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Infection Control


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Infection Control

  1. 1. 1190L NURSING SKILLS LAB Infection Control Justine Clegg, MS, LM, CPM, LMHC Chair/Professor Emeritus Miami Dade College Midwifery Program 97 total slides
  2. 2. Infection control <ul><li>Goal of infection control is to prevent the spread of infectious diseases </li></ul><ul><li>Infectious disease is any disease caused by the growth of pathogens in the body </li></ul><ul><li>Pathogens are disease-causing microorganisms (germs) </li></ul><ul><li>Infectious diseases can cause unnecessary pain, suffering and death </li></ul>97 total slides
  3. 3. Maintain a safe environment <ul><li>Follow specific polices and procedures designed to reduce risk of transferring infectious diseases </li></ul><ul><li>Prevent pathogens from being transmitted: </li></ul><ul><ul><li>Patient to client, staff to client, client to staff, staff to staff </li></ul></ul><ul><ul><li>Improperly cleaned instruments and equipment </li></ul></ul>97 total slides
  4. 4. Infection <ul><li>Infection can be: </li></ul><ul><li>Generalized or systemic (throughout the body) </li></ul><ul><li>Localized (affecting one part of the body) </li></ul><ul><li>Signs and symptoms of infection: </li></ul><ul><li>Systemic: headaches, fever, fatigue, vomiting, diarrhea, increased pulse and respiration </li></ul><ul><li>Localized: redness, swelling, painful, warm to the touch </li></ul>97 total slides
  5. 5. Microbiology <ul><li>Microbiology: the study of microorganisms </li></ul><ul><li>Microorganisms are one celled animals or plants invisible to the eye, can only be seen with a microscope </li></ul><ul><li>1600s: Anton van Leeuwenhoek invented the microscope </li></ul><ul><li>1800s: Louis Pasteur developed germ theory. Stated that microorganisms, called bacteria, cause specific diseases in humans and animals </li></ul>97 total slides
  6. 6. History of infection control <ul><li>1843 Oliver Wendell Holmes: contagious disease or communicable disease can be spread directly or indirectly from one person to another through contaminated hands </li></ul><ul><li>Ignaz Philipp Semmelweis observed high mortality rate from MDs going from morgue to patients’ bedside without washing hands </li></ul><ul><li>1864 Joseph Lister: developed surgical aseptic technique to prevent wound contamination </li></ul>97 total slides
  7. 7. Facts about microorganisms <ul><li>Not all are harmful </li></ul><ul><li>Normal flora (microorganisms) are found on skin, in the intestines and vagina </li></ul><ul><li>Some are necessary to maintain normal bodily functions </li></ul><ul><ul><li>Escherichia coli (E. coli): </li></ul></ul><ul><ul><ul><li>Aids the digestive process in the colon </li></ul></ul></ul><ul><ul><ul><li>Can cause infection in the blood or urine; can cause spontaneous abortion </li></ul></ul></ul>97 total slides
  8. 8. Facts about microorganisms <ul><li>Some microorganisms are part of the normal flora but have no beneficial role </li></ul><ul><li>Normally they do no harm unless the person is susceptible to infection due to supression of the body’s immune response </li></ul><ul><li>The immune response: the body fights infection by producing antibodies (protective proteins that combat pathogens) </li></ul>97 total slides
  9. 9. Facts about microorganisms <ul><li>Antibiotics are drugs which inhibit the growth of or destroy microorganisms </li></ul><ul><li>They also suppress the body’s normal flora and create an imbalance that can decrease the body’s ability to resist other infections </li></ul><ul><li>Age, overall health, stress, nutrition and drugs can also weaken the body </li></ul><ul><li>Opportunistic infections take advantage of the body’s weakened state to grow </li></ul>97 total slides
  10. 10. Growth of microorganisms <ul><li>Aerobic – require oxygen to live </li></ul><ul><li>Anerobic – do not require oxygen to live </li></ul><ul><li>Many microorganisms thrive in warm, moist, dark environments like the human body which becomes a host to the microorganism </li></ul><ul><li>Symbiosis – the host benefits </li></ul><ul><li>Neutralism – no damage is done to the host </li></ul><ul><li>Parasitic – the host is damaged, the pathogen causing damage is called the parasite </li></ul>97 total slides
  11. 11. Types of microbes <ul><li>Microbe – a pathogenic microorganism </li></ul><ul><li>Classifications of plant and animal microbes: </li></ul><ul><ul><li>Bacteria </li></ul></ul><ul><ul><li>Viruses </li></ul></ul><ul><ul><li>Fungi </li></ul></ul><ul><ul><li>Rickettsia </li></ul></ul><ul><ul><li>Protozoa </li></ul></ul>97 total slides
  12. 12. Bacteria <ul><li>One-celled plants </li></ul><ul><li>Either pathogenic or non-pathogenic </li></ul><ul><li>Many produce toxins (poisonous substances) </li></ul><ul><li>Most bacteria are aerobic (need oxygen) and grow best in moderate temperatures </li></ul><ul><li>A group of bacteria growing in one place is called a colony </li></ul>97 total slides
