infection infectious agents

2. Microorganisms are necessary for normal body
functions. Some organisms produce food and maintain
normal planet’s ecology. The moment harmony is
upset, microorganisms are capable of producing
diseases. An infection occurs when a disease-causing
organism enters the body and starts to multiply when
they come in contact with favorable environment. An
infection results when a microorganism or pathogen
colonizes a host organism, using its resources to live
and replicate. A disease results when there is a change
or impairment of normal tissue function due to the
pathogen. An infectious disease is any disease caused
by the growth of pathogenic microbes in the body. It
may or may not be communicable (i.e. contagious).

3.  Bacteria are present inside us, on us and
around us in our environment.
 Resident Flora- Bacteria present inside us.
Helps in digestion of food. (Unharmful)
 Transient Flora- Bacteria which we get from
environment. Air, Drinking Water, food,
Harmful Get Activated when meet Dust,
clothes etc. favorable environment

4.  Infection occurs Pathogens (a
microorganism that causes disease Invades
body Multiply Produces disease Begins
Usually causing harm to the host.

5.  Infection is the invasion of a host organism’s
bodily tissues by disease-causing organisms,
their multiplication, and the reaction of host
tissues to these organisms and the toxins they
produce. Infections are caused by
microorganisms such as viruses, prions, bacteria,
and viroids and larger organisms like parasites
and fungi.
 Infection is the establishment of the organisms in
the tissues resulting in injury or harmful effect to
the host. oInfection is the entry and development
or multiplication of disease producing agents in
the body of the host.

6.  Primary infection vs. secondary infection •
Primary Infection- An infection that develops in
an otherwise healthy individual.
 Secondary Infection- An infection that develops
in an individual who is already infected with a
different Pathogen.
 Localized infection vs. systemic infection
 Local or Localized Infection- An infection that is
restricted to a specific location or region within
the body of the host.
 Systemic Infection- An infection that has spread
to several regions or areas in the body of the
host.

7.  Clinical infection vs. subclinical infection
 Clinical Infection- An infection with obvious
observable or detectable symptoms.
 Subclinical Infection- An infection with few or no
obvious symptoms.
 Opportunistic infection- An infection caused by
microorganisms that are commonly found in the
host’s environment. This term is often used to
refer to infections caused by organisms in the
normal flora.
 CROSS INFECTION- It is transfer of new infection
from another host or external environment.

8.  REINFECTION: Subsequent infection by same
organism in a host is called reinfection.
 FOCAL INFECTION: it is a condition where due
to infection at localized sites like appendix
and tonsil, general effects are produced.
 SUBCLINICAL INFECTION: It is one where
clinical affects are not apparent.

9.  Infections may me endogenous or
exogenous. ENDOGENOUS INFECTIONS •
Endogenous infections are contracted from
the host himself from the normal flora. •
Many areas of the body have normal
commensal flora. • They have many
functions. • They provide barrier to the
infection by competing for nutrition with
pathogens. • Some produce vitamins which
are useful for the host. Infections
Endogenous Exogenous

10.  Some produce colicins to act against pathogens.
 Generally they do not cause any infections. But
there are expectations.
 Eg.- Streptococcus mitis, Streptococcus faecalis.
 EXOGENOUS INFECTIONS
 Exogenous infections are derived from man,
animals and soil.
 Man gets the infections from patients suffering
from disease.
 Some person may be carries for the pathogens
and they may transmit the diseases to others
without getting affected.

11.  ROUTES OF SPREAD OF INFECTION There are
five main routes by which a host may become
infected.
 The respiratory route
 The alimentary tract
 The skin and mucous membrane
 Genital tract
 Placenta Routes of spread of infection
Respiratory route Alimentary tract Skin and
mucous membrane Genital tract Placenta

12.  THE RESPIRATORY ROUTE Organisms causing respiratory infections are
as follows:
1. Streptococcus pneumonia, Haemophilus influenzae, Mycobacterium
tuberculosis, Bordetella pertusis are some of the bacterial pathogens.
2. Common cold virus, influenza virus, adeno virus are some of the
viruses producing respiratory infections.
THE ALIMENTARY TRACT The intestinal diseases like cholera, bacillary
dysentery, the enteric fever and bovine tuberculosis are contracted when
the organisms are ingested. But in the case of entero virus infections
(poliomyelitis) and Hepatitis though the organisms enter through gastro
intestinal system, the effects are seen elsewhere in the body.
THE SKIN AND MUCOUS MEMBRANE Organisms may be acquired from the
skin as in the case of herpes virus infection or through wounds as in
tetanus. Wounds may be formed from trauma or thorn pricks or needle
stick injury. Organisms may also be introduced through animal bite as in
the case of rabies or by insect bites as in dengue, malaria, filariasis, and
yellow fever.

