Ignaz Semmelweiss: Breaking The Chain Of Infection
In 1847 Ignaz Semmelweiss discovered that healthcare associated infections (HCAIs) were commonly transmitted by the hands of healthcare workers and hand washing was an important component in breaking the chain of infection (Weston, 2008 and World Health Organization (WHO), 2009). Hand washing helps to control infection rates (Weston, 2008) and is the simplest and most effective way to break the chain of infection and prevent HCAIs (Pittet & Boye, 2001).
This assignment will examine the chain of infection, how infection is spread and the subsequent consequences. The process of hand washing will also be explored, looking at when hand washing should be used, technique and whether when used alone it is enough to break the chain. Ignaz Semmelweiss also discovered that there were significant barriers to hand washing (Weston, 2008), these will be discussed and some solutions will be considered.
The Nursing and Midwifery Council (NMC) Code of Conduct (2008) states that you must identify and minimise any risk to patients, …show more content…
placing a duty on healthcare workers, this is supported by The Health and Safety at Work Act (1974). The Health and Social Care Act (2008) and The Health Act (2006) also protect patients by setting out legal guidelines and requirement for care providers and acute hospitals regarding hand hygiene.
HCAIs cost the NHS approximately one billion pounds each year (Cookson et al., 2001) and can increase patient’s stay in hospital (Pittet et al, 2011). MRSA can be an extra ten days, CDIF up to an extra twenty one days costing between four and ten thousand pounds more to treat a patient (Pittet et al 2011). For the he patient HCAIs mean an extended stay in hospital, unnecessary pain and discomfort and costs resulting from time off work, child or pet care.
HCAIs affect approximately 300, 000 patients each year in the UK and bacterial infections are becoming increasingly difficult to fight (Pittet et al., 2011), HCAIs include Vancomycin- resistant Enterococcus (VRE), Norovirus, Gastroenteritis, Methicillin-resistant Staphylococcus aureus (MRSA) Clostridium difficile infection (CDIF) (Brooker et al, 2000). HCAI prevalence in hospitals in England is 8.19%, a figure that could be significantly reduced (Davies et al., 2006). Hand washing is the leading prevention method and the minimum patients expect from healthcare workers (Pittet et al, 2011). Hand washing also helps reduce costs, morbidity and mortality (Motacki, & Kapoian, 2011).
The chain of infection is the spread of infection from one individual to another (Weston, 2008). It starts with the organism; bacteria, virus, fungi, and parasites. Pathogens are carried in blood, excretions, secretions, skin scales, vomit, food, water and other bodily fluids (Motacki & Kapoian, 2011). Transmission from the source can happen through inhalation, indirect or direct contact or by arthropods (Rogers & William, 2011). The next part in the chain is the reservoir or breeding ground; the hands are an ideal place for bacteria to colonise (Ayliffe et al., 2000).
All humans have resident flora, not likely to cause infection and transient flora which can colonize and multiply on the superficial layers of the hands. It is the transient bacteria that may be pathogenic (Brooker et al., 2000) and contains two types of proteins that cause infection, exotoxins and endotoxins that cause fevers and do not respond to antibiotics (Rogers & William, 2011). Health workers need to be aware that everyday patient care activities that require direct contact can spread infection (Motacki & Kapoian, 2011). Transport via hands is the link in the chain that can be broken (Pittet, 2000).
The next stage in the chain of infection is the portal of entry; pathogens can enter the body through the GI tract, respiratory tract or skin (Weston, 2008).
According to Emmerson et al. (1996) the most common types of infection are on the skin, surgical sites, the urinary tract and the lower respiratory tract and if untreated can cause pneumonia and infections of the blood stream and urinary tract (Pittet et al, 2011). Hand washing is particularly important when dealing with patients with invasive devices and artificial openings (WHO, 2009). Catheter care, enteral feeding and central venous catheters are points of entry for pathogens and bacteria, other points of entry include the mouth, wounds, rectum, urethra and mucus membranes (Weston, 2008). Factors that are likely to increase the risk of transmission and infection include productive coughs, exuding wounds with cellulitis, diarrhoea, incontinence or uncontrolled bleeding (Bowell,
1992).
In hospital healthcare workers have to nurse sicker patients who are more vulnerable to infection as their immune system is weakened (Weston, 2008), particularly after cancer treatment, pregnancy, malnutrition, or therapeutic immunosuppression or for AIDS patients (Rogers & William, 2011, p. 23). Certain patients are more susceptible to infection including the elderly, obese, malnourished, premature babies and patients with immunodeficiency (WHO, 2009).
