Wednesday, July 12th, 2017

Infection Control What It Is

February 27, 2013 by  
Filed under New York

Applicants who apply for RN License in New York, must first obtain the Child Abuse and Infection Control course credits, the NCLEX RN – your admission ticket can be achieved, achieved the Child Abuse and Infection Control credits method is very simple, as long as there is provide to Child Abuse and Infection Control course website, after reading the text through the online test, the credits can be obtained.

Below is the Infection Control teaching content:

Introduction

Infections acquired in hospitals cause serious problems. Infections can complicate illnesses, cause distress to patients and family, and can in some cases lead to patient death. There are also economic consequences for employers and effects on the availability of beds. In addition to concerns over growing costs to healthcare, the use of antibiotics to treat these infections is thought to be contributing to the problems surrounding antibiotic resistance. All healthcare facilities need to have effective systems in place to tackle hospital acquired infection in order to minimize the risk to patients and staff.

Infections are becoming difficult to treat due to an increase in anti- microbial infection, which results in complications, and longer stays in the hospital for those infected. Infection levels tend to be higher in clinical settings where a proportion of seriously ill and elderly receive care. 100,000 patients a year pick up infections and 15% of these infections caught in hospitals are preventable. Consequences of this include an increase in mortality and morbidity rates. Cost implications result from additional hospital stays following hospital infection, together with litigation, sickness absence and other staff costs.

Some actions to combat hospital infection include:

  • The establishment and maintenance of surveillance systems to improve data and information on resistant organisms and the illnesses they cause.
  • Encouraging the prudent use of antibiotics and similar drugs and developing an information campaign to educate the public why antibiotics need to be used more carefully.
  • Strengthening infection control practices and processes in hospital and community health care and promoting collaboration between the U.S. and the World Health Organization.
  • Promoting a coordinated program of research and encouraging the development of new techniques to detect, prevent and treat infection and overcome resistant organisms.

Hospital infection is a huge problem, but with good practice and careful hygiene it can be brought under control. Chief Executives are now responsible for ensuring that there are effective arrangements in place for infection control. Indicators to monitor improvements in control should be in place and all healthcare workers should be provided with training in infection control. (1)

General Principles of Infection Control

There is much published guidance on infection control for nurses working in general practice. All nurses can play their part in helping to minimize the risk of infection – for example, by ensuring that their hands are properly washed, their clinical environment is as clean as possible and their knowledge and skills are continually updated. As nurses, we need to know the general principles of infection control, including decontamination, achieving and maintaining a clean clinical environment, and what to do in the event of an accident.

Standard precautions (formerly known as universal precautions) ensure routine safe practice, protecting both staff and patients from infection. By applying standard precautions at all times and to all patients, best practice becomes second nature and the risks of infection are minimized. They include:

  • Achieving optimum hand hygiene.
  • Using personal protective equipment.
  • Managing sharps.
  • Safely disposing of clinical waste.
  • Managing blood and bodily fluids.
  • Decontaminating equipment.
  • Achieving and maintaining a clean clinical environment.
  • Handling, transporting and processing used/soiled linens correctly.
  • Managing accidents. (2)

Biology of Infectious Disease

A healthy person lives in harmony with the microbial flora that help protect from invasion by pathogens, usually microorganisms that have the capacity to cause disease. Microorganisms colonize body sites by a phenomenon known as tissue tropism, in which some tissues are colonized but others are not. The microbial flora comprises normal resident flora, which is found consistently and promptly reestablishes itself if disturbed, and transient flora, which may colonize the host for hours to weeks but does not permanently establish itself. Bacteria and fungi account for most of the commensal and symbiotic flora.

Species that make up the normal flora are influenced by many factors (e.g. diet, hygiene, sanitary conditions, and air pollution). For example, lactobacilli are common intestinal commensal organisms found in people with a high intake of dairy products; Haemophilus influenza colonize the tracheobronchial tree in patients with COPD.

Pathogens occasionally are part of the normal flora. Organisms in normal flora can cause disease, especially in patients whose defense barriers are disrupted.

