NCM 112: Communicable Disease Lecture PDF

NCM 112: COMMUNICABLE DISEASE – Medical asepsis – includes all practices Lecture intended to confine a specific microorganism to a specific area, limiting the number, growth, and Infec...

NCM 112: COMMUNICABLE DISEASE – Medical asepsis – includes all practices Lecture intended to confine a specific microorganism to a specific area, limiting the number, growth, and Infection – is an invasion of body tissue by transmission of microorganism. microorganism and their proliferation. Surgical asepsis, or sterile technique – refer Asymptomatic or subclinical infection – are to those practices that keep an area or object microorganisms that produces no clinical free of all microorganism; it includes practices evidence of disease. that destroy all microorganisms and spores. It is Some subclinical infections can cause also used for all procedures involving the sterile significant damage, for example areas of the body cytomegalovirus (CMV) infection in a Pathogen is any microorganism (also called an pregnant woman can lead to significant disease agent) capable of producing disease. in the unborn child. Infections can be communicable (transmitted Disease – a detectable alteration in normal from person to person [e.g., influenza]) or not tissue functions communicable (e.g., peritonitis). Communicable disease – are infectious agents Microorganisms with differing levels of that is transmitted to an individual by direct or pathogenicity (ability to cause disease) indirect contact, through a vector or vehicle. surround everyone. Pathogenicity – is the ability to produce disease Virulence is a term for pathogenicity. Pathogens – is a microorganism that causes Virulence is related more to the frequency with disease. which a pathogen causes disease (degree of A “true” pathogen causes disease or infection communicability) and its ability to invade and in a healthy individual damage a host. It can also indicate the severity of the disease. Opportunistic pathogens – are microorganism that causes disease only in a susceptible Many microorganisms live in or on the individual. human host without causing disease. Some microbes are beneficial. Center for Disease Control and Prevention Each body location harbors its own (CDC) – is the principal public health agency at characteristic bacteria, or normal flora. the national level concerned with disease Normal flora often functions to compete prevention and control. with and prevent infection from Sepsis – is the state of infection and can take unfamiliar agents attempting to invade a many forms, including septic shock body site. In some instances, microorganisms that Asepsis – is the freedom from disease – causing are often pathogenic may be present in microorganism the tissues of the host and yet not cause Contagious disease – a term given to a disease symptomatic disease because of normal that is easily transmitted from one person to flora; this process is called colonization another through direct or indirect means. In the United States, the Centers for Disease Control and Prevention (CDC) Disinfection – the destruction of pathogenic collects information about the microorganism outside the body by directly occurrence and nature of infections and applying physical or chemical means infectious diseases. It then recommends Quarantine – is the limitation of freedom of guidelines to health care agencies for movement of a person or animals which have infection control and prevention. been exposed to communicable disease for a Certain diseases, such as tuberculosis, period of time equivalent to the longest must be reported to health departments incubation period of that disease and the CDC. The infection control Surveillance – the act of watching. practitioner (ICP) for each health care agency is responsible for tracking Two basic types of asepsis: infections (surveillance) and ensuring  compliance with federal and local ✓ Endotoxins. Endotoxin, toxic substance bound requirements and accreditation to the bacterial cell wall and released when the standards. bacterium ruptures or disintegrates. Example: E.coli. diseases associated with such endotoxins Types of Microorganism causing infections includes septic shocks, meningitis and cholera. The categories of microorganisms cause Spirochete infection in humans are: ▪ It is a bacterium with flexible, slender, Bacteria undulating spiral rods that possess cell wall. ▪ Are simple one – celled microbes with double ▪ 3 forms that causes disease: Treponema, cell membranes that protects them from harm. Leptospira and Borilia ▪ It is the most common type of infection – Viruses causing microorganisms. ▪ Are the smallest known microbes. They cannot ▪ Several hundred species can cause disease in replicate independently in the host’s cell, rather, human and can live and be transported through they invade and stimulate the host’s cells to air, water, food, soil, body tissue and fluids, an participate in the formation of additional viruses. inanimate object. ▪ Some viruses destroy surrounding tissues and ▪ They are classified to release toxins ✓ Shape: cocci (spherical bacteria), bacilli (rod- ▪ The immune system rapidly controls some viral shaped), spirillae (spiral-shaped) invasions, producing permanent immunity to ✓ Need of oxygen: aerobic, anaerobic that particular virus. Example: a person who gets sick with measles or receives measles ✓ Response to staining: gram (+) or (-) or acid immunization becomes permanently immune to fast the measles virus. ✓ Motility: motile, non-motile ▪ Most viruses enter the body through the respiratory, GI, or