Foundation of nursing / theory

NUR 231
Infection control
 Learning outcome
After completing this unit, the student participant should be able to:

❑ Define the key terms listed.

❑ Purposes of medical asepsis
❑ List types of microorganisms causing infection
❑ Identify types of infection
❑ Discuss infection process
❑ Describe the chain of infection
❑ Explain course of infection
 Learning Outcome cont’d
❑Enumerate defenses against infection
❑Identify Factors increasing susceptibility to infection
❑Discuss Nosocomial infection
❑ Write Standard precaution; Body Substance Isolation
System (BSIS) to prevent blood-born infection

❑Discuss nursing management to patient with infection

 : Outline ∙ Defenses against infection
∙ Definition of terms
∙ Standard precaution: Body Substance
∙ Purposes of medical asepsis
Isolation System (BSIS) to prevent
∙ Types of microorganisms
blood-born infection
causing infection
∙ Miscellaneous guidelines
∙ Types of infection
∙ Infection process
∙ The chain of infection:
∙ Course of infection:
► Contamination: The process by which something is

rendered unclean or unsterile.

► Infection: Is an invasion of the body by pathogens, or

microorganism capable of producing disease.

► Nosocomial infection: are classified as infections
that are associated with delivery of health care
services in a health care facility.

► Nosocomial infections either develop during a

client's stay in a facility or manifested after
discharge.
► Carriers; Are people or animals that show no
symptoms of illness but that have pathogens on or
in their bodies that can be transferred to others.
 :Types of infection
❑ Local or systematic: local is limited to the specific part
of the body where the microorganism remain. If
microorganisms spread and damage different parts of
the body, it is a systemic infection.

❑ Acute or Chronic infections: Acute generally appear

suddenly or last a short time. A chronic infection may

occur slowly, over long period, and may last month or
years
 Types of microorganisms causing infection:
Four major categories of microorganisms cause infection in humans:
1- Bacteria

2- Viruses
3- Fungi

4- Parasites.
 Infection process
•Certain conditions must be met in order for a microbe
or infectious disease to be spread from person to
person.

•This process, called the chain of infection, can only

occur when all six links in the chain are intact. By
breaking this chain at any of the links, the spread of
infection is stopped.
Infection process
 Infection cycle cont’d

There are six links make up the chain of infection :

1. Etiological agent

2. Reservoir

3. Portal of exit

4. Mode of transmission

5. Portal of entry

6. Susceptible host
 1- Etiologic agent

Infectious agent It’s pathogen (germ) that causes diseases

Infectious or etiological agent depends on:
a. Capability of it to producing an infection
b. Number of microorganisms
c. The ability of it to enter the body
d. Susceptibility of the host
:Reservoir .2

❑ Reservoir is a place where microorganisms survive,

multiply, and await transfer to a susceptible host. (this
includes people, animals , insects, medical equipment, and
soil and water)

❑ The reservoir is storage place for growth and

multiplication of microorganisms.

❑ Common reservoirs that support pathogenic

microorganisms are other humans, animals, food, water
and feces eg. Malaria parasite, dog with rabies.
 3. Portal of exit
Portal of exit from the reservoir:

Portal of exit is the way the infectious agent leaves the reservoir

Portals of exit include sites such as (through open wounds,

blood, body fluids mucous membranes, respiratory tract,

genitourinary (GU) tract, gastrointestinal (GI) tract, and trans
placental (mother to fetus).
4. Method of transmission
An organism may be transmitted from its reservoir by three
mechanisms.
Mode of transmission is the way the infectious agent can be passed on
(through direct or indirect contact, ingestion, or inhalation)
a. Direct : from person to person e.g. (sneezing).
b. Indirect : e.g. Vehicle or vector e.g. animal biting.
c. Airborne transmission e.g. dust
5. Portal of entry to susceptible host

Portal of entry is the way the infectious agent can enter a new host
(through broken skin, the respiratory tract, mucous membranes, and
catheters and tubes)
Is the point at which organisms enter a new host.
The entry route into the new host often the same as the exit route
from the prior reservoir.
 6. Susceptible host

• Susceptible host is any person who is at risk for

infection. the most vulnerable of whom are receiving
healthcare, are immunocompromised, or have invasive
medical devices including lines, devices, and airways)

• Hospitalized patients are often in a weakened state of

health because illness & have less resistance.
If the chain is not broken the infectious
organism is able to go on to develop
disease in another person
 Stage of infection

