INFECTION PREVENTION and CONTROL

1. INFECTION PREVENTION and CONTROL

2. Standard Precautions • OR ….How to prevent the spread of disease

3. NORMAL DEFENSES

4. Types of Infections • Heath Care-Associated Infectionsformerly called nosocomial HAIs • Iatrogenic: • Exogenous: • Endogenous:

5. CHAIN OF INFECTION

6. Cholera Outbreak in Haiti • Cholera • Nepalese peacekeeping force • Poop • Latrines near water • River • Drinking contaminated water

7. Historical Perspective • 1847 Dr. Ignaz Philip Semmelweiss • Significance of hand washing is demonstrated • Concept of nosocomial infection is born

8. More History

9. Infectious Disease Process • Infection: • Normal flora: • Colonization:

10. Chain of Infection

11. Causative Agents Bacteria Virus Fungi Protozoa

12. Characteristics of Causative Agents

13. Reservoirs

14. 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

15. Portal of Exit: The path by which the infectious agent leaves the reservoir • Respiratory Tract: • GU Tract • GI Tract: • Skin/Mucous Membranes: • Transplacental • Blood:

16. Mode of Transmission • The mechanism for transfer of an infectious agent from the reservoir to the susceptible host

17. 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

18. 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

19. Modes of Transmission • Contact • Airborne • Vector-Borne

20. Contact • Direct: • Indirect:

21. Modes of Transmission • Direct • Person to Person (Fecal-Oral) • Hepatitis A • Staph • Indirect • Contact with contaminated object • Hepatitis B and C • HIV • RSV • MRSA

22. Airborne • Droplets suspended in air after coughing and sneezing or carried on dust particles • TB • Chicken Pox • Measles (Rubeola) • Aspergillus

23. Droplet transmission • Large particles • Can travel up to 3 feet • Influenza • Rubella (3-day/German Measles) • Bacterial Meningitis

24. Vector-Borne • Vector • External mechanical transfer • Mosquito, Louse, Flea, Tick, Fly • West Nile Virus • Malaria • Lyme Disease • Hanta Virus

25. 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

26. Susceptible Host • A person or animal lacking effective resistance to a particular pathogenic agent

27. Man-Made Epidemics (NYT July 15, 2012)

28. Diseases have always come out of the woods and wildlife

29. West Nile Virus

30. American Robin • Thrives in our backyards and agriculture fields • Mosquitoes that spread the disease find robins particularly appealing

31. H1N1

32. Lyme Disease • .

33. Ebola

34. SARS

35. Bird Flu

36. Isolation Precautions • Historical perspective 1877 to present • 1877 • Aseptic technique • 1910

37. “Barrier” Nursing • Hospital personnel wear gowns between patients • Handwashing between patients with antiseptic solutions after patient contact • Disinfection of objects contaminated by patients

38. 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

39. 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)

40. 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

41. Immunocompromised Pts • Vary in their susceptibility to HAIs • Depends on the severity and duration of immunosupression. • Use the two-tiered system • Neutropenic precautions

42. Critical Thinking Question • Clients in the healthcare setting are at risk for acquiring or developing infections because:

43. 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

44. 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

45. 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.

46. Prevention • To reduce susceptibility provide adequate nutrition and rest, promote body defenses against infection and provide immunization

47. Superbugs • MRSA • VRE: Vancomycin resistant enterococcus

48. 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)

49. 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:

50. 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