Infection prevention control Sa eens CnObjectives © Understand how infections can be spread from one person to another. Recognize the signs and symptoms of an infection. # Take measures to control the spread of microbes that can cause infection. # Apply standard precautions and transmission-based precautions Understand your role and your employers role in protecting you from exposure to bloodborne pathogens on the job. After practicing the corresponding skills, you will have the information needed to: ‘© Wash your hands in a way that controls the spread of microbes that can cause infection. © Put on and take off personal protective equipment (PPE) correctly Open and close a trash bag correctly and double-bag contaminated trash andKey Terms ¢ microbes (microorganisms) pathogens infection mucous membranes chain of infection contaminated health care-associated infection infection control body fluids disinfectant sterilization personal protective equipment (PPE) ¢ high-efficiency particulate air filter (HEPA) mask standard precautions transmission-based precautions sharps container tuberculosis bloodborne pathogens human immunodeficiency virus (HIV) acquired immunodeficiency syndrome (AIDS) hepatitis occupational exposureantibiotic A drug that kills certain microbes that cause infection antisepsis .The processes, procedures, and chemical treatments that kill microbes or prevent them from causing an infection; anti means against and sepsis. means infection asepsis The absence (a) of disease-producing microbes; sepsis means infection carrier A human or animal that is a reservoir for microbes but does not develop the infection clean technique See “medical asepsis” contamination The process of becoming unclean cross-contamination Passing microbes from 1 person to another by contaminated hands, equipment, or supplies disinfectant A liquid chemical that can Kill many or all pathogens except spores disinfection The process of killing pathogens healthcare-associated infection (HAI) An infection that develops in a person cared for in any setting where health care is given; the infection is related to receiving health care immunity Protection against a certain disease infection A disease state resulting from the invasion and growth of microbes in the body infection control Practices and procedures that prevent the spread of infection medical asepsis Practices used to reduce the number of microbes and prevent their spread from 1 person or place to another person or place; clean technique microbe See “microorganism” microorganism A small (micro) living thing (organism) seen only with a microscope; microbe non-pathogen A microbe that does not usually cause an infection normal flora Microbes that live and grow in a certain area pathogen A microbe that is harmful and can cause an infection spore A bacterium protected by a hard shell sterile The absence of all microbes sterile field A work area free of all pathogens and nonpathogens {including spores) sterile technique See “surgical asepsis” sterilization The process of destroying all microbes surgical asepsis The practices used to remove all microbes; sterile technique vaccination Giving a vaccine to produce immunity against an infectious disease vaccine A preparation containing dead or weakened microbes vector A carrier (animal, insect) that transmits disease vehicle Any substance that transmits microbesTypes of Microbes There are 5 types of microbes. Bacteria—1-celled organisms that multiply rapidly. They can cause an infection in any body system. Fungiplant-like organisms that live on other plants or animals. Mushrooms, yeasts, and mold are common fungi Fungi can infect the mouth, vagina, skin, feet, and other body areas. Protozoa—1-celled animals. They can infect the blood, brain, intestines, and other body areas. © Ricke siae—found in fleas, lice, ticks, and other insects. They are spread to humans by insect bites, Rocky Mountain spotted fever is an example, The person hs fever, chills, headache, and rash. © Viruses—grow in living cells. They cause many diseases including the common cold, herpes, acquired immunodeficiency syndrome (AIDS), and hepatitis.Requirements of Microbes Microbes need a reservoir to live and grow. The reservoir (host) is the place where a microbe lives and grows. People, plants, animals, the soil, food, and water are common reservoirs. Microbes need water and nourishment from the reservoir. Most need oxygen to live. A warm and dark environment is needed. Most grow best at body temperature. They are destroyed by heat and light. Normal Flora Normal flora are microbes that live and grow in a certain area. Certain microbes are in the respiratory tract, in the intestines, and on the skin. They are non-pathogens when in or on a natural reservoir. When a non pathogen is transmitted from its natural site to another site or host, it becomes a pathogen. For example, Escherichia coli (E. coli) is normally in the colon. If it enters the urinary system, it can cause an infection.Scenario ¢ During morning report at Metropolitan Hospital Center, your supervising nurse tells you about your new patient, Louise Wang, a 53-year-old woman who was admitted through the emergency room from Morningside Nursing Home last night. Because she was diagnosed with highly contagious staph pneumonia, she is in isolation in Room 117. Last year, she had part of her bowel removed because of colon cancer, and she uses an ostomy appliance (a bag worn on the outside of the body) for the elimination of feces. The feces pass through a surgically made opening in her abdomen and into the ostomy appliance. In addition to assisting Mrs. Wang with changing her ostomy appliance, you will need to help her with a complete bed bath and with transferring from the bed to the chair, because she is very weak. The nurse also tells you that Mrs. Wang is originally from China but speaks and understands English very well. You decide to visit Mrs. Wang immediately because you think she might be afraid. Before going into her room, you wash your hands and put on a gown, mask and gloves. Outside her room, you notice the sign posted on her closed door. The sign requests visitors to report to the nurses’ station. You knock gently, then a little louder when you hear no response. When you finally hear a faint “Come in,” you open the door to see the back of a small woman lying in bed. You walk toward the bed, gently calling Mrs. Wang's name and telling her who you are When she turns toward dyou and sees your masked face, her eyesWhat Causes Infection e Louise Wang is in a room by herself because she has Staphylococcus pneumonia (staph pneumonia), a disease that other people could catch from her. Colds and fl us also are diseases that people can get from one another. Have