Unit 3- isolation

healthcare workers must know

• what infectious diseases are

• how they spread

• how they are controlled

microrganisms

grow in or on a host organism and cause disease

• known as infections

healthcare workers must know

• what infectious diseases are

• how they spread

• how they are controlled

microrganisms

grow in or on a host organism and cause disease

• known as infections

infection

establishment and growth of a microorganism on or in a host

pathogens

disease producing microorganisms

1. multiply in large numbers and cause an obstruction

2. cause tissue damage

3. can secrete organic substances(exotoxins)

   • produce high body temperatures, nausea, vomiting, shock

most common pathogens

fungus, protozoan(parasites), virus, and bacteria

bacteria

microscopic, single-celled organisms

may reside in a host in a group, or cluster (colony)

classification by morphology; size or shape for bacteria

• cocci or spheres

• bacilli or rods

• spirals

common bacteria infections encountered today

• streptococcal pharyngitis(strep throat)

• klebsiella pneumoniae infection(bacterial pneumonia)

• clostridium botulinum infection(food poisoning)

virus

cannot live outside a living cell

depends on host cell to provide missing factors

viral particle attaches to host and inserts its genome/ genetic information into the host

can lay dormant at times(latent or dormant infection)

no antibiotics

common viral diseases

• common cold(rhinovirus)

• infectious mononucleosis

• warts(caused by papillomavirus)

fungi

size much larger than bacteria

some medically important fungi are called dimorphic(can grow as yeast or mold)

common fungal infections

• athlete’s foot

• ringworm

• tinea nigra

protozoa

larger than bacteria

classified by motility

live on or in other organisms at expense of host

usually have motility functionality

can ingest food particles, some equipped with digestive systems

common parasitic( protozoa) infections

• pinworms

• tapeworms

• malaria

factors involved with spread of infection

• host

• infectious microorganism

• mode of transportation

• reservoir

if chain is broken, cycle cannot continue, infection will cease

cycle chain of infection

susceptible host- elderly, infants, immunocompromised

pathogen- bacteria, virus, fungi, parasite

reservoir- people, animals, soil, food, water

portal of exit- coughing/sneezing, bodily secretions, feces

mode of transmission- direct/indirect contact, vectors

portal of entry- mouth, eyes, nose, cuts in skin

human host

we are a favorable host environment because of organic nutrients and metabolites

different temperatures throughout body, pH, or body fluid for pathogen grow

microorganisms tends to like

• warm temperature

• moisture

• darkness

infectious microorganisms

• bacteria

• viruses

• fungi

• protozoa

mode of transmission

how the pathogen transported outside the body and into the next

exogenously

from outside of body

• encounter with a microbe in the environment

• can be direct/indirect

endogenously

from inside the body

• encounter with organisms already inside or on the body; when normal flora of the body is transported to a different area

direct host-to-host

infected individual transmits and infection by any number of methods

• handholding

• coughing

• sexual contact

secretions and excretions with infective microbes can remove them from the body and transmit to susceptible person

• phlegm

• aerosols from sneezing/coughing

indirect host-to-host

“Direct” with assistance via a vector or fomite

indirect host-to-host

vector

usually and arthropod

takes blood from 1 host and carries it to the other

• tick

• some insects

indirect host-to-host

fomite

inanimate object that has been in contact with an infectious organism

• food, water. radiographic equipment

endogenous(inside)

organisms already in the body or normal flora

normal flora transported to a different area

staphylococci on surface of skin can go deeper within a laceration

reservoir

site when an infectious organism can remain alive and from which transmission can occur

types of reservoir

people, animals, inanimate objects

• person- carrier(infected person who does not display the disease symptoms)

• animals- cow(ingestion of milk)

• insects- if it ingests blood containing pathogens

• inanimate objects- dusty corner, contaminated linen, and food

healthcare associated infections(HIA)

infections people can acquire while that are receiving treatment in health care setting for another condition

• nosocomial and iatrogenic

majority of infections include for HIA

• urinary tract infections(most common)

