Course Book : #113 - Infection Control

Infection Control

Course # 113

Author: Monica Oram, RN

 

This course is intended for the reader to be able to achieve the following objectives:

  1. Understand Standard Precautions and Transmission Based Precautions

  2. Identify the links in the chain of infection.

  3. Define what infection control means.

  4. Understand what the CDC does, and what OSHA does in regards to infection control.

  5. Learn how infection is spread.

  6. Understand types of infections

 

What is Infection Control?

 

Infection Control is identifying and reducing the risks of infections developing or spreading. Because of viruses like HIV and the new drug resistant super bacteria, the risk of acquiring infection in healthcare facilities has increased in recent years for both the patient and the staff.

 

As a healthcare worker, you must recognize and understand that these threats are a reality and that universal precautions should always be implemented in all patient care. This is considered one of your biggest job responsibilities.

 

Infection control practices are often ignored, and overlooked because they are so basic. A research study in a hospital found that only 48% of staff in an intensive care unit washed their hands before and after EACH patient in their care. We must think “clean” all the time, and take extra steps to be ever mindful to make a conscious effort to adhere to infection control procedures. These procedures are in place to protect you and the patient from infections.

 

Links Of Infection

 

Infections occur when harmful microorganisms, called pathogens, enter the body and cause illnesses or disease. To understand how to prevent disease we must first understand how it is spread. The chain of infection is a way of describing how disease is transmitted from one living organism to another.

 

There are six links in the chain of infection:

  1. Link One - causative agent

  2. Link Two- Reservoir

  3. Link Three- Portal of exit

  4. Link Four- Mode of transmission

  5. Link Five- Portal of entry

  6. Link Six- Susceptible host

 

Link One

Link One is the need of a causative agent. This means that a pathogen must be present to cause a disease. ( bacteria, virus, fungi, protozoa, ect)

 

Link Two

Link Two is the need for a reservoir. This is a place in the body where the pathogen lives and grows. This can be anywhere in the body such as blood, liver, lungs, colon, ect…..

 

Link Three

Link Three is a portal of exit. This means that there has to be a way for the pathogen to get OUT of the body of an INFECTED person. This will include any body opening on an infected person, such as nose, mouth, eyes, mucous membranes, non-intact skin that is oozing or bleeding, ect……

 

Link Four

Link Four is the mode of transmission. In order for a pathogen to be spread, there has to be a mode for it to be transmitted. This is how the pathogen travels from one person to another. A mode of transmission can be airborne, on hands by direct contact, or on surfaces, as indirect contact.

 

Link Five

Link Five is a portal of entry. This is any body opening on an UNINFECTED individual that allows a pathogen to enter. A pathogen can enter through any mucous membrane, cut in skin, mouth, eyes, or impaired skin.

 

 

Link Six

Link six is the link where a susceptible host has to be present. A susceptible host is an UNINFECTED person who can become sick. This refers to you, your co-workers, and anyone you are caring for who is not already infected with that disease.

 

If ONE of the links in the chain of infection is broken, then the spread of infection CAN NOT TAKE PLACE.

 

By using the infection control practices, such as washing your hands, you will be able to help stop pathogens from traveling. ( link 4) and prevent the pathogen from getting in your mouth, in your eyes, on your skin, ect..

(link 5) Following infection control practices can also reduce your chances of getting sick, which is referred to as susceptibility. It is wise to take advantage of immunizations (link 6) for diseases such as Hepatitis B and influenza.

 

How Infections Spread

 

For infections to spread, there has to be all the links in the chain of infection present. Unfortunately, healthcare facilities have several sources of infectious microorganisms all around us. We deal with sick people, contaminated objects, blood and body fluids, and even sick visitors.

 

People, including patients, staff, and visitors can harbor a variety of infections microorganisms such as bacteria, viruses, parasites, yeasts, and fungus.

 

Although invisible, these microorganisms may be present in blood and body fluids and secretions such as saliva, sputum, nasal and vaginal discharge. They are often present in wounds, and on dressings. They are present in feces and urine and often on the surface of the skin, especially the hands. A person usually does not look or feel sick even when they are infectious. Patients often infect themselves when microorganisms within their own body multiply out of control.

 

Contaminated objects can also be a source of infection. Some objects especially prone to contamination include floors, bedpans, trash cans, medical equipment, invasive medical devices and dirty laundry.

Nosocomial infections are those that are acquired “in house”, or within the facility. They are spread most commonly from not washing hands and

infecting a patient.

 

Clusters of infections can be easily identified in sections from poor hand washing. For example, if a patient has conjunctivitis, and a caregiver takes care of the infectious patient, then moves to the roommate, causing cross contamination.. The room mate becomes infected with conjunctivitis. Now imagine that this same caregiver, now moves across the hall to the next room, still not washing hands, the caregiver cross contaminates the patient in that room as well.. And it goes on and on….

 

Another example, say for instance, C-diff ( clostridium difficille) same scenario of a caregiver takes care of a c-diff infected patient, fails to wash hands and goes to the roommate. The roommate becomes infected with C-diff. Now suppose this caregiver goes across the hall, and cares for those in that room. Because of lack of hand washing, this room now becomes infected with c-diff also… and it goes on and on……….

 

Endemic Infections- are infections that occur at an expected rate. They are present in a population at all times, but affect few people at the same time.

(colds, Flu, chicken pox, ect)

 

Epidemic Infections- are infections that affect more people than expected. They arise suddenly and spread quickly. They are also infections that have a great proportion of infected individuals throughout, such as HIV, which is an epidemic.

 

Standard Precautions

 

In 1996, The Center for Disease Control ( CDC) recommended a new infection control system for reducing the risk of contracting infectious diseases in the healthcare field. This infection control system eliminated several older methods of infection control. There are two tiers of precautions in this system.

A) Standard Precautions

B) Transmission Based Precautions

 

 

Standard Precautions and Transmission Based Precautions provide a way to stop the spread of infection by disrupting the mode of transmission. These guidelines do not stop an infected person from giving off pathogens, but by following standard precautions, you can help prevent these pathogens from infecting you or those in your care.

