Claire Dawson
Cross infections in hospitals are a major concern, as they can cause unnecessary pain and suffering for patients and their families, and can even result in death. They are also a significant cost to the health system. Infections can spread in any setting, and the risk for infection is greater when undergoing a infection procedure. Hospitals and other healthcare settings have procedures to prevent infection, and standard precautions for infection prevention and control are needed. These include regular hand washing, sterilizing equipment, and cleaning rooms with bleach-containing cleansers.
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What You'll Learn
Regular hand washing and sanitising
Washing hands with soap and warm water for at least 20 seconds helps remove bacteria and viruses from the hands. This should be done frequently and vigorously, covering the entire hand, including fingertips and thumbs, and rinsing and drying thoroughly. If soap and water are unavailable, hand sanitiser is the next best option.
Hand hygiene is a cornerstone of infection control, and hospitals should encourage all staff, patients, and visitors to practice good hand hygiene. This includes washing hands before and after eating, drinking, providing care, and between caring for different patients. Hospitals can also implement initiatives to promote hand hygiene, such as the National Hand Hygiene Initiative in Australia, which provides education and feedback to clinicians and hospital executives.
In addition to hand washing, the proper use of personal protective equipment (PPE) is essential. This includes gloves, masks, eye protection, and gowns, which should be worn when appropriate and changed regularly to prevent the spread of infection.
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Sterilise equipment and rooms
Sterilising equipment and rooms is a critical step in preventing cross-infection in hospitals. Here are some detailed instructions for achieving this:
Sterilising Equipment:
- Use an aseptic technique: This is a common process used to sterilise equipment, preventing the spread of harmful microorganisms from one patient to another.
- Implement proper sterilisation techniques: Ensure that all equipment is thoroughly sterilised using appropriate methods, such as autoclaving or chemical disinfection, depending on the type of equipment.
- Follow protocols for percutaneous injuries: Minimise the risk of percutaneous injuries (needlestick injuries) by using personal protective equipment, such as gloves and masks, and by safely disposing of sharps in designated containers.
- Educate and train staff: Provide regular education and training on infection control practices and sterilisation techniques to all staff members.
Sterilising Rooms:
- Clean rooms thoroughly: After each patient, use a bleach-containing cleanser to clean every room thoroughly, including non-patient areas like break rooms and nurses' stations.
- Use negative pressure rooms: In certain cases, such as airborne infections, use negatively pressurised rooms to prevent the spread of infectious agents.
- Maintain good ventilation: Ensure proper ventilation in rooms to reduce the concentration of airborne pathogens.
- Encourage hand hygiene: Hand washing with soap and warm water is crucial before and after patient care and before eating and drinking. Provide hand sanitiser as an alternative when soap and water are unavailable.
- Practice social distancing: Maintain distance between patients and visitors in waiting rooms and other shared spaces to prevent the spread of infections.
By following these measures, hospitals can significantly reduce the risk of cross-infection and create a safer environment for patients and staff.
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Maintain social distancing
Social distancing is a critical measure to prevent cross-infection in hospitals. Here are some detailed instructions for maintaining social distancing in a hospital setting:
For Patients
Patients should be encouraged to maintain a safe distance from one another, particularly in waiting areas and during mealtimes. Hospitals can rearrange waiting room layouts to ensure adequate space between seats or provide designated spaces for patients to wait. Patients should also be advised to eat their meals upon receiving them and avoid leaving food out for extended periods.
For Visitors
Visitor policies should be implemented to control the number of people in the hospital at any given time. This can include allowing only a specific number of visitors per patient or restricting visitors to certain days or times. It is also essential to ensure that visitors are aware of social distancing guidelines and provide clear signage and reminders throughout the hospital.
For Staff
Hospitals should consider adjusting staff schedules to reduce the number of employees in the facility at once. This can include staggered shifts, flexible working hours, and remote work arrangements for non-clinical staff. During shift changes, ensure that staff members do not congregate in one area and maintain distance when handing over patient information.
For Procedures
When performing medical procedures, only essential medical personnel should be present in the room. Non-essential staff and students should join via video conferencing, if possible, to reduce the number of people in the room. For dental procedures, patients with viral influenza or other infectious diseases should be scheduled for the last appointment of the day, minimizing contact with other patients.
For Common Areas
Common areas, such as break rooms and cafeterias, should be rearranged to allow for more space between seats. Hospitals should also consider providing multiple break areas or staggering break times to reduce the number of people in these areas simultaneously. Additionally, hospitals can implement one-way traffic flow systems in corridors and stairwells to minimize close contact between individuals.
By implementing these social distancing measures, hospitals can significantly reduce the risk of cross-infection and protect the health and safety of patients, staff, and visitors.
