Author: Ann M.
Macey. Paediatric Specialist Nurse
Based in Worthing
& Southlands Hospital Trust, UK
INTRODUCTION
The following is a personal
observational report from a nursing perspective. Comparisons between UK and India (Sanjiban,
Kolkata)
are inevitable but
not necessarily negative. The writer has
endeavoured to be candid in all aspects of the report.
As this is a
personal view, the following will be written in the first person.
KEY WORDS
ACOUNTABILITY/RESPONSIBILITY
What does it mean?
blameworthyness, liability, acceptance of responsibilty, answerable
There does not
appear to be a suitable translation into Bangla.
Analogies may help
to clarify the meaning.
Everyone in a
professional nursing position is accountable for their actions.
If you are a Dr, a
nurse in charge of a ward or a senior nurse, if you ask somebody not qualified
to carry out a procedure they are not trained to do you are also accountable for their actions.
For example: A
nurse asks a cleaner to clear up after administation of IV medication and the
cleaner gets a needlestick injury. The
nurse is responsible and accountable for that needlestick injury, not the cleaner.
CONSEQUENCES
Definition: Result
or effect of an action good or bad
Every action we
carry out has a consequence.
For example:
If we comb our hair
(action) we have untangled hair (result) good
If we get up late
and miss the bus (action) we may be late for work (result)bad
On the ward if we
forget to sign that we have given a drug (action) the consequence of your
action is that the drug may be given again and the patient overdose.
If you do not carry
out the correct a-septic procedure when preparing an IV site for medication
that patient may get an infection. That
is the consequence of your actions.
It has been an
observation that Nursing Practice and expertise in Sanjiban is excellent and on
the whole the nursing staff are excellent clinicians and carry out their jobs
well. BUT the consequences of their
actions - thinking ahead of what could or might happen seems to be lacking.
If a patient
develops phlebitis around a cannula site.
The nursing staff will know visually what is wrong but may not why it
has happened, it may not have been kept clean, but they do not appear to know
why or actually what is happening to the vein resulting in the redness.
The knowledge of
the physiology and pathophysiology of the body, the actual function of the
systems and what is happening when something goes wrong appears to be lacking
in their training.
The underpinning
knowledge of nursing actions are key to understanding what can go wrong if
infection control procedures are not carried out correctly.
GOOD HANDWASHING
Correct handwashing
as per handwashing procedure should take at least 2 minutes. Use antiseptic soap and dry with clean paper,
not a towel.
I am pleased to say
the latter has now been replaced in Sanjiban with paper.
Hands should be
washed by ALL staff on entering a ward area, especially from outside. Outside clothing should be removed including
cardigans. Unfortunately I still see
nurses in the Winter with long sleeved cardigans under their uniforms with the
cardigan sleeves down.
Short sleeved clothes
not visible under uniforms should be compulsory.
Outside clothes,
and that includes Drs jackets, have dust and dirt on them.
What is the use of
good handwashing
and removing your shoes if you are bringing
contamination on your clothes?
HOSPITAL ACQUIRED
INFECTIONS (HAI'S)
COMMUNITY ACQUIRED
INFECTIONS (CAI'S)
10% of all patients
will acquire a nosocomsial infection
How do we know what
is an HAI and what is a CAI?
In Sanjiban they
have a very good system. On admission
all patients have a blood sample and a urine sample taken for analysis.
If they have a
catheter a sample can be taken from the neck of the catheter tube between the
patient and the bag. The urine in the
bag may have been in there for several hours.
A sterile catch is essential for a correct result.
If an organism is
found in either within 48 hours we can assume that it is a Community acquired
infection. Any samples taken after 48
hours that contain micro organisms we can assume it is a Hospital acquired
infection.
CROSS INFECTION
Good handwashing is
the best preventative measure against Hospital acquired infections. GLOVES ARE NO SUBSTITUTE FOR HANDWASHING.
Although I am sure
some nurses think they are.
Cross infection is
avoidable:
Not washing hands
between patients, and that includes Doctors.
BAD CATHETER CARE
This starts with the insertion of the
catheter in the first place. If the
genital area is not cleaned sufficiently infection can be transmitted. This is an aseptic procedure and should be
treated as such.
Catheters should
not be on the floor. When moving a
patient the tubing should be clamped off to stop back-flow. Catheters should be regularly emptied and
charted correctly if on a fluid chart.
A urinary tract
infection is unpleasant and not only needs antibiotic medication but delays
discharge.
VENTILATOR
ASSOCIATED INFECTIONS:
The wrong or
careless suction procedure could cause pneumonia (Ventilator Associated
Pneumonia) of pseudomonas which thrives well in damp warm conditions.
A closed circuit
ventilation systems reduces the
incidents of cross infection.
SURGICAL SITE
INFECTION (SSI)
A surgical patient
post-op should arrive on the ward free of infection.
If the patient
develops a site infection it could have
been an infection contracted in theatre.
We must assume that
the hospital staff are well, fit and healthly with excellent immune systems.
Unfortunately the patients are not. Their immune system is low, maybe
immunocompromised, maybe with open wounds. They are susceptible to infections.
MRSA (Methicillin
resistant Staphylococcus)
This is a huge
problem in UK. The probable cause being
over prescribing antibiotics, thus causing resistance to many bacteria.
India does not
appear to have the same problem and in Sanjiban I have been assured this is a
rare occurence.
Infection control
obviously starts with the nursing staff but also asking visitors to wash their
hands before visiting relatives.
No visitor should
be allowed in a ward who has a cold, cough or an open wound. Remember the consequences.
ASEPTIC NON TOUCH
TECHNIQUE (A.N.T.T)
Using this
procedure will go a long way in protecting a patient from cross infection. A sterile procedure is not possible in a ward
situation. Dead skin cells and dust are always in the air whatever you do: a
sterile field may be attainable and certainly an aseptic area is.
IF SOMETHING GOES
WRONG
Reflection is a
wonderful tool for any situation. Gibbs
Reflective Cycle helps anyone to think about a situation and try and improve
next time.
HANDS
Look after them, do
not let them get dry and cracked.
Hospital Gel is freely available and should have hand moisturiser to
keep your hands in good condition.
CONCLUSION
Although Infection
Control procedures are not perfect, and not many systems are, In the past 3
years of observation the improvements have been very positive and noticeable.
HAI's have been
reduced, beds removed to allow more space
beween patients, cleaner uniforms and A.N.T.T. procedures carried out to
a high standard and clean paper to dry hands on the wards.
In UK we have an
infection control nurse allocated in each ward.
There is no extra payment for this but it is his/her job to make sure
all new nurses and students are taught good hand hygeine and A.N.T.T
procedures.
They might also
meet other nurses once a month to discuss improvements. The system seems to
work, maybe it is worth a try in Sanjiban.
References:
W.H.O. Prevention
of Hospital Acquired Infection WHO/CDS/CSR/2002.12
Oxford Journal
(Medicine and Health) Vol 5 Iss 1 (Feb 2014)
Wikipedia - HAI
Gibbs Reflective
Cycle (1988) Cumbria University, UK
