infection control vinay

UNIT 10: INFECTION CONTROL IN CLINICAL SETTINGS

Microorganisms

– Microscopic.– Naturally present on and in the human body andenvironment.– Some microorganisms (pathogens) cause specificdiseases or infections.– Many are harmless (nonpathogenic) and do notproduce disease in most individuals.– If an individual is highly susceptible to infection, thenonpathogenic microorganisms could becomeinfectious.

• Virulence: ability to produce disease• Pathogenicity: ability to produce disease• Pathogen is a microorganism that produces

disease.• A true pathogen causes disease or infection in

a healthy individual• An opportunistic pathogen causes disease

only in a susceptible host

Nature of infection• An infection is the invasion of a susceptible host by

pathogens or microorganisms, resulting in disease.• If the microorganism produces no clinical evidence of

disease , the infection is called asymptomatic or subclinical.

• The principal infecting agents are bacteria, viruses, fungi and protozoa.

• If a microorganism is present or invades a host, grows and/or multiplies but does not cause disease or infection, this is referred to as colonization.

• Disease or infections result only if the pathogens multiply and alter normal tissue function.

• If infectious disease can be transmitted directly from one person to another , it is considered as a contagious or communicable disease

Infection:

• An invasion of pathogens or microorganisms into the body that are capable of producing disease.

• The invasion and reproduction of microorganisms in a body tissue that can result in a local or systemic clinical response such as cellulitis, fever etc.

Types of infections• Colonization: process by which strains of microorganisms

become resident flora. In this state, the microorganisms may grow and multiply but do not cause disease.

• Infection occurs when newly introduced or resident microorganism succeed in invading a part of the body where the host’s defense mechanisms are ineffective and the pathogen causes tissue damage. The infection becomes a disease when the signs and symptoms of the infection are unique and can be differentiated from other conditions.

• Infection can be local or systemic.– Local infection : infection limited to a specific part of the

body where the microorganisms.

Types of infections

– Systemic infection : microorganism spread and damage different parts of the body

• Acute or chronic infections• Acute : appear suddenly or last a short time• Chronic : may occur slowly, over a very long period

and may last months or years

Chain of infection

• The presence of a pathogen does not mean that an infection will begin

• Development of an infection occurs in a cyclic al process that depends on the presence of following elements

• Infectious agent or pathogen, reservoir for pathogen growth, portal of exit from the reservoir, mode of transmission or vehicle, portal of entry and a susceptible host.

• Infection develops if this chain stays contact.• Nsg efforts should be to control and prevent

infections by breaking this chain.

Chain of Infection/Infection Process

Portal of Exit

Portal of Entry

Transmission

Reservoir

Infectious Agent

Host Susceptibility

Chain of Infection: (cont.)

• Development of an infection depends on the six elements identified in the chain of infection.

1)Infectious agent – microorganisms (bacteria, viruses)

• Resident – normally reside on the skin in stable numbers

• Transient – attach loosely to the skin by contact with another – easily removed by handwashing

2) Reservoir:

• A reservoir is any natural habitat of amicroorganism that promotes growth andreproduction.– Examples of reservoirs are soiled or wetdressings, insects, food , water hospital equipment, and

carriers (person or animal who harbors and spreads an microorganism, but show no signs of disease e.g Anopheles mosquito carrier for malaria parasite).

– Food and proper atmosphere are required tothrive.

3)Portal of exit:• Site where microorganism leaves.– A microorganism cannot cause disease inanother host unless it finds a point of escapefrom the reservoir.– Human exit routes are gastrointestinal,respiratory, and genitourinary systems; tissue;and blood.– Handwashing can prevent the spread ofmicroorganisms or cross-contamination.

4)Mode of transmission:

• After a microorganism leaves its source or reservoir, it requires a means of transmission to reach to another person or host through a receptive portal of entry.

