Transcript Infection

HEALTHCARE CORE CURRICULUM
SAFETY & STANDARD PRECAUTIONS
Competency 4
Infections/Infection Control
Dede Carr, BS, LDA
Karen Neu, MSN, CNE, CNP
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2
COMPETENCY 4

4. Describe principals and standards of
infection control.
a.
b.
Explain the purpose of standard precautions and
when they are to be applied.
List guidelines that reduce the spread of infection.
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INFECTION & INFECTION CONTROL

With research and the discovery that
microorganisms cause infection came the
realization that somehow their growth and
reproduction must be inhibited or stopped to
prevent infection. (Kockrow, p. 270)
This lesson will provide information about
microorganisms, infections, and methods to
control infection, which is essential in
healthcare.
MICROORGANISMS
Microorganisms are tiny bodies that are visible
only to a microscope. The most common are
classified as:
Bacteria
 Viruses
 Fungi
 Parasites

Microorganisms are present in the environment & on
body surfaces (such as the skin), in the intestinal tract,
mouth, upper respiratory tract, lower urinary tract, and
vaginal tract. These microorganisms are referred to
normal flora.
(Ramont & Niedringhaus, p. 150)
MICROORGANISMS
Although microorganisms are frequently
referred to as “germs,” most are harmless
and some are even helpful because they
perform essential functions for the body.
 For example, normal flora is the body’s
first line of defense or protection against
infection for patients and health care
providers. (Ramont & Niedringhaus, p. 150)
TYPES OF MICROORGANISMS
Bacteria: most common type of
disease-causing
microorganism
 They can live in & be
transported through air,
water, food, soil, inanimate
objects, & body tissues &
fluid.
 Aerobic bacteria grow in the
presence of oxygen, whereas
anaerobic bacteria grow
only in the absence of oxygen.
(Kockrow, p. 272)
(www.southtektalk.com, n.d.)
TYPES OF MICROORGANISMS
Viruses:
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Smallest known disease-causing agent
They must enter living cells in order to
reproduce.
Viruses cannot survive or maintain
their infectiousness outside a host.
Viral infections are self-limiting
(common cold). Others can cause
serious illnesses or death (hepatitis A,
B, & C, herpes simplex, herpes zoster,
varicella, human immunodeficiency
virus [HIV] & AIDS).
(www.topnews.in, n.d.)
(Kockrow, p. 274)
TYPES OF MICROORGANISM
Fungi are either yeasts or molds &
diseases are called mycotic
infections.
 They may be superficial involving
the skin, hair, nails, & mucous
membranes.
 Examples:
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Athlete’s foot (tina pedis),
Thrush,
Ringworm,
Candida albicans,
Tinea capitus
(Kockrow, pp. 274-275)
Fungi
(www.sciencephoto.com, n.d.)
TYPES OF MICROORGANISMS
Parasites live on other
living organisms.
Examples are
 Protozoa (single-celled
animal) (causes
malaria)
 Helminthes (worms)
 Arthropods (mites,
ticks, & fleas).
Hookworm, Tapeworm, Tapeworm eggs,
Roundworm, Pinworm
Helminthes(Worms)
(www.gifam.org, n.d.)
Tick
(www.blogalaxia.com, n.d.)
DRUG-RESISTANT ORGANISMS
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There has been increased incidence of nosocomial
infections involving drug-resistant organisms.
The use and misuse of antibiotics, as well as the tendency of
clients not to complete a prescribed course of treatment,
have impacted the development of resistant organisms.
Taking antibiotics for viral infections has played a role too.
Currently, the most prominent types of drug-resistant
organisms are Methicillin-resistant Staph Aureus (MRSA),
Vancomycin-resistant enterococci (VRE), and multi-drug
resistant tuberculosis (TB).
Immunocompromised hospitalized patients are highest risk.
Community acquired or CA-MRSA has become more
common in contact sports, the sharing of gym towels, and
living in crowded areas, such as correctional institutes.
(Ramont & Niedringhaus, p. 156)
DRUG-RESISTANT ORGANISMS

Failure to perform appropriate hand hygiene is
considered to be the leading cause of
healthcare associated infections and the
spread of multi-drug-resistant organisms and
has been recognized as a substantial
contributor to outbreaks.
(Ramont & Niedringhaus, p. 156)
TYPES OF MICROORGANISMS
Resident flora (normal flora) are harmless
microorganisms that are found in and on the
body & perform useful protective functions.
For example, intestinal flora help to synthesize
vitamin K, which is important in the body’s
blood-clotting mechanism.
Various other microorganisms make antibioticlike substances & toxic substances that slow or
stop the growth of other organisms.
(Ramont & Niedringhaus, p. 150)
MICROORGANISMS
The process of colonization occurs when
strains of microorganisms become resident
flora.
