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INFECTION PREVENTION and CONTROL. Standard Precautions OR ….How to prevent the spread of disease.

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Presentation on theme: "INFECTION PREVENTION and CONTROL. Standard Precautions OR ….How to prevent the spread of disease."— Presentation transcript:


2 Standard Precautions OR ….How to prevent the spread of disease


4 Types of Infections Heath Care-Associated Infections formerly called nosocomial HAIs Iatrogenic: Exogenous: Endogenous:


6 Cholera Outbreak in Haiti Cholera Nepalese peacekeeping force Poop Latrines near water River Drinking contaminated water

7 Historical Perspective 1847 Dr. Ignaz Philip Semmelweiss Significance of hand washing is demonstrated Concept of nosocomial infection is born

8 More History

9 Infectious Disease Process Infection: Normal flora: Colonization:

10 Chain of Infection

11 Causative Agents Bacteria Virus Fungi Protozoa

12 Characteristics of Causative Agents

13 Reservoirs

14 NCLEX ? Which of the following is an example of a nursing intervention that is implemented to reduce a reservoir of infection for a client? A) Covering the mouth and nose when sneezing B) Wearing disposable gloves C) Isolating clients articles D) Changing soiled dressings

15 Portal of Exit : The path by which the infectious agent leaves the reservoir Respiratory Tract : GU Tract GI Trac t: Skin/Mucous Membranes: Transplacental Blood :

16 Mode of Transmission The mechanism for transfer of an infectious agent from the reservoir to the susceptible host

17 VIGNETTE An older adult, hospitalized with a GI disorder is on bedrest and requires assistance for uncontrolled diarrhea stools. Following one episode of cleaning the patient and changing the bed linens, the nurse went to a second patient to provide tracheostomy care. The nurses hands were not washed before assisting the second patient

18 VIGNETTE ANALYSIS Infectious agent Escherichia Coli Reservoir Large Intestines Portal of Exit Feces Mode of Transmission Nurses Hands Portal of Entry Tracheostomy Susceptible Host Older Adult with Trach

19 Modes of Transmission Contact Airborne Vector-Borne

20 Contact Direct: Indirect:

21 Modes of Transmission Direct Person to Person (Fecal-Oral ) Hepatitis A Staph Indirect Contact with contaminated object Hepatitis B and C HIV RSV MRSA

22 Airborne Droplets suspended in air after coughing and sneezing or carried on dust particles TB Chicken Pox Measles (Rubeola) Aspergillus

23 Droplet transmission Large particles Can travel up to 3 feet Influenza Rubella (3- day/German Measles) Bacterial Meningitis

24 Vector-Borne Vector External mechanical transfer Mosquito, Louse, Flea, Tick, Fly West Nile Virus Malaria Lyme Disease Hanta Virus

25 Portal of Entry: path by which an infectious agent enters the susceptible host Respiratory tract GU tract GI tract Transplacental (fetus from mother) Parenteral: percutaneous, via blood Skin/Mucous Membranes

26 Susceptible Host A person or animal lacking effective resistance to a particular pathogenic agent

27 Man-Made Epidemics (NYT July 15, 2012)

28 Diseases have always come out of the woods and wildlife

29 West Nile Virus

30 American Robin Thrives in our backyards and agriculture fields Mosquitoes that spread the disease find robins particularly appealing

31 H1N1

32 Lyme Disease.

33 Ebola


35 Bird Flu

36 Isolation Precautions Historical perspective 1877 to present 1877 Aseptic technique 1910

37 Barrier Nursing Hospital personnel wear gowns between patients Handwashing between patients with antiseptic solutions after patient contact Disinfection of objects contaminated by patients

38 More Hx 1950s: Infectious Disease hospitals begin to shut down except for TB sanitariums 1960s: TB hospitals begin to shut down 1970: CDC publishes first manual on Isolation Techniques for Use in Hospitals. Diseases were lumped into categories 1980s: Hospitals began to experience new endemic and epidemic nosocomial infection problems caused by multi-drug-resistant organisms

