Chapter 14

1. Chapter 14 Preventing Infection

2. Infection is a major safety and health hazard. • The health team follows certain practices and procedures to prevent the spread of infection. • Called infection control, such practices and procedures protect patients, residents, visitors, and staff from infection.

3. MICROORGANISMS • A microorganism (microbe) is a small living plant or animal seen only with a microscope. • Microbes are everywhere. • Some microbes are harmful and can cause infections. • They are called pathogens. • Non-pathogens are microbes that do not usually cause an infection.

4. There are five types of microbes: • Bacteria are one-celled plants. • Fungi are plants that live on other plants or animals. • Protozoa are one-celled animals. • Rickettsiae are found in fleas, lice, ticks, and other insects. • Viruses grow in living cells.

5. 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. • They are destroyed by heat and light. • Normal flora are microbes that live and grow in a certain area. • They are non-pathogens when in or on a natural reservoir. • When a non-pathogen is transmitted from its natural site to another site or host, it becomes a pathogen.

6. Multidrug-resistant organisms • Multidrug-resistant organisms (MDROs) are microbes that can resist the effects of antibiotics. • Antibiotics are drugs that kill microbes that cause infections. • MDROs are caused by: • Doctors prescribing antibiotics when they are not needed (over-prescribing) • 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. INFECTION • 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. • The chain of infection is a process involving a: • Source • Reservoir • Portal of exit • Method of transmission • Portal of entry • Susceptible host

8. Healthcare-associated infection (HAI) • An HAI is an infection that develops in a person cared for in any setting where health care is given. • HAIs also are called nosocomial infections. • HAIs are caused by: • Normal flora • Microbes transmitted to the person from another source

9. Common sites for HAIs are: • The urinary system • The respiratory system • Wounds • The bloodstream • HAIs are prevented by: • Medical asepsis, including hand hygiene • Surgical asepsis • Standard Precautions • Transmission-Based Precautions • The Bloodborne Pathogen Standard

10. MEDICAL ASEPSIS • Asepsis is being free of disease-producing microbes. • Medical asepsis (clean technique) is the practices used to: • Remove or destroy pathogens • Prevent pathogens from spreading from one person or place to another person or place • Surgical asepsis (sterile technique) is the practices that keep items free of all microbes.

11. Sterile means the absence of all microbes. • Pathogens and non-pathogens • Sterilization is the process of destroying all microbes. • Contamination is the process of becoming unclean. • In medical asepsis, an item or area is clean when it is free of pathogens. • A sterile item or area is contaminated when pathogens or non-pathogens are present. • Aseptic practices break the chain of infection.

12. 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. • Supplies and equipment • Most health care equipment is disposable. • Single-use items are discarded after use. • A person uses multi-use items many times. • Do not “borrow” them for another person. • Non-disposable items are cleaned, then disinfected, and then sterilized.

13. Cleaning reduces the number of microbes present and removes organic matter. • Disinfection is the process of destroying pathogens. Spores are not destroyed. • Germicides are disinfectants applied to skin, tissues, and non-living objects. • Chemical disinfectants are used to clean surfaces. • Sterilizing destroys all non-pathogens and pathogens, including spores. • Very high temperatures are used.

14. ISOLATION PRECAUTIONS • Blood, body fluids, secretions, and excretions can transmit pathogens. • Sometimes barriers are needed to prevent their escape. • The Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007 is followed. • The guideline was issued by the Centers for Disease Control and Prevention (CDC). • Isolation Precautions prevent the spread of communicable diseases (contagious diseases).

15. Isolation precautions are based on clean and dirty. • Clean areas or objects are free of pathogens. • Dirty areas or objects are contaminated with pathogens. • Clean and dirty also depend on how the pathogen is spread. • The CDC’s isolation precautions guideline has two tiers of precautions: • Standard Precautions • Transmission-Based Precautions

16. Standard Precautions: • Are part of the CDC’s isolation precautions • Reduce the risk of spreading pathogens • Reduce the risk of spreading known and unknown infections • Are used for all persons whenever care is given • Prevent the spread of infection from: • Blood • All body fluids, secretions, and excretions (except sweat) even if blood is not visible • Non-intact skin (skin with open breaks) • Mucous membranes

17. Transmission-Based Precautions • Understanding how certain infections are spread helps you understand Transmission-Based Precautions. • In December of 2005, the CDC issued new guidelines for preventing the spread of tuberculosis (TB). • Airborne Precautions are needed. • Some agencies have airborne infection isolation rooms (AIIR).