Host defenses are important in determining whether infection will occur. Defense mechanisms include natural barriers (e.g., skin and mucous membranes); nonspecific immune responses (e.g., phagocytic cells – neutrophils, macrophages – and their products); and specific immune responses (e.g., antibodies).

Natural Barriers

The skin effectively bars invading microorganisms unless it is physically disrupted (e.g., by lesions, trauma, IV catheter, surgical incision, or an insect bite). However, exceptions occur, as with the human papillomavirus, the causative agent of warts, which can invade normal skin. Some parasites can penetrate intact skin (e.g., Schistosoma mansoni, Strongyloides stercoralis); no bacteria are known to be capable of this.

Mucous membranes that are bathed in secretions that have anti- microbial properties provide effective barriers. Local secretions also contain immunoglobulins which act primarily to block the attachment of microorganisms to host cells.

In the respiratory tract inhaled microorganisms must penetrate the filter system of the upper airways and tracheobronchial tree. If the invading organism reaches the tracheobronchial tree, the mucociliary epithelium transports it away from the lung. Coughing also helps remove the organism. If the organism reaches the alveoli, alveolar macrophages and tissue histiocytes engulf it. With lung inflammation, they are aided by an influx of neutrophils and monocytes, which become even more efficient when immune mechanisms are present. However, these defense mechanisms can be overcome by large numbers of organisms or by compromised effectiveness resulting from air pollutants (e.g., cigarette smoke), mechanical ventilators, or tracheotomy.

In the GI tract, the acid pH of the stomach and the antibacterial activity of pancreatic enzymes, bile, and intestinal secretions act as natural barriers. Peristalsis and the normal loss of epithelial cells aid in removing harmful microorganisms from the GI tract. Slowing peristalsis with belladonna or opium alkaloids slows clearance of some pathogens and prolongs some conditions, such as symptomatic shigellosis. Patients with altered defense mechanisms may be predisposed to particular infections. Competition among normal bowel flora plays an important protective role. Alteration of this flora with antibiotics can lead to overgrowth of inherently pathogenic microorganisms or suprainfection with ordinarily commensal organisms.

In the GU tract, men are protected by the length of the urethra. Most bacteria seldom gain entrance unless they are introduced by instrumentation. Women are protected by the acid pH of the vagina. The hypertonic state of the kidney medulla is also an unfavorable environment for most microorganisms. Tamm-Horsfall protein is a lipoprotein produced by the kidney and excreted in large amounts in the urine. Certain bacteria avidly bind to it, preventing them from gaining a foothold in the urinary tract.(3)

Infections in the Compromised Host

Infections in patients whose host defense mechanisms are compromised range from minor to fatal and often are caused by organisms that normally reside on body surfaces. In the hospital setting, they frequently result from colonization by antibiotic-resistant organisms and from use of catheters and mechanical devices. Host defense mechanisms – physiologic, anatomic or immunologic – may be altered or breached by disease or trauma or by procedures or agents used for diagnosis or therapy. Infections in this setting, often called opportunistic infections, occur if any microbial therapy alters the normal relationship between host and microbe or if host defense mechanisms have been altered by age, burns, neoplasms, metabolic disorders, irradiation, foreign bodies, immunosuppressive or catatonic drugs, corticosteroids, or diagnostic or therapeutic instrumentation.

The underlying alteration predisposes the patient to infections from endogenous micro flora that are nonpathogenic or from ordinarily harmless, saprophytic organisms acquired by contact with other patients, hospital personnel, or equipment. These organisms may be bacteria, fungi, viruses, or other parasites. The precise character of the host altered defenses determines which organisms are likely to be involved. These organisms are often resistant to multiple antibiotics. (3)

Nosocomial (Hospital-Acquired ) Infections

These infections are acquired from the hospital environment or personnel (e.g., inadequately sterilized equipment or insufficient hand washing). They usually occur when a susceptible patient has a portal for infection from altered anatomic barriers or has been given broad-spectrum antibiotics. They are commonly due to Staphylococcus, Enterobacter, Klebsiella, Serratia, Pseudomonas, Proteus, Acinetobacter, Aspergillus, or Candida.