you ever caught a cold or flu from someone? You can lessen your chances of getting sick and avoid passing on an illness to someone else by learning about what causes infections and how infections can spread Microbes (microorganisms) are tiny living things that are too small to see but are all around us. Microbes can only be seen using a microscope. Examples of microbes include bacteria, viruses, fungi, yeasts and molds. Most microbes grow rapidly wherever they have warm temperatures, moisture, darkness and food. These characteristics make the human body an ideal place for microbial growth! Some microbes are harmful to humans and some are not. Harmful microbes that cause disease are called pathogens. A disease caused by a pathogen is called an infection. ¢ Microbes are everywhere, even in and on our bodies. Many of the microbes that live in and on our bodies are harmless, and some even perform useful functions. However, even microbes that are useful and necessary in certain areas of the body can cause disease if they spread to another part of the body where they are not normally found. For example,What Causes Infection cont... ¢ The body has many natural defenses against infection. Healthy, intact skin and mucous membranes help to prevent microbes from entering the body. Refl exes, such as coughing and sneezing, help to expel microbes from the body. Finally, white blood cells carried in the blood are able to destroy pathogens that enter the body. These natural defense mechanisms help to keep us healthy. In addition, modern medicine has made other tools available to help us fi ght and prevent infections, such as antibiotic medications and vaccinations. Even though our bodies have ways of protecting us from infection and there are medications available to treat some infections, prevention is still the optimal goal. Some infections can be fatal, especially in people who are not otherwise healthy, and some infections cannot be treated with medication.The Chain of Infection * Many infections can be passed from one person to another. However, for this to occur, six requirements must be Controlling the Spread of Infection be met. These six requirements are called the chain of infection . Eliminating just one link in the chain can prevent an infection from spreading. Let's take a closer look at the six links in the chain of infection: e Pathogen. For an infection to occur, a microbe capable of causing disease must be present. Reservoir. e Reservoir is a French word that means “storehouse.” Here, we are using it to mean a place where microbes can grow and multiply. Possible reservoirs for microbes include the bodies of people and animals, bodies of water, and food. Portal of exit. Portal comes from the Latin word for “gate.” For an infection to occur, the microbe must have a way of leaving the reservoir, or a portal of exit. The portal of exit varies. depending on the pathogen and the reservoir. When the reservoir is a human or animal body, the portal of exit may be the respiratory tract, the digestive tract, the genitourinary tract or breaks in the skin.The Chain of Infection ‘© Method of transmission. The way a pathogen gets from one person to another is called the pathogen's method of transmission. The method of transmission may be direct or indirect. In direct transmission, the pathogen is passed from one person to another through close physical contact, such as touching, kissing, having sex or breathing infected air. Indirect transmission means that pathogens are spread by way of a contaminated surface or object. Usually this situation occurs when an infected person touches something and then someone else touches that same object. For example, if you have a cold and blow your nose into a tissue, and someone else picks up the tissue to throw it away without wearing gloves, that person can get your cold by indirect contact. The germs will spread from your nose secretions to the tissue to the other person's hand. Portal of entry. Just as the pathogen must have a way of leaving the reservoir, it must also have a way of gaining entry to a new reservoir. This is called a portal of entry. In the case of person-to-person (or animal to-person) transmission, potential portals of entry include the respiratory tract, the digestive tract, the genitourinary tract, the eye and breaks in the skin. Susceptible host. Finally, the pathogen must enter a susceptible host, or a person who is capable of becoming infected with that particular pathogen. Some factors increase a person's susceptibility to infection, including very young or very old age, poor general health, and the presence of medical devices that are placed in the body (such as urinary catheters). Many of the people you will care for willhave ors that inctease the eptibility to infectionHEALTH CARE-ASSOCIATED INFECTIONS © A health care-associated infection is an infection that a person gets while receiving care in ahealth care facility. You may also hear health care-associated infections referred to as nosocomial infections. Health care organizations that seek to provide quality care = aASEPSIS Asepsis :Asepsis is the absence (a) of disease-producing microbes. (Sepsis means infection.) Microbes are everywhere. Measures are needed to achieve asepsis. Medical asepsis (clean technique) is the practices used to: © Reduce the number of microbes. © Prevent microbes from spreading from 1 person or place to another person or place. Microbes cannot be present during surgery or on instruments inserted into the body. Open wounds (cuts, burns, incisions) require the absence of microbes. They are portals of entry for microbes. Surgical asepsis (sterile technique) is the practices used to remove all microbes. Sterile means the absence of all microbes—pathogens and nonpathogens. Sterilization is the process of destroying all microbes (pathogens and non-pathogens). Contamination is the process of becoming unclean. In medical asepsis, an item or area is clean when itis free of pathogens. The item or area is contaminated when pathogens are present. A sterile item or area is contaminated when pathogens or non-pathogens are present. Cross contamination is passing microbes from 1 person to another by contaminated hands, equipment, or supplies . Medical asepsis and surgical asepsis (p prevent cross contamination.Common Aseptic Practices Aseptic practices Break the chain of infection. To prevent the spread of microbes, wash your hands: @ After elimination. After changing tampons or sanitary pads. After contact with your own or another person's blood, body fluids, secretions, or excretions. This includes saliva, vomitus, urine, feces (stools), vaginal discharge, mucus, semen, wound drainage, pus, and respiratory secretions. After coughing, sneezing, or