chapter 42 infection control

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 42

Infection Control

Chapter 42

Infection Control


Infection ControlInfection Control

• Clients in all healthcare settings at risk for acquiring nosocomial infections (infections acquired in the healthcare facility, also known as hospital-acquired infections.)


Infection Control, cont.Infection Control, cont.

• Prevention is best method of infection control.

• Control successful when the chain of infection broken

• Several types of infection control/prevention methods used.

• Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires healthcare facilities to have an effective infection control plan to qualify for accreditation


Infection Control PlanInfection Control Plan

• Plan must include

– An infection control committee

– Surveillance of nosocomial infections

– Employee health program

– Isolation policies


Infection Control Plan, cont.Infection Control Plan, cont.

• Plan must include, cont.

– Infection control in-service education for employees

– Procedures for environmental sanitation

– Available microbiology laboratory

– Infection control procedures for client care


Isolation Precaution GuidelinesIsolation Precaution Guidelines

• Per Centers for Disease Control and Prevention (CDC) and the Hospital Infection Control Practices Advisory Committee (HICPAC)

• Two tiers of precautions

– Standard Precautions

• Used for all clients

– Transmission-Based Precautions

• Used with clients with specific infections or diagnoses


**Infection Control Committee**Infection Control Committee

• Provide a central place for reporting infections

• Investigate cases of infection

• Determine the cause of infection

• Maintain total statistics related to the numbers and types of infections that occur in the facility

• Serve as consultants in cases of questions or concerns by healthcare personnel

• Work to prevent further recurrences


Standard PrecautionsStandard Precautions• First and most important

– Care of all clients, regardless of diagnosis or infection status

• Universal Precautions

• Designed to reduce the risk of transmission of blood-borne pathogens

Body Substance Isolation

• Designed to reduce the transmission of pathogens from moist body substances


Standard Precautions, cont.Standard Precautions, cont.

• *Precautions apply to

– Blood

– All body fluids

– Secretions

– Excretions (except sweat)

– Nonintact skin

– Mucous membranes


Occupational Safety and Health Administration (OSHA) Regulations:Blood-Borne Pathogens (BBP)

Occupational Safety and Health Administration (OSHA) Regulations:Blood-Borne Pathogens (BBP)

• Requires and enforces

– Implementation of policies, procedures, and control measures

– Prevention of employee exposure to the blood and body fluids of clients

– Provide free hepatitis B immunizations to staff who might be exposed to blood/body fluids.


Nursing AlertNursing Alert

• You must report unusual exposure to potential infection (eg, a needle stick) immediately.

• OSHA requires initial screening and follow-up care.

• KEY CONCEPT

• *Blood and body fluids flushed , if the amount of fluid or tissue is too large or bulky to be flushed, it must be bagged in a biohazard bag


Transmission-Based PrecautionsTransmission-Based Precautions

• Implemented when caring for clients with a suspected or known infectious disease, based on the disease’s route of transmission

• Three types

– Airborne precautions

– Droplet precautions

– Contact precautions


Transmission-Based Precautions, cont.Transmission-Based Precautions, cont.


Airborne PrecautionsAirborne Precautions• *Tiny microorganisms from evaporated droplets remain suspended in

the air or are carried on dust particles

• Air currents disperse the microorganisms; susceptible host can easily inhale

• *Special air handling and ventilation required to prevent disease transmission

– TB

– Measles

– Chickenpox

• *Private room with monitored negative airflow pressure

– 6-12 air changes occur/her with air being discharged to the outdoors or specially filtered before circulating to other areas of the healthcare facility

• Doors to rooms with airborne precautions kept closed

• Respiratory protection necessary-special mask!!


Droplet PrecautionsDroplet Precautions

• *Droplets containing microorganisms are propelled through the air from an infected person and deposited on the host’s eyes, nose, or mouth.

• Transmission

– Sneezing

– Coughing

– Talking

– During procedures such as suctioning


Droplet Precautions, cont.Droplet Precautions, cont.• Private room or may share a room with another client with the

same infectious disease

• Room door may remain open

• Wear a mask when working within 3 feet of the client.

• Client wears mask if he/she must be transported to an area outside the room

• **Examples of diseases on droplet precautions:

– Strept. Pharyngitis

– Pertussis

– Influenza

– Mumps

– rubella


Contact PrecautionsContact Precautions• Most frequent mode of disease transmission in healthcare

facilities*

• Transmission occurs as a result of direct contact between a susceptible host’s body surface and an infected or colonized person

• Colonization

– Occurs when a microorganism is present in a client, but he or she shows no clinical signs or symptoms of infection

• Indirect contact

– Occurs when a susceptible host comes into contact with an intermediate contaminated object


Contact Precautions, cont.Contact Precautions, cont.

• **Examples include: gastroenterititis and respiratory, skin and wound infections

• May be placed in a room with other clients who are infected with the same microorganism if a private room is unavailable

• Door may remain open

• Wear gloves when entering the room and remove them before leaving.

• Change your gloves after contact with a client’s infective material.


Contact Precautions, cont.Contact Precautions, cont.

