Download Student Version Chapter 5 Preventing infection

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Preventing Infection
Define the following terms:
Infection control
the measures practiced in healthcare facilities to prevent and
control the spread of disease.
Microorganism or Microbe
a living thing or organism that is so small that it can be seen
only through a microscope.
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Define the following terms:
Infection
the state resulting from pathogens invading the body and
multiplying.
Pathogens
harmful microorganisms.
Systemic infection
an infection that is in the bloodstream and is spread
throughout the body, causing general symptoms.
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Define the following terms:
Localized infection
an infection that is confined to a specific location in the body
and has local symptoms.
Healthcare-associated infections (HAIs)
infections that patients acquire within healthcare settings that
result from treatment for other conditions.
Medical asepsis
the process of removing pathogens, or the state of being free
of pathogens.
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Define the following terms:
Clean
in health care, a condition in which objects are not
contaminated with pathogens.
Dirty
in health care, a condition in which objects have been
contaminated with pathogens.
Surgical asepsis
the state of being free of all microorganisms, not just
pathogens; also called sterile technique.
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1. Define “infection control” and related terms
REMEMBER:
Working to prevent the spread of disease is the responsibility of
all care team members.
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Define the following terms:
Causative agent
a pathogen or microorganism that causes disease.
Reservoir
a place where a pathogen lives and grows.
Portal of exit
any body opening on an infected person that allows
pathogens to leave.
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Define the following terms:
Mode of transmission
method of describing how a pathogen travels from one person
to the next person.
Direct contact
touching an infected person or his secretions.
Indirect contact
touching something contaminated by an infected person.
Portal of entry
any body opening on an uninfected person that allows
pathogens to enter.
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Define the following terms:
Mucous membranes
the membranes that line body cavities, such as the mouth,
nose, eyes, rectum, or genitals.
Susceptible host
an uninfected person who could get sick.
Transmission
passage or transfer.
Infectious
contagious.
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Transparency 5-1: The Chain of Infection
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2. Describe the chain of infection
REMEMBER:
If one of the links in the chain of infection is broken—by washing
hands, for example—then the spread of infection is stopped.
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Define the following terms:
Malnutrition
poor nutrition due to improper diet.
Dehydration
a condition that results from inadequate fluid in the body.
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3. Explain why the elderly are at a higher risk for infection and
identify symptoms of an infection
The elderly are at higher risk of infection due to
• Weakened immune systems
• Decreased circulation
• Slow wound healing
• Malnutrition
• Dehydration
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3. Explain why the elderly are at a higher risk for infection and
identify symptoms of an infection
Factors affecting risk of infection in the elderly (cont’d.):
• Limited mobility
• Hospitalization
• Difficulty swallowing
• Incontinence
• Feeding tubes and other tubing
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3. Explain why the elderly are at a higher risk for infection and
identify symptoms of an infection
Report these signs and symptoms of localized infection:
• Pain
• Redness
• Pus
• Swelling
• Drainage (fluid from a wound or cavity)
• Heat
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3. Explain why the elderly are at a higher risk for infection and
identify symptoms of an infection
Report these signs and symptoms of systemic infection:
• Fever
• Chills
• Body aches
• Headache
• Drop in blood pressure
• Nausea, vomiting
• Weakness
• Mental confusion
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Define the following terms:
Centers for Disease Control and Prevention (CDC)
a government agency under the Department of Health and
Human Services (HHS) that issues information to protect the
health of individuals and communities.
Isolate
to keep something separate, or by itself.
Standard Precautions
a method of infection control in which all blood, body fluids,
non-intact skin, and mucous membranes are treated as if
they were infected with an infectious disease.
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Define the following terms:
Body fluids
under Standard Precautions, includes saliva, sputum (mucus
coughed up), urine, feces, semen, vaginal secretions, and pus
or other wound drainage; does not include sweat.
Sharps
needles or other sharp objects.
