infection control

what are the 3 important chains in the chain of infection?

source, transmission, and susceptible host

examples of infection sources?

patients (most common), visitor, staff, environment, equipment, etc.

examples of infection transmission?

contact (skin to skin), indirect contact (handling a bedpan), droplet, airborne, blood and body fluids, vectors

how far can respiratory droplets travel?

depends on size; very large about 1m, smaller droplets closer to 2m/6 feet (currently what we accept)

what are true airborne organisms?

droplet nuclei

what is a vector?

living organisms that transmits disease (ex. mosquitoes)

what factors may be make a host susceptible?

extremes in age, immunosuppression, no immunity, chronic conditions, emergency procedures

what is meant by "tip of iceberg" in regards to pathogens?

tip of iceberg: diseases we can see (ex. rash)
bottom of iceberg: blood borne pathogens and stuff

what are routine practises?

recommended practises for the routine care of all patients in various setting and incorporates previous precautions against blood-borne pathogens

similar to standard precautions published by the CDC

who has current published guidelines for routine practises? year?

the provincial infectious disease advisory committee; 2012

what are routine practises determined by?

the interaction with the patient, not by the patients diagnosis \-- anticipate the risk of exposure to blood and other body fluids

(don't wear gloves just because you're judging a patient)

which body fluids are considered potentially infective?

ALL body substances, of ALL substances

what are routine practices used in conjunction with?

additional precautions

what are additional precautions used for (3)?

- droplet and airborne
- antimicrobial resistant bacteria
- organisms/ infections of significance

what is the health heirarchy of controls (5)?

- elimination
- substitution
- engineering control (ex. negative pressure rooms)
- administrative controls
- PPE

what is a major way to stop transmission of infection?

hand hygiene

terminates outbreaks in health care facilities, reduce transmission of antimicrobial resistant organisms and reduce overall infection rates

what does an increase in hand hygiene by 20% result in?

a 40% reduction in the rate of HAI

bad news; most healthcare providers already believe their practicing good hand hygiene

what are the 2 main strategies for hand hygiene?

- hand washing with soap and water
- hand rubs with alcohol-based products (preferable in health care settings)

what are the 2 major moments where most health care providers miss hand hygiene?

2: before aseptic procedures
4: after patient/ patient environment contact

when should gloves be used?

as an additional measure (when is contact with body fluids or moist substances from exudate/wounds)

NOT a substitute for hand hygiene (use of either does not negate need for the other)

benefits of gloves?

reduce hand contamination by 70-80%, and prevent cross contamination and protect patients and health care personnel from infections

hand hygiene surrounding glove use?

before donning and after doffing

what is the point of mask, eye protection and face shield?

to protect mucus membranes during procedures and patient care activities likely to genera splashes or sprays of blood, body fluids, secretions or excretions

OR within 2 m of a coughing patient

when should gowns be worn?

when clothing is likely to be soiled; procedures likely to generate splashes/sprays of body fluid

accommodation associated with routine practises?

single room not required unless patient visibly soils environment

guidelines for equipment and routine precautions?

clean between all patients

safe sharps disposal

guidelines for environmental control surrounding routine practises?

establish routine care, cleaning of surfaces and furniture, using hospital approved disinfectant

be mindful of high tough surfaces and items

risk factors for infection after exposure to blood (4)?

- pathogen involved
- type of exposure
- amount of blood involved
- amount of virus in the blood

are hepatitis and HIV transmitted by feces, nasal secretions, sputum, tears, urine or vomit?

NO! unless they are visibly contaminated with blood

risk of contracting hepatitis B from blood exposure?

6-10%

visually no risk if vaccinated and developed immunity

risk of contracting hepatitis C (HCV) from blood exposure?

1.8 % after cut or needle stick

risk unknown following a blood splash

risk of contracting HIV after blood exposure (3)?

0.3% after needle stick or cut

0.1% after splashes to nose, mouth, eye

risk

BBP risk prevention?

hepatitis B vaccine, maintain intact skin, maintain good health

BBP risk elimination?

disinfection, safe containment of blood

BBP risk reduction?