• 3 mechanisms:– DIRECT TRANSMISSION

• Immediate and direct transfer of microorganisms from person to person through touching, biting, kissing or sexual intercourse. Droplet spread is also a form of direct transmission but can occur only if source and host are within 3 feet of each other. ( Sneezing, coughing, spitting, singing, talking)


• INDIRECT TRANSMISSION– Either vehicle borne or vector borne

A) VEHICLE BORNEVehicle is any substance that serves an intermediate means to

transport and introduce an infectious agent into a susceptible host through a suitable portal of entry. FOMITES ( inanimate material or objects), such as toys, soiled clothes, utensils, hanky, pen can act ac VEHICLES. Water, food , blood, serum, plasma are other vehicles.

B) VECTOR BORNE TRANSMISSIONAnimal or flying or crawling insect that serves as an intermediate means of

transporting the infectious agent. – AIRBORNE TRANSMISSION– Method of Transmission

4)Mode of transmission

• AIRBORNE TRANSMISSION– May involve droplets or dusts. Droplet nuclei is

the residue of evaporated droplets emitted by an infected host such as someone with TB, can remain in air for long periods.


– There are many vehicles on or by which microorganisms can travel to the next host.

– Fomite• Vehicle is inanimate (nonliving) object• Stethoscope, thermometer, bandage scissors, etc.– Vector• Living carrier

5)Portal of Entry: (to the host)• Entrance of Microorganisms– The microorganism must find a way to enterthe susceptible host.– When the host’s defense mechanisms arereduced, the microorganism has a greaterchance to enter.– The skin is the first line of defense andshould be kept intact, lubricated, andclean. Enter the same way they exit (open wound, breathe in)

6)Host susceptibility:

• Host must be susceptible to the strength and numbers of the microorganisms.

• • To reduce susceptibility – provide adequate

nutrition & rest, promote body defenses against infection & provide immunization.

Breaking the Chain of Infection

The cycle must be interrupted to prevent the spread of a microorganism.

RESPONSE TO INFECTION

• Response– depends on organism and host– normal course of infection

• 1st phase (incubation period)–when pathogen enters the body to the

appearance of first symptoms• 2nd phase (prodromal stage)

–from appearance of first symptoms to more severe symptoms

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• Response – normal course of infection

• 3rd phase (full stage)–symptoms are acute and specific to

type of infection• final phase (convalescence stage)

–when acute symptoms subside and patient recovers

Course of infection

• Pre exposure stage : factors present leading to problem development

• Preclinical stage : exposure to causative agent, no symptoms present

• Clinical stage: symptoms present• Resolution stage : Problem solved. Returned

to health or chronic state of death•

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RESPONSE TO INFECTION• Factors that Influence Infection

– Body’s defense mechanisms– Portal of entry

• only if they gain accessto the body through a specific portal of entry

– Number of microorganism• greater the number, greater the

opportunity to cause disease

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• Factors that Influence Infection – Virulence

• pathogen’s strength to cause disease– Host resistance

• some normal flora have an antibiotic relationship

NOSOCOMIAL INFECTION

• When a client who develops an infection that was not present or incubating at the time of admission to a health care setting, it is called as nosocomial infection

• Exogenous: arises from micro organisms outside the individual. Eg salmonella, clostridium tetani

• Endogenous: when part of patient's flora becomes altered and an overgrowth results ( enterococci, yeasts, and streptococci.

Examples of sites and potential causes for nosocomial infections

• SURGICAL AND TRAUMATIC WOUND INFECTION– Improper surgical technique– Improper skin prep before sx– Improper aseptic technique during dressing change

• PRIMARY BLOODSTREAM INFECTION– Contamination of IV fluids , needles or catheter– improper care of hemodialysis or peritoneal shunt– improper skin prep before insertion of IV access

device

Examples of sites and potential causes for nosocomial infections

• PNEUMONIA– Improper aseptic technique during suctioning– Displacement of NG tube

• URINARY YTRACT INFECTION– Improper insertion of urinary catheter– improper specimen collection technique– contaminated catheter – improper handwashing technique

• GI SYSTEM INFECTION– Contaminated food or water– overuse of antibiotics

• SKIN AND SOFT TISSUE INFECTION– Improper skin care– poor nutrition and hydration

Copyright 2008 by Pearson Education, Inc.

