Chapter 5 Infection control.pptx

Principles of Infection Prevention and Control Learning Objectives • Define health care–associated infections and state how often they occur. • Describe why infection prevention is important in respiratory care. • Identify and describe the three elements that must be present for transmission of in...

Principles of Infection Prevention and Control Learning Objectives • Define health care–associated infections and state how often they occur. • Describe why infection prevention is important in respiratory care. • Identify and describe the three elements that must be present for transmission of infection within a health care setting. • List the factors associated with an increased risk for a patient acquiring a hospital-acquired infection. • State the three major routes for transmission of human sources of pathogens in the health care environment. • Describe strategies to control the spread of infection in the hospital. • Describe how to select and apply chemical disinfectants for processing respiratory care equipment. • Describe equipment-handling procedures that help prevent the spread of pathogens. • Identify circumstances when special infection control procedures are warranted. • State when to use personal protective equipment during patient care. • Describe surveillance with regard to infection control. Infection Control About 4% of patients admitted develop a health care – associated infection Infections can be categorized by where they originate:  Community onset: Those that develop outside the hospital  Hospital-onset (AKA nosocomial): Those that develop in the hospital Health care–associated infection (HAI)  Infections that develop in a patient during the course of medical treatment Infection Control Efforts to decrease hospital-acquired infection and HAIs  Organized and coordinated by a hospital’s Infection Prevention (IP) program IP programs are charged with reducing the risk for HAIs  This protects patients, employees, and visitors IP programs provide guidance to their organizations  So that they can break the chain of events leading to HAIs Spread of Infection Three elements must be present for transmission of infection within a health care setting: I. A source (or reservoir) of pathogens II. A route of transmission for the pathogen III. A susceptible host Sources of Infections Agents Humans are primary source:  Patients, personnel, or visitors Inanimate objects  Contaminated medical equipment, linen medications Patients quickly contaminate their local hospital environment People  Via endogenous flora Susceptible Hosts Susceptibility and resistance to infection vary greatly Host factors increasing chance of infection are:  Poorly controlled diabetes mellitus  Extremes of ages  Underlying acquired (human immunodeficiency virus [HIV] infection)  Iatrogenic o Chemotherapy o Placement of tubes and catheters Modes of Transmission The three major routes for transmission of human pathogens in the health care environment are: Mode of transmissi on contact Direct Indirect Droplet airborne Contact Transmission The most common route of transmission Divided into two subgroups:  Direct o Occurs less frequently than indirect contact in the health care environment Indirect o Most frequent mode of transmission o Involves transfer of a pathogen through a contaminated intermediate object or person o Fomites Contact Transmission Contact Transmission Droplet Transmission A form transmission via respiratory droplets Respiratory droplets are generated when an infected individual discharges large contaminated liquid droplets into the air by coughing, sneezing, or talking  Usually ≤3 feet through the air  Also generated during procedures such as suctioning, bronchoscopy, and cough induction Droplet Transmission Airborne Transmission • Occurs via the spread of airborne droplet nuclei • These are small particles (≤5 μm) of evaporated droplets containing infectious microorganisms • Can remain suspended in air for long periods • Can travel further distances than droplets • Special air handling and ventilation/respiratory protection is required to help prevent airborne transmission Other Sources of Infection Not involving person-to-person transmission  Exposure to pathogens in contaminated food, water, or medications (e.g., heparin solution)  Vector-borne transmission of infectious diseases from insects and rats and other vermin occurs (less significant in U.S. health care facilities) Infection Prevention Strategies: Creating a Safe Culture Creation by leadership at all levels A shared commitment to patient and health care worker safety The responsibility of each individual health care worker Each person is empowered and willing to speak up and “stop the line” • Comprehensive Unit-Based Safety Program (CUSP) • Support of best practices • • • • Infection Prevention Strategies: Maintaining a Healthy Workforce Occupational Safety and Health Administration (OSHA): • A sick health care worker not only has difficulty executing assignments but could also serve as a source of infection for vulnerable patients • Employee immunization and chemoprophylaxis Tips Infection Prevention Strategies:Eliminating the Source of Pathogens Standard infection prevention procedures always include efforts to:  Eliminate pathogens  Recommended practices for cleaning and disinfecting noncritical surfaces in patient care areas Two major categories:  General sanitation measures  Specialized equipment processing Infection Prevention Strategies: Eliminating the Source of Pathogens Methods that kill bacteria  Bactericidal Methods