Fundamental Nursing Chapter 22 Infection Control Inst.: Dr. Ashraf El - Jedi

Infectious diseases (diseases spread from one person to another) are also called or and They were once the leading cause of death, but that is no longer true because of vaccines, aggressive public health measures, and advances in drug therapy. Nevertheless, infectious diseases have not disappeared. Infectious diseases (diseases spread from one person to another) are also called or and They were once the leading cause of death, but that is no longer true because of vaccines, aggressive public health measures, and advances in drug therapy. Nevertheless, infectious diseases have not disappeared.

This chapter discusses precautions that confine the reservoir of infectious agents and block their transmission from one host to another. To understand the concepts of infection control, it is important to understand the chain of infection (see Chap. 10) and the course of an infection. This chapter discusses precautions that confine the reservoir of infectious agents and block their transmission from one host to another. To understand the concepts of infection control, it is important to understand the chain of infection (see Chap. 10) and the course of an infection.Chap. 10Chap. 10

Infection Infection is a condition that results when microorganisms cause injury to a host. Infection is a condition that results when microorganisms cause injury to a host. The host can transmit pathogens and infectious diseases to others. The host can transmit pathogens and infectious diseases to others.

Infections progress through distinct stages (Table 22-1). The characteristics and length of each stage may differ depending on the infectious agent. For example, the incubation period for the common cold is approximately 2 to 4 days before symptoms appear, but it may take months or years before a person infected with HIV demonstrates symptoms of AIDS. Infections progress through distinct stages (Table 22-1). The characteristics and length of each stage may differ depending on the infectious agent. For example, the incubation period for the common cold is approximately 2 to 4 days before symptoms appear, but it may take months or years before a person infected with HIV demonstrates symptoms of AIDS.Table 22-1Table 22-1

Infection Control Precautions Infection control precautions are physical measures designed to curtail the spread of infectious diseases. They are essential when caring for clients. Infection control precautions require knowledge of the mechanisms by which an infectious disease is transmitted and the methods that will interfere with the chain of infection. Infection control precautions are physical measures designed to curtail the spread of infectious diseases. They are essential when caring for clients. Infection control precautions require knowledge of the mechanisms by which an infectious disease is transmitted and the methods that will interfere with the chain of infection.

The Centers for Disease Control and Prevention (1996, 2005) have established guidelines for two major categories of infection control precautions: standard precautions and transmission-based precautions. The Centers for Disease Control and Prevention (1996, 2005) have established guidelines for two major categories of infection control precautions: standard precautions and transmission-based precautions.Centers for Disease Control and Prevention ( Centers for Disease Control and Prevention (

Standard Precautions Standard precautions are measures for reducing the risk for microorganism transmission from both recognized and unrecognized sources of infection. Health care personnel follow standard precautions when caring for all clients, regardless of diagnosis or infection status (Box 22-2). Standard precautions are measures for reducing the risk for microorganism transmission from both recognized and unrecognized sources of infection. Health care personnel follow standard precautions when caring for all clients, regardless of diagnosis or infection status (Box 22-2).Box 22-2Box 22-2

This precautionary system combines methods previously known as universal precautions. This precautionary system combines methods previously known as universal precautions. Health care personnel follow standard precautions whenever there is the potential for contact with the following: Health care personnel follow standard precautions whenever there is the potential for contact with the following: Blood Blood All body fluids except sweat, regardless of whether or not they contain visible blood All body fluids except sweat, regardless of whether or not they contain visible blood Nonintact skin Nonintact skin Mucous membranes Mucous membranes

