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The Infectious Disease Model

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Title: The Infectious Disease Process Author: Ruth Anne Rye, BS, RN Last modified by: Joan Created Date: 9/25/2007 4:05:46 PM Document presentation format – PowerPoint PPT presentation

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Title: The Infectious Disease Model


1
The Infectious Disease Model
Chain of Infection
  • The Chain of Infection helps to explain the
    infection process. Each link represents a
    component or element in the cycle, and must be
    present in sequential order for infection
    transmission to occur. Understanding the
    characteristics of each link and the relation to
    the other links is important to determine
    interventions and strategies to break the chain
    and prevent infection. Breaking the chain of
    infection is the responsibility of every
    healthcare professional.

2
InfectiousAgent
Reservoir
SusceptibleHost
Chain ofInfection
Exit
Entry
Transmission
3
Infectious Agent
Chain ofInfection
  • Bacteria
  • Bacilli
  • Cocci
  • Spirochetes
  • Virus
  • Fungi
  • Rickettsia
  • Protozoa
  • Exogenous from outside the body
  • Endogenous from inside the body

4
Reservoir
Chain ofInfection
  • ? Storage site for growth and reproduction
  • Humans Patients own flora - transient or
    chronically colonized
  • Incubating
  • Active disease
  • Convalescent
  • Animals
  • Environment
  • Food, beverages, soil,
  • Healthcare equipment
  • Contaminated
  • Handling
  • Storage

5
Mode of Exit
Chain ofInfection
  • ? Organism leaves the Reservoir
  • Respiratory tract
  • Cough, sneeze, talking
  • Gastrointestinal tract
  • Saliva, vomitus, feces
  • Skin, mucous membranes
  • Genitourinary tract
  • Urine, semen, vaginal secretions
  • Blood
  • Mother to unborn child
  • Artificial openings

6
Mode of Transmission
Chain ofInfection
  • Contact
  • Direct
  • Indirect
  • Droplet
  • Airborne
  • Other sources of infection
  • Example vector

7
Mode of Entry
Chain ofInfection
  • ?Infectious agent enters the new host
  • Respiratory tract
  • Breathing contaminated air droplets
  • Gastrointestinal tract
  • Eating, drinking, hand-to-mouth (fecal-oral
    route)
  • Skin, mucous membranes
  • Non-intact skin
  • Hand-to-eye and nose
  • Genitourinary tract
  • Urinary tract, sex
  • Blood
  • Placenta-to-baby

8
Susceptible Host
Chain ofInfection
  • Immune system, e.g.transplant,
  • extremes of age,
  • chemotherapy
  • Barrier compromised, e.g. abrasion, burn,
  • device use, surgical procedure
  • Additional factors, e.g. underlying disease,
    medications, nutrition, stress

9
Breaking the Chain
10
Medical Asepsis
  • Definition Purposeful
  • Prevention of infection by
  • Reducing the number of
  • organisms and
  • Preventing their spread

11
Practices that .
  • Keep environment free from contamination
  • Keep patient free of colonization by facility
    microbes
  • ASEPSIS
  • Also protects healthcare workers

12
Asepsis Know What Is Clean
  • Clean, laundered Linen
  • Dishes and utensils after running through
    dishwasher or cleaned sanitized
  • Employee hands following hand hygiene
  • Item thoroughly washed and/or disinfected

13
Asepsis Know What Is Dirty
  • Dirty contaminated (e.g. visible soil), used
    item
  • Examples
  • Any obviously soiled item
  • The floor
  • Any patients body fluid
  • Soiled/used dressing materials
  • Toilet seat soiled with patients body fluids
  • Gloved hands following personal care

14
Asepsis Know What Is Sterile
  • Sterile Absence of all microbes
  • Sterile field
  • Use sterile supplies labeled sterile
  • Example delivered in sealed package,
  • e.g. gauze 4x4, urinary catheter,
  • intravevenous fluids

15
Asepsis Separation Preventing Contamination
  • Keep the three conditions separate
  • Dont allow clean or disinfected items to come in
  • contact with dirty items
  • Clean linen falls on floor floor considered
    dirty
  • Place in laundry for washing
  • Remedy the contamination immediately
  • When you see that dirty, clean, and sterile not
  • kept apart, do something immediately
  • Report any observed breach in technique

16
Surgical Asepsis(sterile technique)
  • Practices that keep an area
  • or objects free from all
  • microorganisms

17
Surgical Asepsis Principles
  • Only sterile items are used withint the sterile
  • field
  • Sterile persons are gowned and gloved
  • Tables are serile ony at table level
  • Sterile persons touch only sterile items or areas
  • Unsterile persons avoid reaching over the sterile
    field
  • The edges of anything that encloses sterile
    contetns are considered unsterile
  • The sterile field is created as close as possible
    to the time of use

18
Principles, continued
  • Sterile areas are continuously kept in view
  • Sterile person keep well within the sterile area
  • Sterile persons keep ontact with sterile areas to
    a minimum
  • Practices
  • Surgical scrub gowning - gloving

