2. CHAPTER 5 Protecting Patients and Ourselves
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3. Introduction Methods of infection prevention Hand washing
Standard precautions
Transmission-based precautions
OSHA regulations
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4. 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
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5. Reservoirs of Infection
Carriers (asymptomatic, but spread disease to others)
Animals
Environment
Fomites (nonliving objects harboring and transmitting diseases)
Hospital procedures
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6. 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)
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7. 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)
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8. 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)
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9. Hand Hygiene
Transient flora—acquired during direct contact with patients or contaminated objects/surfaces; removed by proper hand hygiene
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10. 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)
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11. 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)
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12. 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
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13. 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
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14. 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
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15. 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)
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16. 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
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17. 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
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18. 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)
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19. 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
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20. 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)
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21. 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
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22. 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
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23. 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)
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24. 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)
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25. 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
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26. 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)
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27. 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
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28. Summary Infection can be spread through Contact Common vehicle
Direct
Indirect
Common vehicle
Airborne
Vector
Biological
Mechanical
(Continues)
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29. 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
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