Infection Control

Question 1

Types of Infection

Answer 1

Pathogenic microorganisms cause infection and disease in different ways. Some pathogens produce poisons called toxins, which harm the body. An example is the bacillus that causes tetanus, which produces toxins that damage the central nervous system. Some pathogens cause an allergic reaction in the body, resulting in a runny nose, watery eyes, and sneezing. Other pathogens attack and destroy the living cells they invade. An example is the protozoan that causes malaria; it invades red blood cells and causes them to rupture. Infections and diseases are also classified as endogenous, exogenous, healthcare-associated, or opportunistic.

Question 2

Endogenous

Answer 2

Means the infection or disease originates within the body. These include metabolic disorders, congenital abnormalities, tumors, and infections caused by microorganisms within the body.

Question 3

Exogenous

Answer 3

Means the infection or disease originates outside the body. Examples include pathogenic organisms that invade the body, radiation, chemical agents, electric shock, and temperature extremes.

Question 4

HAI

Answer 4

Health care-associated infection, formerly referred to as nosocomial or hospital-acquired, is an infection acquired by an individual and a healthcare facility such as a hospital or long-term care facility. Healthcare associated infections are usually present in the facility and transmitted by healthcare team members to the patient. Many of the pathogens transmitted in this manner are antibiotic resistant and can cause serious and even life-threatening infections in patients. Common examples are staphylococcus, pseudomonas, and enterococci. Infection control programs are used in healthcare facilities to prevent and deal with HAIs. The infection control professionals that run these programs are called infection preventionists, according to the Association for Professionals in Infection Control and Epidemiology (APIC). Their job is to reduce the incidence of HAIs.

Question 5

Opportunistic infections

Answer 5

Infections that occur when the body’s defenses are weak. These diseases do not usually occur in individuals with intact immune systems. Examples include the development of a yeast infection called candidiasis, Kaposi’s sarcoma (a rare type of cancer), or Pneumocystis carinii pneumonia in individuals who have AIDS.

Question 6

Vaccines

Answer 6

Vaccines are used whenever available to prevent disease. A vaccine stimulates the immune system to produce antibodies, similar to the antibodies made by the body after exposure to a disease. They are made from very small amounts of weak or dead germs that can cause diseases. After getting vaccinated, an individual develops immunity to that disease without having to get the disease first. Vaccinations protect both the individual getting them and the community from the disease. Germs can travel quickly through a community and cause a major outbreak of a disease. If enough people are vaccinated against a certain disease, the germs can’t travel as easily from person to person and the entire Community is less likely to get the disease. This idea is called community immunity.

Question 7

Chain of Infection

Answer 7

• For disease to occur and spread from one individual to another, certain conditions must be met. These conditions are commonly called the chain of infection.
• Healthcare providers must constantly be aware of the parts in the chain of infection. If any part of the chain is eliminated, the spread of disease or infection will be stopped. A healthcare provider who is aware of this can follow practices to interrupt or break this chain and prevent the transmission of disease. It is important to remember that pathogens are everywhere in that preventing their transmission is a continuous process.

Question 8

Infectious agent

Answer 8

A pathogen, such as a bacterium or virus that can cause a disease. This part of the chain of Infection can be prevented by rapid, accurate identification of organisms.

Question 9

Reservoir

Answer 9

• An area where the Infectious agent can live. Some common reservoirs include the human body, animals, the environment, and fomites, or objects contaminated with infectious material that contains the pathogens. Common fomites include doorknobs, bed pans, urinals, linens, instruments, and specimen containers.
• this part of the chain of Infection can be broken by cleaning and sterilizing a blood covered instrument or spraying to destroy mosquitoes.

Question 10

Portal of exit

Answer 10

• A way for the Infectious agent to escape from the reservoir in which it has been growing. In the human body, pathogens can leave the body through urine, feces, saliva, blood, tears, mucus discharge, sexual secretions, and draining wounds.
• this part of the chain of infection can be prevented with thorough washing of the hands and intact, unbroken skin

Question 11

Mode of transmission

Answer 11

• a way that the Infectious agent can be transmitted to another reservoir or host where it can live. The pathogen can be transmitted in different ways. One way is by direct contact, which includes person to person contact (physical or sexual contact) or contact with a body secretion containing the pathogen. Contaminated hands are one of the most common sources of direct contact transmission. Another way is by indirect contact, when the pathogen is transmitted from contaminated substances such as food, air, soil, insects, feces, clothing, instruments, and equipment. Examples include touching contaminated equipment and spreading the pathogen on the hands, breathing in droplets carrying airborne infections, and contacting vectors (insects, rodents, or small animals), such as being bitten by an insect carrying a pathogen.
• a way to eliminate this part of the chain of infection includes thorough washing of the hands, cleaning and sterilizing a blood covered instrument and spraying to destroy mosquitoes.

