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CHAPTER 5
Protecting Patients and Ourselves
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Introduction
• Methods of infection prevention
─Hand washing
─Standard precautions
─Transmission-based precautions
─OSHA regulations
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Portals of Entry
• Openings providing infectious agents
access to the body
– Respiratory tract
– GI tract
– GU tract
– Non-intact skin
– Wounds
• Pathogen may be halted by immune
system, or lead to local/systemic infection
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Reservoirs of Infection
• Carriers (asymptomatic, but spread
disease to others)
• Animals
• Environment
• Fomites (nonliving objects harboring and
transmitting diseases)
• Hospital procedures
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Routes of Transmission
• Contact (direct, indirect)
• Common vehicle (contamination leading to
illness of many people in same locale)
• Airborne (aerosol floats in air and is
inhaled by another person)
• Vector (organisms that act as reservoir of
infection)
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Vector Transmission
• Biological
─Pathogen located inside vector’s body
(e.g., mosquito as carrier of malaria)
• Mechanical
─Pathogen located outside vector’s body
(e.g., fly walks on food)
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Hand Hygiene
• Simplest and most important method of
prevention of spread of infection
• Two types of flora on hands
– Resident (normal)—located on stratum
corneum; prevent contamination by
antagonizing other microorganisms and
competing for food source; nonpathogenic
unless enter sterile body cavity of
immunocompromised patient
(Continues)
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Hand Hygiene
– Transient flora—acquired during direct contact
with patients or contaminated
objects/surfaces; removed by proper hand
hygiene
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Basics of Hand Washing
• Remove jewelry
• Push lever to release paper towel (do not
tear off)
• Set water as hot as tolerable
• Wet hands
• Apply soap and wash hands, between
fingers, and around nails (for 25–30
seconds)
(Continues)
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Basics of Hand Washing
• Rinse with water allowing water to flow
downward from wrists to fingers
• Tear off paper towel
• After drying hands, use paper towel to turn
off water
• Discard towel properly
(Continues)
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Basics of Hand Washing
• May use alcohol-based, antiseptic hand
sanitizers when full hand washing is not
feasible, or if hands are not visibly soiled
• Use same cleaning action for hands,
fingers, and nails
• Continue until sanitizer has evaporated
and hands are dry
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Fundamental Principles of Infection
Prevention and Control
• Standard precautions
– Minimum standards; considers all patients
capable of transmitting disease
• Transmission-based precautions
– Three types (contact, droplet, and airborne
precautions); used with standard precautions
if patient is known or suspected to have
transmittable disease, or infection with
multidrug-resistant bacteria
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Standard Precautions
• Used when possible exposure to blood
and/or body fluids from any patient or from
contaminated equipment
• Include
– Hand hygiene and proper use of personal
protective equipment (PPE)
– Cough etiquette/respiratory hygiene
– Safe injection practice
– Safe handling of potentially contaminated
surface/equipment
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Use of Antimicrobial Soap/
Alcohol-Based Rubs
• Use of water and antimicrobial soap
(include but not limited to)
– After eating
– If hands are visibly soiled
– After using restroom
– If possible exposure to spore-forming
organism
(Continues)
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Use of Antimicrobial Soap/
Alcohol-Based Rubs
• Use of alcohol-based rubs (include but not
limited to)
– Before and after direct patient contact
– After removing gloves
– After contact with patient’s intact skin
– After contact with objects near patient
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Personal Protective Equipment (PPE)
• Specialized clothing provided by employer
• Use is based on type of patient contact
and exposure potential
• Examples
– Gloves
– Gowns
– Face masks
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Cough Etiquette and Respiratory
Hygiene
• Tissues and no-touch waste cans
available in reception areas
• Cover mouth when coughing or sneezing
• Cough/sneeze into crook of elbow if tissue
is not available
• Perform hand hygiene after contact with
respiratory secretion (yours or patient’s)
(Continues)
5-18
Cough Etiquette and Respiratory
Hygiene
• Droplet precaution
– Used with standard precautions
– Avoid direct patient contact if you have
respiratory illness (or wear mask if direct
contact cannot be avoided)
– Hand hygiene
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Safe Injection Practices
• Discard used syringes/needles at point of
use (in puncture-resistant, closable,
leakproof sharps container)
• Dispose of single-use lancets properly and
immediately after use
• Perform phlebotomy in dedicated areas
containing proper supplies and hand
washing stations
(Continues)
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Safe Injection Practices
• Label blood tubes prior to phlebotomy
procedure
• Place blood-containing tubes only on
surfaces that can be properly cleaned if
contamination occurs
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Potentially Contaminated
Surfaces/Equipment
• Clean equipment according to
manufacturer’s instructions
• Clean patient-care areas daily (minimum)
unless visibly contaminated; then clean
area immediately
• Clean and disinfect patient rooms focusing
on areas frequently touched by patients or
staff
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Transmission-Based Precautions
• Three types: contact, airborne, droplet
(all used in conjunction with standard
precautions)
• Contact precautions
– Private room; dedicated equipment for
patient; disinfect equipment when removed
– Hand hygiene and proper use of PPE
(Continues)
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Transmission-Based Precautions
• Airborne precautions
– Transmission by droplet or dust (e.g., TB,
measles)
– Negative-pressure room with door closed
– Proper PPE (mask must be fit-tested for
health care worker)
(Continues)
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Transmission-Based Precautions
• Droplet precautions
– Illness spread by large particle droplets
(e.g., flu, whooping cough)
– Private room; door may remain open
– Surgical mask and/or other PPE
– Hand hygiene before and after contact with
patient or contaminated objects
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Occupational Safety and Health
Administration Regulations
• OSHA mandates blood-borne pathogen
standard with goal to prevent occupational
related exposure to infectious organisms
in blood or body fluids
• Exposure control plan
• Annual update of plan
• Implement use of standard precautions
(Continues)
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OSHA
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Identifying and using engineering controls
Ensuring use of work practice controls
Providing PPE
Availability of HBV vaccine
Post-exposure evaluation/follow-up
Labels/signs denoting hazards
Training for workers annually
Maintaining training records
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Summary
• Infection can be spread through
– Contact
• Direct
• Indirect
– Common vehicle
– Airborne
– Vector
• Biological
• Mechanical
(Continues)
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Summary
• Numerous ways to protect patients and
ourselves from spreading microbes
– Hand washing
– Standard precautions: hand hygiene, use of
PPE, cough etiquette/respiratory hygiene,
safe injection practice, safe handling
– Transmission-based precautions: contact,
airborne, droplet
– OSHA standards
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