Infection Control PSW 159 Lecture Notes PDF

Welcome to PSW 159 Professors Jacobs Preventing Infection Sorrentino’s Textbook Chapter 19 – Page 376 This Photo by Unknown Author is licensed under CC BY-N Infecti Refers to policies and procedures used to prevent the spread of infec...

Welcome to PSW 159 Professors Jacobs Preventing Infection Sorrentino’s Textbook Chapter 19 – Page 376 This Photo by Unknown Author is licensed under CC BY-N Infecti Refers to policies and procedures used to prevent the spread of infection within health care settings. on To prevent infection, you must understand how Contro infections spread. You must also be able to recognize the signs and l symptoms of infection to help treat it and prevent further spread.  Microorganis (Microbe) is a form of life ms so small it can only be seen under a microscope. Live and grow everywhere. Water, air, food, soil, plants, and animals. On inanimate objects: clothing, furniture, medical equipment, and personal items. Fomite(nonliving material) Also grow on people: in the mouth, nose, respiratory tract, stomach, intestines,  Pathogens – Microbes that are harmful and can cause infection or disease Non-pathogens – Most microbes usually do not cause infection or disease. 6  Reservoir Infectious Hiding Places Agent The Germ The Pathogen Chain of Susceptible Transmissio Portal of Host Exit Next Sick n Way Out Person (Infection) Means of Portal of Transmission Entry Getting Around Way In  What is a Bacteria? Single celled microbes that naturally occur on living, dead , or inanimate objects. Multiply rapidly. Can remain dormant. #1.Pathoge Protective shell called endospore, ns make it difficult to kill. Under the right condition can become active. Treated with antibiotics 8  What are viruses? microbes that grow only inside living cells. AIDS, hepatitis, influenza, and the common cold. #2. Virus Can kill host cells while producing new virus particles. Antibiotics – not effective Vaccines – may prevent (measles, mumps, rubella polio, influenza) 9  What are Fungi? microbes that live only on organic matter, such as plants and animals. Yeasts and moulds are common. Can affect the #3. Fungi mouth, vaginal area, skin, feet, and other body areas. Athlete's foot. Candida – (Thrush) 10  What are Parasites? derive nourishment and protection from other living things. #4. Parasites Transmitted from animal to human, human to human, or human to animals Transmitted through contaminated food or water 11  Examples of parasites Protozoa – may infest human fluids Ex: Amoebas, flagellates, ciliates This Photo by Unknown Author is licensed under CC BY- Pathogenic animals Examples: Roundworms Flatworms, flukes Parasitic mites, ticks, lice, fleas Biting or stinging wasps, bees, mosquitoes, spiders 12 This Photo by Unknown Author is licensed under CC  Normal Flora Microbes that usually live and grow in a certain area – nonpathogen. When a nonpathogen is transmitted from its natural site to another site or host, it becomes a pathogen. What is E coli? Escherichia coli (E. coli) is a bacterium found in the colon and This Photo by Unknown Author is licensed under CC assists with food metabolism (breakdown). If E. coli enters the urinary system, it can cause a serious urinary tract infection 14 This Photo by Unknown Author is licensed under CC  This Photo by Unknown Author is licensed under CC BY-NC-ND Antibiotic use can also kill off some of the natural flora. The person can develop a FYI secondary infection. Antibacterial soaps – overuse can destroy natural balance of a person’s natural flora. 15  Multi-Resistant Organisms (MRO’s) Bacteria reproduce very quickly and in large numbers. Not enough normal flora to stop them from multiplying. Misuse and over prescription of antibiotics in past have led certain strains of bacteria to mutate (change) spore coats to protect themselves.  This makes the bacteria more Multi- resistant to normal flora and Resistant antibiotics. Organisms Known as (super bugs) (MRO’s) Continued Since they are difficult to treat, they can become fatal. Easily spread among babies, older adults, and people with serious medical condition or weakened immune system.  