Question 12

Portal of entry

Answer 12

• a way for the Infectious agent to enter a new reservoir or host. Some ways pathogens can enter the body are through breaks in the skin, breaks in the mucous membrane, the respiratory tract, the digestive tract, the genitourinary tract, and the circulatory system. If the defense mechanisms of the body are intact and the immune system is functioning, a human can frequently fight off the Infectious agent and not contract the disease. Body defenses include: mucous membrane, cilia, coughing and sneezing, hydrochloric acid, tears in the eye, fever, inflammation, and immune response

Question 13

Susceptible host

Answer 13

A person likely to get an infection or disease, usually because body defenses are weak.

Question 14

Aseptic Techniques

Answer 14

• A major way to break the chain of infection is to use aseptic techniques while providing healthcare. Asepsis is defined as the absence of disease producing microorganisms, or pathogens.
• sterile means free from all organisms, both pathogenic and non-pathogenic, including spores and viruses. Contaminated means that organisms and pathogens are present. Any object or area that may contain pathogens is considered to be contaminated. Aseptic techniques are directed toward maintaining cleanliness and eliminating or preventing contamination. Common aseptic techniques include hand washing, good personal hygiene, use of disposable gloves when contacting body secretions or contaminated objects. Proper cleaning of instruments and equipment, and thorough cleaning of the environment.
• various levels of aseptic control are possible. These include antisepsis, disinfection, and sterilization. It is important for the healthcare provider to know and use these methods in every aspect of providing Healthcare to prevent the spread and transmission of disease.

Question 15

Antisepsis

Answer 15

Antiseptics prevent or inhibit growth of pathogenic organisms but are not effective against spores and viruses, they can usually be used on the skin. Common examples include alcohol and Betadine.

Question 16

Disinfection

Answer 16

This is a process that uses chemical disinfectants to destroy or kill pathogenic organisms. It is not always effective against spores and viruses. Disinfectants can irritate or damage the skin and are used mainly on objects, not people. Some common disinfectants are bleach solutions and zephirin.

Question 17

Sterilization

Answer 17

This is a process that destroys all microorganisms, both pathogenic and nonpathogenic, including spores and viruses. Steam under pressure, gas, radiation, and chemicals can be used to sterilize objects. An autoclave is the most common piece of equipment used for sterilization.

Question 18

Bioterrorism

Answer 18

The use of microorganisms, or biologic agents, as a weapons to infect humans, animals, or plants. Throughout history, microorganisms have been used in biologic warfare..

Question 19

Biologic agents

Answer 19

Many different microorganisms can cause diseases in humans, animals, and plants. However, only a limited number are considered to be ideal for bioterrorism. Six characteristics of the “ideal” microorganisms include:
- inexpensive and readily available or easy to produce
- spread through the air by winds or ventilation systems and inhaled into the lungs of potential victims, or spread by ingesting contaminated food or water.
- survives sunlight, drying, and heat
- causes death or severe disability and public panic
- easily transmitted from person to person
- difficult to prevent or has no effective treatment

Question 20

High-Priority Bioterrorism Agents

Answer 20

The Centers for Disease Control and Prevention (CDC) has identified and classified major bioterrorism agents. High priority agents that have been identified include:
-smallpox: a highly contagious infectious disease that is caused by a variola virus. Vaccinations against this were no longer required after many years with no reported cases.
- anthrax: an infectious disease caused by the spores of bacteria called Bacillus anthracis. The spores are highly resistant to destruction and can live in soil for years. Grazing animals such as cattle, sheep, and goats eat the contaminated soil and become infected. Humans develop anthrax by exposure through the skin (cutaneous), by eating undercooked or raw infected meat (gastrointestinal), or by inhaling the spores (pulmonary). Cutaneous and gastrointestinal anthrax are usually treated successfully with antibiotics, but some victims die. Inhalation anthrax causes death in more than 80% of its victims. In anthrax vaccine is available for prevention, and the military has an active vaccination program.
- plague: an infectious disease caused by bacteria called Yersinia pestis. Usually plague is transmitted by the bites of infected fleas. In some cases, the organism enters the body through a break in the skin or by contact with the tissue of an infected animal (bubonic plague). Rats, Rock squirrels, prairie dogs, and Chipmunks are the most common sources of plague in the United states. If the disease is not treated immediately with antibiotics, the infection spreads to the blood and lungs, and causes death. No vaccine for plague is available in the United States.
- Botulism: a paralytic illness caused by a nerve toxin produced by bacteria called Clostridium botulinum. Three main types of botulism exist. one type is caused by eating foods that contain the toxin. A second type is caused by the presence of the toxin in a wound or injury to the skin. A third type occurs in infants who eat the spores that then grow in the intestine and release the toxin. The toxin rapidly causes muscle paralysis. If it is not treated with an antitoxin, the paralysis spreads to the respiratory muscles and causes death.
- Hemorrhagic fever: an infectious disease caused by a filovirus. Two filoviruses have been identified: the Ebola virus and the Marburg virus. The source of these viruses is still being researched, but the common belief is that the viruses are transmitted from animals such as bats, monkeys, and chimpanzees. Once the viruses affect a human, the disease is spread rapidly from person to person by contact with body fluids. Treatment is supportive care with fluid and electrolyte replacement, respiratory support, and management of symptoms.

