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INFECTION CONTROL

At the end of the session the student should be able to:


1. Define what is meant by infection
2. Explain what is infection in relation to disease
3. Describe the epidemiological triangle (agent, host, environment)
4. Explain the different modes of disease transmission e.g. direct,
indirect and the terms vector, vehicle
5. Describe the standard, contact, droplet and airborne precautions
6. Outline the principles and practice of hygiene in a healthcare setting
Definition of Terms (1)
Host: living animal or plant

Agent: something that produces or is capable of


producing an effect, i.e. infection

Vector: an organism (as an insect) that transmits


an agent from one organism or source to another

Vehicle: inanimate object (food, water, etc) that


can carry an agent from one organism to another

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Definition of Terms (2)
Disease: impairment of normal functioning, manifested by
signs and symptoms

Infection: the state produced by the establishment of an


infective agent in or on a suitable host , host may or may not
have signs or symptoms

Carrier: individual harbors the agent but does not have


symptoms. Person can infect others.

Reservoir: habitat (man, animal, etc.) in which the agent


normally lives, grows, and multiplies

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DEFINITIONS
• Infection control – the set of methods used to control and prevent the
spread of disease

• Infections - are caused by pathogens (germs)

• Communicable disease – disease spread from one person to another

• Infectious disease – disease caused by a pathogen (germ or bacteria)

01/09/2009
DEFINITIONS

 Contaminated – means dirty, soiled, unclean

 Disinfection – cleaning so that germs (pathogens) are destroyed

 Mode of transmission – the way germs are passed from one person
to another

 Mucous membranes – membranes that line body cavities that open


to the outside of the body

01/09/2009
Types of Infections
Types of Infections

Infection
• invasion of the body by microorganisms
• invading microorganisms:
• use the host’s resources to multiply
• interfere with normal function
• 3rd leading cause of death in the U. S.
Types of Infections
Local infection
• only a specific portion of the body is infected
• pain
• redness
• heat at the site
• swelling
• pus
• foul smelling drainage
Types of Infections
Systemic infection
• affects the entire body
• fever
• aches
• chills
• nausea
• vomiting
• weakness
Types of Infections

• Endogenous (endo- inside; genous- type or kind)


• type or kind of infection or disease that originates from within the
body
• Exogenous (exo- outside; genous- type or kind)
• type or kind of infection or disease that originates outside the
body
Types of Infections
• Nosocomial infections
• Hospital acquired infection
• Transmitted by the health care worker

• Opportunistic infections
• Infections that occur when the body’s defenses
are weakened
Disease Causation

HOST Characteristics Types of AGENTS ENVIRONMENTAL Factors


Age Biologic – bacteria, virus, molds Housing – crowding, noise
Gender Chemical – poison, alcohol Air – temperature, humidity
Occupation Physical - trauma, fire Water , food
Race
Marital status
Genetic profile

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Disease Transmission

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Mode of Transmission
Route Example Disease
Direct contact Kissing, sexual contact, skin-to-skin contact STDs, skin infections, scabies

Droplet Organism on large respiratory droplets that Mumps, pertussis (whooping


people sneeze, cough, drip, or exhale. Disease cough), common cold, ‘strep
spread when people are close to each other throat’, meningitis
(usually <3 feet) and inhale droplet.
Indirect Contact with contaminated surfaces, clothing, Skin infections, diarrheal disease
contact etc
Vector Bite from disease-carrying ticks, fleas, Lyme disease, LaCrosse encephalitis
mosquitoes
Vehicle Eat/drink contaminated food/beverage, Some diarrheal disease, hepatitis
transfuse infected blood, fomites (bedding, b/c
infected tatoo needle)
Airborne Organism on dust particles or small Chickenpox, Tuberculosis,
respiratory droplets that may become Smallpox, SARS,
aerosolized when people sneeze, cough, Anthrax (inhalational)
laugh, or exhale

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Infection Control
Route Example Control Measures
Direct Kissing, sexual contact, skin-to-skin Use of barrier (condom,
contact contact clothing, dressing)

Droplet Organism on large respiratory Respiratory etiquette


droplets that people sneeze, cough,
drip, or exhale.

