Microbiology and Infection Prevention and Control for Nursing Students

Deborah Ward

• Publisher: Learning Matters
• Year: 2016
• ISBN:
  9781473967731
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Preventing and controlling infection has long been an on going challenge for all healthcare workers at every level. High profile examples like the Ebola outbreak in West Africa or the prevalence of 'super bugs' like MRSA demonstrate that this challenge is not going to go away. As a nurse you have a responsibility to protect your patients from harm and preventing and controlling infection is a crucial component of this.

By introducing the unpinning microbiology to explain how infection occurs and spreads and the practical steps and precautions that you need to follow, this book will equip you with the knowledge and information necessary to play your part in preventing and controlling infection.

Key features:

· Written specifically for pre-registration nursing students providing the core, evidence-based knowledge that you need to know

· Breaks the science down using easy-to-follow language, practical examples and case studies

· Applies microbiology to practice introducing practical steps, precautions and strategies that will benefit you as soon as you get onto your placements

· Includes multiple-choice questions to test your understanding and activities to help you engage with wider issues around infection prevention and control.

About the author Deborah Ward is a lecturer at the School of Nursing, Midwifery and Social Work, Manchester University.

Chapter 1 Background

NMC Standards for Pre-registration Nursing Education

This chapter will address the following competencies:

Domain 3: Nursing practice and decision-making

Generic competencies

5. All nurses must understand public health principles, priorities and practice in order to recognise and respond to the major causes and determinants of health, illness and health inequalities. They must use a range of information and data to assess the needs of people, groups, communities and populations, and work to improve health, well-being and experiences of healthcare; secure equal access to health screening, health promotion and healthcare; and promote social inclusion.

NMC Essential Skills Clusters: Infection Control

This chapter will address the following ESCs:

• Discusses the benefits of health promotion within the concept of public health in the prevention and control of infection for improving and maintaining the health of the population (Progression point 2).
• Applies legislation that relates to the management of specific infection risk at a local and national level (Progression point 3).

Chapter Aims

After reading this chapter you will be able to:

• Highlight the extent of the problem of healthcare-associated infection both in the UK and internationally.
• Discuss some of the consequences of healthcare-associated infection.
• Identify some of the important organisations related to infection and its prevention and control in healthcare.

Introduction

In the UK, 5000 people a year die from healthcare-associated infections, with a further 15,000 deaths occurring with such infections as a contributory factor. Around 300,000 hospital infections occur each year. (Health Protection Agency, 2012a)

This chapter will introduce you to infection and healthcare-associated infection and its consequences. Firstly we will consider the effects on patients, then on healthcare staff such as nurses and finally on healthcare organisations. We then go on to discuss the various organisations available to provide information and support to nurses in relation to healthcare-associated infection, the websites for which are provided at the end of the chapter so that you are able to gain access to these before identifying relevant infection prevention and control related legislation. The end of this chapter looks at public health aspects of infection prevention and control. Throughout the chapter are case studies and activities which will enable you to link the information in the chapter with clinical practice as a nurse.

The last point prevalence survey in 2011 in England identified a healthcare-associated infection prevalence of 6.4% with the most common sites being the respiratory and urinary tracts and surgical sites (Health Protection Agency, 2012a). This means that 6.4% of patients admitted to hospital acquire an infection related to their admission. This is considered to be an estimate as many infections occur after discharge from hospital and these are not always identified in hospital statistics. Healthcare-associated (also called nosocomial) infections (HCAIs) are both a national and international issue. According to the European Centre for Disease Prevention and Control (ECDC, 2007) there are an estimated 50,000 deaths every year in Europe from HCAIs and 99,000 deaths every year in the US. HCAI, then, is clearly a global problem. It is estimated that between 15% and 30% of HCAIs are avoidable by the application of what we already know about infection prevention. In nursing we aim to minimise the risk of infection as far as we can to prevent avoidable infection in our patients. To do this we apply specific precautions, discussed later in Chapters 8 and 9. In the UK we are supported by various organisations and pieces of legislation in the form of information and advice, legal frameworks and guidance.

Consequences of Healthcare-associated Infections

HCAIs can have negative effects on patients, staff, healthcare services and the local community. It is important as nurses that we consider these consequences as they can be the direct or indirect result of our action or inaction in the healthcare environment. In order to consider consequences, they can be divided into those related to the patient, those related to staff and those which affect the healthcare organisation involved.

