No,_Fo_Bare_Hands!!

No!.. for Bare Hands Introduction: As nurses we are dealing with different types of patients and experiencing various feelings. In the following lines, I am going to talk about one of my reflections in first clinical rotation of the second semester in Bausher Renal Dialysis Unit (RDU). Event: In Bausher RDU, one day during my posting, I was observing all staff were busy connecting their patients to the dialysis machines. I was observing one staff nurse using aseptic technique in needling the patient, she did not get the blood flow in the line. She called her colleague to assess her in getting the flow. The other staff came and manipulated the needle without wearing sterile gloves. I stopped her and asked her to change the needle and put sterile gloves but she argued that she performed hand hygiene before touching the line. Then she connected the machine and put it on. After that I told her that she should not touch any sterile field with her bare hands even she preformed hand hygiene because she would break the sterility of the procedure. Also, needling is an aseptic procedure and sterile gloves must be worn during it. She was not convinced with my explanation. I offered her to go the infection control nurse (ICN) and seek her opinion about what had happened. The ICN agreed with me that the staff should use sterile gloves when needling the patient even she came to help her colleague, in order to reduce the chance of getting IV line related infections. The staff was convinced and she assured me that she would not repeat such practice again. The ICN decided to make an education session on aseptic technique and safe needling for all staff in the unit. Feelings: That incident is one of my unforgettable events during my clinical rotations. I felt so bad to see what the staff had done and I was surprised that she did not think about the patient's risk of getting blood stream infection from her un safe practice. I was thinking how she can do that when she knew that needling is an aseptic procedure and she is practicing that every day. The staff who asked for help did not bother about breaking sterility of procedure she was doing which made me feel very disappointed. At the end I was glad because the staff admitted her mistake and promised not do it again. Now I think this event was a good experience for me to improve my infection prevention and control skills. Also, it taught me how to deal with different situations in infection control practice. Evaluation: 1 Ii is bad that an experienced staff nurse does not bother about the consequences of her malpractice on the patient's condition as all dialysis patients are immunocompromized and prone to infection very easily. It is also bad that when she was told about the wrong practice, she did not want to accept. The good thing is that she preformed hand hygiene before contact with the patient. More over she also accepted that she was wrong and assured to improve herself in the future. In addition, she took responsibility of conduction an educational setion, to other colleagues. Analysis: Firstly, needling with aseptic technique was preformed by the first staff who started needling as stated in the GCC Manual (2009) "aseptic techniques are designed to render and minimize the number of micro-organisms at the IV. Catheter site and to prevent bloodstream associated infections with IV. catheters" . Then when that nurse called her colleague for help, the colleague did not put on sterile gloves. Use of sterile gloves when performing invasive procedures or connecting the patient to the dialysis machine (GCC Manual, 2009). Did those two staff do not know the consequences of breaking the aseptic technique in connecting the patient to the dialysis machine or they just don’t bother about that matter' Are they aware when to use sterile or clean gloves in dealing with dialysis patient' Is there lack of education of infection prevention and control practice in the RDU' Contact transmission is the most common way of transmission of infection in the RD patients that can be prevented by hand hygiene (i.e., hand washing or use of a waterless hand rub), glove use, and disinfection of environmental surfaces (CDC, 2001). On the other hand, the ICN will conduct learning program about IC practice in the RDU as part of her responsibilities. Conclusion: To sum up, all patients on hemodialysis need to be connected to the machine via AV fistula. For that strict sterile techniques must be implemented when performing such procedures to the patient. In the hemodialysis setting, contact transmission plays a major role in transmission of blood borne pathogens. If a health-care worker's hands become contaminated with virus-infected blood from one patient, the worker can transfer the virus to a second patient's skin or blood line access port, and the virus can be inoculated into that patient when the skin or access port is punctured with a needle (CDC, 2001). Action Plan: This was briefly discussed with the infection control staff. As ICN I will prepare a programme including the following ( in case if I encounter such an incident in my practice in the future): * Staff education on: * Principles and practice of infection control (e.g. aseptic technique, hand hygiene and standard precautions) to prevent the transmission of microorganisms. * The most common pathogens causing infections in dialysis patients. * Proper use of personal protective equipment (PPEs). * Proper infection control techniques for initiation, care, and maintenance of access sites. * Training for all employees at risk for occupational exposure to blood spillage. 2 References: * Center for Disease Control and Prevention (CDC), 2001, Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients, Viewed April 27, http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5005a1.htm * GCC center for infection control, 2009, Prevention of Transmission of Infection Among Chronic Dialysis Patients (ICM-VIII-07), King Fahad National Library, Riyadh. 3