Infection Control - Presentation Transcript

1. Infection control Goal of infection control is to prevent the spread of infectious diseases Infectious disease is any disease caused by the growth of pathogens in the body Pathogens are disease-causing microorganisms (germs) Infectious diseases can cause unnecessary pain, suffering and death Maintain a safe environment Follow specific polices and procedures designed to reduce risk of transferring infectious diseases Prevent pathogens from being transmitted: Patient to client, staff to client, client to staff, staff to staff Improperly cleaned instruments and equipment Infection Infection can be: Generalized or systemic (throughout the body) Localized (affecting one part of the body) Signs and symptoms of infection: Systemic: headaches, fever, fatigue, vomiting, diarrhea, increased pulse and respiration Localized: redness, swelling, painful, warm to the touch Microbiology Microbiology: the study of microorganisms Microorganisms are one celled animals or plants invisible to the eye, can only be seen with a microscope 1600s: Anton van Leeuwenhoek invented the microscope 1800s: Louis Pasteur developed germ theory. Stated that microorganisms, called bacteria, cause specific diseases in humans and animals History of infection control 1843 Oliver Wendell Holmes: contagious disease or communicable disease can be spread directly or indirectly from one person to another through contaminated hands Ignaz Philipp Semmelweis observed high mortality rate from MDs going from morgue to patients bedside without washing hands 1864 Joseph Lister: developed surgical aseptic technique to prevent wound contamination Growth of microorganisms Aerobic require oxygen to live Anerobic do not require oxygen to live Many microorganisms thrive in warm, moist, dark environments like the human body which becomes a host to the microorganism Symbiosis the host benefits Neutralism no damage is done to the host Parasitic the host is damaged, the pathogen causing damage is called the parasite Types of microbes Microbe a pathogenic microorganism Classifications of plant and animal microbes: Bacteria Viruses Fungi Rickettsia Protozoa Bacteria One-celled plants Either pathogenic or non-pathogenic Many produce toxins (poisonous substances) Most bacteria are aerobic (need oxygen) and grow best in moderate temperatures A group of bacteria growing in one place is called a colony

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Treating bacterial infections Almost all bacteria can be destroyed with antibiotics Some are antibiotic-resistant, create threat to health care workers and patients Extremely high temperatures must be used for sterilization to kill bacterial spores Viruses Smallest of the microbes Need electron microscope to see them Viruses are not whole cells, they depend on other living cells to provide food, nutrients and for reproduction They are called obligate intracellular parasites because they can only live inside another living organism Viruses Over 300 viruses have been identified by researchers Some appear to be harmless Cause infections like influenza, pneumonia, chicken pox, croup, hepatitis B, AIDS, measles, mumps, polio, herpes, and warts Transmitted through blood & body secretions Difficult to treat because they are resistant to disinfectants and not killed by antibiotics Fungi Fungi are a large group of simple plants. Two forms of fungi are potential pathogens: yeast and molds Yeasts are one celled Molds are multi-celled Thrive in warm, moist, dark conditions Cannot produce their own nutrients, must rely on living and dead organic materials Fungi Many yeasts and molds are non-pathogenic Penicillin (antibiotic) is produced from a mold Fungi can become pathogenic under the right conditions Can create various opportunistic infections: Mildly annoying Chronic and/or recurrent Life-threatening Fungal infections Cutaneous infections: superficial infections of the skin or mucus membranes, including hair follicles and scalp. Example: ringworm, athletes foot Systemic infections: Example: histoplasmosis (respiratory disease) Difficult or impossible to treat or cure Treatment requires medications toxic to humans Rickettsia Smaller than bacteria, with rod or spherical shapes Called obligate intracellular parasites - must live inside cell of another living organism Rickettsia transmitted through bites of fleas, lice, ticks and mites Diseases: several types of typhus and Rocky Mountain Spotted Fever Typhus is the only rickettsial infection that can be transferred from 1 human to another Protozoa The only microorganism classified as an animal. Plentiful in the environment 45,000 different identified types of protozoa Animal parasites reside in and out of the body Seek locations that provide nutrients, warmth and moisture Protozoa constantly present in intestines, skin, and mucus membranes of the nose and throat Protozoa Found in decayed materials, bird and animal feces, water contaminated with sewage waste, food washed in contaminated water or handled by unwashed hands, and insect bites Common diseases caused by protozoa: dysentery, trichomonas, toxoplasmosis, pneumocystis pneumonia and malaria Chain of infection Model of infectious disease transmission

