infection control

source, transmission, and susceptible host

patients (most common), visitor, staff, environment, equipment, etc.

contact (skin to skin), indirect contact (handling a bedpan), droplet, airborne, blood and body fluids, vectors

depends on size; very large about 1m, smaller droplets closer to 2m/6 feet (currently what we accept)

droplet nuclei

living organisms that transmits disease (ex. mosquitoes)

extremes in age, immunosuppression, no immunity, chronic conditions, emergency procedures

tip of iceberg: diseases we can see (ex. rash) bottom of iceberg: blood borne pathogens and stuff

recommended practises for the routine care of all patients in various setting and incorporates previous precautions against blood-borne pathogens

similar to standard precautions published by the CDC

the provincial infectious disease advisory committee; 2012

the interaction with the patient, not by the patients diagnosis -- anticipate the risk of exposure to blood and other body fluids

(don't wear gloves just because you're judging a patient)

ALL body substances, of ALL substances

additional precautions

• droplet and airborne

• antimicrobial resistant bacteria

• organisms/ infections of significance

• elimination

• substitution

• engineering control (ex. negative pressure rooms)

• administrative controls

• PPE

hand hygiene

terminates outbreaks in health care facilities, reduce transmission of antimicrobial resistant organisms and reduce overall infection rates

a 40% reduction in the rate of HAI

bad news; most healthcare providers already believe their practicing good hand hygiene

• hand washing with soap and water

• hand rubs with alcohol-based products (preferable in health care settings)

2: before aseptic procedures 4: after patient/ patient environment contact

as an additional measure (when is contact with body fluids or moist substances from exudate/wounds)

NOT a substitute for hand hygiene (use of either does not negate need for the other)

reduce hand contamination by 70-80%, and prevent cross contamination and protect patients and health care personnel from infections

before donning and after doffing

to protect mucus membranes during procedures and patient care activities likely to genera splashes or sprays of blood, body fluids, secretions or excretions

OR within 2 m of a coughing patient

when clothing is likely to be soiled; procedures likely to generate splashes/sprays of body fluid

single room not required unless patient visibly soils environment

clean between all patients

safe sharps disposal

establish routine care, cleaning of surfaces and furniture, using hospital approved disinfectant

be mindful of high tough surfaces and items

• pathogen involved

• type of exposure

• amount of blood involved

• amount of virus in the blood

NO! unless they are visibly contaminated with blood

6-10%

visually no risk if vaccinated and developed immunity

1.8 % after cut or needle stick

risk unknown following a blood splash

0.3% after needle stick or cut

0.1% after splashes to nose, mouth, eye

risk <0.1% after exposure to skin

hepatitis B vaccine, maintain intact skin, maintain good health

disinfection, safe containment of blood

PPE

• ability to survive in environment

• low infective dose

• virulence and pathogenicity

• can it exist in the carrier state?

• means of transmission

• symptoms of diarrhea

• requires hand on care

• poor hygiene

• copious respirate secretions

• if housekeeping is poor

• equipment is shared between patients

• multiple bed rooms

• nurse/patient ratio (cut corners when short staffed)

• portals of entry (catheters, skin integrity)

• immune status

• underlying medical conditions

• antibiotic therapy

• high acuity/ hands on care

transmission

required when routine practices are insufficient

• when they have pulmonary/ laryngeal TB

• measles/ measles like rash

• single room with door kept closed

• negative pressure (OR is positive)

• 6-9 air changes/ hour

• direct exhaust -- air from room goes right outside

respirators that filter out sub micron particles and fit around contours of face to avoid air leaks

only to leave room for essential procedures; patient to wear surgical mask

for diseases that spread via respiratory droplets:

colds, bronchitis, bacterial meningitis, COVID, pertussis, flu, etc

single room is preferred (if not able, spatial separation of > 4 meters) -- in nurseries, 1-2 m between bassinets

may cohort patients with same diagnosis, and doors may be kept open

• surgical mask

• eye wear

• gown (routine practise when droplets/ splatters anticipated)

• gloves (when handling respiratory secretions)

