1. Chapter 12
Preventing Infection

2. Infection Infection is a major safety and health hazard.
The health team follows certain practices and procedures to protect patients, residents, visitors, and staff from infection.
Minor infections cause short illnesses.
Some infections are serious and can cause death.
Older and disabled persons are at risk for infection.

3. Microorganisms
A microorganism (microbe) is a small living plant or animal seen only with a microscope.
Pathogens are microbes that are harmful and can cause infections.
Non-pathogens are microbes that do not usually cause an infection.
Microbes need a reservoir (host) to live and grow.
Microbes are everywhere.
Microbes need water and nourishment from the reservoir.
Most microbes need oxygen to live.
A warm and dark environment is needed.
Most grow best at body temperature.
Microbes are destroyed by heat and light.

4. Microorganisms, cont'd.
Multidrug-resistant organisms (MDROs) can resist the effects of antibiotics.
Antibiotics are drugs that kill microbes that cause infections.
MDROs are caused by:
Doctors prescribing antibiotics when they are not needed
Not taking antibiotics for the prescribed length of time
Two common MDROs are resistant to many antibiotics:
Methicillin-resistant Staphylococcus aureus (MRSA)
Vancomycin-resistant Enterococcus (VRE)
Some microbes can change their structures. They can survive in the presence of antibiotics. The infections they cause are hard to treat.
MRSA is commonly called “staph.” It can cause serious wound and bloodstream infections and pneumonia.
VRE can be transmitted to others by contaminated hands, toilet seats, care equipment, and other items that the hands touch.

5. 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.
Review the contents of Box 12-1 on p. 140.

6. The Chain of Infection The chain of infection is a process.
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, gastro-intestinal, urinary, and reproductive tracts; breaks in the skin; and the blood.
Portals of entry and exit are the same.
Susceptible hosts are persons at risk for infection.

7. Resisting Infection The ability to resist infection relates to: Age
Nutrition
Stress
Fatigue
Health
Drugs
Disease
Injury
The human body can protect itself from infection.

8. 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 are caused by:
Microbes normally found in the body
Microbes transmitted to the person from other sources
Microbes can enter the body through equipment and supplies.
Staff can transfer microbes from one person to another and from themselves to others.
HAIs are prevented by:
Medical asepsis (including hand hygiene)
Standard Precautions and Transmission-Based Precautions
The Bloodborne Pathogen Standard
HAIs were once called nosocomial infections.

9. Medical Asepsis Asepsis is being free of disease-producing microbes.
Medical asepsis (clean technique) 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

10. Contamination Contamination is the process of becoming unclean.
In medical asepsis, an item or area is clean when it is free of pathogens.
In medical asepsis, an item or area is contaminated if pathogens are present.
A sterile item or area is contaminated when pathogens or non-pathogens are present.
Sterile means the absence of all microbes.
Aseptic practices break the chain of infection.

11. Common 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
After smoking a cigarette, cigar, or pipe

12. Prevent the Spread of Microbes
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 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.
Review Focus on Older Persons: Common Aseptic Practices on p. 142.

13. 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.
Review the rules in Box 12-2 on p. 143 in the textbook.
Review Promoting Safety and Comfort: Hand Hygiene on p. 143.

14. Supplies and Equipment
Most health care equipment is disposable.
Single-use items are discarded after use.
A person uses multi-use items many times.
Non-disposable items are cleaned and disinfected.
Then they are sterilized.
Cleaning reduces the number of microbes present and removes organic matter.
Disinfection is the process of destroying pathogens.
Sterilization is the process of destroying all microbes (non-pathogens and pathogens).
Very high temperatures are used.
Label multi-use items with the person’s name and room and bed numbers. Do not “borrow” them for another person.
When cleaning equipment, wear personal protective equipment (PPE) when cleaning items contaminated with blood, body fluids, secretions, or excretions.
Germicides are disinfectants applied to skin, tissues, and non-living objects.
Chemical disinfectants are used to clean surfaces and re-usable items.
Review Promoting Safety and Comfort: Disinfection on p. 146.
An autoclave is a pressure steam sterilizer used for glass, surgical items, and metal objects.

15. Other Aseptic Measures
Other aseptic measures include:
Controlling reservoirs (hosts—you or the person)
Controlling portals of exit
Controlling transmission
Controlling portals of entry
Protecting the susceptible host
Review the contents of Box 12-3 on p. 147.

16. Isolation Precautions
Blood, body fluids, secretions, and excretions can transmit pathogens.
Sometimes barriers are needed to prevent their escape.
Recommendations described in the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007 are followed.
The guideline was issued by the Centers for Disease Control and Prevention (CDC).

