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RET 1024 Introduction to Respiratory Therapy

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RET 1024 Introduction to Respiratory Therapy Module 3.0 Infection Control Infection Control Decrease host susceptibility Chemoprophylaxis Postexposure Treatment ... – PowerPoint PPT presentation

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Title: RET 1024 Introduction to Respiratory Therapy


1
RET 1024Introduction to Respiratory Therapy
  • Module 3.0
  • Infection Control

2
Infection Control
  • Nosocomial Infection
  • An infection acquired after hospitalization
  • - AKA hospital-acquired infection

3
Infection Control
  • Nosocomial Infection
  • Account for an estimated 2 million infections
    and 90,000 excess deaths annually

4
Infection Control
  • Nosocomial Infection
  • Infections acquired by those in the intensive
    care unit (ICU) account for gt20 of all HAIs (CDC
    2007)
  • Immunocompromised by disease and/or treatment
  • Major trauma
  • Respiratory failure
  • Myocardial infarction
  • CHF
  • Overdose

5
Infection Control
  • Nosocomial Infection
  • Approximately 25 of patients undergoing
    mechanical ventilation develop pneumonia as a
    complication

6
Infection Control
  • Nosocomial Infection
  • Approximately 30 of patients who develop
    ventilator-acquired pneumonia (VAP) will die

7
Infection Control
  • Nosocomial Infection
  • Historically, non-disposable respiratory
    equipment was identified as a major cause of
    respiratory infection

8
Infection Control
  • Nosocomial Infection
  • Today, procedures have evolved, and with the
    advent of single-patient use equipment,
    infections associated with respiratory equipment
    have decreased significantly

9
Infection Control
  • Nosocomial Infection
  • Healthcare workers must remain vigilant to
    protect their patients and themselves against
    infection to do so, requires strict adherence to
    infection control procedures

10
Infection Control
  • Infection control procedures aim to
  • Eliminate the sources of infectious agents
  • Create barriers to their transmission
  • Monitor and evaluate the effectiveness of control

11
Infection Control
  • Spread of Infection
  • Infection occurs when a pathogen overcomes the
    barrier of the host
  • Pathogen a microorganism capable of producing a
    disease
  • Host an organism in which another, usually
    parasitic, is nourished and harbored

12
Infection Control
  • Spread of Infection
  • Three elements needed to spread an Infection
  • Source of pathogens
  • Route of transmission
  • Susceptible host

13
Infection Control
  • Source of Pathogens
  • People
  • Patients, personnel, visitors
  • Acute disease with symptoms
  • Incubation period (exposed, but no symptoms yet)
  • Colonized by pathogens without symptoms
  • Autogenous infection (originating from within the
    body)

14
Infection Control
  • Source of Pathogens
  • Contaminated objects
  • Equipment
  • Linen
  • Medication

15
Infection Control
  • Transmission Route
  • Contact
  • Droplet
  • Airborne
  • Common vehicle
  • Vectorborne
  • NOTE Some organisms may be spread by multiple
    routes

16
Infection Control
  • Contact Transmission
  • Direct Contact
  • Body-surface-to-body-surface contact
    (person-to-person)
  • Indirect Contact
  • Contaminated object (fomite) to host contact
  • Clothing (uniforms, lab coats, isolation gowns)
  • Equipment
  • Dressings
  • Instruments
  • Shared toys

17
Infection Control
  • Droplet Transmission
  • Contaminated respiratory droplets
  • Discharged into the air (up to 10 feet) during
  • Coughing, sneezing, talking
  • Suctioning, bronchoscopy, intubation, cough
    induction
  • Deposited on the hosts mucosal surfaces
  • Nasal mucosa
  • Mouth

18
Infection Control
  • Droplet Transmission
  • Contaminated respiratory droplets
  • Currently Health Care Infection Control practices
    Advisory Committee (HICPAC) guidelines state it
    may be prudent to don a mask when within 6 feet
    of the patient or upon entry into the room of a
    patient who is on droplet isolation

19
Infection Control
  • Droplet Transmission
  • Haemophilus Influenzae
  • Pneumonia / Epiglotitis
  • Influenza virus
  • Rubella (German measles)

20
Infection Control
  • Airborne Transmission
  • Contaminated droplet nuclei
  • Residue of evaporated water droplets containing
    infectious microorganisms
  • Can remain suspended in air for long periods
  • Respirable particles of less than ? 5 ?m
  • Dust particles
  • Act as fomites

