NICE CG1339 Guidelines for Healthcare-Associated Infections

There are a number of different healthcare-associated infections (HCAI) most commonly referred to as ‘hospital infection’. This is when an infection occurs during the course of care where the patient being admitted in the hospital which was not present beforehand. HCAI affects the patients that receive care from a hospital setting either during or even 10 days after discharge. (Who.int, 2019). The majority of the time the infections are caused by microorganisms that are already in the patient's body but when the body defence is weak, other patients microorganisms may cause an infection that either through contaminated equipment or by direct contact. Everyday HCAI causes increased risks of resistance of microorganisms to antimicrobials.

The most common cause for HCAIs is transient flora which is spread by direct contact with patients or environmental surfaces. Some of the organisms include gram-negative bacilli, S. aureus, respiratory syncytial virus, C. Difficile and enterococci. (Patel 2015). 

Hand hygiene is known to be the biggest factor in pathogenic microorganism transportation and spread. This is due to skin contact between patients and healthcare professionals. (Healio, 2019). Therefore,  it is important that healthcare professionals are more careful and it is recommended to use gloves as well as washing hands after every patient  (Patel 2015).

Therefore the NICE CG139 guidelines are put into practice in order to prevent the spread of infections, bacterias and diseases in healthcare. Different instructions and methods are put into place from hand washing to surfaces and personal belongings as well as protective wear for healthcare professionals.

In order to determine and investigate the reasoning behind the NICE guidelines, a number of different experiments are carried out. All of the samples that are used are a number of things that may come into contact with patients daily. Therefore aseptic technique is used using Petri dishes which are incubated at 37oC for 24 hours and stored at 4oC which is then returned for analysis.

The aim of the first experiment is to show the risks to patients that are found in everyday environments and objects.

Overall, there were 5 Petri dishes for the experiments. The first procedure included finger dabs of both hands which were done on the agar on two different Petri dishes. The second experiment was in between finger dabs were the petri dish was split into two left hand and right hand. The third procedure involved in the plate getting split into three sections one for a tie swab, one for a watch swab and one for a piece of jewellery eg: ring. The final procedure included dividing the dish into four sections; one for the door handle, one for the sink, one for taps and a bench swab.

The results shown from procedure one was very alarming. From the finger dabs, there was a number of bacterial colonies of white/yellow spots surrounding the area of the dabs. A similar result is found in procedure two the in-between finger swabs were there are a number of different bacterial colonies ranging from white circular shapes and yellow/cream splats. This indicates the number of pathogens and bacteria we carry on our hands every day unconsciously. Even Though the majority of the time the bacteria found is not harmful to a healthy person it may affect a minority of patients who may be susceptible to infections and bacterias in a healthcare environment such as sick patients and old patients. The  results found supports the NICE guidelines in which states Section 1.1.2 of NICE CG1

39 reads as follows “1.1.2.1 Hands must be decontaminated immediately before every episode of direct patient contact or care, including aseptic procedures” by all healthcare professionals. As well as that NICE 1.1.2.4 states “The hands must be rubbed together vigorously for a minimum of 10–15 seconds, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers.” this is proven very important as the results included a large amount of bacterial colonies in procedures 1 and 2 further reinstates the need for the guidelines and adherence needed to remove risks from patients.

The third experiment included the use of personal belongings were a tie, watch and ring was used. The results showed a number of different bacteria present. From all of the belongings, in particular, the ring there was a yellow/cream smooth and circular, filamentous bacterial colonies. This evidence supports the 1.1.2.3 stating” Healthcare workers should ensure that their hands can be decontaminated throughout the duration of clinical work by removing wrist and hand jewellery”

The final fourth procedure shows the largest amount of bacteria found with around 25 colonies varying from filamentous and irregular. It had an off white colour with specs of yellow.  The majority of the bacterial colonies was found on the handles with about 20 different types found. This is even more in healthcare environments as there are other infections and microorganisms that are left by patients and the professionals increasing the risks. The NICE guidelines 1.1.2.1 Hands must be decontaminated immediately after any other activity or contact with a patient's surroundings that could potentially result in hands becoming contaminated. 

Furthermore, the second set of experiments were also done which was to test the microorganism before and after washing hands. The first procedures included finger dabs before the hands were washed and the second procedure the hand was swabbed after the hands were washed using a chlorhexidine gluconate scrub. The third and last procedure was to apply UV cream and wash the hands before examining how much of the cream remains.

