Infection Risk and

Prevention
NURS90154

Subject Coordinator: Philippa Marriott

Department of Nursing, the University of Melbourne
Contact: [email protected]
 Welcome to country
I would like to acknowledge the Wurundjeri people who are the Traditional Custodians of this Land. I would also like
to pay respect to the Elders both past and present of the Kulin Nation and extend that respect to other Indigenous
Australians present here today.

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 Lecture Learning Objectives
• Reenforcing the importance of the 5 moments of Hand Hygiene (building on the
knowledge from the hand hygiene module completed before this lecture)
• Provide rationale for selecting the most appropriate personal protective (PPE) for use
across a variety of healthcare settings and different patient conditions
• Identify when to use PPE and potential consequences of poor practice
• Introduction to standard precautions and its application within the healthcare setting
• Demonstrate risk assessment within the healthcare setting for the prevention of
infection
• Summarise the significance of hygiene in reducing infection risk
• Identify factors that influence personal hygiene
• Identify factors that affect hygiene status across the lifespan
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• Application of nursing interventions related to the hygiene needs of the patient
 Infection risk and consequences
Risk to patient: hospital acquired infection (mild to life threatening impact),
injury (e.g. falls, pressure injuries), medication errors (e.g. missed antibiotics)
Risk to self: equipment malfunction or incorrect user technique, dirty
equipment, needle stick injury, contact with bodily fluids, sick leave
Risk to healthcare: cost of patients staying in hospital longer due to hospital
acquired infection ** or poor media coverage (reputation) **
If a patient or staff member has been put at risk (near miss or an incident), it
must be reported through the hospital incident reporting system
(e.g.RiskMan)
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 Hospital infection prevention -
standard precautions
Standard precautions within healthcare providers aim to reduce hospital acquired infections and
transmission of pathogens to staff and the public:
• Hand hygiene
• Respiratory hygiene and cough etiquette
• Appropriate used of personal protective equipment (PPE) when encountering bodily fluids
• Aseptic technique (Standard Aseptic non-touch technique (ANTT), e.g. wound dressing, versus and
Surgical ANTT, e.g. surgical procedure)
• Use and dispose of sharps safely
• Ensure all areas undergo routine cleaning (cleaning of shared equipment, e.g. blood pressure cuff to the
changing of bed sheets daily)
• Safely dispose of waste and used linen

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 Small group activity

• What risks are within the healthcare environment/hospital?

• Who is most at risk?

• How does hand hygiene and personal protective equipment (PPE)

reduce risks?

• Can PPE contribute to infection risk and why?

• What would you do if you observed poor infection control practices on

your first clinical placement?
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 Risk related to poor hygiene

Health problems related to a patient’s hygiene status may include:

• Potential for social isolation related to body odour and an impact on other
patients and staff when in hospital
• Potential for skin breakdown related to excessively moist skin, exacerbated
by incontinence and poor perineal care
• Impact on wound healing
• Altered body image
• Embarrassment
• Reduced sense of wellbeing

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 The importance of hygiene in a hospital setting
• Important for comfort, reduce infection risk, physical and psychological
wellbeing
• Skin - largest organ of the body, performs multiple functions, including the greatest
barrier for infection
• Hair - can fall out with certain medical conditions/infections
• Nails - can break/chip - jagged edges can cause skin tears; avenue for infection -
paronychia
• Mouth/Teeth - mucous membranes can become infected and swollen/painful =
mucositis – pain/poor diet/fungal infections
• Perineal Area - dark, warm and moist environment. A great risk for bacterial and fungal
infections due to skin breakdown from chaffing, poor hygiene, constant moisture,
pressure injuries
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 Self-Care
Self-care refers to a person's ability to perform primary care functions in
the following areas: bathing, feeding, toileting, and dressing without the
help of others

When illness or injury interferes with the ability to perform self-care

activities, nurses assist or perform tasks that the patient cannot manage or
offer support to family members or other care givers

The ability to independently perform self-care and hygiene practices

greatly enhances a person's health status and emotional wellbeing – the
goal is to help patients achieve as much independence in self-care as
possible and reduce infection risk
 Functional Levels
Independent in their hygiene needs

Semi depended – requires help from the nurse for assistance, supervision or teaching

Moderately dependent – requires help from the nurse and equipment or device

Totally dependent – the patient is unable to participate in their self-care activities

 Whose space are you in?
• Public Distance
• Social Distance
• Personal Distance
• Intimate Distance

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 Etiologies of self-care deficits
• Decreased or lack of • Neuromuscular or
motivation musculoskeletal
• Physical restriction impairment
• Weakness or tiredness • Medically imposed
• Pain or discomfort restriction – e.g. injury
• Perceptual or cognitive • Therapeutic procedure
impairment restraining mobility
• Inability to perceive body as • Severe anxiety
part or spatial relationship • Environmental barriers
• Cultural and spiritual practices • Developmental stage
 What other factors can influence hygiene?

