1. Chapter 13 Preventing Infection
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2. Infection Prevention Infection is a major safety and health hazard.
Older and disabled persons are at risk.
The health team follows certain practices and procedures to prevent the spread of infection (infection control).
Infection control protects residents, visitors, and staff from infection.
An infection is a disease state resulting from the invasion and growth of microbes in the body.
Minor infections cause short illnesses. Some infections are serious and can cause death.
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3. Microorganisms
A microorganism (microbe) is a small living plant or animal.
It is seen only with a microscope.
Microbes are everywhere.
Pathogens are harmful and can cause infections.
Non-pathogens are microbes that do not usually cause an infection.
Micro- means “small,” and organism means “living plant or animal.”
Microbes are in the mouth, nose, respiratory tract, stomach, and intestines. They are on the skin and in the air, soil, water, and food. They are on animals, clothing, and furniture.
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4. Microbes Types of microbes
Bacteria are plant life that multiply rapidly.
Fungi are plants that live on other plants or animals.
Protozoa are one-celled animals that can infect the blood, brain, intestines, and other body areas.
Rickettsiae are found in fleas, lice, ticks, and other insects.
Viruses grow in living cells.
Requirements of microbes
Microbes need a reservoir (host) to live and grow.
Microbes need water and nourishment from the reservoir.
Most need oxygen to live.
A warm and dark environment is needed.
Most grow best at body temperature.
Bacteria are often called germs; they are one cell. They can cause an infection in any body system.
Fungi can infect the mouth, vagina, skin, feet, and other body areas.
Rickettsiae are spread to humans by insect bites. Rocky Mountain spotted fever is an example. The person has fever, chills, headache, rash, and other signs and symptoms.
Viruses cause many diseases. The common cold, herpes, acquired immunodeficiency syndrome (AIDS), and hepatitis are examples.
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5. Microbes (Cont’d) Microbes are destroyed by heat and light.
The reservoir (host) is the environment in which a microbe lives and grows. People, plants, animals, the soil, food, and water are common reservoirs.
Bacteria are often called germs; they are one cell. They can cause an infection in any body system.
Fungi can infect the mouth, vagina, skin, feet, and other body areas.
Rickettsiae are spread to humans by insect bites. Rocky Mountain spotted fever is an example. The person has fever, chills, headache, rash, and other signs and symptoms.
Viruses cause many diseases. The common cold, herpes, acquired immunodeficiency syndrome (AIDS), and hepatitis are examples.
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6. Microbes (Cont’d)
Normal flora are microbes that live and grow in a certain area.
Multidrug-resistant organisms (MDROs) are microbes that can resist the effects of antibiotics.
MDROs are caused by:
Doctors prescribing antibiotics when they are not needed
Not taking antibiotics for the length of time prescribed
Two common types of MDROs are resistant to many antibiotics.
Methicillin-resistant Staphylococcus aureus (MRSA)
Vancomycin-resistant Enterococcus (VRE)
Antibiotics are drugs that kill microbes that cause infections. Some microbes can change their structures. This makes them harder to kill. They can survive in the presence of antibiotics. Therefore the infections they cause are hard to treat.
MRSA is commonly called “staph.”
VRE is normally found in the intestines and in feces. VRE can be transmitted to others by contaminated hands, toilet seats, care equipment, and other items that the hands touch. When not in its natural site (the intestines), VRE can cause an infection. It can cause urinary tract, wound, pelvic, and other infections.
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7. Infection
An infection is a disease state resulting from the invasion and growth of microbes in the body.
A local infection is in a body part.
A systemic infection involves the whole body.
An infection can become life-threatening before the older person has obvious signs and symptoms.
During an infection, an older person may not show signs or symptoms. The person may have only a slight fever or no fever at all. Redness and swelling may be very slight. The person may not complain of pain. Confusion and delirium may occur.
Systemic means “entire”; the person has some or all of the signs and symptoms listed in Box 13-1 on p. 177.