Indirect Contact with contaminated surfaces, Hand-hygiene, sanitizing


contact clothing, etc infected surfaces

Vector Bite from disease-carrying ticks, Vector control


fleas, mosquitoes

Vehicle Eat/drink contaminated food/drink, Proper hygiene and


transfuse infected blood, fomites sanitation, cook food/boil
(bedding, infected tatoo needle) water, etc.
Airborne Organism on dust particles or small Respiratory etiquette,
respiratory droplets isolation (if necessary)

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Infection Control
Protecting staff from infection

• Healthcare workers are potentially at risk of infection from a large number of


biological agents, either in the laboratory or directly from patients.

• Most of these infections will be with diarrhoea-causing viruses or bacteria but


there is the potential for more serious infections – a number of healthcare
workers have contracted HIV as a result of needle stick injuries, for example.
• It is likely that the number of healthcare workers infected is under-reported.
• Healthcare workers, who care for patients suffering from potentially dangerous
and highly infectious diseases, are also at risk.
• Procedures that are aimed at protecting patients – who are generally unwell and
therefore more susceptible to some diseases – can also reduce the risk to staff.
• While clinical staff are probably most at risk, there are potential risks to other
staff who come into contact with patients or soiled or infected material.
Infection risks to hospital staff

There are a number of diseases that may theoretically pass from


patients to hospital staff.

• Staphylococcus aureus
• MRSA - Methicillin-resistant Staphylococcus aureus
• Clostridium difficile
• Tuberculosis
• Norovirus or winter vomiting disease
• Influenza
• Hepatitis and HIV
Infection Prevention
Education and Training
Hygiene
Sanitation
Follow public health recommendations – food
preparation, isolation and quarantine

Vaccination
Keep up to date

Medicine
Prophylactic antibiotics – meningitis, pertussis

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Special precautions
Droplet precautions
• Droplet transmission occurs when there is adequate contact between the
mucus membranes of the nose, mouth or conjunctivae of a susceptible
person and large particle droplets.
• These are usually generated from the infected person during coughing,
sneezing, talking or when healthcare workers undertake procedures such as
tracheal suctioning.
• Diseases which are transmitted by this route include pneumonias, pertussis,
diphtheria, influenza type B, mumps and meningitis. The following
precautions should be taken:
implement standard precautions
place patient in a single room or in a room with another patient infected
by
the same pathogen
wear a surgical mask when working within 1-2 metres of the patient
place a surgical mask on the patient if transport is necessary
special air handling and ventilation are not required to prevent droplet
transmission of infection.
Contact precautions
Colonisation or infection with multiple antibiotic resistant organisms,
enteric infections and skin infections can be transmitted by contact
with an infected patient.

The following precautions need to be taken:


• implement standard precautions.
• In particular timely and effective hand decontamination is the
cornerstone of safe care place patient in a single room or in a room
with another patient infected by the same pathogen.
• Consider the epidemiology of the disease and the patient population
when determining patient placement wear clean gloves (preferably
non-latex) when entering the room, wear a clean gown when
entering the room if substantial contact with the patient,
environmental surfaces or items in the patient’s room are anticipated
limit the movement and transport of the patient from the room –
patients should be moved for essential purposes only.
• If transportation is required, use precautions to minimise the risk of
transmission.
Good practice
Staff can avoid risk to themselves and their patients by:
• getting vaccinated and keeping up to date with necessary vaccinations
• learning and following safe sharps practice
• always following infection control procedures
• reporting and getting help with any needle stick accident
• always cleaning hands before contact with any patient or wounds, or if carrying
out any internal examination, taking blood, or eating
• always cleaning hands after contact with any patient; after removing gloves;
changing or ‘lifting’ dressings; going to the toilet; and assisting a patient with the
toilet.