Multidrug Resistant Organisms MRSA VRE C-difficile These Infections require Special Precautions Refer to Sorrentino Textbook – Page 381 – 382 Box 19.1  2.Reservoir (Host) Define: Environment where a microbe lives and grows before infecting a person Pathogens can live on or in a person or animal (a host), food, water, soil, inanimate objects Best environments: water and nourishment Oxygen some are anaerobic (do not need Oxygen.) Warmth, Survive best at body temperature Dark Destroyed by heat and light 19  Path in which the infection leaves the reservoir host., body 3. Portal of openings (mouth, nose, rectal, vaginal and urethra), breaks in skin or mucous membranes Exit Carried by blood, body fluids or secretions – urine, stool, vomit, saliva, mucus, pus, wound drainage, vag, semen, sputum  STOP THE SPREAD AND COVER YOUR MOUTH 21  4. Mode of Transmission How the pathogen travels from the portal of exit to the next reservoir (host): May be transmitted by contact (direct or indirect) Droplets – microbes are spread across short distances (coughing, sneezing, talking) less than 1 metre or 4 feet. Airborne- microbes are spread through long distances (air currents, dust particles) more than 1 metre or 4 feet Vehicle – microbes are spread by a contaminated source.(food, water, medication, invasive medical equipment) Vectorborne – microbes are spread when insects (fleas, ticks, mites, mosquitoes) or pests (mice) transmit the microbe to humans Review Sorrentino Textbook – Page 388 – 389 - Table 19.1 Modes of Transmission of Microorganisms 22 Portal of Entry Where it enters the new host. (body openings and breaks in the skin)  Susceptible Host A person at risk for infection. A person who has never been exposed to that pathogen. Depends on the person’s immune system. The immune system protects the body from infection. Compromised = weakened  Factors that increase risk of infection (Susceptible Host) Extremes of age ( young and old) Poor nutrition Stress Lack of sleep The presence of disease or illness Certain medication Invasive procedures Invasive devices - IV  Factors that increase risk of infection (Susceptible Host) Open wounds Living in close contact with people who have communicable diseases Having contact with several care givers Immunocompromised The immune system is weakened. 26  Possible Outcomes Being exposed to pathogens does not always result in infection: #1. The immune system destroys the pathogen’ #2. The immune system does not destroy the pathogen, but an infection does not develop. “Carrier” Colonization - occurs when bacteria live on or in the body and survive as part of the person’s natural flora. # 3. An infection develops sometime after exposure. Incubation Period - May be short or last for years. During this time, it can be transferred to others. 27  Infection Definition: Infection - A disease state resulting from the invasion and growth of microbes in the body. A local infection is in one part of the body. A systemic infection involves the whole body. Communicable (Contagious) Disease - spreads easily such as: common cold, influenza, pneumonia, hepatitis, tuberculosis, chicken pox, AIDS. Students to read on their own Table 19.2 Sorrentino page 390 - 392 28 This Photo by Unknown Author is licensed under CC Communicable Phase: the time during which a person is at risk of transferring pathogens to others. putting people at risk of “catching” the illness. 29 This Photo by Unknown Author is licensed under CC  Signs and Symptoms of Infection Fever/chills Increased pulse and respiratory rates Aches, pain, and tenderness Fatigue and loss of energy Loss of appetite Nausea Diarrhea Sorrentino Textbook – Page 383 – Box 19.2 30 This Photo by Unknown Author is licensed under CC BY-  Signs and Symptoms of Infection - Continued Rash Sore on mucous membranes Redness and swelling of a body part Discharge or drainage from the infected area that may have a foul odour New or increased cough, sore throat, or runny or stuffy nose Burning pain when urinating or frequency or urgency 31 This Photo by Unknown Author is licensed under CC BY-  Infection in Older Adults Higher risk More likely to become seriously ill + die Fever, pain, and swelling are usually absent They have lower body temperature, decreased body temperature, and less immune response 32 This Photo by Unknown Author is licensed under CC BY-  Infection in Older Adults - Continued Only signs might be a change in behaviour Increased confusion or delirium Increased incontinence Loss of appetite Decreased ability to do ADL’s Falls Changes in mood 33 This Photo by Unknown Author is licensed under CC BY-  Infections in Health Care Settings Health care-associated infection(HAI) OR also called Nosocomial Infection An infection acquired while a patient, client, or resident in a health care facility from any type of