1. Infection Control
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2. Overview You will learn about: The chain of infection
Standard precautions and transmission-based precautions
Proper hand cleansing techniques
Sterile technique
Unit Description
In this unit, you will learn about infection control. You will learn how diseases are spread from person to person through the chain of infection, and you will show how asepsis breaks the chain. You will practice standard precautions by using personal protective equipment. You will also demonstrate transmission-based precautions by wearing appropriate protective garments and by working in an isolation unit. Finally, you will apply sterile technique by using correct procedures for sterile gloves.
In this unit, you will learn that:
Pathogens are microorganisms that cause infection and disease.
Asepsis is a condition that is free of pathogens or any type of contamination.
Hand cleansing is the most effective way to prevent the transmission of pathogens.
Standard precautions are used to protect health care workers and patients from contracting infectious diseases.
Transmission-based precautions are only used for patients who have been diagnosed with highly communicable diseases.
Sterile technique must be practiced for all invasive procedures to protect patients from infection.

3. Questions What risks do you take by not wearing gloves?
What situations do you need to remember to wear Personal Protective Equipment PPE?
How does forgetting to put gloves on affect your patient’s confidence in you as their medical professional?
After completing the unit, students should answer the following questions from the unit assignment sheet. Students will be prompted to print the assignment sheet in Curriculum Viewer. A master copy is available in the unit teacher manual.
What risks did Sammy almost take by not wearing gloves?
In what other situations does Sammy need to remember to wear PPE?
How might Sammy’s forgetting to put gloves on affect Aiden’s confidence in her as an EMT?

4. What do you know about… Infection control?
Why is it important in health care facilities?
Key Question 1
Students will explain what they know about infection control. A typical answer might be, “Infection control includes procedures to protect health care workers from infection and disease. Infection control also includes practices to protect patients from being infected by other patients. Some important aspects of infection control are wearing protective garments, frequent handwashing, and techniques for cleaning and disposing.”
Key Question 2
Students will explain what they know about the importance of infection control. A typical answer might be, “Infection control is important in health care facilities because hospitals are filled with pathogens. If proper infection control practices were not used, health care workers and patients would be at risk of catching many diseases and infections. Infection control prohibits the spread of pathogens from one person to another.”

5. Microorganisms
Microorganisms are small living bodies that are not visible to the naked eye.
Nonpathogens - maintain body processes
Pathogens – cause infection and disease
Aerobic- need O2 to live
Anaerobic-live and reproduce in the absence of O2
Classes of microorganisms:
Bacteria
Protozoa
Fungi
Viruses
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Microorganisms
Microorganisms, or microbes, are small living bodies that are not visible to the naked eye. Some microorganisms are used to maintain body processes. These helpful microorganisms are called nonpathogens. However, many microorganisms are harmful to the body. Microorganisms that cause infection and disease are called pathogens.
Pathogens can cause infection and disease in several ways. One way is by producing toxins, or poisons, which harm the body and cause disease. Another way pathogens can cause infection is by creating an allergic reaction in the body, which results in sneezing, watery eyes, and a runny nose. Finally, pathogens can invade living cells, attack them, and even destroy them.
There are many different classes of microorganisms. The four main classes include bacteria, protozoa, fungi, and viruses.

6. Classes of Microorganisms
Bacteria
Protozoa
Fungi
Viruses

7. Bacteria
Bacteria are one-celled microorganisms that are classified by shape.
Spores are thick-walled cells created by bacteria to aid in reproduction and to make the bacteria resistant to harsh environments. Spores can result in serious illness.
Diseases - food poisoning, strep throat, tetanus, syphilis, and cholera
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Bacteria
Bacteria are one-celled microorganisms that are classified by shape. Cocci are round, bacillia are rod-shaped, and spirilla are spiral or corkscrew in shape. Though bacteria are single-celled organisms, they often join into pairs, chains, or clusters.
Some bacteria are helpful. For example, the bacteria that exist in the small intestines help to digest food. Also, several food products, such as yogurt and cheese, are made by using bacteria.
Some bacteria, however, produce toxins that make people sick. Bacteria can also produce spores. Spores are thick-walled cells created by bacteria to aid in reproduction and to make the bacteria resistant to harsh environments. Spores are difficult to eliminate and can result in serious sicknesses. Diseases caused by bacteria include food poisoning, strep throat, tetanus, syphilis, and cholera.

