HAP LO5

Practice Assessments and Skills Related to infection prevention and control

Vocabulary

Airborne precautions: Droplet nuclei, smaller than 5.; ie chicken pox. Barrier protection-
negative pressure airflow of at least six exchanges per hour, mask or respiratory device.
Antiseptic: An agent capable of preventing or inhibiting the growth of causative micro-
organisms- the prevention of sepsis
Asepsis: The absence of pathogenic (disease- producing) microorganisms
Colonizing: When a pathogen is present on or in the body but does not cause harm
Contact Precaution: Direct client or environmental contact; colonization or infection with
multidrug resistant organism. Barrier protection- private room or cohort clients; gloves, gown
Communicable: when an infection can be transmitted from one person to another. Also called
infectious or contagious
Disinfection: Process of killing pathogenic organisms
Droplet Precaution: Droplets larger than 5m ex. diphtheria, pneumonia, mumps. Barrier
protection- private room or cohort clients; mask
Host: Element of the agent- host- environment model of health and illness; a host is a person or
group who, because of risk factors, may be suspectable to disease or illness
Medical asepsis: Procedures used to reduce and prevent the spread of microorganisms, also
known as clean technique
Personal Protective equipment: Includes gowns, masks, gloves and protective eyewear
Routine practices: apply to blood, all body fluids, secretions, excretions 9except sweat), non-
intact skin, and mucous membranes. Include appropriate use of gowns, gloves, masks, eyewear,
and other protective devices or clothing
Nosocomial infection: Infection acquired during hospitalization or during stay in health care
facility
Isolation precaution: Precautions designed to contain pathogens in one area. Only patients
infected or colonized with certain highly transmissible or epidemiologically significant
pathogens are placed on isolation precautions and include airborne, droplet, and contact
precautions. Also called additional precautions

LS1 Recall of the Chain infection

Reading P and P pages 684- 687
Review on VIH LO2
Chain of infection
1. Infectious agent: normal flora, transient
2. Reservoir: carrier; ideal temperature
 3. Portal of exit
4. Mode of transmission
5. Portal of entry
6. host
Nosocomial Infections: 48 hours from when you got hospitalized

Modes of Transmission
Contact Transmission: transfer of microbes by physical touch
Direct contact: physical skin to skin contact between an infected host; c.diff, staphylococus

2.1 Reading P and P pages 697- 704

Asepsis vs. medical asepsis
Asepsis: the process for keeping away disease- producing microorganisms
: Aseptic technique refers to practices designed to render an area and objects as free
from microorganisms as possible.
a. Medical asepsis: clean technique, includes procedures used to reduce and prevent the
spread of microorganisms.
: hand hygiene using clean gloves to prevent direct contact with blood or
body fluids
: washing hands before preparing a meal
: routine practices/ universal precautions
: udrf in daily routine care to break chain of infection
b. Surgical asepsis: eliminates all pathogens
: used in surgical procedures, catheterization, dressing changes

Principles of cleaning, disinfection, and sterilization

Cleaning: physical removal of foreign material

: brush and detergents are needed for cleaning
Disinfection and sterilization: elimination of pathogens except bacterial spores
: use of chemicals, heat, or ultraviolet light; bleach

Measures to control infection

Control of elimination of reservoirs: sites for infection, nurses need to eliminate or control
sources of body fluids, drainage, or solutions that might harbour microorganisms
: discard articles that become contained with infectious material

Control of portals of exit: to minimize or prevent infectious organisms from exiting the body
: wear a mask as needed, avoid talking directly into patients’ faces, and never talk, sneeze or
cough directly over surgical wounds or sterile dressing fields.
: cover the nose or mouth when sneezing or coughing

Control of transmission: effective control of infection requires nurses to remain aware of

transmission and ways to control them.
: Hand hygiene: using instant alcohol hand antiseptic before and after providing patient care
Components of handwashing
a. Using an adequate amount of soap
b. Rubbing the hands together to lather the soap and create friction
c. Rinsing under the stream of water
Control of portals of entry: measures that control the exit of microorganisms likewise control
their entrance. Maintaining the integrity of skin and mucous membranes reduces the chances
of microorganisms reaching a host.
: the patient’s skin should be lubricated

Steps of hand hygiene:

1. Stand in front of sink, keeping hands and uniform away from sink surfaces.
2. Turn on water. Regulate so that the temperature is warm.
3. Wet hands and wrists thoroughly under running water. Keep hands and forearms
lower than elbows during washing.
4. Apply a small amount of soap, lathering thoroughly.
5. Wash hands using plenty of lather and friction – for at least 10-15 seconds. Rub
thumb, work the fingertips, and get under the nails.
6. Rinse hands and wrists.
7. Dry hands thoroughly from fingers to wrists to forearms with paper towel, single use
cloth, or warm air dryer.
8. Turn off faucet with clean dry paper

3 Describe routine practices and isolation

Caring for a patient on isolation precautions
1. Routine practices: isolation guidelines contain practices designed to care for all patients in
any setting, regardless of their diagnosis or presumed infectiousness
- apply when care worker is or potentially exposed in:
a. blood
b. all body fluids, secretions, and excretions except sweat
c. nonintact skin or
d. mucous membranes
 - include appropriate use of gowns, masks, eyewear, and other protective devices or
clothing
2. additional precautions: designed to contain pathogens in one area, usually the patient’s
room

3. Isolation precautions: only patients infected or colonized with certain highly transmissible
or epidemiologically significant pathogens

Basic principles of isolation precaution

- Observe thorough hand hygiene before entering and leaving the room of a patient in
isolation.
- Dispose of contaminated supplies and equipment in a manner that prevents the
spread of microorganisms to other persons as indicated by the mode of transmission of
the organism.
-Apply knowledge of a disease process and the mode of infection transmission when
using protective barriers.
- Ensure that all persons who might be exposed during transport of a patient outside the
isolation room are protected.