Box 22-2 Standard Precautions Box 22-2 Standard Precautions Handwashing Handwashing Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. Wash hands immediately after gloves are removed, between patient contacts, and when otherwise indicated; wash between tasks and procedures on the same patient to prevent cross-contamination of different body sites. Wash hands immediately after gloves are removed, between patient contacts, and when otherwise indicated; wash between tasks and procedures on the same patient to prevent cross-contamination of different body sites. Use plain (non-antimicrobial) soap for routine handwashing. Use plain (non-antimicrobial) soap for routine handwashing. Use an antimicrobial agent or a waterless antiseptic agent to control outbreaks or hyperendemic infections (highly infectious in all age groups) Use an antimicrobial agent or a waterless antiseptic agent to control outbreaks or hyperendemic infections (highly infectious in all age groups) Gloves Gloves Wear clean, nonsterile gloves when touching blood, body fluids, secretions, excretions, and contaminated items. Wear clean, nonsterile gloves when touching blood, body fluids, secretions, excretions, and contaminated items. Change gloves between tasks on the same patient after contact with material that may contain a high concentration of microorganisms. Change gloves between tasks on the same patient after contact with material that may contain a high concentration of microorganisms. Remove gloves and wash hands immediately before caring for another patient. Remove gloves and wash hands immediately before caring for another patient. Mask, Eye Protection, Face Shield Wear a mask and eye protection, or face shield to protect the eyes, nose, and mouth when there is a likelihood that splashes or sprays of blood, body fluids, secretions, or excretions will occur. Gown Wear a clean, nonsterile gown when there is a likelihood that splashes or sprays of blood, body fluids, secretions, or excretions will occur. Remove a soiled gown promptly and wash hands. Patient-Care Equipment Handle equipment soiled with blood, body fluids, secretions, and excretions so as to prevent the transfer of microorganisms to oneself, others, or the environment. Ensure that soiled reusable equipment is cleaned before another subsequent use. Discard soiled single-use equipment properly.

Environmental Control Environmental Control Ensure that procedures for routine cleaning and disinfection of environmental surfaces, beds, bedrails, bedside equipment, and other frequently touched surfaces are carried out. Ensure that procedures for routine cleaning and disinfection of environmental surfaces, beds, bedrails, bedside equipment, and other frequently touched surfaces are carried out. Linen Linen Handle, transport, and process soiled linen in such a way as to prevent exposure to oneself, others, and the environment. Handle, transport, and process soiled linen in such a way as to prevent exposure to oneself, others, and the environment. Occupational Health and Blood- borne Pathogens Occupational Health and Blood- borne Pathogens Prevent injuries when using needles, scalpels, and other sharp devices Prevent injuries when using needles, scalpels, and other sharp devices Never recap used needles Never recap used needles Use either a one-handed “scoop” method or mechanical device for covering a needle. Use either a one-handed “scoop” method or mechanical device for covering a needle. Place all disposable sharp items in a puncture-resistant container as close to the location of use as possible; transport reusable syringes and needles in a puncture-resistant container for reprocessing. Place all disposable sharp items in a puncture-resistant container as close to the location of use as possible; transport reusable syringes and needles in a puncture-resistant container for reprocessing. Use mouthpieces, resuscitation bags, or other ventilation devices as an alternative to mouth-to-mouth resuscitation methods in areas where the need for resuscitation is predictable. Patient Placement Place a patient who contaminates the environment, who does not— or cannot be expected to— assist in maintaining appropriate hygiene or environmental control in a private room. Consult with an infection control professional concerning alternatives if a private room is not available.

Transmission-Based Precautions Transmission-based precautions are measures for controlling the spread of infectious agents from clients known to be or suspected of being infected with highly transmissible or epidemiologically important pathogens. They are also called The three types of transmission-based precautions are airborne precautions, droplet precautions, and contact precautions (Table 22-2). Transmission-based precautions are measures for controlling the spread of infectious agents from clients known to be or suspected of being infected with highly transmissible or epidemiologically important pathogens. They are also called The three types of transmission-based precautions are airborne precautions, droplet precautions, and contact precautions (Table 22-2).Table 22-2Table 22-2

These three types replace the earlier categories of strict isolation, contact isolation, respiratory isolation, tuberculosis isolation, enteric precautions, and drainage/secretion precautions. These three types replace the earlier categories of strict isolation, contact isolation, respiratory isolation, tuberculosis isolation, enteric precautions, and drainage/secretion precautions.

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Airborne Precautions Airborne precautions are measures that reduce the risk for transmitting airborne infectious agents. They block pathogens 5 microns or smaller that are present in the residue of evaporated droplets that remain suspended in the air, as well as those attached to dust particles. Airborne precautions are measures that reduce the risk for transmitting airborne infectious agents. They block pathogens 5 microns or smaller that are present in the residue of evaporated droplets that remain suspended in the air, as well as those attached to dust particles. Tuberculosis (TB) is an example of a disease transmitted in the air. Tuberculosis (TB) is an example of a disease transmitted in the air.

