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RET 1024
Introduction to Respiratory Therapy
Module 3.0
Infection Control
Infection Control
Nosocomial Infection;
An infection acquired after hospitalization
- AKA: hospital-acquired infection
Infection Control
Nosocomial Infection;
Account for an estimated 2 million
infections and 90,000 excess deaths
annually
Infection Control
Nosocomial Infection
 Infections acquired by those in the
intensive care unit (ICU) account for >20%
of all HAIs (CDC 2007)
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Immunocompromised by disease and/or treatment
Major trauma
Respiratory failure
Myocardial infarction
CHF
Overdose
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Nosocomial Infection
 Approximately 25% of patients undergoing
mechanical ventilation develop pneumonia
as a complication
Infection Control
Nosocomial Infection
 Approximately 30% of patients who
develop ventilator-acquired pneumonia
(VAP) will die
Infection Control
Nosocomial Infection
 Historically, non-disposable respiratory
equipment was identified as a major cause
of respiratory infection
Infection Control
Nosocomial Infection
 Today, procedures have evolved, and with
the advent of single-patient use equipment,
infections associated with respiratory
equipment have decreased significantly
Infection Control
Nosocomial Infection
 Healthcare workers must remain vigilant to
protect their patients and themselves
against infection; to do so, requires strict
adherence to infection control procedures
Infection Control
Infection control procedures aim to:
 Eliminate the sources of infectious agents
 Create barriers to their transmission
 Monitor and evaluate the effectiveness of
control
Infection Control
Spread of Infection
 Infection occurs when a pathogen
overcomes the barrier of the host
 Pathogen; a microorganism capable of
producing a disease
 Host; an organism in which another, usually
parasitic, is nourished and harbored
Infection Control
Spread of Infection
 Three elements needed to spread an
Infection
 Source of pathogens
 Route of transmission
 Susceptible host
Infection Control
Source of Pathogens
 People
 Patients, personnel, visitors
 Acute disease with symptoms
 Incubation period (exposed, but no
symptoms yet)
 Colonized by pathogens without
symptoms
 Autogenous infection (originating from
within the body)
Infection Control
Source of Pathogens
 Contaminated objects
 Equipment
 Linen
 Medication
Infection Control
Transmission Route
 Contact
 Droplet
 Airborne
 Common vehicle
 Vectorborne
 NOTE: Some organisms may be spread by multiple
routes
Infection Control
 Contact Transmission
 Direct Contact
 Body-surface-to-body-surface contact
(person-to-person)
 Indirect Contact
 Contaminated object (fomite) to host contact
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Clothing (uniforms, lab coats, isolation gowns)
Equipment
Dressings
Instruments
Shared toys
Infection Control
 Droplet Transmission
 Contaminated respiratory droplets
 Discharged into the air (up to 10 feet) during:
 Coughing, sneezing, talking
 Suctioning, bronchoscopy, intubation,
cough induction
 Deposited on the host’s mucosal surfaces
 Nasal mucosa
 Mouth
Infection Control
 Droplet Transmission
 Contaminated respiratory droplets
 Currently Health Care Infection Control
practices Advisory Committee (HICPAC)
guidelines state it may be prudent to don a
mask when within 6 feet of the patient or
upon entry into the room of a patient who is
on droplet isolation
Infection Control
 Droplet Transmission
 Haemophilus Influenzae
 Pneumonia / Epiglotitis
 Influenza virus
 Rubella (German measles)
Infection Control
 Airborne Transmission
 Contaminated droplet nuclei
 Residue of evaporated water droplets
containing infectious microorganisms
 Can remain suspended in air for long
periods
