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Chapter 15 Preventing InfectionCopyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Infection Infection is a major safety and health hazard.The health team follows certain practices and procedures to prevent the spread of infection. Infection control—the practices and procedures that protect patients, residents, visitors, and staff from infection Infection- a disease state resulting from the invasion and growth or microbes in the body An infection is a disease state resulting from the invasion and growth of microbes in the body. Infants, older persons, and disabled persons are at risk. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Microorganisms A microorganism (microbe) is a small living thing seen only with a microscope. Microbes are everywhere. 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. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Pathogens Some microbes are harmful and can cause infections.They are called pathogens. Non-pathogens are microbes that do not usually cause an infection. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
What microbes need: Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Pathogens (harmful Microbes)Bacteria germs Fungi Mushrooms, yeasts Mouth,Feet, Vagina Protozoa Blood, brain Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Pathogens (cont) Rickettsiae Viruses Fleas, ticksRocky mountain spotted fever Viruses Colds, AIDS, herpes Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Normal Flora Microbes that live and grow in a certain area-think “it is normal for them to grow there” Example is e-coli that normally lives in the colon. It can cause infection if it enters the urinary track or is ingested. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Multi-drug resistant organisms (MDROs)MDROs are caused by: Prescribing antibiotics when they are not needed (over-prescribing)- giving them for viruses! 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 Enterococci (VRE) Some microbes can change their structures. This makes them harder to kill. They can survive in the presence of antibiotics. The infections they cause are hard to treat. Staph is a bacterium normally found in the nose and on the skin. MRSA is resistant to antibiotics often used for “staph” infections. MRSA can cause serious wound and bloodstream infections and pneumonia. Enterococcus is a bacterium normally found in the intestines and in feces. When not in their normal site (the intestines), enterococci can cause urinary tract, wound, pelvic, and other infections. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Systemic vs Local InfectionA local infection is in a body part. A systemic infection involves the whole body. The chain of infection is a process that involves a: Source—a pathogen Reservoir—where a pathogen can grow and multiply Portal of exit—allows pathogen to leave the reservoir Method of transmission—a vehicle transmits microbes Portal of entry—where the pathogen enters the body Susceptible host—needed for the microbe to grow and multiply Review the contents of Box 15-1 on p. 214 in the Textbook. Review the Focus on Children and Older Persons: Infection Box on p. 214 in the Textbook. 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. To leave the reservoir, the pathogen needs a portal of exit. Exits are the respiratory, gastro-intestinal, urinary, and reproductive tracts; breaks in the skin; and the blood. The pathogen enters the body through a portal of entry. Portals of entry and exit are the same. Susceptible hosts are persons at risk for infection. The ability to resist infection relates to age, nutrition, stress, fatigue, and health. Drugs, disease, and injury are other factors. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Chain of Infection =sourceCopyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Malaria Chain of Infectionsource reservoir Portal of exit=bite Susceptible host MOT= Portal of entry= bite Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Carrier, Vector, VehicleCarrier-transmits the disease but does not show symptoms Human with HIV but not AIDS Vector-a carrier that transmits disease will not have traces of the disease in immune system Mosquitoes-malaria Vehicle- any substance that transmits microbes Think blood tinted with malaria Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Susceptible hosts-young, elderly, sick, poor health care and burn, chemo, transplant patientsCopyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
HAI-think “hospital caused it”Healthcare-associated infection (HAI) An HAI is an infection that develops in a person cared for in any setting where health care is given. HAIs also are called nosocomial infections. HAIs are caused by: Normal flora Microbes transmitted to the person from other sources The infection is related to receiving health care. Hospitals, nursing centers, clinics, and home care settings are examples. See Box 15-2 on p. 215 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Definitions: Asepsis-being free from disease producing microbes (can be medical or surgical) Sterile- means the absence of all microbes. Pathogens and non-pathogens Contamination- is the process of becoming unclean. Hand washing is an important common aseptic practice. Review the Focus on Children and Older Persons: Common Aseptic Practices Box on p. 216 in the Textbook. Review the Focus on Long-Term Care and Home Care: Common Aseptic Practices Box on p. 217 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Infection Prevention How infections are prevented: Asepsis Medical asepsis (clean technique)- reduces numbers-think hand hygiene, cleaning equipment, disinfection (does not kill spores- bacteria protected by hard shell) Surgical asepsis (sterile technique)- keeps items free of all microbes. 