LEC 8.2: Preventing Nosocomial Infections (or HAIs)

Hand Hygiene, Hand Hygiene Using Alcohol-Based Rub, Supporting Defenses of a Susceptible Host, Disinfecting & Sterilizing,

Hand Hygiene

Considered one of the most effective infection prevention measures

1. Before eating

2. After using the bedpan or toilet

3. After the hands have come in contact with any body substances

4. Before & after giving care of any kind

When do hands need to be cleansed?

15-20

For routine client care, vigorous hand washing under a stream of water for ___ seconds using a granular soup, soap-filled sheets or liquid soap

1. Beginning of the nurses’ shift

2. When the hands are visibly soiled

3. After using the toilet

According to WHO in 2009, when should Hand Hygiene should be done?

Antimicrobial Soaps

Usually provided in high-risk areas

Utilized in the following situations, as recommended by the CDC:

• When there are known multiple resistant bacteria

• Before invasive procedures

• In special care units, such as nurseries and ICUs

• Before caring for severely immunocompromised clients

1. When there are known multiple resistant bacteria

2. Before invasive procedures

3. In special care units, such as nurseries and ICUs

4. Before caring for severely immunocompromised clients

According to the CDC, when should antimicrobial soaps be used?

40-60 seconds

How long should hand washing in total take?

Hand Hygiene Using Alcohol-Based Hand Rub

Used before and after each direct client contact

Not sufficient in the following situations:

• Hands have visible dirt or matter

• C. difficile may be present

1. Hands have visible dirt or matter

2. C difficile may be present

What are the situations where Hand Hygiene Using Alcohol-Based Hand Rub may not be sufficient?

1. They kill bacteria more effectively and more quickly than hand washing with soap and water (Except for some microorganisms that are resistant to alcohol).

2. They are less damaging to skin than soap and water, resulting in less dryness & irritation

3. They require less time than hand washing with soap & water

4. Bottles/dispensers can be placed at the point of care so they are more accessible

Why does the CDC promote the use of alcohol-based hand rubs?

Handwashing Before Performing Sterile Skills

Hands must be held higher than the elbows

Susceptibility

Degree to which an individual can be affected

1. Hygiene

2. Nutrition

3. Fluid

4. Sleep

5. Immunizations

5 Measures that can Reduce a Person’s Susceptibility

1. Antiseptics

2. Disinfectants

3. Sterilization

What interrupt the etiologic agent and reservoir?

Antiseptics

Interrupt the etiologic agent and reservoir

Agents that inhibit the growth of the microorganisms

Disinfectants

Interrupt the etiologic agent and reservoir

Agents that destroy pathogens other than spores

Sterilization

Interrupt the etiologic agent and reservoir

Under surgical asepsis

Removes all microorganisms

Antiseptics and disinfectants have similar chemical components and have bactericidal or bacteriostatic properties. However, disinfectant is a more concentrated solution.

How are antiseptics and disinfectants similar and different?

Bactericidal

Property of antiseptics and disinfectants

Kills or destroys the bacteria

Bacteriostatic

Property of antiseptics and disinfectants

Prevents the growth and reproduction of the bacteria but the bacteria is still present in that particular area

Alcohol

One of the commonly used antiseptics and disinfectants

(1)

Chlorine

One of the commonly used antiseptics and disinfectants

(2)

H2O2

One of the commonly used antiseptics and disinfectants

(3)

Iodophors

One of the commonly used antiseptics and disinfectants

(4)

Phenol

One of the commonly used antiseptics and disinfectants

(5)

Chlorhexidine Gluconate

One of the commonly used antiseptics and disinfectants

(6)

Triclosan

One of the commonly used antiseptics and disinfectants

(7)

1. Type and number of infectious organisms

2. Recommended concentration of the disinfectant and duration of contact

3. Presence of soap

4. Presence of organic materials

5. Surface areas to be treated

When disinfecting articles, what 5 things must the nurse consider?

Type and number of infectious organisms

One of the things the nurse must consider when disinfecting articles

Virulence, type, and spread, the probability of causing infection is very high.

Recommended concentration of the disinfectant and duration of contact

One of the things the nurse must consider when disinfecting articles

For example, alcohol, needs to be used for 15 seconds to be considered effective.

Presence of soap

One of the things the nurse must consider when disinfecting articles

There are certain ingredients in the soap that makes germicidal effects of certain disinfectant becomes inactivated when exposed to it.

Presence of organic materials

One of the things the nurse must consider when disinfecting articles

Blood, puss, feces may have an effect on the effectiveness of certain disinfectants. For example, fecal matter may deactivate chlorine.

Surface areas to be treated

One of the things the nurse must consider when disinfecting articles

For example, some disinfectants can’t be used on metal or a porous mat.

Sterilization

Process that destroys all microorganisms, including spores and viruses

1. Moist Heat

2. Gas

3. Boiling

4. Radiation

4 Commonly Used Sterilization Methods

Moist Heat

One of the commonly used sterilization methods

Steam under pressure is used because it attains temperatures higher than the boiling point

Autoclave machine

Gas

One of the commonly used sterilization methods

Ethylene oxide

Destroys microorganisms, including spores, by interfering with metabolic processes

Has good penetration and effectiveness to heat-sensitive items

Disadvantages: Carcinogenic & Teratogenic

Ethylene Oxide

What is the gas used for gas sterilization?

1. Carcinogenic

2. Teratogenic

2 Disadvantages of Gas Sterilization

Boiling

One of the commonly used sterilization methods

Minimum of 15 minutes (1st minute should be counted when the bubbling FIRST starts)

Radiation

One of the commonly used sterilization methods

Uses ionizing and non-ionizing radiation

Uses UV rays

Ionizing Radiation

Type of radiation used for sterilization

Non-Ionizing Radiation

Type of radiation used for disinfection