MODULE C – INFECTION CONTROL

BOOK UNITS: 12, 13, 35

UNIT 12INFECTION

BACTERIA

• Simple one-celled microbes

• Named according to their shapes and arrangement

• Cause infections in the skin, respiratory tract,

urinary tract, and bloodstream

FUNGI

• Two groups of fungi are most commonly associated with infection in

humans

• Yeasts

• Molds

VIRUSES• Smallest microbe

• Not visible with regular microscope

• No own metabolism

• Has a variety of shapes

PROTOZOA

• Simple one-celled organisms

• Visible under microscope

• Live on living matter

BODY FLORA

• Different microbes live on our body surfaces

• Microbes are called the normal body flora

• Flora are not the same in all body areas

• They are not harmful in the area in which they normally reside

• But may cause infection if they are moved to another area of the

body

• Normal flora protects us, unless it travels to a body area, where

it does not belong

INFECTION• Infection: The invasion of a susceptible host by pathogens or microorganisms, resulting in disease.

• Colonization: The presence or invasion of a host by pathogens or microorganisms, NOT resulting in

disease

• Communicable or contagious disease: An infectious disease transmitted directly from one person to

another

• Defenses against infection: skin, normal flora, mucus membranes, immune system (immunity &

vaccines)

• Germs like: dark, moist, warm places in order to grow

CHAIN OF INFECTION P.157 -160

Infectious agent

Reservoir

Portal of exit

Mode of transmiss

ion

Portal of entr

susceptible host

• Infectious agent: bacteria, virus, fungi etc.; virulence is the ability to produce disease

• Reservoir: where microorganisms survive and thrive ex: hosts (humans, animals),

insects, food, water, organic matter, inanimate surfaces

• Portal of exit: the way out of the reservoir, ex: skin, mucous membranes, respiratory

tract, GI (gastrointestinal) tract, reproductive tract, blood

• Mode of transmission: how it travels, ex: contact (direct, indirect touch), airborne

(coughing, sneezing, talking), droplet (large particles from coughing sneezing talking),

vector (through animals ex. Mosquito)

• Portal of entry: how it gets back in: non-intact skin, mucous membranes, GU

(genitourinary) tract, GI tract, respiratory tract

• Susceptible host: susceptibility depends on degree of resistance to pathogens; immunity

= no longer susceptible

The chain can be broken at any link and stop the spread of infection!

INFECTIOUS AGENTS-BACTERIA

NAME• Staphylococcus aureus (Staph. aureus)

• Escherichia coli (E. coli)

• Pseudomonas aeruginosa

• Chlamydia trachomatis

• Mycobacterium tuberculosis

RESERVOIR• Skin, hair, upper respiratory

• Colon

• Water, soil

• Genitourinary tract, rectum

• Droplet nuclei from lungs

• Wound infection, abscess, cellulitis, PNE (pneumonia)

• Gastroenteritis, UTI (urinary tract infection)

• Wound infection, burn infection, UTI, PNE

• STD (chlamydia), PID, neonatal eye and lung infection

• Tuberculosis

DISEASES

INFECTIOUS AGENTS-FUNGI/PROTOZOA

NAME• Candida albicans

• Plasmodium falciparum

RESERVOIR• Skin, mouth, genital tract

• Blood, infected female Anopheles

mosquito

• Bacteremia, pneumonia, wound infection, thrush

• Malaria

DISEASES

INFECTIOUS AGENTS-VIRUSES

NAME• Hepatitis A virus

• Hepatitis B virus

• Hepatitis C virus

• Herpes simplex virus (Type I and II)

• Varizella-zoster virus

RESERVOIR• Feces

• Blood and some body fluids

• Blood

• Lesions of mouth, skin, genitals

• Vesicle fluid, respiratory tract infection

• Hepatitis A

• Hepatitis B

• Hepatitis C

• Cold sores, STD

• Varicella (chickenpox) primary

Herpes Zoster (shingles) reactivated

DISEASES

CHAIN OF INFECTIONCAN BE BROKEN AT ANY LINK

NOSOCOMIAL INFECTIONS• Infection that the patient did not have before being hospitalized, or cared for AND acquired

after admission or after care was provided

• Most are spread from healthcare workers to patients via hand contact

• Most common: UTI, PNE, wound infections, bacteremia

• Risk factors for nosocomial infections:

• Prolonged illness

• Immunosuppression ex: Human immunodeficiency virus (HIV), Acquired immunodeficiency syndrome

(AIDS), chemotherapy, some medications

• Susceptibility: age, Diabetes, other diseases

SUPERBUGS P.162• Bacterial infections are treated with antibiotics

• Viral infections are treated by supporting your body’s own defense mechanisms; antibiotics can not cure

viral infections like the flu or cold.

