Infection Control

Ch 12 Foundations of Nursing

Professional Responsibility

Nurses have the responsibility to adhere to scientifically accepted principles & practices of infection control and to monitor the performance of those for whom the professional is responsible. (nursing assistants, etc.)

Source of Standards Board of Regents (sect. 29.2) Part 92 of Title 10 (health Dept) of the

official compilation of coeds, rules & regulations of New York

Statements of organizations (NYSNA, ANA, Etc) Defines coursework Approves training courses Addresses medical conduct

Governing Agencies

Occupational Safety and Health Administration (OSHA)

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

Centers for Disease Control and Prevention (CDC)

Conduct Standards

Failure to adhere to accepted standards of practice may result in Increased r/o infection to workers &

patients Charges of unprofessional conduct

Compliance

Participation in required infection control training (LPN program is equivalent)

Adherance to accepted principles and practices

A complaint about lax infection control practice will prompt an investigation by the Health Dept./SED

May result in professional misconduct & suspension of license

Some Terms

Microorganisms: germs, microbes Pathogen: germ that causes infection Non-pathogen: harmless germ

(sometimes makes up body flora) Normal body flora: communities of

organisms on body surfaces, specific to different areas of the body

Infectious Cycle

Infectious agent Reservoir Portal of exit Means of transmission Portal of entry Susceptible host

Infectious CycleAgent

Reservoir

Portal of exit

transmissionPortal of entry

Susceptible host

agent

Infectious Agent

Bacteria Anthrax Viruses Fungi Protozoa

Conditions suitable for microbe growth Warmth Darkness Oxygen water nourishment Spores=inactive microbial life form

that can resist heat & survive without moistures…. Difficult to destroy…in favorable conditions, may reactivate and reproduce

Reservoir

Any natural habitat of a microbe that promotes its growth and reproduction.

Fomite: an inanimate object that acts as a vehicle for infection Soiled or wet dressings Hospital equipment Counter tops

Reservoir Con’t

Normal Body Flora: communities of organisms on body surfaces, specific to different areas of the body

Carrier/vector: a person or animal who harbors and spreads an organism, butdoes not become ill.

Portal of Exit

GI Respiratory Genitourinary system Tissues Blood

Mode of Transmission After exiting the reservoir,

microbesneed a means to spread to the next host

Hands Contaminated food, water or air Contaminated equipment

Portal of Entry

Any break in the skin Mucous membranes Mouth Inhalation

Susceptible Host

Another person High risk

Diabetes Heart disease Surgery burns

Normal Defense Mechanisms

Intact Skin Mucous membranes Respiratory tract (clilia) Urinary tract GI tract Vagina

Factors affecting Normal Defense Mechanisms Age (old or very young) Stress Nutritional status Heredity Underlying disease Environmental factors Medical therapy Chemotherapy,radiation

Infectious Process

Follows a progression (box 12-3) Severity depends on

Susceptibility of host Extent of infection Agent factors

Virulence & Numbers of microbes Motility & Ability to invade host Duration of exposure to microbe

Inflammatory Response Body’s cellular response to injury or

infection is inflammation Vascular response of fluid, blood &

nutrients to interstitial tissues in area of injury causes swelling, redness, pain, heat, pus, & loss of function

Inflammatory response is body’s way of attempting to heat up, destroy bacteria, limit spread of infection to bloodstream

Localized vs Systemic

Local infection Limited to 1 certain area See redness, edema, pain, pus, etc

Systemic infection Spread to entire body through

bloodstream may become fatal

Nosocomial Infections

“Hospital acquired” Spread on hands of health care

workers Spread by direct contact between

health personnel and patients Spread from patient to patient

Infection Control Team

Specially trained Responsibility for overseeing

infection control in health facilities

Employee Health

Necessary to protect Workers patients

Hand Hygiene

The single most important means of preventing the spread of infection.

2 minute handwashing to start the day

15-30 sec between patients for minimally soiled hands

The more heavily soiled, the longer the wash

Asepsis

The Practice that decreases or eliminates the number of microbes in an area

Medical Asepsis=clean technique

Principles of Asepsis

Germs are everywhere Blood & body fluids are MAJOR

reservoirs Barriers help stop the spread Keep environment clean Some areas more contaminated

than others

Common Aseptic practices

Handwashing Dressing changes Care of the environment Keep surfaces clean, dry Care of patient supplies, drainage

tubes, etc.

