Infection prevention and control (IPC) plays a crucial role in safeguarding patient health and mitigating the spread of healthcare-associated infections (HAIs) – and it is fundamental to nursing practice. Such infections, acquired during the course of receiving treatment for other conditions within a healthcare setting, impose a significant burden on healthcare systems, leading to severe complications, prolonged hospital stays, and increased healthcare costs (Loveday et al, 2014; Stewart et al, 2021)).
Effective IPC practices are essential to mitigate the risk of HAIs and improve patient outcomes. These practices include regular hand hygiene, the use of personal protective equipment (PPE), environmental cleaning and disinfection, and adherence to protocols for invasive procedures. The importance of a collaborative approach to IPC across disciplines, to ensure comprehensive and consistent implementation of infection control practices, has also been emphasised (Hallam, 2021). This article explores key IPC strategies, highlighting their importance in nursing practice and offering practical guidance for implementation.
Background
Infections that patients acquire while receiving treatment for other conditions within a healthcare environment are known as HAIs. They can result from various pathogens, including bacteria, viruses and fungi, and are considered a key indicator of the quality of healthcare services provided. They are therefore a significant concern in clinical settings, impacting patient outcomes, healthcare costs, and overall quality of care.
The pathogens responsible for HAIs can survive in healthcare environments and are often resistant to common disinfectants and antiseptics, antibiotics and antimicrobial medication. Common bacterial pathogens include Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa, while viruses such as norovirus and influenza, and fungi such as Candida species also contribute to HAIs (Magill et al, 2014). These pathogens are often transmitted through direct contact with contaminated surfaces, medical equipment or healthcare workers, highlighting the need for stringent infection control practices (Khan et al, 2017).
Catheter-associated urinary tract infections
Catheter-associated urinary tract infections (CAUTIs) are among the most common HAIs. They occur when bacteria or fungi enter the urinary tract via a urinary catheter, which is a tube inserted into the bladder to drain urine. CAUTIs can lead to complications such as kidney infections and sepsis. Prevention strategies include the use of aseptic techniques during catheter insertion, proper maintenance of the catheter, and timely removal when no longer necessary (Medina and Castillo-Pino, 2019; Centers for Disease Control and Prevention, 2024).
Central line-associated bloodstream infections
Central line-associated bloodstream infections (CLABSIs) are another significant type of HAI. These infections occur when bacteria or viruses enter the bloodstream through a central venous catheter. CLABSIs can result in severe complications, including sepsis, prolonged hospital stays and increased mortality. Implementing central line insertion protocols and maintenance practices significantly reduces the incidence of CLABSIs. Key among theses are hand hygiene, the use of full barrier precautions during insertion, chlorhexidine skin antisepsis, and proper management of the central line (Buetti et al, 2022).
Surgical site infections
Surgical site infections (SSIs) occur at the site of a surgical incision and are among the most common HAIs. These infections can be superficial, involving the skin or, in more severe cases, they may affect tissues under the skin, organs or implanted material. SSIs can lead to extended hospital stays, additional surgical procedures and increased healthcare costs. A systematic review by Ban et al (2017) indicated that the incidence of SSIs varies depending on the type of surgery and the patient's condition. Prevention strategies include proper surgical hand antisepsis, appropriate use of prophylactic antibiotics, and maintaining a sterile surgical environment (Ban et al, 2017).
Ventilator-associated pneumonia
Ventilator-associated pneumonia (VAP) occurs in patients receiving mechanical ventilation, and it is associated with significant morbidity and mortality. VAP develops when pathogens enter the lower respiratory tract via the ventilator tube. The prevention of VAP involves multiple strategies, including maintaining proper hand hygiene, elevating the head of the bed, daily assessment of the patient's readiness to wean from the ventilator, and using subglottic secretion drainage (Gershonovitch et al, 2020). The implementation of care bundles that combine several preventive measures has been shown to reduce the incidence of VAP (Gershonovitch et al, 2020).
Key strategies in prevention and control
Hand hygiene
Hand hygiene is universally recognised as the single most effective measure for preventing the spread of infections. Proper hand hygiene involves washing hands with soap and water or using alcohol-based hand sanitisers. It is essential to perform hand hygiene before and after patient contact, after contact with potentially contaminated surfaces, and before performing aseptic tasks (Loveday et al, 2014). Consistent hand hygiene practices can significantly reduce the transmission of pathogens in healthcare settings.
