Chain of Infection & Isolation Precautions: Understanding Transmission-Based Precautions

1. Chain of InfectionIsolation precautions August 24, 2017

2. Bell Ringer • In your own words, define normal flora • In your own words, define pathogen • List the pathogens we discussed in class yesterday and give me one fact about each one.

3. Agenda 8-23-17 • Bell Ringer • Review and Most Wanted Posters • Lecture on Transmission-Based Precautions and Chain of Infection • Chain of Infection Activity

4. Standard 15) Correlate the function of normal flora with homeostasis and relate deviation to disease states. Evaluate specific measures to prevent deviation that are aligned with accepted standards of care. 16) Assess the differences between healthcare-associated infections and non-healthcareassociated infections using examples drawn from mock patient documents or case studies. Support explanations with relevant surveillance statistics, preventive measures, and methodologies concerning outbreak detection, management, and education.

5. Objective • By the end of class, students will be able to: • Apply and Identify Transmission-Based Precautions • Apply and Identify the steps in the Chain of Infection

6. Infectious and Communicable Diseases • An infectious disease results from an invasion of microorganisms. • A communicable disease is a type of infectious disease that can be transmitted from one person to another person. • Not all infectious diseases are communicable- cardiovascular diseases, cancers, chronic respiratory diseases and diabetes 

7. Classification of Infections and Diseases • Endogenous – begins inside the body • Exogenous – caused by something outside the body • Nosocomial – acquired by an individual within a health care facility • AKA Health care associated infection • Opportunistic – occur when the body’s defenses are weak

8. Communicable Diseases • Some communicable diseases are spread through direct contact. Others may be spread through indirect contact.

9. Transmission of Communicable Diseases • Not all communicable diseases are transmitted the same way. • There are many different types of communicable diseases, and health care workers must become familiar with the mode of transmission for each disease.

10. Transmission-Based Precautions • Transmission-based precautions are used only with patients who have been diagnosed with highly communicable diseases. • Three types: • Airborne • Droplet • Contact

11. Introduction to Transmission-Based Precautions: • https://www.youtube.com/watch?v=bBLxJ-V8_Ds

12. Personal Protective Equipment • Degree of risk to exposure • Gloves, masks, eye protection, shoe covers, and gowns

13. Gowns • Gowns should be worn when using chemical solutions and during procedures where splashing or spraying of blood and bodily fluid is likely. • Disposable gowns should be placed into biohazardous waste containers after use. • Non-disposable gowns may be placed into biohazardous linens bags.

14. Masks and Eyewear • Masks and eyewear must be worn for procedures that may produce splashes or sprays of blood or bodily fluid. • Masks should be worn once and then discarded into biohazardous waste containers. • Eyewear is often reusable. However, it must be cleaned and disinfected before reuse.

15. Non-Sterile Gloves • Non-sterile gloves should be worn when contacting blood or other bodily fluids and when handling or cleaning contaminated items. • The same pair of gloves should never be worn in more than one procedure. • Wearing gloves should never replace washing hands.

16. https://www.youtube.com/watch?v=oxdaSeq4EVU Write the five steps for Donning (putting on) and Doffing (taking off) PPE.

17. DONNING • Hand hygiene • Gown • Mask • Goggles/Eye Protector • Gloves

18. Doffing • Gloves • Goggles • Gown • Mask • Hand hygiene

19. Airborne Precautions • Airborne precautions are used for patients with disease that are spread through tiny airborne droplets. • Precautions: • Isolation room • Respiratory protection • Negative pressure • Examples of diseases: • Tuberculosis • Chicken pox

20. Droplet Precautions • Droplet precautions are used for patients with diseases that are spread through large airborne droplets. • Precautions: • Isolation room • Standard surgical masks • Examples of diseases: • Pneumonia • Influenza • Whooping cough

21. Contact Precautions • Contact precautions are used for patients with diseases that are spread through direct and indirect contact. • Precautions: • Isolation room • Gowns and gloves • Equipment precautions • Examples of diseases: • MRSA • VRE

22. Transmission-Based Garments • When health care workers enter isolation rooms, they must wear transmission-based garments. • Health care workers must wear appropriate garments based on the disease of the patient. Proper PPE!

23. Isolation Units • Patients with communicable diseases are often placed into private rooms for isolation. • This practice helps prevent the spread of communicable diseases to health care workers and other patients.

24. Meals in an Isolation Unit • Most facilities require that disposable food trays and eating utensils are used in isolation units. • Leftover food and beverages should never be taken out of an isolation unit. Liquids and soft foods should be flushed down the toilet. Solid foods should be placed in biohazardous waste bags.

25. Working in an Isolation Unit • Most of the procedures that take place in isolation units require two health care workers. • Items that are taken from isolation rooms are double-bagged to prevent the spread of dangerous pathogens.

26. Chain of Infection: • Causative agent • Reservoir • Portal of exit • Mode of transmission • Portal of entry • Susceptible host

27. Causative Agent = Pathogen • Disease-producing microorganism; bacteria, virus, fungus, protozoa, and rickettsia • Present in blood or body fluids, called “bloodborne pathogens” • Pathogens need an environment that enables them to survive, grow, and multiply • The human body is a perfect environment

28. Reservoir • Human, animal, or insect that is infected with disease • Other reservoirs may be water, food, and contaminated objects • Host may be symptomatic or asymptomatic • Reservoir host is contagious even though he or she may not appear ill

29. Portal of Exit • Pathogen must be able to exit reservoir host • Any body opening lined with mucous membranes: eyes, nose, throat, vagina, rectum, penis • Injury or surgery • Blood, body fluids: vaginal secretions, semen, urine, feces

30. Mode of Transmission • Direct contact—person-to-person contact or skin-to-skin contact • Handshaking, kissing, and sexual contact • Indirect contact— fomites; ticks, fleas, lice, and countertops • Indirect contact includes airborne and droplet infection—sneezing, coughing, and talking

31. Portal of Entry • Pathogen must find entry into new host • Any opening in the body lined with mucous membranes: nose, mouth, throat, vagina, penis, rectum • Wounds to the skin

32. Susceptible Host • Weakened immune system • Poor hygiene • Inadequate nutrition • Stress • Chronic disease • Poor environmental conditions • Elderly • Very young • Certain medications • Smoking • Alcohol abuse

33. Chain of Infection Video • https://www.youtube.com/watch?v=_o9SxDFPUiA Write down all the ways you see the chain of infection spread.

34. What link in the chain am I? Infant girl Person with hepatitis Bloody nose Blood Door knob Person with AIDS Sexual intercourse Needle Used Kleenex • Yeast infection • Handshake • Open wound • Mucous membranes • Sneeze • Nose • Elderly lady • Person with flu • Mouth • Pencil • Table top • Cold virus

35. Chain of Infection • http://www.vdh.virginia.gov/content/uploads/sites/13/2016/03/Chain-of-Infection-Fact-Sheet.pdf

36. Objective • By the end of class, students will be able to: • Apply and Identify Transmission-Based Precautions • Apply and Identify the steps in the Chain of Infection