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Chapter 13: Infection control

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on 11 May 2015

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Transcript of Chapter 13: Infection control

Chapter 13:
Infection control
5. Portal of entry: Entrance to new reservoir
6. Susceptible host: Can contract disease
a. Common body defenses
(1) Mucous membrane
(2) Cilia: tiny, hairlike structures line respiratory tract to propel pathogens out of body
b. Immune response: allows body to produce antibodies (protective protiens) to combat pathogens

4. Precautions Vary
a. Usually room is cleaned and disinfected before use
b. Frequent disinfection occurs during use
c. People entering must wear clean or sterile gown, gloves, and mask
d. Equipment and supplies brought into room are disinfected or sterilized

c. Use standard precautions
d. Other precautions required
(1) Private room
(2) Visitors should remain 3 feet away
(3) Masks must be worn
(4) Patient wears a mask if transported

E. Classifications of Precautions (6)

(3) N-95, N-100 or more powerful filtering mask such as (HEPA) mask
(4) Men with facial hair cannot wear a standard mask

E. Classifications of Precautions (4)

1. Standard precautions
2. Airborne precautions
3. Droplet precautions
4. Contact precautions

E. Classifications of Precautions

1. Contaminated: Item contains disease producing organisms
Ex: Outside of gown, waist ties, gloves, mask, and cap become contaminated during pt care
2. Clean: Items that do not contain the organism
Ex: Inside of gown and gloves, neck band of gown and ties at the neck

D. Terms Used

1. Limit contact with pathogens
2. Help prevent spread of disease
3. Protect patient, family, and providers
4. Type of transmission based isolation used depends on the causative agent of the disease and way the organism is transmitted

C. Purposes for Isolation Precautions

1. Direct pt contact
2. Contact with equipment, linen, supplies
3. Body fluid contact

B. Ways Communicable Diseases Are Spread

1. Transmission based isolation precaution: Method or technique of caring for patients with communicable diseases
2. Standard precautions do not eliminate need for specific transmission-based isolation precautions
a. Standard precautions used on all pt.
b. Transmission based used in specific cases

A. Introduction

UNIT 13:8

MAINTAINING TRANSMISSION BASED ISOLATION PRECAUTIONS

5. Cleanse wounds with circular motion starting at center and moving out
6. Apply inner and outer dressing
7. Remove sterile gloves
8. Apply tape so it runs opposite of body action or movement

G. Changing Sterile Dressing (2)

1. Use infectious waste bag
2. Wear disposable gloves while removing dressing
3. Note type, color and amt. of drainage
4. Apply sterile gloves to cleanse area and apply new dressing

G. Changing Sterile Dressing

d. Use gloved hand to slip under folded down cuff of second glove
e. Place glove on bare hand
f. Turn cuffs up
5. When gloves are in place hold hands in front of body and above the waist
6. Handle only sterile objects

F. Sterile Gloves (3)

4. Technique for application
a. Open package
b. To don first glove, use thumb and forefinger to grasp the top edge of the folded down cuff
c. Place glove on opposite hand

F. Sterile Gloves (2)

1. Worn while performing sterile procedures
2. Make sure sterile tray is open before putting on gloves
3. Sterile gloves only sterile on outside contaminated on inside

F. Sterile Gloves

1. Drop technique – gauze and sm. Items
2. Mitten technique – sterile bowl on field
3. Transfer forceps – items cannot be removed by drop or mitten technique
a. Keep forceps pointed downward at all times
b. Do not touch sides or rim of container

D. Methods of Removal

5. Two inch boarder around sterile field is considered contaminated
6. While preparing a sterile tray for a dressing change, place the outer larger dressing on the tray first

C. Sterile Field (2)

1. Hold sterile articles away from and in front of body
2. Keep above waist below waist is considered contaminated

B. Handling Sterile Supplies

1. Surgical asepsis: procedure that keeps an object or area free from living organisms
2. Two main terms
a. Sterile: free from all organisms including spores and viruses
b. Contaminated: organisms and pathogens present

