CHAPTER TEN

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CHAPTER TEN PREVENTING INFECTION
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MICROORGANISMS
TERM FOR ANY PLANT OR ANIMAL THAT CANNOT BE SEEN
WITHOUT THE USE OF A MICROSCOPE. MICROORGANISMS
ARE EVERYWHERE. SOME MICROORGANISMS ARE HARMFUL,
SOME ARE NOT.
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ENVIRONMENTAL FACTORS THAT AFFECT MICROORGANISMS
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TYPES OF MICROORGANISMS

• PATHOGENS
• HARMFUL ORGANISMS THAT CAN CAUSE AN INFECTION
  WHEN THEY ENTER THE BODY.
• NONPATHOGENS
• MICROORGANISMS THAT ARE NOT HARMFUL AND DO NOT
  CAUSE AN INFECTION.
• NORMAL FLORA
• MICROORGANISMS THAT LIVE AND GROW IN CERTAIN
  LOCATIONS OF THE BODY.

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INFECTION

• THE INVASION AND GROWTH OF DISEASE CAUSING
  MICROORGANISMS IN THE BODY.

NOSOCOMIAL INFECTION

• AN INFECTION THAT A PERSON ACQUIRES WHILE IN A
  HEALTH CARE INSTITUTION.
• PATIENTS ARE AT RISK FOR DEVELOPING A NOSOCOMIAL
  INFECTION BECAUSE
• THEY HAVE A WEAKENED IMMUNE SYSTEM
• MEDICATION MAY WEAKEN THEIR RESPONSE TO
  INFECTION
• HIGHER INCIDENCE OF EXPOSURE FROM HEALTH CARE
  WORKERS OR OBJECTS CARRYING MICROORGANISMS

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SOURCES OF NOSOCOMIAL INFECTION
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CHAIN OF INFECTION
PATHOGEN
PERSON LIKELY TO GET A DISEASE IF EXPOSED
WHERE THE PATHOGEN LIVES IN THE BODY
WHERE THE PATHOGEN LEAVES THE BODY
WHERE THE PATHOGEN ENTERS THE BODY
HOW THE PATHOGEN TRAVELS
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DRUG RESISTANT ORGANISMS

• INFECTIONS THAT RESIST THE EFFECTS OF
  ANTIBIOTICS
• THIS MAKES THE INFECTION DIFFICULT TO TREAT
• CAUSED BY DOCTORS PRESCRIBING ANTIBIOTICS THAT
  ARE NOT NEEDED OR BY PATIENTS NOT FINISHING A
  COURSE OF ANTIBIOTICS
• TWO COMMON DRUG RESISTANT ORANISMS
• MRSA - METHICILLIN-RESISTANT STAPHYLOCOCCUS
  AUREUS - USUALLY FOUND ON THE SKIN AND NASAL
  PASSAGES. CAUSES SKIN AND LUNG INFECTIONS
• VRE - VANCOMYCIN RESISTANT ENTEROCOCCUS -
  USUALLY FOUND IN THE INTESTINES AND IN FECES.
  CAUSES URINARY, WOUND, PELVIC INFECTIONS

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METHOD OF TRANSMISSION
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PORTAL OF ENTRY
PORTAL OF EXIT
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INFECTION IN OLDER PERSONS

• IMMUNE SYSTEM DOES NOT WORK AS WELL AS A
  YOUNGER PERSONS
• MAY NOT SHOW THE SIGNS AND SYMPTOMS OF AN
  INFECTION
• THEY MAY NOT COMPLAIN OF PAIN
• CONFUSION MAY OCCUR
• AN INFECTION MAY BECOME LIFE-THREATENING BEFORE
  THE OLDER PERSON HAS SIGNS AND SYMPTOMS

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PREVENTING THE SPREAD OF INFECTION
DISINFECTION
THE PROCESS OF DESTROYING PATHOGENS . THE
PROCESS OF DESTROYING ALL MICROORGANISMS. THE
PRACTICES USED IN HEALTH CARE FACILITIES TO
REMOVE OR DESTROY PATHOGENS AND TO PREVENT THEIR
SPREAD FROM ONE PERSON OR PLACE TO ANOTHER.
STERILIZATION
MEDICAL ASEPSIS
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ASEPTIC MEASURES

