CNA Chapter 5: Infection Prevention and Control

Receive their nourishment by secreting enzymes that break down surrounding cells. When this happens on living tissue, it is irritating and uncomfortable.

Fungi

The most common causes of disease in crops and plants

Fungi

The following precautions can help prevent the spread of droplet diseases:

Using a face mask Covering nose and mouth when sneezing or coughing Handwashing

The following precautions can help prevent the spread of airborne diseases:

Using a special face mask (such as N95 or HEPA) Wearing a gown Handwashing Proper ventilation

The following precautions can help prevent the spread of contact diseases:

Using gloves and a gown Resident isolation Washing hands with antimicrobial soap Not touching infected surfaces without gloves Not touching uninfected surfaces with contaminated gloves

Remember:

VRE can also be spread by direct and indirect contact. Prevention of VRE is very important, and proper handwashing is an important part of prevention.

The proper order for donning PPE is as follows:

Wash hands. Put on gown. Put on mask. Put on goggles or face shield. Put on gloves.

Standard Precautions include the following measures:

Wash hands. Wear gloves. Remove gloves immediately when finished with a procedure. Immediately wash skin surfaces. Wear a disposable gown. Wear a mask and goggles and/or face shield. Wear gloves when handling sharp objects. Never attempt to recap needles or sharps. Carefully bag all contaminated supplies. Clearly label body fluids being saved for a specimen. Dispose of contaminated waste properly.

The following factors place the elderly at a higher risk for infection than the general public:

Weakened immune systems Decreased circulation Slow wound healing Malnutrition Dehydration Limited mobility More frequent hospitalization Difficulty swallowing Incontinence Feeding tubes and another tubing

Bloodborne diseases may be transmitted in the following ways:

Infected blood Infected semen or vaginal secretions contacting mucous membranes Sexual contact Sharing infected drug needles Infected pregnant women may transmit to their babies Contact with infected blood or certain other body fluids in healthcare setting

NAs should be familiar with these signs and symptoms of TB disease:

Fatigue Loss of appetite Weight loss Slight fever and chills Night sweats Prolonged coughing Coughing up blood Chest pain Shortness of breath Trouble breathing

It is important to observe and report the following signs and symptoms of systemic infections:

Fever Body aches Chills Nausea, vomiting Weakness Headache Mental confusion Drop in blood pressure

When caring for residents with tuberculosis, NAs should follow these guidelines:

Follow Standard Precautions and Airborne Precautions. Wear PPE as instructed. Handle sputum or phlegm carefully. Keep doors to airborne infection isolation rooms (AIIR) closed except when entering/exiting. If resident is in AIIR isolation room, open and close door slowly. Follow isolation procedures if directed. Help resident remember to take all medications.

Multidrug-resistant organisms (MDROs):

microorganisms, mostly bacteria, that are resistant to one or more antimicrobial agents that are commonly used for treatment.

Pathogens:

microorganisms that are capable of causing infection and disease.

Disease

A disease occurs when tissue that has been damaged due to the entry and multiplication of microorganisms results in clinical signs and symptoms of a recognizable process.

Host

A host is an organism or cell on or in which a microorganism lives or feeds.

PPE must be worn when a caregiver might come into contact with any of the following:

Body fluids Mucous membranes Open wounds

Portal of exit

any body opening on an infected person that allows pathogens to leave.

Microorganism:

: Microorganisms are single-celled organisms that only can be viewed with the aid of a microscope. Microorganisms can be divided into five basic categories—bacteria, viruses, fungi, protozoa, and helminthes. Most microorganisms are harmless—some are even beneficial. Others are capable of causing infection or disease. Microorganisms are often classified as either pathogenic or nonpathogenic.

Nonpathogenic microorganism

A nonpathogenic microorganism is a type of microorganism that is incapable of causing or unable to cause i

Parasite

A parasite is an organism that lives on or in an organism of a different species.