health care provider. This Photo by Unknown Author is licensed under CC BY- Ways the Support Worker can break the chain of infection Take care of yourself Rest (6-8 hrs. of sleep) Follow Canada’s food guide No smoking Remain active Keep immunization up to date. This Photo by Unknown Author is licensed under CC BY-NC-  Vaccination Health care agencies require workers to have their routine vaccinations up to date before they start work Hepatitis B vaccine – (2nd shot) Hepatitis B is spread through direct contact with contaminated blood or body fluids. Affects the liver, jaundice, loss of appetite, changes in urine and stool. Incubation period: 4-20 This Photo by Unknown Author is licensed under CC BY-ND weeks  Vaccination - Continued Flu vaccine – (must have record of) What is it: Respiratory tract infection caused by virus. Different strains Signs & Symptoms: sudden onset, headache, chills, and cough, followed by fever, loss of appetite, muscle aches and tiredness. This Photo by Unknown Author is licensed under CC BY-SA-NC Cold-like symptoms including runny nose, sneezing, watery eyes, throat irritation, nausea, vomiting, diarrhea.  Tuberculosis - TB What is TB? Bacterial infection transmitted by inhalation or ingestion of droplets. Signs & Symptoms: Cough up blood Sneezing, Tiredness, Loss of appetite, Weight loss, Fever, and Night sweats How do we check for TB? – 2 Step TB Skin Test OR Chest X Ray if Medical Provider thinks it is necessary. This Photo by Unknown Author is licensed under CC BY-  Vaccinations - Continued Tetanus vaccine every ten years Make sure covered for MMR(measles, mumps and rubella) and Varicella (chicken pox,shingles). 39  Ways to break the chain of Infection continued Bathe daily, clean hair, teeth, and nails. Bathe No artificial nails. Unifor Clean uniform daily. m Practi Practice proper hand hygiene. Soap and water plus friction ce Hand sanitizers 4 0 This Photo by Unknown Author is licensed under CC BY-SA-  Very Important Proper hand hygiene is the easiest way to reduce the risk of infection spread to yourself and others and should always accompany any other infection control efforts. 41 This Photo by Unknown Author is licensed under CC BY-  Wearing Gloves Gloving – when exposed to body fluids. Proper hand hygiene after removing gloves. Only worn once. Removed when contaminated. Avoid touching your face, hair, or clothing after completing hand hygiene. Review Sorrentino Textbook – Page 396 to 397 42 This Photo by Unknown Author is licensed under CC BY-  Avoid coming to work if you have a fever. Wear a mask if you have a cough or runny nose. Use a Kleenex once and than discard. Wash your hands. Cough in your sleeve Never place clean or soiled linen on the floor. Always use Personal Protective Equipment properly. (Goggles, mask, gloves, gown) 43  Remember Standard Practices Always practice routine precautions. Also known as Standard Practices. Used for all clients. Students to review Medical Asepsis Measures to follow to break the chain of infection. Page 400 – 401 - Box 19.6  Practices that Prevent Infection 1. Medical Asepsis (clean technique) 2. Isolation precautions (Transmission based precautions) 3. Surgical asepsis (sterile technique) This Photo by Unknown Author is licensed under CC BY  Asepsis What is Asepsis? is the practice of reducing or eliminating potential pathogens. Bacteria, viruses, fungi, parasites 46 This Photo by Unknown Author is licensed under CC BY- Two Types of Asepsis #1. Medical asepsis – (Clean Technique) To reduce the number of pathogens Prevent the spread of pathogens from person to person or place to place. After washing your hands After cleaning a surface area We use clean gloves (not sterile gloves) Remember: Most Common Technique and should be practiced by ALL Health Care Workers 47 This Photo by Unknown Author is licensed under CC BY- Contaminated – unclean exposure to pathogens. The process of exposure to pathogens.  Two Types of Asepsis – Continued # 2.Surgical Asepsis ( Sterile Technique): to exclude all micro-organisms and their spores. Sterile- free of all microorganisms – pathogens, non-pathogens, and spores. Sterilization- the process of destroying all microbes, and their spores. Used for surgery or invasive procedures to prevent infection. 