chapter 3: infection control, safety, first aid, and personal wellness

infection

a condition that results when a microbe (microorganism) invades the body, multiplies, an causes injury/disease

microbes

__ include bacteria, fungi, protozoa, viruses

pathogen

a microbe capable of causing disease

communicable infections

• able to be spread from person to person

• CDC charged with investigation and control of disease

endemic

a disease that belongs to a particular area, people, or country and can be commonly found there

outbreak

a sudden increase in cases of a disease in an area beyond what is expected, or an infection in a new area. if not quickly controlled, it can lead to an epidemic

epidemic

when outbreak disease spreads rapidly and affects many people within a community, population, or region, or the number infected in an area is significantly higher than normal

pandemic

when an epidemic of a disease has spread over multiple countries or continents and affects a large portion of the population

nosocomial infection

patient infection acquired in a hospital

healthcare-associated infection

patient infection acquired during healthcare delivery in any healthcare settings

• causes: infected personnel, patients, visitors, food, drugs, equipment

• clostridioides difficile

• MRSA

• enterococcus

well-established antibiotic-resistant bacteria

• carbapenem-resistant enterobacteriaceae (CRE): Escherichia coli and Klebsiella pneumonia

• acinetobacter baumannii

• pseudomonas aeruginosa

multidrug-resistant gram-negative bacteria

chain of infection

1. infectious (causative) agent

2. reservoir

3. exit pathway

4. means of transmission

5. entry pathway

6. susceptible host

infectious (causative) agent

pathogenic microbe responsible for causing an infection

reservoir

• source of infectious agent

• place where microbe can survive and grow or multiply

• includes humans, animals, food, water, soil, equipment

exit pathway

• a way an infectious agent can leave a reservoir host

• secretions and exudates, tissue specimens, blood, feces, urine

means of transmission

• airborne

• contact

  • direct (touching/kissing)

  • indirect (contaminated objects)

• droplet (coughing, sneezing)

• vector (insect, arthropod, animal)

• vehicle (food, water, drugs)

entry pathway

• how an infectious agent enters a susceptible host

• includes body orifices, mucous membranes, and breaks in skin

susceptible host

• someone with a decreased ability to resist infection

• factors: age, health, immune status

breaking the chain of infection

• hand hygiene

• nutrition, rest, stress reduction

• immunization

• decontamination of surfaces/instruments

• disposal of sharps and infectious waste

• use of gloves, gowns, masks, and respirators

• needle safety devices

• infection control programs

• insect and rodent control

• isolation procedures

infection control programs

• to protect patients, employees, visitors, and others

• to break chain of infection

• monitor and collect data on all infections occurring in institution

• institute special precautions in the event of outbreaks

• components

  • employee screening

  • employee immunization

  • evaluation and treatment

  • surveillance

infection control practices

• hand hygiene

• personal protective equipment (PPE)

order of donning PPE

1. gown

2. mask/respirator

3. goggles/face shield

4. gloves

ordering for removing PPE

1. gloves

2. goggles/field shield

3. gown

4. mask

asepsis

condition of being free of contamination/germs that can cause disease

aseptic

free of disease-causing microbes

aseptic technique

practice used to reduce the change of microbial contamination

aseptic technique for blood collection personnel

• proper hand hygiene

• keep supplies within easy reach to avoid dropping them

• open packages in a way to avoid contamination

• prompt and safe disposal of contaminated equipment

• prompt cleanup of infectious material

• wear gloves for blood collection and other PPE when indicated

NICU infection control technique

• wash hands and put on clean gloves

• gather only those items necessary to perform specimen collection

• leave blood collection tray or cart outside the nursery

• remove gloves, decontaminate hands, and put on new gloves between patients

T / F: scrubs/pants that touch the floor can pick up infectious material. CLSI laboratory safety guidelines: pants worn by laboratory personnel should be 1-1.5inches off the floor to prevent contamination

true

T / F: lab coats worn as PPE must not be worn on break, in the cafeteria or other nonpatient areas, or outside the hospital

true

isolation procedures

• protective/reverse isolation

• universal precautions (UP)

• body substance isolation

protective/reverse isolation

for patients highly susceptible to infections (burn and oncology patients)

universal precautions (UP)

blood and body fluids of all people are potentially infectious

body substance isolation

goes beyond UP, gloves for contacting moist body substances

guideline for isolation procedures

• standard precautions

• transmission-based precautions

transmission-based precautions

• airborne

• droplet

• contact

biohazard

any material/substance (potentially) harmful to health

biohazard exposure notes

• airborne

• ingestion

• nonintact skin

• percutaneous (through the skin)

• permucosal (through mucous membranes)

bloodborne pathogens

• hepatitis b (HBV) and hepatitis d virus

• hepatitis c virus (HCV)

