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HEALTHCARE CORE CURRICULUM SAFETY & STANDARD PRECAUTIONS Competency 4 Infections/Infection Control Dede Carr, BS, LDA Karen Neu, MSN, CNE, CNP U.S. DEPARTMENT OF LABOR GRANT “This workforce solution was funded by a grant awarded by the U.S. Department of Labor’s Employment and Training Administration. The solution was created by the grantee and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. This solution is copyrighted by the institution that created it. Internal use, by and organization and/or personal use by an individual or non-commercial purposes, is permissible. All other uses require the prior authorization of the copyright owner.” 2 COMPETENCY 4 4. Describe principals and standards of infection control. a. b. Explain the purpose of standard precautions and when they are to be applied. List guidelines that reduce the spread of infection. 3 INFECTION & INFECTION CONTROL With research and the discovery that microorganisms cause infection came the realization that somehow their growth and reproduction must be inhibited or stopped to prevent infection. (Kockrow, p. 270) This lesson will provide information about microorganisms, infections, and methods to control infection, which is essential in healthcare. MICROORGANISMS Microorganisms are tiny bodies that are visible only to a microscope. The most common are classified as: Bacteria Viruses Fungi Parasites Microorganisms are present in the environment & on body surfaces (such as the skin), in the intestinal tract, mouth, upper respiratory tract, lower urinary tract, and vaginal tract. These microorganisms are referred to normal flora. (Ramont & Niedringhaus, p. 150) MICROORGANISMS Although microorganisms are frequently referred to as “germs,” most are harmless and some are even helpful because they perform essential functions for the body. For example, normal flora is the body’s first line of defense or protection against infection for patients and health care providers. (Ramont & Niedringhaus, p. 150) TYPES OF MICROORGANISMS Bacteria: most common type of disease-causing microorganism They can live in & be transported through air, water, food, soil, inanimate objects, & body tissues & fluid. Aerobic bacteria grow in the presence of oxygen, whereas anaerobic bacteria grow only in the absence of oxygen. (Kockrow, p. 272) (www.southtektalk.com, n.d.) TYPES OF MICROORGANISMS Viruses: Smallest known disease-causing agent They must enter living cells in order to reproduce. Viruses cannot survive or maintain their infectiousness outside a host. Viral infections are self-limiting (common cold). Others can cause serious illnesses or death (hepatitis A, B, & C, herpes simplex, herpes zoster, varicella, human immunodeficiency virus [HIV] & AIDS). (www.topnews.in, n.d.) (Kockrow, p. 274) TYPES OF MICROORGANISM Fungi are either yeasts or molds & diseases are called mycotic infections. They may be superficial involving the skin, hair, nails, & mucous membranes. Examples: Athlete’s foot (tina pedis), Thrush, Ringworm, Candida albicans, Tinea capitus (Kockrow, pp. 274-275) Fungi (www.sciencephoto.com, n.d.) TYPES OF MICROORGANISMS Parasites live on other living organisms. Examples are Protozoa (single-celled animal) (causes malaria) Helminthes (worms) Arthropods (mites, ticks, & fleas). Hookworm, Tapeworm, Tapeworm eggs, Roundworm, Pinworm Helminthes(Worms) (www.gifam.org, n.d.) Tick (www.blogalaxia.com, n.d.) DRUG-RESISTANT ORGANISMS There has been increased incidence of nosocomial infections involving drug-resistant organisms. The use and misuse of antibiotics, as well as the tendency of clients not to complete a prescribed course of treatment, have impacted the development of resistant organisms. Taking antibiotics for viral infections has played a role too. Currently, the most prominent types of drug-resistant organisms are Methicillin-resistant Staph Aureus (MRSA), Vancomycin-resistant enterococci (VRE), and multi-drug resistant tuberculosis (TB). Immunocompromised hospitalized patients are highest risk. Community acquired or CA-MRSA has become more common in contact sports, the sharing of gym towels, and living in crowded areas, such as correctional institutes. (Ramont & Niedringhaus, p. 156) DRUG-RESISTANT ORGANISMS Failure to perform appropriate hand hygiene is considered to be the leading cause of healthcare associated infections and the spread of multi-drug-resistant organisms and has been recognized as a substantial contributor to outbreaks. (Ramont & Niedringhaus, p. 156) TYPES OF MICROORGANISMS Resident flora (normal flora) are harmless microorganisms that are found in and on the body & perform useful protective functions. For example, intestinal flora help to synthesize vitamin K, which is important in the body’s blood-clotting mechanism. Various other microorganisms make antibioticlike substances & toxic substances that slow or stop the growth of other organisms. (Ramont & Niedringhaus, p. 150) MICROORGANISMS The process of colonization occurs when strains of microorganisms