RT101 Module B Infection Control PDF

**RT101 Module B -- Infection Control, Surgical Asepsis, Vital Signs** **Infection Control Concepts (Chp 9)** Why is infection control so important? -- Sick are more vulnerable Why would we be in violation of our ethical code if we disregard infection control? Professional duty: Promote safety fo...

**RT101 Module B -- Infection Control, Surgical Asepsis, Vital Signs** **Infection Control Concepts (Chp 9)** Why is infection control so important? -- Sick are more vulnerable Why would we be in violation of our ethical code if we disregard infection control? Professional duty: Promote safety for pts & staff **Microorganisms** - Microorganisms *causing infections and disease* are called *pathogens* - Pathogens can: - Multiply quickly - Damage - Secret exotoxins (produce side effects) - When the infection results in injury to host, the host is said to have a disease - Microscopic organisms called, *normal flora*, exist in our bodies & don't cause issues; i.e. gut microbiome **Types of Pathogens** 1. Bacteria 2. Viruses 3. Fungi 4. Protozoa: i.e parasites 5. Prions: (1983) smallest and least understood (mad cow) \*pretty new pathogens\* **Bacteria** - **Morphology** = classified by size and shape - Spherical (cocci) - Rod-shaped (bacilli) - Spiral (spirilla) - Able to *mutate* into different genetic forms and treated with antibiotics - Common bacterial infections: - Strep throat, tuberculosis, flesh-eating bacteria, bacterial pneumonia, food poisoning **Viruses** - Viruses have their own DNA or RNA, however, [cannot survive independently] - Rely on host cells to survive & reproduce - Protein coat, or Capsid, surrounds the viral DNA or RNA - Able to *mutate* rapidly, thus few antiviral drugs - Examples of viral diseases: - Common cold from Rhinovirus - Flu from Influenza virus - Mono from Epstein-Barr virus - Warts from Human Papilloma - Chicken pox & shingles from Varicella-Zoster virus - Covid-19 from SARS-CoV-2 virus **Bacterial vs. Viral Infections** - *Antibiotic drugs* usually kill bacteria, not *viruses* - Inappropriate & overuse of antibiotics create strains of bacteria resistant to antibiotic medications - Some ailments such as pneumonia, meningitis, & diarrhea, may be caused by either type of microbe - Difficult to diagnose source of illness **Fungi** - Dimorphic; growth in 2 forms: - Yeast (buds) - Mold (spores) - Fungal infections can be serious in circulatory or lymphatic systems - Typically affects hair, skin, and nails - Common Fungal infections: - Athletes Foot; Ringworm (mold) - Invasive (thrush) and Vaginal Candidiasis (yeast) **Protozoa (Parasites)** - Classified by motility: - Amoeboid -- locomotion - Flagella -- protein tail - Cilia -- numerous short tails - Sporozoans -- nonmotile - Found in GI tract & include worms (helminths) - Types of infections: - Trichomoniasis (STD) - Amebiasis & Giardiasis (unsafe water) - Toxoplasmosis (cat feces, undercook meat) **Chain of Infection (6 links -- can start cycle at any point)** Chain of Infection Components **Elements Needed to Transmit Infection** 1. Infections Agent *(microorganism)* -- causes diseases 2. Reservoir *(habitat)* 3. Exit Portal -- respiratory, urinary, GI tract, bloodstream *(secretions/excretions)* 4. Means of Transmission *(contact, droplet, airborne, vector, fomites)* 5. Entry Portal -- respiratory, urinary, GI tract, bloodstream *(mucous membranes/wounds)* 6. Susceptible Host -- pts w/ reduced natural resistance to infection *(old, young, sick)* **Reservoirs** - **Site** -- where infectious organisms remain alive - i.e. people, animals, inanimate objects, water - **Carrier** -- a person who serves as a reservoir, they're infected but have no signs or disease (asymptomatic) - i.e. Typhoid Mary **Mode of Transmission** - **Direct:** - Touch = person-to-person contact. i.e. by handshake - Droplet = nose or mouth of an infected host. i.e. sneezing & coughing - **Indirect**: - Fomites = contaminated inanimate objects (vehicle born). i.e. x-ray table, x-ray plate - Vectors = animals or insects (mechanical or biological) i.e. mosquitoes, flies - Airborne = inhaled evaporated residue left from droplet i.e. RB **Transmission- Based Precautions** (airborne, droplet, contact) **Airborne (DRY)** - Transmission occurs when microbes are *inhaled from evaporated droplets* that remain suspended in air OR are carried on dust particles in the air - Pt is placed in private room w/ negative air pressure ventilation. *Door remains closed.