The Fundamentals of Infec2on Control Nurse Sharks , Inc.
Laurie Christner, RN, MSN, CRNP
Nurse Sharks, Inc. is an approved provider of
Continuing Education, for nurses in the United States,
through the CA State Board of Nursing, CEP # 14915.
This course is approved from 9/1/14-9/1/16 for 3.0
CEU's
Basic Infec2on Control in Healthcare OBJECTIVES
 Review the infectious disease process through the
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Chain of Transmission
Learn basic techniques to prevent or break the
Chain of Disease Transmission
Know the difference between antisepsis vs.
sterilization
Have knowledge of emerging diseases and
reportable diseases
Learn prevention and control of Multi-drug
Resistant Organisms
Review of LTC infection control regulations; acute
care infection control regulations and work
practices that will minimize your risk of exposure
to pathogenic microorganisms
Disease Transmission and Epidemiology
Section I
Infection Control is
Everyone’s Business
DME’s
P
c
hysi
Hospital
bu
lat
or y
ks
Ca
re
Ce
n
ter
CNA/PCA/CMA
Environmental Services
er
ators
Am
Therapists
Cl
Adm
inistr
ians
Nurses
Patients
Infec2on Control:
Basic Elements
Prevent
io n
Surveillance
Control
Disease Transmission
 .
Disease Transmission
 The chain begins with the
existence of a specific
pathogenic
microorganism
 The second link is the
reservoir, an environment
where the pathogen can
survive.
Disease Transmission
 The third link is the The fourth link is the
means of escape
from the reservoir.
mode of transmission
from the reservoir to
the host.
Disease Transmission
 The fifth link is the
means of entry into
the host.
 And the last link is
the host's
susceptibility to the
pathogenic
microorganism.
Disease Transmission
 For an infectious disease to occur, each link in
the chain must be connected.
 If even one link of the chain is missing, it
interrupts the process, and no infection will
occur.
Routes of Transmission  Droplet transmission (within 3 feet)
 Coughing, sneezing, spitting
 Whopping cough, influenza, meningitis
 Airborne – can remain in air longer and go farther
than droplets
 Coughing, sneezing, spitting, vomiting
 Tuberculosis, Measles
 Vector-borne
 Transmitted by insects
 Malaria, Lyme’s disease
Routes of Transmission
Contact
Examples:
Direct Contact
Indirect Contact
 Host comes into contact
 Disease is carried from
 Kissing, skin-to-skin
 Contaminated surfaces
with reservoir
contact, sexual
intercourse
 Contact with soil or
vegetation
reservoir to host
(fomites)
Infectious Agents
Bacteria
Viruses
Fungi
Protozoa
Helminths
Hand‐Washing, An2sepsis, & Personal Protec2ve Equipment
Section II
Basic hand washing
 The most important means for breaking the Chain of
Transmission and preventing the spread of infection
 Appropriate 20 – 30 second hand washing with antimicrobial or
non-antimicrobial soap and water must be performed as
follows:
 Before and after direct contact with residents
 When hands are visibly dirty or soiled with blood or other body
fluids
 After contact with blood, body fluids, secretions, mucous
membranes, or non-intact skin
 After removing gloves
 Before eating or feeding residents
 After using the restroom
 When there is likely exposure to spores (i.e., C. difficile, or Bacillus
anthracis)
Basic hand washing
 THE USE OF GLOVES DOES NOT
REPLACE HANDWASHING!
 If hands are NOT visibly soiled,
alcohol-based hand gels are
appropriate for all the following
situations:
 Before and after direct contact
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with residents
Before donning sterile gloves
After contact with resident’s
intact skin
After contact with inanimate
objects (e.g. medical equipment)
in the immediate vicinity of the
resident
Before preparing or handling
medications – Nurses must wash
hands after every fifth (5th)
resident using alcohol-based
hand gels in between
Proper hand washing involves the following steps:
• Wet both hands and wrists. Lather well using two squirts of soap or
hand washing solution.
• Spread the lather to the back of the hands and wrists
Clean between the fingers.
Washing time should be 20-30 seconds.
• Rinse hands and wrists well to remove all soap.
• Dry hands completely. Turn off the water using
disposable towels when the faucet has handles. This prevents
recontamination of the hands.
Basic Hand Care
 Do not wear artificial
nails or extender tips
when working with
residents
 Keep natural nail tips
less than ¼ inch long
 Hand hygiene is always
the final step after
removing and disposing
of personal protective
equipment
Standard Precau2ons Standard precautions – once
referred to as universal
precautions, are to be used
in the care of all residents
regardless of their diagnoses
or suspected or confirmed
infection status
Standard precautions
presume that all blood, body
fluids, secretions, and
excretions (except sweat),
non-intact skin and mucous
membranes may contain
transmissible infectious
agents
Standard Precau2ons
 Why do we use Standard Precautions???
 To protect both the resident and the employee
from spreading harmful microorganisms
 Employees are required to use protective
equipment in order to decrease their exposure to
blood/body fluids
Personal Protec2ve Equipment (PPE’s)
 What is Personal Protective Equipment??
 PPE’s or personal protective equipment is used to provide
protection to employees for specific tasks that may involve
exposure to blood/body fluids
 PPE’s are mandated by OSHA to provide a barrier whenever
