PREVENTING INFECTION

IN THE HOSPITAL
• Staff nurses play an important role in
risk reduction by
1. paying careful attention to hand
hygiene,
2. by ensuring careful administration of
prescribed antibiotics,
3. and by following procedures to
reduce the risks associated with
patient care devices.
Specific Organisms With
Health Care- Associated
Infection Potential
1. CLOSTRIDIUM DIFFICILE
• spore-forming
bacterium with
significant HAI
potential.
1. CLOSTRIDIUM DIFFICILE
• Extensive use of antibiotics
in the hospital setting

• preceded by antibiotics :
1. that disrupt normal intestinal flora
2. allow the antibiotic-resistant C.
difficile spores to proliferate within
the intestine.
CLOSTRIDIUM DIFFICILE

• most serious cause of

antibiotic-associated
diarrhea (AAD)
CLOSTRIDIUM DIFFICILE
• can lead to
pseudomembranous colitis,
a severe infection of the
colon, resulting from
eradication of the normal gut
flora by antibiotics
CLOSTRIDIUM DIFFICILE SPORE

1. resistant to disinfectants

2. can be spread on the hands of

health care providers after
contact with equipment that has
previously been contaminated
with C. difficile.
CONTROL
• Control is best achieved by

1.intensifying cleaning,
2.using Contact Precautions for
infected patients
3.stressing glove use
4.hand hygiene for all care workers.
CDC RECOMMENDATION
1. Intensified environmental cleaning
using 1:10 bleach : water solution
2. Equipment cleaned whenever visibly
soiled
3. Items close to the patient should be
cleaned daily
4. IV poles should be cleaned when the
patient is discharged.
PHARMACOLOGICAL TREATMENT

• oral administration
of metronidazole or
vancomycin is the
treatment of choice
CLOSTRIDIUM DIFFICILE
2. METHICILLIN-RESISTANT
STAPHYLOCOCCUS AUREUS
• refers to S. aureus organisms that are
resistant to methicillin

• 1940- PENICILLIN was discovered

• Soon after penicillin was introduced,

S. aureus became all but universally
penicillin resistant
2. METHICILLIN-RESISTANT
STAPHYLOCOCCUS AUREUS

• cephalosporins

• synthetic penicillin solutions such as

methicillin were introduced
MRSA

• late 1970s- S. aureus showed

resistance to methicillin

• Linezolid and vancomycin -

alternative treatments for serious
MRSA infection
MRSA
• Health care providers often
transmit MRSA to patients
because S. aureus easily
colonizes skin
3. VANCOMYCIN-RESISTANT
ENTEROCOCCUS (VRSA)
• April 2002- a patient in Michigan
was diagnosed with an S. aureus
infection that was fully resistant to
vancomycin (ie, vancomycin
resistant S. aureus [VRSA])
VANCOMYCIN-RESISTANT
ENTEROCOCCUS
• Enterococcus is a gram-positive
bacterium that is part of the normal
flora of the gastrointestinal tract.

• It can produce significant disease

when allowed to infect blood,
wounds, or urine.
VANCOMYCIN-RESISTANT
ENTEROCOCCUS
• The host carries an abundance of the
organism even in a noninfected state;

• the organism is bile resistant and can

withstand harsh anatomic sites, such
as the intestine;

• sensitive to teicoplanin
 Preventing Nosocomial Bloodstream
Infections (Bacteremia and Fungemia)
• Bacteremia - bacteria in the
bloodstream.

• Fungemia is a bloodstream infection

caused by a fungal organism.
VAD
Any vascular access device (VAD)
can serve as the source for a
bloodstream infection
HOW?
 Contamination can occur:
1. from the patient’s own flora traversing the
exterior of a catheter or by contamination of
internal tubing during manipulation.

2. The intravenous fluid itself can become

contaminated and serve as a source of infection
DISINFECTING SKIN
1. During the insertion of all VADs, there
must be strict attention to aseptic
technique.

2. Those inserting VADs must

vigorously wash their hands before
insertion.
3. Those inserting central catheters
should use surgical technique,
including sterile gloves, sterile
gowns with long sleeves, masks,
and a large drape over the patient.

4. The preferred solution to disinfect

the insertion site is chlorhexidine
gluconate
5. Alternative solutions are povidone
iodine or alcohol.

6. Triple-antibiotic ointment should

not be used on the insertion site
because it has been shown to
lead to increased colonization
with Candida species
7. if blood is oozing from the catheter insertion site,
a gauze dressing should be used.

8. dressing should be applied using aseptic

technique

9. dressing should be sealed along its entire

perimeter.
• BIOPATCH ANTI-
MICROBIAL- A highly
absorbent CHG
(chlorhexidine gluconate)
impregnated dressing

• -releases disinfectant for

up to 7 days

• - reduces the incidence of

HAI by 60%
 Conditions That Suggest the Presence of
Nosocomial Vascular Access Device-Related
Bacteremia or Fungemia
1. The patient has catheter in place, appears septic,
but has no obvious reason to suggest
predisposition to sepsis.

