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Role of nurses in prevention from hospital infections

Conference Paper · April 2014

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 Global Journal on Advances
in Pure & Applied Sciences

Vol 4 (2014) 171-174

Selected Paper of 1st World Conference on Health Sciences (H-SCI 2014), 24-26 April 2014,
Zeynep Sentido Hotel Convention Center, Antalya, Turkey
Role of nurses in prevention from hospital infections
Fatma Özkal*, Selçuk University, Kadir Yallagöz Health School, Akşehir, Konya, Turkey.
Öznur Erem, Selçuk University, Kadir Yallagöz Health School, Akşehir, Konya, Turkey.
Funda Özpulat, Selçuk University, Kadir Yallagöz Health School, Akşehir, Konya, Turkey.
Melike Baş, Selçuk University, Kadir Yallagöz Health School, Akşehir, Konya, Turkey

Suggested Citation:
Özkal, F., Erem, Ö., Özpulat, F. & Melike, B. Role of nurses in prevention from hospital infections, Global Journal
on Advances in Pure & Applied Sciences [Online]. 2014, 04, pp 171-174. Available from:
http://www.world-education-center.org/index.php/paas

Received November 07, 2013; revised December 01, 2013; accepted March 10, 2014.
Selection and peer review under responsibility of Prof. Dr. Haluk Soran, Near East University, Cyprus.
©2014 SPROC LTD. Academic World Education & Research Center. All rights reserved.

Abstract

Hospital infections are defined as infections that develop 48-72 hours after the hospitalization or within 10 days
following the discharge. In Turkey, the hospital infections are encountered in 5-10% of hospitalized patients in
general.
Being an important public health problem in both developed and developing countries, hospital infections are
considered the most important indicator of the care quality at hospitals and cause the extension of the
hospitalization duration and increase of morbidity, mortality and treatment cost. It may also cause functional
disorders, emotional stress, lower life quality and death in patients.
Hospital infections are secondary preventable infections and nurses play an important role in applying these
preventions.
Being known as the defender of patients, ünurses have a unique position of developing the patient care
standards and creating a change. Nurses should be aware that nosocomial infections are preventable, have up-
to-date information about universal preventions that are accepted in the entire world concerning the prevention
and control of infections and provide the most efficient care for patients in line with this information.

Keywords: hospital infections, prevention, role of nurses.

* ADDRESS FOR CORRESPONDENCE: Fatma Özkal, Selçuk University, Kadir Yallagöz Health School, Akşehir, Konya, Turkey,
E-mail address: fatmaozkal@hotmail.com
Özkal, F., Erem, Ö., Özpulat, F. & Melike, B. Role of nurses in prevention from hospital infections, Global Journal on Advances in Pure &
Applied Sciences [Online]. 2014, 04, pp 171-174. Available from: http://www.world-education-center.org/index.php/paas

Patient infection or infections related to health services in other words are a worldwide problem.
Preventing health care related infections is simple and requires quite a few sources. In its First Global
Patient Safety Challenge World Health Organisation adopted the general vision of “Clean care is safer
care.” [1]. Hospital infections are described as infections that occur 48-72 hours following
hospitalization or within 10 days following being discharged from hospital. In Turkey hospital
infections are seen in 5-10% of the patients in hospitals [2]. Gram (+), staphylococcus and
enterococcus are the most common causes of hospital infections. The rate of multiple drug resistant
microorganisms in hospital infections is increasing day by day [3].
Hospital infections might lead to functional disorders, emotional stress, deterioration of life quality
and death. Also, for reasons such as long hospitalization periods, loss of employment, increasing
medication, the need for isolation, and extra laboratory and other diagnosis methods the economic
burden also increases [4].
In general when the distribution of HI by areas is analysed, it is seen that the order is as follows:
urinary system infections, surgical wound infections, respiratory tract infections and bacteraemia. In
Turkey the distribution of infections by areas is as follows: 40% urinary system infections, 30.3 % lower
respiratory tract infections, 20.1% surgical area infections and 7.6% bacteraemia [3].
In the occurrence of hospital infections are changeable and unchangeable risk factors.
Unchangeable risk factors mostly belong to the host (age, disease, the severity of illness, invasive
interventions etc.). Changeable factors belong to the hospital and the health staff for not obeying the
infection control rules sufficiently (lack of infrastructure in hospitals, insufficient and uneducated
health staff, low hand hygiene adaptation of health staff and misuse of gloves, unnecessary invasive
interventions, not obeying asepsis and antisepsis rules etc.). Hospital infections may be lowered by 33
% in countries where protection and control measures are taken adequately. In countries where
protection and control measures are not taken adequately, they are lowered much more than 50 %.
However, recently it is accepted that hospital infections are medical errors and “zero tolerance” to
hospital infections is also accepted. It has been shown that hospital infections may disappear by using
specially educated teams in invasive interventions and creating infection control, prevention packages
[5].
Hospital infections ranks as the second preventable infections and nurses have a great role in the
practice of these measures [6]. Nurses who are known to be patient defenders improve patient care
standards and may cause change. Nurses should be aware of the fact that nosocomial infections are
preventable, should have knowledge of global measures regarding preventing and controlling
infections and should provide the most appropriate care in line with this knowledge [7].
Evaluation and improvement of hand hygiene has been emphasized to prevent and control health
care related infections. It is accepted that hand hygiene is the one and only method to prevent cross
contamination of highly resistant microorganisms and infections related to health care services. It is
possible to examine hand washing under three main categories: social hand washing, hygienic hand
washing and surgical hand washing. The World Health Organisation has described five moves in 2007
to improve hand hygiene adaptation: 1. Before contacting the patient, 2. Before aseptic procedures,
3.After being exposed to bodily fluids, 4. After contacting the patient, 5. After touching the close
environment of the patient [1].
Units such as intensive care units are risky in terms of cross infections. One of the most common
and significant practices of nurses who work in these units to prevent cross infections is wearing
gloves, but although gloves are used to prevent cross contamination, they may cause direct cross
contamination in cases of misuses. Providing care with the same gloves to every patient without
taking them off for a long time cause the hands to sweat and an appropriate environment for bacteria
to reproduce [7].