21
Infection Control
  • Airborne Transmission
  • Mycobacterium tuberculosis (TB)
  • Rubeola (Measles)
  • Varicella-zoster (Chicken Pox)
  • Note Special air handling and ventilation, as
    well as respiratory protection are required

Mycobacterium Tuberculosis
22
Infection Control
  • Common Vehicle Transmission
  • Pathogens in water and food
  • Food
  • Salmonellosis
  • Hepatitis A
  • Water
  • Shigellosis
  • Cholera
  • Medications (e.g., heparin solution)

23
Infection Control
  • Vectorborne Transmission
  • Animals or insects transfer pathogens
  • Malaria
  • West Nile Virus
  • Rabies
  • Note Vectorborne transmission are of little
    significance in hospital-acquired infections

24
Infection Control
  • Spread of Infection to the Lungs
  • Pathogens enter the lungs via
  • Aspiration of contaminated -
  • Oropharyngeal secretions
  • Gastric secretions
  • Inhaled droplets, droplet nuclei, or dust
    particles containing pathogens (fomites)
  • Hematogenous
  • Via the blood

25
Infection Control
  • Host
  • Host infection dependent upon
  • Virulence of the organism
  • Resistance of the host

26
Infection Control
  • Host
  • Increased susceptibility
  • Diabetes mellitus
  • Lymphoma
  • Leukemia
  • Neoplasia
  • Those treated with
  • Corticosteroids, irradiation, certain
    antimicrobials, immunosuppressive agents

27
Infection Control
  • Host
  • Increased susceptibility
  • Age
  • Chronic disease
  • Shock
  • Coma
  • Traumatic injury
  • Surgical procedure

28
Infection Control
  • Host
  • Most nosocomial pneumonias occur in surgical
    patients, especially those who have had chest or
    abdomen procedures
  • Clearance mechanisms impaired
  • Bacterial enters lower airway
  • Intubation
  • Anesthesia
  • Surgical pain
  • Narcotics and sedatives

29
Infection Control
  • Host
  • Surgical Patients with Highest Risk of Pneumonia
  • Elderly
  • Severely obese
  • COPD
  • History of smoking
  • Those with artificial airways
  • Endotracheal / Tracheostomy tubes

30
Infection Control
  • Infection Control Strategies
  • Infection control aims to break the chain of
    events causing the spread of infection

31
Infection Control
  • Infection Control Strategies
  • Decrease host susceptibility
  • Eliminate the source of pathogens
  • Interrupt the transmission routes

32
Infection Control
  • Decrease host susceptibility
  • Hospital efforts focus on employee immunization
    and chemoprophylaxis

33
Infection Control
  • Decrease host susceptibility
  • Immunizations
  • Hepatitis B
  • Varicella (chicken pox)
  • Rubella (German measles)
  • Measles
  • Pertussis (Whooping cough)
  • When working with infants and children
  • Influenza

34
Infection Control
  • Decrease host susceptibility
  • Chemoprophylaxis
  • Postexposure Treatment
  • Bordetella pertussis (whooping cough)
  • Neisseria meningitis (meningococcal meningitis)
  • Bacillus anthracis (anthrax)
  • Influenza virus
  • HIV
  • Group A streptococci

35
Infection Control
  • Eliminating Source of Pathogens
  • Procedure to remove pathogens from the
    environment fall into two major categories
  • General Sanitation
  • Specialized Equipment Processing

36
Infection Control
  • Eliminating Source of Pathogens
  • General Sanitation
  • Help keep overall environment clean
  • Sanitary laundry management
  • Sanitary food preparation
  • Sanitary housekeeping
  • Environmental control of the air
  • Specialized ventilation systems
  • Environmental control of the water

37
Infection Control
  • Eliminating Source of Pathogens
  • Specialized equipment handling
  • Decontamination of equipment capable of spreading
    infection
  • Cleaning
  • Disinfection
  • Sterilization

38
Infection Control
  • Specialized Equipment Handling
  • Cleaning
  • Removes dirt and organic material from equipment,
    usually by washing
  • Failure to do this will render subsequent
    processing ineffective !!!
  • Should be done in a designated Dirty area

39
Infection Control
  • Specialized Equipment Handling
  • Cleaning
  • Soaps, detergents, or enzymatic cleaners should
    be used
  • Some contain germicide
  • Automated washers available
  • (pasteurization / chemical disinfection cycle)
  • Must be rinsed and dried
  • Reassembled aseptically
  • Designated Clean area

