Unit 3: Your Working Environment

Unit 3: Your Working Environment Competent Healthcare Basic Nurse Assistant Training Program

Key Terms • Antibiotic • Asepsis • Biohazardous waste • Carrier • Clean technique (medical asepsis) • Communicable disease • Contamination • Disinfection • Healthcare-associated infection (HAI) • Immunity • Infection • Infection control • Medical asepsis • Microbe (microorganism) • Non-pathogen • Normal flora • Pathogen • Reservoir • Spore • Sterile • Sterile field • Sterile technique (surgical asepsis) • Sterilization • Vaccination • Vaccine • Vector • Vehicle

Preventing Infection

An infection is a disease state resulting from the invasion and growth of microbes in the body. Infection is a major safety and health hazard. Minor infections cause short illnesses. Some infections are serious and can cause death. • Infants, older persons, and disabled persons are at risk. The health team follows certain practices and procedures to prevent the spread of infection (infection control). The goal is to protect patients, residents, visitors, and staff from infection.

Microorganisms • A microorganism (microbe) is a small living thing (organism). It is only seen with a microscope. • Microbes are everywhere-in the mouth, nose, respiratory tract, stomach, and intestines. They are on the skin and in the air, soil, water, and food. They are on animals, clothing, and furniture. • Some microbes are harmful and can cause infections. They are called pathogens. • Microbes that do not usually cause infection are non-pathogens.

Types of microbes There are five types of microbes • Bacteria-one-celled organisms that multiply rapidly. Often called germs, they can cause an infection in any body system. • Fungi- plant-like organisms that live on other plants or animals. Mushrooms, yeasts, and molds are common fungi. Fungi can infect the mouth, vagina, skin, feet, and other body areas. • Protozoa- one-celled animals. They can infect the blood, brain, intestines, and other body areas. • Rickettsiae- found in fleas, lice, ticks and other insects. They are spread to humans by insect bites. Rocky Mountain spotted fever is an example. The person has fever, chills, headache, rash and other signs and symptoms. • Viruses- grow in living cells. They cause many diseases. The common cold, herpes, acquired immunodeficiency syndrome (AIDS), and hepatitis are examples.

Requirements of Microbes • Microbes need a reservoir to live and grow. The reservoir (host) is the environment in which a microbe lives and grows. • People, plants, animals, the soil, food, and water are common reservoirs. Microbes need water and nourishment from the reservoir. Most need oxygen to live. A warm and dark environment is needed. Most grow best at body temperature. They are destroyed by heat and light.

Normal Flora • Normal flora are microbes that live and grow in a certain area. Certain microbes are in the respiratory tract, in the intestines, and on the skin. They are non-pathogens when in or on a natural reservoir. When a non-pathogen is transmitted from its natural site to another site or host, it becomes a pathogen. For example, Escherichia coli (E. coli) is normally found in the colon. If it enters the urinary system, it can cause an infection.

Multidrug-Resistant Organisms • Multidrug-resistant organisms (MDROs) are microbes that can resist the effect of antibiotics. Antibiotics are drugs that kill certain microbes that cause infections. Some microbes can change their structures. This makes them harder to kill. They can survive in the presence of antibiotics. Therefore the infections they cause are hard to treat. • MDRO’s are caused by prescribing antibiotics when they are not needed (over-prescribing). Not taking antibiotics for the length of time prescribed is another cause.

Two types of MDRO’s • Methicillin-resistant Staphylococcus aureus (MRSA): • Staphylococcus aureus (“staph) is a bacterium normally found in the nose and on the skin. MRSA is resistant to antibiotics often used for “staph” infections. MRSA can cause serious wound and bloodstream infections and pneumonia. • Vancomycin-resistant Enterococcus (VRE): • Enterococcus is a bacterium normally found in the intestines and in feces. It can be transmitted to others by contaminated hands, toilet seats, care equipment, and other items that the hands touch. When not in their natural site (the intestines), enterococci can cause urinary tract, wound, pelvic, and other infections. Vancomycinis an antibiotic often used to treat such infections. Enterococci resistant to Vancomycin are Vancomycin-resistant enterococci (VRE).

