INFECTION PREVENTION and CONTROL
Mar 29, 2015
INFECTION PREVENTION and CONTROL
Standard Precautions OR ….How to prevent the spread of disease
NORMAL DEFENSES
Types of Infections
Heath Care-Associated Infections formerly called nosocomial
HAIs Iatrogenic:
Exogenous:
Endogenous:
CHAIN OF INFECTION
Cholera Outbreak in Haiti
Cholera
Nepalese peacekeeping force
Poop
Latrines near water
River
Drinking contaminated water
Historical Perspective 1847 Dr. Ignaz Philip Semmelweiss
Significance of hand washing is demonstrated
Concept of nosocomial infection is born
More History
Infectious Disease Process
Infection:
Normal flora:
Colonization:
Chain of Infection
Causative Agents Bacteria
Virus
Fungi
Protozoa
Characteristics of Causative Agents
Reservoirs
NCLEX ? Which of the following is an example of a
nursing intervention that is implemented to reduce a reservoir of infection for a client?
A) Covering the mouth and nose when sneezingB) Wearing disposable glovesC) Isolating client’s articlesD) Changing soiled dressings
Portal of Exit: The path by which the infectious agent leaves the
reservoir Respiratory Tract:
GU Tract
GI Tract:
Skin/Mucous Membranes:
Transplacental
Blood:
Mode of Transmission
The mechanism for transfer of an infectious agent from the reservoir to the susceptible host
VIGNETTE
An older adult, hospitalized with a GI disorder is on bedrest and requires assistance for uncontrolled diarrhea stools.
Following one episode of cleaning the patient and changing the bed linens, the nurse went to a second patient to provide tracheostomy care.
The nurse’s hands were not washed before assisting the second patient
VIGNETTE ANALYSIS
Infectious agent → Escherichia Coli
Reservoir → Large Intestines
Portal of Exit → Feces
Mode of Transmission → Nurses Hands
Portal of Entry → Tracheostomy
Susceptible Host → Older Adult with Trach
Modes of Transmission
Contact
Airborne
Vector-Borne
Contact Direct:
Indirect:
Modes of Transmission
Direct Person to
Person (Fecal-Oral) Hepatitis A
Staph
Indirect Contact with
contaminated object Hepatitis B
and C
HIV
RSV
MRSA
Airborne Droplets suspended in air after coughing
and sneezing or carried on dust particles TB Chicken Pox Measles (Rubeola) Aspergillus
Droplet transmission Large particles Can travel up to
3 feet Influenza
Rubella (3-day/German Measles)
Bacterial Meningitis
Vector-Borne Vector
External mechanical transfer Mosquito, Louse, Flea, Tick, Fly
West Nile Virus Malaria Lyme Disease Hanta Virus
Portal of Entry: path by which an infectious agent enters the
susceptible host Respiratory tract
GU tract
GI tract
Transplacental (fetus from mother)
Parenteral: percutaneous, via blood
Skin/Mucous Membranes
Susceptible Host A person or animal lacking effective
resistance to a particular pathogenic agent
Man-Made Epidemics (NYT
July 15, 2012)
Diseases have always come out of the woods
and wildlife
West Nile Virus
American Robin Thrives in our backyards and agriculture
fields
Mosquitoes that spread the disease find robins particularly appealing
H1N1
Lyme Disease .
Ebola
SARS
Bird Flu
Isolation Precautions Historical perspective 1877 to present
1877
Aseptic technique
1910
“Barrier” Nursing Hospital personnel wear gowns between
patients
Handwashing between patients with antiseptic solutions after patient contact
Disinfection of objects contaminated by patients
More Hx 1950s: Infectious Disease hospitals begin to
shut down except for TB sanitariums
1960s: TB hospitals begin to shut down
1970: CDC publishes first manual on Isolation Techniques for Use in Hospitals. Diseases were lumped into categories
1980s: Hospitals began to experience new endemic and epidemic nosocomial infection problems caused by multi-drug-resistant organisms
HX 1980: CDC publishes new Isolation guidelines
1985: Universal precautions come into being (HIV, HBV, blood borne pathogens)
1990s HICPAC: 2 tier system
Standard Precautions
Transmission-Based Precautions (Contact, Droplet, Airborne)
HAIs
Surgical Sites
Blood Stream
Urinary System
Cardiovascular
Eye/Ear/Throat/Mouth Infection
Reproductive System
Respiratory
Bone and Joint Infection
CNS
Gastrointestinal
Skin and Soft Tissue
Immunocompromised Pts
Vary in their susceptibility to HAIs
Depends on the severity and duration of immunosupression.
