Infection Control.

Infection Control

“It may seem a strange principle to enunciate as the very first requirement of a hospital that it do the sick no harm.” Florence Nightingale, Notes on Hospitals, 1863

14:1 Principles of Infection Control
Understanding is essential to all health care workers A basic knowledge of how disease is transmitted is vital. The main emphasis on prevention of disease transmission

What is Infection Control?
Infection control is a term used that describes ways we can prevent the spread of infection.

Why is infection control important in health care?
Infections can cause pain, suffering and often, permanent scarring. In the worst cases, death can occur. Infections cause extra days in the hospital and lead to higher costs for patients and their families.

What you can’t see, CAN hurt you!!
We are surrounded by tiny, living organisms: In the air we breathe On and in our body In our food On everything we touch What you can’t see, CAN hurt you!!

Microorganisms or Microbes
Small living organisms Not visible to the naked eye Microscope must be used to see them Found everywhere in the environment Found on and in the human body Many are part of normal flora of body May be beneficial (continues)

Microorganisms or Microbes (continued)
Called “nonpathogens” when not harmful to the body Called “pathogens” (germs) when able to harm the body Cause infections and diseases (continues)

Microorganisms or Microbes (continued)
Most prefer warm environments Most prefer darkness Need source of food and moisture Need for oxygen varies Aerobic (requires oxygen to live) Anaerobic (lives without oxygen) Human body is ideal supplier of all the requirements

Microbe Classifications
Bacteria Protozoa Fungi Rickettsiae Viruses Helminths

Bacteria Simple, one-celled organisms Multiply rapidly
Classified by shape and arrangement (continues)

Bacteria (continued) Cocci are round or spherical in shape
Diplococci—in pairs (gonorrhea, meningitis, pneumonia) Streptococci—in chains (Strept throat, rheumatic fever) Staphylococci—clusters or groups (Boils, UTI, wound infections, Toxic Shock Syndrome)

Bacteria (continued) Bacilli are rod shaped Examples of diseases
Occur singly, in pairs, or in chains May have flagella Ability to form spores Examples of diseases Tuberculosis Tetanus Pertussis Botulism Diptheria Typhoid

Bacteria (continued) Spirilla are spiral or corkscrew shaped Diseases
syphilis cholera

Antibiotics Antibiotics are used to kill bacteria
Some strains of bacteria have become antibiotic-resistant When antibiotic-resistant, the antibiotic is no longer effective against the bacteria Example: MRSA (Methicillin-resistant staphylococcus aureus)

Protozoa One-celled, animal-like organism
Found in decayed materials and contaminated water May have flagella for movement Some are pathogenic Examples of diseases Malaria Amebic dysentery Trichomonas African sleeping sickness

Fungi Simple, plant-like organisms that live on dead organic matter
Yeast and molds are 2 common types Can be pathogenic Examples of diseases Ringworm Athlete’s foot Antibiotics do not kill fungi, need antifungal medications

Rickettsiae Parasitic microorganisms which means they cannot live outside the cells of another living organism Transmitted to humans by the bites of insects (e.g., fleas, lice, ticks, mites) Examples of diseases- Rocky Mountain spotted fever, typhoid fever Antibiotics are effective against many of them

Viruses Smallest microorganisms, seen on with the use of an electron microscope Must be inside another living cell to reproduce – invades other cells and destroys them. Spread by blood and body secretions Very difficult to kill bc resistant to many disinfectants, not affected by antibiotics Cause many diseases

Viruses Diseases include: Common cold Measles Mumps Chicken pox Herpes
Warts Influenza Polio

Viruses (continued) Viruses infecting animals can mutate to infect humans Examples include: Severe acute respiratory syndrome (SARS) West Nile Virus (WNV) Monkeypox (smallpox) Ebola H5N1 (avian flu) H1N1 (swine flu)

Viruses (continued) Three other diseases of major concern to Health Care workers include: Hepatitis B Hepatitis C AIDS

Virus—Hepatitis B Also called “serum hepatitis”
Caused by Hepatitis B Virus Transmitted by blood, serum, and other body secretions Affects the liver Can lead to destruction and scarring of liver cells Vaccine is available for protection given in a series of 3 injections

Virus—Hepatitis B (continued)
By federal law, employers must provide vaccine at no cost to employees with occupational exposure to blood or other body secretions If employee refuses, written statement must be signed documenting refusal

