Chapter 5 [cna]-2 - cna textbook notes PDF

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Chapter 5: Infection Prevention and Control Define infection prevention and discuss types of infections • •

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Infection prevention: set of methods practiced in healthcare facilities to prevent and control the spread of disease Microorganism (MO): living thing that is so small it is only visible under a microscope o Microbe: another name for MO o Always present in environment Infections: occur when harmful microorganisms invade body and multiply o Pathogens: harmful microorganisms 2 main types of infections: o Localized infection: infection limited to a specific location in the body ▪ Local symptoms (near site of infection) o Systemic infection: affects entire body ▪ Travels through bloodstream, causes general symptoms like fever, chills, mental confusion Healthcare associated infection (HAI): type of infection that can be localized or systemic o Infection acquired in a healthcare setting during delivery of medical care o Recognize signs and symptoms of infections so they can report: ▪ Pain, redness, swelling, pus, drainage, heat – localized ▪ Fever, body aches, nausea, vomiting, weakness, headache, mental confusion, drop in blood pressure – systemic

Describe the chain of infection • •

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Chain of infection: way of describing how disease is transmitted from one human being to another Chain link 1: o Causative agent: pathogenic MO that causes disease o CA include bacteria, viruses, fungi, and parasites o Normal flora: MO that live in and on the body and normally do not cause harm to a healthy person as long as the flora remain in that particular are. When they enter a different part, they may cause an infection Chain link 2: o Reservoir: where the pathogen lives and multiplies o Can be human, animal, plant, substance o Warm dark and moist places is ideal environment to live grow and multiply o Some MO need oxygen, others don’t o Ex of reservoirs: lungs, blood and large intestine Chain link 3: o Portal of exit: any body opening on an infected person that allows pathogens to leave o Nose, eyes, mouth, cut, genitals, gi tract, respiratory tract, skin

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Chain link 4: o Mode of transmission: describe how pathogen travel o Direct contact: touching infected person or his secretions o Indirect: touching an object contaminated by infected person Chain link 5: o portal of entry: body opening on an uninfected person that allows pathogens to enter o Mucous membranes: membranes that line body cavities that open to the outside of the body (linings of mouth, nose, eyes, rectum, genitals) Chain link 6 o Susceptible host: uninfected person who could become ill o If one links in the chain of infection is broken, spread stops o Transmission: passage or transfer of most infectious diseases can be blocked by using proper infection prevention practices like handwashing (most important way to stop spread of infection) o Handwashing: ▪ Part of medical asepsis: refers to measures used to reduce and prevent the spread of pathogens ▪ Surgical asepsis: sterile technique, makes an object or area completely free of all MO not just pathogens. Use for procedures like changing catheters

Explain why the elderly are at a higher risk for infection • • • •

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Weakened immune system due to aging Decreased circulations, slow wound healing Risk for malnutrition: person who is not getting proper nutrition Dehydration: condition that occurs when there is an inadequate amount of fluid in the body o Difficulty chewing, swallowing, lack of appetite and thirst, illnesses, weakness, medication Body not getting nutrients, higher risk Limited mobility: pressure injuries, skin infections, pneumonia Hospitalized more....more likely to HAI Difficulty swallowing increase risk of resp and uti. Tubes increase risk Small viruses can turn into bigger, longer recovery

Explain Standard Precautions • •

Occupational Safety and Health Administration (OSHA): federal government agency that makes rules to protect workers from hazards on the job Center for Disease Control and Prevention CDC: federal government agency that issues guidelines to protect and improve health of individuals and communities o Created new infection prevention system to reduce risk of contracting infectious diseases in healthcare settings (2 levels of precautions):

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Standard precautions: treating blood, body fluids and nonintact skin and mucous membranes as if they were infected ▪ Must be practiced with every single person in a NA care ▪ Wash hands, wear gloves, remove gloves, wash all contaminated skin surfaces, gown, mask, goggles, sharps: needles or sharp objects, bag contaminated supplies, label body fluids, dispose of wastes properly Transmission based precautions: vary based on how an infection is transmitted. Used in addition to standard precautions

