Infection Control Principles

Introduction
Infection Control Principles

1. Client safety in the health care environment requires
the reduction of microorganism transmission.
2. Infection control practices are directed at controlling
or eliminating sources of infection in the health care
agency or home.
3. Nurses are responsible for protecting clients and
themselves by using infection control practices.
4. Nurses and clients must be educated on the types of
infections, modes of transmission, risks for
susceptibility, and infection control practices required
to control or prevent further transmission.
Microorganism
• Comes from Micro = small organism

• Cannot be seen with the naked eye, only
under the microscope
• Are found everywhere, both inside
(resident flora) and outside the body
unattached and easily removed (transient
flora)
2
• Patients are at risk of infection from
their own resident micro
organisms(endogenous infection)
• Or from external micro-organisms

(exogenous infection).
3
• Some microorganisms essential for
maintaining health (no harmful effect
on the body)→ non-pathogens).
• Colonies of non-pathogens present in
the body known as normal body flora
• Flora not the same in all body areas,
e.g. normal flora in the intestines is
different from the normal flora of the
skin.
4
• Non-pathogens misplaced to another part of
the body can become pathogens; e.g.
intestinal flora entering the urinary bladder
can cause a urinary tract infection.
• Infections that are acquired in the hospital
are called nosocomial infections or hospital
acquired infection.
Fundamentals of nursing II 5
Local infection
• Only a specific portion of the body is
infected
• Pain
• Redness
• Heat at the site
• Swelling
• Pus
• Foul smelling drainage Fundamentals of nursing II 6
Systemic infection
Affects the entire body
• Fever
• Aches
• Chills
• Nausea
• Vomiting
• Weakness
7
Chain of Infection (Infection cycle)
Infection:
Is a disease state that results from the presence
pathogens in the body.
 Communicable disease is infection transmitted
directly from one person to another.
 If the pathogens multiply and cause clinical signs
and symptoms, the infection is symptomatic.
 If clinical signs and symptoms are not present, the
illness is termed asymptomatic.
Chain of Infection (Infection cycle)
The six components in the infection cycle are:-
1.Infection /Causative Agent
 Bacteria
• Viruses
• Fungi
• Protozoa
2.Reservoir (sources)
• Human with active cases of disease or
those that carry disease without having
symptoms
• Animals/insects
• Fomites
• Environment
3- Portal of Exit(Causative Agent)
• Tears (slight risk)
• Saliva/respiratory tract secretions
• Urine
• Feces
• Wound drainage
• Reproductive tract
secretions
• Blood
4- Mode of Transmission
The four main routes of transmission are:
A-Contact transmission :
 Direct → contact body surface to body surface
(kissing and sexual intercourse).
 Indirect → susceptible host is exposed to a
contaminated object (dressing, needle or surgical
instrument).
B-Droplet transmission that occurs when mucous
membranes of the nose, mouth, or conjunctiva are
exposed to secretions of an infected person who is
coughing, sneezing or talking.
C-Vehicle transmission: vehicle (contaminated
items) as food that can carry Salmonella, water,
drugs and blood that can carry hepatitis and AIDs.
D-Airborne transmission → fine particles are
suspended in the air for a long time or when dust
particles contains pathogens.
These organisms can be inhaled by or deposited on
the skin of a susceptible host.
5- Portal of Entry
 Cuts/break in skin
 Openings in the
mucous membranes
 Respiratory system
 Gastrointestinal
system
 Urinary system
 Reproductive system
 Mother to fetus
6- Susceptible Host
• Human being: that
can be affected by an
agent.
Susceptibility:
• Poor diet
• Fatigue
• Inadequate rest
• Stress
• poor health
Factors increased the liability to infection
 lack immunity.
Age (immunity declines as age increases)
Illness and Injury
Stress (decreases immune response)
Immunization/Vaccination Status
Lifestyle (sharing needles, multiple sex partners,
smoking, alcohol and drug abuse)
Occupation (chemical agents, needle sticks)
Skin breaks which is the first line of defense
(surgical, pressure ulcer, IV)
Nutritional Status (overweight, underweight)
Heredity
Medications (steroids, non-steroidal anti-
inflammatory agents NSAIDs (ibuprofen,
aspirin), chemotherapy, antibiotics lead to
vaginal yeast infections
Nursing and Medical Procedures (urinary
catheters, IV)
Three main factors determine whether the
pathogen successfully causes infection:
1. Susceptibility of the host
2. Amount of the pathogen.
3. The presence of all elements of the
infection chain
Body Defenses
1.Non-Specific Immune Responses
a. Skin and its normal flora
b. Mucous membranes
c. Coughing, sneezing, tearing reflexes.
d. Elimination and acid environment
e. Flora in the large intestine prevent growth of
pathogens and peristalsis removes them with
feces.
f. Natural urine acidity prevents growth of
microorganisms
g. Vaginal Flora is acidic
2-Specific Immune Response
 Response to invading antigen

