Infection Prevention Basics

Week One: Infection Prevention

• Instructor: Christine Chan
• Contact via GBC email only
• Returns emails in 24 hours, Monday to Friday.
• Email again if no response after 48 hours.

About This Course

• Provides background knowledge on the hands-on skills PSWs use when caring for clients.
• Explains the "why" and "how" behind these skills based on research and evidence.
• Skills are practiced in the lab class (PSW1019) later.
• Course (PSW1017) a co-requisite to PSW1019 (LAB).
• Failure to pass either course requires retaking BOTH.
• Students are responsible for paying for both courses if they need to be repeated

Preventing Infection

• Goal: Define Microbes, Bacteria, Pathogens, Non-pathogens, MRO, PPE, and Modes of Transmission
• Goal: Describe the infection cycle, hand washing guidelines, and the chain of infection
• Goal: Describe the difference between Standard and Transmission-Based Precautions

What is an Infection? Why is Preventing Infection Important?

• Infection: An illness caused by germs.

• Localized Infections

  • Confined to a specific body part
  • Delay recovery

• Systemic Infections

  • Affect the whole body.
  • Can prolong hospital stays
  • Can cause death if serious

• PSWs should:

  • Understand how infections spread.
  • Understand how to prevent infections
  • Follow infection prevention and control policies.

Microorganisms

• Also called microbes or germs.
• Microorganism definition: A form of life too small to be seen without a microscope
• Micro means very small
• Organism means a form of life
• Types of Microorganisms: bacteria, virus, fungus, and parasite.

Differences Between Microorganisms

• Bacteria

  • Lives naturally on everything

• Pathogenic (causes illness) or Non-Pathogenic (doesn't cause illness)

• Multiplies quickly

• Has a hard shell (endospore)

• Virus

  • Infects and disrupts living cells
  • Takes over living cells to grow and multiply
  • Can be dormant, then activate years later
  • Antibiotics do not kill viruses, antivirals are needed

• Fungus

  • Lives on organic matter, such as humans, animals, and plants
  • includes Yeasts and molds
  • Common in mouth, groin, feet, and skin
  • Athlete's foot, and vaginal yeast infections

• Parasite

  • Gets nourishment by living off another thing
  • Can be transmitted between humans, or animals to humans
  • Spread by contaminated food and water
  • Sometimes seen without a microscope

How Microbes Grow

• Grow well in warm, wet, dark places

• Many grow well at body temperature, especially on wet skin

• PSWs must consider this when giving care

• Can live long on surfaces

• Normal Flora

  • Microorganisms naturally found on the skin's surface, mucous membranes, and in the gastrointestinal tract
  • Can be beneficial, like bacteria needed in the gastrointestinal tract.

Multi-Drug Resistant Organisms (MROs)

• Bacteria which are resistant to (not killed by) more than one antibiotic

  • VRE (vancomycin resistant enterococcus)
  • MRSA (methicillin-resistant staph-aureus)
  • C-Diff (Clostridium-Difficile): Causes severe diarrhea in patients taking antibiotics

• Caused mostly by overuse or not finishing all of them

• Factors

  • Spread easily in hospitals.
  • Learn how to change their DNA and structure to protect themselves against antibiotics

Hospital Acquired Infections (HAIs)

• HAIs are infections patients' acquire during a health care facility visit.
• Healthcare Workers can spread infection to multiple patients.
• Healthcare workers can acquire infections, so it's important to follow infection control precautions including keeping healthy

Infections in Health Care Settings

• Patients at greater risk in healthcare settings

Chain of Infection

• Pathogen
  • Disease-causing microbe
  • E.g., bacteria, virus, etc.
• Reservoir
  • Where the pathogen lives before infecting a person.
  • A different person, food, water, a table, a bedsheet, etc.
• Susceptible Host
  • A person at risk for infection
  • People with weakened immune systems, the elderly, children, people taking chemotherapy, etc.
• Portal of Entry
  • How a pathogen enters a new host
  • Mouth, genitals, cuts in skin, wounds
• Mode of Transmission
• How the pathogen travels