• surgical site infections

• bloodstream infections

• pneumonia

nosocomial infection

infections acquired while receiving treatment at the hospital

about 5% of hospital patients acquire an additional condition while in hospital

hospital patients greater sensitivity to infection(compromised/ immunosuppressed)

most common nosocomial infection

• UTI

• surgical site infections

• bloodstream infections

• pneumonia

iatrogenic

infection that is the result of intervention with a physician

• patient had lung biopsy and developed pneumonia

• improper handwashing by physician between patients

most hospital patients have greater sensitivity to infection(compromised, immuno-suppressed)

sources

• medical personnel

• patient flora

• contaminated healthcare environment

• blood-borne pathogens

• invasive procedures

communicable diseases

disease spread from 1 person to another through a variety of ways(direct/indirect)

• contact with blood and bodily fluid

• inhaling an airborne virus

• insect bite

examples of communicable diseases

• HIV

• HBV

• influenza

• chicken pox

• malaria

• tuberculosis

• polio

human immunodeficiency virus(HIV)

virus that attacks body's immune system-without treatment can lead to AIDS

no effective cure, proper treatment can control

transmitted by infected bodily fluids- blood, sharing needles semen, vaginal fluids, breast milk

hepatitis B/HBV

blood-borne pathogen

cause illness that primarily affect liver

results in swelling, soreness, and loss of normal function in liver

Hepatitis B is transmitted through

• contaminated needle- biggest for hospital workers

• penetrating injury

• intimate contact

hepatitis B vaccination

best way to prevent hepatitis B

series of 3 injections

after receiving vaccine, positive antibody titer is obtained, there is no risk of hepatitis B disease

Multi-drug resistance organism(MDRO)

bacteria and other microorganisms that have developed resistance to antibodies

common examples of MDRO

• MRSA - Methicillin/oxacillin-resistant Staphylococcus aureus

• VRE - Vancomycin-resistant enterococci

• C. Diff – Clostridium Difficile

• ESBLs - Extended-spectrum beta-lactamases (which are resistant to cephalosporins and monobactams)

• PRSP - Penicillin-resistant Streptococcus pneumoniae

• Multi-drug resistant Tuberculosis (MDR)

MRSA - Methicillin/oxacillin-resistant Staphylococcus aureus

staph aureus is easily colonized on skin

assume all patients may be carriers

from direct control

must susceptible patients in MRSA

• nursing home

• dialysis

• the ages and debilitated

• intensive care

• hospitalized for long periods

MRSA examples

• decubitus ulcers

• pneumonia

• endocarditis

• bacteremia

• osteomyelitis

• septic thrombophlebitis

VRE - Vancomycin-resistant enterococci

infections caused by enterococci- typically in hospital patients

• Urinary tract, surgical wounds, blood streams

enterococci bacteria found in normal flora in gastrointestinal tract(vancomycin treats it)

spread direct contact with contaminated hands, surfaces, or equipment

C. Diff – Clostridium Difficile

spore forming bacterium that releases toxins into the bowel

resistant to disinfectants

easily spread from hands of health care providers

frequent cause of nosocomial infections

tuberculosis(TB)

drug resistant; airborne bacilli

recurrent, chronic disease affecting the lungs caused by spore-forming mycobacterium tuberculosis

can spread by droplets from cough, sneezes

treatable with antibiotics

primary, latent, and active disease

to prevent disease transmission

• wash hands

• get immunizations

• get boosters

• follow post-exposure protocols

CDC

centers for disease control and prevention

mission is centered on preventing and controlling disease and promoting environmental health and health education in US

standard precautions

used when performing procedures that may require contact with blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin

all patients should be regarded as potentially infectious

practice biosafety

• handwashing

• gloving

• personal protective equipment(PPE)

• needle recapping

• biospills

standard precautions primary purpose

protect the following against acquiring pathogens that are known or unknown:

• healthcare workers

• patients

• anyone in direct/indirect contact

handwashing

most effective method used to prevent spread of infection

before/ after performing invasive procedure after touching: blood, bodily fluids, secretions. and contaminated items(even if gloves were worn)

gloves

anytime a procedure or contact may include body fluids, blood, secretions, excretions, mucous membranes, non intact skin and contaminated items

