Role of Nursing in

Infection Control
Dr.T.V.Rao MD

Dr.T.V.Rao MD

The very first requirement in a hospital is that it should do the sick no harm
Dr.T.V.Rao MD 2

 Definition: Injurious contamination of body or parts of the body by bacteria, viruses, fungi, protozoa and rickettsia or by the toxin that they may produce. Infection may be local or generalized and spread throughout the body. Once the infectious agent enters the host it begins to proliferate and reacts with the defense mechanisms of the body producing infection symptoms and signs: pain, swelling, redness, functional disorders, rise in temperature and pulse rate and leukocytosis.
Dr.T.V.Rao MD 3

INFECTION

The risk of infection is always present.

Patient may acquire infection before admission to the hospital = Community acquired infection. Patient may get infected inside the hospital = Nosocomial infection. It includes infections
not present nor incubating at admission, infections that appear more than 48 hours after admission, those acquired in the hospital but appear after discharge also occupational infections among staff.
Dr.T.V.Rao MD 4

HEALTH CARE ASSOCIATED INFECTION (NOSOCOMIAL)

Infections that are a result of health care delivery, not present at admission
EXOGENOUS ENDOGENOUS IATROGENIC
Refer to Potter & Perry Table 34-2 Pg. 648 (Sites for Causes of HAIs)

Common Health-Care Associated Infections

Urinary Tract Infection
Surgical/Traumatic Wound Infection

Respiratory Tract Bloodstream

Modes of Transmission
Contact (Direct & Indirect) Droplet Airborne Vehicles Vectors
Dr.T.V.Rao MD 7

Chain of Infection
Pathogen
Susceptible Host

Reservoir

Portal of Entry
Mode

Portal of Exit

of
Transmissi on

Why Isolation?.. because transmission is Dr.T.V.Rao MD than the source / host! easier to control

Scope of Infection Control

Aiming at preventing spread of infection:

Standard precautions: these measures must be

applied during every patient care, during exposure to any potentially infected material or body fluids as blood and others.

Components:
A. Hand washing. B. Barrier precautions. C. Sharp disposal. D. Handling of contaminated material.
Dr.T.V.Rao MD 9

1st principale of infection prevention

at least 35-50% of all healthcare-associated infections are asociated with only 5 patient care practices:

Use and care of urinary catheters Use and care of vascular access lines Therapy and support of pulmonary functions Surveillance of surgical procedures Hand hygiene and standard precautions
Dr.T.V.Rao MD 10

Healthcare-Associated Urinary Tract Infection

Urinary tract infection (UTI) causes ~ 40% of hospital-acquired infections
Most infections due to urinary catheters 25% of inpatients are catheterized

Leads to increased morbidity and costs

Dr.T.V.Rao MD 11

Nurses should be Familiar INTERVENTIONS

ISOLATION PRECAUTIONS HYPERTHERMIA INTERVENTION
ELIMINATE UNDERLYING CAUSE FEVER MANAGEMENT

HEALTH TEACHING ANTIBIOTIC THERAPY PSYCHOSOCIAL SUPPORT HEALTH CARE RESOURCES

Read Manuals on Isolation Precautions

CDC and OSHA Guidelines on
1. Contact 2. Droplet 3. Airborne

Personal Protective Equipment

Gowns Respiratory Masks Eye Protection Gloves Specimen Collection Bagging Trash & Linen Transporting Patients
Dr.T.V.Rao MD 14

HAND WASHING
Proper hand washing is the

single most important ay to prevent and reduce infections Wash and rinse hands for 15 seconds, using a dry paper towel to turn off faucet Alcohol based hand wash is also available in all patient care areas
Dr.T.V.Rao MD 15

Hands should be washed:

Before and after patient contact Before putting on gloves and after taking them off After touching blood and body substances (or contaminated patient-care equipment), broken skin, or mucous membranes (even if you wear gloves) Between different procedures on the same patient
Dr.T.V.Rao MD 16

HAND WASHING
Hand washing is the single most effective precaution for prevention of infection transmission between patients and staff. Hand washing with plain soap is mechanical removal of soil and transient bacteria (for 10- 15 sec.) Hand antisepsis is removal & destroy of transient flora using anti-microbial soap or alcohol based hand rub (for 60 sec.)
Dr.T.V.Rao MD 17

Methods in Hand Washing

Surgical hand scrub: removal or destruction of transient flora and reduction of resident flora using anti-microbial soap or alcohol based detergent with effective rubbing (for least 2-3 min) Our hands and fingers are our best friends but still could be our enemies if they carry infective organisms and transmit them to our bodies and to those whom we care for. Sinks & soap must be found in every patient care room. Doctors, nurses must comply to hand washing policy.
Dr.T.V.Rao MD 18