blowing your nose. Before and after handling, preparing, or eating food After smoking. Also do the following. Provide all persons with their own linens and personal care items Cover your nose and mouth when coughing, sneezing, or blowing your nose. If without tissues, cough or sneeze into your upper arm . Do not cough or sneeze into your hands. Sneezing into the upper arm. Bathe, wash hair, and brush your teeth regularly.HEALTH CARE-ASSOCIATED INFECTIONS Ahealth care-associated infection is an infection that a person gets while receiving care in ahealth care facility. You may also hear health care- associated infections referred to as nosocomial infections. Health care organizations that seek to provide quality care make it a priority to prevent health care—associated infections from occurring. If a person develops an infection while in a health care facility, he may need to stay in the facility longer so that the infection can be treated, delaying the person's recovery and driving up health care costs. In addition, developing a health care-associated infection can put the person at risk for serious complications and even death. As noted earlier, many people who are receiving care in health care facilities are more susceptible to developing infections, and if they do develop an infection, it is harder for their bodies to overcome it. In addition, some of the microbes that commonly cause health care-associated infections are very difficult to treat. Over time, these microbes have become resistant to the antibiotics (such as methicillin and vancomycin) used to treat the infections they cause, which means that these medications are no longer effective for eliminating the infection. Examples of these hard-to-treat super bugs include the following:HEALTH CARE~ASSOCIATED INFECTIONS © Methicillin-resistant Staphylococcus aureus (MRSA). Staph infections are spread by direct contact, and can cause serious skin infections. If the bacterium enters the body (for example, through a cut on the skin), the person can develop serious infections of the blood, lungs, heart or bone. Clostridium difficile, or C-diff. C. difficile is a microbe that is passed from the body in feces. Contact with surfaces or hands contaminated by the microbe spreads the infection to others. The bacteria invade the bowel, causing diarrhea and abdominal pain. C. difficile produces spores that can live on hands and surfaces for a long time. When a person is known to have C. difficile infection, you must always wash your hands with soap and water, because alcohol-based hand rubs are not effective for removing C. difficile from the hands. In addition, a disinfectant containing bleach must be used to clean hard surfaces. ¢ Vancomycin-resistant enterococcus (VRE). This microbe can infect wounds, the intestinal tract and the urinary tract.Multidrug-Resistant Organisms Multidrug-resistant organisms (MDROs) are microbes that can resist the effects of antibiotics. Antibiotics are drugs that kill certain microbes that cause infections. Some microbes can change their structures, making them harder to kill. They can live in ‘the presence of antibiotics. Therefore the infections they cause are hard to treat. MDROs are caused by prescribing antibiotics when not needed (over-prescribing). Not taking antibiotics for the days prescribed is another cause. Common MDROs are’ + Methicillin-resistant Staphylococcus aureus (MRSA). Staphylococcus aureus (‘staph’) is found in the nose and on the skin. MRSA is resistant to antibiotics often used for “staph’ infections. MRSA can cause serious wound and bloodstream infections and pneumonia. + Vancomycin-resistant Enterococci (VRE). Enterococcus is found in the intestines and in feces. It can be transmitted to others by contaminated hands, toilet seats, care equipment, and other items that the hands ‘touch. When not in the intestines, enterococci can cause urinary tract, wound, pelvic, and other infections. Enterococci resistant to vancomycin (an antibiotic) are called vancomycin-resistant Enterococci (VRE).How To Recognize Infection ‘An infection occurs when pathogens grow inside the body. Almost any part of the body can become infected, You can recognize a possible infection in a person's body by certain signs and symptoms High body temperature Red or draining eyes Stuffy nose Coughing Headache Sore throat Flushed face Loss of appetite Nausea Stomach pain Diarrhea, Vomiting Cloudy or smelly urine Joint pain Muscle ache ‘Skin rash SoresHow to Recognize Infection signs and symptoms of infection vary according to the pathogen and the place in the body where the infection is occurring. If you notice that someone in your care has one or more of the signs and symptoms , report your observations to the nurse. By recognizing infections early, you help to ensure that the person receives prompt treatment, which in turn helps to prevent the spread of infection to other people. Remember that not all people with infections will show common signs and symptoms of infection. This is why it is important to practice infection control with every person in your care, even when you do not observe any signs or symptoms of infection.Elder Care Note. e In older adults, fever may not be present even if an infection is present. That's because many older adults have other chronic conditions, are taking medications, or have changes in their immune system that can interfere with the body's ability to produce a fever. So be alert for other possible signs and symptoms in older adults, such as: Anew onset of confusion or increased confusion (if the person is already confused). Changes in eating or appetite. New onset of the loss of bladder or bowel control or more frequent episodes of incontinence. Loss of the ability to complete tasks the person is usually able to do. Fatigue or lethargy. Flutlike symptomsY Box 6-2 General Actions That Help to Control the Spread of Microbes * Cloanse your hands trequentiy, using soap and ‘water or an aleohot-based hand rub {= Take care of your body. Eat wel excise and got enough resto keep your immune system heathy. © Got vaccinated, Vacones ave avalable o prevent mary inlectous deeasen, neuting mfuenza and hepatitis 8. Recolang sppropratevaccnabons and kaopeg thom uo to date hope to protwct you om geting hes infectious Soeaeon. = Stay nome you ae sek youn wp ome ness wth your supeeting nurse 2 hat he or ahe can make decions about what tasks you can do and wet are you can safely provide to others. = Recognize and report signs and symptoms ‘of infection. Be on th ockout rary nn of lation Sr repor any fndngs remediate othe mse Maintain cleanliness. Keep yours, those your care, Ensure single use of personal equipment. Mako suze each person in your cate has hao hr own psa ‘ome evoh as beapare. us, washonsins. ems basin tothbrushes. toothpaste ton and eoap, These Handle tinens property. Vin nancing bd ions, bo sie to towp dy none away rm your ustorm. Avo Shaking ty nen, bocaune hi can spread meabes into he enaronment. Place dtyinene nthe lar ‘bag inthe persons room bor you cary the bag to the laundry hamper outdo the room Pace wet and soled none na plas or akpoot sundry bop. Gover bedpans and urinals To contan Mud won carina thom nom one ace to anoor, aways over bbedpons and ures ‘Prepare food carefully. When prparng fod for youre or for tree in your eae: ‘Wash your handset ‘anh tate and vegetables bette using hem ‘Ens that cooked foods (espacay mea! reach the rope orperature. Wook, dry and store dchos and wtonsis afer each vee ‘ash cuting boards used o prepare meat and pouty raat soupy mater mma ser une: Use ‘Separate extng boards for cuting meat or pouty and {Sreutng vogue ht or nt gong tobe cocked ‘Serve meals immediately. Aa food aries om he ‘etary department fs hosp r nrg hore, ofa 20 ‘2 you prepare oda psa home, swe # rene ‘Store foods careuly. Wako sure poocle donot 0 ‘ood thor rom, wes tho food nonporshabl ad ie ‘tered ina ht sealed container apart wants save pat of mato ater exp ther ht unegerted fod ‘an row barton that can make hor and tal or at you el bng har tea eran of tho fod ate de wanaHOW TO CONTROL THE SPREAD OF MICROBES ¢ Health care workers take certain actions to control the spread of microbes that can cause disease. This practice is called infection control. Protecting those in your care from infections is an important part of ensuring their safety, one of the five principles of care. You probably already practice some types of infection control in your daily life without thinking much about it. If you cough or sneeze, for example, do you cover your mouth with a tissue or cough or sneeze into your elbow to control the spread of germs? If someone you know has a cold or flu, do you try to keep your distance from that person so that you will not catch the cold or fl u yourself? Do you always wash your hands after using the bathroom? If you do these things, you already are using infection control methods. © Box 6-2 summarizes general actions that can be taken to help control the spread of microbes. Four common methods of infection control used in health care settings include hand washing (also called hand hygiene), decontaminating objects and surfaces, using personal protective equipment (PPE) and taking isolation precautions.Hand Washing Washing your). As a nurse assistant, you hands is the most important thing you can do to control the spread of microbes (Figure 6-2wash yourHandwashing Continued. Washing your hands is the most important thing you can do to control the spread of microbes (Figure 6-2). As a nurse assistant, you wash your hands in a special way to ensure that all surfaces are clean. You should wash your hands whenever they are visibly soiled with dirt or body fl uids, and at specific times throughout the day (Box 6-3). Guidelines for proper hand washing are given in Box 6-4. The specific procedure for hand washing is explained step by step in Skill 6-1. When your hands are visibly soiled, you must wash them with soap and water. However, if your hands are not visibly soiled with dirt or body fluids, you may use an alcohol-based hand rub to decontaminate your hands instead of washing with soap and water. When using an alcohol-based hand rub, use the amount of product recommended by manufacturer. Rub it thoroughly over all surfaces of the hands, including the nails and between the fingers, until the product dries (Figure 6-3) Sometimes you may think that hand washing is an inconvenience when you have so much else to do. But the one time you decide to skip hand washing may be the time you infect yourself or someone else with microbes from another person,When to Wash hands ‘As you are coming on duty Before and after contact with a person in your care Before and after putting on gloves After using the bathroom After coughing, sneezing or blowing your nose After smoking After handling dirty supplies or equipment Any other time you think it may be importantKeeping Objects and Surfaces Clean When you work in any health care setting, you can help control the spread of infection if you understand exactly what is meant by clean and what is meant by dirty. Clean items or surfaces are considered to be free of dirt and pathogens. Dirty items or surfaces are considered contaminated because they contain dirt or pathogens. An unused item is considered to be clean until it comes in contact with a person or his environment. It is then considered dirty and cannot be reused for another person. © Ina hospital or nursing home, clean, unused supplies (such as linens and dressings) are stored in the clean utility room. Used supplies that must be cleaned or laundered are returned to the dirty utility room. The dirty utility room also has trash containers for disposing of disposable supplies. As a nurse assistant, one of your responsibilities is to help keep the person's environment clean. You may also be responsible for cleaning some types of equipment after you use it. © Health care workers use many strategies to remove microbes from objects and surfaces Simply washing the object or surface with soap and water will remove dirt and some microbes. Or you can use disinfectant to kill microbes on the object or surface (Figure 6-4)Nurse Assistant DO's and DON'Ts Hand Washing ‘DO hoop your ingrained shor and use a nabrush or orange stick lo remove dt and microbes from uundoroath thom. DON'T wear artificial nals onal polih, Microbes canbe very dificult ‘to remove trom the spaces created ‘when artificial nals it or nail polish peels and cracks. DONT woa ings to work. Tho tny spaces injewoly ao difeut to clean and can harbor mictbes. In ation, its cfc to remove microbes from undomaath the ow. 10 push your watch above your wri, puttin your pocket opin to your ‘orm. This enables you to wash your wists along wih you hands. 