Signs of Localized Infection

• Localized swelling• Localized redness• Pain or tenderness with palpation or

movement• Palpable heat in the infected area• Loss of function of the body part affected,

depending on the site and extent of involvement


Signs of Systemic Infection

• Fever• Increased pulse and respiratory rate if the

fever high• Malaise and loss of energy• Anorexia and, in some situations, nausea and

vomiting• Enlargement and tenderness of lymph nodes

that drain the area of infection


Signs of Infection

• Laboratory data– Elevated WBC count– Increase in specific WBC types– Elevated ESR– Cultures of urine, blood, sputum, or other

drainage


Risks for Nosocomial Infections

• Diagnostic or therapeutic procedures– Iatrogenic infections

• Compromised host• Insufficient hand hygiene


Factors Influencing Microorganism’s Capability to Produce Infection

• Number of microorganisms present• Virulence and potency of the microorganisms

(pathogenicity)• Ability to enter the body• Susceptibility of the host• Ability to live in the host’s body


Anatomic and Physiologic Barriers Defend Against Infection

• Intact skin and mucous membranes • Moist mucous membranes and cilia of the nasal

passages• Alveolar macrophages• Tears• High acidity of the stomach• Resident flora of the large intestine• Peristalsis• Low pH of the vagina• Urine flow through the urethra


Active Immunity

• Host produces antibodies in response to natural antigens or artificial antigens

• Natural active immunity– Antibodies are formed in presence of active infection in

the body – Duration lifelong

• Artificial active immunity– Antigens administered to stimulate antibody formation– Lasts for many years– Reinforced by booster


Passive Immunity

• Host receives natural or artificial antibodies produced from another source

• Natural passive immunity– Antibodies transferred naturally from an immune mother

to baby through the placenta or in colostrums– Lasts 6 months to 1 year

• Artificial passive immunity – Occurs when immune serum (antibody) from an animal or

another human is injected– Lasts 2 to 3 weeks


NANDA Diagnosis

• Risk for Infection– State in which an individual is at increased risk for

being invaded by pathogenic microorganisms

• Risks factors– Inadequate primary defenses– Inadequate secondary defenses


Related Diagnoses

• Potential Complication of Infection: Fever• Imbalanced Nutrition: Less than Body

Requirement• Acute Pain• Impaired Social Interaction or Social Isolation• Anxiety


Interventions to ReduceRisk for Infection

• Proper hand hygiene techniques• Environmental controls• Sterile technique when warranted• Identification and management of clients at

risk

ASEPSIS

• Definition (Asepsis)– practices that minimize or eliminate organisms

that can cause infection and disease• medical asepsis

–clean technique• surgical asepsis

–sterile technique

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Asepsis

• Medical asepsis

– Includes all practices intended to confine a specific microorganism to a specific area

– Limits the number, growth, and transmission of microorganisms

– Objects referred to as clean or dirty (soiled, contaminated)

• Surgical asepsis– Sterile technique– Practices that keep an

area or object free of all microorganisms

– Practices that destroy all microorganisms and spores

– Used for all procedures involving sterile areas of the body

Medical asepsis

• Includes all practices intended to confine aspecific microorganism to a specific area• Limits the number,growth, and transmissionof microorganisms• Clean or dirty (soiled,contaminated)

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MEDICAL ASEPSISDefinition (Medical Asepsis): reduce/prevent

number of microorganism transmissionscomponents

1. GENERAL CLEANLINESS/ CLEAN ENVIRONMENT.

2. HANDWASHING3. BARRIER TECHNIQUES4. DISINFECTION OF ALL

ARTICLES THAT MAY BE CONTAMINATED, OR USED FOR MORE THAN ONE PATIENT.

