Unit VII Infection Control Flashcards
Overview and Objectives of Infection Control
Unit Overview:
Focuses on understanding infection and control measures necessary for safe clinical practice and delivering high-quality resident and patient care.
Unit Learning Objectives:
Identify microorganisms and explain how they cause infection.
Describe the chain of infection and the complete infection process.
Describe and apply Standard Precautions across healthcare settings.
Demonstrate effective handwashing techniques.
Demonstrate effective gloving procedures.
Demonstrate cleaning and disinfection procedures, and explain sterilization techniques.
Microorganisms and the Infection Process
Definition and Environment of Microorganisms:
Microorganisms are commonly known as germs.
Commonly found in everyday environments, including soil, air, water, and both in and on human bodies.
Definition of Infection:
An infection occurs when germs enter the body, increase in number, and trigger a reaction within the body.
Three Essential Elements Required for Infection:
Source: Places where infectious agents (germs) live.
Susceptible Person: A host with a pathway for germs to enter the body.
Transmission: A mechanism by which germs move from the source to the susceptible person.
Necessary Means for Infection: Source and Susceptible Person
Source Characteristics:
Infectious Agents: Viruses, bacteria, or other microbes.
Human Sources: Patients, healthcare workers, visitors, and household members.
Individuals may be actively sick with infectious symptoms.
Individuals may be colonized with germs, meaning they carry no symptoms of infection but are capable of transmitting the germs to others.
Environmental Sources:
Dry surfaces in patient care areas.
Wet surfaces, moist environments, and biofilms.
Indwelling medical devices.
Dust or decaying debris.
Susceptible Person (Host) Characteristics:
Definition: Often termed the Susceptible Host; an individual unable to resist infection, allowing germs to enter, invade, and multiply.
Risk Factors:
Unvaccinated or non-immune status.
Weakened or suppressed immune system.
Advanced age (elderly individuals often have decreased immune function and contract infections more easily).
Immunocompromised Conditions:
Underlying medical conditions such as diabetes, cancers, and organ transplants.
Medical Interventions:
Certain medications that increase infection risk.
Lifesaving treatments and invasive procedures, including intravenous (IV) lines, catheters, feeding tubes, and surgeries.
Modes of Infectious Transmission
Transmission Mechanisms:
Germs cannot move on their own; specific transmission modes transport them to a susceptible host.
Contact: Touching a resident directly or touching objects handled by the resident.
Sprays and Splashes: An infected individual coughs or sneezes, generating droplets that travel approximately to reach a susceptible person.
Inhalation: Germs become aerosolized in tiny particles that float on air currents, remaining viable over great distances and extended periods.
Sharps Injuries: Transmission of blood-borne pathogens resulting from needle sticks involving used needles contaminated by an infected person.
The Chain of Infection
Process and Links:
A sequential series of events (links) must occur for germs (bacteria, fungi, viruses) to cause infection.
Intercepting or breaking any single link halts the spread of infection.
Link 1: Infectious Agent:
The microorganism (germ, bug, pathogen, or microbe) capable of causing harmful infections.
Microbes can be beneficial and protective; they become problematic only upon moving, entering the body, and multiplying.
Common care home infections include respiratory bugs (colds, flu) and gastrointestinal pathogens such as Norovirus and Clostridioides difficile (C. diff).
Link 2: Reservoir:
The habitat where germs live, survive, and multiply.
Can be a person (resident, client, patient, or healthcare worker) or environmental objects (medical equipment, personal belongings, food, water, or the human respiratory tract).
Link 3: Portal of Exit (Way Out):
The pathway by which germs escape from the reservoir to spread.
Examples include healthcare workers' hands, body fluids, air exhaled from lungs, sickness (vomiting), diarrhoea, and respiratory secretions from sneezing or coughing.
Link 4: Mode of Transmission:
The mechanism by which the germ travels from the exit portal to another host.
Examples include contaminated hands, shared equipment (such as a commode), airborne dispersion through coughing, or direct contact with blood and body fluids.
Link 5: Portal of Entry (Way In):
The site through which germs gain access to a new host.
Entry points include eyes, mouth, hands, open wounds, cuts, swallowing, inhalation, and invasive devices like catheters or feeding tubes.
High-risk activities and treatments include drug injections with needles, skin incisions, or internal placement of medical instruments.
Link 6: Susceptible Host:
An individual vulnerable to infection due to an inability to fight off pathogens.
Care homes present high infection risks due to elderly populations with weakened immune systems residing in close proximity.
Clinical Scenario Analysis: Infection Chain Application
Clinical Case Study:
A Certified Nursing Assistant (CNA) enters the room of a resident diagnosed with a bacterial urinary tract infection (UTI).
The resident voids into a bedpan.
The CNA removes the bedpan and accidentally splashes urine.
The CNA is not wearing gloves and fails to perform proper handwashing.
The CNA proceeds directly to a second resident, touching the resident's hands while discussing care.
The second resident subsequently uses the bathroom and wipes after voiding, resulting in a new UTI.
Infection Chain Breakdown:
Reservoir: The first resident with the bacterial UTI / contaminated urine and bedpan.
Portal of Exit: The urinary tract / contaminated urine during bedpan emptying.
