Infection Control

in Critical Care
SUBMITTED TO : Sir Akash
SUBMITTED BY : Iqra, Shazza, Radika, Sidra, Tayyaba, Sundas,
Amina, Rimsha Bashir, Rimsha Boota, Priya
CONTENTS
Definition and Types of Infection

Definition and Types of Asepsis

Types of Precautions

Role of Nurse in Infection Control

INFECTION
Definition :
An infection is the growth of microorganisms in body tissue
where they are

Types of infection
Local infection : It is limited to
the specific part of the body where the microorganisms remain.

Systemic infection : If the microorganisms spread and damage

different parts of the body, the infection is a systemic infection.
ROUTES OF TRANSMISSION
1. Direct transmission : Direct transmission involves immediate
and direct transfer of microorganisms from person to person. Sneezing, coughing,
spitting, singing, or talking can project droplet spray into the conjunctiva or onto th
mucous membranes of the eye, nose, or mouth of another person present within 1
m (3 ft).

2. Indirect transmission : They are either vehicle borne or vector borne:

a. Vehicle-borne transmission :A vehicle is any substance that serves as an

intermediate means to transport and introduce an infectious agent into a
susceptible host through a suitable portal of entry. Fomites (inanimate materials or
CONT...
eatingToutensils, and surgical instruments or dressings, water, food, blood,
serum, and plasma etc. For example, food or water may become
contaminated by a food handler who carries the hepatitis A virus.

b. Vector-borne transmission : A vector is an animal or flying or crawling

insect that serves as an intermediate means
of transporting the infectious agent. Transmission may occur
by injecting salivary fluid during biting or by depositing feces
or other materials on the skin through the bite wound or a
traumatized skin area.
 CONT...
3. Airborne transmission : It may involve droplets or dust. Droplet
nuclei, the residue of evaporated droplets emitted by an infected host
such as someone with tuberculosis, can remain in the air for long
periods. Dust particles containing the infectious agent (e.g., C. difficile,
spores from the soil) can also become airborne. The material is
transmitted by air currents to a suitable portal of entry, usually the
respiratory tract, of another person.
SEPSIS AND ASEPSIS
Sepsis is the condition in which acute organ dysfunction occurs
secondary to infection.

Asepsis :
It is the freedom from disease-causing microorganisms.
To decrease the possibility of transferring microorganisms from one
place to another, aseptic technique is used.

Types of asepsis
There are two types of asepsis
• Medical asepsis
• Surgical asepsis
MEDICAL ASEPSIS
• Medical asepsis includes all practices intended to confine a
specific microorganism to a specific area, limiting the number,
growth, and transmission of microorganisms.
• In medical asepsis, objects are referred to as clean, which means
the absence of almost all microorganisms, or dirty (soiled,
contaminated), which means likely to have microorganisms, some
of which may be capable of causing infection.
SURGICAL ASEPSIS
• Surgical asepsis, or sterile technique, refers to those practices that
keep an area or object free of all microorganisms; it includes
practices that destroy all microorganisms and spores (microscopic
dormant structures formed by some pathogens that are very
hardy and often survive common cleaning techniques). Surgical
asepsis is used for all procedures involving the sterile areas of the
body.
TYPES OF PRECAUTIONS
STANDARD
PRECAUTIONS

TRANSMISSION
PRECAUTIONS
 STANDARD PRECAUTIONS
Set of infection control practices used to prevent the transmission of disease that can be
acquired by contact with blood, body fluids, non intact skin & mucous membrane

HAND WASHING

PERSONAL PROTECTIVE EQUIPMENTS

DISCONTAMINATION

PROPER WASTE DISPOSAL

Precautions
HAND WASHING
Hand wash is one of the effective measure in infection control. 80% of the
diseases are spread through hands.
According to CDC, Hand washing should be done :
 4
3 5
STEPS OF
HAND
2 WASHING 6