  13. 13. Categories of Bacteria <ul><li>Bacteria are categorized according to shape </li></ul><ul><li>Each type causes certain conditions and diseases </li></ul><ul><li>Types of bacteria: </li></ul><ul><ul><li>Round or ovoid shape </li></ul></ul><ul><ul><li>Rod </li></ul></ul><ul><ul><li>Spiral </li></ul></ul>97 total slides
  14. 14. Round/Ovoid Bacteria <ul><li>Round or ovoid bacteria are called Cocci </li></ul><ul><li>Cocci are further defined by their appearance: </li></ul><ul><ul><li>Micrococci – appear singly </li></ul></ul><ul><ul><li>Diplococci – appear in pairs </li></ul></ul><ul><ul><li>Staphylococci – appear as irregular clusters </li></ul></ul><ul><ul><li>Streptococci – form chains </li></ul></ul>97 total slides
  15. 15. Infections caused by cocci <ul><li>Micrococci cause skin and wound infections </li></ul><ul><li>Diplococci cause gonorrhea, meningitis and some pneumonias </li></ul><ul><li>Staphylococci are pus-producing and can cause abscesses, boils, wound infections, UTIs and some pneumonias </li></ul><ul><li>Streptococci can cause rheumatic fever and strep throat </li></ul>97 total slides
  16. 16. Rod shaped bacteria <ul><li>Rod shaped bacteria are called bacilli </li></ul><ul><li>Bacilli are further defined by their appearance </li></ul><ul><ul><li>Bacilli – appear singly </li></ul></ul><ul><ul><li>Coccobacilli – when rods are somewhat oval </li></ul></ul><ul><ul><li>Diplobacilli – appear in pairs </li></ul></ul><ul><ul><li>Streptobacilli – attached end to end to form a chain </li></ul></ul><ul><li>Bacilli diseases: TB, tetanus, pertussis, typhoid fever, botulism and diphtheria </li></ul>97 total slides
  17. 17. Spiral shaped bacteria <ul><li>Spiral shaped bacteria are defined by their appearance </li></ul><ul><ul><li>Vibrios – form curved rods </li></ul></ul><ul><ul><li>Spirilla: organism is rigid </li></ul></ul><ul><ul><li>Spirochetes: organism is flexible </li></ul></ul><ul><li>Common diseases caused by spiral shaped bacteria are syphilis and cholera </li></ul>97 total slides
  18. 18. Bacteria and locomotion <ul><li>Cocci are incapable of movement </li></ul><ul><li>Some rod and spiral shaped bacteria have slender whip-like appendages called flagella (singular: flagellum ). </li></ul><ul><li>Flagella enable the bacteria to move. </li></ul>97 total slides
  19. 19. Diagnosing bacterial infections <ul><li>Essential for proper treatment of infection </li></ul><ul><li>Gram staining: frequently used lab method </li></ul><ul><li>Bacteria are stained with crystal violet </li></ul><ul><li>Type of cell wall determines how it reacts to staining. Three categories of reactions: </li></ul><ul><ul><li>Gram positive: cell wall retains the stain </li></ul></ul><ul><ul><li>Gram negative: cell wall loses the stain </li></ul></ul><ul><ul><li>Acid fast: cell wall retains the stain even when treated with acid </li></ul></ul>97 total slides
  20. 20. Diagnosing bacterial infections <ul><li>Growing the microorganism in various culture media is also used for diagnosis </li></ul><ul><li>Takes 24-72 hours for colonies to form </li></ul><ul><li>Can identify exact bacteria </li></ul><ul><li>Can choose a more precise antibiotic for a specific bacterium </li></ul>97 total slides
  21. 21. Spores: the resting stage <ul><li>Some bacteria can grow spores </li></ul><ul><li>Spores are thick capsules which the bacteria creates for self-protection </li></ul><ul><li>Spores are created when life-supporting conditions are not favorable </li></ul><ul><li>Bacteria is alive but dormant, difficult to kill, resistant to heat, drying and disinfectants </li></ul><ul><li>Can lie dormant for months or years until conditions are favorable for re-emergence </li></ul>97 total slides
  22. 22. Treating bacterial infections <ul><li>Almost all bacteria can be destroyed with antibiotics </li></ul><ul><li>Some are antibiotic-resistant, create threat to health care workers and patients </li></ul><ul><li>Extremely high temperatures must be used for sterilization to kill bacterial spores </li></ul>97 total slides
  23. 23. Viruses <ul><li>Smallest of the microbes </li></ul><ul><li>Need electron microscope to see them </li></ul><ul><li>Viruses are not whole cells, they depend on other living cells to provide food, nutrients and for reproduction </li></ul><ul><li>They are called obligate intracellular parasites because they can only live inside another living organism </li></ul>97 total slides
  24. 24. Viruses <ul><li>Over 300 viruses have been identified by researchers </li></ul><ul><li>Some appear to be harmless </li></ul><ul><li>Cause infections like influenza, pneumonia, chicken pox, croup, hepatitis B, AIDS, measles, mumps, polio, herpes, and warts </li></ul><ul><li>Transmitted through blood & body secretions </li></ul><ul><li>Difficult to treat because they are resistant to disinfectants and not killed by antibiotics </li></ul>97 total slides
