Lesson 12

Infection Control

  • Hand Hygiene: Handwashing is the most important method of infection prevention; wearing gloves does not replace hand hygiene.

  • Central Venous Catheters: Most common source of bloodstream infections in hospitalized patients.

  • Skin Preparation: CDC recommends chlorohexidine as preferred skin prep before central line placement.

  • Alcohol-based Products: Flammable; must dry for 2 minutes prior to use during surgery.

Surgical Care Improvement Project (SCIP) Protocol

  • SCIP aims to reduce perioperative surgical site infections through seven measures; three key measures include:
    1. Administer prophylactic antibiotics within 60 minutes of incision (120 minutes for vancomycin).
    2. Achieve glycemic control for cardiac surgery patients (< 200 mg/dL).
    3. Ensure colorectal patients are normothermic upon arrival to PACU (> 36 °C).

Infection Precautions

  • Contact Precautions: Gown and gloves.

    • Diseases: Methicillin-resistant staphylococcus aureus (MRSA), Clostridium difficile (C diff).

  • Droplet Precautions: Gown, gloves, and surgical mask.

    • Diseases: Influenza, Respiratory syncytial virus.

  • Airborne Precautions: Gown, gloves, N95 respirator, and negative pressure room.

    • Diseases: Mycobacterium tuberculosis, SARS-CoV-2 (COVID-19), Human Immunodeficiency Virus.

Occupational Exposure to HIV

  • Most common cause of occupational exposure is needle-stick injury with hollow-bore needle.
  • Seroconversion rates after exposure to HIV-infected blood:
    • Percutaneous injury = 0.3%
    • Mucous membrane exposure = 0.09%

Creutzfeldt-Jakob Disease

  • A prion disease leading to encephalopathy and dementia.
  • Etiologies include:
    • Consumption of contaminated animal protein.
    • Contaminated implants (corneal or dural tissue).
    • Cadaveric pituitary hormone supplementation.
  • No data supporting transmission through blood, air, or droplets; standard precautions recommended.