Most common mode of transmission of pathogens is via hands!
Infections acquired in health care settings
Spread of antimicrobial resistance
So Why All the Fuss About Hand Hygiene?
Evidence of Relationship Between Hand Hygiene and
Health Care Associated Infections
Substantial evidence that hand hygiene reduces the incidence of infections
Historical study: Semmelweis
More recent studies: rates lower when antiseptic handwashing was performed
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
Indications for Hand Hygiene
When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water.
If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
Specific Indications for Hand Hygiene
Before:– Patient contact – Donning gloves when inserting a CVC– Inserting urinary catheters, peripheral vascular
catheters, or other invasive devices that don’t require surgery
After:– Contact with a patient’s skin – Contact with body fluids or excretions, non-intact skin,
wound dressings– Removing gloves
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
Recommended Hand Hygiene Technique
Handrubs– Apply to palm of one hand, rub hands together
covering all surfaces until dry
– Volume: based on manufacturer
Handwashing
– Wet hands with water, apply soap, rub hands together for at least 15 seconds
– Rinse and dry with disposable towel
– Use towel to turn off faucet
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
Fingernails and Artificial Nails
Natural nail tips should be kept short; no longer than the end of the finger tip
Artificial nails should not be worn
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
PREVENTIONIS PRIMARY!
Protect patients…protect health care personnel…
promote quality health care!
Personal Protective Equipment Definition
“specialized clothing or equipment worn by an employee for protection against infectious materials” (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
OSHA issues workplace health and safety regulations. Regarding PPE, employers must:– Provide appropriate PPE for employees
– Ensure that PPE is disposed or reusable PPE is cleaned, laundered, repaired and stored after use
OSHA also specifies circumstances for which PPE is indicated
CDC recommends when, what and how to use PPE
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
• Gloves – protect hands
• Gowns/aprons – protect skin and/or clothing
• Masks and respirators– protect mouth/nose – Respirators – protect respiratory tract from
airborne infectious agents
• Goggles – protect eyes
• Face shields – protect face, mouth, nose, and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selection
• Type of exposure anticipated– Splash/spray versus touch
– Category of isolation precautions
• Durability and appropriateness for the task
• Fit
PPE Use in Healthcare Settings
Gloves• Purpose –
• patient care
• environmental services
• Glove material –
• Vinyl
• Latex
• Nitrile
• Sterile or nonsterilePPE Use in Healthcare Settings
Gloves
• Purpose – patient care, environmental services, other
• Glove material – vinyl, latex, nitrile, other
• Sterile or non-sterile
• One or two pair
• Single use or reusablePPE Use in Healthcare Settings
Do’s and Don’ts of Glove Use
Change gloves– During use if torn and when heavily soiled (even
during use on the same patient)
– After use on each patient Discard in appropriate receptacle
– Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Aprons
• Purpose of use
• Material –– Natural or man-made
– Reusable or disposable
– Resistance to fluid penetration
• Clean or sterile
PPE Use in Healthcare Settings
Face Protection
• Masks – protect nose and mouth– Should fully cover nose and mouth and
prevent fluid penetration
• Goggles – protect eyes– Should fit snuggly over and around eyes– Personal glasses not a substitute for goggles– Anti-fog feature improves clarity
PPE Use in Healthcare Settings
Face Protection
Face shields – protect face, nose, mouth, and eyes– Should cover forehead, extend below chin and
wrap around side of face
PPE Use in Healthcare Settings
Respiratory Protection
• Purpose – protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis)
• PPE types for respiratory protection– Particulate respirators– Half- or full-face elastomeric respirators– Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
• Medical evaluation
• Fit testing
• Training
• Fit checking before use
PPE Use in Healthcare Settings
Key Points About PPE
• Don before contact with the patient, generally before entering the room
• Use carefully – don’t spread contamination
• Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room
• Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence* for Donning PPE
• Gown first
• Mask or respirator