 Resident flora can grow in & on the body &
not cause disease, however if the person’s
defenses become weak, flora can invade a part
of the body they normally would not & cause
illness or infection. (Ramont & Niedringhaus, p. 150-151)

INFECTION
An infection is defined as an invasion of the
body by a disease-causing called the infectious
agent.
 Microorganisms that cause disease are called
pathogens. A “true” pathogen causes disease
or infection in a healthy person.
 An opportunistic pathogen causes a disease
only in a susceptible person (someone whose
immune system is not functioning as a defense
system).
(Ramont & Niedringhaus, p. 150-151)
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DISEASE
When an infection occurs, the signs & symptoms
of the infection are distinctive, & the person’s
health is recognized as being different from
normal.
 Disease causes detectable change in the way the
body functions. In some cases, the
microorganisms will not cause any signs or
symptoms of disease, and the infection is called
asymptomatic or subclinical. For example, many
cases of mumps are asymptomatic.
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(Ramont & Niedringhaus, p. 151)
MICROORGANISMS
Various microorganisms are stronger than others
& are called virulent. Virulence refers to the
organism’s ability to produce disease & survive
both inside and outside the body.
 Microorganisms also differ in their strength and
their communicability (how easily they are
spread).
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The common cold or the annual strain of influenza (flu)
can be easily spread by hands and coughing or sneezing,
whereas blood borne pathogens such as hepatitis C and
AIDS are not easily transmitted, because they require
blood-to-blood contact to pose a risk of transmission.
(Ramont & Niedringhaus, p. 151)
COMMUNICABLE DISEASE
A communicable disease is one that is spread by
direct or indirect contact.
 The transmission by an organism can be caused
by a vector or vehicle (an insect, or used drinking
glass, etc.).

West Nile virus is the newest vector-borne disease. It
has been in the US for a short time, but has been
spread across the U.S. by migrating birds. Birds
contract the disease and die.
 Mosquitoes then pick up the virus from the dead birds
and pass the disease to humans.

(Ramont & Niedringhaus, p. 151)
MICROORGANISMS
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Microorganisms can be airborne and carried by air
currents.
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For example, an airborne disease such as tuberculosis can be
transmitted from one person to another in a close living
situation.
Microorganisms that develop resistance to various
antibiotics can lead to outbreaks of infections in both
the medical facility and the community.
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One disease resistant microorganism is methicillinresistant Staphylococcus aureus (MRSA).
This strain of staph has been responsible for deaths in
hospitals and in the community setting. This infections has
become an issue in gyms, prisons, and school locker rooms.
(Ramont & Niedringhaus, p. 151)
TYPES OF INFECTION
TYPES OF INFECTIONS
Infectious disease presents as illness in the patient, but is
not transmissible to others.
Communicable diseases can be transmitted from one
person to another.
 Infection in a patient can be either local or systemic.
 A local infection occurs when the microorganisms are
in only a specific part of the body.
 A systemic infection exists when the microorganisms
spread to other body areas. The person has bacteremia
if the microorganisms enter the blood stream.
 When bacteremia spreads through all the body systems,
the condition is called septicemia.
(Ramont & Niedringhaus, p. 151)
TYPES OF INFECTIONS
Acute infections occur suddenly or last a short
time (i.e., ear infections).
Chronic infections happen slowly over a long
period of time and may last months or years
(i.e., hepatitis C viral infection).
 Infections that occur after hospital admission,
and for which the patient had no symptoms at
the time of admission are called nosocomial
infections (hospital-acquired infections).
(Ramont & Niedringhaus, p. 151)
TYPES OF INFECTIONS
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Nosocomial infections (hospital-acquired):
many factors contribute to nosocomial
infections (i.e., bacteremia [infection of the
blood] caused by an intravenous (IV) site. An
infection directly caused by any diagnostic or
therapeutic source is called an iatrogenic
infection (i.e., a negative result from a patient
given a wrong medication).
(Ramont & Niedringhaus, p. 151)
TYPES OF INFECTIONS
A microorganism that comes from the patient’s
own body and causes a nosocomial infection is
referred to as being from an endogenous source.
 If the organism causing the infection comes from
the healthcare environment or personnel, it is
from an exogenous source.
 Three of the most common microorganisms
causing exogenous infections are E. coli, S. aureus,
and Enterococcus species.

(Ramont & Niedringhaus, p. 151)
NOSOCOMIAL INFECTIONS
The cost of nosocomial infections to the client,
the facility, and funding sources (i.e., insurance
companies & federal, state, & local
governments) is great.
 Nosocomial infections extend hospitalization
time, increase client’s time away from work,
cause disability & discomfort, & even result in
loss of life.
