1. Infection Control Practices

2. Principles of Infection Control
Microorganism: A small living organism that is not visible to the naked eye.
Non-pathogen: Non-disease causing organism
Pathogen (Germs): Disease causing organism

3. How Diseases Spread Most pathogens prefer a warm, dark environment
Need source of food and moisture
Need for oxygen varies
Aerobic (requires O2)
Anaerobic (Does not require O2)
Human body is an ideal supplier

4. B. Microbe Classifications
Viruses
Rickettsiae
Fungi
Protozoa
Bacteria

5. 1. Viruses Smallest microorganisms Spread by blood and body secretions
Very difficult to kill
Cause many diseases

6. 2. Rickettsiae Parasitic microorganisms
Transmitted to humans by the bites of insects (e.g., fleas, lice, ticks, mites)

7. 3. Fungi Simple, plant-like organisms Live on dead organic matter
Yeast and mold
Antibiotics do not kill

8. 4. Protozoa One-celled, animal-like organism
Found in decayed materials and contaminated water
May have flagella for movement

9. Bacteria Simple, one-celled organisms Multiply rapidly
Classified by shape and arrangement
Cocci: round
Bacilli: rod-shaped
Spirrilla: spiral/twisted

10. Antibiotics Antibiotics are used to kill bacteria
Some strains of bacteria have become antibiotic-resistant
When antibiotic-resistant, the antibiotic is no longer effective against the bacteria

11. Chain of Infection Diagram

12. The Chain of Infection Infectious Agent Pathogen must be present
Examples: bacteria or viruses

13. The Chain of Infection Infectious Agent Reservoir Host
Where agent can live
Examples: human body, animals, and the environment

14. The Chain of Infection Infectious Agent Reservoir Host Portal of Exit
Way for causative agent to escape from the reservoir
Examples: bodily fluids

15. The Chain of Infection Infectious Agent Reservoir Host
Direct contact: person-to-person, spread by physical or sexual contact
Indirect contact: from contaminated substances to the person
Portal of Exit
Mode of Transmission

16. The Chain of Infection Way to enter a new reservoir or host
Examples: breaks in the skin or mucous membranes,
Infectious Agent
Reservoir Host
Portal of Exit
Portal of Entry
Mode of Transmission

17. The Chain of Infection Infectious Agent Reservoir Host
Susceptible Host
Portal of Exit
Individual who can contract the disease
Can usually fight off disease
Portal of Entry
Mode of Transmission

18. Ending the Chain of Infection
Eliminate any step in the chain and infection is stopped
Follow practices to interrupt or break the chain
Examples

19. Chain of Infection
Chain of Infection – Must be present for disease to occur and spread from one individual to another
Proper hand washing is essential to prevent the spread of disease-producing microorganisms

20. C. How Pathogens Cause Infection and Disease
Some produce poisons called toxins
Some cause an allergic reaction
Others attach and destroy the living cells they invade

21. How pathogens cause infection or disease
Endogenous
Originates within the body
Exogenous
Originates outside the body
Nosocomial
Acquired in a health care facility
Opportunistic
Infections that occur when the body’s defenses are down

22. Universal Precautions
Precautions we take for every patient we encounter.
All blood and body fluid are considered to be contaminated.
These are standard

23. Standard/Universal Precautions
All blood and body fluid are considered to be contaminated.
Health care workers must wear personal protective equipment (PPE) when they may be exposed to blood and body fluids.
Gowns, gloves, mask, and face shields

24. Handwashing 
The single most effective way to prevent the spread of infection

25. Methods that Destroy Microorganisms
Three common practices are used to prevent the growth and the spread:
Antiseptics
Disinfection
Sterilization

26. Methods that Destroy Microorganisms
Antiseptics – solution that are applied directly to the skin; prevent or slow the growth of pathogens
Ex: handwashing with soap or alcohol based hand sanitizer

27. Methods that Destroy Microorganisms
Disinfection – strong chemicals such as bleach solution used to kill many pathogen.
mainly on objects and not on the skin because they may cause skin irritation

28. Methods that Destroy Microorganisms
Sterilization – the best way to kill all microbes and their spores
Steam under pressure
autoclave

29. Bloodborne Pathogens
Pathogenic organisms that are present in blood and bodily fluids that can lead to a disease:
Blood
Urine
Stool
Sexual secretions
Cerebrospinal fluids
Saliva
Mucous

30. Personal Protective Equipment (PPE)
Things you wear to prevent spread of blood borne pathogens:
Gloves
Gown
Mask

31. Sharps Container Dispose of all needles in appropriate containers
Never overfill containers
Usually RED in color

32. Hand Hygiene

33. So Why All the Fuss About Hand Hygiene?
Most common mode of transmission of pathogens is via hands!
Infections acquired in healthcare
Spread of antimicrobial resistance
Clean hands are the single most important factor in preventing the spread of pathogens and antibiotic resistance in healthcare settings.
Hand hygiene reduces the incidence of healthcare associated infections.
CDC estimates that each year nearly 2 million patients in the United States get an infection in hospitals, and about 90,000 of these patients die as a result of their infection.
More widespread use of hand hygiene products that improve adherence to recommended hand hygiene practices will promote patient safety and prevent infections.

