Download INFECTION PREVENTION and CONTROL

INFECTION PREVENTION and
CONTROL
Standard Precautions

OR ….How to prevent the spread of disease
NORMAL DEFENSES
 Heath Care-Associated
Types of
Infections
Infections formerly
called nosocomial
HAIs
 Iatrogenic:
 Exogenous:
 Endogenous:
CHAIN OF INFECTION
Cholera Outbreak in
Haiti
 Cholera
 Nepalese peacekeeping
force
 Poop
 Latrines near water
 River
 Drinking contaminated
water
Historical Perspective
 1847 Dr. Ignaz Philip Semmelweiss
 Significance of hand washing is demonstrated
 Concept of nosocomial infection is born
More History
Infectious Disease
Process
 Infection:
 Normal flora:
 Colonization:
Chain of Infection
Causative Agents
 Bacteria
 Virus
 Fungi
 Protozoa
Characteristics of
Causative Agents
Reservoirs
NCLEX ?
Which of the following is an example of a nursing
intervention that is implemented to reduce a reservoir of
infection for a client?
A) Covering the mouth and nose when sneezing
B) Wearing disposable gloves
C) Isolating client’s articles
D) Changing soiled dressings
Portal of Exit: The path by which the
infectious agent leaves the reservoir
 Respiratory Tract:
 GU Tract
 GI Tract:
 Skin/Mucous Membranes:
 Transplacental
 Blood:
Mode of Transmission
 The mechanism for transfer of an infectious agent
from the reservoir to the susceptible host
VIGNETTE
 An older adult, hospitalized with a GI disorder is on
bedrest and requires assistance for uncontrolled
diarrhea stools.
 Following one episode of cleaning the patient and
changing the bed linens, the nurse went to a second
patient to provide tracheostomy care.
 The nurse’s hands were not washed before assisting
the second patient
VIGNETTE ANALYSIS
 Infectious agent → Escherichia Coli
 Reservoir → Large Intestines
 Portal of Exit → Feces
 Mode of Transmission → Nurses Hands
 Portal of Entry → Tracheostomy
 Susceptible Host → Older Adult with Trach
Modes of Transmission
 Contact
 Airborne
 Vector-Borne
Contact
 Direct:
 Indirect:
Modes of Transmission
 Direct
 Person to Person
(Fecal-Oral)
 Indirect
 Contact with
 Hepatitis A
contaminated
object
 Staph
 Hepatitis B and C
 HIV
 RSV
 MRSA
Airborne
 Droplets suspended in air after coughing and
sneezing or carried on dust particles
 TB
 Chicken Pox
 Measles (Rubeola)
 Aspergillus
 Droplet
transmission
 Large particles
 Can travel up to 3
feet
 Influenza
 Rubella (3-
day/German
Measles)
 Bacterial
Meningitis
Vector-Borne
 Vector
 External mechanical transfer
 Mosquito, Louse, Flea, Tick, Fly
 West Nile Virus
 Malaria
 Lyme Disease
 Hanta Virus
Portal of Entry: path by which an
infectious agent enters the susceptible
host
 Respiratory tract
 GU tract
 GI tract
 Transplacental (fetus from mother)
 Parenteral: percutaneous, via blood
 Skin/Mucous Membranes
Susceptible Host
 A person or animal lacking effective resistance to a
particular pathogenic agent
Man-Made Epidemics
(NYT July 15, 2012)
Diseases have always come out
of the woods and wildlife
West Nile Virus
American Robin
 Thrives in our backyards and agriculture fields
 Mosquitoes that spread the disease find robins
particularly appealing
H1N1
Lyme Disease
 .
Ebola
SARS
Bird Flu
Isolation Precautions
 Historical perspective 1877 to present
 1877
 Aseptic technique
 1910
“Barrier” Nursing
 Hospital personnel wear gowns between patients
 Handwashing between patients with antiseptic
solutions after patient contact
 Disinfection of objects contaminated by patients
More Hx
 1950s: Infectious Disease hospitals begin to shut down
except for TB sanitariums
 1960s: TB hospitals begin to shut down
 1970: CDC publishes first manual on Isolation
Techniques for Use in Hospitals. Diseases were lumped
into categories
 1980s: Hospitals began to experience new endemic
and epidemic nosocomial infection problems caused
by multi-drug-resistant organisms
HX
 1980: CDC publishes new Isolation guidelines
 1985: Universal precautions come into being (HIV,
HBV, blood borne pathogens)
 1990s HICPAC: 2 tier system
Standard Precautions
Transmission-Based Precautions (Contact, Droplet,
Airborne)
HAIs
 Surgical Sites
 Reproductive System
 Blood Stream
 Respiratory
 Urinary System
 Bone and Joint
 Cardiovascular
 Eye/Ear/Throat/Mout
h Infection
Infection
 CNS
 Gastrointestinal
 Skin and Soft Tissue
Immunocompromised
Pts
 Vary in their susceptibility to HAIs
 Depends on the severity and duration of
immunosupression.
 Use the two-tiered system
 Neutropenic precautions
Critical Thinking
Question
 Clients in the healthcare setting are at risk for
acquiring or developing infections because:
Prevention
 Most HAIs are transmitted by the HCWs and clients
as the result of direct contact
 We as nurses must pay attention to
handwashing after contact with
clients and equipment
Prevention
 Microorganisms move through space on air currents
 Microorganisms are transferred from one surface to
another whenever objects touch, a clean item touching
a less clean item becomes “dirty”
 Microorganisms are transferred by gravity when one
item is held above another
Prevention
 Microorganisms are released into the air on droplet
nuclei whenever a person breaths or speaks Microroganisms move slowly on dry surfaces, but very
quickly through moisture –
 Proper handwashing removes many of the
microorganaisms that would be transferred by the
hands from one item to another- always
hands between patients.
wash
Prevention
 To reduce susceptibility provide adequate nutrition
and rest, promote body defenses against infection and
provide immunization
Superbugs
 MRSA
 VRE: Vancomycin resistant enterococcus
Break The Chain!
 Implement ASEPSIS: absence of disease-producing
microorganisms; refers to practices/procedures that
assist in reducing the risk of infection
 2 Types

