Infection prevention and control is the responsibility of all healthcare providers.
With the COVID-19 pandemic upon us, infection prevention and control are on everyone’s radar — including the general public.
Nurses learn about clean and sterile techniques as part of infection prevention in their licensing programs. However, caring for patients can be hectic. This can lead to omitting important steps — either wittingly or unwittingly — regarding best practices with infection control.
In order to keep your patients and yourself safe, it’s imperative to use evidence-based infection prevention and control practices at all times.
We spoke with two experts in the field of infection control and prevention and performance improvement to review five essential tools for nurses.
1 — Hand-washing
“The most important tool for infection control and prevention is proper hand-washing,” said Michele George, MBA, BSN, RN, CLSSGB, a national director on the Academy of Medical-Surgical Nurses board of directors and a performance improvement specialist at Memorial Hermann Health System in Spring, Texas. “Its significance cannot be overstated. Hand-washing is one of the best ways to protect yourself, your family and others from illness.”
Everyone should follow these five steps described by the Centers for Disease Control and Prevention (CDC) every time they wash their hands:
- Wet your hands with clean, running water.
- Lather your hands, including the back of your hands, between your fingers and under your nails.
- Rub your hands together for a minimum of 20 seconds. Sing the Happy Birthday song from start to finish twice, which lasts about 20 seconds.
- Rinse your hands well under clean, running water.
- Dry your hands using a fresh paper towel or clean cloth towel, or air dry them.
George said it may sound crazy, however, it’s important to take a sixth step, which many nurses already practice.
“Remember to turn off the faucet with a clean, dry paper towel and use the towel when touching the door handle to leave the bathroom,” she said. “Dispose of the towel in the trash. If you don’t, you’ll be recontaminating your hands when you shut off the faucet and/or open the door to exit the bathroom.”
2 — Hand sanitizer
With regards to hand sanitizer, George pointed out the CDC recommends washing hands with soap and water whenever possible because hand-washing reduces the amount of many types of germs, chemicals and visible dirt and grease.
“If soap and clean water are not available, using a hand sanitizer with at least 60% alcohol can help reduce the number of germs,” she said.
Per the CDC, George said hand sanitizers may not be as effective as soap and water as they:
- Cannot remove all types of microbes
- Are not as efficient for removing visible dirt and grease
- Do not remove harmful chemicals, pesticides and heavy metals
The CDC advises using the right amount of hand sanitizer based on the label’s instructions. Apply sanitizer on the palm of one hand, rub both hands together while rubbing the gel on all surfaces of the hands and all fingers until your hands become dry, which takes about 20 seconds.
3 — The bundle approach
Another important tool in preventing infections is use of the bundle approach, said Luci Perri, MSN, MPH, RN, CIC, FAPIC, CSPDT, owner and president of Infection Control Results, a consulting company based in Charlotte, N.C.
“Using a specific set of evidence-based steps, known as bundles, for performing specific procedures such as for aseptic insertion and proper maintenance of urinary catheters and central lines as two examples, can help reduce the risk of catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI) and improve patient outcomes,” Perri said.
Other points to consider are the removal of catheters and central lines whenever it’s feasible for patients and assessing the need for a Foley catheter if a patient needs frequent straight caths, according to Perri. “It’s important your nursing practice is evidence-based and you advocate for your patient,” she said.
4 — PPE and practice controls
Personal protective equipment (PPE) for nurses encompasses not only masks, gowns, gloves, face shields and goggles, according to Peri, but also sharps safety devices and practice controls.
“Following policies and procedures such as not recapping needles, is one example of a utilizing a practice control to prevent needlesticks,” she said.
Learning and practicing the correct sequence of donning and doffing PPE is imperative.
“Many times, nurses and others contaminate themselves when they remove PPE,” Peri said. “It’s essential all the correct steps are followed to prevent contaminating yourself and others by accurately putting on and taking off your PPE.”
5 — Proper use of disinfectants
“Even though your facility’s environmental services staff cleans patient rooms on a routine basis, it’s important nurses also ensure they disinfect equipment they’re using throughout the day,” George said. “High-use items such as computer keyboards, computers on wheels, phones, countertops, doorknobs and light switches are some examples.”
Another important factor is following instructions regarding disinfectant contact time, which can vary from 15 seconds to 10 minutes.
“Nurses are busy,” Peri said. “However, it’s imperative they follow the disinfectant contact time for the products they’re using according to the label’s instructions, so the product works as intended.”
Infection prevention at home
Nurses need to be just as vigilant with infection prevention when going home after a shift as they are at work. Of concern is whether the coronavirus can live on their scrubs and other work wear, such as shoes.
Although, transfer of the virus is said to be unlikely for the general public via scrubs or shoes, your position on the front lines means you should take extra precautions — especially considering we have yet to learn everything there is to know about COVID-19. Plus, a new study published by the Centers for Disease Control and Prevention suggests the novel coronavirus can live on the soles of shoes.
With these considerations in mind, here are some tips that can help you avoid bringing contaminated work items into your home:
- Leave your work shoes in the trunk when you get home. If you plan on cleaning them either by hand or in the washing machine, wash your hands before and after touching your shoes, and take your shoes off with your other foot, instead of with your hands.
- Rotate more than one pair of work shoes and use different shoes for non-work-related activities.
- Remove your work clothes before you walk inside the house (or very soon after) and take a shower before interacting with family.
- Immediately wash and sanitize soiled work clothes.
Three recent deadly infections
The correct use of PPE is essential for infection prevention and to protect yourself, your patients and others from infectious diseases. With that in mind, here is a brief overview of three recent deadly infections.
COVID-19: At press time, the world has been dealing with a new pandemic from the novel coronavirus. While the number of cases and deaths increase daily, as of May 1 stats were:
- More than 3.2 million cases worldwide
- Total deaths of more than 230,000
- 1 million-plus patients recovered
For the latest updates, visit the Johns Hopkins University COVID-19 resource center.
Seasonal influenza: This causes high numbers of illnesses and deaths in the U.S. and worldwide each year. The CDC estimates that the current influenza season, from October 2019 through March 2020 in the U.S., caused:
- An estimated 38 million to 54 million cases of influenza-like illnesses
- Total hospitalizations of 390,000 to 710,000
- Total deaths from 23,000 to 59,000
Ebola Virus Disease: Ebola was discovered in 1967. Recent large outbreaks occurred in Africa from 2014-2016, and again from 2018-2019. Ebola’s average mortality rate is 50%, and the approximate number of infections was 35,000.