Patients with extensive burns or those undergoing diagnostic or therapeutic procedures that breach normal anatomic barriers to infection (e.g., tracheotomy, inhalation therapy, urinary tract instrumentation, indwelling urethral or IV catheter placement, surgery, and surgical prostheses application) are vulnerable to infection by endogenous or exogenous antibiotic-resistant organisms. Gram-negative bacteria, particularly Pseudomonas and Serratia, and other multiply resistant organisms, alone or in combination with staphylococci, cause soft tissue infections and bacteremia in severely burned patients. Significant bacteriuria develops in patients with indwelling urethral catheters, increasing the risk of cystitis, pyelonephritis, and bacteremia with gram-negative bacilli. Sepsis from IV catheter sites, due to staphylococci, gram-negative bacilli, or Candida, may cause local suppuration or severe and sometimes fatal systemic infections. Patients with end tracheal tubes or tracheotomies and others who require repeated tracheal suctioning or inhalation therapy with equipment containing a reservoir of nebulization fluid may develop bronchopulmonary infections, usually with nosocomial gram-negative organisms.

Neoplastic and immunodeficiency diseases such as leukemia, aplastic anemia, Hodgkin disease, myeloma, and HIV infection are characterized by selective defects in host resistance. Patients with hypogammaglobulinemia, myeloma, macroglobulinemia, or chronic lymphocytic leukemia tend to have deficient humoral immune mechanisms and to develop pneumococcal and Haemophilus pneumonia and bacteremia. Patients with Neutrogena due to leukemia, intensive immunosuppressive therapy, or irradiation frequently develop gram-negative bacteremia from infections acquired through the mucous membranes or secondary to pneumonia. Severely immunosuppressed patients and those with Hodgkin disease and HIB tend to have depressed cellular immune mechanisms. Serious infections with mycobacterium, Aspergillus, Candida, Cryptococcus, Histoplasma, Mucor, Nocardia, or Staphylococcus are frequent. Herpes zoster, cytomegalovirus, Pneumoncystitis, and Toxoplasma infections also occur. AIDS often leads to infections caused by atypical mycobacterium, herpes simplex, Giardia, Cryptosporidia, Isospora, and many others.

Awareness of the patterns of infection that occur in the compromised host helps in early recognition of infections and initiation of appropriate therapy. Awareness of the specific site of breached defense, the type of defense system that has been weakened or lost, and the characteristics of organisms prevalent in a particular institution, based on continuous hospital surveillance, is also helpful. (3)

Signs and Symptoms of Infection

Localized Infection:

  • Warmth
  • Edema
  • Redness Drainage
  • Itching
  • Pain
  • Swelling
  • Tenderness

Respiratory Tract Infection:

  • Cough
  • Sore throat
  • Congestion
  • Sputum production
  • Chest pain
  • Runny nose
  • Rales
  • Rhonchi

Gastrointestinal Tract Infection:

  • Anorexia
  • Vomiting
  • Diarrhea
  • Nausea

Genitourinary Tract Infection:

  • Urgency
  • Burning
  • Discharge
  • Frequency
  • Flank pain
  • Pelvic pain
  • Itching Odor

Generalized Infection:

  • Anorexia
  • Malaise Fever
  • Headaches
  • Shock
  • Joint pain
  • Weakness
  • Muscle aches (3)

Disease Transmission

Without the proper precautions, your health care facility can actually cause the spread of infections and diseases. When providing health services, it is essential to prevent the transmission of infections at all times. While reducing the risk of all infections is important, of particular concern in the health care setting are infections that cannot be cured, such as the hepatitis viruses and HIV, the virus that causes AIDS. Over the past few decades, the world has seen increased outbreaks of disease that were once better controlled, and infectious agents that can cause incurable diseases have become a significant cause of illness and death in many parts of the world.

There are many complex reasons why outbreaks of infections have increased, including:

  • Rapid population growth
  • Increased poverty
  • Expansion of the population into emote?areas
  • Environmental degradation
  • Improved transportation, leading to easier spread of disease
  • Inadequate or deteriorating public health infrastructure
  • Poor disease control and disease prevention

Although we don often think about it, health care facilities are ideal settings for transmission of disease, because:

  • Whenever clinical procedures are performed, patients are at risk of infection during and immediately following the procedure.
  • Service providers and other staff are constantly exposed to potentially infectious materials as part of their work.
  • Many of the people seeking health care services are already sick and may be more susceptible to infections.
  • Many of the people seeking services have infections that can be transmitted to others.
  • Services are sometimes provided to many clients in a limited physical space, often during a short period of time.

