Medical Asepsis / Infection Control

1. Module 2 Medical Asepsis / Infection Control

2. INFECTION 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.

3. Infections are: Localized Systemic

4. Course of Infection The course of an infection can be divided into four major phases: 1. Incubation 2. Prodromal 2. Period of Clinical illness 3. Convalescence

5. Transmission of Infections • Health Care institutions can present a danger in infectious disease transmission • Nosocomial infection - a hospital-acquired infection • Iatrogenic infection – a direct result of treatments

6. Transmission of Infections 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.

7. PrimaryDefenses Against Infection 1. Skin and mucous membrane 2. Respiratory system 3. Gastrointestinal system 4. Circulatory system

8. Secondary Defenses Against Infection • 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.

9. Chain of Infection Source of infection Infectious agent Host Susceptibility Reservoir Portal of Entry to susceptible host Portal of exit from Reservoir Mode of transmission http://www.d.umn.edu/ehso/training/idp1.html

10. Components of the Infection Cycle • Infectious agent—bacteria, viruses, fungi • Reservoir—natural habitat of the organism • Portal of exit—point of escape for the organism • Means of transmission—direct contact, indirect contact, airborne route • Portal of entry—point at which organisms enter a new host • Susceptible host—must overcome resistance mounted by host’s defenses

11. Link 1 – Source of Infection /Pathogenic Organism What is the type of organism – virus, bacteria, fungi, parasites, etc. Level of virulence Number of organisms

12. Factors Affecting an Organism’s Potential to Produce Disease • Number of organisms • Virulence • Competence of person’s immune system • Length and intimacy of contact between person and microorganism

13. Question Which of the following is the most significant and commonly found infection-causing agent in healthcare institutions? A. Bacteria B. Fungi C. Viruses D. Mold

14. Answer Answer: A. Bacteria Rationale: Bacteria are the most significant infection-causing agents in the healthcare system. Bacteria can be categorized by shape, by their reaction to the Gram stain, or according to their need for oxygen. Fungi (molds and yeasts) can cause infection and are present in the air, soil, and water. Viruses cause infections including the common cold, and do not respond to antibiotics.

15. Link 2 - Possible Reservoirs for Microorganisms • Other humans • Animals • Soil • Food, water, milk • Inanimate objects

16. Question Which one of the following infections or diseases may be spread by touching a contaminated inanimate article? A. Rabies B. Giardia C. E. coli D. Influenza

17. Answer Answer: D. Influenza Rationale: Influenza may be spread if a person touches a contaminated article and then touches his eyes or nose. The reservoir for rabies is animals; for Giardia, water; and for E. coli, water or food.

18. Link 3 - Common Portals of Exit • Respiratory • Gastrointestinal • Genitourinary tracts • Breaks in skin • Blood and tissue

19. Link 4– Mode of Transmission Direct contact Droplets Vectors Airborne

20. Link 5 – Portal of entry to Host Eyes Mucous membranes Respiratory tract Placenta Breaks in the host barriers

21. Link 6 – Characteristics of the Host Lack of effective resistance Changes in host defense Tissue destruction

22. Factors Affecting Host Susceptibility • Intact skin and mucous membranes • Normal pH levels • Body’s white blood cells • Age, sex, race, hereditary factors • Immunization, natural or acquired • Fatigue, climate, nutritional and general health status • Stress • Use of invasive or indwelling medical devises

23. Factors Predisposing Patients to Nosocomial Infections • Use of invasive medical devices • Antibiotic-resistant organisms developed in hospitals

24. Measures to Reduce Incidence of Nosocomial Infections • Constant surveillance by infection-control committees and nurse epidemiologists • Written infection-prevention practices for all agency personnel • Hand hygiene recommendations • Infection control precaution techniques • Keeping patient in best possible physical condition

25. Stages of Infection • Incubation period—organismsgrowing and multiplying • Prodromal stage—personis most infectious, vague and nonspecific signs of disease • Full stage of illness—presence of specific signs and symptoms of disease • Convalescent period—recoveryfrom the infection

26. Question In which of the following stages of infection is the patient most contagious? A. Incubation period B. Prodromal stage C. Full stage of illness D. Convalescent period

27. Answer Answer: B. Prodromal stage Rationale: The patient is most infectious during the prodromal stage when early signs and symptoms of the disease are present but are often vague and nonspecific. During this stage, the patient often does not realize he or she is contagious and spreads the infection.

28. Body’s Defense Against Infection

29. What are some examples of a Nursing Diagnosis? Risk for Infection RT: • Chronic disease • Altered immune response • Effects of medication • Altered skin integrity • Lack of proper immunization

30. Planning / Goals The patient will: 1. demonstrate effective hand hygiene 2. identify the signs of infection 3. maintain adequate nutrition 4. demonstrate proper disposal of soiled articles.

31. Intervention

32. Infection Control • 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.

33. National Patient Safety Goal • 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.

34. Quality and Safety Education in Nursing (QSEN) 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.

35. Safety – Infection Control • Infection control measures used in the hospital include: • Medical Asepsis • Standard Precautions • Isolation Precautions

36. Infection Control -- Medical Asepsis Definition: • Practices designed to reduce the numbers of pathogenic microorganisms and limit their growth and transmission in the patient’s environment

37. Why Practice Medical Asepsis • Helps the patient fight a current infection and prevent its spread. • Prevents the patient from being re-infected by the same pathogen. • 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.

38. 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 harborinfection. • The desired result is: • to reduce the transmission of the microorganisms from one person to another. • Or from one person to an object

39. Medical Asepsis – Hand Hygiene The first line of defense in medical asepsis is hand hygiene. Proper hand-hygiene is considered the single most effective way to stop the spread of microorganisms and preventing infection.

40. Proper Hand Hygiene Assures: Reduction in the number of pathogens on the hands

41. Safety Check Prior to Hand washing • 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.

42. When Should You Wash Your Hands ? 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 handling body excretions- even with gloves on

43. Before and after performing any treatments After removing gloves At the end of each shift before leaving the health facility

44. WASH YOUR HANDS !

45. Guidelines and Principles wrist Finger tips • Hand-washing is one of the most effective methods of preventing the spread of bacteria. • Usually 15 seconds should be allowed to wash the hands • Clean from the cleanest area to the dirtiest area

46. Guidelines and Principles Medical Asepsis 1. Friction 3. Cleansing Agent 2. Running Water • These 3 are necessary to remove microorganisms • Do not touch the sink when washing hands – stand away • Keep clean items separate from dirty ones. • Turn off water with a dry paper towel – wet acts as a wick.

47. Guidelines and Principles Medical Asepsis • 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. • If using hand lotion—allow hands to dry about 30 minutes before applying. Do NOT apply hand lotion immediately after washing hands.

48. Alcohol Based Handrubs 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.

49. How to use Handrubs • 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.

50. Alcohol based handwash ALCOHOL-BASED HAND RUBS ARE MORE EFFECTIVE IN KILLING BACTERIA THAN SOAP AND WATER.