Hepatitis C Caused by Hepatitis C Virus
Transmitted by blood and blood-containing body fluids Many infected individuals are asymptomatic Others have mild symptoms Can cause severe liver damage

Hepatitis C (continued)
Currently, no vaccine ready for use Vaccine is in developmental stage Extremely difficult to destroy HCV and HBV Both can survive and remain active for several days in dried blood Health care workers must follow precautions to protect against virus

Acquired Immune Deficiency Syndrome (AIDS)
Caused by the Human Immunodeficiency Virus (HIV) Suppresses the immune system Individual becomes susceptible to cancers and infections that would not affect a healthy person No cure presently and no vaccine Take precautions for prevention

Helminths Multicellular parasites, otherwise known as worms or flukes
Are transmitted: By eating contaminated food Being bitten by infected insects When worms enter the skin

How Pathogens Cause Infection and Disease
Some produce poisons, called toxins Some cause an allergic reaction Others attach and destroy the living cells they invade

Classifications of Diseases and Infections
Endogenous Exogenous Nosocomial Opportunistic

Endogenous Originates within the body Examples: metabolic disorders
congenital abnormalities tumors infections caused by microorganisms within the body

Exogenous Originates outside the body Examples: radiation
chemical agents trauma electric shock temperature extremes

Nosocomial Acquired in a health care facility
Usually present in facilities and carried by health care workers to the patient Many are antibiotic-resistant Can cause serious and even life-threatening infections

Nosocomial (continued)
Examples are Staphylococcus pseudomonas enterococci Infection-control programs are used in facilities to prevent and deal with nosocomial infections

Nosocomial (continued)
Did You Know? Health care workers that provide direct patient care should not wear artificial nails or extenders. Artificial nails have been linked to infections in patients.

Hand Care It’s important to keep hands and nails healthy. Keep nails short and hand moisturized. Use only the hand lotion provided by the hospital as it is designed to go with the hospital’s hand hygiene soap and gloves.

Opportunistic Infections that occur when the body’s defenses are down
Usually do not occur in normal immune system Examples (in individuals with AIDS) Kaposi’s sarcoma (rare type of cancer) Pneumocystis carinii pneumonia

CHAIN OF INFECTION

Chain of Infection Must be present for disease to occur and spread from one individual to another Infectious/Causative agent (Pathogen) Reservoir (Host) – an area where causative can live Human body Animals Environment Fomites – objects contaminated with infectious material, commonly doorknobs, bedpans, urinals, linens, instruments and specimen containers

Portal of exit Mode of transmission Portal of entry Susceptible host
Way for agent to escape from reservoir Mode of transmission A way that causative agent can be transmitted to another reservoir or host Direct contact Indirect contact Portal of entry Way for causative agent to enter a new reservoir or host Susceptible host A person likely to get an infection or disease

Common Body Defenses Skin Hairs Mucous membranes Cilia
Coughing and sneezing Hydrochloric acid (HCL) in the stomach Tears – contain bacteriocidal chemicals Fever Inflammation response – leukocytes Immune response – antibodies, chemicals

Ending the Chain of Infection
Eliminate any step in the chain and infection is stopped Follow practices to interrupt or break the chain Remember, pathogens are everywhere Prevention is a continuous process

Aseptic Techniques Asepsis: defined as the absence of disease-producing microorganisms Sterile: means free from all organisms, including spores and viruses Contaminated: means organisms and pathogens are present

Aseptic Techniques Major aim: maintaining cleanliness and eliminating or preventing every aspect of contamination

Common Aseptic Techniques
Thorough handwashing Good personal hygiene Disposable gloves Cleaning instruments and equipment Proper cleaning of environment

Levels of Aseptic Control
Antisepsis: Antiseptics prevent or inhibit growth of pathogenic organisms, but not effective against spores or viruses Can be used on the skin Alcohol, betadine Disinfection: A process that destroys pathogenic organisms, but not always effective against spores or viruses Can irritate skin, used mainly on objects Bleach solutions Sterilization: A process the destroys all microorganisms, including pores and viruses Ex. steam under pressure (autoclave), gas, radiation, and chemicals on objects

Summary Important for health care workers to know and use proper aseptic techniques at all times Prevents spread and transmission of disease

