Color-Coded Guidelines and Hygiene Policies: Strategies for Preventing Nosocomial Infections in Healthcare Settings

Introduction

The act of preventing nosocomial related infections is one of the greatest concerns. Hospital acquired infections (HAIs) is a major health related concern for the health care providers and patients alike. Considering the rate of mortality and morbidity, increased length of stay and cost effectiveness should work on making the hospitals a safe place to stay (Volc et al. 2019, p. 434). The current research literature works on proposing suitable colour coded guidelines that can work on ensuring that the rate of infection incidence is limited within the healthcare settings.

Keeping the hospitals clean is one of the evident ways of reducing infection. However, without the probable ways of hygiene policies they could result in serious implication for the patients, visitors and staff. Although healthcare organizations these days practice proper hygiene policies by making use of soap dispensers for cleaning hands and taps for washing hands, contamination continues to be a prime issue and can lead to serious consequences. A study conducted by Basildon and Thurrock University NHS Hospitals Foundation Trust in 2009 suggested that poor nursing practices and lack of proper hygiene policies can lead up to 400 deaths annually (Chadwick et al. 2019, p. 28). Thus, the purpose of the current research paper is to provide practical guidance on the ways to undertake cleaning of infected areas such as the outpatient department, inpatient hospital ward, clinic room and minor injuries unit. The policy will work on describing cleaning activities carried out on a daily basis, deep cleaning and annual cleaning.

The objectives of the policies mentioned are as follows:

To reduce the potential costs related to cross infection from the ambience where infected patients have been nursed back to health

To make sure that the isolation rooms and other areas used for treating the infected patients are cleaned properly and as soon as the patient vacates the bed

To ensure that the hospital makes use of suitable colour coding systems for cleaning equipment as adhered to

To ensure that the nurses and the other housekeeping staff are aware of their responsibilities while carrying out enhanced deep cleaning activities

To impart sufficient knowledge to the nurses and other housekeeping staff about the needed protective clothing to be worn while carrying out the cleaning activities

Colour coding cleaning materials and equipment makes sure that these items are not used in several areas, thus reducing the chances of cross infection. The National Patient Safety Agency (NPSA) has formed a national colour coding scheme for cleaning materials found within the hospital and associated health care settings (viols et al. 2019, p. 434). The current research progresses with the prospective aim that it can work on providing suitable recommendation to adopt the possible code as a standard to be implemented for improving the safety procedure and streamlining the existing scheme with limited resource implication for service. All the cleaning materials, disposable and reusable buckets, mops, aprons and cloths should be properly coded by colour. The method implemented to colour code items should be permanent and as per the local existing practices to ensure proper hygiene. NPSA further recommends, NHS organizations providing inpatient services should work on adopting the policy to embrace National Colour Coding Scheme. The reason for such recommendation can be attributed to the fact that the current practices, there differ from the standard practices (animation et al. 2017, p. 66). The prime aim of the colour coding system is to raise awareness of revised practice among the healthcare workers. A detailed understanding about the colour coding practice across various NHS organizations will make it easier to understand the existing practice and stick to one hygiene practice

The colour coding is as follows:

Red is used bathroom, showers, toilet and the floors of the mentioned areas

Blue assigned to the general areas such as departments, medical wards, public basins and offices

Green is used in departments that deal with food services

Yellow is used in case of isolation areas

Background

It is the responsibility of the nurses to limit the chances of infection and maintain health quality within the hospital settings. In the mentioned research literature, colour coding mop can be termed as a quick way to maintain hygiene standards. The correct way of preventing the chances of infection is maintaining hand hygiene. As per the observation by Nematian et al. (2017, p. 65), there remains a high chance of infection being spread if a wrong mop is being used for cleaning the isolation room. The reason for such enhanced intervention to stop the possibilities of infection spread. The recent pandemic outbreak of nCoV-2019 can be termed as a matter of concern. The mentioned intervention can work on reducing the chances of infection. The novel coronavirus is highly infectious in nature and poor hygiene practice can lead to potential problems (Pfäfflin et al. 2016, p. 3). The coronavirus problem can work on increasing the potential risks.