 

Standard Precautions is a system of infection control practices which is designed to protect you from the prevention of disease transmission of diseases that can be transmitted through all body fluids and substances, and infected blood, such as HIV, Hepatitis B, and Hepatitis C, and other blood borne pathogens. Standard precautions should be utilized with ALL patients, regardless if they are known to be infected or not.

 

The body fluids covered under Standard Precautions are blood and blood products, all body fluids, secretions, excretions, except sweat, regardless of whether or not there is visible blood present. Standard Precautions also includes non-intact skin, acne, and open sores, and mucous membranes.

 

Standard precautions are to be used on all patients regardless of known infectious status. These precautions are used because you cannot tell if a person is infected by looking at them, or even from reading a chart, in many cases. There is no quick surefire way of knowing who is infected.

 

Standard precautions COMBINE the features of universal precautions and Body Substance Isolation (BSI). Body substance isolation reduces the risk of transmission of pathogens of moist body fluids.

 

You must use Standard Precautions EVERY TIME you anticipate contact with blood or body fluids. Standard Precautions include all direct care staff, and everybody else in support areas who come in contact with potential sources of infection.

Standard Precautions outlines a system of safeguarding to help you protect yourself from disease transmission. Your employer has developed policies using standard precautions which includes the following:

  1. Protective work practices

  2. Use of PPE ( personal protective equipment)

  3. Protective housekeeping

  4. Protection through Hepatitis B vaccination

  5. Exposure reporting

Transmission Based Precautions

 

Transmission based precautions of certain highly infectious or drug resistant organisms, a second level of precautions may need to be used. Transmission based precautions must be used IN ADDITION TO, NOT IN PLACE OF STANDARD PRECAUTIONS.

 

Categories of Transmission Based Precautions include:

  • Airborne Precautions

  • Droplet Precautions

  • Contact Precautions

 

Sometimes it is necessary to combine categories as needed, individualized to the needs of particular patients. Depending on the particular category, Transmission Based Precautions may involve some of the following precautions:

  • Placing the patient in a private room, or cohorting patients with similar infections

  • Keeping the room door closed

  • Wearing masks when entering a room

  • Moving patients out of the room only for essential purposes

  • Having the patient wear a mask outside the room

  • Wearing gloves while in the room, and other PPE as appropriate

  • Placing patients with TB in rooms with proper ventilation and negative air pressurized room. Staff to wear special TB masks upon entry. (N95)

 

Airborne Precautions

Airborne precautions are used when providing care to a patient who has an airborne disease. TB disease particles are small enough to slip through the pores of regular surgical masks and therefore, special precautions need to be used to isolate the patient from other non-infected individuals. Airborne precautions reduce, but do not eliminate the risk of airborne transmission of infectious agents.

 

Examples of airborne diseases include:

  • Pulmonary Tuberculosis (TB)

  • Measles

  • Chicken Pox ( Varicella Zoster)

  • Respiratory MRSA ( airborne or droplet)

 

Negative Air Pressure Rooms

Keep in mind that the air we breathe is in a positive air pressure environment. Negative air pressure means air flows into the room from the outside. Air inside the room is cycled through at least six times per hour. The air is also filtered back to the outside, passing through specially designed filters. Remember to open these doors SLOWLY, to prevent air from flowing back into the building. THE DOOR MUST ALWAYS REMAINED CLOSED! Wear a respirator mask when entering a room that has known TB infection. A special TB mask is required. (for more on TB see course # 114)

 

DO NOT enter a room of a patient with measles or chicken pox if you have not had them. These are serious infections in adults.

 

TIP: *** If you must take a patient out of the room for essential purposes, the patient is to wear a REGULAR SURGICAL MASK, NOT a respirator type N95 like staff wears to ENTER the room because respirator masks only FILTER INHALED air, NOT EXHALED air.***

 

Droplet Precautions

 

Droplet precautions are used when caring for patients with a disease whose microbes are expelled from the lungs in drops that fall to the floor and all around the infected person, usually within a three foot radius.

 

Droplets are generated through coughing, singing, yelling, talking, sneezing, laughing, and during some procedures such as suctioning or bronchoscopy. Special precautions must be taken to isolate infected persons and prevent anyone else from contracting a droplet infection.

 

Droplet precautions reduce the risk of infectious agents, but do not eliminate them.

 

Examples of droplet diseases include:

  • Influenza

  • Pneumonia

  • Mumps

  • Common Cold

  • Bronchitis

  • Respiratory MRSA

  • Rubella

  • Meningococcal Meningitis

 

Droplet precautions for caring for infected patients include:

  • Patient placement in a private room, or cohorted with a similar patient with same infection.

  • Maintain at least three feet distance between beds

  • Wear a surgical mask when working within three feet of an infected person

  • If you must take the person out of the room for essential purposes, have the patient wear a surgical mask when out of the room.

 

Droplet precautions are designed to prevent or reduce the transmission of large droplets containing microorganisms generating from an infected source. Transmission occurs when infected droplets travel a short distance and are deposited on a host’s mucous membranes, mouth or nose. THE LARGE DROPLETS DO NOT REMAIN IN THE AIR. They are also larger, and do not require special masks. Regular surgical masks are appropriate. No special ventilation or air handling is required.

 

Chicken Pox and Herpes Zoster require both CONTACT and AIRBORNE PRECAUTIONS.

 

Contact Precautions

 

Contact precautions are used when caring for a patient with a contact disease. This type of disease contains microbes that are spread through direct or indirect contact. Direct contact involves touching an infected person. Indirect contact involves touching an object that has been contaminated, such as equipment or contaminated hands or gloves, and then transmitting the disease to yourself or another person.

 

Special precautions must be taken to isolate an infected person and prevent anyone else from becoming infected. Contact precautions reduce, but does not eliminate the risk of contact transmission of infectious agents.

 

Most contact diseases are spread by INDIRECT CONTACT.

