Infection control unit study guide PDF

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This is a study guide of all the Vital Sign Unit in Mr. Wijotkowski ...

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Infection control unit Principles of Infection Control: - Understanding infection control is essential for all healthcare workers - Provide a basic knowledge of how disease is transmitted - Main emphasis on prevention of disease transmission Facts about Microbes and Microorganisms: - Small living organism - Not visible to the naked eye - Microscope needed to see - Need source of food and moisture - Need for O2 varies (aerobic- live with O2; anaerobicno O2) - Human body is ideal supplier for all microorganisms requirements - Most prefer warm, dark, environments Bad Microorganisms - Microorganisms that cause infection and disease - Called Pathogens or germs Good Microorganisms - Many are part of normal  flora of body - Beneficial in maintaining certain body processes - Called NonPathogens Why are they good?

- At times, microorganisms that is beneficial in one body system can become pathogenic in another body system - Ex: E. Coli is part of the natural flora in the large intestines, but if it enters the urinary tract system, it causes infection Classification of Microorganisms 1. Bacteria 2. Protozoa 3. Fungi 4. Rickettsiae 5. Viruses 6. Helminths Bacteria: - Dimple, one-celled organisms - Multiply rapidly - Classified by shape and arrangement: - Cocci are round or spherical in shape ( Circles in Cocci) - Bacilli are rod shaped - Spirilla are spiral or corkscrew shaped ( Spiral in the word)

Diplococci- Occur in pairs or two circles - Causes diseases such as gonorrhea, meningitis, and pneumonia Streptococci- Cocci occur in chains - Common strep causes strep throat and rheumatic fever Staphylococcus- Occur in clusters or groups - Most common pyogenic (pus-producing) microorganisms - Cause infections such as boils, wound infections, toxic shock - MRSA (methicillin resistant Staphylococcus aureus)

Bacilli: - Bacteria is rod shaped - Can occur singly, in pairs or in chains - Many bacilli contain flagella (threadlike projections similar to a tail) - Have the ability to form spores or thick-walled capsules - This will happen when conditions for growth are poor - Extremely difficult to kill while in the spore form - Causes diseases such as TB, Tetanus, pertussis (whooping cough), Botulism, diphtheria, and typhoid Spirilla: - Include comma-shaped vibrio and corkscrew spirochete - Cause diseases such as syphilis and cholera Bacteria Superbugs: - Antibiotics are used to kill bacteria - Some bacteria strains are multidrug resistant meaning antibiotics will not kill them - MRSA bacterial - causes a severe staph infection that is so difficult to treat (contact precaution) -  VRE (Vancomycin-resistant Enterococcus)  bacterial - No one antibiotic is able to eliminate VRE therefore drug combos are used go treat it (contact precautions) Protozoa: - one-celled, animal-like organism - Found in decayed materials and contaminated water

- May have flagella for movement - Some are pathogenic such as malaria (plasmodium falciparum), amoebic dysentery and trichomonas Fungi: - 2 main types: Yeasts and Molds - Simple plant-like organisms - Live or dead organic matter - Yeast and molds can be pathogenic - Antibiotics do not kill - Antifungal meds for treatment - Cause diseases such as ringworm, athletes foot, histoplasmosis (bird or bat droppings, yeast vaginitis and thrush) - Can not be treated by antibiotics - Antifungal meds are available for many of the pathogenic fungi - Meds are expensive - Must be taken internally for a long period of time - Antifungal meds may cause liver damage Rickettsiae: - Parasitic microorganisms that cannot live outside the cells of another living organism - Transmitted to humans via bites by fleas, ticks, and mites - Cause diseases such as typhus fever and Rocky Mountain spotted fever - Antibiotics are effective against many Viruses:

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Smallest microorganism Must use electronic microscope to see Must be inside another living cell to reproduce Spread by blood and body secretions VERY DIFFICULT TO KILL Not affected by antibiotics bc they do not have a cell wall Those infecting animals can mutate to infect humans: - Severe acute respiratory syndrome (SARS) - West Nile virus (WNV) - Monkeypox - Ebola and Marburg - H5N1, H1N1 (influenza) - Common cold - Measles and Mumps - Chickenpox/Herpes - Warts - Polio

Diseases of major concern to healthcare workers: - Hepatitis B (serum hepatitis) **most infectious - Hepatitis C - AIDS/HIV - As of March… COVID-19 HEPATITIS B: - caused by HBV - Transmitted by blood serum & body secretions - Affects the liver and can lead to destruction and scarring of the liver cells

