Behind the Rituals
All posts from: April 2012
Do you need to wash your hands after removal of gloves? What do you think?
The National Institute for Health and Clinical Excellence has updated infection control guidance originally published in 2003.
The guidance reiterates that hands must be decontaminated immediately before and after every episode of direct contact with patients, after any exposure to body fluids and after contact with a patient’s surroundings that could potentially result in hands being contaminated.
The new version of the guidelines also advises that nurses should decontaminate hands with liquid soap and water, as opposed to handrub, in clinical situations where there is potential for the spread of alcohol-resistant organisms, such as C difficile or other organisms that cause diarrhoeal illness.
This also applies to circumstances when hands are visibly soiled or potentially contaminated with body fluids. In all other situations, NICE said handrub should preferably be used to decontaminate hands.
How do you check the position of a naso-gastric tube? What do you think?
The National Patient Safety Agency has repeated a warning on the risk of harm posed by flushing nasogastric tubes before confirmation of placement.
The rapid response report said nothing should be introduced down the tube before gastric placement has been confirmed; nurses must not flush the tube before gastric placement has been confirmed; and internal guide wires or stylets should not be lubricated before placement confirmation.
The NPSA said it was aware of three incidents, two of which resulted in death, since the alert went out where staff had flushed tubes with water before initial placement was confirmed.
What syringe should you use to administer drugs via an enteral feeding tube? What do you think?
Any substances given through an enteral feeding tube must be via an enteral syringe or designated enteral feeding set (NPSA, 2007). The use of IV syringes to measure and administer medications through enteral feeding tubes has, in the past, led to fatalities due to the inadvertent IV administration of drugs meant for enteral feeding tubes (Hicks et al, 2008; Nevan et al, 2000). Enteral syringes are currently purple in colour and clearly labelled “for oral/enteral use” to distinguish them from IV syringes.
Three-way taps and syringe tip adaptors should not be used in enteral feeding systems because connection design safeguards can be bypassed (NPSA, 2007). All oral/enteral syringes containing oral liquid medicines must be labelled with the name and strength of the medicine, the patient’s name, and the date and time it was prepared and the person who did it, unless preparation and administration is one uninterrupted process and the unlabelled syringe does not leave the hands of the person who has prepared it. Only one unlabelled syringe should be handled at any one time (NPSA, 2007).
Should nurses cut patients’ toe nails? What do you think?
You can join the debate on twitter using #feet.
Currently we teach all people with diabetes to look after their feet, including showing them how the nails should be cut, to prevent problems.
Due to the increasing numbers of people with diabetes, having diabetes alone is no longer a reason to receive free chiropody. Only those people with diabetes who are at risk, such as peripheral neuropathy or had previous foot ulceration have access to free podiatry.
There is no reason why nurses should not cut toenails provided they have had the training and have the appropriate equipment, however, they should be careful with all patients not just those who have diabetes.
Debbie Hicks is nurse consultant, diabetes, Enfield Community Services, Barnet, Enfield and Haringey Mental Health Trust; chair, Forum for Injection Technique; and co-chair, TREND-UK
Should theatre staff wear surgical face masks? What do you think?
A Cochrane review published in 2011 looked at three trials, involving a total of 2113 participants.
No statistically significant difference in infection rates between the masked and unmasked group was identified.
The authors of the review suggest more research is needed.