Medical Asepsis /

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Module 2
Medical Asepsis / Infection Control
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INFECTION

• Definition
• An infection is the result of an interaction
  between a susceptible hose and an infectious
  agent (bacteria, viruses, fungi, parasites) a
  clinical syndrome caused by the invasion and
  multiplication of a pathogen in the body.

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Infections are
Localized
Systemic
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Course of Infection

• The course of an infection can be
• divided into four major phases
• 1. Incubation
• 2. Prodromal
• 2. Period of Clinical illness
• 3. Convalescence

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Transmission of Infections

• Health Care institutions can present a danger in
  infectious disease transmission
• Nosocomial infection - a hospital-acquired
  infection
• Iatrogenic infection a direct result of
  treatments

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Transmission of Infections

• Goal 4 of the National Patient Safety Goals
  (NPSGs) is directed toward infection related
  sentinel events Preventing health-care
  associated infections.
• Health care-associated infections are a serious
  problem and health care workers need to strive
  toward preventing the occurrence.

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PrimaryDefenses Against Infection

• 1. Skin and mucous membrane
• 2. Respiratory system
• 3. Gastrointestinal system
• 4. Circulatory system

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Secondary Defenses Against Infection

• Inflammatory response
• Local reaction to an infectious agent
• Serves to localize, destroy, dilute, neutralize,
  remove a pathogen
• Signs redness, heat, swelling and pain
• 2. Immune response
• Immunity is a measure of a person s ability to
  fight disease by forming immunoglobulins (
  antibodies formed against invading antigens), or
  producing interferon.

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Chain of Infection
Source of infection Infectious agent
Host Susceptibility
Reservoir
Portal of Entry to susceptible host
Portal of exit from Reservoir
Mode of transmission
http//www.d.umn.edu/ehso/training/idp1.html
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Components of the Infection Cycle

• Infectious agentbacteria, viruses, fungi
• Reservoirnatural habitat of the organism
• Portal of exitpoint of escape for the organism
• Means of transmissiondirect contact, indirect
  contact, airborne route
• Portal of entrypoint at which organisms enter a
  new host
• Susceptible hostmust overcome resistance mounted
  by hosts defenses

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Link 1 Source of Infection /Pathogenic Organism

• What is the type of organism virus, bacteria,
  fungi, parasites, etc.
• Level of virulence
• Number of organisms

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Factors Affecting an Organisms Potential to
Produce Disease

• Number of organisms
• Virulence
• Competence of persons immune system
• Length and intimacy of contact between person and
  microorganism

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Question

• Which of the following is the most significant
  and commonly found infection-causing agent in
  healthcare institutions?
• A. Bacteria
• B. Fungi
• C. Viruses
• D. Mold

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Answer

• Answer A. Bacteria
• Rationale
• Bacteria are the most significant
  infection-causing agents in the healthcare
  system. Bacteria can be categorized by shape, by
  their reaction to the Gram stain, or according to
  their need for oxygen.
• Fungi (molds and yeasts) can cause infection and
  are present in the air, soil, and water.
• Viruses cause infections including the common
  cold, and do not respond to antibiotics.

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Link 2 - Possible Reservoirs for Microorganisms

• Other humans
• Animals
• Soil
• Food, water, milk
• Inanimate objects

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Question

• Which one of the following infections or
  diseases may be spread by touching a contaminated
  inanimate article?
• A. Rabies
• B. Giardia
• C. E. coli
• D. Influenza

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Answer

• Answer D. Influenza
• Rationale
• Influenza may be spread if a person touches a
  contaminated article and then touches his eyes or
  nose.
• The reservoir for rabies is animals for
  Giardia, water and for E. coli, water or food.

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Link 3 - Common Portals of Exit

• Respiratory
• Gastrointestinal
• Genitourinary tracts
• Breaks in skin
• Blood and tissue

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Link 4 Mode of Transmission

• Direct contact
• Droplets
• Vectors
• Airborne

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Link 5 Portal of entry to Host

• Eyes
• Mucous membranes
• Respiratory tract
• Placenta
• Breaks in the host barriers

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Link 6 Characteristics of the Host

• Lack of effective resistance
• Changes in host defense
• Tissue destruction

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Factors Affecting Host Susceptibility

• Intact skin and mucous membranes
• Normal pH levels
• Bodys white blood cells
• Age, sex, race, hereditary factors
• Immunization, natural or acquired
• Fatigue, climate, nutritional and general health
  status
• Stress
• Use of invasive or indwelling medical devises