By utilizing Standard precautions, as you are expected to do WITH ALL patients, is focused on isolating THE DISEASE, and not the patient. Contact precautions are covered under Standard Precautions but may be used in addition to Standard Precautions.

 

Precautions for Contact precautions include:

  • Isolate the DISEASE. Private room, if possible, or cohort any other patients with the same disease.

  • Transport for essential purposes only. This is important because it is difficult to keep up with everything that a person can come in contact with when outside of the room.

  • Wash hand frequently

  • Wear gloves at all times when in contact with patient

  • Use antibacterial soap to wash hands

  • Wear gowns if contact is anticipated to protect anything from getting on your clothing. Remove gown and gloves before exiting the patient’s room.

 

Other types of transmission

 

Other types of transmission includes common vehicle transmission and vector borne transmission.

 

Common vehicle transmission- Occurs when microorganisms are transmitted by contaminated items such as food, water, medications, and equipment.

 

Vector borne transmission- Occurs when mosquitoes, flies, rats, and other vermin transmit microorganisms.

 

Handwashing

 

Washing your hands is the SINGLE MOST IMPORTANT thing you can do to prevent the spread of disease to yourself and others.

 

It is essential to wash hands countless times everyday, all day, as you provide care at work. Because of constant washing, hands can become dry and cracked. Use of hand lotion will help prevent this irritation. Remember that broken, dry cracked skin is a source for infection to get into the body.

Always wash hands:

  • Upon arrival to work and when leaving to go home

  • Before and after all patient contact

  • After touching anything contaminated

  • After removing gloves

  • Before and after breaks or eating, or using the restroom

 

Handwashing seems so basic, and so simple, yet it is so forgotten all too frequently. THINK CLEAN!! And wash often….

 

National Agencies involved with Infection Control

 

  • Center for Disease Control (CDC)

  • Occupational Safety and Health Administration (OSHA)

  • Joint Commission on Accreditation (JCAHO)

 

Center For Disease Control

 

Center For Disease Control is housed in Atlanta, Georgia. This Federal public health agency is concerned with the prevention and control of diseases and other preventable conditions. The CDC provides direction and leadership to healthcare facilities and others to protect both patients and healthcare staff.

CDC guidelines are the standards of practice for infection control, but are not required by law. The CDC can only advise, not regulate. Regulation of law comes under OSHA guidelines.

 

OSHA

OSHA is a branch under the United States Department of Labor. Its mission is to ensure that all workplaces are safe and healthy. OSHA researches workplace health issues, develops safety plans, and inspects workplaces.

 

Compliance with OSHA is a requirement under Federal and State laws.

 

JCAHO

Joint Commission on Accreditation of Healthcare Organizations accredits healthcare facilities that comply with its standards. Accreditation shows that a healthcare facility has VOLUNTARILY met strict guidelines. JCAHO reflects a facilities commitment to quality care.

It gives the facility a “report card” to show the community, and may fulfill a State’s licensure requirement for the facility. ( This varies from state to state)

 

Why are these agencies concerned about infections?

 

Infection puts everyone at risk. Infections can spread from and to staff, patients, and visitors. Infections are costly. They can be painful and cause complications. Nosocomial infections can even cause death.

 

Infections are expensive. Infections lead to longer hospital stays, lost work for patients, increased healthcare costs, and legal action, if the facility did not adequately follow infection control procedures.

Infections can also mean lost time from work for the healthcare worker who becomes ill.

 

Summary

 

Healthcare facilities have come a long way from the days when hospitals were full of infections, equipment was not sterilized, and infection control measures were non-existent. However, because of new viruses and drug resistant organisms, medical experts predict that infection control will continue to challenge the healthcare community in the years ahead. By committing yourself to follow infection control practices, you can successfully meet this challenge by protecting yourself and your patients from infection.

 

References:

www.osha.gov

www.cdc.org

 

Handbook of Infectious Diseases

Author, David Longwood, Springhouse publishers

2001

 

Diseases, By Springhouse Publishers

1993 Springhouse, Pa.

Infection Control

Course # 113

Author: Monica Oram, RN

 

This course is intended for the reader to be able to achieve the following objectives:

  1. Understand Standard Precautions and Transmission Based Precautions

  2. Identify the links in the chain of infection.

  3. Define what infection control means.

  4. Understand what the CDC does, and what OSHA does in regards to infection control.

  5. Learn how infection is spread.

  6. Understand types of infections

 

What is Infection Control?

 

Infection Control is identifying and reducing the risks of infections developing or spreading. Because of viruses like HIV and the new drug resistant super bacteria, the risk of acquiring infection in healthcare facilities has increased in recent years for both the patient and the staff.

 

As a healthcare worker, you must recognize and understand that these threats are a reality and that universal precautions should always be implemented in all patient care. This is considered one of your biggest job responsibilities.

 

Infection control practices are often ignored, and overlooked because they are so basic. A research study in a hospital found that only 48% of staff in an intensive care unit washed their hands before and after EACH patient in their care. We must think “clean” all the time, and take extra steps to be ever mindful to make a conscious effort to adhere to infection control procedures. These procedures are in place to protect you and the patient from infections.

 

Links Of Infection

 

Infections occur when harmful microorganisms, called pathogens, enter the body and cause illnesses or disease. To understand how to prevent disease we must first understand how it is spread. The chain of infection is a way of describing how disease is transmitted from one living organism to another.

 

There are six links in the chain of infection:

  1. Link One - causative agent

  2. Link Two- Reservoir

  3. Link Three- Portal of exit

  4. Link Four- Mode of transmission

  5. Link Five- Portal of entry

  6. Link Six- Susceptible host

 

Link One

Link One is the need of a causative agent. This means that a pathogen must be present to cause a disease. ( bacteria, virus, fungi, protozoa, ect)

 

Link Two

Link Two is the need for a reservoir. This is a place in the body where the pathogen lives and grows. This can be anywhere in the body such as blood, liver, lungs, colon, ect…..