Six elements must be present for an infection to develop 1. The infectious agent 2. Reservoir host 3. Portal of exit from the host 4. Route of transmission 5. Port of entry 6. Susceptible host

19. Chain of infection 1. Infectious agent : a pathogen must be present 2. Reservoir host : the pathogen must have a place to live and grow the human body, contaminated water or food, animals, insects, birds, dead or decaying organic material. Humans who can transmit infection but how no signs of the disease are called carriers. Person may be unaware they are a carrier. 3. Portal of exit : the pathogen must be able to escape from the reservoir host where it has been growing. Examples of portals of exit are blood, urine, feces, breaks in the skin, wound drainage, and body secretions like saliva, mucus and reproductive fluids 4. Route of transmission : When the pathogen leaves the reservoir host through the portal of exit, it must have a way of being transmitted to a new host. Examples of routes of transmission are air, food, insects, and direct contact with an infected person 5. Portal of entry : The pathogen must have a way of entering the new host. Common ports of entry are the mouth, nostrils, and breaks in the skin 6. Susceptible host : An individual who has a large number of pathogens invading the body or does not have adequate resistance to the invading pathogen will get the infectious disease 20. Breaking the chain of infection Breaking at least one link stops the spread of infectious disease 1. The infectious agent early recognition of signs of infection Rapid, accurate identification of organisms 2. Reservoir host

Medical asepsis Standard precautions Good employee health Environmental sanitation Disinfectant/sterilization 3. Portal of exit from the host Medical asepsis Personal protective equipment handwashing Control of excretions and secretions Trash and waste disposal Standard precautions 4. Route of transmission Standard precautions Handwashing Sterilization Medical asepsis Air flow control Food handling Transmission-based precautions Portal of entry


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Wound care Catheter care Medical asepsis Standard precautions Susceptible Host Treating underlying diseases Recognizing high-risk patients Defense Mechanisms A number of defense mechanisms exist outside and in the body to break the chain, including decreasing the sources of microorganisms; preventing the transmission of microorganisms; and maximizing the hosts resistance to the microorganism Bodys natural defenses to eliminate/kill pathogens Cilia - in respiratory tract, catch and move pathogens out of the body Coughing/sneezing, to propel pathogens outward Tears - contain chemicals to kill bacteria Hydrochloric acid in stomach Rise in body temperature (fever) Leukocyte (white blood cell) production increases, to destroy pathogens Regulatory Agencies Center for Disease Control and Prevention (CDC) - Responsible for developing safe guidelines to help prevent and control the spread of infectious diseases Occupational Safety and Health Administration (OSHA) - Responsible for maintaining minimum health and safety standards for employees Prevention: Medical Asepsis Medical asepsis (clean technique): procedures to decrease the number and spread of pathogens Hand washing, good personal hygiene, cleaning rooms between patient use, proper disposal of gloves after contact with body fluids or contaminated objects Prevention: Surgical Asepsis Surgical asepsis (sterile technique): procedures that completely eliminate the presence of pathogens from objects and areas Sterile caps, gowns, masks, and gloves Sterilizing instruments Maintaining sterile fields Changing dressing Disposing of contaminated materials Breaking chain of infection Most important concept: breaking at least one link stops the infectious disease Chain of infection summarized into 3 components: Source of infecting microorganisms (1 & 2) Means of transmission for the micro-organisms (3, 4 & 5) Susceptible host (6) Breaking chain of infection Best defenses: Decrease the sources of infecting microorganisms (1 & 2) Prevent means of transmission for the micro-organisms (3, 4 & 5) Maximize the resistance of the host (6) Methods to decrease the source of microorganisms Perform proper hand washing Decontaminate surfaces and equipment with antiseptics, disinfectants and sterilization procedures Avoid contact with patients and others when harboring infectious microorganisms Preventing transmission of microorganisms Wear PPE personal protective equipment: caps, gloves, gowns masks, booties and eye protection Follow isolation procedures when indicated Take additional precautions when working with patients who have highly contagious diseases. Dont ignore posted signs. Maintaining resistance Provide and practice good hygiene


