INFECTION PREVENTION and CONTROL

Standard Precautions OR ….How to prevent the spread of disease

NORMAL DEFENSES

Types of Infections

Heath Care-Associated Infections formerly called nosocomial

HAIs Iatrogenic:

Exogenous:

Endogenous:

CHAIN OF INFECTION

Cholera Outbreak in Haiti

Cholera

Nepalese peacekeeping force

Poop

Latrines near water

River

Drinking contaminated water

Historical Perspective 1847 Dr. Ignaz Philip Semmelweiss

Significance of hand washing is demonstrated

Concept of nosocomial infection is born

More History

Infectious Disease Process

Infection:

Normal flora:

Colonization:

Chain of Infection

Causative Agents Bacteria

Virus

Fungi

Protozoa

Characteristics of Causative Agents

Reservoirs

NCLEX ? Which of the following is an example of a

nursing intervention that is implemented to reduce a reservoir of infection for a client?

A) Covering the mouth and nose when sneezingB) Wearing disposable glovesC) Isolating client’s articlesD) Changing soiled dressings

Portal of Exit: The path by which the infectious agent leaves the

reservoir Respiratory Tract:

GU Tract

GI Tract:

Skin/Mucous Membranes:

Transplacental

Blood:

Mode of Transmission

The mechanism for transfer of an infectious agent from the reservoir to the susceptible host

VIGNETTE

An older adult, hospitalized with a GI disorder is on bedrest and requires assistance for uncontrolled diarrhea stools.

Following one episode of cleaning the patient and changing the bed linens, the nurse went to a second patient to provide tracheostomy care.

The nurse’s hands were not washed before assisting the second patient

VIGNETTE ANALYSIS

Infectious agent → Escherichia Coli

Reservoir → Large Intestines

Portal of Exit → Feces

Mode of Transmission → Nurses Hands

Portal of Entry → Tracheostomy

Susceptible Host → Older Adult with Trach

Modes of Transmission

Contact

Airborne

Vector-Borne

Contact Direct:

Indirect:

Modes of Transmission

Direct Person to

Person (Fecal-Oral) Hepatitis A

Staph

Indirect Contact with

contaminated object Hepatitis B

and C

HIV

RSV

MRSA

Airborne Droplets suspended in air after coughing

and sneezing or carried on dust particles TB Chicken Pox Measles (Rubeola) Aspergillus

Droplet transmission Large particles Can travel up to

3 feet Influenza

Rubella (3-day/German Measles)

Bacterial Meningitis

Vector-Borne Vector

External mechanical transfer Mosquito, Louse, Flea, Tick, Fly

West Nile Virus Malaria Lyme Disease Hanta Virus

Portal of Entry: path by which an infectious agent enters the

susceptible host Respiratory tract

GU tract

GI tract

Transplacental (fetus from mother)

Parenteral: percutaneous, via blood

Skin/Mucous Membranes

Susceptible Host A person or animal lacking effective

resistance to a particular pathogenic agent

Man-Made Epidemics (NYT

July 15, 2012)

Diseases have always come out of the woods

and wildlife

West Nile Virus

American Robin Thrives in our backyards and agriculture

fields

Mosquitoes that spread the disease find robins particularly appealing

H1N1

Lyme Disease .

Ebola

SARS

Bird Flu

Isolation Precautions Historical perspective 1877 to present

1877

Aseptic technique

1910

“Barrier” Nursing Hospital personnel wear gowns between

patients

Handwashing between patients with antiseptic solutions after patient contact

Disinfection of objects contaminated by patients

More Hx 1950s: Infectious Disease hospitals begin to

shut down except for TB sanitariums

1960s: TB hospitals begin to shut down

1970: CDC publishes first manual on Isolation Techniques for Use in Hospitals. Diseases were lumped into categories

1980s: Hospitals began to experience new endemic and epidemic nosocomial infection problems caused by multi-drug-resistant organisms

HX 1980: CDC publishes new Isolation guidelines

1985: Universal precautions come into being (HIV, HBV, blood borne pathogens)

1990s HICPAC: 2 tier system

Standard Precautions

Transmission-Based Precautions (Contact, Droplet, Airborne)

HAIs

Surgical Sites

Blood Stream

Urinary System

Cardiovascular

Eye/Ear/Throat/Mouth Infection

Reproductive System

Respiratory

Bone and Joint Infection

CNS

Gastrointestinal

Skin and Soft Tissue

Immunocompromised Pts

Vary in their susceptibility to HAIs

Depends on the severity and duration of immunosupression.

