1. RET 1024L Introduction to Respiratory Therapy Lab
Module 3.0
Infection Control

2. Infection Control Specialized Equipment Handling
Equipment Handling Procedure
Equipment handling procedures help prevent the spread of pathogens

3. Infection Control Specialized Equipment Handling
Equipment Handling Procedure
Nebulizers
Large Volume Nebulizers
Always fill with STERILE water
Do not add fluid to partially filled reservoirs – discard old fluid first
Drain tubing condensate away from patient – not back into reservoir (considered contaminated waste)

4. Infection Control Specialized Equipment Handling
Equipment Handling Procedure
Nebulizers
Small Volume Nebulizers
Between treatment on the same patient, rinse with sterile water and air-dry
Use only sterile fluids for nebulization and dispense these fluids aseptically
When possible, use single-use medication vials

5. Infection Control Specialized Equipment Handling
Equipment Handling Procedure
Humidifiers
Whenever possible, prefilled, sterile disposable humidifiers should be used
With reusable humidifiers, fluid reservoirs should be filled with sterile distilled water
Do not add fluid to partially filled reservoirs – discard old fluid first

6. Infection Control Specialized Equipment Handling
Equipment Handling Procedure
Humidifiers
Prefilled, disposable humidifiers can be used safely for up to 30 days
Prefilled, sterile, disposable humidifiers do not need to be changed between patients in high-use areas such as recovery room

7. Infection Control Specialized Equipment Handling
Equipment Handling Procedure
Bag-Valve-Mask Devices
BVMs should be sterilized or high-level disinfected between patients
Exterior surface should be cleaned of visible debris and disinfected at least once a day

8. Infection Control Specialized Equipment Handling
Equipment Handling Procedure
Ventilators and Ventilator Circuits
An inspiratory (high-efficiency particulate air/aerosol (HEPA) filter should be placed between the machinery and the external circuit
Expiratory filters also prevent pathogens from being expelled into the surroundings from the patient’s expired air
Use sterile water to fill bubble type humidifiers

9. Infection Control Specialized Equipment Handling
Equipment Handling Procedure
Ventilators and Ventilator Circuits
Contaminated condensate in the patients breathing circuit needs to be drained away from the patient – not back into reservoir (considered contaminated waste)
Autogenous infection may result
Wash hands after draining tubing condensate or handling the fluid

10. Infection Control Specialized Equipment Handling
Equipment Handling Procedure
Condensation

11. Infection Control Specialized Equipment Handling
Equipment Handling Procedure
Ventilators and Ventilator Circuits
Change HMEs according the manufacturers recommendation and/or whenever gross contaminants or dysfunction are observed
Do not routinely change HME breathing circuits while in use

12. Infection Control

13. Infection Control Specialized Equipment Handling
Equipment Handling Procedure
Pulmonary Function Equipment
Tubing, connectors, rebreathing valve and mouth pieces should be subjected to high-level disinfection or sterilization between patients

14. Infection Control
Precautions To Prevent Transmission of Infectious Agents
Because of the nature of the hospital workplace, occupational exposure to blood and body fluids is expected. This repeated exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious body fluids

15. Infection Control Barrier Measures
The major route for the spread of infections is by contacting infected persons. Thus measures that place “barriers” between the source and the host can help prevent the spread of infection.

16. Infection Control Barrier Measures Handwashing
Personal Protective Equipment (PPE)
Gloves
Masks
Goggles
Gowns
Patient Placement
Patient Transport

17. Infection Control Barrier Measures Handwashing
The most common route for transmission of nosocomial infection is hand contact
Careful, methodical handwashing before and after patient contact, is the single most effective way to reduce exposing patients to contagious disease

18. Infection Control
Barrier Measures
Handwashing

19. Infection Control Barrier Measures Handwashing
You may not realize you have germs on your hands!
The photo shows a blood agar plate 24 hours after an ICU nurse placed her hand on plate

20. Infection Control Barrier Measures Handwashing – Indications
Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items, even if wearing gloves
Wash hands immediately after removing gloves, between patient contacts, and when otherwise indicated to avoid cross contaminations

