so why all the fuss about hand hygiene?

Most common mode of transmission of pathogens is via hands!

Infections acquired in health care settings

Spread of antimicrobial resistance

So Why All the Fuss About Hand Hygiene?

Evidence of Relationship Between Hand Hygiene and

Health Care Associated Infections

Substantial evidence that hand hygiene reduces the incidence of infections

Historical study: Semmelweis

More recent studies: rates lower when antiseptic handwashing was performed

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

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 gloves


Recommended Hand Hygiene Technique

Handrubs– Apply to palm of one hand, rub hands together

covering all surfaces until dry

– Volume: based on manufacturer

Handwashing

– Wet hands with water, apply soap, rub hands together for at least 15 seconds

– Rinse and dry with disposable towel

– Use towel to turn off faucet


Fingernails and Artificial Nails

Natural nail tips should be kept short; no longer than the end of the finger tip

Artificial nails should not be worn


PREVENTIONIS PRIMARY!

Protect patients…protect health care personnel…

promote quality health care!

Personal Protective Equipment Definition

“specialized clothing or equipment worn by an employee for protection against infectious materials” (OSHA)

PPE Use in Healthcare Settings

Regulations and Recommendations for PPE

OSHA issues workplace health and safety regulations. Regarding PPE, employers must:– Provide appropriate PPE for employees

– Ensure that PPE is disposed or reusable PPE is cleaned, laundered, repaired and stored after use

OSHA also specifies circumstances for which PPE is indicated

CDC recommends when, what and how to use PPE


Types of PPE Used in Healthcare Settings

• Gloves – protect hands

• Gowns/aprons – protect skin and/or clothing

• Masks and respirators– protect mouth/nose – Respirators – protect respiratory tract from

airborne infectious agents

• Goggles – protect eyes

• Face shields – protect face, mouth, nose, and eyes


Factors Influencing PPE Selection

• Type of exposure anticipated– Splash/spray versus touch

– Category of isolation precautions

• Durability and appropriateness for the task

• Fit


Gloves• Purpose –

• patient care

• environmental services

• Glove material –

• Vinyl

• Latex

• Nitrile

• Sterile or nonsterilePPE Use in Healthcare Settings

Gloves

• Purpose – patient care, environmental services, other

• Glove material – vinyl, latex, nitrile, other

• Sterile or non-sterile

• One or two pair

• Single use or reusablePPE Use in Healthcare Settings

Do’s and Don’ts of Glove Use

Change gloves– During use if torn and when heavily soiled (even

during use on the same patient)

– After use on each patient Discard in appropriate receptacle

– Never wash or reuse disposable gloves


Gowns or Aprons

• Purpose of use

• Material –– Natural or man-made

– Reusable or disposable

– Resistance to fluid penetration

• Clean or sterile


Face Protection

• Masks – protect nose and mouth– Should fully cover nose and mouth and

prevent fluid penetration

• Goggles – protect eyes– Should fit snuggly over and around eyes– Personal glasses not a substitute for goggles– Anti-fog feature improves clarity


Face Protection

Face shields – protect face, nose, mouth, and eyes– Should cover forehead, extend below chin and

wrap around side of face


Respiratory Protection

• Purpose – protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis)

• PPE types for respiratory protection– Particulate respirators– Half- or full-face elastomeric respirators– Powered air purifying respirators (PAPR)


Elements of a Respiratory Protection Program

• Medical evaluation

• Fit testing

• Training

• Fit checking before use


Key Points About PPE

• Don before contact with the patient, generally before entering the room

• Use carefully – don’t spread contamination

• Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room

• Immediately perform hand hygienePPE Use in Healthcare Settings

Sequence* for Donning PPE

• Gown first

• Mask or respirator

• Goggles or face shield

• Gloves

*Combination of PPE will affect sequence – be practical


How to Don a Gown

• Select appropriate type and size

• Opening is in the back

• Secure at neck and waist

• If gown is too small, use two gowns– Gown #1 ties in front

– Gown #2 ties in back


How to Don a Mask

• Place over nose, mouth and chin

• Fit flexible nose piece over nose bridge

• Secure on head with ties or elastic

• Adjust to fit


How to Don a Particulate Respirator

• Select a fit tested respirator• Place over nose, mouth and chin• Fit flexible nose piece over nose bridge• Secure on head with elastic• Adjust to fit• Perform a fit check – – Inhale – respirator should collapse

– Exhale – check for leakage around facePPE Use in Healthcare Settings

How to Don Eye and Face Protection

• Position goggles over eyes and secure to the head using the ear pieces or headband

• Position face shield over face and secure on brow with headband

• Adjust to fit comfortablyPPE Use in Healthcare Settings

How to Don Gloves

• Don gloves last

• Select correct type and size

• Insert hands into gloves

• Extend gloves over isolation gown cuffs


How to Safely Use PPE

• Keep gloved hands away from face

• Avoid touching or adjusting other PPE

• Remove gloves if they become torn; perform hand hygiene before donning new gloves

• Limit surfaces and items touched


PPE Use in Healthcare Settings:How to Safely Remove PPE

“Contaminated” and “Clean” Areas of PPE

• Contaminated – outside front• Areas of PPE that have or are likely to have been

in contact with body sites, materials, or environmental surfaces where the infectious organism may reside

• Clean – inside, outside back, ties on head and back

• Areas of PPE that are not likely to have been in contact with the infectious organism


Sequence for Removing PPE

• Gloves

• Face shield or goggles

• Gown

• Mask or respirator


Where to Remove PPE

• At doorway, before leaving patient room or in anteroom*

• Remove respirator outside room, after door has been closed*

*Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub


How to Remove Gloves (1)

• Grasp outside edge near wrist

• Peel away from hand, turning glove inside-out

• Hold in opposite gloved hand


How to Remove Gloves (2)

• Slide ungloved finger under the wrist of the remaining glove

• Peel off from inside, creating a bag for both gloves

• DiscardPPE Use in Healthcare Settings

Remove Goggles or Face Shield

• Grasp ear or head pieces with ungloved hands

• Lift away from face

• Place in designated receptacle for reprocessing or disposalPPE Use in Healthcare Settings

Removing Isolation Gown

• Unfasten ties

• Peel gown away from neck and shoulder

• Turn contaminated outside toward the inside

• Fold or roll into a bundle

• DiscardPPE Use in Healthcare Settings

Removing a Mask

• Untie the bottom, then top, tie

• Remove from face

• Discard


Removing a Particulate Respirator

Lift the bottom elastic over your head first

Then lift off the top elastic

Discard


Hand Hygiene

• Perform hand hygiene immediately after removing PPE.– If hands become visibly contaminated during PPE

removal, wash hands before continuing to remove PPE

• Wash hands with soap and water or use an alcohol-based hand rub


*Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub

Standard Precautions

• Assumes blood and body fluid of ANY patient could be infectious

• Recommends PPE and other infection control practices to prevent transmission in any healthcare setting

• Decisions about PPE use determined by type of clinical interaction with patient


PPE for Standard Precautions (1)

• Gloves – Use when touching blood, body fluids, secretions, excretions, contaminated items; for touching mucus membranes and nonintact skin

• Gowns – Use during procedures and patient care activities when contact of clothing/ exposed skin with blood/body fluids, secretions, or excretions is anticipatedPPE Use in Healthcare Settings

PPE for Standard Precautions (2)

• Mask and goggles or a face shield – Use during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions


What Type of PPE Would You Wear?

• Giving a bed bath?

• Suctioning oral secretions?

• Transporting a patient in a wheel chair?

• Responding to an emergency where blood is spurting?

• Drawing blood from a vein?

• Cleaning a patient with diarrhea?

• Irrigating a wound?

• Taking vital signs?


What Type of PPE Would You Wear?

• Giving a bed bath?• Generally none

• Suctioning oral secretions?• Gloves and mask/goggles

or a face shield – sometimes gown

• Transporting a patient in a wheel chair?

• Generally none required

• Responding to an emergency where blood is spurting?

• Gloves, fluid-resistant gown, mask/goggles or a face shield

• Drawing blood from a vein?• Gloves

• Cleaning an incontinent patient with diarrhea?

• Gloves w/wo gown

• Irrigating a wound?• Gloves, gown,

mask/goggles or a face shield

• Taking vital signs?– Generally none


PPE for Expanded Precautions

• Expanded Precautions include– Contact Precautions

– Droplet Precautions

– Airborne Infection Isolation


Use of PPE for Expanded Precautions• Contact Precautions – Gown and gloves for

contact with patient or environment of care (e.g., medical equipment, environmental surfaces)

• In some instances these are required for entering patient’s environment

• Droplet Precautions – Surgical masks within 3 feet of patient

• Airborne Infection Isolation – Particulate respirator*

*Negative pressure isolation room also requiredPPE Use in Healthcare Settings

Hand Hygiene

• Required for Standard and Expanded Precautions

• Perform…– Immediately after removing PPE

– Between patient contacts

• Wash hands thoroughly with soap and water or use alcohol-based hand rub


PPE Use in Healthcare Settings:Final Thoughts

PPE is available to protect you from exposure to infectious agents in the healthcare workplace

Know what type of PPE is necessary for the duties you perform and use it correctly

Classes of Microorganisms

Non-pathogenic– normal– do not produce disease– beneficial

Pathogenic– cause infection and disease

May be non-pathogenic in one body system, pathogenic in another (E. coli)

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2.02 Understand infection control procedures


Aerobic– requires oxygen to live

Anaerobic– does not require oxygen to live

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6 classes of microorganisms– Bacteria

– Protozoa

– Fungi

– Rickettsiae

– Viruses

– Helminths

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Bacteria Often considered the causes of disease Certain bacteria

– produce antibiotics– live in the body without problems– live on the roots of certain plants, converting

nitrogen into a usable form – help break down dead organic matter

Classified by shape and arrangement Treated with antibiotics

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Bacteria– Cocci-

• round in shape– diplococci– streptococci– staphylococci

Streptococci

Staphylococcal clusters

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http://en.wikipedia.org/wiki/File:Staphylococcus_aureus_Gram.jpg

http://en.wikipedia.org/wiki/File:Streptococcus.jpg

http://upload.wikimedia.org/wikipedia/commons/4/4a/Pos_strep.JPG



Bacteria– Bacilli

• rod shape– single– pairs– chains

• may have flagella• may form spores

– difficult to treat

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http://en.wikipedia.org/wiki/File:Bacillus_subtilis_Gram.jpg



Bacteria– Spirilla

• spiral or corkscrew shape– vibrio - spirochete

Treponema pallidumCholera54

http://en.wikipedia.org/wiki/File:Treponema_pallidum.jpg

http://upload.wikimedia.org/wikipedia/commons/d/db/Vibrio_cholerae_01.jpg



Bacteria Some bacteria develop resistance to antibiotics Very difficult to cure

– Methicillin-resistant Staphylococcus (MRSA)

– Multidrug-resistant Staphylococcus (MDSA)

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Protozoa– One celled, animal-like organism

– Contain a nucleus and other defined organelles

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Fungi– organisms that usually enjoy a symbiotic, but

sometimes parasitic relationship with their host

– provide numerous drugs and foods

– provide bubbles in bread, champagne, and beer

– cause a number of plant and animal diseases

– fungal diseases are very difficult to treat

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Fungi

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http://en.wikipedia.org/wiki/File:Ringworm_on_the_arm,_or_tinea_corporis_due_to_Trichophyton_mentagrophytes_PHIL_2938_lores.jpg



Rickettsiae– rod-shaped, parasitic bacteria – live in the tissues of ticks,

fleas, and lice– transmitted to humans

through bites– invade the new host from

within

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http://upload.wikimedia.org/wikipedia/commons/f/fc/Rocky_mountian_spotted_fever.jpg

http://upload.wikimedia.org/wikipedia/commons/3/37/Life_cycle_of_ticks_family_ixodidae.PNG



Viruses– small, infectious agent

– requires a host for survival

– over 5,000 types

– can combine in multiple ways to produce a wide range of diseases

– produce immune response in humans

– treated with antiviral drugs

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Helminths– Parasitic worm-like organisms– Live inside the host– Feed off their host– Disrupt nutrient absorption– Lead to weakness– Excrete toxins making host

susceptible to other diseases– Approximately 30 billion people

globally are infected

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Bacteria Protozoa Fungi Rickettsiae Viruses Helminths

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Methods used to control the spread of infection Vaccinations


Administration of a foreign antigen to produce immunity to a disease.

Most effective and least expensive method to prevent disease

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Injected pathogen may be live, weakened, killed or inactivated

Administered to stimulate the immune response

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May be given after disease exposure or after the disease was contracted

Given by injection or orally

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Methods used to control the spread of infection Aseptic Control

Antisepsis

Disinfection

Sterilization

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Antisepsis– effective in preventing or inhibiting the growth of

pathogenic organisms, but not spores or viruses

– safe to be used on skin

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Disinfection– destroys pathogenic organisms that are already

present

– not effective against spores or viruses

– chemicals are used

– not used on skin

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Sterilization– kills all microorganisms, including spores and

viruses

– methods• steam under pressure• gas• radiation• chemicals

– not used on skin

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Antisepsis

Disinfection

Sterilization

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Methods used to control the spread of infectionMethods used to control the spread of infection