Pathogenic microorganism:

A pathogenic microorganism is a type of microorganism that is capable of causing infection or disease; it is also called a pathogen.

Gloves should be removed:

After use (and then wash hands) Before touching non-contaminated items or surfaces, like a doorknob

Infection

An infection occurs when microorganisms enter and multiply within the tissue of a host, causing damage to that tissue. Symptoms may be apparent, or the host may display no symptoms.

Gloves must be changed in these situations:

Before contact with mucous membranes or broken skin If they become wet, soiled, worn, or damaged

C. Difficile is spread in the following ways:

By spores via direct contact When intestinal flora is altered due to enemas, use of a nasogastric tube, GI tract surgery, or overuse of antibiotics

The CDC recommends the following measures (part of Standard Precautions) to prevent the transmission of respiratory illnesses in healthcare settings: Alerts should be posted instructing patients and visitors to inform staff of respiratory symptoms and to practice respiratory hygiene/cough etiquette, which includes:

Cover noses/mouths with a tissue when coughing or sneezing Dispose of used tissues in nearest waste container after use Wash hands after contact with respiratory secretions or contaminated objects Healthcare facilities must make these items available to staff, patients, and visitors: Tissues and no-touch receptacles for disposal Conveniently located hand rub dispensers and handwashing supplies During times of increased respiratory infections, masks should be offered to anyone who is coughing and coughing people encouraged to sit at least three feet away from others. Healthcare personnel should observe droplet precautions, in addition to Standard Precautions, when interacting with a patient with symptoms of a respiratory infection.

The following are an employer's responsibilities regarding infection prevention:

Establish procedures and exposure control plan. Provide in-service education. Have written procedures for exposures. Provide proper PPE. Provide HBV vaccination.

NAs should remember these points about gowns:

Gowns protect exposed skin. They prevent soiling of clothing. They should fully cover the torso, and the sleeves should fit snugly.

Two major bloodborne diseases in the U.S. are

HIV/AIDS Hepatitis

Remember:

Hand-washing is the single most important thing an NA can do to prevent the spread of disease.

There are three common types of hepatitis:

Hepatitis A results from fecal-oral contamination. Hepatitis B is transmitted through Sexual contact Sharing infected needles From mother to baby during delivery Exposure at work from accidental contact with sharps Hepatitis C is transmitted through blood or body fluids.

Remember:

Hepatitis B (HBV) is a serious threat to healthcare workers. Employers must offer NAs a free vaccine to protect them from hepatitis B. Employees should take the vaccine when it is offered.

There are two types of MRSA:

Hospital-associated MRSA (HA-MRSA) Community-associated MRSA (CA-MRSA)

Remember:

If even one link in the chain of infection is broken, the spread of infection is stopped.

Gloves must be worn in the following situations:

If the NA might touch blood or any body fluid During mouth care or care of any mucous membrane During perineal care When providing personal care on non-intact skin When the NA has open sores or cuts on hands When shaving resident When disposing of soiled linens, gowns, dressings, and pads When touching contaminated surfaces or equipment

Remember:

It is important the absorb a spill and remove the fluid before treating the area with disinfectant. If the spilled fluid is not absorbed and removed first, it may neutralize the disinfectant on contact.

Remember:

It is impossible to tell from looking at a person whether he or she has an infectious disease.

Remember:

It is safe to touch and spend time with residents who have bloodborne diseases. Residents with these illnesses need the same thoughtful, personal attention NAs give to all their residents.

Remember:

It is the responsibility of the employer to provide appropriate PPE. It is the responsibility of the NA to know where it is kept and how to use it.

Remember:

It is very important to wash hands frequently with soap and water. NAs should not rely solely on alcohol-based rubs.

Hepatitis B may cause few symptoms or may become a severe infection. It can cause the following symptoms and complications:

Loss of appetite Diarrhea and vomiting Fatigue Jaundice Pain in muscles, joints, and stomach Liver damage (cirrhosis) Liver cancer Death

Remember:

MRSA can be spread by direct and indirect contact. Handwashing is the single most important measure to control the spread of MRSA.