Practice nurses work in isolation, as compared to the nurses working within the acute sector. It is believed that updates related to general practices implement the changes at similar rates within same standards. However, this may not be the case all the time and the information in regards to decontamination and additional infection control issues may not reach the practice staff. The local guidelines on clinical governance by CICN proposes the right kind of infection control guidelines for general practices and secondly makes use of policies such as keeping the hands clean, while making use of protective clothing (Tenenbaum et al. 2016, p. 1312). The second clinical guideline is related to managing incidents related to blood borne viral infection. The current practices of hygiene followed within the settings of health care are as follows:

Handwashing: Sinks for washing hands should be available within all clinical areas. The taps should be preferably elbow or wrist taps, to prevent contamination of hands after washing (Boisset et al. 2019, p. 1095). Well mounted, liquid soap should be available for daily hands-on activities. Disposable towels and soap bars need to be discarded after use as they may work on harbouring microorganism

Gluteraldehyde: The use of Gluteraldehyde was found in several practices. However, Gluteraldehyde is no longer available within the general and is considered inappropriate. Safe disposal of Gluteraldehyde needs to be arranged and alternative methods are suggested for the practice (George et al. 2016, p. 233).

Benchtop steam sterilisers: Guidance related to Benchtop steam sterilisers was provided by the Medical Devices Agency and were used for educating the nursing to attend the training related to the same (Mutters and Mutters, 2016, p. 266).

Clinical disposal of waste: The safe disposal of waste is influenced by the Environmental Protection Act 1990 and the responsibility of whoever generates the waste makes sure that the waste is generated as per national guidelines (Banks et al. 2019, p. 6). Some practices need to be remembered about the criticality of ensuring security related to waste collection points and the safe sitting of the containers. However, with the recent changes within the structure and integration of community within the domain of primary care services, the audits can be termed as a good baseline indicator for measuring the health standards and standards are needed to establish the recommended changes related to infection control. There is an absolute need to ensure the safety of the patient and provide quality care to the same (Reinheimer et al. 2016, p. 30110). This could easily be available through the implementation of yearly infection control audit visit and is greatly dependent on the resources available. It becomes clear enough to understand that not all practices are incorporated within the audit project and will continue to work under the guidance of clinical governance team for producing necessary advice.

Discussion

As per the study conducted by Malonga et al. (2017, p. 75), there remains no dearth of policies to maintain the level of hygiene within the workplace. Despite training the staff through the implementation of path goal theory of leadership there remains no fruitful result in a cross infection incidents decrease. The leader nurses were asked to emerge out as potential role models and train the junior nurses about the importance and ways to maintain hygiene. Citing the recent examples, two patients died while being admitted at the Queen Elizabeth University hospital. The patients were a 10 year old child and a 73 year old elderly woman, both infected with Cryptococcus, a yeast like infection (BBC News, 2020). The most common form in humans is related to bird droppings that enter the hospital’s ventilation system after the birds get into the machine room near the roof. One more patient was subjected to serious health concern, due to Mucor infection, a type of mould found in rotting material such as food or found in soil. As influenced by Weiss and Simon (2016, p. 259), the Mucor infection is generally caused by breathing the fungal spores. Further incidents provide unfortunate news of a pair of premature babies dying and one more becoming seriously diseased at the Princess Royal Maternity Hospital, reports suggest that they were infected with Staphylococcus aureus (BBC News, 2020). There remains no doubt that the presence of bacteria is common and it is found on the skin. However, the staph genus bacteria cause infection that can compromise the human immune system, leading to serious health concerns.

To understand the problem related to cross infection within hospitals

There remains no doubt in relation to the fact that there has been a significant decrease in hospital acquired infections. Ten years ago, 200 staphylococcus aureus infections were documented within the healthcare setting (Nexonhygiene.co.uk, 2020). That number has fallen to 110 in a month. As per the recent figures, most improvement was witnessed in 2012. However, since then, the rates of infection have been static. A major outbreak of C. diff can be termed as a contributing factor in 34 deaths at Leven Hospital between 2007 and 2008 (Nexonhygiene.co.uk, 2020). An inquiry based on the same was blamed on systematic failure and personal failure within the healthcare setting. However, over the decade, the rate of infection has fallen. Additionally, lack of historic data makes it difficult to identify the possible trends. The hospitals are doing as much as they can. However, there continues to remain potential gaps that can ensure the control of infection (Weiss and Simon, 2016, p. 258). Thus, it can be conclusively stated it is important to ensure that the healthcare professionals take proactive measures to promise better health outcomes. Newly employed health care professionals, often in charge of maintaining the level of cleanliness.