• Goggles or face shield
• Gloves
*Combination of PPE will affect sequence – be practical
PPE Use in Healthcare Settings
How to Don a Gown
• Select appropriate type and size
• Opening is in the back
• Secure at neck and waist
• If gown is too small, use two gowns– Gown #1 ties in front
– Gown #2 ties in back
PPE Use in Healthcare Settings
How to Don a Mask
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with ties or elastic
• Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
• Select a fit tested respirator• Place over nose, mouth and chin• Fit flexible nose piece over nose bridge• Secure on head with elastic• Adjust to fit• Perform a fit check – – Inhale – respirator should collapse
– Exhale – check for leakage around facePPE Use in Healthcare Settings
How to Don Eye and Face Protection
• Position goggles over eyes and secure to the head using the ear pieces or headband
• Position face shield over face and secure on brow with headband
• Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Gloves
• Don gloves last
• Select correct type and size
• Insert hands into gloves
• Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPE
• Keep gloved hands away from face
• Avoid touching or adjusting other PPE
• Remove gloves if they become torn; perform hand hygiene before donning new gloves
• Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings:How to Safely Remove PPE
“Contaminated” and “Clean” Areas of PPE
• Contaminated – outside front• Areas of PPE that have or are likely to have been
in contact with body sites, materials, or environmental surfaces where the infectious organism may reside
• Clean – inside, outside back, ties on head and back
• Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPE
• Gloves
• Face shield or goggles
• Gown
• Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPE
• At doorway, before leaving patient room or in anteroom*
• Remove respirator outside room, after door has been closed*
*Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)
• Grasp outside edge near wrist
• Peel away from hand, turning glove inside-out
• Hold in opposite gloved hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)
• Slide ungloved finger under the wrist of the remaining glove
• Peel off from inside, creating a bag for both gloves
• DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shield
• Grasp ear or head pieces with ungloved hands
• Lift away from face
• Place in designated receptacle for reprocessing or disposalPPE Use in Healthcare Settings
Removing Isolation Gown
• Unfasten ties
• Peel gown away from neck and shoulder
• Turn contaminated outside toward the inside
• Fold or roll into a bundle
• DiscardPPE Use in Healthcare Settings
Removing a Mask
• Untie the bottom, then top, tie
• Remove from face
• Discard
PPE Use in Healthcare Settings
Removing a Particulate Respirator
Lift the bottom elastic over your head first
Then lift off the top elastic
Discard
PPE Use in Healthcare Settings
Hand Hygiene
• Perform hand hygiene immediately after removing PPE.– If hands become visibly contaminated during PPE
removal, wash hands before continuing to remove PPE
• Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
*Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub
Standard Precautions
• Assumes blood and body fluid of ANY patient could be infectious
• Recommends PPE and other infection control practices to prevent transmission in any healthcare setting
• Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)
• Gloves – Use when touching blood, body fluids, secretions, excretions, contaminated items; for touching mucus membranes and nonintact skin
• Gowns – Use during procedures and patient care activities when contact of clothing/ exposed skin with blood/body fluids, secretions, or excretions is anticipatedPPE Use in Healthcare Settings
PPE for Standard Precautions (2)
• Mask and goggles or a face shield – Use during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear?
• Giving a bed bath?
• Suctioning oral secretions?
• Transporting a patient in a wheel chair?
• Responding to an emergency where blood is spurting?
• Drawing blood from a vein?
• Cleaning a patient with diarrhea?
• Irrigating a wound?
• Taking vital signs?
PPE Use in Healthcare Settings
What Type of PPE Would You Wear?
• Giving a bed bath?• Generally none
• Suctioning oral secretions?• Gloves and mask/goggles
or a face shield – sometimes gown
• Transporting a patient in a wheel chair?
• Generally none required
• Responding to an emergency where blood is spurting?
• Gloves, fluid-resistant gown, mask/goggles or a face shield
• Drawing blood from a vein?• Gloves
• Cleaning an incontinent patient with diarrhea?
