Week 2 - Infection Prevention & Control Flashcards
1
Q
What does HAI stand for?
A
Health care associated infections
2
Q
What are HAI?
A
Infections the patient did not have but picked up at health care
3
Q
True or false?
1/9 patients admitted to Canadian hospitals acquire an infection as a consequence of their hospital stay
A
True
- Health care associated infections were the 11th leading cause of death two decades ago
- But are now the fourth leading cause of death for Canadians
4
Q
What are the factors affecting infection risk?
A
Age
Nutrition and protein intake
Stress
Chronic disease
Medical therapies/immunosuppression
5
Q
How does age affect infection risks?
A
Age
- Infants and older adults at increased risk b/c they don’t have great immunity
6
Q
How does nutrition & protein intake affect infection risks?
A
Nutrition and protein intake
- To have the ability to fight off infections
7
Q
How does stress affect infection risks?
A
Stress
- Hormones released (cortisone) decrease inflammatory responses; prolonged stress decreases resistance to infection
8
Q
How does chronic disease affect infection risks?
A
Chronic disease
- Immune system (leukemia, AIDS)
- Burns
- Open wounds
- Peripheral vascular disease
- Damage of BVs in hands, feet, face, etc
- Emphysema
- Can’t cough & clear things out
- Bronchitis
- Can’t take deep breaths
9
Q
How does medical therapies/immunosuppression affect infection risks?
A
Medical therapies/immunosuppression
- Chemotherapy
- Cancer treatment: will also wipe out all fast growing cells in the immune system
- Radiation
- Organ transplants
- Taking medication to suppress immune system to avoid body not getting used to the new organ thus immune system is very weak
- Steroid (anti-inflammatory) therapy
- Surgery
- Can’t take deep breaths
10
Q
What are defenses against infection?
A
Immune response protects the body by neutralizing pathogen and repairing damaged body cells
Specific protection against pathogens
- Antibodies
Non-specific protection:
- Normal flora help fight infection and maintain homeostasis
- Body systems defences (eg. skin, saliva, respiratory cilia, gastric acid)
11
Q
What is an inflammation?
A
Inflammation: vascular reaction delivers fluid, blood products, nutrients & immune cells to area of tissue injury
12
Q
What is the cycle of the chain of infection?
A
Infectious agent
Reservoir
- Right pH, temp
- Most organisms like dark, moist, damp
Portal of exit
- Openings on body
Mode of transmission
- Airborne
- Common vehicle
- Physical contact
Portal of entry
- Similar to portal of exit
Host
- Factors can increase the risk
13
Q
Give some examples of infectious agent
A
Microorganisms such as bacteria, viruses, fungi, and protozoa cause infection.
14
Q
What does the spread of infectious agent depend on?
A
– Number
– Virulence (ability to cause disease)
– Entry and survival in host
– Susceptibility of host
15
Q
What is a reservoir?
A
Place where a pathogen can survive or grow
16
Q
What are the 6 factors that pathogen requires to be appropriate in order to survive?
A
Food
Oxygen
Water
Temperature
pH
Minimal light
17
Q
What is the most common reservoir for a pathogen?
A
The human body
18
Q
What does it mean to be colonized? Think in terms of infections
A
“Colonized”
pathogen is present, does not cause disease
- Common for ppl in health care
- Can still transfer the disease to other ppl
19
Q
What does it mean to be carriers? Think in terms of infections
A
“Carriers”
animals or persons who show no symptoms, but disease may be transferable
- carrier of Hepatitis B without the symptoms
20
Q
What is the portal of exit?
A
Path away from the reservoir
- Required in order to enter another host
- Natural (eg. mouth, nares) and artificial openings (eg. catheters
21
Q
What are the 5 ways of transmission?
A
- Contact: direct & indirect
- Droplet
- Airborne
- Vehicle-common contaminated source
- Vectorborne
Some organisms can be spread in more than one way (chicken pox, influenza)
22
Q
How does airborne transmission work?
A
Airborne
- Can float & travel
- Can not control
- Distance does not matter
- eg. chicken pox
23
Q
How does droplet transmission work?
A
Droplet
- Wet particles carrying bacteria
- Only go/travel maximum of 6 feets (only heavy enough for 6 feets)
24
Q
How does contact transmission work?
A
Contact
- Direct
- Indirect
- Can still be through touch
- Can be a third person (eg. person A transferred to person C then person C gives it to person B)
25
What are vectorborne transmission?
