Chain of Infection Isolation precautions Sept. 14, 2017

In your own words, define normal flora Bell Ringer In your own words, define normal flora In your own words, define pathogen List the pathogens we discussed in class yesterday and give me one fact about each one.

Standard 15) Correlate the function of normal flora with homeostasis and relate deviation to disease states. Evaluate specific measures to prevent deviation that are aligned with accepted standards of care. 16) Assess the differences between healthcare- associated infections and non-healthcare associated infections using examples drawn from mock patient documents or case studies. Support explanations with relevant surveillance statistics, preventive measures, and methodologies concerning outbreak detection, management, and education.

Objective By the end of class, students will be able to: Apply and Identify Transmission-Based Precautions Apply and Identify the steps in the Chain of Infection

Infectious and Communicable Diseases An infectious disease results from an invasion of microorganisms. A communicable disease is a type of infectious disease that can be transmitted from one person to another person. Not all infectious diseases are communicable - cardiovascular diseases, cancers, chronic respiratory diseases and diabetes  Infectious and Communicable Diseases Diseases are also classified according to whether or not they can be transmitted from one person to another person. An infectious disease results from an invasion of microorganisms. A communicable disease is a type of infectious disease that can be transmitted from one person to another person. Not all infectious diseases are communicable. For example, lyme disease is caused by bacteria, but it cannot be transmitted from person to person. Hepatitis B, on the other hand, is caused by a virus. The hepatitis B virus can be passed from person to person if exposure to blood or bodily fluids occurs. One of the goals of infection control is to prevent the transmission of these communicable diseases.

Classification of Infections and Diseases Endogenous – begins inside the body Exogenous – caused by something outside the body Nosocomial – acquired by an individual within a health care facility AKA Health care associated infection Opportunistic – occur when the body’s defenses are weak

Communicable Diseases Some communicable diseases are spread through direct contact. Others may be spread through indirect contact. Communicable Diseases A communicable disease is a type of infectious disease that can be transmitted from one person to another person. Some communicable diseases are spread through direct contact. Examples of direct contact are touching an open wound on an infected person or having a sexual relationship with an infected person. Communicable diseases can also be spread through indirect contact. Indirect contact includes inhaling the air after an infected person has sneezed or handling soiled bed sheets from an infected patient.

Transmission of Communicable Diseases Not all communicable diseases are transmitted the same way. There are many different types of communicable diseases, and health care workers must become familiar with the mode of transmission for each disease. Transmission of Communicable Diseases Not all communicable diseases are transmitted the same way. For example, AIDS, Hepatitis B, and strep throat can be spread only through direct contact. On the other hand, chicken pox, pink eye, and pneumonia can be spread through direct or indirect contact. There are many different types of communicable diseases, and health care workers must become familiar with the mode of transmission for each disease.

Transmission-Based Precautions Transmission-based precautions are used only with patients who have been diagnosed with highly communicable diseases. Three types: Airborne Droplet Contact Transmission-Based Precautions Standard precautions are practiced with all patients, regardless of their sickness. But there is another set of precautions that are only used with patients who have been diagnosed with highly communicable diseases. These precautions are called transmission-based precautions. The three types of transmission-based precautions are airborne, droplet, and contact.

Introduction to Transmission-Based Precautions: https://www.youtube.com/watch?v=bBLxJ-V8_Ds

Airborne Precautions Airborne precautions are used for patients with disease that are spread through tiny airborne droplets. Precautions: Isolation room Respiratory protection Negative pressure Examples of diseases: Tuberculosis Chicken pox Airborne Precautions Some communicable diseases are spread by tiny airborne droplets. When an infected person coughs or sneezes, tiny droplets are released into the air. Because the droplets are so small, they can remain in the air for a long time and cause infection in people who inhale the droplets. Diseases that require airborne precautions include tuberculosis and chicken pox. Patients who are diagnosed with this type of communicable disease must be treated with special care. First, they should be placed into a private room. This practice is called isolation. Second, health care workers who enter the private room must wear special respiratory protection, such as a high-efficiency particulate air filter (HEPA mask). Finally, the room must be kept at negative pressure with the door closed. Negative pressure will keep droplets from being drawn into other rooms.

