Download CNA Unit 3 - Lesson 3rev-20

Nurse
Assistant
In a Long-Term
Care Facility
Terms and Definitions
• Asepsis – the absence of germs
• Aseptic – free of microorganisms
• Contaminated – exposed to germs
• Germ - microorganism
• Infection – invasion of the body by a disease-producing
(pathogenic) microorganism
• Micro - small
Unit III:
Safety
Lesson Plan 3:
Infection Control
• Microorganism – a very small living thing (a germ) that
can only be seen with a microscope
• Pathogens – microbes that cause disease
• Resistance – ability to fight off
• Toxin – a poisonous substance
• Transmitted – transferred or spread
Nurse
Assistant
In a Long-Term
Care Facility
Lymphatic System
• Organs
Tonsils
Lymph nodes
(with lymph fluid)
Spleen
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Lesson Plan 3:
Infection Control
Figure 3.1 – Lymphatic System
Nurse
Assistant
In a Long-Term
Care Facility
Lymphatic System
• Lymphatic System
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Safety
Lesson Plan 3:
Infection Control
Nurse
Assistant
In a Long-Term
Care Facility
Lymphatic System
• Functions
Produces antibodies to fight infection
Manufactures white blood cells
Filters impurities such as dead cells and bacteria
• Aging process
Less resistant to disease and infections
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Lesson Plan 3:
Infection Control
Wound healing takes longer.
• Related health problems
Infections (pneumonia, influenza, etc.)
HIV, AIDS
Hepatitis
Nurse
Assistant
In a Long-Term
Care Facility
Microorganisms (Microbes)
Bacteria and viruses are the most common in the spread
of disease.
• Grow best in the following conditions:
Warm environment
Dark environment
Moist environment
Where there is a food supply
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Infection Control
• Found everywhere
Everything we use in daily living – food, water, objects we
touch
An object used by others
Nurse
Assistant
In a Long-Term
Care Facility
Bacteria
Small microorganisms that can cause infection – Major
bacterial infections are listed below.
• Staphylococcus (staph)
• Streptococcus (strep)
• Mycobacterium tuberculosis (TB)
• Syphilis
• Escherichia coli (E. coli)
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• Gonococcus (GC)
• Clostridium difficile (C. diff)
• Methicillin-resistant Staphylococcus aureus (MRSA)
• Vancomycin-resistant enterococci (VRE)
• Vancomycin-resistant Staphylococcus aureus (VRSA)
Nurse
Assistant
In a Long-Term
Care Facility
Unit III:
Safety
Lesson Plan 3:
Infection Control
Bacteria
• Staphylococcus
• Mycobacterium
Tuberculosis
Streptococcus
• Syphilis
Nurse
Assistant
In a Long-Term
Care Facility
Bacteria
• E. Coli
• E. Coli
Outbreak
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Lesson Plan 3:
Infection Control
• Clostridium
Difficile
• C.Diff
Information
• Gonococcus
Nurse
Assistant
In a Long-Term
Care Facility
Bacteria
• MRSA
• MRSA
Information
Unit III:
Safety
Lesson Plan 3:
Infection Control
• Vancomycinresistant
enterococci
(VRE)
• Vancomycinresistant
Staphylococcus
Aureus (VRSA)
Nurse
Assistant
In a Long-Term
Care Facility
Viruses
Tiny microorganisms much smaller than bacteria that can
cause infection. Major viral infections are listed below.
• Hepatitis
• Herpes
• Human immunodeficiency virus (HIV)
• Influenza
• Common cold
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Safety
Lesson Plan 3:
Infection Control
• Measles
• Herpes zoster (chicken pox/shingles)
• Ebola
Nurse
Assistant
In a Long-Term
Care Facility
Unit III:
Safety
Lesson Plan 3:
Infection Control
Hepatitis A,B,C,D,E
• Hepatitis A and E viruses- spread by
contaminated food and water or by
coming in direct contact with
contaminated stool (feces).Fecal or
Oral
• Hepatitis B, C, and D viruses- spread
when an uninfected person comes in
contact with blood, semen, or vaginal
fluid (including menstrual blood) that
is infected with one of these viruses.
