Class 2_Infection Control_BB_F 2024-1.pptx

Infection Control Principles Hess, Chapter 31 Class Routine Lecture vs. Lab Breaks PowerPoints / Slides Study & read everyday  Quiz #1 Which of the following are true statements? I. I’ve been biten by snakes ~ 50 times. II. I was a pilot in the USAF. II...

Infection Control Principles Hess, Chapter 31 Class Routine Lecture vs. Lab Breaks PowerPoints / Slides Study & read everyday  Quiz #1 Which of the following are true statements? I. I’ve been biten by snakes ~ 50 times. II. I was a pilot in the USAF. III. I performed in a professional improv company. IV. I use to be a semi-professional race car driver. V. I was the keyboardist in a touring rock band. a. II, IV, and V are correct. b. II, III, and IV are correct. c. I, II, and III are correct. d. All the above are correct.  Quiz #2 Which of the following is not true? 1. I broke my leg hiking in the mountains of Arizona. 2. I’ve been to China 10 times. 3. I have 3 kids and 3 grandchildren. 4. I once owned an art & photography studio. 5. I own a German Sheppard named Lucy.  Importance of Hand-washing Hand-washing is the most important way to prevent the transmission of microorganisms via the contact route of transmission. Different techniques may be used in various areas of the hospital… Scrub or Wash?  Importance of Hand-washing The 20-second scrub is the most common duration of hand-washing in the hospital setting. It is used between patients, before preparing medications, before and after eating, and after contact with contaminated equipment Even when wearing gloves, discard the gloves following patient or body fluid contact and wash your hands.  Importance of Hand-washing The three-minute scrub should be used when arriving at work in the hospital or leaving the facility at the end of the day. The lower forearms, wrists, and hands are thoroughly scrubbed.  Transmission Route There are five major routes for transmission of pathogens: contact, droplet, airborne, common vehicle, and vectorborne.  Host The mere presence of microorganisms in a host is called colonization. Infection results when microorganisms cause cell or tissue damage. Whether a host actually becomes infected or not depends on both the organism’s virulence and the host’s resistance.  Immunocompromised and Burn Patients Patients with leukemia, cancer, and severe burns, or patients receiving immunosuppressive therapies are highly susceptible to infection. Neutropenia – A decrease in the number of neutrophils (WBC) in the blood. In the past, these patients were placed in “protective isolation.” Recent evidence indicates that this approach is no more useful in preventing infection than rigorous hand-washing.  RULE OF THUMB All respiratory care practitioners, due to their frequent contact with contaminated blood and body fluids, should undergo immunization against hepatitis. Hepatitis B vaccine x 3 with a titer drawn to prove immunity.  Standard Precautions Standard Precautions are strongly recommended for all hospitals. Standard Precautions require that the health care provider make informed decisions as to the likelihood of coming into contact with moist body fluids.  Standard Precautions You! must then decide which infection control procedures are most appropriate for the immediate situation. Gloves? Goggles? Gown? When would or should you change your gloves or gown?  Standard Precautions Treat everyone! no matter who, as if they have an infectious communicable disease. This is a habit that must be formed.  Airborne Transmission Patients requiring isolation should have the door closed. Laminar flow (airflow without turbulence) in the ICU, ER, and surgery suites is intended to minimize airborne transmission  Respiratory Protection Caregivers entering N95 the patient’s room should wear additional respiratory protection consisting of an OSHA- approved High Efficiency Particulate Air (HEPA) mask.  Mycobacterium Tuberculosis M. Tuberculosis is a slow growing bacteria. TB is carried in airborne particles. These 1-5 micron sized particles are so small that ordinary air ventilation keeps them airborne and circulates the particles throughout a room, building, or vehicle. The HEPA N95 mask is able to filter at a 0.3 micron size with a 99.97 percent efficiency level.  Patient Transport Avoid transporting patients who are infected with TB, varicella, and measles within the hospital unless for specific essential purposes only. When transporting these patients, have the patient wear a simple surgical mask or a HEPA mask. This will help to prevent the transmission of droplet nuclei.  