UNIT 10: INFECTION CONTROL IN CLINICAL SETTINGS

Microorganisms
Microscopic. Naturally present on and in the human body and environment. Some microorganisms (pathogens) cause specific diseases or infections. Many are harmless (nonpathogenic) and do not produce disease in most individuals. If an individual is highly susceptible to infection, the nonpathogenic microorganisms could become infectious.

 Virulence: ability to produce disease Pathogenicity: ability to produce disease Pathogen is a microorganism that produces disease. A true pathogen causes disease or infection in a healthy individual An opportunistic pathogen causes disease only in a susceptible host

Nature of infection
An infection is the invasion of a susceptible host by pathogens or microorganisms, resulting in disease. If the microorganism produces no clinical evidence of disease , the infection is called asymptomatic or subclinical. The principal infecting agents are bacteria, viruses, fungi and protozoa. If a microorganism is present or invades a host, grows and/or multiplies but does not cause disease or infection, this is referred to as colonization. Disease or infections result only if the pathogens multiply and alter normal tissue function. If infectious disease can be transmitted directly from one person to another , it is considered as a contagious or communicable disease

Infection:
An invasion of pathogens or microorganisms into the body that are capable of producing disease. The invasion and reproduction of microorganisms in a body tissue that can result in a local or systemic clinical response such as cellulitis, fever etc.

Types of infections
Colonization: process by which strains of microorganisms become resident flora. In this state, the microorganisms may grow and multiply but do not cause disease. Infection occurs when newly introduced or resident microorganism succeed in invading a part of the body where the host s defense mechanisms are ineffective and the pathogen causes tissue damage. The infection becomes a disease when the signs and symptoms of the infection are unique and can be differentiated from other conditions. Infection can be local or systemic. Local infection : infection limited to a specific part of the body where the microorganisms.

Types of infections
Systemic infection : microorganism spread and damage different parts of the body Acute or chronic infections Acute : appear suddenly or last a short time Chronic : may occur slowly, over a very long period and may last months or years

Chain of infection
The presence of a pathogen does not mean that an infection will begin Development of an infection occurs in a cyclic al process that depends on the presence of following elements Infectious agent or pathogen, reservoir for pathogen growth, portal of exit from the reservoir, mode of transmission or vehicle, portal of entry and a susceptible host. Infection develops if this chain stays contact. Nsg efforts should be to control and prevent infections by breaking this chain.

Chain of Infection/Infection Process

Transmission Portal of Exit

Portal of Entry

Reservoir Infectious Agent

Host Susceptibility

Chain of Infection: (cont.)

Development of an infection depends on the six elements identified in the chain of infection. 1)Infectious agent microorganisms (bacteria, viruses)
Resident normally reside on the skin in stable numbers Transient attach loosely to the skin by contact with another easily removed by handwashing

2) Reservoir:
A reservoir is any natural habitat of a microorganism that promotes growth and reproduction. Examples of reservoirs are soiled or wet dressings, insects, food , water hospital equipment, and carriers (person or animal who harbors and spreads an microorganism, but show no signs of disease e.g Anopheles mosquito carrier for malaria parasite). Food and proper atmosphere are required to thrive.

3)Portal of exit:
Site where microorganism leaves. A microorganism cannot cause disease in another host unless it finds a point of escape from the reservoir. Human exit routes are gastrointestinal, respiratory, and genitourinary systems; tissue; and blood. Handwashing can prevent the spread of microorganisms or cross-contamination.

4)Mode of transmission:
After a microorganism leaves its source or reservoir, it

requires a means of transmission to reach to another person or host through a receptive portal of entry. 3 mechanisms:
DIRECT TRANSMISSION Immediate and direct transfer of microorganisms from person to person through touching, biting, kissing or sexual intercourse. Droplet spread is also a form of direct transmission but can occur only if source and host are within 3 feet of each other. ( Sneezing, coughing, spitting, singing, talking)

4)Mode of transmission:
INDIRECT TRANSMISSION

Either vehicle borne or vector borne A) VEHICLE BORNE Vehicle is any substance that serves an intermediate means to transport and introduce an infectious agent into a susceptible host through a suitable portal of entry. FOMITES ( inanimate material or objects), such as toys, soiled clothes, utensils, hanky, pen can act ac VEHICLES. Water, food , blood, serum, plasma are other vehicles. B) VECTOR BORNE TRANSMISSION Animal or flying or crawling insect that serves as an intermediate means of transporting the infectious agent. AIRBORNE TRANSMISSION Method of Transmission

4)Mode of transmission
AIRBORNE TRANSMISSION
May involve droplets or dusts. Droplet nuclei is the residue of evaporated droplets emitted by an infected host such as someone with TB, can remain in air for long periods.