19
STANDARD PRECAUTIONS (SP)
  • Principle that all blood, body fluids, secretions
    (except sweat), excretions, non-intact skin, and
    mucous membranes may contain transmissible
    microbes
  • Group of prevention practices that apply to all
    patients, regardless of suspected or confirmed
    infection status, in any setting in which
    healthcare is delivered.
  • Application of SP determined by
  • the nature of the HCW-resident interaction, and
  • the extent of anticipated blood, body fluid, or
    pathogen exposure (e.g. only gloves for drawing
    blood vs gown gloves to dress a wound with
    excess drainage)

20
? Standard Precautions
  • Hand hygiene
  • Personal protective equipment (PPE)
  • Gloves, gown, face protection
  • Patient resuscitation
  • Environmental measures
  • Cleaning and disinfection
  • Soiled patient-care equipment
  • Textiles and laundry
  • Safe injection practices
  • Patient placement
  • Respiratory hygiene/cough etiquette

Recommendations chart http//www.cdc.gov/ncidod/d
hap/pdf/guidelines/isolation2007.pef (Table 4, pp
125, 126)
21
Hand Hygiene Why?
  • Single most important practice to reduce the
    transmission of infectious agents in healthcare
    settings
  • Reduce risk of morbidity, mortality and cost
    associated with healthcare-associated infections
  • Eliminate transient organisms and reduce resident
    hand flora

22
Evidence
Chain ofInfection
  • The relationship betweenhand hygiene and HAIs
  • Substantial evidence that hand hygiene reduces
    the incidence of infections
  • Historical study Semmelweis
  • More recent studies rates lower when antiseptic
    hand hygiene was performed

23
Hand Hygiene Methods
  • Hand hygiene is a general term that applies to
    either
  • handwashing, antiseptic handwash, alcohol-based
    handrub, or
  • surgical hand hygiene/antisepsis.
  • Handwashing
  • Washing hands with plain soap and water.
  • Antiseptic handwash
  • Washing hands with water and soap or other
    detergents
  • containing an antiseptic agent
  • Alcohol-based handrub (ABHR)
  • Rubbing hands with an alcohol-containing
    preparation
  • Surgical hand hygiene/antisepsis
  • Handwashing or using an alcohol-based handrub
    before operations by surgical personnel

Guideline for Hand Hygiene in Health-care
Settings. MMWR 2002 vol. 51, no. RR-16.
24
Which Method Kills Bacteria Better?
Better
Good
Best
Antimicrobial soap
Plain Soap
Alcohol-based handrub
25
Time constraint major obstacle for hand hygiene
  • Handwashing (HW) with water and soap requires
    4060 seconds from start to finish
  • 7 times / shift 56 min.
  • Alcohol-based handrubbing (ABHR) 2030 seconds
    total
  • 7 times / shift 18 min.
  • If HCW used hand hygiene for every indication in
    an 8 hr shift
  • HW 16 hours !
  • ABHR 5 hours

Voss A and Widmer AF, Infect Control Hosp
Epidemiol 199718205-208.
26
Indications for ABHR
  • All situations where
  • soap and water are
  • not required

27
Dispenser Placement and Storage
  • CMS encourages use of alcohol-based hand rubs
  • Dispensers in patient rooms, dining rooms and,
    as determined, in all settings
  • Placement in corridors and rules for storage
    should follow CMS regulations
  • Based on NFPA standards published in Federal
    Register March 25, 2005, effective May 2005
    (Criteria pg FR 15237)
  • MSIPC website provides specific directions for
  • locations, e.g. distances between
    dispensers,
  • distance from electrical plates
  • http//www.msipc..org/advocacy.html

28
Recommended Hand Hygiene Technique
  • Handrubs
  • Apply to palm of one hand, rub hands together
    covering all surfaces until dry
  • Handwashing
  • Wet hands with water, apply soap, rub hands
    together for at least 15 seconds
  • Rinse and dry with disposable towel
  • Use towel to turn off faucet



Guideline for Hand Hygiene in Health-care
Settings. MMWR 2002 vol. 51, no. RR-16.
29
Indications for Hand Hygiene
  • NOTE This list is too prescriptive for inclusion
    in a policy
  • may be useful when teaching risk reduction/task
  • identification
  • When coming on-duty and at shift completion
  • Before and after patient contact
  • Between all patient contacts
  • Before performing invasive procedure
  • Before medication preparation
  • Before and after eating
  • Before donning/after removing gloves
  • Before and after personal restroom use

30
HH Indications, cont
  • When moving from a contaminated body site to a
    clean body site
  • After touching inanimate objects that are likely
    to be contaminated with pathogenic microorganisms
  • Urine measuring/collecting containers
  • After contact with objects (including equipment)
    located in the patients environment
  • After touching an animal or animal waste, e.g.
    therapy dog, bird
  • After touching garbage
  • After smoking

