Chapter 23 - Preventing Infection

Question 1

Infection

Answer 1

• Infection is a serious safety and health hazard.
• The health team follows certain practices and procedures to prevent the spread of infection.
  > Called infection control – practices and procedures that protect clients, residents, visitors, and staff from infection.

Question 2

Micro-organisms

Answer 2

• A micro-organism (microbe) is a small living plant or animal seen only with a microscope.
  > Microbes are everywhere.
  > Some microbes are harmful and can cause infections.
  > They are called pathogens.
  > Non-pathogens are microbes that do not usually
  cause an infection.

There are 4 major types of microbes:
> Bacteria are one-celled microbes
> Viruses invade living cells in order to grow and
multiply
> Fungi are microbes that live on organic matter, such
as plants or animals
>Parasites are organisms that derive nourishment and
protection from other living organisms, known as hosts

Requirements of microbes
- Microbes need a reservoir (host) to live and grow.
> Microbes need water and nourishment from the
reservoir.
> Most need oxygen to live.
> A warm and dark environment is needed.
> Most grow best at body temperature.
> They are destroyed by heat and light.

Normal flora
- Microbes that live and grow in a certain area.
- They are non-pathogens when in or on a natural
reservoir.
- When a non-pathogen is transmitted from its natural
site to another site or host, it becomes a pathogen.

Question 3

– Micro Organisms –

Multidrug-resistant organisms (MROs)

Answer 3

• Microbes that can resist the effects of antibiotics.
  Antibiotics are drugs that kill microbes that cause infections.
• MROs are caused by:
  > Doctors prescribing antibiotics when they are not
  needed (over-prescribing)
  > Patients not taking antibiotics for the length of time
  prescribed

Two common types of MROs are resistant to many antibiotics:
> Methicillin-resistant Staphylococcus aureus (MRSA)
> Vancomycin-resistant Enterococcus (VRE)
> Box 20-1: MRSA and VRE (p. 356)

Question 4

Infection

Answer 4

Infection is a disease state resulting from the invasion and growth of microbes in the body.
> A local infection is in a body part.
> A systemic infection involves the whole body.

3 possible outcomes of exposure to pathogens:
> Immune system destroys pathogen
> Immune system does not destroy pathogen, but no
infection develops
> An infection develops after exposure to the pathogen

Question 5

Health care-associated infection (HAI)

Answer 5

• An infection that develops in a client cared for in any setting where health care is given.
• HAIs also are called nosocomial infections.
• HAIs are caused by:
  > Normal flora
  > Microbes transmitted to the client from another
  source

Question 6

Common HAI infections are:

Answer 6

• Urinary tract infections
• Respiratory system (colds, pneumonia, bronchitis, flu)
• Gastrointestinal system (nausea, diarrhea)
• Skin (wound or IV site infections)

Question 7

HAIs are prevented by:

Answer 7

• Medical asepsis, including hand hygiene
• Isolation precautions
• Surgical asepsis

Question 8

H1N1 Virus and New Strains

Answer 8

• H1N1 flu virus is contagious and is spread the same way as regular seasonal flu
• Not possible to catch the disease by eating pork or through blood transfusions
• Main symptoms are fever and cough

Question 9

Chain of Infection

Answer 9

• Pathogen
• Reservoir
• Portal of exit
• Mode of transmission
• Portal of entry
• Susceptible host

Question 10

Vaccinations

Answer 10

• Proven to prevent serious communicable illnesses
• Health care agencies require workers to have their routine vaccinations up to date before they start work
• Hep B vaccination is recommended for all those working in health care settings
• Yearly influenza vaccination is highly recommended
• New staff and residents of long-term care facilities are required to have a two-step TB skin test

Question 11

Medical Asepsis

Answer 11

• Sterile means the absence of all microbes.
  > Pathogens and non-pathogens
• Sterilization is the process of destroying all microbes.
• Contamination is the process of becoming unclean.
  > In medical asepsis, an item or area is clean when it is
  free of pathogens.
  > A sterile item or area is contaminated when
  pathogens or non-pathogens are present.
• Aseptic practices break the chain of infection.

Question 12

Hand Hygiene

Answer 12

• Hand hygiene is the easiest and most important way to prevent the spread of infection.
• Practice hand hygiene before and after giving care.
  > Using waterless, alcohol-based sanitizers, or
  handwashing with soap and water
• Wearing gloves
  > Provide a protective barrier between your hands and
  client’s blood, body fluids, secretions, excretions, non-
  intact skin, and mucous membranes
  > Gloves are additional protection, and not a substitute
  for hand hygiene

Question 13

Care of Supplies & Equipment

Answer 13

Cleaning
- Reduces the number of microbes present and removes organic matter.

