Module B: Infection Prevention Presentation Notes

Infection Prevention Overview

An infection is a condition caused by harmful germs that enter the body, multiply, and can lead to illness. Common examples include urinary tract infections (UTIs), skin infections, respiratory infections, and gastrointestinal (GI) infections.

Infections can be categorized into two main types:

  • Localized Infection: Affects a single body part, presenting with limited symptoms. Symptoms typically include pain, redness, warmth, swelling (puffy), and sometimes drainage in the affected area.

  • Systemic Infection: Impacts an entire body system or the whole body. Signs often include fever, chills, fatigue, nausea, and vomiting.

Common Infection Types and Symptoms

  • Respiratory Infection: Can be triggered by exposure to respiratory droplets from coughs or sneezes, contact with contaminated tissues containing yellow, thick mucus, or close proximity to someone experiencing fever and chills.

  • Bladder Infection (UTI): A female resident may exhibit symptoms such as fever and chills, pain during urination, urine with a strong or foul odor, and urine that appears to contain blood. A resident might verbalize discomfort, saying, “My urine smells bad and it hurts when I use the bathroom.”

  • Stomach Infection: A resident with a stomach infection may experience symptoms commonly associated with gastrointestinal distress, such as nausea, vomiting, diarrhea, and abdominal pain. Effective cleaning protocols for vomit and other spills are crucial in these scenarios, and understanding personal feelings towards such clean-up tasks is important for care providers.

Microorganisms (Germs)

Microorganisms, often referred to as germs, are ubiquitous, living almost everywhere. They can be either beneficial or detrimental, and they require a hospitable environment—including factors like moisture, warmth, and nutrients—to survive and multiply.

Medical Asepsis

Medical asepsis, also known as the clean technique, involves practices designed to remove or destroy microorganisms, thus preventing the spread of infection.

The Chain of Infection

To understand how infections spread, it's essential to recognize the Chain of Infection, which consists of six interconnected links:

  1. Causative Agent: The specific harmful germ responsible for causing an infection.

  2. Reservoir: The place where the germ lives and multiplies.

  3. Portal of Exit: The pathway by which germs escape from the reservoir.

  4. Mode of Transmission: The method by which germs travel from one host to another.

  5. Portal of Entry: The opening through which germs enter a new host's body.

  6. Susceptible Host: An individual at risk of becoming infected.

1st Link – Causative Agent

This is the harmful germ that directly causes an infection, which can be a bacterium, virus, fungus, or parasite. Examples include viruses like COVID-19, Staphylococcus (often found on unwashed hands), and Streptococcus, a leading cause of pneumonia.

2nd Link – Reservoir

The reservoir is where harmful germs live and multiply. When a person is the reservoir, germs can reside in bodily fluids such as blood, or within systems like the skin, digestive tract, or respiratory tract. It's crucial to remember that a person's appearance doesn't always reveal if they are infected.

People as reservoirs can be categorized:

  • Not infected: Healthy individuals.

  • Infected and symptomatic: Individuals showing signs of illness.

  • Carriers: Individuals who carry and can spread germs without displaying symptoms themselves.

Key point: To effectively prevent infection for yourself, coworkers, and residents, always assume everyone is a potential reservoir for germs. Treat all body fluids as if they contain infectious agents.

3rd Link – Portal of Exit

This is how germs leave the reservoir. Common portals of exit include the nose and mouth (e.g., through sneezing or coughing), the gastrointestinal tract (e.g., through stool or vomit), and the skin (e.g., through open wounds or drainage).

4th Link – Mode of Transmission

This describes how germs travel to a new host. The primary modes include:

  • Direct contact: Touching body fluids directly where germs reside (e.g., blood, sputum, wound fluid/pus, saliva, stool, vomit).

  • Indirect contact: Touching objects contaminated with body fluids from an infected person.

Other less common routes of transmission include infected animals (such as the virus in rabies saliva), insect bites, and contaminated food or water.

5th Link – Portal of Entry

This refers to any opening on a person's body that allows harmful germs to enter. Examples include the nose, mouth, gastrointestinal tract, and skin breaks. Importantly, many portals of entry, like the nose and mouth, can also serve as portals of exit.