Bioterrorism Bioterrorism: use of microorganisms or biologic agents for warfare to infect humans, animals, or plants Have been used over time by different nations not only in war, but also on innocent people

Examples from history 1346 – throwing dead plague victims over wall of a city to cause epidemic 1763 – British giving Delaware Indians items contaminated with smallpox WWI – Germans using animal and human pathogens WWII – Japanese experimenting on POW with different pathogens 1960s – various countries developing biologic weapons 1995 – Release of sarin gas in Tokyo 2001 – Anthrax contaminated mail in US

Biologic Agents Microorganisms with characteristics suitable for bioterrorism: Inexpensive, available, easily produced, spreads quickly Maintains its survival Brings death or disability Travels from person to person Difficult to prevent/treat

Biologic Agents (continued)
High priority agents include: Smallpox: contagious and infectious disease, result of the Variola virus Vaccine can protect against some types of smallpox One type, hemorrhagic smallpox, is usually fatal Anthrax: infectious disease caused by spores of Bacillus anthracis Spores highly resistant to destruction Can live in soil for years Plague: infectious disease from the bacteria Yersinia pestis Transmitted by bites of infected fleas

Biologic Agents (continued)
Botulism: paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinum Toxin causes muscle paralysis Tularemia: infectious disease from the bacteria Fracisella tularensis Filoviruses: infectious diseases causing severe hemorrhagic fever 2 are Ebola virus and Marburg virus No effective treatment exists 50-90% of infected individuals die

Preparing for Bioterrorism
Bioterrorism attack would result in a public health emergency Would have impact on health care facilities Social disorder would ensue Comprehensive plan was prepared – Bioterrorism Act of 2002

Preparing for Bioterrorism (continued)
Bioterrorism Act 2002 passed by Congress and signed into law Involves local, regional, state, and national government and includes: Early detection by communities Public to be notified Infection control and education Funding available for studying organisms, developing vaccines, researching treatments, determining preventative actions

Preparing for Bioterrorism (continued)
Guidelines and restrictions Nationwide immunizations Protection of food/water supplies Trained personnel available Emergency management controls Investigation of potential threats Preparation of health care facilities Efficiency of communication

Summary All health care workers need to be aware of bioterrorism
Attack could occur at any time Being prepared and properly trained will result in saving many lives

Washing Hands Major aspect of standard precautions
Most important aseptic technique Hands are perfect media for the spread of pathogens

Purpose of Handwashing
Prevent and control spread of pathogens Protect the health care worker from disease and illness

Recommendations for Handwashing
Regular handwashing with plain soap and water Antiseptic handwashing with antimicrobial soap and water Antiseptic hand rub with alcohol-based cleaner (waterless)

When to Wash Hands On arrival at facility
Immediately before leaving facility Before and after every patient contact After contact with patient’s skin Before moving from a contaminated site to a clean site

When to Wash Hands (continued)
Anytime the hands become contaminated during a procedure Before applying gloves Immediately after removing gloves When gloves are torn or punctured Before and after handling specimens After contact with any soiled or contaminated item

When to Wash Hands (continued)
After picking up any item off the floor After personal use of the bathroom Following a cough, sneeze, or using a tissue Before and after any contact with mouth or mucous membranes

Principles of Handwashing
Use soap as a cleansing agent Use warm water Use friction (15 seconds) Clean all surfaces Clean nails and wrists Point fingertips down Use dry paper towels to turn faucet off

Waterless Hand Cleaning
Alcohol-based gel, lotion, or foam Used if hands are not contaminated with blood or body fluids Apply cleaner to palm of hand Rub hands together vigorously for at least 15 seconds until dry After six to ten cleanings, hands need to be washed with soap and water

Observing Standard Precautions
Blood and body fluids are the main ways pathogens are spread Major pathogens: HBV, HCV, HIV Extreme care must be taken at all times when there is an area, object, or person contaminated with blood or body fluids

Bloodborne Pathogen Standards
Established in 1991 by OSHA Must be followed by all health care workers Civil penalties if not implemented and followed

Regulation Requirements
Written exposure control plan Identify all employees with occupational exposure Provide Hepatitis B vaccines free of charge Provide personal protective equipment