genital tract. A few, such as ✓ Tendency to capsulate: encapsulated, HIV, are transmitted in blood and body fluid. capsulated Rickettsia ✓ Capacity to form spores: spore forming, non – spore forming ▪ Are small, grams negative (-) bacteria – like microbes that can induce life – threatening How can bacteria form disease? infections. Bacteria damage body tissue by interfering with ▪ Like viruses, they require a host cell for essential cell function or by releasing toxins that replication. cause cell damage. ▪ These are usually transmitted through a bite of Several types of bacterial toxins arthropod carriers like lice, fleas, ticks as well as through waste products. ✓ Exotoxins. Are protein release from bacterial cells into the surrounding medium. ✓ Rickettsial diseases are: Example: diphtheria, botulism and tetanus ✓ Rocky mountain spotted fever ✓ Enterotoxins. Are exotoxins that affects the ✓ Typhus fever vomiting centers of the brain and cause gastroenteritis. Example: Staphylococcus ✓ Q fever aureus, Vibrio cholerae, Shigella dysenteriae and other microbes that lives in the GI tract. Chlamydiae ▪ Are smaller than rickettsia but larger than a virus. These are the common cause of infection of the urethra, bladder, fallopian tubes, and It occurs when newly introduced or prostate gland. resident microorganism succeed in invading a part of the body where the ▪ The most common chlamydial infection is host’s defense mechanisms are transmitted through sexual contract. ineffective and the pathogen cause tissue damage. Fungi The infection become a disease when the ▪ Includes yeast and molds sign and symptoms of the infection are unique and can be differentiated from ▪ They live in organic matter, soil, water, animal, other conditions. and plants. Types of infections: ▪ They can also live inside and outside the body. Local infection – are limited to the specific part ▪ They may be harmful or beneficial of the body where the microorganism remains. ▪ Candida albicans is a yeast considered to be Systemic infection – microorganism that normal flora in the human vagina spread and damage different parts of the body. ▪ Fungi are beneficial in cheese, yogurt, beer, Acute infection – appears suddenly or last a wine and certain drugs. short time Parasites Chronic infection – may occurs slowly, over a very long period and may last months and years. ▪ A parasite is an organism that lives on or in a host organism and gets its food from or at the Difference between Bacteremia and expense of its host. Septicemia ▪ There are three main classes of parasites that Bacteremia can cause disease in humans: protozoa, helminths, and ectoparasites ▪ It is a condition when the culture of person’s blood reveals microorganism Protozoa are microscopic, one-celled organisms that can be free-living or ▪ Bacteremia is when there are bacteria present parasitic in nature. in the patient bloodstream. Helminths are large, multicellular ▪ Common ways in which bacteremia occurs organisms generally visible to the naked include: eye in their adult stages. There are three main groups of helminths (derived from ✓ through a dental procedure such as a routine the Greek word for worms) that are teeth cleaning or through a tooth extraction human parasites: Flatworms (platyhelminths), Thorny-headed worms ✓ from a surgery or procedure (acanthocephalins), Roundworms (nematodes) ✓ an infection spreading from another part of the Ectoparasites can broadly include blood- body into the bloodstream sucking arthropods such as mosquitoes ✓ via medical devices, particularly in-dwelling (because they are dependent on a blood catheters and breathing tubes meal from a human host for their survival) ✓ through severe injuries or burn Colonization Different bacteria that can cause bacteremia. It is the process by which strain of Examples of such bacteria include: microorganism become resident flora. In this state the microorganism may grow ✓ Staphylococcus aureus, including MRSA and multiply but do not cause disease. ✓ Escherichia coli (E. coli) Infection ✓ Pneumococcal bacteria ✓ Group A Streptococcus Is a serious bloodstream infection. It’s also known as blood poisoning. ✓ Salmonella species It occurs when a bacterial infection ✓ Pseudomonas aeruginosa elsewhere in the body, such as the lungs or skin, enters the bloodstream. ▪ Some cases of bacteremia are asymptomatic. This is dangerous because the bacteria In these cases, the immune system will often and their toxins can be carried through clear the bloodstream to your entire body Septicemia can quickly become life- the bacteria without any use of antibiotic. threatening. It must be treated in a ▪ Common symptoms: hospital. If left untreated, septicemia can progress to sepsis. ✓ fever Sepsis is a serious complication of septicemia. ✓ chills Sepsis causes inflammation throughout ✓ shaking or shivering the body. This inflammation can cause blood clots ▪ Bacteremia can be diagnosed using: and block oxygen from reaching vital organs, ✓ blood culture – a sample of blood will be taken resulting in organ failure. from a vein and it will then be sent to a lab The most common infections that lead to to be tested for the presence of bacteria. septicemia are: Bacterial infection ✓ sputum culture – if the patient appears to have Fungal infection a respiratory infection or are using a Viral infection Examples: urinary tract infections, lung breathing tube example: patient on infections, such as pneumonia, kidney endotracheal tube infections, infections in the abdominal ✓ wound culture – if patient been injured, area burned, or have recently undergone