(Berman et al., p. 671)
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Health Care Core
Curriculum
CHAIN OF INFECTION
CHAIN OF INFECTION
The presence of a pathogen does not mean that
an infection will occur. Infection occurs in a
cycle that depends on the presence of all of the
following elements:
An
infectious agent or pathogen
A reservoir or source for pathogen growth
A portal of exit from the reservoir
A mode of transmission
A portal of entry to a host
A susceptible host
(Potter & Perry, p. 642)
CHAIN OF INFECTION
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Access the website
and actively engage
in your learning
about the
Chain of Infection
Describe each of the
six components in
the Chain of
Infection.
CHAIN OF INFECTION LINK
Infectious Agent
 Microorganisms (bacteria, viruses, fungi, &
protozoa)
 Microorganisms on the skin are either resident or
transient flora. Resident organisms (normal flora)
are permanent residents of the skin, where they
survive & multiply without causing illness.
 Resident flora on the skin covers the entire
exterior of the body and protects against
pathogens.
(Ramont & Niedringhaus, p. 151)
CHAIN OF INFECTION LINK
Infectious Agent
Transient microorganisms attach to the skin when a person has
contact with another person or object during normal activities.
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For example, a healthcare worker touches a bedpan or a
contaminated dressing, transient bacteria adhere to the healthcare
worker’s skin. The organisms attach loosely to the skin in dirt and
grease or under fingernails. These organisms may be readily
transmitted unless removed using hand hygiene. (Larson, 2005, as cited in
Potter & Perry, p. 642)
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If hands are visibly soiled with proteinaceous material, soap
and water is the preferred practice.
If hands are not visibly soiled, use of an alcohol-based hand
product or hand washing with soap and water is acceptable for
disinfecting hands of the healthcare worker.
(Potter & Perry, p. 642)
CHAIN OF INFECTION LINK
Infectious Agent
The potential for microorganisms or parasites to cause
disease depends on the following factors:
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Sufficient number of organisms (dose)
Virulence, or ability to survive in the host or outside the
body
Ability to enter and survive in the host
Susceptibility of the host (host resistance)
Length of exposure to infectious agent
Resident skin microorganisms are not virulent, however
they can cause serious infection when surgery or other
invasive procedures allow them to enter deep tissues or
when a client is severely immunocompromised (impaired
immune system.
(Potter & Perry, p. 643)
CHAIN OF INFECTION LINK
Reservoir
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Reservoir is a place where a pathogen can survive may
or may not multiply.
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For example, hepatitis A virus survives in shellfish, but does
not multiply.
Pseudomonas organisms may survive and multiply in
nebulizer reservoirs used in the care of patients with
respiratory problems. The most common reservoir is the
human body.
A variety of microorganisms live on the skin and within
the body cavities, fluids, & discharges.
The presence of microorganisms so does not always
cause a person to be ill.
(Potter & Perry, p. 643)
CHAIN OF INFECTION LINK
Reservoir
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Carriers are persons who show no symptoms of illness
but who have pathogens on or in their bodies that can
be transferred to others.
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For example, a person can be a carrier of hepatitis B virus
without having symptoms of infection. These persons
transmit the disease to others through their blood or
through sexual contact.
Animals, food, water, insects, and inanimate objects can
also be reservoirs for infectious organisms.
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Clostridium botulism toxin, which causes botulism, survives
in improperly processed foods (i.e., infant formula).
(Potter & Perry, p. 643)
CHAIN OF INFECTION LINK
Reservoir
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To thrive, organisms require a proper environment
including appropriate food, oxygen, water,
temperature, pH, and light.
Organisms need food for energy to grow & multiply.
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Oxygen
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Aerobic bacteria need oxygen for survival & multiplication.
Anaerobic organisms thrive where little or no free oxygen
is available (Clostridium difficile, an organism that causes
antibiotic-induced diarrhea).
(Potter & Perry, pp. 643-644)
CHAIN OF INFECTION LINK
Reservoir
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Water or moisture is required for survival of most
organisms. Most microorganisms grow in drainage
from wounds.
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Some bacteria assume a form of spore that is resistant to
drying & include organisms such as anthrax, botulism, &
tetanus, which can live without water.
Temperature: microorganisms can live in certain
temperature ranges; each species has a specific
temperature at which if grows best. The ideal
temperature for most human pathogens is 68°-109° F.
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Cold temperature tend to prevent growth & reproduction of
bacteria (bacteriostasis). A temperature that destroys
bacteria is bactericidal.
(Potter & Perry, p. 644)
CHAIN OF INFECTION LINK
Reservoir
 pH: The acidity of an environment determines
the viability of microorganisms; most prefer
and environment within a pH range of 5-7.
Bacteria thrive in urine with an alkaline pH.
Most organisms cannot survive in the gastric
acid of the intestinal tract.
 Light: Microorganisms thrive in dark
environments, such as those under dressings
and within body cavities. (Potter & Perry, p. 644)
CHAIN OF INFECTION LINK
Portal of Exit
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After microorganisms find a site to grow and multiply,
they must find a portal of exit if they are to enter
another host and cause illness.
