PREVENTION AND CONTROL OF INFECTION:
Breaking the Chain

Nurses maintain the immediate health care environment. Because they provide care for a variety of patients, the risk of contamination from pathogenic microorganisms is increased. The practice of medical asepsis and standard precautions provides the nurse with techniques for destroying or containing pathogens and for preventing contamination to other people or to bedside materials and equipment.

Medical Asepsis
The practice of medical asepsis helps to contain infectious organisms and to maintain an environment free from contamination. The techniques used to maintain medical asepsis include hand washing, gowning and wearing facial masks when appropriate, as well as separating clean from contaminated or potentially contaminated materials and providing information to patients about basic hygienic practices. Appropriate hand washing by the nurse and the patient remains the most important factor in preventing the spread of microorganisms.

One common example of medical asepsis involves the steps taken by the nurse to ensure that only clean linen is applied to each patient's bed. Clean linen remains in the clean linen cabinet until taken to the patient's room. The hands of the health care worker are washed before handling the clean linen. Unused bed linen from one patient's room cannot be returned to the clean linen cabinet and cannot be used for any other patient. This linen is considered soiled and placed in the soiled linen bag.

Standard Precautions
Standard precautions combine the major features of universal precautions and body substance isolation. These standard precautions alert the health care worker to patient situations that require special barrier techniques. These barrier techniques are used when working with any patient where potential or actualized contact with blood or body fluid exists.

Universal Precautions
Universal precautions help control contamination from bloodborne viruses such as human immunodeficiency virus (HIV) and hepatitis viruses. When in contact with a patient's blood or any body secretion that may be contaminated with blood, protective measures such as wearing gloves, gown, facial mask, and/or goggles must be followed.

Body Substance Isolation
Body substance isolation protects against bacterial organisms that may exist in body substances. Body substance isolation applies in all patient encounters regardless of the diagnosis. The application of gloves for contact with moist body surfaces and areas of nonintact skin, gowns when in contact with body secretions, and facial mask when in danger of contact with respiratory droplet secretions, prevents the contamination of both health care worker and patient.

Psychosocial Effect
Strict adherence to basic techniques such as hand washing, wearing barrier gloves and protective isolation provides the foundation for life saving measures. However, the physical protection gained from barrier isolation may have a negative psychological impact on the patient.

Many principles of infection control limit contact between the nurse and patient. Wearing barrier gloves for example, prevents direct physical contact through touch and may cause an individual to feel dirty or contaminated. Protective isolation, one form of isolation, limits contact with health care workers and visits from family and friends. Protective isolation often results in feelings of loneliness and interferes in needed emotional support.

The knowledgeable nurse balances the principles of asepsis, standard precautions and psychological support. Knowledge of the infectious agent allows the nurse to use protective measures without isolating the patient beyond what is necessary. The nurse recognizes the importance of interaction in maintaining psychological health and therefore provides appropriate contact within safe limits. For example, nurses wear barrier gloves when handling moist body secretions. However, holding a hand without the barrier glove to provide psychological comfort is, in most situations, an acceptable and important intervention as well. Psychological support for the patient in isolation comes in many forms, such as allowing an individual to express feelings about the constraints of isolation and providing information about the purpose of barrier techniques. The nurse provides psychological support through the development and maintenance of an effective nurse-patient relationship.

Guidelines for Specific Institutions
Methods to control the spread of infections are standardized in recommendations from the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA). These prevention standards are applied in all health care settings and modified according to the needs of each health care facility. The health care worker must practice within the guidelines of the specific institution.