In delivering services, it is important to prevent infections to patients at all times. With appropriate infection prevention practices, you can:

  • Prevent post procedure infection, including surgical site infections.
  • Provide high-quality, safe services.
  • Prevent infections in service providers and other staff.
  • Protect the community from infections that originate in health care facilities.
  • Prevent the spread of antibiotic-resistant microorganisms.
  • Lower the costs of health care services, since prevention is cheaper than treatment.

Service providers are at significant risk of infection because they are exposed to potentially infectious blood and other body fluids on a daily basis. Staff who process instruments and other items, clean up after procedures, clean operating theaters and procedure rooms, and dispose of waste are particularly at risk. Patient-to-health care worker transmission can occur through exposure to infectious blood and other body fluids:

  • When a health care worker skin is pierced or cut by contaminated needles or sharp instruments.
  • When fluids are splashed on the mucous membranes of the health care worker (e.g., eyes, nose, or mouth).
  • Through broken skin due to cuts, scratches, rash, acne, chapped skin, or fungal infections.

Almost all cases of hepatitis B and HIV transmission to health care workers have occurred through preventable accidents, such as puncture wounds.

Patients are at risk of post procedure infection when service providers do not wash their hands between patients and procedures, when they do not adequately prepare patients before a clinical procedure, and when used instruments and other items are not cleaned and processed correctly. It is very rare for patients to get a blood borne infection like HIV from an infected health care worker. Because this risk is so small, in most cases, infected health care workers should not be kept from their regular activities based solely on their medical diagnoses.

The community is also at risk of infection, particularly from inappropriate disposal of medical waste. Improperly disposed of medical waste, including contaminated dressings, tissue, needles, syringes, and scalpel blades, can be found by children or others scavenging in open dumps, or can scatter on the ground where adults and children travel, putting them at risk of injury and infection. Some infections can be spread by staff to their families or others in the community. Infection prevention is everybody business. Just as everyone who works at a health care facility is at risk of infection, every health care worker has a role to play in practicing appropriate infection prevention.

Modes of transmission

There are four ways that infections are transmitted:

  1. Contact – Direct transfer of microorganisms through touch (staphylococcus), sexual intercourse (gonorrhea, HIV), fecal/oral transmission (hepatitis A, shigella), or droplets (influenza, TB).
  2. Vehicle – Material that serves as a means of transfer of the microorganisms. This can be food (salmonella), blood (HIV, HBV), water (cholera, shigella), or instruments and other items used during clinical procedures (HBV, HIV, pseudomonas).
  3. Airborne – Microorganisms can be carried by air currents (measles, TB).
  4. Vector – Invertebrate animals can transmit the microorganisms (mosquito: malaria and yellow fever; flea: plague)

All microorganisms, including normal flora, can cause infection or disease under certain circumstances. (4)

HIV and Hepatitis B

Because of widespread biases and misinformation, it is common for staff and patients to have misconceptions about the transmission of these diseases. It is important to ensure that all staff in your facility know that HIV and hepatitis B are transmitted through:

  • Blood and other body fluids: Through contact with broken skin, or through injuries with contaminated needles and/or sharp instruments; through transfusion of infective blood or blood products; through IV drug use with shared needles and syringes or drugs; through splashes of contaminated body fluid into the mucous membranes of a health care worker; through use of contaminated razors; through tattooing.

Hepatitis C, which may be passed through blood and other body fluids, is only rarely transmitted in other ways.

  • Sexual contact: During both heterosexual and homosexual contact through unprotected vaginal or anal intercourse.
  • Vertical transmission: These infections may be passed from mother to infant (during pregnancy, delivery, or breastfeeding).

