Chapter 42 Infection Control

1. Chapter 42Infection Control

2. Infection Control • Clients in all healthcare settings at risk for acquiring nosocomial infections (infections acquired in the healthcare facility, also known as hospital-acquired infections.)

3. Infection Control, cont. • Prevention is best method of infection control. • Control successful when the chain of infection broken • Several types of infection control/prevention methods used. • Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires healthcare facilities to have an effective infection control plan to qualify for accreditation

4. Infection Control Plan • Plan must include • An infection control committee • Surveillance of nosocomial infections • Employee health program • Isolation policies

5. Infection Control Plan, cont. • Plan must include, cont. • Infection control in-service education for employees • Procedures for environmental sanitation • Available microbiology laboratory • Infection control procedures for client care

6. Isolation Precaution Guidelines • Per Centers for Disease Control and Prevention (CDC) and the Hospital Infection Control Practices Advisory Committee (HICPAC) • Two tiers of precautions • Standard Precautions • Used for all clients • Transmission-Based Precautions • Used with clients with specific infections or diagnoses

7. **Infection Control Committee • Provide a central place for reporting infections • Investigate cases of infection • Determine the cause of infection • Maintain total statistics related to the numbers and types of infections that occur in the facility • Serve as consultants in cases of questions or concerns by healthcare personnel • Work to prevent further recurrences

8. Standard Precautions • First and most important • Care of all clients, regardless of diagnosis or infection status • Universal Precautions • Designed to reduce the risk of transmission of blood-borne pathogens Body Substance Isolation • Designed to reduce the transmission of pathogens from moist body substances

9. Standard Precautions, cont. • *Precautions apply to • Blood • All body fluids • Secretions • Excretions (except sweat) • Nonintact skin • Mucous membranes

10. Occupational Safety and Health Administration (OSHA) Regulations:Blood-Borne Pathogens (BBP) • Requires and enforces • Implementation of policies, procedures, and control measures • Prevention of employee exposure to the blood and body fluids of clients • Provide free hepatitis B immunizations to staff who might be exposed to blood/body fluids.

11. Nursing Alert • You must report unusual exposure to potential infection (eg, a needle stick) immediately. • OSHA requires initial screening and follow-up care. • KEY CONCEPT • *Blood and body fluids flushed , if the amount of fluid or tissue is too large or bulky to be flushed, it must be bagged in a biohazard bag

12. Transmission-Based Precautions • Implemented when caring for clients with a suspected or known infectious disease, based on the disease’s route of transmission • Three types • Airborne precautions • Droplet precautions • Contact precautions

13. Transmission-Based Precautions, cont.

14. Airborne Precautions • *Tiny microorganisms from evaporated droplets remain suspended in the air or are carried on dust particles • Air currents disperse the microorganisms; susceptible host can easily inhale • *Special air handling and ventilation required to prevent disease transmission • TB • Measles • Chickenpox • *Private room with monitored negative airflow pressure • 6-12 air changes occur/her with air being discharged to the outdoors or specially filtered before circulating to other areas of the healthcare facility • Doors to rooms with airborne precautions kept closed • Respiratory protection necessary-special mask!!

15. Droplet Precautions • *Droplets containing microorganisms are propelled through the air from an infected person and deposited on the host’s eyes, nose, or mouth. • Transmission • Sneezing • Coughing • Talking • During procedures such as suctioning

16. Droplet Precautions, cont. • Private room or may share a room with another client with the same infectious disease • Room door may remain open • Wear a mask when working within 3 feet of the client. • Client wears mask if he/she must be transported to an area outside the room • **Examples of diseases on droplet precautions: • Strept. Pharyngitis • Pertussis • Influenza • Mumps • rubella

17. Contact Precautions • Most frequent mode of disease transmission in healthcare facilities* • Transmission occurs as a result of direct contact between a susceptible host’s body surface and an infected or colonized person • Colonization • Occurs when a microorganism is present in a client, but he or she shows no clinical signs or symptoms of infection • Indirect contact • Occurs when a susceptible host comes into contact with an intermediate contaminated object

18. Contact Precautions, cont. • **Examples include: gastroenterititis and respiratory, skin and wound infections • May be placed in a room with other clients who are infected with the same microorganism if a private room is unavailable • Door may remain open • Wear gloves when entering the room and remove them before leaving. • Change your gloves after contact with a client’s infective material.

19. Contact Precautions, cont. • Wash your hands with an antimicrobial agent or waterless antiseptic agent. • Wear a gown, gloves, and mask into the room if you anticipate contact with infectious matter, and remove them before leaving the room. • Try to restrict the use of noncritical equipment to one client only. • Clean and disinfect equipment before using it for other clients.

