How Do Nurses Protect Themselves from Highly Infectious Patients?
Nurses are expected to be intimately involved with the care of the public regarding health matters such as prevention of disease, healthy lifestyles, and the treatment of disease and conditions. This care and exposure is not without direct risk to the nurse. There are many inherent risks to nurses that include potential physical risks. Nurses must be constantly vigilant in their practice of infection prevention to keep themselves protected in the ever-changing environment of healthcare.
Prior to the outbreak of highly infectious blood-born pathogens such as human immunodeficiency virus (HIV) in the late 1970s, healthcare institutions were cavalier about measures to prevent infectious diseases. The early 1980s saw isolation of diseases in hospitals, but it was not until 1987 that the Centers for Disease Control (CDC) made recommendations that all blood products should be considered potentially hazardous.
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Through the use of evidenced-based practice and studies related to the prevention of disease, nursing has come a long way and has lead the charge of decreasing risks to the profession. Appropriate hand hygiene is the number one measure to prevent contracting and passing infectious pathogens. Studies have shown that institutions that educate nurses on basic hand hygiene and require a demonstrated competency have the least amount of hospital acquired infections and illness to staff. Another measure is to reinforce to nurses not to touch their face, nose or hair with their hands in an effort to reduce the spread of pathogens. While washing the hands with soap and water is an extremely effective method to kill most pathogens, the use of de-germer gel agents can be as effective as soap and water (but not for all pathogens).
Personal Protective Equipment (PPE) is designed to prevent exposure from the infectious agent or person to the nurse or caregiver. Types of PPE include:
- Gloves to protect the hands
- Gowns/aprons to protect the skin or clothing
- Masks to protect the mouth and nose
- Respirators to protect the respiratory tract from airborne agents
- Goggles to protect the eyes
- Face shields to protect the face, nose, mouth and eyes
Nurses must choose the appropriate PPE based on the expected exposure risk being assessed. Most facilities, and all facilities that are The Joint Commission certified, have policies related to infection control and prevention, and plans for accidental exposure to the staff and public. The next consideration when choosing the appropriate PPE is the duration of the exposure, as some products are more durable or water resistant for longer use. Nurses must always ensure that the chosen PPE fits the wearer and is not too small or too large. Improper fitting PPE is a potential risk of exposure or injury if the equipment fails.
A key component of proper use of PPE is when and how to put it on (don) and how to take it off (doff). PPE should be donned prior to exposure with the patients. Gloves, masks, and other equipment must be securely fastened and fitting well before coming into exposure with infectious agents. Some PPE plans for highly infectious agents such as Ebola require a second nurse or team member to watch and critique the PPE donner to ensure maximum protection. Removal of the PPE is usually at the point of least exposure to the public, or in the room where the nurse is caring for the patient. PPE should be disposed of in the appropriate receptacles based on the institution's policies. Appropriate hand hygiene always follows the removal of PPE.
Nurses must be constantly attentive to the prevention of the spread of contagious matter and to avoid the risk of acquiring illness themselves. Hand washing, the use of de-germer agents, and the wearing of PPE are all measures nurses can employ to keep themselves, and the public, healthy. Nurses must check with the policy of their local institutions for infection prevention guidelines and expectations.
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