Copyright © 2008 Delmar Learning. All rights reserved. Unit 13 Infection Control.

Copyright © 2008 Delmar Learning. All rights reserved.

Unit 13

Infection Control


Objectives

• Spell and define terms.• Explain the principles of medical

asepsis.• Explain the components of standard

precautions.


Objectives

• List the types of personal protective equipment.

• Describe nursing assistant actions related to standard precautions.


Objectives

• Describe airborne precautions.• Describe droplet precautions.• Describe contact precautions.


Disease Prevention

• In the last unit, you learned what infections are and some of their causes

• In this unit– You will learn actions and procedures that

can help prevent the transmission of infection to protect yourself, your coworkers, and those in your care


Medical Asepsis

• Asepsis– Absence of disease-producing

microorganisms


Medical Asepsis

• Medical asepsis– Reducing the numbers of disease-

producing microorganisms – Or interrupting transmission from one

person to another person or from a person to a place or an object


Handwashing

• Single most important health procedure any individual can perform to prevent the spread of microbes


Handwashing

• Vigorous, short rubbing together of all the surfaces of soap-lathered hands

• Followed by rinsing under a stream of running warm water

• Handwashing should take at least 15 seconds


Waterless Hand Cleaners

• Many facilities provide dispensers containing waterless hand cleaners in various locations


Waterless Hand Cleaners

• Hand cleaners – Alcohol-based gel, lotion, or foam that is

dispensed in small dime- to quarter-sized portions

– Alcohol products may be used to clean your hands for most routine care


Using Alcohol Hand Cleaner

• Wash at the sink if:– Hands are soiled with a protein substance– Patient is known or suspected of having a

disease caused by spores


Hand Lotion and Cream

• Maintaining the integrity of the skin on your hands– Very important to prevent injury and

exposure to microbes


Hand Lotion and Cream

• Hand care products – Use products from individual, personal size

packages, or from a pump dispenser or squeeze bottle, but don’t touch the spout

– Avoid products in a jar


Protecting Yourself

• As you perform your duties, you may contact potentially infectious material– Blood or other body fluids, that may

contain pathogens


Standard Precautions

• Infection control actions used for all people receiving care– Regardless of their condition or diagnosis



• Previously called Universal Precautions• Assumes blood and body fluid of any

patient could be infectious



• Recommends PPE and other infection control practices to prevent transmission in any healthcare setting

• Decisions about PPE use determined by type of clinical interaction with patient


PPE for Standard Precautions (1)

• Gloves– Use when touching blood, body fluids,

secretions, excretions, contaminated items– For touching mucus membranes and

nonintact skin



• Gowns – Use when in contact with clothing, exposed

skin with blood/body fluids, secretions, or excretions



• Mask and goggles or a face shield– Used during patient care activities likely to

generate splashes or sprays of blood, body fluids, secretions, or excretions


Transmission-Based Precautions

• Standard precautions do not eliminate the need for other isolation precautions

• A second set of precautions is used with certain highly transmissible diseases

• Second tier of precautions is called transmission-based precautions


Four Isolation Techniques

1. Isolation technique is the name given to the method of caring for patients with easily transmitted diseases

2. Essential that every person take responsibility and use the proper isolation techniques to prevent the spread of disease to others


Four Isolation Techniques

3. All items that come into contact with a patient’s excretions, secretions, blood, body fluids, mucous membranes, or nonintact skin are considered contaminated. Infectious material must be treated in a special way.