*do not touch any clean surfaces, if so-disinfect

take off inside out

sequence for donning PPE

• gown first

• mask/respirator

• goggles/face shield

• gloves- extend over isolation gown cuffs

sequence for doffing PPE

• gloves inside out

• goggles/face shield

• gown

• mask/respirator

needle recapping

800,000 needle stick injuries and other sharp objects occur annually in US

must be placed in sharp containers

biohazard spills

gloves/ appropriate PPE

put in red biohazard bag or designated waste container

fluoro- not due to spill, must wear PPE when placing certain used instruments into biohazard container and disinfectant spray

red bag

blood and body fluids

• contaminated items that are “Saturated or dripping” and those “caked with dried blood or dried body fluids”

transmission-based precautions(isolation procedures)

• airborne

• droplet

• contact

applied when patient is infected with pathogenic organism/communicable disease

or

when patient is at risk of becoming infected, such as immunosuppressed

airborne

pathogenic organisms that remain suspended in the air for long periods on aerosol droplets or dust

• TB, chickenpox(varicella), and measles(rubeola)

• patient placed in negative-pressure isolation room

• need to wear N95 respirator

• hand hygiene- alcohol rub, soap, or water

droplet

infected with pathogenic organisms

• rubella, mumps, influenza, and adenovirus

pathogens disseminate through large particulate droplets expelled from the patient during coughing, sneezing, or talking

infect another people through contact with the mouth, nasal mucosa, or conjunctiva

protect yourself by wearing a surgical mask when within 3 feet of patient

hand hygiene: alcohol rub or soap and water

contact

patient is infected with a virulent pathogen that spreads by direct contact with the patient or by indirect contact with contaminated object(patient’s dressing booth, bed rail)

• staphylococcus aureus, hepatitis A, impetigo, varicella, and varicella zoster

properly don on gloves, gown, possible face shield and bouffant prior to going into room

all radiographic equipment should be cleaned with antiseptic solution after procedure is performed

hand hygiene: alcohol rub or soap and water

environmental contact

patient will be placed in specific contact for:

• having diarrhea of unknown origin

• C. diff

• norovirus

reverse isolation

• compromised/ immunosuppressed patients

• known as neutropenic and protective precautions

• you wear PPE to protect patient

• hand hygiene: alcohol rub or soap and water

patient who is at increased risk for infection against contact with potential pathogens

• aplastic anemia

• leukemia

• lymphoma

• AIDS

• severe burns

psychological considerations

• patient feels alone, embarrassed, rejected

• forced to remain in solitude for periods of time and often treated by visitors and hospital personnel as if undesirable

• treat them with respect and dignity

• explain what is going to happen and ask if they have concerns/questions

• no different than any other patient or person

aseptic technique

• medical asepsis

• surgical asepsis

asepsis: “freedom from infection”

pathogens may lead to infections to a patient through: environment, personnel, or equipment

scenarios that require it are: surgery, insertion of IV, catheters and drains

goal of aseptic technique

to protect from infection and prevent pathogens and microorganisms from spreading

medical asepsis

reduction in numbers of infectious agents-decreasing probability of infection

not necessarily a reduction to 0

*growth requirement for a microorganism are the right: oxygen, pH, temp, and moisture

surgical asepsis

used to prevent contamination of microbes and endospores before, during, and after surgery using sterile technique

complete removal of microorganism and their spores

hand washing is the FIRST priority for proper sterile technique

disinfection

as many microorganisms as possible are removed from surfaces by chemical or physical means

sterilization

complete destruction or elimination of all living microorganisms by dry heat, moist heat, gas, or chemicals

absolute killing of ALL life forms

if proper technique is used, probability of infection is 0

*you cannot fully sterilize skin, only disinfect

chemical

chemicals that alter the environment available to the microbe: disinfectant

can inactive/inhibit growth

applied topically: antiseptic

categorized by how they are used:

• use on living body

• if they kill or do not kill microbes

effectiveness depends on concentration, temp, time of exposure, types/number of microbes and the object/person

physical

1. moist heat-autoclave steam under pressure, rapid sterilization

2. dry heat- oven used, requires higher temp for longer time

3. gas- ethylene oxide destroys microorganisms; used for electronic and plastic equipment that could be damaged by heat(toxic to humans)

4. chemicals- used for objects that are high heat sensitive

5. radiation/UV

sterile procedures for radiology

• angiography

• arthrograms

• hysterosalpingograms

• x-ray in OR

• myelograms

sterile field

microorganism-free area that can receive sterile supplies

established using a sterile drape

confirm sterility of packaging: package must be clean, dry, unopened, check expiration date

