Chapter 4 Principles of Infection Control. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Objectives Define health

Chapter 4 Chapter 4

Principles of Infection ControlPrinciples of Infection Control

2Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

ObjectivesObjectives

Define health careDefine health careassociated infections and state how often associated infections and state how often they occur.they occur.

Describe why infection control is important in respiratory care.Describe why infection control is important in respiratory care.

Identify and describe the three elements that must be present Identify and describe the three elements that must be present for transmission of infection within a health care setting.for transmission of infection within a health care setting.


Objectives (cont.)Objectives (cont.)

List the factors associated with an increased risk of a patient List the factors associated with an increased risk of a patient acquiring a nosocomial infection.acquiring a nosocomial infection.

State the three major routes for transmission of human sources State the three major routes for transmission of human sources of pathogens in the health care environment.of pathogens in the health care environment.

Describe strategies to control the spread of infection in the Describe strategies to control the spread of infection in the hospital.hospital.

Describe how to select and apply chemical disinfectants for Describe how to select and apply chemical disinfectants for processing respiratory care equipment.processing respiratory care equipment.


Objectives (cont.)Objectives (cont.)

Describe equipment handling procedures that help prevent the Describe equipment handling procedures that help prevent the spread of pathogens.spread of pathogens.

State when and to use general barrier measures during patient State when and to use general barrier measures during patient care.care.

Describe surveillance with regard to infection control.Describe surveillance with regard to infection control.


Infection ControlInfection Control

IntroductionIntroduction Hospital-acquired infections (HAIs) account for 2 million Hospital-acquired infections (HAIs) account for 2 million

infections and 90,000 excess deaths annually.infections and 90,000 excess deaths annually.

About 5% of all patients admitted develop an HAI.About 5% of all patients admitted develop an HAI.

About 25% of mechanically ventilated patients develop About 25% of mechanically ventilated patients develop pneumonia, and 30% (of those 25%) will die.pneumonia, and 30% (of those 25%) will die.


Infection Control (cont.)Infection Control (cont.)

Introduction (cont.)Introduction (cont.) Infection control procedures aim toInfection control procedures aim to

Eliminate the sources of infectious agentsEliminate the sources of infectious agents Create barriers to their transmissionCreate barriers to their transmission Monitor the effectiveness of controlMonitor the effectiveness of control

All health care workers must take responsibility and follow All health care workers must take responsibility and follow procedures carefully.procedures carefully.


Spread of InfectionSpread of Infection

Three elements must be present for infection to spread:Three elements must be present for infection to spread: Source of pathogensSource of pathogens Susceptible hostSusceptible host Route of transmissionRoute of transmission


Spread of Infection (cont.)Spread of Infection (cont.)

Sources of Infectious AgentsSources of Infectious Agents Humans are the primary source.Humans are the primary source. Inanimate objects (e.g., contaminated medical equipment) can Inanimate objects (e.g., contaminated medical equipment) can

spread infection.spread infection. Individuals in the hospital capable of being the source include Individuals in the hospital capable of being the source include

workers, visitors, and patients.workers, visitors, and patients.



Susceptible HostsSusceptible Hosts Resistance to infection varies greatly from one person to the Resistance to infection varies greatly from one person to the

next.next.

Host factors that increase the chance of infection areHost factors that increase the chance of infection are Poorly controlled diabetesPoorly controlled diabetes Increased ageIncreased age Chemotherapy Chemotherapy Placement of tubes and cathetersPlacement of tubes and catheters



Nosocomial Infections are those acquired in the hospital.Nosocomial Infections are those acquired in the hospital.

Most nosocomial pneumonias occur in patients having chest or Most nosocomial pneumonias occur in patients having chest or abdominal surgery.abdominal surgery.

Those with a history of COPD, cigarette smoking, or obesity and Those with a history of COPD, cigarette smoking, or obesity and with advanced age have the greatest risk for nosocomial with advanced age have the greatest risk for nosocomial pneumonia following major surgery.pneumonia following major surgery.


