Module 2 Learning Supplement Safety Medical Asepsis/Infection Control Infection Control

Definition An infection is the result of an interaction between a susceptible hose and an infectious agent (bacteria, viruses, fungi, parasites) a clinical syndrome caused by the invasion and multiplication of a pathogen in the body. Infections are: Localized ystemic Course of Infection !he course of an infection can be divided into four ma"or phases: Phases of an infection #. Incubation phase $. %rodromal phase &. %eriod of 'linical illness (. 'onvalescence Transmission of Infection !he health care system itself is another factor in infectious disease transmission. !he public has a right to e)pect that the ris* for ac+uiring an infection during hospitalization be minimal, however controlling hospital,ac+uired infections is a ma"or health care problem. A nosocomial infection is one that a patient ac+uires while in a health care facility. !he infections can be simple and uncomplicated, or ma"or and life threatening. %atients are at ris* for nosocomial infection because they often have wea*ened immune system sand because the health care facility contains patients and e+uipment that harbor infection. An Iatrogenic infection is the direct result of treatments. -oal ( of the .ational %atient afety -oals (.% -/s) is directed toward infection, related sentinel events0 1%reventing health,care associated infections0. A sentinel event is an une)pected occurrence that leads to serious in"ury or death. .ot all infections result in sentinel events, but health,care related infections are a serious problem. In the 2nited tates, health care,associated infections occur in about one tenth of hospitalized patients, and about 34,444 patients die of such infections each year. 5ealth care,associated infections are preventable. Defenses against Infection %rimary: #. *in and mucous membrane

$. 6espiratory system &. -astrointestinal system (. 'irculatory system econdary: #. Inflammatory response $. Immune response Chain of Infection 7or an infection to occur, certain conditions must be met. !his process can be thought of as a chain of infection. !here are si) lin*s in the chain of infection: #. $. &. (. :. <. ource of infection 8 causative agent %ortal of 9ntry to susceptible host 6eservoir %ortal of 9)it from the reservoir ;ode of !ransmission 'haracteristics of the usceptible 5ost

!"SI # DIA# $SIS 6is* for infection 6!:

#$ALS !he patient will: #. $. &. I T%"&% TI$ S Although it is impossible to ensure that the patient/s environment is free of microorganisms, there are many steps that a nurse can ta*e to reduce the spread of microorganisms and thus promote safety for both the patient and the staff.

Infection control measures used in the hospital include: #. ;edical Asepsis $. tandard %recautions &. Isolation %recautions Medical Asepsis ;edical asepsis, or clean techni+ue, refers to practices designed to reduce the numbers of pathogenic microorganisms and limit their growth and transmission in the patient/s environment. 'hy practice Medical Asepsis( #. 5elps the patient fight a current infection and prevent its spread. $. %revents the patient from being re,infected by the same pathogen. &. %revents the patient from being infected with a new pathogen. (. %revents health care professionals and visitors who come in contact with the patient from being infected. :. 5elps decrease the chance of the patient ac+uiring a nosocomial infection and dying because of a hospital,ac+uired infection. !he desired result is to reduce the transmission of the microorganisms from one person to another or from one person to an ob"ect. Medical Asepsis )and*+ashing !he first line of defense in medical asepsis is hand*+ashing. %roper hand,washing is considered the single most effective way to stop the spread of microorganisms and preventing infections.

Safety Chec, Prior to )and +ashing%rior to the start of hand washing it is important to ma*e a safety chec* of the hands. Assess that the nails are short (can not be seen from the palm side), "ewelry is removed and s*in is free of lesions. If the s*in should have a small lesion, bandage the area and then double glove. 'hen Should .ou 'ash .our )andsAt the start and end of each shift After sneezing or coughing After using the bathroom After handling contaminated (soiled) items such as urinal, bedpan, dirty linen =efore and after giving patient care> between patients After handling body e)cretions even with gloves on =efore and after performing any treatments After removing gloves. =acteria on the s*in both transient and resident multiply rapidly on the warm, moist s*in under the gloves. In addition, gloves have pores, can have small microscopic holes or tears that allow microorganisms to spread.

