1190L NURSING

SKILLS LAB
Infection Control
Justine Clegg, MS, LM, CPM, LMHC
Chair/Professor Emeritus
Miami Dade College Midwifery Program

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 Infection control
• Goal of infection control is to prevent the
spread of infectious diseases
• Infectious disease is any disease caused
by the growth of pathogens in the body
• Pathogens are disease-causing
microorganisms (germs)
• Infectious diseases can cause unnecessary
pain, suffering and death

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Maintain a safe environment
• Follow specific polices and procedures
designed to reduce risk of transferring
infectious diseases
• Prevent pathogens from being transmitted:
– Patient to client, staff to client, client to
staff, staff to staff
– Improperly cleaned instruments and
equipment

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 Infection
Infection can be:
• Generalized or systemic (throughout the body)
• Localized (affecting one part of the body)
Signs and symptoms of infection:
• Systemic: headaches, fever, fatigue, vomiting,
diarrhea, increased pulse and respiration
• Localized: redness, swelling, painful, warm to
the touch

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 Microbiology
• Microbiology: the study of microorganisms
• Microorganisms are one celled animals or plants
invisible to the eye, can only be seen with a
microscope
• 1600s: Anton van Leeuwenhoek invented the
microscope
• 1800s: Louis Pasteur developed germ theory.
Stated that microorganisms, called bacteria,
cause specific diseases in humans and animals

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History of infection control
• 1843 Oliver Wendell Holmes: contagious disease
or communicable disease can be spread directly
or indirectly from one person to another through
contaminated hands
• Ignaz Philipp Semmelweis observed high
mortality rate from MDs going from morgue to
patients’ bedside without washing hands
• 1864 Joseph Lister: developed surgical aseptic
technique to prevent wound contamination

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Facts about microorganisms
• Not all are harmful
• Normal flora (microorganisms) are found on skin,
in the intestines and vagina
• Some are necessary to maintain normal bodily
functions
– Escherichia coli (E. coli):
• Aids the digestive process in the colon
• Can cause infection in the blood or urine; can
cause spontaneous abortion

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Facts about microorganisms
• Some microorganisms are part of the normal
flora but have no beneficial role
• Normally they do no harm unless the person
is susceptible to infection due to supression
of the body’s immune response
• The immune response: the body fights
infection by producing antibodies (protective
proteins that combat pathogens)

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Facts about microorganisms
• Antibiotics are drugs which inhibit the growth of
or destroy microorganisms
• They also suppress the body’s normal flora and
create an imbalance that can decrease the body’s
ability to resist other infections
• Age, overall health, stress, nutrition and drugs
can also weaken the body
• Opportunistic infections take advantage of the
body’s weakened state to grow

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 Growth of microorganisms
• Aerobic – require oxygen to live
• Anerobic – do not require oxygen to live
• Many microorganisms thrive in warm, moist,
dark environments like the human body which
becomes a host to the microorganism
• Symbiosis – the host benefits
• Neutralism – no damage is done to the host
• Parasitic – the host is damaged, the pathogen
causing damage is called the parasite

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 Types of microbes
• Microbe – a pathogenic microorganism
• Classifications of plant and animal microbes:
– Bacteria
– Viruses
– Fungi
– Rickettsia
– Protozoa

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 Bacteria
• One-celled plants
• Either pathogenic or non-pathogenic
• Many produce toxins (poisonous substances)
• Most bacteria are aerobic (need oxygen) and
grow best in moderate temperatures
• A group of bacteria growing in one place is
called a colony

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 Categories of Bacteria
• Bacteria are categorized according to shape
• Each type causes certain conditions and
diseases
• Types of bacteria:
– Round or ovoid shape
– Rod
– Spiral

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 Round/Ovoid Bacteria
• Round or ovoid bacteria are called Cocci
• Cocci are further defined by their
appearance:
– Micrococci – appear singly
– Diplococci – appear in pairs
– Staphylococci – appear as irregular
clusters
– Streptococci – form chains

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 Infections caused by cocci
• Micrococci cause skin and wound infections
• Diplococci cause gonorrhea, meningitis and
some pneumonias
• Staphylococci are pus-producing and can
cause abscesses, boils, wound infections,
UTIs and some pneumonias
• Streptococci can cause rheumatic fever and
strep throat