  25. 25. Fungi <ul><li>Fungi are a large group of simple plants. </li></ul><ul><li>Two forms of fungi are potential pathogens: yeast and molds </li></ul><ul><ul><li>Yeasts are one celled </li></ul></ul><ul><ul><li>Molds are multi-celled </li></ul></ul><ul><li>Thrive in warm, moist, dark conditions </li></ul><ul><li>Cannot produce their own nutrients, must rely on living and dead organic materials </li></ul>97 total slides
  26. 26. Fungi <ul><li>Many yeasts and molds are non-pathogenic </li></ul><ul><li>Penicillin (antibiotic) is produced from a mold </li></ul><ul><li>Fungi can become pathogenic under the right conditions </li></ul><ul><li>Can create various opportunistic infections: </li></ul><ul><ul><li>Mildly annoying </li></ul></ul><ul><ul><li>Chronic and/or recurrent </li></ul></ul><ul><ul><li>Life-threatening </li></ul></ul>97 total slides
  27. 27. Fungal infections <ul><li>Cutaneous infections: superficial infections of the skin or mucus membranes, including hair follicles and scalp. Example: ringworm, athlete’s foot </li></ul><ul><li>Systemic infections: Example: histoplasmosis (respiratory disease) </li></ul><ul><ul><li>Difficult or impossible to treat or cure </li></ul></ul><ul><ul><li>Treatment requires medications toxic to humans </li></ul></ul>97 total slides
  28. 28. Rickettsia <ul><li>Smaller than bacteria, with rod or spherical shapes </li></ul><ul><li>Called obligate intracellular parasites - must live inside cell of another living organism </li></ul><ul><li>Rickettsia transmitted through bites of fleas, lice, ticks and mites </li></ul><ul><li>Diseases: several types of typhus and Rocky Mountain Spotted Fever </li></ul><ul><li>Typhus is the only rickettsial infection that can be transferred from 1 human to another </li></ul>97 total slides
  29. 29. Protozoa <ul><li>The only microorganism classified as an animal. </li></ul><ul><li>Plentiful in the environment – 45,000 different identified types of protozoa </li></ul><ul><li>Animal parasites reside in and out of the body </li></ul><ul><li>Seek locations that provide nutrients, warmth and moisture </li></ul><ul><li>Protozoa constantly present in intestines, skin, and mucus membranes of the nose and throat </li></ul>97 total slides
  30. 30. Protozoa <ul><li>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 </li></ul><ul><li>Common diseases caused by protozoa: dysentery, trichomonas, toxoplasmosis, pneumocystis pneumonia and malaria </li></ul>97 total slides
  31. 31. Chain of infection <ul><li>Model of infectious disease transmission </li></ul><ul><li>Six elements must be present for an infection to develop </li></ul><ul><li>1. The infectious agent </li></ul><ul><li>2. Reservoir host </li></ul><ul><li>3. Portal of exit from the host </li></ul><ul><li>4. Route of transmission </li></ul><ul><li>5. Port of entry </li></ul><ul><li>6. Susceptible host </li></ul>97 total slides
  32. 32. Chain of infection 97 total slides Infectious agent Reservoir Host Portal of exit Route of transmission Portal of entry Susceptible host
  33. 33. Chain of infection <ul><li>1. Infectious agent : a pathogen must be present </li></ul><ul><li>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. </li></ul><ul><li>Humans who can transmit infection but how no signs of the disease are called carriers. Person may be unaware they are a carrier. </li></ul>97 total slides
  34. 34. Chain of infection <ul><li>3. Portal of exit : the pathogen must be able to escape from the reservoir host where it has been growing. </li></ul><ul><li>Examples of portals of exit are blood, urine, feces, breaks in the skin, wound drainage, and body secretions like saliva, mucus and reproductive fluids </li></ul>97 total slides
  35. 35. Chain of infection <ul><li>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. </li></ul><ul><li>Examples of routes of transmission are air, food, insects, and direct contact with an infected person </li></ul>97 total slides
  36. 36. Chain of infection <ul><li>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 </li></ul><ul><li>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 </li></ul>97 total slides
  37. 37. Breaking the chain of infection <ul><li>Breaking at least one link stops the spread of infectious disease </li></ul><ul><li>1. The infectious agent </li></ul><ul><ul><li>early recognition of signs of infection </li></ul></ul><ul><ul><li>Rapid, accurate identification of organisms </li></ul></ul><ul><li>2. Reservoir host </li></ul><ul><ul><ul><li>Medical asepsis </li></ul></ul></ul><ul><ul><ul><li>Standard precautions </li></ul></ul></ul><ul><ul><ul><li>Good employee health </li></ul></ul></ul><ul><ul><ul><li>Environmental sanitation </li></ul></ul></ul><ul><ul><ul><li>Disinfectant/sterilization </li></ul></ul></ul>97 total slides