49 This Photo by Unknown Author is licensed under CC  Hand Washing Definition: Hand washing with soap and water is the easiest and most important way to prevent the spread of infection. You can also use Waterless, alcohol-based hand sanitizers When do we perform? New 5 moments of hand hygiene: Before care After care Visibly soiled After contact with blood, body fluids, secretions, or excretions Upon leaving the room 50 When do we perform Hand Hygiene? Before and after care Visibly soiled After contact with blood, body fluids, secretions, or excretions After touching contaminated objects Ex: Soiled linen, tissues, toilet paper, garbage bags, bed pans, or diapers. Before and after preparing, handling, or eating food. Before feeding a client Before putting on gloves and after removal After personal body functions. 51  Guidelines For Hand Washing Wash hands under warm running water Stand away from the sink. Do not let your hands, body, or uniform touch the sink. The sink is contaminated. Keep you hands and forearms lower than your elbows. Your hands are dirtier than This Photo by Unknown Author is licensed under CC BY-SA your forearm therefore dirty water runs down.  Guidelines For Hand Washing Rub your palms together to work up a good lather. Friction helps move microbes and dirt. Pay attention to areas often missed: thumbs, knuckles, sides of the hands, little fingers, and under the nails. Clean fingernails by rubbing the fingertips of one hand against the palm of the other hand. Use nail file or orange stick if available. Spend at least 15-20 seconds.  Guidelines For Hand Washing Using paper towel. Start at fingers and work your way up to forearms. Use clean paper towel to shut off taps. Apply hand lotion or cream after washing your hands. This prevents skin chapping and drying.  Taking Care of Hands Using moisturizer Wearing gloves and mittens in cold weather No artificial nails Wearing a plain ring Keeping nails short. 55 This Photo by Unknown Author is licensed under CC  Wearing Gloves Disposable clean gloves provide a protective barrier between your hands and the client’s When do we wear them? blood, body fluids, secretions, excretions, nonintact skin, and mucous membranes. Not a substitute for handwashing Not required for most routine care. Wear gloves if you have a cut on your hand. Liquid Band-Aid. Often made of latex This Photo by Unknown Author is licensed under CC  FYI Latex Alternatives Vinyl Nitrile Neoprene polyethylene 58  Care of supplies and equipment Some items are reused: bedpans, urinals, washbasins, water pitchers, and drinking cups. They are labeled with the client’s name, room number and bed number. They are never used for another client. Reusable items must be decontaminated. 59 This Photo by Unknown Author is licensed under CC BY-  Cleaning Reduces number of microbes present It removes organic material such as dirt, blood, body This Photo by Unknown Author is licensed under CC BY fluids and secretions. Wear Personal Protective Equipment(PPE) as per employer policies. They include gloves, gowns, masks, and eye protector goggles or face shields. This Photo by Unknown Author is licensed under CC BY  Steps To Cleaning Equipment Rinse first in cold water. Wash item with soapy hot water Scrub item with brush Rinse in warm water Dry the item Disinfect or sterilize the item Disinfect sink use. Discard PPE. Wash your hands. This Photo by Unknown Author is licensed under CC  Disinfection Destroys all pathogens except spores. Detergent and hot water, vinegar Spores are bacteria protected by hard shell. Reusable items are disinfected with chemicals such as alcohol or chlorines. Items: metal bedpans, glass thermometers, commodes, countertops, tubs, and furniture. 62 This Photo by Unknown Author is licensed under CC BY-  Remember Chemical disinfectants can burn or irritate the skin. Wear utility gloves. See Safety Data Sheet 63 This Photo by Unknown Author is licensed under CC  Bedpan Some facilities use a slipcover that is discarded. Bedpan Sterilizer Pg. 399-Home care Detergents Vinegar (1 cup-3 cups water) 64 This Photo by Unknown Author is licensed under CC BY-  Sterilization Destroys all non-pathogens, pathogens and spores. Bleach, boiling water (15 minutes) Very high temperatures are used Radiation, liquid or gas chemicals, dry heat, and steam under pressure. Autoclaving most effective. 65 Used to sterilize equipment This Photo by Unknown Author is licensed under CC BY-  #3 - Isolation Precautions Along with medical asepsis, infection control policies, isolation precautions reduce the risk of infection. Isolation precautions are guidelines for preventing the spread of pathogens. Also known as Transmission based precautions. 