1. Define important words in this chapter antimicrobial: an agent that destroys or resists pathogens. autoclave: machine creating steam or a type of gas that kills all microorganisms. barrier: block or obstacle; object(s) worn by healthcare providers to prevent the transmission of infectious diseases. biohazard container: hard, leakproof containers into which sharp objects and items contaminated with infectious material are placed.

1. Define important words in this chapter (con’t) bloodborne pathogens: microorganisms found in human blood that can cause infection and disease in humans. Bloodborne Pathogen Standard: federal law requiring that healthcare facilities protect employees from bloodborne health hazards. body fluids: tears, saliva, sputum (mucus coughed up), urine, feces, semen, vaginal secretions, and pus or other wound drainage. carrier: person who carries a pathogen without signs or symptoms of an illness or disease and who can spread the disease.

1. Define important words in this chapter (con’t) catheter: tube inserted through the skin or into a body opening; used to add or drain fluid. C. difficile (C. diff, clostridium difficile): a bacterial illness that can cause diarrhea and colitis; spread by spores in feces that are difficult to kill. The Centers for Disease Control and Prevention (CDC): federal government agency responsible for improving the overall health and safety of the people of the United States. clean: a condition in which an object has not been contaminated with pathogens.

1. Define important words in this chapter (con’t) clean technique: process of removing pathogens; also called medical asepsis. communicable disease: disease transmitted when a pathogen is spread from one person to another. contagious disease: a communicable disease that is spread easily from person to person. contaminated: soiled, unclean; having disease-causing organisms or infectious material on it.

1. Define important words in this chapter (con’t) cross-infection: acquiring an infection from someone else; also called cross-contamination. dehydration: a condition that occurs when a person does not have enough fluid in the body. direct contact: way to transmit pathogens through touching the infected person or his or her secretions. direct spread: method of transmission of disease from one person to another.

1. Define important words in this chapter (con’t) dirty: a condition in which an object has been contaminated with pathogens. disinfection: a measure used to decrease the spread of pathogens and disease by destroying pathogens. drainage: flow of fluids from a wound or cavity. exposure control plan: plan that identifies the step-by-step method of what to do if exposed to infectious material; also includes specific work practices that must be followed.

1. Define important words in this chapter (con’t) exposure incident: situation that occurs when a person is exposed to infectious blood or material. fomite: an object that is contaminated with a pathogen and can now spread the pathogen to another person. hand hygiene: handwashing with either plain or antiseptic soap and water and using alcohol-based hand rubs. healthcare-associated infection (HAI): an infection associated with various healthcare settings, such as long-term care facilities, hospitals, ambulatory settings and home care.

1. Define important words in this chapter (con’t) hepatitis: inflammation of the liver caused by infection. immunity: resistance to infection by a specific pathogen. incubation period: the period of time between the time the pathogen enters the body and the time it causes an infection. indirect contact: a way to transmit pathogens by touching something contaminated by the infected person.

1. Define important words in this chapter (con’t) indirect spread: method of transmission of disease from an object, insect, or animal to a person. infection: the state resulting from pathogens invading and growing within the human body. infection control: set of methods used to control and prevent the spread of disease. infection disease: any disease caused by growth of a pathogen.

1. Define important words in this chapter (con’t) isolate: to keep something separate, or by itself. localized infection: infection limited to a specific part of the body; has local symptoms. malnutrition: a serious condition in which a person is not getting proper nutrition. medical asepsis: process of removing pathogens; also called clean technique.

1. Define important words in this chapter (con’t) microbe: a tiny living thing visible only by microscope; also called a microorganism. microorganism: a tiny living thing not visible to the eye without a microscope; also called a microbe. MRSA (methicillin-resistant Staphylococcus aureus) infection: an infection caused by bacteria that are resistant to many antibiotics; can develop when people do not take all of the medication prescribed to them. mucous membranes: the membranes that line body cavities that open to the outside of the body, such as the linings of the mouth, nose, eyes, rectum, and genitals.

1. Define important words in this chapter (con’t) multidrug-resistant organisms (MDROs): microorganisms, mostly bacteria, that are resistant to one or more antimicrobial agents. non-communicable disease: a disease not capable of being spread from one person to another. non-intact skin: skin that is broken by abrasions, cuts, rashes, acne, pimples, lesions, surgical incisions or boils. normal flora: the microorganisms that normally live in and on the body and do not cause harm in a healthy person.

1. Define important words in this chapter (con’t) nosocomial infection: an infection acquired in a hospital. Occupational Safety and Health Administration (OSHA): a federal government agency that makes rules to protect workers from hazards on the job. pathogen: the microorganisms that cause disease. perineal care: care of the genitals and anal area by cleansing.

1. Define important words in this chapter (con’t) PPE (personal protective equipment): a barrier between a person and disease; includes gloves, gowns, masks, goggles, and face shields. reinfection: being infected a second time with an infection. resistance: the body’s ability to prevent infection and disease. sanitation: ways communities maintain clean, hygienic conditions that help prevent disease, such as the disposal of sewage and solid waste.

