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Infection Control
Infection Control
Disease
Any deviation or interruption of the normal structure or
function of any part, organ, or system of the body
Caused by microbes
Absence of health
HCPs need to understand infectious diseases and how they
are spread and controlled
Infection Control
Infection
Growth of a microbe in a host resulting in illness
Caused by pathogenic organisms
Hospitals are :
gathering place for the sick
breeding ground for germs
easy transmission due to frequent close contact
Employees have a professional duty to follow infection control policies
Promotes safety – yours, patients, co-workers, visitors
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Infection Control
Hospital acquired infections (HAI)
previously eradicated infections are returning
(measles, whooping cough, diphtheria)
new diseases are being discovered
(ESBL, flu strains)
developing resistance to treatment
(MRSA, VRE)
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Micro-organisms – too small to be seen by the naked eye
bacteria, viruses, protozoa, prions, fungi
Most micro-organisms are necessary for our well being
Most micro-organisms do not cause infections (normal flora)
skin, digestive tract, mucous membranes
Protect from other diseases
Good bacteria vs. bad bacteria
Micro-organisms that cause infection = pathogen
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Colonized vs Infected
Carry bacteria without evidence of infection (fever, increased
WBC) are colonized
Once infected and treated – bacteria become dormant
Dormant bacteria can be transmitted from one patient to
another
Usually by the hands/equipment of health care workers
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Types of Pathogens
Bacteria
Viruses
Fungi
Parasitic protozoa
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Bacteria
Small single cell organisms
Grow independently/reproduce without a host
Classified according to shape: cocci, bacilli, spiral/spirochetes
Dye is used to determine : gram (–) or gram (+)
Stained and heated to determine acid fast or non acid fast
Aerobic vs. anaerobic vs. facultative
Cell wall is essential for survival
Antibiotics are used to attack and destroy the cell wall
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Bacteria
Staphylococcus and streptococcus = gram + cocci
MRSA, strep throat, necrotizing fasciitis
E. Coli = gram – bacillus
infectious diarrhea, vaginal infections
Tuberculosis = acid fast bacillus
Adapt to new conditions easily and become resistant to
antibiotics
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Infection Control
Viruses
Sub-cellular organisms
Smallest disease causing organisms
Viewed only with electron microscope
Contain genetic material (DNA/RNA)
Covered with a lipoprotein that has spikes so they can attach to a host
HIV, influenza, Hepatitis B
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Viruses
Cannot survive independently
Attach to host cells that have a specificity
Hepatitis – liver
Influenza – respiratory tract
HIV – lymphatic system
Difficult to create antiviral drugs that are not toxic to the host cells
Relatively few antiviral agents exist
Epstein Barr - mononucleosis, chronic fatigue syndrome
Varicella – herpes zoster, chicken pox
Infection Control
Fungi (fungus)
Single cell are typically yeast which reproduce by forming buds
Multi cell chains are typically mold which reproduce by forming spores
Over 100,000 diverse species (most common are yeast and mold)
Most serve useful purposes – cheese, breads, antibiotics, alcohol
Decompose plants and animals to fill the soil with nutrients
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Infection Control
Fungi (fungus)
Can be destructive
erode wood and leather
Cause infections
athletes foot and ringworm
Opportunistic infections (immunosuppressed patients)
pneumocystis carinii pneumonia and candidiasis
Infection Control
Protozoa
Complex single cell organisms
Generally live in the environment
Some are parasitic and live in a host
Most will produce some form of resistant strain
Complicated lifestyles traveling back and forth between hosts and infected vectors
Malaria
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Protozoa
Infect the GI tract, GU tract, respiratory and circulatory system
Amebiasis and guardiasis (GI tract) – diarrhea
Trichomoniasis (GU tract) – causes discharge from penis or vagina (STD)
Toxoplasmosis (blood, lymphatic, and neurological systems)
found in cat feces and undercooked meats
can affect any of these systems
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Infection Control
Establishing an Infection
Encounter
Entry
Spread
Multiplication
Damage
Outcome
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Encounter:
infectious organism comes in contact with a host
Entry:
Access to the organism thru a portal of entry
nose, eyes, mouth, ears, blood, vagina, penis, wound, GI/GU etc…
Spread/Multiplication:
Infectious organism travels through body and multiplies
Overcomes body’s immune defenses
Damage:
Either direct or indirect
Causes tissue and cell death by activating inflammatory and immune responses
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Outcome
Results in any of three outcomes:
Host gains control and eliminates microbe
Microbe overcomes host’s immunities - causes disease
Host and microbe compromise and live in a symbiotic state
