Infection Control Principles PDF

**Infection Control Principles 🚨** **Healthcare-associated infections (HAIs)**: infections that patients acquire during the delivery of care in any healthcare setting. - Approximately 2,000,000 HAIs occur each year in the United States. - 100,000 of these cases are associated with death. -...

**Infection Control Principles 🚨** **Healthcare-associated infections (HAIs)**: infections that patients acquire during the delivery of care in any healthcare setting. - Approximately 2,000,000 HAIs occur each year in the United States. - 100,000 of these cases are associated with death. - 1/3 of these infections are completely preventable. - HAIs cost approximately \$6,650,000,000 per year in the United States. **Transmission of Infections** There are three conditions necessary for the transmission of infectious agents: - **Source of the infectious agent** - **Susceptible host** - **Mode of transportation** Infections are transmitted during patient care primarily via: - Human contact - Inanimate source (e.g., stethoscope, pulse oximeter) **Factors that Increase Susceptibility to Infection** - Underlying diseases - Immunocompromised patients (e.g., undergoing chemotherapy, radiation, or with immunodeficiency syndrome such as AIDS or HIV) **Modes of Transmission** **Mode** **Description** **Examples** ------------------------------- ---------------------------------------------------------------------------------------------- ----------------------------------------------------------------- **Direct Contact** Body surface to body surface transmission HIV, Ebola, influenza **Indirect Contact** Contaminated object transmission Staphylococcus, Pseudomonas aeruginosis, Hepatitis B and C, HIV **Droplet Transmission** Droplets larger than 5 micrometers propelled through coughing, sneezing, talking, or singing Rhinovirus, severe acute respiratory syndrome, rubella **Airborne Transmission** Evaporated droplet nuclei containing microorganisms suspended in the air Tuberculosis, SARS, COVID-19 **Vehicle Transmission** Contaminated food, water, medications, devices, or equipment transmission Cholera, foodborne salmonella, hepatitis **Vector-Borne Transmission** Vectors such as mosquitoes or flies transmit microorganisms Lyme disease, Rocky Mountain spotted fever, malaria **Strategies for Protecting Patients and Healthcare Workers** - **Infection Control Procedures**: decrease the spread of infection - **Proper PPE**: protect healthcare workers and patients - **Immunization Programs**: implement vaccination programs for healthcare workers (e.g., Hepatitis A and B, varicella, rubella, and measles) - **Safety Training**: provide training for healthcare workers on infection control and safety protocols - **Employee Health**: employees should not report to work with potentially infectious conditions (e.g., fever, diarrhea, chickenpox) **Equipment Processing** A rational approach to disinfection and sterilization of patient care equipment focuses on three levels of concern: - **Critical Equipment**: must be sterile when being used on or with patients (e.g., chest tubes) - **Semi-Critical Equipment**: must be disinfected - **Non-Critical Equipment**: can be cleaned and disinfected\#\# Equipment Processing and Disinfection 💊 **Classification of Equipment** Equipment can be classified into three categories: - **Critical**: Equipment that penetrates the body surface or comes into contact with mucous membranes (e.g., bronchoscopes, ventilator circuits) - **Semi-critical**: Equipment that does not penetrate the body surface but comes into contact with the patient (e.g., components of a ventilator circuit) - **Non-critical**: Equipment that does not come into contact with the patient (e.g., office equipment) **Equipment Processing Steps** The four important steps in equipment processing are: 1. **Cleaning**: Removing gross contamination, dirt, secretions, or other visible materials from a surface to reduce the number of microorganisms and remove their potential growth. 2. **Disinfection**: Reducing the number of microorganisms on a surface, but not necessarily removing all microorganisms. Spores and mycobacteria viruses are resistant to disinfection. 3. **Sterilization**: The complete elimination of all microorganisms, including spores. 4. **Monitoring and Surveillance**: Ensuring that the cleaning, disinfection, and sterilization procedures are done correctly. **Cleaning Equipment** To clean equipment, disassemble and examine it, then place it in a sink or basin filled with hot water, soap detergent, or enzymatic cleaner. Rinse thoroughly and dry to prevent bacterial growth. **Disinfection Methods** Disinfection can be achieved through physical or chemical methods. The type of contamination, temperature, and pH of the disinfection solution affect the disinfection process. **Method** **Description** ---------------------------- ------------------------------------------------------------------------------------------------------------ **Pasteurization** Immersing equipment in water heated to 70°C for 30-45 minutes, then drying. **Chemical Disinfectants** Using disinfectants such as alcohol, chlorine, or glutaraldehyde on the contaminated surface of equipment. **Disinfectants** Familiarize yourself with the following disinfectants: **Disinfectant** **Description** ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- **Alcohol** Can damage some equipment, causing rubber or plastic tubing to harden or swell, and may discolor some equipment. **Glutaraldehyde (Cidex)** A high-level disinfectant that can disinfect surfaces within 20 minutes and sterilize them in 6-10 hours. It is safe to use on metals, rubber, and plastic, but has a strong odor and can be toxic. **Hydrogen Peroxide** Typically used on ventilator surfaces, it has no activation requirements, enhances removal of organic material, and has no disposal issues. However, it has material compatibility concerns and can cause serious eye damage. **Acetic Acid (Vinegar)** Typically used for home care equipment, it is readily available and has a low toxicity profile. **Note:** Always follow proper precautions when handling disinfectants, including wearing gloves and eye protection, and rinsing equipment thoroughly after disinfection.