The immune system protects the body from disease and infection (see Chapter 7). Like other body systems, changes occur in the immune system with aging. Therefore older persons are at risk for infection.
You must be alert to the most minor changes in the person’s behavior or condition. Report any concerns to the nurse at once.
Healing takes longer than when younger. Therefore an infection can prolong the rehabilitation process. Independence and quality of life are affected.
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8. Chain of Infection The chain of infection is a process. 8
It begins with a source (a pathogen)
It must have a reservoir where it can grow and multiply.
To leave the reservoir, the pathogen needs a portal of exit.
After leaving the reservoir, the pathogen must be transmitted to another host.
The pathogen enters the body through a portal of entry.
A susceptible host is needed for the microbe to grow and multiply.
Humans and animals are reservoirs. If they do not have signs and symptoms of infection, they are carriers.
Carriers can pass the pathogen to others.
Portals of exit are the respiratory, gastrointestinal, urinary, and reproductive tracts; breaks in the skin; and the blood.
Portal of entry and exit are the same.
Susceptible hosts are persons at risk for infection.
See Figure 13-1 on p. 177 for the Chain of infection and Figure 13-2 on p After leaving the reservoir the pathogen must be transmitted to another host. The pathogen enters through a portal of entry.
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9. Resisting Infection The ability to resist infection relates to: 9 Age
Nutrition
Stress
Fatigue
Health
Drugs
Disease and injury
The human body can protect itself from infection. Susceptible hosts are persons at risk. They include those who are very young or who are older, the ill, those exposed to pathogens, and those who do not follow infection control practices.
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10. Healthcare-Associated Infection
A healthcare-associated infection (HAI) is an infection acquired in a health care agency.
HAIs are caused by:
Normal flora
Microbes transmitted to the person from another source
HAIs are prevented by:
Medical asepsis—this includes hand hygiene
Surgical asepsis
Standard precautions
Transmission-based precautions
Isolation precautions
The Bloodborne Pathogen Standard
HAIs also are called nosocomial infections.
Microbes can enter the body through equipment used in treatments, therapies, and tests. Such items must be free of microbes. Staff can transfer microbes from one person to another and from themselves to others. Common sites for HAIs are the urinary system, the respiratory system, wounds, and the bloodstream.
Older persons have a hard time fighting infections. The health team must prevent the spread of infection.
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11. Medical Asepsis Asepsis is being free of disease-producing microbes.
Measures are needed to achieve asepsis.
Medical asepsis (clean technique)
Surgical asepsis (sterile technique)
Medical asepsis is the practices used to:
Remove or destroy pathogens. The number of pathogens is reduced.
Prevent pathogens from spreading from one person or place to another person or place.
Sterilization is the process of destroying all microbes.
Contamination is the process of becoming unclean.
In medical asepsis, an item or area is clean when it is free of pathogens.
An item or area is contaminated if pathogens are present.
A sterile item or area is contaminated when pathogens or nonpathogens are present.
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12. Aseptic Practices To prevent the spread of microbes, wash your hands:
After urinating or having a bowel movement
After changing tampons or sanitary pads
After contact with your own or another person’s blood, body fluids, secretions, or excretions
After coughing, sneezing, or blowing your nose
Before and after handling, preparing, or eating food
Aseptic practices break the chain of infection.
Body fluids include saliva, vomitus, urine, feces, vaginal discharge, mucus, semen, wound drainage, pus, and respiratory secretions.
Also wash your hands after smoking a cigarette, cigar, or pipe. (Better yet, quit smoking!!)
Review Residents with Dementia: Common Aseptic Practices, on p. 179.
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13. Aseptic Practices (Cont’d)
To prevent the spread of microbes, also do the following:
Provide all persons with their own linens and personal care items.
Cover your nose and mouth when coughing, sneezing, or blowing your nose.
Bathe, wash your hair, and brush your teeth regularly.
Wash fruits and raw vegetables before eating or serving them.
