Download Unit 3: Your Working Environment

Module 3: Infection Control in the
Health Care Setting
Competent Healthcare
Basic Nurse Assistant Training Program
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Time: 4 hours
Infection Prevention
 An infection is a disease state resulting from the invasion
and growth of microbes in the body. Infection is a major
safety and health hazard. Minor infections cause short
illnesses. Some infections are serious and can cause
death.
 Infants, older persons, and disabled persons are at risk.
The health team follows certain practices and procedures
to prevent the spread of infection (infection control).
The goal is to protect patients, residents, visitors, and
staff from infection.
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Microorganisms
 A microorganism (microbe) is a small living thing
(organism). It is only seen with a microscope.
 Microbes are everywhere-in the mouth, nose, respiratory
tract, stomach, and intestines. They are on the skin and in the
air, soil, water, and food. They are on animals, clothing, and
furniture.
 Some microbes are harmful and can cause infections. They
are called pathogens.
 Microbes that do not usually cause infection are nonpathogens.
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Normal Flora
 Normal flora are microbes that live and grow in a certain
area. Certain microbes are in the respiratory tract, in the
intestines, and on the skin. They are non-pathogens when in
or on a natural reservoir. When a non-pathogen is
transmitted from its natural site to another site or host, it
becomes a pathogen. For example, Escherichia coli (E. coli)
is normally found in the colon. If it enters the urinary
system, it can cause an infection.
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Multidrug-Resistant Organisms
 Multidrug-resistant organisms (MDROs) are microbes that
can resist the effect of antibiotics. Antibiotics are drugs that
kill certain microbes that cause infections. Some microbes
can change their structures. This makes them harder to kill.
They can survive in the presence of antibiotics. Therefore the
infections they cause are hard to treat.
 MDRO’s are caused by prescribing antibiotics when they are
not needed (over-prescribing). Not taking antibiotics for the
length of time prescribed is another cause.
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Two types of MDRO’s
 Methicillin-resistant Staphylococcus aureus (MRSA):
 Staphylococcus aureus (“staph) is a bacterium normally found in the nose
and on the skin. MRSA is resistant to antibiotics often used for “staph”
infections. MRSA can cause serious wound and bloodstream infections
and pneumonia.
 Vancomycin-resistant Enterococcus (VRE):
 Enterococcus is a bacterium normally found in the intestines and in feces.
It can be transmitted to others by contaminated hands, toilet seats, care
equipment, and other items that the hands touch. When not in their
natural site (the intestines), enterococci can cause urinary tract, wound,
pelvic, and other infections. Vancomycin is an antibiotic often used to
treat such infections. Enterococci resistant to Vancomycin are
Vancomycin-resistant enterococci (VRE).
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Infection
 A local infection is in a body part. A systemic infection
involves the whole body. (systemic means entire). The person
has some or all of the signs and symptoms.
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Chain of Infection
 Source (Causative Agent)
 Reservior
 Portal of exit
 Method of transmission
 Portal of entry
 Susceptible host
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Susceptible hosts
 Susceptible hosts include persons who:
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Are very young and who are older
Are ill
Were exposed to the pathogen
Do not follow practices to prevent infection
The human body can protect itself from infection. The ability to
resist infection relates to age, nutrition, stress, fatigue, and health.
Drugs, disease, and injury also are factors.
Some persons are at great risk for infection. Burn, transplant, and
chemotherapy patients are examples. Severe infections can be
deadly for these persons.
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Signs and Symptoms of Infection
 Include but are not limited to:
 Pain
 Heat
 Redness
 Swelling
 Change in resident behavior
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Healthcare-Associated Infection
 A healthcare-associated infection (HAI) is an infection
that develops in a person cared for in any setting where
care is given. The infection is related to receiving health
care. Also, called nosocomial infections.
 Microbes can enter the body through equipment used in
treatments, therapies, and tests. Staff can transfer
microbes from one person to another and from
themselves to others.
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Medical Asepsis
 Asepsis is being free of disease-producing microbes.
 Microbes are everywhere. Measures are needed to achieve
asepsis.
 Medical asepsis (clean technique) is the practices used to:
 Remove or destroy pathogens (number of pathogens reduced)
 Prevent pathogens from spreading from one person or place to
another.
 Contamination is the process of becoming unclean. In
medical asepsis, an item or area is “clean” when it is free of
pathogens. The item or area is “contaminated” when
pathogens are present.
