Infection Prevention and Control Care

Infection Prevention and Control Care

Introduction

Of all branches of nursing care, prevention of infectious diseases is the most fundamental
for healthcare worldwide. Prevention and control of infection is care that requires the input of all
medical professionals in ensuring control procedures, practices, and recommendations are
implemented to protect both patients and healthcare staff. The topic looks into microorganisms,
requirements for growth, transmission, diseases and infections they cause as well as model of
change to determine the significance of prevention and control over treatment in healthcare of
the general adult population.
Importance of studying the impact prevention and control care has on health of people of
United Kingdom over treatment should be determined prior to further research. Prevention and
control care benefits medical practitioners, patients and health care stakeholders. Prevention is
better and cheaper than cure therefore further researching on it will improve nursing practice and
healthcare at large.
Over past centuries, global discovery of infectious diseases evident through outbreaks
have been a major threat to the health well-being of human beings (Department of Health, 2001).
The relationship and interconnection between diseases and microorganisms discovered by Louis
Pasteur under the science of microbiology was an eye-opener and stepping stone to controlling
and preventing diseases caused by microorganisms. According to research done by World Health
Organization (WHO) in 2004, diseases like HIV/AIDS, tuberculosis, and malaria globally cause
millions of deaths every year with a slower mortality rate in Britain (Department of Health,
2001). Modern healthcare is trying its best to treat people from varying infections through
different healthcare programs but infections remain a major challenge. Emergence of diseases
like AIDS, cancer, and severe acute respiratory syndrome (SARS) has statistically contributed to
increased threat posed by infectious diseases. The increasing number of healthcare associated
infections and antibiotic resistant bacteria are the two specific infection control challenges in the
United Kingdom. They inhibit recovery hence making frequent headlines in news related to
hospital care. According Dewing in 2007, healthcare associated infections are caused by
Clostridium difficile and meticillin-resistant Staphylococcus aureus (MRSA) often called
“superbug”.
According to Edwards et al., healthcare related infections and increased resistance to
antimicrobials has put infection prevention and control at the centre of initiatives aimed at
improving quality of care. The 2007 meticillin-resistant Staphylococcus aureus (MRSA)
bloodstream infections and Clostridium difficile infections in England, incidences have
decreased significantly due to the United Kingdom policies of increased compulsory
surveillance, published evidence-based guidelines, and incorporation of national infection
reduction programs. However, evidence-based guidelines and policies have not led to best
practice standardization.
Globally, adherence to infection prevention precautions is suboptimal (Edwards, 2012).
Hand hygiene is the cornerstone of infection prevention and control yet compliance to it is still at
40% hence proving the preceding statement. As a result of this, effective methods of changing
infection prevention behavior of health practitioners are necessary in reducing healthcare related
infections hence improving patient safety. According to this paper infection prevention and
control is practice focused on reduction or prevention of health care associated infections.
Therefore this systematic review aims at assessing the effectiveness and sustainability of