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. The health team must prevent the spread of infection. Review the Focus on Long-Term Care and Home Care: Healthcare-Associated Infection Box on p. 216 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Rules of thumb for patient care:Medical Asepsis Rules of thumb for patient care: Supplies and equipment Most health care supplies and equipment are disposable. Discard single-use items after use. A person uses multi-use items many times-there own toothbrush or hairbrush. Do not “borrow” them for another person. Non-disposable hospital items are cleaned, disinfected, and then sterilized. Your hands are used for almost everything. They are easily contaminated and can spread microbes to other persons or items. Review the rules of hand hygiene in Box 15-3 on pp in the Textbook. Review the Promoting Safety and Comfort: Hand Hygiene Box on p. 219 in the Textbook. Disposable items help prevent the spread of infection. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Surgical Asepsis Surgical asepsis (sterile technique) is required any time the skin or sterile tissues are entered. If a break occurs in sterile technique, microbes can enter the body. Infection is a risk. Requires a sterile field and sterile equipment Foley catheters, IV starts etc. You can assist nurses with sterile procedures. Some states let nursing assistants perform certain sterile procedures. Review the Delegation Guidelines: Assisting With Sterile Procedures Box on p. 238 in the Textbook. Review the Promoting Safety and Comfort: Assisting With Sterile Procedures Box on p. 239 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Barrier Methods (PPE) Gloves GownsWear gloves whenever contact with blood, body fluids, secretions, excretions, mucous membranes, or non-intact skin is likely. Gowns Protect your clothes and body from contact with blood, body fluids, secretions, and excretions. Protect against splashes and sprays. Must completely cover you from your neck to your knees Are used once Are considered contaminated when wet Are disposable and are discarded after use The skin prevents microbes from entering the body. Small skin breaks on the hands and fingers are common. Gloves protect you from pathogens in the person’s blood, body fluids, secretions, and excretions. They also protect the person from microbes on your hands. Wearing gloves is the most common protective measure used with Standard Precautions and Transmission-Based Precautions. Review the Promoting Safety and Comfort: Gloves Box on p. 230 in the Textbook. The gown opens at the back. It is tied at the neck and waist. The gown front and sleeves are considered contaminated. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Standard Precautions-done for every patient, every time!Reduce the risk of spreading known and unknown infections Are used for all persons whenever care is given Prevent the spread of infection from: Blood All body fluids, secretions, and excretions (except sweat) even if blood is not visible Non-intact skin (skin with open breaks) Mucous membranes Review the information in Box 15-5 on pp in the Textbook. Sweat is not known to spread infection. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Transmission based precautions-Isolation PrecautionsIsolation precautions are based on clean and dirty. Clean areas or objects are free of pathogens. Dirty areas or objects are contaminated with pathogens. Clean and dirty also depend on how the pathogen is spread (may need gown and mask if respiratory) Patients in isolation are kept in separate double rooms with their own ventilation areas. If a clean area or object has contact with something dirty, the clean area is now dirty. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Bloodborne Pathogen StandardThe Bloodborne Pathogen Standard (OSHA) is intended to protect the health team from exposure. HIV and HBV: Are found in the blood Are bloodborne pathogens Exit the body through blood Are spread to others by blood Requires exposure control plan-Reason for your Hep B vaccine Blood contaminated items are placed in red biohazard bags and cleaned up with spill kits The human immunodeficiency virus (HIV) and the hepatitis B virus (HBV) are major health concerns. The Bloodborne Pathogen Standard is a regulation of the Occupational Safety and Health Administration (OSHA). Review the contents of Box 15-8 on p. 236 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Bloodborne Pathogen Standard (cont’d)Preventive measures to reduce the risk of exposure include: Hepatitis B vaccination Training for employees Engineering and work practice controls These reduce employee exposure in the workplace. Personal protective equipment (PPE) PPE protects your clothes, undergarments, skin, eyes, mouth, and hair. The hepatitis B vaccine produces immunity against hepatitis B. Immunity means that a person has protection against a certain disease. All tasks involving blood or OPIM are done in ways to limit splatters, splashes, and sprays. Blood or OPIM must not pass through PPE. OSHA-required work practice controls are listed on p. 237 in the Textbook. PPE is free to staff. Correct sizes are available. The agency makes sure that PPE is cleaned, laundered, repaired, replaced, or discarded. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Bloodborne Pathogen StandardExposure incidents An exposure incident is any eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or OPIM. Parenteral means piercing the mucous membranes or the skin. Report exposure incidents at once. Confidentiality is important. The source individual is the person whose blood or body fluids are the source of an exposure incident. Medical evaluation, follow-up, and required tests following an exposure incident are free. You are told of evaluation results and any medical conditions that may need treatment. You receive a written opinion of the medical evaluation within 15 days after its completion. The agency informs you about laws affecting the source’s identity and test results. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Practice State QuestionsWhat is the most important way to prevent the spread of infection? Handwashing, handwashing, handwashing What is the most important part of effective handwashing? Friction! For at least 20 seconds! Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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