Fire Safety and Infection Control

• O2 is nonflammable but accelerates combustion.
• Burning speed increases with higher O2 concentration or partial pressure.
• Flammable materials should be kept away from O2 to minimize hazards.
• Ignition sources are prohibited in rooms with O2.
• Children should not play with spark-creating toys where O2 is in use.
• PASS: Pull the pin, Aim the nozzle, Squeeze the handle, Sweep the nozzle across the base of the fire.
• RACE: Rescue patients, Alert other personnel, Contain the fire, Evacuate others.

Infections

• Infections developing outside hospitals are community onset.
• Infections developing inside hospitals are hospital-acquired (HAI) or nonsocomial infections.
• Three elements are required for infection transmission: pathogen source, susceptible host, and transmission route.

Susceptible Hosts

• Susceptible hosts include those with poorly controlled diabetes mellitus, extremes of age, HIV infection, immunodeficiency (cancer, chemotherapy), surgical incisions, radiation therapy, and medical devices like catheters, central venous catheters, and endotracheal tubes.

Modes of Transmission

• Transmission happens through contact (direct and indirect), droplets, and airborne routes.
• Direct contact transmission involves pathogen transfer from one person to another.

Indirect Contact Transmission

• Indirect contact transmission, the most frequent healthcare setting, involves pathogen transfer through a contaminated item or person.
• Unwashed hands and healthcare personnel touching infected sites or objects, then other patients, are common causes.
• Fomites are inanimate objects that can transfer pathogens.

Droplet and Airborne Transmission

• Droplet transmission involves respiratory droplets (large particles) that travel short distances before landing.
• Breathing, talking, laughing, and singing can expel aerosols.
• Airborne transmission involves pathogens that stay infectious while suspended in the air.
• Airborne transmission requires special handling and respiratory protection.
• Controlled rooms use negative air pressure and direct air exhaustion to control pathogen spread.
• N-95 or higher respirators are needed to prevent airborne transmission.
• Surgical masks are less effective at preventing airborne transmission.

Occupational Safety and Health Administration (OSHA)

• OSHA mandates employers provide hepatitis B vaccinations.
• Healthcare workers can't work with a fever, as they risk spreading illness.

Source Elimination

• Removing environmental pathogens includes general sanitation and specialized equipment processing.
• Pathogen reduction is achieved through sanitary laundry, food preparation, and housekeeping.
• Environmental air control (using specialized ventilation) and water complement reduction efforts.

Standard Precautions

• Standard precautions involve basic infection control, assuming all blood, body fluids, secretions, and excretions (except sweat) can transmit infectious agents.
• Washing with soap and water for at least 15 seconds is essential.

Contact Precautions

• Contact precautions reduce transmission risk through direct/indirect contact with patients or their environment.
• Gowns and gloves are worn for all interactions that involve contact.

Droplet Precautions

• Droplet precautions are for patients with presumed or confirmed infections transmitted by respiratory droplets, like influenza.

Airborne Infection Isolation (AII)

• Airborne infection isolation reduces risk from aerosolized infectious agents (e.g., tuberculosis).
• Airborne precautions include using N-95 or higher respirators.
• Single-patient rooms with special air handling are used.

Engineering Approach

• A specialized engineering approach for immunocompromised patients is a protective environment.
• It includes HEPA filtration, directed room airflow, positive room air pressure, sealed rooms, ventilation providing 12+ air changes per hour, dust reduction, and prohibiting flowers/potted plants.

Cystic Fibrosis (CF)

• All people with CF may have transmissible pathogens in their respiratory tracts.
• Contact precautions are needed in all clinical settings.
• CF patients should wear masks outside rooms.

Variations of Ventilator-Associated Pneumonia (VAP)

• Common components of VAP bundles include early mobilization, head of the bed at 30-45 degrees, hourly mouth care with toothbrushing, early enteral nutrition, changing ventilator circuits only when visibly soiled, minimizing sedation, and routine mechanical ventilation assessment.

Equipment and Procedures

• Check Table 4.2 for medical equipment processing based on infection risk.
• Disinfection destroys vegetative pathogenic organisms on medical equipment or inanimate objects, but not spores.
• Sterilization destroys all microorganisms on devices or in fluids; steam sterilization is nontoxic, inexpensive, and efficient.
• Internal ventilator workings are uncommon infection sources due to HEPA filters.
• Reducing circuit condensation prevents infection using heated wire circuits or heat and moisture exchangers (HME).
• HMEs should be inspected and replaced if contaminated, or if flow resistance increases.
• Change vent circuits if visibly soiled or malfunctioning.
• Hand hygiene is crucial for RTs before and after contact with patients.
• Contact with the patient’s ventilator is considered contact with the patient’s body.

Bronchoscope Reprocessing

• Bronchoscopes become highly contaminated due to their use in body cavities.
• These can harbor TB, nontuberculous mycobacteria, and P. Aeruginosa.
• Cleaning must precede sterilization or high-level disinfection.