Nurse
Assistant
In a Long-Term
Care Facility
Hepatitis B and C
• Definition
Unit III:
Safety
Lesson Plan 3:
Infection Control
Nurse
Assistant
In a Long-Term
Care Facility
Herpes Simplex Virus
• Herpes type 1 (HSV-1, or oral herpes)
ex. fever blisters or cold sores
Cause- oral secretions, sharing
eating utensils
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Safety
Lesson Plan 3:
Infection Control
• Herpes type 2 (HSV-2, or genital herpes)
ex. sores around the genitals or rectum.
Nurse
Assistant
In a Long-Term
Care Facility
Unit III:
Safety
Lesson Plan 3:
Infection Control
Herpes Simplex Virus
• How is the Herpes Infections and
Spread?
• Symptoms?
• Diagnosed?
• Treated?
No cure, meds for symptom relief
Ex Zovirax, Valtrex and warm baths
Nurse
Assistant
In a Long-Term
Care Facility
Unit III:
Safety
Lesson Plan 3:
Infection Control
Human immunodeficiency virus
(HIV)
• HIV- causes AIDS
• HIV/AIDS weakens a person’s ability to
fight infections and cancer.
• HIV transmission- unprotected sex or with
needle sharing.
• You CANNOT get HIV from: touching,
hugging, public bathrooms or swimming
pools. Sharing cups, utensils, or telephones
with someone who has HIV/AIDS.
• Bug bites
Nurse
Assistant
In a Long-Term
Care Facility
Unit III:
Safety
Lesson Plan 3:
Infection Control
Acute HIV Infection
Nurse
Assistant
In a Long-Term
Care Facility
Unit III:
Safety
Lesson Plan 3:
Infection Control
HIV
• (HIV) test detect antibodies to HIV
or the genetic material (DNA or
RNA)of HIV in the blood or
another type of sample. This
determines whether an HIV
infection is present.
• NO CURE- Meds used to treat s/s
Nurse
Assistant
In a Long-Term
Care Facility
Unit III:
Safety
Lesson Plan 3:
Infection Control
Influenza
• Caused by- influenza A or B viruses
• Definition- extremely contagious
respiratory
• Spread- inhale droplets in the air that
contain the flu virus, make direct contact
with respiratory secretions through sharing
drinks or utensils, or handle items
contaminated by an infected person
• S/S- cough, chest discomfort, congestion,
FEVER
• DX- by symptoms
• Tx- antiviral meds tx symptoms
Nurse
Assistant
Common cold
In a Long-Term
Care Facility
• Cause-more than 200 different
viruses are known to cause the
common cold
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• Rhinoviruses -- causing 10% to 40% of colds
• Coronaviruses -- causing 20% of colds
• Respiratory syncytial virus (RSV) -- responsible
for 10% of colds
Nurse
Assistant
In a Long-Term
Care Facility
Unit III:
Safety
Lesson Plan 3:
Infection Control
Common Cold
• Definition
• Spread by Droplet (ex sneezing,
coughing), touching a surface
,contaminated with cold germs (ex.
computer keyboard, doorknob, or
eating utensil, for example -- and
then touching your nose or mouth.
Nurse
Assistant
In a Long-Term
Care Facility
Unit III:
Safety
Lesson Plan 3:
Infection Control
Common Cold
• S/S- congestion, itchy and sore throat
• Dx- Symptoms
• TX- to alleviate symptoms
– Decongestants reduce swelling in nasal
passages, relieves the feeling of pressure and
improves airflow through your nose.
