Module one INFECTION CONTROL

1. King Saud University College of Nursing Fundamental of nursing Module one INFECTION CONTROL

2. COMMON TERMINOLOGIES IN INFECTION CONTROL • CONTAMINATION Bacteria present on surface • COLONIZATION :presence and multiplication of microorganisms • in or on a host without tissue damage. • Bacteria present on surface. • INFECTION :invasion and multiplication of an infectious agent in the tissues of the host.

3. COMMON TERMINOLOGIES IN INFECTION CONTROL cont’d ENDOGENOUS INFECTION : The organisms derived from patients own flora. EXOGENOUS INFECTION : Organisms are derived from outside forces. INCUBATION PERIOD :time of initial contact with the infectious agent to the appearance of the first symptoms.

4. COMMON TERMINOLOGIES IN INFECTION CONTROL cont’d Asepsis : The freedom from disease causing micro-organism. Medical asepsis:Includes all practices intended to confine a specific microorganism to a specific area, limiting the number, growth, & transmission of microorganisms. Surgical asepsis (sterile technique):Refers to those practices that keep an area or object free of all microorganisms; it include all practices that destroy all microorganisms & spores.

5. COMMON TERMINOLOGIES IN INFECTION CONTROL cont’d COMMUNITY ACQUIRED INFECTION : infection present or incubating on admission with no association to previous hospitalization at the same facility HOSPITAL ACQUIRED INFECTION :A nosocomial infection can be defined as an infection acquired in the hospital after 72 hours of admission to hospital.

6. HOSPITAL AQUIRED INFECTION ( NOSOCOMIAL INFECTION ) It is an infection meeting the following criteria : Not present or incubating on admission • An infection temporarily associated with admission to or a procedure done at health care facility . • An infection incubating at that time of admission that is related to previous hospitalization at the same facility or identified on admission following performance of the procedure during a previous admission

7. CHAIN OF INFECTION COMPONENTS OF INFECTION PROCESS CAUSATIVE AGENTS RESERVOIR OF THE AGENT PORTAL OF EXIT MODE OF TRANSMISSION PORTAL OF ENTERY SUSCEPTIBLE HOST

8. CAUSATIVE AGENTS • Any biological ,physical or chemical entity capable of causing disease is called an agent )The micro-organism that can cause infection). • MICRO-ORGANISMS:Organisms that can be seen only with the magnification of a microscope . # Bacteria # Viruses # Fungi # Parasites

9. CAUSATIVE AGENTS CONT'D • Some Micro-organisms are normally present on people’s skin & in Respiratory ,Intestinal , & Genital tract ; these micro-organisms are calledNORMAL FLORA. • Other Micro-organisms are normally not found on or in the human body & are usually associated with disease ;these micro-organism are known asPATHOGENS. • ALL MICRO-ORGANISMS, including normal flora ,can cause infection or disease if certain conditions exist: • Normal flora are introduced an area of the body in which they are not normally found . • Pathogens are introduced into the body . • Micro-organisms are introduced into the body of a person who is immunocomprimised & thus susceptible to infections to which he or she otherwise would not be susceptible .

10. RESERVOIR • It is a place in which an infectious agent can survive but may or may not multiply # Human-Beings (most common). # Animals #Plants #Soil #Air #Water #Solutions & Instruments

11. PORTAL OF EXIT • It is the path by which an infectious agent leaves the source. • Respiratory tract(e.g., lung, nose). • Genitourinary tract(e.g., vagina, penis). • Mucous membranes(e.g., eyes, nose, mouth). • Gastrointestinal tract(e.g., mouth ,anus). • Blood-stream (open wound, needle puncture). • Broken skin(e.g., puncture ,cut, surgical site, rash). • Trans-placental( mothers –to- fetus ).

12. MODE OF TRANSMISSION • The mechanisms or the way in which the infectious agent moves from the reservoir to a susceptible host. • Transmission can occur by four modes: • CONTACT TRANSMISSION:The infectious agent can be transmitted directly from the reservoir to a susceptible host throughtouch (e.g.,staphyllococcus) ,sexualinter-course (e.g., gonorrhea, HIV), ordroplets(e.g., influenza).