1 7
POINTS TO REMEMBER
 Ensure that cuts and wounds are properly covered.
 Gloves are not a substitute for hand wash.
 Hands that are visibly dirty or contaminated with body fluids
should be washed with soap and water.
 If hands are not visibly soiled or contaminated, alcohol-based
hand products should be used.
 Ensure that hands are completely dry before starting any activity
PERSONAL PROTECTIVE EQUIPMENTS
GLOVES
Gloves should be worn if being exposed to the
following situations or substances:
• Bood or body substances
Gown
• Mucous membranes - oral, nasal, conjunctival,
Protective
eye wear Gloves rectal, genital
• Non intact skin - wound, surgical incision
PPEs
• Indwelling devices - urinary and intravenous
Face Mask catheters, feeding tubes
shield • Visibly soiled equipments, supplies or Linens
Footware that may have been in contact with blood or
body fluid
• Shared equipments moving between patients
PERSONAL PROTECTIVE EQUIPMENTS
MASK

Masks are worn to reduce the risk for transmission of

organisms by the droplet contact and airborne routes
Gown and by splatters of body substances. The CDC
Protective recommends that masks be worn:
eye wear Gloves 1. By those close to the client if the infection (e.g.,
measles, mumps, or acute respiratory diseases in
PPEs children) is transmitted by large-particle aerosols
(droplets).
Face
shield
Mask 2. By all individuals entering the room if the infection
(e.g., pulmonary tuberculosis and SARS-CoV) is
Footware transmitted by small particle aerosols (droplet nuclei).
PERSONAL PROTECTIVE EQUIPMENTS
FOOTWEAR

Footwear must cover the entire foot to avoid

Gown
contamination with blood or other body Fluids or
potential injury from shrubs they should be
Protective removed before leaving a care area e.g theatre
eye wear Gloves

PPEs

Face
Mask
shield

Footware
PERSONAL PROTECTIVE EQUIPMENTS
FACE SHIELD

• Face shield adds a layer of protection from

other people's sneeze and cough
Gown • May prevent face touching or remind people
Protective not to touch their face while doing procedures
eye wear Gloves
• Can be potential source of infection if not
properly handled and disinfected after each
PPEs
use.
Face
Mask • Fogg can build up and reduce visibility
shield

Footware
PERSONAL PROTECTIVE EQUIPMENTS
PROTECTIVE EYE WEAR

Protective eyewear (goggles, or glasses)

are indicated in situations where body
Gown substances may splatter
the face. If the nurse wears prescription
Protective
eye wear Gloves eyeglasses, goggles must still be worn over
the glasses because the protection must
PPEs extend around the sides of the glasse

Face
Mask
shield

Footware
PERSONAL PROTECTIVE EQUIPMENTS
GOWN

Clean or disposable impervious (water-resistant)

gowns or plastic aprons are worn during
procedures when the nurse’s uniform is likely to
Gown
become soiled.
Protective Sterile gowns may be indicated when the nurse
eye wear Gloves
changes the
dressings of a client with extensive wounds (e.g.
PPEs
burns).
Face
Mask
shield

Footware
 TYPES OF DISINFECTANTS
DISINFECTION
A disinfectant is a chemical preparation
used on inanimate objects. Disinfectants
High level disinfection
are frequently
caustic and toxic to tissues. It is 2% glutaraldehyde (cidex)
concentrated solution which possess Stabilized hydrogen peroxide
1% Sodium hypochlorite
bactericidal
or bacteriostatic properties. Intermediate level disinfection

0.1% Sodium hypochlorite

Phenolic solutions

Low level disinfection

Ammonium compounds
STERILIZATION
Sterilization is a process that destroys all microorganisms, including
spores and viruses.

Methods of sterilization

• Moist Heat : To sterilize with moist heat (such as with an

autoclave), steam under pressure is used because it attains
temperatures higher than the boiling point.
• Gas : Ethylene oxide gas destroys microorganisms by interfering
with their metabolic processes. It is also effective against spores.
Its advantages are good penetration and effectiveness for heat-
sensitive items. Its major disadvantage is its toxicity to humans.
CON...
• Boiling Water : This is the most practical and inexpensive method
for sterilizing in the home. The main disadvantage is that spores
and some viruses are not killed by this method. Boiling a
minimum of 15 minutes is advised for disinfection of articles in
the home.