There is no evidence of transmission through other modes. Transmission of these infections does not occur:

  • During casual social contact
  • Through shared eating utensils
  • From insect bites
  • From donating blood
  • From consumption of food or drink

Infrequently, cases of household transmission of hepatitis B have been documented. Household transmission refers to transmission of a virus without recognized blood, sexual, or perinatal exposure. In these cases, infection occurs primarily among young children who are exposed for long periods of time to family members who are persistent hepatitis B carriers – although it is likely that most of these cases are actually due to unrecognized exposure of mucous membranes, cuts, or other breaks in the skin to infectious blood or saliva. There are no documented cases of household transmission of either HIV or hepatitis C.

Although tears, saliva, and urine could contain the HIV virus, these body fluids do not contain high enough amounts of virus to cause infection, and no infections have ever been documented from these fluids. Blood, semen, and cervical/vaginal secretions are the only documented body fluids through which these viruses are transmitted.

Stopping the Cycle of Transmission

As health professionals, we can provide health care services without some exposure to potentially infectious materials, but we can prevent transmission in many cases. The only way to prevent infections is to stop the transmission of microorganisms. The best way to prevent infections is to follow the standard precautions. Standard precautions should be followed with every patient regardless of whether or not you think the patient might have an infection. This is important because it is not possible to tell who is infected with viruses such as HIV and the hepatitis viruses, and often the infected persons themselves do not know if they are infected.

Hospital staff often believe that the incidence of post-procedure infection is low in their facility and thus not of concern. In reality, incidence rates are not easy to know. Post-procedure infections may be difficult to identify, especially for outpatient services. For example, surgical-site infections do not occur until 7-10 days post-procedure. Infections do not always cause problems serious enough to make the patient seek medical attention but may prolong the healing process, eventually resolving on their own. The facility may never discover that these infections occurred. Patients may seek treatment for post-procedure infections at another facility or a pharmacy. Patients and staff may attribute the infection to other factors and never realize that the infection was acquired as a result of service provision. Patient may not find out they are infected with HIV or the hepatitis viruses until years after the infection, when little connection to a past clinical procedure would be evident.

Staff may believe that the prevalence of serious infections is low in their community. In actuality, the real prevalence may not be known. There is little reliable data on the prevalence of viruses such as HIV or the hepatitis viruses for many countries throughout the world. Because of perceived biases towards infection with HIV, infected persons may keep their condition secret and avoid treatment, thereby artificially lowering the number of known cases of infection within the community. It does not take many infected people to put the community at risk of infection. Few initial infections can lead to many other infections. The time to institute effective infection prevention practices is now, so that if life-threatening infections are not already prevalent in the community, they do not become so. (4)

Misconceptions about transmission of infections can influence how health care workers provide services to patients. Because of these misconceptions:

  • Health care workers may deny services to some patients.
  • Health care workers may be unnecessarily afraid of or worried about providing services to patients who have these infections.
  • The practices of staff may place patients at an increased risk of infection.
  • Health care workers may not take appropriate steps to protect themselves.

It is useful to hold broad orientations to infection prevention in which staff can receive information and ask questions about disease transmission. Staff should remember that most of the infections in health care settings are spread by direct contact, primarily by the hands of health care workers – not by airborne transmission or casual contact, as many people believe. (4)

Hand Hygiene

Hand hygiene is the single most important means of preventing the spread of infection. Hands must be disinfected with an alcohol hand rinse after providing care that involves touching the patient, and after removing gloves, gowns, or respiratory protection devices, or touching contaminated items or surfaces. If hands are visibly soiled then wash hands with soap and water, dry hands, and apply an alcohol-based hand rinse. The purpose of hand hygiene for routine patient care is to reduce microbial contamination acquired by recent contact with infected or colonized patients or environmental surfaces. Hand hygiene includes both hand disinfection with an alcohol-based hand rinse and hand washing. Indications for hand disinfection include:

  • After ANY patient contact.
  • Before and after touching wounds.
  • After situations for which microbial contamination of hands is likely, especially those involving contact with mucous membranes, blood or body fluids, secretions or excretions.
  • After contact with inanimate surfaces likely to be contaminated.
  • After removing gloves.
  • Before invasive procedures.
  • After contact with patients on Contact Precautions for multiple antibiotic-resistant organisms.
  • Before contact with particularly susceptible patients, such as severely immunocompromised patients, recent transplants, and newborns.