  38. 38. Breaking the chain of infection <ul><li>3. Portal of exit from the host </li></ul><ul><ul><li>Medical asepsis </li></ul></ul><ul><ul><li>Personal protective equipment </li></ul></ul><ul><ul><li>handwashing </li></ul></ul><ul><ul><li>Control of excretions and secretions </li></ul></ul><ul><ul><li>Trash and waste disposal </li></ul></ul><ul><ul><li>Standard precautions </li></ul></ul>97 total slides
  39. 39. Breaking the chain of infection <ul><li>4. Route of transmission </li></ul><ul><ul><li>Standard precautions </li></ul></ul><ul><ul><li>Handwashing </li></ul></ul><ul><ul><li>Sterilization </li></ul></ul><ul><ul><li>Medical asepsis </li></ul></ul><ul><ul><li>Air flow control </li></ul></ul><ul><ul><li>Food handling </li></ul></ul><ul><ul><li>Transmission-based precautions </li></ul></ul>97 total slides
  40. 40. Breaking the chain of infection <ul><li>Portal of entry </li></ul><ul><ul><li>Wound care </li></ul></ul><ul><ul><li>Catheter care </li></ul></ul><ul><ul><li>Medical asepsis </li></ul></ul><ul><ul><li>Standard precautions </li></ul></ul><ul><li>Susceptible Host </li></ul><ul><ul><li>Treating underlying diseases </li></ul></ul><ul><ul><li>Recognizing high-risk patients </li></ul></ul>97 total slides
  41. 41. Defense Mechanisms <ul><li>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 host’s resistance to the microorganism </li></ul>97 total slides
  42. 42. Body’s natural defenses to eliminate/kill pathogens <ul><li>Cilia - in respiratory tract, catch and move pathogens out of the body </li></ul><ul><li>Coughing/sneezing, to propel pathogens outward </li></ul><ul><li>Tears - contain chemicals to kill bacteria </li></ul><ul><li>Hydrochloric acid in stomach </li></ul><ul><li>Rise in body temperature (fever) </li></ul><ul><li>Leukocyte (white blood cell) production increases, to destroy pathogens </li></ul>97 total slides
  43. 43. Scope of the problem <ul><li>Health care facilities or “sick care buildings” have higher concentration of microorganisms than a normal environment </li></ul><ul><ul><li>Patients with lowered levels of resistance due to illness </li></ul></ul><ul><ul><li>Health care personnel have frequent contact with body fluids </li></ul></ul><ul><li>Nosocomial infection – contracted by 5-10% of patients while receiving health care </li></ul><ul><ul><li>Results in 80,000 deaths per year </li></ul></ul>97 total slides
  44. 44. Scope of the problem <ul><li>Industrial illness – a disease contracted by a health care professional during work </li></ul><ul><li>Blood-borne pathogens such as Hepatitis B and HIV can be transmitted through needle sticks </li></ul><ul><li>800,000 needle sticks occur each year </li></ul><ul><li>Up to 500 health care workers die each year from Hepatitis B </li></ul><ul><li>Follow precautions when performing procedures </li></ul><ul><li>Dispose of all sharps in proper containers </li></ul>97 total slides
  45. 45. Regulatory Agencies <ul><li>Center for Disease Control and Prevention (CDC) - Responsible for developing safe guidelines to help prevent and control the spread of infectious diseases </li></ul><ul><li>Occupational Safety and Health Administration (OSHA) - Responsible for maintaining minimum health and safety standards for employees </li></ul>97 total slides
  46. 46. Prevention: Medical Asepsis <ul><li>Medical asepsis (clean technique): procedures to decrease the number and spread of pathogens </li></ul><ul><li>Hand washing, good personal hygiene, cleaning rooms between patient use, proper disposal of gloves after contact with body fluids or contaminated objects </li></ul>97 total slides
  47. 47. Prevention: Surgical Asepsis <ul><li>Surgical asepsis (sterile technique): procedures that completely eliminate the presence of pathogens from objects and areas </li></ul><ul><ul><li>Sterile caps, gowns, masks, and gloves </li></ul></ul><ul><ul><li>Sterilizing instruments </li></ul></ul><ul><ul><li>Maintaining sterile fields </li></ul></ul><ul><ul><li>Changing dressing </li></ul></ul><ul><ul><li>Disposing of contaminated materials </li></ul></ul>97 total slides
  48. 48. Breaking chain of infection <ul><li>Most important concept: breaking at least one link stops the infectious disease </li></ul><ul><li>Chain of infection summarized into 3 components: </li></ul><ul><ul><li>Source of infecting microorganisms (1 & 2) </li></ul></ul><ul><ul><li>Means of transmission for the micro-organisms (3, 4 & 5) </li></ul></ul><ul><ul><li>Susceptible host (6) </li></ul></ul>97 total slides
  49. 49. Breaking chain of infection <ul><li>Best defenses: </li></ul><ul><ul><li>Decrease the sources of infecting microorganisms (1 & 2) </li></ul></ul><ul><ul><li>Prevent means of transmission for the micro-organisms (3, 4 & 5) </li></ul></ul><ul><ul><li>Maximize the resistance of the host (6) </li></ul></ul>97 total slides
  50. 50. Methods to decrease the source of microorganisms <ul><li>Perform proper hand washing </li></ul><ul><li>Decontaminate surfaces and equipment with antiseptics, disinfectants and sterilization procedures </li></ul><ul><li>Avoid contact with patients and others when harboring infectious microorganisms </li></ul>97 total slides