Explain hand hygiene and identify when to wash hands • •

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Most common way for HAI to spread is by hands of healthcare workers CDC identified hand hygiene as: washing hands with either plain or antiseptic soap and water or using alcohol based hand rubs o Hand sanitizer: effective in reducing bacteria on the skin, but are not a substitute for handwashing. o Antimicrobial agents: destroys, resists, or prevents the development of pathogens o Hand rubs can be used any time hands are not visibly soiled, hands must be rubbed together until product has completely dried Avoid wearing rings or bracelets, no fake nails Steps for washing hands o Turn water, keep clothes dry because moisture breeds bacteria, do not let clothing touch outside portion of sink or counter o Wet hands and wrists thoroughly o Apply soap o Keep your hands lower than elbows and your fingertips down. Rub hands together and fingers between each other to create a lather. Later all surfaces of wrists, fingers, and hands, using friction for at least 20 seconds. Friction helps clean o Clean your fingernails by rubbing them in the palm of your other hand o Keep your hands lower than your elbows and your fingertips down. Being careful not to touch the sink, rinse thoroughly under running water. Rinse all surfaces of your hands and wrists. Run water down from wrists to fingertips. Do not run water over unwashed arms down to clean hands o Use clean, dry paper towel to dry all surfaces of your hands, wrists, and fingers. Do not wipe towel on unwashed forearms and then wipe clean hands. Dispose of paper towel into waste container without touching the container. If your hands touch sink or waste basket start over o Use a clean dry paper towel to turn off the faucet. Dispose of paper towel into waste container. Do not contaminate your hands by touching the surface of the sink or faucet

Discuss the use of personal protective equipment (PPE) in facilities

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PPE is equipment that helps protect employees from serious workplace injuries or illnesses resulting from contact with workplace hazards Don: to wear Hand hygiene before and after Gowns o Protect exposed skin and clothing o OSHA requires these if fluid penetration is likely o If it becomes wet or soiled, it should be discarded and a new gown should be donned o Doff: to remove o Wash hands o Open gown. Hold it out in front of you and allow gown to open/unfold. Do not shake the gown or touch it to the floor. Facing the back opening of the gown, place your arms through each sleeve. o Fasten the neck opening o Reaching behind you, pull the gown until it completely covers your clothing's. Secure the gown at your waist o Put on your gloves after putting on the gown. The cuffs of the gloves should overlap the cuffs of the gown. o When removing a gown, first remove and discard gloves properly. Then unfasten the gown at the neck and waist. Remove the gown without touching the outside of the gown. Roll the dirty side in, while holding the gown away from your body. Dispose of the gown properly and wash your hands Mask and goggles o Special masks (respirators) for TB o Goggles work with a mask whenever blood or body fluids could possibly splash o Wash your hands o Pick up the mask by the top strings or the elastic strap. Do not touch the mask where it touches your face. o Pull the elastic strap over your head, or if the mask has strings, tie top strings first, then bottom strings. Do not wear a mask hanging from only the bottom ties or straps o Pinch the metal strip at the top of the mask tightly around your nose so that it feels snug. Fit the mask snugly around your face and below the chin o Put on the goggles over your eyes or eyeglasses. Use the headband or earpieces to secure them to your head. Make sure they are on snugly o Put on gloves after putting on the mask and goggles Face shields o When blood or body fluids may be splashed or sprayed in the eyes o Substituted for mask and goggles Gloves o Non sterile used for basic care o No powdered patient exam gloves o After removing gloves, na should wash hands before donning new gloves