13.  GENITAL TRACT Syphilis, gonorrhea, hepatitis
B and AIDS are some of the sexually
transmitted diseases. Treponema pallidum,
Neisseria gonorrhoeae, Hepatitis B virus and
Human Immunodeficiency Virus are the
etiologic agents respectively. PLACENTA
Bacteria like T .pallidum, Viruses like rubella,
cytomegalovirus, parasite like Toxoplasma
gondii are some of the organisms that enter
through placenta and cause disease in the
newborn.

14.  Redness
 Swelling
 Tenderness
 Warmth
 Drainage
 Red streaks leading away from Wound
Development of Infection:
Clinical Signs and Symptoms
Local signs
Inflammation
Purulent exudate if bacterial infection; serous exudate if viral
Tissue necrosis
Lymphadenopathy
Respiratory effects
Systemic signs
Fever, fatigue, headache, nausea

15.  THE INFECTIOUS PROCESS Chain of infection
is a process of infection that begins when an
agent leave its reservoir through portal of exit
& is conveyed by mode of transmission then
enters through an appropriate portal of entry
to infect a susceptible host. or Chain of
infection is a process in which a favorable
condition is required for microorganism to
spread or transfer from reservoir to a
susceptible host.

16.  The chain of the infection includes six
components that must be in succession for
any infectious disease to evolve.
 If one link is eliminated from the chain, then
transmission of the pathogen will not occur.
 Infection control strategies are based on
breaking the chain of infection.

17.  Development of an infection occurs in a cycle
that depends on the following elements:
1. An infection agent or pathogen.
2. A reservoir ( source for pathogen growth).
3. A portal of exit from the reservoir.
4. A mode of transmission.
5. A portal of entry to a host.
6. A susceptible host.

18.  These are any microorganism that can cause a disease such as a
bacteria, virus, parasite, or fungus. Reasons that the organism
will cause an infection are virulence (ability to multiply and
grow), invasiveness (ability to enter tissue), and pathogenicity
(ability to cause disease). Any organism is capable of causing
infection if all the links/components are present. Must be able to
enter the body and invade or colonize host tissue by attaching to
specific host cells then cause damage to those cells by
production of toxin or destructive enzymes. The pathogen may
enter the body through any body orifice or broken skin.
 There are five types of infectious agents:
 Bacteria
 Viruses
 Fungi
 Parasites (protozoa, helminthes)
 Prions

19.  Pathogenicity Virulence Infectious dose Toxigenicity Adaptability Ability
to produce disease Disease severity Number of organisms needed to
initiate infection. Capacity to produce injurious substances that damage
the host Ability to adjust to changing conditions, i.e., resistance to
antimicrob ial agents.
 The potential for microorganisms or parasites to cause disease depends
on the following factors: a. Sufficient number of organisms b. Virulence
or ability to produce disease c. Ability to enter and survive to the host d.
Susceptibility of host RESERVOIR z A reservoir is where a pathogen can
survive. z It is the place where the microorganism resides, thrives, and
reproduces, i.e., skin of patients, carriers, inanimate objects, insects,
food, water, toilet seat, elevator buttons, human feces, respiratory
secretions etc. z The environment in which a pathogenic microorganism
lives and survives naturally; can be human, animal, or environmental. z A
reservoir is the place in the environment where infectious agents live,
multiply, and reproduce so they can be transmitted to a susceptible
host. A reservoir can be animate, such as people, insects, animals, and
plants, or inanimate, such as water, soil, or medical devices.