– Antihistamines block histamine that is
produced by the body in response to allergens
or irritant
– Cough Syrup- Expectorant or Suppressant
Nurse
Assistant
In a Long-Term
Care Facility
Measles
- Rubella, Rubeola
• Cause- measles virus Morbillivirus
• Spread- Airborne Transmission, Droplet, Contact
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• Symptoms- dusky red maculopapular eruption, fever, lymph
nodes in your neck may swell
-macule- flat like freckle
-papule- elevated like a pimple
• Dx-Blood test or viral culture
• Tx-Take medicines to lower your fever. Also, get plenty of
rest and drink lots of fluids
Nurse
Assistant
Herpes zoster (chicken
pox/shingles)
In a Long-Term
Care Facility
Unit III:
Safety
Lesson Plan 3:
Infection Control
•
•
•
•
•
Caused by the varicella zoster virus
Spread by contact and airborne
S/S- very itchy, blistery rash, fever
Dx- Symptoms
Home Tx- resting and taking
medicines to reduce fever and itching
(oatmeal baths)
Nurse
Assistant
In a Long-Term
Care Facility
Unit III:
Safety
Ebola
• Texas Nurse Union Report
• https://www.youtube.com/watch?v=f
-K1m6IsxKI
• https://www.youtube.com/watch?v=
GimY45M-z4o
Lesson Plan 3:
Infection Control
• http://www.today.com/health/insideebola-isolation-unit-how-doctorsnurses-protect-themselves2D80215459
Nurse
Assistant
In a Long-Term
Care Facility
How Microorganisms (Bacteria and
Viruses) Are Spread
• Direct contact (See Figure 3.2.)
Touching the resident
Bathing the resident
Secretion from the resident
Urine from resident
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Safety
Lesson Plan 3:
Infection Control
Feces from resident
Nurse
Assistant
In a Long-Term
Care Facility
How Microorganisms (Bacteria and
Viruses) Are Spread
Figure 3.2 – Direct Contact
Unit III:
Safety
Lesson Plan 3:
Infection Control
Nurse
Assistant
In a Long-Term
Care Facility
How Microorganisms (Bacteria and
Viruses) Are Spread
• Indirect contact – touching objects (See Figure 3.3.)
Dishes
Bed linen
Clothing
Instruments
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Safety
Lesson Plan 3:
Infection Control
Belongings
Figure 3.3 – Indirect Contact
Nurse
Assistant
In a Long-Term
Care Facility
How Microorganisms (Bacteria and
Viruses) Are Spread
• Droplet spread within 3 feet (See Figure 3.4.)
Sneezing
Talking
Coughing
Chewing gum (especially blowing bubbles and popping
them)
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Safety
Lesson Plan 3:
Infection Control
Figure 3.4 – Droplet Spread
Nurse
Assistant
In a Long-Term
Care Facility
How Microorganisms (Bacteria and
Viruses) Are Spread
• Vehicle contamination (See Figure 3.5.)
Food
Drugs
Water
Blood
Unit III:
Safety
Lesson Plan 3:
Infection Control
• Airborne transmission
Dust particles
Moisture in the air
Figure 3.5 – Vehicle Contamination
Nurse
Assistant
In a Long-Term
Care Facility
Symptoms of Bacterial/Viral Infections
• Drainage from wound, eyes, ears, or nose
• Reddened or inflames area
• Increased heat in an area
• Pain
• Swelling
• Fever
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Safety
Lesson Plan 3:
Infection Control
• Confusion
Nurse
Assistant
In a Long-Term
Care Facility
Other Harmful Microorganisms
• Yeast infection (Candida albicans) can affect mouth,
genital tract, or skin.
• Scabies, head and body lice are transmitted by direct or
indirect contact. They may affect head and body,
especially genitals, hands, and feet.
Unit III:
Safety
Lesson Plan 3:
Infection Control
Nurse
Assistant
In a Long-Term
Care Facility
Portal of Entry – Microorganisms Enter
the Body (See HO 1.) *CNA
• Break in the skin or mucous membrane (Staphylococci)
• Respiratory tract (common cold)
• Genitourinary tract (syphilis, AIDS, bladder and kidney
infections)
• Gastrointestinal tract (salmonellosis, hepatitis)
• Circulatory system (meningitis, malaria)
Unit III:
Safety
Lesson Plan 3:
Infection Control
Nurse
Assistant
In a Long-Term
Care Facility
Portal of Exit – Microorganisms Leave
the Body *CNA
• Excretions from respiratory tract
• Excretions from genital tract
Semen
Vaginal secretions
• Drainage of wounds
• Urine
Unit III:
Safety
Lesson Plan 3:
Infection Control
• Feces
• Blood
• Saliva
• Emesis
• Excretions from the digestive tract
Nurse
Assistant
In a Long-Term
Care Facility
The Susceptible Host *CNA
A person with low resistance or poor immunity – The
elderly resident is a susceptible host.
