Electronic Health Reporter

Hospital-acquired infections are a challenge to clinicians as they increase the mortality and morbidity rate. Sources of infections in hospitals include pathogens from patients, inanimate environments, and medical personnel. In any healthcare delivery setting, infection control and prevention standard precautions should be taken into account. It is everyone’s responsibility to exercise the following tips to prevent exposure and contamination in hospitals. This way, they can avoid causing unnecessary suffering and pain to patients and their loved ones.

Thorough cleaning

Regular cleaning of surfaces in the hospital is among the common practices that ensure hygiene is maintained. Many people visit the hospital daily, including patients, medics, suppliers, or family members visiting their loved ones. Everyone comes from different settings where there are high chances of exposure to germs and environmental elements like dirt and dust. These are among the leading causes of infection in hospitals.

Every hospital must hire cleaning services to ensure that every surface is free of dirt. Provide clean water, detergent, and equipment to make cleaning efficient and fast. Thorough cleaning eliminates over 90% of microorganisms and bacteria by suspending them in the cleaning fluid and removing them from the surfaces.

Hand hygiene

Healthcare workers come into contact with many patients and hospital equipment as they go about their duties. They are, therefore, the most frequent drive for nosocomial infections, and hand hygiene is an ideal preventive measure. Hand hygiene involves disinfection and regular hand washing. Washing hands thoroughly with running water and soap eliminates over 90% of most or all of the superficial and flora contaminants.

When your hands are dirty, use antimicrobial soap for hand-washing to reduce transient flora, but when you come into contact with an infected patient, use medicated soap or an alcohol-based hand-disinfectant. During an operation, many gloves tear. Therefore, disinfect your hands with a long-acting disinfectant before wearing gloves.

Isolation of infected patients

Patients with nosocomial infections should be kept in isolation as a first essential measure. There are different kinds of isolation depending on the extent of risk of infection. For extremely infectious diseases, such as diphtheria and hemorrhagic fever, isolation measures are stringent, while infectious diarrhea and less-infectious respiratory infections aren’t as stringent.

Since isolation is a labor-intensive and expensive process for healthcare workers and patients, it should be adapted to causative agents and disease severity. Practice standard precautions of isolation by wearing protective equipment and keeping patients in private rooms away from other patients. Also, minimize interaction with isolated patients by ensuring they are tended to by a few medical personnel and hospital staff.

Disinfection

It is challenging to define disinfection, but the Centers for Disease Control (CDC) gives guidelines to allow for distinction.

High-level disinfection: eliminates all microorganisms apart from the majority of bacterial spores.

Intermediate disinfection: incapacitates most viruses, vegetative bacteria, and fungi but doesn’t remove bacterial spores.

Low-level disinfection: kills some viruses, fungi, and bacteria but can’t be relied on to eliminate resistant microorganisms like bacterial spores.

There are many uses for disinfectants in different situations depending on the gravity of the infection. However, the ideal disinfectant provides satisfactory results by ensuring it can outdo the antimicrobial activity. Toxic disinfectants are the most active and are used on surfaces or inanimate objects. However, less hazardous disinfectants are considered for human tissues. Alternatively, you can use antiseptic to apply on wounds, membranes, and intact skin.

Antiseptics lack toxicity and act rapidly on pathogenic bacteria and natural flora. In general, whichever disinfectant you choose to use in your hospital should make human tissues or objects of use on patients safe and free of bacteria.

Sterilization

Sterile objects are free of harmful microorganisms. Although sterilizing hospital tools eliminates close to 99% of all germs, it is vital to reduce contamination by removing visible dirt through thorough cleaning. You can achieve sterilization through two means; chemical and physical. Chemical sterilization involves gaseous use that contains ethylene oxide and disinfectant solutions that have properties like glutaraldehyde.

Physical sterilization involves mechanical separation through filtration, irradiation, and heating, for example, through autoclaving. However, distinguish between objects that should undergo sterilization and those that should be disposed of. Needles and scalpels, for example, shouldn’t be used twice, but tongs and scissors can be sterilized.

Wearing personal protective equipment (PPEs)

PPEs create a protective barrier between the skin, clothing, mucous membranes, and infectious agents. However, PPE selection depends on the nature of patient interaction and the likely modes of transmission. PPEs include gloves, masks, isolation gowns, goggles, and face shields. In addition, healthcare personnel need surgical caps from Uniform Advantage to protect their hair from exposure. 