Question 21

Preparing for Bioterrorism

Answer 21

A bioterrorism attack could cause an epidemic and a public health emergency. Large numbers of infected people would place a major stress on Healthcare facilities. Fear and panic could lead to riots, Social disorder, and disregard for authority. For these reasons, the Bioterrorism Act of 2002 was passed by Congress and signed into law in June 2002. This act requires the development of a comprehensive plan against bioterrorism to increase the security of the United states. Preparing for bioterrorism will involve government at all levels including local regional, state, and national. Some of the major aspects of preparation include:
- community-based surveillance to detect early indications of a bioterrorism attack
- notification of the public when a high risk situation is detected
- strict infection control measures and public education about the measures
- funding for studying pathogenic organisms, developing vaccines, researching treatments, and determining preventive actions.
- strict guidelines and restrictions for purchasing and transporting pathologic microorganisms
- Mass immunization, especially for military, first responders, police, fire department, and healthcare personnel
- increased protection of food and water supplies
- training personnel to properly diagnose and treat infectious diseases
- establishing emergency Management policies
- criminal investigation of possible threats
- improving the ability of healthcare facilities to deal with an attack by increasing emergency department space, preparing decontamination areas, and establishing isolation facilities
- improving communications so information about bioterrorism is transmitted quickly and efficiently

Every healthcare provider must constantly be alert to the threat of bioterrorism. In today’s world, it is likely that an attack will occur. Careful preparation and thorough training can limit the effect of the attack and save the lives of many people.

Question 22

Washing Hands

Answer 22

Hand washing is a basic task required in any Healthcare occupation. An aseptic technique is a method followed to prevent the spread of germs or pathogens. Hand washing is the single most important method used to practice aseptic technique. Hand washing is also the most effective way to prevent the spread of infection. The hands are a perfect medium for the spread of pathogens. Thoroughly washing the hands helps prevent and control the spread of pathogens from one person to another. It also helps protect the healthcare provider from disease and illness.

Question 23

Regular Hand washing

Answer 23

The CDC publishes the results of hand washing research and provides recommendations for hand hygiene. The recommendations call for regular hand washing using plain soap and water for routine cleansing of the hands when the hands are visibly dirty or soiled with blood or other body fluids.

Question 24

Antiseptic Hand Washing

Answer 24

Antiseptic hand washing uses an antimicrobial soap and water. The CDC recommends antiseptic handwashing before invasive procedures, in critical care units, while caring for patients on specific organism transmission based precautions, and in specific circumstances defined by the infection control program of the healthcare facility.

Question 25

Antiseptic Hand Rubs (waterless handwashing)

Answer 25

antiseptic hand rubs are recommended by the CDC if the hands are not visibly dirty or are not soiled with blood or body fluids. Waterless hand cleaning with an alcohol-based gel, lotion, or foam has been proved safe for use during routine patient care. Most waterless hand cleaning products contain at least 60 to 90% alcohol to provide antisepsis and a moisturizer to prevent the drying of the skin. It is important to read the manufacturers instructions before using any product. Usually, a small amount of the alcohol-based cleaner is applied to the palm of the hands. The hands are then rubbed vigorously so the solution is applied to all surfaces of the hands, fingers, nails, and wrists. The hands should be rubbed until they are dry, usually at least 20 to 30 seconds. Most manufacturers recommend that the hands be washed with soap and water after 6 to 10 cleanings with the alcohol-based product. In addition, if the hands are visibly soiled, or if there has been contact with blood or body fluid, the hands must be washed with soap and water.