• human immunodeficiency virus (HIV)

hepatitis b and d virus

• present in blood and other body fluids

• can survive up to a week on objects

• transmitted via needlesticks, sexual contact

  • symptoms: flu-like, fatigue, loss of appetite, mild fever, muscle/joint/abdominal pain, nausea, vomiting

hepatitis c virus

• present in blood and serum, sometimes saliva

• infection primarily occurs after large or multiple exposures

• transmitted via needlesticks, sexual contact

• symptoms: flu-like, fatigue, loss of appetite, mild fever, muscle/joint/abdominal pain, nausea, vomiting

human immunodeficiency virus (hiv)

• present in blood, semen, saliva, tears, urine, CSF, amniotic fluid, breast milk, cervical secretions, and tissue

• risk to healthcare workers (HCW) primarily through exposure to blood

• symptoms: progression through mild to severe flu-like symptoms, hairy leukoplakia, white lesion on tongue, kaposi sarcoma, neurological symptoms, dementia

OSHA BBP Standard

• enforced by federal law

• intended to reduce/eliminiate BBP exposure

• engineering and work practice controls to prevent exposure incidents

needlestick safety and prevention act

required OSHA to revise BBP standard in four key areas:

• revision and updating of exposure control plan

• solicitation of employee input in selecting engineering and work practice controls

• modification of engineering definition

• new record-keeping requirement, including the requirement to keep a sharps injury log

exposure control plan

• must be written

• must be reviewed and updated at least annually

BBP exposure routes

• skin pierced by contaminated needle or sharp object

• blood or other body fluid splashes in eyes, nose, or mouth

• blood or other body fluid contacts cut, scratch, or abrasion

• human bite breaks skin

exposure incident procedure

• needlestick/other sharps injury

• mucous membrane exposure

• surface decontamination

• cleanup of body fluid spills

• biohazard waste disposal

exposure incident procedure: needlestick/other sharps injury

• wash site with soap and water at least 30 secs

exposure incident procedure: mucous membrane exposure

• flush site with water/sterile saline for at least 10mins

• use eyewash station if available to flush a splash to eyes

• remove contact lenses asap and disinfect them

• report incident to immediate supervisor

• report directly to provider for evaluation, treatment, counseling

exposure incident procedure: surface decontamination

• 1:10 bleach solution or other epa-approved solution

T/F: chemical safety- always wear PPE

true

OSHA hazard communication (hazcom) standard (HCS)

• hazcom labeling requirements

• safety data sheets

• DOT hazardous material label example

• national fire protection association labeling system

• safety showers and eyewash stations

• chemical spill clean-up

electrical safety

• shut off source of electricity

• use nonconducting item to remove electricity source from victim

• call for medical assistance

• start cardiopulmonary resuscitation if needed

• keep victim warm

components needed for fire to occur

• fuel: combustible material

• heat: temperature of material until ignition

• oxygen: to maintain combustion

• chemical reaction: produces fire

class a fire

• ordinary combustible materials (wood, paper)

• require water/water-based solutions to extinguish

class b fire

• flammable liquids and vapors (paint, oil, grease, gasoline)

• require blocking oxygen or smothering to extinguish

class c fire

• electrical equipment

• require nonconducting agents to extinguish

class d fire

• combustible/reactive metals (sodium, potassium, magnesium, lithium)

• require dry powder agents/sand to extinguish

class k fire

• high temperature cooking oils, grease, fats

• require agents that prevent splashing and cool and smother fire

principles of radiation exposure

• distance

• shielding

• time

first aid for external hemorrhage

firm, direct pressure to wound using cloth or gauze

T/F: the original compress should not be removed when adding additional ones because removal can disrupt the clotting process

true

shock

occurs when insufficient return of blood to the heart results in inadequate oxygen supply to body organs/tissues

• causes: hemorrhage, heart attack, trauma, drug reactions

• symptoms:

  • pale, cold, clammy skin

  • rapid, weak pulse

  • increased, shallow breathing rate

  • expressionless face and staring eyes

first aid for shock

• maintain open airway for victim

• call for emergency assistance

• keep victim lying down

• elevate legs so head is lower than body (unless would cause further pain/injury)

• attempt to control bleeding or other cause of shock

• keep victim warm until help arrives

stroke

• leading cause of death and serious disability in adults

• best if diagnosed within 3 hours of symptom onset

signs of stroke

• f - face dropping

• a - arm weakness

• s - speech difficulty

• t - time to call 911

CPR order

CAB: compressions, airway, breathing

CPR for adults

• compression to ventilation ratio of 30:2

• compression rate 100-120/min

• compression depth at least 5cm (2in), no greater than 6cm (2.4in)

CPR for infant/child

• beginning with 30 compressions (1 rescuer) or 15 (by 2)

• compression depth at least 1/3 the anterior-posterior diameter of the chest (approx 4cm or 1.5in for infants, and 5cm or 2 in for chldren up to the onset of puberty)