Isolation Technique

4. Standard precautions are always used in addition to transmission-based precautions


Isolation Unit

• May be an area or a private room• Patients with the same disease may

share a room• A room with handwashing facilities and

an adjoining room with bathing and toilet facilities is best


AII (A2) Rooms

• Rooms with a special air handling system may be called A2 rooms

• These rooms have negative pressure– Air flow in which air from the room is

vented directly to the outside– Or filtered so pathogens cannot escape


AII (A2) Rooms

• Ventilation is needed for airborne precautions

• A HEPA respirator or NIOSH-approved mask – Must always be worn when entering an

airborne precautions room


Ultraviolet Germicidal Irradiation (UVGI)

• Ultraviolet Germicidal Irradiation (UVGI) lights – Used to eliminate pathogens in some

isolation rooms



• UVGI lights– Used intermittently as a secondary

measure to kill or inactivate the pathogens in the upper portion of the room or passing through the air duct



• Lights are not on all the time• Not a threat to the patient or health care

workers


The Anteroom

• Used to enter some isolation rooms• Is a small room inside the entrance to

the patient room• It contains a sink and containers for

trash disposal


The Anteroom

• Reduces escape of infectious organisms when the door is opened and closed

• It serves as a buffer between the changes in air pressure in the patient room and the hallway

• Refer to Figure 13-11


The Anteroom


Additional Respiratory Precautions

• CDC recommends:– Teaching new admissions and those who

accompany them to use respiratory precautions

– Notifying staff if symptoms of a respiratory infection are present when they first register for care



• Other respiratory precautions are:– Practicing respiratory hygiene/cough

etiquette– Containing secretions– Covering the nose and mouth when

coughing or sneezing



• Other respiratory precautions are:– Using tissues to contain respiratory

secretions– Discarding the tissues in the nearest trash

can after use



• Other respiratory precautions are:– Performing hand hygiene after contact with

respiratory secretions and/or contaminated objects and/or materials

– Using alcohol hand cleaner from dispensers mounted in public areas


Preparing for Isolation

• To prepare a patient room for isolation, do the following:– Indicate type of isolation precautions on

the door to the patient’s room– Place an isolation cart next to the door

• Provide PPE (personal protective equipment) as needed



• To prepare a patient room for isolation, do the following:– Line wastepaper basket inside the room

with a plastic bag labeled or color-coded for infectious waste

– Place a laundry hamper in the room• Line it with a yellow biohazard laundry bag



• To prepare a patient room for isolation, do the following:– At the sink, check the supply of paper

towels and soap– Soap should be in a wall dispenser or foot-

operated dispenser


Personal Protective Equipment

• Personal protective equipment includes:– Gloves, gown, mask, and goggles or face

shield

• Regular eyeglasses do not provide adequate protection


Personal Protective Equipment

• Eye protection must also protect the sides of the eyes

• A mask may be worn without eye protection– But eye protection should never be worn

without a mask


Selecting PPE

• For maximum protection, select the appropriate PPE based upon: – Type of anticipated exposure– Whether you expect only touch, or if

splashes, sprays, or large volumes of blood or body fluid, secretions, or excretions may be present


Selecting PPE

• For maximum protection, select the appropriate PPE based upon: – Durability and appropriateness of the PPE

for the task – How well the PPE fits you


Key Points About PPE

• Don before contact with the patient, generally before entering the room

• Use carefully– Don’t spread contamination


Key Points About PPE

• Remove and discard carefully– Either at the doorway or

immediately outside patient room– Remove respirator outside room

• Immediately perform hand hygiene


Sequence for Applying Personal Protective Equipment1) Wash hands

2) Gown

3) Mask or respirator

4) Goggles or face shield

5) Gloves


How to Don a Gown• Select appropriate type

and size• Opening is in the back• Secure at neck and

waist• If gown is too small, use

two gowns• Gown #1 ties in front• Gown #2 ties in back


How to Don a Mask• Place over nose, mouth,

and chin• Fit flexible nose piece

over nose bridge• Secure on head with

ties or elastic• Adjust to fit


How to Don a Particulate Respirator

• Select a fit tested respirator

• Place over nose, mouth and chin

• Fit flexible nose piece over nose bridge

• Secure on head with elastic

• Adjust to fit


How to Don a Particulate Respirator

• Perform a fit check – Inhale – respirator

should collapse– Exhale – check

for leakage around face


How to Don Eye and Face Protection

• Position goggles over eyes• Secure to the head using the

ear pieces or headband• Position face shield over face• Secure on brow with

headband• Adjust to fit comfortably


How to Don Gloves

• Don gloves last• Select correct type and

size• Insert hands into gloves• Extend gloves over

isolation gown cuffs


Do’s and Don’ts of Glove Use• Work from “clean to dirty”• Limit opportunities for “touch