become resident flora. Resident flora can grow in & on the body & not cause disease, however if the person’s defenses become weak, flora can invade a part of the body they normally would not & cause illness or infection. (Ramont & Niedringhaus, p. 150-151) INFECTION An infection is defined as an invasion of the body by a disease-causing called the infectious agent. Microorganisms that cause disease are called pathogens. A “true” pathogen causes disease or infection in a healthy person. An opportunistic pathogen causes a disease only in a susceptible person (someone whose immune system is not functioning as a defense system). (Ramont & Niedringhaus, p. 150-151) DISEASE When an infection occurs, the signs & symptoms of the infection are distinctive, & the person’s health is recognized as being different from normal. Disease causes detectable change in the way the body functions. In some cases, the microorganisms will not cause any signs or symptoms of disease, and the infection is called asymptomatic or subclinical. For example, many cases of mumps are asymptomatic. (Ramont & Niedringhaus, p. 151) MICROORGANISMS Various microorganisms are stronger than others & are called virulent. Virulence refers to the organism’s ability to produce disease & survive both inside and outside the body. Microorganisms also differ in their strength and their communicability (how easily they are spread). The common cold or the annual strain of influenza (flu) can be easily spread by hands and coughing or sneezing, whereas blood borne pathogens such as hepatitis C and AIDS are not easily transmitted, because they require blood-to-blood contact to pose a risk of transmission. (Ramont & Niedringhaus, p. 151) COMMUNICABLE DISEASE A communicable disease is one that is spread by direct or indirect contact. The transmission by an organism can be caused by a vector or vehicle (an insect, or used drinking glass, etc.). West Nile virus is the newest vector-borne disease. It has been in the US for a short time, but has been spread across the U.S. by migrating birds. Birds contract the disease and die. Mosquitoes then pick up the virus from the dead birds and pass the disease to humans. (Ramont & Niedringhaus, p. 151) MICROORGANISMS Microorganisms can be airborne and carried by air currents. For example, an airborne disease such as tuberculosis can be transmitted from one person to another in a close living situation. Microorganisms that develop resistance to various antibiotics can lead to outbreaks of infections in both the medical facility and the community. One disease resistant microorganism is methicillinresistant Staphylococcus aureus (MRSA). This strain of staph has been responsible for deaths in hospitals and in the community setting. This infections has become an issue in gyms, prisons, and school locker rooms. (Ramont & Niedringhaus, p. 151) TYPES OF INFECTION TYPES OF INFECTIONS Infectious disease presents as illness in the patient, but is not transmissible to others. Communicable diseases can be transmitted from one person to another. Infection in a patient can be either local or systemic. A local infection occurs when the microorganisms are in only a specific part of the body. A systemic infection exists when the microorganisms spread to other body areas. The person has bacteremia if the microorganisms enter the blood stream. When bacteremia spreads through all the body systems, the condition is called septicemia. (Ramont & Niedringhaus, p. 151) TYPES OF INFECTIONS Acute infections occur suddenly or last a short time (i.e., ear infections). Chronic infections happen slowly over a long period of time and may last months or years (i.e., hepatitis C viral infection). Infections that occur after hospital admission, and for which the patient had no symptoms at the time of admission are called nosocomial infections (hospital-acquired infections). (Ramont & Niedringhaus, p. 151) TYPES OF INFECTIONS Nosocomial infections (hospital-acquired): many factors contribute to nosocomial infections (i.e., bacteremia [infection of the blood] caused by an intravenous (IV) site. An infection directly caused by any diagnostic or therapeutic source is called an iatrogenic infection (i.e., a negative result from a patient given a wrong medication). (Ramont & Niedringhaus, p. 151) TYPES OF INFECTIONS A microorganism that comes from the patient’s own body and causes a nosocomial infection is referred to as being from an endogenous source. If the organism causing the infection comes from the healthcare environment or personnel, it is from an exogenous source. Three of the most common microorganisms causing exogenous infections are E. coli, S. aureus, and Enterococcus species. (Ramont & Niedringhaus, p. 151) NOSOCOMIAL INFECTIONS The cost of nosocomial infections to the client, the facility, and funding sources (i.e., insurance companies & federal, state, & local governments) is great. Nosocomial infections extend hospitalization time, increase client’s time away from work, cause disability & discomfort, & even result