MODULE C – INFECTION
CONTROL
BACTERIA
• Simple one-celled microbes
• Named according to their shapes and arrangement
• Cause infections in the skin, respiratory tract,
urinary tract, and bloodstream
FUNGI
• Two groups of fungi are most commonly associated with infection in
humans
• Yeasts
• Molds
VIRUSES
• Smallest microbe
• Not visible with regular microscope
• No own metabolism
• Has a variety of shapes
PROTOZOA
• Simple one-celled organisms
• Visible under microscope
• Live on living matter
BODY FLORA
• Different microbes live on our body surfaces
• Microbes are called the normal body flora
• Flora are not the same in all body areas
• They are not harmful in the area in which they normally reside
• But may cause infection if they are moved to another area of the
body
• Normal flora protects us, unless it travels to a body area, where it
does not belong
INFECTION
• Infection: The invasion of a susceptible host by pathogens or microorganisms, resulting in disease.
• Colonization: The presence or invasion of a host by pathogens or microorganisms, NOT resulting in
disease
• Communicable or contagious disease: An infectious disease transmitted directly from one person to
another
• Defenses against infection: skin, normal flora, mucus membranes, immune system (immunity &
vaccines)
• Germs like: dark, moist, warm places in order to grow
•
•
•
•
•
•
CHAIN OF INFECTION P.157 -160
Infectious agent: bacteria, virus, fungi etc.; virulence is the ability to produce
disease
Infectious
agent
Reservoir: where microorganisms survive and thrive ex: hosts (humans, animals),
insects, food, water, organic matter, inanimate surfaces
Portal of exit: the way out of the reservoir, ex: skin, mucous membranes,
respiratory tract, GI (gastrointestinal) tract, reproductive tract, blood
Mode of transmission: how it travels, ex: contact (direct, indirect touch), airborne
(coughing, sneezing, talking), droplet (large particles from coughing sneezing
talking), vector (through animals ex. Mosquito)
Portal of entry: how it gets back in: non-intact skin, mucous membranes, GU
(genitourinary) tract, GI tract, respiratory tract
Susceptible host: susceptibility depends on degree of resistance to pathogens;
immunity = no longer susceptible
The chain can be broken at any link and stop the spread of infection!
susceptible
host
Reservoir
Portal of entr
Portal of exit
Mode of
transmission
INFECTIOUS AGENTS-BACTERIA
NAME
•
•
•
•
•
Staphylococcus aureus (Staph. aureus)
Escherichia coli (E. coli)
Pseudomonas aeruginosa
Chlamydia trachomatis
Mycobacterium tuberculosis
RESERVOIR
•
•
•
•
•
Skin, hair, upper respiratory
Colon
Water, soil
Genitourinary tract, rectum
Droplet nuclei from lungs
DISEASES
•
•
•
•
•
Wound infection, abscess, cellulitis, PNE (pneumonia)
Gastroenteritis, UTI (urinary tract infection)
Wound infection, burn infection, UTI, PNE
STD (chlamydia), PID, neonatal eye and lung infection
Tuberculosis
INFECTIOUS AGENTS-FUNGI/PROTOZOA
NAME
RESERVOIR
•
Candida albicans
•
•
Plasmodium falciparum
•
Skin, mouth, genital tract
Blood, infected female Anopheles
mosquito
DISEASES
•
Bacteremia, pneumonia, wound infection, thrush
•
Malaria
INFECTIOUS AGENTS-VIRUSES
NAME
•
•
•
•
•
Hepatitis A virus
Hepatitis B virus
Hepatitis C virus
Herpes simplex virus (Type I and II)
Varizella-zoster virus
RESERVOIR
•
•
•
•
•
Feces
Blood and some body fluids
Blood
Lesions of mouth, skin, genitals
Vesicle fluid, respiratory tract infection
DISEASES
•
•
•
•
•
Hepatitis A
Hepatitis B
Hepatitis C
Cold sores, STD
Varicella (chickenpox) primary
Herpes Zoster (shingles) reactivated
CHAIN OF INFECTION
CAN BE BROKEN AT ANY LINK
NOSOCOMIAL INFECTIONS
• Infection that the patient did not have before being hospitalized, or cared for
AND acquired
after admission or after care was provided
• Most are spread from healthcare workers to patients via hand contact
• Most common: UTI, PNE, wound infections, bacteremia
• Risk factors for nosocomial infections:
• Prolonged illness
• Immunosuppression ex: Human immunodeficiency virus (HIV), Acquired immunodeficiency syndrome
(AIDS), chemotherapy, some medications
• Susceptibility: age, Diabetes, other diseases
SUPERBUGS P.162
•
•
•
•
•
Bacterial infections are treated with antibiotics
Viral infections are treated by supporting your body’s own defense mechanisms; antibiotics can not cure viral
infections like the flu or cold.