17. Isolation Precautions, cont'd.
Isolation precautions prevent the spread of communicable diseases (contagious diseases).
They are diseases caused by pathogens that spread easily.
Isolation precautions are based on determining what is clean and what is 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.
If a clean area or object has contact with something dirty, the clean area or object is now dirty.

18. Standard Precautions
The CDC’s isolation precautions guideline has two tiers of precautions:
Standard Precautions
They reduce the risk of spreading pathogens and known and unknown infections.
They are used for all persons whenever care is given.
They 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
Review Delegation Guidelines: Transmission-Based Precautions on p. 151.
Review Promoting Safety and Comfort: Transmission-Based Precautions on p. 151.
Review Focus on Communication: Transmission-Based Precautions on p. 151.
Review the contents of Box 12-6 on p. 151.

19. Transmission-Based Precautions
Understanding how certain infections are spread helps you understand the 3 types of Transmission-Based Precautions.
Contact precautions
Droplet precautions
Airborne precautions
Some infections require Transmission-Based Precautions.

20. Protective Measures Protective measures
Isolation precautions involve wearing personal protective equipment (PPE).
Gloves, a gown, a mask, and goggles or a face shield
Removing linens, trash, and equipment from the room may require double-bagging.
Follow agency procedures when collecting specimens and transporting persons.
Review Promoting Safety and Comfort: Transmission-Based Precautions on p. 151.

21. Gloves and Gowns Gloves Gowns
Wear gloves whenever contact with blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin is likely.
Wearing gloves is the most common protective measure used with Standard Precautions and Transmission-Based Precautions.
Gowns
Gowns protect your clothes and body from contact with blood, body fluids, secretions, and excretions.
They protect against splashes and sprays.
Gowns must completely cover you from your neck to your knees.
Gowns are used once.
A wet gown is contaminated.
Disposable 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.
Contact may be direct. Contact may be with items or surfaces contaminated with blood, body fluids, secretions, or excretions.
Review Promoting Safety and Comfort: Gloves on p. 153.
Gowns prevent the spread of microbes.
The gown opens at the back. It is tied at the neck and waist.
The front of the gown and sleeves are considered to be contaminated.
A wet gown is removed and a dry one put on.

22. Masks and Respiratory Protection
Masks prevent contact with infectious materials from the patient or resident.
Masks are disposable.
A wet or moist mask is contaminated.
Practice hand hygiene before putting on a mask.
When removing a mask, touch only the ties or the elastic bands.
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.
Apply a new mask when contamination occurs.
A mask fits snugly over your nose and mouth.
The front of the mask is contaminated.
The ties, ear-pieces, or headband used to secure the device are considered clean.
Discard disposable goggles or face shields after use.
Re-usable eyewear is cleaned with soap and water before re-use. Then a disinfectant is used.
Review Promoting Safety and Comfort: Goggles and Face Shields on p. 156.

23. Bagging Items Bagging items
Contaminated items are bagged to remove them from the person’s room.
Leak-proof plastic bags are used.
Bags have the biohazard symbol.
Biohazardous waste is items contaminated with blood, body fluids, secretions, or excretions.
Bag and transport linens following agency policy.
Trash is placed in a container labeled with the biohazard symbol.
Follow agency policy for bagging and transporting trash, equipment, and supplies.
Double-bagging is not needed unless the outside of the bag is soiled.
All linen bags need a biohazard symbol. Melt-away bags are common.
Once soiled linen is bagged, no one needs to handle it.
Do not overfill the bag. Tie the bag securely.
Two staff members are needed for double-bagging.

24. Collecting and Transporting
Collecting specimens
Blood, body fluids, secretions, and excretions often require laboratory testing. Specimens are transported to the laboratory in biohazard specimen bags. Follow agency procedures to collect and transport a specimen when a person is on Transmission-Based Precautions.
Transporting persons
Persons on Transmission-Based Precautions usually do not leave their rooms, but sometimes they go to other areas for treatments or tests.
Follow agency procedures for a safe transport when a person is on Transmission-Based Precautions.

25. Meeting Basic Needs Meeting basic needs
Often love, belonging, and self-esteem needs are unmet when Transmission-Based Precautions are used.
You need to:
Remember, the pathogen is undesirable, not the person.
Meet love, belonging, and self-esteem needs.
Visitors and staff often avoid the person. The person may feel lonely, unwanted, and rejected.
Review Focus on Older Persons: Meeting Basic Needs on p. 158.

