infection control anf principles of asepsis

• Asepsis means no pathogenic microorganisms are present
• Medical asepsis refers to the state of being free from disease-causing microorganisms.
• Surgical asepsis denotes removing all microorganisms when doing invasive procedures.
• PPE (Personal Protective Equipment) protects the person or health care provider from infection.
• Hand hygiene involves handwashing, antiseptic handwash, antiseptic hand rub, and surgical hand antisepsis
• Donning means to put something on
• Doffing means to remove something
• Infection - an invasion of the body by pathogenic microorganisms

More definitions

• Contaminated - soiled w/ microorganisms
• Disinfection - reduction of microorganisms w/o destroying the spores
• Spores - inactive but variable state of microorganisms
• Sterile - free from microorganisms but not the spores
• Sterilization - technique used to eliminate all microorganisms, including spores
• Pathogenicity - ability to produce disease
• Opportunistic pathogen - pathogen that causes disease only to susceptible individuals
• Carrier - person or animal that harbors an infectious agent and capable of transferring it to other persons
• Colonization – presence of microorganisms in the body secretion or excretions that does not cause illness

Chain of Infection

• Etiological Agent
• Disease-causing microorganisms including bacteria, virus, fungi, and parasites
• Reservoir is a place where microorganisms survive, multiply, and await transfer to a susceptible host
• Includes human beings, animals, inanimate objects, plans, general environment e.g. water and soil

2 Types of individuals with disease

• Acute or symptomatic disease
• Those without signs of disease (asymptomatic) but are carriers

Portal of Exit from Reservoir

• After microorganisms find a site to grow and multiply, they need to find a portal of exit if they are to enter another host and cause disease
• Examples are Sputum, emesis, stool, blood

Common Portal of Exit

• Respiratory: droplets, sputum
• GI tract: vomitus, feces, saliva, drainage tubes
• Urinary: urine, urethral catheters
• Reproductive: semen, vaginal discharge
• Blood: open wound, needle puncture site

Modes of Transmission

• Direct contact
• immediate transfer of microorganisms from person to person via touch, bite, kiss, droplet, or sex
• Droplet spread can occur if the source and host are 1m (3ft) from each other
• Sneeze, cough, spit, singing, or talking can project droplet spray into the conjunctiva or onto the mucous membrane of the eye, nose, or mouth of another person
• Indirect contact
  • Vehicle-borne transmission: any substance that serves as an intermediate means to transport and introduce an infectious agent into a susceptible host thru a suitable portal or entry
  • Fomites (inanimate materials) such as clothes or surgical instruments can act as vehicle as contaiminated food or water
  • Vector-borne transmission: an animal or flyig/crawling insect that serves as an intermediate means to transporting the infectious agent
  • Transmitted by injecting salivary fluid during biting or by depositing feces or other materials on the skin thru a bite wound or traumatized skin area.

MRS. WEE (Direct Contaect)

• M - ultidrug resistant organism
• R - espiratory infection
• S - kin infections
• W - ound infection
• E - ntric infection - clostridium difficile
• E - ye infection – conjunctivitis

VCHIPS (Skin Infections)

• V - aricella zoster
• C - utaneous diptheria
• H - herpes simplex
• I - mpetigo
• P - ediculosis
• S - cabies

Airborne transmission

• Droplet nuclei or residue evaporated droplets in air during coughing or sneezing or carries on dust particles
  • May involve droplets or dust
  • Droplets nuclei – residue of evaporated droplets by an infected host can remain in the air for long periods
  • Dust particles with infectious agent
  • Material is transmitted by air currents to a suitable portal of entry, usually the respiratory tract, of another person
• Ex. measles, chickenpox, tuberculosis

My Chicken Hez TB/MTV (Airborne transmission)

• My - Measles
• Chicken - Chicken Pox/Varicella
• Hez - Herpes Zoster/Shingles
• TB - Tuberculosis
• V - aricella-Chicken Pox/Herpes Zoster-Shingles

