RET 1024 Introduction to Respiratory Therapy

1
RET 1024Introduction to Respiratory Therapy

• Module 3.0
• Infection Control

2
Infection Control

• Nosocomial Infection
• An infection acquired after hospitalization
• - AKA hospital-acquired infection

3
Infection Control

• Nosocomial Infection
• Account for an estimated 2 million infections
  and 90,000 excess deaths annually

4
Infection Control

• Nosocomial Infection
• Infections acquired by those in the intensive
  care unit (ICU) account for gt20 of all HAIs (CDC
  2007)
• Immunocompromised by disease and/or treatment
• Major trauma
• Respiratory failure
• Myocardial infarction
• CHF
• Overdose

5
Infection Control

• Nosocomial Infection
• Approximately 25 of patients undergoing
  mechanical ventilation develop pneumonia as a
  complication

6
Infection Control

• Nosocomial Infection
• Approximately 30 of patients who develop
  ventilator-acquired pneumonia (VAP) will die

7
Infection Control

• Nosocomial Infection
• Historically, non-disposable respiratory
  equipment was identified as a major cause of
  respiratory infection

8
Infection Control

• Nosocomial Infection
• Today, procedures have evolved, and with the
  advent of single-patient use equipment,
  infections associated with respiratory equipment
  have decreased significantly

9
Infection Control

• Nosocomial Infection
• Healthcare workers must remain vigilant to
  protect their patients and themselves against
  infection to do so, requires strict adherence to
  infection control procedures

10
Infection Control

• Infection control procedures aim to
• Eliminate the sources of infectious agents
• Create barriers to their transmission
• Monitor and evaluate the effectiveness of control

11
Infection Control

• Spread of Infection
• Infection occurs when a pathogen overcomes the
  barrier of the host
• Pathogen a microorganism capable of producing a
  disease
• Host an organism in which another, usually
  parasitic, is nourished and harbored

12
Infection Control

• Spread of Infection
• Three elements needed to spread an Infection
• Source of pathogens
• Route of transmission
• Susceptible host

13
Infection Control

• Source of Pathogens
• People
• Patients, personnel, visitors
• Acute disease with symptoms
• Incubation period (exposed, but no symptoms yet)
• Colonized by pathogens without symptoms
• Autogenous infection (originating from within the
  body)

14
Infection Control

• Source of Pathogens
• Contaminated objects
• Equipment
• Linen
• Medication

15
Infection Control

• Transmission Route
• Contact
• Droplet
• Airborne
• Common vehicle
• Vectorborne
• NOTE Some organisms may be spread by multiple
  routes

16
Infection Control

• Contact Transmission
• Direct Contact
• Body-surface-to-body-surface contact
  (person-to-person)
• Indirect Contact
• Contaminated object (fomite) to host contact
• Clothing (uniforms, lab coats, isolation gowns)
• Equipment
• Dressings
• Instruments
• Shared toys

17
Infection Control

• Droplet Transmission
• Contaminated respiratory droplets
• Discharged into the air (up to 10 feet) during
• Coughing, sneezing, talking
• Suctioning, bronchoscopy, intubation, cough
  induction
• Deposited on the hosts mucosal surfaces
• Nasal mucosa
• Mouth

18
Infection Control

• Droplet Transmission
• Contaminated respiratory droplets
• Currently Health Care Infection Control practices
  Advisory Committee (HICPAC) guidelines state it
  may be prudent to don a mask when within 6 feet
  of the patient or upon entry into the room of a
  patient who is on droplet isolation

19
Infection Control

• Droplet Transmission
• Haemophilus Influenzae
• Pneumonia / Epiglotitis
• Influenza virus
• Rubella (German measles)

20
Infection Control

• Airborne Transmission
• Contaminated droplet nuclei
• Residue of evaporated water droplets containing
  infectious microorganisms
• Can remain suspended in air for long periods
• Respirable particles of less than ? 5 ?m
• Dust particles
• Act as fomites

21
Infection Control

• Airborne Transmission
• Mycobacterium tuberculosis (TB)
• Rubeola (Measles)
• Varicella-zoster (Chicken Pox)
• Note Special air handling and ventilation, as
  well as respiratory protection are required