4)Mode of transmission:
There are many vehicles on or by which microorganisms can travel to the next host. Fomite Vehicle is inanimate (nonliving) object Stethoscope, thermometer, bandage scissors, etc. Vector Living carrier

5)Portal of Entry: (to the host)

Entrance of Microorganisms The microorganism must find a way to enter the susceptible host. When the host s defense mechanisms are reduced, the microorganism has a greater chance to enter. The skin is the first line of defense and should be kept intact, lubricated, and clean. Enter the same way they exit (open wound, breathe in)

6)Host susceptibility:
Host must be susceptible to the strength and numbers of the microorganisms. To reduce susceptibility provide adequate nutrition & rest, promote body defenses against infection & provide immunization.

Breaking the Chain of Infection

The cycle must be interrupted to prevent the spread of a microorganism.

RESPONSE TO INFECTION
Response depends on organism and host normal course of infection 1st phase (incubation period) when pathogen enters the body to the appearance of first symptoms 2nd phase (prodromal stage) from appearance of first symptoms to more severe symptoms

RESPONSE TO INFECTION
Response normal course of infection 3rd phase (full stage) symptoms are acute and specific to type of infection final phase (convalescence stage) when acute symptoms subside and patient recovers
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Course of infection
Pre exposure stage : factors present leading to problem development Preclinical stage : exposure to causative agent, no symptoms present Clinical stage: symptoms present Resolution stage : Problem solved. Returned to health or chronic state of death

RESPONSE TO INFECTION
Factors that Influence Infection Body s defense mechanisms Portal of entry only if they gain access to the body through a specific portal of entry Number of microorganism greater the number, greater the opportunity to cause disease

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RESPONSE TO INFECTION
Factors that Influence Infection Virulence pathogen s strength to cause disease Host resistance some normal flora have an antibiotic relationship

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NOSOCOMIAL INFECTION
When a client who develops an infection that was not present or incubating at the time of admission to a health care setting, it is called as nosocomial infection Exogenous: arises from micro organisms outside the individual. Eg salmonella, clostridium tetani Endogenous: when part of patient's flora becomes altered and an overgrowth results ( enterococci, yeasts, and streptococci.

Examples of sites and potential causes for nosocomial infections

SURGICAL AND TRAUMATIC WOUND INFECTION
Improper surgical technique Improper skin prep before sx Improper aseptic technique during dressing change

PRIMARY BLOODSTREAM INFECTION

Contamination of IV fluids , needles or catheter improper care of hemodialysis or peritoneal shunt improper skin prep before insertion of IV access device

Examples of sites and potential causes for nosocomial infections

PNEUMONIA
Improper aseptic technique during suctioning Displacement of NG tube

URINARY YTRACT INFECTION

Improper insertion of urinary catheter improper specimen collection technique contaminated catheter improper handwashing technique

GI SYSTEM INFECTION
Contaminated food or water overuse of antibiotics

SKIN AND SOFT TISSUE INFECTION

Improper skin care poor nutrition and hydration

Signs of Localized Infection

Localized swelling Localized redness Pain or tenderness with palpation or movement Palpable heat in the infected area Loss of function of the body part affected, depending on the site and extent of involvement
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Signs of Systemic Infection

Fever Increased pulse and respiratory rate if the fever high Malaise and loss of energy Anorexia and, in some situations, nausea and vomiting Enlargement and tenderness of lymph nodes that drain the area of infection
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Signs of Infection
Laboratory data
Elevated WBC count Increase in specific WBC types Elevated ESR Cultures of urine, blood, sputum, or other drainage

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Risks for Nosocomial Infections

Diagnostic or therapeutic procedures
Iatrogenic infections

Compromised host Insufficient hand hygiene

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Factors Influencing Microorganism s Capability to Produce Infection

Number of microorganisms present Virulence and potency of the microorganisms (pathogenicity) Ability to enter the body Susceptibility of the host Ability to live in the host s body

