1. Define the following terms:
Infection control
the measures practiced in healthcare facilities to prevent and control the spread of disease.
Microorganism or Microbe
a living thing or organism that is so small that it can be seen only through a microscope.

2. Define the following terms:
Infection
the state resulting from pathogens invading the body and multiplying.
Pathogens
harmful microorganisms.
Systemic infection
an infection that is in the bloodstream and is spread throughout the body, causing general symptoms.

3. Define the following terms:
Localized infection
an infection that is confined to a specific location in the body and has local symptoms.
Healthcare-associated infections (HAIs)
infections that patients acquire within healthcare settings that result from treatment for other conditions.
Medical asepsis
the process of removing pathogens, or the state of being free of pathogens.

4. Define the following terms:
Clean
in health care, a condition in which objects are not contaminated with pathogens.
Dirty
in health care, a condition in which objects have been contaminated with pathogens.
Surgical asepsis
the state of being free of all microorganisms, not just pathogens; also called sterile technique.

5. 1. Define “infection control” and related terms
REMEMBER:
Working to prevent the spread of disease is the responsibility of all care team members.

6. Define the following terms:
Causative agent
a pathogen or microorganism that causes disease.
Reservoir
a place where a pathogen lives and grows.
Portal of exit
any body opening on an infected person that allows pathogens to leave.

7. Define the following terms:
Mode of transmission
method of describing how a pathogen travels from one person to the next person.
Direct contact
touching an infected person or his secretions.
Indirect contact
touching something contaminated by an infected person.
Portal of entry
any body opening on an uninfected person that allows pathogens to enter.

8. Define the following terms:
Mucous membranes
the membranes that line body cavities, such as the mouth, nose, eyes, rectum, or genitals.
Susceptible host
an uninfected person who could get sick.
Transmission
passage or transfer.
Infectious
contagious.

9. Transparency 5-1: The Chain of Infection

10. 2. Describe the chain of infection
REMEMBER:
If one of the links in the chain of infection is broken—by washing hands, for example—then the spread of infection is stopped.

11. Define the following terms:
Malnutrition
poor nutrition due to improper diet.
Dehydration
a condition that results from inadequate fluid in the body.

12. 3. Explain why the elderly are at a higher risk for infection and identify symptoms of an infection
The elderly are at higher risk of infection due to
Weakened immune systems
Decreased circulation
Slow wound healing
Malnutrition
Dehydration

13. 3. Explain why the elderly are at a higher risk for infection and identify symptoms of an infection
Factors affecting risk of infection in the elderly (cont’d.):
Limited mobility
Hospitalization
Difficulty swallowing
Incontinence
Feeding tubes and other tubing

14. 3. Explain why the elderly are at a higher risk for infection and identify symptoms of an infection
Report these signs and symptoms of localized infection:
Pain
Redness
Pus
Swelling
Drainage (fluid from a wound or cavity)
Heat

15. 3. Explain why the elderly are at a higher risk for infection and identify symptoms of an infection
Report these signs and symptoms of systemic infection:
Fever
Chills
Body aches
Headache
Drop in blood pressure
Nausea, vomiting
Weakness
Mental confusion

16. Define the following terms:
Centers for Disease Control and Prevention (CDC)
a government agency under the Department of Health and Human Services (HHS) that issues information to protect the health of individuals and communities.
Isolate
to keep something separate, or by itself.
Standard Precautions
a method of infection control in which all blood, body fluids, non-intact skin, and mucous membranes are treated as if they were infected with an infectious disease.

17. Define the following terms:
Body fluids
under Standard Precautions, includes saliva, sputum (mucus coughed up), urine, feces, semen, vaginal secretions, and pus or other wound drainage; does not include sweat.
Sharps
needles or other sharp objects.

18. 4. Describe the Centers for Disease Control and Prevention (CDC) and explain Standard Precautions
Think about this question:
Why should Standard Precautions be practiced with every resident in your care?

19. 4. Describe the Centers for Disease Control and Prevention (CDC) and explain Standard Precautions
Use these Standard Precautions measures with every resident:
Wash hands.
Wear gloves.
Remove gloves immediately when finished with a procedure.
Immediately wash skin surfaces.
Wear a disposable gown when appropriate.
Wear a mask and goggles when appropriate.

20. 4. Describe the Centers for Disease Control and Prevention (CDC) and explain Standard Precautions
Standard Precautions measures (cont’d.):
Wear gloves when handling sharp objects.
Never attempt to cap a needle or syringe.
Avoid nicks and cuts.
Bag all contaminated supplies.
Clearly label body fluids.
Dispose of contaminated waste properly.