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4. Describe the Centers for Disease Control and Prevention (CDC)
and explain Standard Precautions
Think about this question:
Why should Standard Precautions be practiced with every
resident in your care?
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4. Describe the Centers for Disease Control and Prevention (CDC)
and explain Standard Precautions
Use these Standard Precautions measures with every resident:
• Wash hands.
• Wear gloves.
• Remove gloves immediately when finished with a procedure.
• Immediately wash skin surfaces.
• Wear a disposable gown when appropriate.
• Wear a mask and goggles when appropriate.
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4. Describe the Centers for Disease Control and Prevention (CDC)
and explain Standard Precautions
Standard Precautions measures (cont’d.):
• Wear gloves when handling sharp objects.
• Never attempt to cap a needle or syringe.
• Avoid nicks and cuts.
• Bag all contaminated supplies.
• Clearly label body fluids.
• Dispose of contaminated waste properly.
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Define the following terms:
Hand hygiene
washing hands with either plain or antiseptic soap and water
and using alcohol-based hand rubs.
Hand antisepsis
washing hands with water and soap or other detergents that
contain an antiseptic agent.
Antimicrobial
destroying or resisting pathogens.
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5. Explain the term “hand hygiene” and identify when to wash
hands
REMEMBER:
Although alcohol-based rubs are useful, it is still very important
to wash hands with soap and water and not to rely solely on
alcohol-based rubs.
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5. Explain the term “hand hygiene” and identify when to wash
hands
NAs should wash their hands at all of the following times:
• Arrival at work
• Any time they are visibly soiled
• Before, between, and after all resident contact
• After contact with body fluids, mucous membranes, non-intact
skin, dressings
• After handling contaminated items
• After contact with objects in resident’s room
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5. Explain the term “hand hygiene” and identify when to wash
hands
Wash hands (cont’d.):
• Before and after touching meal trays
• Before and after feeding residents
• Before putting on gloves and after removing gloves
• Before getting clean linen
• After touching garbage or trash
• After picking up things from the floor
• After using the toilet
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5. Explain the term “hand hygiene” and identify when to wash
hands
Wash hands (cont’d.):
• After blowing nose or sneezing into hand
• Before and after eating
• After smoking
• After touching areas on the body
• Before and after applying makeup
• After any contact with pets/pet care items
• Before leaving facility
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5. Explain the term “hand hygiene” and identify when to wash
hands
REMEMBER:
Handwashing is the single most important thing you can to do
prevent the spread of disease.
Washing hands
Equipment: soap, paper
towels
1.
Turn on water at sink.
Keep your clothes dry,
because moisture breeds
bacteria.
2.
Angle your arms down,
holding your hands lower
than your elbows. This
prevents water from
running up your arm.
Wet hands and wrists
thoroughly.
Washing hands (cont’d.)
3. Apply skin cleanser or
soap to your hands.
4. Rub hands together and
fingers between each
other to create a lather.
Lather all surfaces of your
fingers and hands,
including your wrists. Use
friction for at least 20
seconds. Friction helps
clean.
5. Clean your nails by
rubbing them in palm of
other hand.
Washing hands (cont’d.)
6. Being careful not to touch
the sink, rinse thoroughly
under running water. Rinse
all surfaces of your hands
and wrists. Run water
down from wrists to
fingertips. Do not run
water over unwashed arms
down to clean hands.
7. Use a clean, dry paper
towel to dry all surfaces of
your hands, wrists, and
fingers. Do not wipe towel
on unwashed forearms and
then wipe clean hands.
Dispose of towel without
touching wastebasket. If
your hands touch the sink
or wastebasket, start over.
Washing hands (cont’d.)
8. Use a clean, dry paper
towel to turn off the
faucet. Do not
contaminate your hands
by touching the surface of
the sink or faucet.
9. Dispose of used paper
towel(s) in wastebasket
immediately after shutting
off faucet.