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Properly sanitise linens and laundry
To prevent cross-infection in hospitals, linens and laundry must be properly sanitised. This is because fabrics used in healthcare settings, such as bed sheets, patient gowns, and medical scrubs, can be fomites—materials that are likely to carry infections.
Firstly, it is important to separate soiled and clean linen storage areas, with the soiled linen area ideally at negative pressure relative to other areas. Designated containers for soiled linen should always be used, and staff should never carry soiled linen against their bodies. Staff should wear tear-resistant reusable rubber gloves when handling soiled linen, and if there is a risk of splashing, they should also wear face protection and a gown or apron.
When laundering soiled linens, hot water (70–80°C for 10 minutes) and an approved laundry detergent should be used. Chlorine bleach is an economical, broad-spectrum chemical germicide that can enhance the laundering process, but it is not suitable for all fabrics. Modern-day flame-retardant fabrics can tolerate chlorine bleach, but these fabrics should be thoroughly rinsed during the rinse cycle as detergent residues can support combustion.
After linens have been cleaned, they should be dried, pressed as needed, and packaged to prevent contamination by dust, debris, or other soiled items. Clean linens should be transported to patient care areas on designated carts or within designated containers that are regularly cleaned with a neutral detergent and warm water solution.
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Food safety and waste disposal
Food Safety
- Hand washing is a fundamental aspect of food safety. All food handlers, including staff and patients, should wash their hands with soap and water, followed by drying with paper towels, before eating or drinking. Handwashing is also essential after coughing, sneezing, using the toilet, and handling soiled equipment.
- "Touchless" or "hands-free" faucets and paper towel dispensers are recommended to reduce the risk of cross-contamination.
- Food handlers should also wash their hands and exposed portions of their arms after touching bare human body parts, handling service or aquatic animals, using tobacco, and before donning gloves for tasks involving food.
- During food preparation, hands should be washed as often as necessary to prevent cross-contamination when switching between tasks, such as moving from raw food to ready-to-eat food.
- The temperature of refrigerators used for patient snacks should be checked regularly to ensure food safety.
- Patients should be encouraged to eat their meals promptly. Food left in a patient's room for several hours should be discarded to prevent spoilage and the risk of infection.
Waste Disposal
- Different types of waste (general, clinical, and pharmaceutical) require distinct waste management procedures. Clinical and pharmaceutical waste, for example, should be collected by licensed waste disposal companies and treated in specialised facilities.
- Contaminated surfaces and spills in laboratories should be treated with 2.0-2.5% sodium hypochlorite and cleaned with paper towels, which are then disposed of as clinical waste.
- Operating rooms and isolation rooms must be cleaned after each session and spot-cleaned after each case.
- Waste should be stored in secure areas until it is collected, with clinical waste removed at least three times daily.
- Single-use sharps should be placed in designated sharps containers that meet safety standards.
- Leftover pharmaceuticals should be returned to the pharmacy for proper disposal.
- Most disinfectants can be disposed of through the sewer system, but they should be poured into a sink with running cold water.
- Floors in hospitals should be cleaned daily with vacuum cleaners fitted with particulate-retaining filters. Brooms should be avoided in patient and clinical areas as they disperse dust and bacteria into the air.
By adhering to these guidelines, hospitals can significantly reduce the risk of cross-infection associated with food safety and waste disposal practices.
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Frequently asked questions
Hospitals can prevent cross-infection by following standard precautions and transmission-based precautions. Standard precautions are the basic strategies used to prevent and minimize the risk of infection transmission and are taken with all patients. Transmission-based precautions are extra protections used when standard precautions are insufficient to prevent the spread of certain infectious microbes. Transmission-based precautions are used when patients are suspected or known to be infected with pathogens that can be transmitted by contact, droplets, or air. Hospitals can also implement infection control practices, such as hand washing, proper sterilization techniques, and proper waste management of sharps.
Standard precautions for infection prevention and control are needed in hospitals to minimize the risk of patients acquiring healthcare-associated infections. These include hand washing, personal protective equipment (PPE), such as masks, eye protection, gloves, and gowns, and proper waste management of sharps.
Transmission-based precautions are used when standard precautions are insufficient to prevent the spread of certain infectious microbes. These include using negatively pressurized rooms and P2 (N95) surgical respirators, which provide a better seal with the face, postponing non-emergency dental treatment for patients with viral influenza, and scheduling patients with known infections for the last appointment of the day to minimize contact with others.
Hospitals can implement the following measures to prevent cross-infection:
- Encourage frequent and thorough hand washing among staff, patients, and visitors.
- Clean rooms and surfaces with bleach-containing cleansers between patients to prevent the transmission of infections.
- Sanitize and clean linens, changing them daily and whenever they are visibly dirty.
- Follow proper sterilization techniques for equipment and dental instruments to prevent cross-contamination.
- Implement protocols to minimize percutaneous injuries and manage common infectious agents, such as gastrointestinal viruses and influenza.
