Infection Control and Principles of Asepsis - PDF

2 – Infection Control and Principles of Asepsis 2 types Vocabulary a) Those w/ acute or symptomatic disease  Asepsis – absence of path...

2 – Infection Control and Principles of Asepsis 2 types Vocabulary a) Those w/ acute or symptomatic disease  Asepsis – absence of pathogenic b) Those who show no signs of disease microorganisms (asymptomatic) but are carriers of it  Medical asepsis –term used to the state of being free from microorganisms that can cause 3. Portal of Exit from Reservoir diseases.  After microorganisms find a site to grow  Surgical asepsis – demotes the absence of all and multiply, they need to find a portal of microorganisms when doing invasive exit if they are to enter another host and procedures. cause disease  PPE (Personal Protective Equipment) –  Sputum, emesis, stool, blood materials or equipment designed to protect the person or health care provider from infection Common Portal of Exit  Hand hygiene – involves four different a. Respiratory: droplets, sputum procedures: handwashing, antiseptic handwash, b. GI tract: vomitus, feces, saliva, drainage tubes antiseptic hand rub, and surgical hand antisepsis c. Urinary: urine, urethral catheters  Donning – to put on d. Reproductive: semen, vaginal discharge  Doffing – to remove e. Blood: open wound, needle puncture site  Infection – invasion of the body by pathogenic microorganisms  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 4. Modes of Transmission  Carrier – person or animal that harbors an A. Direct contact infectious agent and capable of transferring it to  Involves immediate and direct transfer other persons of microorganisms from person to  Colonization – presence of microorganisms in person via touch, bite, kiss, droplet, or the body secretion or excretions that does not sex cause illness  Droplet spread can occur if the source and host are 1m (3ft) from each other  Sneeze, cough, spit, singing, or talking Chain of Infection can project droplet spray into the 1. Etiological Agent conjunctiva or onto the mucous  Disease-causing microorganisms including membrane of the eye, nose, or mouth of bacteria, virus, fungi, and parasites another person 2. Reservoir B. Indirect contact  Place where microorganisms survive, a) Vehicle-borne transmission multiply, and await transfer to a  Any substance that serves as an susceptible host intermediate means to transport and  Human beings, animals, inanimate objects, introduce an infectious agent into sa plans, general environment e.g. water and susceptible host thru a suitable portal or soil entry   Fomites (inanimate materials) such as SPIDERMAN (droplets example) clothes or surgical instruments can act as vehicle  S – sepsis  Ex. contaminated food or water  S – scarlet fever b) Vector-borne transmission  S – streptococcal pharyngitis  P – parvovirus B19  Vector – an animal or flyig/crawling insect that serves as an intermediate  P – pneumonia means to transporting the infectious  P – pertussis agent  I – influenza  Transmitted by injecting salivary fluid  D – diptheria (pharyngeal)  E – epiglottitis during biting or by depositing feces or other materials on the skin thru a bite  R – rubella wound or traumatized skin area.  M – mumps  M – meningitis MRS. WEE (Direct Contact)  M – mycoplasma/meningeal pneumonia  An – adenovirus  M – ultidrug resistant organism  R – espiratory infection Note: “-itis” – inflammation  S – kin infections  W – ound infection 5. Portal of Entry to the Susceptible Host  E – ntric infection – clostridium difficile Microorganisms enter the body via:  E – ye infection – conjunctivitis  Mucous membrane VCHIPS (Skin Infections)  Non-intact skin  V – aricella zoster  GI tract  C – utaneous diptheria  GU tract  H – herpes simplex  Respiratory tract  I – mpetigo  P – ediculosis 6. Susceptible Host  Any person who is at risk for infection  S – cabies  Impairment of body’s natural defenses can Airborne transmission affect susceptibility to infection  Immunosuppressed children/elderly  Droplet nuclei or residue evaporated droplets in  Chronically ill clients air during coughing or sneezing or carries on  Clients w/ trauma or injury dust particles  May involve droplets or dust  Droplets nuclei – residue of evaporated droplets Course of Infectious by Stage by an infected host can remain in the air for long periods 1. Incubation period  Dust particles with infectious agent  Interval between entrance of pathogen o Material is transmitted by air currets to a into body and appearance of first suitable portal of entry, usually the symptoms respiratory tract, of another person  Chickenpox: 14-16 days after exposure  Ex. measles, chickenpox, tubercolosis  Common cold: 1-2 days  Influenza: 1-4 days My Chicken Hez TB/MTV (Airborne transmission)  Measles: 10-12 days  Mumps: 16-18 days  My – Measles  Ebola: 2-21 days  Chicken – Chicken Pox/Varicella 2. Prodromal Stage  Hez – Herpes Zoster/Shingles  Interval from onset of nonspecific signs  TB – Tuberculosis and symptoms (malaise, low-grad fever, or fatigue) to more specific symptoms  Microorganisms grow and multiply and  M – easles patients may be capable of spreading  TB disease to others  V – aricella-Chicken Pox/Herpes Zoster-Shingles  3. Illness Stage that can be transmitted by airborne, droplet, or  Interval when patient manifests signs and contact routes symptoms specific to type of infection  Ex. Strep throat is manifested by sore Airborne Precautions throat, pain, and swelling  Use for patients who have infections that spread 4. Interval through the air and possibly severe acute  Acute symptoms of infection disappear respiratory syndrome  Length of recovery depends on severity of 1) Focus on diseases that are transmitted by infection and patient’s hot resistance smaller droplets  Recovery may take several days to months  Smaller droplets remain in the air longer 2) Requires a specially equipped room w/ a Health Care Associated Infections negative air flow referred to as an airborne  a.k.a nosocomial infections and/or hospital- infection isolation room acquired infections  Air is not returned to the inside  acquired in a hospital or other health care ventilation system but is filtered through facility that were not present or incubating at a high-efficiency particulate air (HEPA) the time of a client’s admission filter and exhausted directly to the  hospital environment provides exposure to a outside variety of virulent organisms that the client has 3) All health care personnel must wear an N95 not been exposed to in the past respiratory every time they enter the room  infections can be transmitted by health care Droplet Precautions personnel who fail to practice proper hand washing or fail to change gloves between client  Focus on diseases transmitted by large droplets contacts (greater than 5 microns) in the air and by being 3ft from a patient 2 types of pneumonia  Wear surgical mask when within 3ft of the 1. Community-acquired patient, proper hand hygiene, and some 2. Hospital-acquired dedicated-care equipment How to Break Chain of Infection Contact Precautions  Decrease source of microorganisms  Use for direct and indirect contact w/ patients o Wash hands and their environment o Decontaminate surfaces and equipment  Direct contact refers to the care and handling o Avoid contact when contagious of contaminated body fluids  Prevent transmission of microorganisms  Require a gown and gloves o Wear personal protective equipment  Ex. Blood or other body fluids from an infected (PPE) patient o Follow isolation precautions  Indirect contact – transfer of an infectious  Maximize resistance agent thru a contaminated intermediate object o Provide good hygiene such as contaminated instruments or hands of o Ensure proper nutrition and fluid intake health care workers o Decrease stressors that weaken immune  The health care worker may transmit response microorganisms from one patient site to another if hand hygiene is not performed between Breaking the Chain of Infection patients 1. Standard Precautions  Observe contact precautions in the presence of  Use of PPE excessive wound drainage, fecal incontinence, or  Aseptic Techniques other discharges from the body that suggest an 2. Transmission-based Precautions increased potential for extensive environmental contamination and risk of transmission. Transmission Based Precaution  Place patient in a private room if available.  Wear PPE when entering the room for all  Used in addition to standard precautions for interaction that may involve contact w/ patient patients with suspected infection with pathogens  and potentially contaminated areas in the If hands are not clearly dirty, use an alcohol-based, patient’s environment. waterless antiseptic agent for the following clinical situations: Module  Each time a direct contact is made on a different patient (e.g., taking a pulse, lifting a patient) Asepsis  During donning doffing of sterile gloves and during invasive procedures such as such as a  the exclusion of pathogenic or disease-causing peripheral vascular, catheter, or urinary catheter microorganisms insertion Aseptic technique  In rendering patient care or handling body fluids or excretions, mucous membranes, non-intact  covers the practices or procedures that aim to skin, and wound dressings (even if gloves are minimize the risk for infection caused by worn) contamination of microorganisms  During patient care, when moving from a dirty  2 types: Medical and surgical asepsis to a clean body site Medical Aseptic Technique  After touching or handling objects or surfaces in the patient's room (e.g., overbed table, IV  involves the process that breaks the chain of pump) infection by reducing the microorganisms  After patient care, when gloves are removed present and preventing its transfer  These techniques should be used by all patients, Performing Hand Hygiene using Soap and Water whether with or without infection. 1. Assemble the necessary supplies and remove Examples: pieces of jewelry. 2. Open the faucet and adjust its pressure.  Hand hygiene 3. Wet the hands and wrist area and apply liquid soap  Barrier techniques and lather thoroughly.  Routine environmental cleaning 4. Wash the palms and backs of the hands, each finger, the spaces between the fingers, as well as Surgical Aseptic Technique the knuckles, wrists, and forearms using hard  commonly called sterile technique rubbing and circular motions.  prevents an open wound from being 5. A clean orangewood stick may be used to clean contaminated by infectious microorganisms and under the fingernails or fingernails of the opposite keeps an object or area sterile for surgery hand. 6. Rinse both hands thoroughly with water toward Hand Hygiene fingertips 7. Dry both hands with a paper towel, starting with  the most efficient common method for the fingers and going upward toward the forearm. preventing and managing infection Close the faucet with another paper towel and  Involves four techniques: (1) handwashing, (2) then discard. antiseptic handwash, (3) antiseptic hand rub, or surgical hand antisepsis Cleaning  a strong, quick rubbing of all surfaces of lathered hands together followed by 15 seconds  the process of eliminating organic (e.g., blood) of rinsing under a stream of warm water or inorganic (e.g., soil) material from objects  focuses on mechanically eliminating bacteria and surfaces comprises the use of water, from hands before rinsing them with water detergent/disinfectant, and general mechanical scrubbing. When to do Handwashing:  Prior to disinfection and sterilization, make sure everything is clean.  When hands are visibly filthy, contaminated with blood or other bodily fluids, before eating, and Different Types of PPE after using the bathroom.  When hands are exposed to spore-forming 1. Gowns organisms such as C. difficile, Bacillus anthracis,  main objective is to prevent soiling one's or norovirus clothes   Health care workers and visitors are Steps in doing Open Technique Method protected from infectious material, blood, and bodily fluids by wearing gowns or 1. Do hand hygiene. cover-ups. 2. Carefully separate and peel away the sides of the outer glove package wrapping.  When working with infectious materials, 3. Open the inner package and place it just above gowns are frequently required. waist level on a clean, flat surface. Open the  Fluid-resistant material is used to make package while keeping your gloves on the barrier-protection gowns wrappers on the inside surface. 4. Determine which glove is on the right and which 2. Face Masks  aims to decrease the risk of transmission is on the left 5. From your non-dominant hand, making use of of microorganisms through droplets and your thumb and first two fingers, hold the cuff’s airborne routes edge of the glove for your dominant hand. The Wear mask if: inside surface of the gloves only be touched. 6. Carefully pull the glove over the dominant hand, a) patient has an infection which are transmitted leaving the cuff and ensuring that it does not roll by large particle aerosol (droplets) up from the wrist. Be sure that the thumb and b) All persons entering the room of a patient, fingers are in proper space. primarily if the infection is transmitted by a small 7. With the gloved dominant hand, slip fingers particle by aerosols (droplet nuclei) like underneath the cuff of the second glove. pulmonary tuberculosis and SARS-CoV 8. Carefully pull the second glove over the non- Types of Face Mask dominant hand. Do not allow fingers and thumb of the gloved dominant hand to touch any part a) Cloth Mask (Cloth/paper mask) of the exposed non-dominant hand. Keep thumb b) 3-Ply Mask (3-ply surgical mask) of dominant hand abducted back. c) N95 Respirator (N95 respirator) 9. After the second glove is on, interlock fingers of gloved hands and hold away from the body 3. Eye Protection above waist level until beginning procedure.  special glasses or goggles that are worn during procedures that may produce Steps in doing Closed Technique Method splashes or splatter. 1. Open the inner sterile glove packet with your Some of these procedures include: hands covered by your gown sleeves. 2. With the dominant hand inside the gown cuff, o irrigation of a large abdominal wound or pick up the glove for the non-dominant hand by insertion of an arterial catheter wherein the HCP grasping the folded cuff. acts as an assistant. 3. Extend the non-dominant forearm with palm up  removable, reusable, or disposable side and place the glove’s palm against the palm of shields available in plastic glasses or the non-dominant hand. Glove fingers point goggles. toward the elbow.  