\#\# Disinfection and Sterilization 🧹 **Disadvantages of Disinfection** - Need to dilute before use - Requires long exposure times to kill off some pathogens **Sterilization 💡** **Definition:** The complete destruction of all microorganisms, including spores. **Purpose:** Prevents the transmission of diseases. **Types of Sterilization** **Physical Processes** - Steam - Radiation **Chemical Processes** - Ethylene oxide (ETO) - Hydrogen peroxide gas plasma - Peracetic acid **Steam Autoclaving 💧** **Definition:** Uses heat to kill microorganisms and spores. **Advantages:** - Non-toxic to patients and staff - Environmentally friendly - Rapidly kills off microorganisms and spores - Easy to control and monitor - Least affected by organic or inorganic soils **Disadvantages:** - Some equipment can be heat sensitive - Can damage microsurgical instruments - Potential to cause burns **Hydrogen Peroxide Gas Plasma ⚡️** **Advantages:** - Safe for the environment - Simple to operate and install - Requires only an electrical outlet - Used for heat and moisture sensitive items **Disadvantages:** - Linens, paper, and liquids cannot be processed - Sterilization chamber size varies - Hydrogen peroxide can be toxic **Ethylene Oxide (ETO) 💡** **Advantages:** - Penetrates packaging materials and device lumens - Simple to use and operate - Compatible with most medical materials **Disadvantages:** - Toxic and carcinogenic - Flammable - Requires aeration time to remove ETO residue - Sterilization chamber sizes vary **Peracetic Acid 🌿** **Advantages:** - Rapid cycle time (30-45 minutes) - Low temperature immersion sterilization (50-55°C) - Environmentally friendly - Used for endoscopes **Disadvantages:** - Point of use system with no sterile storage - Biological indicators may not be suitable for routine monitoring - Incompatible with some materials - Limited number of instruments can be processed per cycle - Potential for serious eye and skin damage **Equipment Surveillance and Monitoring 🔍** **Purpose:** Ensures that sterile and disinfected equipment is properly processed to meet necessary levels of cleanliness. **Components:** 1. Monitoring equipment processing procedures 2. Sampling and testing equipment 3. Microbiologically identified suspect pathogens **Methods of Surveillance** **Aspiration** Draws sterile saline through the lumen of a piece of equipment to test for microorganisms. **Plating** Cultures an exterior surface by rolling equipment onto a petri dish filled with agar. **Swabbing** Tests irregular surfaces by swabbing onto a culture medium. **Standard Precautions for All Patients 🚨** **Hand Hygiene:** - Wash hands thoroughly after touching blood, body fluids, secretions, excretions, or contaminated items - Wash hands between patient contacts - Use alcohol-based foam or hand cleaner and put on gloves before treating a patient\#\# Hand Hygiene and Personal Protective Equipment (PPE) 🚿 **Hand Hygiene** Hand hygiene is the most important factor in the prevention of the spread of infection. **Alcohol-based hand rubs** are an effective form of keeping hands clean. Wash hands especially if they are soiled by blood or body fluids or excrement. **Important:** Hand hygiene effectiveness is reduced if: - You have long nails - You wear jewelry (especially rings, which can be a breeding ground for bacteria) **Personal Protective Equipment (PPE)** PPE includes: - Gloves - Gowns - Masks - Eye protectant (goggles or face shields) **When to wear PPE:** - When touching blood, body fluids, secretions, or excretions - When touching mucous membranes or non-intact skin - During procedures and patient care activities when contact with clothing or exposed skin with blood, body fluids, secretions, or excretions is anticipated - During procedures and patient care activities that generate splashes or sprays of blood, body fluids, or secretions **Standard Precautions** **Definition:** *Standard precautions are a set of guidelines for healthcare workers to follow to prevent the transmission of infectious diseases.