1. CHAPTER 6: INFECTION CONTROL Roosevelt Health Science Clinical Rotations Successful Nursing Assistant Care, 2 nd Ed.

2. Chapter 6 Objectives Define important words Define “infection control” and discuss types of infections Discuss terms related to infection control Describe the chain of infection Explain why the elderly are at high risk for infection Describe the CDC and explain Standard Precautions Define “hand hygiene” and identify when to wash hands. Discuss the use of Personal Protective Equipment (PPE) List guidelines for handling linen and equipment Explain how to handle spills Discuss Transmission-Based Precautions Describe care of the resident in an isolation unit Explain OSHA’s Bloodborne Pathogen Standard Discuss two important bloodborne diseases Discuss MRSA, VRE, and C. Difficile

3. Infection Control Communities strive to maintain clean conditions in order to help prevent the spread of disease. This is known as sanitation. Infection Control- the set of methods used to control and prevent the spread of disease. It is the responsibility of all members of the care team Know the facility policies on infection control and follow them to protect you, patients, visitors, and other staff members. By using proper infection control methods, you can prevent all people in your care, as well as other staff members and visitors, from acquiring an infection from someone else. This is called cross-infection or cross-contamination Also prevents residents from being infected a second time, called reinfection

4. Infections Microorganism (MO) is a tiny living thing visible only by a microscope. Also known as a microbe They are always present in the environment, though many are not harmful. Bacteria, viruses, fungi, protozoa are types of MOs Pathogens are harmful microorganisms that can cause infections or infectious disease. For infections to develop, pathogens must invade and grow within the human body. Grow best in warm, dark, and moist places where food is present, and in hosts who have low resistance. Some MOs need to survive, while others do not.

5. Types of Infections A localized infection is limited to a specific part of the body. It has local symptoms, near the site of infection. For example, eye infections could be red, swollen, painful, and warm to the touch. S/Sx include redness, swelling, pain, heat, drainage (fluid from a wound or cavity). A systemic infection occurs when pathogens enter the bloodstream and move throughout the body, causing generalized symptoms. Acquired Immune Deficiency Syndrome (AIDS) is an example S/Sx include fever, chills, headache, change in other vital signs, nausea, vomiting, diarrhea, mental confusion.

6. Types of Infections As special type of infection that can be localized or systemic is a healthcare-associated infection (HAI), an infection associated with various healthcare setting, including long-term care facilities, hospitals, ambulatory settings and home care. A second type of infection that can be localized or systemic is a nosocomial infection, which comes from a hospital. Example: a resident gets a UTI from a urinary catheter after entering a facility. Catheter- a tube inserted through the skin or into a body opening that is used to add or drain fluid. HAIs and nosocomial infections can be mild or life-threatening Report to nurse immediately

7. Infectious Disease A communicable disease occurs when a pathogen is spread from one person to another. Ex: Hepatitis, Influenza, Polio, TB, Malaria, etc. A contagious disease is a communicable disease is spread easily from person to person. Ex: STDs, MRSA, Varicella (Chicken Pox), etc. A non-communicable disease is a disease not capable of being spread from one person to another. Ex: Emphysema, Diabetes, Stroke, COPD, etc.

8. Terms related to Infection Control Transmission Clean Technique or Medical Asepsis Clean Contaminated Dirty Disinfection Autoclave Surgical Asepsis or Sterile Technique

9. Describe the Chain of Infection

10. Chain Link 1: Causative Agent The causative agent is a pathogen that causes disease. Normal Flora are the microorganisms that normally live in and on the body without causing harm to a healthy person. If they enter a different part of the body, they may cause infection There is a waiting period between the time the pathogen enters the body and the time it causes an infection, called an incubation period. Ex: Varicella (10-21 days), Influenza (1-3 days), and Measles (10-21 days) Vaccines can give immunity to a disease w/o causing the sx of the disease. Immunity may not last forever Created from weakened or killed microbes of the disease

11. Chain Link 2: Reservoir The reservoir is where the pathogen lives and grows; can be human, animal, plant, soil, or substance. Two main ways of spreading an infection from a reservoir: direct and indirect. Direct Spread occurs when a person gets a disease directly from another person (reservoir). The human reservoir may be a person with an active disease or a person carrying the disease w/o s/sx (carrier). Indirect Spread occurs when a person gets a disease from an object, insect, or animal (reservoir). Objects contaminated with a pathogen are also called fomites, such as water, food, food utensils, bedpans, or bed linens.

12. Chain Link 3: Portal of Exit There can be different exit routes, or portals of exit, from a reservoir. The portal of exit is any opening on an infected person allowing pathogens to leave. These include the nose, mouth, eyes, or a cut in the skin.

13. Chain Link 4: Mode of Transmission Mode of Transmission describes how the infectious disease travels. This can include contact, droplet, and airborne transmission. Contact with blood or body fluids (tears, saliva, sputum, urine, feces, semen, vaginal secretions, pus or other wound drainage) Droplets come from coughing, sneezing, talking, laughing, suctioning, singing, and spitting Less than 3 ft Airborne travels in the air (more than 3 ft) through moisture and dust.

14. Chain Link 5: Portal of Entry Pathogens enter the human host through different portals of entry. The portal of entry is any body opening on an uninfected person that allows pathogens to enter. Includes nose, mouth, eyes, and other mucous membranes, cuts in the skin, and cracked skin. Mucous membranes are membranes that line body cavities that open to the outside of the body such as the mouth, nose, eyes, rectum, and genitals. Many areas of the body are protected from invading pathogens, sort of like an “armor.”