Mode of Transmission: Direct contact via the CNA's unwashed, ungloved hands and urine splash droplets.
Portal of Entry: The perineal area / urinary tract of the second resident during post-void wiping.
Susceptible Host: The second resident.
Points of Interruption: Wearing proper gloves, washing hands thoroughly between residents, preventing urine splashing, and avoiding direct contact prior to hand hygiene.
Standard Precautions
Definition and Scope:
The baseline, minimum infection prevention measures mandated for ALL patients across ALL healthcare settings.
Developed from evidence-based practices to protect healthcare workers and prevent cross-infection among patients.
Operates under the fundamental assumption that all blood, body fluids, non-intact skin/wounds, and mucous membranes may carry infectious agents.
Core Components:
Hand hygiene.
Personal Protective Equipment (PPE) utilization tailored to anticipated exposure (gloves, gowns, masks).
Respiratory hygiene and cough etiquette.
Safe injection practices.
Safe handling and cleaning of potentially contaminated equipment and surfaces in the patient environment.
Hand Hygiene Standards and Guidelines
Clinical Importance:
Clean hands represent the single most critical factor in preventing pathogen transmission and antibiotic resistance in clinical settings.
Significantly lowers the rate of Healthcare-Associated Infections (HAIs).
Infection Statistics:
CDC estimates that approximately patients in the United States contract a hospital-acquired infection annually.
Approximately of these patients die each year as a direct result of their infection.
Indications for Hand Hygiene:
Before and after performing any care procedure.
Before starting a work shift and after completing a work shift.
Before touching a patient or initiating patient contact.
Before donning gloves or other PPE.
Before handling or serving food.
Before cleaning clinical areas.
Before collecting body fluid specimens.
Between care activities on the same resident (e.g., after assisting with toileting and before assisting with a bath).
After contact with a patient's intact skin.
After contact with body fluids, excretions, non-intact skin, or wound dressings.
After collecting body fluid specimens.
After contact with any object or surface suspected of being contaminated.
After removing gloves or other PPE.
After using the restroom.
After coughing, sneezing, or blowing the nose.
After cleaning any room or equipment.
Product Effectiveness Comparison:
Plain Soap and Water: Effective at reducing bacterial counts.
Antimicrobial Soap: Superior to plain soap in reducing bacteria.
Alcohol-Based Hand Rubs: The most effective option for routine hand decontamination when hands are not visibly soiled.
Visibly Soiled Hands: Must be washed using water and either non-antimicrobial or antimicrobial soap.
Personal Hygiene and Grooming Regulations:
Fingernail Length: CDC guidelines require natural fingernails to be no longer than () because bacteria readily accumulate beneath longer nails.
Artificial Nails: Acrylic and silk nails trap and harbor pathogens; they are strictly prohibited in healthcare environments.
Jewelry: Rings and bracelets trap bacteria; their use should be strictly limited during working hours.
Personal Protective Equipment (PPE) and Gloving Protocols
Definition of PPE:
Specialized clothing or equipment worn by healthcare employees to shield against exposure to infectious materials.
Types of PPE and Protective Functions:
Gloves: Protect the hands.
Gowns / Aprons: Protect skin and clothing from splashes or fluid contact.
Masks and Respirators: Protect the mouth and nose.
Goggles: Protect the eyes.
Face Shields: Provide comprehensive protection for the face, mouth, nose, and eyes.
Factors Governing PPE Selection:
Anticipated exposure type (touch vs. splash/spray).
Category of isolation precautions in effect.
Durability and task appropriateness.
Proper size and fit.
Glowing Requirements and Rules:
Mandatory when touching blood, body fluids, secretions, excretions, contaminated items, mucous membranes, or non-intact skin.
Gloves are disposable and clean (non-sterile).
Must fit snugly without restricting hand movement or over-stretching to the point of compromising the protective barrier.
Must be changed between tasks, before touching non-contaminated items/surfaces, and before providing care to another resident.
Must change gloves and perform hand hygiene immediately if gloves become visibly soiled or when transitioning from a contaminated body site to a clean body site.
Work direction must always progress from clean to dirty.
Limit touch contamination: Never touch face, adjust PPE, or touch unnecessary environmental surfaces with contaminated gloves.
Replace gloves immediately if torn or heavily soiled during patient care.
Discard gloves into appropriate receptacles after single-patient use.
Never wash, sanitize, or reuse disposable gloves.
Gown, Face Protection, and PPE Donning Sequence
Gown Application:
Indicated when clothing requires protection from fluid contact or potential splashing.
When wearing both a gown and gloves, don the gown first.
Pull glove cuffs over the gown sleeves to ensure an overlapping protective barrier.
Face Protection Specifications:
Masks: Must fully cover the nose and mouth, fit snugly, and block fluid penetration.
Goggles: Provide dedicated barrier protection for the eyes.
Face Shields: Shield the entire face, including eyes, nose, and mouth.
Four Key Principles of PPE Usage:
Always don PPE before initiating contact with a resident, typically prior to entering the room.
Correct Sequence for Donning PPE:
Gown: Put on first and secure properly.
Mask / Respirator: Put on second and adjust over nose and mouth for a snug fit.
Goggles / Face Shield: Put on third over eyes and face.
Gloves: Put on last, pulling cuffs over the gown sleeves.