Infection ControlSec. 1, Unit 5

Part 1

Introduction● Infections are a significant cause of illness, disease and death for residents that

reside in certain living situations including nursing facilities.● Residents of long-term care facilities are particularly at risk for infection due to

the increased severity of illness experienced by residents being cared for in the facilities.

● The resident is more at risk because of multiple underlying diseases, medications that reduce resistance to microorganisms, and use of medical devices such as urinary catheters to treat symptoms.

● Infection control is one of the most important aspects of providing a safe environment for residents.

● Nurse aides must understand and follow the facility’s infection control policies and procedures

Introduction● Microorganisms, or germs, occur nearly everywhere in nature.

○ air○ skin○ bodies○ food○ water○ any surface we touch

● occur most abundantly where they find food, warmth, moisture, darkness, and either oxygen (aerobic) or without oxygen (anaerobic)

● our bodies are natural sites (reservoirs) for microorganisms

Pathogen● Microorganisms, only seen with a microscope, that cause illness=pathogens

○ most do not cause illness or disease, keep bodies in balance○ Non-disease causing pathogens=nonpathogens

■ ex. normal bacteria (flora) in our intestines, lungs, on our skin

● Pathogens, in normal state, are nonpathogenic○ when out of their “normal location” is when they become a pathogen

■ ex. e-coli is good in intestines and therefore is a non-pathogen, but when it enters the urinary tract, it becomes a pathogen because it causes a UTI

■ when not in their “normal site” they destroy human tissue by using it for food and may also give off waste products, called toxins, that are absorbed in the body and poison it

Microorganisms● Have certain requirements to survive

○ Oxygen (aerobic)○ No oxygen (anaerobic)○ Warm temperature○ Moist environment○ Darkness for growth○ Food – dead tissue or live tissue

Infections● a disease in the body resulting from the invasion and growth of these pathogens● infection is a major safety and health hazard in the healthcare setting● constant battle in healthcare settings is preventing the spread of infection

Types of Infections● 2 Broad categories of infections:

○ local=limited to a specific area of the body■ symptoms appear at the site of infection

○ systemic=cause general symptoms such as fever, chills, vomiting, diarrhea, or mental confusion

The Body’s Defenses Against Infections● Beneficial in maintaining balance in our bodies and in our environment● Microorganisms may cause illness, infection and disease● External defenses to prevent illness, infection and disease

○ Intact (unbroken) Skin as a barrier ○ Intact mucous membranes○ Cilia (hair-like projections that trap foreign particles in some mucous membranes)○ Coughing/Sneezing to remove foreign particles○ Acid in the stomach that destroys some microorganisms○ Tears wash away foreign particles from the eye

● Internal Defenses○ Inflammation-red, hot, painful, local infection (walls off the spread of disease)○ Fever-makes the environment too hot for pathogen to survive○ Natural Immune Response, body making white blood cells to fight infection

Susceptibility to Infections● Elderly are at higher risk for infections, partly due to a weakened immune

system as a result of aging● Weakened immune systems can also occur from:

○ chronic illness○ decreased circulation○ slow wound healing○ malnutrition○ limited mobility○ medications that reduce resistance to microorganisms○ medical devices such as urinary catheters

● Immunity is the natural protection against a certain disease

Causes of Infection

● Primary cause of infection in healthcare setting is transmission of pathogen from its natural reservoir to an unsuspecting patient or resident

● Nosocomial infections are those that were acquired in a hospital (HAI)● Harmful microorganisms are all around us● The job of every member of the healthcare team is to understand that there is a

predictable chain of events that can cause an infection and the chain MUST be successfully broken in order to keep pathogens from growing and spreading.

Chain of Infection1. Pathogen (causative agent)

a. Bacteria b. Virusesc. Fungid. Protozoa

2. Must have a RESERVOIR for the pathogen to grow and multiplya. Humans with disease

i. symptomaticii. asymptomatic

b. animals/insectsc. food/waterd. environmente. inanimate objects such as clothing, bedding mops, resident care devices (called fomites)

3. Must have a point of entry

a. breaks in the skinb. mucous membranes that are not intactc. respiratory systemd. urinary systeme. reproductive system

4. Must have a point of exit

f. saliva/other respiratory secretionsg. urineh. fecesi. drainage from woundsj. reproductive secretionsk. bloodl. tears (minor risk)

5. Must have a mode of transmission (“How could this pathogen be transported from the portal of exit and become infectious to someone else?”)

a. contact=touchingi. direct-person to personii. indirect- inanimate contaminated objects to person

b. airbornei. inhaling small pathogens that float in the air

c. bloodbornei. microorganisms that are present in human blood and can cause disease

d. dropleti. drops of secretions put into the air through sneezing, coughing or talking

e. food and fluidsf. vectors

i. mosquitoes, parasites

6. Must have a host individual to harbor the infectious pathogen-very young and very old most susceptible

Approaches to Prevent & Control Infections● Medical Asepsis (clean technique)● Different methods to kill/control pathogens● Different types of equipment

○ disposable vs reusable

● Standard precautions● Transmission Based precautions

Medical Asepsis● Practices used to remove or destroy pathogens to prevent spread of infection

from one person/place or object to another person/place or object● Asepsis means being free of pathogens