8. Protozoa Protozoa are the simplest organisms in the animal kingdom.
Most protozoa need moisture to survive, so they are often found in watery environments.
Diseases - malaria, dysentery, and African sleeping sickness
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Protozoa
Protozoa are the simplest organisms in the animal kingdom. They are single-celled microorganisms, but they often exist in colonies. Most protozoa need moisture to survive, so they are often found in watery environments.
There are several types of nonpathogenic protozoa, such as the protozoa that exist in the large intestines. However, most protozoa are harmful. Diseases that are caused by protozoa include malaria, dysentery, and African sleeping sickness.

9. Fungi
Fungi are plant-like microorganisms that can be found in the air, in soil, on plants, or in water.
There are thousands of types of fungi, including mushrooms, yeasts, and molds. Only about half of these types of fungi are pathogenic.
Diseases - athlete’s foot, ringworm, yeast infections, and thrush
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Fungi
Fungi are plant-like microorganisms that can be found in the air, in soil, on plants, or in water. There are thousands of types of fungi, including mushrooms, yeasts, and molds. Only about half of these types of fungi are pathogenic.
Many types of fungi have helped to make our lives easier. For example, penicillin is an antibiotic that is used to kill bacteria in our bodies. Penicillin is made from fungi. Additionally, many types of fungi, such as yeast, are used in making food.
Diseases that are caused by fungi are called mycoses. These diseases include athlete’s foot, ringworm, yeast infections, and thrush.

10. Viruses
Viruses are the smallest type of microorganism. They are made up of only a few molecules.
Viruses invade the cells of a living organism where they reproduce more viruses.
Diseases - common cold, chicken pox, measles, herpes, hepatitis B and C, HIV, and AIDS
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Viruses
Viruses are the smallest type of microorganism. They are smaller than a single cell and are made up of only a few molecules. Viruses invade the cells of a living organism where they reproduce more viruses. A virus cannot reproduce outside a living cell.
Some viruses are helpful and have even been used in treatments for bacterial infections. But, like other microorganisms, many viruses are pathogenic. Diseases caused by viruses include the common cold, chicken pox, measles, herpes, hepatitis B and C, HIV, and AIDS.

11. Types/ Classification of Infections and Diseases
Endogenous – begins inside the body
Exogenous – caused by something outside the body
Nosocomial – acquired by an individual within a health care facility
Opportunistic – occur when the body’s defenses are weak
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Classification of Infections and Diseases
Diseases and infections are often classified according to how and where the infection occurs. An endogenous infection or disease is one that begins inside the body, such as a tumor. An exogenous infection or disease is caused by something outside the body, such as radiation or chemical solutions.
Nosocomial infection or disease is acquired by an individual within a health care facility. Another term for “nosocomial” is “hospital-acquired.” These diseases are usually transmitted from patient to patient by the health care workers. Health care workers must practice proper infection control techniques to reduce the number of nosocomial diseases.
Finally, opportunistic infections occur when the body’s defenses are weak. For example, patients with AIDS have weakened immune systems. Therefore, AIDS patients are more likely to acquire infections than patients with strong immune systems.

12. Infectious and Communicable Diseases
An infectious disease results from an invasion of microorganisms.
A communicable disease is a type of infectious disease that can be transmitted from one person to another person.
Not all infectious diseases are communicable.
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Infectious and Communicable Diseases
Diseases are also classified according to whether or not they can be transmitted from one person to another person. An infectious disease results from an invasion of microorganisms. A communicable disease is a type of infectious disease that can be transmitted from one person to another person.
Not all infectious diseases are communicable. For example, lyme disease is caused by bacteria, but it cannot be transmitted from person to person. Hepatitis B, on the other hand, is caused by a virus. The hepatitis B virus can be passed from person to person if exposure to blood or bodily fluids occurs.
One of the goals of infection control is to prevent the transmission of these communicable diseases.

13. Lesson 2 – Chain of Infection
Causative agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
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Chain of Infection
For a communicable disease to be passed from one person to another, certain conditions must be met. These conditions are known as the chain of infection. The following list describes the steps in the chain of infection:
The chain of infection begins with a pathogen, which is called the causative agent.
The causative agent must find a reservoir, or a place for the causative agent to live and grow. A reservoir could be a human, an animal, or any surface or object.
Next, the pathogen must have a portal of exit to leave the reservoir. In humans, pathogens can leave the body through blood, bodily fluids, or excrement.
After the pathogen leaves the reservoir, it must be moved to another reservoir where it can continue to live and grow. This process is called the mode of transmission.
The pathogen must have access to a portal of entry, which is the place the pathogen will enter the new reservoir.
If the new reservoir has weak defenses, it will contract the disease or infection. The new reservoir is called the susceptible host.
If any part of the chain is broken, the spread of the disease or infection will stop. Health care workers must practice principles of infection control in order to break the chain of infection.

