A nurse plays a critical role in preventing and controlling infectious disease. Dr Manju Chhugani, Principal, Rufaida College of Nursing, Jamia Hamdard, New Delhi, shares her thoughts with Shahid Akhter, ENN, on infection control from a nursing perspective
Where do we stand today in Healthcare Associated Infections (HAI)?
In spite of the exhaustive amount of literature and research evidences available on various aspects of infection “ its causes, factors, preventive strategies, control and much more “ infection prevention and control continues to an area of great concern in healthcare. Even after decades of various programmes, guidelines, etc having been invented and adopted for combating infection, both developed and resource-poor countries are still faced with the burden of healthcare associated infections.
Infection prevention saves lives. In developing countries, the WHO reports hospital wide infection rates are usually higher than 15 percent. Maintaining a sterile, well-organised health facility can help protect both the health worker and a patient from risk infection.
How do you define HAI?
As a better reflection to the diverse healthcare settings and health related aspects, the terms nosocomial, hospital- acquired or hospital-onset infections have been replaced by healthcare associated infections. HAIs are defined as infections not present and without evidence of incubation at the time of admission to a healthcare setting. HAI may be caused by viral. Bacterial, fungal pathogens, the most common types being Blood Stream Infections (BSI), Ventilator Acquired Pneumonias (VAP), Urinary Tract Infections (UTIs), Surgical Site Infections (SSI). All such infections result in longer hospital stay, increased mortality and morbidity while also enhancing healthcare costs. On the other hand a decrease in the HAIs will lead to better utilisation of resources and improving upon the quality and satisfaction of client care.
What role does the nurse play in preventing HAI?
Because of the proximity to the patients and the pivotal role in healthcare delivery, nurses are in a unique position to make efforts in breaking the chain of infection. Being frontline workers, it is essential to educate and train them in various methods, norms, strategies, etc for prevention and control of HAIs.
How do nurses or other healthcare workers protect themselves?
We need to understand the importance of protecting ourselves and thus helping in the control of infections. Immunisation also has a role to play in this. For example Hepatitis B vaccine can prevent blood-born infection Hepatitis. In hospitals there should be clear display and availability of Post Exposure Prophylaxis in case of needle stick injury to protect the staff from blood-born infection (such as HIV). There should be refresher training programme for all levels of workers in healthcare setting to update them with best practices. Infection prevention and control is a team work and every one and every action counts and thus in training and monitoring even sweepers and ward boys need to be taught and monitored adequately to break the cycle of infection.
An important aspect in preparing for clinical nursing practice is an understanding of the infection process and prevention techniques? How far do you think this objective is fulfilled?
The Nursing curriculum, infection control has always been a subject of utmost importance. Right from the first year of the entry of students in the Nursing profession, they are taught and trained about various spheres of infection and its prevention like study of microbes, procedure for hand washing, gowning, gloving, etc, methods of disinfection, sterilization, so on in subjects like microbiology, fundamentals of Nursing, etc. If you ask students or fresh recruited staff theoretical questions related to infection prevention they usually answer but if you ask them to really do it they partially do it. When I was interacting with one of my hospital nurse about this, she said, madam they need to do it during their training with close supervision and monitoring by clinical instructors so that they really do drill.
Researchers found that nurses had highest compliance rates, 71 percent across all pilot sites and doctors compliance rate was 60 percent
Do you find anything amiss in the curriculum?
There are loopholes in the implementation aspect. Hence it is recommended to have more of practice in clinical area, synchronization of practices taught and implemented in health care setting and then plan repeated trainings and more focus on this area.
The major problem in relation to nursing is that they are taught as per syllabus, but when they are exposed to clinical setting they do not find in India the protocols being followed as per their teaching so they land up into confusion between what is being taught and practiced. In developed countries, the protocols are so strictly followed and remain same in teaching as well as in practice.
Who is more responsible for infection prevention? Doctors or nurses?
Infection prevention and control cannot be successfully achieved only by nurses. Microbes cannot identify Doctor, nurse, patient and sweeper thus to achieve infection prevention every personnel working in the hospital has to know the sources of infection and basic guidelines to prevent it, because its team work.
It has been evident from the research that Nurses wash hands more and doctors neglect this aspect. In 250 bedded hospital in a infection prevention team, a nurse in an important member and is actually a functionally active member around whom most of the activities revolve. She takes round, takes culture and strictly stops people entering Critical areas without following protocols for example in my own hospital at HAHC, Jamia Hmadard my nurse will not let even VC to enter ICU without wearing shoe cover and using hands rub. Thus nurses are gatekeeper of checking others also so that they do not break the protocols. In short, clinical care nurses directly prevent infections by performing, monitoring, and assuring compliance with aseptic work practices; providing knowledgeable collaborative oversight on environmental decontamination to prevent transmission of microorganisms from patient to patient.
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