Definition An infection is the result of an interaction between a susceptible hose and an infectious agent (bacteria, viruses, fungi, parasites) a clinical syndrome caused by the invasion and multiplication of a pathogen in the body. Localized Systemic The course of an infection can be divided into four major phases: 1. Incubation 2. Prodromal 2. Period of Clinical illness 3. Convalescence Health Care institutions can present a danger in infectious disease transmission ‣ Nosocomial infection infection a hospital-acquired ‣ Iatrogenic infection – a direct result of treatments Goal 4 of the National Patient Safety Goals (NPSG’s) is directed toward infection related sentinel events: “Preventing health-care associated infections”. Health care-associated infections are a serious problem and health care workers need to strive toward preventing the occurrence. 1. Skin and mucous membrane 2. Respiratory system 3. Gastrointestinal system 4. Circulatory system 1. Inflammatory response Local reaction to an infectious agent Serves to localize, destroy, dilute, neutralize, remove a pathogen Signs – redness, heat, swelling and pain 2. Immune response Immunity is a measure of a person’ s ability to fight disease by forming immunoglobulins ( antibodies formed against invading antigens), or producing interferon. Host Susceptibility Source of infection Pathogenic microorganism Portal of Entry to susceptible host Mode of transmission Reservior Portal of exit from Reservior http://www.d.umn.edu/ehso/training/idp1.html What is the type of organism – virus, bacteria, fungi, parasites, etc. Level of virulence Number of organisms Eyes Mucous membranes Respiratory tract Placenta Breaks in the host barriers Humans Animals Environmental surfaces Respiratory tract Genitourinary tract Gastrointestinal tract Skin / mucous membrane Placenta Blood and body fluids Direct contact Droplets Vectors Airborne Lack of effective resistance Changes Tissue in host defense destruction Risk for Infection RT: The patient will: 1. 2. 3. Although it is impossible to ensure that the patient’s environment is free of microorganisms, there are many steps that a nurse can take to reduce the spread of microorganisms and thus promote safety for both the patient and the healthcare personnel. Goal 4 ‣ Reduce the risk of health care–associated infections. According to the Centers for Disease Control and Prevention, each year, millions of people acquire an infection while receiving care, treatment, and services in a health care organization. Consequently, health care-associated infections (HAIs) are a patient safety issue affecting all types of health care organizations. The goal of QSEN is to address the challenge of preparing future nurses with the knowledge, skills and attitudes (KSA) necessary to continuously improve the quality and safety of the healthcare systems in which they work. They have 6 competencies and Safety is one of the main competencies. Infection control measures used in the hospital include: ‣ Medical Asepsis ‣ Standard Precautions ‣ Isolation Precautions Definition: Practices designed to reduce the numbers of pathogenic microorganisms and limit their growth and transmission in the patient’s environment 1. Helps the patient fight a current infection and prevent its spread. 2. Prevents the patient from being re-infected by the same pathogen. 3. Prevents the patient from being infected with a new pathogen. 4. Prevents health care professionals and visitors who come in contact with the patient from being infected. 5. Helps decrease the chance of the patient acquiring a nosocomial infection. ◦ The infections can be simple and uncomplicated, or major and life threatening. Patients are at risk for nosocomial infection because they often have weakened immune systems and because the health care facility contains patients and equipment that harbor infection. The desired result is: ◦ to reduce the transmission of the microorganisms from one person to another. ◦ Or from one person to an object The first line of defense in medical asepsis is hand-washing. Proper hand-washing is considered the single most effective way to stop the spread of microorganisms and preventing infection. Reduction in the number of pathogens on the hands Assess that the fingernails are short Highest concentration of organisms on the hands are found UNDER THE NAILS. Jewelry should be removed, especially rings with stones. Wedding bands may be worn sometimes. Skin is free of lesions ‣ If the skin should have a small lesion, bandage the area then double glove. At the start of each shift After sneezing or coughing After using the bathroom After handling contaminated items Before and after giving patient care and between patients. After on handling body excretions- even with gloves Before and after performing any treatments After At removing gloves the end of each shift before leaving the health facility WASH YOUR HANDS ! 1. Hand-washing is one of the most effective methods of preventing the spread of bacteria. 2. Usually 15 seconds should be allowed to wash the hands 3. Clean from the cleanest area to the dirtiest area wrist Finger tips 1. Friction 3. Cleansing Agent 2. Running Water 4. These 3 are necessary to remove microorganisms 5. Do not touch the sink when washing hands – stand away 6. Keep clean items separate from dirty ones. 7. Turn off water with a dry paper towel – wet acts as a wick. 8. Jewelry makes it difficult to adequately cleanse the hands. It is best to not wear jewelry in the clinical setting. Wedding bands are acceptable sometimes. 