infection prevention

SAFETY: ILLNESS PREVENTION AND INFECTION CONTROL

Presented by: Mrs. Phyllis McLean, MSN, RN
Date: Spring 2026
Institution: Calhoun Community College

OBJECTIVES

  • Explain the inflammatory and immune processes

  • Define infection; identify types of infections, stages, and indications of an infection

  • Identify risk factors for infection

  • Implement standard and transmission-based precautions

  • Differentiate medical versus surgical asepsis

  • Explain the infection cycle/chain and implement measures to prevent infections

NURSING & INFECTION CONTROL

Compassion Quotes:

  • Acknowledgment of Florence Nightingale’s role in infection control today, which involves:

    • Gathering and interpreting data

    • Reporting

    • Infection prevention

    • Education

    • Policies and procedures

PATHOGENS

DISEASE PRODUCING ORGANISMS

  • Microorganisms capable of causing disease include:

    1. Bacteria

    2. Virus

    3. Fungi

    4. Parasites

CHAIN OF INFECTION

Steps in the Chain:

  1. Infectious Agent

  2. Reservoir

  3. Portal of Exit

  4. Means of Transmission

  5. Portals of Entry

  6. Susceptible Host

LINK #1: INFECTIOUS AGENT (PATHOGENS)

Types of Pathogens:

  • Bacteria

  • Viruses

  • Fungi

  • Parasites

Factors Affecting an Organism’s Potential to Produce Disease:

  • Number of organisms present

  • Virulence: The degree to which a pathogen can cause disease

  • Competence of the immune system

  • Length or extent of contact between the person and the microorganism

LINK #2: RESERVOIR

Common Reservoirs:

  • Humans

  • Animals

  • Insects

  • Food

  • Water

  • Soil

  • Environmental surfaces

Conditions Favoring Microorganism Growth:

  • Nutrients

  • Moisture

  • Temperature

  • Oxygen

  • pH and Electrolytes

  • Light

LINK #3: PORTAL OF EXIT FROM RESERVOIR

  • Breaks in skin

  • Open wounds

  • Gastrointestinal or genitourinary issues

  • Bodily fluids/tissues

  • Respiratory secretions (coughing, sneezing)

LINK #4: MODES OF TRANSMISSION

  • Direct Contact: Immediate transfer of pathogens from person to person

  • Indirect Contact: Transfer via surfaces or objects

  • Droplet Transmission: Pathogens spread through moist droplets

  • Airborne Transmission: Pathogens transmitted through the air currents

  • Vector Transmission: Transmission via insects or animals

LINK #5: PORTALS OF ENTRY

  • Broken skin

  • Respiratory tract

  • Mucous membranes

  • Catheters and tubes

LINK #6: SUSCEPTIBLE HOST

  • Refers to anyone susceptible to infection:

    • Immunocompromised individuals

    • Children or elderly

BREAKING THE CHAIN

Infectious Agents

  • Rapid and accurate identification of the organism through:

    • Specimen collection (blood, urine, stool, sputum)

    • Timely administration of medications (prophylaxis/treatment)

    • Prevention of healthcare-acquired infections

Reservoirs

  • Ensure environmental sanitation

    • Follow directions on supplies, policies, and procedures

    • Disinfection and sterilization

    • Monitor water supply, standing water

    • Maintain skin integrity (e.g., CHG baths)

    • Be aware of infected healthcare workers

Portal of Exit

  • Cover wounds, cover mouth when coughing, use PPE

Means of Transmission

  • Follow proper food handling protocols, airflow controls, sterilization techniques, maintain hand hygiene, use individual equipment, clean equipment between patients, apply standard precautions, and transmission-based precautions

Portal of Entry

  • Implement strategies to prevent skin breakdown

Susceptible Host

  • Strategies for recognition of risks include:

    • Immunization

    • Nutrition and exercise

    • Chronic disease management

CLASSIFICATION OF INFECTIONS

Categories

  • Location: Local or Systemic

  • Origin: Primary or Secondary

    • Exogenous: Originating from outside

    • Endogenous: Originating from within a system

  • Duration: Acute, Chronic, or Latent (dormant)

STAGES OF INFECTION

  1. Incubation

  2. Prodromal

  3. Full or Active

  4. Convalescent

Types of Infection

  • Localized: Confined to one area or organ

  • Systemic: Affecting the entire body; present in the bloodstream

  • Disseminated: Spreads from the initial site to multiple organs/systems

  • Community Acquired vs. Healthcare Acquired Infection

  • Drug Resistant: Germs/microbes develop defenses making antibiotics/other medications ineffective

    • Sepsis can lead to septic shock and possibly death

HEALTHCARE-ACQUIRED INFECTIONS (HAI)

  • Acquired during a hospital stay

  • Lengthens hospital admission and can lead to death

  • Many cases are preventable

  • Examples of HAIs: Surgical site infections, bloodstream infections, pneumonia, etc.

BODY'S DEFENSE AGAINST INFECTION

Normal Flora

  • Skin & mucous membranes forming the first line of defense

    • Includes nares, trachea, bronchi, eyes, mouth, gastrointestinal (GI) & genitourinary (GU) tracts

Inflammatory Response

  • Processes include:

    • Phagocytosis: The ingestion of bacteria or other material by phagocytes

    • Complement Cascade: A series of protein interactions that enhance the immune response

    • General Inflammatory Response: Characterized by redness, heat, swelling, and pain

    • Fever: An increase in body temperature as part of the immune response

Immune Response

  • Specific Immunity: Involves recognition of specific pathogens

    • B Cells: Produce antibodies against antigens

    • T Cells: Coordinate the immune response against infected cells

Factors Affecting Host Susceptibility

  • Climate

  • Nutrition

  • General health status

  • Stress

  • Invasive or indwelling medical devices

  • Intact skin and mucous membranes

  • Normal pH levels

  • White blood cells (WBC)

  • Age, gender, race, hereditary factors

  • Immunization (both natural and acquired)

  • Fatigue

INCREASES INFECTION RISK

  • Multiple sexual partners

  • Environmental factors

  • Chronic diseases

  • Medications affecting immune response

  • Medical procedures

  • Developmental stage (children and elderly)

  • Breaks in skin integrity

  • Illness or injury

  • Tobacco use

  • Substance abuse

IMMUNITY

IMPORTANT IMMUNE ORGANS

(Details on specific organs/functions may follow depending on the specific curriculum)

INFLAMMATION AND ADAPTIVE IMMUNITY LAB RESULTS

  • WBC Count: Indicates the immune response level; can show leukocytosis or leukopenia

  • CRP (C-reactive protein): Indicates inflammation in the body

  • ESR (Erythrocyte Sedimentation Rate): Measures the rate at which red blood cells sediment in blood, indicating inflammation

  • Culture & Sensitivity: Tests used to detect specific infections and determine appropriate treatment

  • Procalcitonin: A biomarker for identifying bacterial infections

NURSING PROCESS

ASSESSMENT
Physical Assessment: Localized

  • Localized swelling and/or redness

  • Pain or tenderness with palpation and/or movement

  • Palpable heat in infected area

  • Loss of function in the infected body part

Physical Assessment: Systemic

  • Fever

  • Increased pulse

  • Malaise and loss of energy

  • Loss of appetite

  • Nausea & vomiting

  • Enlargement or tenderness of lymph nodes

  • In elderly patients: Confusion, agitation, incontinence

PLANNING

  • Remain free of signs and symptoms (s/s) of infection

  • At discharge, state the s/s of infection and when to call a physician

IMPLEMENTATION

  • Nursing care based on breaking the chain of infection:

    • Standard precautions

    • Transmission precautions

LEVEL/CATEGORY OF CARE

  • Primary Prevention: Protecting healthy individuals

  • Secondary Prevention: Identifying and treating diseases early

  • Tertiary Prevention: Helping individuals manage complex diseases and injuries

PRIMARY PREVENTION & REDUCING HEALTHCARE ASSOCIATED INFECTIONS

  • Constant surveillance by infection-control committees and nurse epidemiologists

  • Written infection-prevention practices for all agency personnel

  • Hand hygiene, infection control, and barrier techniques

  • Using invasive medical devices with care

  • Sterilizing and disinfecting according to standards

STANDARD PRECAUTIONS

  • Also known as universal precautions; used when exposure is possible

  • Protects from pathogen exposure and helps prevent transmission to others

PERSONAL PROTECTIVE EQUIPMENT (PPE)

  • Types of PPE and uses:

    • Eye/Face protection

    • Hand protection

    • Body protection (gowns)

    • Foot protection (booties)

    • Head protection (caps)

    • Respiratory protection (masks)

PPE REVIEW
DONNING

  1. Perform hand hygiene

  2. Put on gown

  3. Put on mask/respirator

  4. Put on goggles or face shield

  5. Put on gloves

DOFFING

  1. Remove gloves

  2. Perform hand hygiene again

  3. Remove goggles or face shield

  4. Remove gown

  5. Remove mask/respirator

TYPES OF TRANSMISSION PRECAUTIONS

CONTACT PRECAUTIONS

  • Pathogen transmission through contact with infected organisms

    • Examples include draining wounds, contaminated patient supplies, secretions, urine, and feces

    • Most common form of transmission

DROPLET PRECAUTIONS

  • Pathogens can spread via moist droplets through:

    • Sneezing, coughing, or talking

    • Droplets may land on furnishings/equipment, spreading through contact

AIRBORNE PRECAUTIONS

  • Pathogens are transmitted through airborne currents that can travel distances

    • Common examples include:

    • TB (Tuberculosis)

    • Varicella (Chickenpox)

    • SARS (Severe Acute Respiratory Syndrome)

    • Rubeola (Measles)

  • Requires negative air flow room for patient isolation

C-DIFF PRECAUTIONS

  • Direct contact with the Clostridium Difficile pathogen

    • Contaminated environments, patient supplies, and feces as sources of infection

    • Alcohol-based hand sanitizers do not kill C. diff; handwashing is essential with soap and water

REVERSE ISOLATION (NEUTROPENIC)

Purpose

  • Protection for vulnerable clients at high risk for infection

  • Nurses should not care for other patients with active infections

  • All entering must wear a mask, wash hands, don gowns and gloves

Common Conditions Requiring Reverse Isolation

  • Chemotherapy patients

  • Patients with burns

  • Stem cell transplants

  • Patients with leukemia

PRIMARY PREVENTION: SURGICAL ASEPSIS

  • Involves strict sterile technique that is free from all microorganisms

  • Additional protocols:

    • Prevent introducing non-sterile items into the sterile field

    • Change IV tubing and solutions per institutional policy

    • Check sterile equipment for expiration dates

    • Prevent healthcare-associated infections (HAIs)

MEDICAL ASEPSIS

  • Principles of Medical Asepsis:

    • Handwashing practices

    • Implementation of standard/universal precautions

    • Use of PPE when necessary

    • Safe disposal of body secretions, soiled linens, soiled dressings

KEY PRINCIPLES

  • Anything touching the floor is considered contaminated

  • Keep soiled items from touching your uniform

  • Proper disposal of soiled items into the appropriate containers

  • Avoid raising dust; damp cleaning to reduce airborne pathogens

  • Maintain respiratory etiquette

  • Regular disinfection and sterilization of surfaces

PATIENT TEACHING FOR MEDICAL ASEPSIS AT HOME

  • Practical hygiene measures include:

    • Wash hands before preparing or eating food

    • Prepare foods at high enough temperatures

    • Care with cutting boards/utensils

    • Keep food refrigerated

    • Wash raw fruits and vegetables

    • Use pasteurized dairy products

    • Wash hands after using the bathroom

    • Use individual care items to reduce cross-contamination

MAINTAINING A CLEAN ENVIRONMENT

Sterilizing Techniques

  • Methods include:

    • Autoclaving with moist heat

    • Ethylene oxide gas

    • Dry heat sterilization

Critically Sterile Items

  • IV catheters, needles, urinary catheters, surgical instruments, some wound dressings, and chest tubes require sterile handling

SELECTING ASEPTIC TECHNIQUES

  • Determine the appropriate technique based on the procedure being performed. For instance:

    1. Peripheral IV insertion: Medical Asepsis

    2. Urinary catheter insertion: Surgical Asepsis

    3. Insertion of NG tube: Surgical Asepsis

    4. Dressing change on HIV patient: Surgical Asepsis

    5. Chronic leg ulcer dressing change: Medical Asepsis

    6. Leaking ostomy change: Medical Asepsis

    7. Colon surgery open wound packing: Surgical Asepsis

    8. Fresh open heart surgery wound dressing change: Surgical Asepsis

COMMON BREACHES IN INFECTION CONTROL

  • Leaving invasive devices/lines in longer than necessary (IVs, Foley catheters, CVLs)

  • Not changing IV tubing per policy

  • Neglecting to apply sterile end caps to IV tubing

  • Looping IV tubing into itself, risking sterility

  • Breach of sterile technique during procedures

  • Omission of proper mouth care and patient bathing

  • Contact with contaminated surfaces without appropriate cross infection control

  • Personnel unfit for duty

  • Neglecting usage of safety equipment (gloves, needle protection devices, improper disposal)

CLINICAL MANAGEMENT

Secondary Prevention

  • Screening and identifying infections early

  • Collaborative intervention strategies

Tertiary Prevention

  • Utilize antimicrobials:

    • Antibiotics

    • Antivirals

    • Antifungals

    • Nutrition and hydration are critical components to support recovery

LIFESTYLE FACTORS TO PROMOTE WELLNESS

  • Importance of:

    • Nutrition

    • Hygiene

    • Adequate rest and sleep

    • Physical exercise and activity

    • Stress reduction

    • Immunizations

MULTIDRUG RESISTANT PATHOGENS

  • Microorganisms that have mutated to resist one or more antimicrobial drug classes

  • Antibiotic resistance prevalence has increased, leading to:

    • Limited treatment options for infections

    • Association with severe illness, increased mortality, extended hospital stays, and higher costs

COMMON MULTIDRUG RESISTANT ORGANISMS

  • MRSA (Methicillin-Resistant Staphylococcus aureus):

    • Can be fatal, spreads through skin-to-skin contact and in crowded living conditions

  • VRE (Vancomycin-Resistant Enterococci):

    • Primarily occurs within hospital settings, often due to lapses in infection control measures

  • Clostridium difficile:

    • Bacteria found in feces; spores can survive on inanimate objects for extended periods

MEDICATIONS FOR INFECTIONS

  1. Anti-infective agents

  2. Antibiotics

  3. Antiviral agents

  4. Antifungal agents

  5. Antiprotozoal agents

  6. Anthelmintic agents

EXAMPLES OF COMMONLY PRESCRIBED ANTIBIOTICS

  • Amoxicillin: A type of penicillin

  • Ciprofloxacin: A fluoroquinolone

  • Cefaclor: A type of cephalosporin

  • Levofloxacin: A fluoroquinolone

  • Sulfamethoxazole-trimethoprim: A combination antibiotic

  • Gentamicin: An aminoglycoside

GENERAL PRINCIPLES OF ANTIBIOTIC USAGE

  • Peak & Trough Levels:

    • Peak: Maximum blood level of a medication to ensure efficacy

    • Trough: Lowest blood level of a medication to prevent toxicity

    • Monitoring is done to ensure that drug levels remain within the therapeutic range.