Employers must take the following steps to protect employees from bloodborne pathogens:

Maintain a written exposure control plan Provide proper PPE Provide biohazard containers for disposal of sharps and other infected waste Offer free hepatitis B vaccine to employees Affix warning labels to waste containers, refrigerators, and freezers that contain potentially infectious material Keep a log of injuries from contaminated sharps Provide in-service training on the Bloodborne Pathogens Standard

NAs should remember these points about masks and goggles:

Masks can prevent inhalation of microorganisms through the nose or mouth. Masks are worn when the resident has a respiratory illness. Masks should fully cover the nose and mouth. Masks should fit snugly over nose and mouth. It is important to change masks between residents. Goggles are worn with a mask when blood or body fluids may be splashed. Goggles should fit snugly over eyes or eyeglasses.

NAs should know the following about face shields:

May be used when blood or body fluids may be splashed or sprayed into the eyes or eye area Can be substituted for a mask or goggles, or can be worn with a mask Should cover the forehead, go below the chin, and wrap around the sides of the face Headband secures it to the head

Remember:

NAs must wear gowns, masks, goggles, and face shields any time splashing or spraying of body fluids or blood could occur.

The Bloodborne Pathogens Standard designates the following as a significant exposure:

Needle stick Mucous membrane contact Cut from an object containing potentially infectious body fluid Having nonintact skin

NAs should follow these guidelines for cleaning spills involving blood, body fluids, or glass:

Notify proper department about spill immediately if it is not the NA's responsibility to clean up. Put on gloves (possibly heavy-duty gloves, depending on the spill). Use proper product to absorb spill. Scoop up absorbed spill and dispose of it in designated container. Apply disinfectant and allow it to stand wet for 10 minutes. Use proper cleaning solution. Use tools, never hands, to pick up glass. Properly bag waste.

It is important to observe and report the following signs and symptoms of localized infections:

Pain Redness Swelling Drainage (fluid from a wound or cavity) Heat

NAs should follow these guidelines regarding equipment, linen, and clothing:

Prevent skin/mucous membrane contact. Prevent contamination of clothing. Prevent transfer of disease to other residents or areas. Do not use reusable equipment until it has been cleaned properly. Dispose of all single-use equipment properly. Clean and disinfect all environmental surfaces, beds, bedrails, bedside equipment, and all frequently touched surfaces (such as doorknobs and call lights). Handle, transport, and process soiled linens and clothing in a way that prevents skin and mucous membrane exposure, contamination of clothing (hold linen away from uniform), and transfer of disease to other residents and environments. Bag soiled linen at the point of origin. Sort soiled linen away from resident care areas. Place wet linen in leakproof bags

Remember:

Proper handwashing and proper handling of wastes can help prevent C. Difficile. Soap and water must be used each time hand hygiene is performed. Disinfecting surfaces and limiting antibiotic use can also help.

The proper order for doffing PPE is as follows:

Remove and discard gloves. Remove goggles or face shield. Remove and discard gown. Remove and discard mask. Wash hands.

The CDC defines body fluids as including the following substances (note that sweat is not included):

Tears Saliva Sputum (mucus coughed up) Urine Feces Semen Vaginal secretions Pus or other wound drainage Vomit

NAs should know these facts about droplet diseases:

They are spread when pathogens are transmitted through droplets in the air. Droplets normally do not travel more than six feet. Talking, coughing, sneezing, laughing, singing, and suctioning can spread droplets. Influenza is an example.

NAs should know these facts about airborne diseases:

They are spread when pathogens are transmitted through the air after being expelled. The pathogens can remain floating for some time. Tuberculosis (TB) is an example.