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Define the following terms:
Personal protective equipment (PPE)
equipment that helps protect employees from serious
workplace injuries or illnesses resulting from contact with
workplace hazards.
Perineal care
care of the genitals and anal area.
Non-intact skin
skin that is broken by abrasions, cuts, rashes, acne, pimples,
or boils.
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6. Discuss the use of personal protective equipment (PPE) in
facilities
Gloves should be worn at the following times:
• If you might touch blood or any body fluid
• During mouth care or care of any mucous membrane
• During perineal care
• When providing personal care on non-intact skin
• When providing personal care if NA has cuts on hands
• When shaving a resident
• When disposing of soiled linens, gowns, dressings, and pads
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6. Discuss the use of personal protective equipment (PPE) in
facilities
Gloves should be changed
• Immediately before contact with mucous membranes or
broken skin
• If gloves become soiled, worn, or damaged
Putting on gloves
1. Wash your hands.
2. If you are right-handed,
slide one glove on your left
hand (reverse if
left-handed).
3. With gloved hand, slide
the other hand into the
second glove.
4. Interlace fingers. Smooth
out folds and create a
comfortable fit.
Putting on gloves (cont’d.)
5. Carefully look for tears,
holes, or discolored spots.
Replace the glove if
needed.
6. If wearing a gown, pull the
cuff of the gloves over the
sleeve of gown.
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6. Discuss the use of personal protective equipment (PPE) in
facilities
Gloves should be removed
• After use
• Before caring for another resident
• Before touching non-contaminated items or surfaces
Taking off gloves
1. Touch only the outside of
one glove. Pull the first
glove off by pulling down
from the cuff.
2. As the glove comes off
your hand, it should be
turned inside out.
Taking off gloves (cont’d.)
3. With the fingertips of your
gloved hand, hold the
glove you just removed.
With your ungloved hand,
reach two fingers inside
the remaining glove. Be
careful not to touch any
part of the outside of
glove.
4. Pull down, turning this
glove inside out and over
the first glove as you
remove it.
Taking off gloves (cont’d.)
5. You should now be holding
one glove from its clean
inner side. The other glove
should be inside it.
6. Drop both gloves into the
proper container.
7. Wash your hands.
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6. Discuss the use of personal protective equipment (PPE) in
facilities
REMEMBER:
Gowns are worn during any procedure that is likely to cause body
fluid splashes or sprays.
Putting on a gown
1. Wash your hands.
2. Open the gown. Hold out
in front of you and allow
gown to open. Do not
shake it. Slip your arms
into the sleeves and pull
gown on.
Putting on a gown (cont’d.)
3. Tie the neck ties into a
bow so they can be easily
untied later.
4. Reach behind you. Pull the
gown until it completely
covers your clothing. Tie
the back ties.
Putting on a gown (cont’d.)
5. Use a gown only once and
then remove and discard
it. When removing a gown,
roll the dirty side in and
away from the body. If
your gown ever becomes
wet or soiled, remove it.
Check clothing and put on
a new gown. The
Occupational Safety and
Health Administration
(OSHA) requires nonpermeable gowns—gowns
that liquids cannot
penetrate—when working
in a bloody situation.
6. Put on your gloves after
putting on gown.
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6. Discuss the use of personal protective equipment (PPE) in
facilities
Wear masks and goggles
• If there is risk of splashing body fluids or blood.
• Wear masks if respiratory illnesses are present.
Putting on mask and goggles
1. Wash your hands.
2. Pick up the mask by top
strings or elastic strap. Be
careful not to touch the
mask where it touches
your face.
Putting on mask and goggles (cont’d.)
3. Adjust the mask over your
nose and mouth. Tie top
strings first, then bottom
strings. Masks must
always be dry or they
must be replaced. Never
wear a mask hanging from
only the bottom ties.
4. Put on the goggles.
5. Put on your gloves after
putting on mask and
goggles.
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Define the following terms:
Sterilization
a measure that destroys all microorganisms, including
pathogens.