Examples of droplets

• S - sepsis
• S - scarlet fever
• S - streptococcal pharyngitis
• P - parvovirus B19
• P - pneumonia
• P - pertussis
• I - influenza
• D – diptheria (pharyngeal)
• E - epiglottitis
• R - rubella
• M - mumps
• M - meningitis
• M - mycoplasma/meningeal pneumonia
• An - adenovirus

Portal of Entry to the Susceptible Host

• Microorganisms enter the body via Mucous membrane, Non-intact skin, GI tract, GU tract, and the Respiratory tract

Susceptible Host

• Any person who is at risk for infection
• Impairment of body's natural defenses can affect susceptibility to infection
• Includes Immunosuppressed children/elderly, Chronically ill clients, Clients w/ trauma or injury

Course of Infectious by Stage

• Incubation period
• Interval between entrance of pathogen into body and appearance of first symptoms
• Chickenpox: 14-16 days after exposure, Common cold: 1-2 days, Influenza: 1-4 days, Measles: 10-12 days, Mumps: 16-18 days, Ebola: 2-21 days
• Prodromal Stage
• Interval from onset of nonspecific signs and symptoms (malaise, low-grad fever, fatigue) to more specific symptoms
• Microorganisms grow and multiply and patients may be capable of spreading disease to others
• Illness Stage
• Interval when patient manifests signs and symptoms specific to type of infection
• Ex. Strep throat is manifested by sore throat, pain, and swelling
• Interval
• Acute symptoms of infection disappear. Length of recovery depends on severity of infection and patient's hot resistance
• Recovery may take several days to months

Health Care Associated Infections

• AKA nosocomial infections and/or hospital-acquired infections
• Acquired in a hospital or other health care facility that were not present or incubating at the time of a client's admission
• Hospital environment provides exposure to a variety of virulent organisms that the client has not been exposed to in the past
• Infections can be transmitted by health care personnel who fail to practice proper hand washing or fail to change gloves between client contacts
• Two types of pneumonia: Community-acquired and Hospital-acquired

How to Break Chain of Infection

• Decrease source of microorganisms
  • Wash hands
  • Decontaminate surfaces and equipment
  • Avoid contact when contagious
• Prevent transmission of microorganisms Wear personal protective equipment (PPE) Follow isolation precautions
• Maximize resistance
  • Provide good hygiene
  • Ensure proper nutrition and fluid intake
  • Decrease stressors that weaken immune response

Breaking the Chain of Infection

• Standard Precautions: Use of PPE, Aseptic Techniques
• Transmission-based Precautions Used in addition to standard precautions for patients with suspected infection with pathogens that can be transmitted by airborne, droplet, or contact routes

Airborne Precautions

• Use for patients who have infections that spread through the air and possibly severe acute respiratory syndrome
• Focus on diseases that are transmitted by smaller droplets and remain in the air longer
• Requires a specially equipped room w/ a negative air flow referred to as an airborne infection isolation room
• Air isn't returned to the inside ventilation system but is filtered through a high-efficiency particulate air (HEPA) and exhausted directly to the outside
• All health care personnel must wear an N95 respiratory every time they enter the room

Droplet Precautions

• Focus on diseases transmitted by large droplets (greater than 5 microns) in the air and by being 3ft from a patient
• Wear surgical mask when within 3ft of the patient, proper hand hygiene, and some dedicated-care equipment

Contact Precautions

• Use for direct and indirect contact w/ patients and their environment
  • Direct contact is handling contaminated body fluids (Require a gown and gloves)
  • Indirect contact is transfer of an infectious agent thru a contaminated intermediate object such as contaminated instruments or hands of health care workers
• The health care worker may transmit microorganisms from one patient site to another if hand hygiene is not performed between patients
• Contact precautions for excessive wound drainage, fecal incontinence, or other discharges from the body that suggest an increased potential for extensive environmental contamination and risk of transmission.