The WHO (2009) guidelines specify the five moments of hand hygiene (Appendix 1) which are before patient contact, before an aseptic task, after bodily fluid exposure risk, after patient contact and after contact with patient surroundings and surfaces. This includes after contact with contamination, before and after glove use, aseptic or sterile procedures and when visibly soiled (Wilson, 2006). The purpose of hand washing is to remove transient bacteria, dirt and debris from the hands to make them clean and to prevent cross infection (Pittet et el., 2007).
Technique is more important than the substance used or the time taken (Ayliffe et al., 1992 and Rogers & William, 2011). Using Ayliffe’s technique hands should be wet before applying sufficient soap, then follow each step for around 10-15 seconds, rinse hands turn off the tap with your elbow, dry hands thoroughly with a paper towel, not touching the bin when disposing and moisturise (Ayliffe et al., 2000). The use of antiseptic agents rather than soap is much more successful in the reduction of infection (Weston, 2008). Drying with paper towels is an essential part of hand washing as conditions of moisture produce ideal conditions for microorganisms to live on and multiply (WHO, 2009).
Hand washing is one of a number of components, others include being naked from the elbow down, no jewellery (except a wedding band), short, clean finger nails, no false nails or nail varnish, washing uniforms at sixty degrees, foot operated bins, disposable towels, covering wounds or lesions with a waterproof dressing and the use of personal protective equipment (PPE) such as gloves, visors, hats and aprons (WHO, 2009). It is important to make sure that sharps and clinical waste are disposed of in the correct way and equipment is never used twice (WHO, 2009).
Alcohol gel can be used but is not effective against some bacteria like Clostridium difficile (C-diff) or viruses that cause diarrhoea (Norovirus). Practising asepsis and the insertion of invasive devices correctly using NICE and EPIC guidelines (WHO, 2009), and the use of isolation (Cardo et al., 2007) also helps to prevent the transmission of infection. Gloves should be worn when dealing with bodily fluids, blood and some chemicals but do not totally protect hands and can actually be a mode of transmission for infection (WHO, 2009).
There is a close correlation between the length of patient care and possibility of contamination (Cardo et al., 2007 and WHO, 2009) so healthcare workers should avoid unnecessary contact with patients. Good diet, continence, personal hygiene, more mobility and a positive attitude all help to boost the immune system and vaccinations will help to protect patients and health workers (WHO, 2009).
According to Motacki and Kapoian (2011) and Pittet et al. (2011) there are numerous barriers and complex factors that affect compliance. Education, campaigns and training do not last and perceptions about hand washing can be very different from the truth (Pritchard & Raper, 1996). The compliance of doctors was much lower than the doctors themselves reported and this was also the case with healthcare assistants (Pittet, 2000). Non compliance may also be attributed to chemicals used in soaps and alcohol rubs which can cause irritation, dryness and poor skin health (Pittet, 2000).
Other barriers may include a lack facilities, understaffing, overcrowding (Pittet, 2000), time, patient priority, perceived interference with patient relationship and low infection risk, lack of knowledge, forgetfulness, lack of role models, scepticism and disagreement (Motacki & Kapoian, 2011 and WHO, 2009). Barriers to non-compliance can be overcome with education and training, awareness, the availability of hand washing facilities and moisturizers and the promotion of a zero tolerance policy (WHO, 2009). Using observational and assessment tools such as The Lewisham Tool or The Feedback Intervention Trial Tool (Fit) helps save lives by reducing infection and delivering clean and safe care to patients (WHO, 2009).
Nurses have the most contact with patients so should take more of an active role in antimicrobial stewardship programmes enabling them to manage antimicrobial agents (Drumright et al., 2011). This would help reduce HCAIs, increase antimicrobial resistance, minimise the length of stay and cost (Drumright et al., 2011). Patient empowerment (Gillespie, 2001) is also important and by creating an ‘It’s ok to ask’ environment, patients can question others to promote hand washing intervention (Pittet et al, 2011). All patients need to be encouraged to wash their hands too, it is possible to be an MRSA carrier but be perfectly healthy (Willliams, 1963).
It is impossible to completely remove exposure to infection but by adhering to standard guidelines and precautions and avoiding unnecessary exposure it is possible to minimise the risk. Routine and surgical hand washing is a simple and most cost effective way to break the chain of infection significantly reducing costs, morbidity and mortality. Hand washing alone is not enough to eliminate infection and must be used alongside other preventative measures. Perceptions and attitudes are central to achieving compliance and a change in culture is necessary to achieve maximum results using training, patient and health worker empowerment, assessment tools and a zero tolerance policy.
