Ch. 4 Principles of Infection Prevention and Control

Fomites

inanimate objects that help transfer pathogens

Nosocomial

infections acquired in the hospital

Sterilization

death of all microorganisms

Disinfection

death of pathogenic microorganisms

Standard precautions

universal method of protection for health workers

What is a health care associated infection?

refers to infections that develop in a patient during the course of medical treatment

What type of program is charged with reducing the risk of hospital-accquired infections (HAIs)?

commonly organized and coordinated by a hospital's Infection Prevention (IP) program. IP programs are charged with reducing the risk of HAIs and thereby protecting patients, employees, and visitors.

List three elements that are required for infections to develop

Source or reservoir of pathogens

Susceptible host barriers to their transmission

Route of transmission for the pathogen

List six vaccinations that might help you decrease the risk of transmitting an HAI

MMR
COVID-19
Varicella
Hepatitis B
Pertussis
Influenza

RTs must know the routes of disease transmission so we can avoid infection. What are the three MAJOR routes?

Contact/unwashed hands (Instruments)
Droplet transmission (coughing, sneezing, talking)
Airborne transmission (tuberculosis, measles, chickenpox)

Define Cleaning (equipment processing)

Removal of all foreign material

(e.g., soil, organic material) from objects

Disinfection, low-level (equipment processing)

Inactivation of most bacteria, some viruses, and fungi without destruction of resistant microorganisms such as Mycobacterium tuberculosis or bacterial spores

Disinfection, intermediate-level (equipment processing)

Inactivation of all vegetative bacteria, fungi, most viruses, and M. tuberculosis without destruction of bacterial spores

Disinfection, high-level (equipment processing)

Inactivation of all microorganisms except bacterial spores (with sufficient exposure times, spores may also be destroyed.)

Sterilization (equipment processing)

Complete destruction of all forms of microbial life

List the 3 general barrier methods to prevent exposure to organisms.

Gloves: touching body fluids or mucous membranes

Gown: during procedures

Goggles/mask: procedures like suctioning that might splash

What agent is an option for high-level disinfection of semicritical respiratory equipment?

2.4% or greater glutaraldehyde
0.55% orthophthaldehyde
3100 to 3800 ppm peracetic acid
2.0% hydrogen peroxide

Among respiratory care equipment, what type has the greatest potential to spread infection?

Because they produce aerosols capable of spreading pathogenic microbes, large-volume (Jet) nebulizers remain among the most common types of respiratory equipment linked to HAIs.

What protective equipment should be worn during any procedure that can generate splashes or sprays of body fluids?

masks; goggles

What protective equipment is part of routine care when there is skin contact?

gloves

You work in the surgical intensive care unit (ICU) of a large urban hospital. Over the past 2 days, a number of postoperative patients in the unit have developed serious Staphylococcus aureus infections

Why do postoperative patients have an increased risk of infection?

Surgical incision, pain, anesthesia, intubation, and narcotics all impair host defenses.

You work in the surgical intensive care unit (ICU) of a large urban hospital. Over the past 2 days, a number of postoperative patients in the unit have developed serious Staphylococcus aureus infections

What is the most common source of S. aureus organisms?

commonly colonizes the skin of healthcare professionals and visitors.

You work in the surgical intensive care unit (ICU) of a large urban hospital. Over the past 2 days, a number of postoperative patients in the unit have developed serious Staphylococcus aureus infections

Identify three ways to disrupt the route of transmission in this situation

Rigorous handwashing
Use of gloves
Isolate the infected patients

During the third day of your clinical rotation. you are assigned to a therapist who has an extremely heavy workload on a medical floor of the hospital. The therapist puts on gloves for each patient contact and asks you to do so also. When you go to wash your hands after the first treatment, the therapist tells you, “We don’t have time for that, and besides the gloves will keep our hands clean.”

Explain the roles of gloves in protecting practitioners and preventing the spread of infection.

Gloves protect caregivers from contamination when contacting patients' blood and body fluids. Gloves also protect patients from bacteria that colonizes the caregivers' hands. You still need to clean or wash your hands, because gloves may have very small defects, and you may contaminate your hands when removing the gloves.

A serious COVID-19 outbreak occurs in a crowded local prison facility. You are called to the emergency department as four of the sickest patients are being admitted together to your hospital for treatment.

By what route does COVID-19 spread?

Through infectious respiratory aerosols and droplets released when breathing, talking, laughing, coughing, or singing.

A serious COVID-19 outbreak occurs in a crowded local prison facility. You are called to the emergency department as four of the sickest patients are being admitted together to your hospital for treatment.

What conditions could have increased transmission of COVID-19 in this setting?

The concentration of aerosols is greatest in close proximity to the patient. Crowded, poorly ventilated environments and close contact with infected people.

A serious COVID-19 outbreak occurs in a crowded local prison facility. You are called to the emergency department as four of the sickest patients are being admitted together to your hospital for treatment.

What kinds of precautions should be taken to prevent the spread of infection once these patients are admitted?

Use standard and transmission-based precautions, including patient isolation, appropriate PPE, hand hygiene, and proper ventilation.

A serious COVID-19 outbreak occurs in a crowded local prison facility. You are called to the emergency department as four of the sickest patients are being admitted together to your hospital for treatment.

What is a challenging aspect of COVID-19 infection?

can spread before symptoms appear or from individuals who have mild or no symptoms, making transmission difficult to prevent.

A serious COVID-19 outbreak occurs in a crowded local prison facility. You are called to the emergency department as four of the sickest patients are being admitted together to your hospital for treatment.

What should you do if enough private rooms with airborne precautions are not available for this group of patients?

Use physical separation, patient masking, and respiratory protection for healthcare workers to reduce airborne transmission.

A 72-year-old female patient with COPD has a tracheostomy tube in place following prolonged intubation and mechanical ventilation. She is currently in the medical intensive care unit. After you take her off the ventilator, you will need to set up a heated aerosol system with an FiO2 of 40%.

What type of water should be placed in the nebulizer?

Sterile distilled water

A 72-year-old female patient with COPD has a tracheostomy tube in place following prolonged intubation and mechanical ventilation. She is currently in the medical intensive care unit. After you take her off the ventilator, you will need to set up a heated aerosol system with an FiO2 of 40%.

To help lower the risk of a nosocomial infection when using heated aerosol systems, the RT should do what?

Label the equipment with the date and time it started
Use aseptic technique during the initial setup

A 72-year-old female patient with COPD has a tracheostomy tube in place following prolonged intubation and mechanical ventilation. She is currently in the medical intensive care unit. After you take her off the ventilator, you will need to set up a heated aerosol system with an FiO2 of 40%.

The best ways to prevent the spread of infection in the ICU is to?

Wash your hands after every patient contact.

One of your fellow students comes to clinical rotation with a cold. He asks you not to tell your clinical instructor because missed clinical days are hard to make up. What is your reaction to this situation? What are the potential problems with this scenario?

Encourage the student to report their illness to the clinical instructor and follow clinical policies. Patient safety and infection prevention come first.

The college recommends that you get immunized against Hep. B before attending clinical rotation. The consent form lists a number of possible side effects of the vaccine, and the vaccination is expensive. What are the pros and cons of vaccines? What will you choose?

protects healthcare workers from HBV infection. The benefits generally outweigh the risks, so RT students should get vaccinated before clinical rotations.