Improving Infection Control Practice What Can RNs Do? PAGE 16. New President-Elect Announced

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1 IN THIS ISSUE Letter to the Editor CARNA Education Sessions Discipline Decisions NEPAB Update Med-Surg Nurses Recognized Notice Board In Memoriam SEPTEMBER 2007 VOLUME 63 NO 7 Improving Infection Control Practice What Can RNs Do? New President-Elect Announced Alberta registered nurses have elected Joan Petruk of Camrose for president-elect of the College and Association of Registered Nurses of Alberta. Petruk has a wide range of health-care experience encompassing public health and occupational health. She is currently the health and safety coordinator for East Central Health and is a nursing instructor in occupational health nursing and disability management at Grant MacEwan College. In addition to Petruk, registered nurses in Calgary/West elected Dianne Dyer to serve on provincial council. Tammy Syrnyk from Camrose and Ellen Jones from Grimshaw were elected by acclamation to serve in Central and Northwest regions respectively. All newly elected members begin their term of office on Oct. 1, For more details on election results, go to page 5. PAGE 16

2 Informed Infection Control Practice for RNs BY DEBBIE PHILLIPCHUK, RN, MN, NURSING CONSULTANT POLICY AND PRACTICE Recent events and the much publicized review of infection control issues in East Central Health by the Health Quality Council of Alberta have drawn increased attention to infection control practices in relation to patient safety. In 2004, The Canadian Adverse Events Study (Baker, Norton) identified infection as one of the three most common areas for adverse events to occur along with surgery and medication. Concern about the spread of infection is not just local in nature but provincial, national and international in our current global environment. SARS was identified in April 2003 after intensive research around the world (Stirling, Littlejohn & Willbond, 2004). It proved to be highly contagious and spread rapidly. Nurses caring for those patients were at high risk for development of the disease. The United Nations has identified climate change as a factor in the increasing threat of infectious disease on a global basis (UNEP, 2005). Infections such as West Nile virus and malaria emphasize the importance of thorough assessment and careful taking of the complete patient history. Malaria is increasingly common as people travel to holiday destinations where malaria exists and the number of cases of West Nile virus increases each summer. At a provincial or local level, inadequate infection control can result in increased infection rates, antibiotic resistant organisms and the closure of nursing units and health-care facilities. The Canadian Institute for Health Information (CIHI) indicates that one in nine adults acquires an infection while in hospital. Previously these types of infections have been termed nosocomial infections but are more recently being referred to as 10 Alberta RN September 2007 Volume 63 No 7