• Access to facilities
• Social determinants of health
• Overcrowding **

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 Assessment of hygiene needs
Assess current practices at home through clear questioning techniques (this is
part of your health history on admission):
• Routines and rituals
• Use of hygiene products
• Knowledge, attitude, skill
• Assessment of self-care deficit
• Does anyone help them at home?
• Does your patient receive home help?
• Do they have facilities/resources to achieve hygiene needs

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 Physical assessment and risk assessment
Conduct a physical assessment and identify potential infection risks on the following
(remember patient-centred care, ask yourself if it is appropriate):
• Integument – intact, scratch marks, odour, moles, sun damage, scabies
• Oral cavity – teeth, mucous membranes, tongue, inflammation, pain, have their trouble
eating or drinking?
• Eyes, ears & nose – discharge, cerumen build-up, nasal drip
• Hair – pediculosis (lice) and dandruff
• Nails and feet – tinea pedis (athletes' foot), fungal infections
• Perineal and vaginal areas – pads, tampons, vaginal washes, incontinence

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 Integument/Skin assessment

When assisting a patient in the shower it is a good opportunity to

collect objective data on their skin:
• Pale, dark, or reddened in color.
• Rough or chapped in texture.
• Dry or flaking, lacking in moisture.
• Injured (blisters, bruises, or lacerations)
• Sore (pressure sores or infections)
• Scars
 Small group activity: Personal hygiene in the
hospital
• What are the benefits of patient care?
• What do you think nurses do when assisting patients with their hygiene needs?
• What considerations do you need to consider when assisting a patient in the
shower?
• How would we deliver hygiene education and link this to health promotion
• What are you concerned about when you think about assisting a patient with
their personal hygiene needs for the first time?

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 Why bathe patients
Removes perspiration, dirt, and germs
Refreshes patients and makes them more comfortable
Stimulates circulation
Helps prevent skin problems
Provides exercise
Four main types
✓complete bed bath
✓ partial bed bath
✓ tub bath (rarely used)
✓ shower
 How to do it
Cleaning Baths: Therapeutic Baths:
Shower Sitz Bath
• Perianal abscesses
• Ambulatory patients
• Anal fissures
• Minimal assistance
• Haemorrhoids
• Consider falls risk
• Post birth
Bed Bath
Medication Bath:
• Full assist bed wash • Scabies decontamination
• Partial assist bed wash • Relief for sore muscles and joints
• Relief of pruritis, eczema
• To soften and remove crusts,
scales, debris 20
Tips when assisting with hygiene needs

USE GOOD BODY USE STANDARD PROTECT THE PERSON WASH FROM THE
MECHANICS PRECAUTIONS AS FROM FALLING CLEANEST AREA TO
NEEDED THE DIRTIEST AREA

RINSE ALL AREAS PAT SKIN DRY. DO NOT DRY UNDER BREASTS, BATHE SKIN
THOROUGHLY RUB THE SKIN BETWEEN SKIN FOLDS, WHENEVER URINE OR
AND BETWEEN TOES FECES IS PRESENT

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 Planning for hygiene activities
Preparing for self-care
• Consideration for time of day, use a time planner
• Consider and collect equipment (face wash, towels, cleansing solution, clean
clothes, shaver)
• Facilities available (sink, shower)
• How much help will your patient require? (are they independent or fully
dependent)
• Would they prefer a family member to help?

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 Bed bath
Involves washing the person’s entire body in bed and used
for people that are unable to bathe themselves.
Getting started
• Place everything you need on the overbed table before
beginning the bath
• Raise the bed to a comfortable height and raise the rail on
the far side of the bed
• Wash only one part of the body at a time. wash, rinse,
and dry each part and then cover it with a towel or
blanket
• Change the water in the basin whenever it becomes
soapy, dirty, or cool
• Keep the soap in the soap dish between lathering's
• Wash from the cleanest to the dirtiest areas.

