1. Infection Control by Mary beth vogel, bsn, RN-c

2. Useless (Useful) Facts!
Alcohol-based hand rubs take less time to use than h/w. In an 8hr shift, an estimated 1hr of an ICU nurse's time will be saved by using an alcohol- based handrub (CDC)
The CDC recently reported that in US hospitals, HAI account 1.7 million infections and 99,000 associated deaths each year. Of these infections:
32 % of all HAI infections are UTI’s
22 % are surgical site infections
15 % are pneumonias/VAP
14 % are bloodstream infections

3. Principles of Infection Control
Understanding is essential to all health care workers
Provide a basic knowledge of how disease is transmitted
Main emphasis on prevention of disease transmission

4. Microorganisms or Microbes
Small living organisms
Not visible to the naked eye
Microscope must be used to see them
Found everywhere in the environment
Found on and in the human body
Many are part of normal flora of body
May be beneficial
(continues)

5. Microorganisms or Microbes (continued)
Called nonpathogens when not harmful to the body
Some cause infections and disease
Called pathogens (germs) when able to harm the body
(continues)

6. Microorganisms or Microbes (continued)
Most prefer warm environments
Most prefer darkness
Need source of food and moisture
Need for oxygen varies
Human body is ideal supplier of all the requirements

7. Colonized or Infected: What’s the Difference?
Colonization: carry bacteria w/o evidence of infection
Infection can occur d/t colonization
How?
People who carry bacteria without evidence of infection are colonized.
If an infection develops, it is usually from bacteria that colonize patients.
Bacteria that colonize patients can be transmitted from one patient to another by the hands of healthcare workers.

8. Microbe Classifications
1. Bacteria
2. Protozoa
3. Fungi
4. Rickettsiae
5. Viruses

9. Classifications of Microorganisms

10. 1. Bacteria Simple, one-celled organisms Multiply rapidly
Classified by shape and arrangement
(continues)

11. Bacteria (continued) Streptococci Staphylococci
Cocci are round or spherical in shape
Diplococci—in pairs
Streptococci—in chains
Staphylococci—clusters or groups
Examples of diseases
MRSA, Strep throat, pneumonia
Staphylococci
Streptococci
(continues)

12. Bacteria (continued) Bacillus anthracis and WBC Bacilli are rod shaped
Occur singly, in pairs, or in chains
May have flagella
Ability to form spores
Examples of diseases TB
Tetanus
Pertussis
Botulism
C-diff
Bacillus anthracis and WBC

13. Bacteria (continued) Spirilla are spiral or corkscrew shaped
Includes comma-shaped vibrio and corkscrew spirochete
Diseases include syphilis, cholera, and lyme disease

14. Types/shapes of bacteria

15. Antibiotics Antibiotics are used to kill bacteria
Some strains of bacteria have become antibiotic-resistant
When antibiotic-resistant, the antibiotic is no longer effective against the bacteria

16. 2. Protozoa One-celled, animal-like organism
Found in decayed materials and contaminated water
May have flagella for movement
Some are pathogenic
Examples of diseases
Malaria
Tx: prevention and antiprotozoan agents

17. Malaria

18. 3. Fungi Simple, plant-like organisms Live on dead organic matter
Yeast and molds
Can be pathogenic
Examples of diseases
Ringworm, athlete’s foot, thrush
Antibiotics do not kill
Tx: Antifungal medications

19. Ringworm

20. 4. Rickettsiae Parasitic microorganisms
Cannot live outside the cells of another living organism
Transmitted to humans by the bites of insects (e.g., fleas, lice, ticks, mites)
Examples of diseases
Ticks, fleas, lice, thyphus, tapeworms, rocky mountain fever
Antibiotics are effective against many of them

22. 5. Viruses Smallest microorganisms Must use electron microscope to see
Must be inside another living cell to reproduce
Nucleic acid w/ protein coat
Enters host cell, alters dna, replicates
Spread by blood and body secretions
Very difficult to kill
Cause many diseases
Incubation period varies
Examples:
Common cold, Rhinovirus, mumps, varicella, influenza, hepatitis, HIV/AIDS, epstein-barr, HPV, herpes, measles, enterovirus

23. Viruses (continued)
Viruses infecting animals can mutate to infect humans
Examples include:
Severe acute respiratory syndrome (SARS)
West Nile Virus (WNV)
Monkeypox
Ebola
influenza

25. Virus—Hepatitis B Also called serum hepatitis Caused by HBV
Transmitted by blood serum and body secretions
Affects the liver
Vaccine available for protection
Vaccine is expensive
(continues)

26. Virus—Hepatitis B (continued)
Vaccine given in a series of three injections
By law, employers must provide vaccine at no cost to employees with occupational exposure to blood or other body secretions
If employee refuses, written statement must be signed documenting refusal

