Chapter 15

Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 15Chapter 15

Preventing InfectionPreventing Infection


Infection is a major safety and health hazard. Infection is a major safety and health hazard. Older and disabled persons are at risk.Older and disabled persons are at risk.

The health team follows certain practices and The health team follows certain practices and procedures to prevent the spread of infection procedures to prevent the spread of infection (infection control).(infection control).

Infection control protects residents, visitors, Infection control protects residents, visitors, and staff from infection.and staff from infection.

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MicroorganismsMicroorganisms

A microorganism (microbe) is a small living A microorganism (microbe) is a small living plant or animal.plant or animal. It is seen only with a microscope.It is seen only with a microscope.

Microbes are everywhere.Microbes are everywhere. Pathogens are harmful and can cause infections.Pathogens are harmful and can cause infections. Non-pathogens are microbes that do not usually Non-pathogens are microbes that do not usually

cause an infection.cause an infection.

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Types of microbesTypes 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 Protozoa are one-celled animals that can infect the blood, brain, intestines, and

other body areas.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 microbesRequirements 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.Microbes need water and nourishment from the reservoir. 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. The reservoir (host) is the environment in which a microbe lives and The reservoir (host) is the environment in which a microbe lives and

grows. People, plants, animals, the soil, food, and water are grows. People, plants, animals, the soil, food, and water are common reservoirs. common reservoirs.

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Normal flora are microbes that live and grow in a Normal flora are microbes that live and grow in a certain area.certain area.

Multidrug-resistant organisms (MDROs) are Multidrug-resistant organisms (MDROs) are microbes that can resist the effects of antibiotics.microbes that can resist the effects of antibiotics.

MDROs are caused by:MDROs are caused by: Doctors prescribing antibiotics when they are not Doctors prescribing antibiotics when they are not

needed.needed. Not taking antibiotics for the length of time prescribed.Not taking antibiotics for the length of time prescribed.

Two common types of MDROs are resistant to Two common types of MDROs are resistant to many antibiotics.many antibiotics. Methicillin-resistant Methicillin-resistant Staphylococcus aureusStaphylococcus aureus (MRSA) (MRSA) Vancomycin-resistant Vancomycin-resistant EnterococcusEnterococcus (VRE) (VRE)

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InfectionInfection

An infection is a disease state resulting from the An infection is a disease state resulting from the invasion and growth of microbes in the body.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.

An infection can become life-threatening An infection can become life-threatening beforebefore the older person has obvious signs and the older person has obvious signs and symptoms.symptoms.

During an infection, an older person may not During an infection, an older person may not show signs or symptoms. The person may have show signs or symptoms. The person may have only a slight fever or no fever at all. Redness and only a slight fever or no fever at all. Redness and swelling may be very slight. The person may not swelling may be very slight. The person may not complain of pain. Confusion and delirium may complain of pain. Confusion and delirium may occur.occur.

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The chain of infection is a process.The chain of infection is a process. It begins with a source (a pathogen)It begins with a source (a pathogen) It must have a reservoir where it can grow and multiply.It must have a reservoir where it can grow and multiply. To leave the reservoir, the pathogen needs a portal of To leave the reservoir, the pathogen needs a portal of

exit. exit. After leaving the reservoir, the pathogen must be After leaving the reservoir, the pathogen must be

transmitted to another host. transmitted to another host. The pathogen enters the body through a portal of The pathogen enters the body through a portal of

entry.entry. A susceptible host is needed for the microbe to grow A susceptible host is needed for the microbe to grow

and multiply.and multiply.

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The ability to resist infection relates to:The ability to resist infection relates to: AgeAge NutritionNutrition StressStress FatigueFatigue HealthHealth DrugsDrugs Disease and injuryDisease and injury

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A healthcare-associated infection (HAI) is an infection A healthcare-associated infection (HAI) is an infection acquired in a health care agency.acquired in a health care agency.

HAIs are caused by:HAIs are caused by: Normal floraNormal flora Microbes transmitted to the person from another sourceMicrobes transmitted to the person from another source

HAIs are prevented by:HAIs are prevented by: Medical asepsis—this includes hand hygieneMedical asepsis—this includes hand hygiene Surgical asepsisSurgical asepsis Standard PrecautionsStandard Precautions Transmission-Based PrecautionsTransmission-Based Precautions Isolation PrecautionsIsolation Precautions The Bloodborne Pathogen StandardThe Bloodborne Pathogen Standard

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Medical AsepsisMedical Asepsis

Asepsis is being free of disease-producing microbes.Asepsis is being free of disease-producing microbes. Measures are needed to achieve asepsis.Measures are needed to achieve asepsis.