The results of procedure 1 showed a large number of bacteria before the hand was washed however after it was washed the number of bacteria decreased dramatically. Beforehand there were 14 colonies of different bacteria on the agar plate the majority of them were white and yellow circular spots scattered this reduced down to 6 after the hands were washed. This shows the significance of washing hands even if it is just washing with plain soap and water to prevent spreading germs even if it is using hand sanitizers and wipes in healthcare settings. (FDA, 2nd September 2016). It also states in NICE (2012) 1.1.2.5 “The hand rub solution must come into contact with all surfaces of the hand”. The 3rd and final procedure showed results of UV cream after the hands were washed meaning they were not cleaned properly and a wrong technique was used. It states in the guidelines 1.1.2.4 An effective handwashing technique involves three stages: preparation, washing and rinsing, and drying. Preparation requires wetting hands under tepid running water before applying liquid soap or an antimicrobial preparation. The handwash solution must come into contact with all of the surfaces of the hand. The hands must be rubbed together vigorously for a minimum of 10–15 seconds, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers. Hands should be rinsed thoroughly before drying with good quality paper towels. This should be followed to get the most effective results.

A number of different reasons resulted in an increase in antibiotic resistance. There are different strains of bacteria that have developed resistance to many different types of antibiotics meaning we are in more risk. (Guardian, 11.3.16) One of the bacteria that is most likely to infect patients in a healthcare environment is gram-positive strains of methicillin-resistant Staphylococcus aureus (MRSA).MRSA is a risk for patients in a hospital environment due to wounds, feeding tubes, drips and burns which enters the blood. (NHS.uk. 2017). Therefore, hands should be washed and the patient's surroundings must be sanitized.

Finally, the last experiment was to show how different chemical agents can prevent the growth of gram+ve and gram-ve bacteria. In this experiment, two bacterias are used E Coli which is gram -ve and S.aureus which is gram +ve. In this experiment, the resistance susceptibility was tested by putting a Mastring-S M14 and M43 ring on the agar petri dish. The ring had 8 antibiotics impregnated tips which is put onto the agar were the bacterias are present.

The results of the first plate the M14 showed that 4 out of the 8 antibiotics prevent bacteria from growing as the others merged into each other and the results were unclear. CO (Colistin Sulphate) had the smallest radius with only 1.4mm. However, TS (Cotrimoxazole) was successful ad the growth distance was 2.1 mm. Some of them, however, were not effective and the E.Coli bacteria had become resistant such as AP (Ampicillin) and ST.

A similar result was given for the Mastring M43 however, unfortunately, the bacteria were more resistant with the highest width being 1.6mm GM (gentamycin). This shows that the bacteria (S.aureus) is not affected.

In conclusion, hand decontamination is very important and should be adhered to in healthcare settings in order to reduce HCAI. All the regulations and guidelines are supported by the results obtained. This indicates the significance of the NICE regulations for example if there is fewer bacteria and infections being spread around there is less risk of resistance and harm to patients. Hand hygiene is a cost-efficient and more effective way out as bacterial resistance is increasing dramatically. (BBC news item). A number of studies and surveys shows that infection control and aseptic procedures such as washing hands with alcohol-based hand rub can initially save lives and reduce HCAIS. (Abu Bakar, 2019) . this shows how important it is for healthcare professionals to adhere to the NICE guidelines.

References

Who.int. (2019). WHO | The burden of healthcare-associated infection worldwide. [online] Available at: https://www.who.int/gpsc/country_work/burden_hcai/en/ [Accessed 25 Nov. 2019].

I used this website to define what health care infections are and how they affect patients

Patel, M. (2015). Healthcare-associated infection: best practice in prevention and control. [online] Pharmaceutical Journal. Available at: http://www.pharmaceutical-journal.com/learning/learning-article/healthcare-associated-infection-best-practice-in-prevention-and-control/20068843.article#fn_6 [Accessed 25 Nov. 2019].

This source helped me figure out the name of the infections and were the pathogens arrive from

Healio.com. (2019). Infection prevention in hospitals: The importance of hand hygiene. [online] Available at: https://www.healio.com/infectious-disease/nosocomial-infections/news/print/infectious-disease-news/%7Bdd1e115b-8a00-4889-9e85-8566391f2541%7D/infection-prevention-in-hospitals-the-importance-of-hand-hygiene [Accessed 25 Nov. 2019].

From this source, I found out the major factor to HCAI and the main reasons behind it

FDA issues a final rule on safety and effectiveness of antibacterial soaps

I used this source in order to find research on using soaps and sanitizers in a healthcare setting.  

NHS.uk. (2017). MRSA. [online] Available at: https://www.nhs.uk/conditions/mrsa/ [Accessed 24 Nov. 2017].

I used this website to find out what MRSA is and how it restricts antibiotics.

Analysis: Antibiotic apocalypse (BBC news item) 

I used this website/ article in order to show the resistance in bacteria and how it is increasing.

the Guardian. (2019). Antibiotic resistance is not theoretical: the threat is real and immediate. [online] Available at: https://www.theguardian.com/science/2016/mar/11/antibiotics-drug-resistance-is-not-theoretical-threat-real-immediate [Accessed 26 Nov. 2019].

 I used this website to reiterate the spread of bacterial resistance

Abu Bakar, M. (2019). Healthcare-associated infections – an overview. The US National Library of Medicine National Institutes of Health Search database.

I used this website to find the HCAIS and how they can be prevented