??@hen in doubt, @A 5 AB26 5A.C

#uidelines and Principles of Medical Asepsis "elated to )and*+ashing Although the most effective preventive method of decreasing hospital ac+uired infections is hand washing, it is used inconsistently and sometimes is done inade+uately. =oth the Doint 'ommission and the Euality and afety 9ducation for .urses (E 9.) pro"ect funded by the 6obert @ood Dohnson 7oundation (6@D7) are striving to address the challenge of preparing future nurses with the *nowledge, s*ills and attitudes necessary to continuously improve the +uality and safety of the healthcare systems in which they wor*. Bne of the ways to accomplish this goal is to perform hand washing effectively. #. @ash hands for #: seconds $. 'lean from the cleanest area to the dirtiest area (wrist to fingers) &. 7riction, running water, and a cleansing agent are necessary to remove microorganisms (. Co not touch the sin* when washing hands :. Feep clean items separate from dirty ones. <. !urn off water with a dry paper towel G. Dewelry ma*es it difficult to ade+uately cleanse the hands. It is best to not wear any "ewelry in the clinical setting. If rings are worn, wash rings in place on the hands. If a watch is worn, *eep watch higher above the wrist. Alcohol /ased )andru0s Alcohol,based hand rubs (foam or gel) *ill more effectively and more +uic*ly than handwashing with soap and water. !hey are less damaging to s*in than soap and water, resulting in less dryness and irritation. !hey re+uire less time than hand washing with soap and water. =ottles8dispensers can be placed at the point of care so they are more accessible. )o+ to !se )A D "!/ 1foam and gel2 Apply to palm of one hand (the amount used depends on specific hand rub product). 6ub hands together, covering all surfaces, focusing in particular on the fingertips and fingernails, until dry. 2se enough rub to re+uire at least #: seconds to dry.

Modifying )and*+ashing $utside the )ospital Setting#. =ring bacterial soap and paper towels with you to the patient/s home

$. If no running water is available in the home or other setting, use disposable wipes or alcohol.

Infection Control ** Standard Precautions

tandard %recautions are a set of guidelines developed by the 'enters for Cisease 'ontrol and %revention ('C') for preventing contact with potentially infectious blood or body fluids that may harbor diseases regardless of whether or not they contain visible blood. !he 'C' spent several years researching, improving, and developing recommendations to protect health care providers, patients, and their visitors from infectious diseases. !his intensive period of research resulted in tandard %recautions, a set of infection control guidelines that should now be utilized by all health care professionals for all patients. tandard %recautions are those precautions designed for the care of ALL patients in hospitals regardless of their diagnosis or presumed infection status. It is mainly used for: All body fluids, secretions and e)cretions regardless of whether or not they contain visible blood such as: o sputum o urine or feces o nasal secretions o vomitus8 emesis o spinal fluid 8 cerebrospinal fluid o semen o synovial, pleural, peritoneal, pericardial, amniotic fluid All moist body surfaces, mucous membranes both intact and non,intact =lood tandard precautions are used for all patients, not "ust with those with *nown infections. !hese precautions should be implemented whenever contact with potentially infectious material is anticipated. Also used to protect the caregiver. Components / #uidelines of Standard Precautions#. 5and,@ashing $. %ersonal %rotective Cevices a. -loves b. ;as*, 9ye %rotection, 7ace hield, -own &. %atient,care e+uipment (. 9nvironment :. Linen <. harp Bb"ects )and*'ashing 7irst step in standard precautions is hand washing.

5ands must be washed after patient contact regardless of the use of gloves. -loves do not replace proper hand,washing. -loved hands cannot be effectively washed

#lo3es -loves can be used as a physical barrier to interrupt transmission and to avoid direct contact with infectious material. ;ade of vinyl or late) ,, vinyl are used especially if allergy to late) is present. 44Late5 Sensiti3ity 5ealth care providers should be aware that some people, including professionals and patients, can be allergic to late) products. ome personal protective e+uipment (%%9) is made from late)> medical and surgical products also are often made from this product. -loves must be worn to handle: o =lood o =ody fluids o ecretions, 9)cretions o 'ontaminated items H linens, e+uipment. 9tc. o 'ontact with moist body surfaces or open 8 bro*en s*in and mucus membranes. 'hange gloves before proceeding to the ne)t tas*, or touching different areas even on the same patient (moving from oral to perineal care).

Mas,6 %ye Protection6 7ace Shield6 #o+n !hese techni+ues also act as physical barriers and all should be worn to reduce the possibility of contamination of mucous membranes of the mouth, nose, and eyes. ;as*s provide barrier protection against splashes and sprays, and airborne droplets. ;as*s come in various types depending on their permeability to airborne particles. 9ye goggles or glasses and face shields provide barrier protection against splashes and sprays. -owns or aprons should be water impermeable to provide barrier protection. Patient*Care %8uipment 5andle e+uipment in a manner that prevents personal s*in and mucous membrane e)posure and cross contamination to other patient/s. 6eusable e+uipment must be cleaned and reprocessed before using it in the care of another patient. 6esuscitation e+uipment should be readily available. %n3ironment 9ach hospital, clinic should have procedures for care, cleaning, and disinfection of environmental surfaces. !hey must be decontaminated with an approved chemical germicide. pills of blood or body fluids need to be handled with special procedures.

Linen

5andled in a way to prevent contamination of s*in, mucous membranes, and clothing. 7old soiled linen with contaminated area to the inside. 5old away from body and place in appropriate bag and dispose of properly in lea*age resistant bags. Sharp $09ects %lace all needles, syringes, scalpel blades, and other sharp ob"ects in a puncture, proof container. Co not re,cap needles or remove non,sterile needles from disposable syringes. Immediately discard sharps after use. Co not attempt to bend of brea* a needle before discarding. !hrow away the whole thing.