Despite the simplicity of good hand hygiene practices, compliance with this remains a challenge, often due to workload, forgetfulness or insufficient facilities. Continuous education and monitoring can help improve adherence to hand hygiene protocols (NHS England, 2024).
Use of personal protective equipment
Personal protective equipment (PPE), such as gloves, gowns, masks and eye protection are crucial for protecting healthcare workers and patients from infectious agents. The appropriate selection and use of PPE depend on the nature of the patient interaction and the potential for exposure to blood, bodily fluids or infectious agents (Loveday et al, 2014). Proper donning and doffing techniques are essential to prevent self-contamination. Training healthcare workers on the correct use of PPE, ensuring adequate supplies and reinforcing the importance of PPE can mitigate the risk of infections (Barratt and Gilbert, 2021).
Environmental cleaning and disinfection
Regular cleaning and disinfection of healthcare environments are vital for preventing the transmission of infections. This includes cleaning high-touch surfaces such as bed rails, doorknobs and medical equipment with appropriate disinfectants. Ensuring that cleaning staff are trained and adhere to standardised cleaning protocols is crucial for maintaining a safe environment (Loveday et al, 2014). The role of environmental cleaning extends beyond routine cleaning to include terminal cleaning of patient rooms after discharge, especially for those that had been occupied by patients with known infections. Innovations such as ultraviolet (UV) light disinfection and hydrogen peroxide vapour systems are increasingly used to enhance environmental cleaning (Royal College of Nursing (RCN), 2021).
Safe injection practices
Safe injection practices prevent the transmission of bloodborne pathogens. This includes using aseptic technique, never reusing needles or syringes, and properly disposing of sharps in designated containers. Education and training of healthcare providers on safe injection practices are critical to preventing HAIs (NHS England, 2024). The implementation of needleless systems and single-use devices can further reduce the risk of infections. Continuous surveillance and audits of injection practices can identify areas for improvement and ensure compliance with safe injection protocols (Loveday et al, 2014).
Antimicrobial stewardship
Antimicrobial stewardship involves the appropriate use of antibiotics to combat antimicrobial resistance. This includes prescribing antibiotics only when necessary, selecting the right antibiotic, and using the correct dose and duration of treatment. Nurses play a key role in monitoring patients for signs of infection and ensuring adherence to antimicrobial protocols. The overuse and misuse of antibiotics have led to the rise of multi-drug-resistant organisms, posing a significant challenge to infection control. Effective antimicrobial stewardship requires collaboration among healthcare providers, including infectious disease specialists, pharmacists, and microbiologists (RCN, 2021).
Antimicrobial stewardship is essential in addressing resistance not only to antibiotics, but also to other antimicrobials, because fungal, viral and bacterial pathogens are becoming more resistant to treatment agents. It is crucial to include antifungals, antivirals and antiparasitic agents in stewardship efforts to ensure comprehensive strategies that limit resistance development and promote the appropriate use of all types of antimicrobials. This holistic approach may be key to safeguarding the effectiveness of these treatments across a wide range of infectious diseases.
Implementation challenges and solutions
Implementing IPC measures effectively can be challenging due to factors such as staff shortages, lack of resources and varying levels of compliance. Overcoming these challenges requires a multifaceted approach. Education and training are paramount; regular training sessions and educational programmes can enhance staff knowledge and adherence to IPC protocols (NHS England, 2024). Continuous education keeps healthcare workers informed about the latest guidelines and best practices.
Monitoring and feedback are also essential; continuous monitoring of IPC practices and providing feedback can improve compliance. This includes regular audits and feedback sessions (Loveday et al, 2014). Leadership and support from healthcare management are also crucial for the successful implementation of IPC measures. This will include providing adequate resources and fostering a culture of safety. Strong leadership can drive adherence to IPC protocols and address barriers to implementation.
Hand hygiene compliance
Hand hygiene compliance remains a persistent challenge in healthcare settings. Despite its simplicity, factors such as high workloads, skin irritation from frequent washing, and lack of access to hand hygiene facilities can hinder compliance. Strategies to improve compliance include installing hand hygiene stations at convenient locations, using hand sanitisers that are less irritating to the skin, and incorporating hand hygiene into the workflow.
Regular hand hygiene audits and real-time feedback can also enhance compliance. Peer influence and role modelling by senior staff can encourage adherence to hand hygiene practices (Loveday et al, 2014; NHS England, 2024).
Use of personal protective equipment
The effective use of PPE requires proper training and adherence to protocols. Common challenges include improper donning and doffing techniques due to lack of training, which can lead to self-contamination, and the discomfort associated with prolonged use of PPE.
