Introduction

• Infection prevention practices reduce / eliminate sources and transmission of infections.

• Helps protect patients and providers from disease.

• Nurses are responsible for educating patients and their families about signs and symptoms of
infections, modes of transmission, and prevention methods.

• Health-care associated infections (HAIs) are localized or systemic infections NOT present during
admission to facility (ie were acquired in the facility).

• Formerly called nosocomial infections (1/20 hospitalized patients).

Chain of Infections

• Cyclical process which includes six

elements:

1. Infectious agent or pathogen

2. Reservoir or source for pathogen growth

3. Portal of exit from the reservoir

4. Method or mode of transmission

5. Portal of entrance into the host

6. Susceptible host

Asepsis

• Medical Asepsis (clean technique) includes procedures used to reduce the number of and prevent
the spread of microorganisms

• Involves: hand hygiene, barrier techniques, and routine environmental cleaning

• Surgical Asepsis (sterile technique) includes procedures used to eliminate all microorganisms
from an area

• Performed in: Operating room, labor and delivery and procedural areas

• Also used when:

1. Skin perforation procedures (ie IV)

2. Dressing a wound, incision or burn (open skin)

3. Inserting instruments in normally sterile areas (ie urinary catheter)

Hand Hygiene

• Four techniques

• Handwashing: vigorous, brief rubbing together of all surfaces of the hands lathered in soap and
water, followed by rinsing under a stream of water.

• Antiseptic hand wash: washing hands with warm water and soap / detergent containing an
antiseptic agent.

• Antiseptic hand rub: alcohol-based waterless product that, when applied to all surfaces of
hands, reduces the number of microorganisms on the hands. NOT effective on soiled hands!

• Surgical hand antisepsis: antiseptic handwash or hand rub used by surgical personnel before
performing a surgical procedure.

• Decision to perform hand hygiene depends on four factors:

1. Intensity / degree of contact with patients / contaminated objects

2. Amount of contamination that may occur with contact

3. Patient / provider susceptibility to infection

4. Procedure or activity to be performed

Hand hygiene is not an option!

Guidelines for hand hygiene:

1. Wash when hands visibly dirty, when soiled with bodily fluids, before eating, and after using
toilet.

2. Wash with soap and water if exposed to spore-forming organisms

3. If hands are not soiled, use an alcohol-based hand rub in:

a) Before / after direct contact with patient

b) Before applying sterile gloves and inserting an invasive devise such as a catheter

c) After contact with body fluids or excretions, mucous membranes, or nonintact skin

d) After contact with wound dressings (if hands not visibly soiled)

e) When moving from a contaminated body site to a clean site

f) After contact with inanimate object in the immediate vicinity of a patient

g) After removing gloves

AD + PIE

Assesment

1. Inspect surfaces of hands for breaks or cuts in the skin / cuticles. Cover any skin lesions when
dressing before providing care. If lesion too large, patient access may be restricted.

Rationale: Open cuts or wounds can harbor high concentrations of microorganisms.

2. Note condition of your nails. Avoid artificial nails, extenders, and long or unkempt nails. Natural
nail tips should be less than 1/4 inch long.

Rationale: Subungual areas of the hand harbor high concentrations of bacteria. Long and chipped /
old nail polish increase number of bacteria residing on nails, requiring more vigorous hand hygiene.
Artificial nails have shown high rates of infectious agents.

3. Inspect hands for visible soiling

Rationale: Visible soiling requires hand washing with soap and water.

4. Consider the type of nursing activity being performed. Decision whether or not to use antiseptic
depends on procedure being performed and the patient’s immune status.

Rationale: Type of nursing activity determines the hand hygiene technique to use.

Planning

Expected outcomes

Focus on preventing the transmission of infection

1. Hands and areas under fingernails are clean and free of debris.

Delegation and Collaboration

The skill of hand hygiene is performed by all caregivers. Not optional.

Equipment

Handwashing

• Easy-to-reach sink with warm running water

• Antimicrobial or nonantimicrobial soap

• Paper towels or air dryer

• Optional disposable nail cleaner

Antiseptic Hand Rub

• Alcohol-based waterless antiseptic-containing emollient

Implementation for Hand Hygiene

Evaluation

1. Inspect surfaces of hands for obvious signs of soil or other contaminants

2. Inspect hands for dermatitis or cracked skin

Unexpected Outcomes and Related Interventions

1. Hands or areas under fingernails remained soiled

A: repeat hand hygiene

2. Repeated use of soap / antiseptics cause dermatitis or cracked skin

A: Rinse and dry hands throughly; avoid excessive amounts of soap; try various products; use hand
lotions or barrier creams.

Recording and Reporting

• Unnecessary to document hand washing.

• Report dermatitis, psoriasis, and cuts to facility employee health or infection control department.

Special Considerations

Geriatric

• Older adults are at greater risk for infection

• The impact of infections is greater