Infection Control Vocabulary

Adhering to Infection Control Safety Precautions

Defining Terms Associated with Infection Control

• Airborne-infectious agents: These remain infectious over long distances when suspended in the air. Airborne transmission involves the dissemination of either airborne droplet nuclei or small particles (in the respirable size range) containing infectious agents that remain infective over time and distance.

• Centers for Disease Control and Prevention (CDC): A federal agency of the U.S. Government that provides facilities and services for the investigation, identification, prevention, and control of disease.

• Cohorting: Grouping patients infected or colonized with the same infectious agent together to confine their care to one area and prevent contact with susceptible patients. During outbreaks, healthcare personnel may be assigned to a cohort of patients to further limit opportunities for transmission (cohorting staff).

• Droplet: A small drop discharged from the mouth during coughing, sneezing, or speaking. These may transmit infections while airborne to others. Droplet transmission is a form of contact transmission. Respiratory droplets transmit infection when they travel directly from the respiratory tract of the infectious individual to susceptible mucosal surfaces of the recipient, generally over short distances, necessitating facial protection.

• Hospital Infection Control Practices Advisory Committee (HICPAC): A federal advisory committee assembled to provide advice and guidance to the Centers for Disease Control and Prevention (CDC) and the Secretary of the Department of Health and Human Services (HHS) regarding the practice of infection control and strategies for surveillance, prevention, and control of healthcare-associated infections, antimicrobial resistance, and related events in United States healthcare settings.

• Host: A person or other living animal, including birds and arthropods, that affords subsistence or lodgment to an infectious agent under natural (as opposed to experimental) conditions.

• Incubation period: The time interval between initial contact with the infectious organism and the first appearance of symptoms associated with the infection.

• Infection: The entry and development or multiplication of an infectious agent in the body of persons or animals.

• Infectious Agent: An organism (virus, rickettsia, bacteria, fungus, protozoan, or helminth) that is capable of producing infection or infectious disease.

• Nosocomial infection: An infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission; or the residual of an infection acquired during a previous admission.

• Portal of entry: The means of entry for an infectious agent into a host, e.g., breaks in the skin, respiratory tract, urinary tract, bloodstream, or gastrointestinal tract.

• Reservoir: Any person, animal, arthropod, plant, substance, or combination of these in which an infection agent normally lives and multiplies, on which it depends primarily for survival, and where it reproduces itself in such a manner that it can be transmitted to a susceptible host.

• Susceptible: A person or animal not possessing sufficient resistance against a particular infectious agent to prevent contracting infection or disease when exposed to the agent.

Explaining Infection Control Safety Precautions

• Universal precautions: Developed by the Centers for Disease Control and Prevention (CDC) to facilitate breaking the chain of infection. In 1996, the terminology was changed to standard precautions.

• Standard precautions: The concepts in which all body fluids are assumed to be infected with blood-borne pathogens.

• Blood-borne pathogens: Microorganisms that are present in human blood and can cause disease in humans (e.g., HIV, Hepatitis A, and Hepatitis B). These microorganisms can be transmitted from patient to provider, provider to patient, and equipment to patient.

• Airborne pathogens: Microorganisms that are transported through the air (e.g., Tuberculosis).

• Standard precautions should be used for every patient contact.

Assessing Isolation Requirements

• Primary purposes of isolation requirements or transmission-based precautions: For patients who are known or suspected to be infected or colonized with infectious agents, including certain pathogens, which require additional control measures to effectively prevent transmission.

• Since the infecting agent is not known at the time of admission to a healthcare facility, they are used according to the clinical syndrome and the likely etiologic agents at the time and then modified when the pathogen is identified or an infectious etiology is ruled out.

• CDC developed isolation precautions for hospitals to protect people. The isolation precautions consist of two tiers:

  • Tier 1 - Standard precautions
  • Tier 2 - Isolation precautions

Isolation Precautions Categories

• There are three categories:

  • Contact Precautions
  • Droplet Precautions
  • Airborne Precautions

• They are used when the route of transmission is not interrupted using Standard Precautions alone.

• The isolation precautions are:

  • Hand hygiene before entering and after leaving the room of a patient in isolation.
  • Use of gown, gloves, mask by health care workers and visitors according to Standard Precautions and as indicated for suspected or proven infections for which Transmission-Based Precautions are recommended.
  • Don PPE upon entry to the room and doff PPE before exiting room.
  • Dispose of contaminated supplies and equipment.