Modes of Transmission

• Contact
  • Direct: Touching the infected person
  • Indirect: Touching a contaminated object
    • Examples of contaminated object include the patient's room: cups, clothes, sheets, etc.
• Droplet
  • Spread by coughs, sneezes, mucus, saliva
  • Short distances: less than 1m.
• Airborne
  • Dust particles carry pathogens such as attach to dust in the air and travel long distances of more than 1m.
  • Inhaled
• Vehicle
  • Contaminated water, food, medical equipment
  • Examples include urinary catheters and body fluids

How Health Care Workers Break the Chain of Infection

• PSWs have an essential role in stopping the spread of microorganisms.
• Taking careful actions can break the chain of infection.
• Know about how infections spread
• Proper hand-washing technique
• Appropriately use hand sanitizer
• Wear personal protective equipment
• Following cleaning/disinfecting equipment procedures that prevent infection spread Follow waste disposal procedures, so that pathogens are disposed of correctly

Contaminated vs Clean and Aseptic

• Contaminated:
  • Anything that has been exposed to pathogens, whether visible or not.
  • Pathogens are microbes and are too tiny to be seen.
  • Contamination is exposure to pathogens.
• Dirty or Visibly Soiled:
  • Anything that has visible contaminants like dirt and body fluids.
• Clean:
  • Anything that has no visible contaminants.
• Asepsis
  • The practice of reducing or eliminating pathogens.
  • Two Types
  • Medical - Reduces pathogens and prevents the spread between individuals and places
  • Surgical - Eliminates all microbes and their spores

Standards vs Precautions

• Standard Practices: Basic principle is to treat everyone as a potential source of infection.
• Standard Precautions are guidelines to prevent the spread of infection
  • Blood.
  • All body fluids, secretions, and excretions, whether or not it is visible
  • Non-intact skin, like skin with open sores, wounds, cuts, scrapes, or breaks.
  • Mucous membranes, including membranes in the nose, eyes, mouth, vagina, and

Standard Precautions - Key Questions

• Ask yourself

  • Doing this task, is there a chance I might come into contact with body fluids?
  • Is the patient vomiting? Could I get splashed with vomit?
  • Is the patient coughing? Could I get splashed with saliva?
  • Is there bleeding? Could I get splashed with blood?
  • Will I be I touching mucous membranes?

• If YES to any, wear gloves, gown, mask or goggles depending on the situation

COVID-19

• Epidemic: An increase in disease cases above the expected level in a community.
• Pandemic: An epidemic spread over several countries or continents.
• Read pg 385 for more information on Coronavirus and COVID-19

Covid 19 - New Standard Precautions

• Infection control practices are frequently changing and continue to evolve as our understanding increases
• PPE practices have changed because Covid-19 has been shown to transmit without symptoms
• Because everyone is assumed to have Covid 19, standard precautions now include droplet precautions.

Standard Precautions include surgical mask and goggles or shield.

Aerosol Generating Medical Procedures (AGMPs)

• AGMP: Medical Procedures involving the respiratory tract that generate aerosols smaller than 5 microns (could contain the virus)
• Particles smaller than 5 microns require an N95 mask.
• When caring for a patient during a pandemic who will have AGMP requires an N95 mask as a healthcare worker

examples:

• Patients using oxygen.
• Patients requiring suction
• Patients intubated -Patients on a ventilator

Isolation Precautions

Isolated Patients: Clients infected with certain pathogens are placed

• Guidelines to contain pathogens to the client's room or area.
• Wearing specific personal protective equipment (PPE) in the patient’s room or space.
• Isolation Precautions are extra precautions, followed in addition to Standard Practices.