Droplet Precautions Droplet precautions are measures that block pathogens within moist droplets larger than 5 microns. They are used to reduce pathogen transmission from close contact (usually 3 feet or less) between an infected person or a person who is a carrier of a droplet-spread microorganism and others. Droplet precautions are measures that block pathogens within moist droplets larger than 5 microns. They are used to reduce pathogen transmission from close contact (usually 3 feet or less) between an infected person or a person who is a carrier of a droplet-spread microorganism and others.

Microorganisms carried on droplets commonly exit the body during coughing, sneezing, talking, and procedures such as airway suctioning (see Chap. 36) and bronchoscopy. Airborne precautions are not used because droplets do not remain suspended in the air. Microorganisms carried on droplets commonly exit the body during coughing, sneezing, talking, and procedures such as airway suctioning (see Chap. 36) and bronchoscopy. Airborne precautions are not used because droplets do not remain suspended in the air.Chap. 36Chap. 36

Contact Precautions Contact precautions are measures used to block the transmission of pathogens by direct or indirect contact. This is the final category of transmission-based precautions. Direct contact involves skin-to-skin contact with an infected or colonized person. Contact precautions are measures used to block the transmission of pathogens by direct or indirect contact. This is the final category of transmission-based precautions. Direct contact involves skin-to-skin contact with an infected or colonized person.

Indirect contact occurs by touching a contaminated intermediate object in the client's environment. Additional precautions are necessary if the microorganism is antibiotic resistant Indirect contact occurs by touching a contaminated intermediate object in the client's environment. Additional precautions are necessary if the microorganism is antibiotic resistant

Infection Control Measures Infection control measures involve the use of personal protective equipment (garments that block the transfer of pathogens from one person, place, or object to oneself or others) and techniques that serve as barriers to transmission (Fig. 22-3). Infection control measures involve the use of personal protective equipment (garments that block the transfer of pathogens from one person, place, or object to oneself or others) and techniques that serve as barriers to transmission (Fig. 22-3).Fig. 22-3Fig. 22-3

Locating a client and equipping a room so as to confine pathogens to one area Locating a client and equipping a room so as to confine pathogens to one area Using personal protective equipment such as cover gowns, face shields or goggles, cloth or paper masks or respirators (see Chap. 10), and gloves to prevent spreading microorganisms through direct and indirect contact Using personal protective equipment such as cover gowns, face shields or goggles, cloth or paper masks or respirators (see Chap. 10), and gloves to prevent spreading microorganisms through direct and indirect contactChap. 10Chap. 10 Depending on the type of precautions used, nurses implement all or some of the following measures:

Disposing of contaminated linen, equipment, and supplies in such a way that nurses do not transfer pathogens to others Disposing of contaminated linen, equipment, and supplies in such a way that nurses do not transfer pathogens to others Using infection control measures to prevent pathogens from spreading when transporting laboratory specimens or clients Using infection control measures to prevent pathogens from spreading when transporting laboratory specimens or clients

1. Client Environment The client environment includes the room designated for the care of a client with an infectious disease and the equipment and supplies essential to controlling transmission of the pathogens The client environment includes the room designated for the care of a client with an infectious disease and the equipment and supplies essential to controlling transmission of the pathogens

Infection Control Room Most health care agencies assign infectious or potentially infectious clients to private rooms. Most health care agencies assign infectious or potentially infectious clients to private rooms. They keep the door to the room closed to control air currents and the circulation of dust particles. They keep the door to the room closed to control air currents and the circulation of dust particles. The room has a private bathroom so that personnel can flush contaminated liquids and biodegradable solids. A sink is also located in the room for handwashing. The room has a private bathroom so that personnel can flush contaminated liquids and biodegradable solids. A sink is also located in the room for handwashing.

Staff members post an instruction card stating that isolation precautions are required on the door or nearby at eye level (Fig. 22-4). Staff members post an instruction card stating that isolation precautions are required on the door or nearby at eye level (Fig. 22-4).Fig. 22-4Fig Nurses are responsible for teaching visitors how to comply with the infection control measures. Nurses are responsible for teaching visitors how to comply with the infection control measures.

