Infection Control Principles/Universal Precautions

1. Transmission of Infection
   1. Patients who have an infection could be the source of an infection for you; you could be the source of an infection for your patient
   2. The chain of infection
      1. The pathogen is the causative agent
         1. Protozoa are parasites that live off cell nutrients and cause malaria and amebic dysentery
         2. Rickets are transmitted by insects and cause Rocky Mountain spotted fever and Typhus
         3. Fungi cause Thrush and Athlete’s Foot
         4. Bacteria cause a multitude of diseases; such as Diphtheria, Gonorrhea, Typhoid Fever, Tuberculosis, Cholera, and wound infections
         5. Viruses cause Polio, Influenza, AIDS, Measles, Mumps, and the common cold
      2. The Reservoir is the environment where pathogens can survive
         1. The human reservoir can be a person infected with the disease or a carrier who shows no signs of the infection
         2. Animals
         3. Non-animal reservoirs, such as street dust, lint, or soil
      3. Mode of escape is the exit route for Pathogens
         1. Human: Intestinal Tract, Respiratory Tract, Genitourinary Tract, lesions, breaks in the skin, or through the blood
         2. Animal bites
      4. Mode of transmission is the way Pathogens spread from one place to another
         1. Direct contact with the infected person
         2. Direct contact with the infectious material; such as nose and throat secretions, blood, urine, feces, saliva, semen, vaginal fluids
         3. Indirect contact with objects contaminated with the secretions; such as dressings, food, needles, or shape instruments
         4. Vectors; such as animals, insects, fleas, and ticks
      5. Mode of entry is the way into the body
         1. Corresponds to the modes of escape
         2. Mouth, breaks in the skin or mucous membranes, Respiratory Tract, Genitourinary Tract, lesions, breaks in the skin, or through the bloodstream
      6. The susceptible host is where Pathogens can grow and survive
         1. Pathogens entering may not necessarily cause disease
         2. Resistance to disease is based on age, immunity, fatigue, general health, medications, nutrition, and drug and alcohol abuse
         3. Individuals at risk include those with impaired resistance due to chronic or acute illness, injury, surgery, burns, radiation therapy, chemotherapy, stress, infants, children, pregnant women, and the elderly
2. Asepsis
   1. Asepsis means the absence of Pathogens (disease-causing microorganisms)
   2. Asepsis involves two types of actions
      1. Those that kill or retard the growth of germs
      2. Those that prevent contact with Pathogen
   3. Aseptic practices for the environment kill or retard the growth of germs
      1. Disinfect ion is the process that kills all Pathogens with chemicals
      2. Products for disinfect ion include 1:10 bleach solution, 70% Isopropyl Alcohol, 3% Hydrogen Peroxide, and some commercial products
3. Universal Precautions
   1. Consider all patients infectious and capable of spreading an infection
   2. Consider all blood, bodily fluids, and tissue contaminated
      1. Wear gloves when there is a danger of contact with blood or bodily fluids
         1. Wear gloves when giving enemas, emptying drainage bottles, etc.
         2. Gloves are not necessary for casual contact with patients
      2. Properly dispose of all soiled disposables in a double plastic bag, securely closing the bag before disposing
      3. Check with your local health department about trash disposal regulations
      4. Wash hands after removing gloves and after contact with bodily fluids, blood, or materials contaminated with them
      5. Wear protective clothing when there is a chance that blood or other bodily fluids could splash
      6. Use disposable resuscitation aids for CPR
      7. Flush patient’s waste down the toilet
   3. Consider all used needles and other sharp instruments contaminated
      1. Do not recap needles, bend or remove the needles, or handle them carelessly
      2. Dispose of all sharp objects in sharps disposal unit, coffee can with lid, or bleach bottle