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Surgical asepsis
 Microbes cannot be present during surgery or when
instruments are inserted into the body. Open wounds require
the absence of microbes. They are portals of entry for
microbes.
 Surgical asepsis (sterile technique) is the practices that keep
items free of all microbes. Sterile means the absence of all
microbes-pathogens and non-pathogens.
 Sterilization is the process of destroying all microbes
(pathogens and non-pathogens).
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Common Aseptic Practices
 Aseptic practices break the chain of infection. To prevent the
spread of infection, wash your hands.
 After urinating or having a bowel movement
 After changing tampons or sanitary pads
 After contact with your own or another person’s blood, body
fluids, secretions, or excretions. This includes saliva, vomitus,
urine, feces, vaginal discharge, mucus, semen, wound drainage,
pus, and respiratory secretions
 After coughing, sneezing, or blowing your nose
 Before and after handling, preparing, or eating food
 After smoking a cigarette, cigar, or pipe
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Wash your hands
 After urinating or having bowel
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movement
After contact with your own or
another person’s body fluids.
After coughing, sneezing or
blowing your nose
Before and after handling,
preparing, or eating food.
When they are visibly dirty
Before and after patient contact.
After removing gloves.
Also, take these measures
 Provide all persons with their own linens and personal care
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items
Cover your nose and mouth when coughing, sneezing, or
blowing your nose. If tissues are not available, cough or
sneeze into your upper arm. Do not cough or sneeze into
your hands.
Bathe, wash hair, and brush your teeth regularly.
Wash fruits and raw vegetables before eating or serving them
Wash cooking and eating utensils with soap and water after
use.
Hand Hygiene
 Is the easiest and most important way to prevent the spread
of infection.Your hands are used for almost everything. They
are easily contaminated. They can spread microbes to other
persons or items.
 Practice hand hygiene before and after giving care.
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Handwashing
-Lather and rub at least 1520 seconds
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Skills Video Handwashing
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Isolation Percautions
 Blood, body fluids, secretions, and excretions can transmit
pathogens. Sometimes barriers are needed to keep pathogens
within a certain area. Usually the area is the person’s room.
This requires isolation procedures.
 Isolation precautions prevent the spread of communicable
diseases (contagious diseases). They are diseases caused by
pathogens that spread easily.
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Isolation Precautions
 Based on clean and dirty. Clean areas or
objects are free of pathogens. They are not
contaminated. Dirty areas or objects are
contaminated with pathogens. If a clean area
or object has contact with something dirty,
the clean area is now dirty. Clean and dirty
also depend on how the pathogen is spread.
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Isolation Precautions
Two tiers of precautions
 Standard Precautions
 Transmission-Based Precautions
Contact
Airborne
Droplet
The Centers for Disease Control and Prevention (CDC) is a federal
agency that serves to protect the health and safety of people in the
U.S. They develop disease prevention and control guidelines and
standards to improve health.
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Standard Precautions
 Standard precautions are part of the CDC’s isolation
precautions. They reduce the risk of spreading pathogens and
infections. ALWAYS wash your hands then wear gloves if you
come in contact with fluids that can cause infection.
 They prevent the spread of infection from:
 Blood
 all body fluids, secretions, and excretions (except sweat), even
if blood is not visible. Sweat is not known to spread infections
 non-intact skin (skin with open breaks)
 mucous membranes.
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Transmission-based precautions
Some infections require
Transmission-Based Precuations.
You must understand how
certain infections are spread.
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Contact Precautions
Used for persons with known or suspected
infections or conditions that increase the risk of
contact transmission. Patient in single room.
 Wear gloves and gown
 Wash hands after providing care
 Limit transport outside of the room
 Use non-disposable equipment when possible.
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Droplet Precautions
Used for persons know or suspected to be
infected with pathogens transmitted by
respiratory droplets. Such droplets are
generated by a person who is coughing,
sneezing or talking.
 Wear gloves, mask, gown
 Wash hands after providing care
 If transport required, have patient wear mask
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Airborne Precautions
Used for persons known or suspected to be
infected with pathogens transmitted by person
to-person by the airborne route. Tuberculosis,
measles, chickenpox, smallpox, and severe acute
respiratory syndrome (SARS) are examples.
 Wear a TB respirator mask, gown, gloves
 Patient must be in an airborne infection
isolation room or negative pressure room.