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Anatomic and Physiologic Barriers Defend Against Infection

Intact skin and mucous membranes Moist mucous membranes and cilia of the nasal passages Alveolar macrophages Tears High acidity of the stomach Resident flora of the large intestine Peristalsis Low pH of the vagina Urine flow through the urethra
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Active Immunity
Host produces antibodies in response to natural antigens or artificial antigens Natural active immunity
Antibodies are formed in presence of active infection in the body Duration lifelong

Artificial active immunity

Antigens administered to stimulate antibody formation Lasts for many years Reinforced by booster
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Passive Immunity
Host receives natural or artificial antibodies produced from another source Natural passive immunity
Antibodies transferred naturally from an immune mother to baby through the placenta or in colostrums Lasts 6 months to 1 year

Artificial passive immunity

Occurs when immune serum (antibody) from an animal or another human is injected Lasts 2 to 3 weeks
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NANDA Diagnosis
Risk for Infection
State in which an individual is at increased risk for being invaded by pathogenic microorganisms

Risks factors
Inadequate primary defenses Inadequate secondary defenses

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Related Diagnoses
Potential Complication of Infection: Fever Imbalanced Nutrition: Less than Body Requirement Acute Pain Impaired Social Interaction or Social Isolation Anxiety

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Interventions to Reduce Risk for Infection

Proper hand hygiene techniques Environmental controls Sterile technique when warranted Identification and management of clients at risk

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ASEPSIS
Definition (Asepsis) practices that minimize or eliminate organisms that can cause infection and disease medical asepsis clean technique surgical asepsis sterile technique

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Asepsis
Medical asepsis
Includes all practices intended to confine a specific microorganism to a specific area Limits the number, growth, and transmission of microorganisms Objects referred to as clean or dirty (soiled, contaminated)
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Surgical asepsis
Sterile technique Practices that keep an area or object free of all microorganisms Practices that destroy all microorganisms and spores Used for all procedures involving sterile areas of the body

Medical asepsis
Includes all practices intended to confine a specific microorganism to a specific area Limits the number,growth, and transmission of microorganisms Clean or dirty (soiled,contaminated)

MEDICAL ASEPSIS
Definition (Medical Asepsis): reduce/prevent number of microorganism transmissions components 1. GENERAL CLEANLINESS/ CLEAN ENVIRONMENT. 2. HANDWASHING 3. BARRIER TECHNIQUES 4. DISINFECTION OF ALL ARTICLES THAT MAY BE CONTAMINATED, OR USED FOR MORE THAN ONE PATIENT.
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MEDICAL ASEPSIS
Medical Asepsis 1 )HANDWASHING single most effective measure to prevent the spread of disease 2) barrier technique (PPE) keep organisms from entering or leaving the respiratory tract, your eyes or breaks in the skin
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MEDICAL ASEPSIS
Medical Asepsis gloves latex allergy eye protection goggles/glasses gowns/aprons fluid resistant masks disposable
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MEDICAL ASEPSIS
leaving a patient s room discard gown/mask/gloves HANDWASHING terminal disinfecting patient and family teaching HANDWASHING hygienic practices aseptic technique
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Disinfection and methods:

Disinfection is the process of killing the pathogenic or disease producing microorganism but not usually bacterial spores. Disinfectant is germicide an agent which kills pathogenic or disease producing microorganisms but not usually bacterial spores. Eg . phenol and Lysol. Antiseptic is an agent which prevents the growth of microorganisms. Eg alcohol. A deodorant is an agent, which suppresses bad odours. Eg. Lime , bleaching powder Detergent is a surface cleansing agent, which acts by lowering surface tension. Eg soap. Sterilization is a destruction of microorganisms and their spores.

Disinfecting
A disinfectant is a chemical preparation, such as phenol or iodine compounds , used on inanimate objects which kills pathogenic microorganisms but not usually bacterial spores.