The demonstration of forestalling nosocomial related contaminations is perhaps the best concern. Medical clinic procured diseases (HAIs) is a significant wellbeing related worry for the medical services suppliers and patients the same. Thinking about the pace of mortality and dismalness, expanded length of remain and cost viability should chip away at making the medical clinics a protected spot to remain (Dunne et al. 2018, 329). The flow investigates writing takes a shot at proposing appropriate colour coded rules that can chip away at guaranteeing that the pace of disease rate is constrained inside the social insurance settings.

Keeping the medical clinics, clean is one of the apparent methods for lessening disease. Be that as it may, without the likely methods for cleanliness arrangements they could bring about genuine ramifications for the patients, guests and staff. In spite of the fact that human services, associations nowadays practice legitimate cleanliness strategies by utilizing cleanser containers for cleaning hands and taps for washing hands, sullying keeps on being a prime issue and can prompt genuine outcomes. An examination led by Basildon and Thurrock University NHS Hospitals Foundation Trust in 2009 recommended that poor nursing practices and absence of legitimate cleanliness approaches can pave the way to 400 passings every year (Hummel, Vleck and Greenough, 2019, p. 422). In this way, the motivation behind the ebb and flow look into paper is to give handy direction on the approaches to attempt cleaning of contaminated zones, for example, the outpatient office, inpatient medical clinic ward, facility room and minor wound unit. The approach will chip away at depicting wiping exercises completed every day, profound cleaning and yearly cleaning.

Colour coding cleaning materials and gear ensures that these things are not utilized in a few zones, in this manner decreasing the odds of cross disease. The National Patient Safety Agency (NPSA) has framed a national colour coding plan for cleaning materials found in the medical clinic and related human services settings (Degbey et al. 2019, p.2233). The flow explores advances with the planned point that it can take a shot at giving appropriate proposals to embrace the conceivable code as a standard to be actualized for improving the security system and streamlining the current plan with restricted asset suggestion for administration. All the cleaning materials, disposable and reusable containers, mops, covers and fabrics ought to be appropriately coded by colour. The technique actualized to colour code things ought to be changeless and according to the neighbourhood existing practices to guarantee appropriate cleanliness. NPSA further suggests, NHS associations giving inpatient administrations should take a shot at receiving the strategy to grasp the National Colour Coding Scheme (Freuler et al. 2016, p. 278). The explanation behind such suggestion can be credited to the way that the present practices vary from the standard practices. The prime point of the colour coding framework is to bring issues to light of overhauled practice among the social insurance laborers. A thorough comprehension about the colour coding practice across different NHS associations will make it more obvious the current practice and stick to one cleanliness practice.

Practice attendants work in segregation, when contrasted with the medical attendants working inside the intense division. It is accepted that updates identified with general practices executes the progressions at comparable rates inside same gauges. Be that as it may, this may not be the situation constantly and the data with respect to cleaning and extra disease control issues may not arrive at the training staff. The nearby rules on clinical administration by CICN proposes the correct sort of disease control rules for general practices and also utilizes strategies, for example, keeping the hands clean, while utilizing defensive attire (Jones et al. 2017, p. 143). The second clinical rule is identified with overseeing episodes identified with blood borne viral contamination. The standardised competency framework related to clinical research, irrespective of the background can provide valuable guidance related to better practices within the healthcare settings.

Importance of colour coding within hospital settings

Colour coding within the health sector links to the systematic process of displaying information through the use of different colours for display of information. As per the study conducted by Heudorf et al. (2017, p. 11), acknowledging the existing scarcity of professionally trained and skilled healthcare workers, especially with poor resources colour coding can be termed as an important tool for providing quality healthcare. Within the domain of public health care facilities, the aim is to improve the health indicators within the general population, implementation of colour coding practices acts as a rationale to begin a suitable line of management. Furthermore, colour coding can work on reducing the therapeutic errors and enhance ability about differences related to healthcare. Thus, it can be conclusively stated the implementation of colour coding can be termed useful for answering the required need to maintain cross cultural infection (Heudorf et al. 2016, p. 11).

The use of colour coding on the products for the purpose of cleaning has been around years and used in several places such as care homes. Unfortunately, there remains no single code of colour coding to avoid potential confusion. As observed byJolliff and Reed (2017, p. 48), several care homes and hospitals have asked for a universal colour code making the process of cleaning safe and lowering the potential risk of infection. In the UK, NSPA relied on four core colours, blue, red, yellow and green. Nevertheless, there have been an estimated fifty different schemes and most the colour code does not revolve around the exact core colours and each healthcare organization uses it differently, posing risk for new staff workers. A research based study conducted by Türk et al. (2017, p. 113), states that colour coding standards are important as colour coding the products can lower the chances of infection. As supported by Malonga et al. (2017, p. 75), clean same cleaning products are used in multiple areas, the chances of bacterial or viral infection being spread from one place to another tends to be high.