Through insects or animals
26
Give some examples of portal of entry
Path into the host
GI tract
Mucous membranes
Respiratory tract
Broken skin
Genitourinary tract
Can all also be portal of exit
27
What is the meaning of susceptibility?
- Patient’s resistance to the pathogen
28
What does a patient's susceptibility depend on?
- Antibiotic resistance
- If a person is immunocompromised
- Age
- Nutrition
- Stress
- Chronic disease
- Medical therapy
- Immunizations and actual contraction of the disease
29
What are the 2 purposes of infection control?
1. Protecting patients from acquiring infections
2. Protecting health care workers from becoming infected
30
How to break the chain of transmission at:
Infectious agent
- Cleaning
- Disinfection
- Sterilization
- Antimicrobial therapy
- Antibiotics cleaning
31
How to break the chain of transmission at:
Reservoirs
- Engineering controls
- Environmental cleaning/disinfection
- Proper food storage
- Water treatment
- Air filters
32
How to break the chain of transmission at:
Portal of exit
- Hand hygiene
- Disposal of waste and contaminated linen
- Control of excretions and secretions
33
How to break the chain of transmission at:
Modes of transmission
- Avoid patient sharing of bedpans, urinals, bath basins, and eating utensils
- Spatial separation or social distancing
- Ensuring a sheath over thermometer probe
- Soiled items, linens and equipment – hold them away from your body
- Appropriate cleaning, sterilization and disinfection of equipment and supplies
- Engineering controls
- Hand hygiene
- Environmental sanitation
- PPE
- Heating/streaming, cleaning
- One time used, single packaged
34
How to break the chain of transmission at:
Portals of Entry
- Hand hygiene
- Aseptic technique
- Wound care, catheter care
- Don’t talk, sneeze, cough into patient’s face or over wounds or sterile field
- Careful handling of blood, body fluids, secretions, or excretions
- Don’t splash
- Handle with gloves, masks, gowns, and protective eyewear if splashing or more contact anticipated
- Dispose of contaminated objects safely
- Maintaining integrity of the skin
- Frequent oral hygiene
- Decreasing risk for needle stick injuries
- Proper handling and maintenance of drains, catheters, venous access devices
- Cleaning wounds and surgical sites
- PPE
35
How to break the chain of transmission at:
Susceptible Host
- Protecting normal defense mechanisms
- Immunization
- Encourage routine coughing and deep breathing (no deep breaths will increase risk of respiratory infections)
- Encourage oral fluid intake
- Regular bathing
- Recognition of high-risk patients
- Treatment
- Maintaining healing processes
- Assist in stress relief
- Encourage well-balanced diet
36
Breaking the chain at reservoir & portal of exit
Control or eliminate places that would harbour infections
- Eg. Take good deep breaths after injury
Discard contaminated objects when possible (eg. needles)
Change dressings that become wet or soiled
Keep patient clean and dry of drainage, perspiration and secretions
Keep bedside area clean and dry
Wear PPE, cover coughs & sneezes
Hand hygiene
37
When to apply routine precautions?
Routine Precautions- apply when the healthcare worker is potentially exposed to (applies to ALL patients):
- Blood
- Body fluids, secretions, excretions
- Nonintact skin
- Mucous membranes
38
Who should be applied routine precautions?
ALL patients
39
When to apply additional precautions?
Applied to contain pathogens to one room and prevent spread.
40
What are routine practices?
Routine practices are practices designed to care for all patients in any setting, regardless of their diagnosis or presumed infectiousness.
41
What are routine practices applied for?
Applies for any actual or potential exposure to blood, body fluids (secretions and excretions), non-intact skin, or mucous membranes
If there are any potential then wear PPEs
42
What does routine practices include and involve?
Includes proper use of gowns, gloves, masks, eyewear
Involves hand hygiene, proper disposal of linens and sharps, cleaning/disinfecting/sterilizing equipment
43
What is the role of the nurse in breaking the chain of transmission?
Education re: occurrence and prevention of infection
Remind visitors to limit contact with patients and avoid areas that may be more susceptible to infections (eg. wounds)
Proper disposal of contaminated equipment
Protocols for handling equipment and supplies
44
What is the #1 way to break the chain of infection?
Hand hygiene
45
When are the 4 moments for hand hygiene?
1. Before initial patient/patient environment contact
2. Before aseptic procedure
3. After body fluid exposure risk
4. After patient/patient environment contact
- Before preparing, handling, serving or eating food
- After personal body functions
- Before putting on and after taking off gloves
- Whenever a health care provider is in doubt about the necessity for doing so
46
How to clean hands properly?