Infection • A local infection is in a body part. A systemic infection involves the whole body. (systemic means entire). The person has some or all of the signs and symptoms.

Chain of Infection • Source (Causative Agent) • Reservior • Portal of exit • Method of transmission • Portal of entry • Susceptible host

Chain of infection • The source is a pathogen. It must have a reservoir where it can grow and multiply. Humans, animals, and objects are reservoirs. • A carrier is a human or animal that is a reservoir for microbes but does not develop the infection. Carriers can pass pathogens to others. • A vector is a carrier (animal, insect) that transmits disease. Common vectors are: • Dogs, which carry rabies • Mosquitoes, which carry malaria • Ticks, which carry Rocky Mountain spotted fever • Mites, which cause scabies.

Chain of infection • To leave the reservoir, the pathogen must be transmitted to another host. • A vehicle is any substance that transmits microbes. The pathogen enters the body through a portal of entry. Portals of entry and exit are the same-the respiratory, GI, urinary, and reproductive tracts; breaks in the skin; and the blood. • A susceptible host is needed for the microbe to grow and multiply. Susceptible hosts are persons at risk for infection.

Susceptible hosts • Susceptible hosts include persons who: • Are very young and who are older • Are ill • Were exposed to the pathogen • Do not follow practices to prevent infection The human body can protect itself from infection. The ability to resist infection relates to age, nutrition, stress, fatigue, and health. Drugs, disease, and injury also are factors. Some persons are at great risk for infection. Burn, transplant, and chemotherapy patients are examples. Severe infections can be deadly for these persons.

Healthcare-Associated Infection • A healthcare-associated infection (HAI) is an infection that develops in a person cared for in any setting where care is given. The infection is related to receiving health care. Also, called nosocomial infections. • Microbes can enter the body through equipment used in treatments, therapies, and tests. Staff can transfer microbes from one person to another and from themselves to others.

Medical Asepsis • Asepsis is being free of disease-producing microbes. • Microbes are everywhere. Measures are needed to achieve asepsis. • Medical asepsis (clean technique) is the practices used to: • Remove or destroy pathogens (number of pathogens reduced) • Prevent pathogens from spreading from one person or place to another. • Contamination is the process of becoming unclean. In medical asepsis, an item or area is “clean” when it is free of pathogens. The item or area is “contaminated” when pathogens are present.

Surgical asepsis • Microbes cannot be present during surgery or when instruments are inserted into the body. Open wounds require the absence of microbes. They are portals of entry for microbes. • Surgical asepsis (sterile technique) is the practices that keep items free of all microbes. Sterile means the absence of all microbes-pathogens and non-pathogens. • Sterilization is the process of destroying all microbes (pathogens and non-pathogens).

Common Aseptic Practices • Aseptic practices break the chain of infection. To prevent the spread of infection, wash your hands. • After urinating or having a bowel movement • After changing tampons or sanitary pads • After contact with your own or another person’s blood, body fluids, secretions, or excretions. This includes saliva, vomitus, urine, feces, vaginal discharge, mucus, semen, wound drainage, pus, and respiratory secretions • After coughing, sneezing, or blowing your nose • Before and after handling, preparing, or eating food • After smoking a cigarette, cigar, or pipe

Wash your hands • After urinating or having bowel movement • After contact with your own or another person’s body fluids. • After coughing, sneezing or blowing your nose • Before and after handling, preparing, or eating food. • When they are visibly dirty • Before and after patient contact. • After removing gloves.

Also, take these measures • Provide all persons with their own linens and personal care items • Cover your nose and mouth when coughing, sneezing, or blowing your nose. If tissues are not available, cough or sneeze into your upper arm. Do not cough or sneeze into your hands. • Bathe, wash hair, and brush your teeth regularly. • Wash fruits and raw vegetables before eating or serving them • Wash cooking and eating utensils with soap and water after use.

Hand Hygiene • Is the easiest and most important way to prevent the spread of infection. Your hands are used for almost everything. They are easily contaminated. They can spread microbes to other persons or items. • Practice hand hygiene before and after giving care.