  51. 51. Preventing transmission of microorganisms <ul><li>Wear PPE – personal protective equipment: caps, gloves, gowns masks, booties and eye protection </li></ul><ul><li>Follow isolation procedures when indicated </li></ul><ul><li>Take additional precautions when working with patients who have highly contagious diseases. Don’t ignore posted signs. </li></ul>97 total slides
  52. 52. Maintaining resistance <ul><li>Provide and practice good hygiene </li></ul><ul><li>Ensure proper nutrition and fluid intake </li></ul><ul><li>Get enough rest </li></ul><ul><li>Decrease stressors – physical and psychosocial - that weaken the immune response </li></ul><ul><li>What can you do in your life to increase resistance to disease-causing pathogens? </li></ul>97 total slides
  53. 53. Standard Precautions <ul><li>Developed by the CDC </li></ul><ul><li>Follow at all times and apply to every patient </li></ul><ul><li>To prevent contact with potentially infectious body fluids: blood, secretions, excretions, non-intact skin and mucous membranes </li></ul>97 total slides
  54. 54. Handwashing <ul><li>Perform proper handwashing techniques: </li></ul><ul><ul><li>when coming on the clinical site </li></ul></ul><ul><ul><li>when taking a break or leaving work </li></ul></ul><ul><ul><li>between client contacts </li></ul></ul><ul><ul><li>before gloving and after ungloving </li></ul></ul><ul><ul><li>before and after touching your face </li></ul></ul><ul><ul><li>after contact with any contaminants </li></ul></ul><ul><ul><li>before touching items considered clean </li></ul></ul>97 total slides
  55. 55. Handwashing <ul><li>See Practical Skills Guide for Midwifery: </li></ul><ul><li>Procedure – step-by-step how to do it </li></ul><ul><li>Explain why is it important to know </li></ul><ul><li>(1) the procedure – what to do </li></ul><ul><li>(2) the rationale – the reason you do it that way, why each step is important </li></ul>97 total slides
  56. 56. Personal Protective Equipment <ul><li>Abbreviated PPE </li></ul><ul><li>Includes gloves, masks, protective eyewear, gowns, caps and shoes </li></ul><ul><li>Use appropriate PPE in situations that could cause infection to you or your client </li></ul><ul><li>Use clean, non-sterile gloves when handling blood, body fluids, secretions, excretions, contaminated items, mucous membranes and non-intact skin </li></ul>97 total slides
  57. 57. Gloves <ul><li>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) </li></ul><ul><li>Remove gloves promptly after use, before touching non-contaminated items and environmental surfaces and before taking care of another patient </li></ul><ul><li>After removing gloves, wash your hands </li></ul>97 total slides
  58. 58. Face Protection <ul><li>Face protection: Mask, Eye Protection and Face Shield </li></ul><ul><li>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. </li></ul>97 total slides
  59. 59. Gowns <ul><li>Gowns may be cloth or paper </li></ul><ul><ul><li>Cloth gowns are reusable </li></ul></ul><ul><ul><li>Paper gowns are disposable </li></ul></ul><ul><li>Some clinical sites provide gowns to clients for physical exams </li></ul><ul><li>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. </li></ul><ul><li>Follow the procedures on your clinical site(s) </li></ul>97 total slides
  60. 60. Removing a Gown <ul><li>Remove a soiled gown as promptly as possible </li></ul><ul><li>Fold front of gown into itself, outside in </li></ul><ul><li>Place cloth gowns in a closed receptacle marked with the biohazard symbol to be picked up, laundered and re-used </li></ul><ul><li>Place paper gowns in a closed waste can in a red plastic bag marked with the biohazard symbol </li></ul><ul><li>Wash hands promptly to avoid transferring microorganisms </li></ul>97 total slides
  61. 61. Client care equipment <ul><li>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 </li></ul><ul><li>Reusable equipment must be properly cleaned and reprocessed before being used on another client </li></ul><ul><li>Discard single-use items appropriately </li></ul>97 total slides
  62. 62. Environmental Control <ul><li>Follow procedures for the routine care, cleaning and disinfection of environmental surfaces, beds, bedside equipment, and other frequently touched surfaces </li></ul><ul><li>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 </li></ul>97 total slides
  63. 63. Occupational Health and Blood-Borne Pathogens <ul><li>Take care to prevent injuries when using and cleaning/disposing of “sharps” - needles, scalpels, and other sharp instruments </li></ul><ul><li>Place used disposable syringes, needles and scalpel blades in appropriate puncture-resistant containers </li></ul><ul><li>Containers should be located close by for convenient disposal </li></ul><ul><li>Placer reusable syringes and needles in a puncture resistant container for transport to be reprocessed (sterilized) </li></ul>97 total slides