This assignment will examine the chain of infection, how infection is spread and the subsequent consequences. The process of hand washing will also be explored, looking at when hand washing should be used, technique and whether when used alone it is enough to break the chain. Ignaz Semmelweiss also discovered that there were significant barriers to hand washing (Weston, 2008), these will be discussed and some solutions will be considered.
The Nursing and Midwifery Council (NMC) Code of Conduct (2008) states that you must identify and minimise any risk to patients, …show more content…
placing a duty on healthcare workers, this is supported by The Health and Safety at Work Act (1974). The Health and Social Care Act (2008) and The Health Act (2006) also protect patients by setting out legal guidelines and requirement for care providers and acute hospitals regarding hand hygiene.
HCAIs cost the NHS approximately one billion pounds each year (Cookson et al., 2001) and can increase patient’s stay in hospital (Pittet et al, 2011). MRSA can be an extra ten days, CDIF up to an extra twenty one days costing between four and ten thousand pounds more to treat a patient (Pittet et al 2011). For the he patient HCAIs mean an extended stay in hospital, unnecessary pain and discomfort and costs resulting from time off work, child or pet care.
HCAIs affect approximately 300, 000 patients each year in the UK and bacterial infections are becoming increasingly difficult to fight (Pittet et al., 2011), HCAIs include Vancomycin- resistant Enterococcus (VRE), Norovirus, Gastroenteritis, Methicillin-resistant Staphylococcus aureus (MRSA) Clostridium difficile infection (CDIF) (Brooker et al, 2000). HCAI prevalence in hospitals in England is 8.19%, a figure that could be significantly reduced (Davies et al., 2006). Hand washing is the leading prevention method and the minimum patients expect from healthcare workers (Pittet et al, 2011). Hand washing also helps reduce costs, morbidity and mortality (Motacki, & Kapoian, 2011).
The chain of infection is the spread of infection from one individual to another (Weston, 2008). It starts with the organism; bacteria, virus, fungi, and parasites. Pathogens are carried in blood, excretions, secretions, skin scales, vomit, food, water and other bodily fluids (Motacki & Kapoian, 2011). Transmission from the source can happen through inhalation, indirect or direct contact or by arthropods (Rogers & William, 2011). The next part in the chain is the reservoir or breeding ground; the hands are an ideal place for bacteria to colonise (Ayliffe et al., 2000).
All humans have resident flora, not likely to cause infection and transient flora which can colonize and multiply on the superficial layers of the hands. It is the transient bacteria that may be pathogenic (Brooker et al., 2000) and contains two types of proteins that cause infection, exotoxins and endotoxins that cause fevers and do not respond to antibiotics (Rogers & William, 2011). Health workers need to be aware that everyday patient care activities that require direct contact can spread infection (Motacki & Kapoian, 2011). Transport via hands is the link in the chain that can be broken (Pittet, 2000).
The next stage in the chain of infection is the portal of entry; pathogens can enter the body through the GI tract, respiratory tract or skin (Weston, 2008).
According to Emmerson et al. (1996) the most common types of infection are on the skin, surgical sites, the urinary tract and the lower respiratory tract and if untreated can cause pneumonia and infections of the blood stream and urinary tract (Pittet et al, 2011). Hand washing is particularly important when dealing with patients with invasive devices and artificial openings (WHO, 2009). Catheter care, enteral feeding and central venous catheters are points of entry for pathogens and bacteria, other points of entry include the mouth, wounds, rectum, urethra and mucus membranes (Weston, 2008). Factors that are likely to increase the risk of transmission and infection include productive coughs, exuding wounds with cellulitis, diarrhoea, incontinence or uncontrolled bleeding (Bowell,
1992).
In hospital healthcare workers have to nurse sicker patients who are more vulnerable to infection as their immune system is weakened (Weston, 2008), particularly after cancer treatment, pregnancy, malnutrition, or therapeutic immunosuppression or for AIDS patients (Rogers & William, 2011, p. 23). Certain patients are more susceptible to infection including the elderly, obese, malnourished, premature babies and patients with immunodeficiency (WHO, 2009).