NAs should know this information about non-sterile gloves:

They are used for basic care. Due to allergy issues, some facilities have banned latex gloves. The FDA has banned all powdered gloves due to the powder posing numerous health risks to residents and healthcare workers.

NAs should know these facts about contact diseases:

They can be spread when an uninfected person comes into contact with the skin, wound, or infection of an infected person. Contaminated items such as linens, equipment, or supplies can also cause contact diseases to spread. Conjunctivitis (pink eye) and Clostridium difficile are examples.

When isolation precautions are required, the NA should remember these points:

Transmission-Based Precautions always used in addition to Standard Precautions Nurses will set up the isolation unit. Use PPE as instructed. Do not wear PPE outside the resident's room, and perform hand hygiene following removal of PPE. Do not share equipment with residents. Wear proper PPE when serving food and drink. Follow Standard Precautions in dealing with body waste removal. Wear proper PPE required to take a specimen. Reassure residents and explain why these steps are being taken.

Remember:

Transmission-Based Precautions are always used in addition to Standard Precautions.

NAs should wash their hands at the following times:

When first arriving at work Any time they are visibly soiled Before, between, and after all resident contact Before putting on gloves and after removing gloves After contact with body fluids, mucous membranes, non-intact skin, wound dressings After handling contaminated items After contact with objects in the resident's room Before and after touching meal trays or handling food Before and after assisting residents with meals Before getting clean linen Before and after using the toilet After touching garbage or trash After picking up anything from the floor After blowing or wiping nose or coughing or sneezing into hands Before and after eating After smoking After touching areas on the body Before and after applying makeup After any contact with pets/pet care items Before leaving facility

Examples of fungi

Yeasts and molds

Clostridium difficile (C. diff, C. difficile)

a bacterium that is spread by spores in feces that are difficult to kill; it causes symptoms such as diarrhea and nausea and can lead to serious inflammation of the colon (colitis).

Jaundice

a condition in which the skin, whites of the eyes, and mucous membranes appear yellow.

Centers for Disease Control and Prevention (CDC)

a federal government agency that issues guidelines to protect and improve the health of individuals and communities.

Occupational Safety and Health Administration (OSHA)

a federal government agency that makes rules to protect workers from hazards on the job.

Tuberculosis (TB)

a highly contagious lung disease that causes fatigue, loss of appetite, slight fever, prolonged coughing, and shortness of breath.

Microorganism/Microbe:

a living thing or organism that is so small that it can be seen only under a microscope.

Portal of entry:

any body opening on an uninfected person that allows pathogens to enter.

Standard Precautions

a method of infection prevention in which all blood, body fluids, non-intact skin, and mucous membranes are treated as if they were infected with an infectious disease.

Transmission-Based Precautions:

a method of infection prevention used when caring for per- sons who are infected or may be infected with certain infectious diseases.

Causative agent:

a pathogenic microorganism that causes disease.

Reservoir:

a place where a pathogen lives and multiplies.

Disinfection

a process that destroys most, but not all, pathogens; it reduces the pathogen count to a level that is considered not infectious.

Dehydration

a serious condition resulting from inadequate fluid in the body.

Resistant

a state in which drugs no longer work to kill specific bacteria.

Chain of infection:

a way of describing how disease is transmitted from one human being to another.

Indirect contact:

a way of transmitting pathogens from touching something contaminated by the infected person.

Direct contact:

a way of transmitting pathogens through touching the infected person or his secretions.

Antimicrobial

an agent that destroys, resists, or prevents the development of pathogens.

Healthcare-associated infection (HAI)

an infection acquired in a healthcare setting during the delivery of medical care.

Systemic infection:

an infection that is in the bloodstream and is spread throughout the body, causing general symptoms.

Localized infection:

an infection that is limited to a specific location in the body and has local symptoms.

Susceptible host:

an uninfected person who could become sick.