• Wash your hands with an antimicrobial agent or waterless antiseptic agent.

• Wear a gown, gloves, and mask into the room if you anticipate contact with infectious matter, and remove them before leaving the room.

• Try to restrict the use of noncritical equipment to one client only.

• Clean and disinfect equipment before using it for other clients.


IsolationIsolation

• Standard Precautions and Transmission-Based Precautions are isolation guidelines.

• Two primary types of isolation systems

1. Category-specific isolation

2. Disease-specific isolation


Category-Specific IsolationCategory-Specific Isolation

• Specific categories of isolation identified, based on client’s diagnosis

• Color-coded cards posted outside client’s room

• Visitors check with nurses before entering.


Disease-Specific IsolationDisease-Specific Isolation

• Single all-purpose sign

• Select the items on the card that are appropriate for the specific disease that is causing isolation.


Nursing Measures in IsolationNursing Measures in Isolation• Setting up a client’s room for isolation

– Client must stay in his/her own room

– Follow facility’s policy and procedure for isolation.

– Items to be placed outside the room or in the anteroom include a stand or cabinet stocked with PPE’s required for the clients type of isolation*

– Use PPE.

• Education and preparation

– Explain the reasons for the isolation precautions to the client and family.

– Client may become lonely

• Make every effort to visit!


Nursing AlertNursing Alert

• If you will be working in a pediatric unit, determine your immune status regarding the communicable diseases of childhood.

– Young children may not understand good handwashing and need supervision

– Keep surfaces clean

– Shared toys must have cleanable surfaces, don’t share stuffed animals and dolls

• You may require immunization to prevent exposure and infection.


Administering Medications in IsolationAdministering Medications in Isolation

• Follow Standard Precautions.

• Suggestions for clients in isolation

– *Unwrap medications before going into the client’s room.

• Rationale: Unwrapping will be difficult to do after you put on gloves.

– *To avoid accidental needlestick, DO NOT break or recap needles or detach them from syringes!!

– *If you will need juice or applesauce in which to mix medications, take it with you into the room.


Isolation: Specimen CollectionIsolation: Specimen Collection

• Label container before collecting a specimen.

• Place specimen on a clean paper towel in the anteroom.

• Carefully scrub the container after you are outside the room.

• Place the specimen into a sealable plastic bag identified with the standard “biohazard” label.


Isolation: Specimen Collection, cont.Isolation: Specimen Collection, cont.

• Wash your hands again.

• Take the specimen to the laboratory as soon as possible.

• Use only clean hands to touch the request cards and the outside of the bag containing the specimen.


Isolation: Taking Vital Signs Isolation: Taking Vital Signs • Use the equipment in the room.

– Do not bring items in with you.

• *Wear gloves and whatever other PPE is indicated.

• *Use disposable thermometers, cuffs, and stethoscopes if available.


Double-BaggingDouble-Bagging

• Refuse and linen are “double-bagged” outside the client’s room.

– Procedure is no longer used in all facilities because refuse and linen from all clients are considered contaminated and treated as such

• Requires two nurses

• Nurse inside the room is considered “contaminated”

• Nurse outside is considered “clean”


Transporting the ClientTransporting the Client

• When transporting a client in isolation to another area

– Wear PPE as needed.

– Make sure the client wears appropriate PPE as indicated by his or her condition.

– Control and contain any of the client’s drainage.

– Drape the wheelchair or stretcher with a clean sheet or bath blanket. Wrap the client with the clean material.


Antibiotic-Resistant OrganismsAntibiotic-Resistant Organisms

• Methicillin-resistant Staphylococcus aureus (MRSA)

– Cultures are taken in nares and/or specific wound or drainage sites.

• Vancomycin-resistant Enterococcus (VRE)

– Cultures are obtained from the perirectal (around the rectum) area and/or an open wound or drainage site.


Protective IsolationProtective Isolation

• Protective isolation (reverse or neutropenic isolation) attempts to prevent harmful microorganisms from coming into contact with the client.

• The client requires a private room or total neutropenic unit.

• Persons with communicable diseases may not enter.

• Others entering the room must wear a mask and practice strict handwashing.

• Special linens, scrub suits, and shoe covers may be used.


Protective Isolation (cont’d)Protective Isolation (cont’d)

• The client cannot receive fresh fruit, fresh vegetables, or flowers.

• Rectal temperatures, enemas, suppositories, intravenous and intramuscular injections, and other invasive procedures are to be avoided, if possible.

• The tympanic/ear probe or forehead sensor for monitoring the client’s temperature is recommended.

• A blood culture may be necessary if any reason exists to suspect infection.

• Special air purification measures are used.


Client on Contact PrecautionClient on Contact Precaution

• Clients with MRSA and VRE are placed on Contact Precautions and must have a private room.

• All people interacting with the client must use suitable PPE, and all equipment remains in the isolated client’s room.