Solutions include providing comprehensive training on the correct use of PPE, ensuring adequate supplies, and rotating tasks to minimise the need for prolonged use of PPE. Simulation exercises can help healthcare workers practise donning and doffing in a safe environment. Encouraging a supportive work environment where staff feel comfortable reporting PPE issues can also improve compliance (Loveday et al, 2014; NHS England, 2024).
Environmental cleaning and disinfection
Maintaining high standards of environmental cleaning and disinfection is critical, but can be challenging due to factors such as staffing constraints and inconsistent cleaning practices. Training cleaning staff on standardised cleaning protocols and the importance of their role in infection prevention can enhance compliance. Using checklists and documentation to track cleaning activities ensures accountability. Implementing advanced disinfection technologies, such as UV light and hydrogen peroxide vapour systems, can supplement manual cleaning efforts. Regular environmental audits and feedback can help maintain high standards of cleanliness (Loveday et al, 2014).
Clinical staff should also receive training in respect to the decontamination of the environment (and equipment) because they also have significant responsibility for maintaining a clean/safe clinical environment
Safe injection practices
Safe injection practices are essential to preventing bloodborne infections, but it is imperative to ensure consistent adherence to protocols. Challenges include the lack of access to single-use devices and improper disposal of sharps. Addressing these issues involves educating healthcare workers on safe injection practices, ensuring the availability of single-use devices, and providing adequate sharps disposal containers.
Monitoring injection practices through regular audits and providing feedback can improve adherence. Implementing policies that promote the use of needleless systems can also reduce the risk of infections (Loveday et al, 2014; NHS England, 2024).
Antimicrobial stewardship
Antimicrobial stewardship is critical for preventing the spread of antibiotic-resistant infections. Challenges include overprescription of antibiotics, lack of awareness about antimicrobial resistance, and difficulty in changing prescribing habits. Solutions include implementing antimicrobial stewardship programmes that involve multidisciplinary teams, educating healthcare providers about the importance of appropriate antibiotic use, and monitoring antibiotic prescribing patterns.
Providing decision support tools, such as guidelines and protocols, can assist healthcare providers in making informed prescribing decisions. Regular feedback on antibiotic use and resistance patterns can also promote adherence to stewardship principles.
Education and training
Continuous education and training are essential for effective IPC. Training programmes should be tailored to the needs of different healthcare workers and cover key IPC principles. Interactive training methods, such as simulations and workshops, can enhance learning and engagement. Providing training at regular intervals ensures that healthcare workers remain up to date with the latest guidelines and best practices. Encouraging healthcare workers to participate in IPC training as part of their professional development can also improve compliance (Loveday et al, 2014; NHS England, 2024).
Monitoring and feedback
Monitoring IPC practices and providing feedback are crucial for maintaining high standards. Regular audits of hand hygiene, PPE use, environmental cleaning, and injection practices can identify areas for improvement. Providing real-time feedback to healthcare workers reinforces positive behaviours and addresses non-compliance. Using data from audits to track progress and identify trends can inform quality improvement initiatives (Loveday et al, 2014). Engaging healthcare workers in the monitoring process can foster a sense of ownership and accountability.
Leadership and support
Leadership and support from healthcare management are vital for the successful implementation of IPC measures. Healthcare leaders should prioritise IPC, allocate resources and support staff in adhering to protocols. Creating a culture of safety, where IPC is valued and prioritised, can drive compliance.
Recognising and rewarding healthcare workers for their contributions to IPC can also motivate adherence. Engaging healthcare workers in decision-making processes related to IPC can enhance buy-in and support.
Conclusion
Infection prevention and control is a fundamental aspect of nursing practice that protects patients and healthcare workers from HAIs. By adhering to key IPC strategies, such as hand hygiene, the use of PPE, environmental cleaning, safe injection practices and antimicrobial stewardship, nurses can significantly reduce the incidence of infections. Overcoming implementation challenges through education, monitoring and leadership support is essential to ensure the effectiveness of IPC measures in healthcare settings.
The integration of personalised IPC strategies into standard nursing practice not only improves infection control outcomes, but also contributes to overall patient safety and quality of care. By adopting a holistic approach to IPC, nurses can significantly enhance their patients' overall health and the recovery process.
This article underscores the importance of IPC in nursing practice and has provided a detailed guide on how nurses can effectively incorporate IPC strategies into patient care to achieve the best outcomes.