39 HX 1980: CDC publishes new Isolation guidelines 1985: Universal precautions come into being (HIV, HBV, blood borne pathogens) 1990s HICPAC: 2 tier system Standard Precautions Transmission-Based Precautions (Contact, Droplet, Airborne)

40 HAIs Surgical Sites Blood Stream Urinary System Cardiovascular Eye/Ear/Throat/Mout h Infection Reproductive System Respiratory Bone and Joint Infection CNS Gastrointestinal Skin and Soft Tissue

41 Immunocompromised Pts Vary in their susceptibility to HAIs Depends on the severity and duration of immunosupression. Use the two-tiered system Neutropenic precautions

42 Critical Thinking Question Clients in the healthcare setting are at risk for acquiring or developing infections because:

43 Prevention Most HAIs are transmitted by the HCWs and clients as the result of direct contact We as nurses must pay attention to handwashing after contact with clients and equipment

44 Prevention Microorganisms move through space on air currents Microorganisms are transferred from one surface to another whenever objects touch, a clean item touching a less clean item becomes dirty Microorganisms are transferred by gravity when one item is held above another

45 Prevention Microorganisms are released into the air on droplet nuclei whenever a person breaths or speaks- Microroganisms move slowly on dry surfaces, but very quickly through moisture – Proper handwashing removes many of the microorganaisms that would be transferred by the hands from one item to another- always wash hands between patients.

46 Prevention To reduce susceptibility provide adequate nutrition and rest, promote body defenses against infection and provide immunization

47 Superbugs MRSA VRE: Vancomycin resistant enterococcus

48 Break The Chain! Implement ASEPSIS : absence of disease-producing microorganisms; refers to practices/procedures that assist in reducing the risk of infection 2 Types Medical (clean technique) Surgical (sterile technique)

49 MEDICAL ASEPSIS Clean technique: Aseptic technique 3 components to the technique: Hand washing, Barriers of PPE (gloves, gowns, mask, protective eyewear) Routine environmental cleaning Contaminated area:

50 Disinfection/Sterilization Disinfection = the process that eliminates many or all microorganisms, with the exception of bacterial spores, from inanimate objects Sterilization = complete elimination or destruction of all microorganism, including spores

51 Aseptic technique Handwashing is the single most important procedure for preventing the transfer of microorganisms and therefore preventing the spread of HAIs CD recommends 10-15 second hand wash.

52 Personal Hygiene Restrain Hair: hair falling forward may drop organisms Keep nails short: no acrylic nails or chipped nail polish Minimum jewelry (see agency policy) Cover open wounds with an occlusive dressing.

53 When should hands be washed

54 CDC GUIDELINES Standard Precautions apply to: Blood All body fluids and secretions (feces, urine, mucus, wound drainage) except sweat Non-intact skin Mucous membranes Respiratory secretions

55 STANDARD PRECAUTIONS TIER 1 Hand Hygiene: see next slide Gloves: for touching blood, body fluids, secretions, excretions, non-intact skin, mucous membranes or contaminated areas Masks, Eye Protection or Face Shields: if in contact w/ sprays or splashes of body fluids Gowns: to protect your clothing Contaminated Linen: place in leak-proof bag so no contact with skin or mucous membranes Respiratory Hygiene/Cough Etiquette: provide client with tissues and containers for disposal; stand ~3 feet away from coughing; use masks prn

56 Hand Hygiene


58 ISOLATION PRECAUTIONS TIER 2 Contact = private room or cohort clients, gloves and gowns MDRO, C-Diff, RSV Droplet = private room or cohort clients, mask is required Strept, pertusis, mumps, flu Airborne = private room, negative airflow, hepa filtration; N95 respirator mask required TB, chickenpox, measles Protective Environment = private room, positive- pressure room; hepa filtration; gloves, gowns, mask (controversial); NO flowers or potted plants Stem cell transplant


60 N95 Respirator

61 STANDARD PRECAUTIONS Handwashing Gloves (PPE) Masks (PPE) Eye Protection (PPE) Gowns (PPE) Leak-proof linen bags Puncture proof containers for sharps

