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Infection Control And Prevention Measures:Risk Assessment

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Question:

Discuss about the Infection Control and Prevention Measures for Risk Assessment.

 

Answer:

Risk Assessment Template

Hazard

Who is at risk

Existing control measures

Risk Rating

Proposed control measures

Blood and body Spillage

Medics and patients

Removal of spills of blood or body fluid and then cleaning with disinfection.

Moderate

Use of appropriate disinfectant during cleaning.

Using Sharp hand tools

Medics and patients

Application of PPE

High

Educate medics on the proper use of sharp hand tools.

Hospital design

All staff, medics and visitors

Use of single accommodation for patients with airborne disease.

High

Ventilation that is clean and well designed.

 Bulahdelah Hospital

The risk assessment is at Bulahdelah Hospital. The purpose of the hospital like any other is to provide health services for the sick and occasionally act as an educational center for health science students’ during clinical placement. It is comprised of medical practitioners, that is, doctors, nurses, dentist and pharmacist among others. Also, there premise houses patients under admission programme and outpatients who come during the day. There are also other professional staffs that are not necessarily medics but work in corroboration with healthcare professionals to facilitate delivery of services. The hospital contains various facilities which include but are not limited to a laboratory, ward that houses patients, an examination room which is involved analyzing patients and the reception where people report their concerns. Some of the equipment that is housed in the hospital includes syringes, drugs, and other medical equipment. The purpose of the clinical placement is to not only learn, specifically, acquiring practical skills, but also monitor how the hospital manages disease infection. By so doing, it will be easier for one to make suggestions, on the best control and prevention measures appropriate for the hospital to avoid infection. The design, activities and tools are essential to monitor as far this assessment is concerned.

 

The Hazard

There are many ways that the above hazard can be effectively managed in the hospital.

The best control and prevention measures that the hospital need to put in place are;

  • Educating medics on the best procedures and practices on handling sharp hand tools to avoid mistakes or errors that could lead to injuries.In addition to that, there ought to be training in relation to how to manage these objects and use of personal protective equipment (Dancer, 2014). Lastly, the education must involve risks of transmission of the pathogens associated with using sharp objects.
  • On the other hand, there is the hospital design that has the potential to cause transmission of airborne diseases, such as tuberculosis. This ought to be well maintained in the sense that change rate is well achieved and sustained. The reason is that poorly maintained ventilation has the potential to act as a source of airborne infection. 
  • Lastly, blood and body spillage are other hazards in hospital. The best method of cleaning is to choose an appropriate disinfectant for cleaning.

The impacts of the hazard are numerous. These include but are not limited to;

  • Blood and body spillage have the potential to cause injuries or spread diseases of a patient.
  • On the other hand, hospital design may lead to the spread of airborne diseases such as tuberculosis from one patient to another, or from patients to staff.
  • Lastly, sharp tools may damage the eye or cause cuts which act as an entry point of pathogens and viruses.

In Bulahdelah Hospital, there are various ways that the three hazards are controlled. Specifically,

  • The hospital has set out a single isolation room to cater for patients with airborne diseases.
  • Another control and prevention measure is that the hospital has laid out a clear procedure to be followed by nurses in cleaning and applying disinfectants on spots where blood and spillage have occurred.
  • Lastly, there is the PPE that medics follow in handling sharp hand tools and objects.

In implementing control and prevention measures in the hospital, there is a committee of safety that lay out procedures for medics to follow during the implementation of the control and prevention measures.

 

Analysis of Research

Clean and well-designed Ventilation

Proper ventilation is an important way of preventing the spread of airborne diseases in the hospital. Research indicates that single room accommodation that the hospital use cannot contain is not effective in the prevention of airborne diseases for some reasons. Firstly, this measure is often compromised by lack of proper of hygiene (Damuth et al., 2015). In addition to that, the staff tends to fix the room where the isolated patient is located with the door wide open so that she or he can be in a position to monitor the patient at all times. In addition to that, statistics show that not all hospital can provide patients suffering from those diseases with single room accommodation (Chartier, 2014). However, in hospital, the major reason for ventilation is to offer healthy air for breathing by diluting the contaminated air that is originating from the room, thus, supplying a clean and fresh air from outside the room. Therefore, to monitor airborne diseases, research conducted in 2014, suggest that there is need to consider the quality and amount of air that comes from outside, that is, the ventilation rate (Mehta et al., 2014). In addition to that, there is need to determine the airflow direction and the ideal being that, that which flow from clean zones to the dirty zones. Lastly, the study recommends that distribution of air is important in that, it must be to each part and corner of the room or ward that houses the patients (Klompas et al., 2014). This, according to the study, will make it possible to remove contaminated air but at the same time bring in clean air. This study thus, speaks of the two common ways of containing the spread of the pathogens, which are, dilution of the pathogens and the second one is controlling the distribution or movement of them from one point to another.

