1. Chapter 13 Preventing Infection All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

2. Infection Prevention   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 (infection control).   Infection control protects residents, visitors, and staff from infection. 2 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

3. 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. 3 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

4. Microbes   Types of microbes   Bacteria are plant life that multiply rapidly.   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.   Rickettsiae are found in fleas, lice, ticks, and other insects.   Viruses grow in living cells.   Requirements of microbes   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. 4 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

5. Microbes (Cont’d)   Microbes are destroyed by heat and light.   The reservoir (host) is the environment in which a microbe lives and grows. People, plants, animals, the soil, food, and water are common reservoirs. 5 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

6. Microbes (Cont’d)   Normal flora are microbes that live and grow in a certain area.   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) 6 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

7. 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.   During an infection, an older person may not show signs or symptoms. The person may have only a slight fever or no fever at all. Redness and swelling may be very slight. The person may not complain of pain. Confusion and delirium may occur. 7 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

8. 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. 8 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

9. Resisting Infection   The ability to resist infection relates to:   Age   Nutrition   Stress   Fatigue   Health   Drugs   Disease and injury 9 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

10. Healthcare-Associated Infection   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—this includes hand hygiene   Surgical asepsis   Standard precautions   Transmission-based precautions   Isolation precautions   The Bloodborne Pathogen Standard 10 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

11. Medical Asepsis   Asepsis is being free of disease-producing microbes.   Measures are needed to achieve asepsis.   Medical asepsis (clean technique)   Surgical asepsis (sterile technique)   Medical asepsis 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.   Sterilization is the process of destroying all microbes.   Contamination is the process of becoming unclean. 11 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

12. 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 12 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

13. Aseptic Practices (Cont’d)   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 your 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.   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. 13 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

14. Use Equipment and Supplies Properly   Supplies and equipment   Most health care equipment is disposable.   Single-use items are discarded after use.   A person uses multiuse items many times.   Non-disposable items are cleaned, then disinfected, and then sterilized.   Cleaning Reduces the number of microbes present Removes organic matter 14 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

15. Disinfection   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.   Hand hygiene, cleaning, disinfection, and sterilization are important aseptic measures. 15 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

16. Isolation Precautions   Isolation precautions prevent the spread of communicable or contagious diseases.   Isolation precautions are based on clean and dirty.   Clean areas or objects are free of pathogens.   Dirty areas or objects are contaminated with pathogens.   The precautions reduce the risk of spreading pathogens.   Standard precautions:   Reduce the risk of spreading pathogens   Reduce the risk of spreading known and unknown infections   Are used in the care of all residents 16 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

17. Standard Precautions   Standard Precautions 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   Understanding how certain infections are spread helps you understand the types of transmission-based precautions. 17 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

18. Protective Measures   Protective measures   Isolation precautions involve: Wearing personal protective equipment (PPE) Using special measures for removing linens, trash, and equipment from the room Following procedures when collecting and transporting specimens Using special measures to transport persons on Isolation precautions 18 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

19. Gowning and Gloving   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 must completely cover you from your neck to your knees. A wet gown is contaminated. Disposable gowns are discarded after use. 19 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

20. Choose the Correct Personal Protective Equipment   Masks and respiratory protection prevent the spread of microbes from the respiratory tract. Masks are disposable. A wet or moist mask is contaminated. 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. 20 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

21. Personal Protective Equipment   Discard disposable eyewear after use. Reusable eyewear is cleaned and disinfected before reuse.   Contaminated items are bagged to remove them from the person’s room. Leakproof plastic bags are used and have the BIOHAZARD symbol. Biohazardous waste is items contaminated with blood, body fluids, secretions, or excretions. Bag and transport linens, trash, equipment, and supplies following center policy. 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. 21 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

22. Meeting Needs of the Isolation Precaution Person   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.   Persons with poor vision need to know who you are. Let them see your face before you put on a mask or goggles or a face shield. State your name and explain what you are going to do. THEN put on PPE. 22 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

23. Bloodborne Pathogen Standard   The Bloodborne Pathogen Standard is:   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)   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.   The plan includes actions to take for an exposure incident.   Staff at risk receive free training. 23 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

24. Exposure Control Plan   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. Use a brush and dustpan or tongs to clean up broken glass. 24 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

25. Contaminated Waste   Special measures are required when discarding regulated waste. Containers used for discarding regulated waste are closable, puncture-resistant, leakproof, 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. 25 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

26. Exposure   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. 26 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

27. 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. 27 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

28. Quality of Life   The health team must prevent the spread of microbes and infection.   Even one careless act can spread microbes. 28 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.