Chapter 15 Preventing Infection Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Infection  Infection is a major safety and health hazard.  The health team follows certain practices and procedures to prevent the spread of infection.  Infection control—the practices and procedures that protect patients, residents, visitors, and staff from infection Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 2

Microorganisms  A microorganism (microbe) is a small living thing seen only with a microscope.  Microbes are everywhere.  Some microbes are harmful and can cause infections. They are called pathogens. They are called pathogens.  Non-pathogens are microbes that do not usually cause an infection. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 3

Microorganisms (cont’d)  There are five types of microbes.  Bacteria are one-celled organisms that multiply rapidly.  Fungi are plant-like organisms that live on other plants or animals.  Protozoa are one-celled animals.  Rickettsiae are found in fleas, lice, ticks, and other insects.  Viruses grow in living cells. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 4

Microorganisms (cont’d)  Requirements of microbes  Microbes need a reservoir (host) to live and grow. Microbes need water and nourishment from the reservoir. Microbes need water and nourishment from the reservoir. Most need oxygen to live. Most need oxygen to live. A warm and dark environment is needed. A warm and dark environment is needed. Most grow best at body temperature. Most grow best at body temperature. They are destroyed by heat and light. They are destroyed by heat and light.  Normal flora are 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. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 5

Microorganisms (cont’d)  Multidrug-resistant organisms  Multidrug-resistant organisms (MDROs) are microbes that can resist the effects of antibiotics. Antibiotics are drugs that kill certain microbes that cause infections. Antibiotics are drugs that kill certain microbes that cause infections.  MDROs are caused by:  Prescribing antibiotics when they are not needed (over- prescribing)  Not taking antibiotics for the length of time prescribed  Two common types of MDROs are resistant to many antibiotics.  Methicillin-resistant Staphylococcus aureus (MRSA)  Vancomycin-resistant Enterococci (VRE) Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 6

Infection  Infection is a disease state that results 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 is a process that involves a:  Source—a pathogen  Reservoir—where a pathogen can grow and multiply  Portal of exit—allows pathogen to leave the reservoir  Method of transmission—a vehicle transmits microbes  Portal of entry—where the pathogen enters the body  Susceptible host—needed for the microbe to grow and multiply Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 7

Infection (cont’d)  Healthcare-associated infection (HAI)  An HAI is an infection that develops in a person cared for in any setting where health care is given.  HAIs also are called nosocomial infections.  HAIs are caused by: Normal flora Normal flora Microbes transmitted to the person from other sources Microbes transmitted to the person from other sources Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 8

Infection (cont’d)  Common sites for HAIs are:  The urinary system  The respiratory system  Wounds  The bloodstream  HAIs are prevented by:  Medical asepsis, including hand hygiene  Surgical asepsis  Standard Precautions  Transmission-Based Precautions  The Bloodborne Pathogen Standard Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 9

Medical Asepsis  Asepsis is being free of disease-producing microbes.  Medical asepsis (clean technique) is used to:  Remove or destroy pathogens.  Prevent pathogens from spreading from one person or place to another person or place.  Surgical asepsis (sterile technique) keeps items free of all microbes. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 10

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. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 11

Medical Asepsis (cont’d)  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.  Supplies and equipment  Most health care supplies and equipment are disposable.  Discard single-use items after use.  A person uses multi-use items many times.  Do not “borrow” them for another person.  Non-disposable items are cleaned, disinfected, and then sterilized. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 12

Medical Asepsis (cont’d)  Cleaning reduces the number of microbes present and removes organic matter.  Disinfection is the process of destroying pathogens. Spores are not destroyed.  Chemical disinfectants are used to clean surfaces.  Sterilizing destroys all non-pathogens and pathogens, including spores.  Very  Very high temperatures are used. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 13

Isolation Precautions  Blood, body fluids, secretions, and excretions can transmit pathogens.  Sometimes barriers are needed to keep pathogens within a certain area.  The Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007 is followed. The guideline was issued by the Centers for Disease Control and Prevention (CDC). The guideline was issued by the Centers for Disease Control and Prevention (CDC).  Isolation precautions prevent the spread of communicable diseases (contagious diseases). Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 14

Isolation Precautions (cont’d)  Isolation precautions are based on clean and dirty.  Clean areas or objects are free of pathogens.  Dirty areas or objects are contaminated with pathogens.  Clean and dirty also depend on how the pathogen is spread.  The CDC guideline has two tiers of precautions.  Standard Precautions  Transmission-Based Precautions Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 15

Isolation Precautions (cont’d)  Standard Precautions  Are part of the CDC’s isolation 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  Prevent the spread of infection from: Blood Blood All body fluids, secretions, and excretions (except sweat) even if blood is not visible All body fluids, secretions, and excretions (except sweat) even if blood is not visible Non-intact skin (skin with open breaks) Non-intact skin (skin with open breaks) Mucous membranes Mucous membranes Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 16