14. Mode of Transmission Airborne Transmission Bloodborne Transmission
Vectorborne Transmission
Sexual Transmission
Foodborne Transmission
Casual Contact
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Mode of Transmission
In the chain of infection, transmission can occur in several ways. The following list contains the primary modes of transmission:
Airborne Transmission: Transmission through droplets in a sneeze or cough
Bloodborne Transmission: Transmission through blood or body fluid
Vectorborne Transmission: Transmission through an outside source, such as mosquitoes and ticks
Sexual Transmission: Transmission through sexual contact with an infected person
Foodborne Transmission: Transmission through infected or contaminated foods
Casual Contact: Transmission by close body-to-body contact, such as sharing a hairbrush or comb

15. Aseptic Technique Asepsis is a condition that is free of pathogens.
Maintaining asepsis in a health care facility is the primary way to prevent the spread of disease from person to person.
It works by breaking the chain of infection.
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Asepsis
Asepsis is a condition that is free of pathogens. Maintaining asepsis in a health care facility is the primary way to prevent the spread of disease from person to person. It works by breaking the chain of infection.

16. Lesson 3 – Medical and Surgical Asepsis
Medical asepsis is maintaining a clean environment in order to reduce the number of pathogens. It is also called clean technique.
Surgical asepsis is maintaining a sterile field that is free from all microorganisms and spores. It is also known as sterile technique.
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Medical and Surgical Asepsis
The two basic types of asepsis are medical asepsis and surgical asepsis. Medical asepsis is maintaining a clean environment in order to reduce the number of pathogens. It is also called clean technique. Common medical aseptic practices include handwashing, routine cleaning, and using personal protective equipment, such as gloves and masks.
Surgical asepsis is maintaining a sterile field. A sterile field is an environment that is free from all microorganisms and spores. Surgical asepsis is also known as sterile technique. It is required for most invasive procedures and operations. In order for an environment to stay sterile, only sterile items can come into contact with other sterile items. Surgical asepsis takes skill and foresight.

17. Sterilizing Sterilization is the highest level of asepsis.
Sterilization is a type of surgical asepsis that kills all microorganisms, including viruses and spores.
The most common piece of equipment used for sterilization is called an autoclave.
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Sterilizing
The three levels of asepsis are sterilizing, disinfecting, and cleaning.
Sterilization is the highest level of asepsis. It is a type of surgical asepsis that kills all microorganisms, including viruses and spores. Sterilization is used on objects and equipment, not on people. Sterilization can be accomplished through a pressurized steam bath, extreme temperature, and radiation.
The most common piece of equipment used for sterilization is called an autoclave, which uses pressurized steam and high temperatures to kill microorganisms. Some chemical solutions can also be used for sterilization. However, items must soak in the solutions for over 10 hours to become sterile. Because autoclaving takes only 30 minutes, it is the preferred sterilizing technique in most health care facilities.

18. Disinfecting
Disinfection is a type of medical asepsis that destroys most pathogens, but is not always effective on viruses and spores.
Common disinfectant solutions include chlorine and bleach. An object must soak in a disinfectant solution for at least 20 minutes to be properly disinfected.
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Disinfecting
Disinfection is the middle level of asepsis. Disinfection is a type of medical asepsis that destroys most pathogens, but is not always effective on viruses and spores. Because disinfectants are usually chemical solutions, the disinfection process is generally used on objects and equipment, rather than on people.
Common disinfectant solutions include chlorine and bleach. An object must soak in a disinfectant solution for at least 20 minutes to be properly disinfected.