Medical (clean technique)

Surgical (sterile technique)
MEDICAL ASEPSIS
 Clean technique:
 Aseptic technique
 3 components to the technique:
 Hand washing,
 Barriers of PPE (gloves, gowns, mask, protective
eyewear)
 Routine environmental cleaning
 Contaminated area:
Disinfection/Sterilization
 Disinfection = the process that eliminates many or all
microorganisms, with the exception of bacterial spores,
from inanimate objects
 Sterilization = complete elimination or destruction of all
microorganism, including spores
Aseptic technique
 Handwashing is the single most important procedure
for preventing the transfer of microorganisms and
therefore preventing the spread of HAIs
 CD recommends 10-15 second hand wash.
Personal Hygiene
 Restrain Hair: hair falling forward may drop
organisms
 Keep nails short: no acrylic nails or chipped nail
polish
 Minimum jewelry (see agency policy)
 Cover open wounds with an occlusive dressing.
When should hands be
washed
CDC GUIDELINES
 Standard Precautions apply to:

Blood

All body fluids and secretions (feces, urine, mucus,
wound drainage) except sweat

Non-intact skin

Mucous membranes

Respiratory secretions
STANDARD PRECAUTIONS
TIER 1

Hand Hygiene: see next slide

Gloves: for touching blood, body fluids, secretions,
excretions, non-intact skin, mucous membranes or
contaminated areas

Masks, Eye Protection or Face Shields: if in contact
w/ sprays or splashes of body fluids

Gowns: to protect your clothing

Contaminated Linen: place in leak-proof bag so no
contact with skin or mucous membranes

Respiratory Hygiene/Cough Etiquette: provide client
with tissues and containers for disposal; stand ~3 feet
away from coughing; use masks prn
Hand Hygiene
ISOLATION PRECAUTIONS
TIER 2
 Contact = private room or cohort clients, gloves and
gowns

MDRO, C-Diff, RSV
 Droplet = private room or cohort clients, mask is
required

Strept, pertusis, mumps, flu
 Airborne = private room, negative airflow, hepa
filtration; N95 respirator mask required

TB, chickenpox, measles
 Protective Environment = private room, positive-
pressure room; hepa filtration; gloves, gowns, mask
(controversial); NO flowers or potted plants

Stem cell transplant
N95 Respirator
STANDARD
PRECAUTIONS
 Handwashing
 Gloves (PPE)
 Masks (PPE)
 Eye Protection (PPE)
 Gowns (PPE)
 Leak-proof linen bags
 Puncture proof containers for sharps