Equipment and Supplies The infection control room contains the same equipment and supplies as any other hospital room, with a few modifications. Equipment that personnel would ordinarily use for several noninfected clients, such as a stethoscope and sphygmomanometer, remains in the client's room whenever possible. This prevents the need to clean and disinfect the items each time they are removed. The infection control room contains the same equipment and supplies as any other hospital room, with a few modifications. Equipment that personnel would ordinarily use for several noninfected clients, such as a stethoscope and sphygmomanometer, remains in the client's room whenever possible. This prevents the need to clean and disinfect the items each time they are removed.

For the same reason, disposable thermometers are preferred. Personnel disinfect electronic or tympanic thermometers to make them safe for the next client. For the same reason, disposable thermometers are preferred. Personnel disinfect electronic or tympanic thermometers to make them safe for the next client. Items such as a container for soiled laundry (Fig. 22-5), lined waste containers, and liquid soap dispensers are also placed in the room Items such as a container for soiled laundry (Fig. 22-5), lined waste containers, and liquid soap dispensers are also placed in the roomFig. 22-5Fig. 22-5

2. Personal Protective Equipment. Infection control measures involve the use of one or more items for personal protection. Personal protective equipment, also called barrier garments (Fig. 22-6), includes gowns, masks, respirators, goggles or face shields, and gloves (see Chap. 10). Infection control measures involve the use of one or more items for personal protection. Personal protective equipment, also called barrier garments (Fig. 22-6), includes gowns, masks, respirators, goggles or face shields, and gloves (see Chap. 10).Fig. 22-6Chap. 10Fig. 22-6Chap. 10 These items are located just outside the client's room or in an anteroom (Fig. 22-7). These items are located just outside the client's room or in an anteroom (Fig. 22-7).Fig. 22-7Fig. 22-7

Removing Personal Protective Equipment The procedure involves making contact between two contaminated surfaces or two clean surfaces. Nurses remove the garments that are most contaminated first, preserving the clean uniform underneath (Figure 22-8) The procedure involves making contact between two contaminated surfaces or two clean surfaces. Nurses remove the garments that are most contaminated first, preserving the clean uniform underneath (Figure 22-8)

Disposing of Contaminated Linen, Equipment, and Supplies

Double-bagging is an infection control measure in which one bag of contaminated items, such as trash or laundry, is placed within another.

Removing Reusable Items They are cleaned with an antimicrobial disinfectant, bagged, and sterilized using heat or chemicals (see Chap. 10). They are cleaned with an antimicrobial disinfectant, bagged, and sterilized using heat or chemicals (see Chap. 10).Chap. 10Chap. 10

Transporting Clients During transport, nurses use methods to prevent the spread of pathogens either directly or indirectly from the client. During transport, nurses use methods to prevent the spread of pathogens either directly or indirectly from the client.

The client wears a mask or particulate air filter respirator if the pathogen is transmitted by the airborne or droplet route. Any hospital personnel having direct contact with the client use personal protective equipment similar to that used in client care. The client wears a mask or particulate air filter respirator if the pathogen is transmitted by the airborne or droplet route. Any hospital personnel having direct contact with the client use personal protective equipment similar to that used in client care.

Psychological Implications Although infection control measures are necessary, they often leave clients feeling shunned or abandoned. Clients with infectious diseases continue to need human contact and interaction. Although infection control measures are necessary, they often leave clients feeling shunned or abandoned. Clients with infectious diseases continue to need human contact and interaction.

Promoting Social Interaction Nurses encourage visitors to come as often as the agency's policies and the client's condition permit. They use every opportunity to emphasize that as long as visitors follow the infection control precautions, they are not likely to acquire the disease. Nurses encourage visitors to come as often as the agency's policies and the client's condition permit. They use every opportunity to emphasize that as long as visitors follow the infection control precautions, they are not likely to acquire the disease.

Combating Sensory Deprivation Sensory deprivation results when a person experiences insufficient sensory stimulation or is exposed to sensory stimulation that is continuous and monotonous. Sensory deprivation results when a person experiences insufficient sensory stimulation or is exposed to sensory stimulation that is continuous and monotonous.

Nursing Implications Risk for Infection Risk for Infection Ineffective Protection Ineffective Protection Risk for Infection Transmission Risk for Infection Transmission Impaired Social Interaction Impaired Social Interaction Social Isolation Social Isolation Risk for Loneliness Risk for Loneliness Deficient Diversional Activity Deficient Diversional Activity Powerlessness Powerlessness Fear Fear