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interventions in changing the behavior of health care attendants to improve infection prevention
and control (Edwards, 2012).
Harbarth, in a comparison paper between Europe and United States of America on
infection prevention and control experience, attributes health care infection control practices to
technological developments, historical experiences and research institutions. Globally, health
care related infections are a problem with various disparities leading to different healthcare
associated infection rates. These disparities are as a result of surveillance methods, infection
control knowledge and practices, antibiotic prescription practices, cultural factors, availability of
hospital hygiene resources and legal constraints among others (Harbarth, 2012).
Focusing solely on the Europe review side, the paper states that the fundamental
principles of hospital epidemiology have been successfully introduced in majority of the
European countries. Establishment of the European Centre for Disease Prevention and Control in
2005 significantly contributed to progress made in infection prevention and control (Harbarth,
2012). A wide range of epidemiological research done in European countries, enable understand
the efficiency of infection control here.
Creative antibiotic leadership has been the key topic of research in Europe for the last
decade. There have been publications on various high-quality clinical trials on diagnostic
performance and effectiveness of procalcitonin (Harbarth, 2012). Changes in antibiotic treatment
guidelines related to Clostridium difficile and multi-resistant enterobactericae in the United
Kingdom is yet another emerging story.
Smith et al. in a position paper stated that major elements causing health care related
infections are infectious agent, susceptible host, and transmission mode. This paper looked at
infection prevention and control care in long-term care facilities such as nursing homes. Long-
term care facilities are institutions that provide health care to people incapable of managing
independently in society (Smith et al., 2008). Residents of long-term care facilities are
susceptible to developing health care related infections therefore the paper reviews infection and
infection prevention and control programs literature.
Based on interpretation of currently available evidence, recommendations are established
for long-term care infection control programs. Recommendations look into the structure and
function of infection control programs like surveillance, isolation precautions, outbreak control,
and resident care among others. In the long-term care facilities, patients are at risk of developing
urinary tract infections, lower respiratory tract infections, respiratory infections and
gastrointestinal infections (Smith et al., 2008).
A discussion paper by the Public Health Agency of Canada focuses on description of
vital resources for infection prevention and control programs throughout acute, long-term,
ambulatory and home care settings. The internal and external values of these programs are
reviewed from human and economic perspectives. Policy makers and healthcare administrators
focus on providing detailed, accessible, and affordable high quality health care services for
Canadians. The function of infection prevention and control care is to prevent and control
healthcare related infections. These infections comprise urinary tract, bloodstream, soft tissue,
pulmonary, skin, and surgical site among others. Health care infectious diseases include
respiratory, gastrointestinal, and antibiotic-resistant organisms. Respiratory infections include
severe acute respiratory syndrome (SARS), influenza and tuberculosis: gastrointestinal are
Clostridium difficile colitis and Norovirus while antibiotic-resistant are meticillin resistant
Staphylococcus aureus and vancomycin-resistant enterococcus (Public Health Agency of
Canada).

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According to the discussion paper, old age, prematurity, complex treatment modalities in
hospital and outside hospital settings are factors that increase the susceptibility of patients to
developing health care associated infections. Restructuring of the Canadian health care system
which has comprised nurse staffing number changes and staff mix has also been linked to
increased risks in health care.
Several issues of concern affecting infection prevention and control care are raised in the
paper. They include emergence of new infectious agents like severe acute respiratory syndrome
and re-emergence of community acquired diseases like group A streptococcal disease, meticillin
resistant Staphylococcus aureus and multi-drug resistant tuberculosis. Water-borne infections,
food-borne infections like Salmonella typhi and capability for bioterrorism occurrences also
jeopardize infection prevention and control care.
Infection prevention and control programs need staffing, training, and infrastructure
requirements to meet their duties. Human and economic burden that infections have on patients
and their health care systems emphasizes the importance of effective and efficient infection
prevention and control care (Public Health Agency of Canada). Therefore, this care is a crucial
component of patient safety.
Infection prevention and control care is a category of patient safety hence a science aimed
at stopping harm and death of a patient according to Storr et al. Recently there has been success
in infection prevention and control care like cases of reduced meticillin resistant Staphylococcus
aureus bloodstream infections and Clostridium difficile in the United Kingdom. Despite these
small successes, healthcare related infections are still persistent hence risking health care
systems. Currently, healthcare is complex with several variables like participants’ number,
patient throughput, nurse to patient ratio, patient dependency and clinical areas layout among
others (Storr, Wigglesworth & Kilpatrick, 2013). The complexity of healthcare presents a
difficult situation in an environment designed to enable spread of microbes. Undoubtedly,
patients in health care centers in the United Kingdom and globally continue to suffer from
urinary tract infections, surgical site infections, vascular catheters infections among others. The
high human organizational and financial burden they cause is intolerable to both patients and
health practitioners.
Traditional methods of infection prevention and control like education, audit, surveillance
with feedback, and guidance providence are used in reducing health care associated infections
(Storr, Wigglesworth & Kilpatrick, 2013). Infection prevention and control practitioners use root
cause analysis (RCA), change methodologies and tools like Plan Do Study Act (PDSA) cycles,
and process measurement and feedback through run charts and statistical process control charts.
Root cause analysis is for meticillin resistant Staphylococcus aureus and Clostridium difficile
infections.In spite of the few successful achievements by these methods, there is significant harm
caused by health care related infections.
Infection prevention and control is everyone’s responsibility and a matter of doing things
differently. According to this thought paper, improving patient safety is based on comprehending
the integration within healthcare between people, practices and procedures performed, work
environment, teamwork and value systems (Storr, Wigglesworth & Kilpatrick, 2013). This paper
hence embraces human factors into the larger domain of patient safety as an approach to
improving infection prevention and control care.
According Sax et al., healthcare related infections signify the adversity affecting
hospitalized people hence causing increased morbidity and mortality, longer hospital stay, and
disability. World Health Organization (WHO) estimates that roughly 30% of patient in intensive