13. VEHICLE TRANSMISSION : The infectious agent can be transmitted indirectly from the reservoir to a susceptible host by material that maintains the life of the infectious agent . • Food (e.g, salmonella ) • Blood(e.g, Hepatitis B , HIV) • Water(e.g, Cholera , Shigella) Instruments & Others Items(e.g, Hepatitis B , HIV , Pseudomonas )

14. AIRBORNE TRANSMISSION: The infectious agent can be carried by air currents(e.g, Measles , Mycobacterium Tuberculosis , Varicella zoster ). • VECTOR TRANSMISSION:The infectious agent can be transmitted to a susceptible host through insects & other invertebrate animals (e.g, Mosquitoes can transmit Malaria & Yellow Fever ; fleas can transmit plague ) .

15. PORTAL OF ENTERY • The route by which the infectious agent moves into (enters ) susceptible host. Respiratory tract(e.g., lungs). Genitourinary tract(e.g., vagina, penis). Mucous membranes(e.g., eyes, nose, mouth). Gastrointestinal tract(e.g., mouth ,anus). Blood-stream . Broken skin(e.g., puncture ,cut, surgical site, rash). Trans-placental( mothers –to- fetus ).

16. SUSCEPTIBLE HOST Host is any person who is at risk for infection. Characteristics that influence susceptibility & severity of disease are : • Age • Sex • Socio-Economic status • Disease history • Nutritional status

17. SUSCEPTIBLE HOST CONT'D • Occupation • Immunization status • Diagnostic /Therapeutic procedures • Medications • Pregnancy • Trauma • Heredity • Ethnicity

21. How can we break the chain of infection? Link Intervention • Accurate and rapid identification of micro-organisms • Early recognition of sign and symptoms of infection 1-Infectious or Causative Agent

22. How can we break the chain of infection? Link Intervention • Employee health examinations and screening • Environmental sanitization including floors, walls, exam tables and beds • Disinfection/Sterilization of equipment and instruments • Standard Precautions • Medical Asepsis • Proper Hygiene - bathing and hand washing • Clean gowns, linens and towels • Clean wound dressings 2-Reservoirs

23. How can we break the chain of infection? Link Intervention 3-Portal of Exit • Hand washing • Use of Personal Protective Equipment such as gloves, gowns, facemask, N95 . • Clean dressings over wounds • Medical Asepsis or Clean Technique • Control of excretions and secretions • Covering the mouth and nose when coughing or sneezing • Proper trash and waste disposal • Standard Precautions

24. How can we break the chain of infection? Link Intervention • Hand washing • Standard Precautions • Rooms with air flow control • Safe Food handling • Isolation • Transmission-based precautions • Sterilization of equipment and supplies • Medical and Surgical Asepsis • Use of Personal Protective Equipment such as gloves, gowns, facemask, N95 . • Proper disposal of contaminated objects 4-Method or Mode of Transmission

25. How can we break the chain of infection? Link Intervention • Sterile technique or Surgical Asepsis (dressing, injections, catheterization). • Medical Asepsis or Clean Technique • Catheter Care • Wound care • Proper Disposal of needles or sharps • Maintaining skin integrity • Standard Precautions 5-Portal of Entry

26. How can we break the chain of infection? Link Intervention 6-Susceptible Host • Treatment of Disease • Recognition of clients at risk • Immunization • Exercise • Proper Nutrition • Patient Education

27. PREVENTIVE PATIENT CARE PRACTICES 1.Hand washing 2.Aseptic technique 3.Standard precautions 4.Sterilization 5.Disinfection 6.Isolation Precaution

28. HAND WASHING:- • It is the process for the removal of dirt and transient microorganisms(E.g. E. COLI) from the hands. (it is considered the most effective infection control measure). HAND ANTISEPSIS:- • It is a process of the removal or destruction of transient microorganisms. SURGICAL HAND SCRUB :- • It is a process to remove or destroy the transient microorganisms and reduced resident flora, (E.g. Diphtherias )

29. Types of the Hand Washing • ROUTINE HAND WASHING or HYGIENIC HAND WASHING:- • It is accomplished by vigorously rubbing together all surfaces of lathered hands followed by thorough rinsing under a stream of water. • This should take 10-15 seconds to complete. • The hands should be dried with a paper towel.