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 Rod shaped bacteria
• Rod shaped bacteria are called bacilli
• Bacilli are further defined by their appearance
– Bacilli – appear singly
– Coccobacilli – when rods are somewhat oval
– Diplobacilli – appear in pairs
– Streptobacilli – attached end to end to form a
chain
• Bacilli diseases: TB, tetanus, pertussis, typhoid
fever, botulism and diphtheria

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 Spiral shaped bacteria
• Spiral shaped bacteria are defined by their
appearance
– Vibrios – form curved rods
– Spirilla: organism is rigid
– Spirochetes: organism is flexible
• Common diseases caused by spiral shaped
bacteria are syphilis and cholera

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 Bacteria and locomotion
• Cocci are incapable of movement
• Some rod and spiral shaped bacteria
have slender whip-like appendages
called flagella (singular: flagellum).
• Flagella enable the bacteria to move.

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 Diagnosing bacterial infections
• Essential for proper treatment of infection
• Gram staining: frequently used lab method
• Bacteria are stained with crystal violet
• Type of cell wall determines how it reacts to
staining. Three categories of reactions:
– Gram positive: cell wall retains the stain
– Gram negative: cell wall loses the stain
– Acid fast: cell wall retains the stain even when
treated with acid

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 Diagnosing bacterial
infections
• Growing the microorganism in various culture
media is also used for diagnosis
• Takes 24-72 hours for colonies to form
• Can identify exact bacteria
• Can choose a more precise antibiotic for a
specific bacterium

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 Spores: the resting stage
• Some bacteria can grow spores
• Spores are thick capsules which the bacteria
creates for self-protection
• Spores are created when life-supporting
conditions are not favorable
• Bacteria is alive but dormant, difficult to kill,
resistant to heat, drying and disinfectants
• Can lie dormant for months or years until
conditions are favorable for re-emergence

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 Treating bacterial
infections
• Almost all bacteria can be destroyed with
antibiotics
• Some are antibiotic-resistant, create threat
to health care workers and patients
• Extremely high temperatures must be used
for sterilization to kill bacterial spores

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 Viruses
• Smallest of the microbes
• Need electron microscope to see them
• Viruses are not whole cells, they depend on
other living cells to provide food, nutrients
and for reproduction
• They are called obligate intracellular
parasites because they can only live inside
another living organism

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 Viruses
• Over 300 viruses have been identified by
researchers
• Some appear to be harmless
• Cause infections like influenza, pneumonia,
chicken pox, croup, hepatitis B, AIDS, measles,
mumps, polio, herpes, and warts
• Transmitted through blood & body secretions
• Difficult to treat because they are resistant to
disinfectants and not killed by antibiotics

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 Fungi
• Fungi are a large group of simple plants.
• Two forms of fungi are potential pathogens:
yeast and molds
– Yeasts are one celled
– Molds are multi-celled
• Thrive in warm, moist, dark conditions
• Cannot produce their own nutrients, must rely
on living and dead organic materials

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 Fungi
• Many yeasts and molds are non-pathogenic
• Penicillin (antibiotic) is produced from a mold
• Fungi can become pathogenic under the right
conditions
• Can create various opportunistic infections:
– Mildly annoying
– Chronic and/or recurrent
– Life-threatening

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 Fungal infections
• Cutaneous infections: superficial infections
of the skin or mucus membranes, including
hair follicles and scalp. Example: ringworm,
athlete’s foot
• Systemic infections: Example: histoplasmosis
(respiratory disease)
– Difficult or impossible to treat or cure
– Treatment requires medications toxic to
humans

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 Rickettsia
• Smaller than bacteria, with rod or spherical
shapes
• Called obligate intracellular parasites - must
live inside cell of another living organism
• Rickettsia transmitted through bites of
fleas, lice, ticks and mites
• Diseases: several types of typhus and Rocky
Mountain Spotted Fever
• Typhus is the only rickettsial infection that
can be transferred from 1 human to another