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MEDICAL ASEPSIS

• Medical Asepsis• 1 )HANDWASHING

• single most effective measure to prevent the spread of disease

2) barrier technique (PPE)• keep organisms from

entering or leaving therespiratory tract, your eyesor breaks in the skin

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MEDICAL ASEPSIS

• Medical Asepsis – gloves

• latex allergy– eye protection

• goggles/glasses– gowns/aprons

• fluid resistant– masks

• disposable

Disinfection and methods:

Disinfection is the process of killing the pathogenic ordisease producing microorganism but not usually bacterial spores.Disinfectant is germicide an agent which kills pathogenic ordisease producing microorganisms but not usually bacterial spores.Eg . phenol and Lysol.Antiseptic is an agent which prevents the growth of microorganisms. Eg

alcohol.A deodorant is an agent, which suppresses bad odours. Eg. Lime , bleaching

powderDetergent is a surface cleansing agent, which acts by lowering surface

tension. Eg soap.Sterilization is a destruction of microorganisms and their spores.

DisinfectingA disinfectant is a chemical preparation, such as

phenol or iodine compounds , used on inanimate objects which kills pathogenic microorganisms but not usually bacterial spores.

• An antiseptic is a chemical preparation used on skin or tissues.

• Disinfectants and antiseptics often have similar chemical components, but the disinfectant is more concentrated.

• Both have bactericidal or bacteriostatic properties

Disinfecting

• A bactericidal preparation destroys bacteria whereas bacteriostatic prep prevents the growth and reproduction of some bacteria.

• EXAMPLES: Isopropyl and ethyl alcohol, chlorine ( bleach), hydrogen peroxide, Phenol

Types of Disinfection:

1. Concurrent disinfection: This is disinfection of infectiousmaterial ( eg stools, urine contaminated linen) through outthe course of an illness . This procedure checks or preventsthe dissemination or further spread of the disease agent.2. Terminal disinfection: This is disinfection that isundertaken at the termination of an illness. ( eg. Afterrecovery or death of the patient).3. Prophylactic disinfection: Boiling of water, pasteurisationof milk, washing hands with soap and water are examples.

SURGICAL ASEPSIS• Practices that keep an area or object free of all

microorganisms, no organisms are carried to the patient• Sterile technique (Practices that destroy all microorganisms

and spores)• Used for all sterile areas of the body

– used during dressing changes, administering parenteral medications & sterile procedures

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SURGICAL ASEPSIS

• INCLUDES• 1) Disinfection & Sterilization

– disinfectants destroy most pathogens but not necessarily their spores

– sterilization destroys all pathogens and spores

• 2)Sterile Protective Measures– hair covering, surgical mask, sterile gown

and sterile gloves

Sterilizing– Two types• Physical (uses heat or radiation)– Steam under pressure, boiling water, radiation, or dry

heat• Chemical– Gas– Chemical solutions» Iodine, alcohol, and chlorine bleach

SterilizingSterilisation is a process that destroys all microorganisms

including spores and viruses– 4 commonly used methods of sterilisationMoist heat, gas, boiling water and radiationMoist heat: steam under pressure is used because it attains

temperature higher than the boiling pt .( autoclave) Gas : Ethylene oxide gas destroys microorganisms by interfering

with their metabolic processses. Also effective against spores.Boiling water: minimum 15 minutes boiling is advised for

diisnfection. Most practical and inexpensiveRadiation: Both ionizing ( alpha , beta and xrays) and nonionizing

( ultraviolet light) are used.food, drugs and other items that are sensitive to heat are stterilised by radiation

Principles of Sterile Technique

– A sterile object remains sterile only whentouched by another sterile object.– Only sterile objects may be placed on a sterilefield.– A sterile object or field out of vision or anobject held below the waist is contaminated.– A sterile object or field becomes contaminatedby prolonged exposure to air.The skin can not be sterilized and is unsterile

All personnel must perform a surgical scrub

• Principles of Sterile Technique

– When a sterile surface comes in contact witha wet, contaminated surface, the sterile objector field becomes contaminated.– Fluids flow in the direction of gravity.– The edge of the sterile field or container isconsidered contaminated.