Bacteria and viruses grow and change over time and can become resistant to treatment = drug resistance;
MRSA: Methicillin-resistant staphylococcus aureus;
•
•
•
•
one of the most drug resistant bacteria
spreads quickly by contact
prevalent in hospitals, health care facilities, crowded places, college dorms, prisons
Causes severe illness, wound infections, blood infections, can lead to death
Other common resistant bacteria:
•
•
VRE: Vancomycin-resistant enterococcus; often found in UTI’s
Penicillin-resistant streptococcus pneumonia; often cause of PNE
SUPERBUGS P.163
• TB: Tuberculosis
• Mycobacterium tuberculosis
• spreads quickly through the air by droplets
• At risk: HIV positive, poverty & malnourishment (homeless population)
• TB skin test, Chest X-ray, sputum culture
• Enters lungs, but can infect other parts of body; person is contagious if they have
the active disease; treatment with a variety of antibiotics for up to 2 years
• Clostridium Difficile (C. Diff)
• Resistant bacteria that leads to diarrhea
• NOT killed by hand sanitizers – must wash hands with soap and water!
• Very easily spread – can be devastating to geriatric patients
BLOOD-BORNE PATHOGENS
• HIV = Human immunodeficiency virus p.168
•
•
•
•
•
Caused by HIV-1 and HIV-2 retroviruses that deplete helper T-4 cells
Spread through blood and other body fluids (saliva, urine, sweat)
Ranges from primary asymptomatic infection to AIDS = Acquired immunodeficiency syndrome
Often complicated by opportunistic infections that can lead to death ex. Kaposi’s sarcoma/ pneumocystis
carinii, PNE, cytomegalovirus, herpes simplex, histoplasmosis
HAART = Highly active antiretroviral therapy used to treat HIV/ AIDS; life long treatment required
• Hepatitis type B (HBV) and Hepatitis type C (HCV) p.167
•
•
•
•
Viral hepatitis = major liver infection
Spreads through blood and other body fluids
Generally treatment avoided because liver metabolizes medications
Chronic Hepatitis C treated with interferon
SIGNS OF INFECTION
•
•
•
•
•
•
•
•
•
•
•
High body temperature = FEVER
Red or draining eyes
Stuffy nose
Coughing
Headache
Sore throat
Flushed face
Loss of appetite
Nausea
Stomach pain
vomiting
•
•
•
•
•
•
•
•
•
•
Diarrhea
Cloudy or smelly urine
Joint pain
Muscle ache
Skin rash
Sores
Redness around a wound or incision
Drainage from a wound or incision
Odor from a wound
Swelling
Controlling the spread of germs p.180
MEDICAL ASEPSIS VS. SURGICAL ASEPSIS
• Medical asepsis (=clean technique)
• Reducing the numbers of disease-producing
microorganisms
• Or interrupting transmission from one person to another
person or from a person to a place or an object
• Handwashing – single most important procedure to
prevent spread of microbes
MEDICAL ASEPSIS VS. SURGICAL ASEPSIS
• Surgical asepsis (=sterile technique)
• Environment kept free of microorganisms
• Pathogens and non-pathogens
• In procedures in which surgical asepsis is used; ex:
surgery, catheterization, sterile dressing changes
•
Equipment and supplies must be sterile (ex. Autoclave
equipment)
• Disinfection
•
Process of eliminating harmful pathogens from
equipment and instruments
• Sterilization removes all microorganisms from an
item
CONTROLLING
THE
SPREAD
OF
GERMS
P.180
• Taking daily precautions: p. 180
• wash your hands
• use antimicrobial soap
• eat well and exercise
• stay home if you are sick
• keep things clean, yourself, patient’s environment
• keep dirty linens away from your uniform
• avoid shaking dirty linens or clothing
• bag dirty linens in patient room before taking them out
• single person use of personal equipment – no sharing between patients ex. Toothbrush, bedpan,
washbasins, urinals
• cover bedpans and urinals to prevent splashing
HANDWASHING P.181
•
•
•
Hand washing is the MOST important way to prevent spread of infection; alcohol based hand sanitizers are NOT appropriate if visibly
soiled or for spores ex. when caring for pt with C.diff (Clostridium difficile)
Hand washing precautions:
•
•
•
Keep your fingernails trimmed short, remove any dirt underneath them
Do not wear rings to work except fro a simple wedding band; germs hide in the tine spaces in jewelry
Wear a watch you can push above your wrist or put it in your pocket or pin it to your uniform
When to wash hands:
•