2. There is no infection at another body site to

indicate probable source of sepsis.

3. The site of vascular line insertion is red, swollen,

or draining (especially purulent drainage).
4. The patient has a central vascular line in place at the
onset of sepsis.

4. The bloodstream infection is caused by Candida species

or by common skin organisms such as coagulase-
negative staphylococci, Bacillus species, or
Corynebacterium species.

5. The patient remains septic after appropriate therapy

without removal of the vascular access device.
CHANGING INFUSION SETS, CAPS, AND SOLUTIONS

• Infusion sets and stopcock caps- every 3 days

• Infusion sets and tubing for blood, blood

products, or lipid emulsions should be changed
within 24 hours of initiating the infusion.

• Blood infusions should finish within 4 hours of

hanging the blood;
CHANGING INFUSION SETS, CAPS, AND SOLUTIONS

• lipid solutions should be completed within 24

hours of hanging.

• There are no guidelines for the appropriate

intervals for the hang time of other solutions.

• Injection ports should be cleaned with 70%

alcohol or an iodophor before accessing the
system
Isolation Precautions
Need For Protection
Protection From What?
• Blood (saliva)-borne pathogens

• Air-borne pathogens

• Pathogens transmitted by skin

contact
 Protecting Whom?
• Protecting:

– Ourselves

– Patient

– Other patients

– Other staff

– Our families
Cannot autoclave patients
 Universal Precautions
• CDC (Centers for Disease Control) in 1987:
– All patients be regarded as potentially
infective (HIV & Hepatitis…)

– that all patients are colonized or infected

with microorganisms, whether or not there
are signs or symptoms
Universal Precautions
• Staff members & patients
should be protected from
blood-borne (and all)
infections
I. STANDARD PRECAUTIONS
• was designed for the care of all
patients in the hospital

• the primary strategy for preventing

HAI’s

• “All health care workers should

routinely use appropriate barrier
precautions to prevent skin and
mucous membrane exposure when
contact with blood or other body
fluids of any patient is anticipated”
Elements of Standard Precautions
1. hand hygiene
2. use of gloves and other barriers
(eg, mask, eye protection, face shield,
gown),
3. handling of patient care equipment
and linen
4. environmental control
5. prevention of injury from sharps
devices
6. patient placement.
1. Hand Hygiene
• hands should be washed with soap
and water

• antimicrobial agents (eg,

chlorhexidine gluconate, iodophors,
chloroxylenol, triclosan) may be
used.
Hand Hygiene

• Effective hand washing requires

at least 20 seconds of vigorous
scrubbing with special attention
to the area around nail beds and
between fingers, where there is
high bacterial burden.
Hand Hygiene
• alcohol-based, waterless antiseptic agents
1. If hands are not visibly soiled

2. For routine hand decontamination

3. These solutions are superior to soap or

antimicrobial handwashing agents in their
speed of action and effectiveness against
bacteria and viruses
• Normal skin flora usually consist of
coagulase-negative staphylococci

• In the health care setting, employees

may temporarily carry bacteria (ie,
transient flora) such as S. aureus,
Pseudomonas aeruginosa, and other
organisms with strong pathogenic
potential.

• transient flora are superficially

attached and are shed with hand
hygiene and skin regeneration
Nurses!!
• should not wear artificial fingernails or
extenders when providing patient
care.

• These items have been

epidemiologically linked to several
significant outbreaks of infections.

• Natural nails should be kept less than

0.25-inch (0.6-cm) long
Nurses!!

• nail polish should be removed when

chipped, because it can support
increased bacterial growth
2. Use of Personal
Protective
Equipment (PPE)
Gloves
Glove Use
• Worn when a health care worker has
contact with any patient’s secretions or
excretions

• hands must be thoroughly washed with

soap after gloves are removed

• Vinyl gloves, powder-free gloves, or “low-

protein” latex gloves if allergic to latex
Glove Use
• Should be worn when in contact with patients,
specimen, and hospital equipment.

• Changed between patients.

• Changed when they are visibly soiled.

• Changed when visibly damaged and removed

when leaving the work area.
Glove Use
• For sterile gloves, maintain sterility when
donning until used on the patient.

• Keep sleeves inside the gloves.

• Remove gloves without touching the

contaminated part.

• Wash hands after removing the gloves.

• Dispose gloves in biohazard.

 Gowns
•Must be fluid resistant
with cuffs to protect
clothing and skin from
exposure to patient’s
body samples.

•Completely buttoned
and gloves pulled over
the cuffs.
Gowns
• Worn at all times when working with patient’s
samples and removed when leaving the work
area.

• For sterile gowns, maintain sterility until used

on the patient.

• Changed when become visibly soiled.

Masks/ Goggles/ Face shields.
 Masks/ Goggles/ Face shields.
• Protects mucus membrane.

• Prevents transfer of airborne microorganisms.

• Worn when patient procedures will generate splashes or

sprays.

• Masks are worn after washing the hands; It is worn for

15- 20 minutes before changing.

