Prevention of Nosocomial Infection

Hospitals have sanitation protocols regarding uniforms, equipment sterilization, washing, and other preventative measures. Thorough hand washing and/or use of alcohol rubs by all medical personnel before and after each patient contact is one of the most effective ways to combat nosocomial infections. More careful use of antimicrobial agents, such asantibiotics, is also considered vital.

Despite sanitation protocol, patients cannot be entirely isolated from infectious agents. Furthermore, patients are often prescribed antibiotics and other antimicrobial drugs to help treat illness; this may increase the selection pressure for the emergence of resistant strains.

• Sterilization

Sterilization goes further than just sanitizing. Sterilizing kills all microorganisms on equipment and surfaces through exposure to chemicals, ionizing radiation, dry heat, or steam under pressure.

• Isolation

Isolation precautions are designed to prevent transmission of microorganisms by common routes in hospitals. Because agent and host factors are more difficult to control, interruption of transfer of microorganisms is directed primarily at transmission

• Handwashing and gloving

Handwashing frequently is called the single most important measure to reduce the risks of transmitting skin microorganisms from one person to another or from one site to another on the same patient.

Nosocomial Infection

A nosocomial infection, also known as a hospital-acquired infection or HAI, is an infection whose development is favoured by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff. 

Such infections include fungal and bacterial infections and are aggravated by the reduced resistance of individual patients.In the United States, the Centers for Disease Control and Prevention estimate that roughly 1.7 million hospital-associated infections, from all types of microorganisms, including bacteria, combined, cause or contribute to 99,000 deaths each year.

In Europe, where hospital surveys have been conducted, the category of Gram-negative infections are estimated to account for two-thirds of the 25,000 deaths each year. Nosocomial infections can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Many types are difficult to attack with antibiotics, and antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital. 

Nosocomial infections are commonly transmitted when hospital officials become complacent and personnel do not practice correct hygiene regularly. 

Also, increased use of outpatient treatment means that people who are hospitalized are more ill and have more weakened immune systems[clarification needed] than may have been true in the past. Moreover, some medical procedures bypass the body's natural protective barriers. Since medical staff move from patient to patient, the staff themselves serve as a means for spreading pathogens.

Putting on and taking off the Gloves

Putting on the Gloves

Non-sterile gloves are simpler to handle than non-sterile gloves. Non-sterile gloves simply require the medical professional to thoroughly wash her hands before putting on the gloves.

There's a more complicated procedure for putting on sterile gloves. The professional must, of course, was his hands. He must then handle the gloves carefully. The finger tips and palm of the glove must not come into contact with any non-sterile surfaces.

Taking off the Gloves

Non-sterile gloves can be piled off and thrown in the trash, while sterile gloves must be removed from the wrist, turned inside and carefully removed.

How to wash your hands

It's generally best to wash your hands with soap and water.

Follow these simple steps:

- Wet your hands with running water.Apply liquid, bar or powder soap.

- Lather well.

- Rub your hands vigorously for at least 20 seconds.

- Remember to scrub all surfaces, including the backs of your hands, wrists, between your fingers and under your fingernails. 

- Rinse well.  

- Dry your hands with a clean or disposable towel or air dryer.     

- If possible, use your towel to turn off the faucet.

Keep in mind that antibacterial soap is no more effective at killing germs than is regular soap. Using antibacterial soap may even lead to the development of bacteria that are resistant to the product's antimicrobial agents — making it harder to kill these germs in the future.

Wash your hands

Handwashing is easy to do and it's one of the most effective ways to prevent the spread of many types of infection and illness in all settings—from your home and workplace to child care facilities and hospitals. Clean hands can stop germs from spreading from one person to another and throughout an entire community.

When should you wash your hands?

- Before, during, and after preparing food

- Before eating food

- Before and after caring for someone who is sick

- Before and after treating a cut or wound

- After using the toilet

- After changing diapers or cleaning up a child who has used the toilet

- After blowing your nose, coughing, or sneezing

- After touching an animal, animal feed, or animal waste

- After touching garbage

What is the right way to wash your hands?

Wet your hands with clean running water (warm or cold) and apply soap.

Rub your hands together to make a lather and scrub them well; be sure to scrub the backs of your hands, between your fingers, and under your nails.

Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice.

Rinse your hands well under running water.

Dry your hands using a clean towel or air dry.

Washing hands with soap and water is the best way to reduce the number of germs on them. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations, but sanitizers do not eliminate all types of germs.

Glove Use (continuation)

   The Glove Pyramid – to aid decision making on when to wear (and not wear) gloves.

  Gloves must be worn according to STANDARD and CONTACT PRECAUTIONS. The pyramid details some clinical examples in which gloves are not indicated, and others in which examination or sterile gloves are indicated. Hand hygiene should be performed when appropriate regardless of indications for glove use.

Glove Use

Gloves should therefore be used during all patient-care activities that may involve exposure to blood and all other body fluid (including contact with mucous membrane and non-intact skin), during contact precautions and outbreak situations.

The efficacy of gloves in preventing contamination of health-care workers’ hands and helping to reduce transmission of pathogens in health care has been confirmed in several clinical studies.

Nevertheless, health-care workers should be informed that gloves do not provide complete protection against hand contamination.

Pathogens may gain access to the caregivers’ hands via small defects in gloves or by contamination of the hands during glove removal. Hand hygiene by rubbing or washing remains the basic to guarantee hand decontamination after glove removal

The impact of wearing gloves on adherence to hand hygiene policies has not been definitively established, since published studies have yielded contradictory results. However, the recommendation to wear gloves during an entire episode of care for a patient who requires contact precautions, without considering indications for their removal, such as an indication for hand hygiene, could actually lead to the transmission of germs.

it is important that health-care workers are able to differentiate between specific clinical situations when gloves should be worn and changed and those where their use is not required. Moreover, the health-care worker should be accurately informed on the moment for donning and removing gloves.

Indications for gloving and for glove removal:

	Indication
Gloves on	1) Before a sterile procedure 2) When anticipating contact with blood or another body fluid, regardless of the existence of sterile conditions and including contact with non-intact skin and mucous membrane 3) Contact with a patient (and his/her immediate surroundings) during contact precautions.
Gloves off	1) As soon as gloves are damaged (or non-integrity suspected) 2) When contact with blood, another body fluid, non-intact skin and mucous membrane has occurred and has ended 3) When contact with a single patient and his/her surroundings, or a contaminated body site on a patient has ended 4) When there is an indication for hand hygiene.