Hand Hygiene

• Hand hygiene is a form of medical asepsis.
• Correct hand hygiene is the most important way health care workers prevent the spread of infection.
• Two Types Hand washing with soap and running water Hand sanitization with alcohol rub

The Four Moments of Hand Hygiene

• Before entering the room
• Before approaching the bedspot (if in a multi-bed room)
• Before aseptic procedure, such as inserting a urinary catheter
• After body fluid exposure
• After touching a patient or their equipment.
• After leaving the room
• After leaving the bedspot (if in a multi-bed room)

When to Practice Hypiene

• Immediately before and after giving care
• Wash after giving care and before caring for the second patient.
• Whenever hands are visibly soiled
• After contact with one's own or another person's blood, body fluids, secretions, or excretions
• After touching objects that are contaminated
• Before and after preparing, handling, and eating food
• Before and after feeding a client
• Before putting on disposable gloves and after removing them
• After personal body functions, such as urinating or defecating

Personal Protective Equipment (PPE)

What is PPE?

• Gloves
• Gowns
• Masks
• Goggles/Shields

Gloves: Key Reminders

Always perform hand hygiene before putting on and after removing gloves. Wear the correct size of gloves. Do not use hand sanitizer on gloves as it is weakening the gloves and will cause to tear. Use pair of gloves only once, then discard. Do NOT reuse.

• Ensure gloves always over gown wrist cuffs

Gowns PPE Considerations

• Gowns protect your clothes and body from blood, body fluids, secretions, and excretions. protect you from you from getting wet while you are bathing a client. Gowns must completely cover you from your neck to your knees. The inside and neck are clean, and the outside and waist strings are considered contaminated. Gowns are used once. After leaving the room, discard it and then get a new one when you go back in. Wet gowns are considered contaminated. Don immediately before being used and do not walk around hallways in your gown Disposable gowns (made of paper) are discarded in the garbage after use. Some facilities use fabric gowns and place them in a laundry hamper.

PPE: Masks

• Masks protect you from contact with or inhalation of infectious agents from the patient

• Masks protect the client from infectious agents carried in your nose or mouth during sterile procedures. Two Types of masks

  • Surgical masks: protects from droplet particles and illnesses spread by droplet
  • N95 respirator masks are worn especially caring for clients with airborne illnesses (TB, measles, chicken pox).

• N95 masks should fit various shapes to fit different shaped faces. Ensure the one used is the right one. Fit tests are needed in many cases.

Covid: Mask Preservation

• During Covid, there was a need to preserve PPE by preserving masks
• Health care providers were directed to wear masks for their entire shift, not only in patient rooms. -Masks had to be reused and were stored at eating and drinking locations This directive came out of a unique and exceptional situation due to Covid-19 and PPE shortage. Masks are otherwise never reused**

Donning (Putting On) and Doffing (Taking off) PPE

• Donning and doffing is done in a certain order so that exposure to contaminants is minimized.
• Donning and doffing in the wrong order exposes you clients to microbes
• Correct hand hygiene at correct moemnt can prevent cross contamination

Order for Donning PPE- HGMGG acronym

1. Hand Hygiene
2. Put on gown
3. Mask
4. Goggles
5. Gloves

Order for Doffing PPE - Donning PSW Video in D2L helps!

• If the gown is tied at the first, untie is, but if not move on to the next step

1. Gloves
2. Remove goggles
3. Remove gown
4. Remove mask
5. Hand Hygiene

PPE and Client Consideration

Key factors: Many clients will have cognitive deficits and sensory and emotion challenges around wearing PPE

• Explain what the PPE is for and why itis worn.
• Let the client know the pathogen is undesirable not the client
• Speak slowly and be empathetic

Care of Supplies and Equipment

• Microbes live on surfaces.
• Throw away disposable equipment (as per employer policy) If reusable, clean sterilize per proper procedures

Aseptic Measures

Maintain your own personal hygiene by bathing or showering often changing clothes daily Ensure that there isn't bacteria gathering on nails (no nail polish, kept short and clean)

Disinfection and Sterilization

Cleaning reduces microbes Disinfecting destroys pathogens except spores such as bed pans, wear gloves when doing this process Sterilizing destroys all pathogens including spores specifically on surgical items

Maintaining a Safe Environment

• Items contaminated with blood, body fluids, secretions, or excretions are called biohazardous waste
• Dispose of everything in a proper way
• Laundry with body fluids on it can usually go in Linen hamper but check your employer