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Unit 13
Infection Control
Copyright © 2008 Delmar Learning. All rights reserved.
Objectives
• Spell and define terms.
• Explain the principles of medical
asepsis.
• Explain the components of standard
precautions.
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Objectives
• List the types of personal protective
equipment.
• Describe nursing assistant actions
related to standard precautions.
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Objectives
• Describe airborne precautions.
• Describe droplet precautions.
• Describe contact precautions.
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Disease Prevention
• In the last unit, you learned what
infections are and some of their causes
• In this unit
– You will learn actions and procedures that
can help prevent the transmission of
infection to protect yourself, your
coworkers, and those in your care
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Medical Asepsis
• Asepsis
– Absence of disease-producing
microorganisms
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Medical Asepsis
• Medical asepsis
– Reducing the numbers of diseaseproducing microorganisms
– Or interrupting transmission from one
person to another person or from a person
to a place or an object
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Handwashing
• Single most important health procedure
any individual can perform to prevent
the spread of microbes
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Handwashing
• Vigorous, short rubbing together of all
the surfaces of soap-lathered hands
• Followed by rinsing under a stream of
running warm water
• Handwashing should take at least 15
seconds
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Waterless Hand Cleaners
• Many facilities provide dispensers
containing waterless hand cleaners in
various locations
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Waterless Hand Cleaners
• Hand cleaners
– Alcohol-based gel, lotion, or foam that is
dispensed in small dime- to quarter-sized
portions
– Alcohol products may be used to clean
your hands for most routine care
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Using Alcohol Hand Cleaner
• Wash at the sink if:
– Hands are soiled with a protein substance
– Patient is known or suspected of having a
disease caused by spores
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Hand Lotion and Cream
• Maintaining the integrity of the skin on
your hands
– Very important to prevent injury and
exposure to microbes
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Hand Lotion and Cream
• Hand care products
– Use products from individual, personal size
packages, or from a pump dispenser or
squeeze bottle, but don’t touch the spout
– Avoid products in a jar
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Protecting Yourself
• As you perform your duties, you may
contact potentially infectious material
– Blood or other body fluids, that may
contain pathogens
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Standard Precautions
• Infection control actions used for all
people receiving care
– Regardless of their condition or diagnosis
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Standard Precautions
• Previously called Universal Precautions
• Assumes blood and body fluid of any
patient could be infectious
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Standard Precautions
• Recommends PPE and other infection
control practices to prevent
transmission in any healthcare setting
• Decisions about PPE use determined
by type of clinical interaction with patient
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PPE for Standard Precautions (1)
• Gloves
– Use when touching blood, body fluids,
secretions, excretions, contaminated items
– For touching mucus membranes and
nonintact skin
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PPE for Standard Precautions (1)
• Gowns
– Use when in contact with clothing, exposed
skin with blood/body fluids, secretions, or
excretions
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PPE for Standard Precautions (2)
• Mask and goggles or a face shield
– Used during patient care activities likely to
generate splashes or sprays of blood,
body fluids, secretions, or excretions
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Transmission-Based Precautions
• Standard precautions do not eliminate
the need for other isolation precautions
• A second set of precautions is used with
certain highly transmissible diseases
• Second tier of precautions is called
transmission-based precautions
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Four Isolation Techniques
1. Isolation technique is the name given
to the method of caring for patients
with easily transmitted diseases
2. Essential that every person take
responsibility and use the proper
isolation techniques to prevent the
spread of disease to others
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Four Isolation Techniques
3. All items that come into contact with a
patient’s excretions, secretions, blood,
body fluids, mucous membranes, or
nonintact skin are considered
contaminated. Infectious material must
be treated in a special way.
