Infection Control and Prevention

Explain methods for handling and disposing of sharps

Needlestick injuries are a growing area of concern among health care personnel because accidental skin puncture with a contaminated sharp can transmit blood-borne pathogens such as hepatitis C and HIV to the health care worker. All health care workers should use extreme caution when handling any sharp instruments, including needles and syringes.

Explain the cleaning process (and the importance of drying completely)

The process of cleaning involves in a designated facility with both clean and dirty separated areas. Before being cleaned the equipment should be disassembled and parts checked for worn areas. After dis-assembly, the parts should be placed in a clean basin with hot water and soap, detergent, or enzymatic cleaners. Equipment should be dried completely as to inhibit the growth of bacteria.

Identify and explain the three elements required for infection

Three elements must be present for transmission of infection within a health care setting: (1) A source/ reservoir of pathogens (2) A susceptible host, and (3) A route of transmission for the pathogen

Identify factors to consider when determining the best method for processing reusable equipment

- Infection risk (critical, semi-critical, non-critical) - Material and equipment configuration - Available hospital disinfection resources - Relative cost (labor and materials)

Explain procedure necessary for disposing of contaminated trash

Contaminated items, whether reusable or disposable, should be enclosed in a impervious bag before removal from a patients room. After bagging, reusable patient care equipment must be returned to the applicable processing area. Contaminated reusable equipment should remain bagged until ready for decontamination or sterilization.

Differentiate between high virulence microorganisms and low virulence microorganisms

Aerobic bacteria is considered a type of bacteria that needs oxygen to survive, anaerobic bacteria however does not need oxygen to survive and is more difficult to treat.

Differentiate between the following types of isolation: airborne, droplet, contact, protective isolation

Airborne: - Place the patient in a private negative pressure room that has 6 to 12 air changes per hour and either safe external air discharge or HEPA filtration of recirculated air. - Keep the room door closed and the patient in the room. - Perform hand hygiene and don respiratory protection when entering the room. Droplet: - Place the patient in a private room; if unavailable cohorting is acceptable. - Special air handling and ventilation are unnecessary, and the door may remain open. Contact: - Place the patient in a private room, if unavailable, cohorting is acceptable. - Perform hand hygiene and don gown and gloves to enter room whether direct or indirect patient involvement. - Remove glove and gown before leaving room and perform hand hygiene. - After handwashing and removal of gloves, ensure that hands are not re-contaminated. - Limit transport of patient. Protective: - A specialized engineering approach to protect highly immunocompromised patients is a protective environment. - Air quality is improved through: (1) HEPA filtration of incoming air (2) directed room airflow (3) positive room air pressure relative to the corridor (4) well-sealed rooms to prevent infiltration of outside air (5) ventilation to provide 12 or more air changes per hour (6) strategies to reduce dust, and (7) prohibition of dried and fresh flowers and potted plants in rooms

Differentiate between asepsis and sterile

Asepsis by definition means free of pathogenic microorganisms while sterile means absence of all microorganisms.

Differentiate between physical and chemical processes of disinfection

By definition, disinfection differs from sterilization by it's lack of sporicidal activity. However, a few disinfectants kill spores with prolonged exposure times (hours) and are called chemical sterilants. Disinfection can involve either physical or chemical methods. The most common physical method of disinfection is pasteurization. Many chemical methods are used to disinfect respiratory care equipment.

Differentiate between cleaning, disinfection, and sterilization

Cleaning: Removal of all foreign material (e.g., soil, organic material) from objects. Disinfection (General Term): Inactivation of most pathogenic organisms, excluding spores. Disinfection (Low Level): Inactivation of most bacteria, some viruses, and fungi, without destruction of resistant microorganisms such as Mycobacterium tuberculosis or bacterial spores. Disinfection (Intermediate-Level): Inactivation of all vegetative bacteria, most viruses, most fungi, and M. tuberculosis, without destruction of bacterial spores. Disinfection (High-Level): Inactivation of all microorganisms except bacterial spores. Sterilization: Complete destruction of all forms of microbial life.

Explain process for applying and removing PPE

Firstly a cap should be fitted to the head, face mask, then footies and then washing of hands and afterwards gloves. Lastly a gown should be fitted.