In demonstrating the effect of ventilation in containing or preventing the pathogens causing airborne diseases, scientists have come up with Wells-Riley equation that expresses the influence that ventilation plays in control and prevention measures (Ugurlu et al., 2014). However, the equation has generated so much debate principally because it needs quanta data for its input. On the other hand, studies reveal that ventilation is not only important in patient’s wards or rooms, but also in communal areas, that is, is in lifts, corridors or waiting areas among others.

However, even though ventilation is effective is allowing clean air circulation, there are measures that must be put in place to avoid the same ventilation from infecting the people concerned. Firstly, according to studies by  Phukan (2014), it indicates that well-functioning ventilation is capable of providing such protection must be one that is well maintained so that air change rate must be well maintained to achieve the required air change. It is possible by ensuring that, there are no clogged filters or contaminated filters that have the potential to lead to a buildup of pathogens that the ventilation aims to remove or prevent from spreading (Loveday, 2014). Thus, although studies reveal that ventilation is important for this task, poorly maintained ventilation could act as a source of transmission but not as a defense. 

On the other hand, research indicates that personal ventilation pillow is an effective method that can be used in a hospital to prevent transmission of airborne diseases from patient to patient.  It is so especially in a mixed ventilated room where there are many patients in the same room (Knape, 2015). According to the study, its effectiveness is at 98 percent and prevents infection at mouth level either when patients are lying on their back or sideways. However, the study documents that this is only possible in a single ventilated room but cannot be applicable in a mixed ventilated room. The best method in such cases, according to the study, is to provide personal ventilated pillow to only the person with the infectious disease. The same study documents that the method is also effective, though at 91 percent to reduce the possibility of airborne disease transmission at the receiver patient during continuous movements of patients in hospital (Hobday, & Dancer, 2013). Therefore, these are enough reasons that the hospital needs to apply this method for control and prevention of airborne diseases.

 

Educating Medics

There are many reasons that one can advocate for educating medics on hand tools.  In hospitals, there are many incidences of disease transmission from sharp hand tools that medics use. Ina research conducted in 2011, there were indications that most professionals either ignore or do not follow the guidelines completely laid out in the procedural manure on the effective use and handling of sharp hand objects (Beggs et al., 2015). Firstly, studies indicate that of all workers that experienced injuries, about sixteen percent represent those who did not put on gloves when the incident was taking place (Cao et al., 2014). On the other hand, fifty-five of the cases involved malpractices when using the equipment. Another study stipulates that about twenty-four percent represents injuries as a result of needle recapping while sixteen percent was a result of the careless disposal of sharp objects ( Zingg et al., 2015). Thus, the study reveals that even though there is a general assumption that medics are well knowledgeable in matters of handling hand tools in healthcare, studies reveal otherwise, in that, practitioners have shallow knowledge which is contributing to hand held tools injuries in health care settings.

Whatever control measures that one settle on, it is important that staffs are knowledgeable on how to use it. Frameworks of work might be required for cleaning and support of hardware when this outcome in contact with sharp material. There is a stamped underreporting of needle stick episodes procured by therapeutic services for specialists in Saudi Arabia like numerous different nations. The study demonstrates that the greater part of dentists encountering sharp hand tolls injuries did not report to the proper office. Further, the study demonstrates that under-detailing rate after needle stick damage was 67.4% and that the significant purposes behind underreporting after needle injury were the supposition that no blood-borne pathogens existed in the source tolerant (62.8%), inconvenience (17.9%), and no learning about the announcing methodology (6.0%). In a past report from China, it is accounted for that a noteworthy reduction in needle injuries happened after the arrangement of instructive intercession (P< 0.005) (Elseviers et al., 2014).The training was given the through two days’ workshop on a needle and other sharp objects injuries among medics and undergraduate nursing students and the information gathered through a poll. These discoveries are in congruity with the discoveries of this examination.