there is a potential for exposure to infectious agents
 PPEs, include:
 Gloves (sterile, non-sterile, heavy-duty and/or puncture-resistant)
 Protective eyewear (goggles and/or face shields)
 Face Masks
 Gowns (disposable, cloth, and/or plastic)
PPE’s
 When to use Gloves
 When touching excretions, secretions, blood, body fluids,
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mucous membranes or non-intact skin
When the employee’s hands have any cuts, scrapes,
wounds, chapped skin, dermatitis, etc.
When cleaning spills or splashes involving blood or body
fluids
When cleaning potentially contaminated items
Whenever in doubt!
Hand Washing – Let’s Review Again
 Wet hands with warm (not hot)
water
 Apply antibacterial soap
 Rub hands together for about
25-30 seconds, cleanse
between fingers
 Rinse with clean water
 Dry with disposable towel or air
dry
 Use towel to turn off faucet
Alcohol‐based Hand Rubs
 Effective if hands not visibly soiled
 More costly than soap & water
 Apply appropriate (3ml) amount to
palms
 Rub hands together, covering all
surfaces until dry
 Caution use with open/broken skin
Employee Health Surveillance, Bloodborne Pathogens, & Biohazard Management Section III
Needle Handling and / or Disposal
 Safe handling and proper disposal of used
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needles is essential to prevent needle
stick injuries and exposure to HIV (AIDS)
and hepatitis B viruses or other blood
borne infections through contact with
blood or tissues
After using a needle – discard without
recapping
Do not bend, break, or cut needles
Needles should be placed in puncture
resistant sharps container
When a sharps container is almost filled,
seal the box and label “Biohazard” follow your facility’s policy on storage
until the containers are picked up by a
licensed vendor or incinerated
Employee Health  Infection control education is essential for
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all new employees upon hire
current employees annually
 The facility
 Must have exposure control and prevention plan, including how to
address needle sticks
 Must have tuberculosis control plan including 2 step PPD
 Offer yearly influenza vaccine
 Risk assessments for exposure to infectious disease by job
classification or department
 Offer Hepatitis B vaccine series to potentially exposed
personnel
 Annual tuberculosis testing
Employee Infec2on & Vaccina2on Status  Employees must complete an Employee record of
vaccination upon hire documenting a history of
vaccinations against the following diseases/
infections
 Chickenpox
 Hepatitis
 Measles
 Mumps
 Rubella
 Tetanus-diphtheria
 Influenza
 Pneumonia
Employee Health
 Staff must report any exposure to a resident’s
blood or body fluids to the Director of Nursing or
Infection Control Coordinator as soon as practical
after the exposure
 OSHA released the Blood borne Pathogens
Standard in December, 1991 in an attempt to
reduce the health risk to workers whose duties
involve exposure to blood or other potentially
infectious materials.
Blood borne Pathogens
 Penetration into the Bloodstream
 Blood borne pathogens are
transmitted when an individual
comes in contact with an infected
person's blood or body fluids.
However, contact alone does not
mean infection will result.
Pathogens must enter the
bloodstream to cause infection.
 In the workplace, an employee may
be exposed to Hepatitis B Virus or
HIV when infected blood or body
fluid is allowed to enter the body by
means of penetration.
 This can occur through:
 a needle stick
 a cut or break in the skin
 contact with mucous membranes
such as those of the eye, nose,
and mouth
Blood Borne Pathogens
 Needle sticks
 Should skin exposure occur from a needle stick, cut from
a sharp instrument, or contamination of an open wound
or broken skin, the employee should
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Allow the wound to bleed freely
Wash the exposed area with soap and water
Apply antiseptic as desired
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Isopropyl alcohol 70%; or
Hydrogen peroxide 3%
Report the incident as soon as possible
Complete an exposure report
Obtain counseling
Blood Borne Pathogens
 Needle sticks (continued)
 In January 2001, OSHA revised the BBP Standard and mandated
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that healthcare facilities implement safer needle stick
prevention measures; including engineering controls and safe
medical devices
Recurring needle sticks may require evaluation of you current
systems (retractable vs. needleless system)
A Sharps Injury Record should be kept
Employee Health Records must be documented
Counseling required for further prevention or recurrence
Bloodborne Pathogens
 Hepatitis B
 Hepatitis C
 HIV
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Malaria
Syphilis
Babesiosis
Brucellosis
Leptospirosis
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Arboviruses
Relapsing fever
CJD
HTLV - I & II
Viral hemorrhagic
fever
Hepatitis B
 Incubation period = 6 weeks-6
months
 May shorten life span 10-20 years
 Reported cases of acute Hepatitis
B in US decreased 50% in last
decade (21,102 in 1990 to 10,258
in 1998)
Hepatitis B Transmission
Blood to Blood
Sexual contact
Perinatal
transmission
Hepatitis B Prevention
Vaccination
(Provided at
no cost to all employees)
Standard Universal
Precautions
Safer Sex
No Sharing Needles
Hepa22s B
 Female suffering
from liver cancer
from Hepatitis B
Hepatitis C