3 health-care acquired infections (HAI). The most common types of HAIs are surgical site infections, urinary tract infections, central line related blood stream infections and ventilator associated pneumonias. Transmission of infections, such as MRSA and C. difficile diarrhea, is having an increased impact on client care in health-care agencies and in the community. Although the current focus on adverse events and infection control and prevention is primarily within the hospital, nursing care provided in the broader community also provides opportunities to implement best practices. As the health system has changed and evolved, patients are going home earlier and the health care they need is being provided in the community. Institution infection control practices have to be adapted to the home environment and family members, friends or informal caregivers must be taught the principles that will keep both the client and caregivers safe from infection. Basic infection control to reduce the risk of infection of both the client and caregivers will be particularly important in a pandemic as it is anticipated that most of the care and prevention measures will take place in the home. While the principles of infection control (prevention, transmission and control) do not change, specific clinical practices may evolve as a result of new evidence. New products, procedures and interventions are constantly emerging. Everyone has a part to play in infection control in our practice environments and each one of us must assess our particular environment to identify the risks or potential for infection and reflect on our infection control practices. New programs and strategies to address identified issues have been developed in response to the spotlight on patient safety and on infection prevention and control in particular. The critical issue is how hospitals and other health-care practice settings, which are already stressed in terms of capacity and resources, can implement these changes. Registered nurses (RNs) can, and should, be part of advocating for and implementing changes. Today, more than ever, RNs are provided with an excellent opportunity to review current best practices and/or advocate for increased infection control resources. What Can Registered Nurses Do? Your solid knowledge base along with the presence of RNs 24 hours a day, seven days a week in all health-care settings equips you to play a critical role in patient safety. Listed here are a number of ideas and resources on infection prevention and control to help you assess your practice and your practice setting and to contribute to ensuring the safety of your clients. Get Started The Safer Healthcare Now! (SHN) Getting Started Kits, based on those originally developed by the U.S. Institute for Healthcare Improvement s 100,000 Lives Campaign, are designed to engage your teams and clinicians in a dynamic approach to quality improvement and provide a solid foundation for getting started. The kits and worksheets are available free at The prevention of central line bloodstream infections is one of six targeted interventions of the SHN Campaign which also include the prevention of surgical site infections and ventilator associated pneumonias. The nurses in the Paediatric Critical Care Program at the British Columbia Children s Hospital are members of a clinical team enrolled in the SHN campaign. The team has reduced the rate of catheter-related bloodstream infection at the hospital by 60 per cent over a 12-month period. RNs audit and attend each insertion by a physician and a checklist has been developed from the initial hand washing to documentation when the procedure is done. If the correct technique is not followed, the RN can have the procedure stopped and restarted. The team has also restricted the number of people allowed to insert catheters so only physicians specializing (or training to specialize) in ICU or critical care can perform the procedure. Other improvements include new wall-mounted hand sanitizers so there are now three near each patient. A multi-disciplinary team at the Stollery Children s Hospital in Edmonton has also reported significantly reduced bloodstream infections in the pediatric ICU by improving compliance to evidence-based insertion and maintenance strategies. One in nine adults contracts infection in hospital. (CIHI, 2004) Every year 8,000 to 12,000 Canadians die from a hospital acquired infection. September 2007 Volume 63 No 7 Alberta RN 11

4 The three One most in nine common adults areas for contracts adverse infection events to occur in include hospital. surgery, (CIHI, 2004) medication, and infection. (The Canadian Adverse Events Study, Baker, Norton 2004) Routine practice such as simple hand washing is identified as the most important thing we can do and is the first line of defense. West Nile C.difficile SARS pandemic MRSA Submit (or Resubmit) a Proposal for Infection Control The monthly newsletter Joint Commission Perspectives on Patient Safety gives health-care professionals how to information on analyzing and preventing errors. The June 2005 issue outlined how one registered nurse succeeded in doubling the resources for infection control over five years at the Barnes-Jewish Hospital in St. Louis by making a business case for infection control. She showed health-care executives how reducing health-care associated infections would positively affect the organization s bottom line. The time is right to prepare and submit a business case. With the recent concern being expressed in Alberta over infection control, your proposal for increased infection control resources is more likely to capture the attention of employers. The full text of Making a Business Case for Infection Control is posted under Resources/Alberta RN of the CARNA website or contact the CARNA library by or by phone and request a copy of the article from Joint Commission Perspectives on Patient Safety, June 2005, Volume 5, Issue 6. Members interested in searching for additional topics covered in other issues can log in to the CARNA website to refer to the CINAHL database (Cumulative Index to Nursing and Allied Health Literature Database). STOP! Clean Your Hands Campaign Simple hand washing is the first line of defense and consistently identified by infection control experts as the most important thing we can do to prevent and control infection. Since the time of Florence Nightingale, RNs have always understood the importance of maintaining our vigilance with respect to hand washing and infection control practice. In October, the Canadian Patient Safety Institute (CPSI) will launch Stop! Clean Your Hands, the national hand hygiene campaign aimed at promoting the importance of hand hygiene in reducing the occurrence of health-care associated infections in Canada. A key element of the campaign is a series of toolkits that focus on awareness-raising, education and training and communication and promotion. Each toolkit will include a nationally consistent audit tool to help determine baseline performance on hand hygiene compliance and monitor and report on improvements over time, both at the local health-care facility level, as well as at the national, system-wide level. Over the summer, CPSI launched the campaign in 10 pilot facilities across the country and materials will be refined based on feedback. The University of Alberta Stollery Children s Hospital was one of 10 facilities selected for the pilot. Both the CPSI website and the campaign website have resources available. Consult Your Local Infection Control Professional Infection control is a rapidly evolving science, but RNs can access some of the best informed individuals on current best practice through their employer. Infection Control Professionals (ICPs) employed by health-care facilities and health regions provide services that include surveillance (counting infections), reporting infection rates to appropriate care givers, answering questions regarding infection control practices, assisting staff and patients, clients or residents with implementation of appropriate interventions and provision of education. ICPs are dedicated to the discipline of infection prevention and control and many of them have achieved certification from the Certification Board of Infection Control. Currently, 12 Alberta RN September 2007 Volume 63 No 7