Handwashing Lather and rub at least 20 seconds

Equipment • Soap • Paper towels • Orange stick or nail file • Wastebasket

Performance Skill #1: Wash Hands • Gather equipment • Turn on water and adjust temperature to warm, leave water running. • Wet wrists and hands; keep hands lower than level of elbow throughout procedure. • Apply soap • Wash hands and wrists using friction for 30 seconds. • Rinse hands and wrists well under running water with fingertips pointed down. • Dry hands thoroughly with paper towel(s) from fingertips to wrists. • Dispose of used paper towel(s). • Use dry paper towel between hand and faucet to turn off water • Dispose of used paper towels.

Special Considerations • Do not let your hands, or body touch the sink. • Dirty water runs from your hands to your elbows, so keep your hands lower than your elbows. • Pay attention to areas often missed such as thumbs, knuckles, sides of the hands, little fingers, and under the nails. • Clean under nails by rubbing against opposite palm

Video Link • http://www.nurseaidetesting.com/siu/aa_clip.asp?clipid=3

Cleaning and Disinfection • Cleaning reduces the number of microbes present. It also reduced organic matter such as blood, body fluids, secretions, and excretions. • Disinfection is the process of destroying pathogens. Spores are not destroyed. Spores are bacteria protected by a hard shell. Spores are killed by very high temperatures. • Chemical disinfectants are used to clean surfaces. They are also used to clean re-usable items.

Sterilization • Sterilization destroys all non-pathogens and pathogens, including spores. Very high temperatures are used. Heat destroys microbes. • Boiling water, radiation, liquid or gas chemicals, dry heat, and steam under pressure are sterilization methods. • An autoclave is a pressure steam sterilizer. Glass, surgical items, and metal objects are autoclaved. High temperatures destroy plastic and rubber items. They are not autoclaved. Steam under pressure sterilizes objects in 30 to 45 minutes.

Isolation Percautions • Blood, body fluids, secretions, and excretions can transmit pathogens. Sometimes barriers are needed to keep pathogens within a certain area. Usually the area is the person’s room. This requires isolation procedures. • Isolation precautions prevent the spread of communicable diseases (contagious diseases). They are diseases caused by pathogens that spread easily.

Isolation Precautions • Based on clean and dirty. Clean areas or objects are free of pathogens. They are not contaminated. Dirty areas or objects are contaminated with pathogens. If a clean area or object has contact with something dirty, the clean area is now dirty. Clean and dirty also depend on how the pathogen is spread.

Isolation Precautions Two tiers of precautions • Standard Precautions • Transmission-Based Precautions Contact Airborne Droplet The Centers for Disease Control and Prevention (CDC) is a federal agency that serves to protect the health and safety of people in the U.S. They develop disease prevention and control guidelines and standards to improve health.

Standard Precautions • Standard precautions are part of the CDC’s isolation precautions. They reduce the risk of spreading pathogens and infections. • They prevent the spread of infection from: • Blood • all body fluids, secretions, and excretions (except sweat), even if blood is not visible. Sweat is not known to spread infections • non-intact skin (skin with open breaks) • mucous membranes. Standard precautions are used for all persons when care is given

Transmission-based precautions • Some infections require Transmission-Based Precuations. You must understand how certain infections are spread.

Contact Precautions Used for persons with known or suspected infections or conditions that increase the risk of contact transmission. Patient in single room. • Wear gloves and gown • Wash hands after providing care • Limit transport outside of the room • Use non-disposable equipment when possible.

Droplet Precautions Used for persons know or suspected to be infected with pathogens transmitted by respiratory droplets. Such droplets are generated by a person who is coughing, sneezing or talking. • Wear gloves, mask, gown • Wash hands after providing care • If transport required, have patient wear mask

Airborne Precautions Used for persons known or suspected to be infected with pathogens transmitted by person to-person by the airborne route. Tuberculosis, measles, chickenpox, smallpox, and severe acute respiratory syndrome (SARS) are examples. • Wear a TB respirator mask, gown, gloves • Patient must be in an airborne infection isolation room or negative pressure room. • Limit transportation, person to wear surgical mask if out of room.