General:a. Keep sterile supplies dry and unopenedb. Check package sterilization expiration date to verify sterilityc. Maintain general cleanliness in surgical suited. Maintain surgical asepsis: activities designed to keep sites

free from the presence of microorganisms throughout the procedure

Personnel:

a. Personnel with signs of illness should not report to workb. Surgical scrub, a specific hand washing technique used by

operating room personnel designed to reduce microorganisms in the hands and arms, is done for the length of time designed by hospital policy

PERIOPERATIVE NURSING: PRINCIPLES OF PERIOPERATIVE ASEPSIS

Surgical Scrubi. A sensor-controlled or knee- or foot-operated faucet allows the

water to be turned on and off without the use of the handsii. Remove all rings and watchesiii. Use liquid soaps to prevent the spread of organismsiv. Keep the finger nails short and well-trimmed v. Clean fingernails with a nail stick under running watervi. Hold the hands higher than the elbows throughout the hand

washing procedure so that run-off goes to the elbows vii. Allows the cleanest part of the arms to be the handsviii. A scrub brush facilitates the removal of microorganisms ix. Clean all areas of skin on the hands and arms in sequence starting

at the hands and ending at the elbowsx. After rinsing, dry the hands with paper towels, drying first one

arm from the hand to the elbow, then using a second towel to dry the second hand



Maintaining a Sterile Field (a microorganism-free area):a. Create a sterile field using sterile drapesb. Use the sterile field to place sterile supplies where they will

be available during the procedurec. Drape equipment prior to used. Keep drapes dry and out of contact with nonsterile objects e. Utilize sterile technique while adding or removing supplies

from sterile fields Sterile Supplies and Solutions:

a. Check expiration dates for sterilityb. Don’t use solutions that were opened prior to current usec. “Lip” the solution after initial use by pouring a small amount

of liquid out of the bottle into a waste container to cleanse the bottle lip

7. All OR personnel are required to wear specific, clean attire, with the goal of “shedding” the outside environment. Specific clothing requirements are prescribed and

standardized for all ORs:a. OR personnel must wear a sterile gown, gloves, and

specific shoe coversb. Hair must be completely coverc. Masks must be worn at all times in the OR for the

purpose of minimizing air-borne contamination and must be changed between operations or more often, if necessary

8. Any personnel who harbors pathogenic organisms must report themselves unable to be in the OR to protect the client from outside pathogens

PERIOPERATIVE NURSING: PRINCIPLES OF SURGICAL ASEPSIS

9. Scrubbed personnel wearing sterile attire should touch only sterile items

10. Sterile gowns and sterile drapes have defined borders for sterility. Sterile surfaces or articles may touch other sterile surfaces or

articles and remain sterile. Contact with unsterile objects at any point renders a sterile

area contaminated. 11. The circulator and unsterile personnel must stay at the

periphery of the of the sterile operating area to keep the sterile area free from contamination

12. Sterile supplies are unwrapped and delivered by the circulator following specific standard protocol so as not to cause contamination



13.The utmost caution and vigilance must be used when handling sterile fluids to prevent splashing or spillage

14.Anything that is used for one client must be discarded or, in some cases, resterilized

Surgical Asepsis (Opening Sterile Packages)

•– Sterile supplies have dated labels or chemicaltapes that indicate the date when thesterilization expires.– If the integrity of the sterile package isquestionable, the item should not be used.

Handling of Sterile articles:

1. Always wear a mask when handling sterile articles.2. Sterilized articles must be kept in sterile containers or onsterile towels, and kept covered till used. Never allowcontact of unsterile with sterile articles.3. Make sure there is no dampness, as this could make thethings unsterile.4. Never allow any unsterile article including the arms andhands to pass a sterile field.