Essentially, research conducted in the Netherlands utilized a three-equipped grouped randomized controlled trial to diminish needle-stick wounds; two intercession clinics and a control health care center (Hajiyev, 2014). The two intercessions were a conventional workshop, and utilizing needle security gadget with a customary workshop, these reduced the notion of sharp objects altogether among attendants, in spite of the fact that consolidating the two mediations gave better outcomes (P = 0.046). Another investigation was directed in Switzerland in which a training program was sorted out through four customary workshops to actualize the mediation (Graban, 2016). The sharp objects injuries diminished from 13% to 11.2%, which is additionally reliable. Another investigation was led in China to affirm the impact of training medics on how to use sharp objects in the hospital and other healthcare settings and the injuries associated with the same.

A study on occupational health found out that nurses experience stress on working with sharp objects and it is through education and awareness that can alleviate this problem from affecting their daily activities (Anderson et al., 2013). The study reveals that occupational safety awareness and safety behaviors significantly reduced incidences of injuries both among patients and nurses. Thus, the study recommends that both novice and experienced nurses must undergo continuance training to enhance not only their competence but also to be able to deal with stress while working with sharp objects (Hoffmann, Buchholz, & Schnitzler, 2013). The study, as it documents, suggest that nurses who undergo training have recorded a reduced level of injuries and stress when working with hand tools in hospitals. It is a control measure that the hospital must embrace.

 

Use of Appropriate Disinfectant

The utilization of sodium hypochlorite is not important for routinely overseeing spills, yet it might be utilized as a part of a disinfectant in such particular conditions. There is a confirm supporting the utilization of sodium hypochlorite to inactivate different bloodborne and gastrointestinal infections (Rutala, & Weber, 2014).The thought to utilize sodium hypochlorite ought to be founded medics appraisal and the effectiveness of the chemical on nature, the spill, danger of transmission of a malady, and the surface region and potential risks with utilizing the item.  A study conducted by researchers in Saudia Arabia demonstrates that a disinfectant is required, especially amid the usage of transmission-based insurances, a TGA-enrolled clinic review disinfectant must be utilized.

The disinfectant picked ought to have mark claims against the living being of concern (Memish et al., 2013). It goes on to suggest that, perfect disinfectant and the best trade-off ought to be picked as per the circumstance. Thus, a disinfectant arrangement is viewed as fitting at the point when the tradeoff between the antimicrobial movement and the lethality of the item is acceptable for the given application. Another thought may well be the cost. The more dynamic disinfectants are naturally, the more lethal ones; possibly harmful items can be connected to lifeless things or surfaces, while for the cleansing of human tissues just the less poisonous disinfectants can be considered ( Zingg et al., 2015). For antisepsis, distinctive disinfectants are utilized for application to the in-place skin and mucous layers or wounds. The cost is a less vital thought for a germ-free than for a disinfectant. The key prerequisites for a decent germicide are nonattendance of poisonous quality. Additionally, fast and satisfactory movement on both common greenery and, particularly, pathogenic microbes that are different from microorganisms after a short presentation time appears to be effective. Basic prerequisites for a disinfectant are fairly unique.

Lastly, there must be satisfactory action against microscopic organisms, parasites, and infections that might be available in substantial numbers and secured by soil or natural matter (Beggs et al., 2015). Moreover, since disinfectants are connected in vast amounts, they ought to be of low ecotoxicity. By and large, utilization of the picked disinfectant, at the fitting fixation, in addition to that, for the suitable time, the chemical used should kill pathogenic microorganisms, rendering a protest alright for use in a patient, or human tissue free of pathogens to prevent and control transmission of pathogens.

Summary

In conclusion, I have learned that the hospital design, blood and body spillage and using sharp hand tools can be a potential source of transmitting diseases in hospitals. In addition to that, I have come the risk assessment has helped me get to know some of the control and prevention measures to solve the hazard and effectively handle them in a way that they cannot transmit diseases. In the control measures that I have proposed, studies or scientific literature demonstrate that they can be effective in controlling and containing the hazard from medics, students, other staffs and all those that are involved in the activities of the hospital. In particular, the risk assessment reveals that ventilation needs to be well implemented to avoid airborne disease transmission. On the other hand, not all disinfectants work well in removing blood and body spillage and medics needs to find effective disinfectants during cleaning and removal of body and blood spillage. Lastly, medics tend to face difficulties in handling sharp objects, research show of a high number of them causing injuries while others appear to have stress in using sharp objects. The risk assessment puts it clear that continuance education among medics can help solve this problem.