Staff should stay off the wards if:


• they develop any possible infectious rash
• they are unwell with diarrhoea or vomiting
• they have been in contact with chickenpox or shingles (unless they have proven
previous infection) – contact with chickenpox should be reported to the OH service
• they are unwell – feverish, dizzy and so on
• they have a sore throat – this could indicate B- Haemolytic streptococcus A and
staff should contact their health department.
INFECTION CONTROL
UNIVERSAL PRECATIONS

01/09/2009
MODES OF TRANSMISSION
 Body fluids – tears, saliva, sputum (mucus coughed up), urine, feces,
semen, vaginal secretions, pus or other wound drainage, blood

 Touching the infected person or their secretions

 Touching something contaminated by the infected person.

 Droplets – coughing, sneezing, laughing, spitting, talking

01/09/2009
PORTALS OF ENTRY

• Any body opening of an uninfected person which allows pathogens to


enter

• Nose, mouth, eyes, rectum, genitals and other mucous membranes

• Cuts, abrasions or breaks in the skin

01/09/2009
WHO IS AT RISK??
 Anyone whose resistance to disease decreases

 Reasons for lowered resistance: age, existing illnesses, fatigue and


stress

 The elderly have weaker immune systems and a lower resistance to


pathogens

 Elderly are hospitalized more often, increasing the chance for hospital-
acquired infections

 Recovery longer in the elderly

01/09/2009
UNIVERSAL PRECAUTIONS
 Universal precautions are infection control guidelines designed to
protect workers from exposure to diseases spread by blood and
certain body fluids.

 Always treat blood, body fluids, broken skin and mucous membranes
as if they were infected

 Always follow Universal Precautions because you cannot tell by looking


at a person whether they have a contagious disease

01/09/2009
UNIVERSAL PRECAUTIONS

• Use practical, common sense

• Wash your hands before putting on gloves and immediately after


removing gloves

• Do not touch clean objects with contaminated gloves

01/09/2009
UNIVERSAL PRECAUTIONS

• Wear gloves if you may come in contact with blood, body fluids,
secretions and excretions, broken or open skin, human tissue of
mucous membranes

• Bag all disposable contaminated supplies

• Clean all surfaces that may be contaminated with infectious waste,


such as beds, wheelchairs and shower chairs

01/09/2009
WHAT CAN I DO??

• Good hand washing is the most effective method to prevent the


spread of infection

• May use an alcohol-based hand cleaner in place of washing with soap


and water

• Avoid touching eyes, nose or mouth

01/09/2009
WHAT CAN I DO??

• Cover your nose and mouth with a tissue every time you cough or
sneeze

• Throw used tissue in a wastebasket

• If you don’t have a tissue, sneeze or cough into your sleeve

• Always clean your hands after coughing or sneezing

01/09/2009
HAND WASHING
• Remove any jewelry or watch
• Wet hands with warm, running water
• Add soap
• Rub hands vigorously for 20 seconds, washing all surfaces (about the
time it takes to sing “Happy Birthday” twice)
• Rinse, keeping fingers pointing down
• Dry with paper or clean cloth towel
• Turn off faucet with towel and open door with towel

01/09/2009
WATERLESS HAND SANITIZER

• Make sure all visible dirt is removed from your hands


• Apply a dime sized amount of waterless hand sanitizer to the palm of
one hand or use a waterless hand sanitizer wipe
• Rub hands together covering all surfaces of hands and fingers
• Rub until waterless hand sanitizer is absorbed
• Remember, waterless sanitizers are not effective if dirt is visible on
your hands

01/09/2009
HAND HYGIENE VIDEO

• View these videos on hand hygiene:


http://www.cdc.gov/CDCTV/HandsTogether/

Play entire video:


http://www.publichealthgreybruce.on.ca/Communicable/Handwashin
g/

Application of learning – student return demonstration

01/09/2009
WHEN SHOULD I USE GLOVES ?

• When you may come in contact with blood or any body fluids, open
wounds, or mucous membranes

• Performing or helping with mouth care

• Performing or helping with perineal care

• Performing care on a consumer who has broken skin

01/09/2009
WHEN SHOULD I USE GLOVES ?

