Infection Prevention

and Control
Chapter 28

Fundamentals of Nursing
Chain of Infection
Infectious Agent

Examples:

Staphylococcus aureus
• Endocarditis,
• Osteomyelitis,
• Septicemia

Streptococcus pneumoniae -
• Acute bacterial meningitis
• Pneumonia
• Endocarditis,

• E. Coli
• UTI
Reservoir
Portal of Exit

 Skin & mucous membranes

 Respiratory tract
 Urinary tract
 GI tract
 Reproductive tract
 Blood
 Modes of Transmission

• Direct- Person-to-person (fecal, oral) physical

contact
• Indirect- Personal contact of susceptible host
with contaminated inanimate object
• Droplet
• Airborne
• Vehicles/Inanimate objects- dirty items
• Vector- Mosquito, Flea, Tick
Portal of Entry
Susceptible Host

 Strength in numbers
 Impaired nutritional status
 Chronic disease
 Trauma
Bloodborne Pathogens

 Microorganisms which are found in blood and body fluids,

causes life threatening infections.

Hepatitis B

Hep C

HIV
Transmission of Bloodborne Pathogens

o Accidental injuries: needle pricks, sharps, blood/fluid

splashes
o Sharing needles
o Blood and blood products transfusions
o Sexual contact
Universal/Standard Precautions

 Is an approach to infection control to treat all blood and

body fluids as if they were known to be infectious.
 Protect yourself, patients, coworkers, and your family
 Recommends PPE and other infection control practices to
prevent transmission in any healthcare setting
 Decisions about PPE use determined by type of clinical
interaction with patient
Hand Hygiene
oWash hands before and after touching patients,
procedure.
oWash for15 seconds (Happy Birthday, ABCs).
oSeal cuts in your hands.
oWear gloves for any potential contact with blood,
body fluids, secretions, excretions, mucous
membranes, open wounds and contaminated items.
oWash hands before donning gloves and after removing
gloves.
oGloves do not take the place of hand hygiene
Prevention and Infection Control

o Vaccination
o Patient and Family education
o Safe clinical practice: Use PPE (Personal Protective Equipment)
 Gloves – Use when touching blood, body fluids, secretions, excretions,
contaminated items; for touching mucus membranes and nonintact skin
 Gowns – Use during procedures and patient care activities when contact
of clothing/ exposed skin with blood/body fluids, secretions, or excretions
is anticipated
 Mask and goggles or a face shield – Use during patient care activities
likely to generate splashes or sprays of blood, body fluids, secretions, or
excretions
Infection Control Practices

o Wearing gloves
o Washing hands
o Spill disinfection
o Proper waste disposal
o Use sharp containers
o Disinfection
o Sterilization
Personal Protective Equipment (PPE)

Centers for Disease Control and Prevention

guidelines recommend initially hand hygiene and
then donning of gown, mask, goggles, and finally
gloves to protect staff members and limit the
spread of contamination.
Removal of PPE

Remove in Alphabetical Order:

Gloves & Gown

Goggles
Mask
Airborne

 Most Common:
 Tuberculosis

 Rule out Tuberculosis

 Measles
Droplet

 Most Common
 Meningococcal meningitis
 Meningococcal pneumonia
 Meningococemia

 Influenza

 German Measles (Rubella)

Contact

 MRSA

 VRE

 Lice/Scabies

 Major draining wounds

 ESBL extended spectrum beta
lactamase
E.g.E-Coli, Klebsiella
pneumoniae, Klebsiella
oxytoca, Enterobacter)
Contact (Special for C. diff)

 You should always wash your hands

with soap and water and not alcohol-
based hand sanitizer when exiting the
room.
 Equipment is cleaned/disinfected with
Wet Task or PDI wipes followed by a
bleach solution.