surgery High risk of developing septicemia if the patient: ✓ taking samples from in-dwelling catheters or have severe wounds or burns other devices adult older than 65 babies under 1 year of age ✓ Imaging tests such as an X-ray, CT scan, or have a compromised immune system, ultrasound – to identify potential sites of which can occur from conditions, such as infection in the body. HIV or leukemia, or from medical treatments such as chemotherapy or The treatment for a bloodstream infection steroid injections requires prompt use of antibiotics – to have a urinary or intravenous catheter on prevent complications like sepsis from mechanical ventilation occurring. The most common initial symptoms When bacteria are confirmed in your are: blood, broad-spectrum antibiotics via IV chills is given. fever The length of treatment can depend on Tachypnea and tachycardia the cause and severity of the infection. Difficulty breathing Maximum time need to be on antibiotics Clammy or sweating is 1 to 2 weeks. Extreme pain or discomfort Septicemia Severe symptoms once septicemia progresses without proper treatment. It is a condition when bacteremia results These include the following: in systemic infection. confusion or inability to think clearly  nausea and vomiting Rashes reduced urine volume inadequate blood flow shock or signs of shock Low blood pressure Dizziness Pale, discolored or mottled skin Skin that feel unsusually warm or cold Reduce alertness Change in person’s mentation Feeling of doom Severe of extreme generalized body pain Shortness of breath Common complication of septicemia if left untreated ✓ Sepsis This leads to widespread inflammation throughout the body. It’s called severe sepsis if it leads to organ failure. People with chronic diseases are at a higher risk of sepsis. The chain of infection is made up of six links: ✓ Septic shock 1. The pathogen Toxin released by the bacteria in the The first link in the chain of infection is the bloodstream can cause extremely low infectious agent or pathogen which can take the blood flow, which may result in organ or form of: tissue damage. Septic shock is a medical emergency. Viruses – such as Influenza A, shingles and Hepatitis ✓ Acute respiratory distress syndrome (ARDS) Bacteria – including Lyme disease and Leptospirosis This is a life-threatening condition that Fungi – for example Candidiasis and prevents enough oxygen from reaching Aspergillosis the lungs and blood. Parasitic protozoan diseases – such as It often results in some level of Malaria, Giardia and Toxoplasmosis permanent lung damage. It can also Prions – which are the cause of rare damage the brain, leading to memory progressive neurodegenrative disorders problems. such as Creutzfeldt-Jakob disease (CJD) Treatment How well any pathogen is able to thrive depends treating the cause of the infection on three factors: administering antibiotics, if the infection Its pathogenicity – its ability to produce is bacterial disease providing oxygen and intravenous fluids to ensure blood flow to the organs Its degree of virulence – its severity or providing a means of assisted breathing, harmfulness if appropriate scheduling surgery, if necessary, to Its invasiveness – its tendency to spread remove damaged tissue 2. The reservoir A reservoir is the principal habitat in which a fever, respiratory diseases and sexually pathogen lives, flourishes and is able to multiply. transmitted diseases. Indirect transmission can occur through Common reservoirs for infectious agents include animate mechanisms such as fleas, humans, animals or insects and the ticks, flies or mosquitoes or via inanimate environment. mechanisms such as food, water, biological products or surgical a.Human reservoirs instruments. In humans, there are two forms of reservoir: - Indirect transmission can also be acute clinical cases (in which someone is airborne, in which tiny particles of an infected and is displaying signs and symptoms infectious agent are carried by dust or of the disease); and carriers (where someone droplets in the air and inhaled into the has been colonized with an infectious agent but lungs. is not unwell. Breaking the chain of infection Acute clinical cases are more likely to be diagnosed and treated which means that the Etiologic agent (microorganisms) patient’s contacts and normal activities will - Correctly cleaning, disinfecting or normally be restricted. Carriers, however, can sterilizing articles before use present more of a risk to those around them - Educating clients and support persons because they do not display any signs or about appropriate methods to clean, symptoms of illness disinfect, and sterilize article b. Environmental reservoirs Reservoir (source) The environment contains a large number of Changing dressings and bandages reservoirs of infection, including soil (which acts when soiled or wet as a reservoir for Clostridium tetani, the Appropriate skin and oral hygiene causative agent of tetanus) and water (which is a Disposing of damp, soiled linens reservoir for Legionella pneumophila, the appropriately causative agent of Legionnaire’s disease). Disposing of feces and urine in appropriate receptacles 3. The portal of exit Ensuring that all fluid containers are covered or capped The portal of exit is any route which enables a Emptying suction and drainage pathogen to leave the reservoir or host. In bottles at end of each shift or before humans the key portals of exit are: full or according to agency policy Alimentary – via vomiting, diarrhea or Portal of exit (from the reservoir) biting - Avoiding talking, coughing, or Genitourinary – via sexual transmission sneezing over open wounds or Respiratory – through coughing, sneezing sterile fields and talking - Covering the mouth and nose Skin – via skin lesions when coughing or sneezing Trans-placental – where transmission is Method of transmission from mother to fetus Proper hand hygiene 4. The mode of transmission Instructing clients and support persons to perform hand hygiene The two main ways that an infection can be before handling food, eating, after transmitted from its reservoir to a susceptible eliminating and after touching host are via direct transmission or indirect infectious material transmission. Wearing gloves when handling secretions and excretions Direct transmission tends to be Wearing gowns if there is danger of instantaneous and occurs when there is soiling clothing with body substances direct contact with the infectious agent. Portal of entry (to the susceptible Examples include tetanus, glandular host) - Using sterile technique for invasive or defenses against infection. When procedures, when exposing open this barrier is broken, infection often wounds or handling dressings results. - Placing used disposable needles and Microorganisms may enter the body in syringes in puncture-resistant a variety of ways, including the containers for disposal respiratory tract, GI tract, - Providing all clients with own personal genitourinary tract, skin and mucous care items membranes, and bloodstream. Susceptible host Maintaining the integrity of the client’s Factors That May Increase Risk for Infection in the Older Patient skin and mucous membranes Ensuring that the client receives a balanced diet Educating the public about the importance of immunizations The patient's immune status plays a large role in determining risk for infection. Congenital abnormalities, as well as acquired health problems (e.g., renal failure, steroid Environmental factors can also influence dependence, cancer, acquired patients' immune status and thus their immune deficiency syndrome [AIDS]), susceptibility to or ability to fight can result in numerous immunologic infection. deficiencies. Examples include alcohol consumption, Depression of immunity may make nicotine use, inhalation of bone marrow– the host more susceptible to infection suppressing toxic chemicals, and certain or impair the ability to combat vitamin deficiencies. organisms that have gained entry. Malnutrition, especially protein-calorie Immunity is resistance to infection; it malnutrition, places patients at increased is usually associated with the risk for infection. presence of antibodies or cells that Diseases such as diabetes mellitus also act on specific microorganisms. predispose a patient to infection. Passive immunity is of short duration Older adults have decreased immunity, (days or months) and either natural by as well as other physiologic changes that transplacental transfer from the make them very susceptible to infection. mother or artificial by injection of antibodies (e.g., immunoglobulin). Routes of Transmission Active immunity lasts for years and is natural by infection or artificial by Pathogens may enter the body through stimulation of the body’s immune the respiratory tract. Microbes in droplets defenses (e.g., vaccination). are sprayed into the air when people with Medical and surgical interventions infected oral or nasal tissues talk, cough, may impair normal immune response. or sneeze. Steroid therapy, chemotherapy, and A susceptible host then inhales droplets, anti-rejection drugs increase the risk and pathogens localize in the lungs or are for infection. distributed via the lymphatic system or Medical devices (e.g., intravascular or bloodstream to other areas of the body. urinary catheters, endotracheal Microorganisms that enter the body by tubes, synthetic implants) may also the respiratory tract and produce distant interfere with normal host defense infection include influenza virus, mechanisms. Mycobacterium tuberculosis, and Surgery, trauma, radiation therapy, Streptococcus pneumoniae. and burns result in nonintact skin. The Other pathogens enter the body through body's skin is one of the best barriers the GI tract. Some stay there and produce  disease (e.g., Shigella causing self- For infection to be transmitted from an limited disease). Others invade the GI infected source to a susceptible host, a tract to produce local and distant transport mechanism is required. infection (e.g., Salmonella enteritidis). Microorganisms are transmitted by Some produce limited GI symptoms, several routes: causing systemic infection (e.g., Contact transmission (indirect and direct) Salmonella typhi) or profound Droplet transmission involvement of other organs (e.g., Airborne transmission hepatitis A virus). 1. CONTACT TRANSMISSION Millions of foodborne illness cases occur is the usual mode of transmission of most each year in the United States. This type infections. of illness results in many hospitalizations Direct Or Indirect Contact and deaths. With direct contact, the source and host Microorganisms also enter through the have physical contact. Microorganisms genitourinary tract. Urinary tract infection are transferred directly from skin to skin (UTI) is one of the most common health or from mucous membrane to mucous care–associated infections (HAIs). More membrane. than half of patients in adult intensive Often called person-to-person care units (ICUs)have urinary catheters in transmission, direct contact is best place. Indwelling urinary catheters are a illustrated by the spread of the “common primary cause of catheter-associated cold.” urinary