role of nursing in infection control

Dr.T.V.Rao MD 1

Role of Nursing in Infection Control

Dr.T.V.Rao MD

Dr.T.V.Rao MD 2

The very first requirement in

a hospital is that it should do

the sick no harm

Dr.T.V.Rao MD 3

INFECTION• Definition: Injurious contamination of body

or parts of the body by bacteria, viruses, fungi, protozoa and rickettsia or by the toxin that they may produce.

Infection may be local or generalized and spread throughout the body.

Once the infectious agent enters the host it begins to proliferate and reacts with the defense mechanisms of the body producing infection symptoms and signs: pain, swelling, redness, functional disorders, rise in temperature and pulse rate and leukocytosis.

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Patient may acquire infection before admission to the hospital = Community acquired infection.

Patient may get infected inside the hospital = Nosocomial infection.

It includes infections not present nor incubating at admission, infections that appear more than 48 hours

after admission, those acquired in the hospital but appear after

discharge also occupational infections among staff.

The risk of infection is always present.

HEALTH CARE ASSOCIATED INFECTION (NOSOCOMIAL)

• Infections that are a result of health care delivery, not present at admission– EXOGENOUS– ENDOGENOUS– IATROGENIC

Refer to Potter & Perry Table 34-2 Pg. 648 (Sites for Causes of HAI’s)

Common Health-Care Associated Infections

• Urinary Tract Infection

Surgical/Traumatic Wound Infection• Respiratory Tract• Bloodstream

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Modes of Transmission• Contact (Direct & Indirect)• Droplet• Airborne• Vehicles• Vectors

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Chain of Infection

Pathogen

Reservoir

Portal of Exit

Mode

of

Transmission

Portal of Entry

Susceptible Host

Why Isolation?.. because transmission is easier to control than the source / host!

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Scope of Infection Control Aiming at preventing spread of infection:

Standard precautions: these measures must be applied during every patient care, during exposure to any potentially infected material or body fluids as blood and others.

Components: A. Hand washing. B. Barrier precautions. C. Sharp disposal. D. Handling of contaminated material.

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1st principale of infection prevention at least 35-50% of all healthcare-associated infections are

asociated with only 5 patient care practices:• Use and care of urinary catheters• Use and care of vascular access lines• Therapy and support of pulmonary

functions• Surveillance of surgical procedures• Hand hygiene and standard precautions

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Healthcare-Associated Urinary Tract Infection

• Urinary tract infection (UTI) causes ~ 40% of hospital-acquired infections

• Most infections due to urinary catheters

• 25% of inpatients are catheterized

• Leads to increased morbidity and costs

Nurses should be Familiar INTERVENTIONS

• ISOLATION PRECAUTIONS• HYPERTHERMIA INTERVENTION– ELIMINATE UNDERLYING CAUSE– FEVER MANAGEMENT

• HEALTH TEACHING• ANTIBIOTIC THERAPY• PSYCHOSOCIAL SUPPORT• HEALTH CARE RESOURCES

Read Manuals on Isolation Precautions

• CDC and OSHA Guidelines on

1. Contact

2. Droplet

3. Airborne

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Personal Protective Equipment

• Gowns• Respiratory Masks• Eye Protection• Gloves• Specimen Collection• Bagging Trash & Linen• Transporting Patients

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HAND WASHING• Proper hand washing is the

single most important ay to prevent and reduce infections

• Wash and rinse hands for 15 seconds, using a dry paper towel to turn off faucet

• Alcohol based hand wash is also available in all patient care areas

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Hands should be washed:

• Before and after patient contact• Before putting on gloves and after taking them

off• After touching blood and body substances (or

contaminated patient-care equipment), broken skin, or mucous membranes (even if you wear gloves)

• Between different procedures on the same patient

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HAND WASHINGHand washing is the single most effective

precaution for prevention of infection transmission between patients and staff.

Hand washing with plain soap is mechanical removal of soil and transient bacteria (for 10- 15 sec.)

Hand antisepsis is removal & destroy of transient flora using anti-microbial soap or alcohol based hand rub (for 60 sec.)

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Methods in Hand Washing Surgical hand scrub: removal or destruction of

transient flora and reduction of resident flora using anti-microbial soap or alcohol based detergent with effective rubbing (for least 2-3 min)

Our hands and fingers are our best friends but still could be our enemies if they carry infective organisms and transmit them to our bodies and to those whom we care for.

