Chapter 20

1. Chapter 20 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 – practices and procedures that protect clients, residents, visitors, and staff from infection.

3. Micro-organisms • A micro-organism (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. Micro-organisms (Cont’d) • There are 3 major types of microbes: • Bacteria are one-celled microbes. • Viruses invade living cells in order to grow and multiply. • Fungi are microbes that live on organic matter, such as plants or animals.

5. Micro-organisms (Cont’d) • 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 • 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. Micro-organisms (Cont’d) • Multidrug-resistant organisms (MROs) • Microbes that can resist the effects of antibiotics • Antibiotics are drugs that kill microbes that cause infections. • MROs are caused by: • Doctors prescribing antibiotics when they are not needed (over-prescribing). • Patients not taking antibiotics for the length of time prescribed. • Two common types of MROs are resistant to many antibiotics. • Methicillin-resistant Staphylococcus aureus (MRSA) • Vancomycin-resistant Enterococcus (VRE) • Box 20-1: MRSA and VRE (p. 330)

7. Infections • 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 involves: • Pathogen • Reservoir • Portal of exit • Mode of transmission • Portal of entry • Susceptible host

8. Infections (Cont’d) • Health care associated infection (HAI) • An infection that develops in a client 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 client from another source

9. Infections (Cont’d) • Common sites for HAIs are: • Urinary system • Respiratory system (colds, pneumonia, bronchitis, flu) • Gastrointestinal system (nausea, diarrhea) • Skin (wounds or IV site infections) • HAIs are prevented by: • Medical asepsis, including hand hygiene • Isolation Precautions • Surgical asepsis

10. Infections (Cont’d) • Medical asepsis • Asepsis is being free of disease-producing microbes. • Medical asepsis (clean technique) is the practice used to: • Remove or destroy pathogens • Prevent pathogens from spreading from one client or place to another client or place • Surgical asepsis (sterile technique) is the practice that keeps items free of all microbes.

11. Infections (Cont’d) • Medical asepsis (cont’d) • 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. • Using waterless, alcohol-based sanitizers, or handwashing with soap and water • Wearing gloves • Provide a protective barrier between your hands and client’s blood, body fluids, secretions, excretions, non-intact skin, and mucous membranes • Gloves are additional protection and not a substitute for hand hygiene.

13. Care of Supplies & Equipment • Cleaning • Reduces the number of microbes present and removes organic matter. • Disinfection • 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. • Isolation Precautions prevent the spread of communicable diseases (contagious diseases). • Two types: • Standard Practices (Routine Precautions) • Transmission-Based Precautions

15. Isolation Precautions (Cont’d) • Standard Practices: • Also called Routine Practices or Standard 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

16. Isolation Precautions (Cont’d) • Standard Practices (cont’d): • 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 (including in the nose, eyes, mouth, vagina, and rectum)

17. Isolation Precautions (Cont’d) • Transmission-Based Precautions • Guidelines to contain pathogens in one area (usually the client’s room) • You will be told when Transmission-Based Precautions are ordered for a client • Client usually placed in private or semi-private room to isolate his/her germs from infecting others • Box 20-8: General Rules for Transmission-Based Precautions (p. 347)

18. Isolation Precautions (Cont’d) • 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. Protective Apparel • Gloves • Wear gloves whenever contact with blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin is likely. • Gowns and other attire 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. Protective Apparel (Cont’d) • Masks are worn for these reasons: • For protection from contact with infectious agents from the client or resident • During sterile procedures to protect the client from infectious agents carried in your nose or mouth • Tuberculosis respirators are worn when caring for clients with tuberculosis (TB). • It is your responsibility to be fitted for the correct type of mask and to wear it properly, following employer policy.

21. Protective Apparel (Cont’d) • Goggles and face shields protect your eyes, mouth, and nose from the 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 your employer’s procedures.

22. Preventing Infection • Bagging items • 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 employers. • A safe transport means that other persons are protected from the infection.

23. Basic Needs and Transmission-Based Precautions • 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.

24. Surgical Asepsis • Surgical asepsis (sterile technique) is the practice 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.

25. Surgical Asepsis (Cont’d) • Principles of surgical asepsis • All items in contact with the client are kept sterile. • A sterile field is needed. • A sterile field is a work area free of all pathogens and nonpathogens (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.