Prevention of Infections in Patients with Hematological Disorders

Aims: To identify and implement strategies that will reduce the incidence of health care associated infections in patients with hematological disorders   

Background: Infections are common in patients with hematological disorders. Most of these infections are Health Care Associated (HAI) and occur because of the prolonged and repeated contact with the hospital environment. HAI presents a significant monetary burden on the current healthcare system.

 

Methods: Five aspects of nursing care related to preventing infections in patients with hematological diseases were studied. Prospective Randomized controlled trial of 1000 patients with two different methods of PICC dressings to assess the rate of infection and non-infectious complications. Prospective observational study to assess compliance with hand hygiene practices among health care personnel to a prescribed protocol. Descriptive observational study to evaluate adherence with established protocol in the administration of intravenous injections among nurses. Prospective Randomized controlled trial to compare the efficacy of perianal application of Betadine antiseptic ointment versus cleaning with soap and water in the reduction of perianal infections. Descriptive study to assess the knowledge, attitude and infection control practices of patients using a teaching module on general infection control measures.

 

Results:  There was no difference in the exit site and catheter related blood stream infection rates (CLBSI) between the dressings - incidence per thousand catheters (days). There was no difference in the overall non- infectious complications between the groups (P = 0.08). 170 observations made on 49 registered nurses and 15 medical personnel, requiring 1925 opportunities requiring hand hygiene, the overall compliance was 75.2% to hand hygiene. The compliance of health personnel in Ward A and Ward B showed significant difference in the compliance. 134 observations made on injection practice for 6 months among 67 registered nurses, the mean practice score was 82.2 %. The incidence of perianal infections were very low in both the groups. The knowledge, attitude and practice scores did not differ with gender and educational background of the participants.

Implications: The high permeable transparent dressings and impermeable gauze dressings were equally effective in controlling PICC related sepsis. However, the transparent dressings needed to be performed less frequently reducing health care personnel time and reduced patient visits making these the preferred dressing on patients with hematological disorders. Povidone iodine (Betadine) antiseptic ointment applied to the perianal region after soap and water washing did not help in reducing perianal infections compared to the practice of washing with soap and water. Compliance to hand hygiene can be easily achieved with education and adequate provision of the necessary hand rubs and dispensers at every bedside in the clinical units. Adherence to universal infection control practices can be measured. Findings from this study have clearly demonstrated that education and monitoring of these practices can increase adherence among nurses and adherence to established protocols does not necessarily depend on the experience of the nurse. The survey of patients in this study showed good attitude and eagerness to acquire knowledge and good practice of infection control and prevention practices.