• Due to aging process, decreased immune system
• Some diseases and conditions predispose the elderly to
infection.
Diabetes mellitus
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Infection Control
Congestive heart failure
Dehydration
Malnutrition
Immobility
Hospitalization
Diminished pain sensitivity symptoms
Decreased mental ability (unable to describe illness)
Nurse
Assistant
In a Long-Term
Care Facility
The Susceptible Host
Tumors
Drugs
Physical or emotional stress
• Nosocomial infection
*Infection that develops when a person is in a health care
facility
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Lesson Plan 3:
Infection Control
Studies show that nosocomial infections are common in
long-term facilities with a prevalence of 1.6 to 15% of all
residents being affected. Most common infections are the
following:
• Urinary tract infections (UTIs)
• Respiratory infections
• Gastrointestinal infections
• Skin infections
Nurse
Assistant
In a Long-Term
Care Facility
The Susceptible Host
• Acute phase of infection may be missed because of
several underlying factors.
Afebrile
Resident may be receiving medications such as aspirin or
steroids for other diseases that keep the temperature from
rising.
Decreased sensitivity to pain.
Resident may develop confusion.
Unit III:
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Lesson Plan 3:
Infection Control
Fluid and nutritional balance are not maintained.
Skin loses fat and becomes thin.
Gastric acid decreases.
Decreased urinary flow and the presence of catheters
may lead to urinary tract infection.
Decreased cough reflex and less mucus, due to
dehydration or medication.
Nurse
Assistant
In a Long-Term
Care Facility
Body Substance Precautions (BSP)
Precautions used by all health care providers to minimize
the risk of exposure to disease through contact with body
fluids (See HO 2.)
• Hands
Wash before and after contact with resident.
NOTE: Long nails, artificial nails, chipped nail polish, and
hand jewelry can harbor harmful microorganisms.
Unit III:
Safety
Lesson Plan 3:
Infection Control
After using gloves.
If hands come in contact with blood and/or body fluids
containing blood, wash immediately with soap and water
and report to charge nurse.
Always wash hands before clocking out.
Nurse
Assistant
In a Long-Term
Care Facility
Body Substance Precautions (BSP)
• Use personal protective equipment (PPE) when
necessary. PPE includes gloves, apron, or gowns,
goggles, and masks.
Gloves should be worn when contact is likely with the
following:
• Any body opening
• Blood
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Safety
Lesson Plan 3:
Infection Control
• All moist body fluids
• Mucous membranes (nose, mouth, etc.)
• Nonintact skin (pressure ulcers, skin tears)
• Dressings
• Used tissues or wipes
• Surfaces or items contaminated with blood or body fluids
• Specimen containers being transported
Nurse
Assistant
In a Long-Term
Care Facility
Body Substance Precautions (BSP)
Gowns or plastic aprons should be worn if blood
splattering might occur. Remove and discard aprons
after completing the task.
Face and eye protection – Wear goggles for eye
protection when it is likely that eyes will be splashed with
body substances. Use a mask to protect the mucous
membranes of the nose and mouth. Discard masks after
use and place reusable goggles/face shields in a specified
container for cleaning.
Unit III:
Safety
Lesson Plan 3:
Infection Control
Nurse
Assistant
In a Long-Term
Care Facility
Body Substance Precautions (BSP)
• Disposable razors should never be recapped. Discard in
a sharps container.
• Blood spills should be cleaned up according to facility policy.
• Laboratory specimens and containers should be handled
and labeled carefully according to facility policy.
Unit III:
Safety
Lesson Plan 3:
Infection Control
• All laboratory specimens and
containers should be labeled
with a biohazard symbol.
(See Figure 3.6.)
• Laboratory specimens should
not be stored in a refrigerator
containing food or drink.
Figure 3.6 – Biohazard
Symbol
Nurse
Assistant
In a Long-Term
Care Facility
Infection Control
• The Centers for Disease Control and Prevention (CDC),
located in Atlanta, Georgia, and the Missouri Department
of Health issue guidelines to protect people and prevent
the spread of infection.