Surgical Asepsis

Measures that render supplies and equipment totally free of microorganisms

Sterile Technique: practices that avoid contamination of microbe free items

Sterilization

Physical Radiation Boiling water Free flowing steam Dry heat Steam under pressure (autoclaving)

Sterilization

Chemical Peracetic acid Ethylene oxide gas

Skills for surgical asepsis

Donning sterile gloves Donning sterile gown Adding items to a sterile field

Surgical Asepsis

Work place called sterile field Use inner surface of sterile wrapper

or sterile drape Gather needed supplies Never leave sterile field unattended Perform thorough handwashing (5-10

min in OR, min. 1-2 min for other settings

Principles con’t

Always work at waist high level Keep items in sight at all times Never turn back on sterile field Open sterile items as follows

TOP FLAP AWAY FROM BODY SIDE SIDE LAST FLAP TOWARD BODY

Principles Con’t

Never cross over sterile field Pouring sterile solutions

Sterile inside, clean outside Place cap sterile side up on clean

surface Perform “lipping” pour small amt of

solution off before pouring into sterile container

Principles Con’t Touch sterile items to sterile items only Only sterile items allowed on sterile field Out of range of vision = contaminated Prolonged exposure to air=contaminated Sterile surface in contact with wet

surface becomes contaminated 1 in margin of sterile field is

contaminated

Standard Precautions Blood and body fluid

pre-cautions to be used when caring for ALL patients

Includes: Hand hygiene Gloves Masks Eye shields gowns

PPE

Gowns Face masks Goggles Gloves Booties caps

Infection control strategies of the CDC

Standard Precautions Transmission Based Precautions:

1996 addresses isolation precautions for patients with highly contagious pathogens

Isolate specific to the way a disease is transmitted

Isolation Techniques

Transmission Based Precautions Standard precautions Airborne Droplet Contact

Transmission Based Precautions

Airborne precautions need mask to block 5 micron or smaller particles (TB, measles-rubeola)

Droplet precautions: mask to block > 5 microns (flu, Rubella, Strep pneumonia

Contact precautions: protect from direct/indirect contact using gloves, gown

(wounds, rashes, diarrhea Etc)

Transmission Based con’t

Isolation or private room, or roommate with same diagnosis

Sign on door Use of PPE before entering room, remove

before leaving Concurrent cleaning by housekeeping

Dept. Dedicated equipment (stays in room) Transport patient with mask, bath blanket

Transmission Based Con’t

Pre-employment health assessments Immunizations & TB screening up to date S/S requiring immediate attention

Fever Cough Rash Vesicles Vomiting diarrhea

Psychological aspect of Isolation Patients

Feel frightened, “unclean”, neglected Allow paitent to ventilate feelings Show acceptance of person Stress that it’s the microbes, not the

patient that is unwanted Provide for sensory stimulation:

reading, TV, etc Visitors allowed (following CDC

guidelines)

Blood Borne Pathogens Risks

Direct contact with blood or body fluids of infected individuals

Sharing needles Needle stick injuries Exchange of body fluids (blood, semen, vaginal fluids

during unprotected sex

Post Exposure Management Obligation to inform patients who have been

exposed to healthcare workers’s blood or body fluids

Blood Borne Pathogens

Evaluation of healthcare workers infected with HBV, HCV, HIV

Expert panels Compliance with infection control

standards Nature & scope of practice Cognitive function

TB Precautions

Early identification and treatment is key

Suspect TB when s/s persist >3 wks S/S; fatigue, weight loss, dyspnea,

fever, night sweats, cough (w/blood) Isolation room HEPA respirator mask (1mm) Annual TB testing

Work-Practice Controls Handwashing Prompt cleaning of blood and body

fluid spills Reusable equipment must be rinsed

and sent to central service for autoclaving

Prompt disposal/handling of blood and body fluids and contaminated patiebt care items

Work Practice Controls Con’t

Dispose of needles and sharps in proper receptical

Do not recap needles that have been injected

Use PPE as indicated

Cleaning & Disinfecting

Rinse soil, debris off external & internal surfaces of reusable equipment

Transport to central service or appropriate dept for reprocessing

Follow manufacturer’s recommendation for cleaning/sterilizing