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Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
Infection contro2008
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Infection contro2008

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  • 1. Infection Control Ch 12 Foundations of Nursing
  • 2. Professional Responsibility  Nurses have the responsibility to adhere to scientifically accepted principles & practices of infection control and to monitor the performance of those for whom the professional is responsible. (nursing assistants, etc.)
  • 3. Source of Standards  Board of Regents (sect. 29.2)  Part 92 of Title 10 (health Dept) of the official compilation of coeds, rules & regulations of New York  Statements of organizations (NYSNA, ANA, Etc)  Defines coursework  Approves training courses  Addresses medical conduct
  • 4. Governing Agencies  Occupational Safety and Health Administration (OSHA)  Joint Commission on Accreditation of Healthcare Organizations (JCAHO)  Centers for Disease Control and Prevention (CDC)
  • 5. Conduct Standards  Failure to adhere to accepted standards of practice may result in  Increased r/o infection to workers & patients  Charges of unprofessional conduct
  • 6. Compliance  Participation in required infection control training (LPN program is equivalent)  Adherance to accepted principles and practices  A complaint about lax infection control practice will prompt an investigation by the Health Dept./SED  May result in professional misconduct & suspension of license
  • 7. Some Terms  Microorganisms: germs, microbes  Pathogen: germ that causes infection  Non-pathogen: harmless germ (sometimes makes up body flora)  Normal body flora: communities of organisms on body surfaces, specific to different areas of the body
  • 8. Infectious Cycle  Infectious agent  Reservoir  Portal of exit  Means of transmission  Portal of entry  Susceptible host
  • 9. Infectious Cycle Agent Reservoir Portal of exit transmissionPortal of entry Susceptible host agent
  • 10. Infectious Agent  Bacteria  Anthrax  Viruses  Fungi  Protozoa
  • 11. Conditions suitable for microbe growth  Warmth  Darkness  Oxygen water nourishment  Spores=inactive microbial life form that can resist heat & survive without moistures…. Difficult to destroy…in favorable conditions, may reactivate and reproduce
  • 12. Reservoir  Any natural habitat of a microbe that promotes its growth and reproduction.  Fomite: an inanimate object that acts as a vehicle for infection  Soiled or wet dressings  Hospital equipment  Counter tops
  • 13. Reservoir Con’t  Normal Body Flora: communities of organisms on body surfaces, specific to different areas of the body  Carrier/vector: a person or animal who harbors and spreads an organism, but does not become ill.
  • 14. Portal of Exit  GI  Respiratory  Genitourinary system  Tissues  Blood
  • 15. Mode of Transmission  After exiting the reservoir, microbes need a means to spread to the next host  Hands  Contaminated food, water or air  Contaminated equipment
  • 16. Portal of Entry  Any break in the skin  Mucous membranes  Mouth  Inhalation
  • 17. Susceptible Host  Another person  High risk  Diabetes  Heart disease  Surgery  burns
  • 18. Normal Defense Mechanisms  Intact Skin  Mucous membranes  Respiratory tract (clilia)  Urinary tract  GI tract  Vagina
  • 19. Factors affecting Normal Defense Mechanisms  Age (old or very young)  Stress  Nutritional status  Heredity  Underlying disease  Environmental factors  Medical therapy  Chemotherapy,radiation
  • 20. Infectious Process  Follows a progression (box 12-3)  Severity depends on  Susceptibility of host  Extent of infection  Agent factors  Virulence & Numbers of microbes  Motility & Ability to invade host  Duration of exposure to microbe
  • 21. Inflammatory Response  Body’s cellular response to injury or infection is inflammation  Vascular response of fluid, blood & nutrients to interstitial tissues in area of injury causes swelling, redness, pain, heat, pus, & loss of function  Inflammatory response is body’s way of attempting to heat up, destroy bacteria, limit spread of infection to bloodstream
  • 22. Localized vs Systemic  Local infection  Limited to 1 certain area  See redness, edema, pain, pus, etc  Systemic infection  Spread to entire body through bloodstream  may become fatal
  • 23. Nosocomial Infections  “Hospital acquired”  Spread on hands of health care workers  Spread by direct contact between health personnel and patients  Spread from patient to patient
  • 24. Infection Control Team  Specially trained  Responsibility for overseeing infection control in health facilities
  • 25. Employee Health  Necessary to protect  Workers  patients
  • 26. Hand Hygiene  The single most important means of preventing the spread of infection.  2 minute handwashing to start the day  15-30 sec between patients for minimally soiled hands  The more heavily soiled, the longer the wash
  • 27. Asepsis  The Practice that decreases or eliminates the number of microbes in an area  Medical Asepsis=clean technique
  • 28. Principles of Asepsis  Germs are everywhere  Blood & body fluids are MAJOR reservoirs  Barriers help stop the spread  Keep environment clean  Some areas more contaminated than others
  • 29. Common Aseptic practices  Handwashing  Dressing changes  Care of the environment  Keep surfaces clean, dry  Care of patient supplies, drainage tubes, etc.
