As part of this article on the importance of hygienic practices, the information has been compiled under several headings. The report concentrates on the importance of cleaning, infection control, vulnerability of staff and health care patients, infection prevention, the importance of personal hygiene, health care waste segregation and safe working practices. Through careful and thorough research I have developed a better understanding of the hygienic practices and the importance it has in the health care environment. My objective was to portray this information to the reader accurately and in detail.
Part 1. The Importance of Cleaning
Cleaning is necessary to prevent the spread of bacteria, and ultimately infectious agents from spreading, causing illness. The process of cleaning physically removes contamination but does not necessarily destroy micro organisms.
There are many different methods of cleaning
1. Damp Dusting – A form of cleaning involving the use of a detergent and hot water, where chemical disinfectants are not used.
2. Disinfection – A process that reduces the number of micro organisms but which may not inactivate bacteria
3. Decontamination – A more thorough cleaning process that removes or destroys contamination and prevents micro organisms from reaching susceptible sites to cause infection.
4. Sterilization – The most thorough form of cleaning. This process renders an object free from viable micro organisms including viruses and bacterial spores.
Part 2. Infection Control & The Chain of Infection
Infection control can be implemented through the Chain of Infection –
- Infectious Agents
- Portal of Exit
- Mode of Transmission
- Portal of Entry
- Susceptible Host
Understanding the characteristics of each link in the chain provides a Paramedic with the methods to support vulnerable patients or victims and prevent the spread of infection.
1. Infectious Agent – Etiologic agent, an agent is any micro organism that is capable of producing an infection.
2. Reservoir – The place where the micro organism resides. It can be a food or water source, but it can also have a human source e.g. faeces or respiratory secretions.
3. Portal of Exit – In order for an infection agent to establish it must have a reservoir. In humans this portal of exit can be the nose, mouth, wounds, urethra, open wounds, rectum or vagina.
4. Mode of Transmission – The method in which the micro organism travels to another ‘host’ – direct, indirect or droplet.
5. Portal of Entry – The place where the infectious agent enters the body.
6. Susceptible Host – A person who is susceptible to an infection. A compromised host is a person at high risk of infection.
To stop infection, the chain of infection must be broken.
Part 3. Vulnerability to Infection
Health care patients and of course, staff are vulnerable to infection. As hospital staff treat many patients it is easy for them to contract bacteria from ill patients.
Patients are prone to infection for many reasons, their immune systems may be weaker and they may have open areas on their skin from surgery or wounds. Health care patients come under the susceptible host link of the chain of infection. As staff treat or come into close proximity with patients, it is easy to pass on bacteria from other patients, if proper procedures are not followed by staff.
Part 4. Demonstration of The Chain Of Infection
An example of the chain of infection being applied in the workplace. The nurse in the following example breaks the chain of infection.
A patient assigned for morning care has an open wound on her left lower leg. The wound is draining and when last cultured, the micro-organism MRSA was identified. In preparation for bed making, hands of the nurse were washed. Clean linen and a bag for soiled linen were gathered from the linen room and placed on the patient’s clean bedside stand. To remove the soiled linen from the bed, the following procedure was followed;
- Hands washed
- Gloves worn
- Each side of the soiled linen ends folded towards the middle of the bed
- Soiled linen held away from the nurse’s clean uniform
- Soiled linen placed in the linen bag for later discard
- Protective gloves removed
- Hands washed
The nurse applied principles of medical asepsis and standard precautions with the use of body substance isolation to contain the infectious organism at many points in the chain of infection. By washing her hands, the nurse has eliminated the infectious agent and mode of transmission. By wearing gloves she has eliminated the portal of entry. When folding the linen ends, she has contained the reservoir and a possible mode of transmission. When the nurse held the soiled linen away from her uniform she broke the chain of infection by closing the mode of transmission and a possible portal of entry, then by putting it in the linen bag for discard she reinforced the elimination of the reservoir and mode of transmission. Then the protective gloves were removed again eliminating a reservoir and mode of transmission. Finally she washed her hands, a possible portal of entry, reservoir and mode of transmission.
Part 5. Infection Prevention
Infection is one of the leading causes of preventable death in hospitals every year. The importance of keeping hospitals clean and infection free is greater now than ever. Hospitals are responsible for maintaining a safe environment in which infections are not easily spread. Infection prevention can be implemented by having all staff follow procedure, such as
- Washing hands regularly and after every patient.
- Clean as you go
- Cleaning of medical equipment and machines
- Keeping the sick patients from the healthy i.e. single patient room/quarantine
- Use of PPE such as gloves, masks etc.
- Proper disposal of waste
- Adequate ventilation systems
All those using acute hospitals have the right to assume that the environment is one where hazards are adequately controlled. This is done by decontamination.
Decontamination is a process that removes or destroys contamination and prevents micro organisms from reaching susceptible sites to cause infection. The aims of decontamination are to make items safe for handling by;
- Health care workers Patients Maintenance staff
There are 3 levels of decontamination –
2. Cleaning followed by disinfection, a process that reduces the number of micro organisms but which may not inactivate bacteria.
3. Cleaning followed by sterilization, a process that renders an object free from viable micro organisms including viruses and bacterial spores.
Part 6. Color Coded Bins
The aim of color coded systems in hospitals, is to prevent cross contamination. The use of color coded bins, provides a system of disposing waste safely and effectively, keeping the environment cleaner and prevents cross contamination. Along with bins, uniforms and equipment are also color coded.