Disinfection

• Process of destroying pathogens. Spores are not destroyed.
• Germicides are disinfectants applied to skin, tissues, and non-living objects.
• Chemical disinfectants are used to clean surfaces.

Sterilization

• Destroys all non-pathogens and pathogens, including spores.
• Very high temperatures are used.

Question 14

Isolation Precautions

Answer 14

• Blood, body fluids, secretions, and excretions can transmit pathogens.
  > Sometimes barriers are needed to prevent their escape.
• Isolation Precautions are guidelines to prevent the spread of communicable diseases (contagious diseases).
• Two types:
  > Standard Practices (Routine Precautions)
  > Transmission-Based Precautions
• Standard Practices:
  > Also called Routine Practices, or Standard Precautions
  > Reduce the risk of spreading pathogens
  > Reduce the risk of spreading known and unknown
  infections
  > Are used for all persons whenever care is given

Standard Practices (cont’d):
> Prevent the spread of infection from:
- Blood
- All body fluids, secretions, and excretions (except
sweat) even if blood is not visible
- Non-intact skin (skin with open breaks)
- Mucous membranes (including in the nose, eyes,
mouth, vagina, and rectum)

Transmission-Based Precautions
➢3 types: airborne, droplet and contact precautions
➢Guidelines to contain pathogens in one area (usually the client’s room)
➢You will be told when Transmission-Based Precautions are ordered for a client
➢Client usually placed in private or semi-private room to isolate his/her germs from infecting others
•Box 20-8: General Rules for Transmission-Based Precautions (p. 378)

Protective measures
➢Isolation Precautions involve wearing personal protective equipment (PPE).
➢Removing linens, trash, and equipment from the room may require double bagging.
➢Follow agency procedures when collecting specimens and transporting persons.

Question 15

Protective Apparel

Answer 15

➢Gloves
•Wear gloves whenever contact with blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin is likely.
➢Gowns and other attire protect your clothes and body from contact with blood, body fluids, secretions, and excretions.
•They protect against splashes and sprays.
•Gowns must completely cover you from your neck to your knees.
•Gowns are used once.
•A wet gown is contaminated.
•Disposable gowns are discarded after use.

Masks are worn for these reasons:
➢For protection from contact with infectious agents from the client or resident
➢During sterile procedures to protect the client from infectious agents carried in your nose or mouth
•Tuberculosis respirators are worn when caring for clients with tuberculosis (TB).
•It is your responsibility to be fitted for the correct type of mask and to wear it properly, following employer policy.

Goggles and face shields protect your eyes, mouth, and nose from splashing or spraying of blood, body fluids, secretions, and excretions.
➢The front of goggles or a face shield is contaminated.
➢Discard disposable goggles or face shields after use.
➢Reusable eyewear is cleaned before reuse following your employer’s procedures.

Question 16

Disposing of Sharps

Answer 16

-You may come across needles that are improperly disposed of
•Especially common in home care settings
•Used needles must not be bent or broken
•Never ignore a sharps injury- treat and report!
•Place into a container that is:
     ➢Tightly capped
     ➢Puncture-resistant
     ➢Leak proof

Question 17

Bagging Items

Answer 17

Contaminated items are bagged to remove them from the person’s room.
➢Leak-proof plastic bags are used.
➢Bags have the BIOHAZARD symbol.
➢Biohazardous waste is items contaminated with blood, body fluids, secretions, or excretions.
➢Trash is placed in a container labeled with the BIOHAZARD symbol.
➢Double bagging is not needed unless the outside of the bag is soiled.
•Transporting procedures for persons on Transmission-Based Precautions vary among employers.
•A safe transport means that other persons are protected from the infection.

Question 18

Basic Needs and Transmission-Based Precautions

Answer 18

➢Meeting basic needs
•Often love, belonging, and self-esteem needs are unmet when Transmission-Based Precautions are used.
•Visitors and staff often avoid the person.
•The person may feel lonely, unwanted, and rejected.

➢You can help meet love, belonging, and self-esteem needs.
•Always treat the person with respect, kindness, and dignity.

Question 19

Surgical Asepsis

Answer 19

Surgical asepsis (sterile technique) is the practices that keep equipment and supplies free of all microbes.
➢Sterile means the absence of all microbes, including spores.
•Surgical asepsis (sterile technique) is required any time the skin or sterile tissues are entered.

➢If a break occurs in sterile technique, microbes can enter the body.
➢Infection is a risk

➢Principles of surgical asepsis
•All items in contact with the client are kept sterile.
•A sterile field is needed.
•A sterile field is a work area free of all pathogens and nonpathogens (including spores).

➢You might need sterile gloves when assisting with a sterile procedure.
•The sterile field is set up first. Then sterile gloves are put on.
•After sterile gloves are on, you can handle sterile items within the sterile field.
•Do not touch anything outside the sterile field.