1. Define important words in this chapter (con’t) Standard Precautions: a method of infection control in which all blood, body fluids, non-intact skin (like abrasions, pimples, or open sores), and mucous membranes (lining of mouth, nose, eyes, rectum, or genitals) are treated as if they were infected with a disease. sterilization: a measure used to decrease the spread of pathogens and disease by destroying all microorganisms, including pathogens. surgical asepsis: method that makes an area or an object completely free of microorganisms; also called sterile technique.

1. Define important words in this chapter (con’t) systematic infection: an infection that occurs when pathogens enter the bloodstream and move throughout the body; causes general symptoms, such as chills and fever. transmission: transfer of a disease. vaccine: a substance prepared from weakened or killed microbes that is used to give immunity to disease. VRE (vancomycin-resistant enterococcus): branches of the passages of the respiratory system that lead from the trachea into the lungs.

2. Define “infection control” and discuss types of infection Infection control is the set of methods used to control and prevent the spread of disease. Types of infection include: Localized infection Systemic infection Healthcare-associated infection (HAI) Nosocomial infection

3. Discuss terms related to infection control Transmission of disease can be blocked by using good infection control. Clean technique or medical asepsis is the process of removing pathogens and maintaining good infection control. An object is “clean” if it has not been contaminated by pathogens and “dirty” if it has been contaminated by pathogens. Disinfection means that only pathogens have been destroyed while sterilization means that all microorganisms have been destroyed.

Transparency 6-1: The Chain of Infection

5. Explain why the elderly are at a higher risk for infection The changes of aging that cause the elderly to be at a higher risk for infection include: Immune systems become weaker Hospitalized more often Recovery from illness takes longer Infections are more dangerous Skin becomes thinner and easier to tear Limited mobility Bones become more brittle, etc.

6. Describe The Centers for Disease Control and Prevention (CDC) and explain Standard Precaution The CDC is a federal government agency that issues guidelines to protect and improve health. Standard Precautions means treating blood, body fluids, non-intact skin, and mucous membranes as if they were infected.

7. Define “hand hygiene” and identify when to wash hands Hand hygiene is defined by the CDC as any method that removes or destroys microorganisms on hands. The times to wash your hands include: When you first arrive at work When you enter a resident’s room When you leave a resident’s room Before and after feeding a resident Before you put on gloves and after removing them, etc.

Equipment: soap, paper towels Washing Hands Equipment: soap, paper towels Identify yourself by name. Identify the resident. Greet the resident by name. Turn on water at sink. Angle your arms downward, with your fingertips pointing down into the sink. Your hands should be lower than your elbows. Wet hands and wrists thoroughly (Fig. 6-10). Fig. 6-10

Apply skin cleanser or soap to hands. Washing Hands Apply skin cleanser or soap to hands. Lather all surfaces of hands, wrists, and fingers. Use friction for at least 20 seconds (Fig. 6-11). Clean your nails by rubbing your fingertips in palm of your other hand. Fig. 6-11

Washing Hands Rinse all surfaces of wrists, hands, and fingers. Keep your hands lower than your elbows and your fingertips down. Use a clean, dry paper towel to dry all surfaces of hands, wrists, and fingers.

Washing Hands Use clean, dry paper towel or your knee to turn off the faucet. Do not contaminate your hands by touching the inside of the sink or the faucet at any time. (Fig. 6-12). Dispose of used paper towels in wastebasket immediately after shutting off faucet. Fig. 6-12

8. Discuss the use of personal protective equipment (PPE) in facilities Personal protective equipment (PPE) is a barrier (a block or obstacle) between a person and disease. PPE includes: Gloves Gowns Mask and Goggles Face Shields

Equipment: clean gloves in the correct size Wash your hands. Putting on Gloves Equipment: clean gloves in the correct size Wash your hands. If you are right-handed, slide one glove onto your left hand (reverse if left- handed). Using your gloved hand, slide the other hand into the second glove. Interlace fingers to smooth out folds and create a comfortable fit.

Putting on Gloves Check for tears, holes, cracks, or discolored spots in the gloves. Replace the gloves if needed. Adjust gloves until they are pulled up over the wrist and fit correctly. If wearing a gown, pull the cuffs of the gloves over the sleeves of gown (Fig. 6-13). Fig. 6-13

As the first glove comes off, it should be turned inside-out. Taking Off Gloves Touch only the outside of one glove. Pull the first glove off by pulling down from the cuff toward the fingers (Fig. 6-14). As the first glove comes off, it should be turned inside-out. With the fingertips of your gloved hand, hold the glove you just removed. Fig. 6-14

Taking Off Gloves With your ungloved hand, reach two fingers inside the remaining glove. Be careful not to touch any part of the outside of the glove (Fig. 6-15). Pull down, turning this glove inside-out and over the first glove, as you remove it. You should now be holding one glove from its clean inner side. The other glove should be inside it. Fig. 6-15

Drop both gloves into the proper container. Wash your hands. Taking Off Gloves Drop both gloves into the proper container. Wash your hands.