Droplet Precautions Droplet precautions are used for patients with diseases that are spread through large airborne droplets. Precautions: Isolation room Standard surgical masks Examples of diseases: Pneumonia Influenza Whooping cough Droplet Precautions For some types of communicable diseases, droplets that are released when a patient sneezes or coughs are large and do not stay in the air for a long period of time. Droplet precautions are required for these diseases. Diseases that require droplet precautions include pneumonia, influenza, and whooping cough. Patients with these diseases must be placed into an isolation room, but negative air pressure is not needed. Health care workers who enter these rooms must wear standard surgical masks. However, respiratory filters are not required.

Contact Precautions Contact precautions are used for patients with diseases that are spread through direct and indirect contact. Precautions: Isolation room Gowns and gloves Equipment precautions Examples of diseases: MRSA VRE Contact Precautions Some communicable diseases can be spread through direct contact and indirect contact. Two examples are MRSA (methicillin-resistant staphylococcus aureus) and VRE (vancomycin-resistant enterococcus). These two infections are highly contagious and very dangerous. Therefore, special precautions must be applied to patients with these diseases. Patients who require contact precautions must be placed in an isolation room. Health care workers who treat these patients must put on gowns and gloves before entering the room. After the procedure, protective equipment must be removed and discarded carefully to avoid transmitting the disease. Whenever possible, the medical equipment used on these patients should be disposable or used only with the infected patient. If equipment must be used for additional patients, it must be disinfected and sterilized first.

Transmission-Based Garments When health care workers enter isolation rooms, they must wear transmission- based garments. Health care workers must wear appropriate garments based on the disease of the patient. Proper PPE! Transmission-Based Garments Patients with highly communicable diseases must be placed into isolation rooms. When health care workers enter isolation rooms, they must wear transmission-based garments. Recall that there are three types of transmission-based precautions: airborne, droplet, and contact. These precautions require different types of protective garments. Health care workers must wear appropriate transmission-based garments based on the disease of the patient.

Isolation Units Patients with communicable diseases are often placed into private rooms for isolation. This practice helps prevent the spread of communicable diseases to health care workers and other patients. Isolation Units Patients with communicable diseases are often placed into private rooms for isolation. This practice helps prevent the spread of communicable diseases to health care workers and other patients. Health care facilities must establish specific regulations for working in isolation units. Health care workers must always use the special precautions outlined by their facility.

Meals in an Isolation Unit Most facilities require that disposable food trays and eating utensils are used in isolation units. Leftover food and beverages should never be taken out of an isolation unit. Liquids and soft foods should be flushed down the toilet. Solid foods should be placed in biohazardous waste bags. Meals in an Isolation Unit Certain rules should be followed for meals in isolation units. For example, most facilities require that disposable food trays and eating utensils are used. The trays and utensils can then be discarded into biohazardous waste bags instead of risking contamination to other patients and health care workers. Additionally, leftover food and beverages should never be taken out of an isolation unit. Liquids and soft foods should be flushed down the toilet. Solid foods should be placed in biohazardous waste bags.

Working in an Isolation Unit Most of the procedures that take place in isolation units require two health care workers. Items that are taken from isolation rooms are double- bagged to prevent the spread of dangerous pathogens. Working in an Isolation Unit Most of the procedures that take place in isolation units require two health care workers. One worker will go into the room, and the other worker will wait outside the door. The worker inside the room will perform necessary tasks, such as collecting trash and soiled linens, helping the patient eat, and taking vital signs. When items must be removed from the room, the worker will collect the items in a biohazardous waste bag. The worker will then open the door and place the waste bag into another biohazardous waste bag that is being held by the second worker. The double-bagging technique helps to prevent the spread of dangerous pathogens. Another way to prevent the spread of pathogens is by removing all protective garments while still inside the isolation room. If a health care worker removes the garments outside the isolation room, pathogens can easily spread to other areas of the hospital.

