Decontamination

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The purpose of this assignment is to discuss and rationalise the key requirements for decontamination of patient commodes in an Acute Hospital Trust, demonstrating the application of these requirements and how they impact on patient safety. Decontamination can be defined as the process, or combination of processes, that remove or inactivate contaminants, resulting in the prevention of these potential pathogens making contact with vulnerable areas and developing in to infection. The Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance (Department of Health (DH), 2010) recommends that, in order to reduce the risk of infection to patients, a health care provider should have appropriate methods of decontamination in place for equipment that comes in to direct contact with a patient and/or their bodily fluids. These methods should be reflected in appropriate local policies and procedures and assurance of their implementation demonstrated through audit. As an integral part of clinical governance, the purpose of clinical audit is to improve quality of patient experience, care and the outcomes of this care (NICE, 2002). Following the audit cycle, on analysis of the data collected, if standards are not being met, changes must be implemented to improve this – these changes should aim to meet the standards undergoing audit or exceed them. This approach to practice is also advocated by the National Patient Safety Agency (NPSA) and is clearly illustrated in their ‘Circle of Safety’ (NPSA, 2003). A component of the Acute Hospital Trust’s Infection Prevention and Control Annual Plan of Work is an audit programme. As part of this audit programme, spot checks of commode cleanliness are undertaken. The audit tool used is a simple visual tool that scrutinises cleanliness of the commode, whether it is in a good state of repair and whether or not a system has been used to identify that the commode has been decontaminated. The author of this assignment, as a member of the Infection Prevention and Control Team undertaking the audit, observed members of health care staff adhering to Trust policy by using the indicated product to decontaminate. However, it was noticed that the technique used by the staff was variable and so to eliminate this variability the Infection Prevention and Control Team concluded that an evidence based standard operating procedure (SOP) was indicated and planned to propose this at the Acute Hospital Trust’s Infection Prevention and Control Steering Committee. Corbett-Nolan and Hazan (2010) discuss that failure to follow procedure is often an underlying factor in the root cause of iatrogenic harm. Using the person approach for management of errors, as defined by Reason (2000), the purpose of developing and implementing a standard operating procedure (SOP) would be to standardise practice. Vardhan et al (2000) implicated commodes as potential reservoirs of pathogens and therefore, a likely contributing factor in healthcare acquired infections. In relation to this assignment, reducing variability in the methods used to decontaminate a commode may therefore reduce the risk of the process being carried out incorrectly and ultimately reduce the risk of transmission of infection. Since the publication of the Chief Medical Officer’s report Winning Ways: Working together to reduce Healthcare Associated Infection in England (DH, 2003), action to drive down these infections has become one of the NHS’ highest priorities. The report acknowledged that contaminated equipment was a factor in the increase of healthcare associated infections (HCAI) and included recommendations around decontamination. Preceding this the National Audit Office (NAO) published a report reasoning that nosocomial infections could be considerably reduced provided that existing infection prevention and control principles and practices were in operation (NAO, 2000).This is a concept that is also alluded...
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