All Clean Hands on Deck: The Nurses Role in Healthcare Associated Infection Prevention

 Spencer Jones, Registered Nurse and CTO/Founder of Lineus Medical

Spencer Jones, Registered Nurse and CTO/Founder of Lineus Medical

Despite their ability to heal the masses, hospitals have been known to sometimes get people sick after they arrive. When this occurs, they are called Healthcare Associated Infections (HAIs), and hospitals take them very seriously. A 2013 article from the Journal of the American Medical Association found that an estimated 440,000 adult inpatients acquire one of the top five nosocomial infections in the United States every year (1). These HAIs come at a price tag of an estimated $9.8 billion, with surgical site infections accounting for roughly one-third of the total cost (1). The Center for Disease Control and prevention (CDC) monitors these closely, with one of their organizational goals being to eliminate HAIs completely (2). In this article, we will look at the top four HAIs and discuss the role that nurses play in preventing their spread. 

CLABSIs – Central Line-Associated Bloodstream Infections 

CLABSIs account for roughly 9% of all HAIs in the United States, and can be spread in a number of ways (1). Nurses, other healthcare staff and visitors can carry germs on their hands, and if they touch the central line without using gloves or other protective measures, they can spread into the central line. Naturally present germs on the surface of the patient’s skin can also enter the bloodstream and cause CLABSIs. One of the best ways to prevent CLABSIs is by using proper hand hygiene (3). Using soap and water, or an alcohol-based hand rub is recommended prior to touching any part of the central line (3). Making sure the insertion site is cleansed with an antiseptic prior to device insertion is another key prevention measure, as well as keeping the dressing over the insertion site clean and dry (3). With nurses being the primary caregivers handling central lines, it is up to us keep these CLABSIs in check! 

SSI – Surgical Site Infections 

Clocking in at over 158,000 per year, Surgical Site Infections take the top spot as the most common type of HAI in America (1). Accounting for 36% of all HAIs, SSIs typically occur within 30 days after surgery (4). The CDC describes three types of SSIs: superficial incisional, deep incisional, and organ/space. SSIs typically happen through various forms of contact with the wound by a contaminated surface. This could be the contaminated glove of a caregiver, a contaminated surgical instrument, through germs in the air, or even germs that are already on the patient’s body and then spread into the wound. One of the best ways to help your patient avoid an SSI is to encourage them to stop smoking prior to their surgery, and implore them to tell their surgical team about their medical history, especially if they have diabetes or another chronic illness (4). Also, it is recommended to avoid shaving in the skin area that the surgeon is planning to operate (4). Ensuring proper hand hygiene whenever the surgical site is being touched or cleaned is key, as introduction of germs can easily happen during dressing changes or wound cleaning. 

“C-diff” - Clostridium difficile 

C-diff is one of the more unique HAIs, often affecting older patients who are on long term antibiotic use for another ailment. When a person takes long-term antibiotics, good germs that protect against infection are destroyed for several months along with bad germs. During this time period, patients can get sick from contaminated surfaces or from a healthcare provider’s hands that have not been properly cleansed. Because C-diff is found in feces, people can become infected if they touch items contaminated with feces and then touch their mouth or mucous membranes. Nurses and healthcare workers that are providing toileting care for someone known to have C-diff should be especially careful, and may consider using gowns, goggles and masks in addition to gloves. 

CAUTI – Catheter Associated Urinary Tract Infection 

While CAUTIs account for approximately 17% of HAIs, they are less expensive to treat and only contributed to less than 1% of the total HAI expenditure (1). CAUTIs occur when germs enter the urinary tract through the urinary catheter and cause infection. While uncomfortable for the patient, they have also been found to increase morbidity, mortality, and prolong the patient’s length of stay (5). One of the best ways to prevent CAUTIs is by ensuring that urinary catheters are only used when necessary and removed as soon as possible (5). Insertion using proper aseptic technique is also important, as is maintaining a closed sterile drainage system while they are in practice. 

Regardless of which HAI above that we have discussed, there is a common denominator in their prevention: Nurses! Each HAI can be reduced by nurses paying close attention to their hand hygiene, and washing their hands for the full 15-20 seconds with an antiseptic soapy solution (6). Nurses have the power to heal, and with that comes great responsibility, so always remember to wash or foam before entering every patient room! 

MKG-0055 11/18 Rev. 00 

References 

1. Zimlichman, E. (2013, December 09). Meta-analysis of Health Care–Associated Infections. Retrieved October 18, 2018, from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1733452 

2. CDC Organization | About | CDC. (n.d.). Retrieved October 18, 2018, from https://www.cdc.gov/about/organization/cio.htm 

3. Ellingson, K. (2017). Hand Hygiene Promotion from the US Perspective: Putting WHO and CDC Guidelines into Practice. Hand Hygiene, 221-229. doi:10.1002/9781118846810.ch32 

4. Surgical Site Infections. (2018). John Hopkins Medicine Health Library. doi:10.3897/bdj.4.e7720.figure2f 

5. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, and HICPAC. Guideline for Prevention of Catheter ‐associated Urinary Tract Infections 2009.http://www.cdc.gov/hicpac/cauti/001_cauti.html 

6. Toney-Butler, T., & Carver, N. (2018). Hand Washing (Hand Hygiene). StatPearls. Retrieved November 5, 2018.