21. Infection Control Barrier Measures Handwashing – Indications
Wash hand between tasks and procedures on the same patient if cross contamination of different body sites is possible (e.g., tracheostomy care following assistance with a bedpan)
Use plain soap for routine handwashing; use an antimicrobial soap or a waterless antiseptic if specified by the infection control program

22. Infection Control Barrier Measures Handwashing – Indications
When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water
If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands

23. Infection Control Barrier Measures Handwashing
Remove jewelry (rings, watches, bracelets), turn on water (avoid hot water) and thoroughly wet wrists and hands

24. Infection Control Barrier Measures Handwashing
Apply 3-5 mL of soap to hands and rub together for at least 15 seconds; cover all surfaces of the wrists, hands and fingers

25. Infection Control Barrier Measures Handwashing
Scrub the palm of the hand

26. Infection Control Barrier Measures Handwashing
Washing between digits and back of hand

27. Infection Control Barrier Measures Handwashing
Washing around the cuticle

28. Infection Control Barrier Measures Handwashing
Rinse wrists and hands with water and dry with a clean paper towel

29. Infection Control Barrier Measures Handwashing
Using paper towel, turn off faucet

30. Infection Control Barrier Measures Handwashing
When using an alcohol-based handrub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. Note that the volume needed to reduce the number of bacteria on hands varies by product.

31. Infection Control Barrier Measures CDC Guideline for Fingernails
“Health care personnel should avoid wearing artificial nails and keep natural nails less than one quarter of an inch long if they care for patients at high risk of acquiring infections (e.g. Patients in intensive care units or in transplant units)”

32. Infection Control Barrier Measures Gloves
Three major reasons for wearing gloves
Protects caregivers from contacting a patient’s contaminated blood, body fluids, secretions, excretions, mucous membranes, nonintact skin, and other potentially infectious material
Protection of patients from colonized healthcare workers during invasive procedures
Reduce the likelihood of cross contamination between patient’s via caregivers’ hands

33. Infection Control Barrier Measures Gloves
Wash hands before putting on gloves
Clean, non-sterile gloves are satisfactory for most purposes; however, caregivers must wear sterile gloves during invasive procedures
Should be changed between each patient contact

34. Infection Control Barrier Measures Gloves
Should be changed after direct contact with infectious material, even if in the middle of a procedure
Hands must always be washed after removal of gloves
Invisible defects in gloves
Contamination occurs when removed

35. Infection Control Barrier Measures Gloves
Learn to recognize the symptoms of latex allergy: skin rash, hives, flushing, itching, nasal, eye, or sinus symptoms, asthma

36. Infection Control Barrier Measures
Masks, Goggles, Face Shields and Respiratory Protection
Provide protection of eyes, nose, and mouth against contact transmission of pathogens
Should be worn during procedures that can generate splashing or sprays of blood, body fluids, secretions or excretions

37. Infection Control Barrier Measures
Masks, Goggles, Face Shields and Respiratory Protection
Masks become ineffective when moist
Should be discarded after each use
N95 respirators must be worn for protective use with TB
National Institute for Occupational Safety and Health (NIOSH)

38. Infection Control Barrier Measures
Gowns, Aprons, and Protective Apparel
Prevent clothing contamination
Protect skin from blood and body fluids

39. Infection Control Barrier Measures
Gowns, Aprons, and Protective Apparel
Worn when caring for patients with contagious disorders
May help reduce cross contamination
Should be removed before leaving patient’s room
Worn only once, then discarded
Sterile gowns should be worn when caring for patients with burns or wounds

40. Infection Control Barrier Measures PPE - Putting It All On
Put on isolation gown – opening in the back
If needed, shoe covering would go on first
Place mask / respirator on face
Need to be “fit-tested” for N95 respirator mask
Put on goggles or face shield
Don correct type / size gloves

41. Infection Control Barrier Measures Using PPE Effectively
Work from “clean to dirty” areas
Touch as few surfaces and items with your PPE as possible
Keep gloved hands away from face