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care units (ICU) are affected by healthcare related infection accompanied by morbidity and
mortality. Patient in intensive care units are at risk of catheter-related bloodstream infections,
urinary tract infections, surgical site infections and ventilator-related pneumonia (Sax et al.,
2013). Catheter-related bloodstream infections are more persistent with higher rates among
European hospitals.
Bloodstream infection rate can potentially be reduced by a substantial level through
application of strict procedures, technological inventions, hand hygiene promotion, and
implementation of particular interventions (Sax et al., 2013). There are stipulated guidelines that
ensure sterile insertions and central vascular catheters handling. According to Sax and others,
these guidelines emphasize on less infection prone insertion sites, specific catheter type usage,
formal training of medics and effective skin antiseptic among others.
Health care related infections are those contracted while in a health care environment
without proof that it was present or incubating at the time a patient entered the health care center
according to Syndor and Perl. Current medical care is more invasive hence posing greater risks
of occurrence of infectious complications. Factors like aging population, increase in
chemotherapeutic options for cancer treatment, AIDS epidemic and increasing transplant
population have increased population at risk of healthcare infections due to health care system
interactions (Syndor & Perl, 2011).
According to the paper, the Study on the Efficacy of Nosocomial Infection Control
(SENIC) showed that surveillance of nosocomial infections and infection control practices were
significant in enhancing infection prevention and control care. Increase in complexity of medical
care resulted to increased antimicrobial resistance, health care related infections, morbidity,
hospital costs and mortality (Syndor & Perl, 2011). This concurrently led to implementation of
infection surveillance and control programs. In 1974 the SENIC project was used to determine
the impact of infection surveillance and control programs on health care related infections. This
project illustrated that surveillance with feedback of infection control rate, enforcement of
preventative practices, supervision of infection prevention and involvement of a specialized
physician in infection prevention were essential components of an effective infection prevention
and control program.

Model of change

Considering all factors and intensive interventions done by governments’, especially the
United Kingdom, in enhancing infection prevention and control care, integrating human factors
and infection prevention and control is a crucial model of change to be considered. According to
a thought paper written by Storr, Wigglesworth, Kilpatrick the need to understand and address
interactions has led to a recent approach to improvement called human factors into larger domain
of patient safety. Human factors or rather ergonomics is a discipline that considers
comprehending interactions among human beings and elements of a system, principles, data, and
design methods at optimal level of human well-being and overall system performance (Storr,
Wigglesworth & Kilpatrick, 2013). Ergonomics is therefore a broad field which can be broken
down into physical, cognitive, and organizational among others.
Ergonomics has a basic principle of thinking that human error is not completely
preventable; hence healthcare systems should be designed with resilience to human errors
(Reason, 2000). Therefore, healthcare systems should have the capability to prevent error
occurrence, mitigate unpreventable errors, and recognize occurrence of unpreventable errors to
prevent catastrophic health problems. James Reason came up with the Swiss cheese model of
error causation which demonstrates an infection hazard and shows how system factors that