62 Donning and Removing PPE Donning Gown Mask or respirator Goggles/face shield Gloves Keep hands away from face Work from clean to dirty Lime surfaces touched Change when torn or heavily soiled Removing Gloves Goggles/face shield Gown Mask or respirator Remove at doorway before leaving pt. room Perform hand hygiene immediately after removing all PPE

63 Surgical Asepsis Sterile technique that prevents contamination of an open wound, serves to isolate the operative area from the unsterile environment, and maintains sterile field for surgery

64 Principles of Surgical Asepsis

65 For which procedure would the nurse use aseptic technique and which would require the nurse to use sterile technique? A) Aseptic technique for urinary catheterization in the hospital and sterile technique for cleaning surgical wound B) Aseptic technique for changing the patients linen and sterile technique for assisting in surgery C) Aseptic technique for food preparation and sterile technique for starting an IV line D) Aseptic technique for a spinal tap and sterile technique for placing a central line

66 LAB Practice: Isolation Precautions Demonstrate donning Isolation Gown, Mask, Gloves, Eyewear Demonstrate removing Isolation Gown, Mask, Gloves, Eyewear Demonstrate proper disposal of PPE before leaving Isolation Room When performing care/treatments use hospital provided stethoscope and leave in the room

67 Lab Practice Contd. Practice pretending you are entering patient room (use curtains) and give Complete Bed Bath and do Bed Linen Change wearing PPE (gown, mask, gloves) Remember to dispose of PPE INSIDE the patients room before you leave Practice bringing in all the supplies you need so you can stay in the room & not have to leave (de-gown etc) and come back in (re-gown etc)

68 LAB Practice: Sterile Procedures Opening sterile packages – Flap fartherest away from nurse first, then sides, then flap closest to nurse Preparing a sterile field Pouring sterile solutions – label to palm, lip it Donning sterile gown and gloves

69 Critical Thinking Exercise Mrs. Jaycock had an indwelling urethral catheter for 1 week. The catheter has now been out for 24 hours. She complains of frequency and pain on urination. Mrs. Jaycock suggests reinsertion of the catheter because of the need to get up frequently. What can frequency or pain on urination be an indication of?

70 Answer UTI Should the catheter be reinserted? Why or why not?

71 Answer No reinserting the catheter may aggravate the infection and promote the spread of the infection to the bloodstream. Describe at least one appropriate assessment measure and one independent nursing action or intervention for Mrs. Jaycock

72 Nursing Response Increase her fluid intake if not clnically contraindicated Check her urinalysis

73 Situation You are caring for Mr. Huang, who has a large open, and draining abdominal wound. You notice another health care worker changing Mr. Huangs dressing without wearing gloves or using sterile technique. When you question the health care worker regarding his or her practice, this person says, Dont worry, the wound is already infected, and the antibiotics and drainng will take care of any contaminants. How would you respond to this comment?

74 Response It is important to not only protect Mr. Huang from additional infection, but also to protect ourselves from becoming contaminated. What would your next steps be in following up on this incident?

75 Situation Mrs. Niles is 83 years of age and lives alone. She has difficulty walking and relies on a church volunteer group to deliver lunches during the week. Her fixed income limits her ability to buy food. Last week, Mrs. Niles 79-year-old sister died. The two sisters had been very close. As a home care nurse, explain the factors that might increase Mrs. Niles risk for infection.

76 Response Age Potential for poor nutrition Potential for depression

77 Situation Mr. Vargas is admitted to the facility with a history of recent weight loss, a cough that has persisted for 2 months, and hemoptysis. His chest x-ray film shows a cavity lesion in one lung, and his physician suspects tuberculosis. What type of isolation precautions would you use for Mr. Vargas? What protection would you use to provide care? What education would you provide to the family?

78 Response Airborne precautions Wear an N95 mask Keep the door closed Educate the pt and family on transmission of TB and reason for isolation.

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