Differentiate between high level, intermediate level, and low level disinfectants and give examples of each

High-Level Disinfection This procedure kills vegetative microorganisms and inactivates viruses, but not necessarily high numbers of bacterial spores. Such disinfectants are capable of sterilization when the contact time is relatively long (e.g., 6 to 10 hours). As high-level disinfectants, they are used for relatively short periods of time (e.g., 10 to 30 minutes). These chemical germicides are potent sporicides and, in the United States, are classified by the FDA as sterilant/disinfectants. They are formulated for use on medical devices, but not on environmental surfaces such as laboratory benches or floors. Intermediate-Level Disinfection This procedure kills vegetative microorganisms, including Mycobacterium tuberculosis, all fungi, and inactivates most viruses. Chemical germicides used in this procedure often correspond to Environmental Protection Agency (EPA)- approved "hospital disinfectants" that are also "tuberculocidal." They are used commonly in laboratories for disinfection of laboratory benches and as part of detergent germicides used for housekeeping purposes. Low-Level Disinfection This procedure kills most vegetative bacteria except M. tuberculosis, some fungi, and inactivates some viruses. The EPA approves chemical germicides used in this procedure in the US as "hospital disinfectants" or "sanitizers."

Define nosocomial infection

Hospital-acquired or nosocomial infections are infections that are acquired in the hospital. The high incidence of nosocomial gram-negative bacterial pneumonia is associated with factors that promote colonization of the pharynx with these organisms.

Identify factors that increase a host's susceptibility to infection

Host factors, such as poorly controlled diabetes mellitus, extremes of age, and underlying acquired (HIV infections) or iatrogenic (through chemotherapy or anit-tumor necrosis factor inhibitors) immunodeficiency, can enhance susceptibility for infections. Surgical incisions and radiation therapy impair defenses of the skin and organ space.

Identify common sources responsible for the spread of infection

Humans (patients, personnel, or visitors) are the primary source for infectious agents in the health care setting, but inanimate objects (e.g., contaminated medical equipment, linen, medications) have also been implicated in transmission. People may also serve as their own source of infection, via endogenous flora. This latter process is known as autogenous infection.

Identify ways in which infection is spread into the lungs

In patients with infections, normal swallowing and clearance mechanisms are impaired, allowing bacteria to enter and remain in the lower respiratory tract.

Identify the three infection control strategies and methods in which they can be accomplished

Infection prevention efforts can be divided into efforts that: (1) Decrease host susceptibility: Most difficult and least feasible approach to infection control, includes hospital efforts that focus mainly on employee immunization and chemoprophylaxis. (2) Efforts that eliminate the source of pathogens: fall into two major categories such as general sanitation methods and specialized equipment processing. (3) Interrupting transmission: include standard precautions and transmission-based precautions.

Identify who is responsible for adherence to infection control procedures

Infection prevention is a major and ongoing responsibility of all health care workers, including respiratory therapists (RTs).

Explain the purpose of and requirements for using private rooms with isolated patients

Isolation for the control of infection is used to prevent infected patients from infecting others (source isolation) , and/or prevent susceptible patients from being infected (protective isolation). The methods of physical protection are: - Barrier nursing - special nursing procedures which reduce the risks of person to person transmission, especially by direct contact or by fomites. - Segregation into single rooms, cubicles, or plastic isolators which reduces airborne spread to from patients, and facilitates nursing techniques. -Mechanical ventilation - which reduces the risks of airborne spread by removing bacteria from the patient's room and by excluding bacteria present in the outside air from the room.

Identify the most common route of transmitting nosocomial infections

Most nosocomial pneumonias occur in surgical patients, especially in patients who have had chest or abdominal procedures.

Differentiate between noncritical, semi-critical, and critical infection risk categories

Noncritical: Description: Devices that touch only intact skin or do not contact patient Examples: Face Masks; Blood pressure cuffs; Ventilators Processing: Detergent washing; Low to intermediate level disinfection Semi-critical: Description: Devices that directly or indirectly contact mucous membranes Examples: Bronchoscopes; Oral, Nasal, and tracheal airways; Ventilator circuits/humidifiers; PFT mouthpieces and tubing; Nebulizers and their reservoirs; resuscitation bags; laryngoscope blade/stylet; Pressure, gas, or temperature probes. Critical: Description: Devices introduced into the bloodstream or other parts of the body. Examples: Surgical Devices; Intravascular Catheters; Implants; Heart-Lung Bypass Components; Dialysis Components; Bronchoscope forceps/brushes.