Question 26

Times for Handwashing

Answer 26

The World Health Organization (WHO) has developed guidelines for handwashing called My 5 Moments for Hand Hygiene. The five essential times for hand washing include:
- before touching a patient
- before a clean or aseptic procedure. - after body fluid exposure or risk of exposure
- after touching a patient
- after touching the patient’s surroundings.
In addition, handwashing should be done:
- when you arrive at the facility and immediately before leaving the facility
- after contact with a patient’s intact skin (ex: after taking blood pressure)
- before moving from a contaminated body site to a clean body site during patient care (for example, before washing the patient’s hands after removing a bed pan)
- anytime the hands become contaminated during a procedure
- before applying and immediately after removing gloves
- anytime gloves are torn or punctured
-before and after handling any specimen
- after contact with any soiled or contaminated item
- after picking up any item off the floor
- after personal use of the bathroom
- after you cough, sneeze, or use a tissue
- before and after any contact with your mouth or mucous membranes, such as eating, drinking, smoking, applying lip balm, or inserting or removing contact lenses

Question 27

Method for Handwashing

Answer 27

The recommended method for hand washing is based on the following principles; they should be observed whenever hands are washed:
- soap is used as a cleansing agent because it aids in the removal of a germs through its sudsy action and alkali content. Pathogens are trapped in the soap suds and rinsed away. Liquid soap from a dispenser should be used whenever possible because bar soap can contain microorganisms.
- warm water should be used. This is less damaging to the skin than hot water. It also creates a better lather with soap than does cold water.
- friction must be used in addition to soap and water. This action helps rub off pathogens from the surface of the skin.
- all surfaces on the hands must be cleaned. This includes the palms, The backs/tops of the hands, and the areas between the fingers.
- fingertips must be pointed downward. The downward direction prevents water from getting on the forearms and then running down to contaminate the clean hands.
- dry paper towels must be used to turn the faucet on and off. This action prevents contamination of the hands from pathogens on the faucet. A dry towel must be used because pathogens can travel more readily through a wet towel.

Nails also harbor dirt and pathogens, and must be cleaned during the handwashing process. An orange/cuticle stick can be used. Care must be taken to use the blunt end of the stick because the pointed end can injure the nail beds. A brush can also be used to clean the nails. If a brush or orange stick is not available or the nails are not visibly dirty, the nails can be rubbed against the palm of the opposite hand to get soap under the nails. Most healthcare facilities prohibit the use of artificial nails or extenders and require that Nails be kept short, usually less than 1/4 inch long. Artificial or long nails can Harbor organisms and increase the risk for infection for both of the patient and healthcare provider. In addition, long nails can puncture or tear gloves.

Question 28

Observing Standard Precautions

Answer 28

To prevent the spread of pathogens and disease, the Chain of Infection must be broken. In 1985, the CDC developed a set of Common Sense practices called a standard precautions to prevent the spread of infection. The standards have been updated frequently. These standards are meant to protect Healthcare providers and patients from disease transmission.

Question 29

Bloodborne Pathogens Standard

Answer 29

One of the main ways that pathogens are spread is by blood and body fluids. Three pathogens of major concern are the hepatitis B virus (HBV), the hepatitis C virus (HCV), and the human immunodeficiency virus (HIV), which causes AIDS. Consequently, extreme care must be taken at all times when an area, an object, or a person is contaminated with blood or body fluids. In 1991, the OSHA, or Occupational Safety and Health Administration, established Bloodborne Pathogen Standards that must be followed by all Healthcare facilities. The employer faces civil penalties if the regulations are not implemented by the employer and followed by the employees. These regulations require all healthcare facility employers to:
- develop a written exposure control plan, and update it annually, to minimize or eliminate employee exposure to bloodborne pathogens.
- identify all employees who have occupational exposure to blood or potentially infectious materials such as semen, vaginal secretions, and other body fluids.
- provide hepatitis B vaccine free of charge to all employees who have occupational exposure, and obtain a written release form signed by any employee who does not want the vaccine.
- provide personal protective equipment (PPE) such as gloves, gowns, lab coats, masks, and face shields in appropriate sizes and in accessible locations.
- provide adequate hand washing facilities and supplies.
- ensure that the work site is maintained in a clean and sanitary condition, follow measures for immediate decontamination of any surface that comes in contact with blood or infectious materials, and dispose of infectious waste correctly.
- enforce rules of no eating, drinking, smoking, applying Cosmetics or lip balm, handling contact lenses, and a mouth pipetting or suctioning in any area that can be potentially contaminated by blood or other body fluids.
- provide appropriate containers that are color coded (fluorescent orange or orange-red) and labeled for contaminated sharps (needles, scalpels) and other infectious or biohazard wastes.
- post signs at the entrance to work areas where there is occupational exposure to biohazardous materials. Label any item that is biohazardous with the red biohazard symbol. The label must show both the symbol and the word biohazard.
- provide a confidential medical evaluation and follow-up for any employee who has an exposure incident. Examples might include an accidental needle stick or the splashing of blood or body fluids on the skin, eyes, or mucous membranes.
- provide training about the regulations and all potential biohazards to all employees at no cost during working hours, and provide additional education as needed when procedures or working conditions are changed or modified.

