ans:-Although Pam almost followed the protocol for the management of general wastes but, Pam would have used signs or texts to indicate that the bag contains infectious wastes.  Pam could have worn other protective clothing along with the gloves. The Blood soiled    pads or adult diapers may carry infectious pathogens which can spread if not discarded properly.

It was necessary to use hazard signs while mopping the floor as the floor might contain infectious germs that can be carried to the hospital wards via shoes (Biswal 2013).

After monitoring Pam’s work practices, Ian discussed the observations with Pam. It was evident from the discussion that Pam does not possess an insight into Infection Control – Spills Management – Biological, Chemical and Waste Protocol implemented in VCHN Regional. Pam did attend the orientation provided to her on day one and two. However, Pam is in need for more training.

Ans:- Apart from Ian , a registered nurse and consultant microbiologist can be present. A registered nurse would give a better insight of the places in the hospital that required more attention in terms of infections and a more detailed description of the VCHN Regional Health Policies.  The microbiologist can provide information regarding the different portals of entry of the microbes and the diseases caused by them.

Compliance monitoring for infection control

Write in your own words how Ian could provide a constructive feedback to Pam based on the discussions above. Include the information on the infection control protocol in your answer.

Ans: – Female hygiene stuffs and used adult diapers can account for nosocomial infections and can be lethal to certain patients. Hence it is necessary to maintain the protective gears. Pam should have used a face mask and a leg protector as well while clearing out the wastes. Pam should have used hazard signs around the wastes unless the spill is clear. While dealing with blood soiled pads it is necessary to dispose the wastes with the help of a pan (Chartier 2014). While cleaning the blood spills it is necessary to cover the spill with an absorbent clumping for allowing the spill to absorb. After washing the area with a detergent solution, it is better to cleanse the area with sodium hypochlorite solution. Hand and hygiene should be performed after the procedure.

Ian considers the statement ‘Protective clothing shall be worn’ as vague.

Ans: – Protective clothing like latex gloves, face masks, coveralls, leg protectors and hospital aprons should be worn (Mayhall 2012).

Ans: – There has to be differently coloured plastic bags for the disposal of the general wastes and highly infectious wastes. After the cleaning of the spills, it is important to restock or replace the spill kit with a new one, such that they are readily available in times of need. It is better that the kit should be used in a 6 gallon leak proof bucket. A laminated copy of the spill cleanup procedures should be provided to the new comers handling with spills (Chartier  2014).

Include in your answer how Ian could involve the healthcare team members in amending the protocol.

Ans: – Inadequacies should be brought under the notice of the registered nurse, the quality improvement coordinator or finally under the occupational health and the safety committee. It is important to point out the changes and the rationale behind the changes, and then record them officially on paper before proposing them in front of the committee.

Adopting the role as Ian, complete the report template “Attach Files” section of the question.

Crystal, enrolled nurse, is taking care of Mr. Adam who is infected with hepatitis B (HBV). Adam is concerned about the stigma and discrimination associated with his hepatitis B virus (HBV) status. Provide responses to the following questions based on this scenario.

Ans: – Hepatitis B virus is transmitted through blood, semen or other infected body fluids. Hepatitis B can be transmitted through unprotected sex with infectious partners. Thus the patient might experience a high level of stigma, shame and anxiety which can destroy their dignity and integrity. Destruction of the dignity may further deteriorate their physical and mental health status. Maintenance of the privacy and confidentiality of a person is one of the ethics of nursing that should not be breached.

Ans: – Confidentiality shall be maintained while dealing with the medical records. Electronic health records shall be well preserved under legal laws to prevent any unauthorised access. Separate rooms shall be managed and care should be taken such that any medical discussions are not overheard. Medical reports should only be disclosed to authentic person or for public welfare.

You observed that Emma, a student nurse, always takes one additional wound dressing pack while performing wound care to clients. This pack usually remains unpacked and is thrown away with the used materials. Is there any issue in this scenario? What could you do in this scenario being a responsible enrolled nurse?

Ans: – Prevention of the wastage of excessive clinical toolkits can be helpful in reducing the health care cost of a particular health care setting. Emma can take the additional wound dressing pack, but it should be preserved at a secured and a clean place such that it can be used further. 

As a responsible nurse I would try to encourage Emma to do the dressing using one pack only and if she needed one then an extra dressing pack can be brought from the storage.

References

Biswal, S., 2013. Liquid biomedical waste management: An emerging concern for physicians. Muller Journal of Medical Sciences and Research, 4(2), p.99.

Chartier, Y. ed., 2014. Safe management of wastes from health-care activities. World Health Organization.

Magill, S.S., Hellinger, W., Cohen, J., Kay, R., Bailey, C., Boland, B., Carey, D., de Guzman, J., Dominguez, K., Edwards, J. and Goraczewski, L., 2012. Prevalence of healthcare-associated infections in acute care hospitals in Jacksonville, Florida. Infection Control & Hospital Epidemiology, 33(3), pp.283-291.

Mayhall, C.G., 2012. Hospital epidemiology and infection control. Lippincott Williams & Wilkins.

Nhmrc.gov.au. (2018).  [Australian Guidelines for the Prevention and Control of Infection in Healthcare (2010) | National Health and Medical Research Council. [online] Available at: https://www.nhmrc.gov.au/guidelines-publications/cd33 Accessed 7 Feb. 2018].