34. Definitions Hand hygiene Handwashing Alcohol-based handrub
Performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis
Handwashing
Washing hands with plain soap and water
Alcohol-based handrub
Rubbing hands with an alcohol-containing preparation
Hand hygiene is a general term that applies to either handwashing, antiseptic handwash, alcohol-based handrub, or surgical hand hygiene/antisepsis.
Handwashing refers to washing hands with plain soap and water. Handwashing with soap and water remains a sensible strategy for hand hygiene in non-healthcare settings and is recommended by CDC and other experts.
Antiseptic handwash refers to washing hands with water and soap or other detergents containing an antiseptic agent.
Alcohol-based handrub refers to the alcohol-containing preparation applied to the hands to reduce the number of viable microorganisms.
Surgical hand hygiene/antisepsis refers to an antiseptic handwash or antiseptic handrub performed preoperatively by surgical personnel to eliminate transient and reduce resident hand flora. Antiseptic detergent preparations often have persistent antimicrobial activity.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

35. Wash Hands (continued)
When do you wash your hands?
When arrive to and leaving facility
Before and after every patient contact
Anytime the hands become contaminated
Before and after applying gloves
After you cough, sneeze, or use a tissue
Before and after any contact with your mouth, eating, drinking, smoking, applying lip balm, or removing or inserting contacts.

36. Steps to Hand Washing Review the steps on the handout provided.
Procedure
Stand back from sink. Avoid touching the inside of your sink.
Remove Jewelry.
Turn the faucet. Regulate the temperature of the water.
Let water flow over your hands with your fingers pointed down, wet hands completely.
Use soap to get a lather on your hands
Put the palms of your hands together and rub them using friction and a circular motion for approximately seconds.
Put the palm of one hand on the back of the other hand. Rub them together several times. Reverse hands and repeat.
Interlace the fingers on both hands and rub them back and forth.
Clean the nails on the palm of the hand.
Make sure all parts of hands have been cleaned approximately 2 inches above wrist.
Rinse your hands, keeping your fingers down, 2 inches above wrist.
Use a clean paper towel to dry hands thoroughly, from tips of fingers to wrist.
Use paper towel to turn off faucet.
Discard the towel in the waste container.

37. Why are these steps important?
Equipment and Supplies:
Paper Towels
Why? _______________________________________________________
Soap
Why?_______________________________________________
Note: _______________________________________________
Procedure
Stand back from sink.
Pathogens live on towels.
Helps remove pathogens by its sudsy action.
Liquid Soap is better than bar soap.
so you do not contaminate your clothing
Avoid touching the inside of your sink.

38. Turn on the faucet. Use warm water.
Why? _____________________________________________
_________________________________
Let water flow over your hands with your fingers pointed down, wet hands completely.
Why?_____________________________________________
Lather on your hands
Friction
Use paper towel to turn off faucet.
Less damaging to the skin than hot water.
Creates better lather with soap,
Prevents pathogens from running down your arm.
Pathogens are trapped in the soap and washed away.
Helps rub pathogens off.
Prevents contamination of hands.

39. Recommended Hand Hygiene Technique
Handrubs
Apply to palm of one hand, rub hands together covering all surfaces UNTIL DRY
Handwashing
Wet hands with water, apply soap, rub hands together for at least 15 seconds
Rinse and dry with disposable towel
Use towel to turn off faucet
These recommendations will improve hand hygiene practices of HCWs and reduce transmission of pathogenic microorganisms to patients and personnel in healthcare settings.
When decontaminating hands with an alcohol-based handrub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry.
When washing hands with soap and water, wet hands first with water, apply the amount of soap recommended by the manufacturer, and rub hands together for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water, dry thoroughly with a disposable towel, and use the towel to turn off the faucet.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

40. Summary Alcohol-Based Handrubs: What benefits do they provide?
Require less time
More effective for standard handwashing than soap
More accessible than sinks
Reduce bacterial counts on hands
Improve skin condition
In summary, alcohol-based handrubs provide several advantages compared with handwashing with soap and water, because they not only require less time, they also act faster. In addition, alcohol-based handrubs are more effective for standard handwashing than soap, are more accessible than sinks, are the most efficacious agents for reducing the number of bacteria on the hands of healthcare workers, and can even provide improved skin condition.