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Wash the eyes first. from the After washing the face, neck, and ears, Place the towel over the patient’s
inside corner to the outside, remove the gown and wash the arms, chest. lift the corner as you wash the
using a different area of the one at a time. chest. repeat for the abdomen.
cloth for each eye.

Wash and dry one

leg at a time. Wash the back and
the buttocks. a
Change the water at backrub may be given
this time if you have at this time.
not already needed
to do so.
 Shower
• Collect all hygiene aids, toiletry items etc. and
place within reach
• Supply shower chair if required and point out
safety bars
• Ensure nurse call bell is within easy reach
• Place “occupied” sign on door
• You may need to adjust the water
temperature before you place the person in
the shower.
• Assist patient as required
• Assist patient back to room 25
 Perineal Care

• Involves the cleaning of the genital and anal areas of the body
• The perineal area is warm, dark, and moist and so provides an
ideal environment for microorganisms to grow.
• Should be cleaned at least once daily to prevent infection and
odors and to provide comfort – more frequently if gynecological
surgery.
• Peri-care should be provided after each incontinent episode.
• Use standard precautions
 Female Perineal Care
• Change continence pads or sanitary pads
when necessary (not too long that it becomes
an infection risk)
• Always cleanse from the urinary meatus
toward the anus. (clean to dirty )
• May have a prepackaged kit or use wet
washcloths.
• Use a different part of the washcloth for each
stroke
• To clean the anal area , cleanse from the
vagina toward the anus (clean to dirty)
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 Male Perineal Care

• Change continence
pads when necessary (not too long
that it becomes an infection risk)
• Start at the urinary meatus and use
circular motions as you wipe
downward to the base
• Retract the foreskin if the patient is
uncircumcised and remember to
return the foreskin to its natural
position when you are finished
 Shaving a patient
Never use a razor to shave patients with clotting
disorders, those on thinners or being treated for
haematological disorders
• Always wear gloves
• Place a towel on the patient’s chest
• Apply shaving cream to the face
• Shave in the direction of hair growth
• Hold the skin taut with your other hand
• Rinse the razor frequently
• Wash the face when finished
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 Oral Hygiene
Mouth care keeps the mouth and teeth clean
• Prevents mouth odours
• Prevents infections
• Increases comfort
• Makes food taste better
• Prevents cavities

Must be done for

• Comatose patients
• Confused persons
• People that cannot use their arms

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 Oral Hygiene: what to look for

DRY, CRACKED, SWOLLEN, UNPLEASANT MOUTH LOOSE, BROKEN OR SWELLING , REDNESS,

OR BLISTERED LIPS ODORS DECAYED TEETH SORES, BLEEDING, OR WHITE
PATCHES IN THE MOUTH OR
ON THE TONGUE

BLEEDING, SWELLING, OR LOOSE, CHIPPED, OR LISTEN TO PATIENT

REDNESS OF THE GUMS BROKEN DENTURES COMPLAINTS

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 Oral Hygiene
Brushing the teeth, gums, and tongue
Flossing the teeth (removes plaque and tartar)
Rinsing the mouth with mouthwash
Brush the teeth in an up and down motion, brushing all surfaces of the teeth
Cleaning dentures is also a part of oral hygiene
Oral hygiene is given every two hours for
✓comatose patient
✓ patient with a nasogastric tube
✓ patient receiving oxygen
✓ patient receiving specific chemotherapy or certain medications
 Oral Hygiene: Denture Care

• Dentures should be cleaned as often as natural

teeth.
• Dentures are slippery when wet. they can easily
break if dropped onto a hard surface.
• Dentures are expensive and are the patient’s
personal property. losing or damaging dentures
is negligent conduct.

Carry the dentures back and forth from the sink in an

emesis basin lined with a paper towel.
 Case Study - Anne
Looking at the case study you completed with Andrew, where you explored
the Human Anatomy and Physiology of a Spider Bite on Anne, we will now
explore the Nursing Assessment for this patient.

When looking at the bite what questions would you ask and what
observations would you make?

In Josh's session this afternoon you will move on to identifying nursing

problems and management
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Questions?
Thank you