  64. 64. Occupational Health and Blood-Borne Pathogens <ul><li>Never recap used needles </li></ul><ul><li>Follow facility policies on how to handle contaminated needles </li></ul><ul><li>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 </li></ul><ul><li>Do not remove used needles from disposable syringes by hand </li></ul><ul><li>Do not bend, break or manipulate used needles </li></ul>97 total slides
  65. 65. Occupational Health and Blood-Borne Pathogens <ul><li>Use mouthpieces, resuscitation bags, or other ventilation devices as an alternative to mouth-to-mouth resuscitation methods. </li></ul><ul><li>Keep these devices available in areas where clients may need to be resuscitated (ie, birth rooms) </li></ul>97 total slides
  66. 66. Self-inflating resuscitation bag (Ambu bag) 97 total slides
  67. 67. Using a flow inflating resuscitation bag on a baby 97 total slides
  68. 68. Environmental control <ul><li>Follow facility infection control procedures for cleaning the environment, jacuzzi tubs, etc. </li></ul><ul><li>Use Transmission-Based Precautions: </li></ul><ul><ul><li>Airborne precautions </li></ul></ul><ul><ul><li>Droplet precautions </li></ul></ul><ul><ul><li>Contact precautions </li></ul></ul>97 total slides
  69. 69. Airborne Precautions <ul><li>Airborne droplets or dust particles containing infectious agents can remain suspended in the air for long periods of time </li></ul><ul><li>Air currents can blow them long distances </li></ul><ul><li>Can be emitted during talking, sneezing, coughing and whispering </li></ul><ul><li>Examples: Mycobaterium tuberculosis, Rubeola (measles) and Varicella (chicken pox) </li></ul>97 total slides
  70. 70. Droplet Precautions <ul><li>Propelled short distances through the air </li></ul><ul><li>Deposited on host’s conjunctiva, nasal mucosa or mouth </li></ul><ul><li>Can be emitted during talking, sneezing, coughing and during procedures like suctioning and bronchoscopy </li></ul><ul><li>Examples: streptococcal pharyngitis, mumps, influenza, rubella, some some pneumonias, meningitis and sepsis </li></ul>97 total slides
  71. 71. Contact Precautions <ul><li>Most important and frequent mode of transmission for nosocomial infections </li></ul><ul><ul><li>Nosocomial = originates/takes place in hospital or other health care facility </li></ul></ul><ul><ul><li>Nosocomial infection = the client gets it as a result of being in the health care facility </li></ul></ul><ul><li>Example: herpes (HSV), impetigo, scabies, some gastrointestinal, respiratory, skin and wound infections </li></ul><ul><li>Direct-contact & Indirect-contact transmission </li></ul>97 total slides
  72. 72. <ul><li>Direct Contact Transmission </li></ul><ul><li>Occurs when touching the infected client’s dry skin during client care activities like giving a massage </li></ul><ul><li>Can occur between two clients: a source of the infecting micro-organism and a susceptible host </li></ul><ul><li>Indirect contact transmission </li></ul><ul><li>Occurs when a contaminated object is touched. </li></ul><ul><li>For example, coming in contact with needles, instruments, environmental surfaces or client care items. </li></ul>97 total slides
  73. 73. Double-bagging technique <ul><li>Used when disposing of medical waste from clients with infections (ex HIV) </li></ul><ul><li>Health care worker “A”, wearing proper PPE, takes the contaminated bag from the area </li></ul><ul><li>“ A” slips it into another bag held by co-worker “B” </li></ul><ul><li>“ B” does not touch the contaminated bag </li></ul><ul><li>“ A” does not touch the clean bag </li></ul><ul><li>The bags are labeled according to the facility policy with hazardous waste or linen markers to alert to the need for special handling </li></ul>97 total slides
  74. 74. Sterilization <ul><li>Chemical agents and physical methods used to destroy or inhibit growth of pathogens </li></ul><ul><li>Bacteriostatic – inhibits growth </li></ul><ul><li>Bacteriocidal/germicidal – kills microorganisms </li></ul><ul><li>Antiseptics – bacteriostatic chemical agents, mild enough to use on skin: 70% isopropyl alcohol </li></ul><ul><li>Disinfectants – destroy most bacteria and viruses. Used for instruments that do not penetrate the skin and for cleaning the environment – floors, bathrooms, equipment </li></ul>97 total slides
  75. 75. Disinfectants <ul><li>Chemical disinfectants can be harmful to the skin. When using chemical disinfectants follow manufacturer’s directions for dilution and for antidoting any exposure </li></ul><ul><li>10% household bleach in water meets OSHA requirements, kills HBV, HIV and TB </li></ul><ul><li>Soaking for 20-30 minutes in 70% isopropyl alcohol acts as a disinfectant: used for some instruments, glass thermometers </li></ul><ul><li>Boiling instruments in water: cover and boil in “rolling water” for 20 mins. Rarely used today. </li></ul>97 total slides