Incubation Prodromal Full stage of Convalescent

period stage illness stage
 Stages of infection
1) Incubation Period: Interval between entrance of pathogen into
body & appearance of first symptoms.
2) Prodromal Stage: Interval from onset of nonspecific signs and
symptoms (malaise, low grade fever, fatigue) to more specific
symptoms.
3) Illness Stage: Interval when patient manifests signs and symptoms
specific to type of infection.
4) Convalescence: Interval when acute symptoms of infection
disappear.
 Body Defenses against infection
❑ Skin
❑ Mouth

❑ Respiratory tract

❑ Urinary tract

❑ Gastrointestinal tract

❑ Vagina

❑ Immune system
 Factors increasing
Intrinsic susceptibility to infection
host susceptibility :
❑ Age

❑ Poor nutritional status

❑ Co morbidity

❑ severity of underlying disease

❑ Fatigue

❑ Stress
 2-Factors increasingfactors
Environment susceptibility to infection

❑ Hospital location
❑ diagnostic procedures
❑ Medication (immunosuppressive, chemotherapy and antibiotics)

❑ Medical & surgical devices

❑ Exposure to infected patients or health workers
❑ Asymptomatic carriers
 Infection prevention and control

Infection prevention and control (IPC) is a practical,

evidence-based approach preventing patients and
health workers from being harmed by avoidable
infections.
 Methods of infection control
1. Medical asepsis

2. Standard and Transmission based precaution

Asepsis: Is a freedom from disease-causing
microorganisms. To decrease the possibility of transferring
microorganisms from one place to another, there are two
basic types of asepsis; medical asepsis and surgical
asepsis.
 • In medical asepsis, an area or object is considered contaminated
only if it is suspected of containing pathogen (e.g., used bedpan,
the floor & a wet piece of gauze).
► Purposes of medical asepsis:

∙ To prevent cross infection on hospital environment.

∙ To control infection.

∙ To ensure patient's comfort safety and psychological well-being.

 :Cleaning
► Cleanliness inhibits the growth of microorganisms.

► Is the removal of all foreign materials such as soil & organic

material from objects.

► Generally, cleansing involves use of water & mechanical

action with or without detergents.

► When cleaning equipment that is soiled by organic material

such as blood, fecal matter, mucus or pus, the nurse applies
PPE; a mask, protective eyewear, & waterproof gloves. These
barriers provide protection from infectious organisms. A brush,
detergent or soap is needed for cleaning.
► Disinfection: process of eliminating pathogenic organisms on
inanimate object with the exception of spores.

► Disinfectant: Is a chemical substance that is used for

disinfecting only an inanimate object e.g. (phenol, chlorine).
► Antiseptic solution: Is a substance that is used on
person's skin to inhibit the growth and activity of
microorganisms, but not necessarily destroy them.
 Surgical asepsis or sterile technique
Includes procedures used to eliminate microorganisms from an area.
Sterilization destroys all microorganisms including spores & viruses.
► Sterilizing: Is the process that destroyed all microorganisms,
including spores and viruses.

► Four commonly used method;

1. Moist heat (Autoclave supply steam under pressure121to 123C for 29

min).
2. Gas (ethylene oxide).
3. Boiling water; the water temp rises no higher than 100C for 15 min.
4. Radiation; both ionizing and no ionizing radiation such as ultraviolet
light type of non ionizing radiation.
 Standard precautions
❑ Standard precautions are the work practices required to
achieve a basic level of infection prevention and control.
❑ Standard precautions are the minimum infection
prevention and control practices that must be used at all
times for all patients in all situations
 Standard Infection Control and Prevention (SICP)
There are 10 elements of SICPs:

1. Patient placement/assessment of infection risk

2. Hand hygiene

3. Respiratory and cough hygiene

4. Personal protective equipment

5. Safe management of the care environment

6. Safe management of care equipment

7. Safe management of healthcare linen

8. Safe management of blood and body fluids

9. Safe disposal of waste (including sharps)

10. Occupational safety/managing prevention of exposure (including sharps)

 1- Patient placement/assessment for infection risk
Patients must be promptly assessed for infection risk on arrival at
the care area, e.g. inpatient/outpatient/care home, (if possible,
prior to accepting a patient from another care area) and should be
continuously reviewed throughout their stay.
 The most frequent cause of infection outbreaks in health care institutions is
transmission by hands of health care workers.

Hand hygiene very important when practicing standard precautions. Hands

are to be washed:-

• Before patient care and after touching blood, body fluids, secretions,
excretions, and contaminated items, regardless of whether gloves are worn.