• Should be tied securely.

3. Needlestick Prevention
• needles, scalpels, and other
sharp objects

• Used needles should not be

recapped- placed directly into
puncture resistant containers
in the vicinity of their use.

• Puncture proof containers are

changed when they are ¾ full.
 Needles and Sharps
• If a situation dictates that a
needle must be recapped, the
nurse must use a mechanical
device to hold the cap or use a
one-handed approach to
decrease the likelihood of skin
puncture.

• OSHA has required nurses to

use needleless devices and
other instruments designed to
prevent injury from sharps when
appropriate
Needles and Sharps
• Reusable needles and sharps are
placed in puncture proof container
before transporting to reprocessing
area.

• If these injuries occur, report the

incident promptly according to Hospital
protocol
4. Proper Handling of
Soiled Linens
• Change linens in between patients.

• Observe aseptic technique when changing

soiled linens.

• Fold soiled linens as small as possible. Do not

place soiled linens on the floor.

• Clean the bed with antiseptic solution as

necessary.
• Contaminated linens, especially
those with body fluids should be
placed in yellow bags then placed in
appropriate laundry container.
5. Care of Hospital Equipment/
Environmental Control
• Clean hospital equipment(including counter
tops) every shift.

• Use disinfectant to clean hospital equipment as

necessary.

• Clean equipment in between patients.

• Disposable equipment should not be re used.

• Follow hospital procedures for routine care, cleaning

and disinfection of environmental surfaces, beds and
equipment.

• Used equipment should be identified as infected and

handled with gloves before discarding into container,
or washing and autoclaving.
6. Correct Patient Placement
• Place patients who contaminates the
environment or who cannot assist in
maintaining proper hygiene in a private
room.

• Avoid transporting the patient out of the

room unless necessary
II. TRANSMISSION-BASED PRECAUTIONS
1. Airborne Precautions
• are required for patients with
presumed or proven pulmonary TB or
chickenpox.

• if, as a victim of bioterrorism, a patient

is suspected of having smallpox.

• When hospitalized, patients should be

put in rooms with negative air
pressure;
II. TRANSMISSION-BASED PRECAUTIONS
Airborne Precautions
• the door should remain closed, and
health care providers should wear an
N-95 respirator (ie, protective mask)
at all times while in the patient’s
room.(suspected with Infectious
PTB.)
• Limit transport and movement to
essential purposes.

• Use surgical mask when transporting

patient.

• If resuscitation is necessary, use

resuscitative devices.
II. TRANSMISSION-BASED PRECAUTIONS
2. DROPLET Precautions

• for organisms that can be

transmitted by close, face-to-face
contact, such as influenza or
meningococcal meningitis.

• nurse should wear a facemask if

within 3 feet of the patient.

• Remove mask when leaving the

room.
II. TRANSMISSION-BASED PRECAUTIONS
2. DROPLET Precautions

• the risk of transmission is limited to

close contact, the door may remain
open.

• The CDC advises that negative-

pressure rooms should be used in
hospitals if available.
II. TRANSMISSION-BASED PRECAUTIONS
3. CONTACT Precautions
• used for organisms that are spread
by skin-to-skin contact, such as
antibiotic-resistant organisms or C.
difficile.

• Patient is placed in a private room to

facilitate hand hygiene and
protection of garments from
environmental contamination.
II. TRANSMISSION-BASED PRECAUTIONS
3. CONTACT Precautions
• Masks are not needed, and doors do
not need to be closed

• Do not touch potentially contaminated

surfaces.

• Wear gloves and other PPE when in

contact with the patient.

• Remove when before leaving the

room.
Proper Segregation and
Disposal of Hospital Refuse
a.Black bag
• Used to dispose normal household wastes.

b. Yellow Bag
• Used to dispose any waste arising from
direct patient care (soiled dressing, bloody
gauze, suction tips etc.)
Proper Reporting and
Documentation of Infectious
Cases.
• SOP of the hospital regarding reporting
of communicable cases

• Filling of Notification Form for

Communicable Disease as necessary.
You • Make sure working clothing is
clean. Contaminated clothing
(e.g. blood-stained) must be
changed immediately.

• Hands should be washed

thoroughly when entering or
leaving clinical areas and before
eating or drinking.
You • Soap dispensers and taps should be
operated by the elbows or wrists not
gloves or hands.

• All specimens for laboratory tests

should be placed in appropriate
containers and sealed into plastic
bags separate from the request
form

• Do not eat, drink, comb hair, brush

teeth or apply cosmetics in clinical
areas
END
 www.animationfactory.com

Backdrops: Title Backdrop Slide Backdrop Transitional Backdrop Print Backdrop

- These are full sized

backdrops, just scale them up!
- Can be Copy-Pasted out of
Templates for use anywhere!

Additional Graphics: Animated .GIFs

- Scale them up or down!
- .GIF clipart is animated.
- .JPG clipart can be scaled
up and take up little file
space.
- .PNG clipart can be scaled
unusually large without
distortion.
Still Frame .PNGs