9. If using hand lotion—allow hands to dry about 30 minutes before applying. Do NOT apply hand lotion immediately after washing hands. Alcohol-based hand rubs (foam or gel) kill more effectively and more quickly than handwashing with soap and water. They are less damaging to skin than soap and water, resulting in less dryness and irritation. They require less time than handwashing with soap and water. Bottles/dispensers can be placed at the point of care so they are more accessible. HAND RUB (foam and gel) ‣ Apply to palm of one hand (the amount used depends on specific hand rub product). ‣ Rub hands together, covering all surfaces, focusing in particular on the fingertips and fingernails, until dry. Use enough rub to require at least 15 seconds to dry. ALCOHOL-BASED HAND RUBS ARE MORE EFFECTIVE IN KILLING BACTERIA THAN SOAP AND WATER. Bring bacterial soap and paper towels with you to the patient’s home If no running water is available in the home, use disposable wipes or alcohol-based rubs. Standard Precautions are: ‣ Those precautions designed for the care of all patients in hospitals regardless of their diagnosis or presumed infection status. Standard Precautions Set of guidelines developed by the Centers for Disease Control and Prevention (CDC) for preventing contact with potentially infectious blood or body fluids that may harbor diseases regardless of whether or not they contain visible blood All body fluids, secretions and excretions regardless of whether or not they contain visible blood All Sputum, saliva Urine Feces Nasal secretions, tears Vomitus Spinal fluid/ cerebrospinal fluid Synovial, pleural, peritoneal , pericardial, amniotic fluid moist body surfaces, mucus membranes Blood Used for all patient’s, not just those with known infections These precautions should be implemented whenever contact with potentially infectious material is anticipated. Used to protect the caregiver. 1. Hand-Washing 2. Personal Protective Devices 3. 4. 5. 6. Gloves Mask, Eye Protection, Face Shield, Gown Patient-care equipment Environment Linen Sharp Objects Hands must be washed after patient contact regardless of the use of gloves. Even if you wear gloves, wash your hands Gloved hands cannot be effectively washed. Gloves can be used to avoid direct contact with infectious material Wear gloves to handle: ‣ Blood ‣ Body fluids ‣ Secretions, Excretions ‣ Contaminated items Change gloves before preceding to the next task, or touching non-contaminated items even on the same patient. Made of vinyl or latex -- vinyl are used if allergy to latex is present. Masks provide barrier protection against splashes and sprays, and airborne droplets Masks come in various types depending on their permeability to airborne particles. Eye goggles or glasses and face shields provide barrier protection against splashes and sprays. Gown – should be water impermeable to provide barrier protection Handle equipment in a manner that prevents personal skin and mucous membrane exposure and cross contamination to other patient’s. Reusable equipment must be cleaned/ disinfected and reprocessed before using it in the care of another patient. Each hospital, clinic has procedures for care, cleaning, and disinfection of environmental surfaces. Spills of blood or body fluids need to be handled with special procedures. Handled in a way to prevent contamination of skin, mucous membranes, and clothing. Fold soiled linen with contaminated area to the inside. Do not shake. Hold away from body and place in appropriate bag and dispose of properly. Place all sharp objects in a puncture-proof container. Do not re-cap needles Immediately discard after use. Do not attempt to bend or break a needle before discarding. Throw away the whole thing. Isolation precautions are utilized when: ‣ patients have a greater susceptibility to infection than others ‣ A patient or patient’s body fluids are a carrier of microorganisms that can easily be transmitted to other patients, family members, or health care workers. In addition to standard precautions, the CDC recommends three categories of transmission-based precautions. They include: ‣ 1. ‣ 2. ‣ 3. Airborne precautions Droplet precautions Contact precautions The fourth type of isolation is protective isolation. Used when the organism is capable of remaining in the air for prolonged periods of time and can be transported in the air for distances greater than 3 feet. Most common organisms are: ‣ Tuberculosis ‣ Chicken pox ‣ Measles Must wear a special particulate filter mask A private negative air pressure room is used for patients needing airborne precautions. ‣ Negative air pressure rooms are used for ‣ ‣ patients needing airborne precautions Bring air into the room from the hallway and have a separate exhaust system. Outside the room is isolation cart that contains supplies needed to care for the patient and protects persons entering the room. Caring for the patient in isolation ‣ Personal Care - **Remember it is the disease that is being isolated, not the patient. Place linens in proper contaminated –waste container, and soiled paper towels in an isolation waste container. ‣ Food Service – disposable paper trays and disposable dishes that are discarded in proper isolation waste container. Do not put tray back on the food cart. ‣ Contaminated articles – according to agency policy, usually double bagged or color-coded waste bags to indicate contaminated waste. All patients on airborne precautions should wear surgical masks when leaving the negative air pressure room for x-rays, tests, or procedures. Organisms that can be spread by large airborne droplets through the air but are unable to remain in the air further than 3 feet. Examples of organisms include: ‣ Influenza ‣ Cold ‣ Meningitis ‣ Mumps ‣ Pertussis Single rooms are preferable Patients with same disease can share the same room Standard surgical masks without a filter must be worn for anyone coming within 5 feet of the patient. Gowns should be worn if clothing or uniforms are likely to become contaminated with respiratory secretions. Gloves should be worn anytime handling tissues or items contaminated with the respiratory secretions Purpose is to prevent the transmission of disease by direct or indirect contact ‣ Direct contact involves: Touching Bathing Skin-to-skin contact ‣ Indirect contact involves: Contact with inanimate objects – doorknobs, light switches, tabletops, telephones Examples of diseases are: staph, herpes, diphtheria, and many others Contact precautions include use of barrier precautions such as gloves and impermeable gowns to prevent direct contact with infectious organism Used: ‣ For patient with diarrhea ‣ When coming into contact with draining wounds ‣ Patients with acquired antibiotic resistance infections You have gone in Mr. A.’s room to perform a dressing change. What What type of isolation is he in? equipment would you use? ‣ A. Gloves only ‣ B. Gloves and gown ‣ C. Gloves, gown, and mask Used with patients who are immunocompromised such as: ‣ Chemotherapy ‣ AIDS ‣ Organ transplants 1. 2. 3. 4. 5. 6. 7. __ __ __ __ __ __ __ Influenza Diarrhea Tuberculosis AIDS Chicken pox Draining wound Chemotherapy pt’s A. Airborne B. Droplet C. Contact D. Protective / Strict Mrs. B. is on airborne isolation. What specific equipment is used in airborne isolation that is not used in other types of isolation? When would the nurse apply goggles or a face mask?