10 apply hand lation to elp prevent tho ‘chapping and dryness that can oceur with ‘requent hand washing.Keeping the Objects and Surfaces clean @ The facility will specify which disinfectant solution to use, or you may make a disinfectant solution by mixing a solution of 1% cups bleach to 1 gallon of water. When using a bleach solution, always ensure good ventilation and wear gloves and eye protection. Let the disinfectant or bleach solution stand on the surface for the recommended amount of time (for example, 1 to 3 minutes for a disinfection solution. © 10 to 15 minutes for a bleach solution). When itis necessary to destroy all of the microbes on an object or surface, sterilization is used. Objects that are going to be placed inside a person's body (for example, indwelling urinary catheters) must be sterile. Sterilization is achieved using gas, chemicals, dry heat or pressurized steam. In facilities, a special department (often called Central Supply) is usually responsible for sterilizing objects. In the homeUsing Personal Protective Equipment © Personal protective equipment (PPE) is used to prevent microbes from contaminating your uniform, skin or mucous membranes. Properly using PPE eliminates a portal of entry for potential pathogens, and helps to keep you safe from infection. © PPE includes gloves, gowns, masks and eyewear (Figure 6-5). PPE is usually put on outside of the person's room, and removed and discarded inside the persor’s room. When it is necessary to put on multiple types of PPE, items are put on in the following order: gown, mask, protective eyewear, gloves. When it is necessary to remove the PPE, the order is as follows: gloves, protective eyewear, gown, mask. Removing PPE in the proper order helps to protect you from contaminating yourself or your uniform. © Guidelines for the proper use of PPE are given in Box 6-5. Skill 6-2 describes step by step how to put on and remove each article of PPEEz Nurse Assistant DO’s and DON'Ts Using Personal Protective Equipment (PPE) Properly BO choose gloves that ft yourhands _aurfaces with dirty gloves, and always DON'T use gloves that have rips, tears or propery ‘discard your gloves and wash your hands punctures, or that appear discolored. ‘when you have finished the procedure. DON'T woar gloves as a “second skin" BO change masks and gowns if they ‘throughout the day. Replace your gloves DON'T wash or disinfect disposable become moist. ‘as often as necessary twoughout a gloves for re-use. They are meant to be mand : ee (D0 put on and take off PPE in tho properGloves © Disposable gloves are typically made of vinyl, nitrile or latex. These gloves are meant to be worn once and then discarded. Gloves should fit properly, and be free of rips or tears. © Gloves are worn whenever there is a possibility that you will come in contact with a person's blood or body fluids (Box 6-6). For example, you wear gloves when you provide mouth care, perineal care or care for someone who has a draining wound or open sores on the skin. ¢ You also wear gloves when there is a break in the skin on your own hands. You may need to change gloves several times during one procedure to avoid contaminating clean surfaces by touching them with dirty gloves. Always wash your hands after removing your gloves and before putting on a new pair. When you are finished caring for one person, always remove and discard your gloves and wash your hands before leaving the room or assisting another person . Some people are allergic to latex, a material commonly used to make disposable gloves. If you or the person you are caring for develops skin redness, a rash, hives, itching, a runny nose, sneezing, itchy eyes, a scratchy throat or difficulty breathing while you are providing care using latex gloves, wash the area in contact with the gloves immediately, and notify the nurse. In the future, you will need to use disposable gloves made of vinyl or nitrile whenRecall that you wil be responsible for helping Mrs. Wang with changing her ostomy appliance and with bathing Should you wear gloves when assisting ‘Mrs, Wang with these activities? Why or why not? YY Box 6-6 When to Wear Gloves "© When thor isa possibilty that you wil touch blood or other body fide 5 When you are providing care that requis you to touch ‘mucous membyanes 1 Whon the person in your cae has broken skin, oF you have broken skin on your hands "When you must hand ites or surfaces sod wih blood or other body fdsGowns, Masks * A gown is worn to protect your clothes and body from splashes and sprays of blood and body fl uids. The gown must completely cover you from your neck to your knees. A gown is worn only once and then is placed in a laundry hamper (if it is made of fabric) or thrown away (if itis made of paper). Because a damp or wet gown will not protect you, you must change your gown if it becomes wet. Masks. ‘* Amask covers your nose and mouth to protect you from inhaling pathogens into your lungs. You may also wear a mask when it is important to protect the person from pathogens you may exhale. The mask should fi t snugly over your nose and mouth. Use a mask only once. Change your mask if it becomes moist, becauise moisture reduces the effectiveness of the mask. There are two types of masks you may use. A surgical (face) mask is most commonly used. These masks are effective for providing a barrier that large droplets cannot pass through, When a person is known to have a disease that is caused by very small droplets suspended inthe air (called aerosols) a high-efficiency particulate alr fiter (HEPA) mask must be worn. HEPA masks must be specifically fitted to the person who will be wearing them. These masks actively filter the air to prevent aerosols from passing through,Protective Eye Wear © Wear protective eyewear, such as goggles or a face shield, to keep body fluids from splashing into your eyes when cleaning items or disposing of fluids. Protective eyewear may be reusable or disposable.Taking Isolation Precaution ¢ Isolation precautions are actions taken to isolate pathogens to prevent them from spreading throughout © Nurse Assistant Training the facility. Isolation precautions are based on the pathogen's method of transmission. The goal of these precautions is to contain the pathogen and limit others’ exposure to it as much as possible. There are two major types of isolation precautions: standard precautions and transmission-based precautions. Standard precautions Standard precautions (sometimes called universal precautions) are precautions that health care workers take with every person to protect themselves and others from pathogens that are transmitted in body fluids. You must practice standard precautions whenever you come into contact with body fluids, such as when assisting with a medical procedure or when providing personal care—even if you think the person in your care is not infected. Memorize these precautions and make them a way of life as you work as a nurse assistantY Box 6-7 Standard Precautions | Wen sposabe gloves sth bly ents (hatyou ed cone crac wen Bot bay tude ‘Te nla wan you pow cae od santos ny hie Aso wea oven ware you hav bua ‘Wash your hands 2st surfaces etch ad ‘rai 1 yours beans aed th dot ter boa te oyu ave rand poorly soled ‘Ano wa oranda ar omonrg ove a bor puting en goes Your hs ra by ‘ed wit ood we by de, ou may ue at ‘etotbed hard no dacetanat os hed ser terovrg gre nd tere patng on 2 etn pt ‘wear personal protective equipment (PPE) ss ‘nated byte ehaton A gown