 Limit transportation, person to wear surgical mask if out of
room.
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Applying and Removing
Personal Protective Equipment
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Procedure
 Perform beginning tasks
 Identify type of isolation required
 Apply appropriate personal protective equipment outside the
isolation room.
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Gloves
Disposable gloves act as a barrier to protect you from
pathogens in other person’s blood, body fluids, secretions and
excretions. They also protect the person from microbes on
your hands.
Wear gloves whenever contact with blood, body fluids,
secretions, excretions, mucous membranes, or non-intact
skin is likely.
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When using gloves
The outside of gloves is contaminated
Gloves are easier to put on when your hands are dry.
Do not tear gloves when putting them on.
You need a new pair for every person
Remove and discard torn, cut, or punctured gloves at onces.
Practice hand hygiene, then put on a new pair.
 Wear gloves once. Discard them after use
 Put on clean gloves just before touching mucous membranes or
non-intact skin
 Put on new gloves whenever gloves become contaminated with
blood, body fluids, secretions, or excretions. A task may require
more than one pair of gloves.
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When using gloves, continued
 Change gloves whenever moving from a contaminated body
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site to a clean body site.
Change gloves if interacting with the person involves
touching portable computer keyboards or other mobile
equipment that is transported from room to room.
Put on gloves last when they are worn with other PPE.
Make sure gloves cover your wrists. If you wear a gown,
gloves cover the cuffs
Remove gloves so the inside part is on the outside. The inside
is clean.
Practice hand hygiene after removing gloves.
Removing gloves
 There is no special method to put on glove unless sterile.
 To remove gloves make sure glove touches only glove.
 Grasp a glove just below the cuff on the outside
 Pull the glove down over your hand so it is inside out.
 Hold the removed glove with your other gloved hand.
 Reach inside the other glove. Use the first two fingers of the
ungloved hand.
 Pull the glove down (inside out) over your hand and the
other glove
 Discard the gloves.
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Gowns
 Gowns prevent the spread of microbes. They protect your
clothes and body from contact with blood, body fluids,
secretions, and excretions. They also protect against splashes
and sprays. Gowns must completely cover you from your
neck to your knees. The gown opens at the back. It is tied at
the neck and waist. The gown front and sleeves are
considered contaminated.
 Gowns are used once. A wet gown is contaminated. Remove
it and put on a dry one. Discard disposable gowns after use.
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Donning a gown
 Hold a clean gown out in front of you. Let it unfold. Do not
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shake.
Put your hands and arms through the sleeves.
Make sure the gown covers you from your neck to your
knees and from your arms to the end of your wrists.
Tie the strings at the back of the neck
Overlap the back of the gown. Make sure it covers your
uniform. The gown should be snug, not loose.
Tie the waist strings at the back or side.
Put on additional PPE if necessary
Removing a gown
 Remove and discard the gloves. Wash your hands.
 Remove and discard goggles or face shield if worn.
 Untie the neck and waist strings. Do not touch the front of
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the gown.
Pull the gown down from each shoulder toward the same
hand.
Turn the gown inside out as it is removed. Hold it at the
inside shoulder seams, and bring your hands together.
Hold and roll up the gown away from you. Keep it inside
out.
Discard the gown
Donning a mask
 Pick up a mask by its upper ties. Do not touch the part that will
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cover your face.
Place the mask over your nose and mouth.
Place the upper stings above your ears. Tie them at the back in the
middle of your head.
Tie the lower strings at the back of your neck. The lower part of
the mask is under your chin.
Pinch the metal band around your nose. The top of the mask must
be snug over your nose. If you wear eyeglasses, the mask must be
snug under the bottom of the eyeglasses.
Make sure the mask is sung over your face and under your chin.
Masks and Respiratory Protection
 You wear masks for these reasons:
 For protction from contact with infectious materials from the
person. Respiratory secretions and sprays of blood or body
fluids are examples.
 During sterile procedures to protect the person from infectious
agents carried in your mouth or nose.
Masks are disposable. A wet or moist mask is contaminated. Apply
a new mask when contamination occurs. A mask fits over your
nose and mouth. Practice hand hygiene before putting on a
mask. When removing a mask, touch only the ties or the elastic
bands. The front of the mask is contaminated.
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Goggles and face shields
 Goggles and face shields protect your eyes, mouth, and nose
from splashing or spraying of blood, body fluids, secretions,
and excretions.