Use the two-tiered system

Neutropenic precautions

Critical Thinking Question

Clients in the healthcare setting are at risk for acquiring or developing infections because:

Prevention Most HAIs are transmitted by the HCWs and

clients as the result of direct contact

We as nurses must pay attention to

handwashing after contact with clients and equipment

Prevention Microorganisms move through space on air

currents

Microorganisms are transferred from one surface to another whenever objects touch, a clean item touching a less clean item becomes “dirty”

Microorganisms are transferred by gravity when one item is held above another

Prevention Microorganisms are released into the air on

droplet nuclei whenever a person breaths or speaks-

Microroganisms move slowly on dry surfaces, but very quickly through moisture –

Proper handwashing removes many of the microorganaisms that would be transferred by the hands from one item to another-

always wash hands between patients.

Prevention To reduce susceptibility provide adequate

nutrition and rest, promote body defenses against infection and provide immunization

Superbugs MRSA

VRE: Vancomycin resistant enterococcus

Break The Chain! Implement ASEPSIS: absence of disease-

producing microorganisms; refers to practices/procedures that assist in reducing the risk of infection

2 Types Medical (clean technique)

Surgical (sterile technique)

MEDICAL ASEPSIS

Clean technique:

Aseptic technique

3 components to the technique: Hand washing,

Barriers of PPE (gloves, gowns, mask, protective eyewear)

Routine environmental cleaning

Contaminated area:

Disinfection/Sterilization

Disinfection = the process that eliminates many or all microorganisms, with the exception of bacterial spores, from inanimate objects

Sterilization = complete elimination or destruction of all microorganism, including spores

Aseptic technique Handwashing is the single most important

procedure for preventing the transfer of microorganisms and therefore preventing the spread of HAIs

CD recommends 10-15 second hand wash.

Personal Hygiene Restrain Hair: hair falling forward may drop

organisms

Keep nails short: no acrylic nails or chipped nail polish

Minimum jewelry (see agency policy)

Cover open wounds with an occlusive dressing.

When should hands be washed

CDC GUIDELINES Standard Precautions apply to:

Blood

All body fluids and secretions (feces, urine, mucus, wound drainage) except sweat

Non-intact skin

Mucous membranes

Respiratory secretions

STANDARD PRECAUTIONSTIER 1

Hand Hygiene: see next slide

Gloves: for touching blood, body fluids, secretions, excretions, non-intact skin, mucous membranes or contaminated areas

Masks, Eye Protection or Face Shields: if in contact w/ sprays or splashes of body fluids

Gowns: to protect your clothing

Contaminated Linen: place in leak-proof bag so no contact with skin or mucous membranes

Respiratory Hygiene/Cough Etiquette: provide client with tissues and containers for disposal; stand ~3 feet away from coughing; use masks prn

Hand Hygiene

ISOLATION PRECAUTIONSTIER 2

Contact = private room or cohort clients, gloves and gowns MDRO, C-Diff, RSV

Droplet = private room or cohort clients, mask is required Strept, pertusis, mumps, flu

Airborne = private room, negative airflow, hepa filtration; N95 respirator mask required TB, chickenpox, measles

Protective Environment = private room, positive-pressure room; hepa filtration; gloves, gowns, mask (controversial); NO flowers or potted plants Stem cell transplant

N95 Respirator

STANDARD PRECAUTIONS

Handwashing

Gloves (PPE)

Masks (PPE)

Eye Protection (PPE)

Gowns (PPE)