* - Use standard precautions & particle respirator or N95 - Pt should have mask if leaving room - Examples of **airborne diseases:** - TB, Chicken pox, measles **Droplet (WET)** - Transmission occurs when droplets in the air are passed from person infected w/ a droplet-borne infection. i.e. sneezing, coughing, talking - A private room or *door may be left open* - A surgical mask is required, no special air circulation is needed - Examples of **droplet spread pathogens**: - Diphtheria, Mumps, Influenza **Contact** - **Two types of contact** *spread of infection:* - **Direct contact** -- when a susceptible person touches an infected body - **Indirect contact** -- when a susceptible person touches a contaminated object - Example of contact: Staph, Varicella, Hep A, MRSA, C-Diff **Contact Patients** - If pt comes to x-ray dept, they wear protective apparel, usually mask & PPE gown - Portables on pts in isolations - Pts are in a private room - Use PPE, gloves, gown, & mask (specific for type of isolation) - Equip cleaned after exam completed - Upon completion of the exam, **all equipment is disinfected** **Defense Mechanism** The *human body* is *protected* from invasion of microorganisms in *3 ways*: 1. **Natural Resistance** -- Skin & body chemicals 2. **Acquired resistance** -- develop own antibodies -- immunization 3. **Passive Immunity** -- short term: injected w/ antibodies or acquired from mother (i.e.. Newborns) **Invasive Procedure** -- purposeful entry to body via puncture or incision to body i.e. sx (cutting of the skin) - How do they affect infection control? Instrumentation via. Natural orifice **Preventing Disease Transmission (Chp 10)** **Emerging Diseases --** Include: - **New --** newly recognized or existing & rapidly increasing in incidence or geographic range - **Existing --** increasing in incidence or geographic range - **Resurgent** -- old diseases that are recurring due to mutations - Ex: SARS, Anthrax, Lymes, HIV, Swine & Bird Flues (H1N1 & H5N1), Ecoli, COVID **Nosocomial Infections** - **Hospital Acquired** (or healthcare facility); i.e. nursing homes (HAI -- Hospital acquired/associated infection) - In the U.S., there are approx.. 2 Million pts annually who contract this type of infect - Opportunistic pathogens take advantage of compromised (immunosuppressed) pts - ***Iatrogenic*** infections -- ***physician*** causes - ***Idiopathic*** infections -- ***unknown*** cause **Factors for Nosocomial Infection** - Age - Heredity - Nutritional status - Stress - Inadequate rest & exercise - Health history - Inadequate defenses **Common Infection Sites** - The **urinary tract** [is the most common site] of nosocomial infection & is associated w/ the use of indwelling catheters - **Post-surgical wounds -- skin is open** - **Respiratory tract -- airborne pathogens** **Environmental Control** - WHO -- World Health Organization - \*CDC -- Center for Disease Control & Prevention - HHS -- US Dep Health & Human Services - OSHA -- (Occupational Safety & Health Administration) under dept. of labor \*Most complete source of inform about infectious disease in the U.S. **Blood-borne Pathogens** - **HIV & Hepatitis B (HBV)** are the [2 most common] - **Hep B** affects *liver function*, may cause **jaundice.