- rub all parts of the hands with an alcohol-based hand rub or soap and running water.
- pay special attention to fingertips, between fingers, backs of hands and base of the thumbs.
- Keep nails short and clean
- Remove rings and bracelets
- Do not wear artificial nails
- Remove chipped nail polish
- Make sure that sleeves are pushed up and do not get wet
- Clean hands for a minimum of 15 seconds
- Dry hands thoroughly
- Apply lotion to hands frequently (avoid skin break down)
47
What are the 2 methods to cleaning hands?
Alcohol-based hand rub
Hand washing with soap and running water
48
What is the preferred method for cleaning hands?
Alcohol-based hand rub
It is better than washing hands (even with antibacterial soap) when hands are not visibly soiled.
49
When must handwashing with soap and running water be done?
Must be done when hands are visibly soiled
- If running water is not available, use moistened towelettes to remove the visible soil, followed by alcohol-based hand rub.
50
Who sets the standards for infection control for nurses?
College of Nurses of Ontario (CNO)
51
What are the first and second tier of isolation guidelines (CDC and Health Canada's Guidelines)?
First tier are routine practices
Second tier is transmission-based precautions
52
What's the clean technique?
Medical asepsis
53
What's the sterile technique?
Surgical asepsis
54
What is medical asepsis used for?
Methods to prevent and reduce the spread of microorganisms
Eg. hand hygiene, clean gloves, environmental cleaning
55
What is surgical asepsis used for?
Procedures used to eliminate all microorganisms
Common practice in Operating Room (OR); used when skin is perforated, broken skin integrity, procedures where an instrument is inserted into a normally sterile body cavity
Eg. extended hand scrub in OR; sterile supplies in special packaging
56
What are additional or isolation precautions?
The physical separation of infected individuals from uninfected individuals for the period of communicability of a particular disease/infection
57
What's the purpose of additional precautions?
Purpose is to contain the pathogen (mode of transmission) in one isolated room, to prevent a spread to a susceptible host
- Followed in addition to routine practices
- Determined by how the pathogen is spread
- Contact, droplet, airborne
58
Types of additional precautions
Contact
- Direct vs. indirect
- GI illness, C. Difficile, MRSA, VRE, wound infections
Droplet
- Large droplets up to 2m from patient
- Influenza, RSV, mumps, rubella, pertussis, meningococcal pneumonia
Combination precautions for some illness
- Eg. Droplet/contact for influenza
Airborne
- Small particles suspend in air and can travel long distances
- Varicella, tuberculosis, measles
59
When are gloves used?
Gloves must be worn when it is anticipated that the hands will be in contact with mucous membranes, non-intact skin, tissue, blood, body fluids, secretions, excretions, or equipment and environmental surfaces contaminated with the above
60
Key points for the use of gloves
- Select glove appropriate to task.
- Wear the correct size of gloves.
- Gloves should be put on immediately before the activity for which they are indicated.
- Clean hands before putting on gloves for a clean/aseptic procedure.
- Gloves must be removed and discarded immediately after the activity for which they were used.
- Hand hygiene must be performed immediately after glove removal.
- Change or remove gloves if moving from a contaminated body site to a clean body site within the same client/patient/resident.
- Change or remove gloves after touching a contaminated site and before touching a clean site or the environment.
- Do not wash or re-use gloves.
- The same pair of gloves must not be used for the care of more than one client/patient/resident.
61
When should a gown be worn?
A gown is worn when it is anticipated that a procedure or care activity is likely to generate splashes or sprays of blood, body fluids, secretions, or excretions.
Gowns should only be worn when providing care for clients/patients/residents.
62
Key points about the use of gowns
- When use of a gown is indicated, the gown should be put on immediately before the task and must be worn properly, i.e., tied at top and around the waist.
- Remove gown immediately after the task for which it has been used in a manner that prevents contamination of clothing or skin and prevents agitation of the gown.
- Discard used gown immediately after removal into appropriate receptacle. Do not hang gowns for later use.
- Do not re-use gown. Do not go from patient-to-patient wearing the same gown.
63
When should a mask be worn?
A mask is used by a health care provider (in addition to eye protection) to protect the mucous membranes of the nose and mouth when it is anticipated that a procedure or care activity is likely to generate splashes or sprays of blood, body fluids, secretions or excretions, or within two metres of a coughing client/patient/resident.
- For droplet infections
64
What are N95 respirators used for?
