150A - Week 0: Infection, Prevention & Control, Asepsis, Sterility

Factors Contributing to HAIs

• Use of medical devices - Indwelling urinary catheter, IVs, ventilators

• Ineffective cleaning - Lack of hand hygiene, non-adherence to isolation precautions, hospital equipment, improper cleaning of health care environment

• Patient vulnerability - Complications after surgery, older age, comorbidities (diabetes, heart failure, chronic illness), overuse of antibiotics and multi drug resistant organisms (MDROs)

Isolation Precautions

1. Standard Precautions

2. Transmission-based precautions

Standard precautions

The minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered.

• Hand hygiene before and after

• Respiratory hygiene

• Use of PPE (gown, glove, face mask) if risk of contact with bodily fluids

Trasmission-based Precautions

Contact, droplet, airborne

Standard Precaution - Tier One

1. Perform hand hygiene before/between/after direct contact with patients. This includes secretions, blood, body fluids, and excretions and with equipment. ***After gloves removed.

2. Wash hands when hands are visibly soiled or contaminated with blood or body fluids.

3. When hands are not soiled, use 60%+ alc. hand rub to perform hand hygiene.

4. Do not wear artificial nails

5. Wear gloves

6. Wear PPE when you’re anticipating patient interaction that involves contact with blood or body fluids

7. Respiratory hygiene and cough etiquette

5 Moment for Hand Hygiene

1. Before touching a patient

2. Before clean/aseptic procedure

3. After body fluid exposure risk

4. After touching patient

5. After touching patient surroundings

Hand Sanitizer vs. Soap + Water

• Hand Sanitizer - Only use when hands are not visibly soiled and must be 60% alc. Reduce number of microbes but to not eliminate all types of pathogens.

• Soap + Water - Best way to reduce the number of hand microorganisms when: hands are visibly soiled, after exposure to c. difficile or norovirus, before eating, and after toileting.

Contact Precautions

Implemented to prevent transmission of known or suspected infectious agents directly or indirectly from one patient to another. This includes equipment as well

• Require gown and gloves

• Clean hands before and after entering room

• Use patient-dedicated or disposable equipment

• Clean and disinfect shared equipment

• Ex). MRSA, VRE, Scabies

Contact Enteric Precautions (Environmental)

• Ex). C. difficile → The spores can survive for long periods on surfaces and are primary means of transmission, esp. in healthcare settings. Norovirus → Spreads rapidly though contaminated food, water, surfaces, or close contact with infected individuals.

• Must clean hands before and after seeing patient.

• Gown and gloves when entering the room.

• Use patient dedicated or disposable equipment

• Clean and disinfect shared equipment before leaving room

Droplet Precautions

• Implemented for patients who are known or suspected to be infected with an infectious pathogen that can be transmitted by respiratory droplets.

• Must clean hands entering + leaving room.

• Must wear MASK.

• Additional PPE (google, gown, gloves) wear may be required

• Ex). Influenza, Group A Strep, Neisseria Meningitis, Pertussis

Airborne Precautions

• Pathogens that may occur through small droplets or particles suspended in the air for prolonged periods of time, traveling over a greater distance and longer time than droplets.

• Must wash hands entering + leaving room.

• Wear CAPR/PAPR or N95 fitted mask BEFORE entering room.

• Patient must be in NEGATIVE PRESSURE room, with door closed

• Ex). Measles, Chickenpox (varicella) can also get with contact, mycobacterium tuberculosis

Personal Protective Equipment (PPE)

• Used to protect against the spread of infection. PPE includes gloves, masks, goggles, face shields, isolation gowns, head covers, and shoe covers.

Sequence for Donning PPE

Wash Hands → Don Gown → Don mask → Don goggles → Don hair/shoe covers → Gloves

Sequence for Doffing PPE

Gloves → Eyewear → Gown → Mask → Shoe/Head covers → Wash hands

Sterile Technique

• Objects are only sterile when touched by other sterile objects. (Don’t place non-sterile items in the field)

• Sterile object that’s out of range or below a person’s waist is contaminated.

• Never turn away from a sterile field once opened.

• Field must be above waist.

• Never reach across/over sterile field as this will contaminate it.

• New sterile field must be obtained if it' has been contaminated.

Medical Asepsis

“Clean” technique - includes isolation precautions, PPE, and hand hygiene.

• Helps control microorganisms

Surgical Asepsis

“Sterile” technique - prevents the introduction of microorganism into body during specialized procedures.

• Absence of microorganisms