Unit 7 - Introduction to Acute Care - Infection Control PDF

PTH 121- **[Unit 7 -- HO \#1 Intro to Acute Care - Infx control]** References: ***Pierson** 7th ed, Ch 2: Approaches to Infection Control* *Chap 10: Special Equipment and Patient Care Environments* **Learner Objectives:** Upon completion of this unit, including lecture and laboratory attendance,...

PTH 121- **[Unit 7 -- HO \#1 Intro to Acute Care - Infx control]** References: ***Pierson** 7th ed, Ch 2: Approaches to Infection Control* *Chap 10: Special Equipment and Patient Care Environments* **Learner Objectives:** Upon completion of this unit, including lecture and laboratory attendance, completion of reading assignments and review of handout materials, the student will be able to: A1. Discuss infection including the methods of entry and transmission of pathogens. A2. Describe the body's defense mechanisms for fighting infection. A3. Recognize the systemic and local signs/symptoms of infection. **"Intro to acute care - Infection Control" (Culture of inpatient facility)** - Health care--associated infections in 2015 to 2016 were estimated to affect [1 in every 31 patients] in a hospital setting and are the fourth leading cause of death in the United States. - "**HCAP**" - Healthcare-Associated Pneumonia vs "**CAP**" - Community Acquired Pneumonia - **Standard Precautions** for prevention include [frequent handwashing or hand rub]s (before and after treatment of each patient) with the use of proper hand hygiene techniques and the wearing of appropriate [personal protective equipment (**PPE**)] such as shoe coverings, gloves, a gown, protective eyewear, a headcover in some instances, and a mask or respirator. - The emergence of new pathogens such as - **Severe acute respiratory syndrome coronavirus (SARS)**, which is a viral respiratory illness caused by a coronavirus called SARS-associated coronavirus (**SARS-CoV**) - **COVID-19** (caused by a novel coronavirus called **SARS-CoV-2**) - Middle East respiratory syndrome (MERS), - avian influenza in humans, - community-associated methicillin-resistant Staphylococcus aureus (**MRSA**) - **Clostridium difficile** ("C-diff") - Ebola virus - Zika virus - noroviruses - along with the development of new therapies (e.g., gene therapy) - The CDC in June of 2020 - recommend to don the proper PPE (e.g., isolation gown, N95 filtering mask or higher, face shield or goggles, gloves, and head cover where necessary) when entering the patient's room for patients who require contact or droplet precautions because contaminated surfaces are important sources for transmission of pathogens, and interactions with the patient cannot be predicted with certainty. - **Respiratory Hygiene/Cough Etiquette** requires that - a person cover the mouth and nose with a tissue when coughing or sneezing - put the used tissue in a waste container - cough into the upper sleeve or elbow and not into the hands if no tissue is available - perform hand hygiene after contact with respiratory secretions - separate oneself when possible from persons with respiratory infections in waiting rooms ideally by 6 feet - (as of July 15, 2020, everyone should wear a cloth face mask when entering a health care facility due to COVID-19) \[**COVID-19**\] = Coronavirus disease 2019 - On March 11, 2020, the WHO declared a pandemic for the novel coronavirus disease named COVID-19, caused by a new novel coronavirus, SARS-CoV-2, which originated in December of 2019 in Wuhan City, China. [COVID-19 is the fifth documented pandemic after the 1918 Spanish flu pandemic]. - [The virus is spread through respiratory droplets] produced by a cough, sneeze, or talking within proximity of an infected person. Studies have suggested that the virus may also be spread by people who do not show symptoms. - Recommendations were published for hospital-based physical therapists managing patients with COVID-19. The PTJ states "that the hospitalized COVID-19 patients experience a wide variety of symptoms such as fever, cough, muscle pain, tiredness, and difficulty breathing. [PT interventions can include breathing control, thoracic expansion exercises, airway clearance techniques, and