Community infection control: what is the evidence?

Aseptic technique: evidence-based approach for patient safety

The fact that there is a relationship between the standards of aseptic technique performance and the rise in hospital infection rates has been suggested by the Department of Heath's (DoH's, 2004) 'Winning Ways' document. This literature review considers how the aseptic technique is performed in the UK, and examines the nature of ritualistic and evidence-based practice underpinning this skill-based procedure. The findings have identified an emerging glove culture and continuing poor hand-hygiene practices. The alternative 'clean technique' is also adopted widely in clinical practice which confuses the aseptic theory-practice gap. While it is hard to pinpoint an actual time or event that causes infection, it is unlikely nurses will ever become involved in litigation as a result of a poorly performed aseptic technique. However, the review concludes that nurses should not become too complacent. It briefly considers how performance of the aseptic technique can be improved, through creative educational strategy, applied risk assessment and clinical audits of nurses' practices.

Universal precautions: a survey of community nurses' experience and practice

BACKGROUND

Universal precautions are a set of guidelines which aim to protect health care workers from blood-borne infections. Community nurses often have to deliver care to people in less than ideal home conditions, their ability to comply with all universal precautions may therefore be compromised.

AIMS AND OBJECTIVES

This paper presents the findings of a questionnaire survey which aimed to explore community nurses' experience and practices of using universal precautions.

DESIGN AND METHODS

A questionnaire survey was used for this study. All community learning disability nurses, community mental health nurses and generic community nurses from one Welsh Health Authority were surveyed (n = 543) with a response rate of 70%.

RESULTS

The majority of community nurses reported compliance with universal precautions, although a small number of nurses stated that they re-sheathed needles, inappropriately stored sharps containers, inadequately wore gloves and experienced difficulties in handwashing.

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

Community nurses work in a unique and unpredictable environment, which may result in nurses being unable to comply with existing universal precautions guidelines. The production of new infection control guidelines for the community by the National Institute of Clinical Excellence in June 2003, has addressed some of the difficulties faced by community nurses.