40
Infection Control
  • Specialized Equipment Handling
  • Disinfection
  • Destroys the vegetative form of pathogens on
    inanimate objects except bacterial spores
  • Physical methods
  • Chemical methods

41
Infection Control
  • Specialized Equipment Handling
  • Physical Disinfection
  • Pasteurization
  • Submersion in a water bath at temperatures below
    boiling (70? C) for 30 minutes
  • Kills vegetative bacteria and most viruses
  • Does not kill bacteria spores

42
Infection Control
  • Specialized Equipment Handling
  • Chemical Disinfection
  • Low-Level
  • Intermediate
  • High-Level

43
Infection Control
  • Specialized Equipment Handling
  • Low-Level Disinfectants
  • Kills most bacterial, some viruses and fungi
  • Will not kill Mycobacterium tuberculosis (TB)
    spores and nonlipid virus

44
Infection Control
  • Specialized Equipment Handling
  • Low-Level Disinfectants
  • Acetic acid
  • Mostly used for homecare equipment
  • (13 white vinegar/water solution )
  • Quaternary ammoniums
  • Hospital use surface disinfection, e.g.,
    floors, countertops, walls, etc.

45
Infection Control
  • Specialized Equipment Handling
  • Intermediate Disinfectants
  • Kills all vegetative bacteria and fungi, but have
    variable activity against spores and certain
    viruses

46
Infection Control
  • Specialized Equipment Handling
  • Intermediate Disinfectants
  • Alcohol (70 Ethyl, 90 Isopropyl)
  • Not sporicidal
  • Surface disinfectant, e.g., stethoscopes,
    ventilators, etc.
  • Phenolics
  • Not sporicidal
  • Surface disinfectant
  • (added to detergents to enhance germicidal
    activity)

47
Infection Control
  • Specialized Equipment Handling
  • Intermediate Disinfectants
  • Iodophors (iodine surace-active organic
    compounds)
  • Used on skin and tissue

48
Infection Control
  • Specialized Equipment Handling
  • High-Level Disinfectants
  • Glutaraldehyde
  • Hydrogen peroxide
  • Peracetic acid
  • Chlorine (sodium hypochlorite)

49
Infection Control
  • Specialized Equipment Handling
  • High-Level Disinfectants
  • Glutaraldehyde (Trade name CIDEX)
  • Kills vegetative bacteria, Mycobacterium
    turburculosis, fungi, viruses and spores in lt10
    minutes
  • Commonly used to disinfect/sterilize endoscopes,
    e.g., fiber optic bronchoscopes, respiratory care
    equipment, and spirometry tubing

50
Infection Control
  • Specialized Equipment Handling
  • High-Level Disinfectants
  • Hydrogen Peroxide
  • 6 solution is bactericidal, fungicidal,
    viricidal in 10 minutes,
  • Sterilizes (sporicidal) in 6 hours
  • Does not produce harsh fumes

51
Infection Control
  • Specialized Equipment Handling
  • High-Level Disinfectants
  • Peracetic acid
  • Kills all microorganisms, including spores

52
Infection Control
  • Specialized Equipment Handling
  • High-Level Disinfectants
  • Sodium Hypochlorite
  • 150 dilution kills vegetative bacteria,
    bacterial spores, and Mycobacterium tuberculosis
    in 10 minutes
  • 110 dilution used to clean blood spills

53
Infection Control
  • Specialized Equipment Handling
  • Sterilization
  • Complete destruction of all forms of microbial
    life

54
Infection Control
  • Specialized Equipment Handling
  • Sterilization
  • Incineration
  • Dry heat
  • Boiling
  • Autoclaving
  • Ionizing radiation
  • Ethylene oxide

55
Infection Control
  • Specialized Equipment Handling
  • Steam Sterilization (Autoclaving)
  • Steam under pressure
  • Commonly 15 psi at 121? C for 15 minutes
  • Equipment must be cleaned and wrapped in muslin,
    linen, or paper
  • Most respiratory equipment can be damaged by this
    process

56
Infection Control
  • Specialized Equipment Handling
  • Ethylene Oxide (EtO)
  • Toxic gas
  • Equipment must be cleaned and wrapped in muslin,
    paper, or polyethylene using EtO indicator tape
  • Acute exposure may cause
  • Airway inflammation
  • Nausea
  • Diarrhea
  • Headache
  • Dizziness
  • Convulsion

57
Infection Control
  • Specialized Equipment Handling
  • Equipment Handling Procedure
  • Equipment handling procedures help prevent the
    spread of pathogens
  • Will be covered in Lab
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