 

Link Three

Link Three is a portal of exit. This means that there has to be a way for the pathogen to get OUT of the body of an INFECTED person. This will include any body opening on an infected person, such as nose, mouth, eyes, mucous membranes, non-intact skin that is oozing or bleeding, ect……

 

Link Four

Link Four is the mode of transmission. In order for a pathogen to be spread, there has to be a mode for it to be transmitted. This is how the pathogen travels from one person to another. A mode of transmission can be airborne, on hands by direct contact, or on surfaces, as indirect contact.

 

Link Five

Link Five is a portal of entry. This is any body opening on an UNINFECTED individual that allows a pathogen to enter. A pathogen can enter through any mucous membrane, cut in skin, mouth, eyes, or impaired skin.

 

 

Link Six

Link six is the link where a susceptible host has to be present. A susceptible host is an UNINFECTED person who can become sick. This refers to you, your co-workers, and anyone you are caring for who is not already infected with that disease.

 

If ONE of the links in the chain of infection is broken, then the spread of infection CAN NOT TAKE PLACE.

 

By using the infection control practices, such as washing your hands, you will be able to help stop pathogens from traveling. ( link 4) and prevent the pathogen from getting in your mouth, in your eyes, on your skin, ect..

(link 5) Following infection control practices can also reduce your chances of getting sick, which is referred to as susceptibility. It is wise to take advantage of immunizations (link 6) for diseases such as Hepatitis B and influenza.

 

How Infections Spread

 

For infections to spread, there has to be all the links in the chain of infection present. Unfortunately, healthcare facilities have several sources of infectious microorganisms all around us. We deal with sick people, contaminated objects, blood and body fluids, and even sick visitors.

 

People, including patients, staff, and visitors can harbor a variety of infections microorganisms such as bacteria, viruses, parasites, yeasts, and fungus.

 

Although invisible, these microorganisms may be present in blood and body fluids and secretions such as saliva, sputum, nasal and vaginal discharge. They are often present in wounds, and on dressings. They are present in feces and urine and often on the surface of the skin, especially the hands. A person usually does not look or feel sick even when they are infectious. Patients often infect themselves when microorganisms within their own body multiply out of control.

 

Contaminated objects can also be a source of infection. Some objects especially prone to contamination include floors, bedpans, trash cans, medical equipment, invasive medical devices and dirty laundry.

Nosocomial infections are those that are acquired “in house”, or within the facility. They are spread most commonly from not washing hands and

infecting a patient.

 

Clusters of infections can be easily identified in sections from poor hand washing. For example, if a patient has conjunctivitis, and a caregiver takes care of the infectious patient, then moves to the roommate, causing cross contamination.. The room mate becomes infected with conjunctivitis. Now imagine that this same caregiver, now moves across the hall to the next room, still not washing hands, the caregiver cross contaminates the patient in that room as well.. And it goes on and on….

 

Another example, say for instance, C-diff ( clostridium difficille) same scenario of a caregiver takes care of a c-diff infected patient, fails to wash hands and goes to the roommate. The roommate becomes infected with C-diff. Now suppose this caregiver goes across the hall, and cares for those in that room. Because of lack of hand washing, this room now becomes infected with c-diff also… and it goes on and on……….

 

Endemic Infections- are infections that occur at an expected rate. They are present in a population at all times, but affect few people at the same time.

(colds, Flu, chicken pox, ect)

 

Epidemic Infections- are infections that affect more people than expected. They arise suddenly and spread quickly. They are also infections that have a great proportion of infected individuals throughout, such as HIV, which is an epidemic.

 

Standard Precautions

 

In 1996, The Center for Disease Control ( CDC) recommended a new infection control system for reducing the risk of contracting infectious diseases in the healthcare field. This infection control system eliminated several older methods of infection control. There are two tiers of precautions in this system.

A) Standard Precautions

B) Transmission Based Precautions

 

 

Standard Precautions and Transmission Based Precautions provide a way to stop the spread of infection by disrupting the mode of transmission. These guidelines do not stop an infected person from giving off pathogens, but by following standard precautions, you can help prevent these pathogens from infecting you or those in your care.

 

Standard Precautions is a system of infection control practices which is designed to protect you from the prevention of disease transmission of diseases that can be transmitted through all body fluids and substances, and infected blood, such as HIV, Hepatitis B, and Hepatitis C, and other blood borne pathogens. Standard precautions should be utilized with ALL patients, regardless if they are known to be infected or not.

 

The body fluids covered under Standard Precautions are blood and blood products, all body fluids, secretions, excretions, except sweat, regardless of whether or not there is visible blood present. Standard Precautions also includes non-intact skin, acne, and open sores, and mucous membranes.

 

Standard precautions are to be used on all patients regardless of known infectious status. These precautions are used because you cannot tell if a person is infected by looking at them, or even from reading a chart, in many cases. There is no quick surefire way of knowing who is infected.

 

Standard precautions COMBINE the features of universal precautions and Body Substance Isolation (BSI). Body substance isolation reduces the risk of transmission of pathogens of moist body fluids.

 

You must use Standard Precautions EVERY TIME you anticipate contact with blood or body fluids. Standard Precautions include all direct care staff, and everybody else in support areas who come in contact with potential sources of infection.

Standard Precautions outlines a system of safeguarding to help you protect yourself from disease transmission. Your employer has developed policies using standard precautions which includes the following:

  1. Protective work practices

  2. Use of PPE ( personal protective equipment)

  3. Protective housekeeping

  4. Protection through Hepatitis B vaccination

  5. Exposure reporting

Transmission Based Precautions

 

Transmission based precautions of certain highly infectious or drug resistant organisms, a second level of precautions may need to be used. Transmission based precautions must be used IN ADDITION TO, NOT IN PLACE OF STANDARD PRECAUTIONS.