An antiseptic is a chemical preparation used on skin or tissues. Disinfectants and antiseptics often have similar chemical components, but the disinfectant is more concentrated. Both have bactericidal or bacteriostatic properties

Disinfecting
A bactericidal preparation destroys bacteria whereas bacteriostatic prep prevents the growth and reproduction of some bacteria. EXAMPLES: Isopropyl and ethyl alcohol, chlorine ( bleach), hydrogen peroxide, Phenol

Types of Disinfection:
1. Concurrent disinfection: This is disinfection of infectious material ( eg stools, urine contaminated linen) through out the course of an illness . This procedure checks or prevents the dissemination or further spread of the disease agent. 2. Terminal disinfection: This is disinfection that is undertaken at the termination of an illness. ( eg. After recovery or death of the patient). 3. Prophylactic disinfection: Boiling of water, pasteurisation of milk, washing hands with soap and water are examples.

SURGICAL ASEPSIS
Practices that keep an area or object free of all microorganisms, no organisms are carried to the patient Sterile technique (Practices that destroy all microorganisms and spores) Used for all sterile areas of the body used during dressing changes, administering parenteral medications & sterile procedures

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SURGICAL ASEPSIS
INCLUDES 1) Disinfection & Sterilization disinfectants destroy most pathogens but not necessarily their spores sterilization destroys all pathogens and spores 2)Sterile Protective Measures hair covering, surgical mask, sterile gown and sterile gloves
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Sterilizing
Two types Physical (uses heat or radiation) Steam under pressure, boiling water, radiation, or dry heat Chemical Gas Chemical solutions Iodine, alcohol, and chlorine bleach

Sterilizing
Sterilisation is a process that destroys all microorganisms including spores and viruses 4 commonly used methods of sterilisation Moist heat, gas, boiling water and radiation Moist heat: steam under pressure is used because it attains temperature higher than the boiling pt .( autoclave) Gas : Ethylene oxide gas destroys microorganisms by interfering with their metabolic processses. Also effective against spores. Boiling water: minimum 15 minutes boiling is advised for diisnfection. Most practical and inexpensive Radiation: Both ionizing ( alpha , beta and xrays) and nonionizing ( ultraviolet light) are used.food, drugs and other items that are sensitive to heat are stterilised by radiation

Principles of Sterile Technique

A sterile object remains sterile only when touched by another sterile object. Only sterile objects may be placed on a sterile field. A sterile object or field out of vision or an object held below the waist is contaminated. A sterile object or field becomes contaminated by prolonged exposure to air. The skin can not be sterilized and is unsterile  All personnel must perform a surgical scrub

Principles of Sterile Technique

When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field becomes contaminated. Fluids flow in the direction of gravity. The edge of the sterile field or container is considered contaminated.

PERIOPERATIVE NURSING: PRINCIPLES OF PERIOPERATIVE ASEPSIS

General: a. Keep sterile supplies dry and unopened b. Check package sterilization expiration date to verify sterility c. Maintain general cleanliness in surgical suite d. Maintain surgical asepsis: activities designed to keep sites free from the presence of microorganisms throughout the procedure Personnel: a. Personnel with signs of illness should not report to work b. Surgical scrub, a specific hand washing technique used by operating room personnel designed to reduce microorganisms in the hands and arms, is done for the length of time designed by hospital policy

PERIOPERATIVE NURSING: PRINCIPLES OF PERIOPERATIVE ASEPSIS

Surgical Scrub i. A sensor-controlled or knee- or foot-operated faucet allows the water to be turned on and off without the use of the hands ii. Remove all rings and watches iii. Use liquid soaps to prevent the spread of organisms iv. Keep the finger nails short and well-trimmed v. Clean fingernails with a nail stick under running water vi. Hold the hands higher than the elbows throughout the hand washing procedure so that run-off goes to the elbows vii. Allows the cleanest part of the arms to be the hands viii. A scrub brush facilitates the removal of microorganisms ix. Clean all areas of skin on the hands and arms in sequence starting at the hands and ending at the elbows x. After rinsing, dry the hands with paper towels, drying first one arm from the hand to the elbow, then using a second towel to dry the second hand

PERIOPERATIVE NURSING: PRINCIPLES OF PERIOPERATIVE ASEPSIS

Maintaining a Sterile Field (a microorganism-free area): a. Create a sterile field using sterile drapes b. Use the sterile field to place sterile supplies where they will be available during the procedure c. Drape equipment prior to use d. Keep drapes dry and out of contact with nonsterile objects e. Utilize sterile technique while adding or removing supplies from sterile fields Sterile Supplies and Solutions: a. Check expiration dates for sterility b. Don t use solutions that were opened prior to current use c. Lip the solution after initial use by pouring a small amount of liquid out of the bottle into a waste container to cleanse the bottle lip