27. Hepatitis C Caused by Hcv
Transmitted by blood and blood-containing body fluids
Many infected individuals are asymptomatic
Others have mild symptoms
Can cause severe liver damage
(continues)

28. Hepatitis C (continued)
Currently, no vaccine ready for use
Vaccine is in development stage
Extremely difficult to destroy Hcv
Can survive and remain active for several days in dried blood
Health care workers must follow precautions to protect against virus

29. Hepatitis C

30. Acquired Immune Deficiency Syndrome (AIDS)
Caused by the Human Immunodeficiency Virus (HIV)
Suppresses the immune system
Individual becomes susceptible to cancers and infections that would not affect a healthy person
No cure presently and no vaccine
Take precautions for prevention

31. How Pathogens Cause Infection and Disease
Some produce poisons called toxins
Some cause an allergic reaction
Others attach and destroy the living cells they invade

32. Classifications of Diseases and Infections
Endogenous
Exogenous
Nosocomial
Opportunistic

33. Endogenous Originates within the body
Examples: metabolic disorders, congenital abnormalities, tumors, and infections caused by microorganisms within the body

34. Exogenous Originates outside the body
Examples: radiation, chemical agents, trauma, electric shock, and temperature extremes

35. Nosocomial Acquired in a health care facility (HAI)
Usually present in facilities and carried by health care workers to the patient
Many are antibiotic-resistant
Can cause serious and even life-threatening infections
(continues)

36. Nosocomial (continued)
Examples are staphylococcus, pseudomonas, and enterococci
Infection-control programs are used in facilities to prevent and deal with nosocomial infections

37. Opportunistic Infections that occur when the body’s defenses are down
Usually do not occur in normal immune system
Examples: Kaposi’s sarcoma (rare type of cancer) and Pneumocystis carinii pneumonia in individuals with AIDS
VRE: vancomycin resistant enterococcus
MRSA: methicillin resistant staphylococcus aureus
C-diff: clostridium difficile

38. The Inanimate Environment Can Facilitate Transmission
X represents VRE culture positive sites
In one study, hands of 131 healthcare workers (HCWs) were cultured before, and hands and gloves after, routine care.
A mean of 56% of body sites and 17% of environmental sites were VRE positive.
After touching the patient and environment, 75% of ungloved HCWs hands and 9% of gloved HCWs hands were contaminated with VRE.
After touching only the environment, 21% of ungloved and 0 gloved HCWs hands were contaminated.
The inanimate environment plays a role in facilitating transmission of organisms.

39. Recovery of VRE from Hands and Environmental Surfaces
Up to 41% of HCW’s hands sampled (after patient care and before hand hygiene) were positive for VRE
VRE were recovered from a number of environmental surfaces in patient rooms
VRE survived on a countertop for up to 7 days
Many patients in the hospital acquire Vancomycin-Resistant Enterococci (VRE) from another patient, potentially via the hands of healthcare workers.
In epidemiologic investigations of contamination of the hands of healthcare workers with VRE, up to 41% of hands sampled were positive for VRE.
VRE has been recovered from a number of environmental surfaces in patient rooms, including patient and healthcare worker gowns, door handles, cabinets, floors, blood pressure cuffs, bed rails, urinals, bedpans, and toilet seats.
In one study, VRE survived on a countertop for up to 7 days.

40. Chain of Infection Conditions that allow for spread of infection
6 parts:
1. Causative agent
2. Reservoir
3. Portal of exit
4. Mode of transmission
5. Portal of entry
6. Susceptible host

42. Ending the Chain of Infection
Eliminate any step in the chain and infection is stopped
Follow practices to interrupt or break the chain
Remember, pathogens are everywhere
Prevention is a continuous process

43. Body Defenses Skin Mucous memb Cilia Coughing/sneezing
Chemical inhibitors: tears, HCl
Normal flora
Fever
Inflammation
Immune system (WBC)

44. Aseptic Techniques
Asepsis: absence of disease-producing microorganisms
Contaminated: any object or area that may contain pathogens
Major aim: maintaining cleanliness and eliminating or preventing every aspect of contamination

45. Common Aseptic Techniques
Thorough handwashing
Good personal hygiene
Disposable gloves
Cleaning instruments and equipment
Proper cleaning of environment

46. Levels of Aseptic Control
Antisepsis—used on the skin
Disinfection—used mainly on objects
Sterilization—use of steam under pressure, gas, radiation, and chemicals on objects