Disinfection
process that kills pathogens, but not all microorganisms; it
reduces the organism count to a level that is generally not
considered infectious.
Disposable
only to be used once and then discarded.
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7. List guidelines for handling equipment and linen
Remember these guidelines for equipment, linen, and clothing:
• Prevent skin/mucous membrane contact.
• Prevent contamination of clothing.
• Prevent transfer of disease to other residents or
environments.
• Do not use re-usable equipment until it has been cleaned
properly.
• Dispose of all single-use equipment properly.
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7. List guidelines for handling equipment and linen
Guidelines for equipment, linen, and clothing (cont’d.):
• Clean and disinfect all environmental surfaces, beds, bedrails,
all bedside equipment, and all frequently touched surfaces
(doorknobs are a good example).
• Handle, transport, and process soiled linens and clothing in a
way that prevents skin and mucous membrane exposure,
contamination of clothing (hold linen away from uniform), and
transfer of disease to other residents and environments.
• Bag soiled linen at point of origin.
• Sort soiled linen away from resident care areas.
• Place wet linen in leak-proof bags.
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8. Explain how to handle spills
Remember these guidelines for cleaning spills involving blood,
body fluids, or glass:
• Put on gloves (industrial strength).
• Use proper product to absorb spill.
• Scoop up absorbed spill and dispose of it in designated
container.
• Apply disinfectant.
• Use tools to pick up glass, never hands.
• Properly bag waste.
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Define the following terms:
Transmission-based (isolation) precautions
method of infection control used when caring for persons who
are infected or suspected of being infected with a disease;
also called isolation precautions.
Multidrug-resistant organisms (MDROs)
microorganisms, mostly bacteria, that are resistant to one or
more antimicrobial agents.
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Transparency 5-2: Airborne Precautions
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Transparency 5-3: Droplet Precautions
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Transparency 5-4: Contact Precautions
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9. Explain transmission-based precautions
Remember these guidelines for isolation:
• Transmission-based precautions always used in addition to
Standard Precautions
• Nurses will set up the isolation unit.
• Use PPE as instructed. Do not wear PPE outside resident’s
room and perform hand hygiene following removal of PPE.
• Do not share equipment between residents.
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9. Explain transmission-based precautions
Guidelines for isolation (cont’d.):
• Wear proper PPE and use disposable dishes, etc. as indicated
when serving food and drink.
• Follow standard precautions in dealing with body waste
removal.
• Wear proper PPE if required to take specimen.
• Reassure residents that the disease, not the person, is being
isolated.
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Define the following terms:
Bloodborne pathogens
microorganisms found in human blood, body fluid, draining
wounds, and mucous membranes that can cause infection
and disease in humans.
HIV
stands for human immunodeficiency virus, the virus that can
cause AIDS.
Hepatitis
inflammation of the liver caused by infection.
Jaundice
a condition in which the skin, whites of the eyes, and mucous
membranes appear yellow.
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10. Define “bloodborne pathogens” and describe two major
bloodborne diseases
Bloodborne diseases are transmitted by
• Infected blood
• Infected semen or vaginal secretions
• Sexual contact
• Needle sharing
• Infected mothers
• Contact with infected blood or certain other body fluids in
healthcare setting
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10. Define “bloodborne pathogens” and describe two major
bloodborne diseases
REMEMBER:
Standard Precautions, handwashing, isolation, and PPE are all
used to prevent the spread of bloodborne pathogens.
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Define the following terms:
Occupational Safety and Health Administration (OSHA)
a federal government agency that makes rules to protect
workers from hazards on the job.
Bloodborne Pathogens Standard
federal law that requires that healthcare facilities protect
employees from bloodborne health hazards.
Exposure control plan
plan designed to eliminate or reduce employee exposure to
infectious material.