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Infection Control
Most organisms are fragile
Require moisture, nutrients, right temperature to exist
Some pathogens mutate to adapt to environment
Some pathogens are resistant to extremes
Spores: tetanus, anthrax, botulism
Viruses: herpes (both oral and genital)
Infection Control
HCW are exposed to numerous pathogens every day
in-patients, out-patients, visitors, and co-workers carry germs
Increase your susceptibility when resistance is low
stress, fatigue, poor nutrition
Take care of yourself – its your best defense (and hand hygeine)
Infection Control
External Defense Against Infection
Mechanical barriers
clothing, dressings
Normal Microbial Flora
Hand washing
Antibiotics
Immunizations/Vaccines
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Infection Control
Body’s Defense Against Infection
Protected from pathogens:
natural resistance – immune system (intact skin, cilia, chemicals)
acquired resistance – immunizations, active immunity
short term – passive immunity (Rabies, flu, pneumonia)
weaken over time
Infection Control
Infectious Diseases
New and once eradicated diseases are emerging in epidemic numbers
HCW are on the front line
Infection Control department – protects employees, patients, visitors
Participate in research and develop policy based on recommendations
CDC (Center for Disease Control) – national
WHO (World Health Organization) - international
Infection Control
Infectious Diseases
Diseases travel just as fast as humans
Travel into areas previously not ventured – carry infection back
International sales – big culprit
New strains are mutated – mostly due to overuse of abx
Breakdown in public health standards
Bioterrorism
Hantavirus, dengue fever, rotavirus, swine flu – USA
Cholera – South America, Africa
Diphtheria - Russia
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Infection Control
Nosocomial Infections (HAI)
2 million hospitalized patients acquire annually
Most are not fatal
About 90,000 will die from complications of the infection
Pay for performance
ALL ARE PREVENTABLE!!!!
Community Acquired vs Hospital Acquired
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Risk Factors for Infection
Age
Heredity
Nutritional status
Stress
Inadequate rest or exercise
Health history/Personal lifestyle/Habits
Inadequate defenses
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Routes of Transmission
Air
Droplet
Contact
Transmission may be exogenous or endogenous
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Infection Control
Blood Borne Pathogens
Disease-causing microorganisms present in human blood
Considered nosocomial
Two types are of concern in hospital setting:
–HIV (human immunodeficiency virus)
–HBV (hepatitis B virus)
Infection Control
HIV
Virus specifically infects immune system in host
Responsible for acquired immunodeficiency syndrome (AIDS)
Symptoms: weight loss, muscle/joint pain, glandular pain/swelling, night sweats
May be asymptomatic after exposure to HIV for as long as 10 years
May take up to 1 year for results of blood test to become positive for HIV antibodies
Infection Control
HBV
Primarily affects liver, results in swelling, soreness, and loss of normal function
Symptoms: weakness, fatigue, anorexia, nausea, abdominal pain, fever, and headache
Leads to yellow skin color (jaundice)
May be asymptomatic
Blood will test positive 2 to 6 weeks after symptoms develop
Can recover in 6 to 8 weeks, but blood test will always show they were exposed
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Infection Control
Standard Precautions
Typically includes hand hygiene with gloves
(gown, mask, goggles when appropriate)
Used when you may have contact with blood, body fluids, mucous
membranes, and wounds
Practice biosafety in medical imaging
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Hand Hygiene
Must be performed before and after each patient
Can always find examples of poor technique
Rarely can be traced back to a culprit
May have hygiene police in your facility
Easiest most effective way to prevent spread of infection
do not practice what we preach
not enough sinks, soap dries skin, too busy, lack of role models
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Waterless Soaps
Golf ball size dollop
15 seconds of vigorous rub
Portability
Not effective for Cdif or anthrax
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Infection Control
Visibly soiled hands should be washed with soap and water
Gloves should always be worn
Hand hygiene after removing
Artificial nails prohibited
¼” tip – no longer
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Handling Contaminated Waste
Good housekeeping
Clean equipment
Clean linen
Fold or ball up linen
Use approved receptacles
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Avoiding Spread
Most items are patient specific
bedpans, urinals, commodes, basin
IV poles, BP cuff, thermometers should be cleaned
Disposable items should be discarded
Blood and body fluids go into a biohazard container
Needle safety
Specimens – secure tightly, label, transport appropriately
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Infection Control
Xrays of Isolation Patients
Patients feel rejected/untouchable
Express a friendly interest
Avoid displays of fear or repulsion
Typically requires two people (one clean and one dirty)
Prepare the room
Prepare yourself
References
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