• Gloves w/wo gown
• Irrigating a wound?• Gloves, gown,
mask/goggles or a face shield
• Taking vital signs?– Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautions
• Expanded Precautions include– Contact Precautions
– Droplet Precautions
– Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions• Contact Precautions – Gown and gloves for
contact with patient or environment of care (e.g., medical equipment, environmental surfaces)
• In some instances these are required for entering patient’s environment
• Droplet Precautions – Surgical masks within 3 feet of patient
• Airborne Infection Isolation – Particulate respirator*
*Negative pressure isolation room also requiredPPE Use in Healthcare Settings
Hand Hygiene
• Required for Standard and Expanded Precautions
• Perform…– Immediately after removing PPE
– Between patient contacts
• Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings:Final Thoughts
PPE is available to protect you from exposure to infectious agents in the healthcare workplace
Know what type of PPE is necessary for the duties you perform and use it correctly
Classes of Microorganisms
Non-pathogenic– normal– do not produce disease– beneficial
Pathogenic– cause infection and disease
May be non-pathogenic in one body system, pathogenic in another (E. coli)
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2.02 Understand infection control procedures
Classes of Microorganisms
Aerobic– requires oxygen to live
Anaerobic– does not require oxygen to live
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2.02 Understand infection control procedures
Classes of Microorganisms
6 classes of microorganisms– Bacteria
– Protozoa
– Fungi
– Rickettsiae
– Viruses
– Helminths
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2.02 Understand infection control procedures
Classes of Microorganisms
Bacteria Often considered the causes of disease Certain bacteria
– produce antibiotics– live in the body without problems– live on the roots of certain plants, converting
nitrogen into a usable form – help break down dead organic matter
Classified by shape and arrangement Treated with antibiotics
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2.02 Understand infection control procedures
Classes of Microorganisms
Bacteria– Cocci-
• round in shape– diplococci– streptococci– staphylococci
Streptococci
Staphylococcal clusters
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2.02 Understand infection control procedures
Classes of Microorganisms
Bacteria– Bacilli
• rod shape– single– pairs– chains
• may have flagella• may form spores
– difficult to treat
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2.02 Understand infection control procedures
Classes of Microorganisms
Bacteria– Spirilla
• spiral or corkscrew shape– vibrio - spirochete
Treponema pallidumCholera54
2.02 Understand infection control procedures
Classes of Microorganisms
Bacteria Some bacteria develop resistance to antibiotics Very difficult to cure
– Methicillin-resistant Staphylococcus (MRSA)
– Multidrug-resistant Staphylococcus (MDSA)
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2.02 Understand infection control procedures
Classes of Microorganisms
Protozoa– One celled, animal-like organism
– Contain a nucleus and other defined organelles
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2.02 Understand infection control procedures
Classes of Microorganisms
Fungi– organisms that usually enjoy a symbiotic, but
sometimes parasitic relationship with their host
– provide numerous drugs and foods
– provide bubbles in bread, champagne, and beer
– cause a number of plant and animal diseases
– fungal diseases are very difficult to treat
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2.02 Understand infection control procedures
Classes of Microorganisms
Fungi
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2.02 Understand infection control procedures
Classes of Microorganisms
Rickettsiae– rod-shaped, parasitic bacteria – live in the tissues of ticks,
fleas, and lice– transmitted to humans
through bites– invade the new host from
within
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2.02 Understand infection control procedures
Classes of Microorganisms
Viruses– small, infectious agent
– requires a host for survival
– over 5,000 types
– can combine in multiple ways to produce a wide range of diseases
– produce immune response in humans
– treated with antiviral drugs
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Classes of Microorganisms
Helminths– Parasitic worm-like organisms– Live inside the host– Feed off their host– Disrupt nutrient absorption– Lead to weakness– Excrete toxins making host
susceptible to other diseases– Approximately 30 billion people
globally are infected
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2.02 Understand infection control procedures
Classes of Microorganisms
Bacteria Protozoa Fungi Rickettsiae Viruses Helminths
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Methods used to control the spread of infection Vaccinations
2.02 Understand infection control procedures
Administration of a foreign antigen to produce immunity to a disease.
