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RET 1024 Introduction to Respiratory Therapy

RET 1024 Introduction to Respiratory Therapy. Module 3.0 Infection Control. Infection Control. Nosocomial Infection; An infection acquired after hospitalization - AKA: hospital-acquired infection. Infection Control. Nosocomial Infection;

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RET 1024 Introduction to Respiratory Therapy

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  1. RET 1024Introduction to Respiratory Therapy Module 3.0 Infection Control

  2. Infection Control Nosocomial Infection; An infection acquired after hospitalization - AKA: hospital-acquired infection

  3. Infection Control Nosocomial Infection; Account for an estimated 2 million infections and 90,000 excess deaths annually

  4. Infection Control Nosocomial Infection • Infections acquired by those in the intensive care unit (ICU) account for >20% of all HAIs (CDC 2007) • Immunocompromised by disease and/or treatment • Major trauma • Respiratory failure • Myocardial infarction • CHF • Overdose

  5. Infection Control Nosocomial Infection • Approximately 25% of patients undergoing mechanical ventilation develop pneumonia as a complication

  6. Infection Control Nosocomial Infection • Approximately 30% of patients who develop ventilator-acquired pneumonia (VAP) will die

  7. Infection Control Nosocomial Infection • Historically, non-disposable respiratory equipment was identified as a major cause of respiratory infection

  8. Infection Control Nosocomial Infection • Today, procedures have evolved, and with the advent of single-patient use equipment, infections associated with respiratory equipment have decreased significantly

  9. Infection Control Nosocomial Infection • Healthcare workers must remain vigilant to protect their patients and themselves against infection; to do so, requires strict adherence to infection control procedures

  10. Infection Control Infection control procedures aim to: • Eliminate the sources of infectious agents • Create barriers to their transmission • Monitor and evaluate the effectiveness of control

  11. Infection Control Spread of Infection • Infection occurs when a pathogen overcomes the barrier of the host • Pathogen; a microorganism capable of producing a disease • Host; an organism in which another, usually parasitic, is nourished and harbored

  12. Infection Control Spread of Infection • Three elements needed to spread an Infection • Source of pathogens • Route of transmission • Susceptible host

  13. Infection Control Source of Pathogens • People • Patients, personnel, visitors • Acute disease with symptoms • Incubation period (exposed, but no symptoms yet) • Colonized by pathogens without symptoms • Autogenous infection (originating from within the body)

  14. Infection Control Source of Pathogens • Contaminated objects • Equipment • Linen • Medication

  15. Infection Control Transmission Route • Contact • Droplet • Airborne • Common vehicle • Vectorborne • NOTE: Some organisms may be spread by multiple routes

  16. Infection Control • Contact Transmission • Direct Contact • Body-surface-to-body-surface contact (person-to-person) • Indirect Contact • Contaminated object (fomite) to host contact • Clothing (uniforms, lab coats, isolation gowns) • Equipment • Dressings • Instruments • Shared toys

  17. Infection Control • Droplet Transmission • Contaminated respiratory droplets • Discharged into the air (up to 10 feet) during: • Coughing, sneezing, talking • Suctioning, bronchoscopy, intubation, cough induction • Deposited on the host’s mucosal surfaces • Nasal mucosa • Mouth

  18. Infection Control • Droplet Transmission • Contaminated respiratory droplets • Currently Health Care Infection Control practices Advisory Committee (HICPAC) guidelines state it may be prudent to don a mask when within 6 feet of the patient or upon entry into the room of a patient who is on droplet isolation

  19. Infection Control • Droplet Transmission • HaemophilusInfluenzae • Pneumonia / Epiglotitis • Influenza virus • Rubella (German measles)

  20. Infection Control • Airborne Transmission • Contaminated droplet nuclei • Residue of evaporated water droplets containing infectious microorganisms • Can remain suspended in air for long periods • Respirable particles of less than  5 m • Dust particles • Act as fomites

  21. Infection Control • Airborne Transmission • Mycobacterium tuberculosis (TB) • Rubeola (Measles) • Varicella-zoster (Chicken Pox) • Note:Special air handling and ventilation, as well as respiratory protection are required Mycobacterium Tuberculosis

  22. Infection Control • Common Vehicle Transmission • Pathogens in water and food • Food • Salmonellosis • Hepatitis A • Water • Shigellosis • Cholera • Medications (e.g., heparin solution)

  23. Infection Control • Vectorborne Transmission • Animals or insects transfer pathogens • Malaria • West Nile Virus • Rabies • Note: Vectorborne transmission are of little significance in hospital-acquired infections

  24. Infection Control • Spread of Infection to the Lungs • Pathogens enter the lungs via: • Aspiration of contaminated - • Oropharyngeal secretions • Gastric secretions • Inhaled droplets, droplet nuclei, or dust particles containing pathogens (fomites) • Hematogenous • Via the blood

  25. Infection Control Host • Host infection dependent upon: • Virulence of the organism • Resistance of the host

  26. Infection Control Host • Increased susceptibility: • Diabetes mellitus • Lymphoma • Leukemia • Neoplasia • Those treated with: • Corticosteroids, irradiation, certain antimicrobials, immunosuppressive agents

