Contributors: Katie Rose Davis MSN, RN, CIC and
Wyona Freysteinson, PhD, MN, RN, FAAN
Texas Woman’s University

Imagine a military hospital in the 1850s that is between Russia and Europe. The hospital is dark, with lanterns scattered throughout the drafty, putrid areas. Wounded soldiers shriek out from pain or feverishly hallucinate from infections. This is an imaginative description of the hospital that Nightingale entered. She was tasked with overseeing nursing care in this environment. Nightingale revolutionized nursing care for the wounded, as well as the cleanliness and design of the care environment. Nursing “ought to signify the proper use of fresh air, light, warmth, cleanliness…. all at the least expense of vital power to the patient” (Nightingale, p. 111, 2021).

Today, one in thirty-one patients develops a hospital-acquired infection, with some contracting a multi-drug-resistant organism within two days of admission. These organisms resist multiple antimicrobial medications, leading to unnecessary suffering, extended hospital stays, added financial burdens, and increased mortality (CDC, 2018; Monegro et al., 2023). Hospital administrators employ infection ‘preventionists’ to educate and consult with nurses and other health professionals on preventing infections. As key players in patient care, nurses’ compliance with infection prevention standards is crucial.

However, compliance with hand hygiene and personal protective equipment is poor despite education and consultation. Throughout my nursing career, I have heard nurses say, “It’s just blood,” “It’s just the flu,” or “You don’t have time to put that on” (referring to personal protective equipment). I have observed nurses removing the fingertip of a glove to feel a vein before drawing blood or inserting a peripheral intravenous catheter. Some nurses negatively refer to other nurses following infection prevention guidelines as “germ-a-phobes.” Cleaning of equipment, patient rooms, and nurses’ stations remains a constant tug-of-war between nursing and other hospital teams. These practices lead to an unsafe culture and the potential for patient harm.

Nightingale’s experiences caring for soldiers in the Crimean War shaped the nursing environmental theory about communicable infections and unsanitary conditions. She wrote in “Notes on Nursing” detailed information based on her experiences with attention to air quality, adequate lighting, cleanliness, hand hygiene, and patient bathing. According to her perspective, “If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed-sore, it is generally the fault not of the disease, but of the nursing” (Nightingale, p. 111, 2021).

Proper hand hygiene and personal protective equipment are essential; however, personal protective equipment can be overused. I have seen nurses don gloves unnecessarily during patient care. For patients who are not in isolation, this experience can make them feel ashamed and unclean and prevent the healing power of touch. 

In alignment with Nightingale, Gillian Lemermeyer (2023) described touch as a sacred interaction between a nurse and another individual. This bond goes beyond skills or comfort and is a unique, cherished interaction. Unnecessary use of personal protective equipment can create a barrier that diminishes this connection between nurses and their patients.

Nightingale encouraged nurses to be primarily responsible for a clean environment and culture of safety. Given their extensive patient interaction, it makes sense for nurses to take the lead in infection prevention practices. The focus should not be on fault or blame. Instead, we should focus on our patients and doing the right thing. Nurses at all levels can model infection prevention practices and encourage the art of touch.

I hope nurses reflect on the individuals we care for, ensuring we protect patients from unnecessary harm caused by over- or under-infection prevention. Thank you for your dedicated healing and thoughtful use of infection prevention measures.

References

Centers for Disease Control and Prevention (CDC). (2018, October 5). HAI data. Retrieved from https://www.cdc.gov/hai/data/index.html#:~:text=On%20any%20given%20day%2C%20about,least%20one%20healthcare%2Dassociated%20infection

Lemermeyer, G. (2022). In good hands: The phenomenological significance of human touch for nursing practices. Medical Humanities, 48(2), 230-237. https://doi.org/10.1136/medhum-2021-012220

Monegro, A. F., Muppidi, V., & Regunath, H. (2023, February 12). Hospital-acquired infections. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK441857/

Nightingale, F. (2021). Notes on nursing: What it is and what it is not. [ebook edition]. e-artnow.

About Katie Rose Davis

Katie earned a Bachelor of Science in Nursing from the University of Arlington and a Master of Science in Nursing Administration from the University of Texas at Tyler. She is certified in infection prevention and has a nursing background in pediatrics, medical-surgical, and post-anesthesia care. She is pursuing a Doctor of Philosophy in Nursing Science at Texas Women’s University.

This compilation took shape through the extraordinary leadership and instruction of Dr. Wyona Freysteinson from the Nelda C. Stark School of Nursing at Texas Woman’s University.