An infection is the result of an interaction between a susceptible hose and an infectious agent (bacteria, viruses, fungi, parasites) a clinical syndrome caused by the invasion and multiplication of a pathogen in the body. Infections are: Localized Systemic
Course of Infection
The course of an infection can be divided into four major phases:
Phases of an infection
1. Incubation phase 2. Prodromal phase 3. Period of Clinical illness 4. Convalescence
Transmission of Infection
The health care system itself is another factor in infectious disease transmission. The public has a right to expect that the risk for acquiring an infection during hospitalization be minimal, however controlling hospital-acquired infections is a major health care problem. A nosocomial infection is one that a patient acquires while in a health care facility. The infections can be simple and uncomplicated, or major and life threatening. Patients are at risk for nosocomial infection because they often have weakened immune system sand because the health care facility contains patients and equipment that harbor infection. An Iatrogenic infection is the direct result of treatments. Goal 4 of the National Patient Safety Goals (NPSG’s) is directed toward infection- related sentinel events” “Preventing health-care associated infections”. A sentinel event is an unexpected occurrence that leads to serious injury or death. Not all infections result in sentinel events, but health-care related infections are a serious problem. In the United States, health care-associated infections occur in about one tenth of hospitalized patients, and about 90,000 patients die of such infections each year. Health care-associated infections are preventable.
Defenses against Infection
Primary: 1. Skin and mucous membrane
2. Respiratory system 3. Gastrointestinal system 4. Circulatory system Secondary: 1. Inflammatory response 4. 5. 2. 3. 2. Immune response
Chain of Infection
For an infection to occur, certain conditions must be met. This process can be thought of as a chain of infection. There are six links in the chain of infection: 1. Source of infection / causative agent Portal of Entry to susceptible host Reservoir Portal of Exit from the reservoir Mode of Transmission 6. Characteristics of the Susceptible Host
Risk for infection RT:
The patient will: 1. 2. 3. INTERVENTIONS Although it is impossible to ensure that the patient’s environment is free of microorganisms, there are many steps that a nurse can take to reduce the spread of microorganisms and thus promote safety for both the patient and the staff.
Infection control measures used in the hospital include: 1. Medical Asepsis 2. Standard Precautions 3. Isolation Precautions
Medical asepsis, or clean technique, refers to practices designed to reduce the numbers of pathogenic microorganisms and limit their growth and transmission in the patient’s environment.
Why practice Medical Asepsis?
1. Helps the patient fight a current infection and prevent its spread. 2. Prevents the patient from being re-infected by the same pathogen. 3. Prevents the patient from being infected with a new pathogen. 4. Prevents health care professionals and visitors who come in contact with the patient from being infected. 5. Helps decrease the chance of the patient acquiring a nosocomial infection and dying because of a hospital-acquired infection. The desired result is to reduce the transmission of the microorganisms from one person to another or from one person to an object.
Medical Asepsis – Hand-washing
The first line of defense in medical asepsis is hand-washing. Proper hand-washing is considered the single most effective way to stop the spread of microorganisms and preventing infections.
Safety Check Prior to Hand washing:
Prior to the start of hand washing it is important to make a safety check of the hands. Assess that the nails are short (can not be seen from the palm side), jewelry is removed and skin is free of lesions. If the skin should have a small lesion, bandage the area and then double glove.
When Should You Wash Your Hands:
At the start and end of each shift After sneezing or coughing After using the bathroom After handling contaminated (soiled) items such as urinal, bedpan, dirty linen Before and after giving patient care; between patients After handling body excretions even with gloves on Before and after performing any treatments After removing gloves. Bacteria on the skin both transient and resident multiply rapidly on the warm, moist skin under the gloves. In addition, gloves have pores, can have small microscopic holes or tears that allow microorganisms to spread. **When in doubt, WASH YOUR HANDS
Guidelines and Principles of Medical Asepsis Related to Hand-washing
Although the most effective preventive method of decreasing hospital acquired infections is hand washing, it is used inconsistently and sometimes is done inadequately. Both the Joint Commission and the Quality and Safety Education for Nurses (QSEN) project funded by the Robert Wood Johnson Foundation (RWJF) are striving to address the challenge of preparing future nurses with the knowledge, skills and attitudes necessary to continuously improve the quality and safety of the healthcare systems in which they work. One of the ways to accomplish this goal is to perform hand washing effectively. 4.