Modes of TransmissionModes of Transmission


Transmission RoutesTransmission Routes Contact Transmission –Contact Transmission –

Direct – body susrface to body surface contact. Direct – body susrface to body surface contact. • Touching a pt with your handsTouching a pt with your hands• Changing a dressingChanging a dressing• Any procedure requiring contactAny procedure requiring contact

Indirect Contact – occurs between a host and Indirect Contact – occurs between a host and inanimate object such as:inanimate object such as:• ClothingClothing• DressingsDressings• InstrumentsInstruments• equipmentequipment


Transmission RoutesTransmission Routes

Droplet Transmission – Droplet Transmission – Large contaminated droplets released into the air Large contaminated droplets released into the air

by coughing, sneezing or talkingby coughing, sneezing or talking Can travel 3 feetCan travel 3 feet Influenza and rubella are spread this wayInfluenza and rubella are spread this way



Airborne Transmission –Airborne Transmission – Pathogen can be spread through the air on dust.Pathogen can be spread through the air on dust. Fungal infections are commonly spread this way.Fungal infections are commonly spread this way. Droplet nuclei are very small particles that remain Droplet nuclei are very small particles that remain

suspended for long periods of timesuspended for long periods of time• Example: TB or measlesExample: TB or measles



Vehicle Transmission –Vehicle Transmission – Pathogens are transmitted by food or waterPathogens are transmitted by food or water Examples: Hep A and SalmonellaExamples: Hep A and Salmonella



Vector Borne Transmission –Vector Borne Transmission – Transmission by insectTransmission by insect Examples:Examples:

• West Nile VirusWest Nile Virus

• MalariaMalaria


Spread of Infection to LungsSpread of Infection to Lungs

3 Ways:3 Ways: Aspiration of oral or gastric secretionsAspiration of oral or gastric secretions Inhalation of infected materialsInhalation of infected materials Spread of infection to the lung by the blood Spread of infection to the lung by the blood

(sepsis).(sepsis).


Infection Control StrategiesInfection Control Strategies

1.1. Decreasing host susceptibility Decreasing host susceptibility - Immunizations and chemoprophylaxisImmunizations and chemoprophylaxis

2.2. Eliminating the source of the pathogens Eliminating the source of the pathogens

3.3. Interrupting routes of transmissionInterrupting routes of transmission- Special equipment handlingSpecial equipment handling- Barrier/isolation precautionsBarrier/isolation precautions- Disposable equipmentDisposable equipment


Decrease Host SusceptibilityDecrease Host Susceptibility

Focus on employee immunizationFocus on employee immunization Vaccines include: influenza, hepatitis, diphtheria, Vaccines include: influenza, hepatitis, diphtheria,

tetanus and sometimes TBtetanus and sometimes TB Due to contact with body fluids, employees and Due to contact with body fluids, employees and

students must be vaccinated against Hepatitis.students must be vaccinated against Hepatitis.


Disinfection and SterilizationDisinfection and Sterilization

CleaningCleaning Cleaning is the first step in all equipment processing.Cleaning is the first step in all equipment processing.

It involves removing dirt and organic material.It involves removing dirt and organic material.

Failure to clean equipment properly can render all subsequent Failure to clean equipment properly can render all subsequent processing efforts ineffective.processing efforts ineffective.

Soaps and detergents need to be used.Soaps and detergents need to be used.


Disinfection and Sterilization (cont.)Disinfection and Sterilization (cont.)

DisinfectionDisinfection Disinfection destroys the vegetative form of all pathogens Disinfection destroys the vegetative form of all pathogens

except bacterial spores.except bacterial spores.

Disinfection can involve either chemical or physical methods.Disinfection can involve either chemical or physical methods.

Pasteurization is the most common physical method.Pasteurization is the most common physical method.