20.  PORTAL OF EXIT FROM RESERVOIR z It is the place where
the microorganism leaves the reservoir, such as the
respiratory tract (nose, mouth), intestinal tract (rectum via
stool), urinary tract, or blood and other body fluids. z
Microorganisms can leave the body through a variety of
sites such as :- Skin and mucous membrane
Respiratory tract Urinary tract Gastrointestinal tract
Reproductive tract Blood a. Respiratory Tract:
Microorganisms leave the body of the infected person by
means of droplets exhaled as a spray in coughing,
sneezing, talking, or just breathing. Microorganisms also
escape in nose and throat secretions. b. Gastrointestinal
tract: Microorganisms that leave the body of the infected
person by means of body secretions, for example,
hepatitis, the virus is shed in the stool of the infected
person.

21. c. Skin: Microorganisms that leave the body of
the infected person by wound drainage or
through skin lesions. d. Urine: Microorganisms
leave the body of the infected person by means
of urine such as salmonella typhi. e. Genital
tract: Microorganisms leave the body of the
infected person by means of genital tract such
as gonococci, treponema pallidum, HIV, VD
virus.

22. MODES OF TRANSMISSION Mode of
transmission is the means by which an
organism transfers from one carrier to another
by either direct transmission or indirect
transmission.

23. CONTACT TRANSMISSION- DIRECT & INDIRECT
Contact transmission is the most common
route of transmission of organisms in health
care settings.
DIRECT TRANSMISSION
INDIRECT TRANSMISSION
CONTAMINATED ARTICLES

24.  26. DROPLET TRANSMISSION Droplets
should come in contact with mucus
membrane directly or indirectly through
sneezing, coughing , talking etc.. Examples
of droplet transmission include influenza,
meningitis etc.

25.  27. AIRBORNE TRANSMISSION There are three
common diseases that are transmitted through
the airborne route; chicken pox (varicella),
tuberculosis, and measles.
 28. VECTOR TRANSMISSION Vector
transmission occurs when an insect or animal
transmits disease to humans. e.g. Malaria and
Dengue fever etc.
 29. PORTAL OF ENTRY The opening where an
infectious disease enters the host’s body such as
mucus membranes, open wounds, or tubes
inserted in body cavities like urinary catheters or
feeding tubes.

26.  SUSCEPTIBLE HOST It is a person who is at
risk for developing an infection from the
disease. Factors include young people and
elderly people, chronic diseases such as
diabetes or asthma, conditions that weaken
the immune system like HIV, certain types of
medications, invasive devices like feeding
tubes, and malnutrition.
 BREAKING OF INFECTIOUS CYCLE

27.  33. 1. CONTROL OR ELIMINATION OF INFECTIOUS AGENT
Cleaning, disinfection & sterilization of contaminated
objects significantly reduce & often eliminate
microorganism. It includes 4 steps- Cleaning- It is
removal of all soil from object & surface. Asepsis- It is
absence of pathogenic microorganism. It is of 2 types
medical & surgical asepsis. Disinfection- It is process of
killing microorganisms, spores are not involved.
Sterilization- It is process of killing microorganisms &
their spores.
 34. Clean contaminated objects (reduces the number of
organisms). Perform disinfection and sterilization (kills
or inactivates organisms). Use antiseptics to inhibit
growth. Use antiseptic agents/ antimicrobial agents.

28.  35. 2. CONTROL OR ELIMINATION OF RESERVOIR
It includes following measures- Eliminate
sources of body fluids and drainage. Bathe with
soap and water. Change soiled dressings.
Remove standing water on bedside tables.
Cover bottles of used solutions. Maintain
patency of surgical wound drains. Empty and
rinse suction bottles. Empty drainage bags
every shift. Place syringes and uncapped
needles in moisture- resistant, puncture proof
containers. Limit contact with persons with
infection or exposed to infection.

29.  36. CONTROL OF PORTAL EXIT
 37. Control Of Transmission Reduce
microorganisms spread. Wash hands. Use
personal set of care items for each client.
Avoid shaking bed linens or clothes.
Discard any item that touches the floor.

30.  38. HAND HYGIENE MOMENT
 40. CONTROL OF PORTAL OF ENTRY Skin and
mucous membranes - Maintain skin and
mucous membrane integrity. Use proper
hygiene measures. Clean wound sites
thoroughly. Dispose of used needles in
proper receptacles. Urinary - Keep all
drainage systems closed and intact. Discard
facial tissues, wound dressings, and other
body excreta without touching.