tract infections (CAUTIs), 2. Indirect Contact Transmission especially in older adults. CAUTIs can involves the transfer of microorganisms increase hospital costs by prolonging the from a source to a host by passive patient's length of stay and complicating transfer from a contaminated object. the patient’s recovery. In many settings, Contaminated articles or hands may be nurse-driven protocols have helped sources of infection. For example, decrease the use of urinary catheters and patient-care devices like glucometers associated infections and electronic thermometers may Although intact skin is the best barrier to transmit pathogens if they are prevent most infections, some pathogens contaminated with blood or body fluids. such as Treponema pallidum can enter Uniforms, laboratory coats, and isolation the body through intact skin or mucous gowns used as part of personal protective membranes. Most enter through breaks equipment (PPE) may be contaminated in these normally effective surface as well. barriers. Sometimes a medical procedure creates a break in cutaneous or DROPLET TRANSMISSION mucocutaneous barriers, as in catheter- acquired bacteremia (bacteria in the Indirect transmission may involve contact bloodstream) and surgical-site infections with infected secretions or droplets. (SSIs). Fragile skin of older patients and of Droplets are produced when a person those receivingprolonged steroid therapy talks or sneezes; the droplets travel short increases infection risk. distances. Susceptible hosts may acquire Microorganisms can gain direct access to infection by contact with droplets the bloodstream, especially when deposited on the nasal, oral, or invasive devices or tubes are used. conjunctival membranes. Central venous catheters (CVCs) are a Therefore the CDC recommends that primary cause of these infections. staff stay at least 3 feet (1 m) away from a In the community setting, biting insects patient with droplet infection. An example can inject organisms into the of dropletspread infection is influenza. bloodstream, causing infection (e.g., Susceptible hosts may acquire infection Lyme disease, West Nile viral by contact with droplets deposited on the encephalitis). nasal, oral, or conjunctival membranes. Therefore the CDC recommends that Methods of transmission  staff stay at least 3 feet (1 m) away from a infective fluid in vesicles and by airborne patient with droplet infection. An example transmission. of dropletspread infection is influenza. Physiologic Defenses for Infection AIRBORNE TRANSMISSION Strong and intact host defenses can Airborne transmission occurs when small prevent microbes from entering the body airborne particles containing pathogens or can destroy a pathogen that has leave the infected source and enter a entered. susceptible host. Impaired host defenses may be unable to These pathogens can be suspended in defend against microbial invasion, the air for a prolonged time. The particles allowing entry of organisms that can carrying pathogens are usually contained destroy cells and cause infection. in droplet nuclei or dust; they are usually Common defense mechanisms propelled from the respiratory tract by include: coughing or sneezing. Body tissues A susceptible person then inhales the Inflammation particles directly into therespiratory tract. Phagocytosis For example, tuberculosis is spread via Immune System airborne transmission. Preventing the spread of microbes that Barriers Defend Against Infection are transmitted by the airborne route Intact skin and mucous membranes requires the use of special air handling and ventilation systems in an airborne Moist mucous membranes and cilia of infection isolation room (AIIR). the nasal passages M. tuberculosis and the varicella-zoster Alveolar macrophages virus (chickenpox) are examples of Tears airborne agents that require one of these High acidity of the stomach systems. Resident flora of the large intestine In addition to the AIIR, respiratory Peristalsis protection using a certified powered air Low pH of the vagina purifying respirator (PAPR) is Urine flow through the urethra recommended for health care personnel Level of Disease entering the patient's room. This device has a high efficiency To determine if an infection problem particulate air (HEPA) filter and battery to exists in a particular health care facility or promote positive-pressure airflow and is geographic area, investigators study the more effective than N95 respirators. current incidence of the disease in that Other sources of infectious agents facility por area and compare it to past include the environment, such as incidence rates. contaminated food, water, or vectors. Sporadic- Refers to a disease that occurs Vectors are insects that carry pathogens infrequently and irregularly. between two or more hosts, such as the deer tick that causes Lyme disease. Example: tetanus and gas gangrene The portal of exit completes the chain of infection. Exit of the microbe from the Endemic- A disease outbreak that is host often occurs through the portal of consistently present but limited to a entry. particular region. This makes the disease spread and rates predictable. An organism, such as M. tuberculosis, enters the respiratory tract and then exits Are those that are present or belong to a the same tract as the infected host particular population or community coughs. Example: Malaria in some areas of Africa, Some organisms can exit from the hepatitis B in certain Asian culture infected host by several routes. For Epidemic example, varicella-zoster virus can spread through direct contact with  