 

Categories of Transmission Based Precautions include:

  • Airborne Precautions

  • Droplet Precautions

  • Contact Precautions

 

Sometimes it is necessary to combine categories as needed, individualized to the needs of particular patients. Depending on the particular category, Transmission Based Precautions may involve some of the following precautions:

  • Placing the patient in a private room, or cohorting patients with similar infections

  • Keeping the room door closed

  • Wearing masks when entering a room

  • Moving patients out of the room only for essential purposes

  • Having the patient wear a mask outside the room

  • Wearing gloves while in the room, and other PPE as appropriate

  • Placing patients with TB in rooms with proper ventilation and negative air pressurized room. Staff to wear special TB masks upon entry. (N95)

 

Airborne Precautions

Airborne precautions are used when providing care to a patient who has an airborne disease. TB disease particles are small enough to slip through the pores of regular surgical masks and therefore, special precautions need to be used to isolate the patient from other non-infected individuals. Airborne precautions reduce, but do not eliminate the risk of airborne transmission of infectious agents.

 

Examples of airborne diseases include:

  • Pulmonary Tuberculosis (TB)

  • Measles

  • Chicken Pox ( Varicella Zoster)

  • Respiratory MRSA ( airborne or droplet)

 

Negative Air Pressure Rooms

Keep in mind that the air we breathe is in a positive air pressure environment. Negative air pressure means air flows into the room from the outside. Air inside the room is cycled through at least six times per hour. The air is also filtered back to the outside, passing through specially designed filters. Remember to open these doors SLOWLY, to prevent air from flowing back into the building. THE DOOR MUST ALWAYS REMAINED CLOSED! Wear a respirator mask when entering a room that has known TB infection. A special TB mask is required. (for more on TB see course # 114)

 

DO NOT enter a room of a patient with measles or chicken pox if you have not had them. These are serious infections in adults.

 

TIP: *** If you must take a patient out of the room for essential purposes, the patient is to wear a REGULAR SURGICAL MASK, NOT a respirator type N95 like staff wears to ENTER the room because respirator masks only FILTER INHALED air, NOT EXHALED air.***

 

Droplet Precautions

 

Droplet precautions are used when caring for patients with a disease whose microbes are expelled from the lungs in drops that fall to the floor and all around the infected person, usually within a three foot radius.

 

Droplets are generated through coughing, singing, yelling, talking, sneezing, laughing, and during some procedures such as suctioning or bronchoscopy. Special precautions must be taken to isolate infected persons and prevent anyone else from contracting a droplet infection.

 

Droplet precautions reduce the risk of infectious agents, but do not eliminate them.

 

Examples of droplet diseases include:

  • Influenza

  • Pneumonia

  • Mumps

  • Common Cold

  • Bronchitis

  • Respiratory MRSA

  • Rubella

  • Meningococcal Meningitis

 

Droplet precautions for caring for infected patients include:

  • Patient placement in a private room, or cohorted with a similar patient with same infection.

  • Maintain at least three feet distance between beds

  • Wear a surgical mask when working within three feet of an infected person

  • If you must take the person out of the room for essential purposes, have the patient wear a surgical mask when out of the room.

 

Droplet precautions are designed to prevent or reduce the transmission of large droplets containing microorganisms generating from an infected source. Transmission occurs when infected droplets travel a short distance and are deposited on a host’s mucous membranes, mouth or nose. THE LARGE DROPLETS DO NOT REMAIN IN THE AIR. They are also larger, and do not require special masks. Regular surgical masks are appropriate. No special ventilation or air handling is required.

 

Chicken Pox and Herpes Zoster require both CONTACT and AIRBORNE PRECAUTIONS.

 

Contact Precautions

 

Contact precautions are used when caring for a patient with a contact disease. This type of disease contains microbes that are spread through direct or indirect contact. Direct contact involves touching an infected person. Indirect contact involves touching an object that has been contaminated, such as equipment or contaminated hands or gloves, and then transmitting the disease to yourself or another person.

 

Special precautions must be taken to isolate an infected person and prevent anyone else from becoming infected. Contact precautions reduce, but does not eliminate the risk of contact transmission of infectious agents.

 

Most contact diseases are spread by INDIRECT CONTACT.

By utilizing Standard precautions, as you are expected to do WITH ALL patients, is focused on isolating THE DISEASE, and not the patient. Contact precautions are covered under Standard Precautions but may be used in addition to Standard Precautions.

 

Precautions for Contact precautions include:

  • Isolate the DISEASE. Private room, if possible, or cohort any other patients with the same disease.

  • Transport for essential purposes only. This is important because it is difficult to keep up with everything that a person can come in contact with when outside of the room.

  • Wash hand frequently

  • Wear gloves at all times when in contact with patient

  • Use antibacterial soap to wash hands

  • Wear gowns if contact is anticipated to protect anything from getting on your clothing. Remove gown and gloves before exiting the patient’s room.

 

Other types of transmission

 

Other types of transmission includes common vehicle transmission and vector borne transmission.

 

Common vehicle transmission- Occurs when microorganisms are transmitted by contaminated items such as food, water, medications, and equipment.

 

Vector borne transmission- Occurs when mosquitoes, flies, rats, and other vermin transmit microorganisms.

 

Handwashing

 

Washing your hands is the SINGLE MOST IMPORTANT thing you can do to prevent the spread of disease to yourself and others.

 

It is essential to wash hands countless times everyday, all day, as you provide care at work. Because of constant washing, hands can become dry and cracked. Use of hand lotion will help prevent this irritation. Remember that broken, dry cracked skin is a source for infection to get into the body.

Always wash hands:

  • Upon arrival to work and when leaving to go home

  • Before and after all patient contact

  • After touching anything contaminated

  • After removing gloves

  • Before and after breaks or eating, or using the restroom

 

Handwashing seems so basic, and so simple, yet it is so forgotten all too frequently. THINK CLEAN!! And wash often….

 

National Agencies involved with Infection Control

 

  • Center for Disease Control (CDC)

  • Occupational Safety and Health Administration (OSHA)

  • Joint Commission on Accreditation (JCAHO)

 

Center For Disease Control

 

Center For Disease Control is housed in Atlanta, Georgia. This Federal public health agency is concerned with the prevention and control of diseases and other preventable conditions. The CDC provides direction and leadership to healthcare facilities and others to protect both patients and healthcare staff.

