Infection Control & Non Compliance
Rebecca Hill
Trent University
Previously for clinical placements I was on the Maternity and Child Unit at PRHC and
also had clinical shifts in the Birthing Suite, NICU and the Pediatric Outpatient Clinic. In
these areas, I found that there was a serious lack of infection control practices put in place.
I rarely saw the nurses on those units’ clean their stethoscopes or the vitals machine
between patients, nor did I see to resources to use in order to do so. When I began my
placement on the orthopedic inpatient unit, this was the first time I saw a real initiative for
infection control practices with the “I’m Clean” stickers and bleach wipes. I had honestly
never considered cleaning the vitals machines in between patients because it was never
talked about in lab or demonstrated in practice. Of course this made sense, but it had never
entered my consciousness previously. Equipment like the vitals machine comes in direct
contact with patients, and should be cleaned with each use to prevent the spread of
infections between patients. During orientation to A5, I we learned about all of the infection
control practices including the bleach wipes, although they do pose challenges of there
own. But when I came on the floor, I found that there was a disconnect between the
knowledge of infection control, the policy and the everyday practices of the nurses. There
were a few nurses that I observed who were diligent about cleaning their stethoscope and
the vital machine between patients, but I found that many were not. I noticed that many
moved the “I’m Clean” sticker to the side of the machine, used it and put the machine back
in the main corridor for further use. This gave the impression to other nurses that the
machine had been cleaned because it had the clean sticker on it, when it really was not. I
also witnessed other nurses take the green sticker off the vitals machine, use it, and then
just put it back in the hall without even attempting to clean it, then use it again on other
patients. I observed the same practices for other equipment like the broda chairs,
stretchers and wheelchairs. I would see nurses take the equipment from the equipment
room for use while the sticker remained on it. For example with the broad chair, the green
sticker would remain on the backrest of the chair and a sheet would be thrown right over
top of it during use. After use the sheet would be removed and the chair would be taken
back to the equipment room, with the clean sticker still in place and even the portions that
were in direct contact with the patient were not cleaned. The clean sticker would still be on
the equipment giving the indication to the next person to use it that it has been cleaned
when it was not.
Initially being excited to work in a place that had such high standards for infection
control, I felt let down by the lack of compliance. I found myself questioning each piece of
equipment I went to use that had a clean sticker on it, wondering if it had actually been
cleaned or if it could transfer something potentially harmful to another patient. I felt a little
frustrated when the vitals machine would be placed back on the floor without a sticker on
it, feeling that the nurses expected us, (the students) to do it for them. This made me
wonder why they were not cleaning the equipment and complying with infection control
practices and policies.
I began to think of reasons why the nurses did not clean the equipment after use and
came up with a variety of factors. The bleach wipes themselves are problematic that have
challenges unto themselves. When the bleach wipes are used, it takes a couple minutes for
the equipment to dry and longer with porous materials such as the blood pressure cuff.
Because nurses are busy, they may view this ‘drying time’ as inconvenient as they are often
rushed. Another barrier is that the bleach wipes can cause contact dermatitis and skin
irritation if the bleach wipe comes in direct contact with the skin, or the skin comes in
contact with equipment that is not dry from being cleansed with the bleach wipes. It is also
burdensome because it can discolor clothing due to its bleach content.
I went to the literature to find out more about infection control practices and
barriers nurses face to complying with these policies and practices. In 2005, the World
Health Organization launched a ‘Patient Safety Challenge’ that have 5 major goals, one
being the reduction of health care associated infections (Randle & Clarke, 2011). This was
sparked by a worldwide study that found that health care associated infections are rising to
where currently 1.4 million people worldwide are affected by these (Randle & Clarke,
2011). Many of these health care associates infections can be avoided by applying our
current knowledge to practice around infection control practices.