• Control of infection at the source
Maintain health; have illness and infections treated.
Report any open lesions or weeping skin rash to
supervisor before having contact with the residents.
Unit III:
Safety
Lesson Plan 3:
Infection Control
Notify your supervisor if you are ill or infected.
Correct handwashing technique.
Facility disinfection and sterilization.
Housekeeping. Keep work area neat and clean.
Clean linen properly.
Dispose of soiled disposable articles properly.
Nurse
Assistant
In a Long-Term
Care Facility
Infection Control
• Control of infection at the transmission level
Wash hands before and after caring for each resident.
Long nails, acrylic nails, hand jewelry, and chipped polish
can harbor infectious microorganisms.
Facility policy for catheter care.
Follow Body Substance Precautions.
If several resident have the same symptoms, report to the
charge nurse immediately.
Unit III:
Safety
Lesson Plan 3:
Infection Control
Wear gloves to wipe up any spills of blood and blood
products per facility’s policy.
Treat bloody linens as a biohazard; bag at point of contact
and dispose per facility policy.
Nurse
Assistant
In a Long-Term
Care Facility
Infection Control
• Control of infection at the resident level
Know resident, report any abnormal change in behavior or
symptoms.
Cleaning and giving care from clean to dirty.
Observe residents who are receiving antibiotics for side
effects and report these immediately (e.g., nausea,
vomiting, diarrhea, rashes, yeast infections, thrush).
Unit III:
Safety
Lesson Plan 3:
Infection Control
Prevent pressure ulcers by giving good nursing care.
(See Unit V, Lesson Plan 11, Preventing and Caring for
Pressure Ulcers.)
Do not share articles of personal care among residents.
Personal care items should be labeled with the resident’s
name.
Work toward maintaining nutrition and activity of the
resident.
Nurse
Assistant
In a Long-Term
Care Facility
Infection Control
Use gloves when doing mouth care, perineal care,
skin care, and other procedures involving body fluids.
Wear masks, gloves, goggles, and gown as per facility
policy when caring for the resident who might cough or
spray mucus discharge.
• Specific control measures
Handwashing – the single most important means of
preventing the spread of infection
Unit III:
Safety
Lesson Plan 3:
Infection Control
• Our hands carry germs.
• Good handwashing technique prevents spread of
germs.
Nurse
Assistant
In a Long-Term
Care Facility
Infection Control
• Wash your hands for at least 15 seconds.
When you first come on duty and before going home
Before and after contact with each resident
Before and after glove use
After contact with any waste or contaminated
material
Before any contact with food
Unit III:
Safety
Lesson Plan 3:
Infection Control
Before and after going to the bathroom, breaks, or
smoking
After coughing, sneezing, or blowing nose
• Wash resident’s hands before meals and at other
appropriate times (e.g., after going to the bathroom).
• Any water faucet is always considered contaminated
or dirty.
Nurse
Assistant
In a Long-Term
Care Facility
Infection Control
• Turn the facet off with a clean, dry paper towel.
• Use soap from a dispenser, rather than bar soap.
Bar soap accumulates pools of soapy water in the
soap dish, which is a good medium for germ growth.
• Never use the resident’s bar soap to wash your
hands.
Unit III:
Safety
Lesson Plan 3:
Infection Control
• When washing hands, hold hands below elbows to
allow water to run down the fingertips so germs do
not contaminate your arms and uniform.
Nurse
Assistant
In a Long-Term
Care Facility
Infection Control
Linen changing
• Keep linen away from uniform.
• Avoid shaking or fluffing linen.
Unit III:
Safety
Lesson Plan 3:
Infection Control
• Place used linen in a nonporous bag (e.g., plastic
bag) at the side of the bed. Never put linen directly
on the floor. Placed closed bagged linen in
designated soiled linen container. Do not overfill
bags because they tend to rupture if they are
dropped.
• Change linen any time it is soiled.
Nurse
Assistant
In a Long-Term
Care Facility
Infection Control
Sanitation
• Clean, label, and cover all individual utensils and
return to bedside table after each use.