•
•
•
•
•
•
•
•
•
Arriving at work
Before and after patient contact
Before and after wearing gloves
After using the bathroom
After coughing, sneezing, or blowing your nose
Before and after handling food
After smoking
Before handling clean linens
After handling dirty linens or any kind of trash
Before going home
HANDWASHING – SKILL 1
•
Steps for proper handwashing:
•
•
•
•
•
•
•
•
•
•
•
Gather supplies: soap, paper towels
Turn on water
Wet your hands and wrists
Apply antimicrobial soap from dispenser – keep water running
Keep your hands and wrists below the level of your elbows from this point on
Rub your hands together to work up lather
Wash vigorously for at least 20 seconds, pay particular attention to the wrist,
palms, back of hands, area between fingers, nails
Rinse hands and wrists under running water thoroughly, fingertips point down
Use clean paper towel to dry hands, from fingertips to wrists
Use new paper towel to turn off faucet
Throw away paper towels
REGULATORY AGENCIES
• OSHA = Occupational Safety and Health Administration
• To protects workers from work related injuries and exposures to pathogens
• CDC = Centers for Disease Control and Prevention
• To protects the public from health, safety and security threats
• Bloodborne Pathogens Standard, issued 1991
• To prevent on-the-job needlesticks and other exposures to blood and body fluids
• Requires every workplace, where exposure to blood or infectious materials is possible, to have an
exposure plan in place
10 STANDARD PRECAUTIONS
= UNIVERSAL PRECAUTIONS
1.
2.
3.
Wear gloves when you may touch any blood or body fluids, mucus membranes, broken skin, soiled items or surfaces
4.
5.
6.
7.
Sharps: sharps go into sharps containers immediately after use, don’t let them lay around ex. razors
Wash hands
Wear PPE (personal protective equipment) such as gown or apron when your clothing may become soiled, mask,
goggles or face shield if you think something may splash into your eyes or face
Wear gloves when you have open areas (cuts, sores) on hands
Clean up blood or body fluid promptly using approved disinfectant, ex. Bleach solution
Handle linens carefully, wear gloves, keep them still, bag soiled linens where they were used, put wet linens in leak
proof bags
8. Bag contaminated articles carefully in red bio hazard bags, double bag if first bag may be contaminated
9. Put waste in leak proof container
10. Keep resuscitation masks and/or bags on hand in a hospital or nursing home setting
STANDARD PRECAUTIONS
• Must be followed by all members of the healthcare team
• Apply to all blood and bodily fluids and all clients, regardless of the person’s diagnosis; everyone
is considered infected
• Bodily fluids include: blood, urine, feces, sputum, wound drainage, vomit, breast milk, semen,
vaginal secretions, fluids from nose, lungs, or abdomen
• Wear gloves when there is a possibility you could be exposed to any body fluids, ex. Emptying
bed pan, urinary drainage bag, bathing or cleaning a patient, oral care
• Wear gown and protective eye wear additionally to gloves if there is a possibility of splashing
COMMON SENSE PRECAUTIONS
• Don’t sit on pt’s bed or chair – you carry germs from one room to another
• Don’t hold soiled linens or trash against your body – you’ll get germs on your uniform
• Put clean things on clean surfaces ex. Clean linens on clean table
• Put dirty things on dirty surfaces ex. Dirty linens into linen bag on floor
ISOLATION PRECAUTIONS
• When pt has contagious disease
• Depends on type of germ and how germ spreads
• Types: Airborne, droplet, contact
AIRBORNE PRECAUTIONS P.189
• When disease is transmitted through the air ex. TB (tuberculosis), measles
• Precautions to take:
• Negative pressure room – pulls air into pt’s room, away from hallway
• Keep door to private room closed
• Wash hands when entering and leaving room
• Wear gown
• Wear HEPA (high efficiency particulate air filter) mask or respirator
• Wear gloves
• Bag all linens and contaminated articles
• Discard or throw away articles from the room after use = do not carry anything out of this room
• Everything is placed in red bio-hazard bags, no regular trash from this room
DROPLET PRECAUTIONS P.191
• When disease is transmitted through large droplets through the air from sneezing, coughing, laughing,