Portals of exit include sites such as blood, skin, and
mucous membranes (any break in the integrity of
skin/mucous membranes), respiratory tract
(coughing/sneezing), genitourinary tract (urination,
catheters, & diversions/drains), gastrointestinal tract
(saliva, kissing, bowel elimination, emesis, drainage of
bile from surgical wounds, or draining tubes),
reproductive tract (male’s urethra or woman’s vagina
during sexual contact, semen), blood-to-blood contact
and transplacental (mother to fetus). (Potter & Perry, p. 644)
CHAIN OF INFECTION LINK
Modes of Transmission
Each disease has a specific mode of transmission (manner
in which microorganisms get to the host).
 Once microorganisms have exited, there are many
vehicles (means by which organisms are carried about) on
or by which they can travel to the next host.
Contamination means a condition of being soiled, stained,
touched by, or otherwise exposed to harmful agents, such
as by the entry of infectious or toxic materials into
previously clean or a sterile environment, making an
object potentially unsafe for use.
 If the vehicle is a living carrier it is called a vector.

(Kockrow, p. 276)
CHAIN OF INFECTION LINK
Modes of Transmission
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Indirect Contact
Personal contact of susceptible host with
contaminated inanimate object (e.g., needles
or sharp objects, dressings, environment.
If the vehicle is an inanimate (non-living) object,
it is called a fomite, which may be a
stethoscope, thermometer, bandage scissors,
drinking glass, needle, soiled dressings, or one
of the many objects.
If the vehicle is a living carrier, it is called a
vector.
(Kockrow, p. 276)
Fomite
Vector
CHAIN OF INFECTION LINK
Mode of Transmission
Indirect Contact
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Vehicle-borne - Spread from
one person to another by an
inanimate intermediary.
Vehicles include food, water
and objects.
(Potter & Perry, p. 644-645)
CHAIN OF INFECTION LINK
Mode of Transmission
Indirect Contact
Vector-borne
 Spread by animals, most
often arthropods. Vectorborne diseases include
those spread by ticks and
mosquitoes, bats, etc.
(Potter & Perry, p. 644-645)
CHAIN OF INFECTION LINK
Mode of Transmission
 Direct Contact
 Involves immediate &
direct transfer of
microorganisms from
person to person
through touching,
biting, kissing, or
sexual intercourse.
(Berman et al., p. 672)
Direct Contact
Spread by direct contact with
infected skin, mucus
membranes, or body fluids
 Person to person
 Physical contact between
source & susceptible host
(e.g., touching client’s feces
& then touching your inner
mouth or consuming
contaminated food)
 Ex. Hepatitis A, Shigella,
Staphylococcus
(Berman et al., p. 672)
CHAIN OF INFECTION LINK
Mode of Transmission
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Droplet or Airborne Transmission
These modes usually involve droplet nuclei, the
remains of droplets coming from the infected person,
which are suspended in air. The organisms are
expelled into the air by coughing, sneezing, talking,
singing, or spitting by the infected person and inhaled
into the lungs by another person.
(Ramont & Niedringhaus, p. 152-153)
CHAIN OF INFECTION LINK
Mode of Transmission
Airborne Transmission
Droplet nuclei, the residue of evaporated
droplets emitted by an infected host can
remain in the air for long periods of
time.
Droplet transmission is a form of direct
transmission because a spray of droplets
can only go a few feet before it falls to
the ground.
Large particles that travel up to 3 feet and
come in contact with a susceptible host
through coughing, sneezing, talking,
singing, & spitting.
Examples: Influenza virus, rubella virus,
bacterial meningitis
(Perry & Potter, 644-645)
CHAIN OF INFECTION LINK
Mode of Transmission
Airborne Transmission
Dust particles containing the infectious agent can become
airborne & be transmitted by air currents to a suitable portal
of entry, usually the respiratory tract of another person.
 However, the droplet spread and airborne transmission are
different in a very important way.
 Droplet spread organisms can only contaminate nearby air
(usually within 3 feet of the infected person) while airborne
organisms can spread infection over a much wider area.
 Examples: Tuberculosis, chicken pox, measles virus
(Berman et al., p. 672)
CHAIN OF INFECTION LINK
Mode of Transmission
There are three modes of transmission of microorganisms: direct and
indirect contact, droplet, and airborne.
 The microorganisms can be transmitted through direct contact
when the healthcare worker turns or bathes a patient or uses poor
hand washing technique.
 Air currents can carry microorganisms easily, therefore when beds
are made, the linens should not be shaken. A dampened or treated
cloth should be used when dusting to prevent the circulation of dust
particles.
 The floor is the dirtiest area in any building. Anything dropped, such
as soiled linens should be discarded. Personal should not wear pants
that are too long and drag along the floor.
 All healthcare workers should be conscientious in using infection
control practices as so many factors can promote the spread of
infection.