Droplet Transmission Droplets are generated by: coughing, sneezing, talking When performing procedures: bronchoscopy assisting, suctioning artificial airways, changing a ventilator circuit.  Vehicle Transmission This may involve instruments, contaminated water or food, soil, or other objects. (fomite) Vehicle transmission is important to recognize in respiratory care since some equipment may be used on more than one patient. (Awareness)  When to use gloves? When touching blood, body fluids, secretions, excretions, mucous membranes, broken or non- intact skin, and contaminated items or linens. Anytime you move/position a patient, working around Ventilators or when you suspect that there is a chance of contact.  Disposing of Gloves Always remove your gloves (fold over on self) and properly dispose of them, washing your hands between every patient or soiling of gloves. Remove in the patient’s room, not outside.  Be aware of: When using gloves, be aware of Latex allergies and sensitivity. Markings to ID The Gloves for PPE are not Sterile  Use of Mask, Eye Protection, or Face Shield Use when you as a health care provider feel you may be at risk for being splashed or sprayed by blood, body fluids, secretions, or excretions. You should protect your mouth and eyes with a mask and eye protection or a face shield.  Gowning The use of a gown is indicated to protect your skin and soiling of your clothing during procedures or patient care situations that may produce splashes or sprays of blood, body fluids, secretions, or excretions.  Sharps Precautions Do not ever attempt to recap a needle; this is the most frequent cause of needle sticks. Use blunt needles when drawing up medication from a multidose vial.  Sharps Precautions Special puncture-proof containers are provided for the disposal of these items.  Multi-drug Resistant Organisms (MDRO) are common bacteria (germs) that have developed resistance to multiple types of antibiotics. These bacteria are present on the bodies of many people, including on the skin, in the nose or other moist areas of the body, and in secretions.  What is MRSA? Methicillin Resistant Staphylococcus Aureus Staphylococcus aureus is a bacterium often found in 20-30% of the noses of normal healthy people and is also commonly found on people's skin. Most strains of this bacterium are sensitive to many antibiotics and infections can be effectively treated.  Is MRSA dangerous? MRSA – Methicillin-resistant Staphylococcus aureus. MRSA rarely, if ever, presents a danger to the general public. It is no more dangerous or virulent than methicillin- sensitive S. aureus but it is more difficult to treat. This bacterium is usually confined to hospitals and in particular to vulnerable or debilitated  How is spread of MRSA prevented? Scrupulous hand washing by hospital staff before and after contact with patients and before any procedure, is the single most important infection control measure. It is most likely to prevent spread of MRSA from one patient to another, or from patient to member of staff who may subsequently pass the bacterium on to other patients.  What is VRE? Vancomycin-Resistant Enterococcus.  Vancomycin-Resistant Enterococcus A mutant strain of Enterococcus that originally developed in individuals who were exposed to the antibiotic. It was first identified in Europe in 1986, and in the U.S. in 1988.  Vancomycin Is a powerful antibiotic that is often the antibiotic of last resort. It is generally limited to use against bacteria that are already resistant to penicillin and other antibiotics.  Why is it dangerous? It is not dangerous in healthy people with strong immune systems, where the balance of healthy flora in their digestive tract helps keep VRE from getting out of control.  VRE is dangerous because It cannot be controlled with antibiotics, and it causes life-threatening infections in people with compromised immune systems - the very young, the very old, and the very ill.  C. Diff Clostridium difficile [klo-STRID-ee-um dif-uh-SEEL] Is a bacterium that causes diarrhea and more serious intestinal conditions such as colitis.  Who is most likely to get C. diff infection? The elderly and people with certain medical problems have the greatest chance of getting C. diff. C. diff spores can live outside the human body for a very long time and may be found on things in the environment such as bed linens, bed rails, bathroom fixtures, and medical  Clostridium difficile (C. DIFF) C. diff infection can spread from person-to person on contaminated equipment and on the hands of doctors, nurses, other healthcare providers, and visitors.  