CHAPTER 5 Protecting Patients and Ourselves 5-2

Introduction Methods of infection prevention Hand washing Standard precautions Transmission-based precautions OSHA regulations 5-3

Portals of Entry Openings providing infectious agents access to the body Respiratory tract GI tract GU tract Non-intact skin Wounds Pathogen may be halted by immune system, or lead to local/systemic infection 5-4

Reservoirs of Infection Carriers (asymptomatic, but spread disease to others) Animals Environment Fomites (nonliving objects harboring and transmitting diseases) Hospital procedures 5-5

Routes of Transmission Contact (direct, indirect) Common vehicle (contamination leading to illness of many people in same locale) Airborne (aerosol floats in air and is inhaled by another person) Vector (organisms that act as reservoir of infection) 5-6

Vector Transmission Biological Mechanical Pathogen located inside vector’s body (e.g., mosquito as carrier of malaria) Mechanical Pathogen located outside vector’s body (e.g., fly walks on food) 5-7

Hand Hygiene Simplest and most important method of prevention of spread of infection Two types of flora on hands Resident (normal)—located on stratum corneum; prevent contamination by antagonizing other microorganisms and competing for food source; nonpathogenic unless enter sterile body cavity of immunocompromised patient (Continues) 5-8

Hand Hygiene Transient flora—acquired during direct contact with patients or contaminated objects/surfaces; removed by proper hand hygiene 5-9

Basics of Hand Washing Remove jewelry Push lever to release paper towel (do not tear off) Set water as hot as tolerable Wet hands Apply soap and wash hands, between fingers, and around nails (for 25–30 seconds) (Continues) 5-10

Basics of Hand Washing Rinse with water allowing water to flow downward from wrists to fingers Tear off paper towel After drying hands, use paper towel to turn off water Discard towel properly (Continues) 5-11

Basics of Hand Washing May use alcohol-based, antiseptic hand sanitizers when full hand washing is not feasible, or if hands are not visibly soiled Use same cleaning action for hands, fingers, and nails Continue until sanitizer has evaporated and hands are dry 5-12

Fundamental Principles of Infection Prevention and Control Standard precautions Minimum standards; considers all patients capable of transmitting disease Transmission-based precautions Three types (contact, droplet, and airborne precautions); used with standard precautions if patient is known or suspected to have transmittable disease, or infection with multidrug-resistant bacteria 5-13

Standard Precautions Used when possible exposure to blood and/or body fluids from any patient or from contaminated equipment Include Hand hygiene and proper use of personal protective equipment (PPE) Cough etiquette/respiratory hygiene Safe injection practice Safe handling of potentially contaminated surface/equipment 5-14

Use of Antimicrobial Soap/ Alcohol-Based Rubs Use of water and antimicrobial soap (include but not limited to) After eating If hands are visibly soiled After using restroom If possible exposure to spore-forming organism (Continues) 5-15

Use of Antimicrobial Soap/ Alcohol-Based Rubs Use of alcohol-based rubs (include but not limited to) Before and after direct patient contact After removing gloves After contact with patient’s intact skin After contact with objects near patient 5-16

Personal Protective Equipment (PPE) Specialized clothing provided by employer Use is based on type of patient contact and exposure potential Examples Gloves Gowns Face masks 5-17

Cough Etiquette and Respiratory Hygiene Tissues and no-touch waste cans available in reception areas Cover mouth when coughing or sneezing Cough/sneeze into crook of elbow if tissue is not available Perform hand hygiene after contact with respiratory secretion (yours or patient’s) (Continues) 5-18

Cough Etiquette and Respiratory Hygiene Droplet precaution Used with standard precautions Avoid direct patient contact if you have respiratory illness (or wear mask if direct contact cannot be avoided) Hand hygiene 5-19

Safe Injection Practices Discard used syringes/needles at point of use (in puncture-resistant, closable, leakproof sharps container) Dispose of single-use lancets properly and immediately after use Perform phlebotomy in dedicated areas containing proper supplies and hand washing stations (Continues) 5-20

Safe Injection Practices Label blood tubes prior to phlebotomy procedure Place blood-containing tubes only on surfaces that can be properly cleaned if contamination occurs 5-21

Potentially Contaminated Surfaces/Equipment Clean equipment according to manufacturer’s instructions Clean patient-care areas daily (minimum) unless visibly contaminated; then clean area immediately Clean and disinfect patient rooms focusing on areas frequently touched by patients or staff 5-22

Transmission-Based Precautions Three types: contact, airborne, droplet (all used in conjunction with standard precautions) Contact precautions Private room; dedicated equipment for patient; disinfect equipment when removed Hand hygiene and proper use of PPE (Continues) 5-23

Transmission-Based Precautions Airborne precautions Transmission by droplet or dust (e.g., TB, measles) Negative-pressure room with door closed Proper PPE (mask must be fit-tested for health care worker) (Continues) 5-24

Transmission-Based Precautions Droplet precautions Illness spread by large particle droplets (e.g., flu, whooping cough) Private room; door may remain open Surgical mask and/or other PPE Hand hygiene before and after contact with patient or contaminated objects 5-25

Occupational Safety and Health Administration Regulations OSHA mandates blood-borne pathogen standard with goal to prevent occupational related exposure to infectious organisms in blood or body fluids Exposure control plan Annual update of plan Implement use of standard precautions (Continues) 5-26

OSHA Identifying and using engineering controls Ensuring use of work practice controls Providing PPE Availability of HBV vaccine Post-exposure evaluation/follow-up Labels/signs denoting hazards Training for workers annually Maintaining training records 5-27

Summary Infection can be spread through Contact Common vehicle Direct Indirect Common vehicle Airborne Vector Biological Mechanical (Continues) 5-28

Summary Numerous ways to protect patients and ourselves from spreading microbes Hand washing Standard precautions: hand hygiene, use of PPE, cough etiquette/respiratory hygiene, safe injection practice, safe handling Transmission-based precautions: contact, airborne, droplet OSHA standards 5-29