20. Isolation • Standard Precautions and Transmission-Based Precautions are isolation guidelines. • Two primary types of isolation systems • Category-specific isolation • Disease-specific isolation

21. Category-Specific Isolation • Specific categories of isolation identified, based on client’s diagnosis • Color-coded cards posted outside client’s room • Visitors check with nurses before entering.

22. Disease-Specific Isolation • Single all-purpose sign • Select the items on the card that are appropriate for the specific disease that is causing isolation.

23. Nursing Measures in Isolation • Setting up a client’s room for isolation • Client must stay in his/her own room • Follow facility’s policy and procedure for isolation. • Items to be placed outside the room or in the anteroom include a stand or cabinet stocked with PPE’s required for the clients type of isolation* • Use PPE. • Education and preparation • Explain the reasons for the isolation precautions to the client and family. • Client may become lonely • Make every effort to visit!

24. Nursing Alert • If you will be working in a pediatric unit, determine your immune status regarding the communicable diseases of childhood. • Young children may not understand good handwashing and need supervision • Keep surfaces clean • Shared toys must have cleanable surfaces, don’t share stuffed animals and dolls • You may require immunization to prevent exposure and infection.

25. Administering Medications in Isolation • Follow Standard Precautions. • Suggestions for clients in isolation • *Unwrap medications before going into the client’s room. • Rationale: Unwrapping will be difficult to do after you put on gloves. • *To avoid accidental needlestick, DO NOT break or recap needles or detach them from syringes!! • *If you will need juice or applesauce in which to mix medications, take it with you into the room.

26. Isolation: Specimen Collection • Label container before collecting a specimen. • Place specimen on a clean paper towel in the anteroom. • Carefully scrub the container after you are outside the room. • Place the specimen into a sealable plastic bag identified with the standard “biohazard” label.

27. Isolation: Specimen Collection, cont. • Wash your hands again. • Take the specimen to the laboratory as soon as possible. • Use only clean hands to touch the request cards and the outside of the bag containing the specimen.

28. Isolation: Taking Vital Signs • Use the equipment in the room. • Do not bring items in with you. • *Wear gloves and whatever other PPE is indicated. • *Use disposable thermometers, cuffs, and stethoscopes if available.

29. Double-Bagging • Refuse and linen are “double-bagged” outside the client’s room. • Procedure is no longer used in all facilities because refuse and linen from all clients are considered contaminated and treated as such • Requires two nurses • Nurse inside the room is considered “contaminated” • Nurse outside is considered “clean”

30. Transporting the Client • When transporting a client in isolation to another area • Wear PPE as needed. • Make sure the client wears appropriate PPE as indicated by his or her condition. • Control and contain any of the client’s drainage. • Drape the wheelchair or stretcher with a clean sheet or bath blanket. Wrap the client with the clean material.

31. Antibiotic-Resistant Organisms • Methicillin-resistant Staphylococcus aureus (MRSA) • Cultures are taken in nares and/or specific wound or drainage sites. • Vancomycin-resistant Enterococcus (VRE) • Cultures are obtained from the perirectal (around the rectum) area and/or an open wound or drainage site.

32. Protective Isolation • Protective isolation (reverse or neutropenic isolation) attempts to prevent harmful microorganisms from coming into contact with the client. • The client requires a private room or total neutropenic unit. • Persons with communicable diseases may not enter. • Others entering the room must wear a mask and practice strict handwashing. • Special linens, scrub suits, and shoe covers may be used.

33. Protective Isolation (cont’d) • The client cannot receive fresh fruit, fresh vegetables, or flowers. • Rectal temperatures, enemas, suppositories, intravenous and intramuscular injections, and other invasive procedures are to be avoided, if possible. • The tympanic/ear probe or forehead sensor for monitoring the client’s temperature is recommended. • A blood culture may be necessary if any reason exists to suspect infection. • Special air purification measures are used.

34. Client on Contact Precaution • Clients with MRSA and VRE are placed on Contact Precautions and must have a private room. • All people interacting with the client must use suitable PPE, and all equipment remains in the isolated client’s room.