5 93 RNs in Alberta are members of the Community and Hospital Infection Control Association (CHICA) Canada and are practicing in the area of Infection Prevention and Control (CHICA-Canada 2007/2008 Member and Source Guide). Consult Publications on Best Practice The Canada Communicable Disease Report posted on the Public Health Agency of Canada website contains infection control guidelines for acute care, long-term care, ambulatory and home care practice settings. In addition, the College of Physicians and Surgeons of Alberta has published guidelines to ensure safe practice in physician s offices or clinical settings. Canada Communicable Disease Report, Infection Control: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care (Public Health Agency of Canada 1998) College of Physicians and Surgeons of Alberta, CPSA Guideline: Cleaning, Disinfecting and Sterilizing Office Instruments (1994) Apply Best Practice to Products and Technology New products are also emerging that can be used to increase safety and decrease the incidence of infection. They include better gloves, new antiseptics, safety butterfly needles and IV catheters, kits which facilitate proper oral and dental care (reducing colonization in the mouth to prevent ventilator associated pneumonia) and pre-filled heparin and saline syringes which eliminate multi-dose vials which are more likely to become contaminated with organisms such as hepatitis B and C. Although these products may be helpful in assisting with safer provision of care, it is still up to the nurse to use them according to the manufacturer s written instructions and to ensure that other care givers follow safe care practices at all times. Advocate for a Culture of Safety Infection control is a crucial building block for a culture of safety and prevention. The importance of a healthy organizational culture that promotes and has a strong commitment to safety in infection control was shown in a study by Yassi et al (2007). Their study found that compliance with infection control procedures was significantly affected by the organization and environment. They found that while education is important in building knowledge and skills, the more important result is demonstrating organizational commitment to keeping workers informed and confident that the organization can manage present and emerging infections. Conclusion RNs have always been leaders in infection control practices and knowledge of clinical infection control practices is continually growing and changing. All RNs in all roles and settings can demonstrate leadership in infection prevention and control by using their knowledge, skill and judgment to advocate for the implementation of current best practices in their workplace. RN Resources for RNs listed in this article Making a business case for infection control, Joint Commission Perspectives on Patient Safety. This article is posted at under Resources References Chinnes, L. F. (2005). Infection control: Gain new perspectives in improved guidelines and practices. Nursing Management, 37(12), College and Association of Registered Nurses of Alberta. (2006). Disclosure and reporting of infection with blood-borne pathogens: Guidelines for registered nurses. Edmonton, AB: Author. Making a business case for infection control. (2005). Joint Commission Perspectives on Patient Safety, 5(6), 1-4. McKay, M. & Farley, M. (2006). Infection control: Circle of safety. Canadian Operating Room Nursing Journal, 24(4), 20-24, Safer Healthcare Now! (2005, December) Prevent Central Line Infection, Retrieved Aug. 15, Stirling, B., Littlejohn, P., & Willbond, M. L. (2004). Nurses and the control of infectious disease: Understanding epidemiology and disease transmission is vital to nursing care. Canadian Nurse, 100(9), United Nations Environment Programme. (2005, February 21). UNEP Launches 2004/5 GEO Yearbook [press release]. Retrieved July 18, 2007, from ocumentid=424&articleid=4728&l=en Yassi, A., Lockhart, K., Copes, R., Kerr, M., Corbiere, M., Bryce, E., Danyluk, Q., Keen, D., Shicheng, Y., Kidd, C., Fitzgerald, M., Thiessen, R., Gamage, B., Patrick, D., Bigelow, P., & Saunders, S. (2007). Determinants of healthcare workers compliance with infection control procedures. Healthcare Quarterly, 10(1), September 2007 Volume 63 No 7 Alberta RN 13