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.
  Also called hospital-acquired infection

3
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

4
Infection Control

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

5
Infection Control

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

6
Infection Control

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

7
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

8
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

9
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

10
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

11
Infection Control

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

12
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)

13
Infection Control

• Source of Pathogens
• Contaminated objects
• Equipment
• Linen
• Medication

14
Infection Control

• Host
• Host infection dependent upon
• Virulence of the organism
• Resistance of the host

15
Infection Control

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

16
Infection Control

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

17
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

18
Infection Control

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

19
Infection Control

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

20
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

21
Infection Control

• Droplet Transmission
• Contaminated liquid droplets (gt5µm)
• Discharged into the air (up to 10 feet) during
• Coughing, sneezing, talking
• Suctioning, intubation, cough induction during
  chest PT, CPR
• Deposited on the hosts mucosal surfaces
• Conjuntivae
• Nasal mucosa
• Mouth

22
Infection Control

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

23
Infection Control

• Airborne Transmission
• Contaminated droplet nuclei
• Residue of evaporated water droplets
• Can remain suspended in air for long periods
• ? 5 ?m
• Dust particles
• Act as fomites

24
Infection Control

• Airborne Transmission
• Mycobacterium tuberculosis (TB)
• Rubeola (Measles)
• Varicella-zoster (Chicken Pox)
• Note These patients are placed in negative
  pressure rooms

Mycobacterium Tuberculosis
25
Infection Control

• Common Vehicle Transmission
• Pathogens in water and food
• Food
• Salmonellosis
• Hepatitis A
• Water
• Shigellosis
• Cholera

26
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

27
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

28
Infection Control

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

29
Infection Control

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

30
Infection Control

• Decrease host susceptibility
• Hospital efforts focus on employee immunization
• Influenza
• Hepatitis
• Diphtheria
• Tetanus
• Tuberculosis (TB)
• Bacille Calmette Guérin vaccine (BCG)

31
Infection Control

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

32
Infection Control

• 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

33
Infection Control

• Interrupting Routes of Transmission
• Three major approaches
• Specialized equipment handling
• Barrier/isolation precautions
• Will be covered in laboratory
• Single-patient-use disposable equipment

34
Infection Control

• Specialized Equipment Handling
• Cleaning
• Removes dirt and organic material from equipment
• Failure to do this will render subsequent
  processing ineffective !!!
• Should be done in a designated dirty area

35
Infection Control

• Specialized Equipment Handling
• Cleaning
• Soaps or detergents should be used
• Some contain germicide
• Automated washers available
• (pasteurization / chemical disinfection cycle)
• Must be rinsed and dried
• Reassembled aseptically

36
Infection Control

• Specialized Equipment Handling
• Disinfection
• Destroys vegetative form of pathogen
• Pasteurization
• Moist heat at temperatures below boiling 70? C
  for 30 minutes
• Kills vegetative bacteria and most viruses
• Does not kill bacteria spores

37
Infection Control

• Specialized Equipment Handling
• Disinfection
• Chemical
• Low-Level Disinfectants
• Intermediate Disinfectants
• High-Level Disinfectants

38
Infection Control

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

39
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, devices that
  cannot be soaked

40
Infection Control

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

41
Infection Control

• Specialized Equipment Handling
• Intermediate Disinfectants
• Alcohol (70 Ethyl, 90 Isopropyl)
• Surface disinfectant
• Phenolics
• Surface disinfectant
• (added to detergents to enhance germicidal
  activity)
• Iodophors (iodine surace-active organic
  compounds)
• Used on skin and tissue

42
Infection Control

• Specialized Equipment Handling
• High-Level Disinfectants
• Destroy all microorganisms
• Only some kill spores given adequate exposure
  time

43
Infection Control

• Specialized Equipment Handling
• High-Level Disinfectants
• Glutaraldehyde
• Stabilized hydrogen peroxide
• Chlorine (sodium hypochlorite)
• Peracetic acid

44
Infection Control

• Specialized Equipment Handling
• High-Level Disinfectants
• Glutaraldehyde
• Kills vegetative bacteria, Mycobacterium
  turburculosis, fungi, and viruses in 10 minutes
• Kill common spores in 3 hours
• Used to disinfect, endoscopes, respiratory and
  anesthesia equipment, dialyzers and spirometry
  tubing
• May cause tissue inflammation, epistaxis,
  rhinitis and asthma

45
Infection Control

• Specialized Equipment Handling
• High-Level Disinfectants
• Hydrogen Peroxide
• 6 solution is bactericidal, fungicidal,
  virucidal in 10 minutes, sporicidal in 6 hours
• Does not produce harsh fumes

46
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

47
Infection Control

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

48
Infection Control

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

49
Infection Control

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

50
Infection Control

• Specialized Equipment Handling
• Autoclaving
• Application of steam under pressure
• Equipment must be cleaned and wrapped in muslin,
  linen, or paper
• Commonly 15 psi at 121? C for 15 minutes
• Most respiratory equipment can be damaged by this
  process

51
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

52
Infection Control

• Specialized Equipment Handling
• Equipment Handling Procedure
• Equipment handling procedures help prevent the
  spread of pathogens
• It is important to become familiar with your
  Respiratory Departments, hospital-approved
  procedures