 The front (outside) of goggles or a face shield is
contaminated. The ties, ear-pieces, or headband used to
secure the device are “clean.” use them to remove the device
after hand hygiene. They are safe to touch with bare hands.
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Removing a mask
 Remove the glove
 Wash your hands
 Remove the goggles or face shield and gown if worn.
 Untie the lower strings of the mask.
 Untie the top strings
 Hold the top strings. Remove the mask.
 Discard the mask.
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Procedures, continued
 Remove Personal protective equipment inside the room.
 Wash hand appropriately.
 Discard PPE appropriately.
 Perform completion tasks.
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Performance Skill #17:
Apply and Remove PPE
 Skills Video
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Bagging Items
 Contaminated items are bagged to remove them from the
person’s room. Leak-proof plastic bags are used. They have
the BIOHAZARD symbol.
 Biohazardous waste are items contaminated with blood, body
fluids, secretions, or excretions.
 Usually only one bag is needed. Double-bagging involves two
bags. Double-bagging is needed if the outside of the bag is
wet, soiled or may be contaminated.
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Meeting Basic Needs
 The person has love, belonging, and self-esteem need. Often
they are unmet when Transmission-Based precautions are
used. Visitors and staff often avoid the person. They may need
to put on PPE. This task takes extra effort before entering the
room. Some are not sure what they can touch. They may fear
getting the disease. The person may feel lonely, unwanted,
and rejected. Self-esteem suffers. Without intending to,
visitors and staff can make the person feel ashamed and guilty
for having a contagious disease.
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Bloodborne Pathogen Standard
 The human immunodeficiency virus (HIV) and the hepatitis
B virus (HBV) are major health concenrs. The bloodborne
pathogen standard is intended to protect them from
exposure. It is a regulation of the Occupational Safety and
Health Administration (OSHA).
 HIV and HBV are found in the blood. They exit the body
through blood. They are spread to others by blood.
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Exposure control plan
 The agency has an exposure control plan. It identifies staff at
risk for exposure to blood. The plan tells what to do for an
exposure incident.
 Staff at risk receive free training.
 All caregivers and the laundry, central supply, and
housekeeping staffs are at risk.
 Training is done upon new employment and yearly.
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Preventative Measures
 Preventitive measures reduce the risk of exposure.
 Hepatitis B Vaccinaton is a liver disease caused by HBV. It is
spread by blood and sexual contact. The vaccine produces
immunity against Hepatitis B. Immunity means that a person
has protection against a certain disease.
 A vaccination involves giving a vaccine to produce immunity
against an infectious disease.
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Exposure incidents
 An exposure incident is any eye, mouth, or other mucous
membrane, non-intact skin, or parenteral contact with blood.
(parenteral means piercing the mucous membranes or the
skin.) Piercing occurs by needle-sticks, human bites, cuts,
and abrasion.
 Report exposure incidents at once. Medical evaluation,
follow-up, and required tests are free.
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Cleaning and Disinfection
 Cleaning reduces the number of microbes present. It also
reduced organic matter such as blood, body fluids,
secretions, and excretions.
 Disinfection is the process of destroying pathogens. Spores
are not destroyed. Spores are bacteria protected by a hard
shell. Spores are killed by very high temperatures.
 Chemical disinfectants are used to clean surfaces. They are
also used to clean re-usable items.
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Sterilization
 Sterilization destroys all non-pathogens and pathogens,
including spores. Very high temperatures are used. Heat
destroys microbes.
 Boiling water, radiation, liquid or gas chemicals, dry heat,
and steam under pressure are sterilization methods.
 An autoclave is a pressure steam sterilizer. Glass, surgical
items, and metal objects are autoclaved. High temperatures
destroy plastic and rubber items. They are not autoclaved.
Steam under pressure sterilizes objects in 30 to 45 minutes.
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Surgical Asepsis
 Sterile technique that keeps equipment and supplies free of
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all microbes.
Sterile means the absence of all microbes, including spores.
The nurse assistant can assist with sterile procedures.
All items that come in contact with the person are kept
sterile. If the item is contaminated, infection is a risk.
Maintain a sterile field
Wear sterile gloves
Caring for equipment and supplies
 Most health care supplies and equipment are disposable.
 Discard single use items after use
 Multi-use items such as bedpans, urinals, wash basins, and
water pitchers are for single patient use.
 Non-disposable items are cleaned and then disinfected, they
sterilized.
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