18. Protective measures • Isolation precautions involve wearing personal protective equipment (PPE). • Removing linens, trash, and equipment from the room may require double bagging. • Follow agency procedures when collecting specimens and transporting persons.

19. Gloves • Wear gloves whenever contact with blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin is likely. • Gowns protect your clothes and body from contact with blood, body fluids, secretions, and excretions. • They protect against splashes and sprays. • Gowns must completely cover you from your neck to your knees. • Gowns are used once. • A wet gown is contaminated. • Disposable gowns are discarded after use.

20. Masks are worn for these reasons: • For protection from contact with infectious agents from the patient or resident • During sterile procedures to protect the person from infectious agents carried in your nose or mouth • 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 front of goggles or a face shield is contaminated. • Discard disposable goggles or face shields after use. • Reusable eyewear is cleaned before reuse following agency procedures.

21. Contaminated items are bagged to remove them from the person’s room. • Leak-proof plastic bags are used. • Bags have the BIOHAZARD symbol. • Biohazardous waste is items contaminated with blood, body fluids, secretions, or excretions. • Trash is placed in a container labeled with the BIOHAZARD symbol. • Double bagging is not needed unless the outside of the bag is soiled. • Transporting procedures for persons on Transmission-Based Precautions vary among agencies. • A safe transport means that other persons are protected from the infection.

22. Meeting basic needs • Often love, belonging, and self-esteem needs are unmet when Transmission-Based Precautions are used. • Visitors and staff often avoid the person. • The person may feel lonely, unwanted, and rejected. • You can help meet love, belonging, and self-esteem needs. • Always treat the person with respect, kindness, and dignity.

23. BLOODBORNE PATHOGEN STANDARD • The Bloodborne Pathogen Standard is intended to protect the health team from exposure. • HIV and HBV: • Are found in the blood • Are bloodborne pathogens • Exit the body through blood • Are spread to others by blood • Other potentially infectious materials (OPIM) also spread HIV and HBV.

24. Exposure control plan • The agency 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 upon employment and then yearly. • Training is also required for new or changed tasks involving exposure to bloodborne pathogens.

25. Preventive measures to reduce the risk of exposure include: • Hepatitis B vaccination • Engineering and work practice controls • These reduce employee exposure in the workplace. • Personal protective equipment (PPE) • PPE protects your clothes, undergarments, skin, eyes, mouth, and hair.

26. Contaminated equipment is cleaned and decontaminated with a proper disinfectant: • Upon completing tasks • At once when there is obvious contamination • After any spill of blood or OPIM • At the end of the work shift if surfaces became contaminated since the last cleaning • Special measures are used to discard regulated waste. • Containers used for discarding regulated waste are closable, puncture-resistant, leak-proof, color-coded in red, and have the BIOHAZARD symbol. • The agency must be kept clean and sanitary. • Special measures are required for contaminated laundry.

27. Exposure incidents • An exposure incident is any eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or OPIM. • Parenteral means piercing the mucous membranes or the skin barrier. • Report exposure incidents at once. • Confidentiality is important. • The source individual is the person whose blood or body fluids are the source of an exposure incident.

28. SURGICAL ASEPSIS • Surgical asepsis (sterile technique) is the practices that keep equipment and supplies free of all microbes. • Sterile means the absence of all microbes, including spores. • Surgical asepsis (sterile technique) is required any time the skin or sterile tissues are entered. • If a break occurs in sterile technique, microbes can enter the body. • Infection is a risk.

29. Principles of surgical asepsis • All items in contact with the person are kept sterile. • A sterile field is needed. • A sterile field is a work area free of all pathogens and non-pathogens (including spores). • You might need sterile gloves when assisting with a sterile procedure. • The sterile field is set up first. Then sterile gloves are put on. • After sterile gloves are on, you can handle sterile items within the sterile field. • Do not touch anything outside the sterile field.