CDC guidelines are the standards of practice for infection control, but are not required by law. The CDC can only advise, not regulate. Regulation of law comes under OSHA guidelines.

 

OSHA

OSHA is a branch under the United States Department of Labor. Its mission is to ensure that all workplaces are safe and healthy. OSHA researches workplace health issues, develops safety plans, and inspects workplaces.

 

Compliance with OSHA is a requirement under Federal and State laws.

 

JCAHO

Joint Commission on Accreditation of Healthcare Organizations accredits healthcare facilities that comply with its standards. Accreditation shows that a healthcare facility has VOLUNTARILY met strict guidelines. JCAHO reflects a facilities commitment to quality care.

It gives the facility a “report card” to show the community, and may fulfill a State’s licensure requirement for the facility. ( This varies from state to state)

 

Why are these agencies concerned about infections?

 

Infection puts everyone at risk. Infections can spread from and to staff, patients, and visitors. Infections are costly. They can be painful and cause complications. Nosocomial infections can even cause death.

 

Infections are expensive. Infections lead to longer hospital stays, lost work for patients, increased healthcare costs, and legal action, if the facility did not adequately follow infection control procedures.

Infections can also mean lost time from work for the healthcare worker who becomes ill.

 

Summary

 

Healthcare facilities have come a long way from the days when hospitals were full of infections, equipment was not sterilized, and infection control measures were non-existent. However, because of new viruses and drug resistant organisms, medical experts predict that infection control will continue to challenge the healthcare community in the years ahead. By committing yourself to follow infection control practices, you can successfully meet this challenge by protecting yourself and your patients from infection.

 

References:

www.osha.gov

www.cdc.org

 

Handbook of Infectious Diseases

Author, David Longwood, Springhouse publishers

2001

 

Diseases, By Springhouse Publishers

1993 Springhouse, Pa.

Infection Control

Course # 113

Author: Monica Oram, RN

 

This course is intended for the reader to be able to achieve the following objectives:

  1. Understand Standard Precautions and Transmission Based Precautions

  2. Identify the links in the chain of infection.

  3. Define what infection control means.

  4. Understand what the CDC does, and what OSHA does in regards to infection control.

  5. Learn how infection is spread.

  6. Understand types of infections

 

What is Infection Control?

 

Infection Control is identifying and reducing the risks of infections developing or spreading. Because of viruses like HIV and the new drug resistant super bacteria, the risk of acquiring infection in healthcare facilities has increased in recent years for both the patient and the staff.

 

As a healthcare worker, you must recognize and understand that these threats are a reality and that universal precautions should always be implemented in all patient care. This is considered one of your biggest job responsibilities.

 

Infection control practices are often ignored, and overlooked because they are so basic. A research study in a hospital found that only 48% of staff in an intensive care unit washed their hands before and after EACH patient in their care. We must think “clean” all the time, and take extra steps to be ever mindful to make a conscious effort to adhere to infection control procedures. These procedures are in place to protect you and the patient from infections.

 

Links Of Infection

 

Infections occur when harmful microorganisms, called pathogens, enter the body and cause illnesses or disease. To understand how to prevent disease we must first understand how it is spread. The chain of infection is a way of describing how disease is transmitted from one living organism to another.

 

There are six links in the chain of infection:

  1. Link One - causative agent

  2. Link Two- Reservoir

  3. Link Three- Portal of exit

  4. Link Four- Mode of transmission

  5. Link Five- Portal of entry

  6. Link Six- Susceptible host

 

Link One

Link One is the need of a causative agent. This means that a pathogen must be present to cause a disease. ( bacteria, virus, fungi, protozoa, ect)

 

Link Two

Link Two is the need for a reservoir. This is a place in the body where the pathogen lives and grows. This can be anywhere in the body such as blood, liver, lungs, colon, ect…..

 

Link Three

Link Three is a portal of exit. This means that there has to be a way for the pathogen to get OUT of the body of an INFECTED person. This will include any body opening on an infected person, such as nose, mouth, eyes, mucous membranes, non-intact skin that is oozing or bleeding, ect……

 

Link Four

Link Four is the mode of transmission. In order for a pathogen to be spread, there has to be a mode for it to be transmitted. This is how the pathogen travels from one person to another. A mode of transmission can be airborne, on hands by direct contact, or on surfaces, as indirect contact.

 

Link Five

Link Five is a portal of entry. This is any body opening on an UNINFECTED individual that allows a pathogen to enter. A pathogen can enter through any mucous membrane, cut in skin, mouth, eyes, or impaired skin.

 

 

Link Six

Link six is the link where a susceptible host has to be present. A susceptible host is an UNINFECTED person who can become sick. This refers to you, your co-workers, and anyone you are caring for who is not already infected with that disease.

 

If ONE of the links in the chain of infection is broken, then the spread of infection CAN NOT TAKE PLACE.

 

By using the infection control practices, such as washing your hands, you will be able to help stop pathogens from traveling. ( link 4) and prevent the pathogen from getting in your mouth, in your eyes, on your skin, ect..

(link 5) Following infection control practices can also reduce your chances of getting sick, which is referred to as susceptibility. It is wise to take advantage of immunizations (link 6) for diseases such as Hepatitis B and influenza.

 

How Infections Spread

 

For infections to spread, there has to be all the links in the chain of infection present. Unfortunately, healthcare facilities have several sources of infectious microorganisms all around us. We deal with sick people, contaminated objects, blood and body fluids, and even sick visitors.

 

People, including patients, staff, and visitors can harbor a variety of infections microorganisms such as bacteria, viruses, parasites, yeasts, and fungus.

 

Although invisible, these microorganisms may be present in blood and body fluids and secretions such as saliva, sputum, nasal and vaginal discharge. They are often present in wounds, and on dressings. They are present in feces and urine and often on the surface of the skin, especially the hands. A person usually does not look or feel sick even when they are infectious. Patients often infect themselves when microorganisms within their own body multiply out of control.