- Vaccine has developed to protect individuals - Vaccine is expensive and involves a series of 3 shots (if not all 3 completed then not immune) - Employers must provide vaccine by federal law at no costs to employees w occupational exposure to blood or other body secretions - Individual does not have the right to refuse but a written record must be kept proving the vaccine was offered HEPATITIS C: - Caused by HCV - Transmitted by blood/blood-containing body fluids - Many infected individuals are asymptomatic (no symptoms shown) - HCV can cause severe liver damage - No vaccine available - No preventative immunization - HBV and HCV extremely difficult to destroy - Viruses can remain active for several days in dried blood - Healthcare workers must take every precaution to protect themselves AIDS: - Caused by human immunodeficiency virus (HIV) - Suppresses the immune system - Individual becomes susceptible to cancers and infections that would not affect a healthy person

- No cure or vaccine - Precautions must be taken to prevent the spread of this disease (less infectious than HepB) New Viruses: West Nile Virus- mosquito borne Monkeypox- affected monkeys and spread to humans (hantavirus) Ebola and Marburg- primates to humans (flu like symptoms) HINI (swine flu)- contact with infected hpgs (2009 - global pandemic) H5N1- avian or bird flu SARS- respiratory virus caused by coronavirus family COVID-19- pandemic of 2020 HELMINTHS: Multicellular parasites also known as worms or flukes. - Transmitted by: Eating contaminated food Being bitten by infected insects When worms enter the skin

- Examples of Diseases: - Ascariasis - SI - Trinchinella spiralis: trichinosis (eating raw pork) - Pinworm (some can die in sunlight)

Aerobic organisms require O2 to live Anaerobic organisms live and reproduce in absence of O2 Human body is perfect for both

THREE DIFF. WAYS TO INFECT: - Some pathogens produce poisons called toxins (EX: bacillus tetanis produce toxins to the CNS) - Can cause allergic reaction (resulting in runny nose, watery eyes, and sneezing) - Attach and destroy living cells they invade (the protozoan that causes malaria) (invades the RBC & causes them to rupture)

4 Classifications of Diseases/Infections 1. Endogenous 2. Exogenous 3. Nosocomial/HAI 4. Opportunistic Endogenous: - Means the infection or disease originates  in the body - Includes metabolic disorders, congenital abnormalities, tumors and infections caused by microorganisms within the body Exogenous: - Means that the infection/disease originated  outside the body - EX: pathogenic organisms that invade the body, radiation, chemical agents, trauma, electric shock, and temp extremes

Nosocomial/HAI: - Infections that are acquired  by an individual in a healthcare facility such as hospital or long-term care facility. - Usually present in the facility and transmitted by health care workers to the patients - Many are pathogens transmitted in this manner are antibiotic-resistant - Can cause a serious and even life-threatening infection - Staphylococcus, pseudomonas, enterococci Opportunistic: - Infections that occur  when the body’s defenses are weak - Diseases do not usually occur in individuals with and intact immune system - EX: the development of Kaposi’s sarcoma (a rare type of cancer) or Pneumocystis carinii pneumonia in individuals with AIDS

Chain of Infection: ● Present for disease to occur and spread from one individual to another 1. Infectious agent/Pathogen/Causative agent/Virus 2. Reservoir 3. Portal of exit 4. Mode of transportation 5. Portal of entry

6. Susceptible host Can be Direct or Indirect

moves clockwise Example: 1. COVID-19 2. Your body where the virus is growing and reproducing 3. Nose (sneeze) 4. Droplets 5. Inhaling or close contact 6. Is that person immune or not? Carrier or not PORTAL OF ENTRY: -different portals of entry1. Breaks in the skin or mucous membrane (wounds)  2. Respiratory tract 3. Digestive tract 4. Genitourinary tract (catheters)  5. Circulatory tract Susceptible Host

- Individual who can contract the disease - Usually humans can fight off causative agents and usually not contract disease - Common defenses: 1. Mucous membranes that lines the respiratory, digestive, and reproductive tract and traps pathogens 2. Cilia 3. Coughing/sneezing 4. Hydrocholric acid in the stomach to destroy pathogens 5. Tears in the eye that contain bactericidal chemicals 6. Fever 7. Inflammation resulting in WBCs destroying pathogens 8. Immune response a. Body produces antibodies- protective proteins that combat pathogens b. Cells secrete protective chemicals such as interferon and complement ❖Humans become susceptible hosts in some instances - Large # of the pathogen invade the body - Body defenses are weak Mode of Transmission - DIRECT

a) Person to person b) Sexual c) Contaminated hands - INDIRECT a) Touching contaminated equipment (fomite → when the contaminated thing is an object) b) Breathing droplets (airborne → when contaminated thing is in the air) c) Insect bites (vector) Ending the Chain of Infection - Eliminate any step of the chain and infection has stopped - Prevent the transmission of disease - Follow practices to interrupt or break chain - Remember, pathogens are everywhere - Transmission prevention is a continuous process