(Kockrow, p. 276)
CHAIN OF INFECTION LINK
Portal of Entry
 Route through which the pathogen enters
into the new host.
 Often the route or method of entry is the
same method as the exit.
 When the host’s defense mechanisms are
reduced, the microorganism has a greater
chance to enter.
(Berman et al., p. 672)
CHAIN OF INFECTION LINK
Portal of Entry
Skin Break
Inhalation
Respiratory System
Ingestion
Gastrointestinal System
Sexual Contact
Genitourinary System
CHAIN OF INFECTION LINK
Portal of Entry
 Body openings such as eyes, ears, nose, mouth
 Microorganisms can enter through tubes in the
body:
 Indwelling
urinary catheters
 Gastrointestinal feeding tubes
 Tracheostomy tubes
 Intravenous catheters (IVs)
 Pins-Hardware in Bones
(Berman et al.)
CHAIN OF INFECTION LINK
Susceptible Host
 Susceptible host is an individual who has
impaired immune system response & is at risk for
developing an infection.
 The support of pathogen life & its reproduction
depend on the degree of the host’s resistance.
 A compromised host is someone who has a
higher risk for getting an infection for one or
more reasons.
 Impairments of the body’s natural defenses & a
number of other factors can affect susceptibility
to infections.
(Berman et al., p. 673)
CHAIN OF INFECTION LINK
Susceptible Host
Factors Affecting Immunologic Defense Mechanisms
 Increasing age & the very young
 Stress
 Nutritional status
 Hereditary factors
 Disease processes (chronic illness)
 Environmental factors
 Medical therapy
 Chemotherapy
 Radiation
 Trauma
 Smoking
(Kockrow, p. 276-277)
BREAK THE CHAIN OF INFECTION
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The essential part of patient care and selfprotection is to interrupt the chain of infection
by pathogen identification, asepsis and
hygiene, control portals of exit, prevention of a
route of transmission, protect the portal of
entry, and recognition of susceptible hosts.
(Kockrow)
Health Care Core Curriculum
INFECTION CONTROL
INFECTION CONTROL
In the section that will follow, specific
healthcare workers’ activities are described
that interfere in the chain of infection to
prevent and control transmission of
infectious organisms, and that promote care
of the infected client.
INFECTION CONTROL
Infection control consists of policies and procedures of a
hospital or other healthcare facility to minimize the risk
of nosocomial or community-acquired infections
spreading to patients and other staff members.
 Infection control is routine in whatever actions
healthcare workers perform.
 The healthcare worker’s knowledge of infection, the
application of infection control principles, & use of
common sense help protect patients from infections.
 Healthcare workers are exposed to pathogenic
microorganisms and should use specialized and routine
practices of cleanliness and disinfection to prevent the
spread of infection.
(Kockrow, p. 271)
INFECTION CONTROL
Infection control techniques aid in accomplishing
asepsis (freedom of pathogenic organisms).
 Asepsis Categories: Medical and Surgical Asepsis
Medical asepsis consists of techniques that inhabit
the growth and spread of pathogenic
microorganisms, also know as clean technique.
 Medical asepsis is used in many daily activities,
such as hand washing and changing patient’s bed
linen. Principles of medical asepsis are commonly
followed in the hone as is the case of washing
hands before preparing food. (Kockrow, p. 271)
INFECTION CONTROL
Medical asepsis consists of techniques that inhabit the growth
and spread of pathogenic microorganisms, also know as clean
technique.
Medical asepsis includes all practices intended to confine a
specific microorganism to a specific area, limiting the number,
growth, and transmission of microorganisms.
In medical asepsis, objects are referred to as clean, which means
the absence of most microorganisms, or dirty (soiled,
contaminated), which means likely to have microorganisms,
some of which may be capable of causing infections.
(Berman et al., p. 276)
Medical asepsis is used in many daily activities, such as hand
washing and changing patient’s bed linen. Principles of medical
asepsis are commonly followed in the hone as is the case of
washing hands before preparing food. (Kockrow, p. 271)
INFECTION CONTROL
Surgical Asepsis
Surgical asepsis refers to practices that keep an area or
object free of all microorganisms; it includes practices
that destroy all microorganisms and their spores
(microscopic dormant structures formed by some
pathogens that are very hardy and often survive
common cleaning techniques. (Berman et al., p. 270)
Surgical asepsis is used for all procedures involving the
sterile areas of the body.
Surgical asepsis or sterile technique, is used in
specialized areas or skills, such as care of surgical
wounds, urinary catheter insertion, invasive
procedures, and surgery.
(Kockrow, p. 271)
PREVENTING NOSOCOMIAL INFECTIONS
Meticulous use of medical and surgical asepsis
is necessary to prevent transport of potentially
infectious microorganisms.
 Many nosocomial infections can be prevented
using proper hand hygiene when warranted,
and identification and management of clients
at risk for infections.