Equipment: clean gown in the correct size Wash your hands. Putting on a gown Equipment: clean gown in the correct size Wash your hands. Remove watch and place it on a clean paper towel. If wearing long sleeves, push or roll them up. Open gown. Hold it out in front of you and allow it to open (Fig. 6-16). Do not shake gown or touch it to the floor. Slip your arms into the sleeves and pull the gown on. Fig. 6-16

Putting on a gown Cover torso from the neck, down to and covering the knees. Cover the arms to the end of the wrists and wrap gown completely around the back. Securely fasten at the neck and the waist. Tie the neck ties into a bow so they can be easily untied later, or seal the tapes closed if gown has tapes. Reach behind you. Pull the gown until it completely covers you clothing. Tie the back ties (Fig. 6-17). Fig. 6-17

Put on gloves after putting on a gown. Use gowns only once and then remove and discard. Do not contaminate skin or clothing when removing gowns. Untie neck strings, then waist strings of gown. Peel gown away from body. Hold gown away from body and roll inside-out into a bundle. Discard gown in proper container. Put on gloves after putting on a gown.

Putting on a mask and goggles Equipment: mask, goggles Wash your hands. Pick up mask by the top strings or the elastic strap. Do not touch the mask where it touches your face. Adjust the mask over your nose and mouth. Tie top strings, then bottom strings. Never wear a mask hanging from only the bottom strings (Fig. 6-18). Fig. 6-18

Putting on a mask and goggles Pinch the metal strip at the top of the mask (if part of the mask) tightly around your nose so that it feels snug. Fit mask snugly around face and below the chin. Put on the goggles. Position them over the eyes. Secure them to the head using the headband or earpieces. Put on your gloves after putting on mask and goggles.

Applying and removing the full set of PPE Equipment: gown, mask or respirator, goggles or face shield, gloves Applying: Wash your hands. Put on gown. Apply mask or respirator. Apply goggles or face shield. Apply gloves last.

Applying and removing the full set of PPE Remove gloves first. Discard gloves in proper container. Wash your hands. Remove face shield or goggles, if used. Remove gown next. Discard in proper container. Remove mask or respirator. Discard in proper container.

9. List guidelines for handling linen and equipment Linen and equipment will be separated into “clean” and “dirty,” or contaminated, categories. Guidelines for handling linen and equipment include: Wearing gloves when handling soiled linens Holding and carrying dirty linen away from you Not shaking dirty linens or clothes Placing linen and equipment in proper containers Not touching the inside of disposal containers, etc.

10. Explain how to handle spills Guidelines for handling spills include: Applying gloves immediately Wiping up spills immediately Using a cleaning solution of one part bleach to ten parts water Not picking up glass, even with gloves Calling for the nurse for large spills Immediately washing an area on your body if a substance is spilled on it Washing your hands after cleaning spills

Transparency 6-2: Airborne Precautions

Transparency 6-3: Droplet Precautions

Transparency 6-4: Contact Precautions

13. Explain OSHA’s Bloodborne Pathogen Standard Bloodborne pathogens are microorganisms found in human blood. The Occupational Safety and Health Administration (OSHA) is a federal government agency that is responsible for the safety of workers in the U.S. The Bloodborne Pathogen Standard is a law passed in 1991 that requires healthcare facilities to protect employees from bloodborne health hazards.

14. Discuss two important bloodborne diseases AIDS is a disease caused by the human immunodeficiency virus (HIV). HIV is transmitted by blood, infected needles, sexual activity, and from mother to fetus. Hepatitis is an inflammation of the liver caused by infection. Hepatitis A (HAV) is spread by an oral/fecal route. Hepatitis B (HBV) is spread through blood, body fluids, sexual contact, infected needles, from a mother to her baby during delivery, improperly sterilized tattoo needles, and grooming supplies.

15. Discuss MRSA, VRE, and C. Difficile Multidrug resistant organisms (MDROs) are microorganisms, mostly bacteria, that are resistant to one or more antimicrobial agents. Methicillin-resistant Staphylococcus aureus (MRSA) infection is an antibiotic-resistant infection often acquired in healthcare facilities. Vancomycin-resistant enterococcus (VRE) is a mutant strain of a bacterium that lives in the digestive and genital tracts. C. difficile is a spore-forming bacterium which can be part of the normal intestinal flora but, when altered, can cause a watery diarrhea.

15. Discuss MRSA, VRE, and C. Difficile (cont.) Hepatitis C (HCV) is transmitted by blood or body fluids. Hepatitis D (HDV) is transmitted by blood or body fluids. Hepatitis E (HEV) is spread by an oral/fecal route or by contaminated food or water. 48