PERIOPERATIVE NURSING: PRINCIPLES OF SURGICAL ASEPSIS

7. All OR personnel are required to wear specific, clean attire, with the goal of shedding the outside environment.  Specific clothing requirements are prescribed and standardized for all ORs: a. OR personnel must wear a sterile gown, gloves, and specific shoe covers b. Hair must be completely cover c. Masks must be worn at all times in the OR for the purpose of minimizing air-borne contamination and must be changed between operations or more often, if necessary 8. Any personnel who harbors pathogenic organisms must report themselves unable to be in the OR to protect the client from outside pathogens

PERIOPERATIVE NURSING: PRINCIPLES OF SURGICAL ASEPSIS

9. Scrubbed personnel wearing sterile attire should touch only sterile items 10. Sterile gowns and sterile drapes have defined borders for sterility.  Sterile surfaces or articles may touch other sterile surfaces or articles and remain sterile.  Contact with unsterile objects at any point renders a sterile area contaminated. 11. The circulator and unsterile personnel must stay at the periphery of the of the sterile operating area to keep the sterile area free from contamination 12. Sterile supplies are unwrapped and delivered by the circulator following specific standard protocol so as not to cause contamination

PERIOPERATIVE NURSING: PRINCIPLES OF SURGICAL ASEPSIS 13.The utmost caution and vigilance must be used when handling sterile fluids to prevent splashing or spillage 14.Anything that is used for one client must be discarded or, in some cases, resterilized

Surgical Asepsis (Opening Sterile Packages)

Sterile supplies have dated labels or chemical tapes that indicate the date when the sterilization expires. If the integrity of the sterile package is questionable, the item should not be used.

Handling of Sterile articles:

1. Always wear a mask when handling sterile articles. 2. Sterilized articles must be kept in sterile containers or on sterile towels, and kept covered till used. Never allow contact of unsterile with sterile articles. 3. Make sure there is no dampness, as this could make the things unsterile. 4. Never allow any unsterile article including the arms and hands to pass a sterile field.

Handling of Sterile articles:

5. Never touch the inside of a package or container with your fingers. Use the cheatle forceps. 6. To pull a cork from a bottle of sterile fluid, take care not to contaminate the inner part neither of the cork nor inside the rim of the bottle. Replace it carefully. 7. When lifting a cover from a sterile container bring it down with the inner side up and then replace it without delay. 8. To carry a sterile bowl or other container, hold it with your hands underneath, and do not touch the rim.

Rules for use of cheatle forceps

1. The sterile jar holding the forceps must be cleaned, re-sterilized and filled with fresh antiseptic lotion daily. The cheatle forceps should be cleaned and autoclaved or boiled. 2. When in use, keep the forceps at elbow level and pointed downwards because if you lift it upwards the solution may run on to your hand and then back to the forceps, making it unsterile. 3. Put the forceps back into the jar immediately after use. Replace carefully without touching the rim of the jar. If the forceps becomes contaminated, it must be re-sterilized before being put back into the jar.

Isolation
Isolation refers to measures designed to prevent the spread of infections or potentially infectious microorganisms to health personnel, clients and visitors. Isolation for the control of infection is used to prevent infected patients from infecting others (source isolation) , and/or prevent susceptible patients from being infected (protective isolation).

Isolation
Source isolation is the physical separation of one patient from another, in order to prevent spread of infection. Standard Infection Control Precautions must be observed at all times with all patients, including those in isolation. Protective isolation (reverse barrier nursing) is the physical separation of a patient at high risk from common organisms carried by others.The term 'protective isolation' describes a range of practices used to protect highly susceptible hospital patients from infection.

Barrier nursing techniques

Patients who are suffering from contagious infections are often nursed in isolation using a procedure known as barrier nursing. These techniques have developed to protect the hospital environment from contamination with dangerous pathogens. Anything that comes into direct contact with the patient is considered infective and must be sterilised before being returned to general use. If this proves impossible then the item must be incinerated before disposal. Personnel attending the infectious patient wear special protective clothing, masks and gloves.