  • 30. Surgical Asepsis  Measures that render supplies and equipment totally free of microorganisms  Sterile Technique: practices that avoid contamination of microbe free items
  • 31. Sterilization  Physical  Radiation  Boiling water  Free flowing steam  Dry heat  Steam under pressure (autoclaving)
  • 32. Sterilization  Chemical  Peracetic acid  Ethylene oxide gas
  • 33. Skills for surgical asepsis  Donning sterile gloves  Donning sterile gown  Adding items to a sterile field
  • 34. Surgical Asepsis  Work place called sterile field  Use inner surface of sterile wrapper or sterile drape  Gather needed supplies  Never leave sterile field unattended  Perform thorough handwashing (5-10 min in OR, min. 1-2 min for other settings
  • 35. Principles con’t  Always work at waist high level  Keep items in sight at all times  Never turn back on sterile field  Open sterile items as follows  TOP FLAP AWAY FROM BODY  SIDE  SIDE  LAST FLAP TOWARD BODY
  • 36. Principles Con’t  Never cross over sterile field  Pouring sterile solutions  Sterile inside, clean outside  Place cap sterile side up on clean surface  Perform “lipping” pour small amt of solution off before pouring into sterile container
  • 37. Principles Con’t  Touch sterile items to sterile items only  Only sterile items allowed on sterile field  Out of range of vision = contaminated  Prolonged exposure to air=contaminated  Sterile surface in contact with wet surface becomes contaminated  1 in margin of sterile field is contaminated
  • 38. Standard Precautions  Blood and body fluid pre-cautions to be used when caring for ALL patients  Includes:  Hand hygiene  Gloves  Masks  Eye shields  gowns
  • 39. PPE  Gowns  Face masks  Goggles  Gloves  Booties  caps
  • 40. Infection control strategies of the CDC  Standard Precautions  Transmission Based Precautions: 1996 addresses isolation precautions for patients with highly contagious pathogens  Isolate specific to the way a disease is transmitted
  • 41. Isolation Techniques  Transmission Based Precautions  Standard precautions  Airborne  Droplet  Contact
  • 42. Transmission Based Precautions  Airborne precautions need mask to block 5 micron or smaller particles (TB, measles-rubeola)  Droplet precautions: mask to block > 5 microns (flu, Rubella, Strep pneumonia  Contact precautions: protect from direct/indirect contact using gloves, gown (wounds, rashes, diarrhea Etc)
  • 43. Transmission Based con’t  Isolation or private room, or roommate with same diagnosis  Sign on door  Use of PPE before entering room, remove before leaving  Concurrent cleaning by housekeeping Dept.  Dedicated equipment (stays in room)  Transport patient with mask, bath
  • 44. Transmission Based Con’t  Pre-employment health assessments  Immunizations & TB screening up to date  S/S requiring immediate attention  Fever  Cough  Rash  Vesicles  Vomiting  diarrhea
  • 45. Psychological aspect of Isolation Patients  Feel frightened, “unclean”, neglected  Allow paitent to ventilate feelings  Show acceptance of person  Stress that it’s the microbes, not the patient that is unwanted  Provide for sensory stimulation: reading, TV, etc  Visitors allowed (following CDC guidelines)
  • 46. Blood Borne Pathogens  Risks  Direct contact with blood or body fluids of infected individuals  Sharing needles  Needle stick injuries  Exchange of body fluids (blood, semen, vaginal fluids during unprotected sex  Post Exposure Management  Obligation to inform patients who have been exposed to healthcare workers’s blood or body fluids
  • 47. Blood Borne Pathogens  Evaluation of healthcare workers infected with HBV, HCV, HIV  Expert panels  Compliance with infection control standards  Nature & scope of practice  Cognitive function
  • 48. TB Precautions  Early identification and treatment is key  Suspect TB when s/s persist >3 wks  S/S; fatigue, weight loss, dyspnea, fever, night sweats, cough (w/blood)  Isolation room  HEPA respirator mask (1mm)  Annual TB testing
  • 49. Work-Practice Controls  Handwashing  Prompt cleaning of blood and body fluid spills  Reusable equipment must be rinsed and sent to central service for autoclaving  Prompt disposal/handling of blood and body fluids and contaminated patiebt care items
  • 50. Work Practice Controls Con’t  Dispose of needles and sharps in proper receptical  Do not recap needles that have been injected  Use PPE as indicated
  • 51. Cleaning & Disinfecting  Rinse soil, debris off external & internal surfaces of reusable equipment  Transport to central service or appropriate dept for reprocessing  Follow manufacturer’s recommendation for cleaning/sterilizing

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