respiratory muscle strength training. Active mobilization interventions may include bed mobility activities, active ROM exercises, active-assisted limb exercises, activities-of-daily-living (ADL) training, transfer training, cycle ergometer, pre-gait exercises, and ambulation.] Physical therapist management should be tailored to the individual patient's needs concerning frequency, intensity, type, and timing of interventions, in particular for those with severe/critical illness, \>70 years of age, obesity, comorbidity, and other complications." - The spread of and serious consequences associated with acquired immunodeficiency virus (**AIDS**), which is caused by human immunodeficiency virus (**HIV**), and **hepatitis**, especially hepatitis caused by hepatitis B virus (**HBV**), have created a need for health care workers and others who may have close, personal contact with a person who has one of these two diseases to use caution during contact. **Both diseases are life-threatening.** - The hepatitis B virus can survive outside the body for at least 7 days. During that time, the virus is still capable of causing infection. - Hepatitis B is more easily contracted but can be prevented with a vaccine. No vaccine is available at the present time to prevent or cure AIDS, but some drug regimens have demonstrated the ability to slow the disease process. [Because these two life-threatening diseases are prevalent and are spread through contact with various body fluids, emphasis continues to be placed on cleanliness and sterile techniques]. - **In any healthcare setting, we assume that all blood, body fluids, excretions (except sweat), secretions, nonintact skin, and mucous membranes contain transmissible infectious agents. -\> *Standard precautions* protect us from infectious diseases** Table 2.3 - Transmission-Based Isolation Precautions + Table 2.4 - Isolation Precautions (combined summary) +-------------+-------------+-------------+-------------+-------------+ | **Isolation | **Common | **Room | **Mask/Gown | **Pt | | Type** | Clinical | Assignment* | ** | transportat | | | Syndromes** | * | | ion** | | | | | **(Gloves | | | | | | on for | | | | | | ALL)** | | +-------------+-------------+-------------+-------------+-------------+ | **Contact** | MRSA, VISA, | Private or | No/YES | D/C | | | VRE, E-coli | cohort | | precautions | | | | patient | | at | | | | with same | | discharge. | | | | infection | | | | | | | | Minimize | | | | | | transport. | | | | | | | | | | | | **PT?** | +-------------+-------------+-------------+-------------+-------------+ | | Lice, | Private | No/YES | **PT?** | | | scabies, | | | | | | impetigo, | Dedicated | (Haircap- | | | | Bed bugs | equipment | optional) | | | | | in room | | | +-------------+-------------+-------------+-------------+-------------+ | | Ebola virus | | YES (+face | **PT?** | | | disease | | shield)/YES | | | | (EVD) | | -2 | | | | | | pairs | | +-------------+-------------+-------------+-------------+-------------+ | | Zika virus | | YES/YES- 2 | **PT?** | | | | | pairs | | +-------------+-------------+-------------+-------------+-------------+ | **Enteric | Uncontrolle | | No/YES | Continue | | Contact** | d | | | contact | | | diarrhea | | Use | precautions | | | (\*Clostrid | | chlorhexidi | for at | | | ium | | ne | least 48 h | | | difficile) | | gluconate | after | | | | | (**CHG**) | diarrhea is | | | | | soap for HW | resolved | | | | | | | | | | | **Needs | **PT?** | | | | | bleach to | | | | | | kill | | | | | | C-Diff** | | +-------------+-------------+-------------+-------------+-------------+ | **Droplet** | Mumps | Private | YES/YES | Minimize | | | | room | | transport | | | | | | of patient. | | | | | | | | | | | | Use | | | | | | precautions | | | | | | until 5 | | | | | | days after | | | | | | onset of | | | | | | swelling. | | | | | | | | | | | | **PT?** | +-------------+-------------+-------------+-------------+-------------+ | | Neisseria | | YES/YES | Mask | | | meningitidi | | | patient | | | s | | | when | | | | | | transport | | | | | | is | | | | | | necessary. | | | | | | Droplet | | | | | | precautions | | | | | | until 24 h | | | | | | after | | | | | | initiation | | | | | | of | | | | | | effective | | | | | | therapy. | | | | | | | | | | | | **PT?