👩‍⚕️Foundations of Nursing Practice Unit 6 – Infection Prevention and Control

Key Concepts in Infection Prevention

• Infection prevention aims to reduce the risk of acquiring and transmitting infections in healthcare settings
• Pathogens, including bacteria, viruses, fungi, and parasites, can cause infections
• The chain of infection consists of six links: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host
• Breaking any link in the chain of infection can prevent the spread of infections
• Healthcare-associated infections (HAIs) are infections acquired during the course of receiving healthcare services
  • HAIs can lead to prolonged hospital stays, increased healthcare costs, and higher morbidity and mortality rates
• Antimicrobial resistance occurs when microorganisms develop the ability to withstand the effects of antimicrobial agents, making infections more difficult to treat
• Infection prevention and control programs in healthcare facilities establish policies, procedures, and best practices to minimize the risk of infections

Types of Infections and Transmission

• Endogenous infections originate from the patient's own flora, while exogenous infections are caused by microorganisms from external sources
• Localized infections are confined to a specific body site or organ, while systemic infections spread throughout the body via the bloodstream
• Direct transmission occurs through physical contact between an infected person and a susceptible host
  • Examples of direct transmission include touching, kissing, and sexual contact
• Indirect transmission involves the transfer of pathogens through contaminated objects, surfaces, or vectors
  • Fomites are inanimate objects that can carry and transmit infectious agents (door handles, shared medical equipment)
• Droplet transmission occurs when respiratory droplets containing pathogens are expelled by an infected person and come into contact with the mucous membranes of a susceptible host
• Airborne transmission involves the spread of infectious agents through small droplet nuclei that remain suspended in the air for long periods
• Vector-borne transmission occurs when insects or animals transfer pathogens to humans through bites or contact with infected bodily fluids

Standard Precautions

• Standard precautions are a set of infection control practices used to prevent the transmission of infectious agents in healthcare settings
• Standard precautions assume that all blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes may contain transmissible infectious agents
• Hand hygiene is a critical component of standard precautions and should be performed before and after patient contact, after exposure to body fluids, and before and after using gloves
• Personal protective equipment (PPE) should be used when there is a risk of exposure to infectious materials
  • PPE includes gloves, gowns, masks, eye protection, and face shields
• Respiratory hygiene and cough etiquette involve covering the mouth and nose when coughing or sneezing and properly disposing of used tissues
• Safe injection practices, including the use of single-dose vials and avoiding the reuse of needles and syringes, help prevent the transmission of bloodborne pathogens
• Proper handling and disposal of sharps, such as needles and scalpels, reduce the risk of needlestick injuries and exposure to infectious agents

Isolation Techniques

• Isolation techniques are used to prevent the spread of infections from patients known or suspected to be infected with highly transmissible or epidemiologically important pathogens
• Contact isolation is used for patients with infections spread through direct or indirect contact (MRSA, VRE, C. difficile)
  • Healthcare workers wear gloves and gowns when entering the patient's room and remove them before leaving
• Droplet isolation is used for patients with infections spread through respiratory droplets (influenza, pertussis, meningococcal disease)
  • Healthcare workers wear masks when within 3-6 feet of the patient
• Airborne isolation is used for patients with infections spread through small droplet nuclei that remain suspended in the air (tuberculosis, measles, chickenpox)
  • Patients are placed in negative pressure rooms with specialized ventilation systems
  • Healthcare workers wear fit-tested N95 respirators or higher-level respiratory protection
• Protective environment isolation is used for immunocompromised patients to minimize their exposure to potential pathogens
  • Patients are placed in positive pressure rooms with HEPA filtration
• Cohorting involves grouping patients with the same infection together to limit the spread of the pathogen to other patients

Hand Hygiene and Personal Protective Equipment

• Hand hygiene is the most effective way to prevent the spread of infections in healthcare settings
• Alcohol-based hand rubs containing at least 60% alcohol are the preferred method for routine hand hygiene
  • Hand rubs should be used when hands are not visibly soiled
• Handwashing with soap and water should be performed when hands are visibly soiled, after using the restroom, and before eating
• The World Health Organization (WHO) recommends a six-step hand hygiene technique to ensure thorough cleaning of all hand surfaces
• Gloves should be worn when there is a risk of contact with blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, or contaminated surfaces
• Gowns are used to protect healthcare workers' clothing and skin from contamination during procedures or activities that may generate splashes or sprays of blood or body fluids
• Masks, eye protection, and face shields protect the mucous membranes of the eyes, nose, and mouth from exposure to infectious materials
• Respiratory protection, such as N95 respirators, are used when caring for patients with airborne infections or during aerosol-generating procedures

Aseptic Technique

• Aseptic technique is a set of practices designed to prevent the introduction, transmission, or spread of microorganisms during medical procedures
• The goal of aseptic technique is to minimize the risk of infection by maintaining a sterile or microbe-free environment
• Surgical aseptic technique is used during invasive procedures, such as surgery, to maintain a sterile field
  • This involves the use of sterile gloves, gowns, drapes, and instruments
• Medical aseptic technique, also known as clean technique, is used during less invasive procedures, such as wound care or catheter insertion
  • This involves the use of clean gloves and the maintenance of a clean field
• Key principles of aseptic technique include hand hygiene, the use of barriers (gloves, gowns, drapes), the creation and maintenance of a sterile or clean field, and the prevention of contamination
• Non-touch technique involves the use of instruments or devices to avoid direct contact with potential sources of contamination
• Aseptic technique requires careful planning, preparation, and attention to detail to ensure the integrity of the sterile or clean environment is maintained throughout the procedure

Environmental Cleaning and Disinfection

• Environmental cleaning and disinfection play a crucial role in preventing the spread of infections in healthcare settings
• Cleaning involves the physical removal of dirt, debris, and organic matter from surfaces using water, detergents, and mechanical action
• Disinfection is the process of eliminating most pathogenic microorganisms on inanimate objects and surfaces using chemical or physical methods
• High-touch surfaces, such as doorknobs, light switches, and bed rails, should be cleaned and disinfected frequently
• The choice of disinfectant depends on the type of surface, the level of contamination, and the specific pathogens of concern
  • Common disinfectants include chlorine-based products, quaternary ammonium compounds, and hydrogen peroxide
• Disinfectants should be used according to the manufacturer's instructions, including the appropriate concentration and contact time
• Spills of blood or other potentially infectious materials should be cleaned up promptly using appropriate personal protective equipment and disinfectants
• Environmental services staff should receive regular training on proper cleaning and disinfection techniques, as well as the safe handling of cleaning products and equipment

Nursing Role in Infection Control

• Nurses play a critical role in preventing the spread of infections in healthcare settings
• Nurses are responsible for implementing infection control policies and procedures, educating patients and families, and serving as role models for best practices
• Nurses should consistently adhere to standard precautions, including hand hygiene and the appropriate use of personal protective equipment
• Nurses assess patients for signs and symptoms of infection and promptly report any suspected infections to the healthcare team
• Nurses collect specimens for microbiological testing, ensuring proper collection techniques and timely transport to the laboratory
• Nurses administer antimicrobial agents as prescribed, monitoring patients for adverse reactions and ensuring the completion of the appropriate duration of therapy
• Nurses educate patients and families about infection prevention measures, such as hand hygiene, respiratory etiquette, and wound care
• Nurses participate in surveillance activities, including monitoring healthcare-associated infection rates and identifying potential outbreaks
• Nurses collaborate with other members of the healthcare team, including infection control professionals, to develop and implement infection prevention strategies tailored to their specific patient populations and care settings