○ sterile means the absence of ALL microbes, not just the pathogen ones

● Referred to as the “clean to dirty” technique● used to remove or destroy pathogens to prevent the spread of infection from one

person/place or object to another● aseptic practices break the chain of infection thereby preventing the spread of

infections

Practices to Promote Medical Asepsis● proper hand washing etiquette

○ staff and residents

● proper use of hand sanitizer● proper use of gloves● Following CDC recommendations for Respiratory Hygiene/ Cough Etiquette

○ covering your nose and mouth when sneezing or coughing

● cleaning and storing sed equipment properly● using proper precautions when exposed to potentially infectious materials

***The purpose of cleaning is to reduce the number of microbes present.

Practices to Promote Medical Asepsis● Keep work surfaces clean● Keep equipment/ supplies, linen from touching clothing, never shaking linen

cleaning from CLEANEST to MOST SOILED AREA, cleaning AWAY from you, pouring contaminated liquids into approparaite palces, cleaning multiuse equipment between EACH resident.

***Handwashing is the single most important practice to prevent the spread of infection.

Handwashing● Wash hands with soap and water according to CDC guidelines● Situations that require hand washing:

○ anytime hands are visibly soiled ○ after personal use of the toilet○ before & after caring for a resident’s personal care, assisting to toilet, feeding, and procedures○ before & after eating or handling food○ after coming in contact with a resident’s skin, mucous membranes or body fluid○ after contact with any infections materials○ after removing gloves○ after blowing or wiping nose or covering mouth while coughing○ after handling soiled materials○ after handling used linens, bedpans or urinals

CDC Respiratory Hygiene/Coughing Etiquette● Combination of measures designed to minimize transmission of pathogens via

droplet/airborne routes● cover mouth & nose during coughing & sneezing● use tissues to contain any respiratory secretions/promptly dispose of tissue● Wear a mask when coughing to decrease environmental contamination (follow

facility policy)● Turn head away from others when coughing, try to maintain a distance of 3

feet from others

Methods to Kill/Control Pathogens● disinfection

○ use of chemical disinfectants to clean equipment

● Sterilizations○ process of killing all microorganisms

Caring for Supplies/Equipment● Disposable equipment

○ use once and discard in appropriate container■ ex. needles, wipes

● Non-disposable equipment ○ follow facility policy○ disinfectants○ soap and hot water○ disposable wipes, cloths

Other Measures of Asepsis● Keep equipment and supplies, lines, etc. from touching clothing● never shake linen, used or unused.● always clean form cleanest area to the soiled area● when cleaning, clean away fro you to prevent contamination of clothing● pour contaminated liquids into appropriate places, designated hoppers, toilets

(follow facility policy)● Clean equipment used on multiple residents BETWEEN each resident (follow

facility policy)

Standard Precautions● EVERYONE is potentially infected or colonized with an organis● CDC developed strategy known as Standard Precautions to prevent the

transmission of unknown infections among patients and healthcare personnel● Treat ALL blood, body fluids, non-intact skin, and mucous membranes as if

they’re infected● precautions are to be followed in EVERY situation● standard precautions include using proper hand hygiene and using personal

protective equipment (PPE) as necessary○ ex. gloves, gowns, and masks/eye protection/face shields

Standard Precautions● Based upon the premise that every person is potentially infected or colonized

with an organism that could be transmitted to others in a healthcare setting● The primary strategy for preventing healthcare associated transmission of

infections among residents and healthcare personnel● The nurse aide must be knowledgeable about and closely follow the facility

policies

Hand Hygiene● Hands may be washed using friction with soap and warm water for all cases● Hands are visibly soiled● Before direct contact with patients● After contact with blood body fluids or excretions, mucous membranes,

nonintact skin, wound dressing● Immediately after removing gloves● Between resident contacts● Between tasks and procedures on the same resident to prevent cross

contamination

Personal Protective Equipment (PPE)● Gloves

○ When touching blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, contaminated items or contact with resident

○ Remove gloves after contact with a resident or surrounding environment including medical devices

○ Do not wear the same pair of gloves for the care of more than one resident○ Never wash or reuse gloves

PPE● Gown Guidelines

○ During procedures/resident care activities when contact of clothing/exposed skin is anticipated from blood, body fluids, secretions and excretions

○ Do not reuse gowns○ Place used gowns in appropriate container

● Mask, Eye Protection, Face Shield Guidelines○ During procedures/resident care activities likely to generate splashes or sprays of blood, body

fluids, secretions

● Multiple Use Resident Care Equipment Guidelines○ Handle in a manner that prevents transfer of pathogens to others or the environment; wear

gloves if visibly contaminated○ Always perform hand hygiene after using equipment

PPE● Environmental Control Guidelines

○ Follow facility procedures for cleaning and disinfecting environmental surfaces and equipment

● Textiles and laundry Guidelines○ Keep linen away from clothing○ Handle in a manner that prevents transfer of pathogens to you , others and the environment○ place soiled linen in specified containers○ never mix soiled linen with clean linen