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Practice questions: Solving your clinical dilemmas

Nursing practice often involves undertaking procedures about which there is debate or uncertainty. In Practice Questions we ask experts to determine how nurses should approach these procedures

Q Do you need to put on gloves and apron to transfer a patient from their bed to a chair?

A Helping a patient to transfer from their bed to a chair requires close contact between nurse and patient. In order to protect one’s uniform from contamination a disposable plastic apron is required. However the apron should be worn for
this purpose only and removed as soon as the transfer is complete.

In the epic2 infection prevention guidelines (Pratt et al, 2007) it clearly states that ‘disposable plastic aprons must be worn when close contact with the patient, materials or equipment are anticipated and when there is a risk that clothing may become contaminated with pathogenic microorganisms or blood, body fluids, secretions or excretions, with the exception of perspiration’.

There is clear evidence that uniforms do become contaminated during a shift of work. In a systematic review undertaken by Loveday et al (2007) six studies were identified concerning contamination of uniforms or white coats during episodes of clinical care. All demonstrated progressive contamination over time. The speed of contamination depends on, for example, the amount of patient microbial colonisation, type and frequency of clinical activity and use of protective clothing.

Where aprons were used exogenous contamination of uniforms was minimised (Babb et al, 1983). Although none of the studies demonstrated a link between uniform and a healthcare-associated infection, good practice suggests the need to wear a clean uniform every shift.

Whether gloves are also required depends on a risk assessment of the situation.

There are two indications for glove use:

  • To protect hands from contamination with organic matter or microorganisms;

  • To reduce the risk of transmission of microorganisms to both patients and staff.

If the patient has an invasive device in situ, such as a urinary catheter, which needs to be handled in the transfer process then single-use (non-sterile) disposable gloves are required. Likewise if the patient has been incontinent, gloves should be worn.

Gloves, like aprons, should be used for one activity only and removed on completion of that activity. After disposing of gloves, hands should washed with soap and water rather than decontaminated with alcohol handgel. This is because the integrity of gloves cannot be guaranteed and hands may become contaminated as the gloves are being removed.

Q Can overnight urine drainage bags be reused if they have been attached to the leg bag of an indwelling urinary catheter?

A The question relates to the use of what is known as a link system, whereby a daytime urine bag is attached to a larger-capacity bag overnight. The answer to this question depends on the setting in which the bag is being used and whether or not the patient is self-caring.

Overnight bags are not always marked as single-use items but if they are they must be disposed of after one use. Re-use of any urinary continence equipment in care settings (hospitals, residential or nursing homes) is not permitted as the risk of contamination and infection is too great.

Some primary care trusts advocate single use of urinary drainage equipment in the community but there does not appear to be universal agreement on this. For people being cared for in their own homes those bags not marked as single-use only can be re-used. According to the Drug Tariff (NHS Business Services Authority, 2008) drainage bags ‘have a life-in-use of on average 5–7 days’. The exception is non-drainable bags.

A spokesperson for the Association for Continence Advice advised that in situations where clients are self-caring, they are advised to rinse freshly drawn tap water through the bag each morning and allow it to drain. Both the NICE infection prevention guidelines (Pellowe et al, 2003) and epic2 (Pratt et al, 2007) advise against adding any antiseptic or microbial preparations to bags, as they are not associated with a reduction in bacteriuria. When self-care is no longer an option, then switching to single-use night drainage bags will be necessary.

Author
Carol Pellowe, EdD, MA Ed, BA Hons, RN, RNT
, is deputy director, Richard Wells Research Centre, Joanna Briggs Institute Collaborating Centre, Faculty of Health and Human Sciences, Thames Valley University, Brentford.

References

Babb J.R. et al (1983) Contamination of protective clothing and nurses’ uniforms in isolation wards. Journal of Hospital infection; 4: 2, 149–157.

Loveday H.P. et al (2007) Public perception and the social and microbiological significance of uniforms in the prevention and control of healthcare-associated infections: an evidence review. The British Journal of Infection Control; 8: 4, 10–21.

NHS Business Services Authority, Prescription Pricing Division (2008) The Drug Tariff (8th ed). London: The Stationery Office.

Pellowe, C.M. et al (2003) Evidence-based guidelines for preventing healthcare-associated infections in primary and community care in England. Journal of Hospital Infection; 55 Supp 2; S1–S127.

Pratt, R.J. et al (2007) Epic2: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection; 65: supplement 1: S1-69.

Do you have a burning question on a practice issue? Is there something you and your colleagues have always wanted to check with an expert?

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