Chapter 15 Preventing Infection Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved

Chapter 15Chapter 15

Preventing InfectionPreventing Infection

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

InfectionInfection

Infection is a major safety and health hazard.Infection is a major safety and health hazard. The health team follows certain practices The health team follows certain practices

and procedures to prevent the spread of and procedures to prevent the spread of infection.infection.

Infection control—the practices and procedures that Infection control—the practices and procedures that protect patients, residents, visitors, and staff from protect patients, residents, visitors, and staff from infectioninfection

Infection- a disease state resulting from the invasion Infection- a disease state resulting from the invasion and growth or microbes in the bodyand growth or microbes in the body

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 2

MicroorganismsMicroorganisms

A microorganism (microbe) is a small living A microorganism (microbe) is a small living thing seen only with a microscope.thing seen only with a microscope.

Microbes are everywhere.Microbes are everywhere.


PathogensPathogens

Some microbes are harmful and can cause Some microbes are harmful and can cause infections.infections.

They are called They are called pathogenspathogens.. Non-pathogens are microbes that do not Non-pathogens are microbes that do not

usually cause an infection.usually cause an infection.


What microbes need:What microbes need:


Pathogens (harmful Microbes)Pathogens (harmful Microbes)

BacteriaBacteria germsgerms

FungiFungi Mushrooms, yeastsMushrooms, yeasts Mouth,Feet, VaginaMouth,Feet, Vagina

Protozoa Protozoa Blood, brainBlood, brain


Pathogens (cont)Pathogens (cont)

RickettsiaeRickettsiae Fleas, ticksFleas, ticks Rocky mountain spotted feverRocky mountain spotted fever

VirusesViruses Colds, AIDS, herpes Colds, AIDS, herpes


Normal FloraNormal Flora

Microbes that live and grow in a certain area-Microbes that live and grow in a certain area-think “it is normal for them to grow there”think “it is normal for them to grow there” Example is e-coli that normally lives in the colon. It Example is e-coli that normally lives in the colon. It

can cause infection if it enters the urinary track or can cause infection if it enters the urinary track or is ingested. is ingested.


Multi-drug resistant organisms Multi-drug resistant organisms (MDROs)(MDROs)

MDROs are caused by:MDROs are caused by: Prescribing antibiotics when they are not needed (over-Prescribing antibiotics when they are not needed (over-

prescribing)- giving them for viruses!prescribing)- giving them for viruses! Not taking antibiotics for the length of time prescribedNot taking antibiotics for the length of time prescribed

Two common types of MDROs are resistant to Two common types of MDROs are resistant to many antibiotics.many antibiotics.

Methicillin-resistant Methicillin-resistant Staphylococcus aureusStaphylococcus aureus (MRSA) (MRSA) Vancomycin-resistant Vancomycin-resistant EnterococciEnterococci (VRE (VRE))


Systemic vs Local InfectionSystemic vs Local Infection

A local infection is in a body part.A local infection is in a body part. A systemic infection involves the whole A systemic infection involves the whole

body.body. The chain of infection is a process that involves a:The chain of infection is a process that involves a: Source—a pathogenSource—a pathogen Reservoir—where a pathogen can grow and multiplyReservoir—where a pathogen can grow and multiply Portal of exit—allows pathogen to leave the reservoirPortal of exit—allows pathogen to leave the reservoir Method of transmission—a vehicle transmits microbesMethod of transmission—a vehicle transmits microbes Portal of entry—where the pathogen enters the bodyPortal of entry—where the pathogen enters the body Susceptible host—needed for the microbe to grow and Susceptible host—needed for the microbe to grow and

multiplymultiply


Chain of InfectionChain of Infection


=source

Malaria Chain of InfectionMalaria Chain of Infection


source

reservoirPortal of exit=bite

MOT=

Susceptiblehost

Portal of entry=bite

Carrier, Vector, VehicleCarrier, Vector, Vehicle

Carrier-transmits the disease but does not Carrier-transmits the disease but does not show symptoms show symptoms Human with HIV but not AIDSHuman with HIV but not AIDS

Vector-a carrier that transmits disease will not Vector-a carrier that transmits disease will not have traces of the disease in immune systemhave traces of the disease in immune system Mosquitoes-malariaMosquitoes-malaria

Vehicle- any substance that transmits Vehicle- any substance that transmits microbesmicrobes Think blood tinted with malariaThink blood tinted with malaria


Susceptible hosts-young, elderly, sick, poor health care Susceptible hosts-young, elderly, sick, poor health care and burn, chemo, transplant patientsand burn, chemo, transplant patients


HAI-think “hospital caused it”HAI-think “hospital caused it”

Healthcare-associated infection (HAI)Healthcare-associated infection (HAI) An HAI is an infection that develops in a person An HAI is an infection that develops in a person

cared for in any setting where health care is given.cared for in any setting where health care is given. HAIs also are called HAIs also are called nosocomial infectionsnosocomial infections.. HAIs are caused by:HAIs are caused by:

• Normal floraNormal flora

• Microbes transmitted to the person from other sourcesMicrobes transmitted to the person from other sources


Definitions:Definitions:

Asepsis-being free from disease Asepsis-being free from disease producing microbes (can be medical or producing microbes (can be medical or surgical)surgical)

Sterile- means the absence of all Sterile- means the absence of all microbes.microbes.

Pathogens and non-pathogensPathogens and non-pathogens Contamination- is the process of Contamination- is the process of

becoming unclean.becoming unclean.