- Red – Signifying all clothes and equipment for use in sanitary areas, appliances and washroom floors.
- Yellow – For hand wash sinks and all other washroom equipment For health care risk waste
- Blue – All clothes and equipment including general areas and ward areas
- Green – The color of all kitchens at ward level
- White – White clothes are required for all isolation rooms and theaters. For general waste disposal
By coordinating proper disposal systems within the hospital, certain types of wastes can be grouped together. By segregating health care risk waste and general waste hospitals can lower waste costs, whilst improving its carbon footprint.
Part 7. The importance of good personal hygiene
Personal hygiene may be described as the principle of maintaining cleanliness and grooming of the external body. It is in general, looking after oneself.
Personal hygiene can be controlled by sustaining high standards of personal care and humans have been aware of the importance of hygiene for thousands of years. The ancient Greeks and Romans spent many hours in the bath, using fragrances and make-up in an effort to beautify themselves and be presentable to others. Maintaining personal hygiene is necessary for many reasons, whether it be personal, social, for health reasons, psychological or simply as a way of life. Essentially keeping a good standard of hygiene helps to prevent the development and spread of infections, illnesses and bad odors. Poor personal hygiene, in relation to preventing the spread of disease is paramount in preventing epidemic or even pandemic outbreaks. Engaging in some very basic measures could help prevent many coughs and colds from being passed from person to person. If a cut occurs, the wound should be cleaned and dressed suitably, this can help reduce the risk of infection and pain. Conditions such as head lice, athlete’s foot for example, should be treated immediately to prevent further infections and spread to others.
The Effects of Poor Personal Hygiene –
Failure to keep up a standard of hygiene can have many implications. Not only is there an increased risk of getting an infection or illness, but there are many social and psychological aspects that can be affected.
Aspects of Personal Hygiene
There are many contributory factors that make up personal hygiene such as;
- Oral care
- Hair care
- Nail care
- Wound care
- Cleansing of personal utensils
- Preventing infection
Part 8. Waste Segregation, disposal and transportation
Hospitals generate millions of tons of waste each year. In the past, many hospitals simply dumped all waste types together, from paper waste or general waste to operating room waste. Proper waste segregation is vital to prevent the spread of disease, especially where the disposal of such items like syringes and needles occur.
There is tremendous scope for hospitals to reduce the amount of hazardous waste they produce. Minimizing the amount of hazardous waste a hospital produces brings many environmental and health benefits. This can be done by;
Separating general waste with infectious medical waste. By having a recycling system in place, a hospital can cut down on waste reducing its environmental footprint.
General disposal of hospital medical waste is by incineration or by crushing followed by sterilization before being land filled. Appropriate, dedicated vehicles are used along with the appropriate paperwork having to be filled out and signed by hospital and contract staff alike.
Part 9. Safe Working Practices
In the health care sector, especially in hospitals safe working practices are a vital necessity. Maintaining a safe environment reflects a level of compassion and vigilance for patient welfare that is as important as any other aspect of competent health care. Safe working practices include;
1. Hand washing –
Hand washing is arguably the most important work practice. Employees should be instructed in proper hand washing techniques and employers should ensure compliance with proper hand washing procedures.
Health care workers particularly nurses and staff who have contact with patients should wash their hands after contact with each patient.
The health care employee must wear the appropriate PPE (personal protective equipment) such as gloves when providing patient care. Health care employees should wash their hands after removing PPE gloves.
2. Handling and using sharps –
Needles, sutures and scalpels are common tools of the healthcare trade. Because of the possibility of injury and contamination through accidental cuts and sticks with these devices, healthcare providers should use extreme care when working with or disposing of sharps. As a general rule needles and syringes should be disposed of appropriately and immediately after use and should not be bent.
3. Isolation Practices –
Health care providers use the principle of isolation to combat the spread of health care associated infections (HAI’s). Patients with infectious diseases are isolated from non-infected patients in an effort to control the spread of infection within the hospital population.
4. Airborne Precautions –
Are used for patients known or suspected to be infected with airborne transmissible diseases like tuberculosis (TB) and measles. Emphasis is placed on patient placement and respiratory protection. Infected patients should be isolated from other patients and staff should wear an appropriate respirator.
5. Droplet Precautions –
Droplet precautions are used to protect the health care provider from inhaling large particle droplets of moisture that carry contaminants. The patient should be isolated from other patients and health care workers should wear the relevant PPE like masks.
6. Contact Precautions –
Contact precautions deal with coming into contact with an infected person or their personal items, such as bed linens or clothing. Patients should be isolated from other patients to the extent possible. Gloves should be worn when caring for the patient and removed immediately after patient contact. Hand washing with soap and warm water should take place after removing gloves.
1. The conditions expected and required by patients in health care environments must be upheld by staff and hospital management in particular, as a critical ingredient to recovery and well being of a patient.
2. Hospital staff must follow procedures put in place by their employers and the law in relation to safe working practices in health care environments, for their own benefit and that of patients.
3. Proper waste disposal should be put in place for environmental as well as financial reasons by all health care providers.
4. Proper personal hygiene has to be evident from all staff reflecting professionalism and reinforcing a safe, healthy environment.
5. All staff should be trained and provided with regular refresher tests enabling them to maintain a high standard of hygienic vigilance in hospitals