Acinetobacter (ass in ée toe back ter) Acinetobacter poses very little risk to healthy people. However, people who have weakened immune systems, chronic lung disease, or diabetes may be more susceptible to infections with Acinetobacter. Acinetobacter can be spread to susceptible persons by person-to-person contact, contact with contaminated surfaces, or exposure in the environment.  ESBL Extended Spectrum Beta- Lactamase It's an enzyme found in some strains of bacteria and is not limited to any one specific type of bacteria. The bacteria use ESBLs to become resistant to antibiotics. The most common types of bacteria that produce ESBLs include: Escherichia coli Klebsiella Penicillin and cephalosporin are not effective against ESBLs. Cleaning, Disinfection, and Sterilization of Medical Equipment An Attitude & A Skill DO IT RIGHT !  SPREAD OF INFECTION Three elements must be present for an infection to spread: (1) a source of pathogens (2) a susceptible host (3) a route of transmission  Source In the hospital, the primary sources of pathogens are either people (patients, personnel, or visitors) or contaminated objects (for example, equipment, linen, medications).  Host A host refers to a living organism that acts as a harbor for invading pathogenic organisms. The host also includes the living cells, tissue and any specialized organs of a living organism. The host can be humans, plants, or most likely, animals.  Microorganisms and virulence Virulence – The disease evoking severity of a pathogen. Highly virulent organisms need only be present in small numbers to cause infection. Microorganisms of low virulence must exist in large numbers to cause infection or be present in an immunocompromised host.  EQUIPMENT PROCESSING Cleaning is the first step in all equipment processing. Cleaning involves removing dirt and organic material from equipment, usually by washing Failure to properly clean equipment can render all subsequent processing efforts ineffective. Cleaning should take place in a designated facility with separate dirty and clean areas.  Sterilization vs. Disinfection Disinfection and sterilization are both decontamination processes. Disinfection is the process of eliminating or reducing harmful microorganisms from inanimate objects and surfaces. Sterilization is the process of killing all microorganisms, including spores.  Prior to cleaning, Disassemble the equipment and examine it for worn parts. After disassembly, you should place the parts into a clean basin filled with hot water and soap or detergent. Water alone cannot dissolve organic matter; we must use soaps or detergents to clean equipment.  After cleaning, Carefully rinse and dry all equipment. Good rinsing removes any soap or detergent residues, which can irritate human tissue. Drying is important because residual water dilutes and alters the pH of disinfectant solutions.  Disinfection Destroys the vegetative form of pathogenic organisms but cannot kill bacterial spores. Disinfection can involve either physical or chemical methods. The most common physical method of disinfection is pasteurization. There are many chemical methods used to disinfect respiratory care equipment.  Pasteurization The application of moist heat at temperatures below the boiling point of water. Like heat sterilization, pasteurization coagulates cell proteins. Pasteurization temperatures are too low to kill spores.  Respiratory care equipment Pasteurized using the batch method. In this process, you immerse previously cleaned equipment in a water bath at 70C for 30 minutes. These conditions kill all vegetative bacteria and most viruses, including HIV. Most equipment can easily withstand these conditions without damage.  Categories of disinfectants Low, intermediate and high-level  Low-Level Disinfectants. Kill most bacteria and some viruses and fungi but do not eliminate resistant microorganisms such as Mycobacterium tuberculosis, spores, and nonlipid viruses. Agents in this category include acetic acid and the quaternary ammonium compounds, or “quats.”  Acetic acid Found in white vinegar; has been used for disinfection in both the hospital and home. A 1.25% solution, equal to one-part white vinegar (5% acetic acid) to three parts water, kills most vegetative bacteria, including Pseudomonas aeruginosa.  