Infection PreventionInfection Prevention

How infections are prevented:How infections are prevented:AsepsisAsepsis

• Medical asepsis (clean technique)-Medical asepsis (clean technique)-reduces numbers-think hand reduces numbers-think hand hygiene, cleaning equipment, hygiene, cleaning equipment, disinfection (does not kill spores-disinfection (does not kill spores-bacteria protected by hard shell)bacteria protected by hard shell)

• Surgical asepsis (sterile Surgical asepsis (sterile technique)- technique)- keeps items free of all keeps items free of all microbes.microbes.


Medical Asepsis Medical Asepsis

Rules of thumb for patient care:Rules of thumb for patient care:

Supplies and equipmentSupplies and equipmentMost health care supplies and equipment are Most health care supplies and equipment are disposable.disposable.Discard single-use items after use.Discard single-use items after use.A person uses multi-use items many times-there own A person uses multi-use items many times-there own toothbrush or hairbrush.toothbrush or hairbrush.Do not “borrow” them for another person.Do not “borrow” them for another person.Non-disposable hospital items are cleaned, Non-disposable hospital items are cleaned, disinfected, and then sterilized.disinfected, and then sterilized.


Surgical AsepsisSurgical Asepsis

Surgical asepsis (sterile technique) is Surgical asepsis (sterile technique) is required any time the skin or sterile tissues required any time the skin or sterile tissues are entered.are entered. If a break occurs in sterile technique, microbes If a break occurs in sterile technique, microbes

can enter the body.can enter the body.• Infection is a risk.Infection is a risk.

• Requires a sterile field and sterile equipmentRequires a sterile field and sterile equipment

Foley catheters, IV starts etc. Foley catheters, IV starts etc.


GlovesGloves Wear gloves whenever contact with blood, body fluids,

secretions, excretions, mucous membranes, or non-intact skin is likely.

GownsGowns Protect your clothes and body from contact with blood,

body fluids, secretions, and excretions. Protect against splashes and sprays. Must completely cover you from your neck to your knees Are used once Are considered contaminated when wet Are disposable and are discarded after use


Barrier Methods (PPE)Barrier Methods (PPE)

Standard Precautions-done for Standard Precautions-done for every patient, every time!every patient, every time!

Standard PrecautionsStandard Precautions Reduce the risk of spreading known and unknown Reduce the risk of spreading known and unknown

infections infections Are used for all persons whenever care is givenAre used for all persons whenever care is given Prevent the spread of infection from:Prevent the spread of infection from:

• BloodBlood

• All body fluids, secretions, and excretions (except All body fluids, secretions, and excretions (except sweat) even if blood is not visiblesweat) even if blood is not visible

• Non-intact skin (skin with open breaks)Non-intact skin (skin with open breaks)

• Mucous membranesMucous membranes


Transmission based precautions-Transmission based precautions-Isolation PrecautionsIsolation Precautions

Isolation precautions are based on clean and Isolation precautions are based on clean and dirty.dirty.

Clean areas or objects are free of pathogens.Clean areas or objects are free of pathogens. Dirty areas or objects are contaminated with pathogens.Dirty areas or objects are contaminated with pathogens. Clean and dirty also depend on how the pathogen is Clean and dirty also depend on how the pathogen is

spread (may need gown and mask if respiratory)spread (may need gown and mask if respiratory) Patients in isolation are kept in separate double rooms Patients in isolation are kept in separate double rooms

with their own ventilation areas. with their own ventilation areas.


Bloodborne Pathogen StandardBloodborne Pathogen Standard

The Bloodborne Pathogen Standard (OSHA) is The Bloodborne Pathogen Standard (OSHA) is intended to protect the health team from intended to protect the health team from exposure.exposure. HIV and HBV: Are found in the bloodHIV and HBV: Are found in the blood

• Are bloodborne pathogensAre bloodborne pathogens

• Exit the body through bloodExit the body through blood

• Are spread to others by bloodAre spread to others by blood

Requires exposure control plan-Reason for your Hep Requires exposure control plan-Reason for your Hep B vaccineB vaccine

Blood contaminated items are placed in red Blood contaminated items are placed in red biohazard bags and cleaned up with spill kitsbiohazard bags and cleaned up with spill kits


Preventive measures to reduce the risk of Preventive measures to reduce the risk of exposure include:exposure include: Hepatitis B vaccinationHepatitis B vaccination Training for employeesTraining for employees Engineering and work practice controlsEngineering and work practice controls

• These reduce employee exposure in the workplace.These reduce employee exposure in the workplace.

Personal protective equipment (PPE)Personal protective equipment (PPE)• PPE protects your clothes, undergarments, skin, eyes, PPE protects your clothes, undergarments, skin, eyes,

mouth, and hair.mouth, and hair.


Bloodborne Pathogen Standard (cont’d)Bloodborne Pathogen Standard (cont’d)

Exposure incidentsExposure incidents An exposure incident is any eye, mouth, other An exposure incident is any eye, mouth, other

mucous membrane, non-intact skin, or parenteral mucous membrane, non-intact skin, or parenteral contact with blood or OPIM.contact with blood or OPIM.• Parenteral means piercing the mucous membranes or Parenteral means piercing the mucous membranes or

the skin.the skin.

Report exposure incidents at once.Report exposure incidents at once. Confidentiality is important.Confidentiality is important. The source individual is the person whose blood The source individual is the person whose blood

or body fluids are the source of an exposure or body fluids are the source of an exposure incident.incident.


Bloodborne Pathogen Standard Bloodborne Pathogen Standard

Practice State QuestionsPractice State Questions

What is the most important way to prevent the What is the most important way to prevent the spread of infection?spread of infection? Handwashing, handwashing, handwashingHandwashing, handwashing, handwashing

What is the most important part of effective What is the most important part of effective handwashing?handwashing? Friction! For at least 20 seconds!Friction! For at least 20 seconds!


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Chapter 15 Preventing Infection Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved