INFECTION PREVENTION AND CONTROL

Learning Objectives
• Define isolation
• Enumerate interventions to reduce the risks for infections.
• Compare and contrast category-specific, disease specific, universal, body substance, standard and transmission-
based isolation precaution.

Introduction:
• Nurses are directly involved in providing a biologically safe environment. Isolation precautions create barriers
between people and microorganisms. There are several types precautions that help to prevent the spread of
microorganisms and viruses in the hospital. It is very important for us to know these things since later on we will
be handling different cases/ diseases of patients. Thus, we prevent the cross contamination among patients and
for the safety of the nurses and other health care providers.

Isolation
• Refers to the measures designed to prevent the spread of infections or potentially infectious microorganisms.

Types of Isolation
A. Category-specific Isolation Precaution
• Uses 7 categories:
- Strict - Tuberculosis (blood - Drainage/Secretions
- Contact cough) (nana)
- Respiratory - Enteric (fecal) - Blood/body Fluids
B. Disease-specific Isolation Precaution
• Delineate use of private rooms with special ventilation, having the client share a room with other clients infected
with the same organism and gowning to prevent gross soilage of clothes for specific infectious diseases.

Hospital Infection Control Practices Advisory Committee Guidelines

A. Standard Precautions
• Designed for all clients in hospital.
• These precautions apply to (a) blood; (b) all body fluids, excretions, and secretions except sweat; (c) nonintact
(broken) skin; and (d) mucous membranes.
• Designed to reduce risk of transmission of microorganisms from recognized and unrecognized sources.

(a) hand hygiene

(b) use of personal protective equipment (PPE), which includes gloves, gowns, eyewear, and masks
(c) safe injection practices
(d) safe handling of potentially contaminated equipment or surfaces in the client environment
(e) respiratory hygiene/cough etiquette

1. Perform proper hand hygiene after contact with blood, body fluids, secretions, excretions, and contaminated
objects whether or not gloves are worn.
2. Wear clean gloves when touching blood, body fluids, secretions, excretions, and contaminated items (i.e.,
soiled gowns).
3. Wear a mask, eye protection, or a face shield if splashes or sprays of blood, body fluids, secretions, or
excretions can be expected.
4. Wear a clean, nonsterile, water-resistant gown if client care is likely to result in splashes or sprays of blood,
body fluids, secretions, or excretions. The gown is intended to protect clothing.
5. Handle client care equipment that is soiled with blood, body fluids, secretions, or excretions carefully to
prevent the transfer of microorganisms to others and to the environment.
 6. Handle all soiled linen as little as possible. Do not shake it. Bundle it up with the clean side out and dirty side
in, and hold away from self so that the nurse’s uniform or clothing is not contaminated.
7. Place used needles and other “sharps” directly into puncture-resistant containers as soon as their use is
completed.
B. TRANSMISSION-BASED PRECAUTIONS
• Used in addition to standard precautions for clients with known or suspected infections that are spread in one of
three ways:
1. Airborne Precautions
o Used for clients known to have or suspected of having serious illnesses transmitted by airborne droplet
nuclei smaller than 5 microns.
a. Place client in an airborne infection isolation room (AIIR). An AIIR is a private room that has negative
air pressure, 6 to 12 air changes per hour, and either discharge of air to the outside or a filtration
system for the room air.
b. If a private room is not available, place client with another client who is infected with the same
microorganism.
c. Wear an N95 respirator mask when entering the room of a client who is known to have or suspected
of having primary tuberculosis.
d. Susceptible people should not enter the room of a client who has rubeola (measles) or varicella
(chickenpox). If they must enter, they should wear a respirator mask.
e. Limit movement of client outside the room to essential purposes. Place a surgical mask on the client
during transport.
2. Droplet Precautions
o Used for clients known to have or suspected of having serious illnesses transmitted by particle droplets
larger than 5 microns.
a. Place client in private room.
b. If a private room is not available, place client with another client who is infected with the same
microorganism.
c. Wear a mask if working within 1 m (3 ft) of the client.
d. Limit movement of client outside the room to essential purposes. Place a surgical mask on the client
while outside the room.
3. Contact Precautions
o Used for clients known to have or suspected of having serious illnesses easily transmitted by direct client
contact or by contact with items in the client’s environment.
a. Place client in private room.
b. If a private room is not available, place client with another client who is infected with the same
microorganism.
c. Wear gloves as described in standard precautions.
d. Wear a gown (see standard precautions) when entering a room if there is a possibility of contact with
infected surfaces or items, or if the client is incontinent, or has diarrhea, a colostomy, or wound
drainage not contained by a dressing.
e. Limit movement of client outside the room.
f. Dedicate the use of noncritical client care equipment to a single client or to clients with the same
infecting microorganisms.