When to Wash our Hands

1. Before & after an aseptic technique or invasive procedure. 2. Before & after contact with a patient or caring of a wound or IV line. 3. After contact with body fluids & excreta removal. 4. After handling of contaminated equipment or laundry.
Dr.T.V.Rao MD 19

When to Wash our Hands

5. Before the administration of medicines 6. After cleaning of spillage. 7. After using the toilet. 8. Before having meals. 9. At the beginning and end of duty. 10. Gloves cannot substitute hand washing which must be done before putting on gloves and after their removal.
Dr.T.V.Rao MD 20

How to Wash our Hands

Jewelry must be removed. If unable to remove rings, wash and dry thoroughly around them. Wet your hands with running warm water, dispense about 5 ml of liquid soap or disinfectant into the palm of the hand. Rub hands together vigorously to lather all surfaces and wrist paying particular attention to thumbs, finger tips and webs.
Dr.T.V.Rao MD 21

How to Wash our Hands

Rinse hands thoroughly. Turn off water using elbow-on elbow taps, dry hands thoroughly on a paper towel OR where elbow taps are not present, first dry hands, thoroughly, then turns off the taps using fresh paper towel. Hand cream can be used on persona basis. If a staff member develops a skin problem, he or she must consult dermatologist.
Dr.T.V.Rao MD 22

Risk Reduction: Antimicrobial

Pre-Operative Shower Chlorhexidine Gluconate Primary choice

Iodophores Hexachlorophene
23 Dr.T.V.Rao MD

Barrier Precautions
1. Gloves:

Disposable gloves must be worn when:

a) Direct contact with B/BF is expected. b) Examining a lacerated or non-intact skin e.g wound dressing. c) Examination of oropharynx, GIT, UIT and dental procedures.

Dr.T.V.Rao MD

24

Barrier Precautions
contaminated instruments or equipment. e) HCW has skin cuts, lesions and dermatitis Sterile gloves are used
d) Working directly with

for invasive procedures.

GLOVES MUST BE of good quality, suitable size and material. Never reused.
Dr.T.V.Rao MD 25

Barrier Precautions
Masks & Protective eye wear:
MUST BE USED WHEN: engaged in procedures likely to generate droplets of B/BF or bone chips During surgical operations to protect wound from staff breathings, Masks must be of good quality, properly fixed on mouth and nasal openings.
Dr.T.V.Rao MD 26

Barrier Precautions
3) Gowns/ Aprons: Are required when: Spraying or spattering of blood or body fluids is anticipated e.g surgical procedures. Gowns must not permit blood or body fluids to pass through.

Sterile linen or disposable ones are used for sterile procedures.

Dr.T.V.Rao MD 27

What to do if exposed to blood / body fluids

Puncture wounds should be washed immediately and the wound should be caused to bleed If skin contamination should occur, wash the area immediately Splashes to the nose or mouth should be flushed with water Eye splashes require irrigation with clean water, saline, or a sterile irritant Most importantly: Complete a GBMC Employee Incident Report. Report exposure to charge nurse and Agency immediately
Dr.T.V.Rao MD 28

Sharp precautions
Needle stick and sharp injuries carry the risk of blood born infection e.g AIDS, HCV,HBV and others. Sharp injuries must be reported and notified NEVER TO RECAP NEEDLES Dispose of used needles and small sharps immediately in puncture resistant boxes (sharp boxes). Sharp boxes: must be easily accessible, must not be overfilled, labeled or color coded. Needle incinerators can be another safe way of disposal. Reusable sharps must be handled with care avoiding direct handling during processing.

Dr.T.V.Rao MD

29

Handling of Contaminated Material

1. Cleaning of B/BF spills:
a- wear gloves. b- wipe-up the spill with paper or towel. c- apply disinfectant.

2. Cleaning & decontamination of equipment:

protective barriers must be worn.