Asepsis

• Aims to exclude pathogenic or disease-causing microorganisms

Aseptic technique

• Covers the practices or procedures that aim to minimize the risk for infection caused by contamination of microorganisms
• Has 2 types: Medical and surgical asepsis

Medical Aseptic Technique

• Involves the process that breaks the chain of infection by reducing the microorganisms present and preventing its transfer
• These techniques should be used by all patients, whether with or without infection.
• Examples: Hand hygiene, Barrier techniques, Routine environmental cleaning

Surgical Aseptic Technique

• Sterile technique prevents an open wound from being contaminated by infectious microorganisms.

Hand Hygiene

• Common method for preventing and managing infection.
• Involves four techniques: (1) handwashing, (2) antiseptic handwash, (3) antiseptic hand rub, or surgical hand antisepsis.
• Rtrong, quick rubbing of all surfaces of lathered hands together followed by 15 seconds of rinsing under a stream of warm water
• Focuses on mechanically eliminating bacteria from hands before rinsing them with water

When to do Handwashing:

• When hands are visibly filthy, contaminated with blood or other bodily fluids, before eating, and after using the bathroom.
• When hands are exposed to spore-forming organisms.

If hands are not clearly dirty, use an alcohol-based, waterless antiseptic agent for these situations:

• Each time a direct contact is made on a different patient.
• During donning doffing of sterile gloves and during invasive procedures .
• In rendering patient care or handling body fluids or excretions, mucous membranes, non-intact skin, and wound dressings even if gloves are worn
• During patient care, when moving from a dirtyto a clean body site After touching or handling objects or surfaces in the patient's room After patient care, when gloves are removed

Performing Hand Hygiene using Soap and Water:

1. Assemble the necessary supplies and remove pieces of jewelry.
2. Open the faucet and adjust its pressure.
3. Wet the hands and wrist area and apply liquid soap and lather thoroughly.
4. Wash the palms and backs of the hands, each finger, the spaces between the fingers, as well as the knuckles, wrists, and forearms using hard rubbing and circular motions.
5. A clean orangewood stick may be used to clean under the fingernails or fingernails of the opposite hand.
6. Rinse both hands thoroughly with water toward fingertips
7. Dry both hands with a paper towel, starting with the fingers and going upward toward the forearm. Close the faucet with another paper towel and then discard.

Cleaning process

• Eliminates organic (e.g., blood) or inorganic (e.g., soil) material from objects and surfaces comprises the use of water, detergent/disinfectant, and general mechanical scrubbing. Make sure everything is clean

PPE.

• Gowns' main objective is to prevent soiling one's clothes

Face Masks

• Aims to decrease the risk of transmission of microorganisms through droplets and airborne routes

Wear Mask when

(1) a patient has an infection which is transmitted by large particle aerosol (droplets) (2) All persons entering the room of a patient, primarily if the infection is transmitted by a small particle by aerosols (droplet nuclei)

Types of Face Mask

• Cloth Mask (Cloth/paper mask)
• 3-Ply Mask (3-ply surgical mask)
• N95 Respirator (N95 respirator)

Eye Protection

• Special glasses or goggles that are worn during procedures that may produce splashes or splatter
• Include irrigation of a large abdominal wound or insertion of an arterial catheter wherein the HCP acts as an assistant
• Removable, reusable, or disposable side shields available in plastic glasses or goggles

Gloves

• Prevent of microorganism transmission.
• Gloves are needed when handling blood, body fluids, secretions, excretions (excluding sweat), moist mucous membranes, non-intact skin, or contaminated things or surfaces.

Two Gloving Techniques

1. Open technique method
2. Closed techniques method

Steps in doing Open Technique Method

1. Do hand hygiene.
2. Carefully separate and peel away the sides of the outer glove package wrapping.
3. Open the inner package and place it just above waist level on a clean, flat surface. Open the package while keeping your gloves on the wrappers on the inside surface.
4. Determine which glove is on the right and which is on the left
5. From your non-dominant hand, making use of your thumb and first two fingers, hold the cuff's edge of the glove for your dominant hand. Only touch the inside surface of the gloves only be touched.
6. Carefully pull the glove over the dominant hand, leaving the cuff and ensuring that it does not roll up from the wrist. Be sure that the thumb and fingers are in proper space.
7. With the gloved dominant hand, slip fingers underneath the cuff of the second glove.
8. Carefully pull the second glove over the non-dominant hand. Do not allow fingers and thumb of the gloved dominant hand to touch any part of the exposed non-dominant hand. Keep thumb of dominant hand abducted back.
9. After the second glove is on, interlock fingers of gloved hands and hold away from the body above waist level until beginning procedure.