mar be wo wane ‘he poet eet tat your fom coud be ele by ‘hespiading o band oer boy tad Posen ‘gone tran orbo mua be wom where ctl ecu ht od er bed de oe {leh your ees oe mouth Mande sharp objects earful, Pte yous and ‘ta fom iy cased by supa at maybe feeb ood oer boy Ri a8 ates ad ‘news y aapoang of tm in sharp container Never aap ash bet blo apn of, becane You cous youret wie wyg a epace he ap Cleanup blood or body ld ple promptly ng ts npn rtrd seen mse ty adtng "cup ofeach gun of wa Be ro {owen sepape PPE when ceri be wo Mando contaminated artes caretay Pace ‘thane Been contri wh od or body hae ato ‘puncte pro abled ohare Bog Pac a socond tag oar et hn ch feta ay ane ‘come cota Sl 8 ders tb sop rw thane plate tah bg an ow desea Practice reepratryhylane and cough tqueti “he mann cnt par ert ha can reasnectane such ar rors Exergy pene hs ‘tre ot white ng fa oar Io tena or ane no stones cram sper, ova aow ono propery run or hard Tecting cog tg tytn Pool wth "ne fen Snes ayaa be proved wh mae ‘phy sepa’ tom ahr pepe ae Interne ming wan ter tb a beter coed by apesTransmission Precaution Transmission-based precautions When a person's primary care provider suspects or confirms that the person has an infection that can be spread to others, you must take additional precautions to prevent the spread of ‘he infection to other people. These precautions are referred to as transmission-based precautions. The primary care provider decides which transmission-based precautions must be followed. This decision is based on two things: the pathogen and how that pathogen spreads. When transmission-based precautions are in effect, you will usually put on the appropriate PPE before entering the person's room, and remove it at the doorway right before leaving the person's room. The three types of transmission-based precautions are airborne precautions, droplet precautions and contact precautions. ‘Airbome precautions are used when caring for a person who is known or thought to have an illness that is transmitted through the air. For example, tuberculosis (Box 6-8) and measles are spread in this manner. Airbome pathogens (pathogens expelled into the air when an infected person breathes, coughs or sneezes) can travel a long distance on air currents and through ventilation systems. Therefore, airborne precautions include placing the person in a private room and keeping the door closed, wearing a HEPA mask when providing care, andhaving the person wear a mask when he or she must leave the room Droplet precautions are used when caring for a person who is known or thought to have an illness that is iransmitted by large droplets in the air, such as a respiratory virus or meningitis. These droplets are spread by sneezing, coughing, laughing, singing and talking. The droplets do not travel far. Droplet precautions are similar to airbome precautions, except a surgical (face) mask can be worn instead of a HEPA mask. Contact precautions are used when caring for a person who is known or thought to have an illness that can be spread by direct or indirect contact. Some types of wound infections and skin infections can be spread in this way. Contact precautions include wearing a gown and gloves when providing care, and containing and disposing of contaminated items properly.Transmission Precaution \When transmission-based precautions are in effect, a sign may be posted outside the person's room so that all health care workers and visitors (if permitted) are aware of the precautions that must be taken. Make sure visitors and other health care workers follow these precautions. Having transmission-based precautions in effect can be very difficult for the person. How would you feel ifthe door to your room had tobe closed all the time for isolation? Perhaps you would feel as ifno one wanted to be near you or that no one liked you. You might feel lonely, angry, depressed, embarrassed, afraid or all of these things! What if the people caring for you could not come rear you without wearing gowns, masks and gloves? Even though you must follow transmission-based precautions as ordered, you can also be sensitive to the person's feelings. Make sure the person knows why Because health care workers are at risk for exposure to the pathogen that causes tuberculosis, health care facilities routinely screen employees for infection. Many states also require health care workers to be screened for tuberculosis infection as a requirement for employment. Screening can be done using a skin test called the Mantoux test, which involves placing a small amount of tuberculin (a protein made fram the bacteria that causes tuberculosis) under the skin using a needle or tines, Afters few days, the area will acome red and swollen Ifthe person is infected with the pathogen tht causes tuberculosis. blood test may also be used to screen for tuberculosis. Remember that a positive result on a screening test does not mean that you have active tuberculosis. The pathogen that causes tuberculosis may be alive in your body, but inactive. if a screening test indicates exposure to tuberculosis, other follow-up tests, such as sputum testing or chest x-rays, are ordered to rule out active tuberculosis. the transmission-based precautions are being taken, and stress that these precautions will help to speed her recovery and prevent others from getting sick. Explain the purpose of the PPE you are wearing. This can help the person get used to seeing you in protective clothing. Make a special effort 0 check non the person often and take time to talk wth ne. Spenting time with the person and offering reassurance can elfYou know from the nurse’ report that droplet precautions are in effect for Mrs. Wang because staph pneumonia is contagious. As you enter Mrs. Wang's room, she turns her face away and covers her eves #0 that you can't see her tears. “Good morning, Mrs. Wang,” you say and then introduce yourself. You explain that you will be taking care of her today. Mrs. Wang looks at you and smiles sadly. What might be bothering Mrs. Wang? How could you provide emotional support to Mrs. Wang. in addition to providing physical care? What information would you give Mrs. Wang about the transmission-based precautions that are being used?