in loss of life. (Berman et al., p. 671) Health Care Core Curriculum CHAIN OF INFECTION CHAIN OF INFECTION The presence of a pathogen does not mean that an infection will occur. Infection occurs in a cycle that depends on the presence of all of the following elements: An infectious agent or pathogen A reservoir or source for pathogen growth A portal of exit from the reservoir A mode of transmission A portal of entry to a host A susceptible host (Potter & Perry, p. 642) CHAIN OF INFECTION Access the website and actively engage in your learning about the Chain of Infection Describe each of the six components in the Chain of Infection. CHAIN OF INFECTION LINK Infectious Agent Microorganisms (bacteria, viruses, fungi, & protozoa) Microorganisms on the skin are either resident or transient flora. Resident organisms (normal flora) are permanent residents of the skin, where they survive & multiply without causing illness. Resident flora on the skin covers the entire exterior of the body and protects against pathogens. (Ramont & Niedringhaus, p. 151) CHAIN OF INFECTION LINK Infectious Agent Transient microorganisms attach to the skin when a person has contact with another person or object during normal activities. For example, a healthcare worker touches a bedpan or a contaminated dressing, transient bacteria adhere to the healthcare worker’s skin. The organisms attach loosely to the skin in dirt and grease or under fingernails. These organisms may be readily transmitted unless removed using hand hygiene. (Larson, 2005, as cited in Potter & Perry, p. 642) If hands are visibly soiled with proteinaceous material, soap and water is the preferred practice. If hands are not visibly soiled, use of an alcohol-based hand product or hand washing with soap and water is acceptable for disinfecting hands of the healthcare worker. (Potter & Perry, p. 642) CHAIN OF INFECTION LINK Infectious Agent The potential for microorganisms or parasites to cause disease depends on the following factors: Sufficient number of organisms (dose) Virulence, or ability to survive in the host or outside the body Ability to enter and survive in the host Susceptibility of the host (host resistance) Length of exposure to infectious agent Resident skin microorganisms are not virulent, however they can cause serious infection when surgery or other invasive procedures allow them to enter deep tissues or when a client is severely immunocompromised (impaired immune system). (Potter & Perry, p. 643) CHAIN OF INFECTION LINK Reservoir Reservoir is a place where a pathogen can survive may or may not multiply. For example, hepatitis A virus survives in shellfish, but does not multiply. Pseudomonas organisms may survive and multiply in nebulizer reservoirs used in the care of patients with respiratory problems. The most common reservoir is the human body. A variety of microorganisms live on the skin and within the body cavities, fluids, & discharges. The presence of microorganisms does not always cause a person to be ill. (Potter & Perry, p. 643) CHAIN OF INFECTION LINK Reservoir Carriers are persons who show no symptoms of illness but who have pathogens on or in their bodies that can be transferred to others. For example, a person can be a carrier of hepatitis B virus without having symptoms of infection. These persons transmit the disease to others through their blood or through sexual contact. Animals, food, water, insects, and inanimate objects can also be reservoirs for infectious organisms. Clostridium botulism toxin, which causes botulism, survives in improperly processed foods (i.e., infant formula). (Potter & Perry, p. 643) CHAIN OF INFECTION LINK Reservoir To thrive, organisms require a proper environment including appropriate food, oxygen, water, temperature, pH, and light. Organisms need food for energy to grow & multiply. Oxygen Aerobic bacteria need oxygen for survival & multiplication. Anaerobic organisms thrive where little or no free oxygen is available (Clostridium difficile, an organism that causes antibiotic-induced diarrhea). (Potter & Perry, pp. 643-644) CHAIN OF INFECTION LINK Reservoir Water or moisture is required for survival of most organisms. Most microorganisms grow in drainage from wounds. Some bacteria assume a form of spore that is resistant to drying & include organisms such as anthrax, botulism, & tetanus, which can live without water. Temperature: microorganisms can live in certain temperature ranges; each species has a specific temperature at which if grows best. The ideal temperature for most human pathogens is 68°-109° F. Cold temperature tend to prevent growth & reproduction of bacteria (bacteriostasis). A temperature that destroys bacteria is bactericidal. (Potter & Perry, p. 644) CHAIN OF INFECTION LINK Reservoir pH: The acidity of an environment determines the viability of microorganisms; most prefer and environment within a pH range of 5-7. Bacteria thrive in urine with an alkaline pH. Most organisms cannot survive in the gastric acid of the intestinal tract. Light: Microorganisms thrive in