31.  41. PROTECTION OF SUSCEPTIBLE HOST
Provide adequate nutrition. Ensure adequate
rest. Promote body defenses against
infection. Provide immunizations.
Maintenance of hygiene. Use of personal
protective equipments like gloves, gown,
Shoe cover, masks & cap.

32.  42. COURSE OF INFECTION BY STAGE
INCUBATION PERIOD Internal between
entrance of pathogen into body and
appearance of first symptoms. E.g.,
Chickenpox 2-3 weeks. Common cold 1-2
days Mumps 18 days Course of infection by
stage Incubatio n period Prodrom al stage
Illness stage Convalescence

33.  43. PRODROMAL STAGE Interval from onset of non-
specific signs and symptoms (malaise, low- grade fever,
fatigue) to more specific symptoms. During this time,
microorganisms grow and multiply and patient is more
capable of spreading disease to others. ILLNESS STAGE
Interval when patient manifests signs and symptoms
specific to a particular disease. E.g., Common cold- Sore
throat. Rhinitis - Sinus congestion. Mumps - earache, high
fever, parotid and salivary gland swelling. The severity of
patient’s illness depends on the extent of infection, the
pathogenicity of the microorganisms and susceptibility of
individuals. CONVALESCENCE Interval when acute
symptoms of infection disappear until the individual
regain his normal health. Length of recovery depends on
severity of infection and patient’s general health status.
Recovery may take several days to months.

34.  44. DEFENSES AGAINST INFECTION The body incorporates certain defenses against
the invasion of pathogens causing infection. 1. SKIN : The skin is the first line of
defense since most pathogens cannot enter unbroken skin. Defenses against
infection Skin Phagocyte Normal body flora Immune substances Lymphatic system
Factors which lesson body defenses
 45. 2. PHAGOCYTE : Another line of defense is phagocyte cells such as white
blood cells. These cells engulf pathogens and absorb them. Phagocytes increase in
numbers at the site of infection. 3. NORMAL BODY FLORA : Normal body flora that
reside inside and outside of the body protect a person from several pathogens. 4.
IMMUNE SUBSTANCES : Still another line of defense is the development by the
body of antibodies and antitoxins. Because pathogens are foreign substances, the
body reacts and destroys them by producing immune bodies. All patients
vulnerable to cross infection or infectious diseases, particularly tetanus, should
receive indicated prophylactic doses of antibiotics and immunizing agents. 5.
LYMPHATIC SYSTEM : The lymphatic system also defends the body against
invading pathogens. The lymph acts like a washing machine for the body. It
cleanses the body tissues. Lymph flows into the tubules and glands that act as
filters and strains the invaders. 6. FACTORS WHICH LESSON BODY DEFENSES :
Several factors that may be present in combat casualties tend to lessen to lessen
body defenses. They include wound injuries, chilling, exposure, fatigue, and
malnutrition.

35.  46. ASEPSIS Asepsis means absence of disease
producing organisms. The microorganisms of
different types are present everywhere in our
environment and in the human body. The
purpose of medical asepsis is to prevent by all
means of cross-infections from one patient to
another, including communicable disease
infections. The purpose of surgical asepsis is to
prevent by all means of infections of the wounds
of surgical patients, infection of the uterus
during and after delivery, and infection that could
be introduced by invasive procedures such as
catheterization, injections and infusions. Asepsis
Medical asepsis Surgical asepsis

36.  47. MEDICAL ASEPSIS This includes : 1. General
cleanliness. 2. Isolation of infected persons. 3. Disinfection
of all articles that may be contaminated, or used for more
than one patient. 4. Correct and frequent hand-washing
by all those caring for patients. SURGICAL ASEPSIS This
means keeping objects and areas ‘sterile’ free from all
organisms. Surgical asepsis (Sterile technique) is used in
the operating room, delivery room, in doing surgical
dressings and many other invasive procedures. The nurse
must thoroughly understand the principle of surgical
asepsis. She must be reliable in always keeping to these
principles. She must know about the use and care of the
masks, gloves, and gowns, the proper technique of hand
washing for surgical procedures and the sterilizing and
handling of sterile equipments.