19. Cleaning
Cleaning is the lowest level of asepsis, and is also called sanitization.
The cleaning process does not require harsh chemicals to destroy pathogens, so cleaning can be used on people.
Antiseptic solutions such as iodine, betadine, and alcohol are often used in the cleaning process.
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Cleaning
Cleaning is the lowest level of asepsis. It is also called sanitization. The cleaning process does not require harsh chemicals to destroy pathogens, so cleaning can be used on people. Examples include using soap to wash hands or using alcohol to prepare a patient’s skin for a procedure. Antiseptic solutions such as iodine, betadine, and alcohol are often used in the cleaning process.
Cleaning can also be used on objects and equipment. However, the process does not destroy viruses or spores.

20. Hand Washing
Hand washing is the most basic and important type of medical asepsis.
Hand washing is the number one way to prevent the spread of infection.
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Hand Washing
Hand washing is the most basic and important type of medical asepsis. Hand washing is the number one way to prevent the spread of infection. Hands can act as a mode of transmission in the chain of infection by carrying pathogens from one patient to another patient. Additionally, when pathogens are on a health care worker’s hands, the health care worker is in danger of contracting the disease or infection. Because of this danger, health care workers must use appropriate hand washing hygiene.

21. Handwashing
When arriving at the health care facility and immediately before leaving the facility
Before and after every patient contact
Before and after a procedure
Before and after handling a specimen
Before and after touching the mouth
Before and after wearing gloves.
After contacting soiled or contaminated items
After picking up any item from the floor
After using the bathroom
After coughing, sneezing, or using a tissue
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When to Wash Hands
Health care workers should wash their hands frequently. Hands should be washed:
When arriving at the health care facility and immediately before leaving the facility.
Before and after every patient contact.
Before and after performing a procedure.
Before and after handling a specimen.
Before and after touching the mouth by way of eating, drinking, smoking, or applying lip balm.
Before donning gloves and immediately after removing gloves.
After contacting soiled or contaminated items.
After picking up any item from the floor.
After using the bathroom.
After coughing, sneezing, or using a tissue.

22. Handwashing Use liquid soap Use warm water Rub hands together firmly
Clean all surfaces of the hands
Keep fingers pointed downward
Wash for at least 15 to 20 seconds
Use only dry paper towels to dry hands
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Guidelines for Hand Washing
Before you learn the procedure for hand washing, you must become familiar with several hand washing guidelines. Keep the following guidelines in mind each time you wash your hands:
Use liquid soap whenever possible. Bar soap often contains microorganisms.
Use warm water. Hot water damages the skin.
Rub hands together firmly. Friction is needed to rub pathogens off the skin.
Be sure to clean all surfaces of the hands, including the palms, the back of hands, fingers, the area between fingers, and underneath fingernails.
Keep fingers pointed downward during hand washing. If the fingers are pointed upward, you may contaminate your hands, wrists, or arms with dirty water.
Wash your hands for at least 15 to 20 seconds. You may find it helpful to sing “Happy Birthday” or “The A, B, C Song” in your head to be sure that you wash for the appropriate length of time.
Use only dry paper towels. Wet paper towels may be contaminated.

23. Standard Precautions
The Center for Disease Control and Prevention developed a list of standard precautions that should be used for all patients, regardless of their type of illness.
Two reasons for standard precautions:
To protect health care workers
To protect patients
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Standard Precautions
The Center for Disease Control and Prevention (CDC) developed a list of standard precautions that should be used for all patients, regardless of their type of sickness. The CDC created the standard precautions for two reasons. The first reason is to protect health care workers from contact with infectious materials. The second reason is to protect patients from contracting infectious diseases. Standard precautions include guidelines for patient contact and environmental cleanliness.

24. Standard Precautions for Patient Contact
Use appropriate personal protective equipment
Wash hands frequently
Bandage cuts properly
Use face shields during CPR
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Standard Precautions for Patient Contact
According to the CDC, every bodily fluid must be considered infectious. Therefore, health care workers must use appropriate personal protective equipment, such as gloves, masks, eyewear, and gowns, when they are likely to contact infectious materials. Infectious materials include blood and other bodily fluids, mucous membranes, non-intact skin, and tissue specimens.
Hands must be washed frequently to avoid spreading infection. Hands should always be washed before and after wearing gloves, before and after performing a procedure, after contacting blood or other bodily fluids, and between patient contacts.
Health care workers must bandage all cuts and scratches properly. Patient contact should be limited if a worker has a wound or skin condition that is likely to seep or bleed. In addition, health care workers that are sick must avoid direct contact with patients.
Whenever possible, face shields should be used instead of mouth-to-mouth contact during CPR. These devices should be stored in convenient places throughout a medical facility.