Isolating Infectious Patients

• Airborne Precautions: Prevent transmission of infectious agents that remain infectious over long distances when suspended in the air (e.g., rubeola virus [measles], varicella virus [chickenpox], and M. tuberculosis).

  • Place patient in an airborne infection isolation room (AIIR). If an AIIR is not available, mask the patient and place into a private room with the door closed.
  • Health care workers (HCW) will wear a respirator or mask when caring for patients.

• Droplet Precautions: Intended to prevent transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions.

  • Place patient is a single patient room. When a single patient room is not available, consult with infection control personnel.
  • Health care workers will wear a mask.
  • Patients wear a mask when being transported outside the room and follow Respiratory Hygiene/Cough Etiquette.

• Contact Precautions: Intended to prevent transmission of infectious agents, including microorganisms, which are spread by direct or indirect contact with the patient or the patient's environment.

  • Place the patient is a single room. When a single patient room is not available, consult with infection control personnel.
  • Health care workers caring for patients wear gloves and a gown.

• Standard precautions

• Perform the following when isolating a patient:

  • Verify doctor's orders.
  • Verify Transmission-Based Precautions and determine which precautions to use.
  • Utilize Standard Precautions
    • Hand hygiene before donning PPE before entering patient's room
    • Don PPE for specific transmission-based precaution
    • Maintain standard precautions and transmission-based precautions while caring for patient.
    • Doff PPE before exiting room and disposing of properly.
    • Hand hygiene after doffing PPE after exiting patient's room.

Explaining Concepts and Principles of Patient Isolation

• Isolation Initiation

  • The procedure for initiating patient isolation is as follows:
    1. Place the patient in a room designated for isolation use.
    2. Post appropriate isolation card on the door.
    3. Stock the isolation room with needed equipment.
    4. Stock an isolation cart and place it outside the patient's room.
    5. Notify Food Service that the patient is in isolation. Food items may need to be sent in disposable containers.
    6. Do not take the clinical chart into the room.

• Psychological Impact

  • Isolation can have a psychological impact on the patient and their significant others. Loneliness may develop because normal social relationships have become disrupted. Some may feel unclean, rejected, lonely, or guilty. Infection control procedures further intensify these feelings. Patients in isolation may also experience sensory deprivation and depression because they are prevented from participating in activities outside the isolation room.
  • Take measures to improve the patient's sensory stimulation during isolation.
    • Make sure the room is clean and pleasant, drapes opened, and remove excess supplies.
    • Recreational activities such as cards or board games are an option.
    • Listen to the patient's concerns; rushing through care will only make the patient feel rejected.

• Isolation Considerations

  • Explain to the patient and family members the nature of the disease or condition, the purposes of isolation, and the steps for carrying out specific precautions. Instruct them about any special isolation procedures including:
    1. Thorough hand washing.
    2. Proper disposal of tissues or contaminated items.
    3. Keeping doors and windows closed.
    4. Any other appropriate precautions (e.g., patient in respiratory isolation must wear a mask when out of the room).
  • Explain to the patient that special precautions are taken to avoid the spread of contagious disease. Stress that it is the microorganism, not the patient that is unwanted.
  • Maintain patient privacy, safety, and comfort by:
    1. Assuring the bed wheels are locked at all times.
    2. Keeping the patient's linen and gown dry.
    3. Making sure the patient is covered with a sheet.
    4. Keeping a blanket available for use.
    5. Closing the curtains before a procedure.

• Protective Environment Transmission-Based Precaution Techniques

  • The cleaning disinfecting non-critical surfaces in patient-care areas are part of Standard Precautions and is important for frequently touched surfaces, especially those closest to the patient, that are most likely to be contaminated(e.g., bedrails, bedside tables, commodes, doorknobs, sinks, surfaces and equipment in close proximity to the patient
  • The needs of the healthcare facility for routine cleaning and disinfection should be selected.
  • Follow the established policies and procedures for routine and targeted cleaning of environment surfaces.

• Isolation Precautions - Determine PPE equipment necessary for:

  • Airborne Precautions
  • Contact Precautions
  • Droplet Precautions
  • Protective Environment Precautions

Summary and Review