26. Bloodborne Pathogen Standard
The Bloodborne Pathogen Standard protects against the human immunodeficiency virus (HIV) and the hepatitis B virus (HBV).
It is a regulation of the Occupational Safety and Health Administration (OSHA)

27. Bloodborne Pathogen Standard, cont'd.
HIV and HBV are found in the blood.
They are bloodborne pathogens.
They are spread to others by blood and other potentially infectious materials (OPIMs).
OPIMs are contaminated with blood or with a body fluid that may contain blood.
Semen, vaginal secretions, and saliva
Needles, suction equipment, soiled linens, dressings, and other care items
They exit the body through the blood.

28. Bloodborne Pathogen Standard, cont'd.
Staff at risk for exposure to blood or OPIMs receive free training:
Upon employment
Yearly
For new tasks involving exposure to bloodborne pathogens
For changed tasks involving exposure to bloodborne pathogens

29. Hepatitis B Hepatitis B vaccination
Hepatitis B is a liver disease caused by HBV.
HBV 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.
You can receive the hepatitis B vaccination within 10 working days of being hired.
The agency pays for it.
A vaccination involves giving a vaccine to produce immunity against an infectious disease.
If you refuse the vaccination, you must sign a statement refusing the vaccine. You can have the vaccination later.

30. Engineering and Work Practice Controls
Engineering controls reduce employee exposure in the workplace.
Special containers for contaminated sharps and specimens remove and isolate the hazard from staff.
Containers are:
Puncture-resistant
Leak-proof
Color-coded in red
Have the biohazard symbol
Work practice controls also reduce exposure risks.
All tasks involving blood or OPIMs are done in ways to limit splatters, splashes, and sprays.
Producing droplets is avoided.
OSHA requires these work practice controls:
Do not eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses in areas of occupational exposure.
Do not store food or drinks where blood or OPIMs are kept.
Practice hand hygiene after removing gloves.
Wash hands as soon as possible after skin contact with blood or OPIMs.
Never recap, bend, or remove needles by hand.
When recapping, bending, or removing contaminated needles is required, use mechanical means (forceps) or a one-handed method.
Never shear or break contaminated needles.
Discard contaminated needles and sharp instruments in containers that are:
Closable, puncture-resistant, and leak-proof
Color-coded in red and have the biohazard symbol
Upright and not allowed to overfill

31. PPE Personal protective equipment (PPE)
Blood or OPIMs must not pass through PPE.
They protect your clothes, undergarments, skin, eyes, mouth, and hair.
PPE is free to employees.
OSHA requires special measures for the safe handling and use of PPE.
OSHA requires these measures for the safe handling and use of PPE:
Remove PPE before leaving the work area.
Remove PPE when a garment becomes contaminated.
Place used PPE in marked areas or containers when being stored, washed, decontaminated, or discarded.
Wear gloves when you expect contact with blood or OPIMs.
Wear gloves when handling or touching contaminated items or surfaces.
Replace worn, punctured, or contaminated gloves.
Never wash or decontaminate disposable gloves for re-use.
Discard utility gloves that show signs of cracking, peeling, tearing, or puncturing.

32. Contaminated Equipment
Contaminated equipment is cleaned and decontaminated.
Decontaminate work surfaces with a proper disinfectant:
Upon completing tasks
At once when there is obvious contamination
After any spill of blood or OPIM
At the end of the work shift when surfaces have become contaminated since the last cleaning
Use a brush and dustpan or tongs to clean up broken glass.
Discard broken glass into a puncture-resistant container.
OSHA requires special measures for handling contaminated laundry.
Never pick up broken glass with your hands.
OSHA requires these measures for contaminated laundry:
Handle it as little as possible.
Wear gloves or other needed PPE.
Bag contaminated laundry where it is used.
Mark laundry bags or containers with the biohazard symbol for laundry sent off-site.
Place wet, contaminated laundry in leak-proof containers before transport. The containers are color-coded in red or have the biohazard symbol.

33. Exposure Incidents Exposure incidents
An exposure incident is any eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or OPIMs.
Parenteral means piercing the mucous membranes or the skin barrier.
Report exposure incidents at once.
You are told of any medical conditions that may need treatment.
The source individual is the person whose blood or body fluids are the source of an exposure incident.
Piercing occurs through needle-sticks, human bites, cuts, and abrasions.
After an exposure incident, medical evaluation and follow-up are free.
Your blood is tested for HIV and HBV. If you refuse testing, it is done later if you change your mind.
The agency informs you about laws affecting the source’s identity and test results.
Review Focus on PRIDE: The Person, Family, and Yourself on p. 159.