The WHO (2009) guidelines specify the five moments of hand hygiene (Appendix 1) which are before patient contact, before an aseptic task, after bodily fluid exposure risk, after patient contact and after contact with patient surroundings and surfaces. This includes after contact with contamination, before and after glove use, aseptic or sterile procedures and when visibly soiled (Wilson, 2006). The purpose of hand washing is to remove transient bacteria, dirt and debris from the hands to make them clean and to prevent cross infection (Pittet et el., 2007).
Technique is more important than the substance used or the time taken (Ayliffe et al., 1992 and Rogers & William, 2011). Using Ayliffe’s technique hands should be wet before applying sufficient soap, then follow each step for around 10-15 seconds, rinse hands turn off the tap with your elbow, dry hands thoroughly with a paper towel, not touching the bin when disposing and moisturise (Ayliffe et al., 2000). The use of antiseptic agents rather than soap is much more successful in the reduction of infection (Weston, 2008). Drying with paper towels is an essential part of hand washing as conditions of moisture produce ideal conditions for microorganisms to live on and multiply (WHO, 2009).
Hand washing is one of a number of components, others include being naked from the elbow down, no jewellery (except a wedding band), short, clean finger nails, no false nails or nail varnish, washing uniforms at sixty degrees, foot operated bins, disposable towels, covering wounds or lesions with a waterproof dressing and the use of personal protective equipment (PPE) such as gloves, visors, hats and aprons (WHO, 2009). It is important to make sure that sharps and clinical waste are disposed of in the correct way and equipment is never used twice (WHO, 2009).
Alcohol gel can be used but is not effective against some bacteria like Clostridium difficile (C-diff) or viruses that cause diarrhoea (Norovirus). Practising asepsis and the insertion of invasive devices correctly using NICE and EPIC guidelines (WHO, 2009), and the use of isolation (Cardo et al., 2007) also helps to prevent the transmission of infection. Gloves should be worn when dealing with bodily fluids, blood and some chemicals but do not totally protect hands and can actually be a mode of transmission for infection (WHO, 2009).
There is a close correlation between the length of patient care and possibility of contamination (Cardo et al., 2007 and WHO, 2009) so healthcare workers should avoid unnecessary contact with patients. Good diet, continence, personal hygiene, more mobility and a positive attitude all help to boost the immune system and vaccinations will help to protect patients and health workers (WHO, 2009).
According to Motacki and Kapoian (2011) and Pittet et al. (2011) there are numerous barriers and complex factors that affect compliance. Education, campaigns and training do not last and perceptions about hand washing can be very different from the truth (Pritchard & Raper, 1996). The compliance of doctors was much lower than the doctors themselves reported and this was also the case with healthcare assistants (Pittet, 2000). Non compliance may also be attributed to chemicals used in soaps and alcohol rubs which can cause irritation, dryness and poor skin health (Pittet, 2000).
Other barriers may include a lack facilities, understaffing, overcrowding (Pittet, 2000), time, patient priority, perceived interference with patient relationship and low infection risk, lack of knowledge, forgetfulness, lack of role models, scepticism and disagreement (Motacki & Kapoian, 2011 and WHO, 2009). Barriers to non-compliance can be overcome with education and training, awareness, the availability of hand washing facilities and moisturizers and the promotion of a zero tolerance policy (WHO, 2009). Using observational and assessment tools such as The Lewisham Tool or The Feedback Intervention Trial Tool (Fit) helps save lives by reducing infection and delivering clean and safe care to patients (WHO, 2009).
Nurses have the most contact with patients so should take more of an active role in antimicrobial stewardship programmes enabling them to manage antimicrobial agents (Drumright et al., 2011). This would help reduce HCAIs, increase antimicrobial resistance, minimise the length of stay and cost (Drumright et al., 2011). Patient empowerment (Gillespie, 2001) is also important and by creating an ‘It’s ok to ask’ environment, patients can question others to promote hand washing intervention (Pittet et al, 2011). All patients need to be encouraged to wash their hands too, it is possible to be an MRSA carrier but be perfectly healthy (Willliams, 1963).
It is impossible to completely remove exposure to infection but by adhering to standard guidelines and precautions and avoiding unnecessary exposure it is possible to minimise the risk. Routine and surgical hand washing is a simple and most cost effective way to break the chain of infection significantly reducing costs, morbidity and mortality. Hand washing alone is not enough to eliminate infection and must be used alongside other preventative measures. Perceptions and attitudes are central to achieving compliance and a change in culture is necessary to achieve maximum results using training, patient and health worker empowerment, assessment tools and a zero tolerance policy.