NOTE: Disposable items should not be reused.
Return soiled dishes to dietary department after each
meal. Damp-wipe overbed tables.
Unit III:
Safety
Lesson Plan 3:
Infection Control
• Each resident should have his/her own hygiene
supplies and equipment. The equipment should be
cleaned regularly and labeled with the resident’s
name.
• Transfer belts should be kept clean and washed
weekly and whenever necessary.
• When cleaning an item or part of the body, start with
the cleanest area and work toward the dirtiest area.
Nurse
Assistant
In a Long-Term
Care Facility
Infection Control
Disinfection
• Disinfection is a process of destroying as many
harmful microorganisms as possible.
• See facility’s procedure regarding disinfecting
thermometers, utensils, shower chairs, bathtubs, bed
frames, mattresses, and denture cups.
NOTE: Disinfection is accomplished by thoroughly
cleansing an object by hand.
Unit III:
Safety
Sterilization – used on metal or rubber objects that are
reusable
Lesson Plan 3:
Infection Control
• A process that kills all microorganisms
• Requires special processing and handling
NOTE: Sterilization is accomplished using
chemical/mechanical methods.
Nurse
Assistant
In a Long-Term
Care Facility
Important Factors
• Be aware of and follow specific measures to take for
each type of transmission-based precaution.
A “Stop Sign Alert” card should be posted on the door of
each resident who is on transmission-based precautions.
Follow recommendations given to protect everyone.
Gowns, gloves, and/or masks may be required for the
nurse assistant.
• Always organize your work before going into the room.
Unit III:
Safety
Lesson Plan 3:
Infection Control
Gather all supplies and linens needed.
Inform other staff members if you need their assistance.
• Remember to wash hands before and after contact
with the resident. This is the single most important
means of preventing the spread of infection.
• Gloves do not eliminate the need to wash your hands;
they just provide a barrier between you and potentially
infectious microorganisms.
Nurse
Assistant
In a Long-Term
Care Facility
Important Factors
• Never touch unnecessary articles in the room or one’s
face, hair, contact lens, or glasses when wearing gloves.
• Always wear gloves when handling or picking up any
medication patches.
• Remove gloves before leaving the resident’s room.
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Safety
Lesson Plan 3:
Infection Control
Nurse
Assistant
In a Long-Term
Care Facility
Unit III:
Safety
Lesson Plan 3:
Infection Control
Conclusion
Understanding germs and the importance of controlling
them in the long-term care environment is essential for
controlling infection. Handwashing is so simple but often
neglected. Take time to protect everyone – yourself, your
family, coworkers, and the residents.
Nurse
Assistant
In a Long-Term
Care Facility
Steps of Procedure for Washing Hands
1.
Remove wristwatch and/or rings if necessary. Roll up
your sleeves. (Wash wristwatch and rings if they
come into contact with contaminated material.)
2.
Turn on water with knee, foot, or hand controls; adjust
temperature so it is comfortable for you.
CAUTION: Do not touch controls during the rest of the
procedure.
3.
Wet hands thoroughly, including 2 to 3 inches above
wrists. Hold hands with wrists lower than elbows and
fingertips pointed downward.
4.
Apply a generous amount of soap to hands. Do not
use bar soap.
5.
Scrub hands for at least 15 seconds.
Unit III:
Safety
Lesson Plan 3:
Infection Control
a.
Wash palms and back of hands with at least 10
circular motions.
Nurse
Assistant
In a Long-Term
Care Facility
Unit III:
Safety
Lesson Plan 3:
Infection Control
Steps of Procedure for Washing Hands
b.
Wash fingers and between fingers with at least 10
circular motions.
c.
Wash wrists with at least 10 circular motions.
d.
Wash round and under fingernails.
6.
Rinse wrists and hands well. Keep wrists lower than elbows.
7.
Dry hands well with paper towel or fresh clean towel,
using one for each hand.
8.
Turn off faucet with clean, dry paper towel.
9.
Discard paper towel. Be careful not to touch the part
that touched the faucet.
10. Use a clean paper towel to turn knob on door or pull
door open.