Hand washing Procedure:

  • Pump paper towel dispenser to have towels readily accessible.
  • Turn on faucet.
  • Wet hands.
  • Apply hand washing soap.
  • Wash vigorously for at least 10 seconds, using friction over all surfaces of the hand with particular attention to fingertips and nails.
  • Rinse hands well in a downward position.
  • Dry hands.
  • Turn off the faucet using paper towels to avoid contamination from the faucet handle.
  • Discard towels in a trash receptacle.
  • Disinfect with alcohol hand rinse.

Hand Disinfection Procedure:

  • Apply alcohol hand rinse.
  • Distribute to all surfaces of the hands including nail beds.
  • Rub hands until dry.
  • Do not use water or paper towels. (5)

Personal Protective Equipment

Gloves: Clean, non-sterile gloves must be worn when touching blood, body fluids, secretions, excretions, mucous membranes, and contaminated medical equipment. Contaminated medical equipment includes in-use respiratory tubing and soiled respiratory equipment. Remove gloves after use and before touching non-contaminated items or surfaces and before providing care for another patient. Disinfect hands immediately after removing gloves to avoid transfer of organisms to other patients. There are three kinds of gloves used in the clinical setting. Each is used in different situations: surgical gloves, single-use examination gloves, and utility or heavy-duty household gloves.

Gowns: Clean, non-sterile gowns must be worn to protect skin and to prevent soiling of clothing during activities that may generate splashes or sprays of blood, body fluids, secretions, or excretions. Remove a soiled gown immediately upon leaving the patient room and disinfect hands to avoid transfer of organisms to other patients.

Mask, Eye Protection, Face Shield: A mask, in combination with eye protection or a face shield, is worn to protect mucous membranes of the eyes, nose, and mouth during activities that may generate splashes or sprays of blood, body fluids, secretions, or excretions. (5)

Aseptic Technique

Aseptic technique refers to practices that help reduce the risk of post procedure infections in patients by reducing the likelihood that, during clinical procedures, microorganisms will enter areas of the body where they can cause disease.

A surgical hand scrub should be performed before all surgical procedures. A surgical hand scrub should be performed to prevent the rapid growth of microorganisms inside surgical gloves for a period of time and reduce the risk of infections to patients if gloves develop holes, tears, or nicks during the procedure.

A surgical hand scrub should be performed as follows:

  • Remove all jewelry.
  • Clean fingernails with a stick or brush.
  • Wash hands with an antiseptic soap for 3-5 minutes. Beginning at the fingertips, wash between the fingers and move towards the elbow.
  • Rinse each arm separately, fingertips first, holding hands above the level of the elbows.
  • Dry hands with a sterile towel or allow to air dry.
  • Hold hands above the level of the waist at all times.

If an antiseptic soap is not available or staff are allergic to the available antiseptic, staff should scrub as described above with plain soap and water and then apply 3-5 ml. of alcohol or an alcohol hand rub solution and rub hands together until they are dry. Ideally, surgical hand scrub should be performed between each procedure . However, to prevent skin irritation from too-frequent hand scrubbing in high-volume settings, the surgical team can use 3-5 ml. of an alcohol hand rub solution between patients, rubbing the hands together until they are dry. Staff should scrub every hour or after every four patients (whichever comes first).

Sterile or high-level disinfected surgical gloves should be put on and removed in ways that do not contaminate the gloves or allow the wearer to touch the contaminated outside part of the gloves. Shaving the surgical site should not be performed routinely and should be performed only when absolutely necessary. Shaving can create nicks and breaks in the skin, which can lead to increased risk of post procedure infections. Research has shown a reduction in the number of postoperative surgical site infections when shaving is not performed. Clipping hair with scissors is acceptable if hair interferes with the procedure.

The surgical/procedure site should be prepared properly using an appropriate antiseptic solution. The site should be cleaned with soap and water first. If an iodophor (e.g., Betadine) is used, the antiseptic should be left on for 1-2 minutes before wiping off the excess solution. The site should be wiped using a circular motion, beginning in the center of the site and moving out.

