1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 13 Preventing Infection

2. Slide 2 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Infection is a major safety and health hazard.  Older and disabled persons are at risk.  The health team follows certain practices and procedures to prevent the spread of infection.

3. Slide 3 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. MICROORGANISMS  A microorganism (microbe) is a small living plant or animal.  It is seen only with a microscope.  Microbes are everywhere.  Pathogens are harmful and can cause infections.  Non-pathogens are microbes that do not usually cause an infection.

5. Slide 5 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Types of microbes Bacteria are plant life that multiply rapidly. Bacteria are plant life that multiply rapidly. 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 that can infect the blood, brain, intestines, and other body areas. Protozoa are one-celled animals that can infect the blood, brain, intestines, and other body areas. 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. Requirements of microbes Microbes need a reservoir (host) to live and grow. Microbes need a reservoir (host) to live and grow. Most need oxygen to live. Most need oxygen to live. A warm and dark environment is needed. A warm and dark environment is needed. Most grow best at body temperature. Most grow best at body temperature. Microbes are destroyed by heat and light. Microbes are destroyed by heat and light.

6. Slide 6 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Multidrug-resistant organisms (MDROs) are microbes that can resist the effects of antibiotics.  MDROs are caused by:  Doctors prescribing antibiotics when they are not needed  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 Enterococcus (VRE)

7. Slide 7 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. 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.  An infection can become life-threatening before the older person has obvious signs and symptoms.

8. Slide 8 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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  The ability to resist infection relates to: Age Age Nutrition Nutrition Stress Stress Fatigue Fatigue Health Health Drugs Drugs Disease and injury Disease and injury

10. Slide 10 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  A healthcare-associated infection (HAI) is an infection acquired in a health care agency.  HAIs are caused by:  Normal flora  Microbes transmitted to the person from another source  HAIs are prevented by:  Medical asepsis  Surgical asepsis  Isolation Precautions  The Bloodborne Pathogen Standard

11. Slide 11 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. MEDICAL ASEPSIS  Asepsis is being free of disease-producing microbes.  Measures are needed to achieve asepsis. Medical asepsis (clean technique) Medical asepsis (clean technique) Surgical asepsis (sterile technique) Surgical asepsis (sterile technique)  Sterilization is the process of destroying all microbes.  Contamination is the process of becoming unclean.

12. Slide 12 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  To prevent the spread of microbes, also do the following: Provide all persons with their own linens and personal care items. Provide all persons with their own linens and personal care items. Cover your nose and mouth when coughing, sneezing, or blowing your nose. Cover your nose and mouth when coughing, sneezing, or blowing your nose. Bathe, wash hair, and brush your teeth regularly. Bathe, wash hair, and brush your teeth regularly. Wash fruits and raw vegetables before eating or serving them. Wash fruits and raw vegetables before eating or serving them. Wash cooking and eating utensils with soap and water after use. Wash cooking and eating utensils with soap and water after use.  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.

13. Slide 13 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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

19. Slide 19 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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. Non-disposable items are cleaned, then disinfected, and then sterilized. Non-disposable items are cleaned, then disinfected, and then sterilized. Cleaning Cleaning  Reduces the number of microbes present  Removes organic matter

20. Slide 20 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Disinfection is the process of destroying pathogens.  Germicides are disinfectants applied to skin, tissues, and non-living objects.  Chemical disinfectants are used to clean surfaces and reusable items.  Sterilization destroys all non-pathogens and pathogens, including spores.

21. Slide 21 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. ISOLATION PRECAUTIONS  Isolation Precautions prevent the spread of communicable or contagious diseases.  Isolation Precautions are based on clean and dirty.  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 in the care of all residents Are used in the care of all residents

22. Slide 22 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Standard Precautions prevent the spread of infection from: Blood Blood All body fluids, secretions, and excretions (except sweat) even if blood is not visible All body fluids, secretions, and excretions (except sweat) even if blood is not visible Non-intact skin Non-intact skin Mucous membranes Mucous membranes  Understanding how certain infections are spread helps you understand the types of Transmission- Based Precautions.

