Continuing nursing education on nurse’s role in infection prevention and control, in critical care unit

Flora1, Subadhra Devi2, Maha Lakskmi3

1Senior Nursing Supervisor, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

2Nurse Educator Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

3Nursing Superintendent, Kauvery hospital, Cantonment, Trichy, Tamil Nadu

Introduction

The nurse’s role in infection prevention in the critical care unit involves the implementation and monitoring of evidence-based practices to prevent healthcare-associated infections(HAIs) among critically ill patients.

Objectives

Standard precautions

  • Hand hygiene
  • PPE
  • Isolation and barrier precaution
  • Biomedical waste management
  • Sharp disposal
  • Linen management
  • Spill management
  • Care bundles

Hand Hygiene

  • Technique: Emphasize the use of proper hand hygiene techniques (e.g., handwashing, use of alcohol-based hand sanitizers)
  • Compliance: Promote adherence to hand hygiene protocols among staff, doctors, housekeeping and visitors, and conduct regular audits to monitor compliance.
  • 6 steps and 5 moments of hand hygiene to be followed

Bacteria causing hand contamination

  • aureus
  • Proteus mirabilis
  • Klebsiella spp.
  • Acinetobacter spp
  • Staphylococci, enterococci, Clostridium difficile are more resistant to desiccation.

Use of Personal Protective Equipment (PPE)

Selection and Donning: Educate on appropriate selection and correct donning and doffing of PPE (gloves, gowns, masks, face shields).

Safety Protocols: Reinforce the importance of wearing PPE in specific situations to prevent the transmission of infections.

Biomedical waste management

Definition

Any waste which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities” (WHO rule 1998).

Isolation-definition

Set of infection control practices which should be followed for patients who are infected or likely to be infected with an infectious pathogen having specific mode of transmission

Definition of care Bundle

A “bundle” is a group of evidence-based care components that, when executed together, may result in better outcomes than if implemented individually.

PLABSI care Bundle

  • Hand hygiene
  • Aseptic and no touch technique
  • 70% Isopropyl alcohol swab
  • Remove <96 hours

Catheter care Bundle

  • Hand hygiene before & after any contact with the Foley Catheter system
  • Insert using aseptic technique
  • Secure Foley Catheter to thigh always
  • Always keep catheter bag below level of bladder
  • Maintain a sterile continuously closed system
  • Perineal care daily & after any incontinent stool
  • Daily review for early removal

Central Venous Catheter Care Bundle

  • Hand hygiene
  • Maximal barrier precautions before insertion
  • Chlorhexidine skin antiseptic
  • Optimal Catheter site selection-with Subclavian vein as preferred site
  • Daily review of CVC necessity with prompt removal of unnecessary lines

Ventilator care Bundle

  • Head end elevation ≥ 30 to 45
  • Appropriate Deep Vein Thrombosis prophylaxis
  • Appropriate Peptic Ulcer Disease prophylaxis
  • Appropriate sedation
  • Assessment of readiness to extubate

Surgical Site Infection Prevention Bundle

  • Avoid hair removal, if hair removal is necessary, avoid the use of razors.
  • Ensure prophylactic antibiotics were prescribed as per local antibiotic policy.
  • Ensure the antibiotic was being administered within 60 minutes prior to the operation.
  • Ensure the patient’s body temperature is normal throughout the operation.
  • Ensure the patient’s blood glucose level was normal throughout the operation (diabetic patients only).

Antibiotic Stewardship

  • Collaboration with Pharmacists: Work closely with pharmacists to ensure appropriate
  • Antibiotic selection, dosing, and duration to combat resistance.
  • Monitoring: Monitor patients for signs of infection and review cultures to guide therapy

Education and Training

  • Staff Education: Participate in ongoing education and training on infection prevention and control measures.
  • Patient and Family Education: Educate patients and families about infection prevention, including the importance of hand hygiene and recognizing signs of infection

Surveillance and Reporting

  • Infection Surveillance: Participate in surveillance activities to identify trends in infections and report incidents of HAIs.
  • Quality Improvement: Engage in quality improvement initiatives aimed at reducing infection rates in the critical care unit.

Conclusion

Nurses play a crucial role in preventing infections in critical care units by maintaining strict hand hygiene, following aseptic techniques, and adherence established to infection control protocols. Their vigilance and commitment are essential in ensuring patient safety, reducing healthcare associated infection, and promoting the highest standards of quality care

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