16% of viral hepatitis cases

Incubation Period = average 6-7 weeks
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(Range 2-26 weeks)
3.9 million have been infected
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2.7 million are chronically infected
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70% of infected persons develop chronic
liver disease
$600 million annually in medical and work loss
expense - - not including transplantation.
Hepatitis C Transmission
Blood-to-Blood
May cause post
transfusion hepatitis
50-60% of cases are
associated with IV drug use
2% of cases are HCW* infected
through occupational exposure to
infected blood
Hepatitis C Prevention
Standard “Universal” Precautions
Reduce risk by personal choices

NO VACCINE available!
Epidemiology of AIDS
World wide, an
estimated 33.6
million people are
living with AIDS
743,534 reported cases in US since 1990
40,000 new AIDS cases are reported annually in
the US
HIV / AIDS
 Human Immunodeficiency
Virus
 The Human
Immunodeficiency Virus
(HIV) is another blood
borne pathogen. This
life-threatening virus
compromises the body's
immune system. Early
symptoms may be
similar to those of the
flu. During later stages
of the disease, the body
is incapable of warding
off other infections
which frequently prove
fatal
HIV / AIDS
 The total number of people living with HIV rose in
2004 to its highest level ever.
 An estimated 39.4 million people are living with
the virus (2004 CDC reporting)
 Estimated 4.9 million people acquired HIV in 2004
 Global AIDS epidemic claimed 3.1 million lives in
2004
HIV Transmission
Sexual Contact
Mother to Infant
Blood Contact
 IV needle sharing
 Blood products including transfusion
 Healthcare worker exposure to blood and body
fluid
HIV / AIDS
 Symptoms
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Chills
Night sweats
Fatigue
Fever
Headache
Sore throat
Mouth sores
Rash resembling roseola
Skin changes
Swollen lymph nodes
Diarrhea
Weight loss
Shortness of breath
Dry cough
 Spread by
 Direct exposure to body
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fluids (semen, vaginal
secretions)
Direct exposure to blood
Unprotected sexual contact
(anal, vaginal, oral)
Transfusions of blood or
blood products contaminated
with HIV
Contact with HIV
contaminated blood via
mucus membranes or nonintact (open) skin
Perinatal transmission from
an infected mother to her
infant
HIV / AIDS
 HIV is not spread by:
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Everyday contact with an infected person
Eating food prepared from an infected person
Mosquito or other insect bites
Sweat, saliva, tears
Simple kissing
Touching items that an infected person touched
 Clothes
 Drinking fountains
 Telephones
 Toilet seats
 Dishes and dinner table utensils
HIV / AIDS
 There is no cure for AIDS
 There are drugs that can slow HIV and damage
to the immune system
 There are other drugs that can be taken to
prevent or treat opportunistic infections
 Opportunistic infections often cause death
Personal Prevention
Measures
Abstain from sex with infected person
Discuss sexual history with partners
Reduce number of sexual partners
Always use protection with sex
Use only water-soluble lubricants with
condoms
 Avoid illicit drug use and sharing of needles
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All positive HIV tests reported to the
Department of Health
Exceptions to reporting:
 tests performed at anonymous
test sites
 tests of patients performed
because of employee blood/
body fluid exposure
 tests performed on employee
following blood/body fluid
exposure
 certain HIV/AIDS research
settings
Informed Consent
Patient must give informed
consent to be tested for HIV
 Written informed consent is best
 Place on chart