Chain of Infection: Causative agent Reservoir Portal of exit Mode of transmission Portal of entry Susceptible host Chain of Infection For a communicable disease to be passed from one person to another, certain conditions must be met. These conditions are known as the chain of infection. The following list describes the steps in the chain of infection: The chain of infection begins with a pathogen, which is called the causative agent. The causative agent must find a reservoir, or a place for the causative agent to live and grow. A reservoir could be a human, an animal, or any surface or object. Next, the pathogen must have a portal of exit to leave the reservoir. In humans, pathogens can leave the body through blood, bodily fluids, or excrement. After the pathogen leaves the reservoir, it must be moved to another reservoir where it can continue to live and grow. This process is called the mode of transmission. The pathogen must have access to a portal of entry, which is the place the pathogen will enter the new reservoir. If the new reservoir has weak defenses, it will contract the disease or infection. The new reservoir is called the susceptible host. If any part of the chain is broken, the spread of the disease or infection will stop. Health care workers must practice principles of infection control in order to break the chain of infection.

Causative Agent = Pathogen Disease-producing microorganism; bacteria, virus, fungus, protozoa, and rickettsia Present in blood or body fluids, called “bloodborne pathogens” Pathogens need an environment that enables them to survive, grow, and multiply The human body is a perfect environment The first link in the Chain of Infection is the pathogen. The pathogen is required for any infection to be present. The five types of pathogens are bacteria, virus, fungus, protozoa, and rickettsia. Pathogens can be present in our body fluids, including in blood. Pathogens are often referred to as bloodborne pathogens.

Reservoir Human, animal, or insect that is infected with disease Other reservoirs may be water, food, and contaminated objects Host may be symptomatic or asymptomatic Reservoir host is contagious even though he or she may not appear ill A reservoir host is a person who has the pathogen present in his or her body. The reservoir host may be sick and have symptoms of illness or may be perfectly healthy in appearance. A person who is ill but does not show symptoms is called asymptomatic.

Portal of Exit Pathogen must be able to exit reservoir host Any body opening lined with mucous membranes: eyes, nose, throat, vagina, rectum, penis Injury or surgery Blood, body fluids: vaginal secretions, semen, urine, feces In order for the Chain of Infection to continue to spread, the pathogen must be able to leave the reservoir host to infect another person.

Mode of Transmission Direct contact— person-to-person contact or skin- to-skin contact Handshaking, kissing, and sexual contact Indirect contact— fomites; ticks, fleas, lice, and countertops Indirect contact includes airborne and droplet infection—sneezing, coughing, and talking Transmission includes direct contact, indirect contact, and airborne transmission.

Portal of Entry Pathogen must find entry into new host Any opening in the body lined with mucous membranes: nose, mouth, throat, vagina, penis, rectum Wounds to the skin Just as the pathogen has to leave the reservoir host in order to continue to spread, the pathogen also has to find a way to enter another person. The means of exit are exactly like the means of entry—mucous-lined membranes and wounds or nonintact skin.

Susceptible Host Weakened immune system Poor hygiene Inadequate nutrition Stress Chronic disease Poor environmental conditions Elderly Very young Certain medications Smoking Alcohol abuse A variety of conditions contribute to a person being a susceptible host. Medical assistants work to make sure that we do not become a susceptible host. By eating well, exercising, practicing good hygiene, and so forth, medical assistants can lessen the amount of times they are ill.

Chain of Infection Video https://www.youtube.com/watch?v=_o9SxDFPUiA Write down all the ways you see the chain of infection spread.

What link in the chain am I? Yeast infection Handshake Open wound Mucous membranes Sneeze Nose Elderly lady Person with flu Mouth Pencil Table top Cold virus Infant girl Person with hepatitis Bloody nose Blood Door knob Person with AIDS Sexual intercourse Needle Used Kleenex

Chain of Infection http://www.vdh.virginia.gov/content/uploads/sites/13/2016/03/Chain-of- Infection-Fact-Sheet.pdf

Objective By the end of class, students will be able to: Apply and Identify Transmission-Based Precautions Apply and Identify the steps in the Chain of Infection