42. Infection Control Barrier Measures Using PPE Effectively
If gloves become torn or heavily soiled, remove them, wash hands, and replace them even if you are working with only one patient
Avoid touching or adjusting other PPE

43. Infection Control Barrier Measures PPE - Taking It All Off
Remove all PPE, except respirators, at the doorway, before leaving the patient’s room. Respirators are to be removed outside of the patient’s room and discarded in the designated waste receptacle

44. Infection Control Barrier Measures PPE - Taking It All Off Gloves
Outside of gloves are contaminated!
Grasp the outside edge of one glove near the wrist and peel the glove away from hand
While holding the removed glove in your gloved hand, slide the ungloved finger under the wrist of the remaining glove and peel it off. Dispose of your gloves in the appropriate biohazard container (red bag)

45. Infection Control Barrier Measures Taking It All Off – PPE
Goggles/Face Shield
Outside of goggles or face shield are contaminated!
To remove, handle by clean head band or ear pieces
Place in designated receptacle for reprocessing or in waste container

46. Infection Control Barrier Measures PPE - Taking It All Off Gowns
Gown front and sleeves are contaminated!
Unfasten neck, then waist ties
Remove gown by peeling it away from your neck and shoulders
Turn the contaminated outside of the gown toward the inside
Hold the gown away from your body and fold it into a bundle
Discard it in the appropriate biohazard container (red bag).

47. Infection Control Barrier Measures Taking It All Off – PPE
Mask or Respirator
Front of mask/respirator is contaminated!
Untie the bottom and then the top ties of mask, remove it from your face and discard it in the appropriate biohazard container (red bag)

48. Infection Control Barrier Measures Taking It All Off – PPE
Perform hand hygiene immediately after removing PPE

49. Infection Control Barrier Measures Patient Placement
Private rooms help prevent …
Contact transmission
Droplet transmission
Airborne transmission (negative pressure room)

50. Infection Control Barrier Measures Transport of Infected Patients
Transporting infected patients should be limited
The patient being transported needs to wear appropriate PPE
Masks, gowns, impervious dressings

51. Infection Control Barrier Measures
Handling of Contaminated Articles and Equipment
Contaminated items, whether reusable or disposable, should be enclosed in an impervious bag before removal from a patient’s room
Prevents accidental exposure of personnel and environment
Must be bagged without contaminating the bag’s outer surface, otherwise; double bag
Reusable patient-care equipment must be delivered to the applicable processing area

52. Infection Control Barrier Measures
Handling of Contaminated Articles and Equipment
All disposable articles contaminated with blood or body fluids must be disposed of in the proper biohazard container

53. Infection Control Barrier Measures Used Needles and Syringes
Contaminated “sharps” can transmit hepatitis and HIV
Never recap used needles; use one-handed “scoop” method or mechanical device

54. Infection Control One-handed “Scoop” Method
To safely recap needles, use the "one-hand" technique:
Step 1 Place the cap on a flat surface, then remove your hand from the cap.
Step 2 With one hand, hold the syringe and use the needle to "scoop up" the cap.
Step 3 When the cap covers the needle completely, secure the cap onto the needle hub by pressing the cap against a hard surface, e.g., table

55. Infection Control
Mechanical Needle Recapping Devices

56. Infection Control
Be careful !!!

57. Infection Control Used Needles and Syringes
Always dispose of sharps in an appropriate puncture-resistant container

58. Infection Control Handling Laboratory Specimens Gathering Specimens
Do not contaminate exterior of the container
Place in a impervious bag appropriately labeled
Transport in a sturdy container with a secure lid

59. Infection Control Isolation Precautions
Specific combinations of barrier methods
Two levels of Isolation precaution
Standard precautions
Used in caring for ALL patients
Transmission-based precautions
Added to standard precautions when dealing with patients with known or suspected pathogens; contact, droplet, airborne

60. Infection Control Isolation Precautions Standard Precautions
Used when caring for ALL patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is given
These include:
Hand hygiene
Gloves
Gowns
Mask
Eye protection or face shield
Handling of contaminated equipment