  27. Infection Control Host • Increased susceptibility: • Age • Chronic disease • Shock • Coma • Traumatic injury • Surgical procedure

  28. Infection Control Host • Most nosocomial pneumonias occur in surgical patients, especially those who have had chest or abdomen procedures • Clearance mechanisms impaired • Bacterial enters lower airway • Intubation • Anesthesia • Surgical pain • Narcotics and sedatives

  29. Infection Control Host • Surgical Patients with Highest Risk of Pneumonia • Elderly • Severely obese • COPD • History of smoking • Those with artificial airways • Endotracheal / Tracheostomy tubes

  30. Infection Control • Infection Control Strategies • Infection control aims to break the chain of events causing the spread of infection

  31. Infection Control • Infection Control Strategies • Decrease host susceptibility • Eliminate the source of pathogens • Interrupt the transmission routes

  32. Infection Control • Decrease host susceptibility • Hospital efforts focus on employee immunization and chemoprophylaxis

  33. Infection Control • Decrease host susceptibility • Immunizations • Hepatitis B • Varicella (chicken pox) • Rubella (German measles) • Measles • Pertussis (Whooping cough) • When working with infants and children • Influenza

  34. Infection Control • Decrease host susceptibility • Chemoprophylaxis • Postexposure Treatment • Bordetellapertussis (whooping cough) • Neisseria meningitis (meningococcal meningitis) • Bacillus anthracis (anthrax) • Influenza virus • HIV • Group A streptococci

  35. Infection Control • Eliminating Source of Pathogens • Procedure to remove pathogens from the environment fall into two major categories • General Sanitation • Specialized Equipment Processing

  36. Infection Control • Eliminating Source of Pathogens • General Sanitation • Help keep overall environment clean • Sanitary laundry management • Sanitary food preparation • Sanitary housekeeping • Environmental control of the air • Specialized ventilation systems • Environmental control of the water

  37. Infection Control • Eliminating Source of Pathogens • Specialized equipment handling • Decontamination of equipment capable of spreading infection • Cleaning • Disinfection • Sterilization

  38. Infection Control • Specialized Equipment Handling • Cleaning • Removes dirt and organic material from equipment, usually by washing • Failure to do this will render subsequent processing ineffective !!! • Should be done in a designated “Dirty” area

  39. Infection Control • Specialized Equipment Handling • Cleaning • Soaps, detergents, or enzymatic cleaners should be used • Some contain germicide • Automated washers available (pasteurization / chemical disinfection cycle) • Must be rinsed and dried • Reassembled aseptically • Designated “Clean” area

  40. Infection Control • Specialized Equipment Handling • Disinfection • Destroys the vegetative form of pathogens on inanimate objects except bacterial spores • Physical methods • Chemical methods

  41. Infection Control • Specialized Equipment Handling • Physical Disinfection • Pasteurization • Submersion in a water bath at temperatures below boiling (70 C) for 30 minutes • Kills vegetative bacteria and most viruses • Does not kill bacteria spores

  42. Infection Control • Specialized Equipment Handling • Chemical Disinfection • Low-Level • Intermediate • High-Level

  43. Infection Control • Specialized Equipment Handling • Low-Level Disinfectants • Kills most bacterial, some viruses and fungi • Will not kill Mycobacterium tuberculosis (TB) spores and nonlipid virus

  44. Infection Control • Specialized Equipment Handling • Low-Level Disinfectants • Acetic acid • Mostly used for homecare equipment (1:3 white vinegar/water solution ) • Quaternary ammoniums • Hospital use – surface disinfection, e.g., floors, countertops, walls, etc.

  45. Infection Control • Specialized Equipment Handling • Intermediate Disinfectants • Kills all vegetative bacteria and fungi, but have variable activity against spores and certain viruses

  46. Infection Control • Specialized Equipment Handling • Intermediate Disinfectants • Alcohol (70% Ethyl, 90% Isopropyl) • Not sporicidal • Surface disinfectant, e.g., stethoscopes, ventilators, etc. • Phenolics • Not sporicidal • Surface disinfectant (added to detergents to enhance germicidal activity)

  47. Infection Control • Specialized Equipment Handling • Intermediate Disinfectants • Iodophors (iodine + surace-active organic compounds) • Used on skin and tissue

  48. Infection Control • Specialized Equipment Handling • High-Level Disinfectants • Glutaraldehyde • Hydrogen peroxide • Peracetic acid • Chlorine (sodium hypochlorite)

  49. Infection Control • Specialized Equipment Handling • High-Level Disinfectants • Glutaraldehyde (Trade name: CIDEX) • Kills vegetative bacteria, Mycobacterium turburculosis, fungi, viruses and spores in <10 minutes • Commonly used to disinfect/sterilize endoscopes, e.g., fiber optic bronchoscopes, respiratory care equipment, and spirometry tubing

  50. Infection Control • Specialized Equipment Handling • High-Level Disinfectants • Hydrogen Peroxide • 6% solution is bactericidal, fungicidal, viricidal in 10 minutes, • Sterilizes (sporicidal) in 6 hours • Does not produce harsh fumes

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