 Respirable particles of less than  5 m
 Dust particles
 Act as fomites
Infection Control
 Airborne Transmission
 Mycobacterium tuberculosis (TB)
Mycobacterium Tuberculosis
 Rubeola (Measles)
 Varicella-zoster (Chicken Pox)
 Note: Special air handling and ventilation, as
well as respiratory protection are required
Infection Control
 Common Vehicle Transmission
 Pathogens in water and food
 Food
 Salmonellosis
 Hepatitis A
 Water
 Shigellosis
 Cholera
 Medications (e.g., heparin solution)
Infection Control
 Vectorborne Transmission
 Animals or insects transfer pathogens
 Malaria
 West Nile Virus
 Rabies
 Note: Vectorborne transmission are of little
significance in hospital-acquired infections
Infection Control
 Spread of Infection to the Lungs
 Pathogens enter the lungs via:
 Aspiration of contaminated  Oropharyngeal secretions
 Gastric secretions
 Inhaled droplets, droplet nuclei, or dust
particles containing pathogens (fomites)
 Hematogenous
 Via the blood
Infection Control
Host
 Host infection dependent upon:
 Virulence of the organism
 Resistance of the host
Infection Control
Host
 Increased susceptibility:
 Diabetes mellitus
 Lymphoma
 Leukemia
 Neoplasia
 Those treated with:
 Corticosteroids, irradiation, certain
antimicrobials, immunosuppressive agents
Infection Control
Host
 Increased susceptibility:
 Age
 Chronic disease
 Shock
 Coma
 Traumatic injury
 Surgical procedure
Infection Control
Host
 Most nosocomial pneumonias occur in surgical
patients, especially those who have had chest
or abdomen procedures
 Clearance mechanisms impaired
 Bacterial enters lower airway
 Intubation
 Anesthesia
 Surgical pain
 Narcotics and sedatives
Infection Control
Host
 Surgical Patients with Highest Risk of Pneumonia
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Elderly
Severely obese
COPD
History of smoking
Those with artificial airways
 Endotracheal / Tracheostomy tubes
Infection Control
 Infection Control Strategies
 Infection control aims to break the chain of
events causing the spread of infection
Infection Control
 Infection Control Strategies
1. Decrease host susceptibility
2. Eliminate the source of pathogens
3. Interrupt the transmission routes
Infection Control
 Decrease host susceptibility
 Hospital efforts focus on employee
immunization and chemoprophylaxis
Infection Control
 Decrease host susceptibility
 Immunizations
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Hepatitis B
Varicella (chicken pox)
Rubella (German measles)
Measles
Pertussis (Whooping cough)
 When working with infants and children
 Influenza
Infection Control
 Decrease host susceptibility
 Chemoprophylaxis
 Postexposure Treatment
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Bordetella pertussis (whooping cough)
Neisseria meningitis (meningococcal meningitis)
Bacillus anthracis (anthrax)
Influenza virus
HIV
Group A streptococci
Infection Control
 Eliminating Source of Pathogens
 Procedure to remove pathogens from the
environment fall into two major categories
 General Sanitation
 Specialized Equipment Processing
Infection Control
 Eliminating Source of Pathogens
 General Sanitation
 Help keep overall environment clean
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Sanitary laundry management
Sanitary food preparation
Sanitary housekeeping
Environmental control of the air
 Specialized ventilation systems
 Environmental control of the water
Infection Control
 Eliminating Source of Pathogens
 Specialized equipment handling
 Decontamination of equipment capable of
spreading infection
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Cleaning
Disinfection
Sterilization
Infection Control
 Specialized Equipment Handling
 Cleaning
 Removes dirt and organic material from
equipment, usually by washing
 Failure to do this will render subsequent processing
ineffective !!!