30. Types of the Hand Washing cont’d • SURGICAL SCRUB:- • It is the process that begin with washing hands and forearms thoroughly to remove dirt and transient bacteria . • A nail cleaner should be used to clean under the nails. • It should take about 5 minutes.

31. VARIOUS HAND DECONTAMINANTS Soap solution:- • Soap have a detergent effect. • They remove transient microorganisms physically but have no effect on the resident microbial population.

32. VARIOUS HAND DECONTAMINANT cont’d • CHLOROHEXIDINE:- • It has a broad - spectrum activity . • It binds to the stratum corneum, continuing to destroy bacteria for at least six hours.

33. VARIOUS HAND DECONTAMINANTS cont’d • POVIDINE IODINE:- • It is often used in the operating theatre because it destroys spores more effectively than many other antiseptics.

34. VARIOUS HAND DECONTAMINANTS cont’d • ALCOHOL HAND-RUBS, GEL & WIPES:- • They have excellent bactericidal activity against most gram – positive and gram- negative bacteria but have no effect on spores.

35. INDICATIONS FOR HAND WASHING • When coming on duty. • After removing gloves. • When hands are soiled including after sneezing, coughing, or blowing your nose. • Between patients’ contacts. • Before & after medication administration. • After personal use of the toilet. • Before performing invasive procedures.

36. INDICATIONS FOR HAND WASHING cont’d • Before taking care of particularly susceptible patients, such as who are severely Immuno-compromised & Newborns. • Before and after touching wounds. • Before & after eating. • After touching objects that are likely to be contaminated with pathogenic micro-organisms E.g. urine measuring devices, secretion collection apparatus, etc...

37. INDICATIONS FOR HAND WASHING cont’d • After taking care of infected patients or patients who are likely to be colonized with microorganisms for special clinical or epidemiologic significance. (E.g. Multi-drug resistant bacteria-M.D.R.O).

38. ASEPTIC TECHNIQUE • It is an a method used to prevent contamination of wounds and other susceptible sites by organisms that could cause infection. • This can be achieved by using sterile equipment and fluids used for invasive medical and nursing procedures.

39. STERELIZATION • It is the complete elimination of all viable microorganisms including viruses, fungi, and their spores both pathogenic and non- pathogenic. DIS-INFECTION • Disinfection implies the removal of all life forms capable of causing disease.( all viable microorganisms except bacterial spores).

40. STANDARD PRECAUTIONS The term standard precautions refers to a system of infection control practices which assume that every direct contact with blood and body fluids is potentially infectious. CONCEPT OF STANDARD PRECAUTIONS: 1.It should be implemented to all patients. 2. Standard precautions are not generally intended to reduce cross contamination among patients and they do not replace other precautions.

41. ELEMENTS OF STANDARD PRECAUTIONS • Hand washing • Gloves • Masks, eyewear, face shields • Gowns and aprons • Care of sharps and needles • Care of spills of blood and body fluids • Care of laboratory specimens • Disposal of waste • Disposal of linen • Care of resuscitation equipment

42. ISOLATION PRECAUTION • These are guidelines created to prevent transmission of microorganisms in hospitals. • They are Transmission Based Isolation designated for care of patients with known or suspected infectious disease that can spread by one of the following routes:- • AIR-BORNE: (e.g measels, Rubella & TB) • DROPLET: (e.g Diphteria & Pertusis) • CONTACT: (e.g Hepatitis A, herpes simplex).

43. ISOLATION • The separation of a person with infectious disease from contact with other human beings, for the period of communicability

44. BASIC PRINCIPLES FOR ALL CATEGORIES OF ISOLATION 1.Necessity of a single room 2.Hand washing 3.Use of protective barriers as per need 4.Disposal of waste in orange bags. 5.Disposal of linen in water- soluble linen bags. 6.Request for a isolation diet tray (with disposable cutleries)