Quaternary ammonium Compounds, or “quats,” are cationic detergents containing ammonium Modern third-generation quats are fungicidal, bactericidal, and virucidal against lipophilic viruses; but not sporscidal or tuberculocidal. Quats can retain their disinfectant activity for up to 2 weeks if kept undiluted  Intermediate Level Disinfectants. Can kill all vegetative bacteria and fungi but have variable activity against spores and certain viruses. Agents in this category include the alcohols, phenolics, and iodophors. Alcohol wipes are a good choice for disinfecting small surfaces, such as medication vial tops. Alcohols are also useful as surface disinfectants for stethoscopes, ventilators, manual ventilation bags, etc.  High-Level Disinfectants. Can destroy all microorganisms except bacterial spores. Some agents are also sporicidal, given sufficient exposure time. Common high-level chemical disinfectants include glutaraldehyde, stabilized hydrogen peroxide, chlorine (sodium hypochlorite), and peracetic acid.  Glutaraldehyde It has a broad-spectrum antimicrobial activity, that works well in the presence of organic matter and does not damage metals, lensed instruments, rubber, or plastics. This makes it ideally suited for high-level disinfection or sterilization of endoscopes, respiratory, and anesthesia equipment.  Glutaraldehyde The minimum exposure time for these applications is 20 minutes. Due to its toxicity and high cost, glutaraldehyde should not be used as a disinfectant for either surfaces or noncritical items.  Glutaraldehyde Healthcare workers exposed to glutaraldehyde vapors have reported various forms of tissue inflammation, including epistaxis, rhinitis, and asthma  Selection of a Disinfectant Sodium hypochlorite (household bleach) is a fast- acting, inexpensive and broad-spectrum disinfectant. Exposure to a 1:50 dilution for 10 minutes is sufficient to kill vegetative bacteria & bacterial spores. The CDC recommends a 1:10 dilution of bleach to clean blood spills.  Sterilization The complete destruction of all forms of microbial life. Both physical or chemical means can achieve sterilization. Chemical methods of sterilization include ethylene oxide gas and selected liquid solutions. For most objects, heat is the quickest and easiest sterilization method.  Incineration, Burning, is used for sterilization only when the object has no further use or is so contaminated as to prohibit its reuse. Dry heat sterilization uses a simple hot-air oven. To sterilize items, you simply place them in the oven for 1 to 2 hours at temperatures between 160 to 1800 C.  Autoclaving The application of steam under pressure. Autoclaving is efficient, quick, cheap, clean, and reliable. Unfortunately, most respiratory care equipment is heat- labile and can be damaged by autoclaving. Pressure Steam Sterilization (Autoclaving) Steam sterilization is the most common and most preferred method employed for sterilization of all items that penetrate the skin and mucosa if they are heat stable. Steam sterilization is dependable, non-toxic, inexpensive, sporicidal, and has rapid heating and good penetration of fabrics. Method The steam must be applied for a specified time so that the items reach a specified temperature. For unwrapped items: 121 °C for 20 min. at 1.036 Bar (15.03 psi) above atmospheric pressure. 134 °C for 3-4 minutes at 2.026 Bar (29.41 psi) above atmospheric pressure.  EQUIPMENT HANDLING PROCEDURES Equipment handling procedures that help prevent the spread of pathogens include maintenance of in use equipment, processing of reusable equipment, the use of disposables, and fluid and medication precautions.  Large-volume nebulizers The worst offenders. Contamination occurs via use of nonsterile fluids, entrainment of contaminated air, handling of internal parts, or by back-flow of condensate (from the delivery tubing) into the reservoir. Once bacteria is introduced into the reservoir, it can multiply enough within 24 hours to cause infection if nebulized and inhaled.  Ventilators and Ventilator Circuits It is the external ventilator circuitry that poses the most significant contamination risk, particularly in systems using heated humidifiers. The humidifiers themselves are rarely the problem. Bubble or wick designs produce little or no aerosol, and thus pose minimal infection risk.  Fluids and Medications Precautions Contaminated fluids and medications are a common source for spreading infections. Unit dosing has decreased but not eliminated the infection hazard associated with medications.