Fundamental Fundamental NursingNursing

Chapter 22Chapter 22

Infection ControlInfection ControlInst.: Dr. Ashraf El - JediInst.: Dr. Ashraf El - Jedi

Infectious diseasesInfectious diseases (diseases spread from one (diseases spread from one person to another) are also called or and person to another) are also called or and They were once the leading cause of death, but They were once the leading cause of death, but that is no longer true because of vaccines, that is no longer true because of vaccines, aggressive public health measures, and aggressive public health measures, and advances in drug therapy. Nevertheless, advances in drug therapy. Nevertheless, infectious diseases have not disappeared. infectious diseases have not disappeared.

This chapter discusses precautions that confine This chapter discusses precautions that confine the reservoir of infectious agents and block the reservoir of infectious agents and block their transmission from one host to anothertheir transmission from one host to another. . To To understand the concepts of infection control, it understand the concepts of infection control, it is important to understand the chain of is important to understand the chain of infection infection ((see see Chap. 10Chap. 10) and the course of an ) and the course of an infection.infection.

InfectionInfection

InfectionInfection is a condition that results when is a condition that results when microorganisms cause injury to a host.microorganisms cause injury to a host.

The host can transmit pathogens and The host can transmit pathogens and infectious diseases to othersinfectious diseases to others..

Infections progress through distinct stages Infections progress through distinct stages ((Table 22-1Table 22-1). The characteristics and length of ). The characteristics and length of each stage may differ depending on the each stage may differ depending on the infectious agent. For example, the incubation infectious agent. For example, the incubation period for the common cold is approximately 2 period for the common cold is approximately 2 to 4 days before symptoms appear, but it may to 4 days before symptoms appear, but it may take months or years before a person infected take months or years before a person infected with HIV demonstrates symptoms of AIDS.with HIV demonstrates symptoms of AIDS.

Infection Control PrecautionsInfection Control Precautions

Infection control precautionsInfection control precautions are physical are physical measures designed to curtail the spread of measures designed to curtail the spread of infectious diseases. They are essential when infectious diseases. They are essential when caring for clients. Infection control precautions caring for clients. Infection control precautions require knowledge of the mechanisms by require knowledge of the mechanisms by which an infectious disease is transmitted and which an infectious disease is transmitted and the methods that will interfere with the chain the methods that will interfere with the chain of infection. of infection.

The Centers for Disease Control and The Centers for Disease Control and Prevention (1996, 2005) have established Prevention (1996, 2005) have established guidelines for two major categories of guidelines for two major categories of infection control precautions: standard infection control precautions: standard precautions and transmission-based precautions and transmission-based precautions.precautions.

Standard PrecautionsStandard Precautions

Standard precautionsStandard precautions are measures for are measures for reducing the risk for microorganism reducing the risk for microorganism transmission from both recognized and transmission from both recognized and unrecognized sources of infection. Health care unrecognized sources of infection. Health care personnel follow standard precautions when personnel follow standard precautions when caring for all clients, regardless of diagnosis or caring for all clients, regardless of diagnosis or infection status (infection status (Box 22-2Box 22-2). ).

This precautionary system combines methods This precautionary system combines methods previously known as previously known as universal precautions.universal precautions.

Health care personnel follow standard Health care personnel follow standard precautions whenever there is the potential for precautions whenever there is the potential for contact with the followingcontact with the following:: BloodBlood All body fluids except sweat, regardless of whether All body fluids except sweat, regardless of whether

or not they contain visible bloodor not they contain visible blood Nonintact skinNonintact skin Mucous membranesMucous membranes

Box 22-2 • Standard PrecautionsBox 22-2 • Standard Precautions HandwashingHandwashing Wash hands after touching blood, body Wash hands after touching blood, body

fluids, secretions, excretions, and fluids, secretions, excretions, and contaminated items, whether or not gloves contaminated items, whether or not gloves are worn.are worn.

Wash hands immediately after gloves are Wash hands immediately after gloves are removed, between patient contacts, and removed, between patient contacts, and when otherwise indicated; wash between when otherwise indicated; wash between tasks and procedures on the same patient tasks and procedures on the same patient to prevent cross-contamination of different to prevent cross-contamination of different body sites.body sites.

Use plain (non-antimicrobial) soap for Use plain (non-antimicrobial) soap for routine handwashing.routine handwashing.

Use an antimicrobial agent or a waterless Use an antimicrobial agent or a waterless antiseptic agent to control outbreaks or antiseptic agent to control outbreaks or hyperendemic infectionshyperendemic infections (highly (highly infectious in all age groups)infectious in all age groups)

GlovesGloves Wear clean, nonsterile gloves when Wear clean, nonsterile gloves when

touching blood, body fluids, secretions, touching blood, body fluids, secretions, excretions, and contaminated items.excretions, and contaminated items.