172
Özkal, F., Erem, Ö., Özpulat, F. & Melike, B. Role of nurses in prevention from hospital infections, Global Journal on Advances in Pure &
Applied Sciences [Online]. 2014, 04, pp 171-174. Available from: http://www.world-education-center.org/index.php/paas

Ventilator associated pneumonias (VIP) constitute 60-70 % of nosocomial pneumonias. Intubation

increases the occurrence of nosocomial pneumonia by 6-21 folds [8]. Non-pharmacological methods
to prevent nosocomial pneumonia are as follows: hand washing and wearing proper gloves, wearing
proper clothing when identifying antibiotic-resistant pathogens, avoiding intubation, the continuity of
subglottic aspiration, adequate cuff pressure, and placing the patient in a semi-sitting upright position
(30-45 degrees) for aspiration and reflux risks unless there is a contraindication [9].
60-60% of urinary system infections develop because of catheter. For this reason, in case of an
indication, urinary catheter should be inserted [10]. Some suggestions for nurses in preventing urinary
system infections are as follows: following asepsis principles, providing the protection of close
drainage system, providing uninterrupted urine stream, ensuring that catheter and urine bag are
below bladder level, watching out for the catheter not to bend, draining the urine in the urine bag
from the below valve, draining the urine collection bags regularly, ensuring urination in case of need,
using separate urination drainage container for each patient, paying attention to the tap not to
contact drainage container, not chancing the catheter regularly unless obstruction and irrigation in the
catheter, wearing gloves during the aforementioned processes, washing hands before and after the
processes [7].
Nurses are suggested to do the following to prevent catheter related infections: ensuring that the
team to insert intravascular catheter take maximum barrier measures (sterile apron, sterile gloves,
mask and large sterile cover), ensuring that before the process the insertion area of central venous
catheters are sterilized with 70% alcohol, 10% povidone iodine or iodize tincture 2%, preventing the
use of multi lumen catheters unless necessary, preventing that single lumen central venous catheters
used for total parental nutrition are not used for something else, dressing the central venous catheter
with sterile gauze bandage or transparent cover, unless there is another indication, (TPN, lipid
solution, blood transfusion) not changing intravenous application sets before 96 hours, redressing the
wound in case of changing and removing catheter or stained dressing, chancing transparent dressing
in catheter areas every 7 days and gauze bandage dressings every 48 hours, washing hands before and
after contacting central venous catheters [7].
Nurses are greatly responsible for preventing hospital infections. Up-to-date practice manuals
should be used in hospitals. Moreover, nurses should provide proof-based care. It should be
remembered that inadequate and wrong care affects the occurrence of hospital infections to a great
extent.

References
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Hospital Infections 2006, Firat Medicine Journal, 14(4), 242-246
[3] Agirbas I., (2013). Result Report of Scientific Research Project, Cost Analysis of Hospital Infections, Ankara
University Scientific Research Project, Ankara - 2013
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[8] Alp, E. (2012). Hospital Infections, Retrieved from: http://www.tipfakultesi.org

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 Özkal, F., Erem, Ö., Özpulat, F. & Melike, B. Role of nurses in prevention from hospital infections, Global Journal on Advances in Pure &
Applied Sciences [Online]. 2014, 04, pp 171-174. Available from: http://www.world-education-center.org/index.php/paas

[9] Tel Aydın H. (2013). Risk Factors, Prevention and Nursing Interventions of Ventilator associated Pneumonia
(VIP) Risk, Nursing with Health Journal, 3, 34-35
[10] Alp, E. (2012). The Prevention of Nosocomial Urinary System Infections Control Program Kayseri 2012, Part
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