Handling of Sterile articles:

5. Never touch the inside of a package or container with yourfingers. Use the cheatle forceps.6. To pull a cork from a bottle of sterile fluid, take care not tocontaminate the inner part neither of the cork nor inside therim of the bottle. Replace it carefully.7. When lifting a cover from a sterile container bring it downwith the inner side up and then replace it without delay.8. To carry a sterile bowl or other container, hold it with yourhands underneath, and do not touch the rim.

Rules for use of cheatle forceps1. The sterile jar holding the forceps must be cleaned,re-sterilized and filled with fresh antiseptic lotion daily.The cheatle forceps should be cleaned and autoclaved orboiled.2. When in use, keep the forceps at elbow level and pointeddownwards because if you lift it upwards the solution mayrun on to your hand and then back to the forceps, making itunsterile.3. Put the forceps back into the jar immediately after use.Replace carefully without touching the rim of the jar. If theforceps becomes contaminated, it must be re-sterilizedbefore being put back into the jar.

Isolation• Isolation refers to measures designed to prevent the spread of

infections or potentially infectious microorganisms to health personnel, clients and visitors.

• Isolation for the control of infection is used to prevent infected patients from infecting others (source isolation) , and/or prevent susceptible patients from being infected (protective isolation).

Isolation• Source isolation is the physical separation of one patient from

another, in order to prevent spread of infection. Standard Infection Control Precautions must be observed at all times with all patients, including those in isolation.

• Protective isolation (reverse barrier nursing) is the physical separation of a patient at high risk from common organisms carried by others.The term 'protective isolation' describes a range of practices used to protect highly susceptible hospital patients from infection.

Barrier nursing techniques

• Patients who are suffering from contagious infections are often nursed in isolation using a procedure known as barrier nursing. These techniques have developed to protect the hospital environment from contamination with dangerous pathogens.

• Anything that comes into direct contact with the patient is considered infective and must be sterilised before being returned to general use.

• If this proves impossible then the item must be incinerated before disposal.

• Personnel attending the infectious patient wear special protective clothing, masks and gloves.

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INFECTION CONTROL

• Source Isolation– administering medications

• unwrap before going into pt’s room• use disposable med trays and cups• don’t take med cards into pt’s room• HANDWASHING• needles/syringes in sharps container• use & discard IV bags in pt’s room• dispose of all materials in pt’s room

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INFECTION CONTROL

• Source Isolation – taking vital signs

• use equipment in patient’s room• wear PPE as indicated• use clock in patient’s room, not your

watch• use disposable temperature system

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INFECTION CONTROL• Source Isolation

– caring for the patient’s body after death• take special precautions to prevent

spread of infection

Reverse Barrier nursing techniques

• Those people who are most at risk of acquiring infections while in hospital, organ transplant recipients on immunosuppressive therapy, for example, can be protected from infection by reverse barrier nursing.

• Items must be sterilised before coming into contact with the patient and in these cases, personnel wear protective clothing to prevent their microflora from contaminating their patient: an event that may lead to the establishment of a life-threatening infection. All these precautions help to protect patients from infection.

Isolation Precautions

• Standard Precautions• Transmission based Precautions

Standard Precautions• Designed to reduce the risk of transmission of micro-

organisms from known and unknown sources of infection.

• Used in the care of all hospitalized persons regardless of their diagnosis or possible infection status

• Apply to – Blood– All body fluids, secretions, and excretions except sweat (whether or not

blood is present or visible)– Nonintact skin and mucous membranes

• Combine the major features of UP and BSI– Universal Precautions

• reduce risk of transmission of blood-borne pathogens– Body Substance Isolation (BSI)

• reduce transmission from moist body substances

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Standard Precautions• Standard Precautions

– must consider ALL patientsare potentially infected

– wear gloves when in contact with blood, body fluids, non-intact skin, mucous membranes or contaminated items & change them after each contact

– HANDWASHING if contaminated with blood, body fluids, after each patient contact & after removing gloves

Standard PrecautionsStandard Precautions• Cover all cuts and abrasions

– Apply a waterproof dressing.– Get immunised against hep B infection :

if you might be in contact with blood, body fluids or human tissue.