 Should be done in a designated “Dirty” area
Infection Control
 Specialized Equipment Handling
 Cleaning
 Soaps, detergents, or enzymatic cleaners
should be used
 Some contain germicide
 Automated washers available
(pasteurization / chemical disinfection cycle)
 Must be rinsed and dried
 Reassembled aseptically
 Designated “Clean” area
Infection Control
 Specialized Equipment Handling
 Disinfection
 Destroys the vegetative form of pathogens on
inanimate objects except bacterial spores
 Physical methods
 Chemical methods
Infection Control
 Specialized Equipment Handling
 Physical Disinfection
 Pasteurization
 Submersion in a water bath at temperatures below
boiling (70 C) for 30 minutes
 Kills vegetative bacteria and most viruses
 Does not kill bacteria spores
Infection Control
 Specialized Equipment Handling
 Chemical Disinfection
 Low-Level
 Intermediate
 High-Level
Infection Control
 Specialized Equipment Handling
 Low-Level Disinfectants
 Kills most bacterial, some viruses and fungi
 Will not kill Mycobacterium tuberculosis (TB)
spores and nonlipid virus
Infection Control
 Specialized Equipment Handling
 Low-Level Disinfectants
 Acetic acid
 Mostly used for homecare equipment
(1:3 white vinegar/water solution )
 Quaternary ammoniums
 Hospital use – surface disinfection, e.g., floors,
countertops, walls, etc.
Infection Control
 Specialized Equipment Handling
 Intermediate Disinfectants
 Kills all vegetative bacteria and fungi, but have
variable activity against spores and certain
viruses
Infection Control
 Specialized Equipment Handling
 Intermediate Disinfectants
 Alcohol (70% Ethyl, 90% Isopropyl)
 Not sporicidal
 Surface disinfectant, e.g., stethoscopes, ventilators,
etc.
 Phenolics
 Not sporicidal
 Surface disinfectant
(added to detergents to enhance germicidal activity)
Infection Control
 Specialized Equipment Handling
 Intermediate Disinfectants
 Iodophors (iodine + surace-active organic
compounds)
 Used on skin and tissue
Infection Control
 Specialized Equipment Handling
 High-Level Disinfectants
 Glutaraldehyde
 Hydrogen peroxide
 Peracetic acid
 Chlorine (sodium hypochlorite)
Infection Control
 Specialized Equipment Handling
 High-Level Disinfectants
 Glutaraldehyde (Trade name: CIDEX)
 Kills vegetative bacteria, Mycobacterium
turburculosis, fungi, viruses and spores in <10
minutes
 Commonly used to disinfect/sterilize endoscopes,
e.g., fiber optic bronchoscopes, respiratory care
equipment, and spirometry tubing
Infection Control
 Specialized Equipment Handling
 High-Level Disinfectants
 Hydrogen Peroxide
 6% solution is bactericidal, fungicidal, viricidal in 10
minutes,
 Sterilizes (sporicidal) in 6 hours
 Does not produce harsh fumes
Infection Control
 Specialized Equipment Handling
 High-Level Disinfectants
 Peracetic acid
 Kills all microorganisms, including spores
Infection Control
 Specialized Equipment Handling
 High-Level Disinfectants
 Sodium Hypochlorite
 1:50 dilution kills vegetative bacteria, bacterial
spores, and Mycobacterium tuberculosis in 10
minutes
 1:10 dilution used to clean blood spills
Infection Control
 Specialized Equipment Handling
 Sterilization
 Complete destruction of all forms of microbial
life
Infection Control
 Specialized Equipment Handling
 Sterilization
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Incineration
Dry heat
Boiling
Autoclaving
Ionizing radiation
Ethylene oxide
Infection Control
 Specialized Equipment Handling
 Steam Sterilization (Autoclaving)
 Steam under pressure
 Commonly 15 psi at 121 C for 15 minutes
 Equipment must be cleaned and wrapped in muslin,
linen, or paper
 Most respiratory equipment can be damaged by this
process
Infection Control
 Specialized Equipment Handling
 Ethylene Oxide (EtO)
 Toxic gas
 Equipment must be cleaned and wrapped in
muslin, paper, or polyethylene using EtO
indicator tape
 Acute exposure may cause:
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Airway inflammation
Nausea
Diarrhea
Headache
Dizziness
Convulsion
Infection Control
 Specialized Equipment Handling
 Equipment Handling Procedure
 Equipment handling procedures help
prevent the spread of pathogens
 Will be covered in Lab