Applying and Removing Personal Protective Equipment

Equipment • Gloves • Gown • Goggles • Goggles with face shield • Mask • Respirator

Procedure • Perform beginning tasks • Identify type of isolation required • Apply appropriate personal protective equipment outside the isolation room.

Gloves Disposable gloves act as a barrier to protect you from pathogens in other person’s blood, body fluids, secretions and excretions. They also protect the person from microbes on your hands. Wear gloves whenever contact with blood, body fluids, secretions, excretions, mucous membranes, or non-intact skin is likely.

When using gloves • The outside of gloves is contaminated • Gloves are easier to put on when your hands are dry. • Do not tear gloves when putting them on. • You need a new pair for every person • Remove and discard torn, cut, or punctured gloves at onces. Practice hand hygiene, then put on a new pair. • Wear gloves once. Discard them after use • Put on clean gloves just before touching mucous membranes or non-intact skin • Put on new gloves whenever gloves become contaminated with blood, body fluids, secretions, or excretions. A task may require more than one pair of gloves.

When using gloves, continued • Change gloves whenever moving from a contaminated body site to a clean body site. • Change gloves if interacting with the person involves touching portable computer keyboards or other mobile equipment that is transported from room to room. • Put on gloves last when they are worn with other PPE. • Make sure gloves cover your wrists. If you wear a gown, gloves cover the cuffs • Remove gloves so the inside part is on the outside. The inside is clean. • Practice hand hygiene after removing gloves.

Removing gloves • There is no special method to put on glove unless sterile. • To remove gloves make sure glove touches only glove. • Grasp a glove just below the cuff on the outside • Pull the glove down over your hand so it is inside out. • Hold the removed glove with your other gloved hand. • Reach inside the other glove. Use the first two fingers of the ungloved hand. • Pull the glove down (inside out) over your hand and the other glove • Discard the gloves.

Gowns • Gowns prevent the spread of microbes. They protect your clothes and body from contact with blood, body fluids, secretions, and excretions. They also protect against splashes and sprays. Gowns must completely cover you from your neck to your knees. The gown opens at the back. It is tied at the neck and waist. The gown front and sleeves are considered contaminated. • Gowns are used once. A wet gown is contaminated. Remove it and put on a dry one. Discard disposable gowns after use.

Donning a gown • Hold a clean gown out in front of you. Let it unfold. Do not shake. • Put your hands and arms through the sleeves. • Make sure the gown covers you from your neck to your knees and from your arms to the end of your wrists. • Tie the strings at the back of the neck • Overlap the back of the gown. Make sure it covers your uniform. The gown should be snug, not loose. • Tie the waist strings at the back or side. • Put on additional PPE if necessary

Removing a gown • Remove and discard the gloves. Wash your hands. • Remove and discard goggles or face shield if worn. • Untie the neck and waist strings. Do not touch the front of the gown. • Pull the gown down from each shoulder toward the same hand. • Turn the gown inside out as it is removed. Hold it at the inside shoulder seams, and bring your hands together. • Hold and roll up the gown away from you. Keep it inside out. • Discard the gown

Donning a mask • Pick up a mask by its upper ties. Do not touch the part that will cover your face. • Place the mask over your nose and mouth. • Place the upper stings above your ears. Tie them at the back in the middle of your head. • Tie the lower strings at the back of your neck. The lower part of the mask is under your chin. • Pinch the metal band around your nose. The top of the mask must be snug over your nose. If you wear eyeglasses, the mask must be snug under the bottom of the eyeglasses. • Make sure the mask is sung over your face and under your chin.

Masks and Respiratory Protection • You wear masks for these reasons: • For protction from contact with infectious materials from the person. Respiratory secretions and sprays of blood or body fluids are examples. • During sterile procedures to protect the person from infectious agents carried in your mouth or nose. Masks are disposable. A wet or moist mask is contaminated. Apply a new mask when contamination occurs. A mask fits over your nose and mouth. Practice hand hygiene before putting on a mask. When removing a mask, touch only the ties or the elastic bands. The front of the mask is contaminated.

Unit 3: Your Working Environment