 Healthcare workers must use critical thinking
and agency policy in implementing infection
control procedures.

(Berman et al., p. 681)
BREAKING THE CHAIN OF INFECTION
The chain of infection demonstrates how
infectious diseases occur and are spread.
 The important concept to remember is that
breaking at least one link stops the
infectious disease.
 The practices & techniques that health care
workers use daily are designed to break the
chain.
(Berman et al., p. 681)

INFECTION CONTROL
Recall the chain has six elements and are frequently
summarized as three components.
 Component #1: Source of infecting microorganisms-elements #1 (infectious agent) and #2 (reservoir-host)
both involve source of infection.
 Component #2: Means of transmission for the
microorganisms-- elements #3 (portal of exit) and #4
(route of transmission) & #5 (portal of entry) all affect
transmission
 Component #3: Susceptible host—element #6
susceptible host is unchanged in summarized formation.
(Juliar, p. 145)
INFECTION CONTROL
What is the best defense?
 To decrease the sources of microorganisms
 Prevent transmission
 Maximize the resistance of the host
How can the healthcare worker decrease the source of
microorganisms?
 Perform proper hand washing
 Decontaminate surfaces & equipment (antiseptics,
disinfectant, sterilization)
 Avoid contact with patients & others when harboring
infectious microorganisms.
(Juliar, p. 145)
INFECTION CONTROL
How can the healthcare worker prevent the
transmission of microorganisms?
 Wear personal protective equipment (PPE) when
indicated. (PPE includes caps, gloves, gowns,
masks, shoe covers, and eye protection).
 Follow isolation procedures when indicated
(additional precautions used when working with
patients who have highly contagious diseases).
(Juliar, p. 145)
INFECTION CONTROL
How can the healthcare worker maximize the
resistance of the host?
 Provide good hygiene of skin, oral hygiene, bathing &
shampooing
 Ensure proper nutrition and fluid intake
 Adequate sleep
 Decrease stressors that weaken the immune response
 Immunizations for the chronically ill
The first line of defense is medical asepsis and the most
effective way to prevent the spread of microorganisms
is using good hand washing technique. (Juliar, p. 145)
INFECTION CONTROL
Infection control to reduce reservoirs
Bathing: Use soap & water to remove drainage, dried secretions,
excess perspiration, or sediment from disinfectants.
Change wet or soiled dressings.
Contaminated articles: Place tissues, soiled dressings, & soiled
linen in moisture-resistant bags for proper disposal. Place
pourable, dripping dressings in biohazard bags.
Bedside unit: Keep table surfaces clean & dry.
Drainage bottles & bags: Empty & dispose of drainage suction
bottles according to agency policy. Empty all drainage systems
each shift unless otherwise ordered by the physician. Never
raise a drainage system (i.e., urinary drainage bag) above the
level of the site being drained unless it is clamped off.
(Kockrow, p. 275)
INFECTION CONTROL
Infection control to reduce reservoirs:
 Contaminated needles: Place syringes &
uncapped hypodermic needles & IV needles in
moisture-resistant, puncture-proof containers,
which should be located in patient’s rooms or
treatment areas so that exposed, contaminated
equipment need not be carried any distance. Do
not recap needles.
 Bottled solutions: Do not leave bottled solutions
open for prolonged periods. Keep solutions tightly
capped. Date bottles when opened. (Kockrow, p. 275)
HAND HYGIENE
Hand hygiene is important is every setting. It is considered
the most effective infection control measures.
 Any client may harbor microorganisms that are currently
harmless to the client yet potentially harmful to another
person or to the same client if there is a portal of entry.
 It is important for both the healthcare worker and client to
cleanse their hands at the following times to prevent the
spread of microorganisms: before eating, after using the
bedpan or toilet, and after the hands have come in contact
with any body substances, such as sputum, emesis, drainage
from a wound, blood, or feces.
 In addition, all healthcare workers should cleanse their
hands before and after giving care of any kind.
(Berman et al., pp. 681-682)
HAND HYGIENE
Hand hygiene includes using an instant alcohol hand
antiseptic before and after providing client care, hand
washing with soap and water when hands are visibly soiled,
and performing a surgical scrub.
Hand washing is the act of washing hands with soap and
water for 20 seconds (CDC, 2002b).
 The friction used removes soil and transient organisms
from the hands.
 The use of alcohol-based hand rubs is recommended by
the Centers for Disease Control and Prevention to improve
hand hygiene practices, protect healthcare workers’ hands,
and reduce transmission of pathogens to clients and
personnel in health care settings.
(Potter & Perry, p. 655)
HAND HYGIENE
For routine client care, the World Health
Organization (WHO) recommends hand
washing under a running stream of water for
at least 20 seconds using plain granule soap,
soap-filled sheets, or liquid soap when hands
are visibly soiled, after using the restroom,
after removing gloves, before handling invasive
devices (such as intravenous tubing), and after
contact with medical equipment or furniture.