Sinks & soap must be found in every patient care room. Doctors, nurses must comply to hand washing policy.

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When to Wash our Hands1. Before & after an aseptic technique

or invasive procedure. 2. Before & after contact with a patient

or caring of a wound or IV line. 3. After contact with body fluids &

excreta removal. 4. After handling of contaminated

equipment or laundry.

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When to Wash our Hands

5. Before the administration of medicines 6. After cleaning of spillage. 7. After using the toilet. 8. Before having meals. 9. At the beginning and end of duty.10. Gloves cannot substitute hand washing

which must be done before putting on gloves and after their removal.

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How to Wash our HandsJewelry must be removed. If unable

to remove rings, wash and dry thoroughly around them.

Wet your hands with running warm water, dispense about 5 ml of liquid soap or disinfectant into the palm of the hand.

Rub hands together vigorously to lather all surfaces and wrist paying particular attention to thumbs, finger tips and webs.

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How to Wash our HandsRinse hands thoroughly.Turn off water using elbow-on elbow

taps, dry hands thoroughly on a paper towel OR where elbow taps are not present, first dry hands, thoroughly, then turns off the taps using fresh paper towel.

Hand cream can be used on persona basis.

If a staff member develops a skin problem, he or she must consult dermatologist.

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Risk Reduction: Antimicrobial Pre-Operative Shower

Chlorhexidine Gluconate – Primary choice

Iodophores

Hexachlorophene

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Barrier Precautions 1. Gloves: Disposable gloves must be worn when: a) Direct contact with B/BF is expected. b) Examining a lacerated or non-intact

skin e.g wound dressing. c) Examination of oropharynx, GIT, UIT and dental procedures.

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Barrier Precautions d) Working directly with

contaminated instruments or equipment.

e) HCW has skin cuts, lesions and dermatitis

Sterile gloves are used for invasive procedures.

GLOVES MUST BE of good quality, suitable size and material. Never reused.

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Barrier Precautions Masks & Protective eye wear:• MUST BE USED WHEN: engaged in

procedures likely to generate droplets of B/BF or bone chips

• During surgical operations to protect wound from staff breathings, …

• Masks must be of good quality, properly fixed on mouth and nasal openings.

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Barrier Precautions 3) Gowns/ Aprons: Are required when:• Spraying or spattering of blood or body fluids

is anticipated e.g surgical procedures.

• Gowns must not permit blood or body fluids to pass through.

• Sterile linen or disposable ones are used for sterile procedures.

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What to do if exposed to blood / body fluids

• Puncture wounds should be washed immediately and the wound should be caused to bleed

• If skin contamination should occur, wash the area immediately

• Splashes to the nose or mouth should be flushed with water

• Eye splashes require irrigation with clean water, saline, or a sterile irritant

• Most importantly: Complete a GBMC Employee Incident Report. Report exposure to charge nurse and Agency immediately

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Sharp precautions Needle stick and sharp injuries carry the risk of blood

born infection e.g AIDS, HCV,HBV and others. Sharp injuries must be reported and notified NEVER TO RECAP NEEDLES Dispose of used needles and small sharps immediately

in puncture resistant boxes (sharp boxes). Sharp boxes: must be easily accessible, must not be

overfilled, labeled or color coded. Needle incinerators can be another safe way of

disposal. Reusable sharps must be handled with care avoiding

direct handling during processing.

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Handling of Contaminated Material

1. Cleaning of B/BF spills: a- wear gloves. b- wipe-up the spill with paper or towel. c- apply disinfectant.2. Cleaning & decontamination of equipment: protective barriers must be worn.3. Handling & processing lab specimens: must be in strong plastic bags with

biohazard label

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Handling of Contaminated Material

4. Handling and processing linen: Soiled linen must be handled with barrier

precautions, sent to laundry in coded bags.

5. Handling and processing infectious waste: a. must be placed in color coded, leakage proof bags, collected with barrier precautions b. contaminated waste incinerated or better

autoclaved prior to disposal in a landfill.

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Environmental control:1. Including physical facility plans must meet

quality and infection control measures. Patient equipment positioning and installation, traffic flow.