25. Precautions for Environmental Cleanliness
Place sharps in puncture-proof biohazardous waste containers
Clean up spills immediately
Discard infectious waste in biohazardous waste bags
Place contaminated linens in biohazardous laundry bags
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Standard Precautions for Environmental Cleanliness
Used sharps should be placed into puncture-proof, biohazardous waste containers. Sharps include needles, surgical blades, syringes, and razors. Additionally, needles should never be bent or broken after use, and they should never be recapped.
Spills must be cleaned up immediately. Appropriate personal protective equipment should be worn when cleaning. It is also important to read the manufacturer’s instructions and the materials safety data sheet before using a chemical cleaning solution.
All infectious waste must be discarded in a biohazardous waste bag. Infectious waste includes gloves, gowns, masks, disposable eyewear, contaminated dressings, drainage bags, disposable basins and bedpans, and other disposable items that have contacted blood or other bodily fluids.
Linens that are contaminated with blood or other bodily fluids must be placed in biohazardous laundry bags. Contaminated linens must be soaked in disinfectant solution before laundering.

26. Gowns
Gowns should be worn when using chemical solutions and during procedures where splashing or spraying of blood and bodily fluid is likely.
Disposable gowns should be placed into biohazardous waste containers after use.
Non-disposable gowns may be placed into biohazardous linens bags.
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Gowns
Gowns are personal protective equipment that must be worn during certain medical procedures. Health care workers should wear gowns when using chemical solutions for disinfection or sterilization. Gowns should also be worn during procedures where splashing or spraying of blood and bodily fluid is likely.
Health care workers must change gowns between patient visits. The same gown should never be worn for more than one patient. In addition, disposable gowns should be placed into biohazardous waste containers after use. Non-disposable gowns may be placed into biohazardous linens bags and then sent to be laundered and disinfected.

27. Masks and Eyewear
Masks and eyewear must be worn for procedures that may produce splashes or sprays of blood or bodily fluid.
Masks should be worn once and then discarded into biohazardous waste containers.
Eyewear is often reusable. However, it must be cleaned and disinfected before reuse.
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Masks and Eyewear
According to standard precautions, health care workers must wear masks and eyewear for procedures that may produce splashes or sprays of blood or bodily fluid. Masks and eyewear will protect a health care worker’s eyes, mouth, and nose from exposure to pathogens.
For procedures that require other forms of personal protective equipment, masks and eyewear should be put on after gowns and before gloves. Masks should be worn once and then discarded into biohazardous waste containers. If a mask gets wet or is worn for more than 30 minutes, it must be discarded and replaced with a new mask. Eyewear is often reusable. However, it must be cleaned and disinfected before reuse.

28. Non-Sterile Gloves
Non-sterile gloves should be worn when contacting blood or other bodily fluids and when handling or cleaning contaminated items.
The same pair of gloves should never be worn in more than one procedure.
Wearing gloves should never replace washing hands.
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Non-Sterile Gloves
Non-sterile gloves are essential pieces of personal protective equipment. However, wearing gloves should never replace washing hands. Hands must be washed first and then gloved. Health care workers should wear non-sterile gloves when contacting blood or other bodily fluids and when handling or cleaning contaminated items.
If other protective equipment is required for a procedure, gloves should be put on last. Gloves should always be changed between patient visits. The same pair of gloves should never be worn in more than one procedure. In addition, gloves must never be washed and reused. Washing gloves could create holes and make them ineffective.

29. Lesson 12 – Communicable Diseases
A communicable disease is a type of infectious disease that can be transmitted from one person to another person.
Some communicable diseases are spread through direct contact. Others may be spread through indirect contact.
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Communicable Diseases
A communicable disease is a type of infectious disease that can be transmitted from one person to another person. Some communicable diseases are spread through direct contact. Examples of direct contact are touching an open wound on an infected person or having a sexual relationship with an infected person. Communicable diseases can also be spread through indirect contact. Indirect contact includes inhaling the air after an infected person has sneezed or handling soiled bed sheets from an infected patient.

30. Transmission of Communicable Diseases
Not all communicable diseases are transmitted the same way.
There are many different types of communicable diseases, and health care workers must become familiar with the mode of transmission for each disease.
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Transmission of Communicable Diseases
Not all communicable diseases are transmitted the same way. For example, AIDS, Hepatitis B, and strep throat can be spread only through direct contact. On the other hand, chicken pox, pink eye, and pneumonia can be spread through direct or indirect contact. There are many different types of communicable diseases, and health care workers must become familiar with the mode of transmission for each disease.