21. Define the following terms:
Hand hygiene
washing hands with either plain or antiseptic soap and water and using alcohol-based hand rubs.
Hand antisepsis
washing hands with water and soap or other detergents that contain an antiseptic agent.
Antimicrobial
destroying or resisting pathogens.

22. 5. Explain the term “hand hygiene” and identify when to wash hands
REMEMBER:
Although alcohol-based rubs are useful, it is still very important to wash hands with soap and water and not to rely solely on alcohol-based rubs.

23. 5. Explain the term “hand hygiene” and identify when to wash hands
NAs should wash their hands at all of the following times:
Arrival at work
Any time they are visibly soiled
Before, between, and after all resident contact
After contact with body fluids, mucous membranes, non-intact skin, dressings
After handling contaminated items
After contact with objects in resident’s room

24. 5. Explain the term “hand hygiene” and identify when to wash hands
Wash hands (cont’d.):
Before and after touching meal trays
Before and after feeding residents
Before putting on gloves and after removing gloves
Before getting clean linen
After touching garbage or trash
After picking up things from the floor
After using the toilet

25. 5. Explain the term “hand hygiene” and identify when to wash hands
Wash hands (cont’d.):
After blowing nose or sneezing into hand
Before and after eating
After smoking
After touching areas on the body
Before and after applying makeup
After any contact with pets/pet care items
Before leaving facility

26. 5. Explain the term “hand hygiene” and identify when to wash hands
REMEMBER:
Handwashing is the single most important thing you can to do prevent the spread of disease.

27. Equipment: soap, paper towels
Washing hands
Equipment: soap, paper towels
Turn on water at sink. Keep your clothes dry, because moisture breeds bacteria.
Angle your arms down, holding your hands lower than your elbows. This prevents water from running up your arm. Wet hands and wrists thoroughly.

28. Washing hands (cont’d.)
Apply skin cleanser or soap to your hands.
Rub hands together and fingers between each other to create a lather. Lather all surfaces of your fingers and hands, including your wrists. Use friction for at least 20 seconds. Friction helps clean.
Clean your nails by rubbing them in palm of other hand.

29. Washing hands (cont’d.)
Being careful not to touch the sink, rinse thoroughly under running water. Rinse all surfaces of your hands and wrists. Run water down from wrists to fingertips. Do not run water over unwashed arms down to clean hands.
Use a clean, dry paper towel to dry all surfaces of your hands, wrists, and fingers. Do not wipe towel on unwashed forearms and then wipe clean hands. Dispose of towel without touching wastebasket. If your hands touch the sink or wastebasket, start over.

30. Washing hands (cont’d.)
Use a clean, dry paper towel to turn off the faucet. Do not contaminate your hands by touching the surface of the sink or faucet.
Dispose of used paper towel(s) in wastebasket immediately after shutting off faucet.

31. Define the following terms:
Personal protective equipment (PPE)
equipment that helps protect employees from serious workplace injuries or illnesses resulting from contact with workplace hazards.
Perineal care
care of the genitals and anal area.
Non-intact skin
skin that is broken by abrasions, cuts, rashes, acne, pimples, or boils.

32. 6. Discuss the use of personal protective equipment (PPE) in facilities
Gloves should be worn at the following times:
If you might touch blood or any body fluid
During mouth care or care of any mucous membrane
During perineal care
When providing personal care on non-intact skin
When providing personal care if NA has cuts on hands
When shaving a resident
When disposing of soiled linens, gowns, dressings, and pads

33. 6. Discuss the use of personal protective equipment (PPE) in facilities
Gloves should be changed
Immediately before contact with mucous membranes or broken skin
If gloves become soiled, worn, or damaged

34. With gloved hand, slide the other hand into the second glove.
Putting on gloves
Wash your hands.
If you are right-handed, slide one glove on your left hand (reverse if left-handed).
With gloved hand, slide the other hand into the second glove.
Interlace fingers. Smooth out folds and create a comfortable fit.

35. Putting on gloves (cont’d.)
Carefully look for tears, holes, or discolored spots. Replace the glove if needed.
If wearing a gown, pull the cuff of the gloves over the sleeve of gown.

36. 6. Discuss the use of personal protective equipment (PPE) in facilities
Gloves should be removed
After use
Before caring for another resident
Before touching non-contaminated items or surfaces

37. As the glove comes off your hand, 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.
As the glove comes off your hand, it should be turned inside out.

38. Taking off gloves (cont’d.)
With the fingertips of your gloved hand, hold the glove you just removed. With your ungloved hand, reach two fingers inside the remaining glove. Be careful not to touch any part of the outside of glove.
Pull down, turning this glove inside out and over the first glove as you remove it.