6th Link – Susceptible Host

A susceptible host is someone who is currently uninfected but is at risk of becoming infected by harmful germs. Various factors can weaken the body's ability to fight off infection, including:

  • Advanced age

  • Chronic illnesses

  • Fatigue

  • Open cuts or skin breakdown

  • Poor nutrition

  • High stress levels

Residents in Long-Term Care Facilities

Residents residing in long-term care facilities are particularly susceptible to infections, facing a higher risk compared to individuals living in the wider community.

Breaking the Chain of Infection – Nurse Aide Responsibility

Nurse aides bear significant responsibility for protecting themselves, their families, and residents from potentially dangerous infections. The good news is that if any single link in the chain of infection can be broken, the transmission and development of a new infection can be prevented.

You can break the chain of infection through various actions:

  • Break the 1st link (Causative Agent): Get immunized against diseases like the flu (immunization against fluimmunization against flu).

  • Break the 2nd link (Reservoir): Stay home from work when you are sick to prevent yourself from being a source of infection.

  • Break the 3rd link (Portal of Exit): Cover your mouth and nose when you sneeze or cough to prevent germs from escaping.

  • Break the 4th link (Mode of Transmission): Practice frequent and thorough handwashing.

  • Break the 5th link (Portal of Entry): Cover open sores or cuts with a bandage to block germ entry.

  • Break the 6th link (Susceptible Host): Maintain a proper diet and healthy lifestyle to boost your immune system.

Health Care-Associated Infection (HAI)

An HAI, also known as a nosocomial infection, is an infection acquired while a patient is receiving medical care in a healthcare facility, such as a hospital or long-term care facility.

Centers for Disease Control and Prevention (CDC)

The CDC, a federal agency, is tasked with controlling and preventing disease. They employ a two-level approach to public protection:

  1. Standard Precautions

  2. Transmission-based Precautions

Standard Precautions

Standard Precautions represent the first and most fundamental level of infection prevention and control. These are the routine tasks and measures healthcare workers must perform for every resident to prevent and control the spread of infection. The core principle is to treat all body fluids, non-intact skin, and mucous membranes as if they are infected.

Review of Terms

  • Body fluids: This includes substances like blood, saliva, tears, urine, stool, and vomit (Blood, saliva, tears, urine, stool, emesisBlood, saliva, tears, urine, stool, emesis).

  • Non-intact skin: Refers to any breaks in the skin, such as cuts, scratches, or sores, which act as both portals of exit and entry for germs.

  • Mucous membranes: These are the moist linings found in various body openings, including the eyes, nose, mouth, and rectum.

Standard Precautions are crucial because consistently following these rules protects everyone—yourself, visitors, family, coworkers, residents, and other healthcare team members—from acquiring infections.

Hand Hygiene

The CDC defines hand hygiene as cleaning hands using:

  • Soap and water: This is considered the most effective method for removing all types of germs and chemicals from hands, especially when visibly dirty.

  • Alcohol-based hand sanitizer (hand rub): When soap and water are unavailable, a hand rub containing at least 60%60% alcohol can be used.

Handwashing is universally recognized as the number one way to interrupt the transmission of infection, making correct hand hygiene the most critical action a nurse aide can take to prevent germ spread.

Nurse aides must perform hand hygiene at the point of care, meaning before and after direct contact with a resident or their immediate environment.

CDC Recommendations for Hand Hygiene

Wash hands with an alcohol-based hand rub or soap and water:

  • Immediately before touching a resident.

  • Before performing aseptic tasks or handling invasive medical devices.

  • Before moving from a contaminated body site to a clean body site on the same resident.

  • After touching a resident or their environment.

  • After contact with blood, body fluids, or contaminated surfaces.

  • Immediately after removing gloves.

Specific scenarios for hand hygiene:

  • Hand Rub: Use before and after eating, before and after handling food, and before and after routine resident care.

  • Hand Wash: Always use if hands are visibly dirty, after using the restroom, and after blowing your nose or sneezing into your hands.

Personal Protective Equipment (PPE)

PPE comprises items designed to create a barrier, preventing harmful germs from coming into contact with your skin and clothes. It keeps blood, urine, stool, saliva, and other body fluids off your person. The specific type of PPE required depends on the task being performed and the anticipated level of contact with blood, body fluids, non-intact skin, and mucous membranes.