Non-compliance is seen as one of the main barriers to infection control (Schears,
2012). It occurs despite educational efforts, position statements by institutions and
professional organizations, procedural checklists, training, awareness and even financial
incentive (Schears, 2012). Factors that contribute to non-compliance surround the nature
of nursing; as they are busy, understaffed, overworked and do not feel that they have the
time to employ the proper infection control practices (Schears, 2012). In Schears (2012)
study, some nurses in the felt that there was a lack of protocol awareness or too many
protocols to remember (Schears, 2012). Many nurses considered infection control
practices burdensome, and they were of low priority as they had more important things to
do (Schears, 2012). A lack of leadership was found to be a significant barrier to compliance
(Randle & Clarke, 2011). Nurses often felt forced into these practices from management
and this left them with a negative outlook on the practice (Randle & Clarke, 2011).
Consequently nurses were not engaged with infection control practices and protocols
because they were not consulted with the practice in the first place (Randle & Clarke,
2011).
Ward (2010) conducted a study on nursing and midwifery students in clinical
placements and looked at their experiences with infection control. They looked at how,
what student saw in clinical placements affected their perceptions and compliance with
infection control precautions as well as what actions they took when they observed noncompliance. In clinical placement the students observed a lack of hand hygiene before and
after patient contact, the use of glove when exposed to body fluids and safe needle
practices (Ward, 2010). They reported that having good role models, that were dedicated
to infection control practices, strengthened their own confidence and commitment with
infection control (Ward, 2010). When in contact with poor role models that did not
demonstrate appropriate infection control practices, many students felt even more
determined to carry out proper infection control precautions (Ward, 2010). Some students
admitted to changing their infection control practices because of the influence of staff
members (Ward, 2010). This study shows that role models in practice can greatly influence
the student’s learning and infection control practices into the future. Many students found
that there was a divide between what was taught in school versus what was carried out in
clinical practice and this lead to student confusion and frustration (Ward, 2010). This study
suggests that students should be able to report poor practices by nurses to increase
infection control compliance, and that health care professionals should be aware of the
impact of their practices on students learning and future practice (Ward, 2010). The
students noted that a lack of knowledge on behalf of the nurses, the organizational culture
in general, a lack of positive role models, and reduced risk perception were barriers to
infection control compliance (Ward, 2010).
Randle & Clarke (2011) suggest that leadership instead of hierarchal authority
would lead to more positive outlooks from staff and infection control practices that are
initiated and sustained. Leadership could also lead to empowerment by staff owning the
policies and being engaged with the process (Randle & Clarke, 2011). The need for further
education and training in infection control could also be valuable (Randle & Clarke, 2011).
Searching the literature on compliance, infection control practices and barriers
were very insightful and brought to light the multitude of interacting factors that are
involved. Although I am committed to infection control, I consider the non-compliance I
experienced with a different perspective. Being a student in clinical placement and grateful
for the experience and help from the nurses, I find myself in a difficult position when it
comes to seeing nurse non-compliance with infection control. All I can control is my own
actions and hope to inspire other nurses to follow infection control practices. In the future I
will remain committed to proper infection control practices, by cleaning all the equipment I
use and when I encounter equipment that I am unsure if it was cleaned, I will clean it
myself to ensure its cleanliness. Being dedicated to infection control practices I hope to
serve as a positive role model to students, nurses and the public entering the hospital
setting. I also intend to take my dedication to infection control into my practice and hope to
serve as a positive role model to students in that setting as well.
References
Randle, J., & Clarke, M. (2011). Infection control nurses' perceptions of the code of hygiene.
Journal Of Nursing Management, 19(2), 218-225. doi:10.1111/j.13652834.2010.01147.x
Schears, G. J. (2012). Online Surveys: A Potential Weapon Against Clinician NonCompliance. Journal Of The Association For Vascular Access, 17(1), 38-41.
doi:10.2309/java.17-1-5
Ward, D. (2010). Infection control in clinical placements: experiences of nursing and
midwifery students. Journal Of Advanced Nursing, 66(7), 1533-1542.
doi:10.1111/j.1365-2648.2010.05332.x