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Ensure proper nutrition and fluid intake Get enough rest Decrease stressors physical and psychosocial - that weaken the immune response What can you do in your life to increase resistance to disease-causing pathogens? Standard Precautions Developed by the CDC Follow at all times and apply to every patient To prevent contact with potentially infectious body fluids: blood, secretions, excretions, non-intact skin and mucous membranes Handwashing Perform proper handwashing techniques: when coming on the clinical site when taking a break or leaving work between client contacts before gloving and after ungloving before and after touching your face after contact with any contaminants before touching items considered clean Handwashing See Practical Skills Guide for Midwifery: Procedure step-by-step how to do it Explain why is it important to know (1) the procedure what to do (2) the rationale the reason you do it that way, why each step is important Personal Protective Equipment Abbreviated PPE Includes gloves, masks, protective eyewear, gowns, caps and shoes Use appropriate PPE in situations that could cause infection to you or your client Use clean, non-sterile gloves when handling blood, body fluids, secretions, excretions, contaminated items, mucous membranes and non-intact skin Gloves Change gloves between tasks/procedures on the same client if there is contact with material that may contain a high concentration of microorganisms (ex: feces) Remove gloves promptly after use, before touching non-contaminated items and environmental surfaces and before taking care of another patient After removing gloves, wash your hands Face Protection Face protection: Mask, Eye Protection and Face Shield Hospital workers wear a mask and eye protection or a face shield to protect mucous membranes of the eyes, nose and mouth during procedures that could involve splashes or sprays of blood, body fluids, secretions or excretions. Gowns Gowns may be cloth or paper Cloth gowns are reusable Paper gowns are disposable Some clinical sites provide gowns to clients for physical exams A clean, non-sterile gown protects skin and prevents soiling clothing during procedures that could involve splashes or sprays of blood, body fluids, secretions or excretions. Follow the procedures on your clinical site(s) Removing a Gown Remove a soiled gown as promptly as possible Fold front of gown into itself, outside in Place cloth gowns in a closed receptacle marked with the biohazard symbol to be picked up, laundered and re-used Place paper gowns in a closed waste can in a red plastic bag marked with the biohazard symbol Wash hands promptly to avoid transferring microorganisms

39. Client care equipment Handle used/soiled client care equipment to prevent skin, mucous membranes and clothing from exposure to blood, body fluids, secretions and excretions which could be transferred to other patients and environments Reusable equipment must be properly cleaned and reprocessed before being used on another client Discard single-use items appropriately 40. Environmental Control Follow procedures for the routine care, cleaning and disinfection of environmental surfaces, beds, bedside equipment, and other frequently touched surfaces For used linen that is soiled with blood, body fluids, secretions and excretions fold with soiled surface in, handle to prevent exposing skin, mucous membranes and clothing which could transfer microorganisms to other environments, and place in designated biohazardous medical waste receptacle 41. Occupational Health and Blood-Borne Pathogens Take care to prevent injuries when using and cleaning/disposing of sharps - needles, scalpels, and other sharp instruments Place used disposable syringes, needles and scalpel blades in appropriate puncture-resistant containers Containers should be located close by for convenient disposal Placer reusable syringes and needles in a puncture resistant container for transport to be reprocessed (sterilized) 42. Occupational Health and Blood-Borne Pathogens Never recap used needles Follow facility policies on how to handle contaminated needles If the facility allows recapping (for example, drawing up from a multi-dose vial), use either a one-handed scoop technique or a mechanical device to hold the needle sheath Do not remove used needles from disposable syringes by hand Do not bend, break or manipulate used needles

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Occupational Health and Blood-Borne Pathogens