INFECTION CONTROL
Source Isolation administering medications unwrap before going into pt s room use disposable med trays and cups don t take med cards into pt s room HANDWASHING needles/syringes in sharps container use & discard IV bags in pt s room dispose of all materials in pt s room
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INFECTION CONTROL
Source Isolation taking vital signs use equipment in patient s room wear PPE as indicated use clock in patient s room, not your watch use disposable temperature system

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INFECTION CONTROL
Source Isolation caring for the patient s body after death take special precautions to prevent spread of infection

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Reverse Barrier nursing techniques

Those people who are most at risk of acquiring infections while in hospital, organ transplant recipients on immunosuppressive therapy, for example, can be protected from infection by reverse barrier nursing.

Items must be sterilised before coming into contact with the

patient and in these cases, personnel wear protective clothing to prevent their microflora from contaminating their patient: an event that may lead to the establishment of a lifethreatening infection. All these precautions help to protect patients from infection.

Isolation Precautions
Standard Precautions Transmission based Precautions

Standard Precautions
Designed to reduce the risk of transmission of micro-organisms from known and unknown sources of infection. Used in the care of all hospitalized persons regardless of their diagnosis or possible infection status Apply to Blood All body fluids, secretions, and excretions except sweat (whether or not blood is present or visible) Nonintact skin and mucous membranes Combine the major features of UP and BSI Universal Precautions reduce risk of transmission of blood-borne pathogens Body Substance Isolation (BSI) reduce transmission from moist body substances

Standard Precautions
Standard Precautions must consider ALL patients are potentially infected wear gloves when in contact with blood, body fluids, non-intact skin, mucous membranes or contaminated items & change them after each contact HANDWASHING if contaminated with blood, body fluids, after each patient contact & after removing gloves
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Standard Precautions

Cover all cuts and abrasions

Apply a waterproof dressing.

Get immunised against hep B infection :

if you might be in contact with blood, body fluids or human tissue.

Hand hygiene Personal protective equipment wear a gown/apron when clothing could become soiled wear mask, eye protection/face shield if splashing of blood/body fluids is possible Proper disposal of sharps :use proper sharps container Sharps injury:do not recap/break needles/ splash of blood :report any exposures Management of blood spills Care of medical devices/ patient care equipment Environmental cleaning/ decontamination Proper disposal of waste & used linen Cough etiquette.

Management of blood spills using the blood spill kit

Put on apron & gloves Pour granules on spill for 2 mins Prepare chlorine solution of 10,000ppm Scoop up moistened granules and place in biohazard bag or container o Use disposable wipe and chlorine solution to decontaminate area o Place cloth/wipe in biohazard bag when completed o Remove gloves & apron and wash hands o o o o

Standard Precautions
Gloving Don gloves if there is any possibility of contact with infectious material. Gloves are worn only once and then placed into infectious waste containers.

Standard Precautions
Gowning Wear a gown to protect skin and prevent soiling of clothing during procedures and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions or cause soiling of clothing.

Mask/Protective Eyewear
Protects the wearer from inhaling microorganisms that travel on airborne droplets. Prevents inhaling pathogens if resistance is reduced or during transport to another area. Discourages the wearer from touching the mouth, nose, and eyes and from transmitting infectious material

Transmission-based Precautions
Used in addition to standard precautions For known or suspected infections that are spread in one of three ways:
Airborne Droplet Contact

May be used alone or in combination but always in addition to standard precautions

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Transmission-based Precautions
Transmission-Based Precautions airborne precautions tiny microorganisms from evaporated droplets remain suspended in the air or carried by dust particles & inhaled TB, measles and chickenpox private negative pressure room doors of rooms kept closed high-filtration particulate respirator
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Transmission-based Precautions
droplet precautions
microorganisms are propelled through the air through sneezing, coughing, talking or suctioning meningitis, pneumonia, influenza, mumps, rubella, and etc. mask and private room doors may remain open

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Transmission-Based Precautions
contact precautions most frequent mode of transmission direct contact of body surface indirect contact such as needle/hand HEP A, herpes simplex virus, acute diarrhea, draining abscess & etc. gloves, gown and private room use in ADDITION to Standard Precautions
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 Hand washing: simple, hand antisepsis and surgical antisepsis (scrub)

Hand washing
Hand hygiene is the simplest, most effective measure for preventing nosocomial infections Compliance is usually estimated as <50% Two major groups of microorganisms are found on the skin:
organisms that normally reside on it (resident flora) and contaminants (transient flora) . Transient flora, which are easily removed by handwashing, cause most hospital infection resulting from cross-transmission .