Exception to Informed Consent Following a
Healthcare Worker Exposure
Source patient may be tested without informed
consent only when:
 There has been a significant exposure
 There is existing blood available
 The exposed employee consents to be tested or has a
documented HIV test within the previous 6 months
 The source patient dies during emergency treatment.
 The patient has been asked to consent and has
refused. Patient must be told that testing will be done
under Federal Laws to protect healthcare workers..
b Results are not placed in patient’s medical record.
What should I do if an
exposure occurs?
Thoroughly wash exposed area
Contact supervisor and Employee
Health
 Optimal time for postexposure prophylaxis (PEP) is
1-2 hours post exposure
 Post-exposure prophylaxis
(PEP) for HIV = AZT + 3TC +
protease inhibitor
Tuberculosis
 Tuberculosis is a common disease transmitted by
inhaling airborne bacilli from a person with active
TB
 The bacilli multiply in the alveolus and are carried
by macrophages, lymphatic's and blood to distant
sites (e.g., lung pleura, brain, kidney, and bone)
 Latent tuberculosis infection is asymptomatic,
noninfectious and usually detected by a positive
skin test
Tuberculosis
 Signs / Symptoms
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Cough
Hemoptysis
Fever
Night sweats
Weight loss
Malaise
Adenopathy
Pleuritic chest pain
Hepatosplenomegaly
Renal, bone, or CNS disease
are late findings
 Risk factors
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Homeless
Minority
Migrant workers
Close contact with infected
persons
HIV
IV drug abuser
Lymphoma
Diabetes Mellitus
Chronic renal failure
Malnutrition
Immunosuppressed
Institutionalized
 Prisoner
 Nursing home patient/
employee
Tuberculosis Tes2ng and Surveillance
 Based on State and local regulations
 Facility frequency based on TB risk assessment
(Guidelines for Preventing the Transmission of
Mycobacterium tuberculosis in Health-Care Settings,
2005-MMWR 2005; 54 (No. RR-17, 1-141) Usually yearly
 First PPD to be given as 2 step;  second step at least 7-14 days after first step is read
(booster effect)
 On admission and yearly for residents
 Include, for both employees and residents, a yearly
assessment for signs and symptoms of TB
Tuberculosis tes2ng and surveillance
 Policies should exist for employee follow up if infected, as well
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as immediate hospitalization for residents
Hospital requirements for negative pressure isolation room, fit
tested respirators (N94 masks)
Three sputum's negative for acid-fast bacteria necessary for
release from isolation
The bacteria is airborne and floats around on the air currents
Treated with isoniazid (INH), rifampin (RIF), pyrazinamide (PZA),
ethambutol (EMB) and streptomycin
Tuberculosis tes2ng and surveillance
 If positive reaction, do chest x ray to rule out active
disease or exposure
 Once the individual has a positive reaction:
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They can no longer be skin tested
Should have a chest x-ray every three (3) years
Chest x-ray done if symptomatic
Yearly assessment for sign and symptoms
 Employees/residents, who had resided in a foreign
country, may have had exposure and will present
with a positive PPD
Isola2on
Transmission-Based Precautions:
Used whenever measures more stringent than
Standard Precautions are needed to prevent or
control the spread of infection
Based on CDC definitions, there are three types of
Transmission-Based Precautions
Airborne
Droplet
Contact
Isola2on
 Airborne Precautions
 Airborne Precautions
are implemented for
anyone who is
documented or
suspected to be
infected with
microorganisms
transmitted by
airborne droplet nuclei
(small-particle
residue) of evaporated
droplets containing
microorganisms that
remain suspended in
the air and can be
widely dispersed by air
currents within a room
or over a long distance
Isola2on
 Airborne Precaution
 Examples of infections requiring Airborne
Precautions include, but are not limited to:
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Measles
Varicella (including disseminated zoster)
Tuberculosis
Isola2on
 Airborne Precautions
 Isolation Alert
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Colored coded signs should be used to alert staff and
visitors of the implementation of airborne precautions
Resident privacy must be respected
A sign should be placed at the entrance of the doorway
instructing visitors to report to the nurses station
before entering the room
Isola2on
 Droplet Precautions
 Droplet precaution is initiated for any
resident suspected to be infected with
microorganisms transmitted by droplets
(large-particle droplets) that can be
generated by the individual coughing,
sneezing, talking, or by the performance of
procedures such as suctioning
Isola2on  Droplet precaution
 Examples of infections requiring Droplet precautions
include, but are not limited to:
 Influenza
 Mumps
 Rubella
 B. Pertussis
 Mycoplasma pneumonia
 Invasive Haemophilus influenzae type B

Meningitis
 Pneumonia
 Epiglottitis
 sepsis
Isola2on
 Droplet Precaution
 Resident-Care Equipment
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When possible, dedicate the use on non-critical residentcare equipment items such as
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Stethoscope
Sphygmomanometer
Bedside commode
Electronic thermometer (any thermometer)
AVOID SHARING RESIDENT-CARE EQUIPMENT WITH HEALTHY
RESIDENTS!!
Isola2on
 Contact Precautions
 In addition to Airborne and Droplet, Contact
Precautions are also necessary for residents
known or suspected to be infected or colonized
with microorganisms that can be transmitted by
direct contact with the resident or indirect contact
with environmental surfaces or resident-care
items in the resident’s environment
Isola2on
 Contact Precautions
 Examples of infections requiring contact precautions
include, but are not limited to:
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Gastrointestinal Infections
Respiratory Infections
Skin Infections
Wound infections
Colonization with MDRO’s (e.g. MRSA, VRE, VRSA, etc.)
Diarrhea associated with GI infection or Clostridium
difficile
Enterohemorrhagic Escherichia Coli
Shigella
Hepatitis A
Diarrhea associated with Rotavirus
Abscesses, cellulitis, or pressure ulcers with no
contained drainage
Isola2on
 Contact precautions for an infected wound
Cleaning and Disinfec2on for Contact Precau2ons
Detergents
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Remove dirt, soiling
Mechanical force essential
Flush with clean water
Disinfectants
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Kill viruses, bacteria
Decontaminate surfaces
Type depends on infectious agent
Use after detergent
Questions??
Emerging, Reportable, and High Risk Diseases (Including MDRO’s)
Section IV
Endemic - Epidemic - Pandemic
Cases
R>1
R=1
R<1
Time
 Endemic
 Transmission occur, but the number of cases remains
constant
 Epidemic
 The number of cases increases
 Pandemic
 When epidemics occur at several continents – global
epidemic
(www)
Number of Cases of a Disease
Endemic vs Epidemic
Endemic
Time
Epidemic
Modern Day Infec2ons Return of ‘old’ diseases – Tuberculosis
Rise of recent diseases – HIV
Mutations of bacteria – MRSA, VRE
Definition and history of MRSA & VRE
Definition of HIV vs. AIDS (why the difference is
important)
New Emerging Infec2ous Organisms
 Influenza A (H1N1) Virus / SWINE FLU
 Infectious period 1 day prior-7 days after onset
 High risk groups the same as for seasonal influenza
 Droplet isolation
 Viral culture or nasal swab, if not showing local strain, send
out to state  Antiviral treatment for confirmed, probable or suspected
cases:
 oseltamivir or tamiflu
 zanamivir or relenza
 amantadine, rimantadine
Specific Reportable Diseases/Outbreaks
 Chapter 211.1  Reportable within 24
hrs
 Animal bite
 Anthrax
 Arboviruses
 Botulism
 Cholera
 Diptheria
 Enterohamorrhagic E. Coli
 Food poisoning outbreak
 Haemophalis influenza
 Hantavirus pulmonary syndrome
 Hemorrhagic fever
 Lead poisoning
 Legionellosis
 Measles (rubeola)
 Meningococcal invasive disease
 Plague
 Poliomyelitis
 Rabies
 Scabies
 Smallpox
 Typhoid fever
Specific Reportable Diseases/Outbreaks
 Chapter 211.1  Extensive list to be reported within 5 work days of identification
by symptoms, appearance or diagnosis including:
 HIV / AIDS
 Camppylobacteriosis
 Chickenpox / Shingles
 Creutzfeldt-Jacob Disease
 Encephalitis
 Guillain-Barre Syndrome
 Hepatitis
 Listeriosis
 Lyme Disease
 Meningitis (all types)
 Mumps
 Pertussis
 Rickettsial diseases
 Salmonellosis
 Shigellosis
 Staphylococcus aureus
 Vancomycin-resistant (or intermediate) invasive disease
 Streptococcal invasive disease (group A)
 Streptococcus pneumonia, drug resistant invasive disease,
 Tetanus,
 Trichinosis
 Tuberculosis
Other High Risk Diseases (Healthcare Acquired Infec2ons)
Surgical Site
• 17% of HAI
• Break in sterile technique or contaminated equipment
Central Line
* Top 4 listing of HAI
* Break in sterile technique during insertion or dressing change/site
care
Ventilator Associated Pneumonia
* 13% of HAI
* Related to break in sterile technique and/or poor choice of cohort
Catheter Associated UTI
• 34% of HCI
• Improper sterile technique for insertion and/or poor site care
technique or frequency of care given
Other High Risk Infec2ons