37.  48. HOSPITAL INFECTION OR NOSOCOMIAL INFECTION
Nosocomial infections are infections that are acquired by a
patient due to delivery of health care services. The majority of
HAI (human acquired infection) become evident 48 hours or
more following admission. However, it may not become clinically
evident until after discharge. There are various reasons why
patients in hospital acquire infection. Patient with infectious
diseases are frequently admitted to hospital. Some of these
patients are able to spread their organisms to other patients and
they provide one source of infection in hospital patients
admitted for other causes. EXAMPLES of such infections
spreading in hospital include : Salmonellosis, group A
streptococcal infections, tuberculosis, viral hepatitis and other
infections. When such patients require admission to hospital, the
risk has to be assessed for other patients and appropriate
measures taken to contain the infection with isolation
procedures of varying degrees of strictness depending on the
infection.

38.  49. The commonest forms of hospital-acquired
infection are due to invasive procedures carried
out on patients such as surgical operations
intravenous therapy, intubation and
catheterization. A variety of measures is needed
to control such infections. Most nosocomial
infections are transmitted by health care workers.
IATROGENIC INFECTIONS Iatrogenic infections are
a type of nosocomial infection resulting from a
diagnostic or therapeutic procedure. (e.g.)
urinary tract infection that develops after
catheter insertion. Nosocomial infections may be
exogenous infection or endogenous infection.

39.  50. SITES AND CAUSES FOR NOSOCOMIAL
INFECTION URINARY TRACT 1. Insertion of
urinary catheter. 2. Improper hand washing
technique. 3. Contaminated catheter, tube
and bag. 4. Failure to use aseptic techniques.
5. Reflux of urine from bag to bladder. Sites
for nosocomial infection Urinary tract
Respiratory tract Alimentary tract Surgical
wounds Blood stream

40.  51. RESPIRATORY TRACT 1. Aspiration in
unconscious patient. 2. Contaminated ET tubes.
3. Contaminated instruments. 4. Contaminated
catheters. 5. Failure to use aseptic techniques.
ALIMENTARY TRACT 1. Improper hand washing
technique in food handlers. 2. Improper hand
washing technique during tube feeding. 3.
Contaminated food. 4. Contaminated water. 5.
Contaminated milk. 6. Contaminated NG tubes.
7. Carriers of infection. SURGICAL WOUNDS 1.
Improper hand washing technique. 2. Improper
skin preparation. 3. Improper sterilization of
instruments and dressing materials. 4. Failure to
use aseptic techniques.

41. 52. BLOOD STREAM 1. Contaminated intravenous
fluids, tubing or needles. 2. Improper care of
needles, insertion site. 3. Improper hand washing
technique. RISK FACTORS FOR HOSPITAL INFECTION
1. Broken skin or mucous membrane. 2. Obstructed
urine outflow. 3. Decreased mobility. 4. Reduce
haemoglobin level. 5. Neonates. 6. Aged patients.
7. Impaired defense mechanism. 8. Major invasive
procedures. 9. Obesity. 10. Malnutrition. 11.
Steroid therapy. 12. Immunocompromised
individual. 13. Presence of remote infection 14. Use
of unsterile instruments.