and techniques that inhibit the growth of bacteria  Bacteriostatic Methods that destroy spores  Sporicidal Methods that destroy viruses  Virocidal Infection Prevention Strategies: Interrupting Routes of Transmission • Health care personnel must take measures to stop infection • Best practice recommendations by Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Centers for Disease Control and Prevention (CDC) Standard Precautions The simplest level of infection control The primary strategy for the prevention of health care–associated transmission of infections Health care worker should employ personal protective equipment (PPE)  Various barriers used alone or in combination to protect mucous membranes, skin, and clothing from contact with infectious agents Standard Precautions Hand hygiene Gloves Mouth, eye protection, face shields Respiratory protection Gowns Patient care equipment Occupational health and blood-borne pathogens Patient placement Hand Hygiene An essential element of standard precautions Hand hygiene includes hand- washing with either plain or antisepticcontaining soap and water for at least 15 seconds or the use of alcohol-based products (gels, rinses, and foams) Hand Hygiene 1 Perform hand hygiene before and after patient contacts, immediately after removing gloves, and when otherwise indicated to avoid cross contamination. 2 Perform hand hygiene after touching blood, body fluids, secretions, excretions, and contaminated items, even if wearing gloves. 3 Perform hand hygiene between tasks and procedures on the same patient if cross contamination of different body sites is possible (e.g., tracheostomy care after assistance with a bedpan). 4 Use an approved alcohol-based product for routine hand hygiene. If hands are visibly soiled, use soap and water. Hand Hygiene Hand Hygiene Gloves Gloves protect both patients and health care workers. Gloves protect caregivers from contamination when they are contacting blood, body fluids, secretions, excretions, mucous membranes, and nonintact skin of patients and when they are handling or touching visibly or potentially contaminated patient care equipment and environmental surfaces Gloves Perform hand hygiene before and after removing gloves. Wear clean gloves when touching blood, body fluids, secretions, excretions, and contaminated items. Don clean gloves just before touching mucous membranes and non-intact skin. Change gloves between tasks and procedures on the same patient after contact with infectious material. Remove gloves promptly after use, before touching non-contaminated items and environmental surfaces, and before going to another patient. Masks, Eye Protection, Face Shields Face protection is an important component of standard precautions because the mucous membranes of the eyes, nose, and mouth are particularly vulnerable to some types of pathogens. Wear a mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions. Face Shields Masks Eye Protection Respiratory Protection Respiratory protection (use of NIOSH-approved N-95 or higher level respirator) The term respiratory protection has a regulatory context that includes components of a program required by OSHA to protect workers. It requires: (1) medical clearance to wear a respirator (2) provision and use of appropriate- ate NIOSH-approved fit-tested respirators (3) education in respirator use. Respiratory Protection Gowns Wear a clean gown to protect skin and prevent soiling of clothing during procedures and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions. Remove a soiled gown as promptly as possible and perform hand hygiene to avoid transfer of microorganisms to other patients or environments. Cough Etiquette The elements include: Education of health care personnel, patients, and visitors Posted signs in language appropriate to the population served with instructions for patients and accompanying family members or friends Source control measures (covering the mouth and nose with a tissue when coughing or placing a surgical mask on a coughing person when possible) Cough Etiquette Hand hygiene after contact with respiratory secretions Spatial separation (≥3 feet from persons with respiratory infections in common waiting areas). Precautions Used in Addition to Standard Precautions Transmission-Based Precautions Contact precautions o Intended to reduce the risk for transmission by direct or indirect contact with the patient or the patient’s environment Droplet precautions o Employed for patients with presumed or confirmed infection with organisms known to be transmitted by respiratory droplets Precautions Used in Addition to Standard Precautions Precautions Used in Addition to Standard Precautions Airborne infection isolation Isolation techniques intended to reduce risk of selected infectious agents transmitted by “small droplets” of aerosol particles, such as M. tuberculosis Use of N-95 respirator Room must be negative pressured, have 6-12 air exchanges per hour, and use HEPA filters Precautions Used in Addition to Standard Precautions Precautions Used in Addition to Standard Precautions Protective environment Specialized engineering approach to protect highly immunocompromised patients Used with allogeneic stem cell transplant patient Includes: HEPA filtration of incoming air, directed room air flow, positive room air pressure relative to corridor, well-sealed rooms to prevent infiltration of outside air, ventilation to provide 12 or more air changes per hour, strategies to reduce dust, and prohibition of dried and fresh flowers and potted plants in rooms Practice Question What is the