Wash cooking and eating utensils with soap and water after use.
Hand hygiene
Hand hygiene is the easiest and most important way to prevent the spread of infection.
Practice hand hygiene before and after giving care.
Although some of these practices may seem inconvenient, they are much less inconvenient than getting sick! Also, by practicing them regularly, you will develop them as habits.
Review Box 13-2 on p. 179 for the rules of hand hygiene.
Review Promoting Safety and Comfort: Hand Hygiene on p. 179.
Review the Hand Washing procedure in the textbook. See Figures 13-3, 13-4, 13-5, 13-6, and 13-7 on p. 180.
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14. Use Equipment and Supplies Properly
Supplies and equipment
Most health care equipment is disposable.
Single-use items are discarded after use.
A person uses multiuse items many times.
Non-disposable items are cleaned, then disinfected, and then sterilized.
Cleaning
Reduces the number of microbes present
Removes organic matter
Disposable items help prevent the spread of infection.
Nondisposable items are cleaned and then disinfected. Then they are sterilized.
Label multi-use items with the person’s name and room and bed numbers. Do not “borrow” them for another person.
Wear personal protective equipment (PPE) when cleaning items contaminated with blood, body fluids, secretions, or excretions. Personal protective equipment includes gloves, a mask, a gown, and goggles or a face shield.
Nursing centers have “clean” and “dirty” utility rooms. Equipment is cleaned in the “dirty” utility room. Then it is disinfected or sterilized in the “clean” utility room.
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15. Disinfection
Disinfection is the process of destroying pathogens.
Germicides are disinfectants applied to skin, tissues, and non-living objects.
Chemical disinfectants are used to clean surfaces and reusable items.
Sterilization destroys all non-pathogens and pathogens, including spores.
Hand hygiene, cleaning, disinfection, and sterilization are important aseptic measures.
Review Promoting Safety and Comfort: Disinfection on p. 182.
Spores are bacteria protected by a hard shell. Spores are killed by very high temperatures.
Reusable items that require chemical disinfectants include blood pressure cuffs, commodes and metal bedpans, wheelchairs and stretchers, and furniture.
An autoclave is a pressure steam sterilizer. Glass, surgical items, and metal objects are autoclaved.
High temperatures destroy plastic and rubber items. They are not autoclaved. Steam under pressure sterilizes objects in 30 to 45 minutes.
Hand hygiene, cleaning, disinfection and sterilization are important aseptic measures. So are the measures listed in Box 13-3 on pp They are useful in home, work, and everyday life.
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16. Isolation Precautions
Isolation precautions prevent the spread of communicable or contagious diseases.
Isolation precautions are based on clean and dirty.
Clean areas or objects are free of pathogens.
Dirty areas or objects are contaminated with pathogens.
The precautions reduce the risk of spreading pathogens.
Standard precautions:
Reduce the risk of spreading pathogens
Reduce the risk of spreading known and unknown infections
Are used in the care of all residents
Blood, body fluids, secretions, and excretions can transmit pathogens.
Communicable diseases are diseases caused by pathogens that spread easily.
If a clean area or object has contact with something dirty, the clean area is now dirty. Clean and dirty also depend on how the pathogen is spread.
The CDC’s isolation precautions guideline has two tiers of precautions: Standard Precautions and Transmission-Based Precautions.
Review Focus on Communication: Isolation Precautions on p. 184.
Review Delegation Guidelines: Isolation Precautions on p. 184.
Review Promoting Safety and Comfort: Isolation Precautions on p. 187.
Review Teamwork and Time Management: Isolation Precautions on p. 187.
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17. Standard Precautions
Standard Precautions prevent the spread of infection from:
Blood
All body fluids, secretions, and excretions (except sweat), even if blood is not visible
Non-intact skin
Mucous membranes
Understanding how certain infections are spread helps you understand the types of transmission-based precautions.
Standard Precautions are used for all persons whenever care is given.
Review Box 13-4 on p. 185.