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Factors Predisposing Patients to Nosocomial
Infections

• Use of invasive medical devices
• Antibiotic-resistant organisms developed in
  hospitals

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Measures to Reduce Incidence of Nosocomial
Infections

• Constant surveillance by infection-control
  committees and nurse epidemiologists
• Written infection-prevention practices for all
  agency personnel
• Hand hygiene recommendations
• Infection control precaution techniques
• Keeping patient in best possible physical
  condition

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Stages of Infection

• Incubation periodorganisms growing and
  multiplying
• Prodromal stageperson is most infectious, vague
  and nonspecific signs of disease
• Full stage of illnesspresence of specific signs
  and symptoms of disease
• Convalescent periodrecovery from the infection

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Question

• In which of the following stages of infection is
  the patient most contagious?
• A. Incubation period
• B. Prodromal stage
• C. Full stage of illness
• D. Convalescent period

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Answer

• Answer B. Prodromal stage
• Rationale
• The patient is most infectious during the
  prodromal stage when early signs and symptoms of
  the disease are present but are often vague and
  nonspecific. During this stage, the patient often
  does not realize he or she is contagious and
  spreads the infection.

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Bodys Defense Against Infection
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What are some examples of a Nursing Diagnosis?

• Risk for Infection RT
• Chronic disease
• Altered immune response
• Effects of medication
• Altered skin integrity
• Lack of proper immunization

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Planning / Goals

• The patient will
• 1. demonstrate effective hand hygiene
• 2. identify the signs of infection
• 3. maintain adequate nutrition
• 4. demonstrate proper disposal of soiled
• articles.

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Intervention
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Infection Control

• Although it is impossible to ensure that the
  patients environment is free of microorganisms,
  there are many steps that a nurse can take to
  reduce the spread of microorganisms and thus
  promote safety for both the patient and the
  healthcare personnel.

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National Patient Safety Goal

• Goal 4
• Reduce the risk of health careassociated
  infections.
• According to the Centers for Disease Control and
  Prevention, each year, millions of people acquire
  an infection while receiving care, treatment, and
  services in a health care organization.
• Consequently, health care-associated infections
  (HAIs) are a patient safety issue affecting all
  types of health care organizations.

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Quality and Safety Education in Nursing (QSEN)

• The goal of QSEN is to address the challenge of
  preparing future nurses with the knowledge,
  skills and attitudes (KSA) necessary to
  continuously improve the quality and safety of
  the healthcare systems in which they work.
• They have 6 competencies and Safety is one of the
  main competencies.

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Safety Infection Control

• Infection control measures used in the hospital
  include
• Medical Asepsis
• Standard Precautions
• Isolation Precautions

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Infection Control -- Medical Asepsis
Definition

• Practices designed to reduce the numbers of
  pathogenic microorganisms and limit their growth
  and transmission in the patients environment

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Why Practice Medical Asepsis

• Helps the patient fight a current infection and
  prevent its spread.
• Prevents the patient from being re-infected by
  the same pathogen.
• Prevents the patient from being infected with a
  new pathogen.
• 4. Prevents health care professionals and
  visitors who come in contact with the patient
  from being infected.

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• Helps decrease the chance of the patient
  acquiring a nosocomial infection.
• The infections can be simple and uncomplicated,
  or major and life threatening. Patients are at
  risk for nosocomial infection because they often
  have weakened immune systems and because the
  health care facility contains patients and
  equipment that harbor infection.
• The desired result is
• to reduce the transmission of the microorganisms
  from one person to another.
• Or from one person to an object

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Medical Asepsis Hand Hygiene

• The first line of defense in
• medical asepsis is hand hygiene.
• Proper hand-hygiene is considered the single most
  effective way to stop the spread of
  microorganisms and preventing infection.

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Proper Hand Hygiene Assures

• Reduction in the number of pathogens on the hands

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Safety Check Prior to Hand washing

• Assess that the fingernails are short
• Highest concentration of organisms on the
  
• hands are found UNDER THE NAILS.
• Jewelry should be removed, especially rings with
  stones. Wedding bands may be worn sometimes.
• Skin is free of lesions
• If the skin should have a small lesion, bandage
  the area then double glove.

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When Should You Wash Your Hands ?