Pressure Ulcers

Pressure ulcers = soft-tissue lesions, 
blood supply > cell death

Severity: inflammation > ulceration

Infection =

Purulent tissue /drainage
(regardless of culture results)

Serosanguinous drainage, pain,
swelling, heat, induration, or
erythema around lesion

Colonization = positive culture alone

To culture a pressure ulcer:

Clean surrounding skin with
antiseptic
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Clean necrotic tissue with sterile
water
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Aspirate deep drainage or insert
sterile swab deep into wound
Other High Risk Infec2ons
 Gastrointestinal:
 Diarrhea occurs frequently in the elderly
 Prevalence of diarrhea: 1-10% in residents of LTCFs
 Increased antibiotic use 
develop C. difficile diarrhea
and pseudomembranous colitis
 Risk of rotavirus infection due to decrease /disappearance
of rotavirus antibodies in patients > 70 years
 Elderly have greater tendency to become Salmonella
carriers after Salmonella infections
 High severity in elderly



Profuse watery diarrhea  dehydration
Salmonella food poisoning unusually severe, CFR 10%
Viral gastroenteritis may be severe
Other High Risk Infec2ons
 Pneumonia
 3rd common site of infection
 Mortality rate 30-50%
 Risk factors: emphysema, chronic bronchitis, COPD
 Most pneumonias due to aspiration
 Pathogens:



Pneumococcus, most common bacterial cause
H. influenzae, other H.spp, S.aureus
Gram- bacilli (Enterobacteriaceae, Pseudomonas, K. pneumoniae,
Legionella)


Growing problem in institutionalized
Throat flora changes with aging:  Gram-
 Transmission



Endogenous flora /aspiration: S. aureus, pneumococci
Droplet
L. pneumophila if aerosolized: air conditioning, cooling towers,
showerheads
Herpes Zoster
 Primary infection is chicken pox, lies







dormant and can erupt as shingles
later in life
Shingles prevalent in the elderly and
can erupt any where along a path of
a nerve
Maculopapular lesions of shingles
contagious when the lesions are fluid
filled for chicken pox, no longer
contagious when lesions dry
Pregnant health care worker or
individual who has not had chicken
pox should not contact lesions
Treat shingles with acyclovir and
famciclovir
Can be mild or severe
Can also affect the eye
Contact precautions, isolate for 5
days from time of eruption until
lesions dry
Conjunc2vi2s
 Can be bacterial or viral
 Care in administering eye





medications, wear gloves and
wash hands, do not touch tip of
bottle to eye
Acute viral can have sudden
onset of eye pain, photophobia,
blurred vision, fever, malaise
Bacterial shows hyperemia,
lacrimation, edema, purulent
discharge
Contact precautions for viral
form
Can treat bacterial form with
antibiotic eye ointment
Viral no treatment, can use
corticosteroids for residual
opacities
Food‐borne illness
 Can be bacterial (salmonella typhimurium, Shigella dysenteriae,