Question 30

Needlestick Safety Act

Answer 30

In 2001, OSHA revised its Bloodborne Pathogen Standards in response to Congress passing the Needlestick Safety and Prevention Act in the November 2000. This act was passed after the CDC estimated that 600,000 to 800,000 needle sticks occur each year, exposing healthcare workers to bloodborne pathogens. Employers are required to:
- identify and use effective and safer medical devices (ex: syringes with a sliding sheath that Shields at the needle after use, needles that retract into a syringe after use, shielded or retracting catheters that can be used to administer intravenous medications or fluids, and intravenous systems that administer medication or fluids through a catheter port or connector site using a needle housed in a protective covering.)
- incorporate changes in annual updates of the exposure control plan
- solicit input from non-managerial employees who are responsible for direct patient care
- maintain a sharps injury log

Question 31

Standard Precautions

Answer 31

Employers are required to make sure that every employee uses standard precautions at all times to prevent contact with blood or other potentially infectious materials. Standard precautions are rules developed by the CDC to prevent the spread of infection. According to standard precautions, everybody fluid must be considered a potentially infectious material, and all patients must be considered potential sources of infection, regardless of their disease or diagnosis. Standard precautions must be used in any situation where Healthcare providers may contact or be exposed to:
-blood or any fluid that may contain blood
- body fluids, secretions, and excretions, such as mucus, sputum, saliva, cerebrospinal fluid, urine, feces, vomitus, amniotic fluid (surrounding a fetus), synovial (joint) fluid, pleural (lung) fluid, pericardial (heart) fluid, peritoneal (abdominal cavity) fluid, semen, and vaginal secretions.
- mucous membranes
- nonintact skin
- tissue or cell specimens

Question 32

Basic Rules of Standard Precautions

Answer 32

-handwashing: must be washed before and after contact with any patient. If hands or other skin surfaces are contaminated with blood, body fluids, secretions, or excretions, they must be washed immediately and thoroughly with soap and water. If hands are not visibly soiled, and alcohol-based hand cleanser can be used. Hands must always be washed immediately before donning and immediately after removing gloves.
- gloves: gloves must be worn whenever contact with blood, body fluids, secretions, excretions, mucous membranes, tissue specimens, or non-intact skin is possible; when handling or cleaning any contaminated items or surfaces; when performing any invasive procedure; and when performing venipuncture or blood tests. Rings it must be removed before putting on gloves to avoid puncturing the gloves. Gloves must be changed after contact with each patient and even between tasks or procedures on the same patient if there is any chance the gloves are contaminated. Gloves should not be worn out of patient rooms or care areas.
- gowns: must be worn during any procedure that may cause splashing or spraying of blood, body fluids, secretions, or excretions. This helps prevent contamination of clothing or uniforms. Contaminated gowns must be handled according to agency policy and local and state laws. Downs should only be worn once and then discarded. Gowns should not be worn out of patient rooms or care areas. Wash hands immediately after removing a gown.
- Masks and eye protection: masks and protective eyewear or face shields must be worn during procedures that may produce splashes or sprays of blood, body fluids, secretions, or excretions. Examples include irrigation of wounds, suctioning, dental procedures, delivery of a baby, and surgical procedures. This prevents exposure of the mucous membranes of the mouth, nose, and eyes to any pathogens. Masks must be used once and then discarded. In addition, masks should be changed anytime they become moist or wet. They should be removed by grasping the ties or elastic strap. Mask should not be worn out of patient rooms or care areas and should not be left dangling around the neck. Hands must be washed immediately after the mask is removed. Protective eyewear or face shields should provide protection for the front, top, bottom, and sides of the eyes. If I were is not disposable, it must be cleaned and disinfected before it is reused.
- sharps: to avoid accidental Cuts or punctures, extreme care must be taken while handling sharp objects. Whenever possible, safe needles or needless devices must be used. Disposable needles must never be bent or broken after use. They must be left uncapped and attached to the syringe and placed in a leak proof, puncture resistant sharps container. The sharps container must be labeled with a red biohazard symbol. Surgical blades, razors, and other sharp objects must also be discarded in the sharps container. The sharps container must not be emptied or reused. Federal, state, and local laws establish regulations for the disposal of sharps containers.
- spills or splashes: spills or splashes of blood, body fluids, secretions, or excretions must be wiped up immediately. Gloves and must be worn while wiping up the area with disposable cleaning cloths. The area must have then be cleaned with a disinfectant solution such as a 10% bleach solution. Furniture or equipment contaminated by The spill or Splash must be cleaned and disinfected immediately. For large spills, an absorbent powder may be used to soak up the fluid. After the fluid is absorbed, the powder is swept up and placed in an infectious waste container.
- resuscitation devices: mouthpieces or resuscitation devices should be used to avoid mouth to mouth resuscitation. These devices should be placed in convenient locations and to be readily accessible for use. If these devices are not disposable, they must be disinfected between patient use.
- waste and linen disposal: care providers must wear gloves and follow the agency policy developed according to law to dispose of waste and soiled linen. Infectious wastes such as contaminated dressings; gloves; urinary drainage bags; incontinence pads; vaginal pads; disposable emesis basins, bed pans, and urinals; and body tissues must be placed in special infectious waste or biohazard material bags according to law. Other trash is frequently placed in plastic bags and incinerated. The healthcare team member must dispose of waste in the proper container and know the requirements for disposal. Soiled linen should be placed in laundry bags to prevent any contamination. Linen soiled with blood, body fluids, or excretions is placed in a special bag for contaminated linen and is usually soaked in a disinfectant before being laundered. Gloves must be worn while handling any contaminated linen, and any bag containing contaminated linen must be clearly labeled and color coded.
- injuries: any cut, injury, needle stick, or splashing of blood or body fluids must be reported immediately. Agency policy must be followed to deal with the injury or contamination. Every Healthcare facility must have a policy stating actions that must be taken immediately when exposure or injury occurs, including reporting any injury, documenting any exposure incident, recording the caregiving, noting follow-up to the exposure incident, and identifying ways to prevent a similar incident.