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Wash hands Slide one glove on your left had Using your gloved hand, slide the other hand into the second glove Interlace your fingers to smooth out folds and create a comfortable fit Carefully look for tears , holes, or discolored spots. Replace glove if needed Adjust gloves until they are pulled up over your wrist and fir correctly. If wearing a gown pull the cuff of the gloves over the sleeves of the gown Removing gloves: ▪ Touch only the outside of one glove. With one gloved hand, grasp the other glove at the palm and pull the glove off ▪ With the fingertips of your gloved hand, hold the glove you just removed. With your ungloved hand, slip two fingers underneath the cuff of the remaining glove at the wrist. Do not touch any part of the outside of the glove ▪ Pull down, turning this glove inside out and over the first glove as you remove it ▪ You should now be holding on glove from its clean inner side and the other glove should be inside it ▪ Drop both gloves into proper container without contaminating yourself ▪ Wash your hands Donning full set of PPE ▪ Wash hands ▪ Open gown. Hold it out in front of you and allow the gown to open/unfold. Do not shake the gown to touch it to the floor. Facing the back opening of the gown, place your arms through each sleeve ▪ Fasten the neck opening ▪ Reaching behind you, pull the gown until it completely covers your clothing. Secure the gown at your waist ▪ Pick up the mask by the top strings or the elastic strap. Do not touch the mask where it touches your face ▪ Pull the elastic strap over your head, or if the mask has strings, tie top strings first, then bottoms strings. Do not wear a mask hanging from only the bottom ties or straps ▪ Pinch metal strip at top of mask tightly around your nose ▪ Put on goggles over our eyes or eyeglasses. Use headband or earpieces to secure them to your head ▪ Slide one glove on your left hand ▪ Using gloved hand, slide the other hand into the second glove ▪ Interlace your fingers to smooth out folds and create a comfortable fit ▪ Carefully look for tears, holes or discolored spots. Replace the glove if needed ▪ Pull the cuff of the gloves over the sleeves of the gown Donning ▪ All ppe except respirator must be removed before exiting the residents room.

Touch only outside of one glove. With one gloved hand, grasp the other glove at the palm and pull the glove off ▪ With fingertips of gloved hand, hold glove you just removed. With ungloved hand, slip two fingers underneath the cuff of the remaining glove at the wrist. Do not touch any part of the outside of the glove ▪ Pull down, turning this glove inside out and over the first glove as you remove it. ▪ You should now be holding one glove from its clean inner side and the other glove should be inside it ▪ Drop both gloves into the proper container without contaminating yourself ▪ Grasp headband or earpieces of goggles with ungloved hands ▪ Lift goggles away from your face ▪ Put the goggles in the proper container ▪ Unfasten the gown at the neck and waist. Remove the gown without touching the outside of the gown. Roll the dirty side in, while holding the gown away from your body. Dispose of gown properly ▪ If the mask has strings untie the bottom strings first, then the top strings ▪ Remove the mask from you face and discard in the proper container ▪ Wash your hands Osha states that it is the employers responsibility to instruct how to properly don ppe ▪

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List guidelines for handling equipment and linen • • •

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In health care, an object is clean if it has not been contaminated with pathogens Dirty: contaminated with pathogens Disinfection: process that kills pathogens but not all. Reduces count to level that is considered not infectious. o Carried out with pasteurization or chemical germicides o Examples of disinfection: oxygen tanks, wall mouthed blood pressure cuffs, resident care equipment Sterilization: cleaning measure that destroys all microorganisms, including pathogens Spore forming MO special group that have protective covering which is difficult to penetrate Uses surgical asepsis: accomplished through special machines Autoclave: sterilizes objects by using hot steam under pressure Liquid or gas chemicals and dry heat are other ways Items need to be sterilized: directly into body Facilities have special rooms for cleaning

Explain how to handle spills •

Notify proper department

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Don gloves Absorb with product used by facility Scoop up and dispose into container Proper disinfectant Immediately No glass

Explain transmission based precautions • •

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Airborne precautions, droplet precautions, and contact precautions Diseases with transmission based precautions: o Multidrug resistant organisms MDRO’s ▪ Resistant to one or more antimicrobial agents ▪ Methicillin resistant staphylococcus aureus MRSA and vancomycin resistant enterococcus VRE ▪ Clostridium difficile C. Diff ▪ Scabies ▪ Lice ▪ Influenza Airborne precautions o Pathogens remain floating in air o Tuberculosis o Masks Droplet Precautions o Spread by droplets in the air o Do not travel more then 6 feet o Influenza o Face mask, cover noses or mouths when they sneeze Contact precautions o Direct contact with person or object o Spread by touching contaminated area on residents body or her blood or body fluids o Conjunctivitis (pink eye) and c diff o Wear gloves, resident isolation

Define bloodborne pathogens and describe two major bloodborne diseases • • • • •

Bloodborne pathogens: microorganisms found in human blood that can cause infection and disease in humans Transmitted by infected blood entering the bloodstream or if infected semen or vaginal secretions contact mucous membranes Having sexual contact with someone carrying the disease can transmit a bloodborne disease Health care: spread through contact with contaminated blood, body fluids, needles Cannot be spread by casual contact