47. Bioterrorism
Bioterrorism: use of microorganisms or biologic agents for warfare
Infecting humans, animals, or plants
Have been used over time by different nations not only in war but also on innocent people
Microorganisms with characteristics suitable for bioterrorism:
Inexpensive, available, easily produced, spreads quickly
Maintains its survival
Brings death or disability
Travels from person to person
Difficult to prevent/treat

48. High priority agents include:
Biologic Agents
High priority agents include:
Smallpox: contagious and infectious disease, result of the Variola virus
Anthrax: infectious disease caused by Bacillus anthracis
Plague: infectious disease from the bacteria Yersinia pestis
Botulism: paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinum
Tularemia: infectious disease from the bacteria Fracisella tularensis
Filoviruses: infectious diseases causing severe hemorrhagic fever known as Ebola virus and Marburg virus
(continues)

49. Preparing for Bioterrorism
Bioterrorism attack would result in a public health emergency
Would have impact on health care facilities
Social disorder would ensue
Comprehensive plan
Bioterrorism Act 2002 passed by Congress and signed into law
Involves local, regional, state, and national government and includes:
Early detection by communities
Public to be notified
Infection control and education
Funding available
(continues)

50. Preparing for Bioterrorism (continued)
Guidelines and restrictions
Nationwide immunizations
Protection of food/water supplies
Trained personnel available
Emergency management controls
Investigation of potential threats
Preparation of health care facilities
Efficiency of communication

51. Hand Hygiene Aseptic technique to prevent HAI
Skin, nares colonization can be pathogenic to pts
Protects patients, HCWs, visitors
Observations in public restrooms: only 68% h/w before leaving
When should HCW wash their hands?

52. 2,000,000+ HAI occur annually in the US
2,000,000+ HAI occur annually in the US. HAI billion in extended care and tx
HAI occur in about 7-10% of hospitalized patients and account 90,000+ deaths per year (CDC)
Most HCW recognize the importance of H/W but routinely overestimate their own compliance (CDC)

53. Arrival/Departure
Before/after all pt contact
Anytime contamination occurs
Before/after gloves/PPE
After picking anything up off floor
After bathroom use
After coughing, sneezing, blowing nose
Inbetween procedures to prevent cross contamination

54. After handling any specimen
After handling any contaminated/soiled items
Before/after any contact w/ mucous memb
Before eating
At least 30 seconds!

55. Efficacy of Hand Hygiene Preparations in Killing Bacteria
Good
Better
Best
Plain soap is good at reducing bacterial counts but antimicrobial soap is better, and alcohol-based handrubs are the best.
Plain Soap
Antimicrobial soap
Alcohol-based handrub

56. Which hand hygiene method is best at killing bacteria?
Plain soap and water
Antimicrobial soap and water
Alcohol-based handrub
According to the HICPAC hand hygiene guideline, an alcohol-based handrub is the best at killing bacteria.

57. Which of the following hand hygiene agents is LEAST drying to your skin?
Plain soap and water
Antimicrobial soap and water
Alcohol-based handrub
According to the HICPAC hand hygiene guideline, alcohol-based handrubs, particularly those that contain an emollient, are less drying to your skin than plain soap and water, or antimicrobial soap and water.

58. Ability of Hand Hygiene Agents to Reduce Bacteria on Hands
0.0
1.0
2.0
3.0 60
180
minutes
90.0
99.0
99.9
log %
Bacterial Reduction
Alcohol-based handrub
(70% Isopropanol)
Antimicrobial soap
(4% Chlorhexidine)
Plain soap
Time After Disinfection
Baseline
This graph shows that alcohol-based handrub is better than handwashing at killing bacteria.
Shown across the top of this graph is the amount of time after disinfection with the hand hygiene agent.
The left axis shows the percent reduction in bacterial counts.
The three lines represent alcohol-based handrub, antimicrobial soap, and plain soap.
Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999.

59. Waterless handrub:
Increases compliance
Reduces a greater number of bac
Must apply to all hand surfaces (CDC)
Handwashing:
Sudsy action, alkali content of soap, friction reduce pathogens
Use warm water, good lather, point fingertips down when rinsing
Use paper towel to turn on/off faucets

60. Time Spent Cleansing Hands: one nurse per 8 hour shift
Hand washing with soap and water: 56 minutes
Based on seven (60 second) handwashing episodes per hour
Alcohol-based handrub: 18 minutes
Based on seven (20 second) handrub episodes per hour
The time required for nurses to leave a patient’s bedside, go to a sink, and wash and dry their hands before attending the next patient is a deterrent to frequent handwashing or hand antisepsis.
More rapid access to hand hygiene materials could help improve adherence.
Alcohol-based handrubs may be a better option than traditional handwashing with plain soap and water or antiseptic handwash because they require less time, act faster, and irritate hands less often.
Alcohol-based handrubs reduce time needed for hand disinfection .