Regulation Requirements (continued)
Provide adequate handwashing facilities and supplies Ensure worksite is maintained in a clean, sanitary condition Follow measures for immediate decontamination of surfaces when contaminated

Regulation Requirements (continued)
Dispose of infectious waste correctly Enforce rules of limited activities in any potentially contaminated area Provide appropriate containers for contaminated sharps and other contaminated items (color coded and labeled)

Regulation Requirements
Post signs at the entrance to work areas with occupational exposure to biohazardous materials Use Red Biohazard Labels Provide a confidential medical evaluation and follow-up for any employee with an exposure incident Provide training to employees

Needle-Stick Safety Act
Passed by Congress in 2000 Centers for Disease Control and Prevention (CDC) estimated 600,000 to 800,000 needle sticks per year OSHA revised Bloodborne Pathogen Standard to requirements of this act

Employer Requirements
Identify and use effective and safer medical devices Incorporate changes in annual update of exposure control plan Solicit input from non-managerial employees who are responsible for direct patient care

Employer Requirements (continued)
Maintain a sharps injury log Ensure that every employee uses standard precautions at all times

Standard Precautions Rules developed by the CDC
Every body fluid must be considered potential source of infection All patients must be considered potential source of infection

When to Use Standard Precautions
Any situation where you might come in contact with: Blood or any fluid that contains blood Body fluids, secretions, and excretions Mucous membranes Nonintact skin Tissue or cell specimens

Gloves Gloves must be changed after contact with each patient
When removing gloves, do not contaminate your skin Hands must be washed immediately after removal of gloves Gloves must not be reused

When to Wear Gloves Whenever contact with body fluids, secretions, or excretions When handling or cleaning contaminated items or surfaces Performing any invasive procedure Performing venipuncture/blood tests

Gowns Worn during procedures that may cause splashing or spraying
Helps prevent contamination of clothing or uniforms Contaminated gowns must be handled per policy Hands must be washed immediately after removing gown

Masks and Eye Protection
Worn during procedures that may cause splashing or spraying Prevents exposure of mucous membranes of the mouth, nose, and eyes to pathogens Use masks once, then discard—change every 30 minutes if needed

Masks and Eye Protection (continued)
Protective eyewear and face shields protect front, top, bottom, and sides of eyes If not disposable, must be cleaned and disinfected before reuse

Sharp Objects Use extreme caution to avoid cuts and punctures
When possible, use safe needles or needleless system Follow policies regarding needles Use sharps containers Follow laws regarding disposal of sharp objects

Spills or Splashes Wipe up immediately Wear gloves when wiping up
Use disposable cleaning clothes Use disinfectant which contains 10% bleach solution Clean all contaminated surfaces For large spills, can use absorbent powder to absorb fluid

Resuscitation Devices
Use to avoid the need for mouth-to-mouth resuscitation Place in convenient location that is readily accessible

Waste and Linen Disposal
Wear gloves Follow agency policy Use biohazard bags appropriately

Injuries Report any cut or injury, needle stick, or splashing of blood or body fluids immediately Follow agency policy

Summary Standard precautions need to be followed at all times by every health care worker Observing these precautions can help break the chain of infection Health care workers can protect themselves, their patients, and all other individuals

Sterilizing with an Autoclave
Autoclave – Equipment that uses steam under pressure or gas to sterilize equipment and supplies Most efficient method of sterilization Units available in various sizes Procedure Equipment must be properly prepared Thoroughly washed and rinsed Wrapped with material that allows steam to penetrate Indicators placed to ensure proper sterilization Sufficient time allowed for completion

Using Chemicals for Disinfection
Chemicals are frequently used for aseptic control Not sterilization Used on instruments that do not penetrate body tissue, or are destroyed by high heat Examples include dental instruments, percussion hammers, scissors, thermometers Preparation includes proper cleaning and rinsing of equipment before use of chemicals Some chemicals: 90% isopropyl alcohol, 10% bleach solution, gluteraldehyde, iodophor Must remain in solution for specific amount of time, depending on chemical used

Cleaning with Ultrasonic Unit
Ultrasonic cleaning uses sound waves These produce millions of microscopic bubbles in a cleaning solution When bubbles stick an object, they explode, a process known as cavitation and drive the solution onto the article to be cleaned Dirt and residue are easily and gently removed in this process Different solutions used for different materials, most are toxic that can cause skin irritation This is NOT sterilization