31
WHEN? My 5 Moments for Hand Hygiene
WHO 2009
32
Hand Hygiene Patients, Visitors, Volunteers
  • PATIENTS
  • Expected minimally to perform hand hygiene before
    meals and after personal toilet use
  • Nursing staff to review other indications with
    patient
  • VISITORS
  • Expected minimally to perform hand hygiene before
    meals and after personal restroom use
  • If participating in personal patient care,
    nursing staff will review product use and
    indications for hand hygiene

33
Additional Considerations
  • Hand lotion
  • Nails
  • Jewelry
  • Glove use
  • Adherence

34
HP Barriers to adherence
  • Lack of knowledge that guidelines for hand
    hygiene exist
  • Not recognizing opportunities during the
    performance of ones duties
  • Lack of awareness for the risk of
    cross-contamination of organisms

35
Best Practice
  • Facility decision regarding hand hygiene
  • Input into evaluation and selection of products
  • Educate proper HH, product safety, how and when
    to use
  • Competency evaluation and monitoring
    observations, quizzes, skills lab, electronic
    monitoring systems, data collection forms,
  • Encourage patient/family empowerment

36
References/Resources
  • Strategies to Prevent Healthcare-Associated
    Infections Through Hand Hygiene. SHEA August,
    2014
  • Canadas Hand Hygiene Challenge 2012
  • Implementing AORN Recommended Practices for Hand
    Hygiene 2012
  • WHO Guidelines on Hand Hygiene in Healthcare,
    2009
  • Guideline for Hand Hygiene in Health Care
    Settings, 2002 (HICPAC)

37
(SP) Personal Protective Equipment (PPE)
Personal Protective Equipment
Facewear
Gloves
Gown
38
PPE Donning and removing
  • How hard can it be?
  • A learned skill?
  • Does it matter?
  • Practice makes perfect!

39
Gloves
  • Body substance fluid and solids
  • Mucous membrane contact oral, nasal,
    conjunctival, rectal, genital
  • Non-intact skin burns, surgical incisions,
    open skin lesions
  • Device insertion site
  • Contaminated items

40
Gloves
  • Donning gloves
  • If wearing gown, extend to cover wrist of gown
  • Removing gloves
  • - Remember outside of gloves are contaminated
  • Grasp outside of glove with opposite gloved hand
    peel off
  • Hold removed glove in gloved hand
  • Slide fingers of ungloved hand under remaining
    glove at wrist

40
41
Additional Barriers
  • Gown protect arms and exposed body areas
  • Example if soiling of clothes probable,
    procedure likely to generate splashes
  • Facewear (mask/goggles/eyewear) protect
    conjunctiva, nasal mucosa and mouth
  • Example if procedure likely to generate
  • splash, unprotected cough,
  • suctioning
  • Resuscitation device Use Standard
  • Precautions

42
Gowns
  • Gown protect arms and exposed body areas
  • Example if soiling of clothes probable,
    procedure likely to generate splashes
  • Removing gown
  • Unfasten neck, then waist ties
  • Remove gown using a peeling motion gown will
    turn inside out
  • Hold removed gown away from body, roll into a
    bundle and discard in room

42
43
How to Decide
  • Based on nature of task
  • Anticipated degree of contact with potentially
    infectious substance (anything wet)
  • Level of protection needed to prevent fluid
    penetration
  • For healthcare personnel (HP) per
  • organization policy (all decisions are local)

STOP
44
(S.P.) ENVIRONMENTAL MEASURES
  • Cleaning and disinfection
  • Daily room cleaning
  • Periodic cleaning
  • High touch surfaces - bedrails, bedside tables,
    IV poles, call bells, door handles, BR surfaces,
    computer keyboards
  • Care of soiled equipment
  • Textiles and laundry

45
(SP) Safe injection practices
  • Use safer needle/sharp technologies, e.g.
    needles/syringes, lancets (glucometers)
  • Do not recap,bend, break or hand-manipulate used
    needles
  • Must recap? Use 1-handed scoop
  • Place used sharps in puncture-resistant container
  • Resources MIOSHA, CDC, CMS, APIC handouts

46
(S.P.) - Patient Placement
  • Prioritize for single-patient room if patient
  • is at increased risk of transmission
  • is likely to contaminate the environment
  • does not maintain appropriate hygiene
  • is at increased risk of acquiring infection
  • developing adverse outcomes following infection

47
(SP) Respiratory hygiene/cough etiquette
  • Defined Source containment of infectious
    respiratory secretions in symptomatic patients,
    beginning at initial point of encounter, e.g.
    triage and reception areas in emergency depts.
    and physician offices
  • Cover nose/mouth when sneezing/coughing
  • Use tissues and dispose in no-touch receptacle
  • Practice HH after soiling with respiratory
    secretions
  • Wear surgical mask or maintain spatial separation
    more than 3 ft (six feet?) if possible

48
Examples Application of SP
  • Practices that reduce or eliminate organisms
  • Hand hygiene
  • Clean uncontaminated supplies
  • PPE/barriers
  • Sterile solutions
  • Sterile field when indicated
  • Preparation of skin

49
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