31. Transmission-Based Precautions
Transmission-based precautions are used only with patients who have been diagnosed with highly communicable diseases.
Three types:
Airborne
Droplet
Contact
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Transmission-Based Precautions
Standard precautions are practiced with all patients, regardless of their sickness. But there is another set of precautions that are only used with patients who have been diagnosed with highly communicable diseases. These precautions are called transmission-based precautions. The three types of transmission-based precautions are airborne, droplet, and contact.

32. Airborne Precautions
Airborne precautions are used for patients with disease that are spread through tiny airborne droplets suspended in air or dust particles
Precautions:
Isolation room
Respiratory protection
Negative pressure
Examples of diseases:
Tuberculosis
Chicken pox
Measles
Shingles
Herpes zoster
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Airborne Precautions
Some communicable diseases are spread by tiny airborne droplets. When an infected person coughs or sneezes, tiny droplets are released into the air. Because the droplets are so small, they can remain in the air for a long time and cause infection in people who inhale the droplets. Diseases that require airborne precautions include tuberculosis and chicken pox.
Patients who are diagnosed with this type of communicable disease must be treated with special care. First, they should be placed into a private room. This practice is called isolation. Second, health care workers who enter the private room must wear special respiratory protection, such as a high-efficiency particulate air filter (HEPA mask). Finally, the room must be kept at negative pressure with the door closed. Negative pressure will keep droplets from being drawn into other rooms.

33. Airborne Precautions P. 399
Patient MUST be in private room
Door must be kept closed
Air in the room must be discharged to an outdoor air or filtered before being circulated to other areas
Everyone who enters must wear mask N95 or P100- specially fit tested
Limit movement of patient out of the room-
Must wear surgical mask if moved out of room
Use disposable equipment when possible

34. Droplet Precautions p. 399
Droplet precautions are used for patients with diseases that are spread through large airborne droplets- coughing sneezing, talking or laughing
Precautions:
Isolation room
Standard surgical masks
Examples of diseases:
Pneumonia
Influenza
Pertussis
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Droplet Precautions
For some types of communicable diseases, droplets that are released when a patient sneezes or coughs are large and do not stay in the air for a long period of time. Droplet precautions are required for these diseases. Diseases that require droplet precautions include pneumonia, influenza, and whooping cough.
Patients with these diseases must be placed into an isolation room, but negative air pressure is not needed. Health care workers who enter these rooms must wear standard surgical masks. However, respiratory filters are not required.

35. Droplet Precautions Patient MUST be in a private room
A distance of 3 feet should separate the infected patient and other patients/visitors
Masks MUST be worn when working within 3 feet
If patients must be transported– they should wear a mask

36. Contact Precautions
Contact precautions are used for patients with diseases that are spread through direct and indirect contact.
Precautions:
Isolation room
Gowns and gloves
Equipment precautions
Examples of diseases:
MRSA
VRE
Hepatitis A
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Contact Precautions
Some communicable diseases can be spread through direct contact and indirect contact. Two examples are MRSA (methicillin-resistant staphylococcus aureus) and VRE (vancomycin-resistant enterococcus). These two infections are highly contagious and very dangerous. Therefore, special precautions must be applied to patients with these diseases.
Patients who require contact precautions must be placed in an isolation room. Health care workers who treat these patients must put on gowns and gloves before entering the room. After the procedure, protective equipment must be removed and discarded carefully to avoid transmitting the disease. Whenever possible, the medical equipment used on these patients should be disposable or used only with the infected patient. If equipment must be used for additional patients, it must be disinfected and sterilized first.

37. Contact Precautions Patient should be placed in a private room
May be placed in a room with another patient with the same infection ( same organism)
Gloves MUST be worn when entering
Gloves MUST be changed after contact with patient or room surroundings
Gloves MUST be removed before leaning and hands thoroughly washed
A Gown MUST be worn if there is any chance of contact with patient or the room environment

38. Contact Precautions-- Continued
Remove gown when exiting room
Movement of patient out of the room should be limited
Room and items should receive daily cleaning and disinfection
Patient care equipment should stay in room and used only for that patient or disposable items should be utilized

39. Transmission-Based Garments
When health care workers enter isolation rooms, they must wear transmission-based garments.
Health care workers must wear appropriate garments based on the disease of the patient.
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Transmission-Based Garments
Patients with highly communicable diseases must be placed into isolation rooms. When health care workers enter isolation rooms, they must wear transmission-based garments.
Recall that there are three types of transmission-based precautions: airborne, droplet, and contact. These precautions require different types of protective garments. Health care workers must wear appropriate transmission-based garments based on the disease of the patient.