42.  53. PREVENTION OF HOSPITAL INFECTION 1. Proper hand washing technique. 2. Proper sterilization of
instruments and dressing materials. 3. Proper care of needle, insertion site. 4. Isolation of patients having
communicable diseases. 5. Careful and appropriate use of instruments. 6. Proper disinfection of excreta and
infected material. 7. Proper and regular surveillance of infection. 8. Good housekeeping. 9. General hygiene.
10.Exclusion of carriers. 11. Use of vaccines.
 54. Infection Prevention Guidelines The CDC guidelines for infection control and isolation precautions are used
in hospital and health-care agency policies. CDC and agency guidelines are continuously updated and should be
followed for your protection, as well as your patients’. Current CDC guidelines for isolation precautions in
hospitals include two tiers of precautions: standard precautions and transmission-based precautions (Table
7.2). Standard Precautions Standard precautions are used in the care of all patients. These precautions require
you to assume that all patients are infectious regardless of their diagnosis. Standard precautions apply to blood,
secretions, excretions, open skin, mucous membranes, and all body fluids, excluding sweat. All patients with
draining wounds or secretions of body fluids are considered infectious until an infection is confirmed or ruled
out. Using gloves, gowns, masks, goggles, face shields, and, most important, hand washing helps prevent the
spread of infection to health-care workers and other patients. Transmission-Based Precautions Transmission-
based precautions are used for patients with specific communicable diseases that can be transmitted to others.
Transmission-based precautions are an additional layer of protection used in addition to standard precautions.
 55. Prevention of Respiratory Tract Infections Nosocomial pneumonia has been linked with the highest infection
mortality rate in hospitalized patients. Patients who are at highest risk for pneumonia are those with
endotracheal, nasotracheal, or tracheostomy tubes because these invasive tubes bypass the normal defenses of
the upper respiratory tract. Strategies to prevent infections such as ventilator- associated pneumonia (VAP) are
being “bundled” together to get health-care workers to remember to use these strategies. Prevention of
Genitourinary Tract Infections The most common hospital-acquired infection is a urinary tract infection. Patients
with urinary catheters are at the greatest risk. The urinary tract is normally a sterile tract, but insertion of a
catheter into the bladder may allow organisms to enter. Institutional policy on appropriate use of urinary
catheters differs, and you should follow the policy of your particular institution. Appropriate uses of catheters
include use in patients with urinary obstructions, neurogenic bladder conditions, and in those in shock.

43.  56. Indwelling urinary catheters should be removed as soon as possible. For patients requiring long-term use of
urinary catheters, intermittent catheterization is preferred because it has been shown to significantly reduce the
risk of infection. Using strict aseptic technique while inserting and caring for the catheter in the health-care
agency is imperative. The catheter tubing must be securely anchored to the patient’s leg, according to agency
protocol, so it does not move in and out of the urethra. Movement can encourage organisms to enter the urinary
tract. The closed urinary drainage system seal should never be opened. If intermittent irrigation is ordered,
sterile technique must be used to protect both ends from contamination. The drainage bag should be positioned
so that it is never higher than the level of the bladder to prevent backflow of urine into the bladder, which could
contaminate the sterile urinary tract. If an indwelling urinary catheter and drainage system is used long term,
the catheter and the entire system should be changed regularly using sterile technique. Standards in home care
differ from institutional care because patients are generally at lower risk of infection within their own
environment.
 57. All long-term indwelling urinary catheters are considered colonized, but only a few will cause infection in
the patient. Remember that the most crucial point at which bacteria may enter the patient is during the insertion
of the catheter, so excellent technique is required. Another point to remember is that the urinary tract is highly
vascular (many blood vessels close to the surface), so that an infection in this tract can easily result in
bacteremia (bacteria in the blood), which can then progress to septicemia (infection in the blood), a potentially
life- threatening condition. Prevention of Surgical Wound Infections The initial dressing for surgical wounds is
applied in the operating room using sterile aseptic technique. Postoperative orders indicate when to change the
dressing. Sterile technique should be used. The wound is monitored with every dressing change for signs of
infection.
 58. Protection from Septicemia (Sepsis) Septicemia (commonly called blood poisoning) is a blood infection with a
variety of causes, including infection in another body site and contamination of invasive catheters and solutions
(central lines, arterial lines, pulmonary artery catheters, urinary catheters). Insertion and care of these catheters
require sterile technique and careful observation for infection signs. All solutions should be examined for
expiration date, signs of contamination, cloudiness, particles, or discoloration before use. Indications of sepsis
such as fever, tachypnea, tachycardia, hypotension, and elevated white blood cell count should be reported
promptly to the physician for immediate treatment. Blood cultures may be ordered. Antibiotics are used to treat
sepsis. An intravenous (IV) drug, drotrecogin alfa (activated) (Xigris), is available to treat severe sepsis when
death is likely. Drotrecogin alfa (activated) is given for 96 hours. It is associated with a risk of bleeding.
Drotrecogin alfa (activated) has reduced mortality in patients, which may be due to its anti inflammatory effects.