Infection Control Isolation Precautions / Transmission*/ased Precautions

Isolation precautions are utilized when: a. the patient has a greater susceptibility to infection than others b. a patient or a patient/s body fluids are a *nown carrier of infection or microorganisms that can easily be transmitted to other patients, family members, or health care wor*ers. Isolation Precaution Categories In addition to standard precautions, the 'C' recommends three categories of transmission,based precautions. !hey include: #. Airborne precautions $. Croplet precautions &. 'ontact precautions Air0orne Precautions 2sed in addition to standard precautions when the organism is capable of remaining in the air for prolonged periods of time and can be transported in the air for Cistances greater than & feet. ome of the most common organisms are: !uberculosis, 'hic*en po), ;easles. A private negative air pressure room is used for patients needing airborne precautions. .egative air pressure rooms bring air into the room from the hallway and have a separate e)haust system. !he patient/s diagnosis and treatment regime will determine what the nurse needs to wear when entering the room. Butside the room is an isolation cart that contains supplies needed to care for the patient and to protect visitors from infection. !he isolation cart usually contains gowns, disposable gloves, goggles, linen bags, hampers for dirty linen, and medical supplies. ;ost important is should have a respirator mas*. ;ust wear a special particulate filter or respirator mas*. !hese mas*s must be properly fitted to the face of the health care wor*er and then chec*ed to ensure that the mas* fits as securely as possible. 7it testing is performed prior to entering the room. All patients on airborne precautions should wear surgical mas*s when leaving the negative air pressure room for ),rays, tests, or procedures.

Droplet Precautions Cesigned to prevent diseases that can be transmitted by large airborne droplets through the air that can be inhaled by health care wor*ers or visitors. !his includes organisms that can be spread through the air but are unable to remain in the air further than & feet. 9)amples of such organisms include: Influenza, colds, meningitis, mumps, and pertussis. ingle rooms are preferable, but patients with the same disease can share the same room. tandard surgical mas*s without a filter must be worn for anyone coming within : feet of the patient. -owns should be worn if clothing or uniforms are li*ely to become contaminated with respiratory secretions. -loves should be worn anytime handling tissues or any items contaminated with the respiratory secretions. Contact Precautions 'ontact precautions prevent the transmission of disease by direct or indirect contact. Cirect contact involves touching, bathing, or s*in,to,s*in contact. Indirect contact involves contact with inanimate ob"ects such as door*nobs, light switches, tabletops, and telephones. 'ontact precautions include use of barrier precautions such as gloves and impermeable gown to prevent direct contact with the infectious organism. 2sed: , for patient with diarrhea ( 9. coli, c difocelle, etc.) , when coming into contact with draining wounds, cellulitis, burns, con"unctivitis, cabies, or impetigo , for patients with ac+uired antibiotic resistance infections Protecti3e Isolation 2sed with patients who are immunocompromised such as: 'hemotherapy AIC Brgan transplant

Care of %8uipment
9)ample of a hospital/s plan to care for contaminated e+uipment: If 3isi0ly soiled6 clean and +ipe +ith hospital*appro3ed disinfectant the follo+ing items?=8% cuff ? tethoscope =edscales 9lectronic thermometer 7urniture II poles ;attresses and pillows !elephone !rash containers @heel 'hairs

?reusable stethoscopes are used with each category of isolation> =8% cuffs are discarded for certain organisms and types of isolation. (ie. '. difficile and I69) If 3isi0ly soiled6 co3er +ith or place in imper3ious plastic 0ag and send to CS the follo+ing itemsA+ua F machines %neumatic compression machines %rotective eye wear and bags, shoc* bloc*s 6eusable e+uipment, instruments, such as procedure trays Discard the follo+ing items in the regular trash=ath basin 'olostomy bag 'ompression stoc*ings (!9C 5ose) 9ggcrate mattress 9mesis basin 7oley bag (empty first) Isolation attire(mas*,gown,gloves) II bags 8 tubing %aper !ourni+uet @ater pitcher

Discard the follo+ing items in needle 0o5esAll sharps =ro*en glass -lass thermometers Lancet .eedles yringe with needle Iials Cisposable instruments from procedure trays (suture removal) Discard the follo+ing items in /ioha:ard /o5es=lood bags 8 tubing 'hest tubes systems Cressing saturated with blood urgical drains 8 suction bulbs uction canisters regardless of contents Discard the follo+ing items in imper3ious 0agsAll linen regardless of what is on it or where it came from. 9)ceptions: linen so grossly saturated with blood that it will pool if disposed of in biohazard bo)es general service linen (ie. ;op heads) are placed in a clear plastic bag to be laundered on site.