Most effective and least expensive method to prevent disease
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Methods used to control the spread of infection Vaccinations
2.02 Understand infection control procedures
Injected pathogen may be live, weakened, killed or inactivated
Administered to stimulate the immune response
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Methods used to control the spread of infection Vaccinations
2.02 Understand infection control procedures
May be given after disease exposure or after the disease was contracted
Given by injection or orally
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2.02 Understand infection control procedures
Methods used to control the spread of infection Aseptic Control
Antisepsis
Disinfection
Sterilization
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2.02 Understand infection control procedures
Methods used to control the spread of infection Aseptic Control
Antisepsis– effective in preventing or inhibiting the growth of
pathogenic organisms, but not spores or viruses
– safe to be used on skin
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2.02 Understand infection control procedures
Methods used to control the spread of infection Aseptic Control
Disinfection– destroys pathogenic organisms that are already
present
– not effective against spores or viruses
– chemicals are used
– not used on skin
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2.02 Understand infection control procedures
Methods used to control the spread of infection Aseptic Control
Sterilization– kills all microorganisms, including spores and
viruses
– methods• steam under pressure• gas• radiation• chemicals
– not used on skin
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2.02 Understand infection control procedures
Methods used to control the spread of infection Aseptic Control
Antisepsis
Disinfection
Sterilization
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Methods used to control the spread of infectionMethods used to control the spread of infection
PrecautionsPrecautions
2.02 Understand infection control procedures
Methods used to control the spread of infection Standard Precautions
Used on ALL patientsUsed on ALL patients
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2.02 Understand infection control procedures
Methods used to control the spread of infection Standard Precautions
Hand washing
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2.02 Understand infection control procedures
Methods used to control the spread of infection Standard Precautions
Personal protection equipment (PPE)
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2.02 Understand infection control procedures
Methods used to control the spread of infection Standard Precautions
Gloves
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2.02 Understand infection control procedures
Methods used to control the spread of infection Standard Precautions
Gowns
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2.02 Understand infection control procedures
Methods used to control the spread of infection Standard Precautions
Masks and eye protection
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2.02 Understand infection control procedures
Methods used to control the spread of infection Standard Precautions
Needlestick safety
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2.02 Understand infection control procedures
Methods used to control the spread of infection Standard Precautions
Sharps
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2.02 Understand infection control procedures
Methods used to control the spread of infection Standard Precautions
Spills and splashes
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2.02 Understand infection control procedures
Methods used to control the spread of infection Standard Precautions
Resuscitation devices
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2.02 Understand infection control procedures
Methods used to control the spread of infection Standard Precautions
Waste and linen disposal
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2.02 Understand infection control procedures
Methods used to control the spread of infection Standard Precautions
Injuries
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2.02 Understand infection control procedures
Methods used to control the spread of infection Standard Precautions
Used on ALL patientsUsed on ALL patients
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2.02 Understand infection control procedures
Methods used to control the spread of infection Bloodborne Pathogen Standard
Applies to all occupational exposure of blood or other potentially infectious material.
Blood = human blood, blood components, blood products
Bloodborne pathogens = disease causing organisms in blood (Hep. B, Hep. C, HIV)
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2.02 Understand infection control procedures
Methods used to control the spread of infection Bloodborne Pathogen Standard
In an emergency when you cannot identify body fluids or tell whether they contain blood, treat all body fluids as potentially infectious.
