Fukami, Shaina NCM 104-L

BSN3

Different Standard Precaution

Airborne Precaution - designed to reduce the risk or eliminate the airborne

transmission of infectious agents. The infectious particles are so small that they can
remain suspended in the air for long periods of time and are carried on air currents.
Examples of Diseases: varicella (chickenpox), tuberculosis, measles.

 Special Factors:
o Private room with special ventilation; door must be kept closed.
o The patient/resident should stay in his or her room except for essential
reasons; a special mask should be worn when out of the room.
o Respirators are worn by personnel if the patient/resident has or is
suspected of having an airborne illness. In general, students are not
usually fitted for respirators.
o Respirators are worn for chickenpox or measles only if the employee
entering has not had the disease or has not been immunized.
o Gloves: Worn when in contact with respiratory secretions.
o Patient/resident care items such as blood pressure cuffs, etc. should be
dedicated and disinfected or discarded after the patient/resident is
discharged.
o Patient/resident should be taught to cover their nose and mouth with
tissues when coughing or sneezing and to discard tissues in a bag.

Droplet Precaution - designed to reduce the risk of droplet transmission of infectious

agents. Infectious droplets are released when the infected person sneezes or coughs and
the large droplet spray may spread as far as three feet. Examples of Diseases: Influenza,
meningococcal meningitis, mumps, rubella, diphtheria, pneumonic plague, pertussis
and infections caused by multidrug resistant Streptococcus pneumonia.

 Special Factors:
o Private room or rooms with a patient/resident who has a similar
diagnosis.
o Patient/resident should stay in their room except for medically necessary
procedures; a mask should be worn when out of the room.
o A regular/surgical mask should be used for any potential exposure within
three feet of the patient/resident.
o Gloves and gowns are required when delivering patient/resident care in
droplet precautions.
o Patient/resident care items such as blood pressure cuff, etc. should be
dedicated to that patient/resident.
 o Patient/resident should be taught to cover their nose and mouth with
tissues when coughing or sneezing and to discard tissues into a bag.

Reverse Isolation - to protect you from germs when your immune system is not
working properly. Germs can be carried on droplets in the air, medical equipment, or
another person's body or clothing. Healthcare providers will talk with you about the
kinds of precautions you need based on your health. You may need to limit visitors.

 Special Factors:
o Everyone must wash their hands before and after visiting you.
o Everyone will need to wear protective gear.
o Anyone who is sick should not enter the room.
o Do not share personal items. Some examples are drinking glasses, eating
utensils, and bath towels. Objects brought into your room by visitors may
carry germs.

Chain of Infection - transmission occurs when the agent leaves its reservoir or host
through a portal of exit, is conveyed by some mode of transmission, and enters through
an appropriate portal of entry to infect a susceptible host.