A. Introduction

6. Care of glass beakers
a. White opaque coating forms
b. Ultrasonic beakers etched with a white opaque coating must be discarded
7. Permanent tank must be cleaned and drained at intervals

D. Ultrasonic Unit (3)

4. Permanent tank of ultrasonic unit
a. Needs solution present at all times
b. Never run unit unless solution present in both container
5. Items cleaned in ultrasonic
a. Instruments, glass products, jewelry
b. Brush most particles and dirt away

D. Ultrasonic Unit (2)

1. Uses sound waves for cleaning (cavitation)
2. Method of aseptic control (does not sterilize)
3. Only use ultrasonic solutions
a. All solutions are toxic
b. Cause skin irritation

D. Ultrasonic Unit

5. Read MSDS before using chemical
6. May use anti-rust tablets
7. Disinfectant must completely cover item
8. Removal of items
9. Handle chemical solution with care and change frequently

C. Chemical Disinfection (3)

3. Preparation of items
a. Wash all items thoroughly
b. Rinse all items
c. Dry items
4. Chemical solutions used as disinfectants
a. 10% bleach solution
b. 90% isopropyl alcohol
c. Lysol

C. Chemical Disinfection (2)

8. Care of items after autoclaving
a. Surfaces must be dry before removing
b. Store in clean, dustproof areas
c. Usually items remain sterile for 30 days
9. Dry heat sterilization
a. Uses high temps for long period of time
b. Used on instruments that may corrode

B. Autoclave (4)

4. Wrapping items for autoclaving
a. Wrap must allow penetration of steam
b. Different types of wraps
c. Special wrapping technique used
5. Autoclave indicators
(1) Autoclave tape
(2) Sensitive marks/Indicator capsules

B. Autoclave (2)

UNIT 13:4 – 13:6

METHODS OF INFECTION CONTROL

1. Report any cut, injury, needle stick, immediately
2. Agency policy is then followed
3. Standard precautions must be followed at all times by all health care workers

J. Reporting Injuries

1. Should be used to avoid the need for mouth-to-mouth contact
2. Placed in convenient locations

H. Resuscitation Devices

1. Must be wiped up immediately
2. Wear gloves
3. Clean with disinfectant

G. Spills or Splashes

1. Must be worn for any procedure that may produce splashes or sprays of blood, body fluids, secretions, excretions
2. Masks should be changed every 30 minutes or anytime they become moist or wet
3. To remove, handle it by the ties only
4. Protective eyewear disinfect before reuse

E. Masks/Eyewear

1. Gloves must be worn during any procedure that is likely to cause splashing of blood or other body fluids
2. Gloves must be changed after contact with each patient
3. Do not let outside of glove contact skin during removal
4. Gloves must not be washed

C. Gloves

4. Principles of handwashing
a. Use soap
b. Use warm water
c. Friction
d. Clean all surfaces
e. Point fingertips downward
f. Use dry paper towels to turn faucet
g. Clean nails

B. Handwashing (2)

4. Require use of standard precautions
a. Developed by (CDC)
b. Every body fluid considered potential source of infection
c. All patients must be considered potential sources of infection regardless of their disease or diagnosis

A. Bloodborne Pathogen Standards (5)

j. Provide appropriate containers
k. Post signs at rooms with biohazards
l. Provide evaluation to exposed employee
m. Provide training about the regulations and all potential biohazards to all employees at no cost during work hours

A. Bloodborne Pathogen Standards (3)

1. Must be followed by all health care facilities
2. Regulations required
a. Develop written exposure plan
b. ID all employees with exposure
c. Provide hepatitis B vaccine free of charge to all employees with occupational exposure

A. Bloodborne Pathogen Standards

13:2 – 13:3

OBSERVING STANDARD PRECAUTIONS

b. Disinfection:
(1) Process that destroys or kills pathogenic organisms
(2) Not always effective against spores and viruses
(3) Can irritate or damage skin used mostly on objects not people (bleach)