◦ Phagocytes
◦ T-cells (T lymphocytes)
T-cells stimulate B-cell production which
leads to antibody production against
antigen
Course of infection(stages of infection)
1-Incubation Period:
 There is an interval between entrance of
pathogen into the body and appearance of
first symptoms.
2-Prodromal Stage Of Illness:
A person is most infectious during it .
Early signs and symptoms of disease are
present but are vague and non specific
3-Full Stage Of Illness
 Client manifests signs and symptoms
specific to type of infection.
 For example:
Common cold (sore throat, sinus
congestion, rhinitis)
Mumps (earache, high fever, parotid and
salivary gland swelling).
4- Convalescence
 Acute symptoms of infection disappear

and the person returns to a healthy state.
 Length of recovery depends on severity of
infection and client's general state of health
Nosocomial infection
(Hospital acquired infection)
Is an infection that was not present

or incubating upon admission and
may or may not result from the
delivery of health care.
Types :
1. Iatrogenic infection
 Resulting from a diagnostic or therapeutic procedure (urinary
catheter insertion).
2. An exogenous infection
 The causative organism is acquired from other people, such
as Tuberculosis.
3. Endogenous infections
 When sufficient numbers of microorganisms normally found
in one body cavity transferred to another body
site(transmission of enterococci, normally found in fecal
material, from the hands to the skin is a cause of wound
infections).
 Major sites for nosocomial infection include the urinary
tract, surgical wounds, the respiratory tract, and the
bloodstream.
Risk factors for nosocomial infection
1. Environment
2. Therapeutic regimen
Drugs such as steroids.
Equipment
Inadequate dressing techniques for
wounds
3. Client resistance
4. Multiple health care personnel caring for
a client
5. Extended length of hospitalization
Clinical signs and symptoms of infection
1-Systemic (general) manifestations: Fever, fatigue,
malaise, lymph node enlargement, loss of appetite,
nausea, and vomiting may be found.
2- Localized manifestations: Redness, swelling, pain
or tenderness, and restricted movement of a body
part occur. There may be drainage from open
lesions or wounds.
3- Laboratory data:
WBC count, erythrocyte sedimentation rate(ESR),
urine, blood, sputum or other drainage culture add.
Breaking Chain of Infection
A-Infection Control is the First Line of
Defense by:-
1-Hand hygiene is the single most practice in
preventing the spread of infection
2-Wear gloves, masks, gowns and goggles
3-Client Hygiene
4-Dressing Changes using aseptic technique
5-Clean linens
6-Clean Equipment and maintain aseptic
technique.
Breaking Chain of Infection
B-Educate on covering mouth and nose when
coughing and sneezing; throwing tissues into
garbage bag
C-Nutrition (protein needed to maintain and
repair tissues, production of antibodies, and acid-
base balance
D-Exercise
E-Immunizations (measles ‫الحصبه‬, mumps‫ النكاف‬,
rubella‫ الحمي المانية‬, tetanus every 10 years and flu
every year.
Asepsis
 The term asepsis means the absence of

disease-producing microorganisms.
 The
two types of the nurse practices are:
Medical asepsis
Surgical asepsis.
Medical Asepsis
 Medical or Clean Asepsis reduces the
number of organisms & prevents their
spread.
 During daily routine care, to break the
infection chain.
1.Hand Hygiene
 Hand washing
 Hand RUB
When to Wash Hands
 Before and after contact with patient or patient’s
belongings
 Before and after eating
 After using the bathroom
 After handling any contaminated fluid or object
 After touching body fluids
 Before and after wearing gloves
 Between tasks and procedures on the same patient
to prevent cross-contamination of different body
sites
2.Carry soiled items away from body.
3.Do not place soiled items on floor.
4.Client instructed when coughing and

sneezing; (Airborne) on anyone; expectorate
into tissues; cover mouth and nose.
4.Do not shake linens.
5.Place bodily discharge and drainage into
plastic bags or containers (diapers; linens;
specimens).
35
6.Personal Grooming:
Shampoo hair
Fingernails
 Short; ¼ inch
 Clean
 Smooth
 No artificial nails, No overlays. These harbor
bacteria
Do not wear rings with grooves and stones
Keep hair off shoulder
7.Personal Protective Equipment (PPE)
Is any equipment or supplies used to protect
clients and healthcare workers.
 Clean and sterile gloves
 Clean gowns
 Masks
 Face shields
 Protective eye wear
 Surgical caps
 Shoe covers
Surgical Asepsis(Sterile technique)
 Surgical or Sterile Asepsis or Sterile