Identify the group of respiratory care patient's with increased susceptibility to infection

Patients at the highest risk for pneumonia include elderly patients, severely obese patients, patients with chronic obstructive pulmonary disorder (COPD) or a history with smoking, and patients with an artificial airway in for long periods of time.

Differentiate between the 5 routes of transmission

The five routes of transmission include: (1) Contact: Indirect or Direct (2) Droplet: Rhinovirus, SARS- associated coronavirus, and Monkeypox (3) Vehicle: Water-borne, Foodborne (4) Airborne: Aerosols, Droplet Nuclei (5) Vector-Borne: Ticks and mites, Mosquitoes, and Fleas

Explain the foundation for universal precautions and identify the procedures necessary for compliance with each

Standard precautions are intended to be applied to the care of all patients in all health care settings all the time. This includes using: - Hand Hygiene: before and after patient contacts, immediately after removing gloves, and when otherwise indicated to avoid cross contamination - Masks, Eye Protection, and Face Shields: to protect mucous membranes of the eyes, nose, and mouth during procedures and patient care activities that are likely to generate splashes of blood, bodily fluids, secretions, or excretions. - Gowns: wear a gown to protect skin and to prevent soiling of clothing during procedures and patient care activities that are likely to generate splashes or sprays of blood, bodily fluids, secretions or excretions. - Patient Care Equipment: Handle used patient care equipment soiled with blood, bodily fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and environments. - Occupational Health and Blood-Borne Pathogens: Exercise extreme caution when handling needles, scalpels, and other sharp instruments or devices; when cleaning used instruments; and when disposing of used needles. - Patient Placement: Place patients who contaminate the environment or who do not ( or cannot be expected to) assist in maintaining appropriate hygiene or environmental control in a private room.

Differentiate between the physical and chemical processes of sterilization, including advantages of each process: incineration, dry heat, boiling water, autoclaving, irradiation, and ethylene oxide.

Sterilization destroys all microorganisms on the surface of an article or in a fluid, which prevents transmission of pathogens associated with the use of that item. Both physical and chemical means can achieve sterilization. Physical methods involve various forms of heat (steam) and ionizing radiation. Chemical methods of sterilization include low-temperature sterilization technologies such as ethylene oxide gas. Steam: Nontoxic to patient, staff, environment. Cycle easy to control and monitor. Rapid microbial. Least affected by organic/inorganic soils. Rapid cycle time. Penetrates medical packing, device lumes Hydrogen Peroxide gas Plasma: Safe for the environment. Leaves no toxic residuals. Cycle time is 28-75 min. and no aeration necessary. Used for heat and moisture sensitive items. Simple to operate. Compatible with most medical items. Requires electrical outlet only. 100% EtO: Penetrates packaging materials, device lumens. Single dose cartridge and negative pressure chamber minimizes potential for gas leak and EtO exposures. Simple to operate and monitor. Comptible with most medical materials. Peracetic Acid: Rapid cycle time. Low temperature liquid immersion sterilization. Environmentally friendly by-products. Sterilant flows through endoscope, which facilitates salt, protein, and microbe removal.

Identify the purpose, components, and principles of the surveillance process

Surveillance is an ongoing process of monitoring patients and health care personnel for acquisition of infection pr colonization of pathogens, or both. It is one of five key components of an infection prevention program, the others being investigation, prevention, control, and reporting. The following principles should be used with any infection surveillance program: (1) use of standard definitions for HAI's (2) use of microbiology-based data (when available) including resistance patterns for pathogens of significance (3) establishment of risk stratification for infection risk when available (4) monitoring of results prospectively and identifying trends that indicate unusual rates of infection and transmission within the facility (5) Provision of feedback to stakeholders within the institution

Define colonization

The development of a bacterial infection on an individual, as demonstrated by a positive culture. The infected person may have no signs or symptoms of infection while still having the potential to infect others.

Identify procedures necessary for transporting infected patients

When patients need to be transported, they need to wear appropriate barrier protection (mask, gown, impervious dressings) consistent with the route and risk of transmission.