(Berman et al., p. 682)
HAND HYGIENE

Access the following website to view video by
the CDC.
Put Your Hands Together-Hand Washing
Learn more about importance in transmission
of microorganisms.
HAND HYGIENE
Alcohol-Based Waterless Antiseptic Agents
If hands are not visible soiled, use an alcohol-based waterless
antiseptic agent for routine decontaminating hands in all
clinical situations:
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After contact with a client’s intact skin (as in lifting a client)
Before eating
After contact with body fluids or excretions, mucous membranes, nonintact skin, or wound dressings as long a hands are not visibly soiled
When moving from a contaminated body site to a clean body site during
client care
After contact with inanimate objects (medical equipment) in the immediate
patient area
Before caring for client with severe neutropenia or other severe immune
suppression
Before inserting indwelling urinary catheters or other invasive devices
After removing gloves (Potter & Perry, p. 655)
USE OF GLOVES
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Wear clean, non-sterile gloves when you touch, or have
the potential of coming in contact with blood, body
fluids, secretions, excretions, or contaminated items.
Put on gloves before touching mucous membranes and
non-intact skin.
Gloves should be changed between tasks and
procedures on the same patient if there is contact with
material that may contain high concentrations of
microorganisms.
Remove gloves promptly after use, before touching noncontaminated items & environmental surfaces, and
before going to another patient.
(Juliar, p. 148)
USE OF GLOVES
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Use proper hand washing technique before applying gloves.
Remove appropriate-sized clean gloves from box & apply
When removing gloves: grasp on the outside of one glove at
the palm with the other gloved hand; pull the glove down and
turn it inside out while removing it.
Hold the removed glove in the palm of the remaining gloved
hand.
Take the ungloved hand and slide fingers under the cuff of the
remaining glove & push the glove off.
The first glove is now inside the second glove that was
removed.
Discard the gloves in an appropriate container according to
facility policy.
Wash hands immediately after removing gloves. (Juliar, p. 149)
GLOVE USAGE

Access this YouTube to learn how to remove
gloves preventing exposure to blood borne
pathogens
STANDARD PRECAUTIONS
It is impossible to know which pathogens a
person may carry, so specific procedures have
been developed by the CDC know as Standard
Precautions.
 Standard Precautions are applied to every
patient in the healthcare environment—it is
essential to follow the standards at all times.
 Standard Precautions must be followed to
prevent contact with potentially infectious body
fluids.
(Juliar, p. 146)
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STANDARD PRECAUTIONS
Potentially infectious body fluids include:
 Blood
 All body fluids, secretions, & excretions except
sweat, regardless of whether or not they contain
visible blood
 Non-intact skin
 Mucous membranes
 Any unidentified body fluids (Juliar, 146)
Standard Precautions includes hand hygiene, use
of personal protective equipment, cleaning,
disinfection, and sterilization.
INFECTION CONTROL
Cleaning, Disinfection, & Sterilization
 Proper cleansing, disinfection, & sterilization of
contaminated objects significantly reduce & often
eliminate microorganisms. In health care facilities,
a sterile processing department is responsible for
the disinfection & sterilization of reusable
supplies & equipment.
 However, in the homecare setting, sometimes the
healthcare worker has to perform these functions.
Many principles of cleaning and disinfection also
apply to the home. (Potter & Perry, p. 655)
INFECTION CONTROL
Cleaning: the removal of all soil (i.e., organic & inorganic
material) from objects & surfaces.
 Generally cleaning involves the use of water & mechanical
actions with detergents or enzymatic products. Detergents
should have a natural pH.
Disinfection describe a process that eliminate many or all
microorganisms, with an exception of bacterial spores, from
inanimate objects. There are 2 types of disinfection:
Disinfection of surfaces & high-level disinfection, which is
required for some client care items such as endoscopes.
(Potter & Perry, p. 655, 658-659)
Sterilization refers to methods used to kill all microorganisms,
including spores. There are two types: physical & chemical.
(Kockrow, p. 307)
INFECTION CONTROL
Cleaning reusable equipment--Wash items to remove organic
materials (items like bed pans)
 First, cold rinse, because hot water coagulates the protein of
organic material & causes it to stick to items.
 Second, wash items in hot water with soap to emulsify and
dislodge dirt.
 Abrasive action with stiff-bristled brushes will help to
remove materials from crevices in equipment.
 Rinse articles with warm to hot water & dry thoroughly.
 Items are now considered clean.
 However, the process is incomplete until the basin or sink
and any brushes or tools used for cleaning the items are also
cleaned with a disinfectant. This is generally assigned to
housekeeping or central service staff. Check with your
facility.