* **Components of Standard Precautions:** **Component** **Description** ----------------------------- -------------------------------------------------------------------------------------------------------------------------- Hand Hygiene Wash hands with soap and water or use alcohol-based hand rub PPE Wear gloves, gowns, masks, and eye protectant as necessary Patient Placement Prioritize single patient rooms for patients at increased risk of transmission Patient Resuscitation Use mouthpieces or resuscitation bags to prevent contact with mouth or oral secretions Soil Patient Care Equipment Handle equipment in a manner that prevents transfer of microorganisms to others and the environment Textiles and Laundries Handle textiles and laundries in a manner that prevents transfer of microorganisms to others and the environment Environmental Control Develop procedures for routine care, cleaning, and disinfection of environmental surfaces Needles and Sharps Dispose of needles and sharps in sharps containers Respiratory Hygiene Use good cough etiquette, cover mouth and nose when sneezing or coughing, and dispose of tissues in no-touch receptacles **Universal Precautions:** *Universal precautions are a set of precautions designed to prevent transmission of HIV, hepatitis B virus, and other bloodborne pathogens when providing healthcare.\#\# Personal Protective Equipment (PPE) 🧦* **Hand Hygiene** - Use a no-rinse hand hygiene dispenser to kill bacteria on hands - Spread the alcohol-based film well to ensure effective coverage **PPE Components** - Gloves - Eye protection (goggles or face shield) - Face protection (masks) - Gowns **Important:** Wear goggles or face shield over glasses for added protection **Donning and Doffing PPE** - Refer to slides 33-42 for detailed instructions on proper procedure - We will review this process in lab **Powered Air Purifying Respirator (PAPR) 💨** *A device with a half or full face piece breathing tube, battery operated blower, and HEPA filter that supplies purified air to the face piece, used for treating patients with highly contagious bacteria or infection viruses.* **Needle Protection and Sharps Disposal 💉** - Use safety system on needles to prevent accidental injuries and transmission of bloodborne pathogens (e.g. hepatitis C, HIV) - Use needle protection devices on all arterial blood gas syringes - Dispose of needles properly in sharps containers **Transmission-Based Precautions 🚨** **Standard Precautions** - Apply to all patients - Include: - Hand hygiene before and after every patient contact - Wearing gloves, gowns, or eye protection as required - Safe disposal or cleaning of instruments and linens - Good cough etiquette (cover nose and mouth with elbow or tissue, not hands) **Contact Isolation 🛑** - For patients with MRSA, VRE, scabies, abscesses, or ulcers that have tested positive for staph or group A strep - In addition to standard precautions: - Private room preferred - Gloves required upon entering the room - Change gloves after contact with contaminated secretions - Gown is required if clothing may come into contact with the patient or environment surfaces, or if the patient has diarrhea - The patient wears a gown during transport **Droplet Isolation ❄️** - For patients with influenza, meningitis, epiglottitis, parvovirus, adenovirus, or rubella - In addition to standard precautions: - Private room preferred - Wear a surgical mask when within 3 feet of a patient - A patient must wear a surgical mask during transport - Use good cough etiquette **Airborne Isolation 💨** - For patients with tuberculosis, smallpox, measles, or SARS, COVID-19 - In addition to standard precautions: - Place patient in airborne infection isolation room with negative pressure and high-efficiency HEPA filter - Healthcare workers wear N95 respirator masks, which must be fit-tested annually - Minimize patient transport, and have the patient wear a surgical mask if transported\#\# Infection Control Measures 🏥 **Healthcare-Associated Sources of Respiratory Pathogens** Healthcare-associated sources of respiratory pathogens include: - Ventilator circuit changes - Condensate (condensation that builds up inside ventilator tubing, aerosol tubing, or small line nebs) - Humidifiers - Nebulizers - Suction catheters - Pulmonary function testing equipment **Key Points** ***Healthcare-associated infections (HAI)** result in preventable suffering and loss of life.* *Approximately 100,000 people per year die from hospital-acquired infections, which could have been prevented by following CDC guidelines.* **Routes of Transmission** There are four common routes of transmission: - **Contact**: direct or indirect contact with infected individuals or contaminated surfaces - **Vehicle**: contaminated objects or substances - **Airborne**: respiratory droplets or aerosols - **Vector**: insects or animals that transmit pathogens **Infection Control Methods** Infection control methods include: **Method** **Description** ------------------ --------------------------------------------------------- **Cleaning** Removing dirt, dust, and soil from surfaces **Disinfecting** Killing pathogens on surfaces using chemical agents **Sterilizing** Completely eliminating all microorganisms from surfaces **Primary Precautions** Primary precautions include: - **Hand Hygiene**: washing hands before and after every patient contact - **Standard Precautions**: assuming every patient is a potential source of infection and taking universal precautions - **Personal Protective Equipment (PPE)**: using gloves, masks, air eye protection, gowns, and booties to prevent exposure **Transmission-Based Precautions** Transmission-based precautions include: - **Contact Precautions**: Use gloves and gowns to prevent contact transmission - **Droplet Precautions**: Use masks to prevent droplet transmission - **Airborne Precautions**: Use respiratory protection and negative pressure rooms to prevent airborne transmission **Importance of Hand Hygiene** 🚿 **Hand Hygiene** is the most effective way to prevent transmission of infection. It should be performed before and after every patient contact.