dark environments, such as those under dressings and within body cavities. (Potter & Perry, p. 644) CHAIN OF INFECTION LINK Portal of Exit After microorganisms find a site to grow and multiply, they must find a portal of exit if they are to enter another host and cause illness. Portals of exit include sites such as blood, skin, and mucous membranes (any break in the integrity of skin/mucous membranes), respiratory tract (coughing/sneezing), genitourinary tract (urination, catheters, & diversions/drains), gastrointestinal tract (saliva, kissing, bowel elimination, emesis, drainage of bile from surgical wounds, or draining tubes), reproductive tract (male’s urethra or woman’s vagina during sexual contact, semen), blood-to-blood contact and transplacental (mother to fetus). (Potter & Perry, p. 644) CHAIN OF INFECTION LINK Modes of Transmission Each disease has a specific mode of transmission (manner in which microorganisms get to the host). Once microorganisms have exited, there are many vehicles (means by which organisms are carried about) on or by which they can travel to the next host. Contamination means a condition of being soiled, stained, touched by, or otherwise exposed to harmful agents, such as by the entry of infectious or toxic materials into previously clean or a sterile environment, making an object potentially unsafe for use. If the vehicle is a living carrier it is called a vector. (Kockrow, p. 276) CHAIN OF INFECTION LINK Modes of Transmission Indirect Contact Personal contact of susceptible host with contaminated inanimate object (e.g., needles or sharp objects, dressings, environmen). If the vehicle is an inanimate (non-living) object, it is called a fomite, which may be a stethoscope, thermometer, bandage scissors, drinking glass, needle, soiled dressings, or one of the many objects. If the vehicle is a living carrier, it is called a vector. (Kockrow, p. 276) Fomite Vector CHAIN OF INFECTION LINK Mode of Transmission Indirect Contact Vehicle-borne - Spread from one person to another by an inanimate intermediary. Vehicles include food, water and objects. (Potter & Perry, p. 644-645) CHAIN OF INFECTION LINK Mode of Transmission Indirect Contact Vector-borne Spread by animals, most often arthropods. Vectorborne diseases include those spread by ticks and mosquitoes, bats, etc. (Potter & Perry, p. 644-645) CHAIN OF INFECTION LINK Mode of Transmission Direct Contact Involves immediate & direct transfer of microorganisms from person to person through touching, biting, kissing, or sexual intercourse. (Berman et al., p. 672) Direct Contact Spread by direct contact with infected skin, mucus membranes, or body fluids Person to person Physical contact between source & susceptible host (e.g., touching client’s feces & then touching your inner mouth or consuming contaminated food) Ex. Hepatitis A, Shigella, Staphylococcus (Berman et al., p. 672) CHAIN OF INFECTION LINK Mode of Transmission Droplet or Airborne Transmission These modes usually involve droplet nuclei, the remains of droplets coming from the infected person, which are suspended in air. The organisms are expelled into the air by coughing, sneezing, talking, singing, or spitting by the infected person and inhaled into the lungs by another person. (Ramont & Niedringhaus, p. 152-153) CHAIN OF INFECTION LINK Mode of Transmission Airborne Transmission Droplet nuclei, the residue of evaporated droplets emitted by an infected host can remain in the air for long periods of time. Droplet transmission is a form of direct transmission because a spray of droplets can only go a few feet before it falls to the ground. Large particles that travel up to 3 feet and come in contact with a susceptible host through coughing, sneezing, talking, singing, & spitting. Examples: Influenza virus, rubella virus, bacterial meningitis (Perry & Potter, 644-645) CHAIN OF INFECTION LINK Mode of Transmission Airborne Transmission Dust particles containing the infectious agent can become airborne & be transmitted by air currents to a suitable portal of entry, usually the respiratory tract of another person. However, the droplet spread and airborne transmission are different in a very important way. Droplet spread organisms can only contaminate nearby air (usually within 3 feet of the infected person) while airborne organisms can spread infection over a much wider area. Examples: Tuberculosis, chicken pox, measles virus (Berman et al., p. 672) CHAIN OF INFECTION LINK Mode of Transmission There are three modes of transmission of microorganisms: direct and indirect contact, droplet, and airborne. The microorganisms can be transmitted through direct contact when the healthcare worker turns or bathes a patient or uses poor hand washing technique. Air currents can carry microorganisms easily, therefore when beds are made, the linens should not be shaken. A dampened or treated cloth should be used when dusting to prevent the circulation of dust particles. The floor is the dirtiest area in any building. Anything dropped, such as soiled linens should be