• Perform hand hygiene immediately after gloves are removed,

• Between patient contacts, and when otherwise indicated to prevent transfer
of microorganisms to other patients or environments.

• It may be necessary to wash hands between tasks and procedures on the

same patient to prevent cross-contamination of different body sites.
 Standard precautions
Hand hygiene
Your 5 moments for hand hygiene at the point of care
 3. Respiratory hygiene
To prevent the transmission of all respiratory
infections in healthcare setting, including influenza,
the following infection control measures should be
implemented at the first point of contact with a
potentially infected person.
•Persons with respiratory symptoms should apply source control
measures:
 4-Personal Protective measures:

Glove use.

Gowns or Plastic Aprons

Mask, eye protection face shield

5- Safe management of care equipment
Care equipment is easily contaminated with blood, other body
fluids, secretions, excretions and infectious agents. Consequently, it
is easy to transfer infectious agents from communal care equipment
during care delivery.
6 Safe management of the care environment
The care environment must be:
❑ visibly clean, free from non-essential items and equipment to
facilitate effective cleaning
❑ well maintained, in a good state of repair and with adequate
ventilation for the clinical specialty
 •Health care facilities should:
** Environmental cleaning: Use adequate procedures for the routine
cleaning and disinfection of environmental and other frequently touched
surfaces.
** Linens: Handle, transport, and process used linen in a manner which:
Prevent skin and mucous membrane exposures and contamination of clothing.

Avoid transfer of pathogens to other patients and or the environment.

** Waste disposal

Ensure safe waste management.

Treat waste contaminated with blood, body fluids, secretions and excretions as

clinical waste, in accordance with local regulations.

Human tissues and laboratory waste that is directly associated with specimen

processing should also be treated as clinical waste.

 •Health care facilities should:
** Patient care equipment

Handle equipment soiled with blood, body fluids, secretions, and excretions in a

manner that prevents skin and mucous membrane exposures, contamination of

clothing, and transfer of pathogens to other patients or the environment.

Clean, disinfect, and reprocess reusable equipment appropriately before use with
another patient.
** Room Selection: Assign patient with infectious disease to an separate isolation
room or last one on the surgical list.
** Housekeeping:
Clean all rooms on regular schedule.
Clean articles, equipment & furniture soiled with moist body substances immediately.
Wear gloves.
8 - Safe management of blood and body fluid spillages

Spillages of blood and other body fluids may transmit blood borne

viruses.

Spillages must be treated immediately by staff trained to undertake

this safely.

Responsibilities for the management of blood/body fluid spills must

be clear within each area/care setting.

 9- Needle stick prevention:
• The most important aspect of reducing the risk of blood borne infection
is avoidance of percutaneous injury.

• Extreme care is essential in all situations in which needles, scalpels, and

other sharp objects are handled.

• Used needless should not be recapped they are placed directly into
puncture resistance containers.

• Discard in rigid, puncture-resistant containers. Do not recap used needles

by hand. Be particularly careful when manipulating small devices such as
heparin locks.
Transmission based precautions

• Transmission-Based Precautions are the second tier of basic infection

control and are to be used in addition to Standard Precautions for
patients who m»y be infected or colonized with certain infectious agents
for which additional precautions are needed to prevent infection transmission.
 :Miscellaneous guidelines
❖ Place used sharps, such as needles or scalpels, in a designated sharps disposal
container.
❖ Do not purposefully bend, break, or recap needles.
❖ Place disposable wastes and articles contaminated with blood or large amounts of
body fluids in a bio-waste container for a trash pickup.
❖ Clean up spills of blood or body fluids per hospital protocol (i.e., blood spill kit).
❖ Place all soiled linen in a laundry bag. Do not overfill the bag, to prevent
contamination of the environment.
❖ For patients with diarrhea: Strongly recommend soap and water for hand hygiene.
❖ For patients who are coughing: Wear a face mask if within 3 feet of patient and
teach patient about respiratory hygiene.
 :Miscellaneous guidelines
❖ Use mouthpieces, resuscitator bags, or other ventilation devices if resuscitation
is needed.
❖ Health care workers: If you have exudative (draining) lesions, refrain from all
direct patient care and from handling patient care equipment until wound is
healed.
❖ Handle laboratory specimens from all patients as if they are infectious (refer to
agency manual).
❖ Use private rooms for patients with communicable diseases subject to airborne
transmission or patients who soil their environment uncontrollably with body
substances. For certain diseases (e.g., meningococcal meningitis), personnel
and family entering the patient’s room are to wear masks.