Infection Control
*Some policies and procedures may be facility specific.
Healthcare - Associated Infections

Healthcare-Associated Infections are infections that patients aquire during
the course of receiving treatment for other conditions within a healthcare
setting.

Healthcare-Associated infections are one of the top ten leading causes of
death in the United States.

1.7 million patients develop Healthcare-Associated infections and 99,000
die
Healthcare-Associated infections cost up to $45 billion annually

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At least 60% of Healthcare-associated Infections are caused by Drug
Resistant Organisms

20% of these are preventable.
Chain of Events

Three Elements must be present for an infection to spread to
hospital patients:
– Source of Pathogen – Causative Agent
– Susceptible Host – Patients and/or Care Providers
– Mode of Transmission - Transmission route for microorganisms
from person to person or object to person
Chain of Infection
Causative
Agent
Mode of
Transmission
Breaking The Chain

Infection control policies exist to help break the chain of events
that leads to the spread of infection.

Infection Control Activities Include:
–
–
–
–
Handwashing
Isolation Techniques
Use of Personnel Protective Equipment
Occupational Exposure Plan
HANDWASHING

Handwashing is the most important activity you can do to prevent the
spread of infection.
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15-20 seconds of friction
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Rinse from wrist to fingertips
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Turn faucet off with paper towel
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Wash before and after each patient contact or contact with patient room
environment.
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Wash after removing gloves
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Wash after using the restroom
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Wash before eating
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Alcohol handrinse should be used if hands are not visibly soiled
Artificial Nails

CDC advisory – do not wear artificial nails, tips, overlays or decorations
on nails for healthcare workers who have direct contact with patients

Do not wear old or chipped nail polish

Keep nails short.

Scientific studies indicate increased fungal and bacterial colonization in
healthcare workers with artificial nails
Isolation Precautions

Currently there are two types of Isolation Precautions:
– Standard Precautions: Used when caring for all patients, also
known as Universal Precautions
– Transmission Based Precautions: Used in addition to standard
precautions for specific disease processes.
Contact
 Droplet
 Airborne
 Protective

Standard or Universal Precautions
The Key Principle
Treat all Blood, Body Fluid, Secretions and Excretions as if potentially
infectious for HIV (the virus that causes AIDS), Hepatitis B,
Hepatitis C, or other blood borne pathogens
BloodBorne Pathogens




Hepatitis B, Hepatitis C and Human Immunodeficiency Virus
(HIV) are the most commonly known bloodborne pathogens.
The main ways to become infected with these pathogens is
through sexual contact and contact with blood and other body
fluids.
Since we can’t look at a person and tell if they have HIV or HBV,
we have to treat everyone as if they are infected, and follow
standard precautions at all times.
The average risk of infection after accidental exposure is:
– HIV –0.3%
– HBV-5-30% - There is a HBV vaccine series that is available to
reduce healthcare workers risk of infection.
– HCV- 3%
Standard Precautions

Wash hands between patient contact

Use Alcohol hand gel when hands are not visibly soiled

Use proper Personal Protective Equipment (PPE)

Clean up spills with proper technique and disinfectants

Never re-cap needles using two hands

Discard Sharps in approved puncture resistant containers only

Keep food away from possible infectious materials

Never pick up glass with bare hands

Identify places in your work area for eye and face washing if
contamination occurs
Personal Protective Equipment
PPE

PPE is specialized clothing or equipment used to prevent exposure to
health and safety hazards

Gloves should be worn anytime you could potentially come in contact with
blood, body fluids or other potentially infectious materials

Gowns, Masks, Face Shield / Eyewear should be worn anytime a splash of
body fluids is possible

Any contaminated PPE should be disposed of properly in biohazard waste
containers

PPE is supplied by the hospitals

PPE should be in the correct size

You should know where PPE is located

Gloves - latex free and powder free are available
Handling of Needles

Never recap needles using 2
hands

Never bend or break needles

Dispose of all needles in
nearest sharp’s disposal
container

Replace sharps containers
when 2/3 – 3/4 full

Must use safety devices when
available
Cleaning Bloodspills

PPE – Wear gloves. Also gown and eye goggles if a large spill

Contain spill with paper towels or cover; clean with 1:10 fresh
bleach / water solution, or EPA approved germicidal cleaner
then place in red bag

Disinfect by applying 1:10 bleach / water solution ; let air dry

All used linens are to be put
in soiled linen containers /
bags without separating

The biohazard symbol should be used to identify anything or any area
that may present possible exposure to Blood and Body Fluids
Transmission Based Isolation
Precautions

Contact Precautions – Used to reduce transmission of
microorganisms via the contact route. Examples include
Antibiotic Resistant Organisms

Droplet Precautions – Used to reduce transmission of
microorganisms by coughing, sneezing and talking. Examples
include Bacterial Meningitis, Flu, Mumps and Rubella.

Airborne Precautions – Used to reduce transmission via the
airborne route. Examples include TB, Smallpox, SARS and
Chicken Pox – Do not allow non-immune to go in this room

Protective Precautions – For immune-compromised patients
with less than 1000 white blood cells.
Contact Precautions

Follow Standard Precautions .

