Infection Control - NURSING LIJAN - Home

Infection ControlByDr. Amer Hasanien &Dr. Ali Saleh

Related Terms Normal resident flora (bacteria) the collectivevegetation ( )نمو in a given area, yet produce infection inanother.Infection : invasion of body tissue by microorganisms(infectious agents) and their growth there.Disease : a detectable alteration in normal tissue functionVirulence (Pathogenicity): the ability of microorganismto produce disease.Opportunistic pathogen: causes disease only in asusceptible individuals.WHO & CDC (Centre for Disease Control)

Asepsis Asepsis is the freedom from disease-causingmicroorganisms and its spores Medical asepsis:all practices intended to confine aspecific microorganism to a specific area, limiting thenumber of microorganisms, growth and transmission.- Clean objects: absence of almost all microorganisms.- Dirty (Soiled, Contaminated) : have microorganisms,some of which capable of causing infection. Surgicalasepsis (Sterile Technique): practices that keeparea or object free from all microorganisms; destroy allmicroorganisms and spores. Sepsis : the state of infection, may includessepticemia and septic shock.

Microorganisms causing infections Bacteria (Staphs, Streptococci) Viruses (Hepatitis, Herpes.) Fungi (Candida albicans) Parasites [ ( ]طفيليات Malaria) (mites [ ]العث , fleas[ ]البراغيث , ticks [ )]القرادة .

Types of infections Contamination: the presence of microorganisms oncertain areas of the body or environmentColonization : microorganisms become resident flora,they may grow and multiply, but do not cause disease.Local Infection : infection limited to specific area of thebody.Systemic Infection : spread to different parts of the body.Bacteremia : Blood culture reveals microorganismsSepticemia : when bacteremia results in systemicinfection.Acute infection : sudden and in short time.Chronic infection : slow and in very long period.

Blood culture bottles

Nosocomial Infections Infections associated with delivery of health care services ina health care facility (during stay or after discharge) Most common nosocomial infections sites are urinary tract,respiratory tract, bloodstream, and wounds. It may originates as Endogenous (clients themselves) orExogenous (hospital environment and hospital personnel) . Iatrogenic infections are direct result of diagnostic ortherapeutic procedures (e.g. IV insertion).

Chain of Infection

Method of transmission1.2.3.Direct transmission : droplet, touch, bite, sexualintercourse.Indirect transmission:- Vehicle-borne: substance that serves as an intermediatemeans to transport an infectious agent (surgicalinstruments, toys, soiled clothes)- Vector-borne: is an animal or flying insectAirborne transmission: involve droplets or dust(Tuberculosis by droplet nuclei).

Body Defense against infection(Susceptible Host)Nonspecific Defenses : anatomic & Physiologic Barriers: e.g. skin andmucous membranes, nasal passages, saliva, tears,acidity of the stomach inflammatory response : Inflammation:is local and nonspecific defensive responseof the tissues to an injurious or infectious agent. It has 5signs: pain, swelling, redness, heat, and impaired functionof the part. Injurious agents can be physical, chemical, ormicroorganism. Three stages of inflammatory response: vascular andcellular response, exudates production, and reparativephase

Body Defense against infectionSpecific Defenses : antibody-mediated Active immunity: Host produces antibodies inresponse to natural antigens (e.g. infectiousmicroorganisms) or artificial antigens (vaccines)Passive immunity: Host receives natural (e.g. nursingmother) or artificial antibodies (immune serum)produced from another source.cell-mediated: by activating T cell system (cellmediated immunity is lost in HIV)

FACTORS INFLUENCESUSCEPTIBILITY OF THE HOST Age: newborns and elders have reduced defensesagainst infections.HeredityPhysical and Emotional Stressors: blood cortisone anti-inflammatory responses, depletes energy stores,exhaustion, resistance to infections.Nutritional status: e.g. antibodies are protiens.Medical therapy: e.g. radiation, invasive procedures.Certain medication: e.g. antineoplastic medications maydepress bone marrow function.Any disease that lessens the body’s defenses againstinfection.

Nursing Diagnoses Risk for infectionPotential complication of infection: feverImpaired physical mobilityImbalanced nutrition: less than body requirementsAcute painAnxiety

Prevention and Treatment ofInfectionPreventing Nosocomial Infections Proper hand hygiene techniques Environmental controls Sterile technique when warranted Identification and management of clientsat risk

Prevention and Treatment ofInfectionHand Hygiene Before and after eating After using toilets, bedpan Contactwith body substance (sputum, drainage,wound exudates). Before and after giving care For routine care, wash hands with soaps understream water for at least 20 sec. (WHO). ORUsing of alcohol-based antiseptic hand rubs(rinses, gels, or foams) for about 20-30 sec.(CDC).

Prevention and Treatment ofInfection Use antimicrobial agent in: Multiple resistantbacteria (e.g., Methicillin-Resistant Staphylococcus aureus (MRSA), Vancomycin-ResistantEnterococci (VRE)) Invasiveprocedures Special care units such as ICU’S Immunocompromised clients. Frequent use of soap or alcohol antisepticagents may induce: dryness, contact dermatitis lotions, moisturizers

Prevention and Treatment ofInfectionSupporting Defenses of a Susceptible Host Hygiene (bathing and shampooing) Nutrition (well-balanced diet) to maintain healthytissues. Fluids Rest and sleep Stress Immunization

Prevention and Treatment ofInfectionDisinfecting and Sterilizing Antiseptics: agents that inhibit the growth of somemicroorganisms. Disinfectants: agents that destroy pathogens other thansporesDisinfecting Using chemical preparations such as phenol or iodinecompounds. Used on inanimate objects as it is toxic to tissues. More concentrated than antiseptics. Bactericidal (destroy bacteria) and bacteriostatic(prevent growth and reproduction of some bacteria)agents.