** | +-------------+-------------+-------------+-------------+-------------+ | **Droplet + | Strep A | | YES/YES - | Until 24 h | | Contact** | | | if skin | after | | | | | lesions are | initiation | | | | | present | of | | | | | | effective | | | | | | therapy | +-------------+-------------+-------------+-------------+-------------+ | **Airborne* | Measles | Private | YES | Minimize | | * | (pulmonary) | room with | (fit-tested | transport | | | | negative | N95)/YES | of patient. | | | | airflow; | | Observe | | | | keep door | | precautions | | | | closed) | | for 4 days | | | | | | after onset | | | | | | of rash; | | | | | | duration of | | | | | | illness in | | | | | | immune | | | | | | compromised | | | | | | | | | | | | **PT?** | +-------------+-------------+-------------+-------------+-------------+ | | Tuberculosi | | | Mask | | | s | | | patient | | | | | | when | | | | | | transport | | | | | | is | | | | | | necessary. | | | | | | DC | | | | | | precautions | | | | | | only when | | | | | | the results | | | | | | of 3 sputum | | | | | | smears for | | | | | | AFB are | | | | | | negative. | | | | | | | | | | | | **PT?** | +-------------+-------------+-------------+-------------+-------------+ | **Airborne | Chickenpox, | Private | Yes---N95 | Minimize | | +** | disseminate | room with | respirator | transport | | | d | negative | or | of patient. | | **Contact** | herpes | airflow; | higher/YES | Mask | | | zoster in | keep door | | patient | | | immunocompr | closed. | | when | | | omised | Place in an | | transport | | | hosts, | AIIR | | is | | | smallpox, | (Airborne | | necessary. | | | MERS, SARS | Infection | | For SARS, | | | | Isolation | | duration of | | | | Room) if | | illness | | | | available. | | plus 10--20 | | | | | | days after | | | | | | resolution | | | | | | of fever, | | | | | | provided | | | | | | respiratory | | | | | | symptoms | | | | | | are absent | | | | | | or | | | | | | improving. | | | | | | Continue | | | | | | isolation | | | | | | for | | | | | | duration of | | | | | | illness. | | | | | | | | | | | | For | | | | | | COVID-19 | | | | | | patients, | | | | | | Transmissio | | | | | | n-Based | | | | | | Precautions | | | | | | should | | | | | | remain | | | | | | until | | | | | | either: | | | | | | Symptom-bas | | | | | | ed | | | | | | strategy or | | | | | | Test-based | | | | | | strategy is | | | | | | used as | | | | | | defined by | | | | | | the | | | | | | CDC.\*\* | | | | | | | | | | | | **PT?** | +-------------+-------------+-------------+-------------+-------------+ - \* C-diff - handwashing is the better means of decontamination after treating a patient with a C. difficile infection. - \*\*CDC Interim Guidance for Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings. [[Ending Isolation and Precautions for People with COVID-19: Interim Guidance]](https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html). Accessed October 30, 2021. - CHG, Chlorhexidine gluconate; - D/C, discontinuation; - EVD, Ebola virus disease; - MRSA, methicillin-resistant Staphylococcus aureus; - VISA, vancomycin-intermediate-resistant S. aureus; - VRE, vancomycin-resistant Enterococcus. - AFB, Acid-fast bacteria; - MERS (Middle East Respiratory Syndrome; - SARS-CoV-2 (cause of COVID-19) "The Bunny Suit" 8/2020 Professor Bean at SVBGH, CCU-CSICU - Hand Washing for **medical asepsis** (Fig 2.3) - Lather and scrub the palms together. - Interlace the fingers; scrub between and around each finger; wash the web space between each finger (see Fig. 2.3C). - Scrub the dorsum of each hand with the opposite palm or brush (see Fig. 2.3D). - Scrub the fingertips and the dorsal finger creases of each hand with the opposite palm, or use a one-time, disposable brush or a pointed, disposable wood probe ("orange stick") to clean under each fingernail (see Fig. 2.3E). - Encircle each thumb and wrist with the opposite palm and scrub. - Hand Washing for **Surgical Asepsis** (Fig 2.4) 1. Medical Asepsis + need to wash your **entire forearm to approximately 3 inches above your elbow.