INFECTION PREVENTION AND STANDARD SAFETY MEASURES

INTRODUCTION:-

Good health depends in part on a safe environment. Practioners or techniques that control or
prevent transmission of infection help to protect client and health care workers from disease.
These practices are universal or standard which reduce the risk of micro-organisms transmission
from both recognized and unrecognized sources of infections. Infection prevention is the
discipline concerned with preventing noso-comial or healthcare-associated infection. It is an
essential, though often under-recognised and under-supported, part of the infrastructure of
health-care setting (whether patient-to-patient, from patients to staff and staff to patients or
among staff).

DEFINITION:-

1. The condition wherein an infectious agent lives and multiplies in the body of the host.
Multiplication of the bacteria which are part of the normal flora of the gastrointestinal
tract, respiratory mucosa, etc, is not generally considered an infection. On the other hand,
multiplication of certain pathogenic bacteria (e.g. salmonellae) is considered an infection
even if the person is asymptomatic.

2. An infection is an entry and multiplication of an infectious agent in the tissue of host. If

the infectious agent fails to cause injury to cells or tissue, then infection is asymptomatic.

3. If the pathogens multiply and cause clinical signs and symptoms, then it is symptomatic.

4. If the infectious disease can be transmitted directly from one person to another then it is a
communicable disease.

SOURCES OF INFECTION:-There are sources of infection-exogenous and endogenous

sources.

1. EXOGENOUS SOURCES: - The infection is caused by organisms not normally

present in the body but which have gained entrance from the environment e.g. noso-
comial infection is from the environment that is communicated from one person to
another person.

2. ENDOGENOUS SOURCES:- The infection is caused by patients own flora which

get invaded during some surgical operation or instrumental manipulation. For
example: tuberculosis

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Chain of infection

Development of infection occurs in a cycle that depends on the presence of all the following
elements:-

1. An infectious agent or pathogen.

2. A reservoir or source for pathogen growth.

3. A portal of exit from the reservoir.

4. A mode of transmission.

5. A portal of entry to host.

6. A susceptible host.

An infection will not develop if this chain remains intact. Nurses follow infection prevention and
control practices to maintain the chain so that the infection will not develop.

The chain of infection:-

Susceptible host Causative agent

Portal of entry Reservoir

Mode of transmission Portal of exit

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Elements in the chain:-

1. The chain of events in the development of an infectious disease depends on several

factors:

a) A pathogenic organism (infectious agent).

b) A reservoir where the infectious agent resides.

c) A mode of escape from the reservoir.

d) A mode of transmission to the human host.

e) A portal of entry for organism.

2. Disease transmission can be interrupted by breaking the chain at any point, but the mode
of transmission is the weakest link in chain.

3. Whether an infectious disease develops in a person exposed to an infectious organism is

determined by characteristics of the infectious organism and susceptibility of the host.

MODES OF TRANSMISSION OF INFECTION:- Pathogenic organisms spread from one

host to another by variety of mechanisms.

 Direct transmission

 Indirect transmission

Direct transmission:- It may include types:-

 Direct contact:-Infection may be transmitted by direct contact from skin to skin, mucosa
to mucosa or mucosa to skin of the same person or another person. For e.g. skin contact
by touching, kissing or sexual intercourse.

 Droplet infection:-This is the direct projection of a spray of droplets of saliva and

nasopharyngeal secretions during coughing, sneezing or spraying and spitting, talking to
the surrounding atmosphere.

 Inoculation into skin:-The disease agent may be inoculated directly into skin or mucosa.
For e.g. rabies virus by dog bite and Hepatitis-B virus through contaminated needles or
syringes etc.

