1. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 14 Preventing Infection

2. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2  Infection is a major safety and health hazard.  The health team follows certain practices and procedures to prevent the spread of infection. Called infection control, such practices and procedures protect patients, residents, visitors, and staff from infection. Called infection control, such practices and procedures protect patients, residents, visitors, and staff from infection.

3. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3  MICROORGANISMS  A microorganism (microbe) is a small living plant or animal seen only with a microscope. Microbes are everywhere. Microbes are everywhere. Some microbes are harmful and can cause infections. Some microbes are harmful and can cause infections.  They are called pathogens. Non-pathogens are microbes that do not usually cause an infection. Non-pathogens are microbes that do not usually cause an infection.

4. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4  There are five types of microbes: Bacteria are one-celled plants. Bacteria are one-celled plants. Fungi are plants that live on other plants or animals. Fungi are plants that live on other plants or animals. Protozoa are one-celled animals. Protozoa are one-celled animals. Rickettsiae are found in fleas, lice, ticks, and other insects. Rickettsiae are found in fleas, lice, ticks, and other insects. Viruses grow in living cells. Viruses grow in living cells.

5. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5  Requirements of microbes Microbes need a reservoir (host) to live and grow. 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.  They are destroyed by heat and light.  Normal flora are microbes that live and grow in a certain area. They are non-pathogens when in or on a natural reservoir. They are non-pathogens when in or on a natural reservoir. When a non-pathogen is transmitted from its natural site to another site or host, it becomes a pathogen. When a non-pathogen is transmitted from its natural site to another site or host, it becomes a pathogen.

6. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6  Multidrug-resistant organisms Multidrug-resistant organisms (MDROs) are microbes that can resist the effects of antibiotics. Multidrug-resistant organisms (MDROs) are microbes that can resist the effects of antibiotics.  Antibiotics are drugs that kill microbes that cause infections. MDROs are caused by: MDROs are caused by:  Doctors prescribing antibiotics when they are not needed (over-prescribing)  Not taking antibiotics for the length of time prescribed Two common types of MDROs are resistant to many antibiotics: Two common types of MDROs are resistant to many antibiotics:  Methicillin-resistant Staphylococcus aureus (MRSA)  Vancomycin-resistant Enterococcus (VRE)

7. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7  INFECTION  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 local infection is in a body part. A systemic infection involves the whole body. A systemic infection involves the whole body.  The chain of infection is a process involving a: Source Source Reservoir Reservoir Portal of exit Portal of exit Method of transmission Method of transmission Portal of entry Portal of entry Susceptible host Susceptible host

8. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 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. 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 also are called nosocomial infections. HAIs are caused by: HAIs are caused by:  Normal flora  Microbes transmitted to the person from another source

9. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9 Common sites for HAIs are: Common sites for HAIs are:  The urinary system  The respiratory system  Wounds  The bloodstream HAIs are prevented by: HAIs are prevented by:  Medical asepsis, including hand hygiene  Surgical asepsis  Standard Precautions  Transmission-Based Precautions  The Bloodborne Pathogen Standard

10. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10  MEDICAL ASEPSIS  Asepsis is being free of disease-producing microbes.  Medical asepsis (clean technique) is the practices used to: Remove or destroy pathogens Remove or destroy pathogens Prevent pathogens from spreading from one person or place to another person or place Prevent pathogens from spreading from one person or place to another person or place  Surgical asepsis (sterile technique) is the practices that keep items free of all microbes.

11. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11  Sterile means the absence of all microbes. Pathogens and non-pathogens Pathogens and non-pathogens  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. In medical asepsis, an item or area is clean when it is free of pathogens. A sterile item or area is contaminated when pathogens or non-pathogens are present. A sterile item or area is contaminated when pathogens or non-pathogens are present.  Aseptic practices break the chain of infection.

12. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12  Hand hygiene Hand hygiene is the easiest and most important way to prevent the spread of infection. Hand hygiene is the easiest and most important way to prevent the spread of infection. Practice hand hygiene before and after giving care. Practice hand hygiene before and after giving care.  Supplies and equipment Most health care equipment is disposable. Most health care equipment is disposable. Single-use items are discarded after use. Single-use items are discarded after use. A person uses multi-use items many times. A person uses multi-use items many times.  Do not “borrow” them for another person. Non-disposable items are cleaned, then disinfected, and then sterilized. Non-disposable items are cleaned, then disinfected, and then sterilized.

13. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13 Cleaning reduces the number of microbes present and removes organic matter. Cleaning reduces the number of microbes present and removes organic matter. Disinfection is the process of destroying pathogens. Spores are not destroyed. Disinfection is the process of destroying pathogens. Spores are not destroyed.  Germicides are disinfectants applied to skin, tissues, and non-living objects.  Chemical disinfectants are used to clean surfaces. Sterilizing destroys all non-pathogens and pathogens, including spores. Sterilizing destroys all non-pathogens and pathogens, including spores.  Very high temperatures are used.

14. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14  ISOLATION PRECAUTIONS  Blood, body fluids, secretions, and excretions can transmit pathogens. Sometimes barriers are needed to prevent their escape. Sometimes barriers are needed to prevent their escape. The Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007 is followed. The Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007 is followed.  The guideline was issued by the Centers for Disease Control and Prevention (CDC). Isolation Precautions prevent the spread of communicable diseases (contagious diseases). Isolation Precautions prevent the spread of communicable diseases (contagious diseases).

15. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15  Isolation precautions are based on clean and dirty. Clean areas or objects are free of pathogens. Clean areas or objects are free of pathogens. Dirty areas or objects are contaminated with pathogens. Dirty areas or objects are contaminated with pathogens. Clean and dirty also depend on how the pathogen is spread. Clean and dirty also depend on how the pathogen is spread.  The CDC’s isolation precautions guideline has two tiers of precautions: Standard Precautions Standard Precautions Transmission-Based Precautions Transmission-Based Precautions

16. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 16  Standard Precautions: Are part of the CDC’s isolation precautions Are part of the CDC’s isolation precautions Reduce the risk of spreading pathogens Reduce the risk of spreading pathogens Reduce the risk of spreading known and unknown infections Reduce the risk of spreading known and unknown infections Are used for all persons whenever care is given Are used for all persons whenever care is given Prevent the spread of infection from: 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

17. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 17  Transmission-Based Precautions Understanding how certain infections are spread helps you understand Transmission-Based Precautions. Understanding how certain infections are spread helps you understand Transmission-Based Precautions. In December of 2005, the CDC issued new guidelines for preventing the spread of tuberculosis (TB). In December of 2005, the CDC issued new guidelines for preventing the spread of tuberculosis (TB).  Airborne Precautions are needed.  Some agencies have airborne infection isolation rooms (AIIR).

18. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 18  Protective measures Isolation precautions involve wearing personal protective equipment (PPE). Isolation precautions involve wearing personal protective equipment (PPE). Removing linens, trash, and equipment from the room may require double bagging. Removing linens, trash, and equipment from the room may require double bagging. Follow agency procedures when collecting specimens and transporting persons. Follow agency procedures when collecting specimens and transporting persons.

19. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 19 Gloves Gloves  Wear gloves whenever contact with blood, body fluids, secretions, excretions, mucous membranes, and non- intact skin is likely. Gowns protect your clothes and body from contact with blood, body fluids, secretions, and excretions. 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 gowns are discarded after use.

20. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 20 Masks are worn for these reasons: Masks are worn for these reasons:  For protection from contact with infectious agents from the patient or resident  During sterile procedures to protect the person from infectious agents carried in your nose or mouth Tuberculosis respirators are worn when caring for persons with tuberculosis (TB). 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. Goggles and face shields protect your eyes, mouth, and nose from splashing or spraying of blood, body fluids, secretions, and excretions.  The front of goggles or a face shield is contaminated.  Discard disposable goggles or face shields after use.  Reusable eyewear is cleaned before reuse following agency procedures.

21. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 21 Contaminated items are bagged to remove them from the person’s room. 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. Trash is placed in a container labeled with the BIOHAZARD symbol. Trash is placed in a container labeled with the BIOHAZARD symbol. Double bagging is not needed unless the outside of the bag is soiled. Double bagging is not needed unless the outside of the bag is soiled. Transporting procedures for persons on Transmission- Based Precautions vary among agencies. Transporting procedures for persons on Transmission- Based Precautions vary among agencies.  A safe transport means that other persons are protected from the infection.

22. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 22  Meeting basic needs Often love, belonging, and self-esteem needs are unmet when Transmission-Based Precautions are used. Often love, belonging, and self-esteem needs are unmet when Transmission-Based Precautions are used.  Visitors and staff often avoid the person.  The person may feel lonely, unwanted, and rejected. You can help meet love, belonging, and self-esteem needs. You can help meet love, belonging, and self-esteem needs.  Always treat the person with respect, kindness, and dignity.

23. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 23  BLOODBORNE PATHOGEN STANDARD  The Bloodborne Pathogen Standard is intended to protect the health team from exposure.  HIV and HBV: Are found in the blood Are found in the blood Are bloodborne pathogens Are bloodborne pathogens Exit the body through blood Exit the body through blood Are spread to others by blood Are spread to others by blood  Other potentially infectious materials (OPIM) also spread HIV and HBV.

24. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 24  Exposure control plan The agency must have an exposure control plan. The agency 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 upon employment and then yearly.  Training is also required for new or changed tasks involving exposure to bloodborne pathogens.

25. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 25  Preventive measures to reduce the risk of exposure include: Hepatitis B vaccination Hepatitis B vaccination Engineering and work practice controls Engineering and work practice controls  These reduce employee exposure in the workplace. Personal protective equipment (PPE) Personal protective equipment (PPE)  PPE protects your clothes, undergarments, skin, eyes, mouth, and hair.

26. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 26 Contaminated equipment is cleaned and decontaminated with a proper disinfectant: Contaminated equipment is cleaned and decontaminated 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 if surfaces became contaminated since the last cleaning Special measures are used to discard regulated waste. Special measures are used to discard regulated waste.  Containers used for discarding regulated waste are closable, puncture-resistant, leak-proof, color-coded in red, and have the BIOHAZARD symbol. The agency must be kept clean and sanitary. The agency must be kept clean and sanitary. Special measures are required for contaminated laundry. Special measures are required for contaminated laundry.

27. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 27  Exposure incidents An exposure incident is any eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or OPIM. 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 barrier. Report exposure incidents at once. Report exposure incidents at once. Confidentiality is important. Confidentiality is important. The source individual is the person whose blood or body fluids are the source of an exposure incident. The source individual is the person whose blood or body fluids are the source of an exposure incident.

28. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 28  SURGICAL ASEPSIS  Surgical asepsis (sterile technique) is the practices that keep equipment and supplies free of all microbes. Sterile means the absence of all microbes, including spores. Sterile means the absence of all microbes, including spores.  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. If a break occurs in sterile technique, microbes can enter the body.  Infection is a risk.

29. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 29  Principles of surgical asepsis All items in contact with the person are kept sterile. All items in contact with the person are kept sterile. A sterile field is needed. A sterile field is needed.  A sterile field is a work area free of all pathogens and non-pathogens (including spores).  You might need sterile gloves when assisting with a sterile procedure. The sterile field is set up first. Then sterile gloves are put on. The sterile field is set up first. Then sterile gloves are put on. After sterile gloves are on, you can handle sterile items within the sterile field. After sterile gloves are on, you can handle sterile items within the sterile field.  Do not touch anything outside the sterile field.