camphylobacter, Clostridium perfringens, botulinum toxin,
Staphylococcus aureus toxin, Eschericia coli toxin, Listeria
monocytogenes )
Can be viral (hepatitis A) or involve parasites (Toxoplasmosis,
Trichenellosis/trichinosis)
General symptoms include N/V, diarrhea, fever, dehydration,
hypotension and sepsis
Diagnose by quantitative stool cultures
Contact precautions
Treatment includes fluid & electrolyte replacement and
antibiotics for bacterial and metronidazole and furazolidone
for parasites
Scabies
 Caused by a mite, Sarcoptes scabiei
 Parasitic mite penetrates skin causing papules vesicles or linear




burrows
Intense itching and some scaling and crusting, usually in skin
crevices
Diagnosed by scraping
Contact precautions for 24 hours post treatment and all clothing,
objects need to be disinfected
Treat with permethrin, 1% gamma benzene hexachloride
(contraindicated if seizures), crotomition, tetraethylthiuram
monosulfide, benzyl benzoate
Candidiasis
 Common opportunistic





secondary infection of the
superficial skin or mucous
membranes
Usually after antibiotic use
Typical satellite lesions on
skin, itching
Oral thrush, vulvovaginitis,
skin folds, can cause ulcer
formation
Standard precautions
Treat underlying causes,
topical nystatin, miconizole,
fluconazole
Mul2‐Drug Resistant Organisms
 MDROs are multi-drug resistant organisms
which no longer respond to standard
antibiotics and may require more than one
antibiotic for treatment
Mul2‐Drug Resistant Organisms
 Clinical importance of MDRO’s
 In most instances, MDRO infections have clinical
manifestations that are similar to infections caused by
susceptible pathogens. However, options for treating
patients with these infections are often extremely limited
 For example: until recently only vancomycin provided
effective therapy for potentially life-threatening MRSA
infections and during the 1990’s there were virtually no
antimicrobial agents to treat infections caused by VRE.
 Although antimicrobials are now available for treatment of
MRSA and VRE, resistance to each has already emerged in
clinical settings.
Risk Factors for MDROs in Healthcare SeZngs
Patients with Severe disease
Long length of stay in hospitals and ICUs
Recent surgery
Patients receiving care at multiple healthcare facilities
and moving between acute-care, ambulatory and/or
LTC environments
 Use of broad spectrum cephalosporin's, vancomycin and
other antimicrobials
 Invasive procedures, urinary catheterization, dialysis,
endotracheal tubes, other invasive devices
 Chronic renal failure, IDDM, PVD, skin lesions




MDROs Mul2drug resistant organisms
 Types of MDRO’s
 MRSA
 VRE
 Certain Gram-negative bacilli – including those producing
extended spectrum beta-lactamases including:
 Escherichia coli
 Klebsiella pneumoniae
 Strains of Acinetobacter baumannii resistant to all
antimicrobial agents
 Organisms such as Stenotrophomonas maltopilia,
Burkholderia cepacia, and Ralstonia pickettii that are
intrinsically resistant to the broadest-spectrum antimicrobial
agents
MRSA  MRSA tends to colonize and/or
infect debilitated residents
 Transfer of patients with MRSA:
acute-care facilities  LTCFs
 Close living conditions /level of
personal care required for many
residents  acquisition rate (Ex:
5%-10% /year)
 Colonization before invasive
infection
 Once prevalent in a facility, MRSA
extremely difficult to eradicate
 Direct contact, hands of personnel
VRE
 VRE tends to colonize
debilitated resident
 Infrequent cause of infection
in LTCF
 Transfer of the patients with
VRE: acute-care facilities 
LTCFs
 Main transmission is hands
 Immediate environment of
colonized with VRE often
contaminated
 No evidence that
colonization of HCW has a
role
Preven2on and Control of MDROs
 Surveillance for trends, using incidence rates, and
monitoring of colonized individuals should be
done routinely
 New admissions need to be screened for infectious
disease and information needs to be passed on in
the event of discharge/transfer
 Administrative support
 Effective Staff Education
Preven2on and Control of MDROs
 Methods of Prevention
 Optimal management of vascular and urinary



catheters
Prevention of lower respiratory tract infections in
intubated patients
Accurate diagnosis of infectious etiologies
Judicious antimicrobial selection and utilization
Emerging Infec2ons in the World and US since 1973
1973
1976
1977
1977
1977
1977
1980
1981
1982
1982
1982
Rotavirus
Cryptosporidium
Ebola virus
Legionella
Hantaan virus
Campylobacter
HTLV-1
Toxin prod. S.aureus
E.coli 0157:H7
HTLV-II
Borrelia burgdorferi
Enteritis/Diarrhea
Enteritis/Diarrhea
VHF
Legionnaire’s dz
VHF w/ renal flr
Enteritis/Diarrhea
Lymphoma
Toxic Shock Synd.
HUS
Leukemia
Lyme disease
Emerging Infec2ons in the World and US since 1973
1983
1983
1988
1989
1990
1991
1992
1992
HIV
Helicobacter pylori
Hepatitis E
Hepatitis C
Guanarito virus
Encephalitozoon
Vibrio cholerae O139
Bartonella henselae
AIDS
Peptic ulcer dz
Hepatitis
Hepatitis
VHF
Disseminated dz
Cholera
Cat scratch dz
Emerging Infec2ons in the World and US since 1973
1993
1994
1994
1995
1995
1996
1997
1999
1999
2001
2003
2003
Sin Nombre virus
Sabia virus
Hendra virus
Hepatitis G
H Herpesvirus-8
vCJD prion
Avian influenza (H5N1)
Nipah virus
West Nile virus
BT Bacillus anthracis
Monkeypox
SARS-CoV
Hanta Pulm. Synd.
VHF
Respiratory dz
Hepatitis
Kaposi sarcoma
Variant CJD
Influenza
Encephalitis
Encephalitis
Anthrax
Pox
SARS
Regulatory Requirements (Act 52) and Infec2on Control Commi`ees
Section V
Regula2ons R/T Infec2on Control
Federal and State Regulations-DOH (Department of Health)
CDC (Centers for Disease Control)
OSHA (Occupational Safety and Health Administration)
EPA (Environmental Protection agency)
FDA (Food and Drug Administration)
Medical Waste
Local-Public Health Department
Water Department
Non-Regulated Waste Standards
CMS (Centers for Medicare and Medicaid Services)
CLIA Laboratory Standards (Clinical Laboratory Improvement
Amendments)
 Nursing Home Quality Initiatives