Chemical DisinfectionChemical Disinfection Chemical disinfection involves the application of chemical Chemical disinfection involves the application of chemical

solutions to contaminated equipment or surfaces.solutions to contaminated equipment or surfaces.

Equipment must be immersed in the solution for a set period of Equipment must be immersed in the solution for a set period of time.time.




Levels of Chemical DisinfectionLevels of Chemical Disinfection

Low Level Low Level

• 5% acetic acid (vinegar) in a 1:3 solution.5% acetic acid (vinegar) in a 1:3 solution.

• This is often used at home to disinfect equipmentThis is often used at home to disinfect equipment

• Kills most bacteria (including P. aeruginosa) and viruses Kills most bacteria (including P. aeruginosa) and viruses but not resistant bugs or spores.but not resistant bugs or spores.

• Can also use “quats” – cationic detergents that kill Can also use “quats” – cationic detergents that kill everything everything exceptexcept spores and TB. spores and TB.


Levels of Chemical Disinfection Levels of Chemical Disinfection (con’t)(con’t)

Intermediate LevelIntermediate Level Kill all bacteria and fungi but have variable effects Kill all bacteria and fungi but have variable effects

on spores and some viruses.on spores and some viruses. 70% ethyl and 90% isopropyl spray for electrical 70% ethyl and 90% isopropyl spray for electrical

equipment, stethoscopes and skin preps.equipment, stethoscopes and skin preps. Iodopher (Providone or Betadyne) skin prep prior Iodopher (Providone or Betadyne) skin prep prior

to blood draw or IV insertion.to blood draw or IV insertion.


Levels of Chemical Disinfection Levels of Chemical Disinfection (con’t)(con’t)

High LevelHigh Level

Can destroy all microorganisms except spores.Can destroy all microorganisms except spores. Most common is glutaraldehyde.Most common is glutaraldehyde.

• A cold chemical disinfectant that lasts for only 28 daysA cold chemical disinfectant that lasts for only 28 days• Use test strips to confirm strength of solutionUse test strips to confirm strength of solution• Irritation of eyes and hands (always use goggles and gloves)Irritation of eyes and hands (always use goggles and gloves)• Won’t damage equipmentWon’t damage equipment• Soak equipment for 20 minutes, rinse well and aseptically dry.Soak equipment for 20 minutes, rinse well and aseptically dry.

Household Bleach (Sodium Hypochlorite)Household Bleach (Sodium Hypochlorite)• 1:50 dilution for 10 minutes kills 1:50 dilution for 10 minutes kills everythingeverything..• CDC recommends a 1:10 solution for blood spillsCDC recommends a 1:10 solution for blood spills


SterilizationSterilization

The complete destruction of all forms of The complete destruction of all forms of microbial life.microbial life.

• Comparison of Methods (Table 3-4) on p.49Comparison of Methods (Table 3-4) on p.49 Incineration – object of no further useIncineration – object of no further use Dry Heat – 1-2 hours @ 160Dry Heat – 1-2 hours @ 160˙ to 180˙C˙ to 180˙C Boiling – 30 minutes @ 100Boiling – 30 minutes @ 100˙C˙C Autoclave- steam under pressure (Autoclave- steam under pressure (↑P = ↓T)↑P = ↓T) Ionizing Radiation – x-ray and gamma rayIonizing Radiation – x-ray and gamma ray Ethylene Oxide – hazardous but effective gas exposureEthylene Oxide – hazardous but effective gas exposure


SterilizationSterilization

Destroys all microorganismsDestroys all microorganisms

Can be achieved with physical and chemical approachesCan be achieved with physical and chemical approaches

Steam sterilization is most common and easiest.Steam sterilization is most common and easiest.

Low-temperature sterilization technologies include ethylene Low-temperature sterilization technologies include ethylene oxide, a colorless and toxic gas.oxide, a colorless and toxic gas.


Equipment Handling ProceduresEquipment Handling Procedures

NebulizersNebulizers Large-volume nebulizers are often a problem.Large-volume nebulizers are often a problem.

