Fundamentals - Practice & Skills, part 2: Hospital-Acquired Infections and Hand Hygiene
by Meris Shuwarger BSN, RN, CEN, TCRN July 22, 2021 Updated: June 16, 2022 7 min read
What's the best way to prevent an infection from an invasive procedure? When can you wash your hands with hand sanitizer and when must you use soap and water? We'll answer all of this and more in this article on hospital-acquired infections and hand hygiene
The Fundamentals of Nursing video series follows along with our Fundamentals of Nursing flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
What is a hospital-acquired infection?
A hospital-acquired infection is what it sounds like—an infection that a patient acquired while in the hospital. A hospital-acquired infection is nosocomial, which means it originated in the hospital, and it was not present at the time of admission.
For example, if a patient is admitted to the hospital and does not have MRSA, but while they're in the hospital, they acquire MRSA—that would be a hospital-acquired infection (nosocomial).
A hospital-acquired infection may be iatrogenic, which means that it was caused by a procedure, therapy, or intervention. For example, if a patient goes to the hospital and does not have a urinary tract infection, but an indwelling Foley catheter is placed in them, and they get a catheter-associated urinary tract infection (CAUTI), that would be an iatrogenic infection.
Hospital-acquired infections are associated with morbidity, mortality, longer stays, and increased care costs.
Types of hospital-acquired infections
Here are some examples of hospital-acquired infections that can occur:
- Central line-associated bloodstream infection (CLABSI)
- Catheter-associated urinary tract infection (CAUTI)
- Clostridium difficile infection (CDI)
- Hospital-acquired pneumonia (HAP)
- Ventilator-associated pneumonia (VAP)
- Surgical site infection (SSI)
- Hospital-acquired pressure injury (HAPI)
Preventing hospital-acquired infections
Proper hand hygiene is the most important step in the prevention of nosocomial infections. Other important preventative measures include room cohorting, sign posting, adequate PPE, limiting invasive procedures, and equipment maintenance
Hand hygiene is the single most important prophylaxis against hospital-acquired infections. You will wash your hands before and after touching a patient or their surroundings. There are two methods for hand hygiene: washing hands with soap and water, and using hand sanitizer.
Soap and water
You will always use soap and water over hand sanitizer when your hands are visibly dirty, before and after eating, after using the bathroom, and after caring for a patient with infectious diarrhea.
When washing hands with soap and water, make sure to keep your hands lower than your elbows so dirty water doesn't drip down, to drip back towards your hand later. Rub vigorously with soap for at least 15-20 seconds so that the soap has enough time to act on germs, and rinse thoroughly to remove all traces of soap and germs.
If it's a manual faucet, turn off the faucet with a paper towel after drying hands. Yes, you waste a few more seconds of water that way. Yes, it's worth it to protect patient health outcomes and your own health!
Hand sanitizer is an available method of handwashing for all of the times you need to wash your hands that aren't one of the aforementioned situations.
You will use a hand sanitizer that contains at least 60% alcohol. Apply enough (approximately 3 - 5 mL) to cover your hands, and rub together vigorously until completely dry.
You will probably use hand sanitizer quite a bit more frequently than you wash with soap and water throughout the day. That's expected, because the number of times you need to wash your hands total throughout the day, far exceeds the number of times it'd be feasible to do it using soap and water (for the appropriate amount of time) every time. Hospitals have stronger hand sanitizer for this reason.
Room cohorting is placing patients together based on their conditions, and it's another important step to take to reduce and prevent hospital-acquired infections.
For example, if you have two patients with MRSA, they should go in the same room, rather than each of them being in a room with a patient who doesn't have MRSA. MRSA is highly infectious so grouping these patients together is a way to not endanger the other patients.
Transmission precautions are steps taken to prevent transmission of contagious infections/diseases, but they only work to prevent hospital-acquired infections if people know about them! If a patient is in a room with transmission precautions, signs should be posted outside the door so everyone on the floor is aware of the precautions and can follow the appropriate, applicable procedures.
The placement of personal protective equipment (PPE) and medical equipment is another strategy to help prevent hospital-acquired infections.
PPE should be placed outside the door of a room with transmission precautions, so that it can be donned before entering.
There should be disposable equipment within the room so that once the patient has been discharged, you can dispose of that equipment and not use it on other patients (e.g., stethoscope).
Limiting invasive procedures
An invasive procedure is a procedure in which the body is penetrated or entered in some way—something from outside the body, goes inside the body. Because many hospital-acquired infections can be related to invasive procedures, limiting them when they aren't necessary is an easy way to reduce and prevent hospital-acquired infections.
Similar to how abstinence is the most effective form of birth control—not having any invasive procedures is the best prevention for invasive-procedure-related (iatrogenic) infections!
Of course invasive procedures are often needed. But for example, if you don't need to start an indwelling catheter, don't. If you don't need to start an IV, don't.
Invasive procedure maintenance
Invasive procedure/device maintenance is an important part of preventing hospital-acquired infections. This includes tasks like changing IV tubing, IV sites, performing catheter care, giving proper care to wound drains, wound dressing changes, and more.
Your facility will have evidence-based policies on these and it's important to follow them!
If you'd like to learn more about wound care, check out our Wound Care Flashcards for Nurses.
Hi, I'm Meris. And in this video, we're going to be talking about hospital-acquired infections and hand hygiene. I'm going to be following along using our Nursing Fundamentals flashcards. These are available on our website, LevelUpRN.com, if you want to get some for yourself. And if you already have them and you're following along with me, I'm starting on card number 46. So let's get started.
Okay. So first up, we're talking about different types of hospital-acquired infections. You'll see a whole list here of different types.
But what I actually want to draw your eye to is what is in the italicized definition at the top here. We have two different terms that I want you to be familiar with, nosocomial and iatrogenic.
So nosocomial means originating in the hospital. So, for instance, I go to the hospital to have surgery. I don't have MRSA, but while I'm in the hospital, I acquire MRSA.
First of all, that's a hospital-acquired infection, but second of all, you may hear that called nosocomial.
Another word you want to know is iatrogenic. So iatrogenic means coming from a procedure. So for instance, I go to the hospital. I don't have a urinary tract infection. They place an indwelling Foley catheter in me, and I get a catheter-associated urinary tract infection, a CAUTI.
That is now a CAUTI, we can call it that, but we can also call that an iatrogenic infection because it came from a procedure or intervention. Very important terms to know.
Okay. So let's move on to how to prevent these. So I'm looking at card number 47 right now. Very important. There's a whole list here. I'm not going to go through all of them. But you will see that the thing on this card that is bold and red, meaning very important, is hand hygiene.
Proper hand hygiene is the most important step in the prevention of nosocomial infections.
Another thing we can do is room cohorting, meaning that we put patients together based on their condition.
So if I have two patients with MRSA, for instance, they should go together versus both of them being given a room with someone who doesn't have MRSA. That doesn't make any sense.
So make sure that we are cohorting, putting together, based on diagnosis.
We also want to post signs outside the door if there's any sort of transmission precautions.
We're going to want to put PPE outside the door and have disposable equipment inside the room so that once the patient has been discharged, we can get rid of that equipment and not spread those germs to other people.
We're also going to want to limit our invasive procedures. So if I don't need to start an IV, let's not do that. That's another opportunity for infection, right?
If I don't need to start an indwelling catheter, let's not do that. We want to limit those invasive procedures and only do it when we absolutely must.
And then, of course, we're going to want to do whatever kind of maintenance of invasive things that needs to be done. This is going to be per facility policy.
But things like changing IV tubing, IV sites, performing catheter care, giving proper care to wound drains, all of those things are going to be very important for minimizing your patient's risk for a nosocomial infection.
And lastly, we are going to be talking about hand hygiene. So you'll see here on card 48, it sounds super simple. But we actually have a lot of bold and red content on this page along with a super important key point. So let's break it down.
There's two ways to do hand hygiene. One is soap and water. And one is with an alcohol-based hand sanitizer.
Now, this is what you will see most commonly in the hospital because we don't have time to stop and fully wash our hands and make sure that we're doing a good job when we enter and leave a patient's room. It's just not feasible. So we do have hand sanitizer.
Very important to understand when we should use soap and water though. Soap and water should be used instead of sanitizer anytime we are about to eat food, after having gone to the bathroom.
If my hands are visibly dirty, if I can see dirt on my hands, I need to use soap and water.
And then very importantly, if I am caring for a patient with infectious diarrhea, I've got to be using soap and water, not hand sanitizer.
Okay, so that is it for hospital-acquired infections and hand hygiene. I hope that review was helpful. If it was, please go ahead and like this video.
If you have anything else to add or maybe a funny story or some way that you remember things, please put it in the comments. I would love to see that.
My next video is going to be super important. It is on donning and doffing your personal protective equipment and the different types of isolation and transmission precautions, what you need for that.
Super-duper important, so you're going to want to subscribe to the channel to make sure you're the first one to know when that posts. Thanks so much and happy studying!
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