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Isolation Technique
4. Standard precautions are always used
in addition to transmission-based
precautions
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Isolation Unit
• May be an area or a private room
• Patients with the same disease may
share a room
• A room with handwashing facilities and
an adjoining room with bathing and
toilet facilities is best
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AII (A2) Rooms
• Rooms with a special air handling
system may be called A2 rooms
• These rooms have negative pressure
– Air flow in which air from the room is
vented directly to the outside
– Or filtered so pathogens cannot escape
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AII (A2) Rooms
• Ventilation is needed for airborne
precautions
• A HEPA respirator or NIOSH-approved
mask
– Must always be worn when entering an
airborne precautions room
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Ultraviolet Germicidal
Irradiation (UVGI)
• Ultraviolet Germicidal Irradiation (UVGI)
lights
– Used to eliminate pathogens in some
isolation rooms
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Ultraviolet Germicidal
Irradiation (UVGI)
• UVGI lights
– Used intermittently as a secondary
measure to kill or inactivate the pathogens
in the upper portion of the room or passing
through the air duct
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Ultraviolet Germicidal
Irradiation (UVGI)
• Lights are not on all the time
• Not a threat to the patient or health care
workers
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The Anteroom
• Used to enter some isolation rooms
• Is a small room inside the entrance to
the patient room
• It contains a sink and containers for
trash disposal
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The Anteroom
• Reduces escape of infectious
organisms when the door is opened and
closed
• It serves as a buffer between the
changes in air pressure in the patient
room and the hallway
• Refer to Figure 13-11
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The Anteroom
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Additional
Respiratory Precautions
• CDC recommends:
– Teaching new admissions and those who
accompany them to use respiratory
precautions
– Notifying staff if symptoms of a respiratory
infection are present when they first
register for care
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Additional
Respiratory Precautions
• Other respiratory precautions are:
– Practicing respiratory hygiene/cough
etiquette
– Containing secretions
– Covering the nose and mouth when
coughing or sneezing
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Additional
Respiratory Precautions
• Other respiratory precautions are:
– Using tissues to contain respiratory
secretions
– Discarding the tissues in the nearest trash
can after use
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Additional
Respiratory Precautions
• Other respiratory precautions are:
– Performing hand hygiene after contact with
respiratory secretions and/or contaminated
objects and/or materials
– Using alcohol hand cleaner from
dispensers mounted in public areas
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Preparing for Isolation
• To prepare a patient room for isolation,
do the following:
– Indicate type of isolation precautions on
the door to the patient’s room
– Place an isolation cart next to the door
• Provide PPE (personal protective
equipment) as needed
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Preparing for Isolation
• To prepare a patient room for isolation,
do the following:
– Line wastepaper basket inside the room
with a plastic bag labeled or color-coded
for infectious waste
– Place a laundry hamper in the room
• Line it with a yellow biohazard laundry bag
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Preparing for Isolation
• To prepare a patient room for isolation,
do the following:
– At the sink, check the supply of paper
towels and soap
– Soap should be in a wall dispenser or footoperated dispenser
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Personal Protective Equipment
• Personal protective equipment includes:
– Gloves, gown, mask, and goggles or face
shield
• Regular eyeglasses do not provide
adequate protection
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Personal Protective Equipment
• Eye protection must also protect the
sides of the eyes
• A mask may be worn without eye
protection
– But eye protection should never be worn
without a mask
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Selecting PPE
• For maximum protection, select the
appropriate PPE based upon:
– Type of anticipated exposure
– Whether you expect only touch, or if
splashes, sprays, or large volumes of
blood or body fluid, secretions, or
excretions may be present
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Selecting PPE
• For maximum protection, select the
appropriate PPE based upon:
– Durability and appropriateness of the PPE
for the task
– How well the PPE fits you
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Key Points About PPE
• Don before contact with the patient,
generally before entering the room
• Use carefully
– Don’t spread contamination
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Key Points About PPE
• Remove and discard carefully
– Either at the doorway or
immediately outside patient room
– Remove respirator outside room
• Immediately perform hand hygiene
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Sequence for Applying
Personal Protective Equipment
1)
2)
3)
4)
5)
Wash hands
Gown
Mask or respirator
Goggles or face shield
Gloves
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How to Don a Gown
• Select appropriate type
and size
• Opening is in the back
• Secure at neck and
waist
• If gown is too small, use
two gowns
• Gown #1 ties in front
• Gown #2 ties in back
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How to Don a Mask
• Place over nose, mouth,
and chin
• Fit flexible nose piece
over nose bridge
• Secure on head with
ties or elastic
• Adjust to fit