discarded. Personal should not wear pants that are too long and drag along the floor. All healthcare workers should be conscientious in using infection control practices as so many factors can promote the spread of infection. (Kockrow, p. 276) CHAIN OF INFECTION LINK Portal of Entry Route through which the pathogen enters into the new host. Often the route or method of entry is the same method as the exit. When the host’s defense mechanisms are reduced, the microorganism has a greater chance to enter. (Berman et al., p. 672) CHAIN OF INFECTION LINK Portal of Entry Skin Break Inhalation Respiratory System Ingestion Gastrointestinal System Sexual Contact Genitourinary System CHAIN OF INFECTION LINK Portal of Entry Body openings such as eyes, ears, nose, mouth Microorganisms can enter through tubes in the body: Indwelling urinary catheters Gastrointestinal feeding tubes Tracheostomy tubes Intravenous catheters (IVs) Pins-Hardware in Bones (Berman et al.) CHAIN OF INFECTION LINK Susceptible Host Susceptible host is an individual who has impaired immune system response & is at risk for developing an infection. The support of pathogen life & its reproduction depend on the degree of the host’s resistance. A compromised host is someone who has a higher risk for getting an infection for one or more reasons. Impairments of the body’s natural defenses & a number of other factors can affect susceptibility to infections. (Berman et al., p. 673) CHAIN OF INFECTION LINK Susceptible Host Factors Affecting Immunologic Defense Mechanisms: Increasing age & the very young Stress Nutritional status Hereditary factors Disease processes (chronic illness) Environmental factors Medical therapy Chemotherapy Radiation Trauma Smoking (Kockrow, p. 276-277) BREAK THE CHAIN OF INFECTION The essential part of patient care and selfprotection is to interrupt the chain of infection by pathogen identification, asepsis and hygiene, control portals of exit, prevention of a route of transmission, protect the portal of entry, and recognition of susceptible hosts. (Kockrow) Health Care Core Curriculum INFECTION CONTROL INFECTION CONTROL In the section that will follow, specific healthcare workers’ activities are described that interfere in the chain of infection to prevent and control transmission of infectious organisms, and that promote care of the infected client. INFECTION CONTROL Infection control consists of policies and procedures of a hospital or other healthcare facility to minimize the risk of nosocomial or community-acquired infections spreading to patients and other staff members. Infection control is routine in whatever actions healthcare workers perform. The healthcare worker’s knowledge of infection, the application of infection control principles, & use of common sense help protect patients from infections. Healthcare workers are exposed to pathogenic microorganisms and should use specialized and routine practices of cleanliness and disinfection to prevent the spread of infection. (Kockrow, p. 271) INFECTION CONTROL Infection control techniques aid in accomplishing asepsis (freedom of pathogenic organisms). Asepsis Categories: Medical and Surgical Asepsis Medical asepsis consists of techniques that inhabit the growth and spread of pathogenic microorganisms, also know as clean technique. Medical asepsis is used in many daily activities, such as hand washing and changing patient’s bed linen. Principles of medical asepsis are commonly followed in the hone as is the case of washing hands before preparing food. (Kockrow, p. 271) INFECTION CONTROL Medical asepsis includes all practices intended to confine a specific microorganism to a specific area, limiting the number, growth, and transmission of microorganisms. In medical asepsis, objects are referred to as clean, which means the absence of most microorganisms, or dirty (soiled, contaminated), which means likely to have microorganisms, some of which may be capable of causing infections. (Berman et al., p. 276) INFECTION CONTROL Surgical Asepsis Surgical asepsis refers to practices that keep an area or object free of all microorganisms; it includes practices that destroy all microorganisms and their spores (microscopic dormant structures formed by some pathogens that are very hardy and often survive common cleaning techniques). (Berman et al., p. 270) Surgical asepsis is used for all procedures involving the sterile areas of the body. Surgical asepsis or sterile technique, is used in specialized areas or skills, such as care of surgical wounds, urinary catheter insertion, invasive procedures, and surgery. (Kockrow, p. 271) PREVENTING NOSOCOMIAL INFECTIONS Meticulous use of medical and surgical asepsis is necessary to prevent transport of potentially infectious microorganisms. Many nosocomial infections can be prevented using proper hand hygiene when warranted, and identification and management of clients at risk for infections. Healthcare workers must use critical thinking and agency policy in implementing infection control procedures. (Berman et al., p. 681) BREAKING