Week 1: IPAC Flashcards
IPAC
policies/procedures designed to prevent transmission of organisms between EVERYONE entering a facility
Health Care-Associated /
Hospital-Acquired Infection /
Nosocomial Infection
Infection related to care, rather than something associated with why the patients came in.
Examples:
- SSI
- IV infection
- catheter-associated urinary tract infection (CAUTI)
- VAP (ventilator-associated pneumonia)
- central line-associated blood stream infection (CLABSI)
- C.difficile (diarrhea)
- Influenza/resp viruses
- Antibiotic resistant organisms (AROs) (MRSA, VRE, CRE)
People most at risk for HAIs and why
Older persons are most at risk to HAIs due to age, chronic disease, longer hospital stays, and possible prevalence of invasive procedures and multiple care providers
Cost of HAI on health system
$25K
Chain of Transmission (6)
How an infectious agent moves from one person to another
- Infectious Agent
- Reservoir
- Portal of exit
- Mode of transmission
- Portal of entry
- Susceptible host
Infectious Agent (pathogen)
Examples: Bacteria Viruses Parasites Fungi
Pathogenic
an organism that can cause disease (not all organisms are pathogenic)
Resovoir
Place where the agent lives and may or may not multiply
Examples: • Humans • Animals • Environment • Food
Portal of Exit
Where the agent leaves the reservoir
Examples:
- Resp tract
- GI tract
- Wound/open skin
Mode of Transmission
How the agent moves through the environment
- Direct contact: contact with an infected person
- Indirect contact: contact from touching a contaminated surface
Examples:
-Droplet: respiratory or AGMP, heavy and fall down onto a surface (1-6 feet)
- Airborne: particles that are smaller and can travel through the air (5-160+ feet)
- Vector: i.e. insect
- Parenteral: penetration from medical instrument (needle)
- Vehicle: e.g., contaminated multi-use vial like insulin (shared meds)
Portal of Entry
How the agent moves into another person’s body (host)
Examples:
- Resp tract
- Mucous membranes on face (eyes, nose, mouth)
- GI tract (contaminated food)
- Wound/open skin
Susceptible Host
Person who gets sick and is able to get sick at different levels of susceptibility: • Immunosuppression • Age • Comorbidities • open skin • poor nutrition • Stress /fatigue
Note: Agent could enter a host, but if the host is not susceptible (i.e. vaccine), the agent may not infect the patient.
Stages of an infectious process (4)
- Incubation Period
- Prodomal Stage
- Illness Stage
- Convalescent Period
Incubation Period
Time between pathogen entering the body and the appearance of symptoms
Prodomal Stage
The time between nonspecific symptoms (malaise, low fever, etc.) and more specific symptoms – the organisms are growing during this time and patient is quite infectious
Illness stage
Interval where the patient shows specific signs and symptoms to the illness/pathogen
Convalescent Period
Interval when the acute symptoms disappear and the body is trying to return to normal
Recovery can take several days to months depending on severity of illness and patient factors
Routine Practices (definition and examples)
The things that we do all the time, for every patient no matter what we know or don’t know about them, to protect them, other people, and ourselves. In other words, things we do consistently to break the chain of transmission
- Hand Hygiene
- PPE
- Environmental management (laundry, cleaning, waste, etc.)
- Aseptic Non-Touch Technique (ANTT)
Components of effective Hand Hygiene (2)
- Killing or removing microorganisms on the hands:
- sanitizer (preferred)
- soap and water (for messes) - Maintaining good skin integrity
The “4 Moments for Hand Hygiene”
- Before you enter the patient environment
- Immediately before aseptic procedure
- After body fluid exposure
- After exiting patient environment
When to use Personal Protective Equipment (PPE) (4)
- Blood/body fluids
- Non-intact skin
- Mucous membranes
- Contaminated equipment and surfaces
Types of PPE (5)
- Gloves
- Gown (for spills)
- Face protection (masks and face shields)
- Bouffant
- Goggles
Considerations for PPE (3)
- Make sure it fits properly
- Avoid self-contamination when using or removing PPE
(Use the “dirty to clean” concept) - Removing PPE is a risk to HCP, so more is not always better (the more you wear, the more you take off)
Risk Assessment
To determine what PPE you need to use
- What is the task I am going to perform?
- What is the risk of exposure to hazards
- How experienced am I at performing this task?
- How cooperative will the patient be while I perform this task?
Sterile vs. Clean
Sterile (surgical asepsis) = Free from all microorganisms. Very hard to achieve outside of the OR or other controlled environments… unrealistic
Clean (medical asepsis): Free from marks and stains, dirt - Not a satisfactory standard
Asepsis
Free from pathogenic organisms in sufficient numbers to cause infection
Core components of ANTT (6)
- Identify key parts of equipment (i.e. needle) and sites (wound, insertion site) on the patient and ensure they are as clean as possible
- Hand hygiene
- Non-touch technique
- Use sterile equipment (or scrubbed)
- DO NOT TOUCH key parts/sites
- Learn how to sequence practice to ensure efficient, logical, and safe order of tasks
Non-touch technique
Sterile objects must not touch non-sterile objects (clean is not sterile) or will become contaminated
Principles of Surgical Asepsis (8)
- All sterile objects must be kept in sterile field and in VIEW
- Sterile objects must not touch non-sterile objects
- Sterile surfaces and objects must remain DRY
- Prolonged exposure to airborne microorganisms = contamination
- Fluid flows in direction of gravity
- Skin is considered unsterile
- Edges of a sterile field are considered contaminated (2.5cm border)
- Conscientiousness, alertness and honesty are essential qualities in maintaining surgical asepsis. They are what we call the “infection-control conscience”
Additional Precautions (3)
Required when patients are infected or colonized with a known infectious agent OR when patients have symptoms of an infectious disease
- Contact Precautions
- Droplet Precautions
- Airborne Precautions + AGMPs
Antibiotic Resistant Organisms (AROs)
Spread by direct AND indirect
- MRSA: Methicillin-resistant Staphylococcus aureus MRSA
- VRE: Vancomycin-resistant Enterococci VRE
- ESBLs: Extended-spectrum beta lactamase-producing organisms (e.coli, etc.)
- CPE: Carbapenemase-producing Enterobacteriaceae (lives in the bowels)
- Candida auris (fungus)
Colonization
Someone has microorganisms in or on their body that cause no symptoms, but can be transferred to others.
Treatment is NOT required, but managed on APs.
Infection
Clinical signs of illness or inflammation that is due to tissue damage from microorganisms invasion
Treatment IS required, in addition to APs.