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 Protozoa
• The only microorganism classified as an animal.
• Plentiful in the environment – 45,000 different
identified types of protozoa
• Animal parasites reside in and out of the body
• Seek locations that provide nutrients, warmth
and moisture
• Protozoa constantly present in intestines, skin,
and mucus membranes of the nose and throat

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 Protozoa
• Found in decayed materials, bird and animal
feces, water contaminated with sewage
waste, food washed in contaminated water
or handled by unwashed hands, and insect
bites
• Common diseases caused by protozoa:
dysentery, trichomonas, toxoplasmosis,
pneumocystis pneumonia and malaria

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 Chain of infection
• Model of infectious disease transmission
• Six elements must be present for an infection to
develop
1. The infectious agent
2. Reservoir host
3. Portal of exit from the host
4. Route of transmission
5. Port of entry
6. Susceptible host

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Chain of infection
Infectious
agent

Susceptible Reservoir
host Host

Portal of
entry Portal of
exit
Route of
transmission

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 Chain of infection
1. Infectious agent: a pathogen must be
present
2. Reservoir host: the pathogen must have a
place to live and grow – the human body,
contaminated water or food, animals,
insects, birds, dead or decaying organic
material.
• Humans who can transmit infection but how
no signs of the disease are called carriers.
Person may be unaware they are a carrier.

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Chain of infection

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 Chain of infection
4. Route of transmission: When the pathogen
leaves the reservoir host through the
portal of exit, it must have a way of being
transmitted to a new host.
• Examples of routes of transmission are air,
food, insects, and direct contact with an
infected person

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 Chain of infection
5. Portal of entry: The pathogen must have a
way of entering the new host. Common
ports of entry are the mouth, nostrils, and
breaks in the skin
6. Susceptible host: An individual who has a
large number of pathogens invading the
body or does not have adequate resistance
to the invading pathogen will get the
infectious disease

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Breaking the chain of infection
• Breaking at least one link stops the spread of
infectious disease
1. The infectious agent
– early recognition of signs of infection
– Rapid, accurate identification of organisms
2. Reservoir host
• Medical asepsis
• Standard precautions
• Good employee health
• Environmental sanitation
• Disinfectant/sterilization

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Breaking the chain of infection
3. Portal of exit from the host
– Medical asepsis
– Personal protective equipment
– handwashing
– Control of excretions and secretions
– Trash and waste disposal
– Standard precautions

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Breaking the chain of infection
4. Route of transmission
– Standard precautions
– Handwashing
– Sterilization
– Medical asepsis
– Air flow control
– Food handling
– Transmission-based precautions

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Breaking the chain of infection
5. Portal of entry
– Wound care
– Catheter care
– Medical asepsis
– Standard precautions
6. Susceptible Host
– Treating underlying diseases
– Recognizing high-risk patients

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 Defense Mechanisms
• A number of defense mechanisms exist
outside and in the body to break the chain,
including decreasing the sources of
microorganisms; preventing the
transmission of microorganisms; and
maximizing the host’s resistance to the
microorganism

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 Body’s natural defenses to
eliminate/kill pathogens
• Cilia - in respiratory tract, catch and move
pathogens out of the body
• Coughing/sneezing, to propel pathogens
outward
• Tears - contain chemicals to kill bacteria
• Hydrochloric acid in stomach
• Rise in body temperature (fever)
• Leukocyte (white blood cell) production
increases, to destroy pathogens

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 Scope of the problem
• Health care facilities or “sick care buildings”
have higher concentration of microorganisms
than a normal environment
– Patients with lowered levels of resistance
due to illness
– Health care personnel have frequent
contact with body fluids
• Nosocomial infection – contracted by 5-10%
of patients while receiving health care
– Results in 80,000 deaths per year

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 Scope of the problem
• Industrial illness – a disease contracted by a
health care professional during work
• Blood-borne pathogens such as Hepatitis B and
HIV can be transmitted through needle sticks
• 800,000 needle sticks occur each year
• Up to 500 health care workers die each year
from Hepatitis B
• Follow precautions when performing procedures
• Dispose of all sharps in proper containers

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 Regulatory Agencies
• Center for Disease Control and Prevention
(CDC) - Responsible for developing safe
guidelines to help prevent and control the
spread of infectious diseases
• Occupational Safety and Health
Administration (OSHA) - Responsible for
maintaining minimum health and safety
standards for employees