THE CHAIN OF INFECTION The chain of infection demonstrates how infectious diseases occur and are spread. The important concept to remember is that breaking at least one link stops the infectious disease. The practices & techniques that health care workers use daily are designed to break the chain. (Berman et al., p. 681) INFECTION CONTROL Recall the chain has six elements and are frequently summarized as three components. Component #1: Source of infecting microorganisms-elements #1 (infectious agent) and #2 (reservoir-host) both involve source of infection. Component #2: Means of transmission for the microorganisms-- elements #3 (portal of exit) and #4 (route of transmission) & #5 (portal of entry) all affect transmission Component #3: Susceptible host—element #6 susceptible host is unchanged in summarized formation. (Juliar, p. 145) INFECTION CONTROL What is the best defense? To decrease the sources of microorganisms Prevent transmission Maximize the resistance of the host How can the healthcare worker decrease the source of microorganisms? Perform proper hand washing Decontaminate surfaces & equipment (antiseptics, disinfectant, sterilization) Avoid contact with patients & others when harboring infectious microorganisms. (Juliar, p. 145) INFECTION CONTROL How can the healthcare worker prevent the transmission of microorganisms? Wear personal protective equipment (PPE) when indicated. (PPE includes caps, gloves, gowns, masks, shoe covers, and eye protection). Follow isolation procedures when indicated (additional precautions used when working with patients who have highly contagious diseases). (Juliar, p. 145) INFECTION CONTROL How can the healthcare worker maximize the resistance of the host? Provide good hygiene of skin, oral hygiene, bathing & shampooing Ensure proper nutrition and fluid intake Adequate sleep Decrease stressors that weaken the immune response Immunizations for the chronically ill The first line of defense is medical asepsis and the most effective way to prevent the spread of microorganisms is using good hand washing technique. (Juliar, p. 145) INFECTION CONTROL Infection control to reduce reservoirs Bathing: Use soap & water to remove drainage, dried secretions, excess perspiration, or sediment from disinfectants. Change wet or soiled dressings. Contaminated articles: Place tissues, soiled dressings, & soiled linen in moisture-resistant bags for proper disposal. Place pourable, dripping dressings in biohazard bags. Bedside unit: Keep table surfaces clean & dry. Drainage bottles & bags: Empty & dispose of drainage suction bottles according to agency policy. Empty all drainage systems each shift unless otherwise ordered by the physician. Never raise a drainage system (i.e., urinary drainage bag) above the level of the site being drained unless it is clamped off. (Kockrow, p. 275) INFECTION CONTROL Infection control to reduce reservoirs: Contaminated needles: Place syringes & uncapped hypodermic needles & IV needles in moisture-resistant, puncture-proof containers, which should be located in patient’s rooms or treatment areas so that exposed, contaminated equipment need not be carried any distance. Do not recap needles. Bottled solutions: Do not leave bottled solutions open for prolonged periods. Keep solutions tightly capped. Date bottles when opened. (Kockrow, p. 275) HAND HYGIENE Hand hygiene is important is every setting. It is considered the most effective infection control measures. Any client may harbor microorganisms that are currently harmless to the client yet potentially harmful to another person or to the same client if there is a portal of entry. It is important for both the healthcare worker and client to cleanse their hands at the following times to prevent the spread of microorganisms: before eating, after using the bedpan or toilet, and after the hands have come in contact with any body substances, such as sputum, emesis, drainage from a wound, blood, or feces. In addition, all healthcare workers should cleanse their hands before and after giving care of any kind. (Berman et al., pp. 681-682) HAND HYGIENE Hand hygiene includes using an instant alcohol hand antiseptic before and after providing client care, hand washing with soap and water when hands are visibly soiled, and performing a surgical scrub. Hand washing is the act of washing hands with soap and water for 20 seconds (CDC, 2002b). The friction used removes soil and transient organisms from the hands. The use of alcohol-based hand rubs is recommended by the Centers for Disease Control and Prevention to improve hand hygiene practices, protect healthcare workers’ hands, and reduce transmission of pathogens to clients and personnel in health care settings. (Potter & Perry, p. 655) HAND HYGIENE For routine client care, the World Health Organization (WHO) recommends hand washing under a running stream of water for at least 20 seconds using plain granule soap, soap-filled sheets, or liquid soap when hands are visibly soiled, after using the restroom, after removing gloves, before handling