  76. 76. Sterilization <ul><li>Agents/methods that totally destroy all microorganisms including viruses and spores </li></ul><ul><li>Include chemical agents, gas, radiation, dry or moist heat under pressure </li></ul><ul><li>Most common method used is the autoclave, which sterilizes by steam created by a pressurized heating system </li></ul><ul><li>Small units used in a medical office; large units used in hospitals </li></ul>97 total slides
  77. 77. Surgical Asepsis – Sterile Technique <ul><li>Aseptic: free from pathogenic microorganisms </li></ul><ul><li>Sterile Technique: refers to a group pf principles and procedures designed to eliminate pathogens </li></ul><ul><li>Sterile field: an area designated as free from microorganisms </li></ul><ul><li>Example: a sterile towel placed on a clean, dry surface – the towel becomes the sterile field </li></ul><ul><li>Consider the field as a 3-dimensional area </li></ul>97 total slides
  78. 78. Maintaining a sterile field <ul><li>Field should be above the waist height </li></ul><ul><li>Do not bring contaminants into the field </li></ul><ul><li>Actions that contaminate the field: touching it, allowing it to become wet, reaching across it, talking or coughing directly over the surface </li></ul><ul><li>Work to the side of the field </li></ul><ul><li>Sterile gloves come in sealed packages that must be opened at the edge of the sterile field and placed onto the field </li></ul><ul><li>See PSGM Skills Book to put on sterile gloves </li></ul>97 total slides
  79. 79. Blood borne diseases <ul><li>HBV and HIV: put health care workers at risk </li></ul><ul><li>Transmitted by infected blood, mucous, secretions, excretions, any moist body fluid (except sweat) </li></ul><ul><li>Routes of transmission: </li></ul><ul><ul><li>Parenteral – blood transfusion, needle sharing, stick by needle or other sharp instrument </li></ul></ul><ul><ul><li>Mucous membranes – eye or mouth </li></ul></ul><ul><ul><li>Sexual contact </li></ul></ul><ul><ul><li>Perinatal – from infected mother to her baby </li></ul></ul>97 total slides
  80. 80. HBV <ul><li>When infected with HBV, the liver becomes inflamed and can be destroyed </li></ul><ul><li>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 </li></ul><ul><li>Prevention: HBV vaccine, use of PPE, preventing puncture injuries, disinfecting and sterilizing equipment and environments </li></ul>97 total slides
  81. 81. HBV vaccine <ul><li>OSHA requires employers to provide the HBV vaccine free for employees with exposure risk </li></ul><ul><li>A series of 3 doses given over 6 months </li></ul><ul><li>Induce protective antibody levels in 85 – 97% of healthy adults </li></ul><ul><li>Blood test can determine antibody levels </li></ul><ul><li>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 </li></ul>97 total slides
  82. 82. HIV <ul><li>The Human Immunodeficiency virus that causes AIDS </li></ul><ul><li>HIV virus destroys cells in the host that are vital to the immune system function </li></ul><ul><li>Testing: tests for HIV antibodies </li></ul><ul><li>Most infected people test positive within 6-12 weeks up to 6 months from exposure </li></ul><ul><li>HIV positive = infected with the virus, can transmit to others even if non-symptomatic </li></ul><ul><li>AIDS = weakened immune system </li></ul>97 total slides
  83. 83. AIDS <ul><li>Most but not all HIV infected people will eventually develop AIDS and die from “opportunistic infections” such as PCP (Pneumocystis carinii pneumonia) </li></ul><ul><li>Signs and symptoms of AIDS: weakness, chronic fever, night sweats, swelling of lymph nodes, weight loss and diarrhea </li></ul><ul><li>No known vaccine or cure </li></ul><ul><li>Managed by treating symptoms with antiviral drugs and a healthy supportive lifestyle </li></ul>97 total slides
  84. 84. HIV transmission <ul><li>HIV has been isolated from blood, semen, breast milk, vaginal secretions, saliva, tears, urine, cerebrospinal fluid and amniotic fluid </li></ul><ul><li>Only blood, semen, vaginal secretions and breast milk have been proven to transmit HIV </li></ul><ul><li>Transmission not through casual contact: </li></ul><ul><ul><li>Parenteral – blood transfusion, needle stick </li></ul></ul><ul><ul><li>Mucous membranes – eye or mouth </li></ul></ul><ul><ul><li>Sexual intercourse </li></ul></ul><ul><ul><li>Perinatal – from infected mother to baby </li></ul></ul>97 total slides
  85. 85. HIV transmission <ul><li>HIV is NOT transmitted through: </li></ul><ul><li>Sharing household facilities, food, eating utensils, plates, drinking glasses or towels </li></ul><ul><li>Hugging and kissing on the cheek </li></ul><ul><li>Mosquitoes or other animals </li></ul><ul><li>Infection from exposure is determined by: </li></ul><ul><li>Amount of the virus transmitted </li></ul><ul><li>How many exposures </li></ul><ul><li>Overall health of the person </li></ul>97 total slides
