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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Chapter 4
Principles of Infection Prevention and Control
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Learning Objectives
Define health careassociated infections and state how often they occur.
Describe why infection prevention is important in respiratory care.
Identify and describe the three elements that must be present for transmission of infection within a health care setting.
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Learning Objectives (cont.)
List the factors associated with an increased risk of a patient acquiring a nosocomial infection.
State the three major routes for transmission of human sources of pathogens in the health care environment.
Describe strategies to control the spread of infection in the hospital.
Describe how to select and apply chemical disinfectants for processing respiratory care equipment.
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Learning Objectives (cont.)
Describe equipment handling procedures that help prevent the spread of pathogens.
State when and to use general barrier measures during patient care.
Describe surveillance with regard to infection control.
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Infection Control
IntroductionHospital-acquired infections (HAIs) account
for 1.7 million infections & 99,000 excess deaths annually
About 5% of patients admitted develop an HAIAbout 25% of mechanically ventilated patients
develop pneumonia, & 30% (of those 25%) will die
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Infection Control (cont.)
Infection control procedures aim to:Eliminate the sources of infectious agentsCreate barriers to their transmissionMonitor the effectiveness of control
All health care workers must take responsibility & follow procedures carefully
Infection prevention is an ongoing responsibility of all respiratory therapists
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Infection control procedures aim to do the all of the following except?
A.Monitor the effectiveness of control measures
B.Eliminate the sources of infectious agents
C.Restrain infectious patients
D.Create barriers to disease transmission
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Spread of Infection
3 elements must be present for infection to spread:Source of pathogensSusceptible hostRoute of transmission
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Spread of Infection
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Spread of Infection (cont.)
Susceptible hostsResistance to infection varies greatly from one
person to nextHost factors increasing chance of infection are:
Poorly controlled diabetes Increased ageChemotherapy Placement of tubes & catheters
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Spread of Infection (cont.)
Sources of infectious agents:Humans are primary source Inanimate objects (e.g., contaminated medical
equipment) can spread infection Individuals in hospital capable of being source
include:• Workers• Visitors• Patients
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Host factors that increase the chance of infection are all of the following ,except?
A.Poorly controlled diabetes
B.COPD
C.HIV positive
D.Normal white blood cell count
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Spread of Infection (cont.)
Nosocomial Infections acquired in hospitalMost nosocomial pneumonias occur in patients
having chest or abdominal surgeryPatients with history of chronic obstructive
pulmonary disease (COPD), cigarette smoking, or obesity & those with advanced age have greatest risk for nosocomial pneumonia following major surgery
Patients with artificial airways or immuno-compromised are at higher risk of acquiring nosocomial infections
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All of the following population are at risk for nosocomial infections except:
A.Post-op bariatric patients
B.COPD patients
C.Patients with impaired swallowing
D.Diabetic patients
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Modes of Transmission
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Infection Prevention Strategies
Decreasing host susceptibility: Immunizations & chemoprophylaxis Most HAIs from ventilator associated pneumonia
(VAP), catheter related bloodstream infections, & catheter associated UTIs
Limit use of devices associated w/ HAIs & assure proper placement & maintainence
Prevention bundles: use of multiple evidence-based best practices to prevent device related infection
Eliminating source of pathogens
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What is the most effective way to decrease host susceptibility to infection regarding the use of medical devices?
A.Discontinue the device immediately when no longer needed
B.Get an second opinion regarding the medical device
C.Change the device daily
D.Keep the patient on the medical device until they are ready to be discharged
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Infection Prevention Strategies (cont.)
Interrupting routes of transmission Special equipment handling Barrier/isolation precautions using both standard &
transmission based precautions Disposable equipment
Infection prevention programs identify & categorize HAIs & provide guidance to break chain of events
Infection prevention programs endorse prevention by assuring that caregivers have appropriate time, equipment, & training to provide best possible care
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Infection Prevention Strategies (cont.)
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Infection Prevention Strategies (cont.)
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Eliminating Source of Pathogens
General sanitation measures:Help to keep overall environment cleanAim to reduce number of pathogens to safe levelEnvironmental control of air & water complements
efforts
Specialized equipment processing: to decontaminate equipment capable of spreading
infection involves cleaning, disinfection, & sterilization
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Preventing Transmission of Infectious Agents
Standard Precautions: combine major features of Universal Precautions & Body Substance Isolation
To be applied to patients in all health care settings, all the time
Standard precautions apply to:– Blood– All body fluids– Nonintact skin– Mucous membranes
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Preventing Transmission of Infectious Agents (cont.)