Question 33

Using Sterile Techniques

Answer 33

Procedures require the use of sterile techniques to protect the patient from further infection. Surgical asepsis refers to procedures that keep an object or area free from living organisms. While working with sterile supplies, it is important that correct techniques be followed to maintain sterility and avoid contamination. It is also important that you are able to recognize sterile surfaces in contaminated surfaces. In, uncluttered working area is required when working with sterile supplies. A sterile object must never touch a non-sterile object. If other objects are in the way, it is easy to contaminate sterile articles. If sterile articles touch the skin or any part of your clothing, they are no longer sterile. Because any area below the waist is considered contaminated, sterile articles must be held away from and in front of the body and above the waist.
Once a sterile field has been set up (for example, a sterile towel has been placed on a tray), never reach across the top of the field. Microorganisms can drop from your arm or clothing and contaminate the field. Always reach in from either side to place additional articles on the field. Keep the sterile field in constant view. Never turn your back to a sterile field. Avoid coughing, sneezing, or talking over the sterile field because airborne particles can fall on the field and contaminate it. A person must remain alert and honest to properly maintain a sterile field.
The 2-inch border around the sterile field (towel-covered tray) is considered contaminated. Therefore, 2 in around the outside of the field must not be used when sterile articles are placed on the sterile field. All sterile items must be checked carefully before they are used. If the item was autoclaved and dated, most Healthcare facilities believe the date should not be more than 30 days from autoclaving. Follow agency guidelines for time limits. If tears or stains are present on the package, the item should not be used because it could be contaminated. If there are any signs of moisture on the package, it has been contaminated and should not be used.
Organisms and pathogens travel quickly through a wet surface, so the sterile field must be kept dry. If a sterile towel or article gets wet, contamination has occurred. It is very important to use care when pouring solutions into sterile bowls or using solutions around a sterile field.
Make sure the sterile tray is open and you are ready to do the sterile procedure before putting the sterile gloves on your hands. Sterile gloves are considered sterile on the outside and contaminated on the inside. Once they have been placed on the hands, it is important to hold the hands away from the body and above the waist to avoid contamination. Handle only sterile objects while wearing sterile gloves. If at any time during a procedure there is any suspicion that you have contaminated any article, start over. Never take a chance on using contaminated equipment or supplies.

