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Hospital hygiene and HCAIs (healthcare-acquired infections)

We all know that we ought to wash our hands after anything which may contaminate us with micro-organisms of any sort - after going to the toilet, touching a pet animal, or touching surfaces that might be touched by others who are not so careful. If we are preparing food, it is essential that we clean ourselves, wear clean clothes and tie long hair back. We usually use soap or liquid handwash, and warm water, then dry our hands thoroughly with a clean towel, disposable paper towel or under a warm air blower.

In a hospital there is even more emphasis on hygiene. The human skin is quite a good barrier to micro-organisms, being fairly cool and dry. If the skin is punctured in some way, this exposes the body organs beneath, which are warm, moist and possibly provide ideal conditions for micro-organisms to grow. Wounds (including operation sites) can thus easily become infected. Anything which enters the body in an unusual way (air tubes in ventilators, nasal pipes, intravenous "drips", "drains", catheters, endoscopes, tips of oroscopes - used in examining the ear - etc) can also be a source of infection.

Being "unwell", patients are often quite susceptible to micro-organisms to which they are exposed in hospital, often more so than in their home environment.

Operating theatre staff must go through a very thorough cleaning process - "scrubbing-up" - as well as wearing latex gloves and special protective clothing before any sort of surgical procedure. Operating theatres and all parts of hospitals must be kept clean. This should involve not only nursing staff but also cleaners and members of the public visiting patients in hospital. In these conditions it is normal to expect people to (regularly) use alcohol gels on the hands.

The transfer of infectious micro-organisms from one person to another is called cross-infection. The same term also applies to transfer from objects, places and different parts of the body. Surgical apparatus (scissors, scalpels, forceps, and all sorts of equipment) must be sterilised after use, usually by treatment at high temperatures. In many cases, such as syringes and especially needles, disposable versions are preferable, but they must be stored safely and securely before disposal. Cross-infection is a major source of problems in hospitals and a strain on the health service.

Healthcare associated infections HCAI

This term covers hospital acquired infections - sometimes called nosocomial infections - in which there is an infection that is a result of treatment in a hospital (first appearing 48 hours or more after hospital admission) as well within a healthcare service unit (up to 30 days after discharge).

Community-acquired infection

Before being operated on, some patients are checked to see if they are carrying any micro-organisms that might cause problems, especially if they are resistant to antibiotics. Swabs are taken from some parts of the body, especially the throat, and these are sent to the pathology laboratory for testing.

If the infection occurred within 48 hours of admission it is assumed that the patient was already incubating the infection, which they picked up in the community prior to admission. It is not possible to be too strict with the 48 hour period, however.

Some questions

Why is a disposable paper towel better than a cloth one?
> Any contaminating micro-organisms not washed off might stick to a (damp) towel and be transferred to the next user.
What is a catheter?
> A pipe inserted via the urethra to take urine from the bladder, or a tube inserted into another part of the body.
What is an endoscope?
> A flexible tube-like apparatus inserted into some part of the body (usually attached to a camera or computer system, with a lighting system!) to allow things to be seen in there. Some can go into the alimentary canal from either end!
When scrubbing up, surgeons sometimes use a coloured liquid. Why?
> To check they have covered all the important places
How do they wash it off without their clean hands touching the taps they may have contaminated when they started?
> Taps usually have upstanding handles that can be pushed with the elbows - or other controls worked by the knees - (none of which are usually involved in operations!)
Why is clothing used in operating theatres usually brightly coloured?
> So it is not worn in the rest of the hospital
What is the advantage of an alcohol gel?
> It dries quite quickly and does not require to be dried on a towel
Why are operating theatres so called?
> Originally medical students (and even the general public) could observe surgeons at work, and they put on demonstrations as if performing in a play - in the interests of education or entertainment!
After use, needles and scalpel blades are generally placed into a special "sharps" container. What is the purpose of this?
> To store them until disposal, usually by incineration, and to prevent cross-contamination e.g. by bacteria or viruses, and to prevent unauthorised use e.g. by drug addicts

Web links

Nosocomial infection From Wikipedia, the free encyclopedia

INFECTION CONTROL IN HEALTHCARE SETTINGS

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