Mycobacterium Tuberculosis
22
Infection Control

• Common Vehicle Transmission
• Pathogens in water and food
• Food
• Salmonellosis
• Hepatitis A
• Water
• Shigellosis
• Cholera
• Medications (e.g., heparin solution)

23
Infection Control

• Vectorborne Transmission
• Animals or insects transfer pathogens
• Malaria
• West Nile Virus
• Rabies
• Note Vectorborne transmission are of little
  significance in hospital-acquired infections

24
Infection Control

• Spread of Infection to the Lungs
• Pathogens enter the lungs via
• Aspiration of contaminated -
• Oropharyngeal secretions
• Gastric secretions
• Inhaled droplets, droplet nuclei, or dust
  particles containing pathogens (fomites)
• Hematogenous
• Via the blood

25
Infection Control

• Host
• Host infection dependent upon
• Virulence of the organism
• Resistance of the host

26
Infection Control

• Host
• Increased susceptibility
• Diabetes mellitus
• Lymphoma
• Leukemia
• Neoplasia
• Those treated with
• Corticosteroids, irradiation, certain
  antimicrobials, immunosuppressive agents

27
Infection Control

• Host
• Increased susceptibility
• Age
• Chronic disease
• Shock
• Coma
• Traumatic injury
• Surgical procedure

28
Infection Control

• Host
• Most nosocomial pneumonias occur in surgical
  patients, especially those who have had chest or
  abdomen procedures
• Clearance mechanisms impaired
• Bacterial enters lower airway
• Intubation
• Anesthesia
• Surgical pain
• Narcotics and sedatives

29
Infection Control

• Host
• Surgical Patients with Highest Risk of Pneumonia
• Elderly
• Severely obese
• COPD
• History of smoking
• Those with artificial airways
• Endotracheal / Tracheostomy tubes

30
Infection Control

• Infection Control Strategies
• Infection control aims to break the chain of
  events causing the spread of infection

31
Infection Control

• Infection Control Strategies
• Decrease host susceptibility
• Eliminate the source of pathogens
• Interrupt the transmission routes

32
Infection Control

• Decrease host susceptibility
• Hospital efforts focus on employee immunization
  and chemoprophylaxis

33
Infection Control

• Decrease host susceptibility
• Immunizations
• Hepatitis B
• Varicella (chicken pox)
• Rubella (German measles)
• Measles
• Pertussis (Whooping cough)
• When working with infants and children
• Influenza

34
Infection Control

• Decrease host susceptibility
• Chemoprophylaxis
• Postexposure Treatment
• Bordetella pertussis (whooping cough)
• Neisseria meningitis (meningococcal meningitis)
• Bacillus anthracis (anthrax)
• Influenza virus
• HIV
• Group A streptococci

35
Infection Control

• Eliminating Source of Pathogens
• Procedure to remove pathogens from the
  environment fall into two major categories
• General Sanitation
• Specialized Equipment Processing

36
Infection Control

• Eliminating Source of Pathogens
• General Sanitation
• Help keep overall environment clean
• Sanitary laundry management
• Sanitary food preparation
• Sanitary housekeeping
• Environmental control of the air
• Specialized ventilation systems
• Environmental control of the water

37
Infection Control

• Eliminating Source of Pathogens
• Specialized equipment handling
• Decontamination of equipment capable of spreading
  infection
• Cleaning
• Disinfection
• Sterilization

38
Infection Control

• Specialized Equipment Handling
• Cleaning
• Removes dirt and organic material from equipment,
  usually by washing
• Failure to do this will render subsequent
  processing ineffective !!!
• Should be done in a designated Dirty area

39
Infection Control

• Specialized Equipment Handling
• Cleaning
• Soaps, detergents, or enzymatic cleaners should
  be used
• Some contain germicide
• Automated washers available
• (pasteurization / chemical disinfection cycle)
• Must be rinsed and dried
• Reassembled aseptically
• Designated Clean area

40
Infection Control

• Specialized Equipment Handling
• Disinfection
• Destroys the vegetative form of pathogens on
  inanimate objects except bacterial spores
• Physical methods
• Chemical methods

