Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of...

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


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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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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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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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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Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 7

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


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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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



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


Modes of Transmission

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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


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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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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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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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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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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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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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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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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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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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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Sterilization

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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


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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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

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


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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