36. Hepatitis A • oCause-unknown or from contaminated food and seafood from sewage (feces: animal/human) handling of food from infected persons who do not wash their hands • oS/s-incubation for 4 weeks, patient is infectious for 7-10 days • oTx: vaccination or if you have had Hep. A, your body may become immune to future exposures (does not produce a carrier state)

37.   Hepatitis B • oVirus transmitted by sexual contact with infected individuals, sharing needles with infected individuals, tattooing, piercing, accidental needlesticks • oIncubation period 30-180 days • oTx: Vaccination

38. Hepatitis C • oMutates rapidly, no vaccine • oSusceptible people: health care workers, people who have received blood prior to 1987, tattoos, piercings, multiple sexual partners, has been detected through breast milk if mothers viral load is high • oVirus incubates for 14-180 days, found during bloodwork by testing for viral RNA or antibodies • oTreatment combination therapy

39. Hepatitis D • oRelies on Hepatitis B proteins to reproduce; coinfection • oPrevention-Hep. B vaccine • oTx: interferon alfa-2b; if fulminant hepatitis-may need liver transplant

40. Hepatitis E • oRarely seen in the US • oDx made by r/o other types of Hepatitis • oSymptoms occur 15-60 days after exposure • oTx: immune globulin • o   Prevention: boiling drinking water, thoroughly cooking meat, avoid raw foods if traveling

41. Hepatitis G • oLatest hepatitis virus • oTransmitted by blood and body fluids • oDx. By detection of Hep. G RNA in blood or liver tissue • oLong-term effects unknown • oNo vaccine, tx is focused on symptom management • Reference • (Durston, S. (2005). What you need to know about viral hepatitis. Nursing200535(8), p. 36-42).

42. TB • Caused by bacillus Mycobacterium Tuberculosis • Transmitted AIRBORNE!! When a patient coughs, laughs, or sings • At Risk: residents and employees of LTC facilities and shelters, prison inmates, alcoholics, IV drug users, homeless, family of TB patients • Latent TB-person is infected without symptoms, healthy immune system prevents spreading of the disease • Active TB-cough, NIGHT SWEATS, fever, chills, tired, weak, hemoptysis, anorexia and weight loss

43. TB • TB mainly affects lungs, can also affect organs or tissues • Nsg. Care • Airborne precautions: Negative airflow room, special respirator • Dx: Mantoux skin test (PPD), if positive CXR, DX confirmed by sputum specimen • TX: Combo drug therapy lasting months of INH, rifampin, pyrazinamide and ethambutol • DOT (directly observed therapy) • (Frakes, M. & Evans. T. (2004) TB-your vigilance is vital. RN, 67(11), p. 30-36)

44. Tetanus • Infection that affects CNS, produces muscle stiffness, rigidity and convulsive muscle spasms • Caused by Clostridium tetani • Found in soil, dust, animal and human feces in dormant form • Spores enter body through any scratch or break in skin • Can occur in burn victims, patients receiving frequent IM injdections, tattoos • Risk Factors • IV drug use, PVD, chronic wounds, DM

45. Tetanus • Incubation-3-21 days • Progression of the disease leads to fixed smile and raised eyebrows, convulsions may break bones • S/S: Wounds more than six hours old, appear infected • TX: Clean wounds with current vaccine-NO Vaccine • Clean wound-unknown vaccine history-Give tetanus booster Td • Deep or dirty wound with uncertain vaccine Hx-administer TIG (tetanus immune globulin) in addition to tetanus booster • (Baucom, B. (2006). Help stamp out this lingering menace. RN 69(4), p. 43-49.)

46. Streptococcus Pneumonia S. pneumoniae lives in the respiratory tract of children and adults At risk: young, elderly, chronically ill Vaccination offers best defense against disease (PPV); purified protein vaccine Vaccine usually only given once, but may be given 3-5 years after initial vaccination to at risk individuals • (Schweon, S. (2005). Streptococcus pneumonia. RN 68(10), p. 35-39).

47. Streptococcus pharyngitis

48. SWINE FLU 2009 • Pandemic • Combination of pig (swine), bird (avian) and human gene flu • S/S: similar to flu (influenza virus) fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Vomiting and diarrhea may also occur • Greatest affects on ages 5-24 and those with chronic medical conditions • Dx-flu swab • TX-antiviral drugs (oseltamivir and zanamivir) with rare exception, vaccination • Centers for Disease Control. (2009). 2009 H1N1 flu: Situation update. Retrieved September 3, 2009 from http://www.cdc.gov/h1n1flu/update.htm

49. Epidemiological Triad • vCommunicable disease transmission depends on the interacton of the following three factors : • oAgent • Chemical, etc • oHost • Employee • Susceptible person • children • oEnvironment

50. C. diff • Diarrhea • Caused by antibiotics • Tx: • With antibiotic  Metronidazole (Flagyl)