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11. Explain OSHA’s Bloodborne Pathogen Standard
OSHA’s Bloodborne Pathogens Standard calls any of the following
a “significant exposure”:
• Needle stick
• Mucous membrane contact
• Cut from an object containing potentially infectious body fluid
• Non-intact skin contact
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11. Explain OSHA’s Bloodborne Pathogen Standard
Employers must follow these guidelines:
• Written exposure control plan
• Proper PPE
• Biohazard containers
• Hepatitis B vaccine
• Warning labels
• Log of injuries from contaminated sharps
• In-service training
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Define the following terms:
Tuberculosis
an airborne disease carried on very small mucous droplets
suspended in the air.
Latent TB
type of tuberculosis in which the person carries the disease
but does not show symptoms and cannot infect others; also
known as TB infection.
Active TB
type of tuberculosis in which the person shows symptoms of
the disease and can spread TB to others; also known as TB
disease.
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Define the following terms:
Multidrug resistant-TB (MDR-TB)
type of TB that can develop when a person with active TB
does not take all the prescribed medication.
Resistant
state in which drugs no longer work to kill specific bacteria.
Phlegm
thick mucus from the respiratory passage.
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12. Define “tuberculosis” and list infection control guidelines
Signs and symptoms of TB include:
• Fatigue
• Loss of appetite
• Weight loss
• Slight fever and chills
• Night sweats
• Prolonged coughing
• Coughing up blood
• Chest pain
• Shortness of breath
• Trouble breathing
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12. Define “tuberculosis” and list infection control guidelines
Remember these guidelines for infection control when
tuberculosis is present:
• Follow Standard Precautions and airborne precautions.
• Wear mask and gown.
• Handle sputum or phlegm carefully.
• Ensure proper ventilation.
• If resident is in AFB isolation room, open and close door
slowly.
• Follow isolation procedures if ordered.
• Help resident remember to take medications.
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Define the following terms:
Multidrug-resistant organisms (MDROs)
microorganisms, mostly bacteria, that are resistant to one or
more antimicrobial agents.
Antimicrobial
destroying or resisting pathogens.
MRSA
stands for methicillin-resistant Staphylococcus aureus, an
antibiotic-resistant infection often acquired by people in
hospitals and other healthcare facilities who have weakened
immune systems.
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Define the following terms:
VRE
vancomycin-resistant enterococcus, a genetically changed
strain of enterococcus that originally developed in people who
were exposed to the antibiotic vancomycin.
Clostridium difficile (C-diff, C. difficile)
bacterial illness that causes diarrhea and can cause colitis.
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13. Define the terms “MRSA,” “VRE,” and “C. Difficile”
MRSA is spread through
• Direct contact
• Indirect contact
REMEMBER:
Handwashing is the single most important measure to control the
spread of MRSA.
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13. Define the terms “MRSA,” “VRE,” and “C. Difficile”
C. Difficile is spread through
• Direct contact with infected residents
• Contact with environmental surfaces contaminated with
C. Difficile spores
REMEMBER:
C. Difficle is very difficult to kill. Handwashing will not kill the
spores, but will wash them down the drain. Hand rubs may
increase the risk of C. Difficile transmission because many feel a
hand rub is all that is needed, but hand rubs do not kill C.
Difficile spores. Proper handwashing is essential.
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14. List employer and employee responsibilities for infection
control
REMEMBER:
All facilities have policies and procedures in place regarding
infection control. Know and follow your facility’s policies.
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14. List employer and employee responsibilities for infection
control
Employers’ responsibilities regarding infection control include
• Infection control procedures and exposure control plan
• In-service education
• Written procedures to follow
• PPE for employees
• Free hepatitis B vaccine
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14. List employer and employee responsibilities for infection
control
Employees’ responsibilities regarding infection control include
• Follow standard precautions.
• Follow facility’s policies and procedures.
• Follow care plans and assignments.
• Use PPE when appropriate.
• Take advantage of free hepatitis B vaccine.
• Immediately report exposure.
• Participate in education programs.