Use mouthpieces, resuscitation bags, or other ventilation devices as an alternative to mouth-to-mouth resuscitation methods. Keep these devices available in areas where clients may need to be resuscitated (ie, birth rooms) Environmental control Follow facility infection control procedures for cleaning the environment, jacuzzi tubs, etc. Use Transmission-Based Precautions: Airborne precautions Droplet precautions Contact precautions Airborne Precautions Airborne droplets or dust particles containing infectious agents can remain suspended in the air for long periods of time Air currents can blow them long distances Can be emitted during talking, sneezing, coughing and whispering Examples: Mycobaterium tuberculosis, Rubeola (measles) and Varicella (chicken pox) Droplet Precautions Propelled short distances through the air Deposited on hosts conjunctiva, nasal mucosa or mouth Can be emitted during talking, sneezing, coughing and during procedures like suctioning and bronchoscopy Examples: streptococcal pharyngitis, mumps, influenza, rubella, some some pneumonias, meningitis and sepsis Contact Precautions Most important and frequent mode of transmission for nosocomial infections Nosocomial = originates/takes place in hospital or other health care facility Nosocomial infection = the client gets it as a result of being in the health care facility Example: herpes (HSV), impetigo, scabies, some gastrointestinal, respiratory, skin and wound infections Direct-contact & Indirect-contact transmission

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Direct Contact Transmission Occurs when touching the infected clients dry skin during client care activities like giving a massage Can occur between two clients: a source of the infecting micro-organism and a susceptible host Indirect contact transmission Occurs when a contaminated object is touched. For example, coming in contact with needles, instruments, environmental surfaces or client care items. Double-bagging technique Used when disposing of medical waste from clients with infections (ex HIV) Health care worker A, wearing proper PPE, takes the contaminated bag from the area A slips it into another bag held by co-worker B B does not touch the contaminated bag A does not touch the clean bag The bags are labeled according to the facility policy with hazardous waste or linen markers to alert to the need for special handling Sterilization Chemical agents and physical methods used to destroy or inhibit growth of pathogens Bacteriostatic inhibits growth Bacteriocidal/germicidal kills microorganisms Antiseptics bacteriostatic chemical agents, mild enough to use on skin: 70% isopropyl alcohol Disinfectants destroy most bacteria and viruses. Used for instruments that do not penetrate the skin and for cleaning the environment floors, bathrooms, equipment Disinfectants Chemical disinfectants can be harmful to the skin. When using chemical disinfectants follow manufacturers directions for dilution and for antidoting any exposure 10% household bleach in water meets OSHA requirements, kills HBV, HIV and TB Soaking for 20-30 minutes in 70% isopropyl alcohol acts as a disinfectant: used for some instruments, glass thermometers Boiling instruments in water: cover and boil in rolling water for 20 mins. Rarely used today. Sterilization Agents/methods that totally destroy all microorganisms including viruses and spores Include chemical agents, gas, radiation, dry or moist heat under pressure Most common method used is the autoclave, which sterilizes by steam created by a pressurized heating system Small units used in a medical office; large units used in hospitals Surgical Asepsis Sterile Technique Aseptic: free from pathogenic microorganisms Sterile Technique: refers to a group pf principles and procedures designed to eliminate pathogens Sterile field: an area designated as free from microorganisms Example: a sterile towel placed on a clean, dry surface the towel becomes the sterile field Consider the field as a 3-dimensional area Maintaining a sterile field Field should be above the waist height Do not bring contaminants into the field Actions that contaminate the field: touching it, allowing it to become wet, reaching across it, talking or coughing directly over the surface Work to the side of the field Sterile gloves come in sealed packages that must be opened at the edge of the sterile field and placed onto the field See PSGM Skills Book to put on sterile gloves Blood borne diseases HBV and HIV: put health care workers at risk Transmitted by infected blood, mucous, secretions, excretions, any moist body fluid (except sweat) Routes of transmission:


