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INFECTION CONTROL STANDARD PRECAUTIONS How to prevent the spread of disease Historical Perspective 1847 Dr.

1847 Dr. Ignaz Philip Semmelweis 18% Mortality due to Puerperal Fever Streptococcus organism First simple case-control study Significance of hand washing is demonstrated caused by

Concept of nosocomial infection is born 1950s Infection Control as an organized discipline is born and recognized

Post World War II hospital-based outbreaks of infection caused by Staphylococcus Aureus, mostly in newborn nurseries Outbreaks demanded an organized investigation and control response for

INFECTIOUS DISEASE PROCESS INFECTION: presence and multiplication of microorganisms in the tissue of the host which may or may not have signs or symptoms NORMAL FLORA: bacteria that are frequently found everyone in specific parts of the body in

COLONIZATION: presence of bacteria without multiplication and damage to the host tissue

CHAIN OF INFECTION

The interaction between the 6 elements of the chain determine whether an infection will result. 6 Links to the Chain of Infection Portal of Entry Susceptible Host Causative Agent Reservoir Portal of Exit Mode of Transmission

# 1 Causative Agent

Bacteria (includes Richettsia, Chlamydia, and Mycoplasm Viruses Fungi Protozoa Helminths

Characteristics of causative agents Infective dose Pathogenicity Virulence Invasiveness Host Specificity Viability Antigenic Variation Resistance

#2 Reservoir Humans: _ Patients _ Healthcare Workers Reservoirs Animals Insects Rodents Shell Fish

Reservoirs Environment

_ Patient Care Equipment

_ Environmental Surfaces _ Food # 3 Portal of Exit The path by which the infectious organism (agent) leaves the reservoir Respiratory Tract:

_ Coughing _ Sneezing _ Talking _ Suctioning Genitourinary Tract: _Foley Catheters _ Sexually transmitted diseases Gastrointestinal Tract: _Feces _Vomitus Skin/Mucous Membranes _ Wounds _Skin breaks Transplacental Blood: _ Needle stick _ Blood Transfusion #4 Mode of Transmission The mechanism for transfer of an infectious agent from the reservoir to a susceptible host.

4 Modes of Transmission Contact (Direct and Indirect) Airborne Vector-Borne Common Vehicle

CONTACT DIRECT: immediate transmission Person-to-person Actual physical contact between source and patient

INDIRECT CONTACT: Patient to contaminated indirect object (contaminated endoscope) Droplets spread (large particles that rapidly settle out on horizontal surfaces usually within 3 feet of source)

AIRBORNE Organisms contained within droplet nuclei or dust particles (i.e. droplet nuclei of tuberculosis Suspended in air for extended systems periods, may be spread through ventilation

VECTOR-BORN External vector-born transmission; mechanical transfer of microbes on external appendages (feet of flies) Harbored by Vector between vector

Harbored by vector, but no biological interaction and agent (i.e. yellow fever virus #5 PORTAL OF ENTRY

The path by which an infectious agent enters the suceptible host Respiratory Tract Genitourinary Tract

Gastrointestinal Tract Skin/Mucous Membrane Trasplacental (fetus from mother) Parenteral (percutaneous, via blood

#6 SUSCEPTIBLE HOST A person or animal lacking effective resistance to a particular pathogenic agent ISOLATION PRECAUTIONS Historical Perspective 1877 - Present 1877 - First published recommendations

isolation precautions Birth of Infectious Disease Hospitals Patients with infectious disease

process placed in separate facilities Aseptic techniques used to combat

transmission of diseases

1910 - isolation practices are altered by the introduction of the Cubical system of isolation Replaced Infectious Disease Hospitals Multiple-bed wards Barrier Nursing introduced

Barrier Nursing: _ _ Hospital personnel wear gowns between patients Handwashing between patients with antiseptic solutions after patient contact

Disinfection of objects contaminated by patents

1950s - Infection Disease Hospitals begin to shut down (except for TB sanitariums) 1960s - TB Hospitals also begin to shut down. 1970 - Centers for Disease Control publish first manual on Isolation Techniques for Use in Hospitals 7 Categories of Isolation Strict Isolation Respiratory Isolation Protective Isolation Enteric Isolation Wound and Skin Precautions Discharge Precautions Blood Precautions

Disease were lumped into categories based on epidemiological features of the disease (resulted in under or over isolation)

1980s - hospitals begin to experience new endemic and epidemic nosocomial infection problems caused by multi-drug resistant organisms 1983 - CDC publishes new Isolation Guidelines Blood and Body Fluid Precautions Strict Isolation Contact Isolation Respiratory Isolation TB Isolation Enteric Isolation Drainage and Secretion Isolations - Universal Precautions come into being

1985

HIV HBV Blood borne pathogens

1987 - Body Substance Isolation 1990s - HICPAC Isolation System Two tiered system _ Standard Precautions _ Transmission-based _ Contact _ _ Droplet Airborne precautions

NOSOCOMIAL INFECTIONS CAUSES AND SITES SITES Surgical Sites Respiratory Bone and Joint Infection Central Nervous System Gastrointestinal System Skin and Soft Tissue Blood Stream Urinary System (UTI) Cardiovascular Eye/Ear/Throat Mouth Infection Reproductive System

Compromised Patients Immunocompromised patients vary in their susceptibility to nosocomial infections, depending on the severity and duration of immunosuppression. Use of the two tiered system essential to break the Chain of Infection.

3 Major Modes of Transmission in the Healthcare Setting Puncture Wounds Skin Contact Mucous Membranes (eye/mouth/nose)

Bloodborne Pathogens Hepatitis B Virus Hepatitis C Virus Human Immunodeficiency Virus

Role of the Infection Control Nurse/Practioner Surveillance Track/Trend types of infections Education of staff