66  Transmission- Based Precautions Used for clients (who are suspected of having) or have communicable diseases which are highly contagious. Additional precautions are required to protect staff, visitors, and other clients from infection Used to contain pathogens in one area 67 This Photo by Unknown Author is licensed under CC BY-  Transmission- Based Precautions - Continued Usually placed in a private room The room must have hand washing and toilet facilities Waste basket and laundry and garbage containers lined with plastic bags. An isolation sign will indicate precautions needed before entering the room. 68 This Photo by Unknown Author is licensed under CC BY-  3 Types of Transmission-Based Precautions - Continued #1. Airborne Precautions #2. Droplet Precautions #3. Contact Precautions This Photo by Unknown Author is licensed under CC 69  Transmission- Based Precautions - Continued #1. Airborne Caused by microbes transmitted by airborne droplets Ex: Measles, chicken pox, TB, SARS and Covid-19 Private room, door closed Wear N-95 mask (respiratory protection) Client is to wear a mask if transporting him/her from room 70  Transmission- Based Precautions - Continued #2. Droplet: Produced by coughing, sneezing, or talking Meningitis, pneumonia, influenza, mumps, and Covid-19: Private room preferred; door can be open if bed is at least 1 m (3 ft) from door Surgical mask Client should wear a mask if 71  Transmission-Based Precautions - Continued #3. Contact: Direct (skin to skin) Indirect (surfaces or care items) Multidrug-resistant organisms and gastrointestinal, respiratory, skin, or wound infections Private room, door can be left open Wear gloves on entering room If doing patient care – also wear a gown. 72 This Photo by Unknown Author is licensed under CC BY-NC-  Order for Putting on PPE Before entering the client’s room: Hand Hygiene Gown Mask Goggles or face shield Gloves – make sure goes over cuff of gown You may now enter the client’s room 73 This Photo by Unknown Author is licensed under CC BY-  Order to take off PPE – when in client's room remove: Gloves Hand hygiene Gown Hand hygiene 76 Order to take off PPE – may now leave the client’s room and remove: Goggles or face shield Mask Hand hygiene 77  Masks Surgical mask Prevent pathogens from entering your mouth and nose, protect you from splashes Breathing can cause mask to become moist. A wet or moist mask is considered contaminated and should be changed. N-95 respiratory protection Must be fit tested 78  Protective Apparel Gowns, plastic aprons, shoe covers, boots, or leg coverings – protect your clothing, wrists, arms from contact. Must completely cover clothes underneath Opening goes to the back and is tied at waist and neck. If gown does not go all the way around. Put on a second one backwards. The inside and neck are clean. If wet =contaminated =change  Wearing Eye Protection May be used when giving care, cleaning instruments, or disposing of contaminated fluids. Reusable glasses should be washed with soap and water and then disinfected.  Disposing Of Sharps Includes – needles, razors, broken glass. Special container – tightly capped, puncture resistant, leak proof and has biohazardous symbol on it. Yellow container with red symbol. Review Sorrentino Textbook – Page 409 – Focus on Home care Figure 19.18 81 This Photo by Unknown Author is licensed under CC BY- Needle Stick What to Do? Make it bleed Wash with soap and water, disinfect Report it and fill out incident report 83 This Photo by Unknown Author is licensed under CC  Bagging Plastic bag kept in room Double bag in order for it to leave room. 84  Transport of client Client wears clean gown or pajamas covered by isolation gown Client wears a mask Cover any drainage wounds Give client tissues and leak proof bag Wear a gown, mask and gloves as outlined Pad stretcher or wheelchair 85  Transport of client 01 02 03 Do not allow Staff in Disinfect anyone else receiving stretcher or on the area must be wheelchair elevator. taking same afterwards. precautions. 86  Transmission-based precautions Visitors are allowed in if using transmission-based precautions Treat client with respect, kindness, and dignity. Provide hobby, clock, television Organize your work so that you will be able to spend time with the client. 87  Transmission-based precautions 01 02 03 04 Say hello Let client Always Report signs from the see your introduce of increased doorway face before yourself confusion or often you put changes in mask on if behaviour. you can. 88