Donning and Removing
PPERemoving
Donning

Gown

Mask or respirator

Goggles/face shield

Gloves
 Keep hands away from
face
 Work from clean to dirty
 Lime surfaces touched
 Change when torn or
heavily soiled


Gloves

Goggles/face shield

Gown

Mask or respirator
 Remove at doorway
before leaving pt. room
 Perform hand hygiene
immediately after
removing all PPE
Surgical Asepsis
 Sterile technique that prevents contamination of
an open wound, serves to isolate the operative
area from the unsterile environment, and
maintains sterile field for surgery
Principles of Surgical Asepsis
 For which procedure would the nurse use aseptic
technique and which would require the nurse to
use sterile technique?
A) Aseptic technique for urinary catheterization in
the
hospital and sterile technique for cleaning surgical wound
B) Aseptic technique for changing the patient’s linen and
sterile technique for assisting in surgery
C) Aseptic technique for food preparation and sterile
technique for starting an IV line
D) Aseptic technique for a spinal tap and sterile technique
for placing a central line
LAB Practice: Isolation
Precautions
 Demonstrate donning Isolation Gown, Mask, Gloves,
Eyewear
 Demonstrate removing Isolation Gown, Mask, Gloves,
Eyewear
 Demonstrate proper disposal of PPE before leaving
Isolation Room
 When performing care/treatments use hospital
provided stethoscope and leave in the room
Lab Practice Cont’d.
 Practice pretending you are entering patient room (use
curtains) and give Complete Bed Bath and do Bed
Linen Change wearing PPE (gown, mask, gloves)
 Remember to dispose of PPE INSIDE the patient’s
room before you leave
 Practice bringing in all the supplies you need so you
can stay in the room & not have to leave (de-gown etc)
and come back in (re-gown etc)
LAB Practice: Sterile
Procedures
 Opening sterile packages – Flap fartherest away from
nurse first, then sides, then flap closest to nurse
 Preparing a sterile field
 Pouring sterile solutions – label to palm, “lip” it
 Donning sterile gown and gloves
Critical Thinking
Exercise
 Mrs. Jaycock had an indwelling urethral catheter for 1
week. The catheter has now been out for 24 hours.
She complains of frequency and pain on urination.
Mrs. Jaycock suggests reinsertion of the catheter
because of the need to get up frequently. What can
frequency or pain on urination be an indication of ?
Answer
 UTI
 Should the catheter be reinserted?
 Why or why not?
Answer
 No reinserting the catheter may aggravate the
infection and promote the spread of the infection to
the bloodstream.
 Describe at least one appropriate assessment measure
and one independent nursing action or intervention
for Mrs. Jaycock
Nursing Response
 Increase her fluid intake if not clnically
contraindicated
 Check her urinalysis
Situation
 You are caring for Mr. Huang, who has a large open,
and draining abdominal wound. You notice another
health care worker changing Mr. Huang’s dressing
without wearing gloves or using sterile technique.
When you question the health care worker regarding
his or her practice, this person says, “Don’t worry, the
wound is already infected, and the antibiotics and
drainng will take care of any contaminants.” How
would you respond to this comment?
Response
 It is important to not only protect Mr. Huang from
additional infection, but also to protect ourselves from
becoming contaminated.
 What would your next steps be in following up on this
incident?
Situation
 Mrs. Niles is 83 years of age and lives alone. She has
difficulty walking and relies on a church volunteer
group to deliver lunches during the week. Her fixed
income limits her ability to buy food. Last week, Mrs.
Niles’ 79-year-old sister died. The two sisters had
been very close. As a home care nurse, explain the
factors that might increase Mrs. Niles’ risk for
infection.
Response
 Age
 Potential for poor nutrition
 Potential for depression
Situation
 Mr. Vargas is admitted to the facility with a history of
recent weight loss, a cough that has persisted for 2
months, and hemoptysis. His chest x-ray film shows a
cavity lesion in one lung, and his physician suspects
tuberculosis. What type of isolation precautions
would you use for Mr. Vargas? What protection
would you use to provide care? What education
would you provide to the family?
Response
 Airborne precautions
 Wear an N95 mask
 Keep the door closed
 Educate the pt and family on transmission of TB and
reason for isolation.