• Hand hygiene• Personal protective equipment

– wear a gown/apron when clothing could become soiled– wear mask, eye protection/face shield if splashing of blood/body

fluids is possible• Proper disposal of sharps :use proper sharps container• Sharps injury:do not recap/break needles/ splash of

blood :report any exposures• Management of blood spills• Care of medical devices/ patient care equipment• Environmental cleaning/ decontamination• Proper disposal of waste & used linen• Cough etiquette.

o Put on apron & gloveso Pour granules on spill for 2 minso Prepare chlorine solution of 10,000ppmo Scoop up moistened granules and place in

biohazard bag or containero Use disposable wipe and chlorine solution

to decontaminate areao Place cloth/wipe in biohazard bag when

completedo Remove gloves & apron and wash hands

Management of blood Management of blood spills using the blood spill spills using the blood spill

kitkit

Standard PrecautionsStandard Precautions

Gloving– Don gloves if there is any possibility ofcontact with infectious material.• Gloves are worn only once and then placed

into infectious waste containers.

Standard Precautions

• Gowning– Wear a gown to protect skin and preventsoiling of clothing during procedures andpatient care activities that are likely togenerate splashes or sprays of blood, bodyfluids, secretions, or excretions or causesoiling of clothing.

Mask/Protective Eyewear

– Protects the wearer from inhalingmicroorganisms that travel on airbornedroplets.– Prevents inhaling pathogens if resistance isreduced or during transport to another area.– Discourages the wearer from touching themouth, nose, and eyes and from transmittinginfectious material


Transmission-based Precautions

• Used in addition to standard precautions• For known or suspected infections that are

spread in one of three ways: – Airborne– Droplet – Contact

• May be used alone or in combination but always in addition to standard precautions

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• Transmission-Based Precautions– airborne precautions

• tiny microorganisms from evaporated droplets remain suspended in the air or carried by dust particles & inhaled

• TB, measles and chickenpox• private negative pressure room• doors of rooms kept closed• high-filtration particulate respirator

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• droplet precautions• microorganisms are propelled through the air

through sneezing, coughing, talking or suctioning• meningitis, pneumonia, influenza, mumps, rubella,

and etc.• mask and private room• doors may remain open

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Transmission-Based Precautions

– contact precautions• most frequent mode of transmission• direct contact of body surface• indirect contact such as needle/hand• HEP A, herpes simplex virus, acute

diarrhea, draining abscess & etc.• gloves, gown and private room

• use in ADDITION to Standard Precautions

• Hand washing: simple, hand antisepsis and surgical antisepsis (scrub)

Hand washing

• Hand hygiene is the simplest, most effective measure for preventing nosocomial infections

• Compliance is usually estimated as <50%• Two major groups of microorganisms are

found on the skin:• organisms that normally reside on it (resident flora)

and contaminants (transient flora) .• Transient flora, which are easily removed by

handwashing, cause most hospital infection resulting from cross-transmission .

Hand washing1. Hand hygienePerforming handwashing, antiseptic handwash, alcohol-based

handrub, surgical hand hygiene/antisepsis2. HandwashingWashing hands with plain soap and water3. Antiseptic handwashWashing hands with water and soap or other detergents

containing an antiseptic agent4. Alcohol-based handrubRubbing hands with an alcohol-containing preparation5. Surgical hand hygiene/antisepsisHandwashing or using an alcohol-based handrub before

operations by surgical personnel

Materials used

• Soap:• Plain or antimicrobial soap depending on the

procedure.• Specific antiseptics:• 2%-4% chlorhexidine,• 5%-7.5% povidone iodine,• 1% triclosan, or• 70% alcoholic hand rubs.