 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. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 17 Isolation Precautions (cont’d)

 Gloves   Wear gloves whenever contact with blood, body fluids, secretions, excretions, mucous membranes, or non- intact skin is likely.  Gowns   Protect your clothes and body from contact with blood, body fluids, secretions, and excretions.   Protect against splashes and sprays.   Must completely cover you from your neck to your knees   Are used once   Are considered contaminated when wet   Are disposable and are discarded after use Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 18 Isolation Precautions (cont’d)

 Masks are worn:  For protection from contact with infectious materials from the person  During sterile procedures to protect the person from infectious agents carried in your nose or mouth  Tuberculosis respirators are worn when caring for persons with tuberculosis (TB).  Goggles and face shields protect your eyes, mouth, and nose from splashing or spraying of blood, body fluids, secretions, and excretions.  The front (outside) of goggles or a face shield is contaminated.  Discard disposable goggles or face shields after use.  Reusable eyewear is cleaned before reuse. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 19 Isolation Precautions (cont’d)

 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 are items contaminated with blood, body fluids, secretions, or excretions.  Trash is placed in a container labeled with the BIOHAZARD symbol.  Double-bagging is needed if the outside of the bag is wet, soiled, or may be contaminated.  Transporting procedures for persons on Transmission- Based Precautions vary among agencies.  A safe transport means that other persons are protected from the infection. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 20 Isolation Precautions (cont’d)

 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. Visitors and staff often avoid the person. The person may feel lonely, unwanted, and rejected. 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. Always treat the person with respect, kindness, and dignity. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 21 Isolation Precautions (cont’d)

Bloodborne Pathogen Standard  The Bloodborne Pathogen Standard is intended to protect the health team from exposure.  HIV and HBV: Are found in the blood Are found in the blood Are bloodborne pathogens Are bloodborne pathogens Exit the body through blood Exit the body through blood Are spread to others by blood Are spread to others by blood  Other potentially infectious materials (OPIM) also spread HIV and HBV. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 22

 Exposure control plan  The agency has an exposure control plan. It identifies staff at risk for exposure to blood or OPIM. It identifies staff at risk for exposure to blood or OPIM. The plan tells what to do for an exposure incident. The plan tells what to do for an exposure incident. Staff at risk receive free training upon employment and then yearly. Staff at risk receive free training upon employment and then yearly. Training is also done for new or changed tasks involving exposure to bloodborne pathogens. Training is also done for new or changed tasks involving exposure to bloodborne pathogens. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 23 Bloodborne Pathogen Standard (cont’d)

 Preventive measures to reduce the risk of exposure include:  Hepatitis B vaccination  Engineering and work practice controls These reduce employee exposure in the workplace. These reduce employee exposure in the workplace.  Personal protective equipment (PPE) PPE protects your clothes, undergarments, skin, eyes, mouth, and hair. PPE protects your clothes, undergarments, skin, eyes, mouth, and hair. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 24 Bloodborne Pathogen Standard (cont’d)

 Contaminated equipment is cleaned and decontaminated with a proper disinfectant. Upon completing tasks Upon completing tasks At once when there is obvious contamination At once when there is obvious contamination After any spill of blood or OPIM After any spill of blood or OPIM At the end of the work shift when surfaces became contaminated since the last cleaning At the end of the work shift when surfaces became contaminated since the last cleaning  Special measures are used to discard regulated waste. Containers used for discarding regulated waste are closable, puncture-resistant, leak-proof, color-coded in red, and have the BIOHAZARD symbol. Containers used for discarding regulated waste are closable, puncture-resistant, leak-proof, color-coded in red, and have the BIOHAZARD symbol.  The agency must be kept clean and sanitary.  Special measures are required for contaminated laundry. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 25 Bloodborne Pathogen Standard (cont’d)

 Exposure incidents  An exposure incident is any eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or OPIM. Parenteral means piercing the mucous membranes or the skin. Parenteral means piercing the mucous membranes or the skin.  Report exposure incidents at once.  Confidentiality is important.  The source individual is the person whose blood or body fluids are the source of an exposure incident. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 26 Bloodborne Pathogen Standard (cont’d)

Surgical Asepsis  Surgical asepsis (sterile technique) is the practice that keeps 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. Infection is a risk. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 27

Surgical Asepsis (cont’d)  Principles of surgical asepsis  All items in contact with the person are kept sterile.  A sterile field is needed. A sterile field is a work area free of all pathogens and non-pathogens (including spores). A sterile field is a work area free of all pathogens and non-pathogens (including spores).  Sterile gloving  Before donning sterile gloves, the sterile field is set up.  After sterile gloves are on, you can handle sterile items within the sterile field. Do not touch anything outside the sterile field. Do not touch anything outside the sterile field. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 28