Infection control (notes)

Pathogens

Pathogens

Capable of capable of causing disease in a human host and can challenge the immune system in several ways pathogens kill cells disrupt cell fuction

Disinfection

Process used to destroy pathogens examples include lysol bleach rubbing alcohol vinegar

Medical asepsis

Maintaining a clean environment to reduce the number of pathogens hand washing routine cleaning personal protective equipment

Surgical asepsis

Maintaining a sterile field an environment free from all microorganisms and spores also called the sterile technique

Bacteria

1. Bacterial infections are transmitted from person to person by direct contact indirect contact inhalation or ingestion of contaminated food or water

2. Streptococcus staphylococcus aureus mrsa e coli myobacterium tuberculosis bacterial infections include UTI strep throat pneumonia ear infections the

3. Common antibiotic to treat bacterial infections include penicillin erythromycin clindomycin zithromax (2-pack)

Virus

1. Smallest pathogen grows inside living cells making it difficult to treat

2. Enter the body through different portals such as the respiratory tract GI tract and broken skin

3. Usually viruses run their course and then recovery occurs efforts taken to treat the signs and symptoms and relive discomfort

4. Examples of viruses include coronavirus common cold influenza measles chicken pox and shingles (varicella zoster) hep a b c and HIV/AIDS HCWs at risk for blood and body fluid exposure are eligible for free Hep b immuninization

Fungi

1. Most common pathogen found in humans

2. Treatment can take a long time most infections involve skin hair and nails

3. Fungal infection include ringworm athletes foot thrush

4. Treated with antifungal meds like lotrimin (ringoworm) tinactin (athletes foot and nystatin thrush

Parasites

1. Examples include giardin lice roundworm malaria round worm

2. Some parasites can be found in the intestinal tract

3. Treatments include antiparasistics nix (to treat lice)

Mode of transmission

The vehicle in which the microorganisms are carried about the transported to the next host once they have left the reservoir

Contamination

Condition of being soiled dirty exposed to harmful agents

Direct transmission

Touching any body fluids kissing sexual contact bug or animal bite

Indirect transmission

Are food h2o objects clothing blood transfusions

Portal of entry

The way the microorganism enters the body

Examples of contaminations

A contaminated needle a break in the skin indwelling catheter

Factors that affect the immune system

1. Age

2. Stress

3. Fatigue

4. Nutritional status

5. Environmental factors

6. Chemo radiation

7. lifestyle

8. Surgery

Health associated Infections

1. 1 in every 25 patients admitted to the hospital develops an HAI

2. In 2008 medicare and medicaid dicontinued reimbursement for HAIs

3. Common infections include UTIs pneumonia surgical site infections GI tract infections etc

Inflammatory response

1. Inflammation is the bodys response to injury or infection at the cellular level

2. Signs of inflammation infection include edema (swelling) redness heat pain tenderness fever pus warm to touch

Universal standards precautions

1. Practice where everyones blood and body fluid are considered infected

2. Studies show that infections is much more likely to occur when HCWs do not use appropriate protective measures

3. The goal of cdc (centers of disease control and prevention) guidelines is to interrupt the chain of infection and reduce transmission of bloodborne pathogens

4. Precautions promote hand hygiene and use of gloves masks eye protection and gowns ppe (personal protective equipment) when appropriate for patient contact

Universal standard precaution practices

1. Hand hygiene single most important and basic prevention technique that HCWs can do to interrupt the infectious process

2. Only natural nails should be worn in a healthcare setting no longer than ¼ inch

3. Wash hands at the beginning of shifts before and after caring for a patient when hands are visibly soiled before and after using the bathroom before and after eating

4. Wash hands immediately after gloves are removed and after handling contaminated equipment

Masks and protective equipment

Any item that comes into contact with blood or body fluids must be disposed of properly

Sharps container

Used to get rid of contaminated needles non preameable container must be changed when two thirds full syringe needles surgical blades (tounge blades wont go in bag)

Biohazard container

Used to dispose of hazardous materials contaminated with blood and body fluids

Isolation

1. General isolation a patient who is separated away from others because they are contagious examples of isolation include TB MRSA Chicken Pox C.diff

2. Protective isolation protects patients with weak immune systems from pathogens that may be present in others examples of protective isolation include burn patients chemo patients and transplant patients burn patients

Isolation technique

1. Two tier approach first tier is standard precautions and second tier is disease specific based mode of transmission

2. Airborne isolation diseases spread by airborne droplets smaller than 5 microns in diameter TB Chicken Pox Shingles Measles Coronavirus

3. Droplet isolation used for infections spread via droplets larger than 5 microns in diameter pertussis pneumonia influenza meningitis

4. Contact isolation pathogens that are spread by direct or indirect contact MRSA Ebola C diff Hep A

5. Tuberculosis isolation should be practiced for all patients with known or suspected TB

1. Isolation is mandatory in a negative pressure airflow room door must remain closed

1. N-95 particle respirator mask is required

   1. Mandatory for all HCWs to undergo a fit test before using respirator for the first time

Principles of sterile technique

1. A sterile object remains sterile only when touched exclusively by another sterile object

2. Place only sterile object on a sterile field

3. Sterile field out of range in vision or an object held below the waist is contaminated do not turn back or leave unattended