Indications for hand hygiene

• When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water.

• If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands.

Specific indications for hand hygiene

• Before– Patient contact– Donning gloves when inserting a CVC– Inserting urinary catheters, peripheral vascular catheters,

or other invasive devices that don t require surgery• After

– Contact with a patient s skin– Contact with body fluids or excretions, non-intact skin,

wound dressings– Removing glove.

Palm to palm. Right palm over left dorsum and left palm over right dorsum.

Palm to palm fingers interlaced.

Backs of fingers to opposing palms with fingers interlocked.

Rotational rubbing of right thumb clasped in left palm and vice versa.

Rotational rubbing, backwards and forwards with clasped fingers of right

hand in left palm and vice versa.

1 2

4 5 6

, .

’-

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Effective Handwashing TechniqueEffective Handwashing Technique

Repeat each step 5 fives. Hand hygiene should take a minimum of 15 seconds to complete. Following handwashing dry hands thoroughly using paper hand towel.


Handwashing and Gloving Video

Click here to view a video on handwashing and gloving.

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Hand Hygiene: Skill 31-3


Hand Hygiene: Skill 31-1

• Personal protecting equipments: types, uses and

technique of wearing and removing

PERSONAL PROTECTIVE EQUIPMENT (PPE)FOR INFECTION DISEASES REQUIRING DROPLET & STANDARD PRECAUTIONS.

PROCEDURE FOR DONNING PPE (before entering room)Decontaminate hands with Put on mask alcohol based hand rub

Put on apron Put on gloves

PROCEDURE FOR REMOVING PPE Avoid contaminating hands while removing PPE. If hands become contaminated, DECONTAMINATE immediately with alcohol based hand rub. Dispose of PPE as clinical waste.

1.Remove gloves 3. Remove mask.

2. Remove apron. 4. Decontaminate hands.

• Decontamination of equipment and unit

Decontamination of Decontamination of patient-care patient-care equipment.equipment.

• Clean re-useable equipment before use in the care of another patient

• Do not reuse single-use or disposable equipment on other patients

• Know single use symbol

• Never use alcohol wipes for general cleaning.

Environmental CleaningEnvironmental Cleaning

Routine daily:• Standard cleaning • Emphasis on touched surfaces in

room (bed rails, door knobs)Terminal: • Thorough cleaning and

decontamination of all items in room.

Disposal of Contaminated Equipment

– Specially labeled bagging and either sanitary burial or incineration are required.

– Disposal of sharps (needles, blades)• Must be put in a puncture-proof container• Double Bagging– This infection control practice involves placinga bag of contaminated items into anotherclean bag that is held outside an isolationroom by other personnel.– This is recommended when it is impossible tokeep the outer surface of a single bag free

• Transportation of infected patients

Transportation of infected patients

Give the client the appropriate barrier technique if having communicable disease

• Mask for patient if disease is communicable by

• droplet, airborne, or contact route– – Sheet on w/c or cart, then blanket– – Wrap blanket around pt– – In x-ray, cover table with sheet, open blanket– – ( don’t touch inside ) leave on cart or w/c, have

pt move to table, cover with sheet.

Transportation of infected patients

• Pt. back to cart or w/c on top of same cotton blanket, wrap around patient.– – Dispose of soiled linen , wash hands, remove gown.– – Clean cart or w/c with disinfectant and clean table.– – Wash hands

• Transporting personnel should practice the appropriate precautions

•

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INFECTION CONTROL

• Isolation

– transporting the patient to other areas

• wear PPE as indicated to include pt• control/contain patient’s drainage• escort ambulatory patients• notify other areas of patient’s

precautions• disinfect transportation device

infection control vinay

Documents

communicable disease

local infection

infection control

infectious disease

years chain of infection

disease pathogenicity

microorganisms pathogens

clinical evidence of