Medical asepsis (clean technique)Medical asepsis (clean technique) Surgical asepsis (sterile technique) Surgical asepsis (sterile technique)

Medical asepsis Medical asepsis is the practices used to:is the practices used to: Remove or destroy pathogens. The number of pathogens is Remove or destroy pathogens. The number of pathogens is

reduced.reduced. Prevent pathogens from spreading from one person or Prevent pathogens from spreading from one person or

place to another person or place.place to another person or place. Sterilization is the process of destroying all microbes.Sterilization is the process of destroying all microbes. Contamination is the process of becoming unclean.Contamination is the process of becoming unclean.

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To prevent the spread of microbes, wash your To prevent the spread of microbes, wash your hands:hands: After urinating or having a bowel movementAfter urinating or having a bowel movement After changing tampons or sanitary padsAfter changing tampons or sanitary pads After contact with your own or another person’s After contact with your own or another person’s

blood, body fluids, secretions, or excretionsblood, body fluids, secretions, or excretions After coughing, sneezing, or blowing your noseAfter coughing, sneezing, or blowing your nose Before and after handling, preparing, or eating Before and after handling, preparing, or eating

foodfood

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To prevent the spread of microbes, also do the following:To prevent the spread of microbes, also do the following: Provide all persons with their own linens and personal care Provide all persons with their own linens and personal care

items.items. Cover your nose and mouth when coughing, sneezing, or Cover your nose and mouth when coughing, sneezing, or

blowing your nose.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 Wash cooking and eating utensils with soap and water after

use. use. Hand hygieneHand hygiene

Hand hygiene is the easiest and most important way to prevent Hand hygiene is the easiest and most important way to prevent the spread of infection.the spread of infection.

Practice hand hygiene before and after giving care.Practice hand hygiene before and after giving care.

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Supplies and equipmentSupplies 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 Non-disposable items are cleaned, then

disinfected, and then sterilized.disinfected, and then sterilized. CleaningCleaning

• Reduces the number of microbes presentReduces the number of microbes present

• Removes organic matterRemoves organic matter

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Disinfection is the process of destroying Disinfection is the process of destroying pathogens.pathogens.

Germicides are disinfectants applied to skin, Germicides are disinfectants applied to skin, tissues, and non-living objects.tissues, and non-living objects.

Chemical disinfectants are used to clean surfaces Chemical disinfectants are used to clean surfaces and reusable items.and reusable items.

Sterilization destroys all non-pathogens and Sterilization destroys all non-pathogens and pathogens, including spores.pathogens, including spores.

Hand hygiene, cleaning, disinfection, and Hand hygiene, cleaning, disinfection, and sterilization are important aseptic measures.sterilization are important aseptic measures.

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Isolation PrecautionsIsolation Precautions

Isolation precautions prevent the spread of Isolation precautions prevent the spread of communicable or contagious diseases.communicable or contagious diseases.

Isolation precautions are based on clean and dirty.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. The precautions reduce the risk of spreading pathogens.The precautions reduce the risk of spreading pathogens.

Standard Precautions:Standard Precautions: Reduce the risk of spreading pathogensReduce the risk of spreading pathogens Reduce the risk of spreading known and unknown Reduce the risk of spreading known and unknown

infectionsinfections Are used in the care of all residentsAre used in the care of all residents

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Standard Precautions prevent the spread of Standard Precautions prevent the spread of infection from:infection from: BloodBlood All body fluids, secretions, and excretions (except All body fluids, secretions, and excretions (except

sweat), even if blood is not visiblesweat), even if blood is not visible Non-intact skinNon-intact skin Mucous membranesMucous membranes

Understanding how certain infections are Understanding how certain infections are spread helps you understand the types of spread helps you understand the types of Transmission-Based Precautions.Transmission-Based Precautions.

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Protective measuresProtective measures Isolation Precautions involve:Isolation Precautions involve:

• Wearing personal protective equipment (PPE)Wearing personal protective equipment (PPE)

• Using special measures for removing linens, trash, and Using special measures for removing linens, trash, and equipment from the room equipment from the room

• Following procedures when collecting and transporting Following procedures when collecting and transporting specimensspecimens

• Using special measures to transport persons on Isolation Using special measures to transport persons on Isolation PrecautionsPrecautions

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Wear gloves whenever contact with blood, body Wear gloves whenever contact with blood, body fluids, secretions, excretions, mucous membranes, fluids, secretions, excretions, mucous membranes, and non-intact skin is likely.and non-intact skin is likely.

Gowns and other attire protect your clothes and Gowns and other attire protect your clothes and body from contact with blood, body fluids, body from contact with blood, body fluids, secretions, and excretions.secretions, and excretions.• Gowns must completely cover you from your neck to Gowns must completely cover you from your neck to

your knees.your knees.