A sterile field should be established and maintained during all surgical/clinical procedures. A sterile field is maintained by:

  • Placing only sterile items for use within the sterile field.
  • Opening, dispensing, or transferring sterile items without contaminating them.
  • Considering items located below the level of the draped patient to be unsterile.
  • Not allowing sterile personnel to reach across unsterile areas or to touch unsterile items
  • Recognizing and maintaining the service provider sterile area (when gowned, this extends from the chest to the level of the sterile field: sleeves are sterile from 5 cm above the elbow to the cuff)
  • Recognizing that the edges of a package containing a sterile item are considered unsterile
  • Recognizing that a sterile barrier that has been penetrated (wet, cut, or torn) is considered contaminated.
  • Being conscious of where your body is at all times and moving within or around the sterile field in a way that maintains sterility.
  • Not placing sterile items near open windows or doors.

Once the sterile field is established, it should be maintained until the procedure is finished. If a reak?(contamination) occurs, it must be corrected before the procedure continues.

Traffic and activities should be controlled and appropriate attire should be worn in surgical/procedure areas. Minimizing traffic in surgical/procedure areas reduces the amount of dirt, dust, and insects in the area. Only necessary staff should be allowed in these areas during procedures. Changing into attire designated for use in the surgical area further reduces the introduction of microorganisms into the area. Proper surgical attire includes caps, masks, gowns, protective eyewear, and sturdy footwear. (6)

Sharps Disposal

The potential for transmission of blood borne pathogens is greatest when needles, scalpels, and other sharp instruments are employed. Precautions should be taken to prevent injuries during procedures where needles and sharp instruments are required, when cleaning contaminated instruments, and during disposal of contaminated needles. Gloves and other personal protective clothing will not prevent penetrating injuries due to accidental needle sticks or cuts from scalpel blades and other sharp instruments.

To prevent injury:

  • Avoid rushing when handling needles and sharps.
  • Use extreme care when handling contaminated needles and sharp instruments. Obtain assistance when giving injections, starting intravenous lines, and for any other procedure that requires the use of needles and sharp instruments when the patient is uncooperative.
  • Dispose of all needles and other sharps promptly. It is imperative that these items not be left in patient care areas, on food trays, or inadvertently deposited in trash containers.
  • Contaminated needles should not be recapped by hand, removed from disposable syringes by hand, or purposefully bent, broken, or otherwise manipulated by hand.
  • In the event recapping is unavoidable, the one-handed scoop technique or a needle recapping device should be used. (7)

Antiseptics and Disinfectants

Antiseptics are chemical agents that are used on the skin and mucous membranes to remove or kill microorganisms. Examples include alcohol, chlorhexidine gluconate (e.g., Hibitane, Savlon), hexachlorophene (e.g., pHisoHex), iodine, iodophors (e.g., Betadine), and para-chloro-meta-xylenol (PCMX; e.g., Dettol). Disinfectants are chemical agents that are used on inanimate objects, such as instruments and surfaces, to kill microorganisms. Examples include chlorine and glutaraldehyde.

Antiseptics should be used ONLY on the skin and mucous membranes. Antiseptics should never be used on instruments or other items, surfaces, or reusable gloves. In addition, instruments and other items should never be left soaking in an antiseptic solution. Antiseptics are indicated for:

  • Surgical hand scrub.
  • Skin, cervical, and vaginal preparation before a clinical procedure.
  • Hand washing in high-risk situations, such as before invasive procedures or contact with patients at high risk of infections.

Disinfectants should be used ONLY for processing instruments and other items for reuse and for housekeeping activities. Disinfectants are not to be used on the skin or mucous membranes. In addition, instruments and other items should not be left soaking indefinitely or stored in disinfectant solutions. Disinfectants are indicated for:

  • Processing instruments and other items (high-level disinfectants).
  • Cleaning surfaces (low-level disinfectants).

Antiseptics and disinfectants should be handled in a manner that reduces the risk of contamination. They can easily become contaminated. Microorganisms can survive and grow in them. Care must be taken to avoid contamination of antiseptics and disinfectants.