Prevention and Treatment ofInfectionWhen using disinfectants consider: Type and number of organisms Concentration and duration of contact ofdisinfectant Presence of soap Presence of organic materials such as blood The surface area to be treated

Prevention and Treatment ofInfectionSterilization The process of destroying all microorganisms, includingspores and viruses. Methods of sterilization: Moist heat: steam under pressure (autoclaving) Gas: Ethylene oxide gas (interferes with metabolism ofmicroorganisms) for sensitive objects and more penetration.But toxic to humans Boiling water: in home. Spores and some viruses are notkilled. 100 c/ 15 min. Radiation: using ionizing (alpha, beta, and X-Rays) and nonionizing radiation (UV rays). Effective for items difficult tosterilize. It is very expensive.

autoclaving

Isolation Precautions Measures designed to prevent spread of infections orpotentially infectious microorganisms to healthpersonnel, clients and visitors.Category-specific Isolation Precautions: Strictisolation, Contact isolation, Respiratory isolation,Tuberculosis isolation, Enteric precautions,Drainage/secretions precautions, Blood/body fluidprecautions.Disease-specific Isolation Precautions: Delineatepractices for control of specific diseases. Use of private rooms with special ventilationCohorting clients infected with the same organismGowning to prevent gross soiling of clothes

GownPatientHealth care provider

Isolation PrecautionsUniversal Precautions (UP) Used with all clients Decrease the risk of transmitting unidentifiedpathogens Obstruct the spread of bloodborne pathogens(hepatitis B and C viruses and HIV) Used in conjunction with disease-specific orcategory-specific precautions

Isolation PrecautionsBody Substance Isolation (BSI) Employs generic infection control precautions forall clients except for few diseases transmittedthrough air. Body substances include: Blood Urine Feces Wound drainage Oral secretions Any other body productor tissue

Isolation PrecautionsStandard Precautions Used in the care of all hospitalized personsregardless of their diagnosis or possibleinfection status Apply to Blood Allbody fluids, secretions, and excretions exceptsweat (whether or not blood is present or visible) Nonintact skin and mucous membranes Combine the major features of Universal andBody Substance Isolation

Standard Precautions Hand Hygiene Also after removing gloves Using antimicrobial and antiseptic agents.Wearing clean glovesWear mask, Eye protection, or a face shield.Wear clean gownHandle equipments carefullyHandle, transport, and process linenappropriately.Prevent injuries from used scalpels, or otherequipment, and place puncture resistantcontainers.

face shieldpuncture resistantcontainers

Isolation PrecautionsTransmission-based Precautions Used in addition to standard precautions For known or suspected infections that arespread in one of three ways: Airborne:droplet nuclei ( 5 microns) Droplet: droplets ( 5 microns) Contact May be used alone or in combination but alwaysin addition to standard precautionsMicron (US): is an SI derived unit of lengthequaling 1 10 6 of a metre

Transmission-based PrecautionsAirborne Precautions: Private room, negative air pressure 2-same infected clients with samemicroorganism. Respiratory devices (e.g. N95 for tuberculosis) NO entry of susceptible people ((rubella(measles), varisella (chickenpox)). Limit patient’s movement (surgical mask).

N95 for tuberculosis

Transmission-based PrecautionsDroplet Precaution Used in droplet-transmitted infections(diphtheria, pneumonia, pertussis, mumps) Private room 2-same infected clients. Mask Limit patient’s movement (surgical mask).

surgical mask

Transmission-based PrecautionsContact Precautions Used for clients known or suspected to have seriousillnesses easily transmitted by direct contact. e.g.respiratory, skin, or wound infections, drug resistantbacteria (Vancomycine-resistant enterococci). Private room Wear gloves Wear gown Limit patient movement outside Using equipment to a single client (or samemicroorganism patients).

Isolation Practices Personal protective equipments(medical asepsis) Gloves Gowns Face Masks Eyewear

Isolation Practices Disposal of soiled equipment and supplies Bagging Linens lab.Specimens Dishes BP equipments Thermometers Sharps

Isolation PracticesTransporting Clients with Infections Psychosocial Needs of Isolation Clients Sensorydeprivation Feelings of inferiority and low self-esteem.

Sterile TechniqueSterile technique (surgical asepsis)- can be used in OR, LR, and special Dx. Procedures- sterile field: a microorganism- free area- ensure package intact and dry, and check for sterilizationexpiry.- double packed objects- using forceps, drape, sterile solutions.- wearing sterile gloves by open and closed methods- wearing sterile gown

sterile gloves

sterile package

Asepsis Asepsis is the freedom from disease-causing microorganisms and its spores Medical asepsis: all practices intended to confine a specific microorganism to a specific area, limiting the number of microorganisms, growth and transmission. - Clean objects: absence of almost all microorganisms.-Dirty (Soiled, Contaminated) : have microorganisms,