 

Contaminated objects can also be a source of infection. Some objects especially prone to contamination include floors, bedpans, trash cans, medical equipment, invasive medical devices and dirty laundry.

Nosocomial infections are those that are acquired “in house”, or within the facility. They are spread most commonly from not washing hands and

infecting a patient.

 

Clusters of infections can be easily identified in sections from poor hand washing. For example, if a patient has conjunctivitis, and a caregiver takes care of the infectious patient, then moves to the roommate, causing cross contamination.. The room mate becomes infected with conjunctivitis. Now imagine that this same caregiver, now moves across the hall to the next room, still not washing hands, the caregiver cross contaminates the patient in that room as well.. And it goes on and on….

 

Another example, say for instance, C-diff ( clostridium difficille) same scenario of a caregiver takes care of a c-diff infected patient, fails to wash hands and goes to the roommate. The roommate becomes infected with C-diff. Now suppose this caregiver goes across the hall, and cares for those in that room. Because of lack of hand washing, this room now becomes infected with c-diff also… and it goes on and on……….

 

Endemic Infections- are infections that occur at an expected rate. They are present in a population at all times, but affect few people at the same time.

(colds, Flu, chicken pox, ect)

 

Epidemic Infections- are infections that affect more people than expected. They arise suddenly and spread quickly. They are also infections that have a great proportion of infected individuals throughout, such as HIV, which is an epidemic.

 

Standard Precautions

 

In 1996, The Center for Disease Control ( CDC) recommended a new infection control system for reducing the risk of contracting infectious diseases in the healthcare field. This infection control system eliminated several older methods of infection control. There are two tiers of precautions in this system.

A) Standard Precautions

B) Transmission Based Precautions

 

 

Standard Precautions and Transmission Based Precautions provide a way to stop the spread of infection by disrupting the mode of transmission. These guidelines do not stop an infected person from giving off pathogens, but by following standard precautions, you can help prevent these pathogens from infecting you or those in your care.

 

Standard Precautions is a system of infection control practices which is designed to protect you from the prevention of disease transmission of diseases that can be transmitted through all body fluids and substances, and infected blood, such as HIV, Hepatitis B, and Hepatitis C, and other blood borne pathogens. Standard precautions should be utilized with ALL patients, regardless if they are known to be infected or not.

 

The body fluids covered under Standard Precautions are blood and blood products, all body fluids, secretions, excretions, except sweat, regardless of whether or not there is visible blood present. Standard Precautions also includes non-intact skin, acne, and open sores, and mucous membranes.

 

Standard precautions are to be used on all patients regardless of known infectious status. These precautions are used because you cannot tell if a person is infected by looking at them, or even from reading a chart, in many cases. There is no quick surefire way of knowing who is infected.

 

Standard precautions COMBINE the features of universal precautions and Body Substance Isolation (BSI). Body substance isolation reduces the risk of transmission of pathogens of moist body fluids.

 

You must use Standard Precautions EVERY TIME you anticipate contact with blood or body fluids. Standard Precautions include all direct care staff, and everybody else in support areas who come in contact with potential sources of infection.

Standard Precautions outlines a system of safeguarding to help you protect yourself from disease transmission. Your employer has developed policies using standard precautions which includes the following:

  1. Protective work practices

  2. Use of PPE ( personal protective equipment)

  3. Protective housekeeping

  4. Protection through Hepatitis B vaccination

  5. Exposure reporting

Transmission Based Precautions

 

Transmission based precautions of certain highly infectious or drug resistant organisms, a second level of precautions may need to be used. Transmission based precautions must be used IN ADDITION TO, NOT IN PLACE OF STANDARD PRECAUTIONS.

 

Categories of Transmission Based Precautions include:

  • Airborne Precautions

  • Droplet Precautions

  • Contact Precautions

 

Sometimes it is necessary to combine categories as needed, individualized to the needs of particular patients. Depending on the particular category, Transmission Based Precautions may involve some of the following precautions:

  • Placing the patient in a private room, or cohorting patients with similar infections

  • Keeping the room door closed

  • Wearing masks when entering a room

  • Moving patients out of the room only for essential purposes

  • Having the patient wear a mask outside the room

  • Wearing gloves while in the room, and other PPE as appropriate

  • Placing patients with TB in rooms with proper ventilation and negative air pressurized room. Staff to wear special TB masks upon entry. (N95)

 

Airborne Precautions

Airborne precautions are used when providing care to a patient who has an airborne disease. TB disease particles are small enough to slip through the pores of regular surgical masks and therefore, special precautions need to be used to isolate the patient from other non-infected individuals. Airborne precautions reduce, but do not eliminate the risk of airborne transmission of infectious agents.

 

Examples of airborne diseases include:

  • Pulmonary Tuberculosis (TB)

  • Measles

  • Chicken Pox ( Varicella Zoster)

  • Respiratory MRSA ( airborne or droplet)

 

Negative Air Pressure Rooms

Keep in mind that the air we breathe is in a positive air pressure environment. Negative air pressure means air flows into the room from the outside. Air inside the room is cycled through at least six times per hour. The air is also filtered back to the outside, passing through specially designed filters. Remember to open these doors SLOWLY, to prevent air from flowing back into the building. THE DOOR MUST ALWAYS REMAINED CLOSED! Wear a respirator mask when entering a room that has known TB infection. A special TB mask is required. (for more on TB see course # 114)

 

DO NOT enter a room of a patient with measles or chicken pox if you have not had them. These are serious infections in adults.

 

TIP: *** If you must take a patient out of the room for essential purposes, the patient is to wear a REGULAR SURGICAL MASK, NOT a respirator type N95 like staff wears to ENTER the room because respirator masks only FILTER INHALED air, NOT EXHALED air.***

 

Droplet Precautions

 

Droplet precautions are used when caring for patients with a disease whose microbes are expelled from the lungs in drops that fall to the floor and all around the infected person, usually within a three foot radius.