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





Regula2ons R/T Infec2on Control
Department of Health F tag 441
 Outlines requirements for infection control program
including a written plan, surveillance, and risk assessment
 Requires methods for identifying, documenting and
investigating nosocomial infections and communicable
disease
 Includes managing outbreaks, involving State or local
epidemiologist, isolation precautions, in servicing staff, and
hand washing
 Identifies respiratory protection, linen and housekeeping,
needle and hazardous waste disposal
Regula2ons R/T Infec2on Control
Department of Health F tag 441
 Addresses employee health and screening
 New employee orientation
 Includes TB and blood borne pathogen monitoring and surveillance
Department of Health F tag 442
 Addressed preventing the spread of infection
 Following CDC guidelines for hand washing and Hospital
Environmental
Control Regula2ons R/T Infec2on Control
Department of Health F tag 443

Prohibits employees with communicable disease or infected
skin lesions from direct contact with residents or their food if
disease transmission is
likely Department of Health F tag 444

Discusses hand washing and changing
gloves Department of Health F tag 445

Discusses handling of linen
Regula2ons R/T Infec2on Control






Department of Health F tag 334Influenza and pneumococcal vaccination
Department of Health F tag 315Urinary tract infections
Department of Health F tag 371Sanitary conditions and food borne illness
Act 52: Healthcare‐Associated Infec2on Preven2on and Control Act
 Signed into law July 20, 2007
 Amends Medical Care Availability & Reduction of
Error Act (MCARE Act 2002)
 Applies to hospitals, LTCFs, ASFs, and
correctional facilities
 Establishes requirements for Infection Control
Plans
103
Act 52: Healthcare‐Associated Infec2on Preven2on and Control Act
 Establishes requirements for Infection Control
Plans
 Multi-disciplinary committee
Community representatives
 Effective measures for detection, prevention and control of
HAI
 Active surveillance system
 MRSA/MDRO
 Patients admitted from nursing homes and other high
risk groups
 Surveillance and screening of staff who MAY have been
exposed to patients known to be INFECTED OR
COLONIZED with MRSA/MDRO

104
Act 52: Healthcare Facility Repor2ng
 Every hospital in PA must become a member of
the National Healthcare Safety Network (NHSN)
 Report to every module for the entire institution
monthly
 Current and future modules
 Electronic surveillance assessment and
implementation
105
Act 52: Other Issues
 Quality improvement payments by January 1,
2009 for facilities with 10% reduction in HAI
 Penalties: $1,000/day failure to comply
106
Act 52 Repor2ng
 Senate bill 968, Act 52 of 2007; “Health care Associated
Infection Prevention and Control Act”
 Amends Act 13 of 2002; “Medical Care Availability and
Reduction of Error Act”
 Adopts CDC’s National Healthcare Safety Network, NHSN
internet surveillance system for reporting to DOH, Healthcare
Cost Containment Council, and Patient Safety Authority
 Does not replace Mandatory notification to DOH of reportable
diseases
Act 52 Repor2ng
 Defines HAIs (Healthcare associated infections) as
serious events requiring written notice to the
resident or a family representative within 7 days of
confirmed Serious Event
 Mandatory reporting for Nursing Homes as of April
1, 2009 through the PA Patient Safety Reporting
System (PA-PSRS) within 24hrs of confirmed
serious event
Act 52 Repor2ng
Requires an Infection Control Plan with following criteria:
Multidisciplinary Infection Control Committee
Effective detection, control, and prevention of healthcare
associated infections
Culture surveillance processes and policies
System for identification and designation of patients known to be
colonized with MRSA or other MDRO’s
Infection control interventions and protocols
Procedures for distribution of patient safety advisories issued by
Patient Safety Authority
Act 52 Repor2ng
 Reportable Infections:
 Symptomatic Urinary Tract Infection
 Indwelling urinary catheter related
 Non-urinary catheter related
 *Respiratory Tract
Infection
 Lower Respiratory Tract Infection  Influenza-like illness
 Skin and Soft Tissue Infection
 Cellulitis  Burns
 Vascular and Diabetic
ulcers
Act 52 Repor2ng
 Reportable Infections