39. Taking off gloves (cont’d.)
You should now be holding one glove from its clean inner side. The other glove should be inside it.
Drop both gloves into the proper container.
Wash your hands.

40. 6. Discuss the use of personal protective equipment (PPE) in facilities
REMEMBER:
Gowns are worn during any procedure that is likely to cause body fluid splashes or sprays.

41. Putting on a gown
Wash your hands.
Open the gown. Hold out in front of you and allow gown to open. Do not shake it. Slip your arms into the sleeves and pull gown on.

42. Putting on a gown (cont’d.)
Tie the neck ties into a bow so they can be easily untied later.
Reach behind you. Pull the gown until it completely covers your clothing. Tie the back ties.

43. Putting on a gown (cont’d.)
Use a gown only once and then remove and discard it. When removing a gown, roll the dirty side in and away from the body. If your gown ever becomes wet or soiled, remove it. Check clothing and put on a new gown. The Occupational Safety and Health Administration (OSHA) requires non- permeable gowns—gowns that liquids cannot penetrate—when working in a bloody situation.
Put on your gloves after putting on gown.

44. 6. Discuss the use of personal protective equipment (PPE) in facilities
Wear masks and goggles
If there is risk of splashing body fluids or blood.
Wear masks if respiratory illnesses are present.

45. Putting on mask and goggles
Wash your hands.
Pick up the mask by top strings or elastic strap. Be careful not to touch the mask where it touches your face.

46. Putting on mask and goggles (cont’d.)
Adjust the mask over your nose and mouth. Tie top strings first, then bottom strings. Masks must always be dry or they must be replaced. Never wear a mask hanging from only the bottom ties.
Put on the goggles.
Put on your gloves after putting on mask and goggles.

47. Define the following terms:
Sterilization
a measure that destroys all microorganisms, including pathogens.
Disinfection
process that kills pathogens, but not all microorganisms; it reduces the organism count to a level that is generally not considered infectious.
Disposable
only to be used once and then discarded.

48. 7. List guidelines for handling equipment and linen
Remember these guidelines for equipment, linen, and clothing:
Prevent skin/mucous membrane contact.
Prevent contamination of clothing.
Prevent transfer of disease to other residents or environments.
Do not use re-usable equipment until it has been cleaned properly.
Dispose of all single-use equipment properly.

49. 7. List guidelines for handling equipment and linen
Guidelines for equipment, linen, and clothing (cont’d.):
Clean and disinfect all environmental surfaces, beds, bedrails, all bedside equipment, and all frequently touched surfaces (doorknobs are a good example).
Handle, transport, and process soiled linens and clothing in a way that prevents skin and mucous membrane exposure, contamination of clothing (hold linen away from uniform), and transfer of disease to other residents and environments.
Bag soiled linen at point of origin.
Sort soiled linen away from resident care areas.
Place wet linen in leak-proof bags.

50. 8. Explain how to handle spills
Remember these guidelines for cleaning spills involving blood, body fluids, or glass:
Put on gloves (industrial strength).
Use proper product to absorb spill.
Scoop up absorbed spill and dispose of it in designated container.
Apply disinfectant.
Use tools to pick up glass, never hands.
Properly bag waste.

51. Define the following terms:
Transmission-based (isolation) precautions
method of infection control used when caring for persons who are infected or suspected of being infected with a disease; also called isolation precautions.
Multidrug-resistant organisms (MDROs)
microorganisms, mostly bacteria, that are resistant to one or more antimicrobial agents.

52. Transparency 5-2: Airborne Precautions

53. Transparency 5-3: Droplet Precautions

54. Transparency 5-4: Contact Precautions

55. 9. Explain transmission-based precautions
Remember these guidelines for isolation:
Transmission-based precautions always used in addition to Standard Precautions
Nurses will set up the isolation unit.
Use PPE as instructed. Do not wear PPE outside resident’s room and perform hand hygiene following removal of PPE.
Do not share equipment between residents.

56. 9. Explain transmission-based precautions
Guidelines for isolation (cont’d.):
Wear proper PPE and use disposable dishes, etc. as indicated when serving food and drink.
Follow standard precautions in dealing with body waste removal.
Wear proper PPE if required to take specimen.
Reassure residents that the disease, not the person, is being isolated.

57. Define the following terms:
Bloodborne pathogens
microorganisms found in human blood, body fluid, draining wounds, and mucous membranes that can cause infection and disease in humans.
HIV
stands for human immunodeficiency virus, the virus that can cause AIDS.
Hepatitis
inflammation of the liver caused by infection.
Jaundice
a condition in which the skin, whites of the eyes, and mucous membranes appear yellow.