PPE: Gloves

Gloves are to be worn whenever there is a potential for contact with blood, body fluids, non-intact skin (such as sores or cuts), or mucous membranes (eyes, nose, mouth, genitals, rectum). This includes, but is not limited to, mouth care, wiping a resident’s nose, performing perineal care, caring for a sore, and shaving a resident.

PPE: Gown

A gown should be worn when there is a possibility of blood and body fluids contaminating areas of your skin or clothes beyond what your gloved hands cover. This is particularly important when changing and disposing of soiled bed linen, gowns, pads, or bandages that could contact your skin or clothing.

PPE: Mask

A mask is necessary when there's a risk of inhaling harmful germs through your nose and mouth. Wear a mask to protect yourself when a resident has an illness transmitted by droplets (e.g., from coughing or sneezing) or when you exhibit cough or cold symptoms yourself.

Sharps Safety

Sharps are any items with corners, edges, or projections capable of cutting or piercing the skin. Always wear gloves and exercise extreme caution when handling sharps to avoid self-inflicted injuries.

Sharps Handling Rules

  • NEVER, EVER re-cap a needle or any other sharp object.

  • NEVER, EVER place anything sharp in a regular trashcan.

  • Disposal: ALWAYS dispose of any sharp object immediately in a designated sharps container.

Spills on the Floor

Cleaning up spills on the floor, especially in long-term care facilities, is critical due to the fall risk and potential for spreading infection. The steps are:

  1. Put on gloves.

  2. Absorb the spill with appropriate material.

  3. Thoroughly clean the affected area.

  4. Discard waste in the proper container.

  5. Apply disinfectant to the cleaned area.

  6. Place a warning cone or sign around the area until it is completely dry and safe.

Spills on Surfaces

When blood or body fluids contaminate any surface, prompt and thorough cleaning is essential. Always use the cleaning products available in your facility and strictly follow both the facility's procedures and the product instructions for effective disinfection.

Transmission-based Precautions

Transmission-based Precautions represent the second level of infection prevention and control. These are specific tasks and measures implemented for particular types of infections that require more stringent control than Standard Precautions alone. The main types include:

  • Contact Precautions: Designed to prevent the spread of germs through direct contact. In addition to Standard Precautions, a gown and gloves are typically required. Examples include infections like MRSA (Methicillin-resistant Staphylococcus aureus) and Norovirus.

  • Droplet Precautions: Implemented to prevent the spread of germs that travel short distances through the air in droplets (e.g., from coughing or sneezing). Specific PPE beyond Standard Precautions may include a mask.

  • Airborne Precautions: Used to prevent the spread of germs that travel through the air over longer distances, capable of floating on air currents, moisture, and dust particles. This often requires Standard Precautions plus a specialized respirator, depending on the specific disease.

Outbreaks

Certain infections, such as influenza and norovirus, pose a significant danger, particularly to individuals aged 6565 and older. Common viruses implicated in outbreaks include influenza viruses, coronaviruses, noroviruses, and rotaviruses.

Bloodborne Infections

Bloodborne infections are caused by pathogens transmitted through blood. Notable examples include Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV). These infections are primarily transmitted through accidental puncture wounds from needles or sharp objects, or through direct contact with infected blood.

Bloodborne Pathogens – HBV

Hepatitis B (HBV) is a liver disease. Approximately one-third (1331​) of individuals infected with HBV may not show any symptoms. A critical characteristic of HBV is its survivability: the virus can remain viable and infectious outside the body on equipment or surfaces for up to 77 days (HBV characteristics and survivabilityHBV characteristics and survivability during that time).

Bloodborne Pathogens – HCV and HIV

Hepatitis C (HCV) is another bloodborne infection transmitted through blood or other body fluids. Currently, no vaccine exists for Hepatitis C. Details regarding HIV transmission and relevant precautions are consistently aligned with established exposure control plans to minimize risk.

Protect Yourself and Others

To ensure safety for yourself and others:

  • Always wear gloves whenever there is any potential for exposure to blood.

  • Handle all used sharps with extreme care and ensure they are discarded into appropriate sharps containers immediately.

  • If any part of your body is exposed to blood or a contaminated sharp, diligently follow your facility’s established exposure plan and post-exposure protocols.