Change gloves between tasks on the same Change gloves between tasks on the same patient after contact with material that may patient after contact with material that may contain a high concentration of contain a high concentration of microorganisms.microorganisms.

Remove gloves and wash hands Remove gloves and wash hands immediately before caring for another immediately before caring for another patient.patient.

Mask, Eye Protection, Face ShieldMask, Eye Protection, Face Shield Wear a mask and eye protection, or Wear a mask and eye protection, or

face shield to protect the eyes, nose, face shield to protect the eyes, nose, and mouth when there is a likelihood and mouth when there is a likelihood that splashes or sprays of blood, body that splashes or sprays of blood, body fluids, secretions, or excretions will fluids, secretions, or excretions will occur.occur.

GownGown Wear a clean, nonsterile gown when Wear a clean, nonsterile gown when

there is a likelihood that splashes or there is a likelihood that splashes or sprays of blood, body fluids, sprays of blood, body fluids, secretions, or excretions will occur.secretions, or excretions will occur.

Remove a soiled gown promptly and Remove a soiled gown promptly and wash hands.wash hands.

Patient-Care EquipmentPatient-Care Equipment Handle equipment soiled with blood, Handle equipment soiled with blood,

body fluids, secretions, and excretions body fluids, secretions, and excretions so as to prevent the transfer of so as to prevent the transfer of microorganisms to oneself, others, or microorganisms to oneself, others, or the environment.the environment.

Ensure that soiled reusable equipment Ensure that soiled reusable equipment is cleaned before another subsequent is cleaned before another subsequent use.use.

Discard soiled single-use equipment Discard soiled single-use equipment properly.properly.

Environmental ControlEnvironmental Control Ensure that procedures for routine Ensure that procedures for routine

cleaning and disinfection of cleaning and disinfection of environmental surfaces, beds, environmental surfaces, beds, bedrails, bedside equipment, and bedrails, bedside equipment, and other frequently touched surfaces are other frequently touched surfaces are carried out.carried out.

LinenLinen Handle, transport, and process soiled Handle, transport, and process soiled

linen in such a way as to prevent linen in such a way as to prevent exposure to oneself, others, and the exposure to oneself, others, and the environment.environment.

Occupational Health and Blood-Occupational Health and Blood-borne Pathogensborne Pathogens

Prevent injuries when using needles, Prevent injuries when using needles, scalpels, and other sharp devicesscalpels, and other sharp devices Never recap used needlesNever recap used needles Use either a one-handed “scoop” Use either a one-handed “scoop”

method or mechanical device for method or mechanical device for covering a needle.covering a needle.

Place all disposable sharp items in a Place all disposable sharp items in a puncture-resistant container as close puncture-resistant container as close to the location of use as possible; to the location of use as possible; transport reusable syringes and transport reusable syringes and needles in a puncture-resistant needles in a puncture-resistant container for reprocessing.container for reprocessing.

Use mouthpieces, Use mouthpieces, resuscitation bags, or other resuscitation bags, or other ventilation devices as an ventilation devices as an alternative to mouth-to-mouth alternative to mouth-to-mouth resuscitation methods in areas resuscitation methods in areas where the need for where the need for resuscitation is predictable.resuscitation is predictable.

Patient PlacementPatient Placement Place a patient who Place a patient who

contaminates the contaminates the environment, who does not—environment, who does not—or cannot be expected to—or cannot be expected to—assist in maintaining assist in maintaining appropriate hygiene or appropriate hygiene or environmental control in a environmental control in a private room.private room.

Consult with an infection Consult with an infection control professional control professional concerning alternatives if a concerning alternatives if a private room is not available.private room is not available.

TransmissionTransmission--Based Based PrecautionsPrecautions

Transmission-based precautionsTransmission-based precautions are are measures for controlling the spread of measures for controlling the spread of infectious agents from clients known to be or infectious agents from clients known to be or suspected of being infected with highly suspected of being infected with highly transmissible or epidemiologically important transmissible or epidemiologically important pathogens. They are also called The three pathogens. They are also called The three types of transmission-based precautions are types of transmission-based precautions are airborne precautions, droplet precautions, and airborne precautions, droplet precautions, and contact precautions (contact precautions (Table 22-2Table 22-2). ).

These three types replace the earlier categories These three types replace the earlier categories of strict isolation, contact isolation, respiratory of strict isolation, contact isolation, respiratory isolation, tuberculosisisolation, tuberculosis isolation, enteric isolation, enteric precautions, and drainageprecautions, and drainage//secretion secretion precautions. precautions.

