Preventing Health Care–Associated Infections (2008)

It is the responsibility of all health care providers to enact principles of care to prevent health care–associated infections, though not all infections can be prevented. Certain patient risk factors such as advanced age, underlying disease and severity of illness, and sometimes the immune status are not modifiable and directly contribute to a patient’s risk of infection. Depending on the patient’s susceptibility, a patient can develop an infection due to the emergence of their own endogenous organisms or by cross-contamination in the health care setting. Benefits of antimicrobial therapy will alter the microbial flora by reducing one microbial presence but may allow the emergence of another, causing a new infection (e.g., antibiotic-associated diarrhea).Nurses can reduce the risk for infection and colonization using evidence-based aseptic work practices that diminish the entry of endogenous or exogenous organisms via invasive medical devices. Proper use of personal protective barriers and proper hand hygiene is paramount to reducing the risk of exogenous transmission to a susceptible patient. For example, microorganisms have been found in the environment surrounding a patient and on portable medical equipment used in the room. Environmental surfaces around a patient infected or colonized with a multidrug-resistant organism can also become contaminated. Health care workers should be aware that they can pick up environmental contamination of microorganisms on hands or gloves, even without performing direct patient care. Proper use and removal of PPE followed by hand hygiene will reduce the transient microbial load that can be transmitted to self or to others. Identified aseptic and infection control practices have been proven to reduce the dissemination of organisms to a single patient, to prevent repeated transmissions that contribute to an outbreak situation among multiple patients, or to become established in the health care environment as endemic hospital flora.Nursing has many complicated scopes of practice, which challenge time management, priority setting, and efficiency of practice. Although system and administrative support is beneficial to supporting aspects of nursing care, direct care is performed by individuals. Every individual nurse focuses on making a difference throughout the daily workloads and enormous responsibilities but changes in a patient’s medical condition can become overwhelming. One nurse comes to mind who found the resolve to make significant strides within the patient ward dealing with chronically overwhelming situations. She was administratively responsible for directing and addressing the challenges of all patients’ chronic wound infections, ongoing cross-contamination, lack of needed medical supplies and equipment, severe understaffing, working extra shifts, and still finding time to provide care and comfort to patients. By her personal efforts to improve wound care, aseptic practices, and hand hygiene among all nursing and medical staff, mortality dropped in a dramatic decline from 33 percent to 2 percent within a 9-month period. These sustained and dedicated efforts to reduce patient infections and improve patient care in light of overwhelming adversity set a standard of practice for all nurses to follow. That nurse was Florence Nightingale, defining the art of nursing in the 1850s. Although medical care is more advanced and technically more complex since that time, it was the dedication of a nurse (like you) to ensure aseptic practices despite the significant nursing demands of patient care that makes the difference for the patients—then and now.National surveys of the public have repeatedly found nursing to be one of the most trusted professions. The public trusts us to provide safe care and employ best practices by following certain principles: (1) to not work while having an infectious illness, (2) to be knowledgeable about the methods to protect our patients from transmission of disease, (3) to perform aseptic practice and monitor patient infections, (4) to participate in quality improvement initiatives to reduce infections, and (5) to provide care even if it means self-risk from infection. As nurses we have an ethical obligation to meet that trust and uphold the highest standards for our patients and the public, whether we are providing direct care, teaching about proper health care, or overseeing nursing practice.It has been demonstrated that nursing and medical practices can pick up transient microorganisms from intact patient skin and from environmental surfaces. Although the amount of contamination is not quantified and the exact incidence is not apparent, it does occur. Hand hygiene and aseptic practices before caring for a susceptible patient can reduce the transient carriage and transfer of microorganisms. The protective benefits of infection control using evidence-based practices are cost effective and numerous: they not only contribute to the best individual patient care outcome, but also protect health care workers, increase public awareness in all health care settings about infection control issues, and maintain the highest standards in nursing, which positively contributes to our goal for the best possible patient and public health outcomes.