24 JCN supplement
2014,Vol 28, No 5
INFECTION PREVENTION
.
PREVALENCE OF INFECTION
The National Institute for Health
and Care Excellence (NICE, 2012)
have reported that around 300,000
people a year will acquire an infection
associated with their time as an NHS
patient. In 2007, meticillin-resistant
Staphylococcus aureus
(MRSA) and
Clostridium difficile
were reportedly
responsible for some 9,000 deaths in
hospital and community settings in
England (NICE, 2012).
While improvements and
awareness of good practice
(including handwashing) have
resulted in a drop in healthcare-
associated infections (HCAI) —
their prevalence was 6.4% in 2011
compared to 8.2% in 2006 (Health
Protection Agency [HPA], 2012) —
healthcare professionals still need to
promote and practice good infection
prevention and control techniques,
particularly with the rise in antibiotic
resistance threatening our ability
to treat everyday infections and
diseases (DH, 2013).
It has also been shown that
around 20% of all HCAI could
be avoided if correct infection
prevention and control principles
were rigorously followed (Harbarth
et al, 2003).
The cost of HCAI to both the
patient and healthcare provider are
significant. They result in longer
inpatient stays, increased nursing
care after discharge and delay
individuals from resuming normal
activities of daily living — including
going back to work — thus causing
loss of earnings (Plowman et al,
2001; Harrington, 2014).
Twenty percent of all HCAI are
made up of surgical site infections
(SSI) (NICE, 2008). This figure could
well be higher in reality, as many
infections occur after patients have
been discharged (NICE, 2008).
Surgical site infections
Surgical site infections have a
significant impact on patients’quality
of life in that they can cause pain,
isolation and insecurity (Andersson et
al, 2010), and can increase morbidity
and mortality rates (Al Maqbali, 2013).
There are both intrinsic and
extrinsic risk factors for developing an
SSI. Intrinsic factors include:
Age
Active skin condition
Being a smoker
High body mass index (BMI)
Other underlying comorbidities.
Extrinsic factors include:
Poor/inadequate care practices
pre-, peri- and postoperatively
Operations lasting longer
than expected
Type of surgery — some
procedures carry a high risk of
infection, e.g. colorectal surgery
Staff moving around in theatre
Surgical drains
Transplant or other operations.
While intrinsic factors are hard
to control, healthcare professionals
can take steps to reduce extrinsic
factors. Although it is obviously not
appropriate to advise patients on
cleaning their own homes, unless
the situation is extreme and referral
to other health agencies is needed,
e.g. local council and environmental
agencies (DH, 2006), healthcare
professionals can prepare patients
ahead of hospital admissions/elective
surgery by instructing them on good
handwashing techniques and using
skin disinfectants preoperatively.
SOURCES OF INFECTION
Sources of infection include bacteria,
viruses, fungi and parasites.
Bacteria
These are single-cell organisms that
live everywhere, including in and on
the body. Human beings live in close
contact with them and much of the
time they cause no harm. However,
they can infect the body, resulting in
disease, such as streptococcal bacteria
that cause sore throats and colds.
Viruses
These are far smaller than bacteria
and need other living cells to grow
and reproduce (their hosts). They
multiply on entering the body and
can cause minor illnesses such as
common colds, gastroenteritis,
influenza (flu), or more serious
diseases.
Fungi
This group of organisms include
yeasts, moulds and mushrooms. They
prefer to live in damp, warm places.
Some, such as edible mushrooms,
are not dangerous, while others
have been turned into drugs, such as
penicillin. However, they can cause
fungal diseases such as ringworm,
athlete’s foot and thrush, as well as
more serious illnesses.
Parasites
These organisms live off other living
organisms, their hosts, such as head
lice, threadworms, tapeworms and
can be transmitted from one host to
another. They often cause water- or
Top tip:
Remember: Following aseptic
techniques prevents transmission
of bacteria from wounds and
other entry sites and reduces
the risk of cross-contamination
(Preston, 2005).
›
Practice point
Infection spreads by bacteria,
viruses or fungi infecting a
vulnerable individual — this can
either be through a portal of entry
or because the person’s immunity
is low. The source of infection
can be objects within the person’s
own home that have become
contaminated or from another
person, who may or may not be
showing any signs of infection.
The infection is then transmitted
from one person to another.
›
Did you know...
Practices that can help to lessen
the risk of developing SSIs aim
to reduce the number of bacteria
introduced to the incision made
during surgery or the surrounding
skin, for example, preoperative
skin decontamination by
showering with antimicrobial
lotions to reduce normal skin flora.