Small-volume nebulizers can also produce bacterial aerosols.Small-volume nebulizers can also produce bacterial aerosols.

Ventilators and CircuitsVentilators and Circuits

Circuits pose the greatest risk for infection.Circuits pose the greatest risk for infection.


Equipment Handling Procedures Equipment Handling Procedures (cont.)(cont.)


Equipment Handling Procedures (cont.)


CleaningCleaning

If you must clean equipment make sure:If you must clean equipment make sure: Clean in a “dirty” room and move to “clean” room Clean in a “dirty” room and move to “clean” room

to dryto dry Wear gloves when disassembling and cleaning Wear gloves when disassembling and cleaning

equipmentequipment If electrical, spray with 70% alcohol spray or If electrical, spray with 70% alcohol spray or

bactericidal solution and wipe with paper towelsbactericidal solution and wipe with paper towels Make sure your equipment properly dries to Make sure your equipment properly dries to

discourage bacterial growthdiscourage bacterial growth


Equipment HandlingEquipment Handling

Disposable EquipmentDisposable Equipment An important alternative to continually reprocessing equipmentAn important alternative to continually reprocessing equipment

Three major issuesThree major issues CostCost QualityQuality Reuse (raises significant safety concerns)Reuse (raises significant safety concerns)


Preventing Transmission of Preventing Transmission of Infectious AgentsInfectious Agents

Standard PrecautionsStandard Precautions――combines the major features of combines the major features of Universal Precautions and Body Substance IsolationUniversal Precautions and Body Substance Isolation

Standard precautions apply toStandard precautions apply to BloodBlood All body fluidsAll body fluids Nonintact skinNonintact skin Mucous membranesMucous membranes


Preventing Transmission of Preventing Transmission of Infectious AgentsInfectious Agents

Respiratory HygieneRespiratory Hygiene1.1. Education of patients and employeesEducation of patients and employees

2.2. Posted signsPosted signs

3.3. Source control measures (covering your mouth)Source control measures (covering your mouth)

4.4. Hand hygieneHand hygiene

5.5. Spatial separation (at least 3 feet of space)Spatial separation (at least 3 feet of space)


Expanded PrecautionsExpanded Precautions

1.1. Contact precautionsContact precautions Proper use of gowns and glovesProper use of gowns and gloves

2.2. Droplet precautions (see Box 4-11)Droplet precautions (see Box 4-11)

3.3. Airborne infection isolationAirborne infection isolation Use of N-95 respirator when in patient roomUse of N-95 respirator when in patient room

4.4. Protective environmentProtective environment Used with allogeneic stem cell transplant patientsUsed with allogeneic stem cell transplant patients


Expanded Precautions (cont.)


Personal Protective EquipmentPersonal Protective Equipment

GlovesGloves――protect both patients and health care workers from protect both patients and health care workers from exposure to pathogensexposure to pathogens

Mouth, nose, eye, and face protectionMouth, nose, eye, and face protection――mucous membranes mucous membranes are vulnerableare vulnerable

NIOSH-approved N-95 respiratorNIOSH-approved N-95 respirator――intended for diseases intended for diseases transmitted by airborne routetransmitted by airborne route

Gowns and apronsGowns and aprons――when contact with blood and body fluids is when contact with blood and body fluids is likelylikely


SurveillanceSurveillance

An ongoing process of monitoring patients and personnel for the An ongoing process of monitoring patients and personnel for the acquisition of infection in the health care settingacquisition of infection in the health care setting

An infection control committee establishes surveillance policies An infection control committee establishes surveillance policies and an infection control expert administers them.and an infection control expert administers them.


Most Important barrier against Most Important barrier against spread of infection….spread of infection….

http://www.youtube.com/watch?v=Rc6QRM9http://www.youtube.com/watch?v=Rc6QRM9F3IYF3IY

Documents

Chapter 4 Principles of Infection Control. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Objectives Define health