• WASH CONTAMINATED AREAS WITH SOAP AND WATER
• PROVIDE THE PERSON WITH TISSUES TO USE WHEN
  COUGHING OR SNEEZING
• WEAR PERSONAL PROTECTIVE EQUIPMENT AS NEEDED
• DO NOT SHAKE LINENS
• CLEAN FROM THE CLEANEST AREA TO THE DIRTIEST
• DO NOT SIT ON BEDS
• DO NOT USE THINGS THAT HAVE FALLEN TO THE
  FLOOR
• CLEAN AND DISINFECT SHOWERS AND SHOWER CHAIRS
  AFTER EACH USE
• CLEAN AND DISINFECT BEDPANS, URINALS, AND
  COMMODES AFTER USE
• REPORT PESTS - ANTS, SPIDERS, MICE

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DIRTY LINEN GOES IN THE DIRTY LINEN HAMPER. A
PLASTIC BAG IS PLACED ON THE INSIDE OF THE HAMPER
AND CHANGED WHEN IT IS FULL. THERE MAY BE A
SEPARATE HAMPER FOR PERSONAL ITEMS (CLOTHING) AND
LINEN.
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CONTAMINATION
ITEMS OR AREAS THAT HAVE BEEN EXPOSED TO
DISEASE-CAUSING MICROORGANISMS. AN AREA IS CLEAN
WHEN IT IS FREE OF PATHOGENS. AN AREA IS
CONTAMINATED IF PATHOGENS ARE PRESENT
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HANDWASHING BREAKS THE CHAIN OF INFECTION
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WASH YOUR HANDS

• BEFORE AND AFTER CARING FOR EACH PATIENT
• BEFORE AND AFTER USING GLOVES
• BEFORE AND AFTER EATING
• AFTER COUGHING, SNEEZING, OR BLOWING YOUR NOSE
• AFTER COMBING YOUR HAIR
• AFTER USING THE TOLIET
• BEFORE HANDLING CLEAN ITEMS
• AFTER HANDLING DIRTY ITEMS
• BEFORE AND AFTER SMOKING

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RULES OF HANDWASHING

• WASH YOUR HANDS UNDER WARM RUNNING WATER.
• USE PAPER TOWELS TO TURN THE WATER ON AND OFF.
• IF BAR SOAP IS USED, RINSE THE BAR FIRST AND
  HOLD THE SOAP DURING THE ENTIRE PROCEDURE.
• HOLD YOUR HANDS AND FOREARMS LOWER THAN YOUR
  ELBOWS THROUGHOUT THE PROCEDURE.
• ATTENTION IS GIVEN TO THE THUMBS, KNUCKLES,
  SIDES OF THE HANDS, FINGERS, AND UNDER THE NAILS.
• WASH YOUR HANDS FOR AT LEAST 15 - 20 SECONDS.
• DO NOT LEAN AGAINST THE SINK.
• USE A LOTION TO PREVENT CHAPPING AND BREAKS IN
  THE SKIN.

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STANDARD PRECAUTIONS

• DESIGNED TO REDUCE THE RISK OF SPREADING
  PATHOGENS FROM BOTH KNOWN AND UNKNOWN INFECTIONS.
• USED FOR ALL PERSONS WHENEVER CARE IS GIVEN.
• PREVENTS THE SPREAD OF INFECTION FROM
• BLOOD
• ALL BODY FLUIDS, SECRETIONS, AND EXCRETIONS
• NONINTACT SKIN (SORES, SKIN TEARS,OTHER
  INJURIES)
• MUCOUS MEMBRANES

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GUIDELINES FOR STANDARD PRECAUTIONS