Hand washing
1. Hand hygiene Performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis 2. Handwashing Washing hands with plain soap and water 3. Antiseptic handwash Washing hands with water and soap or other detergents containing an antiseptic agent 4. Alcohol-based handrub Rubbing hands with an alcohol-containing preparation 5. Surgical hand hygiene/antisepsis Handwashing or using an alcohol-based handrub before operations by surgical personnel

Materials used
Soap: Plain or antimicrobial soap depending on the procedure. Specific antiseptics: 2%-4% chlorhexidine, 5%-7.5% povidone iodine, 1% triclosan, or 70% alcoholic hand rubs.

Indications for hand hygiene

When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. If hands are not visibly soiled, use an alcoholbased handrub for routinely decontaminating hands.

Specific indications for hand hygiene

Before Patient contact Donning gloves when inserting a CVC Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don t require surgery After Contact with a patient s skin Contact with body fluids or excretions, non-intact skin, wound dressings Removing glove.

Effective Handwashing Technique

, .

Palm to palm.

Right palm over left dorsum and left palm over right dorsum.

Palm to palm fingers interlaced.

Backs of fingers to opposing palms with fingers interlocked.

Rotational rubbing of right thumb clasped in left palm and vice versa.

Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa.

Repeat each step 5 fives. Hand hygiene should take- a minimum of 15 seconds to complete. Following handwashing dry hands thoroughly using paper hand towel.

Handwashing and Gloving Video

Click here to view a video on handwashing and gloving.

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Hand Hygiene: Skill 31-3

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Hand Hygiene: Skill 31-1

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 PERSONAL PROTECTING EQUIPMENTS: TYPES, USES AND TECHNIQUE OF WEARING AND REMOVING

PERSONAL PROTECTIVE EQUIPMENT (PPE) FOR INFECTION DISEASES REQUIRING DROPLET & STANDARD PRECAUTIONS.

PROCEDURE FOR DONNING PPE (before entering room)

Decontaminate hands with alcohol based hand rub Put on apron Put on mask  Put on gloves

PROCEDURE FOR REMOVING PPE

Avoid contaminating hands while removing PPE. If hands become contaminated, DECONTAMINATE immediately with alcohol based hand rub. Dispose of PPE as clinical waste. 1. Remove gloves 3. Remove mask.

2. Remove apron.

4. Decontaminate hands.

 DECONTAMINATION OF EQUIPMENT AND UNIT

Decontamination of patientpatient-care equipment.

Clean re-useable equipment before use in the care of another patient Do not reuse single-use or disposable equipment on other patients Know single use symbol

Never use alcohol wipes for general cleaning.

Environmental Cleaning
Routine daily: Standard cleaning Emphasis on touched surfaces in room (bed rails, door knobs) Terminal: Thorough cleaning and decontamination of all items in room.

Disposal of Contaminated Equipment

Specially labeled bagging and either sanitary burial or incineration are required. Disposal of sharps (needles, blades) Must be put in a puncture-proof container Double Bagging This infection control practice involves placing a bag of contaminated items into another clean bag that is held outside an isolation room by other personnel. This is recommended when it is impossible to keep the outer surface of a single bag free

 TRANSPORTATION OF INFECTED PATIENTS

TRANSPORTATION OF INFECTED PATIENTS

Give the client the appropriate barrier technique if having communicable disease Mask for patient if disease is communicable by droplet, airborne, or contact route
Sheet on w/c or cart, then blanket Wrap blanket around pt In x-ray, cover table with sheet, open blanket ( don t touch inside ) leave on cart or w/c, have pt move to table, cover with sheet.

TRANSPORTATION OF INFECTED PATIENTS

Pt. back to cart or w/c on top of same cotton blanket, wrap around patient.
Dispose of soiled linen , wash hands, remove gown. Clean cart or w/c with disinfectant and clean table. Wash hands

Transporting personnel should practice the appropriate precautions

INFECTION CONTROL
Isolation
transporting the patient to other areas wear PPE as indicated to include pt control/contain patient s drainage escort ambulatory patients notify other areas of patient s precautions disinfect transportation device

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