invasive devices (such as intravenous tubing), and after contact with medical equipment or furniture. (Berman et al., p. 682) HAND HYGIENE Access the following website to view video by the CDC. Put Your Hands Together-Hand Washing Learn more about importance in transmission of microorganisms. HAND HYGIENE Alcohol-Based Waterless Antiseptic Agents If hands are not visible soiled, use an alcohol-based waterless antiseptic agent for routine decontaminating hands in all clinical situations: After contact with a client’s intact skin (as in lifting a client) Before eating After contact with body fluids or excretions, mucous membranes, nonintact skin, or wound dressings as long a hands are not visibly soiled When moving from a contaminated body site to a clean body site during client care After contact with inanimate objects (medical equipment) in the immediate patient area Before caring for client with severe neutropenia or other severe immune suppression Before inserting indwelling urinary catheters or other invasive devices After removing gloves (Potter & Perry, p. 655) USE OF GLOVES Wear clean, non-sterile gloves when you touch, or have the potential of coming in contact with blood, body fluids, secretions, excretions, or contaminated items. Put on gloves before touching mucous membranes and non-intact skin. Gloves should be changed between tasks and procedures on the same patient if there is contact with material that may contain high concentrations of microorganisms. Remove gloves promptly after use, before touching noncontaminated items & environmental surfaces, and before going to another patient. (Juliar, p. 148) USE OF GLOVES Use proper hand washing technique before applying gloves. Remove appropriate-sized clean gloves from box & apply When removing gloves: grasp on the outside of one glove at the palm with the other gloved hand; pull the glove down and turn it inside out while removing it. Hold the removed glove in the palm of the remaining gloved hand. Take the ungloved hand and slide fingers under the cuff of the remaining glove & push the glove off. The first glove is now inside the second glove that was removed. Discard the gloves in an appropriate container according to facility policy. Wash hands immediately after removing gloves. (Juliar, p. 149) GLOVE USAGE Access this YouTube to learn how to remove gloves preventing exposure to blood borne pathogens STANDARD PRECAUTIONS It is impossible to know which pathogens a person may carry, so specific procedures have been developed by the CDC know as Standard Precautions. Standard Precautions are applied to every patient in the healthcare environment—it is essential to follow the standards at all times. Standard Precautions must be followed to prevent contact with potentially infectious body fluids. (Juliar, p. 146) STANDARD PRECAUTIONS Potentially infectious body fluids include: Blood All body fluids, secretions, & excretions except sweat, regardless of whether or not they contain visible blood Non-intact skin Mucous membranes Any unidentified body fluids (Juliar, 146) Standard Precautions includes hand hygiene, use of personal protective equipment, cleaning, disinfection, and sterilization. INFECTION CONTROL Cleaning, Disinfection, & Sterilization Proper cleansing, disinfection, & sterilization of contaminated objects significantly reduce & often eliminate microorganisms. In health care facilities, a sterile processing department is responsible for the disinfection & sterilization of reusable supplies & equipment. However, in the homecare setting, sometimes the healthcare worker has to perform these functions. Many principles of cleaning and disinfection also apply to the home. (Potter & Perry, p. 655) INFECTION CONTROL Cleaning: the removal of all soil (i.e., organic & inorganic material) from objects & surfaces. Generally cleaning involves the use of water & mechanical actions with detergents or enzymatic products. Detergents should have a natural pH. Disinfection describe a process that eliminate many or all microorganisms, with an exception of bacterial spores, from inanimate objects. There are 2 types of disinfection: Disinfection of surfaces & high-level disinfection, which is required for some client care items such as endoscopes. (Potter & Perry, p. 655, 658-659) Sterilization refers to methods used to kill all microorganisms, including spores. There are two types: physical & chemical. (Kockrow, p. 307) INFECTION CONTROL Cleaning reusable equipment--Wash items to remove organic materials (items like bed pans) First, cold rinse, because hot water coagulates the protein of organic material & causes it to stick to items. Second, wash items in hot water with soap to emulsify and dislodge dirt. Abrasive action with stiff-bristled brushes will help to remove materials from crevices in equipment. Rinse articles with warm to hot water & dry thoroughly. Items are now considered clean. However, the process is incomplete until the basin or sink and any brushes or tools used for cleaning the items are also cleaned with a