Download Egan’s Fundamentals of Respiratory Care

Chapter 4
Principles of Infection Control
Objectives

Define health careassociated infections and state how often
they occur.
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Describe why infection control is important in respiratory care.

Identify and describe the three elements that must be present
for transmission of infection within a health care setting.
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Objectives (cont.)
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List the factors associated with an increased risk of a patient
acquiring a nosocomial infection.
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State the three major routes for transmission of human sources
of pathogens in the health care environment.

Describe strategies to control the spread of infection in the
hospital.

Describe how to select and apply chemical disinfectants for
processing respiratory care equipment.
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Objectives (cont.)

Describe equipment handling procedures that help prevent the
spread of pathogens.

State when and to use general barrier measures during patient
care.

Describe surveillance with regard to infection control.
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Infection Control
Introduction
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Hospital-acquired infections (HAIs) account for 2 million
infections and 90,000 excess deaths annually.
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About 5% of all patients admitted develop an HAI.
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About 25% of mechanically ventilated patients develop
pneumonia, and 30% (of those 25%) will die.
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Infection Control (cont.)
Introduction (cont.)

Infection control procedures aim to
 Eliminate the sources of infectious agents
 Create barriers to their transmission
 Monitor the effectiveness of control

All health care workers must take responsibility and follow
procedures carefully.
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Spread of Infection

Three elements must be present for infection to spread:
 Source of pathogens
 Susceptible host
 Route of transmission
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Spread of Infection (cont.)
Sources of Infectious Agents

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Humans are the primary source.
Inanimate objects (e.g., contaminated medical equipment) can
spread infection.
Individuals in the hospital capable of being the source include
workers, visitors, and patients.
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Spread of Infection (cont.)
Susceptible Hosts

Resistance to infection varies greatly from one person to the
next.
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Host factors that increase the chance of infection are
 Poorly controlled diabetes
 Increased age
 Chemotherapy
 Placement of tubes and catheters
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Spread of Infection (cont.)

Nosocomial Infections are those acquired in the hospital.

Most nosocomial pneumonias occur in patients having chest or
abdominal surgery.

Those with a history of COPD, cigarette smoking, or obesity and
with advanced age have the greatest risk for nosocomial
pneumonia following major surgery.
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Modes of Transmission
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Transmission Routes
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Contact Transmission –

Direct – body susrface to body surface contact.
• Touching a pt with your hands
• Changing a dressing
• Any procedure requiring contact

Indirect Contact – occurs between a host and
inanimate object such as:
• Clothing
• Dressings
• Instruments
• equipment
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Transmission Routes

Droplet Transmission –



Large contaminated droplets released into the air
by coughing, sneezing or talking
Can travel 3 feet
Influenza and rubella are spread this way
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Transmission Routes

Airborne Transmission –
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
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Pathogen can be spread through the air on dust.
Fungal infections are commonly spread this way.
Droplet nuclei are very small particles that remain
suspended for long periods of time
• Example: TB or measles
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Transmission Routes

Vehicle Transmission –


Pathogens are transmitted by food or water
Examples: Hep A and Salmonella
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Transmission Routes

Vector Borne Transmission –


Transmission by insect
Examples:
• West Nile Virus
• Malaria
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Spread of Infection to Lungs
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3 Ways:
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
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Aspiration of oral or gastric secretions
Inhalation of infected materials
Spread of infection to the lung by the blood
(sepsis).
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Infection Control Strategies
1.
2.
3.
Decreasing host susceptibility
Immunizations and chemoprophylaxis
Eliminating the source of the pathogens
Interrupting routes of transmission
Special equipment handling
Barrier/isolation precautions
Disposable equipment
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Decrease Host Susceptibility

Focus on employee immunization


Vaccines include: influenza, hepatitis, diphtheria,
tetanus and sometimes TB
Due to contact with body fluids, employees and
students must be vaccinated against Hepatitis.
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Disinfection and Sterilization
Cleaning

Cleaning is the first step in all equipment processing.
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It involves removing dirt and organic material.
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Failure to clean equipment properly can render all subsequent
processing efforts ineffective.

Soaps and detergents need to be used.
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Disinfection and Sterilization (cont.)
Disinfection

Disinfection destroys the vegetative form of all pathogens
except bacterial spores.

Disinfection can involve either chemical or physical methods.