• DO NOT WEAR ARTIFICIAL NAILS OR NAIL EXTENDERS
• WEAR PPE WHEN CONTACT WITH BLOOD OR BODY
  FLUIDES IS LIKELY
• WEAR GLOVES WHEN CONTACT WITH BLOOD OR BODY
  FLUIDS IS LIKELY
• REMOVE GLOVES AFTER FINISHED GIVING CARE
• DISCARD GLOVES AFTER USE
• CHANGE GLOVES IF MOVING FROM CONTAMINATED AREA
  TO CLEAN AREA ON BODY
• REMOVE ALL PPE BEFORE LEAVING THE PATIENTS
  ROOM
• TREAT SOILED LINEN WITH CARE TO PREVENT
  CONTAMINATION OF THE SURROUNDING AREA
• WEAR GOGGLES OR FACE SHIELD DURING PROCEDURES
  THAT MAY CAUSE SPLASHES OR SPRAYS OF BLOOD OR
  BODY FLUIDS
• FOLLOW AGENCY POLICY FOR CLEANING WORK ,
  PATIENT CARE SURFACES, OR SOILED EQUIPMENT (BED
  RAILS, WORK SURFACES)
• USE A FACE SHIELD TO PERFORM RESCUE BREATHING
• A PRIVATE ROOM IS PREFERRED FOR A PERSON AT
  RISK FOR TRANSMITTING AN INFECTION TO OTHERS

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RULES FOR ISOLATION PRECAUTIONS

• COLLECT ALL NEEDED ITEMS BEFORE ENTERING THE
  ROOM
• REMOVE ITEMS FROM THE ROOM BY PLACING THEM IN
  PLASTIC BAGS
• DOUBLE BAG GARBAGE AND LINEN BEFORE REMOVING
  FROM THE ROOM
• REMOVE REUSABLE DISHES. DISCARD DISPOSABLE
  DISHES
• DO NOT TOUCH YOUR HAIR, NOSE, MOUTH, EYES, OR
  OTHER BODY PARTS
• PLACE CLEAN ITEMS ON A PAPER TOWEL
• TELL THE NURSE IF YOU HAVE A SORE THROAT, OPEN
  SKIN AREAS, CUTS, VOMITING, OR DIARRHEA

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TRANSMISSION-BASED PRECAUTIONS

• CONTACT PRECAUTION
• USED TO PREVENT THE SPREAD OF INFECTION BY
  DIRECT CONTACT (TOUCHING THE INFECTED AREA) OR
• INDIRECT CONTACT (TOUCHING AN OBJECT THAT HAS
  BEEN IN CONTACT WITH AN INFECTED AREA)

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• DROPLET PRECAUTION
• FOR INFECTIONS THAT ARE TRANSMITTED BY DROPLETS
  GENERATED BY COUGHING, SNEEZING OR TALKING
• EXAMPLES PNEUMONIA, MENINGITIS, DIPHTHERIA,
  WHOOPING COUGH, MEASLES, MUMPS, STREP INFECTIONS
  OF THE THROAT

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• AIRBORNE PRECAUTIONS
• USED TO PREVENT THE SPREAD OF INFECTIONS CARRIED
  BY SMALL DROPLETS THAT CAN REMAIN SUSPENDED IN
  THE AIR AND BE INHALED BY AN UNINFECTED PERSON
• EXAMPLES CHICKEN POX, TUBERCULOSIS, ANTHRAX

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PROTECTIVE PROCEDURES
PROTECTIVE PROCEDURES ARE THOSE PROCEDURES
NECESSARY TO PROTECT YOU FROM, AND PREVENT THE
SPREAD OF INFECTION. HEALTH CARE FACILITIES MUST
PROVIDE WHATEVER PROTECTIVE EQUIPMENT IS
NECESSARY AT NO CHARGE TO THE EMPLOYEE.
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GLOVES
WEAR GLOVES WHENEVER THERE IS A POSSIBILITY OF
COMING IN CONTACT WITH BLOOD, BODY FLUIDS,
NONINTACT SKIN, SECRETIONS, OR EXCRETIONS.
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GLOVES

• THE OUTSIDE OF THE GLOVES ARE CONSIDERED
  CONTAMINATED
• GLOVES ARE EASIER TO PUT ON WHEN YOUR HANDS ARE
  DRY
• LONG FINGERNAILS AND RINGS CAN TEAR GLOVES
• DISCARD GLOVES AFTER USE
• PUT ON NEW GLOVES WHENEVER GLOVES BECOME
  CONTAMINATED WITH BLOOD OR BODY FLUIDS
• WASH YOUR HANDS AFTER REMOVING GLOVES