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Prevention: Medical Asepsis
• Medical asepsis (clean technique):
procedures to decrease the number and
spread of pathogens
• Hand washing, good personal hygiene,
cleaning rooms between patient use,
proper disposal of gloves after contact
with body fluids or contaminated objects

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Prevention: Surgical Asepsis
• Surgical asepsis (sterile technique):
procedures that completely eliminate the
presence of pathogens from objects and
areas
– Sterile caps, gowns, masks, and gloves
– Sterilizing instruments
– Maintaining sterile fields
– Changing dressing
– Disposing of contaminated materials

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Breaking chain of infection
• Most important concept: breaking at least
one link stops the infectious disease
• Chain of infection summarized into 3
components:
1. Source of infecting microorganisms (1 & 2)
2. Means of transmission for the micro-
organisms (3, 4 & 5)
3. Susceptible host (6)

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Breaking chain of infection
Best defenses:
1. Decrease the sources of infecting
microorganisms (1 & 2)
2. Prevent means of transmission for the
micro-organisms (3, 4 & 5)
3. Maximize the resistance of the host (6)

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Methods to decrease the
source of microorganisms
• Perform proper hand washing
• Decontaminate surfaces and equipment
with antiseptics, disinfectants and
sterilization procedures
• Avoid contact with patients and others
when harboring infectious microorganisms

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 Preventing transmission
of microorganisms
• Wear PPE – personal protective equipment:
caps, gloves, gowns masks, booties and eye
protection
• Follow isolation procedures when indicated
• Take additional precautions when working
with patients who have highly contagious
diseases. Don’t ignore posted signs.

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 Maintaining resistance
• Provide and practice good hygiene
• Ensure proper nutrition and fluid intake
• Get enough rest
• Decrease stressors – physical and
psychosocial - that weaken the immune
response
• What can you do in your life to increase
resistance to disease-causing pathogens?

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 Standard Precautions
• Developed by the CDC
• Follow at all times and apply to every
patient
• To prevent contact with potentially
infectious body fluids: blood, secretions,
excretions, non-intact skin and mucous
membranes

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 Handwashing
• Perform proper handwashing techniques:
– when coming on the clinical site
– when taking a break or leaving work
– between client contacts
– before gloving and after ungloving
– before and after touching your face
– after contact with any contaminants
– before touching items considered clean

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 Handwashing
• See Practical Skills Guide for Midwifery:
Procedure – step-by-step how to do it
• Explain why is it important to know
(1) the procedure – what to do
(2) the rationale – the reason you do it
that way, why each step is important

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Personal Protective Equipment
• Abbreviated PPE
• Includes gloves, masks, protective eyewear,
gowns, caps and shoes
• Use appropriate PPE in situations that could
cause infection to you or your client
• Use clean, non-sterile gloves when handling
blood, body fluids, secretions, excretions,
contaminated items, mucous membranes and
non-intact skin

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 Gloves
• Change gloves between tasks/procedures on
the same client if there is contact with
material that may contain a high
concentration of microorganisms (ex: feces)
• Remove gloves promptly after use, before
touching non-contaminated items and
environmental surfaces and before taking
care of another patient
• After removing gloves, wash your hands

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 Face Protection
• Face protection: Mask, Eye
Protection and Face Shield
• Hospital workers wear a mask and
eye protection or a face shield to
protect mucous membranes of the
eyes, nose and mouth during
procedures that could involve
splashes or sprays of blood, body
fluids, secretions or excretions.