Using Sterile Techniques
Many procedures require use of sterile techniques to protect a patient from infection Surgical asepsis keeps an object or area free from living organisms Sterile: free from all organisms Contaminated: organisms and pathogens present

Using Sterile Techniques (continued)
Important to differentiate between sterile and contaminated areas or items while using sterile technique Correct techniques must be strictly followed to maintain sterility and prevent contamination

Using Sterile Techniques (continued)
Clean working area required Handling of sterile supplies Sterile field: area used for placement of sterile supplies All sterile items need to be checked Observe agency guidelines for date Necessary to keep sterile field dry

Removing Articles from Sterile Wraps
Drop technique—for gauze, pads, dressings, and small items Mitten technique—for bowls, drapes, and linens Transfer forceps—for cotton balls and small items

14:9 Transmission-Based Isolation Precautions
Isolation precautions are in addition to the Standard Precautions Some diseases are communicable Caused by organisms that can be transmitted easily Epidemic—spreads from person to person and affects large numbers Pandemic—spreads over a wide geographic area

Isolation Precautions
Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or “isolation”. The type of precautions depends upon how the infection is spread. Patients who have infectious diseases requiring isolation will have a sign posted outside the door to their room.

Transmission-Based Isolation Precautions (continued)
Helps prevent spread of disease Protects patient, family, and health care workers Type of Isolation used depends on the causative organism of the disease

How Communicable Diseases Spread
Direct contact with a patient Contact with dirty linen, equipment, and supplies Contact with blood, body fluids, secretions, and excretions

Terms Defined Contaminated or dirty: items that contain disease-producing organisms; must not be touched unless protected Clean: items that do not contain the organisms; protect these areas from contamination

Classifications of Precautions
Standard precautions Airborne precautions Droplet precautions Contact precautions

Airborne Precautions Used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nuclei Remain suspended in the air or on dust particles Examples: Rubella (measles) Varicella (Chicken pox) Tuberculosis Shingles (Varicella zoster)

Negative Pressure Ventilation

Airborne Precautions Patient must be in private room
Door remains closed Air in room discharged to outdoor air or filtered before being circulated to other areas People entering room must wear respiratory protection – N95 or more powerful mask such as high-efficiency particulate air (HEPA) mask. If moved, patient wears mask during transport

N95 Masks

Droplet Precautions Fate of Droplets Organisms Liberated Talking 0-200
Coughing Sneezing ,000,000 Droplets can remain suspended in the air for hours.

Droplet Precautions Used for patients known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing, sneezing, talking, laughing Examples Haemophilus influenza meningitis and pneumonia Neisseria meningitis and pneumonia Multidrug resistant Streptococcus meningitis, pneumonia, sinusitis and otitis media, diphtheria, pertussis, mumps, severe viral influenza

Droplet Precautions Patient placed in private room
Can be with patient with same disease but over 3 foot distance separation Masks must be worn if within 3 feet Mask worn on patient when transported

Contact Isolation Followed for any patients known or suspected to be infected with microorganisms that can be transmitted by either direct or indirect contact Examples Gastrointestinal, respiratory, skin, or wound infections caused by multidrug-resistant organisms, incontinent patients with E.coli, Shigella, hepatitis A, rotavirus, viral or hemorrhagic conjunctivitis or fevers, and any skin infections

Contact Isolation Patient placed in private room, or with someone with same illness Gloves must be worn upon entering room Gloves must be changed after contact with infectious material Gloves must be removed before leaving room – hands must be washed with antimicrobial agent Gown must be worn if chance of contact with patient, surfaces, or items in room, then removed before leaving room Patient should not leave room, except for essential purposes Room disinfected daily Equipment left in room - disinfected upon patient discharge

Contact Isolation

Protective or Reverse Isolation
Method used to protect certain patients from organisms present in the environment Used mainly for immunocompromised patients Precautions vary depending on patient’s condition

Summary Exact procedures for maintaining transmission-based isolation will vary from one facility to another Variations caused by different factors Basic principles remain the same in any facility and are directed toward preventing the spread of disease

What Else Can You Do? Make sure you have been immunized and don’t come to school if you are sick. Places of employment will ask for written proof of immunity to measles, mumps, rubella and chickenpox upon employment.

Infection Control.

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