** This process requires approximately **7 min** (see Fig. 2.4A). 2\. Rinse your hands by holding them with your fingers upward so that the rinse water flows from a clean to an unclean area (i.e., from your fingers to your elbows). Do not allow your hands, forearms, or upper arms to contact the sink or your body. 3\. Clean your fingernails, cuticles, and skin creases with a one-time-use brush using vigorous strokes; you may use a pointed, disposable wood probe ("orange stick") to clean under each fingernail. Discard the probe and brush after use. 4\. Perform a final rinse with your hands directed upward (see Fig. 2.4B). 5\. Dry your hands, forearms, and distal area of upper arms thoroughly using a sterile towel or air dryer. Avoid contact between the towel and your clothing and between your washed skin and your clothing or other nonsterile areas. Wrap your hands and forearms in a dry, sterile towel before applying PPE or gloves; hold your hands above waist level and slightly away from your body until you begin your treatment or patient care activities. **How do we fight infection? Mechanism of defense against infection.**  Fig 7.5 Visualization of the body's external defenses. Goodman and Fuller - Chapter 7 (The Immune system) **Systemic and Local signs/symptoms of infection** - Chills and sweats. - Change in cough or a new cough. - Sore throat or new mouth sore. - Shortness of breath. - Nasal congestion. - Stiff neck. - Burning or pain with urination. - Unusual vaginal discharge or irritation. - Increased urination. - Redness, soreness, or swelling in any area, including surgical wounds and ports. - Diarrhea. - Vomiting. - Pain in the abdomen or rectum. - New onset of pain. - Hyperthermia/Fever (this is sometimes the only sign of an infection), *Hypothermia* (immunocompromised elderly, infants,children) - **Shock** - Hypovolemic, Cardiogenic, Neurogenic, Anaphylactic, **Septic**. **FYI- to better understand the etiology of shock.** **In addition to the bolded terms in this handout, familiarize yourself with the following terms.** **Asepsis** Absence of microorganisms that produce disease; the prevention of infection by maintaining a sterile condition. **Contamination** When something is rendered unclean or nonsterile; an item, surface, or field is considered contaminated when it has come into contact with anything that is not sterile. **Decontamination** The use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point at which they are no longer capable of transmitting infectious particles, and the surface or item is rendered safe for handling, use, or disposal. **Disinfection** The destruction or removal of pathogenic organisms, but not necessarily their spores. **Health care--associated infections (HAIs)** Infections associated with health care delivery in any health care setting; previously known as nosocomial infection. **Hepatitis** Inflammation of the liver. **Infection** The production of a disease or harmful condition by the entrance of disease-producing germs into an organism. **Isolation** Separation from others. **Medical asepsis** Practices that help reduce the number and spread of microorganisms. **Microorganism** A tiny living animal or plant that can cause disease. **Pathogen** A microorganism that produces disease. **Personal protective equipment (PPE)** Various barriers and respirators used alone or in combination to protect the skin, mucous membranes, eyes, airways, and clothing from contact with infectious agents; includes gloves, respirators, masks, face shields, goggles, shoe covers, caps, and gowns. **Respiratory hygiene/cough etiquette** The US Centers for Disease Control and Prevention standard that applies to all persons entering a health care setting, including visitors, patients, and health care personnel; also known as "Cough Etiquette." **Sepsis** The presence of pathogenic microorganisms or their toxins in the blood or tissues. **Sterile** Containing no microorganisms; free from germs; aseptic. **Sterilization** Process by which all microorganisms, including spores, are destroyed. **Surgical asepsis** Practices that render and keep objects and areas free of all microorganisms.