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inherently provoke latent conditions combine with inevitable human active failures creating
catastrophic harm on patients. For example, in case a cancer patient has his or her medication
injected into the spine instead of bloodstream this leads to death.
In a review of human factors done by World Health Organization (WHO), the concept of
safety culture and its impact on workers’ behavior in regard to risk taking, rule observation and
communication about safety is largely discussed. The WHO review summarized thinking on
human factors and patient safety. It was not exclusively centered around Moray’s model of
organizational, human and technical components with focus on the patient and influential factors
surrounding the patient. However, this review could not explain patient factors.
Utility of human factors in an infection prevention context can only be fully addressed by
articulating the precise meaning of infection prevention and control (Flin et al., 2009). In most
cases, healthcare practitioners view infection control as a separate activity from other
mainstream activities of medics. A 2012 study by Ward investigating the attitudes of student
nurses and their mentors on infection prevention and control exemplified this healthcare
tendency. Nurses have negative attitude towards infection prevention with thoughts that it is
additional workload instead of an integral aspect of patient safety and quality care. Healthcare
workers belief they can choose between practicing infection control and treating patients (Ward,
2012).
This study instigates situation awareness as a principle of human factors according to the
WHO review of 2009. Situation awareness facet requires medics to have a good mental model
representing current task status and risks in surrounding work environment. The above attitude of
student nurses shows a mental model in which treatment is perceived separate from infection
prevention and control. Student nurses are blind to the possibility of infection prevention being
an integral part of the treatment process (Storr, Wigglesworth & Kilpatrick, 2013). According to
a paper done by Anderson and others this perceptions are attributed to issues like lack of
consistent inbuilt infection control cues, delayed feedback between omission and consequence,
time pressure and high cognitive workload, and lack of mind connection in physician with
positive result among others.
Therefore, according to Anderson the invisibility of microbes has great impact on
performing infection control activities. We humans perceive what we see, touch, and hear hence
act on our perceptions.
Multi-modal behavior change is another group of infection prevention literature that is
influenced by ergonomics from the World Health Organization approach in hand hygiene
improvement. These approaches consider interactions among physicians, patients, care
environment and equipment instead of relying on one intervention level (Storr, Wigglesworth &
Kilpatrick, 2013). For example design of healthcare facility environment in optimizing the
availability of alcohol hand-rub. Explicit descriptions of human factors in healthcare facility
design for reduced infection exist in principle and practice.
Numerous published reports relate teamwork, leadership, communication to an
organization’s ability in reducing incidence of healthcare associated infections. These reports
look into the qualities of leaders on personal behavior, team interactions and influential tools.
Gurses and others emphasized on capacity building among current and future healthcare workers
to enhance comprehending ergonomics and its capability in transforming patient safety mostly
through training.
Despite efforts of infection prevention by medics being unsuccessful, the capability of
human factor principles and methods are largely unexploited in this field. Evidence of usage of