4. Sterile object or field becomes contaminated by prolonged exposure to air

5. Consider edges of sterile field to be contaminated 1-inch boarder

6. Sterilization cleaning process to kill all microorganisms

Two types of sterilization physical and chemical

1. Physical steam under pressure boiling water radiation dry heat autoclave

2. Chemical gas chemical solutions

Specimen collection

Specimen labels should include patients name DOB med record number date time and initials of person who collected it

Culture and sensitivity testing

1. Procedure performed in a microbiology lab to detect growth of a pathogen followed by appropriate screening for antibiotic sensitivity

2. Culture determines if a pathogen is present

3. Sensitivity shows which antibiotics will work best against the pathogen

4. Takes 48-72 hours to get test results

Methods of urine specimen collection

1. Random specimen performed on freshly voided urine want urine at room temperature

2. First morning specimen urine is more concentrated in morning

3. Clean catch midstream used to remove microorganisms from the urinary meatus by cleansing around the urethra collected from the middle of the urinary system use sterile container the goal is to make sure specimen is free of contamination from genital area

Stool specimen

1. Collected and examined for a variety of reasons such as infections blood presence of fats and to indentify parasites

2. Hemoccult or guaiac test done to determine blood in stool

3. Use a tongue blade collect about 2 table spoons

Sputum specimen

1. Secretion from the mucous membranes lining the trachea and lungs (not saliva in mouth)

2. Sputum is usually thick and sticky requires ability to initiate a deep cough

3. Collect early in the morning before the patients has cleared the respiratory passages

Blood glucose

1. Hypoglycemia low blood sugar less than 70mg/dl (sleepiness sweating pallor lack of coordination irritability hunger)

2. Hyperglycemia high blood sugar greater than 200mg/dl (dry mouth increased thirst blurred vision weakness headache frequent urination

What are nosocomial infections

Infections acquired during the process of recieving healthcare that was not present during the time of admission

Chain of infection

1. Step 1 The chain of infection begins with a pathogen called the infectious agent or causative agent

2. Step 2 The infectious agent must find a reservoir or a place for the infectious agent to live and grow a reservoir could be human or animal or any surface or object

3. Step 3 Next the pathogen must have a portal of exit to leave the reservoir in humans pathogens can leave te body through blood bodily fluids or excrement

4. Step 4 After the pathogen leaves the reservoir it must be moved to another reservoir to continue living and growing this process is called the mode of transmission

5. Step 5 The pathogen must have access to a portal of entry where the pathogen will enter the new reservoir

6. Step 5 The pathogen must have access to a portal of entry where the pathogen will enter the new reservoir

7. Step 6 If the new reservoir has weak defenses it will contact the disease or infection the new reservoir is called the susceptible host

What is disinfection explain the levels

1. Disinfection is the middle level of asepsis

2. High level destroys most pathogens but not always effective on spores if it is used for some critical devices such as endoscopes ultra sound probes and ventilator

3. Low level kills most bacteria some fungi and some viruses it is used for non critical patient care surfaces that come in contact with intact skin bed rails call lights and vital signs machines

What is cleaning give three examples of cleaning materials

1. Cleaning is the lowest level of asepsis it is also called sanitization cleaning is the removal of visible organic and inorganic material from objects and surfaces

2. The cleaning process does not destroy viruses or spores cleaning can be used o people objects and equipment examples vinegar lysol bleach

What are some examples of personal protective equipment

1. Gloves

2. Gown

3. Mask

4. Eye wear

5. Shoe covers

When should gown be worn

When using chemical solutions for disinfection or sterilization

What are the three types of transmission based precautions

1. Droplet

2. Airborne

3. Contact

What three bloodborne pathogens are healthcare workers at an increased risk of being exposed to

1. Hepatitis B

2. Hepatitis C

3. HIV

Employees indentified in the (1. Blank) section of the exposure control plan are offered a (2. Blank) vaccination for free

1. Exposure determination

2. Hepatitis B

When an exposure incident incolves a sharp a record of the event must be added to the

Sharps injury log

A (Blank) is a sample that represents a whole

Specimen

Why is urine from the first void of day most often used in routine urine specimen

Its more concentrated in the morning

What is clean catch urine specimen

Is used to collect urine sample that is free from contamination from the surrounding genital area

Urinalysis

1. What is urinalysis Is an examination of urine in the main area

2. which tests are CLIA waived physical and chemical tests

3. What are four areas or physical assessment color odor clarity specific gravity

Ammonia

Specimen is old

Foul or putrid

Presence of bacteria or infection

Sweet or fruity

Diabetes of the presence of acetones or ketones

What can cloudy or milky urine indicate

Cloudy may indicate the presence of pus or mucus milky may indicate the presence of lipids

What temperature should urine be for urinalysis

90-100 degrees F