61. Infection Control Isolation Precautions Standard Precautions
Application of standard precautions is determined by the extent of anticipated blood, body, fluid, or pathogen exposure
Gloves
Worn when touching blood, body fluids, secretions, excretions, mucous membranes, nonintact skin and contaminated items is anticipated

62. Infection Control Isolation Precautions Standard Precautions Gowns
Worn during procedures and patient-care activities when contact of clothing/exposed skin with blood/body fluids, secretions, and excretions is anticipated
Mask, eye protection (goggles), face shield
Worn during procedures and patient-care activities likely to generate splashes or sprays of blood, body fluids, secretions, especially suctioning, endotracheal intubation

63. Infection Control Isolation Precautions Standard Precautions
Respiratory Hygiene/Cough Etiquette – NEW!
Instruct symptomatic persons to cover mouth/nose when sneezing/coughing; use tissues and dispose in no-touch receptacle; observe hand hygiene after soiling of hands with respiratory secretions; wear surgical mask if tolerated or maintain spatial separation, >3 feet if possible

65. Infection Control

66. Infection Control Isolation Precautions Contact Precautions
Intended to prevent transmission of infectious agents which are spread by direct or indirect contact with the patient or the patient’s environment
Single patient room is preferred (cohorting may be required with spatial separation of ≥ 3 feet)
Gowns and gloves are worn for all interactions that involve contact with the patient or contaminated areas in the patient’s environment

67. Infection Control Isolation Precautions Contact Precautions
Donning PPE upon room entry and discarding before exiting the patient room is done to contain pathogens
Common examples of diseases
C. difficile
VRE
Staphylococcal and enteric bacterial infection

68. Infection Control

69. Infection Control Isolation Precautions Droplet Precautions
Intended to prevent the transmission of pathogen spread through close respiratory or mucous membrane contact with respiratory secretions
Special air handling and ventilation are not required to prevent transmission – the door of the room may remain open
Single patient room is preferred (cohorting may be required with spatial separation of ≥ 3 feet with curtains drawn)

70. Infection Control Isolation Precautions Droplet Precautions
Healthcare personnel wear a mask (a respirator is not necessary) for close contact – generally donned upon entering the room
Transport patient with a surgical mask if tolerated and follow Respiratory Hygiene/Cough Etiquette
Some respiratory diseases transmitted via droplets:
H. Influenza (Epiglotitus)
Meningitis
Streptococcal pneumonia
Influenza
Rubella (German measles)

71. Infection Control

72. Infection Control Isolation Precautions Airborne Precautions
Prevent the transmission of infectious agents that remain infectious over long distances when suspended in the air
Common examples of airborne transmitted diseases:
Legionellosis
M. tuberculosis (TB)
Varicella (Chicken pox)
Rubeola virus (Measles)

73. Infection Control Isolation Precautions Airborne Precautions
Special air handling and ventilation are required in patient rooms and in certain special procedure rooms (bronchoscopy suite)
12 air exchanges/hr – new construction and renovation
6 air exchanges/her – existing facilities
Air is exhausted directly outside or recirculated through a HEPA filtration before return

74. Infection Control Isolation Precautions Airborne Precautions
Special air handling and ventilation

75. Infection Control Isolation Precautions Airborne Precautions
Place patient in a private room; if not possible, place patient in a room with a patient who has active infection with the same microorganism (cohorting)
The door to the patient’s room must remain closed and the patient in the room
Healthcare personnel caring for the patient must wear a mask or respirator (N95), depending on the disease-specific recommendations – donned prior to entering the room, removed outside the room
If patient transport is essential, place a surgical mask on the patient

76. Infection Control

77. Infection Control Isolation Precautions Neutropenic Precautions
AKA: Reverse Isolation or Protective Precautions
Primarily used for the following types of patients with:
Extensive burns
Neutropenia; abnormally low number of neutrophils caused by immunosuppressive therapies, e.g., chemotherapy, radiation, or disease

78. Infection Control Isolation Precautions Neutropenic Precautions
Private room with positive pressure - door closed
Strict hand-hygiene
PPE (gloves, gowns, masks) kept outside of the room
PPE removed outside of the room
Transport only if necessary
Patient to wear mask and gown