Minimising the Risk of Cross-Infection

Measures to minimise the risk of cross-infection should be taken. It is estimated that during 2005 there were at least 300 000 hospital-acquired infections (HAIs) per year, with 9% of patients being affected at any one time, and a cost to the NHS of £1 billion per year (Poole 2011). The principal route of HAIs is via the hands and effective hand hygiene is recognised as the most effective intervention to prevent cross-infection and is the simplest (Cantrell et al. 2009; Petty 2009).

The National Institute for Health and Clinical Excellence (NICE 2003) has issued guidance governing the principles of good practice relating to hand washing (which is currently being updated):

• Hands must be decontaminated immediately before each patient and every episode of direct patient contact or care after any activity or contact that could potentially result in hands becoming decontaminated.
  
• Hands that are visibly soiled, or potentially grossly contaminated with dirt or organic material, must be washed with liquid soap and water.
  
• Hands must be decontaminated, preferably with an alcohol-based hand rub unless hands are visibly soiled, between caring for different patients and between different care activities for the same patient.
  
• Before regular hand decontamination begins, all wrist and ideally hand jewellery should be removed. Cuts and abrasions must be covered with waterproof dressings. Fingernails should be kept short, clean and free from nail polish and no artificial nails should be used.
  
• An effective handwashing technique involves three stages: preparation, washing and rinsing, and drying. Preparation requires wetting hands under tepid running water before applying liquid soap or an antimicrobial preparation. The handwash solution must come into contact with all surfaces of the hand. The hands must be rubbed together vigorously for a minimum of 10–15 seconds, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers. Hands should be rinsed thoroughly before drying with good-quality paper towels.
  
• When decontaminating hands using an alcohol hand rub, hands should be free from dirt and organic material. The hand rub solution must come into contact with all surfaces of the hand. The hands must be rubbed together, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers, until the solution has evaporated and the hands are dry.
  
• An emollient hand cream should be applied regularly to protect skin from the drying effects of regular hand decontamination. If a particular soap, antimicrobial hand wash or alcohol product causes skin irritation an occupational health team should be consulted.

Universal Precautions to Blood and Bodily Fluids

Blood is the single most important source of the transmission of human immunodeficiency virus (HIV) and hepatitis B virus (Jevon 2010). Universal precautions should apply to blood, semen, vaginal secretions and cerebrospinal, synovial, pleural, peritoneal, pericardial and amniotic fluids, and any body fluid containing visible blood. Disposable gloves should be worn.

Sharps

Particular care should be taken with sharps because both HIV and the hepatitis B virus have been contracted by health-care workers following needle-stick injuries.