PPE

what microbe factors should be considered when assessing risk of transmission (5)?

- ability to survive in environment
- low infective dose
- virulence and pathogenicity
- can it exist in the carrier state?
- means of transmission

what patient factors should be assessed in regards to risk of transmission?

- symptoms of diarrhea
- requires hand on care
- poor hygiene
- copious respirate secretions

what patient care environment factors should be considered in regards to risk of transmission (4)?

- if housekeeping is poor
- equipment is shared between patients
- multiple bed rooms
- nurse/patient ratio (cut corners when short staffed)

what factors should be assessed in the new susceptible host regarding risk of transmission (5)?

- portals of entry (catheters, skin integrity)
- immune status
- underlying medical conditions
- antibiotic therapy
- high acuity/ hands on care

what are additional precautions based on?

transmission

required when routine practices are insufficient

when might someone be put on airborne precautions (2)?

- when they have pulmonary/ laryngeal TB
- measles/ measles like rash

requirements for airborne precautions (4)?

- single room with door kept closed
- negative pressure (OR is positive)
- 6-9 air changes/ hour
- direct exhaust \-- air from room goes right outside

PPE for airborne precautions?

respirators that filter out sub micron particles and fit around contours of face to avoid air leaks

patient transport with airborne precautions?

only to leave room for essential procedures; patient to wear surgical mask

when are patients typically put on droplet?

for diseases that spread via respiratory droplets:

colds, bronchitis, bacterial meningitis, COVID, pertussis, flu, etc

accommodations for droplet precautions ?

single room is preferred (if not able, spatial separation of \> 4 meters) \-- in nurseries, 1-2 m between bassinets

may cohort patients with same diagnosis, and doors may be kept open

PPE for droplet precautions (4)?

- surgical mask
- eye wear
- gown (routine practise when droplets/ splatters anticipated)
- gloves (when handling respiratory secretions)

patient transport on droplet precautions?

- only leave for essential services
- wear surgical/ procedure mask when leaving

what are the precautions for COVID?

enhanced droplet (N95)

when is a patient placed on contact precautions?

for enteric organisms (ex. c. diff), and antibiotic resistant organisms (ex. MRSA)

PPE for contact precautions?

gown and gloves

accommodation for contact precautions?

single room preferred; assess patient, organism, and roommate when considering shared accommodation

patient transport for routine precautions?

patient should be transported in clean gown and sheet, and preform hand hygiene upon leaving the room

sequence to remove PPE (6)?

- remove gloves
- remove gown
- hand hygiene
- remove eye wear
- remove N95 respirator
- preform hand hygiene

general rules for a healthy workplace (2)?

do not come to the hospital if you have an acute illness that is probably of infection etiology

AND stay up to date on vaccines!!

parameters for patient and family teaching surrounding infection and prevention control?

patients: should have infections and precautionary measures explained to them

family: should understand means of transmission, risk and prevention strategies

all educational material should be clear and in layman's terms

what are some important factors in acute care to consider surrounding precautions (4)?

- more acuity
- skin broken
- incisions
- catheters, IVs, tubes

hand washing, gown and gloves all common

what are some factors to be considered in long term care settings surrounding precautions (4)?

- underlying conditions
- decubitus ulcers
- peg tubes
- partial to total care

hand washing, occasional gowns + gloves

what are some factors that should be considered in lodging homes/ senior residences surrounding precautions (3)?

- higher self care level
- intact skin
- able to follow directions

hand washing, rare need for gown or gloves

HAI are the most common ......

serious complication of hospitalization

5-10% of patients acquire HAI

HAIs are the \____ leading cause of death in Canada.

how has this changed?

4th

11th 20 years ago

what are process indicators?

monitoring compliance with best practise (surrounding prevention of HAIs)

what is syndromic surveillance?

monitoring for new onset of symptoms such as fever, cough, SOB and or GI illness

most common HAI?

UTI

what are the different classifications of surgical wounds, and associated risk of infection (4)?