Ensure all healthcare workers have knowledge on the use, removal, and disposal of PPEs to prevent contamination through clothing or the skin. Designate containers for reusable or disposable PPE and a convenient location to contain contaminated items. Erect taps with running water in particular areas to ensure hand hygiene is exercised after every PPE removal. Here are some of the most common PPEs and their use.

Gloves: Use gloves when there is possible contact of mucous membranes, exposed skin that is abraded, chapped, or has dermatitis, and blood.

Isolation gowns: Wear them when going into isolation wards or collecting viral samples in the community.

Face shields, masks, and goggles: Use these to cover your eyes, nose, and mouth when conducting procedures that could generate chemical splashes or body fluids like blood.

Exercising respiratory hygiene

Respiratory protection or cough etiquette applies to measures taken to prevent airborne infections from being transmitted from one person to another. According to a CDC workshop, there’s a need to provide frequent testing in hospitals to limit respiratory pathogen transmissions. These strategies target patients and people accompanying them who have undiagnosed respiratory infections. They also apply to individuals, including healthcare personnel who have signs of infection like a runny nose, increased respiratory secretion production, congestion, and coughing.

Educational measures should be undertaken in hospitals to ensure medical personnel have adequate knowledge on exercising respiratory hygiene. Cough etiquette and respiratory hygiene are part of the Standard Precautions that make sure healthcare workers prevent respiratory pathogens from spreading by understanding how to protect themselves when they come into contact with symptomatic people. 

Until there are more effective respiratory protective equipment and a better understanding of inhalation transmission, ensure healthcare workers practice respiratory hygiene. They should cover their mouth with surgical masks, respirators, and in the worst cases, practice negative pressure isolation.

Safe disposal and use of sharp tools and equipment

Sharp tools and equipment include stitch cutters, scalpels, needles, and glass ampoules. Sharps pose a risk of causing hepatitis C, HIV, and hepatitis B infection. Poorly disposed sharps not only expose healthcare workers to injuries but also blood-borne viruses. In developing countries, the communities are exposed to these hazards when scavenging at waste disposal sites as people sort dangerous healthcare waste. Waste handlers also face the risk of exposure to infection due to needle-stick injuries.

Establish policies and safety procedures for handling and disposing of sharps in the hospital. Ensure that:

• Handling sharps is done by few people.
• Syringes are thrown away as single units instead of being dismantled.
• Sharps are passed indirectly and not from hand to hand.
• Staff disposes of sharps immediately after use in designated containers.
• Sharps containers are stored away from the public and emptied before filling up to more than two-thirds.
• All staff members know the inoculation injury policy.

Effective waste management

Hospitals produce a lot of waste daily, be it disposed of PPEs, soiled dressings, blood, body parts, medical tools, and non-medical solid waste, all of which are potential sources of infection. Along with every step of waste management from its creation to disposal, there’s a risk of infection.

Poor healthcare waste management exposes patients, healthcare personnel,  waste handlers, and the community to injuries, toxic effects, and infection. It also risks environmental pollution. According to WHO, hospitals must segregate medical waste materials at the point of generation, treat, and dispose of them safely.

Healthcare waste can be classified into:

• laboratory waste
• radioactive waste
• genotoxic waste
• pharmaceutical waste
• pathological waste
• Infectious waste

Waste management is a long-term process that requires the hospital directors to come together and address responsibilities. Build a comprehensive system and allocate adequate resources for handling and disposal. Select environmentally-friendly and safe waste management options and raise risk awareness to promote protection from hazards during collection, storage, transportation, handling, treating, and waste disposal.

Vaccination and immunization

Many patients visit the hospital daily with different ailments, front-line workers such as healthcare personnel must remain safe. In the case of viral diseases such as COVID-19 and SARs that spread fast, causing infection, healthcare personnel should receive priority care through vaccination to enable them to take care of patients. Vaccines provide immunity to protect the body from disease and can be administered orally, by injection, or aerosol.

Healthcare personnel who are more susceptible to infection, for example, surgeons, nurses, and laboratory technicians, need frequent immunization to minimize the risk of transmission and institutional outbreaks.

Bottom line

Although hospitals are designated places where populations seek medical help, they can also cause hazardous health infections. Take into account standard safety precautions to ensure that the community, patients, and health personnel remain safe from risks of disease infection. Input policies, safety procedures, and use the Febris free COVID-19 personal protective equipment training module to ensure health workers know about dealing with patients in isolation, removal, and hygiene procedures.