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Airborne PrecautionsAirborne Precautions

Airborne precautionsAirborne precautions are measures that are measures that reduce the risk for transmitting airborne reduce the risk for transmitting airborne infectious agents. They block pathogens 5 infectious agents. They block pathogens 5 microns or smaller that are present in the microns or smaller that are present in the residue of evaporated droplets that remain residue of evaporated droplets that remain suspended in the air, as well as those attached suspended in the air, as well as those attached to dust particles.to dust particles.

Tuberculosis (TB) is an example of a disease Tuberculosis (TB) is an example of a disease transmitted in the air.transmitted in the air.

Droplet PrecautionsDroplet Precautions

Droplet precautionsDroplet precautions are measures that block are measures that block pathogens within moist droplets larger than 5 pathogens within moist droplets larger than 5 microns. They are used to reduce pathogen microns. They are used to reduce pathogen transmission from close contact (usually 3 feet transmission from close contact (usually 3 feet or less) between an infected person or a person or less) between an infected person or a person who is a carrier of a droplet-spread who is a carrier of a droplet-spread microorganism and others. microorganism and others.

Microorganisms carried on droplets commonly Microorganisms carried on droplets commonly exit the body during coughing, sneezing, exit the body during coughing, sneezing, talking, and procedures such as airway talking, and procedures such as airway suctioning (see Chap. 36) and bronchoscopy. suctioning (see Chap. 36) and bronchoscopy. Airborne precautions are not used because Airborne precautions are not used because droplets do not remain suspended in the air.droplets do not remain suspended in the air.

Contact PrecautionsContact Precautions

Contact precautionsContact precautions are measures used to are measures used to block the transmission of pathogens by direct block the transmission of pathogens by direct or indirect contact. This is the final category of or indirect contact. This is the final category of transmission-based precautions. Direct contact transmission-based precautions. Direct contact involves skin-to-skin contact with an infected involves skin-to-skin contact with an infected or colonized person. or colonized person.

Indirect contact occurs by touching a Indirect contact occurs by touching a contaminated intermediate object in the client's contaminated intermediate object in the client's environment. Additional precautions are environment. Additional precautions are necessary if the microorganism is antibiotic necessary if the microorganism is antibiotic resistantresistant

Infection Control MeasuresInfection Control Measures

Infection control measures involve the use of Infection control measures involve the use of personal protective equipmentpersonal protective equipment (garments (garments that block the transfer of pathogens from one that block the transfer of pathogens from one person, place, or object to oneself or others) person, place, or object to oneself or others) and techniques that serve as barriers to and techniques that serve as barriers to transmission (transmission (Fig. 22-3Fig. 22-3). ).

Locating a client and equipping a room so as Locating a client and equipping a room so as to confine pathogens to one areato confine pathogens to one area

Using personal protective equipment such as Using personal protective equipment such as cover gowns, face shields or goggles, cloth or cover gowns, face shields or goggles, cloth or paper masks or respirators (see Chap. 10), and paper masks or respirators (see Chap. 10), and gloves to prevent spreading microorganisms gloves to prevent spreading microorganisms through direct and indirect contactthrough direct and indirect contact

Depending on the type of precautions Depending on the type of precautions used, nurses implement all or some of used, nurses implement all or some of the following measuresthe following measures::

Disposing of contaminated linen, equipment, Disposing of contaminated linen, equipment, and supplies in such a way that nurses do not and supplies in such a way that nurses do not transfer pathogens to otherstransfer pathogens to others

Using infection control measures to prevent Using infection control measures to prevent pathogens from spreading when transporting pathogens from spreading when transporting laboratory specimens or clientslaboratory specimens or clients

11 . .Client EnvironmentClient Environment

The client environment includes the room The client environment includes the room designated for the care of a client with an designated for the care of a client with an infectious disease and the equipment and infectious disease and the equipment and supplies essential to controlling transmission supplies essential to controlling transmission of the pathogensof the pathogens

Infection Control RoomInfection Control Room Most health care agencies assign infectious or Most health care agencies assign infectious or

potentially infectious clients to private rooms. potentially infectious clients to private rooms.

They keep the door to the room closed to control air They keep the door to the room closed to control air currents and the circulation of dust particles.currents and the circulation of dust particles.

The room has a private bathroom so that personnel The room has a private bathroom so that personnel can flush contaminated liquids and biodegradable can flush contaminated liquids and biodegradable solids. A sink is also located in the room for solids. A sink is also located in the room for handwashing.handwashing.

Staff members post an instruction card stating Staff members post an instruction card stating that isolation precautions are required on the that isolation precautions are required on the door or nearby at eye level (Fig. 22-4). door or nearby at eye level (Fig. 22-4).

Nurses are responsible for teaching visitors Nurses are responsible for teaching visitors how to comply with the infection control how to comply with the infection control measures.measures.

