Control of Infection How to avoid damaging yourself and your patient

Clinical work exposes you to the risk of infection and injury. As well as illness or early
death, your career could be affected. Infection with HIV or blood-borne hepatitis viruses
could prevent you from working in any branch of surgery.

Patients are also at risk careless hygiene practice by doctors & nurses are a major cause
of wound infection. Hospital acquired infection costs the NHS £1 billion every year.
5,000 patients die every year from infections they contracted after admission.

You can avoid risk to yourself and your patient by

Getting & staying vaccinated
Learn and always follow safe sharps practice
Always following infection control procedures
Report and get help with any needlestick accident.
PROTECTING YOURSELF

Clinical vaccinations

You must be vaccinated against hepatitis B, tuberculosis and rubella. Many teaching
hospitals require students to have completed vaccinations before you are allowed to
work with their patients.

You must attend the College OH clinic at South Kensington for vaccinations. Tel 020
7594 9401 for appointments.

Always carry your vaccination card with you. You may not be allowed on the wards if
you are unable to show you have completed your vaccination programme. If you don’t
have one, contact the IC Clinic.

You need to get a hepatitis B booster every 5 years to maintain immunity. The College
OH Service will send you a reminder (by email) when your booster is due

Preventing contact

Before going onto a ward

cover any broken skin— unhealed cuts or grazes— with an adhesive dressing.
When examining a patient
wear your white coat
if you have active eczema on your hands, you should wear disposable gloves (vinyl
are the best choice)
always wear gloves for any internal examination
always wear gloves for examination or dressing of wounds.
After examining a patient
dispose of used gloves etc into a clinical waste bin
 wash your hands after carrying out any internal examination or examination
Safe sharps practice

Your biggest risk of dangerous infections is through inoculation accidents—

‘needlesticks’— from hypodermic needles, scalpels etc. Always follow safe sharps
practice, including when under pressure. The key points are

DO
wear gloves. Even if they cannot prevent an accident, they reduce the risk of
consequent infection
use Vacutainers rather than needle & syringe
discard into sharps bin immediately after use as a single unit (don’t unscrew the
needle)

NEVER
re-sheath needles
carry used sharps in your hand. Take the sharps bin to the bedside
over-fill sharps bins. If you have to push, it’s full.
try to retrieve anything from a sharps bin. Never put your hand inside a bin.
bleed known high-risk patients
It takes time to become good at taking blood. It takes time to become proficient with
Vacutainers. Learn from good teachers. Don’t be afraid to ask an experienced
phlebotomist or doctor to supervise you— more than once—if you’re finding it difficult.

It is School policy that students must not take blood or carry out other procedures
with sharps on patients known to be infected with HIV or other blood-borne
viruses.

Needlestick action Hepatitis B, Hepatitis C and HIV can each be transmitted through
accidents causing exposure to blood or other physiological fluids.

You are at risk of infection from

Any graze or puncture wound from a use sharp
A bite from a violent patient if it breaks the skin
splashing of or blood or other body fluid onto broken skin, or into your eyes or
mouth
You need to
stop what your doing
wash off the contaminating material immediately. Use tap water or normal saline to
wash out an eye splash
encourage bleeding by shaking. Don’t suck or squeeze a wound
wash in running water
report any injury to the hospital Occupational Health Department. Even if you think
the patient involved is not an infection risk they may be unknowingly infected
 with a blood-borne virus or have asked for their immune status not to be recorded
in their notes.
You should also let the charge nurse for the ward or clinic know of an injury and
complete an accident report form.

Post-exposure prophylaxis (PEP)

There is treatment available to prevent or reduce the risk of infection from HIV and
Hepatitis B after a dangerous inoculation accident. The hospital’s occupational health
department usually provides this. You should always seek their help to assess whether
you were at risk and to decide whether PEP treatment is needed. Do not rely soley on
your own or the ward doctor’s assessment.

For HIV, treatment is best started within one hour of an accident. At most hospitals, the
senior doctor on duty in the A&E department, or the senior on-call physician, will
provide help out-of-hours when occupational health is closed. You will be informed of
the local arrangements for each hospital when you start an attachment. Information is
also available on the College OH Service’s web site.

HIV post exposure prophylaxis.

The risk of HIV transmission from exposure incidents is small, but it can happen. The
current treatment is to give a 28-day course of the drugs used to treat established HIV
disease. They often cause unpleasant side effects and, rarely, have dangerous effects so
you need to weigh up the risks and benefits before deciding on whether to take
treatment. The OH physician or nurse will help you with this.

The statistical risk of infection from a patient who is HIV positive is

1300 for a needlestick injury with a hypodermic needle
13000 for a blood splash onto mucous membranes or broken skin.
The risk is higher (up to 130) if
the patient is in the initial sero-conversion phase, or end-stage infection— ‘full-
blown AIDS’.
the injury was caused by a large bore needle e.g. IV cannula
blood is injected in the accident.
the injury is deep e.g. a puncture wound penetrating through the skin
Serum, CSF and other physiological fluids e.g. CSF are potentially infectious, especially
if blood-stained. Faeces, saliva and urine are considered non-infectious unless visibly
bloodstained.

More information on needlestick accidents.

PROTECTING YOUR PATIENT

Nosocomial infection infection contracted during medical treatment is a huge problem in

hospitals. Up to 5,000 patients die every year from nosocomial infections. Up to 30% are
preventable through simple infection control procedures. Infections increase costs,
waiting lists, and harm.

The most important control is also the simplest and cheapest— handwashing, to prevent
accidental transmisson of infection from patient to patient via the hands of their carer
medical students included! All hospitals have defined pr o cedures to try to prevent the
spread of infection between patients and between patient and carer. They have to be
followed to work. Don’t cut corners, don’t follow bad or careless practice you might see
with others. Our first duty is always to the patient.

Infection control hand-washing

Always wash your hands

BEFORE
contact with wounds, IV sites
contact with susceptible patients
carrying out any internal examination
taking blood
eating
AFTER
removing gloves
contact with a patient suffering from infection
changing or ‘lifting’ dressings
going to the toilet
assisting a patient with toiletting

Infection control barrier nursing

Patients with contagious diseases or infected with dangerous bacteria such as MRSA
(Methicillin Resistant Staph. Aureus) or who may be especially vulnerable to infection
(immuno-deficient) will be barrier nursed.

Successful barrier nursing is entirely dependant on all persons in contact with the patient
following procedures.

If you are seeing a patient who is being barrier nursed, always

wear all protective equipment provided
report missing equipment to the nurse-in-charge
remove gowns, gloves & masks before leaving the room
discard disposable clothing correctly
close the door after entering and leaving
wash hands immediately after examining the patient and before leaving the room,
even if you have worn gloves
Infection control illness

If you are unwell with an infectious illness, you may transmit this to a patient if on the
wards or in clinic. Patients are vulnerable an infection that is a minor nuisance to you
could be lethal to the very old, very young or very sick patient.

You must stay off the wards or clinic if

You develop any possible infectious rash
You are unwell with diarrhoea or vomiting
You have been in contact with chickenpox or shingles (unless you have proven
previous infection)
You are unwell with a feverish illness
You should report contact with chickenpox to the Hospital or College OH Service. If you
ever think you may have contracted HIV or other blood-borne infection, you have a
duty, under GMC regulations, to report this in confidence to the School or the College
OH Physician