MRSA is an acronym for Methicillin resistant staphylococcus aureus which is a bacterium that leads to resistance to penicillin based antibiotics. Norovirus and clostridium difficile are viral based and bacterial based infections that can be easily transferred from one human to another and may be fatal. Infection refers to the process of contracting a disease while control of the disease encompasses management and restriction. The radiology department can play a critical role in infection control as I observed during my clinical practise.
How staff manage patients these types of infection and why
Contrary to common perceptions, infection prevention and control of MRSA, C. Diff and Norovirus are not just the responsibility of nurses; during my clinical placement I realised that radiographers may come in contact with such patients and precautions have to be taken in order to prevent their own infection or that of other patients. I did not observe the actual treatment of patients with C. Diff, Norovirus or MRSA because no such infections were reported at the time of my placement. However, I noticed that disease management protocols had been instated. I also asked members of the radiology department whether they had handled such patients and they confirmed that they had. They gave me in depth explanations on what they normally do in those situations. One radiographer told me that he had received a patient with MRSA and was supposed to carry out an x ray on the patient so he decided to start by sanitising surfaces. His actions corresponded to theory as alcohol has been shown to be particularly effective in sanitising surfaces from MRSA (Lynthfield & Harrison, 2007). This particular radiographer told me that sometimes when he wants to extend the sanitising effect then he usually combines alcohol with quaternary ammonium. He added that it is mandatory for radiographers to remove garments after completing x rays and change into others. Lynthfield and Harrison (2007) explain that MRSA can spread to several conventional and unconventional areas such as curtains, surfaces and clothes worn by caregivers and these must be sanitised.
As I was offering assistance in the radiology department one day I was sent to get some liquid soap from their store; I noticed that they had a stock of other hand washing aids. This sparked off my interest and I requested one of the radiographers to explain why they needed so many different types of soap. I was informed that some of the bottles contained alcohol based rubs and that they were used in case patients with infectious diseases had come into the department; Levine and Raygada (2007) say that hand washing is an effective way of dealing with such diseases. The radiographer told me that all staff members must ensure that they wash their hands with the aid of alcohol based rubs because antiseptics do not work against certain diseases like MRSA which have become resistant to the latter solutions. He further told me that in extreme cases; where more than one patient suffers from MRSA, Norovirus or C. Diff., the department sometimes combines Chlorhexidine cleansers with water to wash hands. Levine and Rygada (2009) claim that poor hygiene is the primary problem in curbing the spread of MRSA, Norovirus and C. Diff. Therefore, my area of attachment was keen on this matter and adhered to such protocol relatively well. However, this hospital was not reflective of what goes on in other institutions; studies indicate that there is a practice – theory gap in many areas of clinical practice. This explains why incidences of MRSA are still relatively high in the country. For instance, in a pilot study carried out by Singh (2003) on hand hygiene, it was found that only sixty percent of the staff followed this protocol. Additionally, it has been shown that some radiographers tend to be selective in their implementation of the necessary protocol and this leaves room for further infection (Singh, 2003).
The radiographer who talked to me about hand washing also gave me a few other tips that the hospital had used when patients with infectious diseases had reported. He asserted that staff members were required to cover and protect themselves against infections. (Wilson, 1995) Here, the use of gloves was critical and wearing protective garments and equipments really helped. Any sharp materials and waste were disposed off properly. The logic behind this type of handling is that there is a correlation between microorganism sources, methods of transmission and the susceptibility of the host (Singh, 2010).
In another instance, I noticed that the radiology department had a portable x –ray machine. I therefore asked my supervisor whether they have actually had to take x ray services to patients. My supervisor asserted that in certain instances, isolation was necessary especially during Norovirus infection prevention or control. Majmudar et al (2009) affirm that when an outbreak has occurred then patients need to be placed in their own rooms and staff should not transfer from unaffected and affected areas without consulting one another. I asked him to outline the exact protocol that the department uses in such cases and he was happy to oblige. He said that before radiography, requests must be made to radiography staff members about expected patients. Thereafter, patient beds in the radiography section need to be prepared in order of diminishing risk i.e. from high to low risk patients. This ensures that such patients do not mix up with other uninfected ones (Majmudar et al, 2009) The radiographer then prepares materials to be used during the procedure. Such materials include protective equipment for the radiographer prior to the x-ray and after. Therefore, one needs to be equipped with two sets of clothes for handling patients with the earlier mentioned infections. Such precautions are essential in preventing transmission through radiographer’s garments (Martin et al., 2006). During the actual procedure, it is essential to use a movable x-ray machine and to close the door behind the radiographer. Martin et al (2006) assert that portable machines have to be used in order to minimise contact between infected and uninfected personnel. X rays are carried out by starting with the least infected to the most infected patients. (Straub & Chalmers, 2006) The supervisor ended his outline by informing me that sometimes there may be a need to release staff members from their duties if they get infected.
After he had talked about the issue of staff members, I realised that the human resource department was influential in determining the effectiveness of infection control in radiology. I therefore approached one of the personnel in that department and asked her how the radiology department’s human resource team has managed infectious diseases in the past. She told me that at such times, they normally reorganise staff. This is because severe infections cause the hospital (including the radiology team) to face staff shortages because some of them need to engage in protection management, others may already be infected and have to be released from their duties while others may be dealing with non infected patients. She therefore asserted that staff rotation is critical so that they are not all exposed to the same level of risk. This is a technique supported by Fraise et al. (2000). Additionally, any members who may be away from their duties due to personal reasons like holidays are usually contacted and involved in infection management. I was therefore able to learn a lot about the machinery of human resource during such emergencies and this gave me a lot of insight on infection management in my own area of interest which is radiography.
Conclusion
MRSA, Norovirus and C. Diff. are serious public health concerns. Radiographers may get into contact with such patients and put themselves at risk of being infected or infecting others. In my area of practise, I found that most staff are already familiar with methods of handling such patients and have the right resources for helping them in disease management. Most staff would explain procedures that correlated with theory and this was indicative of sound clinical practice.
References
Levine, D. & Raygada, J. (2009). Managing MRSA infections – emerging and current options. Journal of infections in medicine, 26, 2
Lynthfield, R. & Harrison, L. (2007). Invasive methicillin resistant MRSA in the US. American Medical association Journal, 298(15), 1763
Singh, T. (2003). Infection control in radiology departments. ISRRT report, 43
Wilson, J. (1995). Infection control within clinical practice. London: Tindall publishers
Fraise, A., Ayliffe, G., Mitchell, K. & Geddes, A. (2000). Hospital infection control. Oxford: Heinneman & Butterworth
Straub, M. & Chalmers, C. (2006). Standard principles for controlling and preventing infection. Journal of nursing standards, 20(23), 57-66
Martin, A., Collins, C. Drudy, M. & Kyne, L. (2006). Simultaneous control of clostridium difficile and norovirus due to infection control and prevention measures. Hospital infection journal 68(2), 180-181
Majmudar, N.. Staples, K. Bignardi, G. (2009). A case of clostridium difficile and norovirus infection. Hospital infection journal 67(2), 198-200