Question 34

Techniques for Removing Articles

Answer 34

Various techniques can be used to remove articles from sterile wraps, depending on the article being unwrapped. Some common techniques are the drop, mitten, and transfer-forceps techniques:
- drop technique: this technique is used for gauze pads, dressings, and small items. The rapper is partially opened and then held upside down over the sterile field. The item drops out of the wrapper and onto the sterile field. It is important to keep fingers back so the article does not touch the skin as it falls out of the wrapper. It is also important to avoid touching the inside of the wrapper.
- mitten technique: this technique is used for bowls, drapes, linen, and other similar items. The rapper is opened and it’s a loose ends are grasped around the wrist with the opposite hand. In this way, a mitten is formed around the hand that is still holding the item. With the mitten hand, the item can be placed on the sterile tray.
- transfer forceps: these are used for cotton balls, small items, or articles that cannot be removed by the drop or mitten techniques. Either sterile gloves or sterile transfer forceps are used. Sterile transfer forceps or pickups are removed from their container of disinfectant solution and used to grasp the article from the open package. This item is removed from the opened, sterile wrap and placed on the sterile field. The transfer forceps must be pointed in a downward direction. If they are pointed upward, the solution will flow back to the handle, become contaminated, and return to contaminate the sterile tips when they are being used to pick up items. In addition, care must be taken not to touch the sides or rim of the forceps container while removing or inserting the transfer forceps. Also, the transfer forceps must be shaken gently to get rid of excess disinfectant solution before they are used.

Question 35

Communicable disease

Answer 35

Some diseases are communicable and require isolation. A communicable disease is caused by a pathogenic organism that can be easily transmitted to others.

Question 36

Epidemic

Answer 36

An epidemic occurs when the communicable disease spreads rapidly from person to person and affects a large number of people at the same time.

Question 37

Pandemic

Answer 37

A pandemic exists when the outbreak of a disease occurs over a wide geographic area and affects a high proportion of the population. Because individuals can travel readily throughout the world a major concern is that worldwide pandemics will become more and more frequent.

Question 38

Transmission-based precautions

Answer 38

• transmission based precautions are a method or technique of caring for patients who have communicable diseases. Examples of communicable diseases are tuberculosis, wound infections, and pertussis or whooping cough. Standard precautions do not eliminate the need for specific transmission-based precautions. Standard precautions are used on all patients. Transmission based precautions are used to provide extra protection against specific diseases or pathogens to prevent their spread.
• communicable diseases are spread in many ways. Some examples include direct contact with the patient; contact with dirty linen, equipment, and/or supplies; and contact with blood, body fluids, secretions, and excretions such as urine, feces, droplets, and discharges from wounds. Transmission based precautions are used to limit contact with pathogenic organisms. These techniques help prevent the spread of the disease to other people and protect patients, their families, and Healthcare providers.
• the type of transmission based precautions used depends on the causative organism of the disease, the way the organism is transmitted, and whether the pathogen is antibiotic resistant. Personal protective equipment or PPE is used to provide protection from the pathogen. Some transmission based precautions require the use of gowns, gloves, face shields, and masks, while others require the use of only a mask.
• two terms are extensively used in transmission based precautions: contaminated and clean. These words refer to the presence of organisms on objects.
• contaminated, or dirty, means that objects contain disease producing organisms. These objects must not be touched unless the healthcare provider is protected by gloves, gown, and other required items. The outside and waist ties of the gown, protective gloves, and mask are considered contaminated.
• clean means that objects or parts of objects do not contain disease producing organisms and therefore have minimal chance of spreading the disease. Every effort must be made to prevent contamination of these objects or parts of objects. The insides of the gloves and gowns are clean, as are the neck band, it’s ties, and the mask ties.
• the CDC in conjunction with the National Center for Infectious Diseases (NCIS) and the Hospital Infection Control Practices Advisory Committee (HICPAC) has recommended four main classifications of precautions that must be followed: standard, airborne, droplet, and contact. Healthcare facilities are provided with a list of infections / conditions that shows the type and duration of precautions needed for each specific disease. In this way, facilities can follow the guidelines to determine the type of transmission based isolation that should be used along with the specific precautions that must be followed.

Question 39

Standard Precautions

Answer 39

Use on all patients. In addition, a patient must be placed in a private room if the patient contaminates the environment or does not or cannot be expected to assist in maintaining appropriate hygiene. Every healthcare provider must be well informed about standard precautions and must follow the recommendations for the use of gloves, gowns, and face masks when conditions indicate their use.

Question 40

Airborne Precautions

Answer 40

Airborne precautions are used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nuclei. These are small particles of evaporated droplets that contain microorganisms and remain suspended in the air or on Dust particles. Examples of diseases requiring these isolation precautions are rubella (measles), varicella (chicken pox), tuberculosis, coronavirus, and severe acute respiratory syndrome or SARS. Standard precautions are used at all times. In addition, the following precautions must be taken:
- the patient must be placed in an airborne infection isolation room (AIRR), and the door should be kept closed.
- air in the room must be discharged to outdoor air or filtered before being circulated to other areas.
- each person who enters the room must wear respiratory protection in the form of an N95, P100, or more powerful filtering mask such as a high efficiency particulate air (HEPA) mask. These masks contain special filters to prevent the entrance of the small airborne pathogens.
- people susceptible to measles or chickenpox should not enter the room.
- if at all possible, the patient should not be moved from the room. If transport is essential, however, the patient must wear a surgical mask during transport to minimize the release of droplets into the air