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 Gowns
• Gowns may be cloth or paper
– Cloth gowns are reusable
– Paper gowns are disposable
• Some clinical sites provide gowns to clients
for physical exams
• A clean, non-sterile gown protects skin and
prevents soiling clothing during procedures
that could involve splashes or sprays of blood,
body fluids, secretions or excretions.
• Follow the procedures on your clinical site(s)

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 Removing a Gown
• Remove a soiled gown as promptly as possible
• Fold front of gown into itself, outside in
• Place cloth gowns in a closed receptacle
marked with the biohazard symbol to be
picked up, laundered and re-used
• Place paper gowns in a closed waste can in a
red plastic bag marked with the biohazard
symbol
• Wash hands promptly to avoid transferring
microorganisms

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 Client care equipment
• Handle used/soiled client care equipment to
prevent skin, mucous membranes and clothing
from exposure to blood, body fluids,
secretions and excretions which could be
transferred to other patients and
environments
• Reusable equipment must be properly cleaned
and reprocessed before being used on another
client
• Discard single-use items appropriately

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 Environmental Control
• Follow procedures for the routine care,
cleaning and disinfection of environmental
surfaces, beds, bedside equipment, and other
frequently touched surfaces
• For used linen that is soiled with blood, body
fluids, secretions and excretions – fold with
soiled surface in, handle to prevent exposing
skin, mucous membranes and clothing which
could transfer microorganisms to other
environments, and place in designated
biohazardous medical waste receptacle

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 Occupational Health and
Blood-Borne Pathogens
• Take care to prevent injuries when using and
cleaning/disposing of “sharps” - needles, scalpels,
and other sharp instruments
• Place used disposable syringes, needles and
scalpel blades in appropriate puncture-resistant
containers
• Containers should be located close by for
convenient disposal
• Placer reusable syringes and needles in a puncture
resistant container for transport to be
reprocessed (sterilized)

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 Occupational Health and
Blood-Borne Pathogens
• Never recap used needles
• Follow facility policies on how to handle
contaminated needles
• If the facility allows recapping (for example,
drawing up from a multi-dose vial), use either
a one-handed “scoop” technique or a
mechanical device to hold the needle sheath
• Do not remove used needles from disposable
syringes by hand
• Do not bend, break or manipulate used needles

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 Occupational Health and
Blood-Borne Pathogens
• Use mouthpieces, resuscitation
bags, or other ventilation devices
as an alternative to mouth-to-
mouth resuscitation methods.
• Keep these devices available in
areas where clients may need to be
resuscitated (ie, birth rooms)

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Self-inflating resuscitation
bag (Ambu bag)

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 Using a flow inflating
resuscitation bag on a baby

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 Environmental control
• Follow facility infection control procedures
for cleaning the environment, jacuzzi tubs,
etc.
• Use Transmission-Based Precautions:
– Airborne precautions
– Droplet precautions
– Contact precautions

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 Airborne Precautions
• Airborne droplets or dust particles containing
infectious agents can remain suspended in the
air for long periods of time
• Air currents can blow them long distances
• Can be emitted during talking, sneezing,
coughing and whispering
• Examples: Mycobaterium tuberculosis,
Rubeola (measles) and Varicella (chicken pox)

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 Droplet Precautions
• Propelled short distances through the air
• Deposited on host’s conjunctiva, nasal mucosa
or mouth
• Can be emitted during talking, sneezing,
coughing and during procedures like
suctioning and bronchoscopy
• Examples: streptococcal pharyngitis, mumps,
influenza, rubella, some some pneumonias,
meningitis and sepsis

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 Contact Precautions
• Most important and frequent mode of
transmission for nosocomial infections
– Nosocomial = originates/takes place in
hospital or other health care facility
– Nosocomial infection = the client gets it as a
result of being in the health care facility
• Example: herpes (HSV), impetigo, scabies, some
gastrointestinal, respiratory, skin and wound
infections
• Direct-contact & Indirect-contact transmission

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Direct Contact Indirect contact
Transmission transmission
• Occurs when touching • Occurs when a
the infected client’s dry contaminated
skin during client care object is touched.
activities like giving a • For example,
massage coming in contact
• Can occur between two with needles,
clients: a source of the instruments,
infecting micro- environmental
organism and a surfaces or client
susceptible host care items.