disinfectant. This is generally assigned to housekeeping or central service staff. Check with your facility. (Ramont & Niedringhaus, p. 160) INFECTION CONTROL Disinfecting and Sterilizing The etiologic agent and the reservoir are interrupted by the use of antiseptics (agents that inhibit the growth of some microorganisms & can be used on skin or tissue) and disinfectants (agents that destroy pathogens other than spores & are more concentrated than antiseptics), and by sterilization. Both antiseptics & disinfectants have bactericidal & bacteriostatic properties. Bactericidal preparations destroy the bacteria whereas bacteriostatic preparations prevent the growth and reproduction of some bacteria. (Ramont & Niedringhaus, p. 160) INFECTION CONTROL Disposal of used or soiled equipment Most facilities have policies & procedures in place that state specifically how to dispose of equipment & supplies that have been contaminated. Be familiar with the policies as they are based on the law. Materials may be disposed of, cleaned, disinfected, or sterilized. Some equipment & supplies are for single use only. Others are meant to be used multiple times. (Ramont & Niedringhaus, p. 160) INFECTION CONTROL Disinfecting When disinfecting articles, healthcare workers must follow the agency’s protocol & consider: Type & number of infectious organisms (some are readily destroyed, whereas others require longer contact with the disinfectant) Recommended concentration of the disinfectant & duration of contact Presence of soap (some disinfectants are ineffective in the presence of soap or detergent) Presence of organic material (presence of saliva, blood, pus, or excretions can readily inactivate many disinfectants) Surface areas to be treated (the disinfecting agent must come in contact with all surfaces & areas). (Berman et al., p. 688) INFECTION CONTROL Disposal of used or soiled equipment Bagging is a technique recommended by the CDC for removal of materials from a client’s room (isolation room). The purpose is to prevent any exposure to items contaminated by body secretions. The bag must be impervious to microorganisms. Bags may come in different colors (i.e., red) with labels indicating infectious materials. CDC recommends placing non-contaminated disposable items in a plastic bags that line the waste container. Non-disposable or reusable items should be put into a labeled bag before being removed from the client’s room & sent to a central processing area for decontamination. Rubber, plastic, metal, & glass items may be bagged separately. (Metal & glass can be autoclaved, but rubber & plastic need to be expose to gas sterilization.) Special procedure trays should be disassembled & bagged as already indicated. (Ramont & Niedringhaus, p. 160) INFECTION CONTROL Soiled linen Soiled linen or clothing should be bagged and sent to the facility laundry or home. As linens are removed from the bed avoid from shaking them & dispersing microorganisms. Keep the linen away from your clothing. Roll the soiled linen into a bundle before being placing it into a bag or linen hamper. If clean linen falls onto the floor, discard it into the soiled linen hamper as the floor is the dirtiest place in a healthcare facility. (Potter & Perry, p. 667) INFECTION CONTROL Hazardous waste is disposed in containers labeled for such. Substances commonly considered hazardous include bleach and other disinfectants, chemotherapeutic or antineoplastic agents. Healthcare workers are responsible for knowing the chemical used and any potential risks to themselves and their client. (Ramont & Niedringhaus, p. 131) INFECTION CONTROL You are responsible for providing the client with a safe environment. The effectiveness of infection control practices depends on your conscientiousness and consistency in using effective aseptic technique. It is human nature to forget key procedures or, when hurried, take shortcuts that break aseptic procedures. However, failure to comply with basic procedures places clients at risk for an infection that can seriously impair recovery or lead to death. (Potter & Perry, p. 655) REFERENCES Berman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008).Asepsis. In A. Berman, S.J. Snyder, B. Kozier, & G. Erb (Eds.). Kozier & Erb’s Fundamentals of nursing: Concepts, process, and practice (8th ed.) (pp. 668-709). Upper Saddle River, NJ: Prentice Hall Juliar, K. (2003). Minnesota health care core curriculum, 2e. Clifton Park, NY: Delmar Publishing, Thompson Custom Publishing Kockrow, E.O.(2006). Medical/Surgical asepsis and infection control. In B.L. Christensen & E. O. Kockrow (Eds.). Foundations and adult health nursing (5th ed.) (pp. 270-314). St. Louis, MO: Elsevier, Mosby Potter, P.A. & Perry, A.G. (2009). Infection prevention and control. In P.A. Potter & A.G. Perry (Eds.). Fundamentals of nursing (7th ed.) (pp. 641-685). St. Louis, MO: Elsevier, Mosby Ramon, P.R. & Niedringhaus, D. M. (2008). Infection control and asepsis. Fundamental nursing care (2nd ed.) (pp. 149-176). Upper Saddle River, NJ: Person Prentice Hall