*do not reach across sterile field

*1-inch border around sterile field is NOT considered sterile

sterile trays

different types of trays have different supplies

• myelogram(spinal tap) tray

• arthrogram tray

may be packed commercially or by hospital

trays should be wrapped in autoclave indicator tape(stripes appear when package is sterilized)

have chemical strip when opened

check expiration date

creating sterile field

 Grasp sterile drape with one hand by the corner

 Use corner to fold back the top

 Lift drape out of the cover and open freely without touching anything

 Grasp the opposite corner with the other hand

 Lay on clean, dry surface with bottom away from person

pouring sterile solutions

• into metal bowl on sterile field

• outside of bottle not sterile like inside of bottle

• confirm name, strength, expiration date of solution before pouring(show label to another person)

• label against palm

• hold bottle at angle approximately 6 inches over bowl

purposes for surgical scrubbing

1. removes debris and transient microorganism- hands to forearms, including nails

2. reduces resident microbial count

3. inhibits rapid rebound growth of microorganisms

surgical methods

1. numbered stroke method

2. timed scrub

each method should last minimum 3 minutes per hand/arm

donning sterile gloves

gloves 2 surfaces: inside and outside

before touched, entire glove is sterile

all jewelry removed when gloving

open package facing person who is going to wear them

gloving another person

1. Palm facing away from sterile person

2. Spread cuff making wide opening

o Keep thumbs under the cuff

3. Person thrusts his/her hand

4. Gently release the cuff and roll over sleeve 5. Proceed with left glove

what is sterile during a sterile procedure

• patient

• table and other furniture covered with sterile drapes

• personnel wearing sterile attire

principles of sterile technique

• only sterile items used in sterile fields

• if in doubt of sterility, remove, cover, or replace it

• must be continually monitored

• create sterile fields as close to the time as possible

• gowns considered sterile on sleeves and the front from the waist up

• persons in sterile gowns must pass each other back-to-back

dressing changes

• physicians order must be in place for changing/reapplication

• secure privacy for patient, explain procedure and obtain consent

• hand hygiene

• always wear glove, wound drianing-gown

• use sterile precautions: scissors, forceps, towel, dressing, cotton swab

• non-sterile items: adhesive tape plastic bags for discard

skin prep

• hair removal not always recommended- can cause injury but should be done as close to procedure as possible. after, skin disinfected

• done with razor, clippers, or depilatory agent

• antiseptic soap applied from center out, using circular motion(DO NOT GO BACK OVER AREA)

• repeat procedure with another sponge

• cleaning should take about 5 mins

• sterile drapes placed after skin prep

foley(catheter)

has a balloon filled with sterile water to hold the catheter in place; indwelling catheter-remains in place

straight(catheter)

no balloon and used for short term/quick drainage

urinary catheters

*most common site for HAI

aseptic technique

size range 8-20 in

urine collection bag should be kept below level of bladder

long term and short-term

used for:

• empty bladder

• relieve retention of urine or bypass obstruction

• irrigate the bladder or introduce drugs

• permit accurate measuring of urine output relieve incontinence

• relieve incontinence

suprapubic catheter

closed drainage system inserted approximately 1” above the symphysis pubis into the distended bladder

*reason: long term, urethral injury, obstruction

condom catheter

specially designed condom with a catheter at the end attached to a collection bag

other procedures with sterile technique required

• tracheostomies

• chest tubes

• intravenous and intraarterial lines-central venous and arterial lines

• pacemakers

• surgical and portable radiography

male urinals

• plastic or metal

• shaped so patient can use it lying: supine, right/left side, fowlers position

• privacy

• may need to document urine output

• when patient done, put gloves on, dispose urine, and dispose urinal in trash

• offer hand rub or wet wash cloth for patient

bed pans

two types:

• standard bedpan(made of metal/plastic)

• fracture bedpan(shallower, contoured)

offered to patients who are not ambulatory

used for urine and fecal collection

ALWAYS place sheet over patient

how to assist with bedpan

 If patient is able to move

• Place one hand under lower back, asking the patient to raise his or her hips

• Place bedpan under the hips and position in properly

 If patient is able to sit up

• Elevate to 60 degrees

enemas

cleansing- promote defecation, breaks up fecal mass, stretches rectal wall, and initiates defecation reflux

barium- demonstrate pathologic abnormality, verify normal structures and function