INFECTION CONTROL: A MISCELLANY OF THOUGHTS FROM THE UNITED KINGDOM

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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
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Theme 2 A Safe Workplace
Jill ILIFFE Executive Secretary Commonwealth
Nurses Federation
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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
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(a) WORKPLACE HEALTH AND SAFETY The focus is on
the prevention of injuries and the fair and
equitable treatment of nurses who are injured at
work or develop a work- related illness. Nurses
have the right to work in an environment that
does not threaten their health, safety or welfare.
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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
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WORKPLACE HEALTH AND SAFETY A safe nurse, a safe
patient, a safe workplace, a safe profession are
all embodied in the concept of workplace health
and safety. Workplace health and safety is a
PRIORITY requirement for work.
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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
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• WORKPLACE HEALTH AND SAFETY
• Safe work environments
• Healthy work environments
• Safe workplace design
• Safe work processes and systems
• Safe work procedures and practice
• Safe patient care

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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
____________________________________

• 1. Safe Work Environments
• means the existence of
• Safe equipment
• Hygienic conditions
• Safe walking and working surfaces
• Freedom from violence
• Non-hazardous and toxic materials,
• and if they are present, provision for
• safe handling, storage and disposal of
• them

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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
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2. Healthy work environments Safety measures
are in place in relation to blood borne and body
fluid pathogens to prevent contamination of
nurses and patients
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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
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• 3. Safe workplace design
• Good ergonomics in relation to
• Seating
• Equipment use
• Adequate lighting
• Safe exits/egresses (clearly marked, open and
  well-lit)

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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
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4. Safe work processes and systems

• Written and up-to date standards,
• protocols, policies, procedures
• Adherence and compliance with
• these
• Adequate staffing
• Safe delegation of duties

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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
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5. Safe Work Procedures and Practices

• Lifting techniques
• Prevention of needle stick and other injuries
• Adequate break times for nurses to prevent
  tiredness and increase the risk of medication and
  other errors

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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
____________________________________
6. Safe patient care

• Safe administration of medication and
• other skills
• Competent staff (skilled and
• knowledgeable)
• Adherence to proper work standards
• and ethics

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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
____________________________________
The patients rights are the nurses
responsibilities (professional, ethical,
legal) The nurses rights are the employers
responsibilities (liability laws, ILO
conventions, labour laws, occupational health and
safety legislation)
www.commonwealthnurses.org
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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
____________________________________

• A nurses right to safety is the employers
  responsibility
• The law mandates of the employer
• Safe systems of work
• Safe equipment
• Competent colleagues

www.commonwealthnurses.org
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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
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• Safe systems of work
• Written practice standards
• Written policies, protocols and procedures
• Appropriate documentation systems
• Systems of accountability for care given, or
• not given and actions taken
• Adequate staffing systems

www.commonwealthnurses.org
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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
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• Safe equipment
• Available
• In good working order
• Well maintained
• With staff knowledgeable in its use

www.commonwealthnurses.org
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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
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• Competent colleagues
• Continuing education
• Fair system of appraisal
• Supervisors and managers with the
• necessary skills to manage
• Requires recruitment, training,
• deployment, promotion and retention
• strategies

www.commonwealthnurses.org
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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
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ILO Convention No 155 Concerning Occupational
Safety and Health and the Working
Environment. 22 June 1981
www.commonwealthnurses.org
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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
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Workplace or occupational health and safety
legislation can provide a framework, but what is
required is the development of a culture of
safety in health care.
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• Exposure to hazardous drugs and blood
• borne pathogens
• Air quality compromised by toxic
• environmental cleaning substances
• Heavy lifting and moving of patients and
• medical equipment,
• Workplace violence and abuse (intruders,
• patients, relatives, other staff)
• Needle stick injuries
• Excessively long working hours and heavy
  workloads

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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
____________________________________

• Nurses, at all levels, need to
• embrace safety and consider it
• an integral part to the way work
• is planned, resourced, performed,
• monitored and evaluated