The concept of colour coding is to make the healthcare professional aware of the significance of each colour. Currently there remains a clear lack of knowledge among the professionals associated with hygiene practices. Thus, with the mentioned practices there remains a chance of prevention of cross contamination incidents. Nonetheless, without a proper colour code for practice, of the hygiene related practices. This demands for a universal code all over the UK (Dunne et al. 2018, 328).

Incident related to colour coding

The ongoing pandemic episode of nCoV-2019 can be named as an issue of concern. The referenced intercession can chip away at diminishing the odds of disease. The epic coronavirus is exceptionally irresistible in nature and poor cleanliness practice can prompt potential issues. The coronavirus issue can deal with expanding the potential dangers. However, the mentioned virus is a major cause of concern until recent times and not like MRSA, which is termed to be a leading cause of hospital acquired infection. The case study in the mentioned scenario can be seen to be attributed to the use of a wrong mop for cleaning purposes. The chosen healthcare staff was asked to clean the rooms and was informed to pay additional attention to a special patient suffering from MRSA. However, the staff mopped all the rooms with the same mop, including the room of the patient suffering from MRSA. Within a few days there was a spread of MRSA within the whole ward. The spread of MRSA could have been easily avoided by proper colour coding practices. The root cause analysis of the incident sheds light on the existing gap within policies.

Management of infectious diseases demands the implementation of robust surveillance. As per the study conducted by Malonga et al. (2017, p. 75), Lewin’s model for change can work on making sure that the change needed to implement colour coding practices can work on ensuring better health outcomes. The change in regards to implementation of colour coding can be done smoothly and as per the chain of infection transmission. The use of colour coded mechanism can work on reminding the healthcare professionals about the potential risks. As influenced by Reinheimer et al. (2016, p. 30110), the colour codes can work on providing a visual reminder to the workers about the mops and other cleaning materials as per the area of concern.

For instance, it becomes important to understand that not all healthcare workers are not adequately skilled enough to understand the importance of hygiene maintenance. As influenced by Reinheimer et al. (2016, p. 30110), the contingency theory coupled with systems theory can work on ensuring that managing people and providing the needed guidance. Thus, it can be conclusively stated that cleaners within the healthcare settings tend to have greater health implication, even more than the nurses. The Hawthorne effect can be termed as one of the potential motivators within the domain of hygiene related practices. For instance Banks et al. (2019, p. 6), healthcare staff are seen to maintain a high level of adherence to hygiene related practices. Hence, it can be clearly stated that the health related hygiene practices. This can work on having both positive and negative effects.

Conclusion and recommendation

Based on previous study conducted by researchers on the process of hygiene maintenance, it did not gain significant momentum. The lack of momentum can be attributed to a series of factors such as poor skills or simple reluctance to follow the instructions. However, the aspect of colour coding practices for hygiene maintenance can work on ensuring better practices as it does not demand complex skill and high levels of dedication for following the hygiene related practices. Thus, it can be conclusively stated it is important to understand the importance of hygiene related practices within the healthcare setting and the staff in charge should work on establishing new ways for ensuring lower rates of infection. In similar regards, it is important to train the staff and explain to them the importance of following a secure colour coding practice.A strict adherence to a single colour coding practice can work on ensuring better hygiene compliance.

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Reference list

Åttman, E., Korhonen, P., Tammela, O., Vuento, R., Aittoniemi, J., Syrjänen, J., Mattila, E., Österblad, M. and Huttunen, R., 2018. A Serratia marcescens outbreak in a neonatal intensive care unit was successfully managed by rapid hospital hygiene interventions and screening. Acta Paediatrica, 107(3), pp.425-429.

Banks, M., Phillips, A., Chin, K. and Bruno-Murtha, L.A., 2019, October. 1186. Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital. In Open Forum Infectious Diseases (Vol. 6).

Boisset, S., Saadatian-Elahi, M., Landelle, C., Bes, M., Gustave, C.A., Tristan, A., Fassier, J.B., Laurent, F., Grando, J., Vandenesch, F. and Bouchiat, C., 2019. Unexpected categories at risk of S. aureus nasal carriage among hospital workers. International journal of hygiene and environmental health, 222(8), pp.1093-1097.