1. Wash hands for 15 seconds 2.
Clean from the cleanest area to the dirtiest area (wrist to fingers) 3.
Friction, running water, and a cleansing agent are necessary to remove microorganisms Do not touch the sink when washing hands Keep clean items separate from dirty ones. Turn off water with a dry paper towel Jewelry makes it difficult to adequately cleanse the hands. It is best to not wear any jewelry in the clinical setting. If rings are worn, wash rings in place on the hands. If a watch is worn, keep watch higher above the wrist.
Alcohol Based Handrubs
Alcohol-based hand rubs (foam or gel) kill more effectively and more quickly than handwashing with soap and water. They are less damaging to skin than soap and water, resulting in less dryness and irritation. They require less time than hand washing with soap and water. Bottles/dispensers can be placed at the point of care so they are more accessible.
How to Use HAND RUB (foam and gel):
Apply to palm of one hand (the amount used depends on specific hand rub product). Rub hands together, covering all surfaces, focusing in particular on the fingertips and fingernails, until dry. Use enough rub to require at least 15 seconds to dry.
Modifying Hand-washing Outside the Hospital Setting:
1. Bring bacterial soap and paper towels with you to the patient’s home
2. If no running water is available in the home or other setting, use disposable wipes or alcohol.
Standard Precautions are a set of guidelines developed by the Centers for Disease Control and Prevention (CDC) for preventing contact with potentially infectious blood or body fluids that may harbor diseases regardless of whether or not they contain visible blood. The CDC spent several years researching, improving, and developing recommendations to protect health care providers, patients, and their visitors from infectious diseases. This intensive period of research resulted in Standard Precautions, a set of infection control guidelines that should now be utilized by all health care professionals for all patients. Standard Precautions are those precautions designed for the care of ALL patients in hospitals regardless of their diagnosis or presumed infection status. It is mainly used for: All body fluids, secretions and excretions regardless of whether or not they contain visible blood such as: o o o o sputum urine or feces nasal secretions vomitus/ emesis spinal fluid / cerebrospinal fluid o o o semen synovial, pleural, peritoneal, pericardial, amniotic fluid All moist body surfaces, mucous membranes both intact and non-intact Standard precautions are used for 1.
Blood infections. These precautions should be implemented whenever contact with potentially infectious material is anticipated. Also used to protect the caregiver.
Components / Guidelines of Standard Precautions:
Hand-Washing Personal Protective Devices a.
patients, not just with those with known Mask, Eye Protection, Face Shield, Gown 3.
Patient-care equipment Environment Linen Sharp Objects
First step in standard precautions is hand washing. Hands must be washed after patient contact regardless of the use of gloves. Gloves do not replace proper hand-washing.
Gloved hands cannot be effectively washed
Gloves can be used as a physical barrier to interrupt transmission and to avoid direct contact with infectious material. Made of vinyl or latex -- vinyl are used especially if allergy to latex is present.
Health care providers should be aware that some people, including professionals and patients, can be allergic to latex products. Some personal protective equipment (PPE) is made from latex; medical and surgical products also are often made from this product. Gloves must be worn to handle: o Blood o Body fluids o o o Secretions, Excretions Contaminated items – linens, equipment. Etc. Contact with moist body surfaces or open / broken skin and mucus membranes. Change gloves before proceeding to the next task, or touching different areas even on the same patient (moving from oral to perineal care).
Mask, Eye Protection, Face Shield, Gown
These techniques also act as physical barriers and all should be worn to reduce the possibility of contamination of mucous membranes of the mouth, nose, and eyes. Masks provide barrier protection against splashes and sprays, and airborne droplets. Masks come in various types depending on their permeability to airborne particles. Eye goggles or glasses and face shields provide barrier protection against splashes and sprays. Gowns or aprons should be water impermeable to provide barrier protection.
Handle equipment in a manner that prevents personal skin and mucous membrane exposure and cross contamination to other patient’s. Reusable equipment must be cleaned and reprocessed before using it in the care of another patient. Resuscitation equipment should be readily available.
Each hospital, clinic should have procedures for care, cleaning, and disinfection of environmental surfaces. They must be decontaminated with an approved chemical germicide. Spills of blood or body fluids need to be handled with special procedures.
Handled in a way to prevent contamination of skin, mucous membranes, and clothing. Fold soiled linen with contaminated area to the inside. Hold away from
body and place in appropriate bag and dispose of properly in leakage resistant bags.
