Are we our own impending threat? - preventing microbial spread - Brief Article - Editorial

AORN Journal,  Feb, 2002  by Brenda S. Gregory Dawes

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As nursing students, we learned about bacteria, the spread of microbes, skin as a barrier, effects of antimicrobials, and other facets of microbiology. Sitting through nursing classes and listening to foreign words related to infection prevention could be painful because it was difficult to understand specifically how, when, and where the information would be useful. Words like Staphylococcus aureus, Aspergillus, Pseudomonas, and Staphylococcus epidermis did not become meaningful until the importance of ventilation systems, skin preparation, traffic control, housekeeping, and other infection prevention measures were stressed. Even then, the links between infection prevention, nursing practices, and microbiology were not always apparent nor were they associated significantly with safe patient care.

RULES MAKE A DIFFERENCE

In perioperative settings, standards, guidelines, recommended practices, and other documents from organizations and agencies (eg, AORN, the Joint Commission on Accreditation of Healthcare Organizations, the Centers for Disease Control and Prevention, the Occupational Safety and Health Administration) are followed, and their use makes a difference in patient care. Documents such as these are intended to provide consistency in practices. Even with rules to follow, there are times when behaviors and rules are conflicting and thus challenged, necessitating the presence of someone to monitor the behavior of others. Some team members understand the purpose and meaning of rules and sincerely believe in their value, yet others question or respond to the rules without considering their intent. Even though most would agree that infection prevention practices (eg, skin preparation, antibiotic delivery, aseptic technique) are critical interventions in perioperative practice, these interventions have been questioned because of time-saving or cost-saving measures or even due to a lack of understanding of their purpose.

REAL THREATS

Recently, people around the world have been required to question and evaluate the way things are done. In the perioperative setting, we know that microbial spread is an issue that should not be overlooked. Awareness of the threat of microbial spread has increased because biowarfare has challenged our mind-set and made us realize that we no longer can take our safety for granted. The mail has been attacked; what will be next--the food we eat, the air we breathe?

Time-saving or cost-saving measures are not even considered when dealing with a massive outbreak, yet the same level of threat has been occurring in health care settings for years. Real threats are in our face. Hepatitis C, bloodborne pathogens, vancomycin resistant enterococcus, and nosocomial infections are common. They are routine agenda items at infection control meetings in health care settings through out the country. In spite of attempts to educate and garner support for programs targeted at monitoring and managing infection control issues, some health care workers still do not wear appropriate protective attire and continue to administer antibiotics inappropriately. Though the efforts to control these threats are ongoing and serious, we are losing ground on important issues that put employees and patients at greater risk.

KEY PREVENTION STRATEGIES FORGOTTEN

In spite of advances in practice, we might be losing the battle because our energy is being spent trying to develop new strategies instead of implementing existing strategies. We cannot overlook the value and importance of actions that should be routine in every practice setting, and we cannot be focused so intensely on high levels of prevention that we overlook the value of basic practices. Following the principles of aseptic technique, limiting traffic and closing doors in ORs, wearing masks and gloves correctly, following standard precautions, and using antibiotics appropriately are examples of practices that require consistent behaviors by all team members and control in perioperative settings. Focusing on simple practices such as these can reduce risk to ourselves and our patients.

As our patients' care moves to outpatient and ambulatory settings, we will find that microbial spread and difficulty controlling antibiotic resistance will permeate these settings just as they have permeated inpatient settings. Monitoring by agencies or organizations (eg, the Joint Commission) varies among settings, and the knowledge of safe practices varies among personnel. The realization that threats in health care exist that are becoming unmanageable should give all of us a wake-up call.

Scary facts were presented at a recent infectious disease conference, but what is even more frightening is that although prevention strategies are not new, they are not being followed. Now is not the time to lapse into business as usual; rather it is time to reevaluate our own impending threat and revisit infection prevention practices that have served us well for many years. When we are challenged to take a shortcut to save time or money, we should remember that these are not challenges that will disappear. Today, we are responsible for preventing what can be prevented. Tomorrow, it might not be an option.