 Reservoir - habitat in which the agent normally lives, grows, and multiplies.
Reservoirs include humans, animals, and the environment. The reservoir may or
may not be the source from which an agent is transferred to a host.
 Portal of exit - path by which a pathogen leaves its host. The portal of exit
usually corresponds to the site where the pathogen is localized.
 Modes of transmission - An infectious agent may be transmitted from its
natural reservoir to a susceptible host in different ways. There are different
classifications for modes of transmission. Here is one classification:
 Direct: infectious agent is transferred from a reservoir to a susceptible host by
direct contact or droplet spread.
o Direct contact (skin-to-skin contact)
o Droplet spread (spray with relatively large, short-range aerosols produced by
sneezing, coughing or even talking)
Indirect: transfer of an infectious agent from a reservoir to a host by suspended air
particles, inanimate objects (vehicles) or animate intermediaries (vectors)).
o Airborne (infectious agents are carried by dust or droplet nuclei suspended in
air)
o Vehicleborne (may indirectly transmit an infectious agent including food,
water, biologic products (blood) and fomites (inanimate objects such as
handerkchiefs, beddings or surgical scalpels)).
o Vectorborne (mechanical or biologic) (vectors such as mosquitoes, fleas and
ticks may carry an infectious agent through purely mechanical means or may
support growth or changes in the agent)
 Portal of entry - refers to the manner in which a pathogen enters a susceptible
host. The portal of entry must provide access to tissues in which the pathogen can
multiply or a toxin can act. Often, infectious agents use the same portal to enter a
new host that they used to exit the source host. For example, influenza virus exits
the respiratory tract of the source host and enters the respiratory tract of the new
host. In contrast, many pathogens that cause gastroenteritis follow a so-called
“fecal-oral” route because they exit the source host in feces, are carried on
inadequately washed hands to a vehicle such as food, water, or utensil, and enter
a new host through the mouth. Other portals of entry include the skin
(hookworm), mucous membranes (syphilis), and blood (hepatitis B, human
immunodeficiency virus).
 Host – final link in the chain of infection; Susceptibility of a host depends on
genetic or constitutional factors, specific immunity, and nonspecific factors that
affect an individual’s ability to resist infection or to limit pathogenicity. An
individual’s genetic makeup may either increase or decrease susceptibility. For
 example, persons with sickle cell trait seem to be at least partially protected from
a particular type of malaria. Specific immunity refers to protective antibodies that
are directed against a specific agent. Such antibodies may develop in response to
infection, vaccine, or toxoid (toxin that has been deactivated but retains its
capacity to stimulate production of toxin antibodies) or may be acquired by
transplacental transfer from mother to fetus or by injection of antitoxin or
immune globulin. Nonspecific factors that defend against infection include the
skin, mucous membranes, gastric acidity, cilia in the respiratory tract, the cough
reflex, and nonspecific immune response. Factors that may increase susceptibility
to infection by disrupting host defenses include malnutrition, alcoholism, and
disease or therapy that impairs the nonspecific immune response.

Vaccines
INFANTS
TETANUS TOXOID FOR PREGNANT WOMEN

Basic Principles of Infection Control

Standard precaution guidelines were established to break the chain of infection and
reduce the risk of pathogen transmission in hospitals. Standard precautions apply to
blood and body fluids, secretions and excretions (except sweat), non-intact skin, and
mucous membranes. Following standard precautions not only protects patients, but
also healthcare workers.
Hand hygiene - number one weapon in preventing the spread of microorganisms
and includes alcohol-based hand rubs and hand washing with soap and water. Hand
hygiene should be performed before and after contact with a patient; immediately
after touching blood, body fluids, non-intact skin, mucous membranes, or
contaminated items (even when gloves are worn during contact); and immediately
 after removing gloves. Hand hygiene should also be performed when moving from
contaminated body sites to clean body sites during patient care, before eating, after
using the restroom, and after handling equipment in the vicinity of the patient. In
addition to maintaining strict hand hygiene practices, patients and their family
members should also be taught the importance of washing their hands.
PPE - includes gloves, gowns, masks, respirators, and eyewear that create barriers to
protect skin, clothing, mucous membranes, and the respiratory tract from infectious
organisms. The item selected depends on the infectious agent, the type of interaction,
and the method of microorganism transmission.

Gloves should be worn when touching blood, body fluids, non-intact skin, mucous
membranes, and contaminated items, and for any activities involving vascular access. A
face shield or mask and goggles should be worn if you anticipate a splash or spray of
blood or body fluids that might come in contact with your nose, eyes, or mouth. If you
expect your skin or clothing might be exposed to body fluids or blood, wear a gown.
Knowing how to put on and remove PPE can help prevent cross-contamination.

Environmental cleaning includes medical equipment and environmental surfaces.

Any reusable equipment, including stethoscopes, bandage scissors, and hemostats,
that's used on multiple patients must be cleaned between each patient contact, following
organizational policy, with a broad-spectrum antimicrobial agent such as chlorhexidine-
a commonly used antimicrobial agent for disinfecting topical and hard surfaces in
healthcare agencies. It's effective against Gram-positive and Gram-negative bacteria and
fungi. Nursing staff should work closely with environmental services to ensure that
rooms are thoroughly cleaned and disinfected between patients to prevent the spread of
infection through inanimate objects.
Respiratory hygiene and cough etiquette - infection control measures that should
be implemented when contact is made with a patient who might have an upper
respiratory infection. Patients with signs and symptoms of a respiratory infection should
be taught to cover their mouth and nose with a tissue when coughing or sneezing and
dispose of the tissue in the nearest trash container as soon as possible. These patients
should also perform hand hygiene with alcohol-based rubs, soap and water, or an
antiseptic hand wash after being exposed to respiratory secretions or contaminated
materials or objects.
Types of Microorganisms
Bacteria - single-celled microbes that reproduce by splitting in two. Each
individual bacterium is capable of carrying out all of the activities needed to
metabolise and reproduce.