Hepatitis AHepatitis A

• o Cause-unknown or from contaminated food and seafood from sewage (feces: animal/human) handling of food from infected persons who do not wash their hands

• o S/s-incubation for 4 weeks, patient is infectious for 7-10 days

• o Tx: vaccination or if you have had Hep. A, your body may become immune to future exposures (does not produce a carrier state)


Hepatitis B Hepatitis B

• o Virus transmitted by sexual contact with infected individuals, sharing needles with infected individuals, tattooing, piercing, accidental needlesticks

• o Incubation period 30-180 days

• o Tx: Vaccination


Hepatitis CHepatitis C

• o Mutates rapidly, no vaccine

• o Susceptible people: health care workers, people who have received blood prior to 1987, tattoos, piercings, multiple sexual partners, has been detected through breast milk if mothers viral load is high

• o Virus incubates for 14-180 days, found during bloodwork by testing for viral RNA or antibodies

• o Treatment combination therapy


Hepatitis DHepatitis D

• o Relies on Hepatitis B proteins to reproduce; coinfection

• o Prevention-Hep. B vaccine

• o Tx: interferon alfa-2b; if fulminant hepatitis-may need liver transplant


Hepatitis EHepatitis E

• o Rarely seen in the US

• o Dx made by r/o other types of Hepatitis

• o Symptoms occur 15-60 days after exposure

• o Tx: immune globulin

• o Prevention: boiling drinking water, thoroughly cooking meat, avoid raw foods if traveling


Hepatitis GHepatitis G

• o Latest hepatitis virus

• o Transmitted by blood and body fluids

• o Dx. By detection of Hep. G RNA in blood or liver tissue

• o Long-term effects unknown

• o No vaccine, tx is focused on symptom management

• • Reference

• (Durston, S. (2005). What you need to know about viral hepatitis. Nursing2005 35(8), p. 36-42).

•


TBTB

• Caused by bacillus Mycobacterium Tuberculosis

• Transmitted AIRBORNE!! When a patient coughs, laughs, or sings

• At Risk: residents and employees of LTC facilities and shelters, prison inmates, alcoholics, IV drug users, homeless, family of TB patients

• Latent TB-person is infected without symptoms, healthy immune system prevents spreading of the disease

• Active TB-cough, NIGHT SWEATS, fever, chills, tired, weak, hemoptysis, anorexia and weight loss


TBTB• TB mainly affects lungs, can also affect organs or

tissues

• Nsg. Care

• Airborne precautions: Negative airflow room, special respirator

• Dx: Mantoux skin test (PPD), if positive CXR, DX confirmed by sputum specimen

• TX: Combo drug therapy lasting months of INH, rifampin, pyrazinamide and ethambutol

• DOT (directly observed therapy)

• • (Frakes, M. & Evans. T. (2004) TB-your vigilance is vital. RN, 67(11), p. 30-36)


TetanusTetanus

• Infection that affects CNS, produces muscle stiffness, rigidity and convulsive muscle spasms

• Caused by Clostridium tetani

• Found in soil, dust, animal and human feces in dormant form

• Spores enter body through any scratch or break in skin

• Can occur in burn victims, patients receiving frequent IM injdections, tattoos

• Risk Factors

• IV drug use, PVD, chronic wounds, DM


TetanusTetanus

• Incubation-3-21 days

• Progression of the disease leads to fixed smile and raised eyebrows, convulsions may break bones

• S/S: Wounds more than six hours old, appear infected

• TX: Clean wounds with current vaccine-NO Vaccine

• Clean wound-unknown vaccine history-Give tetanus booster Td

• Deep or dirty wound with uncertain vaccine Hx-administer TIG (tetanus immune globulin) in addition to tetanus booster

• (Baucom, B. (2006). Help stamp out this lingering menace. RN 69(4), p. 43-49.)


Streptococcus Pneumonia Streptococcus Pneumonia

S. pneumoniae lives in the respiratory tract of children and adults

At risk: young, elderly, chronically ill

Vaccination offers best defense against disease (PPV); purified protein vaccine

Vaccine usually only given once, but may be given 3-5 years after initial vaccination to at risk individuals

• (Schweon, S. (2005). Streptococcus pneumonia. RN 68(10), p. 35-39).


Streptococcus pharyngitisStreptococcus pharyngitis


SWINE FLU 2009SWINE FLU 2009

• Pandemic

• Combination of pig (swine), bird (avian) and human gene flu

• S/S: similar to flu (influenza virus) fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Vomiting and diarrhea may also occur

• Greatest affects on ages 5-24 and those with chronic medical conditions

• Dx-flu swab

• TX-antiviral drugs (oseltamivir and zanamivir) with rare exception, vaccination

• Centers for Disease Control. (2009). 2009 H1N1 flu: Situation update. Retrieved September 3, 2009 from http://www.cdc.gov/h1n1flu/update.htm


Epidemiological TriadEpidemiological Triad

Communicable disease transmission depends on the interacton of the following three factors :

• o Agent

– Chemical, etc

• o Host

– Employee

– Susceptible person

– children

• o Environment


C. diffC. diff

• Diarrhea

• Caused by antibiotics

• Tx:

– With antibiotic Metronidazole (Flagyl)