contamination”• Protect yourself, others, and environment• Don’t touch your face or adjust PPE with

contaminated gloves• Don’t touch environmental surfaces

except as necessary during patient care


Do’s and Don’ts of Glove Use

• Change gloves– During use if torn and when heavily soiled

(even during use on the same patient)– After use on each patient

• Discard in appropriate receptacle– Never wash or reuse disposable gloves


How to Safely Use PPE• Keep gloved hands away from face• Avoid touching or adjusting other PPE• Remove gloves if they become torn

– Wash hands before donning new gloves

• Limit surfaces and items touched


“Contaminated” and “Clean” Areas of PPE

• Contaminated – outside front– Areas of PPE that have or are likely to

have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside


“Contaminated” and “Clean” Areas of PPE

• Clean – inside, outside back, ties on head and back– Areas of PPE that are not likely to have

been in contact with the infectious organism


Sequence for Removing Personal Protective Equipment1) Gloves

2) Wash hands

3) Goggles or face shield

4) Gown

5) Mask

6) Wash hands


Where to Remove PPE• At doorway, before leaving patient room

or in anteroom• Remove respirator outside room

– After door has been closed

• Ensure that hand hygiene facilities are available at the point needed– Sink or alcohol-based hand rub


How to Remove Gloves (1)

• Grasp outside edge near wrist• Peel away from hand• Turn glove inside-out• Hold in opposite gloved hand


How to Remove Gloves (2)

• Slide ungloved finger under the wrist of the remaining glove

• Peel off from inside

• Create bag for both gloves

• Discard


Remove Goggles or Face Shield

• Grasp ear or head pieces with ungloved hands

• Lift away from face• Place in designated

receptacle for reprocessing or disposal


Removing Isolation Gown• Unfasten ties

• Peel gown away from neck and shoulder

• Turn contaminated outside toward the inside

• Fold or roll into a bundle

• Discard


Removing a Mask• Untie the bottom & top

tie • Remove from face• Discard


Removing a Particulate Respirator

• Lift the bottom elastic over your head first

• Then lift off the top elastic

• Discard


Hand Hygiene• Perform hand hygiene immediately after

removing PPE• If hands become visibly contaminated

during PPE removal– Wash hands before continuing to remove

PPE


Hand Hygiene• Wash hands with soap and water or use

an alcohol-based hand rub• Ensure that hand hygiene facilities are

available at the point needed– Sink or alcohol-based hand rub


Equipment

• Disposable patient care equipment is used by many facilities

• It is ideal for patients on isolation precautions

• Frequently used equipment remains in the patient’s unit


Containment of Contaminated Articles

• It is important that contaminated equipment be bagged, labeled, and disposed of – According to the health care facility’s policy

for the disposal of infectious waste


Containment of Contaminated Articles

• Contaminated articles leaving the patient’s room– Must be handled so that pathogens will not

be spread


Transporting the Patient in Isolation

• Sometimes a patient in isolation has to be transported to another area of the health care facility for treatment or testing


Transporting the Patient in Isolation

• Notify the receiving unit of your intention to transport the patient– Describe the type of transmission-based

precautions being used


Disinfection and Sterilization

• Disinfection – Process of eliminating harmful pathogens

from equipment and instruments

• Sterilization removes all microorganisms from an item


Sterile Procedures

• Surgical asepsis – Environment kept free of microorganisms– Pathogens and nonpathogens– In procedures in which surgical asepsis is

used• Equipment and supplies must be sterile


Sterile Field

• An area of sterile equipment and materials

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Copyright © 2008 Delmar Learning. All rights reserved. Unit 13 Infection Control.

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