Device Associated Soft Tissue/Wound Tracheostomy site Peripheral/Central IV catheter site
Decubitis ulcer
G-tube site Suprapubic catheter site In-dwelling drain In-dwelling vascular catheters
 dialysis
Act 52 Repor2ng








Reportable Infections
*Gastrointestinal Tract Infection
*Other Infections Intra-abdominal (peritonitis/deep
Meningitis Viral Hepatitis
Osteomyelitis
Primary Bloodstream infection
abscess)
Animal Visita2on  Potential for transfer of microorganisms on fur & paws of




animals
Increased risk if allowed to sit on bed or lick residents
Must have proof of up-to-date files on shots with visitation
Should limit visits to residents who are not ill
Policies and procedures must address restrictions and
limitations of animal visits for resident and other visitor’s
protection
Resources for Act 52 Informa2on
 www.haponline.org
 www.psa.state.pa
Components of the Infec2on Control Commi`ee
 Serves as central decision maker for all infection control






policies and their enforcement
Responsible for dissemination of information to committee
members and all other staff
Multidisciplinary with regular meetings, usually quarterly
Required in some states
Written, detailed and time managed agenda
Will also include hot topics/concerns
Routine topics to include: review previous minutes, review/
approval of policies, surveillance and any action plan,
legislation/regulations, survey results, employee health and
Risk Management
Personnel involved with the Infec2on Control Commi`ee












Infection control Professional
Committee Chairperson-may be ICP
Medical Director
Facility Administration
Pharmacy
Risk Manager
Employee Health/Personnel Director
Central Supply Director
Environmental Services
Dietary
Laboratory support personnel
Nursing and front line staff members
References
 Nutty, Christine J., APIC Certification Study Guide, 3rd edition;
copyright 2007, Washington, DC; pages 40-80,128-158, 197-246,
296-309
 Pennsylvania Patient Safety Authority 2008, PSRS, Health-Care
associated Infections: Reporting Requirements for nursing Homes
 The Pennsylvania Code, Subchapter B. Reporting of Diseases,
Infections and Conditions; www.pacode.com/secure/data/028/
chapter27/subchapBtoc.html
 Wild Iris Medical Education, Multidrug Resistant Organisms (MDROs);
www.nursingceu.com/courses/236/index_nceu.html
References
 Dr Don Wright, MD, MPH, Principal Deputy Assistant Secretary for
Health, U. S. Department for Health and Human Services; Job One:
Reducing HAIs is top priority for U. S. Department of Health and
Human Services, Prevention strategist, winter 2008, volume 1 number
4
 Survey Recommends Improved HAI Prevention and Patient Care
Strategies Prevention strategist, winter 2008, volume 1 number 4
 Weese, J. Scott, DMV, DVSC, Diplomate ACVIM, Department of
Pathobiology, Ontario Veterinary College, University of Guelph and
Lefebvre. Sandra L., DVM, PHD, American Veterinary Medical
Association; When Animals Visit Patients: Reducing the Risk of Disease
Transmission, Prevention strategist, Spring 2008, Premiere issue
References
 Oriola, Shannon, RN, CIC, COHN, Sharp Metropolitan Medical Campus;




Make Needle stick Safety Personal-and protect Staff, Prevention
strategist, Spring 2008, Premiere issue
Tucker, Miriam E., C difficile Treatments in Pipeline Hold Promise,
Caring for the Ages, April 2009, vol 10, No 4
Johnson, Stuart, MD, Clostridium Difficile Associated Diarrhea:WOCN
41st Annual Conference, June 8, 2009, St Louis, Missouri
Washy, Sister Bernadette, CDC’s Newest Guidelines on MDROs: Padona
Conference, March 28, 2008, Hershey, PA
Brennan, P.J., MD, Chief Medical Officer University of Pennsylvania,
SHEA President 2008, Lessons from the Front Line: The Pennsylvania
Experience; www.APIC.org
References
 Kamel, MD, CMD, AGSF, Director, Assistant Clinical Professor of
Geriatrics, Geriatrics and Extended Care; St. joseph’s Mercy health
Center, University of Arkansas for Medical Sciences, Hot Springs, Little
Rock, Arkansas, USA; Managing Urinary Tract Infections in the Nursing
Home: Myths, Mysteries and Realities, The Internet Journal of
Geriatrics and Gerontology; www.ispub.com/ostia/index.php?
xmlFilePath=journals/ijgg/vol1n2/uri.xml
 Swine Flu: Interim Guidance for Infection Control for Care of Patients
with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection
in a Healthcare Setting; April 28, 2009; www.cdc.gov/swineflu/
guidelines-infection-control,htm
References
 HHS Pandemic Influenza Plan; U. S. Department of Health and Human
Services
 AGS Position Statement; Two Step PPD Testing for Nursing Home
Patients on Admission, Annul of Long Term Care, Volume 14, Number
2, February 2006
 Harris, Martha, BS, MT(ASCP), CIC, Inova Health System Continuum of
Care, Clifton, VA, Infections in the Elderly: Risk Factors and
Interventions, APIC Infection Connection, Focusing on Long Term
Care, Winter 2008
 Salgado, Cassandra D., et al Prevention of Catheter –Associated
Urinary Tract Infections, Chapter 21, Prevention and Control of
Nosocomial Infections, Fourht Edition; Wentzel, Richard P., M.D., M.SC.
editor