INFECTION PREVENTION and CONTROL - PowerPoint Presentation

Slide1

INFECTION PREVENTION and CONTROLSlide2

Standard Precautions

OR ….How to prevent the spread of diseaseSlide3

NORMAL DEFENSESSlide4

Types of Infections

Heath Care-Associated Infections

formerly

called

nosocomial

HAIs

Iatrogenic

:Exogenous:Endogenous:Slide5

CHAIN OF INFECTIONSlide6

Cholera Outbreak in Haiti

Cholera

Nepalese peacekeeping force

Poop

Latrines near water

River

Drinking contaminated waterSlide7

Historical Perspective

1847 Dr.

Ignaz

Philip

Semmelweiss

Significance of hand washing is demonstrated

Concept of

nosocomial

infection is bornSlide8

More HistorySlide9

Infectious Disease Process

Infection

:

Normal flora

:

Colonization:

Slide10

Chain of InfectionSlide11

Causative Agents

Bacteria

Virus

Fungi

ProtozoaSlide12

Characteristics of Causative AgentsSlide13

ReservoirsSlide14

NCLEX ?

Which

of the following is an example of a nursing intervention that is implemented to reduce a reservoir of infection for a client?

A) Covering the mouth and nose when sneezing

B) Wearing disposable gloves

C) Isolating client’s articles

D) Changing soiled dressingsSlide15

Portal of Exit

:

The path by which the

infectious agent leaves the reservoir

Respiratory Tract

:

GU Tract

GI Tract:Skin/Mucous Membranes:TransplacentalBlood:Slide16

Mode of Transmission

The mechanism for transfer of an infectious agent from the reservoir to the susceptible hostSlide17

VIGNETTE

An older adult, hospitalized with a GI disorder is on bedrest and requires assistance for uncontrolled diarrhea stools.

Following one episode of cleaning the patient and changing the bed linens, the nurse went to a second patient to provide tracheostomy care.

The nurse’s hands were not washed before assisting the second patientSlide18

VIGNETTE ANALYSIS

Infectious agent → Escherichia Coli

Reservoir → Large Intestines

Portal of Exit → Feces

Mode of Transmission → Nurses Hands

Portal of Entry → Tracheostomy

Susceptible Host → Older Adult with TrachSlide19

Modes of Transmission

Contact

Airborne

Vector-BorneSlide20

Contact

Direct

:

Indirect:Slide21

Modes of Transmission

Direct

Person to Person (Fecal-Oral

)

Hepatitis A

Staph

Indirect

Contact with contaminated object

Hepatitis B and CHIVRSVMRSASlide22

Airborne

Droplets suspended in air after coughing and sneezing or carried on dust particles

TB

Chicken Pox

Measles (

Rubeola

)

AspergillusSlide23

Droplet transmission

Large particles

Can travel up to 3 feet

Influenza

Rubella (3-day/German Measles)

Bacterial MeningitisSlide24

Vector-Borne

Vector

External mechanical transfer

Mosquito, Louse, Flea, Tick, Fly

West Nile Virus

Malaria

Lyme Disease

Hanta VirusSlide25

Portal of Entry: path by which an infectious agent enters the susceptible host

Respiratory tract

GU tract

GI tract

Transplacental

(fetus from mother)

Parenteral

:

percutaneous, via bloodSkin/Mucous MembranesSlide26

Susceptible Host

A person or animal lacking effective resistance to a particular pathogenic agentSlide27

Man-Made Epidemics (NYT July 15, 2012)Slide28

Diseases have always come out of the woods and wildlifeSlide29

West Nile VirusSlide30

American Robin

Thrives in our backyards and agriculture fields

Mosquitoes that spread the disease find robins particularly appealingSlide31

H1N1Slide32

Lyme Disease

.Slide33

EbolaSlide34

SARSSlide35

Bird FluSlide36

Isolation Precautions

Historical perspective 1877 to present

1877

Aseptic technique

1910Slide37

“Barrier” Nursing

Hospital personnel wear gowns between patients

Handwashing

between patients with antiseptic solutions after patient contact

Disinfection of objects contaminated by patientsSlide38

More Hx

1950s: Infectious Disease hospitals begin to shut down except for TB sanitariums

1960s: TB hospitals begin to shut down

1970: CDC publishes first manual on

Isolation Techniques for Use in Hospitals.

Diseases were lumped into categories

1980s: Hospitals began to experience new endemic and epidemic

nosocomial

infection problems caused by multi-drug-resistant organismsSlide39

HX

1980: CDC publishes new Isolation guidelines

1985: Universal precautions come into being (HIV, HBV, blood borne pathogens)

1990s HICPAC: 2 tier system

Standard Precautions

Transmission-Based Precautions (Contact

,

Droplet, Airborne)Slide40

HAIs

Surgical Sites

Blood Stream

Urinary System

Cardiovascular

Eye/Ear/Throat/Mouth Infection

Reproductive System

Respiratory

Bone and Joint InfectionCNSGastrointestinalSkin and Soft TissueSlide41

Immunocompromised Pts

Vary in their susceptibility to

HAIs

Depends on the severity and duration of

immunosupression

.

Use the two-tiered system

Neutropenic

precautionsSlide42

Critical Thinking Question

Clients in the healthcare setting are at risk for acquiring or developing infections because:Slide43

Prevention

Most

HAIs

are transmitted by the

HCWs

and clients as the result of direct contact

We as nurses must pay attention to

handwashing

after contact with clients and equipmentSlide44

Prevention

Microorganisms move through space on air currents

Microorganisms are transferred from one surface to another whenever objects touch, a clean item touching a less clean item becomes “dirty”

Microorganisms are transferred by gravity when one item is held above anotherSlide45

Prevention

Microorganisms are released into the air on droplet nuclei whenever a person breaths or speaks-

Microroganisms

move slowly on dry surfaces, but very quickly through moisture –

Proper

handwashing

removes many of the

microorganaisms

that would be transferred by the hands from one item to another- always wash hands between patients.Slide46

Prevention

To reduce susceptibility provide adequate nutrition and rest, promote body defenses against infection and provide immunizationSlide47

Superbugs

MRSA

VRE:

Vancomycin

resistant

enterococcusSlide48

Break The Chain!

Implement

ASEPSIS

: absence of disease-producing microorganisms; refers to practices/procedures that assist in reducing the risk of infection

2 Types

Medical (clean technique)

Surgical (sterile technique)Slide49

MEDICAL ASEPSIS

Clean technique:

Aseptic technique

3 components

to the technique:

Hand washing,

Barriers of PPE (gloves, gowns, mask, protective eyewear)

Routine environmental cleaning

Contaminated area:Slide50

Disinfection/Sterilization

Disinfection = the process that eliminates many or all microorganisms, with the exception of bacterial spores, from inanimate objects

Sterilization = complete elimination or destruction of all microorganism, including sporesSlide51

Aseptic technique

Handwashing

is the single most important procedure for preventing the transfer of microorganisms and therefore preventing the spread of

HAIs

CD recommends 10-15 second hand wash. Slide52

Personal Hygiene

Restrain Hair: hair falling forward may drop organisms

Keep nails short: no acrylic nails or chipped nail polish

Minimum jewelry (see agency policy)

Cover open wounds with an occlusive dressing.Slide53

When should hands be washedSlide54

CDC GUIDELINES

Standard Precautions

apply to:

Blood

All body fluids and secretions (feces, urine, mucus, wound drainage)

except sweat

Non-intact skin

Mucous membranesRespiratory secretions Slide55

STANDARD PRECAUTIONS

TIER 1

Hand Hygiene:

see next slide

Gloves:

for touching blood, body fluids, secretions, excretions, non-intact skin, mucous membranes or contaminated areas

Masks, Eye Protection or Face Shields:

if in contact w/ sprays or splashes of body fluids

Gowns:

to protect your clothing

Contaminated Linen:

place in leak-proof bag so no contact with skin or mucous membranes

Respiratory Hygiene/Cough Etiquette:

provide client with tissues and containers for disposal; stand ~3 feet away from coughing; use masks prnSlide56

Hand HygieneSlide57
Slide58

ISOLATION PRECAUTIONS

TIER 2

Contact

= private room or cohort clients, gloves and gowns

MDRO, C-Diff, RSV

Droplet

= private room or cohort clients, mask is required

Strept, pertusis, mumps, flu

Airborne

= private room, negative airflow, hepa filtration; N95 respirator mask required

TB, chickenpox, measles

Protective Environment

= private room, positive-pressure room; hepa filtration; gloves, gowns, mask (controversial); NO flowers or potted plants

Stem cell transplantSlide59
Slide60

N95 RespiratorSlide61

STANDARD PRECAUTIONS

Handwashing

Gloves (PPE)

Masks (PPE)

Eye Protection (PPE)

Gowns (PPE)

Leak-proof linen bags

Puncture proof containers for sharpsSlide62

Donning and Removing PPE

Donning

Gown

Mask or respirator

Goggles/face shield

Gloves

Keep hands away from face

Work from clean to dirty

Lime surfaces touchedChange when torn or heavily soiledRemovingGlovesGoggles/face shieldGownMask or respiratorRemove at doorway before leaving pt. room

Perform hand hygiene immediately after removing all PPESlide63

Surgical Asepsis

Sterile technique that prevents contamination of an open wound, serves to isolate the operative area from the unsterile environment, and maintains sterile field for

surgerySlide64

Principles of Surgical AsepsisSlide65

For which procedure would the nurse use aseptic technique and which would require the nurse to use sterile technique?

A) Aseptic technique for urinary catheterization in the hospital and sterile technique for cleaning surgical wound

B) Aseptic technique for changing the patient’s linen and sterile technique for assisting in surgery

C) Aseptic technique for food preparation and sterile technique for starting an IV line

D) Aseptic technique for a spinal tap and sterile technique for placing a central lineSlide66

LAB Practice: Isolation Precautions

Demonstrate donning Isolation Gown, Mask, Gloves, Eyewear

Demonstrate removing Isolation Gown, Mask, Gloves, Eyewear

Demonstrate proper disposal of PPE

before

leaving Isolation Room

When performing care/treatments use hospital provided stethoscope and leave in the roomSlide67

Lab Practice Cont’d.

Practice pretending you are entering patient room (use curtains) and give Complete Bed Bath and do Bed Linen Change wearing PPE (gown, mask, gloves)

Remember to dispose of PPE

INSIDE

the patient’s room before you leave

Practice bringing in all the supplies you need so you can stay in the room & not have to leave (de-gown etc) and come back in (re-gown etc)Slide68

LAB Practice: Sterile Procedures

Opening sterile packages – Flap

fartherest

away from nurse first, then sides, then flap closest to nurse

Preparing a sterile field

Pouring sterile solutions – label to palm, “lip” it

Donning sterile gown and glovesSlide69

Critical Thinking Exercise

Mrs.

Jaycock

had an indwelling urethral catheter for 1 week. The catheter has now been out for 24 hours. She complains of frequency and pain on urination. Mrs.

Jaycock

suggests reinsertion of the catheter because of the need to get up frequently. What can frequency or pain on urination be an indication of?Slide70

Answer

UTI

Should the catheter be reinserted?

Why or why not?Slide71

Answer

No reinserting the catheter may aggravate the infection and promote the spread of the infection to the bloodstream.

Describe at least one appropriate assessment measure and one independent nursing action or intervention for Mrs. JaycockSlide72

Nursing Response

Increase her fluid intake if not clnically contraindicated

Check her urinalysisSlide73

Situation

You are caring for Mr. Huang, who has a large open, and draining abdominal wound. You notice another health care worker changing Mr. Huang’s dressing without wearing gloves or using sterile technique. When you question the health care worker regarding his or her practice, this person says, “Don’t worry, the wound is already infected, and the antibiotics and drainng will take care of any contaminants.” How would you respond to this comment?Slide74

Response

It is important to not only protect Mr. Huang from additional infection, but also to protect ourselves from becoming contaminated.

What would your next steps be in following up on this incident?Slide75

Situation

Mrs. Niles is 83 years of age and lives alone. She has difficulty walking and relies on a church volunteer group to deliver lunches during the week. Her fixed income limits her ability to buy food. Last week, Mrs. Niles’ 79-year-old sister died. The two sisters had been very close. As a home care nurse, explain the factors that might increase Mrs. Niles’ risk for infection.Slide76

Response

Age

Potential for poor nutrition

Potential for depressionSlide77

Situation

Mr. Vargas is admitted to the facility with a history of recent weight loss, a cough that has persisted for 2 months, and hemoptysis. His chest x-ray film shows a cavity lesion in one lung, and his physician suspects tuberculosis. What type of isolation precautions would you use for Mr. Vargas? What protection would you use to provide care? What education would you provide to the family?Slide78

Response

Airborne precautions

Wear an N95 mask

Keep the door closed

Educate the pt and family on transmission of TB and reason for isolation.