Condensed Notes

Wednesday, August 13, 2014

8:00 AM

Learning Objectives
Describe how path orgs spread in health care settings and how to prevent transmission of path orgs
Chain of infection: infectious disease happens from interaction w/ agent, host, and environment
Transmission occurs when agent leaves its reservoir (host) and enters a susceptible host via some mode of transmission
Hospital acquired infections (HAIs) can be prevented by using strategies to prevent chain of infection
HAIs commonly occur by:
Direct cntct w/ infecting agent from infected indiv or from HCW
Indirect cntct from contam equips/other inanimate objects
Resp transmission (airborne/droplet)
To prevent, either eliminate source or interrupt routes of transmission
Hand hygiene
Use barriers/PPEs (gloves, gowns, masks, goggles)
Isolate or cohort infected indivs
Sterilize and disinfect patient care equip
Maintain clean env
Special room ventilation (negative pressure) for pt w/ TB and other airborne infec
Proper disposal of sharps and infec waste
Describe CDC recommendations for use of barriers and personal protective equipment (PPE) to prevent pt and healthcare
worker (HCW) contact w/ potentially infectious material (airborne precaution, droplet, etc.)
Standard precautions
Always be used when pot exposure to any body fluids or blood
Clean hands when entering + leaving pt room
Cover mouth and nose w/ arm or tissue when sneezing/coughing
Wear gown and glove if soiling likely
Wear mask + eye protection if splashing w/ body fluid likely
Airborne (resp) precautions
Used for pt w/ microorganisms transmitted by small-particle residue and remain suspended in air + can disperse widely by
air currents
Wear N95 mask + gown, private neg pressure room
Pt must wear surgical mask if leaving room
Droplet precautions
Used for pt infeced w/ microorg transmitted by droplets that can be generated during coughing, sneezing, talking, or during
performance of a procedure
Use surgical mask and gown when entering room + frequent hand washing
Contact Precautions
Used for pt infected w/ epidemiologically important microorg (multi-drug resist orgs, rotavirus, scabies, etc) that can be
transmitted by direct cntct or indirect cntct (touching pt env surface)
Use gown + alcohol based handwashing products
Contact PLUS precautions
Used for pt w/ serious illnesses easily transmitted by direct cntct or by cntct w/ items in pt env
Hand hygiene must be performed w/ soap + water - not alcohol based rub + room must be disinfected w/ bleach
Reverse (Protective) Isolation
Used for pt w/ compromised health to prvent them from being contaminated by other ppl
Wear surgical mask, gloves, and gown
Define sterilization, disinfection, and antiseptic
Purpose of disinfection + sterilization is to reduce # of microorg to a level that is insufficient to transmit infectious org
Bacterial spores are most resistant to antiseptics and disinfectants > Mycobacteria > non-lipid viruses > fungi > vegetative
bacteria > lipid viruses
Sterilization: process that destroys ALL forms of microbial life via physical or chemical methods. Living tissue can't be
sterilized)
Disinfection: Process that eliminates many or all pathogenic microorgs, except bactra spores. 3 levels of disinfection depending
on how many orgs were removed (high, intermediate, low)
Antiseptic: Reduction of microorg on living tissue. Antiseptics can't kill spores and can't be used as disinfectants; they are
known for their ability to kill or reduce # of disease-causing germs
Distinguish b/w 3 medical device categories for pot for transmitting infectious agents (critical, semicritical, and noncritical)
Not all items must undergo vigorous process to elim all microorgs
Medical devices have categories based on the device's pot for transmitting infectious agents + necessity to either sterilize
or level of disinfection
Critical Items: Items that enter normally sterile parts of human bod (e.g. surgical equip, implants, and invasive monitoring
devices).
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devices).
Physical methods of sterilization is preferred
Semicritical items: Items that come into cntct w/ mucous membrane or nonintact skin should be free of microorganisms (e.g.
resp therapy and anesthesia equip, some endoscopes ,etc).
Use high-level disinfectant
Noncritical items: those that come in cntct w/ intact skin but not mucous membranes (e.g. bedpans, BP cuffs, etc).
Use alcohols, phenolics, halogens, quat cmpnds
Identify physical techs that may be used for sterilization (heat [dry, moist, underpressure/autoclaving], irradiation, gas
plasma, etc)
Physical techs for sterilization
Steam sterilization (autoclaving): high effective, relatively short processing time
Items need to be resistant to moisture
Most commonly used method for sterilizing inanimate objects
Dry heat sterilization: used for products that contain petroleum liqs
Has no corrosive or rusting effect on equip
Irradiation: high energy gamma rad penetrates product = dmg to nucleic acid
Used for sterilizing like syringes, implants, catheters, IV sets, surgical gloves, and gauze
Filtration: Exclude orgs based on size
Used for liqs containing protein or other delicate cmpds that could be destroyed by heat or rad
Gas sterilization: Use ethylene oxide to sterilize surface of item or penetrate porous items
Highly flammable + potentially explosive of agents = disadvantage
Plasma sterilization: high penetration of medical lumens (e.g. endoscopes), no residucal activity.
Hydrogen peroxide or peracetic acid + hydrogen peroxide are used to produce gas plasmas
These free radicals disrupt metabolism of microorgs
Identify chemical agents that may be used as sterilants (glutaraldehydes, hydrogen peroxide, peracetic acid)
Identify major categories of chemical agents that may be used as disinfectants (alcohols, phenolics, halogens, iodophors, etc.)
Alcohols:
Takes less time than hand washing
Alcohol-based rub kills bacteria and most viruses (better than handwashing except for against spores)
Used as surface disinfectants and antiseptic agents
Excellent for intermediate-low alevel of disinfection
Halogens
Chlorine
Active against viruses
Broad antimicrobial spectra; @ high conc, it can kill mycobacteria and spores
Iodine and Iodophors
Iodophores (complex of iodine + detergent); widely used for antisepsis of skin, mucous membrane, and wound site
Tincture is used to prepare skin before drawing blood cultures; Betadineis used as surgical scrub
Chlorhexidine
Used for general skin cleansing, surgical scrub, and pre-op skin prep
Provides persistent antimicrobial action that prevents regrowth for up to 6 hours
Phenolics
Strong bacteriostatic action against many Gram+ orgs, but only a few Gram pHisoHex is a brand used for showering prior to surgery to reduce skin flora + reduce surgical site infection
Quaternary ammonium cmpds
"Quats" are used as antimicrobials and disinfectants b/c they are lethal to wide variety of orgs except endospores,
mycobacteria, and non-enveloped viruses.
Silver + Copper Alloy Surfaces
Silver
Silver ions are effective against broad range of microorgs
Copper-alloy surfaces
Copper surface continuously reduce bacterial contam, achieving 99.9% reduction w/n 2 hours of exposure for both
Gram- & + bactra
This also has ongoing antibacterial action and continues to kill 99% bactra after repeated contam

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