• Radiation : Both ionizing (such as alpha, beta, and x-rays) and

nonionizing (ultraviolet light) radiation are used for disinfection
and sterilization. The main drawback to ultraviolet light is that the
rays do not penetrate deeply. Ionizing radiation is used effectively
in industry to sterilize foods, drugs, and other items that are
sensitive to heat. Its chief disadvantage is that the equipment is
very expensive
Biomedical Waste
According to WHO
Biomedical Waste is a waste generated during the diagnoses,
testing, treatment or research of biological products for human or
animal.

WASTE MANAGEMENT :
Waste management is the collection, transport, processing or
disposal, managing and monitoring of waste material
• To reduce hazardous nature of waste
• To reduce volume of waste
• To prevent misuse or abuse of waste
• To ensure occupational safety and health
• To consider asthetics
TRANSMISSION (ISOLATION ) PRECAUTIONS
These precautions are used in addition to standard precautions and are applied for patients
who are known or suspected to be infected or colonized with infectious agents.

Contact precautions
Prevent transmission of infectious organism spread by direct or indirect contact
with the patient or the patient's environment.Contact precaution include :
• Private room
• Clean, non sterile gloves when enteringincontine, removed before exiting
• Limit transport to essential purposes
• The use of patient care equipment to a singal patient and avoid sharingbetween
patient.
Droplet precautions
Prevent transmission of infectious organism spread by droplet (>5 microns) through
close respiratory or mucous membrane contact with respiratory secretions through
coughing, sneezing and talking precaution include :
• Private room
• Limit transport to essential purposes
• Wear mask if working within 3 feet of the patient
• Wear gown and gloves as per standard precautions
Airborne precautions
Prevent transmission of infectious organism spread by airborne droplet (<5
microns) that remain infectious and suspended in air for long period of time over
long distances and can be widely spread by air currents. Airborne precaution
include :
• Private room with monitored negative pressure ventilation of 6 to 12 air
exchanges per hour. Airborne infection isolation room preferred.
• Doors and windows must be kept closed at all times
• Respiratory protection (usually N-95) mask for susceptible persons must be worn
prior to entering and after leaving the room
• If possible non immune Health Care workers should not care for patients with
airborne diseases
• Limit transport to essential purposes
ROLE OF NURSE
To Remove etiological agent:
• Ensure that articles are correctly cleaned and disinfected or sterilized before use.
• Educate client and support people about appropriate method of cleaning, disinfecting
in sterilizing articles.

To remove Reservoir :
• Change dressing and bandages when they are soiled or wet.
• Assist clients to carry out appropriate skin and oral hygiene.
• Dispose of damp, soiled linens appropriately.
• Dispose of fecesinappropriate appropriate receptacles.
• Ensure that all fluid containers, such as bedside water jugs, suction and drainage
bottles are covered and capped.

To remove Portal of entry :

• Avoid talking, coughing, or sneezing over open wounds or sterile field.
ROLE OF NURSE
To Remove method of transmission :
• Use standard and transmission based precautions.

To remove Portal of entry of susceptible host :

• Use use aseptic technique for invasive procedures (e.g injections and
catheterization).
• Use sterile technique when exposing open wounds or handling dressing
• Place used needles and syringes in puncture resistant containers for
disposal
• Provide all clients with their own personal care items.
ROLE OF NURSE
For Susceptible host:
• Maintain the integrity of the client's skin and mucous membrane.
• Ensure that the client receives a balanced diet.
• Educate the public about the importance of immunization.
• Encourage deep,slow breathing exercises, ambulation and movement.
• Offer stress management Strategies and encounter healthy
relationships.
REFERENCES
• McGuckin, M., & Govednik, J. (2013). Patient empowerment and
hand hygiene, 1997–2012. Journal of Hospital Infection, 84, 191–
199. doi:10.1016/j.jhin.2013.01.014
• World Health Organization. (2009). WHO guidelines on hand
hygiene in health care. Geneva, Switzerland: Author.
• Centers for Disease Control and Prevention (CDC). (2012).
• Types of healthcare-associated infections. Retrieved from
http://www.cdc.gov/HAI/infectionTypes.htm
THANK YOU