Some infections require Transmission-Based Precautions. You must understand how certain infections are spread (see Fig. 13-2).
Review Box 13-5 on p. 186.
Use of an airborne infection isolation room (AIIR) is part of Transmission-Based Precautions.
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18. Protective Measures Protective measures 18
Isolation precautions involve:
Wearing personal protective equipment (PPE)
Using special measures for removing linens, trash, and equipment from the room
Following procedures when collecting and transporting specimens
Using special measures to transport persons on Isolation precautions
Center policies may differ from those in this text.
Review Box 13-6 on on p. 187.
See Promoting Safety and Comfort: Protective Measures on p. 187.
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19. Gowning and Gloving
Wear gloves whenever contact with blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin is likely.
Gowns and other attire protect your clothes and body from contact with blood, body fluids, secretions, and excretions.
Gowns must completely cover you from your neck to your knees.
A wet gown is contaminated.
Disposable gowns are discarded after use.
Review the list in the textbook for what to remember when using gloves.
See Promoting Safety and Comfort: Gloves on p. 189 in the textbook.
Review the Removing Gloves procedure on p. 189 in the textbook.
Gowns prevent the spread of microbes. They also protect against splashes and sprays. However, the gown front and sleeves are considered to be contaminated. The gown opens at the back and is tied at the neck and waist.
Review the Donning and Removing a Gown procedure on p. 190.
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20. Choose the Correct Personal Protective Equipment
Masks and respiratory protection prevent the spread of microbes from the respiratory tract.
Masks are disposable.
A wet or moist mask is contaminated.
Practice hand hygiene before putting on a mask.
Tuberculosis respirators are worn when caring for persons with tuberculosis (TB).
Goggles and face shields protect your eyes, mouth, and nose from splashing or spraying of blood, body fluids, secretions, and excretions.
The outside of goggles or a face shield is contaminated.
You wear masks for protection from contact with infectious materials from the resident. During sterile procedures masks protect the person from infectious agents carried in your mouth or nose. Apply a new mask when contamination occurs.
A mask fits snugly over your nose and mouth. The front of the mask is contaminated.
Review the Donning and Removing a Mask procedure on p. 191.
Splashes and sprays can occur when giving care, cleaning items, or disposing of fluids.
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21. Personal Protective Equipment
Discard disposable eyewear after use.
Reusable eyewear is cleaned and disinfected before reuse.
Contaminated items are bagged to remove them from the person’s room.
Leakproof plastic bags are used and have the BIOHAZARD symbol.
Biohazardous waste is items contaminated with blood, body fluids, secretions, or excretions.
Bag and transport linens, trash, equipment, and supplies following center policy.
Double bagging is not needed unless the outside of the bag is soiled.
Specimens are transported to the laboratory in biohazard specimen bags.
Procedures for transporting persons vary among centers.
The ties, ear pieces, or headband used to secure eyewear are considered “clean.” Use them to remove the device after hand hygiene. They are safe to touch with bare hands.
See Promoting Safety and Comfort: Goggles and Face Shields on p. 191.
Bio means “life.” Hazardous means “dangerous or harmful.”
All linen bags need a biohazard symbol. Melt-away bags are common. They dissolve in hot water.
Tie the bag securely. Then place it in a laundry hamper lined with a biohazard plastic bag.
Trash is placed in a container labeled with the biohazard symbol.
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22. Meeting Needs of the Isolation Precaution Person
Meeting basic needs
Often, love, belonging, and self-esteem needs are unmet when Isolation Precautions are used.
You can help meet love, belonging, and self-esteem needs.
Persons with poor vision need to know who you are.
Let them see your face before you put on a mask or goggles or a face shield.
State your name and explain what you are going to do.
THEN put on PPE.
The nurse helps the person, visitors, and staff understand the need for Transmission-Based Precautions and how they affect the person.
Review Promoting Safety and Comfort: Isolation Precautions on p. 187.