Infection Control Procedures

1. Hand washing
   1. Hand washing with soap and water is the single most effective way to prevent the spread of infection
      1. Hands are constantly in touch with contaminated surfaces so they are principle vehicles for transmitting infection
      2. Purpose of hand washing is to prevent the transfer of disease-producing organisms from person-to-person or place-to-place
   2. When to wash hands
      1. Before and after every significant patient contact
      2. After using a toilet, blowing your nose, covering a sneeze or cough, or combing you hair
      3. After handling soiled items; such as linens, clothing, bedpans, urinals, or garbage
      4. Before and after gloves are used
      5. Before and after touching wounds or performing wound care
      6. After contact with blood or other bodily fluids
      7. Upon arrival at work and before leaving
      8. Any time you think that you may have had contact with infectious material
2. PPE – Personal Protective Equipment
   1. Wear appropriate protective clothing any time there is a chance that bodily fluids will splash, spatter, or soil your clothes
      1. Use gowns or aprons
      2. Disposable masks protect your mouth and nose
      3. Goggles protect your eyes
   2. You must wear gloves when there is any possibility that your hands will come in contact with blood or other bodily fluids that could be contaminated with pathogens
      1. You will contact bodily fluids during procedures such as:
         1. Giving an enema
         2. Emptying drainage bottles
         3. Cleaning the genital area
         4. Performing a Venipuncture
         5. Performing Tracheotomy care
      2. When you handle utensils or supplies that are soiled with bodily fluids
      3. When you change linens soiled with bodily fluids
      4. When you clean up spills of bodily fluids
   3. Remember these important principles
      1. Always keep clean and dirty linen separate
      2. Carry soiled linens away from your clothes
      3. Avoid shaking or fanning linens
      4. Don’t place any linen on the floor
   4. To launder linens
      1. Wash in family machine on hot cycle with detergent
      2. Presoak linens soiled with blood or bodily fluids in cold water and wash separately
      3. Add one cup of bleach to linens and white garments
3. Handling of Wastes and Disposables
   1. Disposal of needles and other sharps immediately in a puncture-resistant, hard plastic or metal container with a tightly secured lid
      1. Commercial containers are available from a pharmacy or equipment company
      2. Or use a bleach bottle or coffee can
   2. Procedure for disposal of a used syringe
      1. Immediately after completing the injection, carefully discard the syringe and needle into the container
         1. Make sure the opening is large enough for disposal of the entire syringe and needle
         2. Never recap the syringe or break the needle off
      2. Seal the container securely
      3. Check with the health department about disposal of container
   3. Disposal of patient wastes
      1. Flush feces, urine, blood, and emesis down the toilet
      2. Be careful not to splash
   4. Disposal of bandages, dressings, catheters, gloves, incontinence pads, and other similar items
      1. Wrap in a plastic bag, brown paper bag, or newspaper
      2. Place in a plastic bag with the patient’s regular garbage
      3. Or double bag immediately and discard with the regular garbage
4. The Patient with an infection
   1. Hepatitis B
      1. Also called HBV
      2. Transmitted when blood, blood products, or bodily fluids contaminated with HBV infect the bloodstream of another person
      3. Almost 100% preventable with a vaccine
   2. AIDS
      1. Acquired Immune Deficiency Syndrome caused by the human immunodeficiency virus (HIV)
      2. No cure or vaccine available
      3. AIDS virus lives in bodily fluids and is most commonly spread
         1. By sexual contact with a HIV infected person
         2. By sharing needles with a HIV infected person
         3. From a HIV infected mother to the infant before or during birth
      4. You cannot get AIDS
         1. By donating blood
         2. Through casual contact; such as sitting next to, caring for, or shaking hands with a HIV infected person
         3. Through doorknobs, toilet seats, animals, air, drinking fountains, food, etc.
   3. AIDS and Hepatitis B
      1. Spread to healthcare workers
         1. Through accidental sticks and cuts from infected needles or sharp instruments
         2. Through contact with damaged skin
         3. Through splashes of bodily fluids into the eyes, mouth, or nose
      2. To protect yourself
         1. Practice Universal Precautions
         2. Practice safe sex
         3. Abstain from illegal IV drug use and needle sharing