• Bacteria and viruses grow and change over time and can become resistant to treatment = drug resistance;

• MRSA: Methicillin-resistant staphylococcus aureus;

• one of the most drug resistant bacteria

• spreads quickly by contact

• prevalent in hospitals, health care facilities, crowded places, college dorms, prisons

• Causes severe illness, wound infections, blood infections, can lead to death

• Other common resistant bacteria:

• VRE: Vancomycin-resistant enterococcus; often found in UTI’s

• Penicillin-resistant streptococcus pneumonia; often cause of PNE

SUPERBUGS P.163• TB: Tuberculosis

• Mycobacterium tuberculosis

• spreads quickly through the air by droplets

• At risk: HIV positive, poverty & malnourishment (homeless population)

• TB skin test, Chest X-ray, sputum culture

• Enters lungs, but can infect other parts of body; person is contagious if they have

the active disease; treatment with a variety of antibiotics for up to 2 years

• Clostridium Difficile (C. Diff)

• Resistant bacteria that leads to diarrhea

• NOT killed by hand sanitizers – must wash hands with soap and water!

• Very easily spread – can be devastating to geriatric patients

BLOOD-BORNE PATHOGENS• HIV = Human immunodeficiency virus p.168

• Caused by HIV-1 and HIV-2 retroviruses that deplete helper T-4 cells

• Spread through blood and other body fluids (saliva, urine, sweat)

• Ranges from primary asymptomatic infection to AIDS = Acquired immunodeficiency syndrome

• Often complicated by opportunistic infections that can lead to death ex. Kaposi’s sarcoma/ pneumocystis

carinii, PNE, cytomegalovirus, herpes simplex, histoplasmosis

• HAART = Highly active antiretroviral therapy used to treat HIV/ AIDS; life long treatment required

• Hepatitis type B (HBV) and Hepatitis type C (HCV) p.167

• Viral hepatitis = major liver infection

• Spreads through blood and other body fluids

• Generally treatment avoided because liver metabolizes medications

• Chronic Hepatitis C treated with interferon

SIGNS OF INFECTION• High body temperature = FEVER

• Red or draining eyes

• Stuffy nose

• Coughing

• Headache

• Sore throat

• Flushed face

• Loss of appetite

• Nausea

• Stomach pain

• vomiting

• Diarrhea

• Cloudy or smelly urine

• Joint pain

• Muscle ache

• Skin rash

• Sores

• Redness around a wound or incision

• Drainage from a wound or incision

• Odor from a wound

• Swelling

INFECTION CONTROL

MOD C

MEDICAL ASEPSIS VS. SURGICAL ASEPSIS

• Medical asepsis (=clean technique)

• Reducing the numbers of disease-producing

microorganisms

• Or interrupting transmission from one person to

another person or from a person to a place or an object

• Handwashing – single most important procedure to

prevent spread of microbes

Controlling the spread of germs p.180

• Surgical asepsis (=sterile technique)

• Environment kept free of microorganisms

• Pathogens and non-pathogens

• In procedures in which surgical asepsis is used; ex:

surgery, catheterization, sterile dressing changes

• Equipment and supplies must be sterile (ex. Autoclave

equipment)

• Disinfection

• Process of eliminating harmful pathogens from equipment and instruments

• Sterilization removes all microorganisms from an item

MEDICAL ASEPSIS VS. SURGICAL ASEPSIS

CONTROLLING THE SPREAD OF GERMS P.180• Taking daily precautions: p. 180

• wash your hands

• use antimicrobial soap

• eat well and exercise

• stay home if you are sick

• keep things clean, yourself, patient’s environment

• keep dirty linens away from your uniform

• avoid shaking dirty linens or clothing

• bag dirty linens in patient room before taking them out

• single person use of personal equipment – no sharing between patients ex. Toothbrush, bedpan,

washbasins, urinals

• cover bedpans and urinals to prevent splashing

HANDWASHING P.181• Hand washing is the MOST important way to prevent spread of infection; alcohol based hand sanitizers are NOT appropriate if visibly

soiled or for spores ex. when caring for pt with C.diff (Clostridium difficile)

• Hand washing precautions:

• Keep your fingernails trimmed short, remove any dirt underneath them

• Do not wear rings to work except fro a simple wedding band; germs hide in the tine spaces in jewelry

• Wear a watch you can push above your wrist or put it in your pocket or pin it to your uniform

• When to wash hands:

• Arriving at work

• Before and after patient contact

• Before and after wearing gloves

• After using the bathroom

• After coughing, sneezing, or blowing your nose

• Before and after handling food

• After smoking

• Before handling clean linens

• After handling dirty linens or any kind of trash

• Before going home

HANDWASHING – SKILL 1• Steps for proper handwashing:

• Gather supplies: soap, paper towels

• Turn on water

• Wet your hands and wrists

• Apply antimicrobial soap from dispenser – keep water running

• Keep your hands and wrists below the level of your elbows from this point on

• Rub your hands together to work up lather

• Wash vigorously for at least 20 seconds, pay particular attention to the wrist,

palms, back of hands, area between fingers, nails

• Rinse hands and wrists under running water thoroughly, fingertips point down

• Use clean paper towel to dry hands, from fingertips to wrists

• Use new paper towel to turn off faucet

• Throw away paper towels

REGULATORY AGENCIES• OSHA = Occupational Safety and Health Administration

• To protects workers from work related injuries and exposures to pathogens

• CDC = Centers for Disease Control and Prevention

• To protects the public from health, safety and security threats

• Bloodborne Pathogens Standard, issued 1991

• To prevent on-the-job needlesticks and other exposures to blood and body fluids

• Requires every workplace, where exposure to blood or infectious materials is possible, to have an

exposure plan in place

10 STANDARD PRECAUTIONS = UNIVERSAL PRECAUTIONS1. Wear gloves when you may touch any blood or body fluids, mucus membranes, broken skin, soiled items or surfaces

2. Wash hands

3. Wear PPE (personal protective equipment) such as gown or apron when your clothing may become soiled, mask, goggles

or face shield if you think something may splash into your eyes or face

4. Sharps: sharps go into sharps containers immediately after use, don’t let them lay around ex. razors

5. Wear gloves when you have open areas (cuts, sores) on hands

6. Clean up blood or body fluid promptly using approved disinfectant, ex. Bleach solution

7. Handle linens carefully, wear gloves, keep them still, bag soiled linens where they were used, put wet linens in leak proof

bags

8. Bag contaminated articles carefully in red bio hazard bags, double bag if first bag may be contaminated

9. Put waste in leak proof container

10. Keep resuscitation masks and/or bags on hand in a hospital or nursing home setting

STANDARD PRECAUTIONS• Must be followed by all members of the healthcare team

• Apply to all blood and bodily fluids and all clients, regardless of the person’s diagnosis; everyone

is considered infected

• Bodily fluids include: blood, urine, feces, sputum, wound drainage, vomit, breast milk, semen,

vaginal secretions, fluids from nose, lungs, or abdomen

• Wear gloves when there is a possibility you could be exposed to any body fluids, ex. Emptying

bed pan, urinary drainage bag, bathing or cleaning a patient, oral care

• Wear gown and protective eye wear additionally to gloves if there is a possibility of splashing

COMMON SENSE PRECAUTIONS

• Don’t sit on pt’s bed or chair – you carry germs from one room to another

• Don’t hold soiled linens or trash against your body – you’ll get germs on your uniform

• Put clean things on clean surfaces ex. Clean linens on clean table

• Put dirty things on dirty surfaces ex. Dirty linens into linen bag on floor

ISOLATION PRECAUTIONS

• When pt has contagious disease

• Depends on type of germ and how germ spreads

• Types: Airborne, droplet, contact

AIRBORNE PRECAUTIONS P.189• When disease is transmitted through the air ex. TB (tuberculosis), measles

• Precautions to take:

• Negative pressure room – pulls air into pt’s room, away from hallway

• Keep door to private room closed

• Wash hands when entering and leaving room

• Wear gown

• Wear HEPA (high efficiency particulate air filter) mask or respirator

• Wear gloves

• Bag all linens and contaminated articles

• Discard or throw away articles from the room after use = do not carry anything out of this room

• Everything is placed in red bio-hazard bags, no regular trash from this room

DROPLET PRECAUTIONS P.191• When disease is transmitted through large droplets through the air from sneezing, coughing, laughing,

singing, or talking ex. Flu, mumps

• Precautions to take:

• May keep door open, closed preferred

• Wash hands when entering and leaving room

• Wear gown

• Wear regular mask

• Wear eye protection

• Wear gloves

• Bag all linens and contaminated articles

• Do not carry anything out of this room

• Everything is placed in red bio-hazard bags, no regular trash from this room

CONTACT PRECAUTIONS P.192• When disease is transmitted through direct or indirect contact (touch) ex. Wound infections,

scabies, C. difficile (diarrhea), MRSA, VRE

• Precautions to take:

• May keep door open, closed preferred

• Wash hands when entering and leaving room

• Wear gown

• Mask not required

• Wear gloves

• Bag all linens and contaminated articles

• Do not carry anything out of this room

• Everything is placed in red bio-hazard bags, no regular trash from this room

PATIENT CONSIDERATIONS P.188

• Private rooms, door often closed

• When transporting pt: have pt wash hands before leaving room, cover oozing wounds etc., pt to

wear mask when on droplet or airborne precautions

• Consider:

• Pt will have limited visitors and staff interaction

• Pt may be lonely, depressed, afraid, angry

• Explain to pt and family why precautions are in place, be patient, understanding

STANDARDSPreparation Standards = Beginning tasks p. 249

1. Wash hands or use hand sanitizer

2. Gather supplies

3. Focus on task

4. Knock and wait

5. Introduce yourself and identify patient

6. Ask visitors to leave

7. Provide privacy

8. Explain procedure and answer questions

9. Gather and prepare

10. Wash hands

11. Position pt

12. Cover pt

13. Raise bed to comfortable level

14. Put on gloves, PPE if necessary

15. Make sure equipment (bed, WC etc) is locked

Completion Standards = Completion tasks p. 251

1. Remove gloves

2. Ensure safety, comfort and body alignment (positioning, bed covers, side

rails)

3. Put disposables in trash bag and laundry in laundry bag

4. Clean and put away equipment

5. Put bed in proper position / safety check

6. Remove PPE, Wash hands or sanitize

7. Open curtains

8. Put call-light, phone, water in reach

9. Dispose of trash

10.Say good-bye / let visitors re-enter

11.Put laundry in hamper

12.Wash hands

13.Note, record, report

PPE- SKILL 2

Putting on PPE

1. Wash hands

2. Gather supplies

3. Gown:

1. Slide arms through armholes, opening in back

2. Fasten ties on back of neck and back

4. Mask:

1. Put over mouth and nose, bend nose wire

2. Tie strings behind head, top strings first

3. Adjust for comfort

5. If face shield/ goggles necessary, put them on now

1. Put on carefully

6. Gloves:

1. Inspect for any defects

2. Put on carefully

Removing PPE1. Gloves:

1. Make cuff on right hand, pull partially down

2. Use right hand to remove left glove, rolling it into ball

3. Hold left glove in right hand

4. Use bare left hand to slide right hand glove over “ball” inside-out, only

touching skin to skin

5. Throw away

6. Wash hands

2. Face shield/ goggles

1. Remove

2. Put in trash

3. Gown

1. Pull one sleeve forward by cuff

2. Use covered hand to pull of other sleeve and hold gown

3. Use “naked” hand to pull of opposite shoulder, turning gown inside out

4. Fold outside inward, roll up

5. Dispose in trash or bio-hazard bag if in isolation romm

6. Dispose of trash

4. Mask:

1. Untie bottom string, then top

2. Hold by strings and throw away

3. Wash hands

HOMEWORK INFECTION CONTROL

Read units 12 and 13 in textbook

Do workbook

• P. 76 Nr. 4 & 5

• p. 77: true/false 1-22

• P. 84 : 1 a-e

UNIT 35THE NURSING ASSISTANT IN HOME

CARE

HOME CARE SETTING:

• Always use standard precautions

• Patients are not put into “isolation” in their own home

• Use proper PPE for contact precautions

• Patients on droplet and airborne precautions are usually admitted to a

hospital

DISCARDING MEDICAL WASTE IN THE HOME CARE SETTING

• Place contaminated supplies in a plastic bag and close tightly.

• Double bag if the outside is torn or contaminated.

• Seal the bag by using a twist tie, taping, or tying.

DISCARDING MEDICAL WASTE IN THE HOME CARE SETTING

• Dispose of the bag in the household trash

• Take it outside to the trash can, if possible

• Wash your hands or use alcohol hand cleaner.

• Sanitize all contaminated equipment and surfaces appropriately.