44.  61. Guidelines to Prevent Spread of Infection to the
Patient, Self, and Family • Bathe daily and wear a
clean uniform/clothing every day. • Keep your
fingernails short and do not wear acrylic nails. Both
long nails and acrylic nails have been associated with
spread of infection to patients and they can be
colonized with harmful bacteria. Multiple studies have
demonstrated that long fingernails and artificial nails
harbor bacteria and have caused infections in
patients that sometimes have resulted in death. •
Avoid wearing rings and bracelets that harbor
organisms. • Cleanse your stethoscope at least daily
and in between patient use with alcohol. VRE bacteria
have been cultured from stethoscopes in a hospital
setting.

45.  62. • Wash your hands between each patient
contact. Hand washing is recognized as the
single most important action to take to prevent
spread of infection. If you are unable to use soap
and water, use a nondrying alcohol hand gel,
which has been shown to be effective in
cleansing hands and preventing drying of the
skin. • Follow prescribed isolation precautions
for your protection, as well as that of the patient.
• Remove your uniform and bathe/shower when
you come home from work. This will decrease the
spread of antibiotic-resistant bacteria to your
home and your family. Keep your nursing shoes
clean and put away from the rest of the family.

46.  63. Prevention of infection in healthcare settings "
The Centers for Disease Control and Prevention (CDC)
recommends two tiers in the prevention of infection
within healthcare settings. The first tier includes
universal precautions and other standard
precautions. Both are intended to reduce the risk of
transmission of bloodborne viruses and other
common organisms found within healthcare settings,
and therefore should be utilized at all times. The
second tier is the use of isolation, or transmission-
based precautions, which will be described later.
These are implemented only when more pathogenic
organisms are of concern. (Examples of organisms
and the precautions that should be taken are found in
Appendix 1.)

47. 64. Universal precautions The CDC adopted the
term universal precautions and devised the
recommendations in 1987, largely in response to
the HIV epidemic. The recommendations state that
blood and body fluid precautions should be
implemented consistently for all patients regardless
of their blood borne infection status, as this would
not always be known. All healthcare workers, staff,
patients, and visitors are encouraged to undertake
universal precautions at all times. In addition, these
measures can also help to minimize cross infection
of other organisms. (A list of body fluids to which
universal precautions apply can be found in
Appendix 2.)

48.  65. Precautions Universal precautions measures include the
following: 1. Gloves, which should be well-fitting and available
for use wherever contact with blood or body fluids is anticipated.
Although gloves cannot prevent penetrating injuries from sharp
instruments and equipment, they can reduce the incidence of
hand contamination from blood and body fluids. In addition, any
broken skin on the hands of health staff – for example, cuts –
should be covered, ideally with an effective barrier that is both
waterproof and breathable. Gloves should be changed
immediately if contamination with blood or body fluids occurs,
or if they are no longer intact. They should also be changed
between patients. If gloves are not changed under these
circumstances the risk of exposure to blood borne viruses is
greatly increased, as is the risk of cross infection. Gloves should
ideally be single use and be made of latex or vinyl, depending on
the task (latex substitutes such as nitrile may be used if latex
allergies are of concern). Sterile surgical gloves, which fit more
tightly than ordinary latex gloves, should also be available for
procedures involving sterile areas of the body.

49.  66. Ideally these gloves should not be washed or disinfected as
these can cause deterioration or disintegration, causing holes
which may not be visible. (Disinfecting used gloves in
circumstances where single use is not feasible will be discussed
later under decontamination). 2.Mucous membranes of
healthcare workers (for example, eyes and mouth) should be
protected from blood or body fluid splashes. Glasses, visors or
shields can be used for the eyes and should be available for use,
especially during procedures with increased risk of splashes, for
example, surgical procedures, intravenous line insertions,
irrigation, airway suctioning or bronchoscopy. Masks should also
be worn during any procedures with an increased risk of
splashes. Masks must be changed if they become contaminated
or if they are not intact. Decontamination of reusable visors
should be carried out frequently. 3. Protective clothing (for
example, impermeable plastic aprons or gowns) should be worn
where there is a risk of blood or other body fluids splashing onto
clothing or bare skin.