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How to Don
a Particulate Respirator
• Select a fit tested
respirator
• Place over nose,
mouth and chin
• Fit flexible nose piece
over nose bridge
• Secure on head with
elastic
• Adjust to fit
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How to Don
a Particulate Respirator
• Perform a fit check
– Inhale – respirator
should collapse
– Exhale – check
for leakage
around face
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How to Don
Eye and Face Protection
• Position goggles over eyes
• Secure to the head using the
ear pieces or headband
• Position face shield over face
• Secure on brow with
headband
• Adjust to fit comfortably
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How to Don Gloves
• Don gloves last
• Select correct type and
size
• Insert hands into gloves
• Extend gloves over
isolation gown cuffs
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Do’s and Don’ts of Glove Use
• Work from “clean to dirty”
• Limit opportunities for “touch
contamination”
• Protect yourself, others, and environment
• Don’t touch your face or adjust PPE with
contaminated gloves
• Don’t touch environmental surfaces
except as necessary during patient care
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Do’s and Don’ts of Glove Use
• Change gloves
– During use if torn and when heavily soiled
(even during use on the same patient)
– After use on each patient
• Discard in appropriate receptacle
– Never wash or reuse disposable gloves
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How to Safely Use PPE
• Keep gloved hands away from face
• Avoid touching or adjusting other PPE
• Remove gloves if they become torn
– Wash hands before donning new gloves
• Limit surfaces and items touched
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“Contaminated” and
“Clean” Areas of PPE
• Contaminated – outside front
– Areas of PPE that have or are likely to
have been in contact with body sites,
materials, or environmental surfaces
where the infectious organism may reside
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“Contaminated” and
“Clean” Areas of PPE
• Clean – inside, outside back, ties on
head and back
– Areas of PPE that are not likely to have
been in contact with the infectious
organism
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Sequence for Removing
Personal Protective Equipment
1)
2)
3)
4)
5)
6)
Gloves
Wash hands
Goggles or face shield
Gown
Mask
Wash hands
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Where to Remove PPE
• At doorway, before leaving patient room
or in anteroom
• Remove respirator outside room
– After door has been closed
• Ensure that hand hygiene facilities are
available at the point needed
– Sink or alcohol-based hand rub
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How to Remove Gloves (1)
• Grasp outside edge near wrist
• Peel away from hand
• Turn glove inside-out
• Hold in opposite gloved hand
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How to Remove Gloves (2)
• Slide ungloved
finger under the
wrist of the
remaining glove
• Peel off from inside
• Create bag for both
gloves
• Discard
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Remove Goggles or Face Shield
• Grasp ear or head
pieces with ungloved
hands
• Lift away from face
• Place in designated
receptacle for
reprocessing or
disposal
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Removing Isolation Gown
• Unfasten ties
• Peel gown away
from neck and
shoulder
• Turn contaminated
outside toward the
inside
• Fold or roll into a
bundle
• Discard
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Removing a Mask
• Untie the bottom & top
tie
• Remove from face
• Discard
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Removing a Particulate Respirator
• Lift the bottom elastic
over your head first
• Then lift off the top
elastic
• Discard
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Hand Hygiene
• Perform hand hygiene immediately after
removing PPE
• If hands become visibly contaminated
during PPE removal
– Wash hands before continuing to remove
PPE
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Hand Hygiene
• Wash hands with soap and water or use
an alcohol-based hand rub
• Ensure that hand hygiene facilities are
available at the point needed
– Sink or alcohol-based hand rub
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Equipment
• Disposable patient care equipment is
used by many facilities
• It is ideal for patients on isolation
precautions
• Frequently used equipment remains in
the patient’s unit
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Containment of
Contaminated Articles
• It is important that contaminated
equipment be bagged, labeled, and
disposed of
– According to the health care facility’s policy
for the disposal of infectious waste
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Containment of
Contaminated Articles
• Contaminated articles leaving the
patient’s room
– Must be handled so that pathogens will not
be spread
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Transporting the
Patient in Isolation
• Sometimes a patient in isolation has to
be transported to another area of the
health care facility for treatment or
testing
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Transporting the
Patient in Isolation
• Notify the receiving unit of your intention
to transport the patient
– Describe the type of transmission-based
precautions being used
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Disinfection and Sterilization
• Disinfection
– Process of eliminating harmful pathogens
from equipment and instruments
• Sterilization removes all
microorganisms from an item
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Sterile Procedures
• Surgical asepsis
– Environment kept free of microorganisms
– Pathogens and nonpathogens
– In procedures in which surgical asepsis is
used
• Equipment and supplies must be sterile
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Sterile Field
• An area of sterile equipment and
materials
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