CHAPTER 17 Infection Control in the Hospital and Home

1
CHAPTER 17 Infection Control in the Hospital and
Home
2
Infection

• Four stages in the infectious process
• Stage one The incubation period
• The time after the body is invaded by the
  organism to the onset of symptoms. In some cases
  the infection can be transmitted during this
  stage
• Stage Two The prodromal period
• The period from the onset of vague symptoms to
  the onset of specific disease symptoms. This
  stage is highly infectious.
• (Contd)

3
Infection

• (Contd)
• Stage Three The illness period
• Localized and systemic symptoms appear.
• Fever, headache, malaise and disease-specific
  symptoms affect the patient (e.g., leukocytosis,
  rash, swelling, wound drainage, diarrhea and
  vomiting).
• Stage Four The convalescent period
• Begins when symptoms begin to subside and
  continues until the person returns to normal

4
Nosocomial Infections

• Nosocomial infections
• Occur when infection is transmitted from one
  person to another while receiving health care
  services
• Health care workers can contract nosocomial
  infections (e.g., head colds, flu, skin
  infections)
• There are approximately 2 million patients
  affected by nosocomial infections each year.

5
Patients at Risk for Nosocomial Infections

• Patients with
• Surgical incisions
• Artificial airways
• Urinary catheters
• Intravenous lines
• Implanted prosthetic devices
• Repeated needle sticks for medication
  administration or laboratory specimens
• Compromised immune systems

6
Infection Control

• Uses medical and surgical asepsis and Standard
  Precautions to prevent the spread of infections
• Strict aseptic technique
• Used in invasive diagnostic and therapeutic
  procedures
• IV catheters, urinary catheters, surgical
  procedures
• (Contd)

7
Infection Control

• (Contd)
• Ways to prevent nosocomial infections (Table
  17-1)
• Handwashing should be performed before and after
  caring for a patient.
• Urinary catheters should be below the level of
  the bladder at all times.
• Residual urine should be cleaned from the
  drainage tube when the drainage bag is emptied.
• (Contd)

8
Infection Control

• (Contd)
• Ways to prevent nosocomial infections
• Turn and assist all patients on bed rest to cough
  and deep-breath every 2 hours.
• Assess IV sites for signs of infection with each
  patient contact.
• Use aseptic technique for any invasive procedure.
• Clean incontinent patients promptly.
• Use aseptic technique when suctioning airways.
• (Contd)

9
Infection Control

• (Contd)
• Involves
• Surveillance for signs of infection
• Procedures to contain microorganisms when
  infection is evident (handwashing)
• Proper handling of contaminated items
• Proper sanitation methods
• Protection of individuals at high risk for
  infection
• Prevention of nosocomial infections

10
History of Infection Control

• Before 1983, the CDC recommended
  category-specific isolation
• Seven categories
• Strict isolation
• Contact isolation
• Respiratory isolation
• Tuberculosis isolation
• Enteric precautions
• Blood/body fluid precautions
• (Contd)

11
History of Infection Control

• (Contd)
• In 1983, the CDC allowed institutions to choose
  between category-specific and disease-specific
  precautions
• (disease-specific listed 170 diseases)
• In 1987, the CDC advised the use of Universal
  Precautions for all patients based on the
  increasing numbers of HIV and AIDS patients.
• (Contd)

12
History of Infection Control

• (Contd)
• In 1991, OSHA established regulations to protect
  health care workers from exposure to blood-borne
  pathogens.
• OSHA then adapted the CDCs Universal Precautions
  with an emphasis on avoiding injury from sharp
  objects such as needles.

13
Guidelines for Patient Care Contact

• Never touch anything with bare hands that comes
  from a body surface or cavity.
• Gloves are to be worn for contact with
• Body fluids of any sort, including
• Saliva, urine
• Feces, blood
• The only times gloves are not worn is for contact
  with intact skin or unsoiled articles.

14
Handwashing

• Handwashing is the best way to prevent nosocomial
  infections.
• Handwashing is required
• Before and after contact with a patient
• Before and after wound care
• Before any invasive procedure
• Before donning gloves and after removing them

15
Transmission Precaution Requirements

• Universal (Standard) Precautionsfor all patients
• Airborne Precautionsmeasles, varicella, TB
  (special mask)
• Droplet Contact PrecautionsGI, skin, wound
  infections, RSV, herpes simplex
• Never touch anything wet that comes from a body
  surface or cavity with bare hands.

16
Isolation Precautions

• Specimen removal Label specimen container before
  entering room, collect specimen and place it in a
  leak-proof container without contaminating the
  outside.
• Linens Handle as little as possible. Roll up and
  place inside the linen hamper inside the
  patients room.
• (Contd)

17
Isolation Precautions

• (Contd)
• Trash Disposable soiled equipment should be
  placed in plastic bags lining the waste
  receptacle. A biohazard (red) bag may be
  needed.
• Sharps Never recap a needle before disposal. All
  sharps are dropped into sharps containers, which
  are replaced when they are two-thirds full.
• (Contd)

18
Isolation Precautions

• (Contd)
• Other equipment Reusable equipment is cleaned if
  visibly soiled, then sent to central supply to be
  disinfected.
• Patient placement Patients in need of
  transmission precautions should be placed in
  aprivate room or with another patient in the
  sameroom if infected with the same organism.

19
Infection Control in the Home

• Infectious patients clothing and linens should
  be laundered separately in hot water with
  chlorine bleach and dried in a dryer on high or
  hung in the sun for 6 to 8 hours.
• Patient and family should be taught proper
  handwashing techniques.
• The bathroom can be disinfected with a 110
  bleach/water solution.
• Dishes should be washed or soaked in scalding
  water and allowed to air dry.
• (Contd)

20
Infection Control in the Home

• (Contd)
• Dishes may be cleaned with the 110 bleach/water
  solution.
• Clean gloves should be used for wound care or
  dressing changes. Family should be taught proper
  method of removing soiled gloves.
• Patients room should be cleaned frequently.

21
Infection Control for the Nurse

• The main modes of exposure to blood-borne
  pathogens through skin, eye, mucous membrane, or
  parenteral route are
• Puncture wounds from contaminated needles or
  other sharps.
• Skin contact allowing infectious fluids to enter
  through broken or damaged skin.
• Mucous membrane contact, in which infectious
  fluids enter through mucous membranes of the
  eyes, mouth, and nose.

22
Surgical Sepsis

• Four rules of surgical sepsis
• Know what is sterile
• Know what is not sterile
• Separate sterile from unsterile
• Remedy contamination immediately
• Review Table 17-5

23
The Surgical Scrub

• More lengthy and vigorous than regular
  handwashing
• Used to remove as many microorganisms as possible
  without damaging the skin
• Timing based on actual time spent scrubbing, not
  including rinse time
• Usually 4 to 6 minutes

24
Principles for Opening Sterile Packages

• Open the sterile package away from the body.
• Touch only the outside wrapper.
• Do not reach across a sterile field.
• Always face the sterile field.
• Allow at least 6 inches between the body and the
  sterile field.