Follow instructions posted on the door.

Always wear gloves when entering the room.

A gown should be worn if you anticipate that your clothing will come
into contact with the patient or room environment.

Patients with MRSA, VRE, and C.Difficile are examples of patients who
should be placed in Contact Isolation.

Students must be supervised by their preceptor the first time they enter
a Contact Precautions room.
MRSA
(Methicillin Resistant Staph Aureus)

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MRSA is transmitted via direct contact between people or contaminated
objects.
S. aureus produces an ENZYME, betalactamase, which allows it to
become RESISTANT to penicillins
In 1960, Methicillin became available for treating penicillin resistant S.
aureus
S. aureus developed strains resistant to Methicillin and by the mid
1970’s MRSA became a problem
MRSA are resistant to many antibiotics, but can be treated with
Vancomycin, some VRSA (Vancomycin Resistant Staph Aureus) are
now being reported.
75-78% of S. aureus isolated from lab cultures are resistant to
methicillin.
ENTEROCOCCUS

Located in normal flora of the GI and female reproductive tract,
also transmitted via the contact route.

Third most common cause of hospital acquired infections.

Infection occurs in: urinary tract, wounds, central lines

VRE – Enterococcus has acquired vancomycin resistance

VRE – 70% from urinary site – nursing home residents

VRE – Reportable to state from sterile body sites
Risk Factors for Developing
Antibiotic Resistance

ICU Patients

Patients with extended length of stay

Patients with previous admissions

Overuse and misuse of antibiotics

Nursing home residents
Preventing The Spread of Drug Resistant
Organisms

Wash hands between each patient contact

Place patient in Contact Isolation Precautions

Use and dispose of PPE correctly
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Follow strict isolation technique

Use antibiotics appropriately
Droplet Precautions

Follow Standard Precautions.
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Follow Instructions Posted on the Door.

Wear an Isolation Mask if coming within 3-6 feet of the patient.

Some hospitals may require a mask upon entering the patient
room.

Patients with the flu should be placed in Droplet Precautions.

Students must be supervised by their preceptor the first time
they enter a Droplet Precautions room.
Influenza
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10% to 20% of U.S. population will get the flu annually.
36,000 will die, 114,000 will be hospitalized
Most who die will be over 65, but children younger than 2 will be
as likely as elderly to be hospitalized
Healthcare employee vaccination rate has been about 65%,
CDC goal is to vaccinate all HCW (who have no
contraindications to flu vaccine).
CDC recommends vaccination against seasonal flu and 2009
H1N1 flu.
*Per CDC current data
Airborne Precautions

Standard Precautions should be followed

Place patient in a negative pressure room

Door remains closed

Personnel entering room must wear an N95 Particulate Respirator

*Employees must be medically screened and fit tested to wear the
respirator.
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Due to the fit test requirement, students are not to enter the room of
patients in TB isolation.

Visitors/Family are encouraged to refrain from entry to the TB patient’s
room. If entry is elected these individuals are strongly encouraged to
wear an approved dust-mist mask, supplied by the hospital.

*Students have not been screened and fit tested and will not be allowed
to care for patients in Airborne Precautions.
Airborne Pathogens

TB

Chicken Pox

Measles
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Disseminated Herpes Zoster
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Smallpox
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SARS (Severe Acute Respiratory Syndrome)
TB

Mycobacterium tuberculosis

One third of the world has been infected with TB

TB Infection: Body holds the germ in check, but PPD is positive

TB Disease: 10% of persons infected will develop active disease, half
within 2 years of exposure

Active disease is defined as having the bacteria, being contagious, and
symptomatic. A person can be infected with TB but not be
symptomatic or contagious.

40-50% of TB patients have a delayed diagnosis an average of 6 days
resulting in exposure of 25-45 workers for each undiagnosed patient

Health Care Workers should have annual PPD testing done
QUESTIONS to detect TB

Have you been coughing for over 3 weeks?

Have you been coughing at all and have any of the following:
a. Coughing up blood?
b. Sweats at night?
c. Loss of weight without trying?
d. Persistent fever?
Exposure Control Plan

OSHA requires that all hospitals develop an Exposure Control Plan
designed to:
– Reduce your risk of exposure to blood and body fluids
– Provide the use of PPE (Personal Protective Equipment)
– Provide the use of Engineering Controls – ex. Negative pressure rooms
for TB patients, sharps disposal containers
– Provide a Hepatitis B vaccine program
– The plan is located in the Epidemiology Manual (Infection Control) in
your area
Needlestick or Blood Exposure
“Actions to Take if Exposure Occurs”

First Aid – thoroughly wash area

If your eyes get splashed, flush them with water
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Notify supervisor immediately
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Notify Occupational/Employee Health

Complete Needlestick/Exposure forms- this will allow for testing
of the source patient
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Counseling

HIV source - begin post -exposure prophylaxis within 2 hours