EVIDENCE-BASED PRACTICE: INFECTION CONTROL
Bacteria, viruses, and parasites, are microorganisms that are normally not found in the
human body. however, these microbes are commonly encountered in hospitals. And if these
microorganisms are ignored and not properly managed, patients in the hospital are at risk for
infection. Due to that reason, infection control practices are essential to prevent the spread of
infection through patients. Infection control prevents or stops the spread of infections in
healthcare settings. This site includes an overview of how infections spread, ways to prevent the
spread of infections, and more detailed recommendations by type of healthcare setting.
Infections spread directly (close contact) and indirectly (person to an object, vice-
versa.)and germs enter through their specified portal of entry such as mouth, skin, eyes, and
genitals. Knowledge of transmissions and the portal of entries plays an important role in
infection control. Due to this knowledge, countermeasures are made. for instance, PPE (personal
protective equipment) that includes a surgical facemask that prevents the microbe from entering
the mouth and nose, face shields/goggles that cover the eye, and others such as sterile gloves,
lab-grown, and shoe cover.
In the hospital, facility’s surveillance program should choose to either track the
prevalence of infections (existing/current cases both old and new) at a specific point, or focus on
regularly identifying new cases during defined periods of time.
Education and Staff Training
The facility should commit openly to staff education and identify methods for delivery. Essential
conditions for training include:
Availability of infection control expertise
Appropriate facilities
Dedicated budget and time during working hours
Educations supports and documents should include the following concepts:
Definitions, impacts and burdens of health care-associated infections (HAI)
Major patterns for transmission of health care-associated pathogens, with a particular
focus on hand transmission
Hand Hygiene
All health care workers, particularly those with direct resident contact, require continuous
training on the importance of hand hygiene. Staff education should include:
Basic concepts of hand hygiene, include why, when and how to perform hand hygiene
Correct techniques for hand washing and use of alcohol-based hand sanitizer
The IP should assess staff compliance with hand hygiene, and implement correction
actions. Regular monitoring is helpful to measure and demonstrate changes resulting
from training.
Use of Medical Devices
The use of medical devices on more than one person increased the risk for infections.
Devices such as blood glucose monitors, blood pressure cuffs, electronic thermometers,
stethoscopes are all devices that have the potential to spread infection from one resident to
another. Guidelines are place the disinfection of these devices (CDC, FDA and CMS).
Critical items (such as needles, intravenous catheters, indwelling bladder catheters) are
items that normally enter sterile tissue or the vascular system, or through which blood
flows. If single use equipment is not used, the item must be sterile when used, based on
the CDC’s sterilization procedures.
Semi-critical items (such as thermometers, podiatry equipment, electric razors, blood
glucose monitors) are objects that have contact with mucous membranes or skin that is
not intact. These items require meticulous cleaning followed by high-level disinfection
treatment using and FDA approved chemo-sterilizing agent or they may be sterilized.
Non-critical items (such as stethoscopes, blood pressure cuffs and over-bed tables) are
items that come into contact with intact skin or do not contact the resident. These items
require low-level disinfection by periodic cleaning, or when visibly soiled, with an EPZ
disinfectant detergent or germicide that is approved for health care settings.
Blood glucose monitors that are shared by multiple residents must be thoroughly wiped
with disinfectant and allowed to air dry after every use and between every resident.
Blood Pressure Cuffs must be cleaned with a disinfectant wipe between each resident use.
Stethoscopes must be cleaned with an alcohol wipe between each resident use.
Why is the infection control important?
Infection Control is so important because at the end of the day that person’s health is in
your hands. If you are trained in Infection Control you must put your understanding into an
action. Carriers must wear correct PPE such as aprons and gloves, wash their hands before and
after preparing meals or making a drink or even when assisting with dressing a client. Bacteria
and germs can spread like wild fire from one client to another if they have an illness such as a
cold. This is why it is important to know when to wear correct PPE and to wash your hands and
follow correct policies and procedures as Infection Control can be prevented this way.
EVIDENCE-BASED PRACTICE: IV CATHETER SIZE AND BLOOD TRANSFUSION
Blood transfusion is an important part of day‐to‐day clinical practice. Blood and blood
products provide unique and life‐saving therapeutic benefits to patients. However, due to
resource constraints, it is not always possible for the blood product to reach the patient at the
right time.
The major concern from the point of view of both user (recipient) and prescriber (clinician) is for
safe, effective and quality blood to be available when required.
Standard practices should be in place to include appropriate testing, careful selection of
donors, screening of donations, compatibility testing, storage of donations for clinical use, issue
of blood units for either routine or emergency use, appropriate use of blood supplied or the return
of units not needed after issue, and reports of transfusion reactions – all are major aspects where
standard practices need to be implemented.
In blood Administration you should be able to:
Perform appropriate assessments and reassessments through-out transfusion process.
Verbalize rationale for blood component.
Ensure patient consent obtained prior to transfusion.
Perform patient teaching prior to transfusion as appropriate to patient condition.
Verify order to administer
Verify correct blood component for patient per facility policy.
Perform baseline vital signs and assessment.
Ensure adequate IV catheter size for purpose of transfusion.
Prime blood tubing with normal saline, clearing air from tubing.
Verbalize and adhere to timeframe for transfusion based on type of blood
component and patient condition.
Monitor for and initiates interventions in the event of an adverse reaction.
For the IV catheter, it is recommended for health care workers to perform hand hygiene with an
antiseptic-containing soap solution or use an alcohol-based waterless cleanser:
Before and after palpating catheter insertion sites.
before and after accessing, repairing, or dressing an intravascular catheter; this includes
associated components such as administration sets and access ports
Size/gauge
It is recommended that specific characteristics of the patient and anticipated therapy are
considered in the selection of PIVC gauge and length. That include, age, condition of veins,
degree of cardiovascular stability, and medical or surgical interventions.
This also includes:
Clinicians should use the smallest gauge and shortest length PIVC that will
accommodate the prescribed therapy to reduce the risk of phlebitis.
It is recommended that the size of the target vein is also considered when selecting PIVC
size.
Large bore catheters are often required for rapid infusions or resuscitation, however high
flow rates are only achieved if the catheter is inserted into a large (low resistance) vein.
• A central venous catheter should be considered for patients with cardiovascular
instability, intended extensive surgery, or requiring long-term intravenous therapy.
Size-related risk of complication:
Larger gauge PIVCs (18 gauge or larger) have been observed to have a lower rate of
Occlusion
Large gauge and longer PIVCs have been observed to increase risk of phlebitis.
Smaller gauge PIVCs (22 gauge or smaller) have been observed to increase risk of
accidental removal.
Longer PIVCs have been observed to have a decreased incidence of infiltration and
extravasation, which is especially important when infusing highly irritant (e.g. vesicant)
substances.
Recommended catheter Size in Blood Transfusion
a. 14, 16, 18 sizes are reserve for rapid infusion of blood.
b. Size 20 is preferred for routine blood transfusion (if vein will accommodate)
c. 22- may be used for blood transfusion to accommodate vein size or patient preference
d. A catheter size of 24 may be used for blood transfusion (small vein)