58. 10. Define “bloodborne pathogens” and describe two major bloodborne diseases
Bloodborne diseases are transmitted by
Infected blood
Infected semen or vaginal secretions
Sexual contact
Needle sharing
Infected mothers
Contact with infected blood or certain other body fluids in healthcare setting

59. 10. Define “bloodborne pathogens” and describe two major bloodborne diseases
REMEMBER:
Standard Precautions, handwashing, isolation, and PPE are all used to prevent the spread of bloodborne pathogens.

60. Define the following terms:
Occupational Safety and Health Administration (OSHA)
a federal government agency that makes rules to protect workers from hazards on the job.
Bloodborne Pathogens Standard
federal law that requires that healthcare facilities protect employees from bloodborne health hazards.
Exposure control plan
plan designed to eliminate or reduce employee exposure to infectious material.

61. 11. Explain OSHA’s Bloodborne Pathogen Standard
OSHA’s Bloodborne Pathogens Standard calls any of the following a “significant exposure”:
Needle stick
Mucous membrane contact
Cut from an object containing potentially infectious body fluid
Non-intact skin contact

62. 11. Explain OSHA’s Bloodborne Pathogen Standard
Employers must follow these guidelines:
Written exposure control plan
Proper PPE
Biohazard containers
Hepatitis B vaccine
Warning labels
Log of injuries from contaminated sharps
In-service training

63. Define the following terms:
Tuberculosis
an airborne disease carried on very small mucous droplets suspended in the air.
Latent TB
type of tuberculosis in which the person carries the disease but does not show symptoms and cannot infect others; also known as TB infection.
Active TB
type of tuberculosis in which the person shows symptoms of the disease and can spread TB to others; also known as TB disease.

64. Define the following terms:
Multidrug resistant-TB (MDR-TB)
type of TB that can develop when a person with active TB does not take all the prescribed medication.
Resistant
state in which drugs no longer work to kill specific bacteria.
Phlegm
thick mucus from the respiratory passage.

65. 12. Define “tuberculosis” and list infection control guidelines
Signs and symptoms of TB include:
Fatigue
Loss of appetite
Weight loss
Slight fever and chills
Night sweats
Prolonged coughing
Coughing up blood
Chest pain
Shortness of breath
Trouble breathing

66. 12. Define “tuberculosis” and list infection control guidelines
Remember these guidelines for infection control when tuberculosis is present:
Follow Standard Precautions and airborne precautions.
Wear mask and gown.
Handle sputum or phlegm carefully.
Ensure proper ventilation.
If resident is in AFB isolation room, open and close door slowly.
Follow isolation procedures if ordered.
Help resident remember to take medications.

67. Define the following terms:
Multidrug-resistant organisms (MDROs)
microorganisms, mostly bacteria, that are resistant to one or more antimicrobial agents.
Antimicrobial
destroying or resisting pathogens.
MRSA
stands for methicillin-resistant Staphylococcus aureus, an antibiotic-resistant infection often acquired by people in hospitals and other healthcare facilities who have weakened immune systems.

68. Define the following terms:
VRE
vancomycin-resistant enterococcus, a genetically changed strain of enterococcus that originally developed in people who were exposed to the antibiotic vancomycin.
Clostridium difficile (C-diff, C. difficile)
bacterial illness that causes diarrhea and can cause colitis.

69. 13. Define the terms “MRSA,” “VRE,” and “C. Difficile”
MRSA is spread through
Direct contact
Indirect contact
REMEMBER:
Handwashing is the single most important measure to control the spread of MRSA.

70. 13. Define the terms “MRSA,” “VRE,” and “C. Difficile”
C. Difficile is spread through
Direct contact with infected residents
Contact with environmental surfaces contaminated with
C. Difficile spores
REMEMBER:
C. Difficle is very difficult to kill. Handwashing will not kill the spores, but will wash them down the drain. Hand rubs may increase the risk of C. Difficile transmission because many feel a hand rub is all that is needed, but hand rubs do not kill C. Difficile spores. Proper handwashing is essential.

71. 14. List employer and employee responsibilities for infection control
REMEMBER:
All facilities have policies and procedures in place regarding infection control. Know and follow your facility’s policies.

72. 14. List employer and employee responsibilities for infection control
Employers’ responsibilities regarding infection control include
Infection control procedures and exposure control plan
In-service education
Written procedures to follow
PPE for employees
Free hepatitis B vaccine

73. 14. List employer and employee responsibilities for infection control
Employees’ responsibilities regarding infection control include
Follow standard precautions.
Follow facility’s policies and procedures.
Follow care plans and assignments.
Use PPE when appropriate.
Take advantage of free hepatitis B vaccine.
Immediately report exposure.
Participate in education programs.