Brusaferro, S., Arnoldo, L., Finzi, G., Mura, I., Auxilia, F., Pasquarella, C. and Agodi, A., 2018. Hospital Hygiene and Infection Prevention and Control in Italy: state of the art and perspectives. Ann Ig, 30(2), pp.1-6.

Chadwick, C., Mumma, J.M., Durso, F.T., Casanova, L.M., Erukunuakpor, K., Salmon, S., Phua, M.Y., Fisher, D., Read, M.E., Olson, A.J. and Calderwood, M.S., 2019. Infection control 4: good hand-hygiene practice for hospital patients. Nursing Times, 115(9), pp.27-28.

Degbey, C.C., Yansambou, M.S., Sopoh, G., Amadou, M.H. and Ouendo, E.M.D., 2019. Assessment of the quality of hospital hygiene at Gaweye District hospital in Niamey in 2018. International Journal of Biological and Chemical Sciences, 13(4), pp.2233-2244.

Dunne, C.P., Kingston, L., Slevin, B. and O'Connell, N.H., 2018. Hand hygiene and compliance behaviours are the under-appreciated human factors pivotal to reducing hospital-acquired infections. Journal of Hospital Infection, 98(4), pp.328-330.

Frantzana, A. and Charalambous, M., 2019. Hospital Hygiene and Safety. Am J Biomed Sci & Res, 2(5), pp.172-176.

Freuler, C., Torres, D., Urquiza, M., Prieto, R., Montero, P., Sanchez, A.V., Wolf, M.M., Posadas, M.G., Radosta, M., Allende, N.G. and Ezcurra, C., 2016. Non-microbiological system to improve hospital hygiene in a critical care unit (CCU). International Journal of Infectious Diseases, 45, pp.278-279.

George, C.M., Monira, S., Sack, D.A., Rashid, M.U., Saif-Ur-Rahman, K.M., Mahmud, T., Rahman, Z., Mustafiz, M., Bhuyian, S.I., Winch, P.J. and Leontsini, E., 2016. Randomized controlled trial of hospital-based hygiene and water treatment intervention (CHoBI7) to reduce cholera. Emerging infectious diseases, 22(2), p.233.

Heudorf, U., Gasteyer, S., Müller, M., Samoiski, Y., Serra, N. and Westphal, T., 2016. Prevention and control of catheter-associated urinary tract infections–implementation of the recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) in nursing homes for the elderly in Frankfurt am Main, Germany. GMS hygiene and infection control, 11.

Heudorf, U., Gruenewald, M. and Otto, U., 2016. Implementation of the updated 2015 Commission for Hospital Hygiene and Infection Prevention (KRINKO) recommendations “Prevention and control of catheter-associated urinary tract infections” in the hospitals in Frankfurt/Main, Germany. GMS hygiene and infection control, 11.

Hummel, A.T., Vleck, K. and Greenough, W.B., 2019. A quality improvement initiative for improving hospital visitor hand hygiene. Journal of Hospital Infection, 101(4), pp.422-423.

Jolliff, K. and Reed, R., 2017. The Journey to Improve Hand Hygiene Compliance Through Data Validation and the Evaluation of Compliance Barriers and Interventions. American Journal of Infection Control, 45(6), p.S48.

Kuelpmann, R., Christiansen, B., Kramer, A., Luederitz, P., Pitten, F.A., Wille, F., Zastrow, K.D., Lemm, F., Sommer, R. and Halabi, M., 2016. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings–Guideline of the German Society for Hospital Hygiene (DGKH). GMS hygiene and infection control, 11.

Malonga, K.F., Mbutshu, H.L., Ngandu, J.J.L., Ntambue, M.A. and Makoutode, M., 2017. Hospital Hygiene Maternity Hospital Public Lubumbashi Democratic Republic of Congo. Open Journal of Preventive Medicine, 7(4), pp.74-85.

Mutters, R. and Mutters, N.T., 2016. Hygiene and infection control measures in intensive care units. Medizinische Klinik, Intensivmedizin und Notfallmedizin, 111(4), pp.261-266.

Nematian, S.S.S., Palenik, C.J., Mirmasoudi, S.K., Hatam, N. and Askarian, M., 2017. Comparing knowledge and self-reported hand hygiene practices with direct observation among Iranian hospital nurses. American journal of infection control, 45(6), pp.e65-e67.

Nobile, M., Agodi, A., Barchitta, M., Brusaferro, S., Castaldi, S., D'Alessandro, D., Montagna, M.T., Mura, I., Tardivo, S., Torregrossa, M.V. and Zannini, L., 2018. The effectiveness of educational interventions in university training on hospital hygiene: results of action research. Annali di igiene: medicina preventiva e di comunita, 30(5 Supple 2), pp.111-120.