H. Aseptic Techniques (3)

1. Major way to break the chain of infection
2. Two main terms
a. Asepsis: absence of disease producing microorganisms or pathogens
b. Contaminated: any area or object that may contain pathogens

G. Aseptic Techniques

Portal of exit
a. An escape from reservoir
b. Pathogen leaving through body fluids
4. Mode of transmission
a. Must be transmitted to another reservoir
b. Done by direct or indirect contact

F. Chain of Infection (2)

1. Endogenous: Originates within the body
2. Exogenous: Originates outside of body
3. Nosocomial: Infection present in a health care facility and transmitted by health care worker to the patient
4. Opportunistic: Infections that occur when the body’s defenses are weak

E. Classifications of Diseased and Infections

1. Microorganisms prefer a dark, warm, moist environment to grow and reproduce
2. Oxygen needs vary
a. Aerobic: require O2 to live
b. Anaerobic: live and reproduce in absence of oxygen

C. Factors For Growth

d. Three disease of major concern
(1) Hepatitis B caused by HBV virus
(aa). Affects the liver
(bb). Employers must provide vaccination to worker at no cost
(2) Hepatitis C caused by HCV virus
(3) AIDS caused by HIV virus

B. Classification of Microorganisms (6)

5. Viruses: Smallest microorganism, visible only in an electron microscope
a. Cannot reproduce unless they are inside another living cell
b. Not affected by antibiotics
c. Examples: cold, measles, hepatitis

B. Classification of Microorganisms (5)

d. Spirilla: Bacteria that are spiral or corkscrew in shape
e. Antibiotics are used to kill bacteria
2. Protozoa: One – celled animal like organism
a. Found in decayed material and contaminated water
b. Disease: malaria and trichomonas

B. Classification of Microorganisms (3)

c. Bacilli: Rod shaped bacteria
(1) Flagella: threadlike projections similar to tails; allow organism to move
(2) Spores: thick walled capsules that form when conditions for growth are poor
(3) Ex: tuberculosis
(4) Extremely difficult to kill in spore form

B. Classification of Microorganisms (2)

1. Bacteria
a. Classified by shape and arrangement
b. Cocci: Round or spherical in shape
(1) Diplococci: occur in pairs or circles
(2) Streptococci: occur in chains
(3) Staphylococci: Cocci that can occur in clusters or groups

B. Classification of Microorganisms

1. Small living organism
2. Found everywhere in the environment
3. Many microorganisms are part of normal flora of the body and are beneficial in maintaining certain body processes (non pathogens)
4. Microorganisms that cause infection and disease are called pathogens (germs)

A. Microorganism or Microbe

13:1

UNDERSTANDING PRINCIPLES OF INFECTION CONTROL

1. Protects certain patients from organisms present in the environment
2. Examples of patients:
a. Severely burned or malnourished
b. Chemotherapy patients
c. Failed immune system

F. Protective/Reverse Isolation

c. Other precautions required
(1) Private room
(2) Gloves applied before entering
(3) Gown worn always
(4) Room and items cleaned/disinfected daily

E. Classifications of Precautions (8)

8. Contact precautions
a. Used on patients known to be infected with epidemiologically microorganism that can be transmitted by direct or indirect contact
b. Use standard precautions

E. Classifications of Precautions (7)

7. Droplet precautions
a. Used with patients infected with pathogens transmitted by large particle droplets (coughing, sneezing…)
b. Examples: meningitis, pneumonia, mumps…


E. Classifications of Precautions (5)

b. Ex: measles, chicken pox, tuberculosis
c. Use standard precautions
d. Other precautions required
(1) Private room
(2) Air in the room should be discharged to outdoor air or filtered

E. Classifications of Precautions (3)

5. Standard precautions
a. Used for all patients
b. Every health care worker must be well informed about standard precautions
6. Airborne precautions
a. Used for patients known to be infected with pathogens transmitted by air


E. Classifications of Precautions (2)

1. Keep sterile field dry
2. Pathogens travel quickly through wet surfaces
3. If sterile item gets wet contamination has occurred