2. Cleaning of hospital environment and dis-infection according to policies.

3. Proper air ventilation. 4. Water pipes examination, check its quality. 5. Proper waste collection and disposal. 6. Cleaning and dis-infection of equipment. 7. Proper linen collection, cleaning, distribution

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Staff health promotion and education:

1. HCW are at risk of acquiring infection, they can also transmit infection to patients and

other employee.2. Employee health history must be reviewed,

immunizations recommendations to be considered.

3. Release from work if sick, occupation injury must be notified.4. Continuous education to improve practice, better

performance of new techniques.

All Nursing Staff should follow Standard Precautions

• Guidelines for preventing exposure to blood, body fluids, secretions, excretions (except sweat), broken skin, or mucous membranes

• Based on the concept that body fluids from ANY patient can be infectious

• Should be used on every patient• Use necessary PPE for protection

– CDC guidelines requires us to use category-specific isolation (ex – TB isolation) in addtion to Standard Precautions when a patient is known or suspected to have an infection

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Do not Recap Needles A threat to LIFE

Infection Control Nurse Orientation

• Objectives:–Understand the significance of antibiotic

resistant organisms seen in hospitals–Understand how surveillance for

hospital acquired (nosocomial) infections is performed and the significance of surveillance data

Follow CONTACT ISOLATION• Used to prevent transmission of

microorganisms spread by direct/indirect contact with the source

• examples:–MRSA–VRE–C. diff– contagious skin infections… Lice & Scabies

DROPLET ISOLATION• used to prevent transmission of microorganisms

spread by large, moist droplets inhaled by or landing on the mucous membranes of the susceptible host

• examples:

– Influenza– Neisseria meningitidis– some pneumonias– vaccine preventable diseases:• rubella, mumps, pertussis

AIRBORNE ISOLATION• used to prevent transmission of

microorganisms spread on very small particles that drift on air currents (droplet nuclei, dust)

• examples:–pulmonary Tuberculosis– varicella–measles

AIRBORNE ISOLATION• BASIC COMPONENTS:

–negative air pressure isolation room–door remains closed–fit-tested N95 respirator–Call Engineering (ext. 2060) with room

# to check negative pressure.–yes… HANDWASHING!

Nurses should be familiar with Surveillance Activities

• Operative Procedures

• Critical Care Units (MICU, SICU, NICU)

• Targeted Surveillance• Outbreak

Investigation

Benchmarking Hospital Acquired Infections

• CDC’s Hospital Infections Program• Submit monthly data on ICU infections• Benchmarking with similar hospitals• Networking opportunities• Annual reports• Start having a Infection Audit

Surveillance DataImproves the Patient Safety

• USES• Improve patient

outcomes by• modifying patient care

practices• reducing length of stay

• Identify education needs• Evaluate new products• Identify new

opportunities for improvement

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Key Points About PPE• Don before contact with the patient,

generally before entering the room• Use carefully – don’t spread

contamination• Remove and discard carefully, either at

the doorway or immediately outside patient room; remove respirator outside room

• Immediately perform hand hygiene

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Sequence for Donning PPE

• Gown first• Mask or

respirator• Goggles or face

shield• Gloves

How to Don a Gown• Select appropriate type and size• Opening is in the back• Secure at neck and waist• If gown is too small, use two gowns

– Gown #1 ties in front– Gown #2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask• Place over nose, mouth and chin

• Fit flexible nose piece over nose bridge

• Secure on head with ties or elastic• Adjust to fit

PPE Use in Healthcare Settings

How to Don Eye and Face Protection• Position goggles over eyes and secure to

the head using the ear pieces or headband• Position face shield over face and secure

on brow with headband• Adjust to fit comfortably

PPE Use in Healthcare Settings

How to Don Gloves• Gloves last• Select correct type and size• Insert hands into gloves• Extend gloves over isolation gown

cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

Keep gloved hands away from faceAvoid touching or adjusting other PPERemove gloves if they become torn;

perform hand hygiene before donning new gloves

Limit surfaces and items touched

Nurses should Evaluate their Outcome

• MEASURE SUCCESS OF INFECTION CONTROL TECHNIQUES

• COMPARE PATIENT’S RESPONSE TO ACTUAL OUTCOME

• WHAT WILL YOU DO IF GOAL/OUTCOMES NOT ACHIEVED?

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Our Hands are Threat to LIFEJust Washing can Save Many LIVES

Clinical Microbiology at your Finger Tips

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