 Clostridium difficile – spores are

extremely hardy, alcohol is ineffective
Airborne/Contact

 Most Common
 Varicella (chickenpox)
 Herpes zoster/Shingles
 SARS (Severe Acute
Respiratory Syndrome)
 Small pox
Droplet/Contact

 Most Common
 Flu (including rule out)
 MRSA (in sputum) Methicillin
Resistant Staph Aureus
 Pneumococcus resistant to penicillin
 VRSA (Vancomycin-resistant Staph
aureus)
 ESBL (E-Coli, Klebsiella pneumoniae,
Klebsiella oxytoca, Enterobacter.)
PPE for COVID-19
 Patients with confirmed or possible SARS-
CoV-2 infection should wear a facemask
when being evaluated medically
 Before caring for patients with confirmed
or suspected COVID-19, healthcare
personnel (HCP) must receive
comprehensive training on when and what
PPE is necessary, how to don (put on) and
doff (take off) PPE, limitations of PPE, and
proper care, maintenance, and disposal of
PPE.

[Link]
Question #1
Give three examples of a reservoir in the chain of infection:

a) ____________________________
b) ____________________________
c) ____________________________
Answer

Give three examples of a reservoir in the chain of infection:

a) Bedside table
b) IV pump
c) Door handle
Question #2

What is the most effective way to control transmission of

infection?
a) Isolation precautions
b) Identify the infectious agent
c) Hand hygiene
d) Vaccines
Answer

What is the most effective way to control transmission of

infection?
a) Isolation precautions
b) Identify the infectious agent
c) Hand hygiene
d) Vaccines
Question #3

A nurse is caring for a pediatric client placed into airborne

precautions to rule out tuberculosis. Which personal protective
equipment should the nurse wear?
(Select all that apply)
a) Disposable gown
b) Goggles
c) Surgical Mask
d) N 95 respirator mask
e) Gloves
Answer

A nurse is caring for a pediatric client placed into airborne

precautions to rule out tuberculosis. Which personal protective
equipment should the nurse wear?
(Select all that apply)
a) Disposable gown
b) Goggles
c) Surgical Mask
d) N 95 respirator mask
e) Gloves
Question #4

A student nurse is caring for a client with Clostridium

difficile. You know the student nurse needs further
education regarding the proper care of the client when she
does which of the following?
a) Dons a disposable gown
b) Washes her hands prior to donning disposable gloves
c) Uses hand sanitizer using friction when leaving the room
d) Uses the disposable stethoscope to assess the client
Answer

A student nurse is caring for a client with Clostridium

difficile (C. difficile). You know the student nurse needs
further education regarding the proper care of the client
when she does which of the following?
a) Dons a disposable gown
b) Washes her hands prior to donning disposable gloves
c) Uses hand sanitizer using friction when leaving the
room
d) Uses the disposable stethoscope to assess the client
Question #5

A client is diagnosed with methicillin-resistant

Staphylococcus aureus (MRSA) of a wound. Which type of
isolation precaution is most appropriate for this patient?
a) Reverse isolation
b) Droplet precautions
c) Standard precautions
d) Contact precautions
Answer

A client is diagnosed with methicillin-resistant

Staphylococcus aureus (MRSA) of a wound. Which type of
isolation precaution is most appropriate for this patient?
a) Reverse isolation
b) Droplet precautions
c) Standard precautions
d) Contact precautions
Question

 In which order will the nurse take these actions before doing wound
irrigation and a dressing change for a client who has a wound infected with
methicillin-resistant Staphylococcus aureus (MRSA)?

 a. don gloves
 b. put on gown
 c. perform hand hygiene
 d. put googles to protect eyes
 e. put on mask to cover nose and mouth
Answer
 In which order will the nurse take these actions before doing wound
irrigation and a dressing change for a client who has a wound infected with
methicillin-resistant Staphylococcus aureus (MRSA)?

 a. don gloves Correct Order: C, B, E, D, A

 b. put on gown
 c. perform hand hygiene
 d. put googles to protect eyes
 e. put on mask to cover nose and mouth

Centers for Disease Control and Prevention guidelines recommend initially hand hygiene and
then donning of gown, mask, goggles, and finally gloves to protect staff members and limit
the spread of contamination. Goggles and a mask (or use of a face shield) will be needed with
this dressing change because of the possibility of splashing during wound irrigation.
Question
 A client who has had recent exposure to Ebola while traveling in Africa arrives in the
emergency department with fever, headache, vomiting, and multiple ecchymoses. Which
action should the nurse take first?