40. Protective Garments Order for donning PPE Order for removing PPE
Gown
Mask
Eyewear
Gloves
Order for removing PPE
Always cleanse hands before donning the items and immediately after removing them.
Health care workers must not touch the outer surface of any protective garments.
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Donning and Removing Protective Garments
The correct sequence for donning any personal protective equipment is gown first, mask second, eyewear third, and gloves last. To remove PPE, take off gloves first, then eyewear, then the gown, and finally the mask.
Always cleanse hands before donning the items and immediately after removing them. Also, do not touch the outer surface of any protective garments. The outer surfaces are considered contaminated, and touching the surfaces may cause infection.
Special care must be taken when removing transmission-based garments because the items may be contaminated with highly infectious pathogens. Transmission-based garments must be removed and disposed inside the door of the patient’s room. If garments are taken outside of the room, the infection may spread to surrounding rooms.

41. Isolation Units
Patients with communicable diseases are often placed into private rooms for isolation.
This practice helps prevent the spread of communicable diseases to health care workers and other patients.
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Isolation Units
Patients with communicable diseases are often placed into private rooms for isolation. This practice helps prevent the spread of communicable diseases to health care workers and other patients. Health care facilities must establish specific regulations for working in isolation units. Health care workers must always use the special precautions outlined by their facility.

42. Meals in an Isolation Unit
Most facilities require that disposable food trays and eating utensils are used in isolation units.
Leftover food and beverages should never be taken out of an isolation unit. Liquids and soft foods should be flushed down the toilet. Solid foods should be placed in biohazardous waste bags.
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Meals in an Isolation Unit
Certain rules should be followed for meals in isolation units. For example, most facilities require that disposable food trays and eating utensils are used. The trays and utensils can then be discarded into biohazardous waste bags instead of risking contamination to other patients and health care workers.
Additionally, leftover food and beverages should never be taken out of an isolation unit. Liquids and soft foods should be flushed down the toilet. Solid foods should be placed in biohazardous waste bags.

43. Working in an Isolation Unit
Most of the procedures that take place in isolation units require two health care workers.
Items that are taken from isolation rooms are double-bagged to prevent the spread of dangerous pathogens.
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Working in an Isolation Unit
Most of the procedures that take place in isolation units require two health care workers. One worker will go into the room, and the other worker will wait outside the door. The worker inside the room will perform necessary tasks, such as collecting trash and soiled linens, helping the patient eat, and taking vital signs. When items must be removed from the room, the worker will collect the items in a biohazardous waste bag. The worker will then open the door and place the waste bag into another biohazardous waste bag that is being held by the second worker. The double-bagging technique helps to prevent the spread of dangerous pathogens.
Another way to prevent the spread of pathogens is by removing all protective garments while still inside the isolation room. If a health care worker removes the garments outside the isolation room, pathogens can easily spread to other areas of the hospital.

44. Sterile Technique
Sterile technique, also called surgical asepsis, is maintaining an area that is free from all microorganisms.
Sterile technique must be practiced for all invasive procedures to protect patients from infection.
To maintain a sterile area, only sterile items may touch other sterile items.
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Sterile Technique
Sterile technique, also called surgical asepsis, is maintaining an area that is free from all microorganisms. Sterile technique must be practiced for all invasive procedures to protect patients from infection.
To maintain a sterile area, only sterile items may touch other sterile items. These techniques take skill and careful planning.

45. Sterile Fields
Sterile fields are areas that are set up for procedures and are free from microorganisms.
A sterile field is usually a tray covered with a small sterile towel. The tray contains equipment and supplies for a specific procedure.
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Sterile Fields
Sterile fields are areas that are set up for procedures and are free from microorganisms. A sterile field is usually a tray that is covered with a small sterile towel. The tray contains equipment and supplies for a specific procedure, such as changing a dressing or cleaning a wound. All of the items in the sterile field must be sterile.