3. Handling & processing lab specimens:

must be in strong plastic bags with biohazard label
Dr.T.V.Rao MD 30

Handling of Contaminated Material

4. Handling and processing linen:
Soiled linen must be handled with barrier precautions, sent to laundry in coded bags.

5. Handling and processing infectious waste:

a. must be placed in color coded, leakage proof bags, collected with barrier precautions b. contaminated waste incinerated or better autoclaved prior to disposal in a landfill.
Dr.T.V.Rao MD 31

Environmental control:
1. Including physical facility plans must meet quality and infection control measures. Patient equipment positioning and installation, traffic flow. 2. Cleaning of hospital environment and disinfection according to policies. 3. Proper air ventilation. 4. Water pipes examination, check its quality. 5. Proper waste collection and disposal. 6. Cleaning and dis-infection of equipment. 7. Proper linen collection, cleaning, distribution
Dr.T.V.Rao MD 32

Staff health promotion and education:

1. HCW are at risk of acquiring infection, they can also
transmit infection to patients and other employee. 2. Employee health history must be reviewed, immunizations recommendations to be considered. 3. Release from work if sick, occupation injury must be notified. 4. Continuous education to improve practice, better performance of new techniques.
Dr.T.V.Rao MD

33

All Nursing Staff should follow Standard Precautions

Guidelines for preventing exposure to blood, body fluids, secretions, excretions (except sweat), broken skin, or mucous membranes Based on the concept that body fluids from ANY patient can be infectious Should be used on every patient Use necessary PPE for protection
CDC guidelines requires us to use category-specific isolation (ex TB isolation) in addtion to Standard Precautions when a patient is known or suspected to have an infection

Do not Recap Needles A threat to LIFE

Dr.T.V.Rao MD

35

Infection Control Nurse Orientation

Objectives:
Understand the significance of antibiotic resistant organisms seen in hospitals Understand how surveillance for hospital acquired (nosocomial) infections is performed and the significance of surveillance data

Follow CONTACT ISOLATION

Used to prevent transmission of microorganisms spread by direct/indirect contact with the source
examples:

MRSA VRE C. diff

contagious skin infections Lice & Scabies

DROPLET ISOLATION
used to prevent transmission of microorganisms spread by large, moist droplets inhaled by or landing on the mucous membranes of the susceptible host
examples:

Influenza Neisseria meningitidis some pneumonias vaccine preventable diseases:

rubella, mumps, pertussis

AIRBORNE ISOLATION
used to prevent transmission of microorganisms spread on very small particles that drift on air currents (droplet nuclei, dust)
examples: pulmonary Tuberculosis varicella measles

AIRBORNE ISOLATION
BASIC COMPONENTS:

negative air pressure isolation room door remains closed fit-tested N95 respirator Call Engineering (ext. 2060) with room # to check negative pressure. yes HANDWASHING!

Nurses should be familiar with Surveillance Activities

Operative Procedures Critical Care Units (MICU, SICU, NICU) Targeted Surveillance Outbreak Investigation

Benchmarking Hospital Acquired Infections

CDCs Hospital Infections Program Submit monthly data on ICU infections Benchmarking with similar hospitals Networking opportunities Annual reports Start having a Infection Audit

Surveillance Data Improves the Patient Safety

USES
Improve patient outcomes by
modifying patient care practices reducing length of stay

Identify education needs Evaluate new products Identify new opportunities for improvement

Key Points About PPE

Don before contact with the patient, generally before entering the room Use carefully dont spread contamination Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room Immediately perform hand hygiene
Dr.T.V.Rao MD

44

Sequence for Donning PPE

Gown first Mask or respirator Goggles or face shield Gloves
Dr.T.V.Rao MD 45

How to Don a Gown

Select appropriate type and size

Opening is in the back

Secure at neck and waist

If gown is too small, use two gowns

Gown #1 ties in front

Gown #2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

Place over nose, mouth and chin

Fit flexible nose piece over nose bridge Secure on head with ties or elastic Adjust to fit

PPE Use in Healthcare Settings

How to Don Eye and Face Protection

Position goggles over eyes and secure to the head using the ear pieces or headband Position face shield over face and secure on brow with headband

Adjust to fit comfortably

PPE Use in Healthcare Settings

How to Don Gloves

Gloves last

Select correct type and size

Insert hands into gloves Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings

How to Safely Use PPE

Keep gloved hands away from face
Avoid touching or adjusting other PPE

Remove gloves if they become torn;

perform hand hygiene before donning new gloves

Limit surfaces and items touched

Nurses should Evaluate their Outcome

MEASURE SUCCESS OF INFECTION CONTROL TECHNIQUES COMPARE PATIENTS RESPONSE TO ACTUAL OUTCOME WHAT WILL YOU DO IF GOAL/OUTCOMES NOT ACHIEVED?

Our Hands are Threat to LIFE Just Washing can Save Many LIVES

Dr.T.V.Rao MD

52

Clinical Microbiology at your Finger Tips

To Learn More about Microbiology and Infectious Diseases Join Raos Microbiology and Raos Infection care on FACEBOOK
Dr.T.V.Rao MD 53

 Programme create by Dr.T.V.Rao MD Medical and Health Care Workers in the Developing World Email doctortvrao@gmail.com

Dr.T.V.Rao MD

54