Textbook for Nursing Assistants

1. Textbook for Nursing Assistants Chapter 10: Communicable Disease and Infection Control

2. What are Communicable Diseases?

3. Communicable Diseases • Communicable diseasesare diseases that can be spread from one person to another • You must learn to protect yourself, your family members, and your patients or residents from catching a communicable disease • You must also learn about the causes of communicable disease, and the ways communicable diseases are spread from one person to another

4. What is a Microbe?

5. What is a Microbe? • A microbe, also called a microorganism, is a living thing that cannot be seen with the naked eye • Most microbes cause no harm and are actually essential for healthy living: called normal (resident) flora • Some microbes, however, can cause illness and are known as pathogens

6. Opportunistic Microbes • Sometimes microbes can be considered normal flora in one part of the body and pathogens in another • These types of microbes are called opportunistic microbes • For example: • Escherichia coli. When E. coli finds its way out of the intestine and into another part of the body where it is not normal flora, such as the bladder, it can cause an infection

7. Classification of Microbes MICROBES Bacteria Viruses Fungi Parasites Helminths Protozoa

8. Microbes: Bacteria • Bacteria cause many of the infections you will encounter in the health care setting • The ability of bacteria to adapt to all sorts of environments is proof of this life form’s ability to survive • Scientists classify and name bacteria in many different ways • By their shape • By the way they arrange themselves in a colony • By the way they stain (i.e., how they react to the dye scientists use to make microbes more visible under a microscope)

9. Microbes – Bacteria – Classification Classification on the basis of shape Spiral-shaped or curved bacteria are called spirilla Round bacteria are called cocci Rod-shaped bacteria are called bacilli

10. Microbes – Bacteria – Classification (cont.) By the way they arrange themselves in a colony Grape-like clusters of bacteria (indicated by the prefix staphylo-) Chains of bacteria (indicated by the prefix strepto-) Pairs of bacteria (indicated by the prefix diplo-)

11. Microbes – Bacteria – Classification (cont.) By their basic requirements for survival Aerobic: need oxygen to live Anaerobic: die if oxygen is present

12. Microbes – Bacteria – Endospores • Some types of bacteria can surround themselves with a hard shell, called an endospore, and enter a state of inactivity • Once the inactive bacterium’s best growing conditions become available, the bacterium will become active again • Because of their protective endospores, these types of bacteria are very difficult to kill using the standard techniques

13. Microbes – Bacteria – Illnesses • Illnesses caused by bacteria: • Tetanus (lockjaw) • Botulism (food poisoning) • Strep throat • Some bladder infections • Some skin infections • Rocky Mountain spotted fever • Typhus • Some types of pneumonia • Some infections of the reproductive and urinary systems

14. Microbes – Viruses • Viruses are the smallest of all microbes • They can only be seen using a special kind of microscope, called an electron microscope • Many illnesses are caused by viruses, such as: • The common cold • Fever blisters • Chicken pox • Hepatitis • AIDS

15. Microbes – Fungi • Fungi are a group of plant-like organisms that scientists have classified together because of certain characteristics, including the make-up of their cell walls • Examples of illnesses caused by fungi are • Ringworm • Athlete’s foot • Thrush • Candidiasis

16. Microbes – Parasites • Parasites live in or on a host, such as a plant or animal, and use that host for food and protection • Examples of illnesses caused by parasites are • Scabies (mites) • Pediculosis (lice) • Other types of parasites are • Helminths (pinworms, tapeworms, roundworms) • Protozoa (malaria, amebic dysentery)

17. Question • Although there are many microbes found throughout nature, only about one-half will cause disease in humans. • True • False

18. Answer • B. False • Most microbes cause no harm and are actually essential for healthy living.

19. Defenses Against Communicable Disease

20. The Immune System • Many, many microbes share the Earth with us • If microbes are everywhere, and some of them can make us sick, then why aren’t we all always sick? • The answer to this question lies in the body’s immune system, the wonderful defense system that protects us from infection

21. Nonspecific Defense Mechanisms • Our main nonspecific defense mechanism is healthy, intact skin and mucous membranes • Skin that is without cuts, scrapes, or wounds physically prevents pathogens from entering the body • Mucous membranes line all of the organ systems that come in contact with the outside world (namely, the respiratory, digestive, urinary, and reproductive systems)

22. Nonspecific Defense Mechanisms (cont.) • If a pathogen gets past the first lines of defense and an infection results, the body activates a general immune response • Fever, inflammation, warmth, and redness at the site of infection: a normal response to infection

23. Specific Defense Mechanisms • The immune system also has the ability to develop specialized proteins called antibodies, which help our bodies to fight off specific microbes • A person develops antibodies following exposure to the microbe • Vaccines expose the body to the microbe, stimulating antibody production without causing actual illness

24. Antibiotics • An antibiotic is a drug that is able to kill bacteria or make it difficult for them to reproduce and grow • Penicillin – first antibiotic, used in WWII • Multidrug-resistant organisms (MDROs) • Resistant to one or more classes of antibiotics • Methicillin-resistant Staphylococcus aureus (MRSA) • Vancomycin-resistant enterococci (VRE)

25. Antibiotics (cont.) • Some good bacteria are destroyed when using antibiotics to treat infections, resulting in infections • Clostridium difficile (C. diff), major cause of health care–associated diarrhea • Although antibiotics have given us more options for treating infectious disease than we had in the past, they do not work against all pathogens all of the time • The best policy is clearly to avoid infection in the first place