** - Healthcare workers ***must take care to avoid*** accidental needle sticks **HIV/AIDS** - **HIV** = Huma Immunodeficiency Virus - **AIDS** = Acquired Immunodeficiency Syndrome **Tuberculosis** - Chronic disease caused by the spore -- forming Mycobacterium tuberculosis bacterium - Affects the lungs but can possibly infect any part of the body - Communicable disease & must be treated as such by all healthcare workers - Use an N-95 w/ these possibly infected pts. - Airborne: transmitted in particles called droplet nuclei (tiny bacteria carried in the air) **Standard Precautions (Universal Precautions)** - Designed to reduce the risk of transmission of innfections - Standard precautions assume that all persons are potentially infectious and are for the protection of hospital staff - Wear new gloves for every pt contact & wash your hands \*started in the 80s' following AIDs outbreak called universal for all pts to prevent bloodborne pathogens, in mid 90s' evolved to standard precautions to encompass airborne pathogens **Asepsis: Free from Infection** - Surgical -- eliminate all pathogens (sterilization) - Medical -- reduce number of infectious agent (disinfecting) **Methods of Control** - **Disinfectants** = [Destruction] of pathogens [using chemical materials] - Antiseptics -- applied topically - Bacterio*static* -- *stops* growth - Bacteri*cidal* -- *kills* cells (Bleach, iodine, gas sterilization) - **Protective Barriers -- 1^st^ method** - Gloves, gowns, masks, protective eyewear (P.P.E) - Handwashing **Housekeeping** - Paper towel to sop up spill - Clean from least contaminated toward most contaminated area & from top to bottom (big spill work from outside to inside) - Use bleach solution or hospital-grade disinfectant - Avoid raising dust - Clean all equipment in contact w/ pts. **Handling Linens** - Use gloves, and fold edges to middle w/o shaking or flapping. Place item in hamper immediately - If drench in blood -- special bag marked w/ biohazard symbol - Hospital laundry bags to dissolve in hot water. **Contaminated Waste** - Use needles & syringes go into SHARPS container - Never recap needles - Specimens going to lab are capped & placed in plastic bags w/ biohazard label **Isolation Patients** - Clean vs. Dirty - Clean machine vs. Dirty pt - *Dirty* tech *dons* apparel - *Clean* tech *handles equipment* **Protective Precautions** - Precautions that are used to protect a pt from becoming infected - A.K.A. Reverse Isolation or Strict Isolation - Pts are highly susceptible to infection due to a particular treatment or condition (i.e. burns, AIDS) - Protecting the pt from us, assuming we are the infected & take precautions to protect these pts. **Newborns -- Remember:** - Carefully *clean* the portable machine w/ disinfectant wipes before entering nursery - A clean cloth (diaper, receiving blanket) is used to *cover the IR* - Wash steam under pressure* - **Fenestrated drape** -- A drape w/ *one or more openings* - **Sterilization --** *Treatment* of items with *heat, gas, or chemicals* to make germ-free - **Surgical Asepsis --** Process of creating and maintaining an area that is completely *free of pathogens* - **Surgical hand scrub --** Specific *method* using a brush & antimicrobial soap to *reduce* the number of *pathogens* on hands & forearms & decrease the rate of growth for hours **Medical vs. Surgical Asepsis** Medical (M-minimize) -- reduces number of pathogens, referred to as "clean technique", handwashing is \#1 Surgical Asepsis (total destruction) -- eliminates all pathogens, referred to as "sterile technique" **The Environment and Surgical Asepsis** - An environment in a surgical suite or special procedure room created to avoid any possible infection to the pt. i.e. surgical corridor - Proper attire required for tech & equipment (scrubs, cap, mask, gloves, shoe covers, C-arm drapes) - OR Considerations: AWARENESS **Surgical Scrubbing** - Purpose: - Remove debris - Reduce microbial count to a minimum - For radiographic procedures, the lead apron is put on prior to the hand scrub **Surgical Scrub Drying** - Dry from fingertips down to elbow - Flip towel & repeat on opposite arm using the "clean" side of towel **Sterile Gowning** - Lead Apron 1^St^ - Cap - Mask - Hand Scrub - Gown - Gloves - Tie Waist **Disrobing** - First: Remove gloves properly - Next: Remove mask, cap, booties - Last: remove gown -- pull off so that it too, is inside out & you do not touch the outside surface **Central Sterile Supply Room** - Most items used now are disposable - Sterilization Methods: - **Autoclave -- steam (most common)\*** really high temp, most effective & easiest way to disinfect - Chemical - Gas or Gas Plasma - Dry Head (oven) **Sterility Indicators** - **Chemical** -- indicators display diagonal lines when sterile & change color if gas, steam, or gas plasma has penetrated surfaces - **Biological** -- used for implantable devices. Inability for sterile resistant organisms to culture spores after sterilization - **Expiration dates**: Check them! **Special Radiographic Procedures & Sterile Technique** - Technologists may be responsible for skin prep & tray set-up during specific radiologic exams - Angiography - Arthrography - Hysterosalpingogram - Operating Room Radiography **Patient Skin Prep** - Required for *invasive procedures* - Minimizes introduction of pathogens into body via puncture or incision - Hair must be removed, if necessary - Application of antiseptic solution - Betadine most common \*\* - Create a circle around the puncture site, wiping inside to out - W/ a new applicator, cleanse the skin a second time. **Sterile Field** - Microorganism-free area for prepared for the use of sterile supplies & equipment - Establishing a sterile field - Remove the factory cover. *The outside surface is not sterile*. 1inch border around the paper is considered non-sterile - Place tray that enables you to: Remove the *1^st^ flap away* - Open the first side flap by carefully grasping the corner tip - Open the second side flap in the same manner - *Avoiding contamination*, carefully grasp outside surface of the flap - Open the *4^th^ flap toward you* \*done immediately before exam and once established, never be out of your sight\* **Adding Liquids to a Sterile Field** A. Check label and open bottle. B. Cleanse lip of container, by pouring or squirting small amount into waste container C. Pour required amount into the receptacle tray, taking care NOT to contaminate sterile field **After Procedures** - Don gloves then: - Discard sharps - Rinse reusables thoroughly - Central Sterile Supply \*\* - Discard all disposals and tray **Non-aseptic Technique -- not cutting skin** - NG Tubes, Urinals, Bedpans, Enemas, Colostomies **Difference Between Aseptic and Antiseptic?** - Aseptic: absence of microorganisms - Antiseptic: discouragement of microorganism growth **Dressing Change** 1. Wash your hands, ensure pt privacy, & obtain consent 2. W/ gloved hands (unsterile) remove old dressing, discard proper receptacle 3. New dressing (sterile technique) 4. Wash hands, prepare supplies: - Open sterile towel, place on table/mayo stand - Dressings added to sterile field - Tape cut and placed nearby but not touching sterile field 5. Don (sterile) gloves & apply clean dressing 6. Unglove & secure dressing w/ tape. **Basic Principles of Sterile Techniques** - **"When in doubt, throw it out!"** - Only *sterile* *items* used in *sterile fields* - Sterile field must remain dry - *Below the waist* or *back of gown is unsterile* - Gloved hands up & in sight - Stay in sterile "corridor" - Pass back-to-back **Most Common Causes of Contamination** - The use of contaminated instruments - Contaminated gloves - Wet or damp sterile field - Microorganisms blow onto a surgical site -When in doubt throw it out -- New pt, new gloves -- Know wet times -- wear a mask, cap, & gown **Donning -- Apply:** 1. Cap 2. Mask 3. Gown 4. Gloves \*Practice hand hygiene at start and finish \*\* **Doffing -- Remove and dispose:** 1. Gloves 2. Gown 3. Mask 4. Cap \*Practice hand hygiene **[Patient Assessment -- Vital Signs]** **Assessing Patient Current Physical Status** - You must assess each pt on their physical status - Can they stand, skin coloring, breathing **Check the Patient's Chart** - Form a clear understanding of the pts baseline status - Review "admitting diagnosis" or "progress notes" to assess whether a pt is able to stand, ambulate, or can not move on their own - Patient color-coded bracelets: - Allergies (RED) - Fall Risk (YELLOW) - DNR (PURPLE) **Physical Appearance & Responses** Change in Skin Color: - **Cyanotic** = bluish coloration