An N95 respirator is used to prevent inhalation of small particles that may contain infectious agents transmitted via the airborne route
- Need a fit-test
- For airborne infections
65
Key points about the use of masks
Select a mask appropriate to the activity.
Mask should securely cover the nose and mouth.
Change mask if it becomes wet.
Do not touch mask while wearing it.
Remove mask correctly immediately after completion of task and discard into an appropriate waste receptacle.
Do not allow mask to hang or dangle around the neck.
Clean hands after removing the mask.
Do not re-use disposable masks.
Do not fold the mask or put it in a pocket for later use.
66
When should eyewear/face shield be used?
Eye protection is used by health care providers (in addition to a mask) to protect the mucous membranes of the eyes when it is anticipated that a procedure or care activity is likely to generate splashes or sprays of blood, body fluids, secretions or excretions, or within two metres of a coughing client/patient/resident.
Eye protection should also be worn for wound irrigation procedures if there is any risk of sprays or splashes.
Eye protection should be used whenever there is a potential for splashes or sprays to the eyes, such as operating room procedures, labour and delivery and wound irrigation.
67
Key points about the use of eyewear/face shield
- Glasses don't count
- Eye protection must be removed immediately after the task for which it was used and discarded into waste or placed in an appropriate receptacle for cleaning.
- Prescription eye glasses are not acceptable as eye protection.
- Eye protection includes: safety glasses, safety goggles, face shields, visors attached to masks.
68
Contact precautions
Contact - transfer of microbes by physical touch
Direct
- physical skin to skin contact between infected and host (eg. handshake, sexual contact, etc)
Indirect
- contact between a host and a contaminated object (eg. needlestick; instruments; surfaces)
- Hospital acquired infections: MRSA and VRE
- C. Difficile can live on objects through spores for prolonged time (month)
- Droplet viruses can be transmitted via contact
- Private room or cohort
69
Droplet precautions
Droplet - large particles (droplets) of the respiratory system of an infected source are propelled through the air up to 1m
- Sneezing and coughing
- Influenza, Rhinovirus or RSV (colds), mumps, meningococcal pneumonia
- Private room or cohort (patient with the same illness or be 6 feet apart)
- Mask if 2m within patient; door can stay open if bed is 2m away from door
- If patient have to leave their room, they need to wear masks
70
Most of times it would be ____ and droplet, and not just droplet
Most of times it would be contact and droplet, and not just droplet
71
Airborne precautions
Airborne- small airborne particles containing microbes remain suspended in the air for long periods of time (>1m)
- Dust can hold the infectious particles as well
- Can be inhaled by or deposited on a susceptible host
- Eg. tuberculosis, chicken pox, measles
ALSO needed:
- Hepa-filter or
- Clean the air and avoid the airborne particles to leave the room
- Negative Pressure Room
- So when the door open, the airborne particles does not leave the room
- Fitted Particulate Masks- N95
72
Order of applying PPEs
1. Hand hygiene
2. Put on gown
3. Put on mask/N95 respirator
4. Put on protective eyewear
5. Put on gloves
Order doesn't really matter when putting ON PPEs (just wash hands first)
73
Order when taking off PPEs
1. Remove gloves
Hand hygiene (optional)
2. Remove gown
3. Hand hygiene
4. Remove eye protection
Hand hygiene (optional)
5. Remove mask/N95 respirator
6. Hand hygiene
Order matters
- Take off the dirtiest things first
- Leave face protected for the longest
74
When to complete a risk assessment?
Completed before an interaction with a patient or their environment in order to determine which interventions are required to prevent transmission of infection
75
What to assess in a risk assessment?
Assess the risk of the:
- the client/patient/resident infection status (including colonization)
- type of care activities to be performed
- the resources available for control
- the health care provider immune status
76
What would you do if your patient in additional precautions was sent off the unit for a test?
- See if the test can come to them
- Wear PPEs when outside of the room
- Take off PPEs when inside the room (unless airborne)
- If they have to leave:
- Communicate with the next unit
- PPE for patient
77
Transferring patients off the unit
- Patient should perform hand-hygiene
- Patients with airborne precautions should only leave room if absolutely necessary (eg. MRI, surgery) and will wear a mask for transport
- Patients in droplet precautions should also wear a mask if leaving their room for a test or treatment
- Nurse may require PPE if he/she will have contact with the patient
- Personnel to be working with patients need to be notified of isolation precautions being used
- Type of isolation precaution to be noted on patient’s chart
Patients may need to leave the unit for tests, etc (eg. x-ray)