Sepsis- lots of infection within the body Asepsis- absence of disease-producing microorganisms Sterile- Free of all organisms Contaminated- any object or area that may contain pathogens

Aseptic Techniques - Major ways to break the chain of infection - Handwashing

- Good personal hygiene - Use of disposable gloves - Properly cleaning instruments and equipment - Thorough cleaning of equipment - Aseptic techniques are directed toward maintaining cleanliness and eliminating or preventing contamination LEVELS OF ASEPTIC CONTROL 1. Antisepsis (lowest level) - Prevent or inhibit the growth of pathogenic organisms - Usually not effective against spores and viruses - Can usually be on the skin - Ex: alcohol and betadine 2. Disinfection (intermediate level) - Process that destroys or kills pathogenic organisms - Not always effective against spores and viruses - Chemical disinfectants can irritate/damage the skin and are used mainly on objects not people - Ex: bleach solutions and zephirin 3. Sterilization (highest level) - Process that destroys all microorganisms 1. Both pathogenic and nonpathogenic 2. Includes spores and viruses - Steam under pressure, gas, radiation, and chemicals can be used to sterilize objects - Autoclave is the most common equipment used (not sterile after 30days)

HAND HYGIENE: - Handwashing is the number one way to reduce the spread of microorganisms/infection control - Hands are perfect medium for spread of pathogens - Major aspect of standard precautions to keep all patients safe - Most important aseptic technique - Regular handwashing w plain soap & water - Antiseptic handwashing w antimicrobial soap & water - Antiseptic hand rub w alcohol-based cleaner (waterless)

W.H.O. on when to wash hands 1. Before & after any patient contact 2. Before performing a clean or aseptic procedure 3. After body fluid exposure 4. After contact with a patient’s skin 5. After touching patient surroundings Also to consider… 1. On arrival at facility 2. Before moving from contaminated body site to clean body site during patient care 3. If hands become contaminated during a procedure 4. Before applying and immediately after removing gloves 5. When gloves are torn or punctured 6. Before and after handling specimens (ex- tumor x-ray)

7. After contact w soiled or contaminated item 8. After picking up any item off the floor 9. After use of the bathroom 10. Following cough,sneeze, or using a tissue 11. Before or after contact w mouth or mucous membranes Hand-washing Technique: - Use soap as a cleansing agent - Warm water - Friction - Clean all hand surfaces - Point fingertips downward - Use dry paper towels to turn faucet on and off - Clean nails during handwashing - Waterless hand cleaning w alcohol-based gel, lotion, or foam - Use if hands are not visibly dry or contaminated w blood or body fluids - After 6-10 cleanings hands must be washed w soap & water

Types of Precautions for Healthcare - Bloodborne pathogens - Needlestick Safety act - Standard precautions

- Transmission Based precautions Standard Precautions: - Rules developed by the CDC to prevent spread of infection - Every body fluid considered potentially infectious - All patients considered potential sources of infection - Use in any situation where you might contact: - Blood or any fluid that contains blood - Body fluid, secretions, and excretions - Mucous membranes - Non-intact skin - Tissue or cell specimens - Blood and body fluids are main ways pathogens are spread - Three major pathogens: HBV, HBC, HIV - Extreme care must be taken at all times where there is an area, object or anything contaminated w blood or body fluids

GLOVES: - Handwashing before and after patient contact even with gloves - For possible contact w blood, bodily fluids, secretions, excretions, mucus membranes, tissue specimens, or nonintact skin - Handling/cleaning contaminated items or surfaces

- When performing invasive procedures or for venipuncture/blood tests - Hands must be washed immediately after removal of gloves - Gloves must not be reused

GOWNS: - For procedures that cause splashing or spraying - Help prevent contamination of clothing or uniform - Contaminated gowns must be handled per policy - Hands must be washed immediately after gown removal **required with contact spread precautions

MASKS & EYE PROTECTION: - For procedures that cause splashing/spraying - Prevent exposure of mucous membranes of mouth, nose, and eyes to pathogens - Use masks once and discard; change every 30 mins if needed - Protective eyewear & face shields protect front, top. Bottom, and sides of eyes - If not disposable, must be cleaned and disinfected before reuse

SHARPS: - Use extreme caution to avoid cuts and punctures - When possible, use safe needles or needleless devices - Use sharps containers - Follow laws regarding disposal of sharp objects