Steps in doing Closed Technique Method

1. Open the inner sterile glove packet with your hands covered by your gown sleeves.
2. With the dominant hand inside the gown cuff, pick up the glove for the non-dominant hand by grasping the folded cuff.
3. Extend the non-dominant forearm with palm up and place the glove's palm against the palm of the non-dominant hand. Glove fingers point toward the elbow.
4. Grasp back of glove cuff with the covered dominant hand and turn glove cuff over end of the non-dominant hand and gown cuff.
5. Grasp the top of the glove and underlying gown sleeve with the covered dominant hand. Carefully extend fingers into the glove, being sure that the glove cuff covers the gown cuff.
6. Glove dominant hand in the same manner, reversing hands. Use the gloved non-dominant hand to pull on the glove. Keep hand inside.
7. Ensure that both gloves' fingers are fully extended

Doffing

1. Hold the palmar surface of the first glove, then carefully remove it. Ensure that the contact is glove to glove only.
2. Pull the first glove completely off by inverting or rolling the glove inside out.
3. Using the fingers of the remaining gloved hand, hold the inverted removed glove. Put the first two fingers of the bare hand inside the cuff of the remaining glove.
4. The second glove can now be pulled off to the fingers by turning it inside out. This will pull the first glove inside the second glove.
5. Do hand hygiene.

Surgical Asepsis

• Refers to those techniques that keep an area or object free of all microorganisms
• Includes practices that destroy all microorganisms and spores

When to use Surgical Asepsis

• During procedures that require intentional perforation of the patient's skin.
• When the skin is not intact as a result of trauma, surgical incision, or burns
• When doing invasive procedures

Surgical Scrubbing

1. Remove bracelets, rings, and watches.
2. Make sure your fingernails are short, tidy, and in good shape. Artificial nails must be discarded.
3. Inspect the cuticles, hands, and forearms for abrasions, wounds, and open lesions.
4. Wear surgical shoe covers, a cap or hood, a face mask, and safety glasses.
5. Use knee or foot controls to turn on the water and set the temperature to a comfortable level.
6. Pro Scrub wash/rinse: Wet hands and arms under running lukewarm water and lather with detergent to 5cm above elbows
7. Rinse hands and arms thoroughly under running water. Always keep hands above elbows
8. Clean under nails of both hands with nail pick under running water. Discard after use.

Surgical hand scrub (with sponge or sponge brush)

1. Wet sponge and apply anti-bacterial agent.
2. Divide the arm mentally into thirds: scrub each third ten times. Some health care facility policies require scrub by total time rather than the number of strokes. Rinse brush and repeat sequence for the other arm. A two- sponge method may be substituted.
3. Discard the brush. Flex arms and rinse in one continuous from fingertips to elbows.
4. Proceed to the sterile setup carefully, holding the sterile towel so that water does not drip onto the sterile arrangement.
5. Grab one end of the sterile towel and dry one hand in bending slightly at the waist with hands and arms stretched.
6. Repeat the drying technique with the other hand.
7. Place the towel in the linen bin or the hand of the circulating nurse

Optional: Brushless antiseptic hand rub

1. After pre scrub wash, dry hands and forearms thoroughly with a paper towel
2. Dispense antimicrobial agent into the palm of one hand and dip other fingertips in. Spread up to just above the elbow, covering all surfaces.
3. Repeat with the other hand.
4. Reapply on all parts of hands. Allow complete drying before gloves. Proceed with sterile gowning.