the eyeglasses should fit firmly around the 4. Grasp back of glove cuff with the covered face to avoid fluid from getting between dominant hand and turn glove cuff over end of the face and the glasses the non-dominant hand and gown cuff. 4. Gloves 5. Grasp the top of the glove and underlying gown  help in the prevention of microorganism sleeve with the covered dominant hand. transmission both directly and indirectly Carefully extend fingers into the glove, being  gloves are needed when handling blood, sure that the glove cuff covers the gown cuff. body fluids, secretions, excretions 6. Glove dominant hand in the same manner, (excluding sweat), moist mucous reversing hands. Use the gloved non-dominant membranes, non-intact skin, or hand to pull on the glove. Keep hand inside. contaminated things or surfaces. 7. Ensure that both gloves' fingers are fully extended 2 Gloving Techniques 1. Open technique method 2. Closed techniques method Doffing Surgical hand scrub (with sponge or sponge brush) 1. Hold the palmar surface of the first glove, then carefully remove it. Ensure that the contact is 1. Wet sponge and apply anti-bacterial agent. glove to glove only. Imagine that each finger, hand, and arm has 2. Pull the first glove completely off by inverting or four sides. Effectively clean all four sides. Scrub rolling the glove inside out. one hand's nails with 15 strokes. With ten 3. Using the fingers of the remaining gloved hand, strokes, scrub the palm, each side of the thumb hold the inverted removed glove. Put the first and fingers, and the back of the hand. two fingers of the bare hand inside the cuff of 2. Divide the arm mentally into thirds: scrub each the remaining glove. third ten times. Some health care facility policies 4. The second glove can now be pulled off to the require scrub by total time (e.g., 5 minutes) fingers by turning it inside out. This will pull the rather than the number of strokes. Rinse brush first glove inside the second glove. and repeat sequence for the other arm. A two- 5. Do hand hygiene. sponge method may be substituted. 3. Discard the brush. Flex arms and rinse in one Surgical Asepsis continuous motion from fingertips to elbows,  refers to those techniques that keep an area or allowing water to run off at the elbow. While the object free of all microorganisms hands are raised in front of and away from the  includes practices that destroy all body, close the faucet with foot or knee control microorganisms and spores and enter the sterile area in a backward manner. When to use Surgical Asepsis 4. Proceed to the sterile setup carefully, holding the sterile towel so that water does not drip a) During procedures that require intentional onto the sterile arrangement. perforation of the patient's skin, such as 5. Grab one end of the sterile towel and dry one insertion of peripheral IV catheters or a central hand in a rotating motion, bending slightly at intravenous line the waist and maintaining hands and arms b) When the skin is not intact as a result of trauma, above the waist and outstretched. surgical incision, or burns 6. Carefully inverting the towel or using a new c) When doing invasive procedures such as sterile towel, repeat the drying technique for the catheterization and insertion of a wound drain opposite hand. Surgical Scrubbing 7. Place the towel in the linen bin or the hand of the circulating nurse 1. Remove bracelets, rings, and watches. 2. Make sure your fingernails are short, tidy, and in Optional: Brushless antiseptic hand rub good shape. Artificial nails must be discarded. 1. After pre scrub wash, dry hands and forearms 3. Inspect the cuticles, hands, and forearms for thoroughly with a paper towel abrasions, wounds, and open lesions. 2. Dispense 2 mL of antimicrobial agent hand 4. Wear surgical shoe covers, a cap or hood, a face preparation into the palm of one hand. Dip mask, and safety glasses fingertips of opposite hand into hand 5. Use knee or foot controls to turn on the water preparation and work it under nails. Spread and set the temperature to a comfortable level. remaining hand preparation over hand and up to 6. Pre Scrub wash/rinse: Wet hands and arms just above the elbow, covering all surfaces. under running lukewarm water and lather with 3. Using another 2 mL of hand preparation, repeat detergent to 5cm (2 inches) above elbows with the other hand. (hands need to be above elbows at all times). 4. Dispense another 2 mL of hand preparation into 7. Rinse hands and arms thoroughly under running either hand and reapply to all aspects of both water. Always keep hands above elbows. hands up to the wrist. Allow to dry thoroughly 8. Clean under nails of both hands with nail pick before donning gloves. under running water. Discard after use. 5. Proceed with sterile gowning.