PrecautionsPrecautions


Methods used to control the spread of infection Standard Precautions

Used on ALL patientsUsed on ALL patients

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Hand washing

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Personal protection equipment (PPE)

74



Gloves

75



Gowns

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Masks and eye protection

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Needlestick safety

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Sharps

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Spills and splashes

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Resuscitation devices

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Waste and linen disposal

82



Injuries

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Used on ALL patientsUsed on ALL patients

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Methods used to control the spread of infection Bloodborne Pathogen Standard

Applies to all occupational exposure of blood or other potentially infectious material.

Blood = human blood, blood components, blood products

Bloodborne pathogens = disease causing organisms in blood (Hep. B, Hep. C, HIV)

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Methods used to control the spread of infection Bloodborne Pathogen Standard

In an emergency when you cannot identify body fluids or tell whether they contain blood, treat all body fluids as potentially infectious.

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Methods used to control the spread of infection Tuberculosis Standard

OSHA Standard to reduce occupationally transmitted/acquired TB

Requires FIT tested and training in the use of specific respiratory PPE

PPD skin test annually


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Methods used to control the spread of infectionExtended Infection Control Precautions


Standard Precautions PLUSAirborne Precautions

Contact Precautions

Droplet Precautions

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Transmission based precautions– Additional precautions used with patients infected

with pathogens that are spread via:• airborne transmission• droplet transmission• direct contact

– Requires isolation

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Airborne precautions– Patient pathogens are transmitted by airborne

droplets

– Specific PPEs-• fitted mask

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Contact precautions– Patient pathogens are able to

be spread by direct or indirect contact

– Specific PPEs• gloves• gowns

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Droplet precautions– Used when large-particle droplets are expelled

during coughing, sneezing, talking or laughing

– Specific PPEs-• mask if working within

3 feet of patient

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Protective or reverse precautions

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Standard Precautions PLUSAirborne Precautions

Contact Precautions

Droplet Precautions

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Transmitting Infection Direct contact

Indirect contact

Airborne

Vector-borne

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Transmitting Infection

Direct contact

Person to person

Animal to person

Mother to unborn child

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Indirect contact Pathogens are passed along on inanimate

objects

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Airborne Pathogens are carried

through the air Cling to surroundings and

are spread

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Vector-borne Insects carry pathogen from

host to host Flea

Tick

Mosquito

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http://upload.wikimedia.org/wikipedia/commons/3/37/Life_cycle_of_ticks_family_ixodidae.PNG



How you get an infection…– Causative agent

– Reservoir

– Portal of exit

– Mode of transmission

– Portal of entry

– Susceptible host…breaking the chain!

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Chain of InfectionCausative agent

Source or

reservoir

Portal of exit

Mode of transmission

Portal of entry

Susceptible host

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Chain of Infection

Causative agent– pathogen

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Chain of Infection

Reservoir– area where the pathogen

can live

103


Chain of Infection

Portal of exit– way for the pathogen to

escape from the reservoir

104


Chain of Infection

Mode of transmission– way for pathogen to be

transmitted

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Chain of Infection

Portal of entry– way to enter new

reservoir

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Chain of Infection

Susceptible host– able to be affected

– person likely to get sick

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Chain of InfectionCausative agent

Source or

reservoir

Portal of exit

Mode of transmission

Portal of entry

Susceptible host

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Types of Infections



Types of Infections

Infection invasion of the body by microorganisms invading microorganisms:

– use the host’s resources to multiply

– interfere with normal function

– 3rd leading cause of death in the U. S.

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Types of InfectionsLocal infection only a specific portion of the body is infected

– pain

– redness

– heat at the site

– swelling

– pus

– foul smelling drainage

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Types of InfectionsSystemic infection affects the entire body

– fever

– aches

– chills

– nausea

– vomiting

– weakness

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Types of Infections

Endogenous (endo- inside; genous- type or kind)– type or kind of infection or

disease that originates from within the body

Exogenous (exo- outside; genous- type or kind)– type or kind of infection or

disease that originates outside the body

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Types of Infections Nosocomial infections

– Hospital acquired infection– Transmitted by the health care

worker

Opportunistic infections– Infections that occur when the

body’s defenses are weakened

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Types of Infections

VERY IMPORTANT

Any sign of infection must be reported to the nurse or doctor!

so why all the fuss about hand hygiene?

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healthcare settings

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