61. Can a Fashion Statement Harm the Patient?
ARTIFICIAL
POLISHED
NATURAL
Studies have shown that hospital personnel with artificial nails harbor more potential pathogens both before and after handwashing than personnel with natural nails.
Artificial nails contribute to nail changes that can increase the risk of colonization and transmission of organisms from HCWs to patients.
Natural nail tips should be kept to ¼ inch in length.
Avoid wearing artificial nails, keep natural nails <1/4 inch if caring for high risk patients (ICU, OR)

62. This is one of the materials distributed by CDC to improve hand hygiene in healthcare settings. Buttons, bearing the graphic, as well as other hand hygiene promotional materials, may be found at

63. Standard Precautions CDC regulations
Blood and body fluids are the main ways pathogens are spread
Every body fluid must be considered potential source of infection
All patients must be considered potential source of infection
Major pathogens: HBV, HBC, HIV
Extreme care must be taken at all times when there is an area, object, or person contaminated with blood or body fluids
ALL HCW, ALL THE TIME, FOR ALL Patients!!!!!!!!

64. Standard Precautions Guidelines
Use anytime there is poss contact w/: body fluids
Rules:
H/W guidelines
PPE where indicated
No jewelry
Do not reuse gloves
Masks must be changed q 30 min or if wet
Sharps disposal, no recapping
Spill/splash clean-up
Mouthpieces for resuscitation
Contaminated waste, linen handling
Exposures must be reported!

66. Using Sterile Technique
Many procedures require use of sterile techniques to protect a patient from infection
Surgical asepsis keeps an object or area free from living organisms
Sterile: free from all organisms
Contaminated: organisms and pathogens present
(continues)

67. Using Sterile Techniques
Important to differentiate between sterile and contaminated areas or items while using sterile technique
Correct techniques must be strictly followed to maintain sterility and prevent contamination
Clean working area required
Handling of sterile supplies
Sterile field: area used for placement of sterile supplies
All sterile items need to be checked
Observe agency guidelines for date
Necessary to keep sterile field dry
(continues)

68. Transmission-Based Isolation Precautions
Some diseases are communicable
Caused by organisms that can be transmitted easily
Epidemic—spreads from person to person and affects large numbers
Pandemic—spreads over a wide geographic area
These precautions are in addition to the Standard Precautions
(continues)

69. Transmission-Based Isolation Precautions (continued)
Helps prevent spread of disease
Protects patient, family, and health care workers
Type used depends on the causative organism of the disease

70. How Communicable Diseases Spread
Direct contact with a patient
Contact with dirty linen, equipment, and supplies
Contact with blood, body fluids, secretions, and excretions

71. Terms Defined
Contaminated or dirty: items that contain disease-producing organisms; must not be touched unless protected
Clean: items that do not contain the organisms; protect these areas from contamination

72. Classifications of Precautions
1. Standard precautions
Contact precautions
Airborne precautions
Droplet precautions
Reverse isolation/neutropenic precautions

73. 2. Contact Precautions Most common
Microorganisms spread by direct/indirect contact (VRE, MRSA, C-diff)
Also: GI,skin, eye inf
Standard Precautions plus:
Gown, gloves. Mask if in nares, sputum
Limit pt transport
Dedicated pt care equipment

75. 3. Droplet Precautions
Inf transmitted by lg particle droplets that are expelled by coughing, sneezing, talking
Meningitis, pneumonia, influenza, r/o MRSA
Standard precautions plus:
Masks if w/in 3 feet of pt
Mask pt during any transport

77. 4. Airborne Precautions
Pathogens transmitted by airborne droplet nuclei
TB, chicken pox, rubella
Standard precautions plus:
Specialized air filtration (neg press)
Fit tested masks: N-95,P100 HEPA
Limit pt transport; pt must be masked

79. Protective/Reverse Isolation
For immunocompromised patients
Standard precautions plus:
Private room
Frequent disinf of room, equip
PPE for all who enter
Specialized air filtration
Limit patient transport

81. Blood Borne Pathogens HBV, HCV, HIV Requires all hc facilities to:
Have a written exposure plan
Tx exposures
Provide Hep B vaccine
Provide PPE, h/w facilities, decontam proced, sharps disposal, ee training
No recapping
Post signs for any poss biohazards

82. @6-800,000 needlestick inj occur annually; half go unreported
Post inj risk of transmission: HIV .3%, HCV 1.8%, HBV 2-30% (CDC)
TX: labs, HBV immunoglob and revacc, tetanus, prophylactic
antivirals and
antibiotics

83. Needlestick Safety Act
Update of BBP standard
Employers required to:
Use safer devices
Incorporate technology changes
Solicit input for direct pt care HCW
Maintain sharps injury log