¥ Box 6:8 Tuberculosis and the Health Care Worker ‘anes sai josny eer pedah we, ‘alien telnge batt ah ea tomerepeno ate Pp mtn et SSyipmoe tect pe yap ‘wean con once ea pe ta tc he agen at ‘teiunaoa eb asta pan ‘epttomgonm ans manana stacy Tope erin tenance cine ‘Soran ty ppc ee Sones cen ee oes nt he oqetatcaser teens ecu otel ma ‘ecpenn deep nora ng torn eect aa ttn fee bcoepeand rcs gay at ‘mcsaue our ancora pogroms huh cr whee Sen cere: tesa ya CStcancgttmtetcee beter aor ‘her crs nan st bwin pe rade woe tac a suse tec) na ‘ntanga ms rts Aerator ese fe ttc ns Nai ty ie hc Te tp a cna ube ‘eptwanemourboy aan ase at ‘tans nae ersten whe op ateBloodborne Pathogens As a nurse assistant, you are responsible for keeping yourself and others safe from all infections. However, some infections pose particular risk to you as a health care worker, because of their long-term effects on your health if you become infected. e Many of the most serious infections that health care workers may be exposed to are caused by bloodborne pathogens. Infection occurs when blood from an infected person enters the bloodstream of a person who is not infected. In the workplace, this could happen if you stick yourself with a contaminated needle (a “needlestick injury”) or cut yourself with broken glass that has been soiled with blood. * You could also become infected through direct contact with another person's blood if it comes in contact with your eyes, mucous membranes or an area of broken skin on your body. * Bloodborne diseases that pose particular risk to health care workers are human immunodefi ciency virus (HIV) infection and hepatitis B, C and D. ¢ HIVis a virus that that invades and destroys the cells that help us to fight off infections. A person who is infected with HIV may look and feel healthy for many years. However, during this time, the virus is breaking down the person's immune system. Eventually, most peopleBlood Pathogens © The person dies from one of these infections, or another complication of HIV infection. Although medications have been developed to help slow the progression of HIV infection, currently there is no cure. Hepatitis is inflammation of the liver, an organ that performs many vital functions for the body. There are many different types and causes of hepatitis. Hepatitis B, hepatitis C and hepatitis D are caused by infection with bloodborne viruses. Chronic infection with the viruses that cause hepatitis B, C or D can lead to liver failure, liver cancer and other serious conditions. A vaccine is available to protect against hepatitis B virus (HBV). Vaccination for HBV also offers protection from hepatitis D virus (HDV).. # However, there is no vaccine to protect against hepatitis C virus (HCV). You and your employer share the responsibility for protecting you from occupational exposure to bloodborne pathogens. Remember that the standard precautions we take with every person are designed to prevent accidental exposure to blood and other body fluids. This is because you may not know whether a person is infected with a bloodborne pathogen or not, and it is important to protect yourself and others from accidental exposure. © To effectively limit your risk for exposure to bloodborne pathogens while you are on the job, you must practice standard precautions consistently and correctly. Your employer also has responsibility for keeping you safe from bloodborne pathogens on the job by making sure you have the equipment andY Box 6-9 Bloodborne Pathogens Standard To pro heath xe wats om pone he bo blootbe phon, neler a ogre ado the flowing sind © Exposure conto plan Th acy msthae a ln that ies cio at ibe ko fan ple pod a od or abr boa ud onthe. The pln must vowed array and ade lta ab eons writen om Erpiayts ar respon ‘ering econ tha proper flop Gr vance, made esing) canbe proved. ‘Proper training. Employers must provide training about fats susocaied ah ooare pahogesanhow to mize tase rk al enlyes who mayb exposed ‘to bloodbome pathogens on the job. Training usually cus ding enpoee oetaton ad ta a eat ‘traitor "Proper equipment. pyers ate espenaio prvi Personal protective equpment PPE fr anployen use. HBV vaccination. Employers mus fer employees who have ak of exposure to Bead an opportunity to ecave tro cost a vaccination that protects against hepa ‘An employee ay reuse tho vaccination, but at any time the employee ater decides to accep the vacation the employer mus provide it Work practice controls The enpoyer = responsible for establahing and evforcing procedures for handing cortarirated wasto, andy and 8 0, and supojing the equipment needed to fallow these procedures. The ‘mplayer must so ensue that necessary sya ae instal and running ta maintain a safe environment (or example, ertlation systems). Engineering controls. The employoris responsible for making equipment avaiable that nts the ‘employee's sk for neodl-stick injures, suchas sharps containers.CHECK YOUR UNDERSTANDING Questions for Review 1. When yu taka ity inane the aunty hamper ou shoud “elo ey on chat a eo rover ‘Save ge by ting thai tela imoerton 8 sha dtr 2 What te most important ing you ean oto contol the spread of meres? |b Sagal coasters, 1 Wi yourtara © Anaya eve bears anda when caring ‘emtom place lac 14 Etat arcnd et nd ty hay. 2 You shold practice andar precasions: When ye provide care orn pron. 1 Onin upon car pape ected inte Onin paon isn islaton “4 On aon ou rouowash yur had When you ge onsen a backs Won you eeughor neces Won yu sene meal aye When you toh aed octhar Body ie Hyouhave acu oapen ste on your hand lahat mat you doe potest youll ‘rom eteton?| oid roving cata or poop wih incon Sty ana ram orca te wounds War gover wi ovdeg exe. Hare ol Oman is En Jones ho wots oa mse ast, became anges carte ohana She wat tar a engage io ok on May tate can chow of Wha oer eed ier wa ecg hte Ye eg? he une ak your lp gstion a perso rhs Teperson han ge ope, inh tein matron co, Ie re ple {Syou tae rat et ofhnon wi be oe ‘wor ta Bay ph Wht ere gmc eoenet PPO cme et 1 Wen ofthe fotowing i a roason pace ‘acne nln? ‘Tha peer hs a contain denen ‘Me sowsn esau. ‘hepa ead = cava tong mone, Questions to Ask Yourself Ju pronde caer person wah ah opan ond? 2 How canyousoasiectondyouhare acu? 2 Inte pst how bare you pony rend puhogas eg doce det eal? ‘into re ware Wha wit you dont ft at proaing pxhogrs by dec and iat comet? Tet ‘Arbame procs a jn afc rie Damesan ‘ous chara Tomosers mes when 20 mae hat you bv newt (ra ew uty han sprit wold ou ae at? onan you poten ge fa i Wison wih noth ara he jes th gover sya So? Inve IDS, jos tow iy ayo wen fase tng?” Hon sow you teh?Hand Hygiene ‘+ Hand hygiene is the easiest and most important way to prevent the spread of microbes and infection. You use your hands for almost everything, They are easily contaminated. They can spread microbes to other persons or items Practice hand hygiene before and after giving care forthe rules of hand hygiene. Rules of Hand Hygiene Wash your hands (with soap and water): + When they are visibly dirty or soiled with blood, body fuids, secretions, or excretions + Before eating and after using a restroom + After known or suspected exposure to oF to persons with infectious diarrhea + If exposure to the anthrax spore is suspected or proven + fan aleohol-based hand