Personal Protective Equipment (PPE) must be worn at all timesGloves: must be sterile whenever performing invasive
procedures
Masks: protect mucosal surfaces against splashes or sprays but should not be confused w/ particulate respirators
N-95 or higher-level respirator: intended for diseases that could be airborne transmitted
Gowns: provide barrier protection & can prevent contamination of clothing & exposed body areas
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Preventing Transmission of Infectious Agents (cont.)
Respiratory Hygiene/cough etiquette:Education of patients & employeesPosted signsSource control measures (covering mouth/nose, or
using surgical mask)Hand hygieneSpatial separation (at least 3 feet of space)
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Expanded Precautions
Transmission Based Precaution: patients who are known/suspected to be infected w/ pathogens requiring additional control measures to prevent transmission
Contact precautions: Intended to reduce risk of transmission by direct or
indirect contact Proper use of gowns & gloves Most commonly employed to decrease spread of
multidrug resistant organisms, such as Clostridium difficile
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Expanded Precautions (cont.)
Droplet precautions (see Box 4-5) To prevent form of contact transmission that occurs
when droplets are propelled short distances, such as influenza
Generated w/ coughing, sneezing, suctioning, bronchoscopy, & cough induction
Surgical mask must be worn
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Expanded Precautions (cont.)
Airborne infection isolation (see Box 4-7) Isolation techniques intended to reduce risk of
selected infectious agents transmitted by “small droplets” of aerosol particles, such as M. tuberculosis
Use of N-95 respirator Room must be negative pressured, 2 air exchanges
per hour, & use HEPA filters
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Expanded Precautions (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Expanded Precautions (cont.)
Protective environment Specialized engineering approach to protect highly
immunocomprised patients
Used w/ allogeneic stem cell transplant patient
Includes: HEPA filtration of incoming air, directed room air flow, positive room air pressure relative to corridor, well-sealed rooms to prevent infiltration of outside air, ventilation to provide 12 or more air changes per hour
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Expanded Precautions (cont.)
Patient placement & transportSingle occupancy room ideal
Cohorting: grouping patients w/ same infection
Limit transport of patients w/ contagious diseases
During transport: patient needs to wear appropriate barrier protection (masks, gowns, impervious dressings) consistent w/ route & risk for transmission
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Disinfection & Sterilization
CleaningCleaning is first step in all equipment processing Involves removing dirt & organic materialFailure to clean equipment properly can render all
subsequent processing efforts ineffectiveSoaps & detergents need to be usedNon-critical items, such as commodes, intravenous
pumps, & ventilator surfaces, must be thoroughly cleaned & disinfected before use w/ another patient
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Disinfection & Sterilization (cont.)
DisinfectionDisinfection destroys vegetative form of all pathogens
except bacterial sporesDisinfection can involve either chemical or physical
methodsPasteurization is most common physical method
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Disinfection & Sterilization (cont.)
Chemical DisinfectionChemical disinfection involves application of chemical
solutions to contaminated equipment or surfacesEquipment must be immersed in solution for set
period of timeMany chemical methods used to disinfect respiratory
care equipmentLabels should be read carefully & instructions
properly followed during use
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Sterilization
• Destroys all microorganisms• Can be achieved w/ physical & chemical
approaches• Steam sterilization is most common & easiest• Low-temperature sterilization technologies
include ethylene oxide: colorless & toxic gas• Medical devices contacting with sterile body
tissues or fluids are critical items & should be sterile before use
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Sterilization
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Sterilization
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Which one of the following equipment requires to be “sterilized” ?
A.ventilator
B.stethoscope
C.bronchoscope
D.oxygen therapy device
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Equipment Handling Procedures
Include: Maintenance of in-use equipment Processing of reusable equipment Application of one-patient–use disposables Fluid & medication precautions
Respiratory care equipment that can spread pathogens include: nebulizers, ventilator circuits, bag-valve-mask devices (BVMs; manual resuscitators), & suction equipment
Oxygen therapy & pulmonary function equipment are also implicated as potential sources of nosocomial infections
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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Equipment Handling Procedures (cont.)
NebulizersLarge-volume nebulizers are often problemSmall-volume nebulizers can also produce bacterial
aerosols
Ventilators and CircuitsCircuits pose greatest risk for infectionHigh-efficiency particulate air/aerosol (HEPA) filters
help reduce endotracheal tube contamination
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Equipment Handling Procedures (cont.)
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Equipment Handling Procedures (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Equipment Handling
Disposable EquipmentImportant alternative to continually reprocessing
equipment3 major issues
1. Cost
2. Quality
3. Reuse (raises significant safety concerns)
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What does a room that is on airborne isolation need to have?
A.no windows
B.HEPA filters
C.a disposable ventilator
D.positive pressure air
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Surveillance
Ongoing process of monitoring patients & personnel for acquisition of infection
Infection control committee establishes surveillance policies & infection control expert administers them
Common for infection prevention programs to oversee hand hygiene & standard precautions adherence observations
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