Describes as an unexpected increase in Nosocomial infection- Also known as a the number of disease cases in a specific hospital-acquired infection or HAI geographical area. It is an infection whose development is It refers to a disease or other specific favored by a hospital environment, such health-related behavior with rates that as one acquired by a patient during a are clearly above the expected hospital stay, or one developing among occurrence in a community or region. hospital staff and was not present or Refers to an increase, often sudden, in incubating at the time of admission. the number of cases of a disease above It usually appears before the patient is what is normally discharged, although some typically are expected in that population in that area. incubating at discharge Example: Yellow fever, smallpox, Community-Acquired Infection measles, and polio are prime examples of It is present or incubating at the time of epidemics that occurred throughout admission in a patient who has no history American history. of previous hospitalization to the same Pandemic facility Refers to an epidemic that has spread Infections that are contracted outside of over several countries or continents, a hospital or are diagnosed within 48 usually affecting a large number of hours of admission without any previous people. health care encounter. The World Health Organization (WHO) Iatrogenic infection declares a pandemic when a disease’s It is caused by the actions or treatment of growth is exponential. This means growth a health care provider. rate skyrockets, and each day cases grow Infection may also represent a secondary more than the day prior. condition caused by treatment of a Example: COVID primary condition. Why outbreaks occur? defined as an infection after medical or There are many complex reasons why surgical management, whether or not the microbes that causes infectious disease patient was hospitalized. are so difficult to Methods of Infection Control and Prevention overcome 1. Some bacteria develop a resistance to All health care workers who come in antibiotics contact with patients or care areas are 2. Some microbes such as influenza involved in some aspect of the infection virus have so many different strains control program of the agency. According that a single vaccine can't protect to the CDC, infections can be prevented against them all. or controlled in several ways: 3. Most viruses resist antiviral drugs Hand hygiene 4. New infectious agents occasionally Disinfection/sterilization arise example corona virus Standard Precautions 5. Some microbes localize in areas of Transmission-Based Precautions the body that makes treatment Staff and patient placement and difficult example: CNS cohorting 6. Opportunistic organism can cause infection in immunocompromised Hand Hygiene individuals 7. Most people are not vaccinated. Health care workers' hands are the primary way in which infection is Infection Control in Health Care transmitted from patient to patient or Settings staff to patient. Hand hygiene refers to both handwashing Infections among patients in health care and alcohol-based hand rubs (ABHRs) facilities are classified as nosocomial, (“hand sanitizers”). community acquired or iatrogenic Sterilization and Disinfection Standard precautions apply to all patients regardless of their diagnosis or presumed Sterilization means destroying all living infection status. organisms and bacterial spores. Many Standard precautions must be used in the invasive procedures, such as inserting handling of: vascular access devices (VADs) and ✓ blood (including dried blood) urinary catheters, require sterile ✓ all other body fluids/substances technique. (except sweat) Disinfection does not kill spores and only ✓ non-intact skin ensures a reduction in the level of ✓ mucous membranes. disease-causing organisms. High-level disinfection is adequate when Standard precautions consist of the following an item is going inside the body where the practices: patient has resident bacteria or normal flora (e.g., GI and respiratory tracts). ✓ hand hygiene As with sterilization, no high-level Handwashing: Hands should be washed disinfection can occur without first with soap and water when visibly soiled and after using the toilet. cleaning the item. Hand rubbing: Hand rubbing with an This can be especially difficult with items that have narrow lumens in which organic alcohol-based hand rub (ABHR) is the debris can become trapped and is not preferred method for hand cleansing in easily visible. For example, endoscopes the healthcare setting when hands are have been especially challenging to clean not visibly soiled. and have been linked to a number of The 5 moments are: before touching a infectious outbreaks. client, before performing a procedure, after a procedure or exposure to body Methods of Infection Control and Prevention fluids/substances, after touching a client and after touching the environment Standard Precautions around a client the safe use and disposal of sharps Standard Precautions are based on the the use of aseptic "non-touch" technique belief that all body excretions, secretions, for all invasive procedures, including and moist membranes and tissues, appropriate use of skin disinfectants excluding perspiration, are potentially infectious. reprocessing of reusable instruments and equipment As barriers to potential or actual infections, personal protective routine environmental cleaning equipment (PPE) is used. PPE refers to waste management gloves, isolation gowns, face protection respiratory hygiene and cough etiquette (masks, goggles, face