Psychological implications of isolation precautions: A patient required to be in isolation in as

private room may become lonely because normal social relationships are disrupted.
- Patient’s may feel unclean, rejected, lonely, or guilty
- limits sensory contact

Caring for patient on isolation precautions

1. Assess isolation indications
2. Review agency policies and precautions necessary for isolation category
3. Review nurse’s notes
4. Hand hygiene
5. Prepare for entrance- a. hand hygiene b. gown c. mask d. eyewear e. gloves
6. Enter the room; arrange supplies and equipment
7. Explain purpose of isolation
8. Assess vital signs
9. Administer medication
10. Administer hygiene measures, encourage the patient to ask questions
11. Collect specimens
12. Dispose of linen and garbage bags
13. Resupply room as needed
14. When leaving- remove PPE except; remove N95 after closing the patient’s door
 The process for collecting specimens, bagging linen, and transporting patients
Collecting species
- when obtaining specimens, nurses should be using disposable gloves and sterile equipment
- all specimen containers should be sealed tightly to prevent spillage and contamination of the
outside container
Bagging linen
- use special bagging procedures
- ensure that the outside bag is not contaminated to prevent accidental exposure to
surroundings.
- soiled linen should be placed in an impervious laundry bag in the patient’s room
- double bagging is only recommended if it is impossible to prevent the contamination of the
bag’s outer surface.
Transporting patients
- nurse should have the patient perform hand hygiene and give the patient clean gowns and
robes before the transport
- the equipment has to be cleaned and disinfected if necessary after the patient returns to the
room
- an extra layer of sheets may be used to cover the stretcher of the wheelchair

Infection- control professional: these individuals are responsible for advising hospital
personnel regarding infection prevention and control for monitoring infections within the
hospitals

3.6 Review

Routine precautions – precautions against blood borne pathogens and body substance
Airborne precautions – negative pressure room, N95 mask
Droplet precautions – private room, mask worn when within 2 m of the patient
Contact precautions – private room, gown, and gloves
Isolation precautions – designed to contain pathogens in one area
Nosocomial infection – acquired after admission to health care facility
Dedicated equipment – for use only with the patient on isolation
C. Difficile – Clostridium Difficile which can produce spores, can live in hospitals for months
 LO5 ppts

Isolation Practices
Tier 1
- designed to protect healthcare worker; and to prevent healthcare worker from spreading
infections
- feces, saliva, drainage, fluids
a. applied if nurse is exposed to
- blood, all body fluid, non- intact skin, non- intact mucous membranes
b. hand hygiene
c. use of appropriate PPE
d. equipment cleaned properly
e. soiled linen handled the same way
f. sharp instruments discarded appropriately
g. single room at necessity
h. restrict ill visitors/ health care workers
Tier 2
a. patients who are infected or colonized with certain highly transmissible pathogens
b. want to contain the pathogen in one area
c. categorized in 4 ways
i. Contact
ii. Droplet
iii. Airborne
iv. or combination of above

Positive Pressure room

- air flow out of the room
- this keeps airborne microorganisms that may infect the patient away
Negative Pressure room
- ventilation that allows air to flow into the room but not escape
- prevents contaminated air from escaping
- used for airborne patients
Immune Compromised: keeping a particular client safe from us
Protective environment
- visitors should check with nurse prior to entering room
- visitors may be limited
- strict adherence to hand hygiene
- wash all fresh fruit/ vegetables
- no fresh or dead flowers
Psychological impact
- lonely, depressed, guilty, undesirable, sensory deprivation
What can we do to help?
Educate
• patient/ family
• nature of disease/ condition
• purpose of isolation
• steps for carrying out precautions
• Hand hygiene
Transporting
• only if necessary
• proper PPE
• notify area patient on isolation
Improve sensory stimulation
• clean pleasant environment
• drapes/ shades open
• excess supplies/ equipment removed
• take time with care activities
• provide comfort measures
• Encourage walking/ mobilizing/ being out of bed
• recreational activities

Antibiotic resistant
- bacteria that have evolved to withstand usual antibiotic treatments
- Spread:
a. person- to- person
b. Contaminated surfaces
c. Food, water, soil
d. Animals
e. Travel
- Common AROs: MRSA, ESBL, VRE, CPO
Ways to prevent antibiotic resistance
1. Minimize overprescribing of antibiotics
2. Complete the entire course of prescribed antibiotics
3. Practice good hand hygiene!