Compromised Clients
• Compromised clients (those highly susceptible to infection) are often infected by their own microorganisms, by
microorganisms on the inadequately cleansed hands of health care personnel, and by nonsterile items (food,
water, air, and client-care equipment).
 • Clients who are severely compromised include those who:
- Have diseases, such as leukemia, or treatments such as chemotherapy that depress the client’s resistance to
infectious organisms.
- Have extensive skin impairments, such as severe dermatitis or major burns, which cannot be effectively
covered with dressings.

Isolation Practices
• Assessment
• Client’s normal defense mechanism
• Client’s ability to implement necessary precautions
• Source and mode of transmission of the infectious agent
• GOLDEN RULE: nurses must cleanse their hands before and after giving care

Personal Protective Equipment

1. Clean or sterile gloves
Three Reasons Gloves Should be Worn:
• Protect nurses when handling body substances
• Reduce the transmission of endogenous microorganism from the nurses to the clients
• Reduce the transmission of microorganism from the nurses’ hands or fomite to another client
Two Reasons for Handwashing After Wearing Gloves:
• Gloves are damaged
• Hands may be contaminated during glove removal
Methods of Glove Downing:
• Open gloving
• Closed gloving
Latex Allergy:
• People who are greater at risk of developing latex allergies are those with allergic conditions and those
who have had frequent or long-term exposure to latex.
• Can either be local or systemic
Types:
• Clean or Disposable Impervious (water resistant) gowns –also known as PLASTIC APRON
• Sterile gown
• Single-use gown technique
2. Gowns
3. Mask
• Worn to reduce the risk for transmission of microorganisms by the droplet contact and airborne routes
and by splatters of body substances.
Masks Should be Worn:
• By those close to client if the infection is transmitted by large particles
• By all persons entering the room if the infection is transmitted by small particles.
4. Protective eyewear
• Protective eyewear such as goggles, glasses or face shield and mask
• Goggles is still worn with eye glasses because the protection must extend around the sides of the glasses
5. Cap and shoe covering
Disposal of Soiled Equipment and Supply
• To prevent inadvertent exposure of health care workers to articles contaminated with body substances
• To prevent contamination of the environment.
TECHNIQUES BAGGING CDC Guidelines:
• A single bag, if it is sturdy and impervious to microorganisms and if the contaminated articles can be placed
in the bag without soiling or contaminating its outside.
• Double-bagging if the above conditions are not met.
Bagging
• Articles contaminated, or likely to have been contaminated, with infective material such as pus, blood, body
fluids, feces, or respiratory secretions need to be enclosed in a sturdy bag impervious to microorganisms
before they are removed from the room of any client.
• Some agencies use labels or bags of a particular color that designate them as infective wastes.
CDC guidelines recommend the following methods:
• A single bag, if it is sturdy and impervious to microorganisms, and if the contaminated articles can be placed
in the bag without soiling or contaminating its outside
• Double-bagging if the above conditions are not met.
• Follow agency protocol, or use the following CDC guidelines to handle and bag soiled items:
• Place garbage and soiled disposable equipment, including dressings and tissues, in the plastic bag that lines
the waste container and tie the bag.
• Place non-disposable or reusable equipment that is visibly soiled in a labeled bag before removing it from the
client’s room or cubicle, and send it to a central processing area for decontamination.
• Disassemble special procedure trays into component parts. Some components are disposable; others need to
be sent to the laundry or central services for cleaning and decontaminating.
• Bag soiled clothing before sending it home or to the agency laundry.
CDC Guidelines to Handle and Bag Soiled Linen
• Place garbage and soiled disposable equipment
• Place non disposable or reusable equipment that is visibly soiled in a labeled bag before removing it from the
room or cubicle and send it to a central processing area for decontamination
• Disassemble special procedure trays into component parts
• Bag soiled clothing before sending it home or to the agency laundry
Examples:
• Linens
• Laboratory specimens
• Dishes
• Blood pressure equipment
• Thermometers
• Disposable needles, syringes and sharps

Transporting Clients with Infections

• If a client must be moved, the nurse implements appropriate precautions and measures to prevent contamination
of the environment.

Psychological Needs of Isolation Clients

Two Most Common Problems in Patient with Isolation:
• Sensory Deprivation
• Decreased Self-Esteem
 Nursing Interventions:
• Assess the individual’s need for stimulation
• Initiate measure to help meet the need for an adult. Stimulate the client’s visual sense by providing view or
activity to watch
• Explain the infection and the associated procedures to help clients and support people understand and accept
the situation
• Demonstrate warm, accepted procedure.
• Do not use stricter precautions than are indicated by the diagnosis and client’s condition.

INFECTION CONTROL FOR HEALTHCARE WORKERS

THREE MAJOR MODES OF TRANSMISSION OF INFECTIOUS MATERIALS IN THE CLINICAL AREA:
• Puncture wounds from contaminated needles or other sharps
• Skin contact
• Mucous membrane contact

Role of Infection Control Nurse

• The infection control nurse is specially trained to be knowledgeable about the research and practices in
preventing, detecting, and treating infection.
• Involved in employee education and implementation of the blood-borne pathogen exposure control plan
mandated by OSHA.