shields), and appropriate handling of linen. powered air purifying respirators (PAPRs) the use of personal protective equipment, or N95 respirators which may include gloves, impermeable gowns, plastic aprons, masks, face Standard Precaution shields and eye protection Are a set of activities designed to prevent Personal protective equipment (PPE) the transmission of organisms between patients/staff and, in turn, prevent HCAIs PPE protects the healthcare worker from It enquired to achieve a basic level of exposure to blood and body infection prevention and control. fluids/substances. The use of standard precautions aims to Gloves minimize, and where possible, eliminate the risk of transmission of infection, The use of gloves is not considered an particularly those caused by blood borne alternative to performing hand hygiene. viruses. Hand hygiene is required before putting  on gloves and immediately after Perform hand hygiene immediately after removal. removal. Wear gloves (single-use non-sterile) when Protective eyewear such as face-shields there is the potential for contact with or goggles should also be worn where the blood, body fluids/substances, mucous potential exists for splashing, splattering membranes or non-intact skin. or spraying of vomit and feces. Sterile gloves are only required for certain Reusable goggles should be washed with invasive procedures, otherwise non- detergent and water between uses sterile gloves may be used if a aseptic non-touch technique Transmission-based Precautions is used. Are designed for patients with Change gloves between tasks and documented or suspected infection with procedures on the same patient. pathogens for which additional Gloves should be removed immediately precautions beyond Standard after a procedure and hand hygiene Precautions are needed to prevent performed so as to transmission. avoid contaminating the environment, Transmission-based precautions are other required in patients known or suspected patients or other sites on the same to be infected with highly transmissible or patient. epidemiologically important pathogens, Gloves used for healthcare activities are in which standard precautions may be to be single-use only. insufficient to prevent transmission. Empiric or Syndrome Precaution – is a Gowns and aprons transmission-based Precautions that are Wear an apron or gown to protect skin applied at the time of initial contact, and prevent soiling of clothing during based on the clinical presentation and procedures and the most likely pathogens patient care activities that are likely to This approach is useful especially for generate splashing or sprays of blood, emerging agents (e.g., SARS-CoV, avian body fluids, influenza, secretions or excretions, or cause soiling pandemic influenza), for which of clothing. information concerning routes of Select a gown or apron (i.e., long or short transmission is still evolving. sleeves) that is appropriate for the activity The three categories of Transmission- and the amount of fluid likely to be based Precautions are: Contact encountered. If an apron is used, staff Precautions, Droplet Precautions, and should ensure they are “bare below-the- Airborne Precautions. elbows”. Airborne transmission precautions Remove the used gown as promptly as possible and roll it up carefully and These apply to situations in which discard appropriately. pathogens can be transmitted by the Perform hand hygiene immediately after airborne route, that is, by small droplets removal. of 5 µm or smaller Masks, eye protection, face shields Example: organisms that cause Wear a mask and eye protection, or a tuberculosis, measles, and chickenpox face shield to protect mucous and Aspergillus membranes of the eyes, nose and mouth during procedures, patient-care activities Droplet transmission precaution and cleaning procedures that are likely to These apply to situations in which generate splashes or sprays of blood, pathogens can be transmitted by large body fluids, secretions and excretions. particle droplets, greater than 5 µm Remove the mask by holding the ties only and dispose of the mask into a waste bin.  Droplets can be generated by coughing, Active – acquires through the sneezing, talking or during the administration of vaccine and toxoid performance of procedures Subclinical – an immunity acquired Example: organisms that cause mumps, through constant exposure to a particular rubella, pertussis and influenza disease or organism Types of Antigens: Contact transmission precautions Inactivated (killed organism) – not long lasting, multiple doses needed and These apply to situations in which booster dose is needed pathogens can be transmitted by direct or indirect contact Attenuated (live organism) – single dose needed and long-lasting immunity. Direct contact example: through the patient’s secretions or bodily fluids; i.e. What damages Vaccine? contact which occurs when performing Heat and sunlight damage vaccines, patient-care activities that require especially live vaccines touching the patients skin, secretions or Freezing damage vaccines like those of bodily fluids killed vaccine and toxoids Indirect contact example: touching Antiseptic, disinfectants and detergents potentially contaminated environmental may lessen the potency of vaccines surfaces or equipment in the patients The safest temperature to keep all environment vaccines is 0 – 8 degrees Celsius Example: methicillin-resistant Environmental Sanitation Staphylococcus aureus (MRSA), herpes simplex virus, and hepatitis A virus Water policy sanitation program Excreta and sewage disposal policies