• only leave for essential services

• wear surgical/ procedure mask when leaving

enhanced droplet (N95)

for enteric organisms (ex. c. diff), and antibiotic resistant organisms (ex. MRSA)

gown and gloves

single room preferred; assess patient, organism, and roommate when considering shared accommodation

patient should be transported in clean gown and sheet, and preform hand hygiene upon leaving the room

• remove gloves

• remove gown

• hand hygiene

• remove eye wear

• remove N95 respirator

• preform hand hygiene

do not come to the hospital if you have an acute illness that is probably of infection etiology

AND stay up to date on vaccines!!

patients: should have infections and precautionary measures explained to them

family: should understand means of transmission, risk and prevention strategies

all educational material should be clear and in layman's terms

• more acuity

• skin broken

• incisions

• catheters, IVs, tubes

hand washing, gown and gloves all common

• underlying conditions

• decubitus ulcers

• peg tubes

• partial to total care

hand washing, occasional gowns + gloves

• higher self care level

• intact skin

• able to follow directions

hand washing, rare need for gown or gloves

serious complication of hospitalization

5-10% of patients acquire HAI

4th

11th 20 years ago

monitoring compliance with best practise (surrounding prevention of HAIs)

monitoring for new onset of symptoms such as fever, cough, SOB and or GI illness

UTI

1. clean (ex. eye, or heart): 1-5%

2. clean contaminated (exposure to normal flora, such as mouth): 3-11%

3. contaminated (areas of inflammation): 10-17%

4. dirty (ex. soiled wound): >20%

• age

• diabetes

• immunosuppression

• obesity

• malnutrition

• emergency surgery

• duration of surgery

personnel (skin, hair, anus, vagina and throat)

patient (normal flora, skin and mucus)

environment (air handling, instruments, bandages)

• showers

• hair removal

• skin prep

• drapes

• prophylactic antibiotics

• low OR traffic (keep doors closed)

• duration of the procedure

• sterile insertion of drains, catheters and IVs

masks, gowns, gloves, and cap

• clean air rooms

• laminar airflow rooms

between cases: horizontal surfaces, 1 m radius around OR table

daily: full floor, lights, walls

weekly: shelves, external vents

monthly: hallways and additional storage

• site

• prep (skin and solution)

• technique

• daily observation (be concerned if anything strange!)

• duration of IV insitu

instrumentation and catheter care

minimize catheters (sterile technique when needed), keep bag below patients hips (prevent back flow), and select appropriate catheter.

daily peri care

not present or incubating at time of admission; no incubation within the first 48-72 hours

• aspiration

• inhalation of aerosols

• hematogenous spread

the prevalence of virus in community; does not predominantly hit the high risk group

the immunosuppressed, and transplant cases

concerns such as construction, renovations and water features increase risk

• thoracic operations

• old age (60+)

• patients who aspirate

• reduced ability to cough

• patients having invasive procedures

• colonization of some organisms

• impaired immunity

immunization, sterile technique, oral care, precautions, etc

im not gonna list them all cuz you already know

antiseptics: used on living tissue disinfectant: used on material to remove/ climate some organisms sterilization: kills ALL microorganisms

cleaning

goop is not sterile, even if sterilized

items that will enter sterile body cavities, or come in contact with sterile tissue (ex: surgical clamp)

require sterilization

items that only contact with mucous membranes or non-intact skin (ex: endoscope)

requires high level disinfection minimum!

devices that come into contact with intact skin (ex. urinal)

require sanitization

removes blood, body fluid and tissue in order to ensure sterilization

makes items safe to handle

thermal and chemical

spores stay

disinfection with things like house hold cleaning products such as bleach can kill most bacteria, some viruses and some fungi (ex. TB, vegetative bacteria)

used for cleaning general patient care areas (ex. IV poles, bedside)

process destroying everything but bacterial spores

requires special ventilation, PPE , and specific tech

used in outpatient settings

• steam under pressure

• dry heat

• ethylene oxide gas

• chemical sterilants (take 10-12 hours)

reducing micro-organisms by thermal disinfection (ex: hot water for 30 minutes)

typically used with respiratory equipment

disposable/ single use: one and done (discard)

single patient use: can be used repeatedly but only by the same patient