 

References

Anderson, J. E., Kodate, N., Walters, R., & Dodds, A. (2013). Can incident reporting improve safety? Healthcare practitioners' views of the effectiveness of incident reporting. International journal for quality in health care, 25(2), 141-150.

Beggs, C., Knibbs, L. D., Johnson, G. R., & Morawska, L. (2015). Environmental contamination and hospital?acquired infection: factors that are easily overlooked. Indoor air, 25(5), 462-474.

Cao, G., Awbi, H., Yao, R., Fan, Y., Sirén, K., Kosonen, R., & Zhang, J. J. (2014). A review of the performance of different ventilation and airflow distribution systems in buildings. Building and Environment, 73, 171-186.

Chartier, Y. (Ed.). (2014). Safe management of wastes from health-care activities. World Health Organization.

Damuth, E., Mitchell, J. A., Bartock, J. L., Roberts, B. W., & Trzeciak, S. (2015). Long-term survival of critically ill patients treated with prolonged mechanical ventilation: a systematic review and meta-analysis. The Lancet Respiratory Medicine, 3(7), 544-553.

Dancer, S. J. (2014). Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clinical microbiology reviews, 27(4), 665-690.

Elseviers, M. M., Arias?Guillén, M., Gorke, A., & Arens, H. J. (2014). Sharps injuries amongst healthcare workers: review of incidence, transmissions and costs. Journal of renal care, 40(3), 150-156.

Graban, M. (2016). Lean hospitals: improving quality, patient safety, and employee engagement. CRC press.

Hajiyev, E. (2014). Assessing the Relationship between Risk Management and Safety Climate in Healthcare Organizations(Master's thesis, Eastern Mediterranean University (EMU)-Do?u Akdeniz Üniversitesi (DAÜ)).

Hobday, R. A., & Dancer, S. J. (2013). Roles of sunlight and natural ventilation for controlling infection: historical and current perspectives. Journal of Hospital Infection, 84(4), 271-282.

Hoffmann, C., Buchholz, L., & Schnitzler, P. (2013). Reduction of needlestick injuries in healthcare personnel at a university hospital using safety devices. Journal of occupational medicine and toxicology, 8(1), 20.

Klompas, M., Branson, R., Eichenwald, E. C., Greene, L. R., Howell, M. D., Lee, G., ... & Yokoe, D. S. (2014). Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(S2), S133-S154.

Knape, L., Hambraeus, A., & Lytsy, B. (2015). The adenosine triphosphate method as a quality control tool to assess ‘cleanliness’ of frequently touched hospital surfaces. Journal of Hospital Infection, 91(2), 166-170.

Loveday, H. P., Wilson, J., Pratt, R. J., Golsorkhi, M., Tingle, A., Bak, A., ... & Wilcox, M. (2014). epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection, 86, S1-S70.

Mehta, Y., Gupta, A., Todi, S., Myatra, S. N., Samaddar, D. P., Patil, V., ... & Ramasubban, S. (2014). Guidelines for prevention of hospital acquired infections. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 18(3), 149.

Memish, Z. A., Assiri, A. M., Eldalatony, M. M., Hathout, H. M., Alzoman, H., & Undaya, M. (2013). Risk analysis of needle stick and sharp object injuries among health care workers in a tertiary care hospital (Saudi Arabia). Journal of epidemiology and global health, 3(3), 123-129.

Phukan, P. U. R. A. B. I. (2014). Compliance to occupational safety measures among the paramedical workers in a tertiary hospital in Karnataka, South India. The international journal of occupational and environmental medicine, 5(1 January), 339-40.

Rutala, W. A., & Weber, D. J. (2014). Selection of the ideal disinfectant. Infection Control & Hospital Epidemiology, 35(7), 855-865.

Ugurlu, A. O., Sidhom, S. S., Khodabandeh, A., Ieong, M., Mohr, C., Lin, D. Y., ... & Hill, N. S. (2014). Use and outcomes of noninvasive positive pressure ventilation in acute care hospitals in Massachusetts. CHEST Journal, 145(5), 964-971.

Zingg, W., Holmes, A., Dettenkofer, M., Goetting, T., Secci, F., Clack, L., ... & Pittet, D. (2015). Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. The Lancet Infectious Diseases, 15(2), 212-224.

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