Aspects of care of patient with communicable Food sanitation program disease Hospital waste management program Preventive Aspects Health Education Control System Aspect Educate the family and client with respects to availability and importance of Isolation and quarantine prophylactic immunization, manner in Disinfection which infectious illness is spread, Fumigation / disinfectant fogging – importance of seeking medical advices application of gaseous agents to kill or for any signs of health problem and drive organism or insects importance of environmental cleanliness and personal hygiene. Curative and Rehabilitative Aspect Immunization – is the introduction of specific protective antibodies in a Medical management and Nursing susceptible person or animal, or the management production of cellular immunity in such Activity (Eliminating the source of persona or animal infection, transmission and protection of Immunity – is a condition of being secure susceptible host) and nutrition against any particular disease Types of immunity: Natural Immunity Passive – acquired through placental transfer Infection Control Bundles in the Critical Care Active – acquired through immunization Units and or recovery from certain disease Infection Control Care Bundles Artificial Immunity Passive – acquired through the It is a simple set of evidence-based administration of antitoxin, antiserum, practice that when implemented convalescent serum and gamma globulin collectively, reliably and continuously  has been proven to improve patient’s ✓ Internal jugular line outcome (International Society for ✓ Femoral line Infectious Diseases) It is a tool with a clear parameter. Central Line – Associated Bloodstream Infections Bundles These care bundles contribute to: It is defined as a laboratory – confirmed Infection prevention in the critical care bloodstream infection not related to an units infection at another site and that Reduce unnecessary antibiotic develops within 48 hours of central line prescribing placement. Limit the development of antibiotic resistance in the healthcare facilities. Components of CLABSI Bundles General Principles of IC Care Bundles During Insertion of Central Line Access Assist in enhancing compliance to evidence – based quality process a. Hand Hygiene measures to improve patient care b. Maximal sterile barrier precautions is Create reliable and consistent care required. system in the hospital setting c. Standardized insertion pack and the Skin Promotes a multi – disciplinary should be cleanse with alcohol – based collaboration among health care workers. solution e.g. Chlorhexidine solution d. Optimal catheter site selection. Aims of IC Care Bundles Avoidance of femoral vein for venous access instead subclavian vein Care Bundles aim to ensure that patients e. Staff should have finished the receive recommended treatment on a competency training for central line consistent basis. insertion List of IC Bundles in the Critical Care Areas f. Availability of insertion guidelines and use of checklist with trained observers Central Line – Associated Bloodstream Infections (CLABSI) Bundles Maintenance of the bundles Catheter – Associated Urinary Tract a. Daily review of central line Infections (CAUTI) Bundles b. Prompt removal of unnecessary lines ✓ Ventilator Associated Pneumonia (VAP) c. Disinfection prior to manipulation of the Bundles lines d. Disinfect catheter hubs, port, connectors CLABSI Bundles before using the catheter ▪ What is Central Line? e. Change dressing and disinfect site with alcohol – based chlorhexidine every 5 to 7 Also known as central venous catheter. days f. Replace administration sets within 96 It is a small soft tube catheter that is put hours (immediately if used for blood in a vein that leads to the heart. products or lipids) A central line is often used instead of a standard IV (intravenous) line when a CAUTI Bundles patient need treatment for longer than a week or so. CAUTI is defined as a urinary tract infection The line can deliver medicine or nutrition (significantly bacteriuria plus symptoms and / or right into the bloodstream. signs attributable to the urinary tract with no other identifiable source) in a patient with Types of Central lines: current urinary tract catheterization or who has been catheterized in the past 48 hours. ✓ Peripherally inserted central catheter (PICC) ▪ Guidelines to prevent CAUTI ✓ Subclavian line  a. Hand hygiene before handling the catheter b. Avoiding the use of urinary catheters by considering alternative methods for urine collection. c. Using an aseptic technique for insertion and proper maintenance after insertion. d. Maintain a sterile closed drainage system e. Position drainage bag below the level of the bladder f. Ensure daily catheter care hygiene measure g. Daily assessment of the presence and need for indwelling urinary catheters Indications for urinary catheterizations includes: a. Urinary retention (mechanical obstruction or neuropathic) b. Needs to closely monitor the urine output in unstable patients c. To assist perineal wound care VAP Bundles Ventilator Associated Pneumonia (VAP) Bundles is defined as a new pneumonia occurring > 48 hours after endotracheal intubation. It is common and serious hospital – acquired infection for patients who are on mechanical ventilator. International guidelines of VAP bundles: a. Elevate the head of the bed to between 30 to 45 degrees b. Daily “sedation vacation” c. Daily assessment of readiness to exubate d. Daily oral care with chlorhexidine e. Prophylaxis for peptic ulcer disease f. Prophylaxis for deep venous thrombosis