• At the start of each shift
• After sneezing or coughing
• After using the bathroom
• After handling contaminated items
• Before and after giving patient care and between
  patients.
• After handling body excretions- even with gloves
  on

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• Before and after performing any treatments
• After removing gloves
• At the end of each shift before leaving the
  health facility

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WASH YOUR HANDS !
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Guidelines and Principles

• Hand-washing is one of the most effective methods
  of preventing the spread of bacteria.
• Usually 15 seconds should be allowed to wash the
  hands
• Clean from the cleanest
• area to the dirtiest area

wrist
Finger tips
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Guidelines and Principles Medical
Asepsis

• These 3 are necessary to remove microorganisms
• Do not touch the sink when washing hands stand
  away
• Keep clean items separate from dirty ones.
• Turn off water with a dry paper
• towel wet acts as a wick.

1. Friction
3. Cleansing Agent
2. Running Water
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Guidelines and Principles
Medical Asepsis

1. Jewelry makes it difficult to adequately cleanse
   the hands. It is best to not wear jewelry in the
   clinical setting. Wedding bands are acceptable
   sometimes.
2. If using hand lotionallow hands to dry about 30
   minutes before applying. Do NOT apply hand
   lotion immediately after washing hands.

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Alcohol Based Handrubs

• Alcohol-based hand rubs (foam or gel) kill more
  effectively and more quickly than handwashing
  with soap and water.
• They are less damaging to skin than soap and
  water, resulting in less dryness and irritation.
• They require less time than handwashing with soap
  and water.
• Bottles/dispensers can be placed at the point of
  care so they are more accessible.

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How to use Handrubs

• HAND RUB (foam and gel)
• Apply to palm of one hand (the amount used
  depends on specific hand rub product).
• Rub hands together, covering all surfaces,
  focusing in particular on the fingertips and
  fingernails, until dry. Use enough rub to require
  at least 15 seconds to dry.

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Alcohol based handwash
ALCOHOL-BASED HAND RUBS ARE MORE EFFECTIVE IN
KILLING BACTERIA THAN SOAP AND WATER.
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Infection Control Standard
Precautions Tier 1

• Standard Precautions are
• Those precautions designed for the care of all
  patients in hospitals regardless of their
  diagnosis or presumed infection status.

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Standard Precautions

• Set of guidelines developed by the Centers for
  Disease Control and Prevention (CDC) for
  preventing contact with potentially infectious
  blood or body fluids that may harbor diseases
  regardless of whether or not they contain visible
  blood

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Standard Precautions are used for

• All body fluids, secretions and excretions
  regardless of whether or not they contain visible
  blood
• Sputum, saliva
• Urine
• Feces
• Nasal secretions, tears
• Vomitus
• Spinal fluid/ cerebrospinal fluid
• Synovial, pleural, peritoneal , pericardial,
  amniotic fluid
• All moist body surfaces, mucus membranes
• Blood

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Standard Precautions

• Used for all patients, not just those with known
  infections
• These precautions should be implemented whenever
  contact with potentially infectious material is
  anticipated.
• Used to protect the caregiver.

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Components of Standard Precautions Tier 1

• Hand Hygiene
• Personal Protective Devices
• Gloves
• Mask, Eye Protection, Face Shield, Gown
• Respiratory Hygiene/ Cough Etiquette
• Avoid recapping of needles dispose of sharp
  objects appropriately
• Handle Patient-care equipment appropriately
• Use adequate Environment controls
• Review room assignments

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Hand Hygiene

• Hands must be washed after patient contact
  regardless of the use of gloves. Even if you
  wear gloves, wash your hands
• Gloved hands cannot be effectively washed.

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Personal Protective Equipment PPE
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Gloves

• Gloves can be used to avoid direct contact with
  infectious material
• Wear gloves to handle
• Blood
• Body fluids
• Secretions, Excretions
• Contaminated items
• Change gloves before preceding to the next task,
  or touching non-contaminated items even on the
  same patient.
• Made of vinyl or latex -- vinyl are used
• if allergy to latex is
  present.

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Mask, Eye Protection, Face
Shield, Gown

• Masks provide barrier protection against splashes
  and sprays, and airborne droplets
• Masks come in various types depending on their
  permeability to airborne particles.
• Eye goggles or glasses and face shields provide
  barrier protection against splashes and sprays.
• Gown should be water
• impermeable to provide barrier
• protection

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Infection Control Patient-Care Equipment

• Handle equipment in a manner that prevents
  personal skin and mucous membrane exposure and
  cross contamination to other patients.
• Reusable equipment must be cleaned/ disinfected
  and reprocessed before using it in the care of
  another patient.

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Environment

• Each hospital, clinic has procedures for care,
  cleaning, and disinfection of environmental
  surfaces.
• Spills of blood or body fluids need to be handled
  with special procedures.

