Infection Prevention and Control

Fatima, a home-visiting nurse, has a patient with an open drain wound on her abdomen. A recent wound culture found the antibiotic resistant organism (ARO). How should Fatima demonstrate appropriate infection prevention and control?

Response:

According to CNO’s practice standard, Therapeutic Nurse-Client Relationship, Revised 2006, nurses are accountable to protect patients from harm. This also applies to protecting them from infection risks. Nurses maintain commitments to quality practice settings, as highlighted in the Code of Conduct. All nurses, regardless of their position, need to advocate for quality practices which may include professional development systems, organizational supports, equipment and care delivery processes. They demonstrate maintaining commitments to quality practice settings by:

• Continually evaluating the workplace environment to identify opportunities for improving the quality of care
• Respecting organisational policies
• Making those in authority aware of concerns within the setting
• Exploring solutions within the setting to meet the patient’s and the setting’s needs
• Advocating for nursing input on patient care policies 

Fatima can reduce her patient’s and her risk of infection by: 

• reviewing relevant organizational policies on infection prevention and control
• identifying patient and nurse risks by:
  • identifying hazards and injury potential
  • intervening and providing appropriate care to patient(s), self or another health care provider after exposure
• reporting an infection control technique breach and taking action to limit further harm and to prevent risks
• applying and advocating for evidence-based practice such as
  • applying hand hygiene principles;
  • choosing appropriate measures to prevent and control infection transmission such as donning appropriate protection equipment
  • applying principles for safely handling, cleaning and disposing of materials and equipment
• communicating and educating the patient (for instance, expectations, rationale)
• collaborating with the patient and  health care team on a plan of care that meets the patient’s needs  and promotes safety  

For more information, please read:

• Therapeutic Nurse-Client Relationship, Revised 2006
• Code of Conduct

 

A patient enters a hospital emergency department (ED) complaining of nausea, vomiting, diarrhea and a low-grade fever. As Lisa, RN, begins to assess the patient he has an episode of diarrhea. In keeping with the hospital’s protocol on infection control, Lisa puts on a pair of gloves and a gown before providing personal care and changing the bed linen. The ED is busy, and when she finishes patient care she quickly disposes the soiled laundry and removes her gloves and gown. She then begins assessing her next patient’s vital signs.  Lisa does not wash her hands before performing her assessment. How does Lisa’s practice impact infection prevention and control?

Response:

By not washing her hands, Lisa potentially transmits micro-organisms from one patient to another, and breaches facility protocols on infection control. Her actions also place the public at harm. As highlighted by Infection Prevention and Control Canada, proper hand hygiene is the single most-important infection prevention and control practice.

The Code of Conduct also emphasizes, all nurses are accountable for seeking and using the best available evidence to inform their practice. This accountability includes identifying situations that place a patient at risk of harm and taking evidence-informed measures to minimize and prevent such risks.

The following principles guide nursing practice when implementing infection prevention and control measures:

• Placing patient safety and well-being  at the centre of the care plan
• Reflecting on nursing practice, including factors  impacting clinical decision-making and professional judgment
• Incorporating best available evidence to inform practice
• Advocating and collaborating to create policies based on the best available evidence
• Documenting situations where care is compromised

This case study was developed in collaboration with Public Health Ontario.

Mary, a nurse, is providing cosmetic filler injections in a medical spa to a number of patients. Mary injects approximately six patients per day using pre-loaded syringes that come packaged with two sterile needles from the manufacturer. The manufacturer label states that the product is for single-use. At times, there may be leftover filler in the syringe, so she removes the used needle, caps the syringe with the plastic cap, and stores the used syringe for later use. Mary reuses the leftover filler syringe, with a new sterile needle, on other patients. How does Mary’s practice impact infection prevention and control?

Response:

By reusing a syringe on another patient, even with a new, sterile needle attached, Mary potentially transmits micro-organisms from one patient to another. Her actions place other patients at risk because she failed to assess the risk of potential infectious disease transmission related to syringe reuse.

Mary did not read the product monograph that indicates the product is single-use only and that any remaining unused product needs to be discarded. The Medication standard emphasizes that nurses have an accountability to administer medications safely. This accountability includes taking appropriate action to resolve or minimize the risk of patient harm with any medication practice.

The Code of Conduct also emphasizes, all nurses are accountable for seeking and using the best available evidence to inform their practice. This accountability includes identifying situations that place a patient at risk of harm and taking evidence-informed measures to minimize and prevent such risks.