Most nurses instinctively consider practicing good infection prevention. Have you reviewed the history of infection prevention and the immeasurable contribution nurses have made to its pullulation? Has anyone discussed with you the significant economic and other impacts of practicing good hand hygiene? This article will discuss the indelible contribution of nurse midwives to best infection prevention practices and how continuation and expansion of these practices by nurses has shaped healthcare delivery.
A brief history of hand hygiene.
Working collaboratively, physicians and nurses can improve documentation, reduce medical errors, improve patient satisfaction and medical outcomes while reducing hospital costs. Ignaz Semmelweis, a Hungarian physician who practiced during the mid-1800s was instrumental in cementing one of the best infection prevention practices around labor and delivery. The incidence of puerperal sepsis was significantly higher among physicians than in midwives at that time. He supported the best infection prevention practices of the nurse midwives. These midwives consistently practiced hand hygiene as a reproducible and reliable way to improve the outcome of mothers and their babies during the peripartum period. Semmelweis’s colleagues and other physicians during that era thought he had lost his mind. Because of his advocacy for infection prevention, he was eventually committed to a provincial lunatic asylum where he later died of septic shock.
What were the nurse midwives doing?
Nurse midwives were focused on providing care around the peripartum period to mothers, especially during delivery. A standard practice of these midwives was to routinely wash their hands before doing a pelvic examination. They also washed their hands before each delivery and afterwards. The midwives consistently got better outcomes for the patients they managed than were the physicians managing the same cohort of patients. The physicians would come straight from completing an autopsy and with those same unwashed hands proceed to do pelvic examinations and deliveries. Semmelweis, though unable to clearly explain why, was able to determine that by washing their hands the midwives were delivering better care, and outcome, including reduction of infections, for their patients.
How today’s nurses continue the noble tradition of excellent patient care!
Most nurses are cognizant of the need to and benefits of good hand hygiene. Some of these best practices for hand hygiene include keeping nails trimmed short, avoiding artificial nails, removing rings and watches and wearing gloves when appropriate contact isolation is indicated. Other best practices include frequently and reliably washing hands with soap and water, using alcohol-based hand sanitizer, and drying hands thoroughly. Additionally, many nurses engage other healthcare providers by reminding them in a collaborative way of the need to practice best hand hygiene etiquette. These nurses ensure infection prevention signs are posted and respected by all healthcare providers. Many nurses share their concern with healthcare providers and family members regarding poor patient outcomes when good hand hygiene is forgotten or ignored. Infectious disease physicians especially have benefited from nurses alerting them to infection prevention requirements when they overlook the expected practices while entering a patient’s room. Nurses have also nudged other physicians to practice hand hygiene when they failed to complete these basic hand hygiene best practices. On some occasions the nurse will offer to help a physician to properly apply barrier protections when indicated for patients in specific types of isolation. This spirit of collaboration is welcomed and promotes not only best practices but improved patient satisfaction and optimizes resource utilization.
What benefits accrue for collaboration around good infection prevention?
Today many insurance companies, including Medicare, do not reimburse for some hospital acquired infections. Since some infections like central line associated bloodstream infections (CLABSI) are not reimbursed, the hospital must provide the care without being able to offset the cost. Serious implications arise from this non-payment including negative impact on nurse staffing ratios, patient and provider satisfaction and hospital quality scores. For many hospitals this could impact the very survival of the institution. By consistently collaborating with physicians and other healthcare providers around infection prevention best practices, nurses continue to make sometimes unrecognized, outsized contributions to the improved outcomes of their patients and the financial soundness of the hospital.
A challenge for nurses and other healthcare providers.
This article will be consequential if each healthcare provider commits to:
1. Obtaining additional information about the history and benefits of good infection prevention.
2. Optimal patient satisfaction and outcomes by consistently implementing the best infection prevention practice for every patient encounter.
3. Intervening in a collegial manner whenever proper infection prevention strategies are overlooked, ignored or improperly applied.
4. Becoming an advocate for the best infection prevention practices.
5. Understanding and reducing the negative financial implications of improper infection prevention on the hospitals/institutions bottom line.
6. Not being the weakest link and thus preventing the healthcare institution from obtaining the highest quality scores/ratings around infection prevention.
What does the future hold?
Since the benefits of infection prevention and hand hygiene are acknowledged here are a few questions to ponder.
Has non-reimbursement for hospital/healthcare acquired infections achieved the desired goals?
Should payers link documented evidence of the completion of the practice of infection prevention to reimbursement?
Will hospital and healthcare systems providing patient care require satisfaction of hand hygiene targets when credentialing/recredentialing providers who deliver healthcare at the bedside?
Handwashing; infection prevention; healthcare collaboration; healthcare acquired infections; hospital infections; hospital quality score; hospital ratings; hand hygiene; infection control; infection preventionist; physician-nurse collaboration; patient outcomes; alcohol based hand gels; soap and water; bacterial infections; contact isolation.
Written by:
Wycliffe L. Wright, M.D, MBBS, CHCQM
Board Certified Internal Medicine and Infectious Disease.
Certified Diplomate of the American Board of Quality Assurance and Utilization Review Physicians in Case Management and Physician Advisor
Extensive experience in IRF, Hospital, Nursing Home, and Correctional Healthcare.
“Every challenge is an opportunity for success”