Use the two-tiered system
Neutropenic precautions
Critical Thinking Question
Clients in the healthcare setting are at risk for acquiring or developing infections because:
Prevention Most HAIs are transmitted by the HCWs and
clients as the result of direct contact
We as nurses must pay attention to
handwashing after contact with clients and equipment
Prevention Microorganisms move through space on air
currents
Microorganisms are transferred from one surface to another whenever objects touch, a clean item touching a less clean item becomes “dirty”
Microorganisms are transferred by gravity when one item is held above another
Prevention Microorganisms are released into the air on
droplet nuclei whenever a person breaths or speaks-
Microroganisms move slowly on dry surfaces, but very quickly through moisture –
Proper handwashing removes many of the microorganaisms that would be transferred by the hands from one item to another-
always wash hands between patients.
Prevention To reduce susceptibility provide adequate
nutrition and rest, promote body defenses against infection and provide immunization
Superbugs MRSA
VRE: Vancomycin resistant enterococcus
Break The Chain! Implement ASEPSIS: absence of disease-
producing microorganisms; refers to practices/procedures that assist in reducing the risk of infection
2 Types Medical (clean technique)
Surgical (sterile technique)
MEDICAL ASEPSIS
Clean technique:
Aseptic technique
3 components to the technique: Hand washing,
Barriers of PPE (gloves, gowns, mask, protective eyewear)
Routine environmental cleaning
Contaminated area:
Disinfection/Sterilization
Disinfection = the process that eliminates many or all microorganisms, with the exception of bacterial spores, from inanimate objects
Sterilization = complete elimination or destruction of all microorganism, including spores
Aseptic technique Handwashing is the single most important
procedure for preventing the transfer of microorganisms and therefore preventing the spread of HAIs
CD recommends 10-15 second hand wash.
Personal Hygiene Restrain Hair: hair falling forward may drop
organisms
Keep nails short: no acrylic nails or chipped nail polish
Minimum jewelry (see agency policy)
Cover open wounds with an occlusive dressing.
When should hands be washed
CDC GUIDELINES Standard Precautions apply to:
Blood
All body fluids and secretions (feces, urine, mucus, wound drainage) except sweat
Non-intact skin
Mucous membranes
Respiratory secretions
STANDARD PRECAUTIONSTIER 1
Hand Hygiene: see next slide
Gloves: for touching blood, body fluids, secretions, excretions, non-intact skin, mucous membranes or contaminated areas
Masks, Eye Protection or Face Shields: if in contact w/ sprays or splashes of body fluids
Gowns: to protect your clothing
Contaminated Linen: place in leak-proof bag so no contact with skin or mucous membranes
Respiratory Hygiene/Cough Etiquette: provide client with tissues and containers for disposal; stand ~3 feet away from coughing; use masks prn
Hand Hygiene
ISOLATION PRECAUTIONSTIER 2
Contact = private room or cohort clients, gloves and gowns MDRO, C-Diff, RSV
Droplet = private room or cohort clients, mask is required Strept, pertusis, mumps, flu
Airborne = private room, negative airflow, hepa filtration; N95 respirator mask required TB, chickenpox, measles
Protective Environment = private room, positive-pressure room; hepa filtration; gloves, gowns, mask (controversial); NO flowers or potted plants Stem cell transplant
N95 Respirator
STANDARD PRECAUTIONS
Handwashing
Gloves (PPE)
Masks (PPE)
Eye Protection (PPE)
Gowns (PPE)
Leak-proof linen bags
Puncture proof containers for sharps
Donning and Removing PPE Donning
Gown
Mask or respirator
Goggles/face shield
Gloves
Keep hands away from face
Work from clean to dirty
Lime surfaces touched
Change when torn or heavily soiled
Removing Gloves
Goggles/face shield
Gown
Mask or respirator
Remove at doorway before leaving pt. room
Perform hand hygiene immediately after removing all PPE
Surgical Asepsis Sterile technique that prevents
contamination of an open wound, serves to isolate the operative area from the unsterile environment, and maintains sterile field for surgery
Principles of Surgical Asepsis
For which procedure would the nurse use aseptic technique and which would require the nurse to use sterile technique?