Virus:

are small packages of DNA or RNA encased in protein shells that invade a cell (host cell) and incorporate themselves into the host cell's DNA. When the infected host cell begins to produce (replicate) new viral particles, the infected cell dies.

Vancomycin-resistant enterococcus (VRE)

bacteria (enterococci) that have developed resistance to the antibiotic vancomycin.

MRSA (methicillin-resistant Staphylococcus aureus)

bacteria (staphylococcus aureus) that have developed resistance to the antibiotic methicillin.

Pathogenic bacteria:

can cause cell damage or death by producing substances known as toxins. Other cell damage can occur when the host's immune system produces substances to eliminate bacteria, and these substances damage the infected cells and adjacent cells.

Perineal care

care of the genitals and anal area.

Sterilization

cleaning measure that destroys all microorganisms, including pathogens.

Infectious:

contagious.

Dirty

in health care, a condition in which objects have been contaminated with pathogens.

Bloodborne pathogens

microorganisms found in human blood, body fluid, draining wounds, and mucous membranes that can cause infection and disease in humans.

Personal protective equipment (PPE)

equipment that helps protect employees from serious workplace injuries or illnesses resulting from contact with workplace hazards.

Bloodborne Pathogens Standard:

federal law that requires that healthcare facilities protect employees from bloodborne health hazards

Clean

in health care, a condition in which objects are not contaminated with pathogens.

Hepatitis

inflammation of the liver caused by certain viruses and other factors, such as alcohol abuse, some medications, and trauma.

Medical asepsis:

measures used to reduce and prevent the spread of pathogens.

Fungi:

multi-celled or single-celled organisms. They can be pathogenic, causing infections in healthy persons, or opportunistic, causing infections in people with weakened immune systems. Fungi can be nonpathogenic as well, and some types of fungi are even beneficial, such as those used to make antibiotics. A few types of fungi are considered delicacies, such as truffles and edible mushrooms.

Sharps

needles or other sharp objects.

Transmission:

passage or transfer.

Exposure control plan

plan designed to eliminate or reduce employee exposure to infectious material.

Malnutrition

poor nutrition due to improper diet.

Bacteria:

single-celled microorganisms that lack nuclei and organized cell structures. Bacteria can exist independently (on their own) or as parasites, dependent upon a host for life. Bacteria can be found in three basic shapes—round, rod, or spiral. While some bacteria are capable of causing disease, most are non-infectious and many have critical roles in decay, fermentation, and nutrient recycling. help people digest food. Some bacteria destroy disease-causing cells, and some produce important vitamins in the gastrointestinal tract. Bacteria also play a role in food processing, such as in the production of yogurt and cheeses

Non-intact skin

skin that is broken by abrasions, cuts, rashes, acne, pimples, lesions, surgical incisions, or boils.

Mucous membranes:

the membranes that line body cavities that open to the outside of the body, such as the linings of the mouth, nose, eyes, rectum, and genitals.

Mode of transmission:

the method of describing how a pathogen travels.

Infection prevention:

the set of methods practiced in healthcare facilities to prevent and control the spread of disease.

Surgical asepsis:

the state of being free of all microorganisms; also called sterile technique.

Infection:

the state resulting from pathogens invading the body and multiplying.

Human immunodeficiency virus (HIV)

the virus that attacks the body's immune system and gradually disables it; eventually can cause AIDS.

Phlegm

thick mucus from the respiratory passage.

Disposable

to be used only once and then discarded.

Isolate

to keep something separate, or by itself.

Don

to put on.

Doff

to remove.

Latent TB infection (LTBI)

type of tuberculosis in which the person carries the disease but does not show symptoms and cannot infect others.

TB disease

type of tuberculosis in which the person shows symptoms of the disease and can spread it to others.

Multidrug-resistant TB(MDR-TB)

type of tuberculosis that is caused by an organism that is resistant to medication that is used to treat TB.

Hand hygiene

washing hands with either plain or antiseptic soap and water and using alcohol-based hand rubs.