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 Double-bagging technique
• Used when disposing of medical waste from
clients with infections (ex HIV)
• Health care worker “A”, wearing proper PPE,
takes the contaminated bag from the area
• “A” slips it into another bag held by co-worker
“B”
• “B” does not touch the contaminated bag
• “A” does not touch the clean bag
• The bags are labeled according to the facility
policy with hazardous waste or linen markers
to alert to the need for special handling

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 Sterilization
• Chemical agents and physical methods used to
destroy or inhibit growth of pathogens
• Bacteriostatic – inhibits growth
• Bacteriocidal/germicidal – kills microorganisms
• Antiseptics – bacteriostatic chemical agents,
mild enough to use on skin: 70% isopropyl
alcohol
• Disinfectants – destroy most bacteria and
viruses. Used for instruments that do not
penetrate the skin and for cleaning the
environment – floors, bathrooms, equipment

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 Disinfectants
• Chemical disinfectants can be harmful to the
skin. When using chemical disinfectants follow
manufacturer’s directions for dilution and for
antidoting any exposure
• 10% household bleach in water meets OSHA
requirements, kills HBV, HIV and TB
• Soaking for 20-30 minutes in 70% isopropyl
alcohol acts as a disinfectant: used for some
instruments, glass thermometers
• Boiling instruments in water: cover and boil in
“rolling water” for 20 mins. Rarely used today.

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 Sterilization
• Agents/methods that totally destroy all
microorganisms including viruses and spores
• Include chemical agents, gas, radiation, dry or
moist heat under pressure
• Most common method used is the autoclave,
which sterilizes by steam created by a
pressurized heating system
• Small units used in a medical office; large units
used in hospitals

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 Surgical Asepsis – Sterile
Technique
• Aseptic: free from pathogenic microorganisms
• Sterile Technique: refers to a group pf
principles and procedures designed to eliminate
pathogens
• Sterile field: an area designated as free from
microorganisms
• Example: a sterile towel placed on a clean, dry
surface – the towel becomes the sterile field
• Consider the field as a 3-dimensional area

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 Maintaining a sterile field
• Field should be above the waist height
• Do not bring contaminants into the field
• Actions that contaminate the field: touching
it, allowing it to become wet, reaching across it,
talking or coughing directly over the surface
• Work to the side of the field
• Sterile gloves come in sealed packages that
must be opened at the edge of the sterile field
and placed onto the field
• See PSGM Skills Book to put on sterile gloves

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 Blood borne diseases
• HBV and HIV: put health care workers at risk
• Transmitted by infected blood, mucous,
secretions, excretions, any moist body fluid
(except sweat)
• Routes of transmission:
– Parenteral – blood transfusion, needle sharing,
stick by needle or other sharp instrument
– Mucous membranes – eye or mouth
– Sexual contact
– Perinatal – from infected mother to her baby

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 HBV
• When infected with HBV, the liver becomes
inflamed and can be destroyed
• Symptoms range from mild to severe -jaundice
(yellowing of the eyes, skin, mucous
membranes), dark urine, extreme fatigue, loss
of appetite, nausea, abdominal pain, joint pain,
rash and fever
• Prevention: HBV vaccine, use of PPE, preventing
puncture injuries, disinfecting and sterilizing
equipment and environments

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 HBV vaccine
• OSHA requires employers to provide the HBV
vaccine free for employees with exposure risk
• A series of 3 doses given over 6 months
• Induce protective antibody levels in 85 – 97%
of healthy adults
• Blood test can determine antibody levels
• An employee has the right to refuse the HBV
vaccine but must sign a form to release the
facility from responsibility if the health care
worker becomes infected

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 HIV
• The Human Immunodeficiency virus that
causes AIDS
• HIV virus destroys cells in the host that are
vital to the immune system function
• Testing: tests for HIV antibodies
• Most infected people test positive within 6-12
weeks up to 6 months from exposure
• HIV positive = infected with the virus, can
transmit to others even if non-symptomatic
• AIDS = weakened immune system

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 AIDS
• Most but not all HIV infected people will
eventually develop AIDS and die from
“opportunistic infections” such as PCP
(Pneumocystis carinii pneumonia)
• Signs and symptoms of AIDS: weakness,
chronic fever, night sweats, swelling of lymph
nodes, weight loss and diarrhea
• No known vaccine or cure
• Managed by treating symptoms with antiviral
drugs and a healthy supportive lifestyle