16. Chain Link 6: Susceptible Host A susceptible host is an uninfected person who could get sick. A person becomes susceptible when his/her resistance decreases due to age, existing illness, fatigue, and/or stress. When a pathogen invades the body, it will start reproducing itself. As pathogens grow, they damage healthy tissue.

17. Reasons for Increased Risk of Infection for Elderly Immune systems become weaker Hospitalized more frequently (nosocomial) Longer recovery Thinner skin Limited mobility Bones become more brittle Decreased circulation Slow wound healing Frequent use of catheters Dehydration Malnutrition

18. Center for Disease Control CDC is a federal government agency that issues guidelines to protect and improve health. It promotes public health and safety through education and tries to control and prevent disease. In 1996, the CDC created new guidelines to protect people in health care from contracting infectious diseases. It was updated 2007 There are two levels of precautions in the infection control system recommended by the CDC. Standard Precautions and Isolation Precautions

19. Standard Precautions Standard Precautions means treating blood, body fluids, non- intact skin, and mucous membranes as if they were infected. They are always followed because you cannot tell by looking at a patient or his/her chart if they have a contagious disease. Assume everyone has something!!!!!!!! For guidelines, please view the chapter provided.

20. Hand Hygiene Hand hygiene is defined by the CDC as any method that removes or destroys microorganisms on hands, including handwashing and hand sanitizer. Alcohol-based hand rubs ARE NOT a substitute for frequent and proper handwashing! As you move between patients’ rooms, always wash your hands. Taking care of patients means you will get microorganisms on your hands. Wash your hands before giving care. It will help prevent the spread of disease.

21. Personal Protective Equipment (PPE) PPE is a barrier between a person and disease. It is what you wear to prevent the transmission of disease. PPE includes gloves, gowns, masks, goggles, and face shields. See chapter provided for proper steps to putting on and removing PPEs.

22. Handling Linen and Equipment Facilities handle storage and disposal of linen and equipment by following guidelines set by the CDC. Facilities have separate areas for clean and dirty items called clean and dirty utility rooms. Linen and equipment will be placed in separate containers to be cleaned or discarded. There will be disposal containers for linen, trash, equipment, and special infectious waste disposal. Guidelines can be found in the chapter provided.

23. Handling Spills Spills happen when blood, body fluids, or other fluids get on any person, object, or area in a facility. Spills pose a serious risk of infection and fall risk for patients. Clean spills using proper equipment and procedures. Wear gloves and wipe up immediately for the outside moving in. Use a cleaning solution of 1 part bleach to 10 parts water. There may be ready-to- use spray bottles at the facility. Be careful if any glass or other sharp objects are in a spill. Get help when picking up and disposing of sharps. NEVER PICK UP GLASS EVEN WITH GLOVED HANDS For large spills, call the nurse and follow your facility policy for large spills. If you spill on your body, wash it off immediately. Report the exposure. Wash your hands after cleaning spills

24. Transmission-Based Precautions Precautions beyond Standard Precautions. These guidelines were for persons who are infected or may be infected with diseases. Also known as Isolation Precautions, consisting of three categories. Airborne Droplet Contact Refer to chapter provided

25. Isolation Unit Patients who require Transmission-Based Precautions are referred to as being in “isolation.” A sign should be on the door indicating “isolation” or alerting people to see the nurse before entering the room. Patients in isolation cannot move about freely, and are separated from everyone else. May cause resident loneliness, be empathetic They may be allowed visitors, but all visitors must be trained in PPEs Follow the guidelines in the chapter provided.

26. OSHA’s Bloodborne Pathogen Standard Bloodborne pathogens are MOs found in human blood that can cause infection and disease. They may also be found in body fluids, draining wounds, and mucous membranes Occupational Safety and Health Administration (OSHA) is a federal government agency that is responsible for the safety of workers in the U.S. By law, employers must follow these rules to reduce the risk of acquiring infectious disease. The Standard also guides employer and employees through the steps to follow if exposed to infectious material. Refer to the chapter provided for specific guidelines

27. HIV/AIDS Bloodborne pathogen, HIV, can lead to AIDs. Over time, HIV damages the immune system so that the body cannot fight infections HIV is transmitted by blood, infected needles, and from mother to fetus. Also transmitted sexually!

28. Hepatitis Hepatitis is an inflammation of the liver caused by infection. Liver function can be permanently damaged by hepatitis. There are several types of hepatitis, including A, B, C, D, and E Most common are A, B, C Hepatitis B and C are Bloodborne Pathogens, and can cause death. More people have Hepatitis B (HBV) than HIV. For more facts about Hepatitis see chapter provided.

29. Multidrug-Resistant Organisms (MDROs) MDROs are microorganisms, mostly bacteria, that are resistant to one or more antimicrobial agents. Two common types of MDROs are MRSA and VRE Methicillin-resistant Staphylococcus aureus (MRSA) is a strain of staph bacteria that can cause disease and is resistant to powerful antibiotics in the methicillin family. Spreads by direct contact and indirect contact Sx of MRSA include drainage, fever, chills, and redness Vancomycin-resistant enterococcus (VRE) is a bacterium that is resistant to the antibiotic Vancomycin. Very dangerous because it cannot be treated with antibiotics at all, causes life-threatening infections. Spreads by direct contact and indirect contact Sx of VRE include fever, fatigue, chills, and drainage. For more information on MDROs and how to handle them, see chapter provided