Effects on Patients

Patients who acquire a HCAI (also referred to as nosocomial if specifically acquired in hospital) can suffer a range of associated consequences from relatively minor to so severe that they result in their death. They may have to stay in hospital for a longer period, be off work for longer or may even suffer permanent consequences such as a disability that means they can no longer work in their current job role or at all. If at home with an HCAI they may require additional services from the health and care sectors including their GP, district and practice nurses and their local pharmacist. There will often be delays in a return to a patient's normal level of function so that some patients require relatives to care for them at home. HCAIs also result in a poorer physical and mental health status.

Effects on Staff

Effects on staff could be considered both as a consequence of caring for patients who may be more severely ill or for themselves if they acquire an infection through their work. When healthcare workers such as nurses acquire infections at work, they may need to be on sick leave which affects both them and their colleagues; the latter may need to work in an area where they are now short of staff or bank/agency staff may be required to cover the absent member of staff. For nurses who work full time for an agency, being on sick leave means that they do not earn their salary which clearly has financial implications for them. However, the risk of infection to staff is very small if infection prevention and control precautions are applied, as detailed in Chapters 8 and 9. When an infection occurs on a ward, for example, staff may feel guilty about whether the infection was avoidable. Root cause analysis is a process within healthcare that looks at the causes of an incident, such as an HCAI, and nurses may need to be involved in this process which can be worrying for them. There are also set targets within organisations for infection rates relating to some infections so the Infection Control Team (see Chapter 7) may be involved in investigating cases of HCAI which can also have consequences for nurses caring for patients.

Effects on the Healthcare Organisation

There is a potentially avoidable cost of £150 million per annum associated with HCAI in England, with each such infection costing an additional £4000–10,000 (National Audit Office, 2009). There are therefore financial costs associated with HCAI. Data on infections in England are regularly updated on the Public Health England website (see later for website). In addition to this, we need to consider costs to reputation.

In order to put these effects into context, it is worth considering a real situation.

Activity 1.1 Reflection

Consider what occurred at East Maidstone and Tunbridge Wells Trust in relation to an outbreak of Clostridium difficile by searching online. What do you think the consequences have been of the outbreak to this NHS Trust?

An outline answer is provided at the end of the chapter.

As you will have seen from your research around this event, the consequences were far-reaching, beyond even the affected organisation.

In terms of reputation, this might lead from newspaper or television reports related to HCAI in the local and national media as in the activity case above. The effects of negative attention such as this on an NHS organisation could be devastating in terms of commissioning and funding for future services. It is not within the remit of this book to discuss commissioning arrangements for services within the NHS, but funding for services that are not seen as meeting required standards or which patients no longer wish to access due to a poor reputation, could be severely restricted leading to scaling back or even closure of services.

Case Study

Julian is a 32-year-old self-employed plumber. He is involved in a road traffic collision while out on his motorbike which has resulted in multiple fractures to his left tibia and fibula. He is admitted to an orthopaedic ward at his local hospital and undergoes surgery to pin the breaks in the operating theatre. Five days after his surgery his wound shows signs and symptoms of infection (discussed in Chapter 2) and his nurse obtains a wound swab to test for the presence of micro-organisms. The laboratory identifies the presence of bacteria and combined with his signs and symptoms this indicates a bacterial infection which needs to be treated with antibiotics.

Activity 1.2 Critical Thinking

Consider the case study above. What are the possible effects of this infection on Julian, the hospital staff and the hospital as an organisation?

An outline answer is provided at the end of the chapter.

The above case study should have enabled you to consider the consequences and effects of healthcare-associated infection on an individual patient. In order to assist you in your role as a nurse when caring for such patients, there are various national and international organisations which provide support, in addition to local sources of information such as care plans, care pathways and local policies and procedures.

Important Organisati...

Table of contents

• Cover
• Half Title
• Publisher Note
• Title Page
• Copyright Page
• Contents
• Publisher Note
• About the Author
• Acknowledgements
• Introduction
• Chapter 1 Background
• Chapter 2 Introduction to Microbiology
• Chapter 3 Bacteria
• Chapter 4 Viruses
• Chapter 5 Fungi, Parasites and Prions
• Chapter 6 Microbiological Specimens
• Chapter 7 Roles and Responsibilities in Infection Prevention and Control
• Chapter 8 Standard Infection Prevention and Control Precautions
• Chapter 9 Other Infection Prevention and Control Precautions
• Glossary
• References
• Index