Pasquarella, C., Ciorba, V., Arnoldo, L., Auxilia, F., Baldovin, T., Barchitta, M., Bianco, A., Calagreti, G., Casini, B., Cristina, M.L. and De, O.G., 2018. Hospital hygiene in Italy: the GISIO-SItI survey. Annali di igiene: medicina preventiva e di comunita, 30(5 Supple 2), pp.7-14.

Pfäfflin, F., Tufa, T.B., Getachew, M., Nigussie, T., Schönfeld, A., Häussinger, D., Feldt, T. and Schmidt, N., 2017. Implementation of the WHO multimodal hand hygiene improvement strategy in a University Hospital in Central Ethiopia. Antimicrobial Resistance & Infection Control, 6(1), p.3.

Reinheimer, C., Kempf, V.A., Göttig, S., Hogardt, M., Wichelhaus, T.A., O’Rourke, F. and Brandt, C., 2016. Multidrug-resistant organisms detected in refugee patients admitted to a University Hospital, Germany June‒December 2015. Eurosurveillance, 21(2), p.30110.

Richter, A., Chaberny, I.F., Surikow, A. and Schock, B., 2019. Hygiene in medical education–Increasing patient safety through the implementation of practical training in infection prevention. GMS journal for medical education, 36(2).

RN, O.D., Jones, D., Martello, M., Biron, A. and Lavoie‐Tremblay, M., 2017. A systematic review on the effectiveness of interventions to improve hand hygiene compliance of nurses in the hospital setting. Journal of Nursing Scholarship, 49(2), pp.143-152.

Rodríguez-Sánchez, B., Cercenado, E., Coste, A.T. and Greub, G., 2019. Review of the impact of MALDI-TOF MS in public health and hospital hygiene, 2018. Eurosurveillance, 24(4).

Steul, K., Exner, M. and Heudorf, U., 2019. Personal preconditions for the prevention of nosocomial infections-guidelines of the German Commission for Hospital Hygiene and Infection Prevention (KRINKO), federal state hygiene regulations in Germany, and compliance by hospitals in Frankfurt am Main. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 62(3), pp.329-340.

Tamburrano, A., Mariani, M., Giubbini, G., Barbara, A., Sabetta, T., Bruno, S., Quaranta, G., Vincenti, S., Cambieri, A., Damiani, G. and Laurenti, P., 2018. Resident physicians' participation to the activities of the hospital hygiene unit in a teaching hospital: a pilot study. Igiene e sanita pubblica, 74(5), pp.407-418.

Tenenbaum, T., Becker, K.P., Lange, B., Martin, A., Schäfer, P., Weichert, S. and Schroten, H., 2016. Prevalence of multidrug-resistant organisms in hospitalized pediatric refugees in an University Children’s Hospital in Germany 2015–2016. infection control & hospital epidemiology, 37(11), pp.1310-1314.

Türk, S., Christersson, J., Rööp, T. and Didenko, D., 2017. Comparison of bacterial loads of two types of hospital pillows: Perspectives of improving hospital hygiene standards. Canadian Journal of Infection Control, 32(2), pp.112-114.

Türk, S., Christersson, J., Rööp, T. and Didenko, D., 2017. Comparison of bacterial loads of two types of hospital pillows: Perspectives of improving hospital hygiene standards. Canadian Journal of Infection Control, 32(2), pp.112-114.

Volc, S., Maier, J.C.P., Breuninger, H., Hund, V., Häfner, H.M. and Kofler, L., 2019. Manufacture and use of tumescence solution meeting hospital‐required hygiene conditions–practical implications. Journal of the European Academy of Dermatology and Venereology, 33(11), pp.e434-e435.

Ward, D., 2017. Implementing infection prevention and control precautions in the community. British journal of community nursing, 22(3), pp.116-118.

Waters, R., 2016. Colour-coded dental care. Dental Nursing, 12(9), pp.520-521.

Weiss, K. and Simon, A., 2016. Antibiotic Stewardship and Hospital Hygiene in German Paediatric Inpatient Facilities: A Qualitative Survey from the Paed IC Working Group. Klinische Pädiatrie, 228(05), pp.257-262.

Wigglesworth, N., 2019. Infection control 3: use of disposable gloves and aprons. Nursing Times, 115(7), pp.34-36.