41
Infection Control

• Specialized Equipment Handling
• Physical Disinfection
• Pasteurization
• Submersion in a water bath at temperatures below
  boiling (70? C) for 30 minutes
• Kills vegetative bacteria and most viruses
• Does not kill bacteria spores

42
Infection Control

• Specialized Equipment Handling
• Chemical Disinfection
• Low-Level
• Intermediate
• High-Level

43
Infection Control

• Specialized Equipment Handling
• Low-Level Disinfectants
• Kills most bacterial, some viruses and fungi
• Will not kill Mycobacterium tuberculosis (TB)
  spores and nonlipid virus

44
Infection Control

• Specialized Equipment Handling
• Low-Level Disinfectants
• Acetic acid
• Mostly used for homecare equipment
• (13 white vinegar/water solution )
• Quaternary ammoniums
• Hospital use surface disinfection, e.g.,
  floors, countertops, walls, etc.

45
Infection Control

• Specialized Equipment Handling
• Intermediate Disinfectants
• Kills all vegetative bacteria and fungi, but have
  variable activity against spores and certain
  viruses

46
Infection Control

• Specialized Equipment Handling
• Intermediate Disinfectants
• Alcohol (70 Ethyl, 90 Isopropyl)
• Not sporicidal
• Surface disinfectant, e.g., stethoscopes,
  ventilators, etc.
• Phenolics
• Not sporicidal
• Surface disinfectant
• (added to detergents to enhance germicidal
  activity)

47
Infection Control

• Specialized Equipment Handling
• Intermediate Disinfectants
• Iodophors (iodine surace-active organic
  compounds)
• Used on skin and tissue

48
Infection Control

• Specialized Equipment Handling
• High-Level Disinfectants
• Glutaraldehyde
• Hydrogen peroxide
• Peracetic acid
• Chlorine (sodium hypochlorite)

49
Infection Control

• Specialized Equipment Handling
• High-Level Disinfectants
• Glutaraldehyde (Trade name CIDEX)
• Kills vegetative bacteria, Mycobacterium
  turburculosis, fungi, viruses and spores in lt10
  minutes
• Commonly used to disinfect/sterilize endoscopes,
  e.g., fiber optic bronchoscopes, respiratory care
  equipment, and spirometry tubing

50
Infection Control

• Specialized Equipment Handling
• High-Level Disinfectants
• Hydrogen Peroxide
• 6 solution is bactericidal, fungicidal,
  viricidal in 10 minutes,
• Sterilizes (sporicidal) in 6 hours
• Does not produce harsh fumes

51
Infection Control

• Specialized Equipment Handling
• High-Level Disinfectants
• Peracetic acid
• Kills all microorganisms, including spores

52
Infection Control

• Specialized Equipment Handling
• High-Level Disinfectants
• Sodium Hypochlorite
• 150 dilution kills vegetative bacteria,
  bacterial spores, and Mycobacterium tuberculosis
  in 10 minutes
• 110 dilution used to clean blood spills

53
Infection Control

• Specialized Equipment Handling
• Sterilization
• Complete destruction of all forms of microbial
  life

54
Infection Control

• Specialized Equipment Handling
• Sterilization
• Incineration
• Dry heat
• Boiling
• Autoclaving
• Ionizing radiation
• Ethylene oxide

55
Infection Control

• Specialized Equipment Handling
• Steam Sterilization (Autoclaving)
• Steam under pressure
• Commonly 15 psi at 121? C for 15 minutes
• Equipment must be cleaned and wrapped in muslin,
  linen, or paper
• Most respiratory equipment can be damaged by this
  process

56
Infection Control

• Specialized Equipment Handling
• Ethylene Oxide (EtO)
• Toxic gas
• Equipment must be cleaned and wrapped in muslin,
  paper, or polyethylene using EtO indicator tape
• Acute exposure may cause
• Airway inflammation
• Nausea
• Diarrhea
• Headache
• Dizziness
• Convulsion

57
Infection Control

• Specialized Equipment Handling
• Equipment Handling Procedure
• Equipment handling procedures help prevent the
  spread of pathogens
• Will be covered in Lab