• When you have open sores or cuts on your hands

• When shaving a consumer

• When disposing of soiled bed linens, gowns, dressings and pads

01/09/2009
WHEN SHOULD I CHANGE GLOVES?

• When touching surfaces that may be contaminated

• Right before contact with mucous membranes or broken skin

• Immediately if they become wet, worn, soiled or torn

01/09/2009
GENERAL GUIDELINES

• Wear gloves when handling soiled linens

• Fold or roll linen so that the dirtiest area is inside

• Hold and carry dirty linen away from your body

• Do not shake dirty linen or clothes

01/09/2009
GENERAL GUIDELINES

• Use appropriate receptacles for disposal

• Do not touch the inside of any disposal container

• Do not use “re-usable” equipment again until it has been properly


cleaned

• Never use disposable equipment more times than recommended by


the manufacturer

01/09/2009
PUTTING ON GLOVES
• 1. Remove any sharp jewelry

• 2. Remove glove from box. Gloves come in small, medium and large.
Most are rubber latex and are pre-powdered. Those who are allergic to
latex should use vinyl gloves.

• 3. Hold glove with your thumb and forefinger and insert hand into
gloves

• 4. Work fingers into proper places

01/09/2009
PUTTING ON GLOVES - VIDEO

• http://www.uams.edu/csc/programs/orientation/gloves/glovesOn.mov

• Application of learning – student return demonstration

01/09/2009
REMOVING GLOVES WITHOUT
CONTAMINATING YOUR HANDS
• 1. Pinch the palm of one glove and pull away from the palm.

• 2. Push the fingers of the pinching hand up inside the other glove,
stretching the material of the glove towards the cuff of the other glove
until it emerges by the wrist.

• 3. Pull the fold down until the glove is almost off (you will be pulling the
glove inside-out).

01/09/2009
REMOVING GLOVES WITHOUT
CONTAMINATING YOUR HANDS
• 4. DO NOT take the glove completely off.

• 5. Hook the ungloved thumb between the wrist and the skin of the
other gloved hand and pull down, pulling both gloves off. (Both gloves
will now be inside out.)

• 6. Dispose of the gloves properly.

01/09/2009
REMOVING CONTAMINATED GLOVES -
VIDEO
• Click for video instruction for removing contaminated gloves:
http://www.hse.gov.uk/mvr/myths/video/video9.htm

01/09/2009
Personal Respiratory Protection

• Respirators can protect health care workers;

• Respirators may be unavailable in low-resource


settings;

• Face/surgical masks act as a barrier to prevent


infectious patients from expelling droplets

• Face/surgical masks do
not protect against inhalation
of microscopic TB particles
Masks and Respirators

Respirators rely on an airtight seal


and have tiny pores which block
droplet nuclei
respirators

Masks have large pores and do not


have an airtight seal to around the
edge, permitting inflow of droplet
nuclei

Face/surgical mask
Personal Respiratory Protection

Use of respirators should be encouraged in high risk


settings:

• Rooms where cough-inducing procedures are


done (i.e., bronchoscopy suites)

• TB “isolation” rooms

• Referral centers or homes of infectious TB


patients

• CDC/NIOSH-certfied N95 (or greater) respirator


should be used
N95 Respirator Dos and Don’ts

*Image courtesy of: CDC Image Library


Do
Be sure your respirator
is properly fitted!

[Should fit snugly at


nose and chin]

*Image courtesy of: CDC Image Library


Note poor fit at the bridge of
nose

Note poor fit at the chin-


Respirator should cover chin
and create a seal
Don’t forget to WEAR it!

*Image courtesy of: CDC Image Library


Efficacy

Respiratory protection is effective only if:

• The correct respirator is used,


• It's available when you need it,
• You know when and how to put it on and take it off, and
• You have stored it and kept it in working order in accordance
with the manufacturer's instructions

• http://www.cdc.gov/niosh/npptl/topics/respirators/factsheets/respfact.html
Thank You