1. clean (ex. eye, or heart): 1-5%

2. clean contaminated (exposure to normal flora, such as mouth): 3-11%

3. contaminated (areas of inflammation): 10-17%

4. dirty (ex. soiled wound): \>20%

what factors may increase susceptibility to an SSI (surgical site infection) (7)?

- age
- diabetes
- immunosuppression
- obesity
- malnutrition
- emergency surgery
- duration of surgery

what are the different sources for reservoirs for microorganisms (3)?

personnel (skin, hair, anus, vagina and throat)

patient (normal flora, skin and mucus)

environment (air handling, instruments, bandages)

what are pre-op prevention strategies for SSI (5)?

- showers
- hair removal
- skin prep
- drapes
- prophylactic antibiotics

what are intra-operative prevention strategies for SSI?

- low OR traffic (keep doors closed)
- duration of the procedure
- sterile insertion of drains, catheters and IVs

appropriate attire for a safe/ sterile operation (4)?

masks, gowns, gloves, and cap

how is the environment controlled in the OR?

- clean air rooms
- laminar airflow rooms

what are the OR cleaning procedures (case/daily/weekly/monthly)?

between cases: horizontal surfaces, 1 m radius around OR table

daily: full floor, lights, walls

weekly: shelves, external vents

monthly: hallways and additional storage

what is IV infection risk based on (5)?

- site
- prep (skin and solution)
- technique
- daily observation (be concerned if anything strange!)
- duration of IV insitu

what is the primary risk for HAI UTI?

instrumentation and catheter care

stratagies for UTI prevention?

minimize catheters (sterile technique when needed), keep bag below patients hips (prevent back flow), and select appropriate catheter.

daily peri care

what is considered nosocomial pneumonia?

not present or incubating at time of admission; no incubation within the first 48-72 hours

how is bacterial nosocomial pneumonia primarily spread (3)?

- aspiration
- inhalation of aerosols
- hematogenous spread

what does viral pneumonia reflect?

the prevalence of virus in community; does not predominantly hit the high risk group

who does fungal and unusual bacteria primarily effect?

the immunosuppressed, and transplant cases

what role does the hospital environment play in fungal and unusual bacterial infections?

concerns such as construction, renovations and water features increase risk

what patient factors increase pneumonia risk (7)?

- thoracic operations
- old age (60+)
- patients who aspirate
- reduced ability to cough
- patients having invasive procedures
- colonization of some organisms
- impaired immunity

examples of control measures for pneumonia?

immunization, sterile technique, oral care, precautions, etc

im not gonna list them all cuz you already know

what is the different between antiseptics/ disinfectants and sterilization?

antiseptics: used on living tissue
disinfectant: used on material to remove/ climate some organisms
sterilization: kills ALL microorganisms

\____________________ must proceed all sterilization and disinfection

cleaning

goop is not sterile, even if sterilized

what are critical items?

items that will enter sterile body cavities, or come in contact with sterile tissue (ex: surgical clamp)

require sterilization

what are semi-critical medical devices?

items that only contact with mucous membranes or non-intact skin (ex: endoscope)

requires high level disinfection minimum!

what are non critical medical devices?

devices that come into contact with intact skin (ex. urinal)

require sanitization

what is the decontamination process?

removes blood, body fluid and tissue in order to ensure sterilization

makes items safe to handle

what are the disinfection methods? what can't it eliminate?

thermal and chemical

spores stay

what is low level disinfection?

disinfection with things like house hold cleaning products such as bleach can kill most bacteria, some viruses and some fungi (ex. TB, vegetative bacteria)

used for cleaning general patient care areas (ex. IV poles, bedside)

what is high level disinfection?

process destroying everything but bacterial spores

requires special ventilation, PPE , and specific tech

used in outpatient settings

what are the types of sterilization?

- steam under pressure
- dry heat
- ethylene oxide gas
- chemical sterilants (take 10-12 hours)

what is pasteurization?

reducing micro-organisms by thermal disinfection (ex: hot water for 30 minutes)

typically used with respiratory equipment

disposable/ single use, vs. single patient use?

disposable/ single use: one and done (discard)

single patient use: can be used repeatedly but only by the same patient