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.
Fundamentals of Nursing - Flashcards
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
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
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
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.
Sign posting
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.
Equipment placement
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.