46. Working with Sterile Fields
Create sterile field in a clean, uncluttered area
Never reach across a sterile field
Keep your eyes on a sterile field at all times
Keep the sterile field dry
Create the sterile field again if you suspect that it has become contaminated
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Working with Sterile Fields
Health care workers must follow specific rules when setting up a sterile field. A sterile field must not be created in a cluttered area. Sterile items are likely to become contaminated in a messy environment. If a sterile item touches any part of a health care worker’s skin or clothing, the item is considered contaminated and cannot be used. Additionally, any area below the waist is considered contaminated. Therefore, health care workers must hold sterile items above the waist and away from the body.
When working with sterile fields, health care workers must never reach across the sterile area. Microorganisms could drop from the clothing onto the field and cause contamination. Always reach to the sides of a sterile field.
After preparing a sterile field, health care workers must keep their eyes on it at all times. If a sterile field is left alone even for a moment, there is no way of knowing if the field has remained sterile or if it has become contaminated. Sterile fields must also be kept dry because pathogens travel quickly through wet areas. If any item in a sterile field becomes wet, it must be considered contaminated and cannot be used.
If any item in a sterile field becomes contaminated or if a health care worker suspects that an item may be contaminated, the entire field must be created again. It is better to take the time to do a procedure correctly than to put a patient’s health in danger.

47. Sterile Packages
Most of the items used to create a sterile field are pre-packaged in sterile wraps.
A sterile package must be opened with care. The outside of the package is considered contaminated, but the inside is sterile.
Only sterile items, such as a sterile transfer forceps, may touch the inside of a sterile package.
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Sterile Packages
Most of the items used to create a sterile field are pre-packaged in sterile wraps. Some of these items are packaged individually, such as gauze, bandages, and small towels. Other sterile items are packaged together for specific procedures, like changing a dressing.
A sterile package must be opened with care. The outside of the package is considered contaminated, but the inside is sterile. A sterile package should be opened with ungloved hands, but health care workers must be sure to touch only the outside of the package. Only sterile items, such as a sterile transfer forceps, may touch the inside of a sterile package.

48. Sterile Glove
Sterile gloves are a key tool in maintaining a sterile field.
Sterile gloves should be worn whenever health care workers treat an open wound, perform an invasive procedure, or apply a dressing.
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Sterile Gloves
Sterile gloves are a key tool in maintaining a sterile field. Unlike non-sterile gloves, sterile gloves are packaged in individual sterile wraps. The sterile wrap keeps the gloves from becoming contaminated with microorganisms.
Sterile gloves should be worn whenever health care workers treat an open wound, perform an invasive procedure, or apply a dressing. On the other hand, non-sterile gloves should be worn whenever health care workers remove a dressing or perform other non-invasive procedures.

49. Reflect – Unit Questions
The common cold is a virus. Beginning with the causative agent, explain how the cold could be passed from one person to another through the chain.
Describe how you would decide which level of asepsis is needed for a piece of equipment and how each level of asepsis could be attained.
In what work situations should a health care worker wash their hands? What are some ways that you can apply proper hand washing hygiene outside of work?
Identify the standard precautions that should be applied if you must change the bandage of a patient with a seeping wound. What precautions should you take to clean up blood from an examination room?
Reflection
Use the items below to engage students in critical thinking and discussion. Ask students to write answers to the following questions in their student journal. Then discuss each of the questions as a class. The questions are also located in the unit teacher manual.
The common cold is a virus. Beginning with the causative agent, explain how the cold could be passed from one person to another through the chain.
Describe how you would decide which level of asepsis is needed for a piece of equipment and how each level of asepsis could be attained.
In what work situations should a health care worker wash their hands? What are some ways that you can apply proper hand washing hygiene outside of work?
Identify the standard precautions that should be applied if you must change the bandage of a patient with a seeping wound. What precautions should you take to clean up blood from an examination room?

50. PPE Video

51. Simmers, K. , Simmers-Kobrelak, K. , Simmers-Narkter, K. , (2009)
Simmers, K. , Simmers-Kobrelak, K., Simmers-Narkter, K., (2009). Diversified Health Occupations . Clifton Park: NJ : Delmar Cengage Learning.

52. Short Answer Question – Worth 15 points
Trace the Chain of Infection of Tuberculosis
Include all 6 links in the chain- make sure you include specific examples with each link
What type of Transmission Based Precautions would you expect the patient to be on? Why-
Include all PPE that must be used.