Pasteurization is the most common physical method.
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Disinfection and Sterilization (cont.)
Chemical Disinfection

Chemical disinfection involves the application of chemical
solutions to contaminated equipment or surfaces.

Equipment must be immersed in the solution for a set period of
time.
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Disinfection and Sterilization (cont.)
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Levels of Chemical Disinfection

Low Level
• 5% acetic acid (vinegar) in a 1:3 solution.
• This is often used at home to disinfect equipment
• Kills most bacteria (including P. aeruginosa) and viruses
but not resistant bugs or spores.
• Can also use “quats” – cationic detergents that kill
everything except spores and TB.
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Levels of Chemical Disinfection
(con’t)

Intermediate Level



Kill all bacteria and fungi but have variable effects
on spores and some viruses.
70% ethyl and 90% isopropyl spray for electrical
equipment, stethoscopes and skin preps.
Iodopher (Providone or Betadyne) skin prep prior
to blood draw or IV insertion.
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Levels of Chemical Disinfection
(con’t)

High Level


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Can destroy all microorganisms except spores.
Most common is glutaraldehyde.
• A cold chemical disinfectant that lasts for only 28 days
• Use test strips to confirm strength of solution
• Irritation of eyes and hands (always use goggles and gloves)
• Won’t damage equipment
• Soak equipment for 20 minutes, rinse well and aseptically dry.
Household Bleach (Sodium Hypochlorite)
• 1:50 dilution for 10 minutes kills everything.
• CDC recommends a 1:10 solution for blood spills
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Sterilization
The complete destruction of all forms of
microbial life.
• Comparison of Methods (Table 3-4) on p.49
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Incineration – object of no further use
Dry Heat – 1-2 hours @ 160˙ to 180˙C
Boiling – 30 minutes @ 100˙C
Autoclave- steam under pressure (↑P = ↓T)
Ionizing Radiation – x-ray and gamma ray
Ethylene Oxide – hazardous but effective gas exposure
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Sterilization

Destroys all microorganisms

Can be achieved with physical and chemical approaches
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Steam sterilization is most common and easiest.

Low-temperature sterilization technologies include ethylene
oxide, a colorless and toxic gas.
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Equipment Handling Procedures
Nebulizers

Large-volume nebulizers are often a problem.

Small-volume nebulizers can also produce bacterial aerosols.
Ventilators and Circuits

Circuits pose the greatest risk for infection.
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Equipment Handling Procedures
(cont.)
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Equipment Handling Procedures
(cont.)
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Cleaning

If you must clean equipment make sure:




Clean in a “dirty” room and move to “clean” room
to dry
Wear gloves when disassembling and cleaning
equipment
If electrical, spray with 70% alcohol spray or
bactericidal solution and wipe with paper towels
Make sure your equipment properly dries to
discourage bacterial growth
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Equipment Handling
Disposable Equipment

An important alternative to continually reprocessing equipment

Three major issues
 Cost
 Quality
 Reuse (raises significant safety concerns)
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Preventing Transmission of
Infectious Agents

Standard Precautions―combines the major features of
Universal Precautions and Body Substance Isolation

Standard precautions apply to
 Blood
 All body fluids
 Nonintact skin
 Mucous membranes
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Preventing Transmission of
Infectious Agents
Respiratory Hygiene
1.
2.
3.
4.
5.
Education of patients and employees
Posted signs
Source control measures (covering your mouth)
Hand hygiene
Spatial separation (at least 3 feet of space)
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Expanded Precautions
1.
2.
3.
4.
Contact precautions

Proper use of gowns and gloves
Droplet precautions (see Box 4-11)
Airborne infection isolation

Use of N-95 respirator when in patient room
Protective environment

Used with allogeneic stem cell transplant patients
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Expanded Precautions (cont.)
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Personal Protective Equipment

Gloves―protect both patients and health care workers from
exposure to pathogens

Mouth, nose, eye, and face protection―mucous membranes are
vulnerable

NIOSH-approved N-95 respirator―intended for diseases
transmitted by airborne route

Gowns and aprons―when contact with blood and body fluids is
likely
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Surveillance

An ongoing process of monitoring patients and personnel for the
acquisition of infection in the health care setting

An infection control committee establishes surveillance policies
and an infection control expert administers them.
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Most Important barrier against
spread of infection….

http://www.youtube.com/watch?v=Rc6QRM9
F3IY
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