Place all needles, syringes, scalpel blades, and other sharp objects in a puncture proof container. Do not re-cap needles or remove non-sterile needles from disposable syringes. Immediately discard sharps after use. Do not attempt to bend of break a needle before discarding. Throw away the whole thing.
Isolation precautions are utilized when: a. the patient has a greater susceptibility to infection than others b. a patient or a patient’s body fluids are a known carrier of infection or microorganisms that can easily be transmitted to other patients, family members, or health care workers.
Isolation Precaution Categories
In addition to standard precautions, the CDC recommends three categories of transmission-based precautions. They include: 1. Airborne precautions 2. Droplet precautions 3. Contact precautions
Used in addition to standard precautions when the organism is capable of remaining in the air for prolonged periods of time and can be transported in the air for Distances greater than 3 feet. Some of the most common organisms are: Tuberculosis, Chicken pox, Measles. A private negative air pressure room is used for patients needing airborne precautions. Negative air pressure rooms bring air into the room from the hallway and have a separate exhaust system. The patient’s diagnosis and treatment regime will determine what the nurse needs to wear when entering the room. Outside the room is an isolation cart that contains supplies needed to care for the patient and to protect visitors from infection. The isolation cart usually contains gowns, disposable gloves, goggles, linen bags, hampers for dirty linen, and medical supplies. Most important is should have a respirator mask. Must wear a special particulate filter or respirator mask. These masks must be properly fitted to the face of the health care worker and then checked to ensure that the mask fits as securely as possible. Fit testing is performed prior to entering the room. All patients on airborne precautions should wear surgical masks when leaving the negative air pressure room for x-rays, tests, or procedures.
Designed to prevent diseases that can be transmitted by large airborne droplets through the air that can be inhaled by health care workers or visitors. This includes organisms that can be spread through the air but are unable to remain in the air further than 3 feet. Examples of such organisms include: Influenza, colds, meningitis, mumps, and pertussis. Single rooms are preferable, but patients with the same disease can share the same room. Standard surgical masks without a filter must be worn for anyone coming within 5 feet of the patient. Gowns should be worn if clothing or uniforms are likely to become contaminated with respiratory secretions. Gloves should be worn anytime handling tissues or any items contaminated with the respiratory secretions.
Contact precautions prevent the transmission of disease by direct or indirect contact. Direct contact involves touching, bathing, or skin-to-skin contact. Indirect contact involves contact with inanimate objects such as doorknobs, light switches, tabletops, and telephones. Contact precautions include use of barrier precautions such as gloves and impermeable gown to prevent direct contact with the infectious organism. Used: - for patient with diarrhea ( E. coli, c difocelle, etc.) - when coming into contact with draining wounds, cellulitis, burns, conjunctivitis, Scabies, or impetigo - for patients with acquired antibiotic resistance infections
Used with patients who are immunocompromised such as: Chemotherapy AIDS Organ transplant
Example of a hospital’s plan to care for contaminated equipment:
If visibly soiled, clean and wipe with hospital-approved disinfectant the following items:
*B/P cuff *Stethoscope Bedscales Electronic thermometer Furniture IV poles Mattresses and pillows Telephone Trash containers Wheel Chairs *reusable stethoscopes are used with each category of isolation; B/P cuffs are discarded for certain organisms and types of isolation.
(ie. C. difficile and VRE)
If visibly soiled, cover with or place in impervious plastic bag and send to CS the following items:
Aqua K machines Pneumatic compression machines Protective eye wear Sand bags, shock blocks Reusable equipment, instruments, such as procedure trays
Discard the following items in the regular trash:
Bath basin Colostomy bag Compression stockings (TED Hose) Eggcrate mattress Emesis basin Foley bag (empty first) Isolation attire(mask,gown,gloves) IV bags / tubing Paper Tourniquet Water pitcher
Discard the following items in needle boxes:
All sharps Broken glass Glass thermometers Lancet Needles Syringe with needle Vials Disposable instruments from procedure trays (suture removal)
Discard the following items in Biohazard Boxes:
Blood bags / tubing Chest tubes systems Dressing saturated with blood Surgical drains / suction bulbs Suction canisters regardless of contents
Discard the following items in impervious bags:
All linen regardless of what is on it or where it came from. Exceptions: linen so grossly saturated with blood that it will pool if disposed of in biohazard boxes general service linen (ie. Mop heads) are placed in a clear plastic bag to be laundered on site.