E. Maintenance of Sterile Field

1. Used for placement of sterile supplies
2. Sterile towel on tray or inside of sterile wrap
3. Do not reach across sterile field reach in from either side
4. Never turn back to sterile field

C. Sterile Field

UNIT 13:7

USING STERILE TECHNIQUES

1. Chemicals used for aseptic control
a. May not kill spores and viruses
b. Usual soaking time for instruments in a chemical disinfectant is 10 hours
2. Used to disinfect instruments that do not penetrate body


C. Chemical Disinfection

6. Loading the autoclave
a. Leave space between all items
b. Place jars and cans on their side, so steam can enter and air flow out
7. Time period for sterilization
a. Length of time and amount of pressure to sterilize items vary
b. Separate loads

B. Autoclave (3)

1. Uses steam under pressure or gas
2. Most efficient method
3. Preparation
a. Wash
b. Rinse
c. Dry
d. Remove oily substance with alcohol or ether

B. Autoclave

1. Various methods used to achieve infection control
2. Different methods lead to different levels of aseptic control
a. Antisepsis: hands and skin
b. Disinfection: floors and tables
c. Sterilization: scalpels

A. Introduction

1. Wear gloves
2. Follow agency policy
3. Infectious waste placed in biohazard bag
4. Linen soiled with blood or body fluids need to be placed in special bag for contaminated linen

I. Waste and Soiled Linen

1. Use extreme care
2. After use sharp objects must be left uncapped and placed in a puncture-resistant sharps container
3. Disposed of according to legal requirements for infectious waste

F. Sharp Objects

1. Must be worn for procedures that is likely to cause splashing or spraying of blood, body fluids, secretions, or excretions
2. Prevents contamination of clothing
3. Wash hands after removing gowns

D. Gowns

1. Most important method used to practice aseptic technique
2. Perfect media for spread of pathogens
3. Wash hand frequently

B. Handwashing

3. Needlestick Safety Prevention Act
a. CDC estimated 600,00 to 800,000 needle sticks occur each year
b. Employers are required to
(1) Use safer medical devices
(2) Solicit input from employees who are responsible for direct patient care
(3) Maintain a sharps log

A. Bloodborne Pathogen Standards (4)

d. Provide personal protective equipment
e. Adequate hand washing facilities
f. Ensure clean sanitary conditions
g. Follow measures for decontamination
h. Dispose infectious waste correctly
i. Enforce rules of no eating, drinking, smoking, applying cosmetics in any area that can be contaminated

A. Bloodborne Pathogen Standards (2)

c. Sterilization:
(1) Process that destroys all microorganisms, including spores and viruses
(2) Steam under pressure, gas, radiation can be used to sterilize objects
(3) Autoclave is the most common equipment used

H. Aseptic Techniques (4)

3. Common aseptic techniques
a. Hand washing/personal hygiene
b. Disposable gloves
c. Proper cleaning
4. Levels of aseptic control
a. Antisepsis: Process that prevents or inhibit the growth of pathogenic organisms Usually used on skin (alcohol)

H. Aseptic Techniques (2)

7. Ending chain of infection
a. Spread of disease can be stopped if any part of the chain is eliminated
b. Follow practices to interrupt or break this chain
c. Preventing pathogen transmission is a continuous process

F. Chain of Infection (4)

1. Causative agent: Pathogen such as bacteria or virus
2. Reservoir
a. Place where causative agent can live
b. Common reservoirs: human body, animals, or contaminated instruments

F. Chain of Infection

1. Some pathogens poisons called toxins

2. Some cause allergic reaction

3. Other pathogens attack and destroy living cells they invade

D. Pathogenic Microorganisms

3. Fungi: simple plant like organism such as yeasts and molds
a. Example: ringworm/athletes foot
b. Antibiotics do not kill fungi
4. Rickettsiae: Parasitic microorganism carried by fleas, ticks, and mites
a. Example: Typhus fever
b. Antibiotics are effective on rickettsiae

B. Classification of Microorganisms (4)
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