26. Question • The best defense against an infection is: • medication • prevention • immune response • antibodies

27. Answer • B. prevention • The best policy is to avoid infection in the first place.

28. Communicable Disease and the Chain of Infection

29. Chain of Infection • For a person to get a communicable infection, six key conditions must be met • These six key elements are known as the chain of infection • Eliminating any one of the six key elements breaks the chain and prevents the spread of infection

30. Chain of Infection (cont.)

31. Breaking the Chain of Infection

32. Susceptible Host • Very young • Immune system not developed • Very old • Immune system not as active with aging • Poor general health • Body defenses already weak • Certain medications and treatments affect immune system • Stress and fatigue • Lack of rest and emotional stress • Indwelling medical devices • Increased risk of infections by providing portal of entry

33. Infection Control in the Health Care Setting

34. Health Care–Associated Infections (HAIs) • Infections people get while a patient or resident • Health care worker can get while providing care • Also called nosocomial infections • Most common method of transmission – the hands!

35. Infection Control in the Health Care Setting • Maintaining cleanliness in health care facilities is essential, because exposure to pathogens is increased in these settings • Most of the people in health care facilities are there because they are not in good overall health and their potential to become infected is increased • All health care facilities follow basic practices that are designed to decrease the chance that an infection will be spread from one person to another. These practices are called infection control

36. Methods of Infection Control • There are four major methods of infection control • Medical asepsis • Surgical asepsis • Barrier methods • Isolation precautions

37. Medical Asepsis • Medical asepsis involves physically removing or killing pathogens, and is primarily achieved through processes involving soap, water, antiseptics, disinfectants, or heat • There are four techniques that make up the practice of medical asepsis: • Sanitization • Antisepsis • Disinfection • Sterilization

38. Medical Asepsis: Sanitization • Sanitization is the word we use to describe practices associated with basic cleanliness, such as: • Hand hygiene • Cleansing of eating utensils and other surfaces with soap and water • Providing clean linens and clothing • Sanitization practices physically remove pathogens, thereby preventing their spread

39. Medical Asepsis: Antisepsis • Antisepsis takes sanitation one step further, by actually killing microbes or stopping them from growing • An antiseptic is a chemical that is capable of killing a pathogen, or preventing it from growing • Antiseptics can be used on the skin or other surfaces to kill pathogens • Examples of antiseptics: • Rubbing alcohol • Iodine • Alcohol-based hand rub

40. Medical Asepsis: Disinfection • Disinfection involves the use of stronger chemicals to kill pathogens • The chemicals used for disinfection are too strong to be used on the skin • Disinfectants are used to clean non-living objects that come in contact with body fluids or substances, such as bedpans, urinals, and tray tables

41. Medical Asepsis: Sterilization • Sterilization is the most thorough method of killing microbes • Sterilization is used on objects that must be completely free of any microbe, such as surgical instruments, hypodermic needles, or intravenous (IV) catheters • Equipment is sterilized either by placing items in an autoclave or by soaking the items in chemicals that destroy all microbes • Boiling is not an effective method of sterilization

42. Medical Asepsis: Sanitization – Hand Hygiene • In the health care setting, hand hygiene takes on a special importance because the chance of picking up a pathogen and passing it on to someone else is greater than in normal, everyday life • Although the specifics of how hand hygiene is performed vary from setting to setting, one aspect of hand hygiene always remains the same – it must be performed thoroughly, properly, and consistently

43. Medical Asepsis: Sanitization – Hand Hygiene (cont.) • At the minimum, wash your hands: • When you first arrive at your facility • When hands are visibly dirty • When hands are visibly soiled with or in contact with blood or other body fluids • When caring for patients or residents who may have certain infections, such as C. diff • Before you go on break and before you leave your shift

44. Medical Asepsis: Sanitization – Hand Hygiene (cont.) • At the minimum, wash your hands: (cont.) • Before and after drinking, eating, or smoking • Before and after inserting contact lenses • After using the bathroom • After coughing, sneezing, or blowing your nose • After touching anything that may be contaminated with blood or other body fluids or substances • After handling your hair or applying make-up or lip gloss

45. Hand Hygiene: Using an Alcohol-Based Hand Rub • Alcohol-based hand rubs have several advantages: • Using an alcohol-based hand rub is quicker than washing your hands at the sink • Alcohol-based hand rubs are gentler on the skin than soap and water • Alcohol-based hand rubs are used without water, so they can be used anywhere

46. Hand Hygiene: Using an Alcohol-Based Hand Rub (cont.) • It is very simple to use an alcohol-based hand rub • The label on the product will tell you how much product to use • Apply this amount to one of your palms and rub your hands together, covering your hands and fingers (front and back) with the product • Continue rubbing your hands together until your skin is dry. That's all there is to it!

47. Question • The chain of infection can be broken by removing one of the five elements that must be present for infection to occur. • True • False

48. Answer • B. False • There are six elements in the chain of infection: • Pathogen • Reservoir • Portal of exit • Method of transmission • Portal of entry • Susceptible host

49. Surgical Asepsis • Surgical asepsis is used for procedures that involve entering a person’s body • Examples of procedures that require surgical asepsis include: • Surgical procedures • Injections • The insertion of intravenous (IV) catheters • The insertion of urinary catheters • In most states, performing procedures that require surgical asepsis is not within a nursing assistant’s scope of practice

50. Barrier Methods • A barrier is an object that physically prevents microbes from reaching a health care provider’s skin or mucous membranes • Examples of barriers used in infection control, called personal protective equipment (PPE), include: • Disposable gloves • Gowns • Masks • Protective eyewear