• A wet gown is contaminated.A wet gown is contaminated.

• Disposable gowns are discarded after use.Disposable gowns are discarded after use.

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Masks and respiratory protection prevent the Masks and respiratory protection prevent the spread of microbes from the respiratory tract.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 Tuberculosis respirators are worn when caring for persons with tuberculosis (TB).persons with tuberculosis (TB).

Goggles and face shields protect your eyes, Goggles and face shields protect your eyes, mouth, and nose from splashing or spraying of mouth, and nose from splashing or spraying of blood, body fluids, secretions, and excretions.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.

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Discard disposable eyewear after use.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 Contaminated items are bagged to remove them from the person’s room.person’s room.

• Leak-proof plastic bags are used and have the Leak-proof plastic bags are used and have the BIOHAZARD symbol.symbol.

• Biohazardous waste is items contaminated with blood, body fluids, Biohazardous waste is items contaminated with blood, body fluids, secretions, or excretions.secretions, or excretions.

• Bag and transport linens, trash, equipment, and supplies following Bag and transport linens, trash, equipment, and supplies following center policy. center policy.

• Double bagging is not needed unless the outside of the bag is Double bagging is not needed unless the outside of the bag is soiled.soiled.

Specimens are transported to the laboratory in biohazard Specimens are transported to the laboratory in biohazard specimen bags.specimen bags.

Procedures for transporting persons vary among centers.Procedures for transporting persons vary among centers.

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Meeting basic needsMeeting basic needs Often, love, belonging, and self-esteem needs are Often, love, belonging, and self-esteem needs are

unmet when Isolation Precautions are used.unmet when Isolation Precautions are used. You can help meet love, belonging, and self-You can help meet love, belonging, and self-

esteem needs.esteem needs. Persons with poor vision need to know who you Persons with poor vision need to know who you

are.are.• Let them see your face before you put on a mask or Let them see your face before you put on a mask or

goggles or a face shield.goggles or a face shield.

• State your name and explain what you are going to do.State your name and explain what you are going to do.

• THEN put on PPE.THEN put on PPE.

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Bloodborne Pathogen StandardBloodborne Pathogen Standard

The Bloodborne Pathogen Standard is:The Bloodborne Pathogen Standard is: Intended to protect the health team from exposure to Intended to protect the health team from exposure to

blood and other potentially infectious materials (OPIM)blood and other potentially infectious materials (OPIM) A regulation of the Occupational Safety and Health A regulation of the Occupational Safety and Health

Administration (OSHA)Administration (OSHA) HIV and HBV are bloodborne pathogens.HIV and HBV are bloodborne pathogens. The center must have an exposure control plan.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 The plan includes actions to take for an exposure

incident.incident. Staff at risk receive free training.Staff at risk receive free training.

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Preventive measures to reduce the risk of Preventive measures to reduce the risk of exposure include:exposure include: Hepatitis B vaccinationHepatitis B vaccination Engineering and work practice controlsEngineering and work practice controls Personal protective equipment (PPE)Personal protective equipment (PPE) Contaminated equipment is cleaned and Contaminated equipment is cleaned and

decontaminated.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 Use a brush and dustpan or tongs to clean up broken glass.glass.

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Special measures are required when discarding Special measures are required when discarding regulated waste.regulated waste.

• Containers used for discarding regulated waste areContainers used for discarding regulated waste are closable, puncture-resistant, leak-proof, and color-coded closable, puncture-resistant, leak-proof, and color-coded in red and have the in red and have the BIOHAZARDBIOHAZARD symbol. symbol.

The center must be kept clean and sanitary.The center must be kept clean and sanitary. Special measures are required for contaminated Special measures are required for contaminated

laundry.laundry.

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Exposure incidentsExposure incidents An exposure incident is any eye, mouth, other An exposure incident is any eye, mouth, other

mucous membrane, non-intact skin, or parenteral mucous membrane, non-intact skin, or parenteral contact with blood or OPIM.contact with blood or OPIM.

Report exposure incidents at once.Report exposure incidents at once. Confidentiality is important.Confidentiality is important.

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Surgical AsepsisSurgical Asepsis

Surgical asepsis (sterile technique) is the Surgical asepsis (sterile technique) is the practices that keep equipment and supplies practices that keep equipment and supplies free of all microbes.free of all microbes.

Surgical asepsis is required any time the skin Surgical asepsis is required any time the skin or sterile tissues are entered.or sterile tissues are entered. If a break occurs in sterile technique, infection is a If a break occurs in sterile technique, infection is a

risk.risk.

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Quality of LifeQuality of Life

The health team must prevent the spread of The health team must prevent the spread of microbes and infection.microbes and infection.

Even one careless act can spread microbes.Even one careless act can spread microbes.

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Chapter 15

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