A) Place the patient in a private room

B) Obtain heart rate and blood pressure
C) Notify the hospital infection control nurse
D) Ask the client to describe the type of Ebola exposure
Question

 A client who has had recent exposure to Ebola while traveling in Africa arrives
in the emergency department with fever, headache, vomiting, and multiple
ecchymoses. Which action should the nurse take first?

1.  Place the client in a private room.

 2.  Obtain heart rate and blood pressure.
 3.  Notify the hospital infection control nurse.
 4.  Ask the client to describe type of Ebola exposure.

 
Rationale:
Centers for Disease Control and Prevention guidelines recommend that the initial action
be to place the client in a private room and implement standard, contact, and droplet
precautions. Further assessment of the type of possible Ebola exposure, obtaining vital
signs, and notification of the infection control nurse will also be needed but should be
done after measures to minimize transmission of Ebola are implemented.
Question

 A client has been diagnosed with disseminated herpes zoster. Which personal
protective equipment (PPE) will the nurse need to put on when preparing to
assess the client? Select all that apply.
Surgical face mask

N95 respirator

Gown

Gloves

Goggles

Shoe covers
Answer
 A client has been diagnosed with disseminated herpes zoster. Which personal
protective equipment (PPE) will the nurse need to put on when preparing to
assess the client? Select all that apply.

Surgical face mask

N95 respirator
Gown
Gloves
Goggles
Shoe covers

Rationale:
Because herpes zoster (shingles) is spread through airborne means and by direct contact with
the lesions, the nurse should wear an N95 respirator or high-efficiency particulate air filter
respirator, a gown, and gloves. Surgical face masks filter only large particles and do not
provide protection from herpes zoster. Goggles and shoe covers are not needed for airborne
or contact precautions.
Question

Four clients arrive simultaneously at the emergency department. Which client

requires the most rapid action by the triage nurse to protect other clients from
infection?

 1. A 3-year-old client who has paroxysmal coughing and whose

  sibling has pertussis
 2. A 5-year-old client who has a new pruritic rash and a possible
  chickenpox infection
 3. A 62-year-old client who has an ongoing methicillin-
  resistant Staphylococcus aureus (MRSA) abdominal wound
infection
 4. A 74-year-old client who needs tuberculosis (TB) testing after
  being exposed to TB during a recent international airplane
flight
 Answer

Four clients arrive simultaneously at the emergency department. Which client

requires the most rapid action by the triage nurse to protect other clients from
infection?  1. A 3-year-old client who has paroxysmal coughing and whose
  sibling has pertussis
 2. A 5-year-old client who has a new pruritic rash and a possible
  chickenpox infection
 3. A 62-year-old client who has an ongoing methicillin-
  resistant Staphylococcus aureus (MRSA) abdominal wound
infection
 4. A 74-year-old client who needs tuberculosis (TB) testing after
  being exposed to TB during a recent international airplane
flight

Rationale:
The child with the rash should be quickly isolated from the other clients through placement in a
negative-pressure room. Droplet or contact precautions (or both) should be instituted for the
clients with possible pertussis and MRSA infection, but this can be done after isolating the child
with possible chickenpox. The client who has been exposed to TB does not place other clients at
risk for infection because there are no symptoms of active TB.
Question

 The nurse notices that the health care provider omits hand hygiene after
leaving a client's hospital room. Which action by the nurse is best at this
time?
• Report the health care provider to the infection control department.
• Offer the health care provider an alcohol based hand sanitizing fluid.
• Provide the health care provider with a list of upcoming inservices on hand
hygiene.
• Remind the health care provider about the importance of minimizing
infection spread.
Answer

 The nurse notices that the health care provider omits hand hygiene after
leaving a client's hospital room. Which action by the nurse is best at this
time?
• Report the health care provider to the infection control department.
• Offer the health care provider an alcohol based hand sanitizing fluid.
• Provide the health care provider with a list of upcoming inservices on hand
hygiene.
• Remind the health care provider about the importance of minimizing
infection spread.

Rationale:
Because the most immediate need is to ensure that hand hygiene is
accomplished, the nurse should offer an alcohol-based cleaner to the health care
provider. The other actions may also be needed, especially if there is a pattern
of nonadherence to hand hygiene, but further assessment is necessary before
these actions are taken.
Additional References:

 [Link]
Questions