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Linen

• Handled in a way to prevent contamination of
  skin, mucous membranes, and clothing.
• Fold soiled linen with contaminated area to the
  inside. Do not shake.
• Hold away from body and place in appropriate bag
  and dispose
• of properly.

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Sharp Objects

• Place all sharp objects in a
• puncture-proof container.
• Do not re-cap needles
• Immediately discard after use. Do not attempt to
  bend or break a needle before discarding. Throw
  away the whole thing.

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Transmission-based guidelines
Tier 2

• Isolation precautions are utilized when
• patients have a greater susceptibility to
  infection than others
• A patient or patients body fluids are a carrier
  of microorganisms that can easily be transmitted
  to other patients, family members, or health care
  workers.

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Isolation Precaution Categories

• In addition to standard precautions, the CDC
  recommends three categories of transmission-based
  precautions. They include
• 1. Airborne precautions
• 2. Droplet precautions
• 3. Contact precautions
• The fourth type of isolation is protective
  isolation.

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Airborne Precautions

• Used when the organism is capable of remaining in
  the air for prolonged periods of time and can be
  transported in the air .
• Most common organisms are
• Tuberculosis
• Chicken pox
• Measles
• Must wear a special particulate filter mask

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• A private negative air pressure room is used for
  patients needing airborne precautions.
• Negative air pressure rooms are used for patients
  needing airborne precautions
• Bring air into the room from the hallway and have
  a separate exhaust system.
• Outside the room is isolation cart that contains
  supplies needed to care for the patient and
  protects persons entering the room.

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• Caring for the patient in airborne isolation
• Personal Care - Remember it is the disease that
  is being isolated, not the patient.
  Place linens in proper contaminated waste
  container, and soiled paper towels in an
  isolation waste container.
• Food Service disposable paper trays and
  disposable dishes that are discarded in proper
  isolation waste container. Do not put tray back
  on the food cart.
• Contaminated articles according
• to agency policy, usually double
• bagged or color-coded waste
• bags to indicate contaminated waste.

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Airborne Isolation

• All patients on airborne precautions should
  wear surgical masks when leaving the negative air
  pressure room for
• x-rays, tests, or
• procedures.

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Droplet Precautions

• Organisms that can be spread by large-particle
  droplets.
• Examples of organisms include
• Influenza
• Cold
• Meningitis
• Mumps
• Pertussis

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Droplet Precautions

• Single rooms are preferable
• Patients with same disease can share the same
  room
• Standard surgical masks and gloves must be worn
  for anyone entering the patients room.
• Gloves should be worn anytime handling tissues or
  items contaminated with the respiratory
  secretions
• Keep visitors 3 feet from the infected patient.

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Contact Precautions

• Purpose is to prevent the transmission of disease
  by direct or indirect contact
• Direct contact involves
• Touching
• Bathing
• Skin-to-skin contact
• Indirect contact involves
• Contact with inanimate objects doorknobs, light
  switches, tabletops, telephones
• Examples of diseases are staph, herpes,
  diphtheria, and many others

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Contact Precautions

• Contact precautions include use of barrier
  precautions such as gloves and impermeable gowns
  to prevent direct contact with infectious
  organism
• Used
• With patients who are infected by a multi-drug
  resistant organism (MDRO)
• For patient with diarrhea
• When coming into contact with draining wounds
• Patients with acquired antibiotic resistance
  infections

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Contact Precautions

• Place the patient in a private room if possible
• Wear PPE when entering the room for all
  interactions that may involve contact with the
  patient or contaminated areas in the patients
  environment
• Remove PPE before leaving the room and perform
  hand hygiene
• Avoid sharing patient-care equipment

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Critical Thinking - Ask Yourself

• You have gone in Mr. A.s room to perform a
  dressing change.
• What type of isolation is he in?
• What equipment would you use?
• A. Gloves only
• B. Gloves and gown
• C. Gloves, gown, and mask

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Protective / Strict Isolation

• Used with patients who are immunocompromised such
  as
• Chemotherapy
• AIDS
• Organ transplants

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Review Match the Following

• __ Influenza
• __ Diarrhea
• __ Tuberculosis
• __ AIDS
• __ Chicken pox
• __ Draining wound
• __ Chemotherapy pts

• A. Airborne
• B. Droplet
• C. Contact
• D. Protective / Strict

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Review

• Mrs. B. is on airborne isolation.
• What specific equipment is used in airborne
  isolation that is not used in other types of
  isolation?

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Review

• When would the nurse apply goggles
• or a face mask?