Spills/Splashes - Wipe up w disposable cleaning cloths - Wear gloves when wiping - Use disinfectant such as 10% bleach solution - Absorbent powder can be used for large spills Resuscitation devices - Use to avoid need for mouth-to-mouth resuscitation - Place in convenient location, have readily accessible Waste and linen disposal - Wear gloves, follow agency policy - Use biohazard bags appropriately Injuries - Immediately report cut/injury, needlestick, or splashing of blood/body fluids - Follow agency policy

Bloodborne Pathogen Standard - Established 1991 by OSHA - Must be followed by all healthcare workers - Civil penalties if not implemented by employers and followed by employees - Develop written exposure control plan - Identify all employees with occupational exposure - Provide hepatitis B vaccines free of charge - Provide PPE - Dispose of infectious waste correctly - Enforce rules on limited activities (eating, drinking, etc) in any potentially contaminated area - Provide appropriate, color-coded, and labeled containers for contaminated sharps and other infectious or biohazard wastes - Confidential medical evaluation and follow-up (free) for employee after exposure incident

Needlestick Safety Act - Passed by Congress in 2000 - CDC estimated 600,000 to 800,000 needle-sticks per year - OSHA revised Bloodborne Pathogens Standard to requirements of this act - Employer requirements - Identify and use effective and safer med devices - Incorporate changes in annual update of exposure control plan

- ENGINEERING CONTROLS make med devices safer - Solicit input from nonmanagerial employees who are responsible for direct patient care - Maintains a sharps injury log

Sterilizing with an Autoclave - Sterilization prevents spread of infection - Autoclave uses steam under pressure or gas or dry heat to sterilize - Destroys all microorganisms (good and bad) - Most efficient method of sterilization - Wrap items that are to remain sterile - Indicators to ensure sterilization - sterilized items can remain sterile for 30 days Using Chemicals for Disinfection - Chemicals disinfect, but do not sterilize - Most do not kill spores or viruses - disinfect instruments that do not penetrate body Cleaning with an Ultrasonic Unit - Used to remove dirt, debris, blood, saliva, tissue from instruments prior to sterilization - BEFORE autoclave

- Uses sound waves for cleaning - Method of aseptic control, not sterilization - Used ultrasonic solutions in unit Sterile - Free from ALL organisms - 100% free - Assume its contaminated unless the indicator says its sterile Contaminated - Organisms and pathogens are present

Using Sterile Techniques - Many procedures require use of sterile techniques to protect patients from infection - Surgical asepsis keeps an object or area free from living organisms Establishing a Sterile Field - Keep dry (blood doesn't count) Adding Items to Sterile Field 1. Drop technique - For gauze, pads, dressings, small items packaged 2. Mitten technique - For bowls, drapes, linens that are wrapped

3. Transfer forceps - For cotton balls, small items Sterile Gowns - Anything below belly button is contaminated

Standard Precautions: (CDC) 1. Hand Hygiene 2. Use PPE

Transmission Based Precautions (dealing w ppl who have or extreme need to stay away from communicable diseases)

- Used on all patients - Patient must be in a private room if they contaminate the environment or cannot maintain appropriate hygiene - Transmission Based Isolation is a step above: 1. Airborne 2. Droplet 3. Contact - Sign on the door to let you know - Communicable diseases spread in many ways - Direct contact - Contact with dirty linen, equipment, supplies - Contact w blood, body fluids, secretions/excretions Clean - Items that do not contain pathogens Airborne Precautions - Transmitted by airborne droplet nuclei - Rubella, varicella, TB, shingles MUST HAVE PPE: filtration mask (N95 masks) Droplet Precautions - Transmitted by large-particle droplets - Neisseria meningitis, multidrug-resistant, Streptococcus meningitis, severe viral influenza MUST HAVE PPE: surgical mask

Contact Precautions - Transmitted by direct or indirect contact - Coral or hemorrhagic conjunctivitis (pink eye) or fevers, scabies, diphtheria MUST HAVE PPE: gown and gloves Ebola Virus Precautions - Strict enforcement of standard, contact, and droplet precautions - Patient placed in airborne infection isolation room (AIIR) with restricted visitation - Medical equipment is dedicated to the patient - Needles and blood draws are limited to necessity only - PPE is high priority - PPE must cover all of the skin, head, neck, body, and feet - Powered air-purifying respirator (PARR) or a N95 respirator (min) must be worn 24/7 - Double gloves - Double hand washing - Separate room or area should be designated for the donning and doffing of the PPE Protective or Reverse Isolation - Methods used to protect certain patients from communicable diseases - Used mainly for Immunocompromised patients - Ex: cancer...