Question 41

Droplet Precautions

Answer 41

Droplet precautions must be followed for a patient known or suspected to be infected with pathogens transmitted by large particle droplets expelled during coughing, sneezing, talking, or laughing. Examples of diseases requiring these isolation precautions include Haemophilus influenzae meningitis and pneumonia; Neisseria meningitis and pneumonia; multi-drug resistant streptococcus meningitis, pneumonia, sinusitis, and otitis media; diphtheria; Mycoplasma pneumonia; pertussis; adenovirus; mumps; and severe viral influenza. Standard precautions are used at all times. In addition, the following precautions must be taken:
- the patient should be placed in a private room. If a private room is not available and the patient cannot be placed in a room with a patient who has the same infection, a distance of at least 3 ft should separate the infected patient and other patients or visitors.
- masks must be worn when entering the room
- if transport or movement of the patient is essential, the patient must wear a surgical mask.

Question 42

Contact Precautions

Answer 42

Contact precautions must be followed for any patients known or suspected to be infected with epidemiological (capable of spreading rapidly from person to person, an epidemic) microorganisms that can be transmitted by either direct or indirect contact. Examples of diseases requiring these precautions include any gastrointestinal, respiratory, skin, or wound infections caused by multi-drug resistant organisms; diapered or incontinent patients with enterohemorrhagic E. coli, Shigella, hepatitis A, or rotavirus; viral or hemorrhagic conjunctivitis or fevers; and any skin infections that are highly contagious or that may occur on dry skin, such as diphtheria, herpes simplex virus, impetigo, pediculosis (head or body lice), scabies, and staphylococcal infections. Standard precautions are used at all times. In addition, the following precautions must be taken:
- the patient should be placed in a private room or, if a private room is not available, in a room with a patient who has an active infection caused by the same organism.
- gloves must be worn when entering the room
- loves must be changed after having contact with any material that may contain high concentrations of the microorganism, such as a wound drainage or fecal matter
- gloves must be removed before leaving the room, and the hands must be washed with an antimicrobial agent
- a gown must be worn in the room. The gown must be removed before leaving the room and care must be taken to ensure that clothing is not contaminated after gown removal.
- movement and transport of the patient from the room should be for essential purposes only
- the room and items in it must receive daily cleaning and disinfection as needed
- if possible, patient care equipment (stethoscope, thermometer) should be left in the room and used only for this patient. If this is not possible, all equipment must be cleaned and disinfected before being used on another patient.

Question 43

Ebola Virus Disease (EVD) Precautions

Answer 43

The first Ebola outbreak to reach epidemic proportions occurred in West Africa in 2014. In October of 2014, the CDC formulated more stringent infection control guidelines to be used when caring for patients with confirmed or suspected Ebola virus disease. These guidelines call for strict enforcement of standard, contact, and a droplet precautions. The patient is to be placed in an airborne infection isolation room (AIIR) with restricted visitation. Medical equipment is dedicated to the patient whenever possible. The use of needles and blood draws are limited necessity only. In addition, personal protective equipment is a high priority. Intense and repeated training must be done to ensure that the correct PPE is used in that it is put on (donned) and taken off (doffed) properly. The proper order and procedure for donning and doffing is essential. The guidelines require a second trained staff member to supervise the donning and the doffing of the PPE at all times. The PPE must cover all of the skin, head, neck, body, and feet. A powered air purifying respirator (PAPR) or a N95 respirator (at a minimum) must be worn at all times. Double gloves should be worn when in direct contact with the patient. Diligent hand hygiene is essential. A separate room or area should be designated for donning and doffing of the PPE. All precautions must be followed by anyone providing care to an infected or suspected patient who has EVD.

Question 44

Protective or Reverse Isolation

Answer 44

Protective or reverse isolation refers to methods used to protect certain patients from organisms present in the environment. Protective isolation is used mainly for immunocompromised patients, or those whose body defenses are not capable of protecting them from infections and disease. Examples of patients who require this protection are patients whose immune systems have been depressed before receiving transplants, patients who are severely burned, patients receiving chemotherapy or radiation treatments for cancer, or patients whose immune systems have failed. Precautions vary depending on the patient’s condition. Standard precautions are used at all times. In addition, the following precautions may be taken:
- the patient is usually placed in a room that has been cleaned and disinfected
- frequent disinfection occurs while the patient occupies the room
- anyone entering the room must wear clean or sterile gowns, gloves, and masks
- all equipment or supplies brought into the room are clean, disinfected, or sterile
- special filters may be used to purify the air that enters the room
- every effort is made to protect the patient from microorganisms that cause infection or disease