41. Gloving
Wear gloves when contact with blood or other potentially infectious materials is possible
Remove gloves after caring for a patient
Do not wear the same pair of gloves for the care of more than one patient
Do not wash gloves
Wearing gloves reduces the risk of healthcare workers acquiring infections from patients, prevents flora from being transmitted from healthcare workers to patients, and reduces contamination of the hands of healthcare workers by flora that can be transmitted from one patient to another.
Gloves should be used when HCWs have contact with blood or other body fluids.
Gloves should be removed after caring for a patient.
The same pair of gloves should not be worn for the care of more than one patient.
Gloves should not be washed or reused.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

42. Practice
You need to practice proper handwashing with partner and check each other off.
You will be given a test grade for proper technique
Also need to put on and remove gloves properly

43. Handwashing lab

44. PPE lab

45. Nosocomial Infections
Nosocomial Infections - Hospital acquired infection that does not relate to illness

46. Socomial Infections: infections that your body acquires outside hospital setting.

47. Transmission-Based Precautions
Aimed at preventing the spread of highly infectious agents.
They can be spread by contact with infected blood and or body fluid as well as by airborne droplets

48. Transmission-Based Precautions
There are 3 types:
Airborne
Droplet
Contact

49. Transmission-Based Precautions
Airborne Precautions – can spread by tiny airborne droplets;
Chicken pox, measles, TB
PPE: gloves, gown, N92 respirator mask

50. Transmission-Based Precautions
Droplet Precautions – spread by droplets, as in a sneeze or cough
Pertussis, flu, mumps, measles
PPE: gloves, gown, mask, goggles if appropriate.

51. Transmission-Based Precautions
Contact Precautions –Diseases spread by contact with infected skin or objects
Cdiff, impetigo, scabies, MRSA
PPE: gloves, gown, and mask (if prolonged contact)

52. Three diseases contracted from exposure to blood and body fluids
Hepatitis B Hepatitis C AIDS (Acquired Immune Deficiency Syndrome)

53. Virus – Hepatitis B Transmitted by blood and body secretions
Affects the liver
Vaccine available
Given in a series of three injections

54. Hepatitis C Transmitted by blood and blood-containing body fluids
Can survive several days in dried blood
Common among IV drug abusers
Many infected individuals are asymptomatic
Can cause severe liver damage

55. Acquired Immune Deficiency Syndrome (AIDS)
Caused by the Human Immunodeficiency Virus (HIV)
Suppresses the immune system
No cure presently and no vaccine
Important to take precautions to prevent

56. PPE (personal protective equipment)
Gloves: use when touching blood, body fluids, secretions, contaminated items
Use to touch mucus membranes and broken skin

57. PPE (cont.)
Gowns: use when contact of clothing/exposed skin is made with blood/body fluids

58. PPE (cont.)
Mask and goggles: use when activities likely to generate splashes or sprays of blood or body fluids

59. stop

60. Biohazard Bags Usually red/orange in color
Will be labeled with symbol:
Always dispose of
contaminated trash and
linen in these

61. Applying & Removing PPE (Personal Protective Equipment)
To apply:
Gown
Mask
Gloves
To remove:
Gloves
Gown
Mask

62. Steps for applying PPE
1. Gown: Put on gown with opening in the back; tie neck band and waste band (if available)

63. (cont)
2. Mask: Cup in hand and secure elastic bands over your head. Pinch metal plate over nose to secure to face

64. (Continued)
3. Goggles: Make sure goggles are snug and on outside of mask at the nose.

65. (Continued)
Gloves: Gloves should fit snuggly and come up over cuff of gown.

66. Removing PPE
To prevent contamination remove PPE in the following order:
Gloves: Carefully remove by placing thumb of one hand under the glove cuff & gently side off hand inside out.

67. Steps for glove removal

68. (Cont) Goggles: Touch sides only and gently pull from face.
Gown: Untie at neck; touch only inside of gown and gently “peel” from arms turning inside out
Mask: Only touch elastic band being careful not to touch outside of mask. Lift gently from face.

69. Disposing of PPE
All used PPE should be placed in a red biohazard bag.

70. What PPE items should be used when…
Your pt. has a scrape on the arm or knee?
Your pt. is vomiting uncontrollably?
Your pt. has been cut and blood is spraying from the wound?
Your pt. has provided a specimen that you need to send to the lab?
Your pt. needs lab work drawn?