See Focus on Communication: Meeting Basic Needs on p. 193.
See Residents with Dementia: Meeting Basic Needs on p. 193.
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23. Bloodborne Pathogen Standard
The Bloodborne Pathogen Standard is:
Intended to protect the health team from exposure to blood and other potentially infectious materials (OPIM)
A regulation of the Occupational Safety and Health Administration (OSHA)
HIV and HBV are bloodborne pathogens.
The center must have an exposure control plan.
It identifies staff at risk for exposure to blood or OPIM.
The plan includes actions to take for an exposure incident.
Staff at risk receive free training.
The human immunodeficiency virus (HIV) and the hepatitis B virus (HBV) are major health concerns. They exit the body through blood. They are spread to others by blood. OPIM also spread the viruses.
The health team is at risk for exposure to these viruses. The Bloodborne Pathogen Standard is intended to protect them from exposure.
Review the bloodborne pathogen standard terms listed in Box 13-7 on p. 194.
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24. Exposure Control Plan
Preventive measures to reduce the risk of exposure include:
Hepatitis B vaccination
Engineering and work practice controls
Personal protective equipment (PPE)
Contaminated equipment is cleaned and decontaminated.
Decontaminate work surfaces with a proper disinfectant.
Use a brush and dustpan or tongs to clean up broken glass.
Hepatitis B is a liver disease. It is caused by the hepatitis B virus (HBV). Hepatitis B virus is spread by blood and sexual contact.
The hepatitis B vaccine produces immunity against hepatitis B. Immunity means that a person has protection against a certain disease. He or she will not get the disease.
A vaccination involves giving a vaccine to produce immunity against an infectious disease. A vaccine is a preparation containing dead or weakened microbes.
Review the list of work practice controls required by OSHA in the textbook.
PPE includes gloves, goggles, face shields, masks, laboratory coats, gowns, shoe covers, and surgical caps.
Review the measures OSHA requires for the safe handling and use of PPE listed in the textbook.
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25. Contaminated Waste
Special measures are required when discarding regulated waste.
Containers used for discarding regulated waste are closable, puncture-resistant, leakproof, and color-coded in red and have the BIOHAZARD symbol.
The center must be kept clean and sanitary.
Special measures are required for contaminated laundry.
A cleaning schedule is required. It includes decontamination methods and the tasks and procedures to be done.
Never pick up broken glass with your hands.
Review the measures OSHA requires for contaminated laundry listed in the textbook.
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26. Exposure Exposure incidents 26
An exposure incident is any eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or OPIM.
Report exposure incidents at once.
Confidentiality is important.
Parenteral means piercing the mucous membranes or the skin barrier. Piercing occurs through needlesticks, human bites, cuts, and abrasions.
Medical evaluation, follow-up, and required tests are free after an exposure. Your blood is tested for HIV and HBV.
You are told of the evaluation results.
The source individual is the person whose blood or body fluids are the source of an exposure incident. His or her blood is tested for HIV or HBV.
State laws vary about releasing the results. The center informs you about laws affecting the source’s identity and test results.
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27. Surgical Asepsis
Surgical asepsis (sterile technique) is the practices that keep equipment and supplies free of all microbes.
Surgical asepsis is required any time the skin or sterile tissues are entered.
If a break occurs in sterile technique, infection is a risk.
Sterile means the absence of all microbes, including spores.
Review Delegation Guidelines: Assisting with Sterile Procedures on p. 195.
Review Promoting Safety and Comfort: Assisting with Sterile Procedures on p. 195.
Review the sterile gloving procedure.
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28. Quality of Life
The health team must prevent the spread of microbes and infection.
Even one careless act can spread microbes.
You must be very careful about your work. Staff and residents assume that you will practice medical asepsis. They also assume that you will follow Standard and Transmission-Based Precautions.
One careless act can affect the person’s safety. The reverse is also true. You can develop the person’s infection.
Practicing hand hygiene before and after resident contact greatly reduces the spread of microbes.
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