23. Slide 23 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Protective measures  Isolation Precautions involve:  Wearing personal protective equipment (PPE)  Special measures for removing linens, trash, and equipment from the room  Following procedures when collecting and transporting specimens  Special measures to transport persons on Isolation Precautions

24. Slide 24 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Wear gloves whenever contact with blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin is likely. Wear gloves whenever contact with blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin is likely. Gowns and other attire protect your clothes and body from contact with blood, body fluids, secretions, and excretions. Gowns and other attire protect your clothes and body from contact with blood, body fluids, secretions, and excretions.  Gowns must completely cover you from your neck to your knees.  A wet gown is contaminated.  Disposable gowns are discarded after use.

25. Slide 25 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Masks and respiratory protection prevent the spread of microbes from the respiratory tract. Masks are disposable. Masks are disposable. A wet or moist mask is contaminated. A wet or moist mask is contaminated. Practice hand hygiene before putting on a mask. Practice hand hygiene before putting on a mask.  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. The outside of goggles or a face shield is contaminated. The outside of goggles or a face shield is contaminated.

26. Slide 26 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Discard disposable eyewear after use. Reusable eyewear is cleaned and disinfected before reuse. Reusable eyewear is cleaned and disinfected before reuse.  Contaminated items are bagged to remove them from the person’s room. Leak-proof plastic bags are used. Leak-proof plastic bags are used. Bag and transport linens, trash, equipment, and supplies following center policy. Bag and transport linens, trash, equipment, and supplies following center policy. 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.  Specimens are transported to the laboratory in biohazard specimen bags.  Procedures for transporting persons vary among centers.

45. Slide 45 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Meeting basic needs  Often, love, belonging, and self-esteem needs are unmet when Isolation Precautions are used.  You can help meet love, belonging, and self- esteem needs.

46. Slide 46 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. BLOODBORNE PATHOGEN STANDARD  The Bloodborne Pathogen Standard is: Intended to protect the health team from exposure to blood and other potentially infectious materials (OPIM) Intended to protect the health team from exposure to blood and other potentially infectious materials (OPIM) A regulation of the Occupational Safety and Health Administration (OSHA) A regulation of the Occupational Safety and Health Administration (OSHA)  HIV and HBV are bloodborne pathogens.  The center must have an exposure control plan. It identifies staff at risk for exposure to blood or OPIM. It identifies staff at risk for exposure to blood or OPIM. The plan includes actions to take for an exposure incident. The plan includes actions to take for an exposure incident. Staff at risk receive free training. Staff at risk receive free training.

47. Slide 47 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Preventive measures to reduce the risk of exposure include:  Hepatitis B vaccination  Engineering and work practice controls  Personal protective equipment (PPE)  Contaminated equipment is cleaned and decontaminated. Decontaminate work surfaces with a proper disinfectant. Decontaminate work surfaces with a proper disinfectant. Use a brush and dustpan or tongs to clean up broken glass. Use a brush and dustpan or tongs to clean up broken glass.

48. Slide 48 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Special measures are required when discarding regulated waste.  Containers used for discarding regulated waste are closable, puncture-resistant, leak-proof, and color-coded in red and have the BIOHAZARD symbol.  The center must be kept clean and sanitary.  Special measures are required for contaminated laundry.

49. Slide 49 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Exposure incidents  An exposure incident is any eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or OPIM.  Report exposure incidents at once.  Confidentiality is important.

50. Slide 50 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. SURGICAL ASEPSIS  Surgical asepsis (sterile technique) is the practices that keep equipment and supplies free of all microbes.  Surgical asepsis is required any time the skin or sterile tissues are entered. If a break occurs in sterile technique, infection is a risk. If a break occurs in sterile technique, infection is a risk.

51. Slide 51 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. QUALITY OF LIFE  The health team must prevent the spread of microbes and infection.  Even one careless act can spread microbes.