They are the key to controlling nosocomial infections:

As with all human activities, running a hospital and treating patients can be very risky. Nosocomial Infections constitute 30% of the sixteen major risks, or “undesirable occurrences”, that affect patient safety.

Controlling N.I.`s (Nosocomial Infections) is a question of risk management. Obviously, it is impossible to eliminate all risk because residual risk will always be a problem. Effective risk management is therefore critical to ensuring quality health care.

Surveillance and protection are the keys to controlling N.I.`s. At least 50% of Nosocomial Infections are avoidable, and with proper measures more than 80% of them could be prevented. This is especially true of blood and respiratory infections, which are the most serious and the most deadly.

 Surveillance

 Vigilant surveillance must become an integral part of hospital routine, and practiced on a regular basis in order to detect anything that could adversely affect patient safety. This requires a thorough epidemiological investigation to determine the causes of N.I.’s, and to implement the following preventative measures:

 Close supervision of the clinical environment

·  Surveillance of high-risk personnel, for example, colonized or infection-carrying health care workers.

·   Stringent inspection of potential sources of infection: examination rooms, medical instruments, the ventilation and heating systems.

·   Thorough assessment of the results obtained by preventative measures.

 
Prevention

 Prevention protocol tends to vary according to risk level of hospitals, clinics and patients. Intensive care units and operating rooms carry a much higher risk that psychiatric units or a general practitioner’s office. Effective surveillance and stringent preventative measures are required. Consequently, the following preventative measures should be standardized and implemented everywhere:

·   Proper hygiene: washing one’s hands is the basic preventative measure and reduces infection by at least 50%. Researchers have known for 150 years that medical personnel can save lives simply by washing their hands prior to treating a patient.

·     Isolating colonized and infected patients is essential. Ideally, each patient should be in a single room, but if space does not allow for this, only patients infected by the same bacteria should be kept together. Patients infected by different bacteria must be separated.

·         Barrier measures such as wearing sterile clothing, latex gloves and masks reduces the spread of bacteria and protects immune-deficient and other high risk patients from contamination. This applies to all personnel, patients and visitors.

·       Limiting the use of antibiotics in order to prevent the development of antibiotic resistant bacteria.

·     Both inside and outside the hospital, clothing worn by health care workers constitutes a serious hazard. Hospital personnel should no longer be allowed to wear their hospital garments outside the establishment. Furthermore, surgical staff should not be permitted to wear their garb outside the operating room. When arriving for their shift, all hospital personnel must remove their street clothing and put on the appropriate hospital garb. The British Medical Association recently recommended (July, 2005) that all hospital clothing be cleaned and disinfected on a daily basis.

·   Good hygiene and regular disinfection are standard preventative measures. Hospital rooms, beds, linen, doorknobs, toilets, and sinks etc. must all be disinfected.  Hospital maintenance workers require specific training in the techniques of disinfection. One simply does not clean a hospital room in the same manner as a hotel room.

·       The World Alliance for Patient Safety recommends that patients and the general public get involved. This organization was founded in 2004 and includes hospital administrators, university professors and researchers, and patient associations. In the USA, many patients associations, consumer protection groups, as well as public and private insurance companies have requested that infection rates for all hospitals be rendered public. They also insist that patients themselves personally intervene in order to ensure their safety. For example, patients should ask health care workers to wash their hands prior to treating them. In June 2005, the Mayo Clinic Medical Association published a document on nosocomial infections in which they informed patients and their families of preventive measures that should be taken.

·      In France, patient’s associations are actively involved in the fight against N.I.’s. Upon admission, all hospital patients receive a booklet that indicates the establishment’s infection rate, and lists all preventative measures undertaken by the hospital. The booklet also contains the Charter of Hospital Patient’s Rights.