Re-engineering of nasopharyngeal aspiration procedures to enhance infection control

Abstract

BACKGROUND: After the SARS epidemic, standard precautions were enforced in all patient care procedures. Use of personal protective equipment (PPE) was particularly indicated for healthcare workers when they perform patient care related activities that were likely to generate splashes. Nasopharyngeal aspiration procedures (NPA) are well known to be high-risk procedures for which use of PPE is necessary. Traditionally, in performing NPA, staff members stand directly facing the patient which increases the risk of direct droplet or aerosol transmission. Use of NPA, however, is important to guarantee a reliable diagnostic yield (with high specificity and sensitivity), e.g., in investigating suspected SARS and influenza. Re-engineering of procedures involved in NPA was therefore necessary to enhance safety in infection control. METHODS: Reliable and safe approaches to NPA were developed by modifying the positioning based on infection control principles. The staff performing NPA stands either posterior or next to the patient, who looks forward. The basic skills remain unchanged, but with strong emphasis of “clean hand and dirty hand” concept after the specimen is collected in order to avoid environmental contamination. RESULTS: Such practice was demonstrated and introduced to different groups of medical and nursing staff via train-the-trainer programs in early 2004. Subsequent evaluation revealed greatly enhanced staff satisfaction with the new procedures. Re-engineering was an important concept in infection control for review of high-risk patient care procedures. CONCLUSIONS: With increased awareness of the importance of infection control in protecting both staff and patients, re-engineering of some patient care procedures may be needed. The modification of NPA procedures served as a good example for developing such approaches to re-engineering. BACKGROUND: After the SARS epidemic, standard precautions were enforced in all patient care procedures. Use of personal protective equipment (PPE) was particularly indicated for healthcare workers when they perform patient care related activities that were likely to generate splashes. Nasopharyngeal aspiration procedures (NPA) are well known to be high-risk procedures for which use of PPE is necessary. Traditionally, in performing NPA, staff members stand directly facing the patient which increases the risk of direct droplet or aerosol transmission. Use of NPA, however, is important to guarantee a reliable diagnostic yield (with high specificity and sensitivity), e.g., in investigating suspected SARS and influenza. Re-engineering of procedures involved in NPA was therefore necessary to enhance safety in infection control. METHODS: Reliable and safe approaches to NPA were developed by modifying the positioning based on infection control principles. The staff performing NPA stands either posterior or next to the patient, who looks forward. The basic skills remain unchanged, but with strong emphasis of “clean hand and dirty hand” concept after the specimen is collected in order to avoid environmental contamination. RESULTS: Such practice was demonstrated and introduced to different groups of medical and nursing staff via train-the-trainer programs in early 2004. Subsequent evaluation revealed greatly enhanced staff satisfaction with the new procedures. Re-engineering was an important concept in infection control for review of high-risk patient care procedures. CONCLUSIONS: With increased awareness of the importance of infection control in protecting both staff and patients, re-engineering of some patient care procedures may be needed. The modification of NPA procedures served as a good example for developing such approaches to re-engineering.