Technique
 Includes procedures used to eliminate
micro-organisms from an area & is
practiced by nurses in operating room,
labor and delivery , and major diagnostic
areas.
 The nurse may also use surgical aseptic
techniques at the client's bedside
(inserting intravenous catheters).
 During procedures that require
intentional perforation of the client's skin
(surgical incision).
 It includes surgical hand washing, sterile
gloves and sterile field. `
Categories
 Sterilization
 Disinfection
 Cleaning
1. Sterilization: It is a process by which all
forms of microorganisms including spores
are destroyed.
Critical items – need to sterilization
 Items that enter sterile tissue or vascular
system.
 Surgical instruments - Cardiac catheters-
Urinary catheters -Needles -Implants
STERILIZATION
This process can be carried out by 4 methods:-
 HEAT  IRRADIATION
- moist heat (Autoclave) - ultra violet light
- dry heat (Hot Air Oven) - gamma rays
 CHEMICAL  FILTRATION
- in solution - applicable to
pharmaceutical laboratory
where it is used in
combination with ultra
violet light.
2. Disinfection: It is eliminates almost all pathogen
organisms on objects, with the exception of
bacterial spores.
 This process can be carried out by two methods:
1. Physical - boiling
2. Chemical - disinfectants
Semi critical items-Disinfection
• Respiratory therapy equipment
• Endotracheal tubes
• Gastrointestinal endoscopes
• Reusable mercury thermometers
3- Cleaning: Is the removal of all foreign materials such
as soil & organic material from objects.
 Generally, cleansing involves use of water & mechanical

action.
- Disposable object has to be discarded.
- Reusable objects must be cleansed thoroughly before

disinfection & sterilization.
Noncritical items - Cleaning
 E.g.(Bedpans, Blood pressure cuffs, Crutches , Linens,
Food utensils).
Universal Precautions
 Precautions that protect the patient/client, co-workers, and
community from infection
Universal Precautions Techniques
(1)Wear gloves when
 Touching blood
 Touching mucous membranes
 Performing veinopuncture
 Touching body fluids (vaginal fluids or semen,
cerebrospinal fluid, pleural fluid, pericardial fluid, synovial
fluid, amniotic fluid, placenta tissue, saliva).
45
(2)Wash hands after glove removal
(3)Protect clothing with apron or gown when
splashing of blood or body fluids is possible
(4)Discard needles or other sharps in puncture-
resistant container
(5)Do not recap needles or work with needles before

disposal
(6)Waste and solid linen must be handled with care
46
Isolation system
Isolation is a protective procedure that limits the

spread of infectious diseases among hospitalized
client, hospital personal and visitors
1-Transmission- based precautions:
A- Airborne precautions are used to protect against

microorganisms transmitted by air currents.
◦ The client should be cared for in a private,
negative airflow room.
◦ Caregivers are to wear masks and the client
should wear a mask when transported out of the
room.
B-Droplet precautions
• The client should be in a private room or
with a person who is infected with the same
microorganism.
• Personnel are to use masks when working
within 3 feet of the client.
• The client should wear a mask when out side
the room.
C-Contact precautions
 Used with organisms that transmitted by hand or
skin to skin contact(during client care or when
touching the patient environmental surface or care
items).
 The client is cared for in a private room.
 Personnel use gloves when entering the room and
remove gloves before leaving the room.
 Gowns and other protective barriers.
2-Protective isolation
 Used in high risk situations to prevent
infection for people whose body defenses are
known to be compromised(clients who are
neutropenic (neutrophils less than 500/mm) as
a result of chemotherapy, radiation therapy or
immunosuppressive medications are prime
candidates.
 Clients with extensive burns or dermatitis.
Such clients are placed in private rooms.
 Visitors are restricted.
 No fresh fruits or vegetables are allowed, only
canned and cooked foods. 51
Role of the nurse
 The nurse is responsible for providing the

client with the safe environment.
 The nurse should also assume responsibility
for monitoring other health care team
members who enter the client's environment.
 Educate others regarding the client's isolation
status.
 The nurse uses precautions for all clients,
even when an infection has not been
diagnosed.
Role Of The Infection Control Department
 Providing staff education on infection control.

 Reviewing infection control policies and
procedures.
 Gathering statistics regarding the epidemiology
of nosocomial infections.
 Investigation of outbreaks of infection.
 Providing input regarding selection of patient-
care products.
 Research related to infection control activities.

Infection Control Principles

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Infection Control Principles

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Introduction

Infection Control Principles

• Comes from Micro = small organism

• Or from external micro-organisms

 Response to invading antigen

 Acute symptoms of infection disappear

Is an infection that was not present

 The term asepsis means the absence of

4.Client instructed when coughing and

 Surgical or Sterile Asepsis or Sterile

 Generally, cleansing involves use of water & mechanical

- Disposable object has to be discarded.

- Reusable objects must be cleansed thoroughly before

(5)Do not recap needles or work with needles before

Isolation is a protective procedure that limits the

A- Airborne precautions are used to protect against

 The nurse is responsible for providing the

 Providing staff education on infection control.

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