Leak-proof linen bags

Puncture proof containers for sharps

Donning and Removing PPE Donning

Gown

Mask or respirator

Goggles/face shield

Gloves

Keep hands away from face

Work from clean to dirty

Lime surfaces touched

Change when torn or heavily soiled

Removing Gloves

Goggles/face shield

Gown

Mask or respirator

Remove at doorway before leaving pt. room

Perform hand hygiene immediately after removing all PPE

Surgical Asepsis Sterile technique that prevents

contamination of an open wound, serves to isolate the operative area from the unsterile environment, and maintains sterile field for surgery

Principles of Surgical Asepsis

For which procedure would the nurse use aseptic technique and which would require the nurse to use sterile technique?

A) Aseptic technique for urinary catheterization in the hospital and sterile technique for cleaning surgical wound

B) Aseptic technique for changing the patient’s linen and sterile technique for assisting in surgery

C) Aseptic technique for food preparation and sterile technique for starting an IV line

D) Aseptic technique for a spinal tap and sterile technique for placing a central line

LAB Practice: Isolation Precautions

Demonstrate donning Isolation Gown, Mask, Gloves, Eyewear

Demonstrate removing Isolation Gown, Mask, Gloves, Eyewear

Demonstrate proper disposal of PPE before leaving Isolation Room

When performing care/treatments use hospital provided stethoscope and leave in the room

Lab Practice Cont’d. Practice pretending you are entering patient

room (use curtains) and give Complete Bed Bath and do Bed Linen Change wearing PPE (gown, mask, gloves)

Remember to dispose of PPE INSIDE the patient’s room before you leave

Practice bringing in all the supplies you need so you can stay in the room & not have to leave (de-gown etc) and come back in (re-gown etc)

LAB Practice: Sterile Procedures

Opening sterile packages – Flap fartherest away from nurse first, then sides, then flap closest to nurse

Preparing a sterile field

Pouring sterile solutions – label to palm, “lip” it

Donning sterile gown and gloves

Critical Thinking Exercise

Mrs. Jaycock had an indwelling urethral catheter for 1 week. The catheter has now been out for 24 hours. She complains of frequency and pain on urination. Mrs. Jaycock suggests reinsertion of the catheter because of the need to get up frequently. What can frequency or pain on urination be an indication of?

Answer UTI

Should the catheter be reinserted?

Why or why not?

Answer No reinserting the catheter may aggravate

the infection and promote the spread of the infection to the bloodstream.

Describe at least one appropriate assessment measure and one independent nursing action or intervention for Mrs. Jaycock

Nursing Response Increase her fluid intake if not clnically

contraindicated

Check her urinalysis

Situation You are caring for Mr. Huang, who has a large

open, and draining abdominal wound. You notice another health care worker changing Mr. Huang’s dressing without wearing gloves or using sterile technique. When you question the health care worker regarding his or her practice, this person says, “Don’t worry, the wound is already infected, and the antibiotics and drainng will take care of any contaminants.” How would you respond to this comment?

Response It is important to not only protect Mr. Huang

from additional infection, but also to protect ourselves from becoming contaminated.

What would your next steps be in following up on this incident?

Situation Mrs. Niles is 83 years of age and lives alone.

She has difficulty walking and relies on a church volunteer group to deliver lunches during the week. Her fixed income limits her ability to buy food. Last week, Mrs. Niles’ 79-year-old sister died. The two sisters had been very close. As a home care nurse, explain the factors that might increase Mrs. Niles’ risk for infection.

Response Age

Potential for poor nutrition

Potential for depression

Situation Mr. Vargas is admitted to the facility with a

history of recent weight loss, a cough that has persisted for 2 months, and hemoptysis. His chest x-ray film shows a cavity lesion in one lung, and his physician suspects tuberculosis. What type of isolation precautions would you use for Mr. Vargas? What protection would you use to provide care? What education would you provide to the family?

Response Airborne precautions

Wear an N95 mask

Keep the door closed

Educate the pt and family on transmission of TB and reason for isolation.