in the skin that indicates a lack of sufficient oxygen in the tissue - You would need to call a nurse or doctor to administer oxygen **Change in skin temperature** - **Diaphoretic** = (cold sweat) pale, cool, and sweaty - **Pyrexia (fever)** = hot, dry skin - **Hypothermia** = temp below the normal limits **4 Levels of Consciousness (AVPU)** 1. Alert & conscious 2. Drowsy but responsive (Voice) 3. Unconscious but reactive to pain stimuli (Pain) 4. Comatose (unresponsive) **Breathing** - Changing in breathing may signal the onset of serious distress - **Normal** = quiet and calm - **Audible breathing** = wheezing, gasping, coughing -- ***respiratory distress*** - Emphysema - Hyperventilation - Orthopnea **Vital Signs** -- (Temperature, Pulse Rate, Respiratory Rate, and Blood Pressure) **Temperature** - The physiological balance between the head produced in the body tissues & the heat lost to the environment - In adults, fever refers to temps of 100.4 F or above - **Factors that affect temperature ranges:** - Environment, time of day, age, weight, hormone levels, emotions, physical exercise, digestion of food, disease, or injury **Oral** -- Thermometer under tongue - Normal reading is 98.6F (37C) Written as 98.6 O **Axillary** -- under armpit - Normal reading is 97.6F. Written as 97.6 Ax **Tympanic** -- uses a disposable sheath over probe - Normal reading as 97.6F. Written as 97.6 T **Rectal** -- most reliable "core" temp. Blunt tip. - Normal reading is 99.6F. Written as 99.6 R **Normal Temperature Ranges** Infant: 0-3yrs. Old -- 99F Child: 5 -13yrs. Old -- 97.8 -- 98.6F Adult: 98.6F **Pulse** - Measures heart rate, beats per minute/bpm - A pulse is the advancing pressure wave in an artery caused by the expulsion of blood when the left ventricle of the hear contracts. - **Common pulse points**: - Radial artery (best) - Carotid artery - Dorsalis pedis (pedal puls) over instep of the food - Apical -- measurement taken by listening to the heartbeat through a stethoscope placed over the apex of the heart **Pulse Rates** - If BP is low, pulse is high, and opposite is true - If pt. is losing blood, pulse is rapid and BP is low - Adult -- Normal Pulse rate (60 -90 beats per/min) - 4-10yrs. Old -- Normal Pulse Rate (90 -100bpm) - Infant -- Normal Pulse Rate (120bpm) **Taking a Pulse** - Do not press too hard or you might compress artery - Do not use thumb to count pulse -- it has its own pulse - Radial pulse is most often used (infants & children -- apical) - Count for 1 full minute - If any irregularity, take an apical pulse. Report irregularity rapid/slow pulse, or weak, thready pulse. **Respiration Rate** Normal Adult Range -- 12-20 breaths/min (Eupnea) Bradypnea -- Slow breathing. Less than 12 breaths/min Tachypnea -- Fast breathing. Greater than 20 breaths/min Dyspnea -- difficulty breathing **Blood Pressure** **Blood Pressure Reading** - A blood pressure reading is usually expressed with two figures. 120/78 - **Systolic** - Top \# - a measure of the pumping action of the heart muscle itself - Normal ranges 95-119mm HG - **Diastolic** - Bottom \# - indicates the ability of the arterial system to accept the pulse of blood forced into the system when the left ventricle contracts. - Normal ranges -- 60-79mmHg **Abnormalities** **Hypertension** - Abnormally high blood pressure - Common in men younger than the age of 50 and in women older than age 50 - Hypertension contributes to the incidence of stroke and CHF **Hypotension** - Abnormally low blood pressure - Can result in a potentially life-threatening condition = **shock** Pulse Oximeter (Pulse Ox) - A common monitoring device placed on a finger, toe, or earlobe that continuously monitors both pulse rate and blood oxygen levels - Normal values range from 95% - 100% - Readings below 95% may indicate that tissues are receiving inadequate oxygen perfusion **Electrocardiogram** - Measures the electrical activity of the heart and displaces the information graphically in the form of waves - **Sinus Rhythm -- normal heart rate** - **Arrhythmia** - **Asystole** - **Fibrillation** - **Cardioversion**