Decontamination According to Associated Risks

High Risk Equipment that:
– enters a sterile body cavity.
– penetrates the skin.
– touches a break in the skin or mucous membranes.
Equipment must be cleaned and sterilized (fully decontaminated) after each patient use. It should be left in a sterile state for subsequent use. Examples include surgical instruments.
Medium Risk Equipment that touches intact skin or mucous membranes. Equipment does not need to be sterile at the point of use but must be cleaned and sterilized (decontaminated) between each patient. Examples include a bedpan.
Low Risk Equipment that does not touch broken skin ormucous membranes, or is not in contact with patients. Equipment must be cleaned and/or disinfected after use. Examples include: ophthalmoscope receiver.

As inadequate decontamination has frequently been associated with outbreaks of infection in hospitals, it is vital that re-usable equipment is scrupulously decontaminated between each patient. To ensure that control of infection is maintained at a high level, all health care staff must be aware of the implications of safe decontamination and their responsibilities to their patients, themselves and their co-workers. Decontamination is the combination of processes (cleaning, disinfection and sterilization) used to ensure a re-usable medical device is safe for further use.

Sterilization ensures that instruments and other items are free of all microorganisms (bacteria, viruses, fungi and parasites), including bacterial endospores, that can cause infections in clients during procedures in which the items will come in contact with the bloodstream or tissues under the skin. Because sterilization is the only procedure that kills all microorganisms, including bacterial endospores, it is preferred for any items that will come in contact with the bloodstream or tissues under the skin. The effectiveness of any method of sterilization depends on both:

  1. The amount and type of microorganisms, organic material (blood, other fluids, tissues), and other matter (such as dirt) present on the instrument or other item.
  2. The amount of protection the item gives the microorganisms (such as whether the item has grooves or other areas in which microorganisms can hide). Therefore, it is important to decontaminate and thoroughly clean instruments and other items before sterilization. (8)

Infection Control Guidelines

The Centers for Disease Control and Prevention (CDC) are responsible for the collection of surveillance data on communicable diseases. Surveillance is used to plan more effective disease control and prevention programs. Each state reports to the CDC. The CDC also gathers data on hospital acquired (nosocomial) infections and publishes guidelines for infection prevention and control. (9)

The Occupational Safety and Health Administration (OSHA) was established to protect the health of American workers. OSHA establishes safety and health standards, and ensures workplace compliance through inspections. Working in cooperation with the Centers for Disease Control and Prevention (CDC), OSHA implemented the Bloodborne Pathogen Standard to protect healthcare workers from occupational exposure and subsequent infection from Hepatitis B, Hepatitis C and Human Immunodeficiency Virus (HIV). (10)

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is an organization that accredits healthcare organizations when they are in compliance with published standards. JCAHO implemented the hospital infection control requirements as a requirement for hospital accreditation. Standards are revised periodically to reflect changes, and are published annually in the Comprehensive Accreditation Manual for Healthcare Organizations. Accreditation of a health facility by JCAHO is required for Medicare and Medicaid participation. (11)

JCAHO recommended hospital infection control committees be used as a mechanism to monitor and prevent the spread of nosocomial infections. The infection control person implements programs developed by these committees. The Association for Professionals in Infection Control and Epidemiology (APIC) was organized and is a multi-disciplinary, international organization. APIC strives to prevent disease and infection through education, collaboration, research, practice, and credentialing. Like the CDC and OSHA, APIC publishes guidelines for healthcare practice. (12)

Types of Precautions

Standard Precautions

Use Standard Precautions for the care of all patients.

Airborne Precautions

In addition to Standard Precautions, use Airborne Precautions for patients known or suspected to have serious illnesses transmitted by airborne droplet nuclei. Examples of such illnesses include measles, varicella, TB.

Droplet Precautions

In addition to Standard Precautions, use Droplet Precautions for patients known or suspected to have serious illnesses transmitted by large particle droplets. Examples are invasive Haemophilus influenza type B disease, including meningitis, pneumonia, epiglottitis, and sepsis; invasive Neisseria meningitides disease, including meningitis, pneumonia, and sepsis; diphtheria (pharyngeal), mycoplasma pneumonia, pertussis, pneumonic plague, streptococcal (group A) pharyngitis, pneumonia, or scarlet fever in infants and young children; adenovirus, influenza, mumps, provirus B19, and rubella.