difference between Contact precautions, Droplet precautions, and Airborne precautions? Transport of Infected Patients Limit the transport of patients with contagious disease When transport occurs: The patient needs to wear appropriate barrier protection If manually ventilating during the transport of a patient on respiratory precautions, ensure that a filter is placed on the expiratory side of the manual resuscitator device Transport of Infected Patients Medical Devices and Bundles A large percentage of HAIs are device-related infections including Ventilator-associated pneumonia (VAP) Catheter-related bloodstream infection Catheter-associated urinary tract infection Prevention bundles The use of multiple different evidence-based best practices to prevent device-related infection Have been shown to decrease the incidence of HAIs significantly Disinfection and Sterilization Cleaning Cleaning is first step in all equipment processing Involves removing dirt and organic material Failure to clean equipment properly can render all subsequent processing efforts ineffective Soaps and detergents need to be used Noncritical items, such as commodes, intravenous pumps, and ventilator surfaces, must be thoroughly cleaned and disinfected before use with another patient Disinfection and Sterilization Disinfection Disinfection destroys vegetative form of all pathogens except bacterial spores Disinfection can involve either chemical or physical methods Pasteurization is most common physical method Disinfection and Sterilization Chemical Disinfection Chemical disinfection involves application of chemical solutions to contaminated equipment or surfaces Equipment must be immersed in solution for set period of time Many chemical methods used to disinfect respiratory care equipment Labels should be read carefully and instructions properly followed during use Disinfection and Sterilization Sterilization Destroys all microorganisms Can be achieved with physical and chemical approaches Steam sterilization is most common and easiest Low-temperature sterilization technologies include ethylene oxide: colorless and toxic gas Medical devices contacting sterile body tissues or fluids are critical items and should be sterile before use Disinfection and Sterilization Immediate Use Sterilization Previously referred to as flash sterilization Item is placed in an open tray or a specially designed container to allow for rapid penetration of steam Not recommended as a routine method of sterilization Low-Temperature Sterilization Technologies Less than <60° C ETO, hydrogen peroxide gas plasma, ozone, vaporized hydrogen peroxide, and peracetic acid Equipment-Handling Procedures Include: Maintenance of in-use equipment Processing of reusable equipment Application of one-patient–use disposables Fluid and medication precautions Respiratory care equipment that can spread pathogens include: nebulizers, ventilator circuits, bag-valve-mask devices (BVMs, or manual resuscitators), and suction equipment Oxygen therapy and pulmonary function equipment are also implicated as potential sources of nosocomial infections Equipment-Handling Procedures Nebulizers Large-volume nebulizers are often a problem Small-volume nebulizers can also produce bacterial aerosols Ventilators and circuits Circuits pose greatest risk for infection High-efficiency particulate air/aerosol (HEPA) filters help reduce endotracheal tube contamination Equipment-Handling Procedures Other respiratory care devices Bag-Mask Devices Suction Systems Oxygen Therapy Apparatus Pulmonary Function Equipment O2 analyzers handheld bedside spirometer Equipment-Handling Procedures Reprocessing Reusable Equipment Factors to consider: Bronchoscope Reprocessing Bronchoscopes routinely become contaminated with high levels of organisms during a procedure  Because of the body cavities in which they are used  The most common reasons for transmission include failure to adhere to recommended cleaning and disinfection procedures, failure of automated endoscope reprocessors, and flaws in design Disposable Equipment An important alternative to reprocessing equipment continually is employing single patient-use disposable devices Three major issues are involved in using disposable devices:  Cost  Quality  Reuse Handling contaminate articles and equipment Handling Laboratory Specimens Surveillance for Hospital- Acquired Infections Surveillance  An ongoing process of monitoring patients and health care personnel for acquisition of infection, colonization of pathogens, or both Infection control committee establishes surveillance policies, and infection control expert administers them Common for infection prevention programs to oversee hand hygiene and standard precautions adherence observations Surveillance for Hospital-Acquired Infections Most hospitals perform surveillance for device-related infections:  Central line-associated bloodstream infections (CLABSI)  Catheter-associated urinary tract infections (CAUTI) VAPs The VAP surveillance definition has significant limitations  Surveillance is performed to look for ventilator- associated events (VAE) Ventilator-Associated Events VAEs are broken down into three tiers:  Ventilator-associated condition (VAC)  Infection-related ventilator-associated complication (IVAC)  Possible VAP (PVAP) Ventilator-Associated Events VAE surveillance starts with the identification of a VAC defined as: an increase in the daily minimum positive end expiratory pressure (PEEP) Or daily minimum fraction of inspired oxygen (FiO2) for 2 calendar days or longer after a period of stability Thank You