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 HIV transmission
• HIV has been isolated from blood, semen,
breast milk, vaginal secretions, saliva, tears,
urine, cerebrospinal fluid and amniotic fluid
• Only blood, semen, vaginal secretions and
breast milk have been proven to transmit HIV
• Transmission not through casual contact:
– Parenteral – blood transfusion, needle stick
– Mucous membranes – eye or mouth
– Sexual intercourse
– Perinatal – from infected mother to baby

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 HIV transmission
HIV is NOT transmitted through:
• Sharing household facilities, food, eating
utensils, plates, drinking glasses or towels
• Hugging and kissing on the cheek
• Mosquitoes or other animals
Infection from exposure is determined by:
• Amount of the virus transmitted
• How many exposures
• Overall health of the person

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 HBV& HIV: Relative risk
• Most health care workers are afraid of
getting HIV, but HIV is much harder to
catch than HBV
• The infection and death rate from HBV far
exceeds HIV
• Only 3-5 health care workers out of 1000
injured with a needle contaminated with
HIV will become infected

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 Tuberculosis
• Airborne pathogen mycobacterium tuberculosis
primarily affects the lungs
• Working with TB clients requires using special
PPE, individually fitted masks, to avoid inhaling
tiny droplets which carry the disease
• Cases of TB have increased in recent years
• Medication must be taken for 6 months
• If clients don’t complete the course of
treatment, a drug-resistant strain can mutate
and re-infect the person

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 Tuberculosis
• Screening for TB is a skin test
• Positive test result means the person has been
exposed to the disease
• A chest x-ray confirms active disease
• Signs and symptoms: lethargy, fever, night
sweats, cough, weight loss, coughing up blood-
tinged sputum, chest pain, and SOB.
• Patients hospitalized with suspected TB are put
in isolation for 2-3 weeks and begin antibiotic
treatment

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 Drug-resistant organisms
• A fairly recent occurrence
• Results from:
– the overuse of antibiotics in the USA to
treat minor conditions
– Using wide-spectrum antibiotics instead of
testing/prescribing for a specific pathogen
– patients not completing an entire course of
prescribed treatment of antibiotics
• These create conditions that encourage
pathogens to become resistant to antibiotics

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 Drug-resistant organisms
• Two drug resistant organisms encountered in
health care:
– MRSA – Methicillin-resistant Staphylococcus
aureas
– VRE – Vancomycin-resistant Enterococcus
• Both are difficult to control and can cause
serious, life threatening infections esp. in
susceptible people (ex: premature babies)
• Treatment is expensive and has severe side
effects – liver, kidney & hearing damage

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 Reporting accidental
exposure
• Report any injury or accident involving exposure
to blood or body fluids immediately to your
clinical preceptor/supervisor
• Complete a written incident or injury report
• Reporting facilitates evaluation, appropriate
treatment and follow-up
• Failure to report can result in negative health
consequences and is in violation of OSHA
requirements

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 OSHA Regulations
• Every facility must have an Exposure Control
Plan:
– Predetermines employee exposure risk to
blood-borne pathogens
– Describes how employees at risk will be
protected
– Gives training and annual retraining and
testing requirements for employees
– Gives policies and procedures to follow in
case of employee exposure

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 SUMMARY
• How do antibiotics work?
• What is an opportunistic infection?
• Define: Aerobic, Anerobic, host, Symbiosis,
Neutralism and Parasitic
• Differentiate plant and animal microbes:
Bacteria, Viruses, Fungi, Rickettsia,
Protozoa

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 SUMMARY
• Explain the chain of infection and how to break
it at each point
1. The infectious agent
2. Reservoir host
3. Portal of exit from the host
4. Route of transmission
5. Port of entry
6. Susceptible host

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 SUMMARY
• What are the body’s natural defense
mechanisms?
• Explain the concept of a sterile field and how to
avoid contaminating it
• Describe standard precautions including
handwashing, gloving, PPE
• Explain the differences between antiseptics,
disinfectants and sterilization

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 SUMMARY
• How is HIV transmitted? How is it NOT?
• What are the 3 major disease risks for health
care workers
• How do pathogens become drug-resistant?
• What is the role of government agencies: CDC,
OSHA
• Explain environmental control and transmission
precautions

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1190L NURSING
SKILLS LAB
Infection Control

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