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GOWN
WORN WHENEVER THERE IS A POSSIBILITY THAT YOUR
CLOTHING MIGHT COME INTO CONTACT WITH BLOOD OR
BODY FLUIDS.
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GOWNS

• GOWNS MUST HAVE LONG SLEEVES THAT FIT TIGHT AT
  THE WRIST
• GOWNS MUST COVER A PERSON FROM THE NECK TO THE
  KNEES
• THE GOWN OPENS AT THE BACK AND IS TIED AT THE
  NECK AND THE WAIST
• THE OUTSIDE OF THE GOWN (FRONT) AND SLEEVES ARE
  CONSIDERED CONTAMINATED. THE BACK OF THE GOWN IS
  CONSIDERED CLEAN
• GOWNS ARE USED ONCE AND DISCARDED

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GOWNS

• TO REMOVE THE GOWN
• UNTIE THE NECK STRINGS
• UNTIE THE WAIST STRINGS
• GRASP THE GOWN AT THE INSIDE OF THE SHOULDER
• PULL THE GOWN DOWN THE ARMS AS THE SLEEVES ARE
  TURNED INSIDE OUT
• TURN THE GOWN INSIDE OUT
• HOLD THE GOWN ON THE INSIDE AS THE OUTSIDE IS
  CONSIDERED CONTAMINATED

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MASK
A MASK PREVENTS CONTACT WITH AIRBORNE PARTICLES
THAT MAY BE INFECTED.
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MASKS

• MASKS ARE DISPOSABLE
• A WET OR MOIST MASK IS CONTAMINATED
• A MASK SHOULD FIT SNUGLY OVER THE MOUTH AND
  NOSE
• A SPECIAL RESPIRATOR IS WOR WHEN CARING FOR
  PERSONS WITH TUBERCULOSIS
• TO REMOVE A MASK -
• REMOVE GLOVES
• UNTIE LOWER STRING FIRST, THEN UPPER STRING

GOGGLES AND FACE SHIELDS

• PROTECT YOUR EYES, MOUTH, AND NOSE FROM
  SPLASHING OR SPRAYING OF BLOOD OR BODY FLUIDS
• THE OUTSIDE OF THE FACE SHIELD AND GOGGLES ARE
  CONSIDERED CONTAMINATED

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DOUBLE BAGGING
EVERYTHING REMOVED FROM AN ISOLATION ROOM MUST BE
DOUBLE BAGGGED.
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TRANSPORTING PERSONS IN ISOLATION

• THE PERSON WEARS A CLEAN GOWN.
• AN EXTRA LAYER OF SHEETS IS PLACED ON THE CART
  OR WHEELCHAIR.
• PERSONS ON AIRBORNE AND DROPLET PRECAUTIONS WEAR
  MASKS.
• YOU WEAR A MASK, GOWN, OR GLOVES AS REQUIRED BY
  THE ISOLATION PRECAUTION.
• DO NOT LET ANYONE ELSE ON THE ELEVATOR.
• THECART OR WHEELCHAIR IS DISINFECTED AFTER USE.

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BIOHAZARDOUS WASTE
ITEMS CONTAMINATED WITH BLOOD, BODY FLUIDS,
SECRETIONS, OR EXCRETIONS
BLOODBORNE PATHOGEN STANDARD
PROTECTS WORKERS FROM EXPOSURE TO THE AIDS OR
HEPATITIS VIRUS INCLUDES ANY ITEM CONTAMINATED
WITH BLOOD AND BODY FLUIDS
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MEETING THE NEEDS OF A PERSON IN ISOLATION

• MAY THINK ISOLATION IS A FORM OF PUNISHMENT FOR
  SOMETHING BAD THAT THEY DID.
• MAY HAVE FEELINGS OF UNWORTHINESS.
• MAY HAVE FEWER VISITORS.
• REMEMBER, THE PATHOGEN IS UNDESIRABLE, NOT THE
  PATIENT.
• ENCOURAGE COMMUNICATION WHEN YOU ARE IN THE ROOM
  CARING FOR THE PATIENT.
• TREAT THE PERSON WITH RESPECT, KINDNESS, AND
  DIGNITY.
• SAY HELLO FROM THE DOORWAY OFTEN.