There are more than 5,000 known species of bacteria, with new ones constantly being
discovered. Familiar species of bacteria include: E.coli, Salmonella, Bacillus.
Bacteria prefer moist conditions and can live in a wide range of temperatures. Most
cannot grow at low pH (i.e. in acid conditions).

In the right conditions of warmth, acidity and moisture they can multiply very fast,
producing millions of cells in a few hours. Some bacteria form spores which are resistant
to drying and heating. When conditions become favourable again, they germinate and
an active cell is released.

Bacteria cells have four basic shapes:

 spheres
 rods
 spirals
 commas.

They can be found as single cells, in pairs, chains or clusters.

A bacterial cell has a wall which maintains its shape and protects it. Some
bacteria can move. Usually they use flagella, which are like little corkscrews.
These rotate from the base like a ship’s propeller. The flagella may be
distributed randomly over the whole cell surface, in groups or singly.

Some bacteria have numerous fringe-like projections called fimbriae which

enable them to stick to each other. Other bacteria produce a sticky substance
around the cell wall. This provides protection and helps them to stick to
substrates, as well as each other.

Virus - are very small and can only be seen under an electron microscope, have no
cellular structure & are obligate intracellular parasites, which means they can only
multiply inside the living cells of animals, plants or other microbes. This process harms
the host, resulting in a disease. Outside of the host they are inert particles called virions.

Examples of virus diseases in humans are measles, chicken pox, flu and AIDS.

Bacteriophages are viruses that infect bacteria. They are used in gene technology to
transfer foreign DNA that has been spliced into their nucleic acid into bacterial cells.
The bacteria then acquire the ability to carry out the function of that particular gene and
make specific proteins.

Fungi - large and diverse group of organisms. Their main characteristics are:

 their cells have membrane-bound nuclei (we call them eukaryotic)

 they do not use photosynthesis
 they form spores
 they have rigid cell walls
 respiration takes place in bodies called mitochondria in the cytoplasm.
Fungal cells have an elaborate arrangement of internal membranes. Fungi can be
divided into two broad groups: filamentous fungi (including moulds and mushrooms)
and yeasts.
Fungi reproduce by sexual and asexual means. Most produce spores which in some
types are borne on bodies called sporangia. Both spores and sporangia vary widely in
size and form, depending on how they are spread – by wind, water, mechanical means
or vectors.

Macrofungi produce large fruiting bodies which are familiar to us as mushrooms and
toadstools. These produce spores in huge numbers and disperse them into the
environment. In favourable conditions, these spores germinate and produce hyphae.

Parasites - organisms that live on or in a host organism and gets its food from or at the
expense of its host.

Three main classes of parasites that can cause disease in humans: protozoa
(microscopic, one-celled organisms that can be free-living or parasitic in nature),
helminths (large, multicellular organisms that are generally visible to the naked eye in
their adult stages), &ectoparasites (although the term ectoparasites can broadly include
blood-sucking arthropods such as mosquitoes (because they are dependent on a blood
meal from a human host for their survival), this term is generally used more narrowly to
refer to organisms such as ticks, fleas, lice, and mites that attach or burrow into the skin
and remain there for relatively long periods of time (e.g., weeks to months).

REFERENCES:

https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section10.html
https://www.drugs.com/cg/reverse-isolation.html
https://www.mass.edu/mcncps/orientation/m2Transmission.asp
https://www.scribd.com/doc/20555056/Expanded-Program-of-Immunization-source-DOH
https://www.nursingcenter.com/cearticle?an=00152258-201505000-
00007&Journal_ID=417221&Issue_ID=2801137
http://resources.schoolscience.co.uk/SGM/sgmmicrobes1.html
https://www.cdc.gov/parasites/about.html