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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
____________________________________
(b) INFECTION CONTROL
Every patient encounter should be viewed
as potentially infectious
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Standard Precautions

• 1. Hand hygiene
• Gloves
• Facial protection
• Gown
• Prevention of needle stick injuries
• Respiratory hygiene and cough etiquette
• Environmental cleaning
• Linens
• Waste disposal
• Patient care equipment

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CHAIN OF INFECTION
Causative agent (Pathogen)

Susceptible host
Reservoir
Portal of entry
Portal of exit
Mode of transmission
All must be present to transmit an infectious
agent
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Infection control is all about interfering with
the chain of infection at as many points as
possibleUse standard precautions
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Hands are the most common mode of disease
transmission
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Hand hygiene

• When hands are visibly dirty,
• contaminated, or soiled, wash
• with non-antimicrobial or
• antimicrobial soap and water.
• If hands are not visibly soiled,
• use an alcohol-based hand-rub
• for routinely decontaminating
• hands.

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Ability of hand hygiene agents to reduce bacteria
on hands
Adapted from Hosp Epidemiol Infect Control, 2nd
Edition, 1999.
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World Health Organisation

• One of the most powerful approaches to fighting
  health care related infections is also the
  simplest health care providers need to clean
  their hands every time they see a patient

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• Immunization of all health care
• workers
• Recommended vaccinations
• Hepatitis B
• Measles/Mumps/Rubella
• Varicella (chicken pox)
• Diphtheria/Tetanus
• Polio
• Influenza
• Others depending on disease prevalence in
• the area

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Prevention of injury Use instruments to
retract Use safety needles and re-cappers
Pass instruments correctly and safely Use
sharps containers and replace before full
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Needle Stick Injuries

• Persons providing routine nursing care (38) and
  cleaning (15)are the most common situations
  where needle stick injuries occur.
• Invasive procedures such as injections and
  venipuncture are the most commonly reported
  causes of injury.

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Risk of infection after needle stick injury

Risk 6.0-30.0 1.8 0.3

• Source
• HBV
• HCV
• HIV

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1300
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Environmental safety Appropriate medical
waste disposal - sharps - blood - contaminated
disposable products
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Who has the responsibility?

• GOVERNMENT
• - recognise the need
• - set the policy in public and environmental
  health
• - provide resources and facilities
• - education and training

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Who has the responsibility?

• HEATH ADMINISTRATORS
• establish a safety culture
• encourage and support reports of unsafe practices
  or situations
• view errors and adverse events as opportunities
  to make systems safer
• put systems in place to avoid predictable adverse
  events

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Who has the responsibility?

• HEALTH CARE WORKERS
• - recognise the need for action
• - undertake training
• - universal use of universal precautions
• - conduct yourselves appropriately
• - persuade others to do the same

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Who has the responsibility?

• PROFESSIONAL ASSOCIATIONS
• monitor quality in professional training
• regulate and monitor safe health practices
• protect the public from unsafe practitioners
• establish and promote codes of ethics and conduct

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Who has the responsibility?

• The public YOU and ME
• - recognise the need for action
• - dont tolerate inappropriate behaviour
• - conduct ourselves appropriately
• - persuade others to do the same

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Commonwealth Nurses Federation South Asia 4
Safety Workshop 2009
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(c) SAFE STAFFING LEVELS The environment in
which health care is provided influences not only
the quality of care delivered but also the safety
and well being of the care provider.
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Nurses need their sleep and they need their
breaks at work

• The effects of fatigue on the brain from sleep
  deficiency are similar to those of alcohol
• Fatigue appears more rapidly with irregular work
  schedules
• Risk of accidents is 7 times higher between
  midnight and 8 am

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• Measures that promote a safe work
• environment
• Ongoing employee education
• Adequate staff so there are reasonable
• shift lengths and workloads
• Supervision and support for inexperienced staff
  
• Measures to prevent stress, isolation and
• burnout
• Adherence to universal precautions
• Provision of personal protective equipment

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• The challenge for nurses is to
• further improve work practices
• to ensure they do not risk their life
• making a living.