 

Droplets are generated through coughing, singing, yelling, talking, sneezing, laughing, and during some procedures such as suctioning or bronchoscopy. Special precautions must be taken to isolate infected persons and prevent anyone else from contracting a droplet infection.

 

Droplet precautions reduce the risk of infectious agents, but do not eliminate them.

 

Examples of droplet diseases include:

  • Influenza

  • Pneumonia

  • Mumps

  • Common Cold

  • Bronchitis

  • Respiratory MRSA

  • Rubella

  • Meningococcal Meningitis

 

Droplet precautions for caring for infected patients include:

  • Patient placement in a private room, or cohorted with a similar patient with same infection.

  • Maintain at least three feet distance between beds

  • Wear a surgical mask when working within three feet of an infected person

  • If you must take the person out of the room for essential purposes, have the patient wear a surgical mask when out of the room.

 

Droplet precautions are designed to prevent or reduce the transmission of large droplets containing microorganisms generating from an infected source. Transmission occurs when infected droplets travel a short distance and are deposited on a host’s mucous membranes, mouth or nose. THE LARGE DROPLETS DO NOT REMAIN IN THE AIR. They are also larger, and do not require special masks. Regular surgical masks are appropriate. No special ventilation or air handling is required.

 

Chicken Pox and Herpes Zoster require both CONTACT and AIRBORNE PRECAUTIONS.

 

Contact Precautions

 

Contact precautions are used when caring for a patient with a contact disease. This type of disease contains microbes that are spread through direct or indirect contact. Direct contact involves touching an infected person. Indirect contact involves touching an object that has been contaminated, such as equipment or contaminated hands or gloves, and then transmitting the disease to yourself or another person.

 

Special precautions must be taken to isolate an infected person and prevent anyone else from becoming infected. Contact precautions reduce, but does not eliminate the risk of contact transmission of infectious agents.

 

Most contact diseases are spread by INDIRECT CONTACT.

By utilizing Standard precautions, as you are expected to do WITH ALL patients, is focused on isolating THE DISEASE, and not the patient. Contact precautions are covered under Standard Precautions but may be used in addition to Standard Precautions.

 

Precautions for Contact precautions include:

  • Isolate the DISEASE. Private room, if possible, or cohort any other patients with the same disease.

  • Transport for essential purposes only. This is important because it is difficult to keep up with everything that a person can come in contact with when outside of the room.

  • Wash hand frequently

  • Wear gloves at all times when in contact with patient

  • Use antibacterial soap to wash hands

  • Wear gowns if contact is anticipated to protect anything from getting on your clothing. Remove gown and gloves before exiting the patient’s room.

 

Other types of transmission

 

Other types of transmission includes common vehicle transmission and vector borne transmission.

 

Common vehicle transmission- Occurs when microorganisms are transmitted by contaminated items such as food, water, medications, and equipment.

 

Vector borne transmission- Occurs when mosquitoes, flies, rats, and other vermin transmit microorganisms.

 

Handwashing

 

Washing your hands is the SINGLE MOST IMPORTANT thing you can do to prevent the spread of disease to yourself and others.

 

It is essential to wash hands countless times everyday, all day, as you provide care at work. Because of constant washing, hands can become dry and cracked. Use of hand lotion will help prevent this irritation. Remember that broken, dry cracked skin is a source for infection to get into the body.

Always wash hands:

  • Upon arrival to work and when leaving to go home

  • Before and after all patient contact

  • After touching anything contaminated

  • After removing gloves

  • Before and after breaks or eating, or using the restroom

 

Handwashing seems so basic, and so simple, yet it is so forgotten all too frequently. THINK CLEAN!! And wash often….

 

National Agencies involved with Infection Control

 

  • Center for Disease Control (CDC)

  • Occupational Safety and Health Administration (OSHA)

  • Joint Commission on Accreditation (JCAHO)

 

Center For Disease Control

 

Center For Disease Control is housed in Atlanta, Georgia. This Federal public health agency is concerned with the prevention and control of diseases and other preventable conditions. The CDC provides direction and leadership to healthcare facilities and others to protect both patients and healthcare staff.

CDC guidelines are the standards of practice for infection control, but are not required by law. The CDC can only advise, not regulate. Regulation of law comes under OSHA guidelines.

 

OSHA

OSHA is a branch under the United States Department of Labor. Its mission is to ensure that all workplaces are safe and healthy. OSHA researches workplace health issues, develops safety plans, and inspects workplaces.

 

Compliance with OSHA is a requirement under Federal and State laws.

 

JCAHO

Joint Commission on Accreditation of Healthcare Organizations accredits healthcare facilities that comply with its standards. Accreditation shows that a healthcare facility has VOLUNTARILY met strict guidelines. JCAHO reflects a facilities commitment to quality care.

It gives the facility a “report card” to show the community, and may fulfill a State’s licensure requirement for the facility. ( This varies from state to state)

 

Why are these agencies concerned about infections?

 

Infection puts everyone at risk. Infections can spread from and to staff, patients, and visitors. Infections are costly. They can be painful and cause complications. Nosocomial infections can even cause death.

 

Infections are expensive. Infections lead to longer hospital stays, lost work for patients, increased healthcare costs, and legal action, if the facility did not adequately follow infection control procedures.

Infections can also mean lost time from work for the healthcare worker who becomes ill.

 

Summary

 

Healthcare facilities have come a long way from the days when hospitals were full of infections, equipment was not sterilized, and infection control measures were non-existent. However, because of new viruses and drug resistant organisms, medical experts predict that infection control will continue to challenge the healthcare community in the years ahead. By committing yourself to follow infection control practices, you can successfully meet this challenge by protecting yourself and your patients from infection.

 

References:

www.osha.gov

www.cdc.org

 

Handbook of Infectious Diseases

Author, David Longwood, Springhouse publishers

2001

 

Diseases, By Springhouse Publishers

1993 Springhouse, Pa.