Equipment and SuppliesEquipment and Supplies

The infection control room contains the same The infection control room contains the same equipment and supplies as any other hospital equipment and supplies as any other hospital room, with a few modifications. Equipment room, with a few modifications. Equipment that personnel would ordinarily use for several that personnel would ordinarily use for several noninfected clients, such as a stethoscope and noninfected clients, such as a stethoscope and sphygmomanometer, remains in the client's sphygmomanometer, remains in the client's room whenever possible. This prevents the room whenever possible. This prevents the need to clean and disinfect the items each time need to clean and disinfect the items each time they are removed.they are removed.

For the same reason, disposable thermometers For the same reason, disposable thermometers are preferred. Personnel disinfect electronic or are preferred. Personnel disinfect electronic or tympanic thermometers to make them safe for tympanic thermometers to make them safe for the next client. the next client.

Items such as a container for soiled laundry Items such as a container for soiled laundry (Fig. 22-5), lined waste containers, and liquid (Fig. 22-5), lined waste containers, and liquid soap dispensers are also placed in the roomsoap dispensers are also placed in the room

22 . .Personal Protective Personal Protective EquipmentEquipment . .

Infection control measures involve the use of Infection control measures involve the use of one or more items for personal protection. one or more items for personal protection. Personal protective equipment, also called Personal protective equipment, also called barrier garments (Fig. 22-6), includes gowns, barrier garments (Fig. 22-6), includes gowns, masks, respirators, goggles or face shields, and masks, respirators, goggles or face shields, and gloves (see Chap. 10). gloves (see Chap. 10).

These items are located just outside the client's These items are located just outside the client's room or in an anteroom (Fig. 22-7).room or in an anteroom (Fig. 22-7).

Removing Personal Protective Removing Personal Protective

EquipmentEquipment The procedure involves making contact The procedure involves making contact

between two contaminated surfaces or two between two contaminated surfaces or two clean surfacesclean surfaces. . Nurses remove the garments Nurses remove the garments that are most contaminated first, preserving the that are most contaminated first, preserving the clean uniform underneath (Figure 22-8) clean uniform underneath (Figure 22-8)

Disposing of Contaminated Linen, Disposing of Contaminated Linen, Equipment, and SuppliesEquipment, and Supplies

DoubleDouble--baggingbagging is an infection control is an infection control measure in which one bag of measure in which one bag of contaminated items, such as trash or contaminated items, such as trash or

laundry, is placed within anotherlaundry, is placed within another. .

Removing Reusable ItemsRemoving Reusable Items

They are cleaned with an antimicrobial They are cleaned with an antimicrobial disinfectant, bagged, and sterilized using heat disinfectant, bagged, and sterilized using heat or chemicals or chemicals ((see Chap. 10). see Chap. 10).

Transporting ClientsTransporting Clients

During transport, nurses use methods to During transport, nurses use methods to prevent the spread of pathogens either directly prevent the spread of pathogens either directly or indirectly from the clientor indirectly from the client..

The client wears a mask or particulate air filter The client wears a mask or particulate air filter respirator if the pathogen is transmitted by the respirator if the pathogen is transmitted by the airborne or droplet routeairborne or droplet route. . Any hospital Any hospital personnel having direct contact with the client personnel having direct contact with the client use personal protective equipment similar to use personal protective equipment similar to that used in client carethat used in client care..

Psychological ImplicationsPsychological Implications

Although infection control measures are Although infection control measures are necessary, they often leave clients feeling necessary, they often leave clients feeling shunned or abandoned. Clients with infectious shunned or abandoned. Clients with infectious diseases continue to need human contact and diseases continue to need human contact and interaction.interaction.

Promoting Social InteractionPromoting Social Interaction

Nurses encourage visitors to come as often as Nurses encourage visitors to come as often as the agency's policies and the client's condition the agency's policies and the client's condition permitpermit. . They use every opportunity to They use every opportunity to emphasize that as long as visitors follow the emphasize that as long as visitors follow the infection control precautions, they are not infection control precautions, they are not likely to acquire the diseaselikely to acquire the disease..

Combating Sensory Combating Sensory DeprivationDeprivation

Sensory deprivation results when a person Sensory deprivation results when a person experiences insufficient sensory stimulation or experiences insufficient sensory stimulation or is exposed to sensory stimulation that is is exposed to sensory stimulation that is continuous and monotonous. continuous and monotonous.

Nursing ImplicationsNursing Implications Risk for InfectionRisk for Infection Ineffective ProtectionIneffective Protection Risk for Infection Transmission Risk for Infection Transmission Impaired Social InteractionImpaired Social Interaction Social IsolationSocial Isolation Risk for LonelinessRisk for Loneliness Deficient Diversional ActivityDeficient Diversional Activity PowerlessnessPowerlessness FearFear