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human factor approaches in healthcare can only be proved by the airline ‘checklist’ model and
absence of ergonomic expertise in tool development (Storr, Wigglesworth & Kilpatrick, 2013).
Impact of multi-professional teamwork, workflow design processes, safety culture, strategies of
decision making and leadership in infection prevention and control is slowly increasing.
Engagement of the science of human factors in infection prevention and control has not been
systematically addressed. This is because the emerging trend of safety case concept in healthcare
contributes significantly to infection prevention and control. Safety case concept is a method that
systematically identifies and manages risks to patient safety (Gurses et al., 2012).
Generally, integrating human factors thinking into infection prevention and control will
require looking into the past and future to analyze structural and process-related factors
contributing to unsafe care hence determining how to improve them (Gurses et al., 2012).
Attempt to comprehend and involve human factors approaches in infection prevention and
control is as a result of drive to reduce avoidable infections and thoughts of great opportunity in
preventing infections.
Progress in integration of human factors and infection prevention and control requires
policy makers and leaders in healthcare institutions to explore and facilitate several things.
Consider how to integrate human factors within infection prevention and control training.
Infection prevention practitioners should recognize their strengths and limitations in human
factors field. This ensures they are confident in their expertise as agents of change and can easily
identify areas where human factor approaches can amend infection prevention and control care.
Engage infection prevention participants into part of the larger coalition of human factors, patient
safety and quality improvement scientific communities. The interrelation between patient safety
and infection prevention groups should focus on determining effective ways to progress this
integration through exploration of research niches and organizations that can best deal with kind
of study (Storr, Wigglesworth & Kilpatrick, 2013). There should be great consideration for
safety culture utility assessments before infection prevention interventions implementation. In
conclusion, infection prevention practitioners should market this care including integration of
human factors into infection prevention and control to ensure its progress in the healthcare
sector.
Thought paper by Storr and others is an eye-opener of impact that integrating human
factor with infection prevention and control has in enhancing infection prevention. Physicians
should work with ergonomic experts to design, implement, and evaluate infection prevention
interventions. Looking at infection prevention and control from the human factors perspective
offers a different view of this care. This enables healthcare workers assess existing problems in
infection prevention and control care to determine if correct approaches are being focused on in
tackling them (Storr, Wigglesworth & Kilpatrick, 2013). This will require transforming our
thinking in that we start listening, reaching out to, and learning from other disciplines. Storr and
others concluded that human factors is an essential approach that can introduce new energy and
urgency necessary in infection prevention and control, efficiency enhancement and removal of
overuse, underuse and misuse of current patient interventions.

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References

Anderson J, Gosbee LL, Bessesen M, William L. (2010). ‘Using human factors engineering to
improve the effictiveness of infection prevention and control,’ Critical Care Medicine,
vol. 38, pp. 269-81
Dewing, J (2007). Values underpinning help, support and care. In: Neno R, Aveyard B, Heath H
(eds) Older people and mental health nursing: a handbook of care. Blackwell, Oxford, pp
40–51.
Edwards, R et al. (2012). Optimisation of infection prevention and control in acute health care
by use of behavior change: a systematic review. National Center for Infection Prevention
and Management: London, UK.
Flin R, Winter J, Sarac C, Raduma M. (2009). Human factors in Patient Safety Review of Topics
and Tools: Report for Methods and Measures Working Group of WHO Patient Safety.
World Health Organization.
www.who,int/patientsafety/research/mthods_measures/human_factors/human
factors_review.pdf
Gurses AP, Ant Ozok A, Pronovost PJ. (2012). ‘Time to accelerate integration of human factors
and ergonomics in patient safety,’ BMJ Qual Saf, vol. 21, pp. 347-351.
Harbarth, S (2012). What can we learn from each other in infection control? Experience in
Europe compared with the USA. The HealthCare Infection Society. Geneva, Switzerland;
Elsevier Ltd.
Moray, N (2000). ‘Culture, politics and ergonomics,’ Ergonomics, vol. 43, pp. 858-868
Public Health Agency of Canada. Essential Resources for Effective Infection Prevention and
Control Programs: A Matter of Patient Safety: A Discussion Paper.
Reason, J (2000). ‘Human Error: Models and management,’ BMJ vol. 320, pp. 768.
Sax, H. et al., (2013). Implementation of infection control best practice in intensive care units
throughout Europe: a mixed-method evaluation study.
Smith, PW et al., (2008). SHEA/APIC Guideline: Infection Prevention and Control in the long-
term care facility. Omaha, Nebrska Medical Center.
Storr, J, Wigglesworth, N & Kilpatrick, C. (2013). Integrating human factors with infection
prevention and control. The Health Foundation Inspiring Improvement
Syndor, ERM & Perl, TM. (2011), ‘Hospital Epidemiology and Infection Control in Acute-Care
Settings. vol 24, no. 1; pp. 141-173.
Ward, DJ (2012). ‘Attitudes towards infection prevention and control: An interview study with
nursing students and nurse mentors,’ BMJ vol. 21, pp. 301-306.

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