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Parenteral blood transfusion, needle sharing, stick by needle or other sharp instrument Mucous membranes eye or mouth Sexual contact Perinatal from infected mother to her baby HBV When infected with HBV, the liver becomes inflamed and can be destroyed Symptoms range from mild to severe -jaundice (yellowing of the eyes, skin, mucous membranes), dark urine, extreme fatigue, loss of appetite, nausea, abdominal pain, joint pain, rash and fever Prevention: HBV vaccine, use of PPE, preventing puncture injuries, disinfecting and sterilizing equipment and environments HBV vaccine OSHA requires employers to provide the HBV vaccine free for employees with exposure risk A series of 3 doses given over 6 months Induce protective antibody levels in 85 97% of healthy adults Blood test can determine antibody levels An employee has the right to refuse the HBV vaccine but must sign a form to release the facility from responsibility if the health care worker becomes infected HIV The Human Immunodeficiency virus that causes AIDS HIV virus destroys cells in the host that are vital to the immune system function Testing: tests for HIV antibodies Most infected people test positive within 6-12 weeks up to 6 months from exposure HIV positive = infected with the virus, can transmit to others even if non-symptomatic AIDS = weakened immune system AIDS Most but not all HIV infected people will eventually develop AIDS and die from opportunistic infections such as PCP (Pneumocystis carinii pneumonia) Signs and symptoms of AIDS: weakness, chronic fever, night sweats, swelling of lymph nodes, weight loss and diarrhea No known vaccine or cure Managed by treating symptoms with antiviral drugs and a healthy supportive lifestyle HIV transmission HIV has been isolated from blood, semen, breast milk, vaginal secretions, saliva, tears, urine, cerebrospinal fluid and amniotic fluid Only blood, semen, vaginal secretions and breast milk have been proven to transmit HIV Transmission not through casual contact: Parenteral blood transfusion, needle stick Mucous membranes eye or mouth Sexual intercourse Perinatal from infected mother to baby HIV transmission HIV is NOT transmitted through: Sharing household facilities, food, eating utensils, plates, drinking glasses or towels Hugging and kissing on the cheek Mosquitoes or other animals Infection from exposure is determined by: Amount of the virus transmitted How many exposures Overall health of the person HBV& HIV: Relative risk Most health care workers are afraid of getting HIV, but HIV is much harder to catch than HBV The infection and death rate from HBV far exceeds HIV Only 3-5 health care workers out of 1000 injured with a needle contaminated with HIV will become infected Tuberculosis Airborne pathogen mycobacterium tuberculosis primarily affects the lungs


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Working with TB clients requires using special PPE, individually fitted masks, to avoid inhaling tiny droplets which carry the disease Cases of TB have increased in recent years Medication must be taken for 6 months If clients dont complete the course of treatment, a drug-resistant strain can mutate and re-infect the person Tuberculosis Screening for TB is a skin test Positive test result means the person has been exposed to the disease A chest x-ray confirms active disease Signs and symptoms: lethargy, fever, night sweats, cough, weight loss, coughing up blood-tinged sputum, chest pain, and SOB. Patients hospitalized with suspected TB are put in isolation for 2-3 weeks and begin antibiotic treatment Drug-resistant organisms A fairly recent occurrence Results from: the overuse of antibiotics in the USA to treat minor conditions Using wide-spectrum antibiotics instead of testing/prescribing for a specific pathogen patients not completing an entire course of prescribed treatment of antibiotics These create conditions that encourage pathogens to become resistant to antibiotics Drug-resistant organisms Two drug resistant organisms encountered in health care: MRSA Methicillin-resistant Staphylococcus aureas VRE Vancomycin-resistant Enterococcus Both are difficult to control and can cause serious, life threatening infections esp. in susceptible people (ex: premature babies) Treatment is expensive and has severe side effects liver, kidney & hearing damage Reporting accidental exposure Report any injury or accident involving exposure to blood or body fluids immediately to your clinical preceptor/supervisor Complete a written incident or injury report Reporting facilitates evaluation, appropriate treatment and follow-up Failure to report can result in negative health consequences and is in violation of OSHA requirements INFECTION CONTROL Other Countries advanced facilities proper segregation of garbage and strictly monitored infection control is well implemented and strictly followed do not recycle medical equipments Philippines less facilities improper garbage segregation not well implemented and not that strict to follow the ethical standards recycled medical equipments such as gowns, gloves ,etc