(Ramont & Niedringhaus, p. 160)
INFECTION CONTROL
Disinfecting and Sterilizing
 The etiologic agent and the reservoir are interrupted by
the use of antiseptics (agents that inhibit the growth of
some microorganisms & can be used on skin or tissue)
and disinfectants (agents that destroy pathogens other
than spores & are more concentrated than antiseptics),
and by sterilization.
 Both antiseptics & disinfectants have bactericidal &
bacteriostatic properties. Bactericidal preparations
destroy the bacteria whereas bacteriostatic
preparations prevent the growth and reproduction of
some bacteria.
(Ramont & Niedringhaus, p. 160)
INFECTION CONTROL
Disposal of used or soiled equipment
 Most facilities have politics & procedures in place that
state specifically how to dispose of equipment &
supplies that have been contaminated.
 Be familiar with the policies as they are based on the
law.
 Materials may be disposed of, cleaned, disinfected, or
sterilized.
 Some equipment & supplies are for single use only.
Others are meant to be used multiple times.
(Ramont & Niedringhaus, p. 160)
INFECTION CONTROL
Disinfecting
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When disinfecting articles, healthcare workers must follow the
agency’s protocol & consider:
Type & number of infectious organisms (some are readily
destroyed, whereas others require longer contact with the
disinfectant)
Recommended concentration of the disinfectant & duration of
contact
Presence of soap (some disinfectants are ineffective in the
presence of soap or detergent)
Presence of organic material (presence of saliva, blood, pus, or
excretions can readily inactivate many disinfectants
Surface areas to be treated (the disinfecting agent must come
in contact with all surfaces & areas. (Berman et al., p. 688)
INFECTION CONTROL
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Disposal of used or soiled equipment
Bagging is a technique recommended by the CDC for removal of
materials from a client’s room (isolation room). The purpose is to
prevent any exposure to items contaminated by body secretions. The
bag must be impervious to microorganisms. Bags may come in
different colors (i.e., red) with labels indicating infectious materials.
CDC recommends placing non-contaminated disposable items in a
plastic bags that line the waste container.
Non-disposable or reusable items should be put into a labeled bag
before being removed from the client’s room & sent to a central
processing area for decontamination.
Rubber, plastic, metal, & glass items may be bagged separately. (Metal
& glass can be autoclaved, but rubber & plastic need to be expose to
gas sterilization.)
Special procedure trays should be disassembled & bagged as already
indicated.
(Ramont & Niedringhaus, p. 160)
INFECTION CONTROL
Soiled linen
 Soiled linen or clothing should be bagged and sent
to the facility laundry or home.
 As linens are removed from the bed avoid from
shaking them & dispersing microorganisms.
 Keep the linen away from your clothing.
 Roll the soiled linen into a bundle before being
placing it into a bag or linen hamper.
 If clean linen falls onto the floor, discard it into the
soiled linen hamper as the floor is the dirtiest
place in a healthcare facility. (Potter & Perry, p. 667)
INFECTION CONTROL
Hazardous waste is disposed in containers
labeled for such.
 Substances commonly considered hazardous
include bleach and other disinfectants,
chemotherapeutic or antineoplastic agents.
 Healthcare workers are responsible for
knowing the chemical used and any potential
risks to themselves and their client. (Ramont &
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Niedringhaus, p. 131)
INFECTION CONTROL
You are responsible for providing the client with a
safe environment.
 The effectiveness of infection control practices
depends on your conscientiousness and
consistency in using effective aseptic technique.
 It is human nature to forget key procedures or,
when hurried, take shortcuts that break aseptic
procedures.
 However, failure to comply with basic procedures
places clients at risk for an infection that can
seriously impair recovery or lead to death.
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(Potter & Perry, p. 655)
REFERENCES
Berman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008).Asepsis. In A.
Berman, S.J. Snyder, B. Kozier, & G. Erb (Eds.). Kozier & Erb’s
Fundamentals of nursing: Concepts, process, and practice (8th ed.) (pp.
668-709). Upper Saddle River, NJ: Prentice Hall
Juliar, K. (2003). Minnesota health care core curriculum, 2e. Clifton Park,
NY: Delmar Publishing, Thompson Custom Publishing
Kockrow, E.O.(2006). Medical/Surgical asepsis and infection control. In
B.L. Christensen & E. O. Kockrow (Eds.). Foundations and adult
health nursing (5th ed.) (pp. 270-314). St. Louis, MO: Elsevier, Mosby
Potter, P.A. & Perry, A.G. (2009). Infection prevention and control. In P.A.
Potter & A.G. Perry (Eds.). Fundamentals of nursing (7th ed.) (pp.
641-685). St. Louis, MO: Elsevier, Mosby
Ramon, P.R. & Niedringhaus, D. M. (2008). Infection control and
asepsis. Fundamental nursing care (2nd ed.) (pp. 149-176). Upper
Saddle River, NJ: Person Prentice Hall