50.  67. 4. Proper handling of contaminated instruments • Needles, blades,
scalpels, intravenous devices, and other sharp instruments should be
handled with care in order to avoid inoculation injuries or contamination
onto mucous membranes. • Care should be taken during the use,
cleaning and on disposal of sharp instruments. • Needles should never
be recapped with their covers, never be removed from the syringes, and
never be bent or broken by hand. If needles have to be recapped,
recapping should be done using a one handed scoop technique or by
using a mechanical device. • The number of sharp instruments should
be kept to a minimum during procedures, and should always be kept in
sight. • After use, all single use sharps should be placed in puncture
resistant containers such as sharps boxes. These containers should be
marked as sharps boxes, be made of a puncture-proof material, and
have a lid that cannot be removed and which can be sealed tightly.
Containers should be kept close to where sharps are used, ensuring
minimal handling of contaminated objects and safe and quick disposal
of them. Hands should never be put inside a container, nor should any
items in the container be retrieved from it.

51.  68. The containers should be changed whenever they become two thirds
full, or if they become contaminated on the outside, to avoid potential
inoculation injuries or contamination on disposal. • Disposal of all sharp
instruments should be by incineration. The above measures will help to
limit the potential exposures of healthcare workers to blood borne
pathogens. 5. Handling and disposal of linen Linen contaminated with
blood or body fluids should be handled carefully. The use of protective
clothing is advised. Contaminated linen (for example, bed sheets,
pajamas, and towels) is usually described as infected or soiled. Such
linen should be disposed of immediately, normally into a watersoluble
bag, and clearly identified as contaminated. Identification of
contaminated linen can be made by using a bag of an agreed-upon
colour, or labelling the bag clearly. If no bags are available and a non-
disposable bucket is used, the bucket must also be clearly marked and
must be disinfected frequently. Clear identification will inform all other
staff that precautions should be taken when handling the bag or the
linen inside it. If the soiled objects are not to be decontaminated
immediately, the bags should be stored safely where they can be easily
recognized.

52.  69. To decontaminate linen, it should be washed at a high temperature
(at least 70° C), or on a heat disinfection cycle. Water-soluble bags are
useful, as they allow staff to avoid handling the contaminated linen. A
temperature of 70° C will kill most common organisms and will also
facilitate the dilution of the particles in the water. If a temperature of 70°
C is not possible, thorough washing, rinsing and drying, at lower
temperatures (preferably using a disinfectant) should be carried out.
Minimal handling of body fluids or moist body substances while washing
is essential. Disinfectants will be discussed under decontamination. 6.
Proper handling of clinical wastes Clinical waste includes any materials
generated from patient care. This includes waste that could potentially
transmit microorganisms. Such clinical waste can include soiled
dressings, cotton swabs, and catheter bags. Disposal of clinical waste,
including waste contaminated with blood or body fluids, should be
carried out immediately, with the wastes put into clearly marked bags.
Gloves and protective clothing should always be used when handling
clinical waste. If bags are not available and non-disposable buckets are
used, the buckets must be disinfected frequently, as they could be a
source of infectious material. Bags or buckets should have a covering lid,
and should be kept close to where contaminated waste will be
generated.

53. 70. Bags and buckets should never be overfilled and should be closed
securely as soon as they are full. They should be sent for incineration, and
stored until they are out of the healthcare setting. If incineration is not
possible, burial should be in deep holes to avoid animal scavenging or
exposure to the public. 7. Cleaning of spillages of blood and body fluids
Spillages of blood and potentially infected body fluids onto the floor, on
equipment, or other surfaces must be cleaned as soon as they occur, in
order to prevent further unnecessary exposure. It is important for health
staff to wear gloves and other protective clothing during cleanup. Spillage
kits are often available in healthcare settings; if not, the preferred method
for cleaning spillages is disinfection granules (for example, hypochlorite)
sprinkled onto the spillage and left for a few minutes, before being cleaned
up with disposal cloths and disposed of into a clinical waste bag. The area
should then be cleaned. Cleaning and disinfectants will be discussed later. If
no disinfection granules are available, disposable paper towels or rags
should be placed on the spillage to absorb it, to prevent its spreading, and
to make it easier to remove. Again, hands must be gloved when cleaning up
spills of infected waste.