  86. 86. HBV& HIV: Relative risk <ul><li>Most health care workers are afraid of getting HIV, but HIV is much harder to catch than HBV </li></ul><ul><li>The infection and death rate from HBV far exceeds HIV </li></ul><ul><li>Only 3-5 health care workers out of 1000 injured with a needle contaminated with HIV will become infected </li></ul>97 total slides
  87. 87. Tuberculosis <ul><li>Airborne pathogen mycobacterium tuberculosis primarily affects the lungs </li></ul><ul><li>Working with TB clients requires using special PPE, individually fitted masks, to avoid inhaling tiny droplets which carry the disease </li></ul><ul><li>Cases of TB have increased in recent years </li></ul><ul><li>Medication must be taken for 6 months </li></ul><ul><li>If clients don’t complete the course of treatment, a drug-resistant strain can mutate and re-infect the person </li></ul>97 total slides
  88. 88. Tuberculosis <ul><li>Screening for TB is a skin test </li></ul><ul><li>Positive test result means the person has been exposed to the disease </li></ul><ul><li>A chest x-ray confirms active disease </li></ul><ul><li>Signs and symptoms: lethargy, fever, night sweats, cough, weight loss, coughing up blood-tinged sputum, chest pain, and SOB. </li></ul><ul><li>Patients hospitalized with suspected TB are put in isolation for 2-3 weeks and begin antibiotic treatment </li></ul>97 total slides
  89. 89. Drug-resistant organisms <ul><li>A fairly recent occurrence </li></ul><ul><li>Results from: </li></ul><ul><ul><li>the overuse of antibiotics in the USA to treat minor conditions </li></ul></ul><ul><ul><li>Using wide-spectrum antibiotics instead of testing/prescribing for a specific pathogen </li></ul></ul><ul><ul><li>patients not completing an entire course of prescribed treatment of antibiotics </li></ul></ul><ul><li>These create conditions that encourage pathogens to become resistant to antibiotics </li></ul>97 total slides
  90. 90. Drug-resistant organisms <ul><li>Two drug resistant organisms encountered in health care: </li></ul><ul><ul><li>MRSA – Methicillin-resistant Staphylococcus aureas </li></ul></ul><ul><ul><li>VRE – Vancomycin-resistant Enterococcus </li></ul></ul><ul><li>Both are difficult to control and can cause serious, life threatening infections esp. in susceptible people (ex: premature babies) </li></ul><ul><li>Treatment is expensive and has severe side effects – liver, kidney & hearing damage </li></ul>97 total slides
  91. 91. Reporting accidental exposure <ul><li>Report any injury or accident involving exposure to blood or body fluids immediately to your clinical preceptor/supervisor </li></ul><ul><li>Complete a written incident or injury report </li></ul><ul><li>Reporting facilitates evaluation, appropriate treatment and follow-up </li></ul><ul><li>Failure to report can result in negative health consequences and is in violation of OSHA requirements </li></ul>97 total slides
  92. 92. OSHA Regulations <ul><li>Every facility must have an Exposure Control Plan: </li></ul><ul><ul><li>Predetermines employee exposure risk to blood-borne pathogens </li></ul></ul><ul><ul><li>Describes how employees at risk will be protected </li></ul></ul><ul><ul><li>Gives training and annual retraining and testing requirements for employees </li></ul></ul><ul><ul><li>Gives policies and procedures to follow in case of employee exposure </li></ul></ul>97 total slides
  93. 93. SUMMARY <ul><li>How do antibiotics work? </li></ul><ul><li>What is an opportunistic infection? </li></ul><ul><li>Define: Aerobic, Anerobic, host, Symbiosis, Neutralism and Parasitic </li></ul><ul><li>Differentiate plant and animal microbes: Bacteria, Viruses, Fungi, Rickettsia, Protozoa </li></ul>97 total slides
  94. 94. SUMMARY <ul><li>Explain the chain of infection and how to break it at each point </li></ul><ul><li>1. The infectious agent </li></ul><ul><li>2. Reservoir host </li></ul><ul><li>3. Portal of exit from the host </li></ul><ul><li>4. Route of transmission </li></ul><ul><li>5. Port of entry </li></ul><ul><li>6. Susceptible host </li></ul>97 total slides
  95. 95. SUMMARY <ul><li>What are the body’s natural defense mechanisms? </li></ul><ul><li>Explain the concept of a sterile field and how to avoid contaminating it </li></ul><ul><li>Describe standard precautions including handwashing, gloving, PPE </li></ul><ul><li>Explain the differences between antiseptics, disinfectants and sterilization </li></ul>97 total slides
  96. 96. SUMMARY <ul><li>How is HIV transmitted? How is it NOT? </li></ul><ul><li>What are the 3 major disease risks for health care workers </li></ul><ul><li>How do pathogens become drug-resistant? </li></ul><ul><li>What is the role of government agencies: CDC, OSHA </li></ul><ul><li>Explain environmental control and transmission precautions </li></ul>97 total slides
  97. 97. 1190L NURSING SKILLS LAB Infection Control 97 total slides