Infection Prevention & Control for SCI

What you need to know to avoid infections when living with a spinal cord injury

Infections are caused by bugs such as bacteria, fungi or viruses entering the body. Infections  can be minor and stay in one area, like a boil, or their effects can be felt throughout the body, like flu. Often, infections are easily dealt with, but sometimes infections can be more serious.


The emergence of MDROs (multi-drug resistant organisms) is increasingly recognized as a major public health threat . A MDRO is a bacteria that is resistant to many antibiotics. If a bacteria is resistant to an antibiotic, it means that certain antibiotics will not work. MDROs can be challenging to treat, since there are limited antibiotics that work to treat them. A person can be either colonised or infected with an MDRO. If a person is colonised, it means that the bacteria is present on their skin or in a body opening e.g. the bowel, but they have no signs of illness. If a person is infected, it means that the bacteria is present on their skin or in a body opening and it is causing illness


UTIs (urinary tract infection) commonly occour in patients with spinal cord injury (SCI) , some patients will have recurrent UTIs.  Recurrent UTI requires multiple courses of antibiotic therapy, markedly increasing the incidence of MDROs (salomen et al 2006). If you catheterise, you will always have bacteria in your urine. Resistant bacteria can form if:

  • You use an antibiotic again and again with bacteria present in the urine but no physical signs of infection,
  • You use antibiotics repeatedly to treat full-blown infections
  • You stop taking prescribed antibiotics before all the targeted bacteria are killed.

In all three cases, some of the bacteria can survive, reproduce and eventually become a completely resistant strain.

Hand Hygiene

Hand hygiene is the most important measure to avoid the transmission of harmful bacteria and prevent health care-associated infections (WHO 2015). Cleaning hands gets rid of bacteria you pick up from other people, from the surfaces you touch and prevents these bacteria being spread to others. Just because hands look clean, we can’t assume that they are clean. To reduce the spread of infection it is important that hand hygiene is carried out at the right time and in the right way. Hand hygiene should be carried out at the following times:


  • Opening a urinary catheter bag
  • Preparing/ handling food
  • Putting on gloves


  • Using the toilet (changing incontinence pads)
  • Blowing your nose or after sneezing in your hands
  • Touching raw meat, poultry, or fish
  • Handling rubbish
  • Visiting or caring for sick people
  • Contact with areas/ items in the home likely to be contaminated during household duties e.g. bins or cleaning cloths, toilets, touching pets


Extra opportunities for Carers:

Hand hygiene should always be carried out:

  • Before any clean task such as assisting a client to brush their teeth, bed bath, shower, putting on gloves
  • After any clean task such as assisting a client to brush their teeth, bed bath, shower dressing the client
  • After contact with body fluids such as handling soiled bed linen, emptying commodes/urinals
  • After removing gloves
  • After they  leave the home when care is finished
  • Hand hygiene can be carried out with alcohol hand rub or soap and water


Alcohol Hand Rub

  • If your hands look clean, use an alcohol based hand rub
  • Apply a sufficient amount to cover hands
  • Rub the alcohol hand rub into all areas of your hands for a minimum of 20 seconds
  • Alcohol hand rub is not effective if your hands are dirty or if you have an infection caused by C. diff.
  • Alcohol content should be at least 70%.


Standard Precautions

Standard Precautions are a set of protective measures designed to prevent contact with blood and body fluids of any other person. They are used at all times regardless of whether or not you know if there is an infection. They include the following:

  • Hand hygiene
  • Sneezing and cough etiquette (sneeze into your arm or a tissue)
  • When to wear gloves, aprons and masks/goggles
  • Cleaning of the home and care equipment
  • Care with laundry
  • Dealing with body fluids safely
  • Care with needles (sharps)

Infectious diseases in carers can be readily transmitted to susceptible clients. Thus a carers health, hygiene and immunisations, e.g. Hep B, influenza, are all important.

Personal protective equipment

Your carer should wearn an apron and gloves while performing intimate care for you. If an MDRO is present, the carer should wear a long sleeved gown for prolonged and intimate care such as turns, bladder or bowel management.


  1.  HSE South (Cork and Kerry) (2011). Infection Prevention & Control. An Information booklet for Home Helps and Personal Assistants.
  2. Lawrence J. and May D. (2003). Infection Control in the Community. London, Churchill Livingstone.
  3. Rhinehart, E. & McGoldrick, M (2006) Infection Control in Home Care and Hospice London, Jones and Bartlett.
  4. HSE/HPSC (2009). Standard and Transmission- based Precautions. Draft consultation document, November 2009. Local contact


Written by Catherine O’Neill, Infection Prevention & Control Nurse at the National Rehabilitation Hospital in Dun Laoghaire.



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