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Methods used to control the spread of infection Tuberculosis Standard
OSHA Standard to reduce occupationally transmitted/acquired TB
Requires FIT tested and training in the use of specific respiratory PPE
PPD skin test annually
2.02 Understand infection control procedures
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Methods used to control the spread of infectionExtended Infection Control Precautions
2.02 Understand infection control procedures
Standard Precautions PLUSAirborne Precautions
Contact Precautions
Droplet Precautions
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2.02 Understand infection control procedures
Methods used to control the spread of infectionExtended Infection Control Precautions
Transmission based precautions– Additional precautions used with patients infected
with pathogens that are spread via:• airborne transmission• droplet transmission• direct contact
– Requires isolation
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2.02 Understand infection control procedures
Methods used to control the spread of infectionExtended Infection Control Precautions
Airborne precautions– Patient pathogens are transmitted by airborne
droplets
– Specific PPEs-• fitted mask
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2.02 Understand infection control procedures
Methods used to control the spread of infectionExtended Infection Control Precautions
Contact precautions– Patient pathogens are able to
be spread by direct or indirect contact
– Specific PPEs• gloves• gowns
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2.02 Understand infection control procedures
Methods used to control the spread of infectionExtended Infection Control Precautions
Droplet precautions– Used when large-particle droplets are expelled
during coughing, sneezing, talking or laughing
– Specific PPEs-• mask if working within
3 feet of patient
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2.02 Understand infection control procedures
Methods used to control the spread of infectionExtended Infection Control Precautions
Protective or reverse precautions
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Methods used to control the spread of infectionExtended Infection Control Precautions
2.02 Understand infection control procedures
Standard Precautions PLUSAirborne Precautions
Contact Precautions
Droplet Precautions
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2.02 Understand infection control procedures
Transmitting Infection Direct contact
Indirect contact
Airborne
Vector-borne
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2.02 Understand infection control procedures
Transmitting Infection
Direct contact
Person to person
Animal to person
Mother to unborn child
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2.02 Understand infection control procedures
Transmitting Infection
Indirect contact Pathogens are passed along on inanimate
objects
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2.02 Understand infection control procedures
Transmitting Infection
Airborne Pathogens are carried
through the air Cling to surroundings and
are spread
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2.02 Understand infection control procedures
Transmitting Infection
Vector-borne Insects carry pathogen from
host to host Flea
Tick
Mosquito
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Transmitting Infection
How you get an infection…– Causative agent
– Reservoir
– Portal of exit
– Mode of transmission
– Portal of entry
– Susceptible host…breaking the chain!
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2.02 Understand infection control procedures
Chain of InfectionCausative agent
Source or
reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
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2.02 Understand infection control procedures
Chain of Infection
Causative agent– pathogen
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2.02 Understand infection control procedures
Chain of Infection
Reservoir– area where the pathogen
can live
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2.02 Understand infection control procedures
Chain of Infection
Portal of exit– way for the pathogen to
escape from the reservoir
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2.02 Understand infection control procedures
Chain of Infection
Mode of transmission– way for pathogen to be
transmitted
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2.02 Understand infection control procedures
Chain of Infection
Portal of entry– way to enter new
reservoir
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2.02 Understand infection control procedures
Chain of Infection
Susceptible host– able to be affected
– person likely to get sick
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2.02 Understand infection control procedures
Chain of InfectionCausative agent
Source or
reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
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Types of Infections
2.02 Understand infection control procedures
2.02 Understand infection control procedures
Types of Infections
Infection invasion of the body by microorganisms invading microorganisms:
– use the host’s resources to multiply
– interfere with normal function
– 3rd leading cause of death in the U. S.
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Types of InfectionsLocal infection only a specific portion of the body is infected
– pain
– redness
– heat at the site
– swelling
– pus
– foul smelling drainage
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2.02 Understand infection control procedures
Types of InfectionsSystemic infection affects the entire body
– fever
– aches
– chills
– nausea
– vomiting
– weakness
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Types of Infections
Endogenous (endo- inside; genous- type or kind)– type or kind of infection or
disease that originates from within the body
Exogenous (exo- outside; genous- type or kind)– type or kind of infection or
disease that originates outside the body
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2.02 Understand infection control procedures
Types of Infections Nosocomial infections
– Hospital acquired infection– Transmitted by the health care
worker
Opportunistic infections– Infections that occur when the
body’s defenses are weakened
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Types of Infections
VERY IMPORTANT
Any sign of infection must be reported to the nurse or doctor!