singing, or talking ex. Flu, mumps
• Precautions to take:
•
•
•
•
•
•
•
•
•
May keep door open, closed preferred
Wash hands when entering and leaving room
Wear gown
Wear regular mask
Wear eye protection
Wear gloves
Bag all linens and contaminated articles
Do not carry anything out of this room
Everything is placed in red bio-hazard bags, no regular trash from this room
CONTACT PRECAUTIONS P.192
• When disease is transmitted through direct or indirect contact (touch) ex. Wound infections,
scabies, C. difficile (diarrhea), MRSA, VRE
• Precautions to take:
• May keep door open, closed preferred
• Wash hands when entering and leaving room
• Wear gown
• Mask not required
• Wear gloves
• Bag all linens and contaminated articles
• Do not carry anything out of this room
• Everything is placed in red bio-hazard bags, no regular trash from this room
PATIENT CONSIDERATIONS P.188
• Private rooms, door often closed
• When transporting pt: have pt wash hands before leaving room, cover oozing wounds etc., pt to
wear mask when on droplet or airborne precautions
• Consider:
• Pt will have limited visitors and staff interaction
• Pt may be lonely, depressed, afraid, angry
• Explain to pt and family why precautions are in place, be patient, understanding
STANDARDS
Preparation Standards = Beginning tasks p. 249
1. Wash hands or use hand sanitizer
2. Gather supplies
3. Focus on task
4. Knock and wait
5. Introduce yourself and identify patient
6. Ask visitors to leave
7. Provide privacy
8. Explain procedure and answer questions
9. Gather and prepare
10. Wash hands
11. Position pt
12. Cover pt
13. Raise bed to comfortable level
14. Put on gloves, PPE if necessary
15. Make sure equipment (bed, WC etc) is locked
Completion Standards = Completion tasks p. 251
1.
2.
Remove gloves
Ensure safety, comfort and body alignment (positioning, bed covers, side
rails)
3. Put disposables in trash bag and laundry in laundry bag
4. Clean and put away equipment
5. Put bed in proper position / safety check
6. Remove PPE, Wash hands or sanitize
7. Open curtains
8. Put call-light, phone, water in reach
9. Dispose of trash
10. Say good-bye / let visitors re-enter
11. Put laundry in hamper
12. Wash hands
13. Note, record, report
PPE- SKILL 2
Removing PPE
1.
Putting on PPE
1.
2.
3.
4.
Gather supplies
Gown:
2.
Put over mouth and nose, bend nose wire
3.
Adjust for comfort
Put on carefully
Gloves:
1.
2.
Inspect for any defects
Put on carefully
4.
Use right hand to remove left glove, rolling it into ball
Hold left glove in right hand
Use bare left hand to slide right hand glove over “ball” inside-out, only touching skin to skin
Throw away
Wash hands
Remove
Put in trash
Gown
1.
2.
3.
4.
5.
6.
Tie strings behind head, top strings first
Make cuff on right hand, pull partially down
Face shield/ goggles
1.
2.
Fasten ties on back of neck and back
If face shield/ goggles necessary, put them on now
1.
6.
Slide arms through armholes, opening in back
Mask:
1.
2.
3.
5.
1.
2.
3.
4.
5.
6.
Wash hands
1.
2.
Gloves:
Pull one sleeve forward by cuff
Use covered hand to pull of other sleeve and hold gown
Use “naked” hand to pull of opposite shoulder, turning gown inside out
Fold outside inward, roll up
Dispose in trash or bio-hazard bag if in isolation romm
Dispose of trash
Mask:
1.
2.
3.
Untie bottom string, then top
Hold by strings and throw away
Wash hands
HOMEWORK INFECTION CONTROL
Read units 12 and 13 in textbook
Do workbook
• P. 76 Nr. 4 & 5
• p. 77: true/false 1-22
• P. 84 : 1 a-e
THE NURSING ASSISTANT IN HOME CARE
HOME CARE SETTING:
• Always use standard precautions
• Patients are not put into “isolation” in their own home
• Use proper PPE for contact precautions
• Patients on droplet and airborne precautions are usually admitted to a
hospital
DISCARDING MEDICAL WASTE IN THE HOME
CARE SETTING
• Place contaminated supplies in a plastic bag and close tightly.
• Double bag if the outside is torn or contaminated.
• Seal the bag by using a twist tie, taping, or tying.
DISCARDING MEDICAL WASTE IN THE HOME
CARE SETTING
• Dispose of the bag in the household trash
• Take it outside to the trash can, if possible
• Wash your hands or use alcohol hand cleaner.
• Sanitize all contaminated equipment and surfaces appropriately.