A) Aseptic technique for urinary catheterization in the hospital and sterile technique for cleaning surgical wound
B) Aseptic technique for changing the patient’s linen and sterile technique for assisting in surgery
C) Aseptic technique for food preparation and sterile technique for starting an IV line
D) Aseptic technique for a spinal tap and sterile technique for placing a central line
LAB Practice: Isolation Precautions
Demonstrate donning Isolation Gown, Mask, Gloves, Eyewear
Demonstrate removing Isolation Gown, Mask, Gloves, Eyewear
Demonstrate proper disposal of PPE before leaving Isolation Room
When performing care/treatments use hospital provided stethoscope and leave in the room
Lab Practice Cont’d. Practice pretending you are entering patient
room (use curtains) and give Complete Bed Bath and do Bed Linen Change wearing PPE (gown, mask, gloves)
Remember to dispose of PPE INSIDE the patient’s room before you leave
Practice bringing in all the supplies you need so you can stay in the room & not have to leave (de-gown etc) and come back in (re-gown etc)
LAB Practice: Sterile Procedures
Opening sterile packages – Flap fartherest away from nurse first, then sides, then flap closest to nurse
Preparing a sterile field
Pouring sterile solutions – label to palm, “lip” it
Donning sterile gown and gloves
Critical Thinking Exercise
Mrs. Jaycock had an indwelling urethral catheter for 1 week. The catheter has now been out for 24 hours. She complains of frequency and pain on urination. Mrs. Jaycock suggests reinsertion of the catheter because of the need to get up frequently. What can frequency or pain on urination be an indication of?
Answer UTI
Should the catheter be reinserted?
Why or why not?
Answer No reinserting the catheter may aggravate
the infection and promote the spread of the infection to the bloodstream.
Describe at least one appropriate assessment measure and one independent nursing action or intervention for Mrs. Jaycock
Nursing Response Increase her fluid intake if not clnically
contraindicated
Check her urinalysis
Situation You are caring for Mr. Huang, who has a large
open, and draining abdominal wound. You notice another health care worker changing Mr. Huang’s dressing without wearing gloves or using sterile technique. When you question the health care worker regarding his or her practice, this person says, “Don’t worry, the wound is already infected, and the antibiotics and drainng will take care of any contaminants.” How would you respond to this comment?
Response It is important to not only protect Mr. Huang
from additional infection, but also to protect ourselves from becoming contaminated.
What would your next steps be in following up on this incident?
Situation Mrs. Niles is 83 years of age and lives alone.
She has difficulty walking and relies on a church volunteer group to deliver lunches during the week. Her fixed income limits her ability to buy food. Last week, Mrs. Niles’ 79-year-old sister died. The two sisters had been very close. As a home care nurse, explain the factors that might increase Mrs. Niles’ risk for infection.
Response Age
Potential for poor nutrition
Potential for depression
Situation Mr. Vargas is admitted to the facility with a
history of recent weight loss, a cough that has persisted for 2 months, and hemoptysis. His chest x-ray film shows a cavity lesion in one lung, and his physician suspects tuberculosis. What type of isolation precautions would you use for Mr. Vargas? What protection would you use to provide care? What education would you provide to the family?
Response Airborne precautions
Wear an N95 mask
Keep the door closed
Educate the pt and family on transmission of TB and reason for isolation.