sanitizer is not available + Use an alcohol-based hand sanitizer for hand hygiene if your hands are not visibly soiled. + Before direct contact with a person + After contact with the persons intact skin. After taking a pulse or blood pressure or after moving a person are examples. + After contact with body fluids or excretions, mucous membranes, nor-intact skin, and wound dressings if hands are not visibly soiled * When moving from a contaminated body site to a clean body site + After contact with items in the person's care settingRules for Hand Hygiene cont-- these efor wasting your hands wih soap andwater Se proce Han Wana, ash your hands under warmruning wate Do not usehet wate, Stand aay fromthe sb Dont your hands boy or uniform ouch the sk Teen tcontainate, Donottouchthalnede ofthe ana ny tine Keep your hands and forearrslowe then your bows yu hold yourhands and forearms up ty water uns fromyour hands your forearms andebows, Those areas become ubyourpalmetopaerandinaaceyou fingers to workup agoodlthe. Theruing actonhpe emoverizcbee and. Pyattrion to res often misses dug hanéwashig—thumbs knuses, sdesofthehand le iges oundr then ‘san fagemaleby rubbing te gers agseet your pam sea ai flor rangewood tito dean under Fiemsis. Miobesarow easly nde the fingernail visen your hand frat sett 20 sean, leh anger ney ar eyo ecleth ld bod hs, sarton or extn, Useyur judgment antl gency oly sent paper tones yur hands ‘by your hand stating at the ingen, Workuptoyou fra. You wildy the cane are fet Uses can by pope tone foreach fouce totum the water of Fig, 161, 9.228). Faucets areconaminsted The paper ones prevent you fomoantamiting yur enhanc Flow thee whan denotaminating your hae wih on slcohbasedhand seit. ee roccie Usinyan Aco Based Hae Sie. App theproducttothepaimet hand, Folow the ranufacturr nstuctone fr tharreunt 19 u56 ‘ub yourhande oases Cover a incest you hands and fingerx applied into a cupped hand. B, The palms are rubbed together. C, The palm of 1 hand is rubbed over the back of the other. D, The palms are rubbed together with the fingers interlaced. E, The fingers are interlocked and rubbed back and forth. F The thumb of 1 hand is rubbed in the palm of the other. G, The fingers of 1 hand are rubbed into the palm of the other hand with circular motions.Using the Hand Sanitizer # Using an Alcohol-Based Hand Sanitizer Procedure 1 See Promoting Safety and Comfort: Hand Hygiene 1.. Apply a palmful of an alcohol-based hand sanitizer into a cupped hand 2. Rub your palms together 3, Rub the palm of 1 hand over the back of the other . Do the same for the other hand. 4, Rub your palms together with your fingers interlaced . 5. Interlock your fingers as in Figure 16-12, E, Rub your fingers back and forth. 6. Rub the thumb of 7 hand in the palm of the other 7.Do the same for the other thumb. 8.Rub the fingers of 1 hand into the palm of the other hand . Use a circular motion. Do the same for the fingers of the other hand. 9. Continue rubbing your hands until they are dry.© Disposable supplies and equipment help prevent the spread of infection. Discard single-use items after use. A person uses multi-use items many times. They include plastic bedpans, urinals, wash basins, and water mugs. Label multi use items with the person's name and room and bed number. Do not “borrow” them for another person * Non-disposable items are cleaned and then disinfected. Then they are sterilized usually by the supply department. Cleaning. Cleaning reduces the number of microbes present. It also removes organic ma er such as food and blood, body fluids, secretions, and excretions. Organic ma er comes from living plants and animals and will decay.To Clean Equipment + Wear personal protective equipment (PPE) to clean items contaminated with blood, body fluids, secretions, or excretions. PPE includes gloves, a mask, a gown, and goggles or a face shield + Work from clean to dirty areas. If you work from a dirty to clean area, the clean area becomes contaminated (dirty). + Rinse the item in cold water to remove organic ma er. Heat makes organic ma er thick, sticky, and hard to remove * Wash the item with soap and hot water. + Scrub thoroughly. Use a brush if necessary. + Rinse the item in warm water. Dry the item. + Disinfect the item. Or have it sterilized. + Disinfect equipment and the sink used for cleaning. * Discard PPE.Disinfection © Disinfection is the process of killing pathogens. Spores are not destroyed. Spores are bacteria protected by a hard shell. Spores are killed by very high temperatures. Disinfectants are used for cleaning. A disinfectant is a liquid chemical that can kill many or all pathogens except spores. Disinfectants are used to clean counters, tubs, showers, and re-usable items. Such items include: “Blood pressure cuffs Commodes and bedpans Shower chairs Wheelchairs and stretchers FurnitureFocus on Long-Term Care and Home Care Disinfection Home Care Detergent and hot water are used to clean cooking, eating, and drinking utensils and linens. Household disinfectants are used for surfaces—floors, toilets, tubs, and showers. Use the products the family prefers or as the nurse instructs. White vinegar and water is a good, cheap disinfectant. You can use it to clean bedpans, urinals, commodes, toilets, mirrors, bathroom tiles, and so on. Recipes for vinegar solutions vary. Ask the nurse how much vinegar and water to use. The following is common. To make a vinegar solution + Mix % cup of white vinegar with % gallon (8 cups) of water. + Label the container as a “vinegar solution: % cup white vinegar, % gallon (8 cups) water.” + Write the date, time, and your name on the label. Promoting Safety and Comfort Disinfection Safety Disinfectants can burn and irritate the skin. Wear utility gloves or rubber household gloves to prevent skin irritation. These gloves are waterproof. Do not wear disposable gloves. Some disinfectants have special measures for use and storage. Check the safety data sheet (SDS) before handling a disinfectant.Sterilization. ¢ Sterilizing destroys all non-pathogens, pathogens, and spores. Very high temperatures are used. Heat destroys microbes. Boiling water, radiation, liquid or gas chemicals, dry heat, and steam under pressure are sterilization methods. An autoclave is a pressure steam sterilizer. Glass, surgical items, and metal items are autoclaved. High temperatures destroy plastic and rubber items. 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Containg erat Eney + ve a nies ta g(t ‘Thngom ne snand meme "he nen ae ya wt mp2 ‘Penal Canc Wipe dnt he oe th ee hp pn Hecate rp cmd Terotting Secepibe Hon etn thecapinio mento an ad eC itanaay fast per ace ace wit depaing aing were (Gate Taps ara cnUsing Personal Protective Equipment (PPE 7 - ‘prertnarion Pingo tank