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HIV: human immunodeficiency virus o Can cause AIDS o HIV weakens immune system and body cannot fight infections o Final stage is AIDS o Aids: loose ability to fight infection and can die from illness Hepatitis o Inflammation of the liver caused by certain viruses and other factors like alcohol abuse, medications and trauma o A, B, and C o Hep b and c are BBP and can cause death o More people have hep b HBV then HIV o Hep a = fecal oral contamination o Hep b ▪ Spread through sexual contact, needles, and mother to baby ▪ Survive outside body for seven days and can still cause infection in others during that time ▪ HBV may cause few symptoms or may be a severe infection • Death, liver cancer, damage, pain in muscle joints stomach, jaundice, fatigue, loss of appetite o Hep c ▪ Cirrhosis and liver cancer ▪ No vaccine o Hep d ▪ Trans by blood and only found in people who carry hep b virus ▪ No vaccine o Hep e HEV ▪ Fecal oral route ▪ Contaminated water ▪ Rare ▪ No vaccine

Explain OSHA’s blood borne pathogens standard • • • •

Requires healthcare facilities to protect employees from bloodborne health hazards Exposure by injection, mucous membrane contact, cut from object containing potentially infections body fluid Nonintact skin including acne Guidelines must follow: o Employers must have written exposure control plan ▪ To eliminate or reduce employee exposure ▪ Step by step what to do if exposed, work practices o Must give everyone ppe when needed o Make biohazard containers o Free hep b vaccine o Warning labels o Log of injures

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In service training on bbp

Define tuberculosis and list infection prevention guidelines • • • • • • • • • • • • • • • • • • • •

Highly contagious disease caused by bacterium Mycobacterium tuberculosis Mucous droplets suspended in air Affects lungs, pulmonary tuberculosis Airborne disease Spend time with person infected, Causes coughing, breathing problems, fever, weightless, fatigue Cured by taking prescribed medication Untreated, death. Latent TB infection (LTBI) TB disease Latent TB carries disease but does not show symptoms and cannot infect others TB disease, symptoms and can spread Spread in areas with poor ventilation More likely to get it if your immune systems are weakened by illness, malnutrition, cancer, HIV, AIDS, alcoholism, drug abuse Multidrug resistant tb MDR-TB: form of tb that is caused by an organism that is resistant to medication that is used to treat tb Resistant" drugs no longer work to kill specific bacteria May develop when a person infected with TB does. not take all medications Full course of medications not taken, bacteria remain in body are less likely to be killed by medication. Disease becomes more difficult to cure Guidelines o Ppe, special care when handling phlegm, tb residents will be placed in a airborne infection isolation room AIIR , follow isolation procedures, help resident take medicine

Discuss MRSE, VRE, and C. Diff • •

MDRO: MO that are resistant to one or more antimicrobial agents Staphylococcus aureus o Common type of bacteria that can cause infection o Methicillin is a powerful antibiotic often used in healthcare facilities o MRSA is an antibiotic resistant infection to methicillin o HA MRSA : hospital associated MRSA o Community associated methicillin resistant staph aureus CA-MRSA: type of infection that occurs in people who have not recently been to healthcare facilities and no past diagnoses of MRSA ▪ Can manifests as skin infections such as boils or pimples o MRSA spread by direct contact with infected people, touching equipment o Symptoms: drainage, fever, chills, redness

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NA prevent spread: proper hygiene, hand washing is best way to control, follow SP and TBP, cuts kept clean

Enterococci o

Bacteria in digestive and genital tracts ▪ Normally do not cause problems ▪ Vancomycin is powerful antibiotic treat infections caused by enterococci ▪ If e became resistant to vancomycin... called vancomycin resistant enterococcus or VRE ▪ Spread through direct and indirect contact ▪ Fever, fatigue, chills, drainage ▪ Difficult to treat, require several medications ▪ Life threatening infections with compromised immune systems, very young old and ill ▪ Preventing: hand hygiene

• Clostridium difficile o o o o o o o o o o

C. diff spore forming bacterium which can be part of the normal intestinal flora Can flourish in intestinal tract and cause infection Toxin that causes watery diarrhea Enemas, nasogastric tube insertion, and GI tract surgery increase risk of developing infection Elderly high risk Over use of antibiotics can alter normal flora and increase risk of developing C diff can form spore that makes it difficult to kill Carried on hands of people who have direct contact with infected residents or environmental surfaces Soap and water must be used...