 Trans-placental:-Some disease agent transmits from mother to fetus through placental

route. For e.g. TORCH agents(toxo-plasma Gondi, rubella virus, cytomegalovirus and
herpes virus)

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Indirect transmission:-This includes a variety of mechanisms including the traditional 5F’s
fingers, flies, fomites, food and fluid. Indirect transmission can occur in a variety of settings:

 Vehicle borne:-It implies transmission of the infectious agent through the agent of water,
food including raw vegetables, fruits, milk and milk products, ice, blood serum, plasma.
For e.g. acute diarrhea, typhoid fever, cholera, polio, Hepatitis-A, food poisoning,
Hepatitis-B, malaria, syphilis, cytomegala virus infection.

 Fomite borne:- Fomites are inanimate articles or substances other than water or food
contaminated by the infectious discharge from a patient and capable of transferring to a
healthyperson.Itincludesoiledclothes,towel,toys,linen,handkerchiefs,cups,spoons, pencils,
books, taps, door handles, surgical dressing.

 Unclean hands and fingers:-Hands are the most common medium by which pathogenic
agents are transferred to food from the skin, nose, bowel etc as well as from other foods
.For e.g. typhoid fever, staphylococcal and streptococcus infections and Hepatitis-A and
intestinal parasites.

Stages of infection:-

 Incubation stage:-It is the amount of time between infection with a virus or bacteria to
the start of symptoms. For e.g. 14-16 days for chicken pox.

 Prodormal stage:- It is a stage in which an early symptoms appears that might indicate
the start of a disease before specific symptoms occur.

 Illness stage:- Period when client manifests signs and symptoms specific to type of
infection.

 Convalesence stage:-Period when acute symptoms of infection disappear.

CLASSIFICATION OF INFECTION:-

 Acute infection:- Short duration of the order of several days.

 Chronic infection:-Long duration of the order of weeks or months.
 Air borne infection:-Infection by inhalation of organisms suspended in air or dust
particles.
 Primary infection:-Initial infection with a parasite in a host is termed primary infection.
 Reinfection:-Subsequent infection with the same parasite in the same host is called
reinfection.
 Secondary infection:-When the body resistance is lowered by a pre-existing infectious
disease a new parasite sets up an infection.

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  Cross infection:-When a patient already suffering from a disease acquires a new infection
from another host or external source.
 Noso-comial infection:-Infection acquired from hospital.
 Iatrogenic infection:-An infection introduced by physician resulting from drug therapy or
investigative procedures.
 Subclinical infection:-When clinical symptoms of an infection are not apparent it is
known as subclinical infection.
 Latent infection:-When causative agent is present in body but there are no clinical sign.
 Persistent infection:-A characteristic of some viruses, particulatly herps viruses and lanti
viruses in which there may be long lasting latent infections with asymptomatic periods
and recurring acute episodes of clinical disease or onset of severe clinical diseases.
 Pyogenic infection:-Infection by pus producing organisms.
 Opportunistic infection:-Infection with organisms which are normally harmless but
becomes pathogenic when the body’s defence mechanisms are compromised.
 Super infection:-A second infection occurs in an animal which is already experiencing an
infection with another agent.
 Endogenous infection:-Infection due to reactivation of organisms present in a dormant
focus as occur in tuberculosis etc.
 Exogenous infection:-Infection caused by organisms not normally present in body but
which have gained entrance from the environment.

NOSOCOMIAL INFECTION (HEALTH CARE ASSOCIATED INFECTIONS):-

DEFINITION:-

It is defined as infection developing in patients after admission to the hospital which was neither
present nor in the incubation period at the time of hospitalization. Such infections may become
evident during their stay in the hospital or sometimes after discharge.

Common hospital acquired infections:-

1. URINARY TRACT INFECTION (UTI):- This is associated with catheterization or

instrumentation of urethra, bladder or kidneys.

Causative agents:-E.coli, Proteus, Pseudomonas, Klebsiella, Candida albicans, Enterococci.

Sign and symptoms:-

 Fever (100 °C)

 Urinary urgency
 Frequency of micturation
 Dysuria
 Burning micturation
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  Supra pubic tenderness

Measures to prevent UTI:-

 Hand washing

 Use aseptic techniques while catheter insertion

 Routine care of catheter

 Use silver coated catheter

 Trained health personnel

 Timely appropriate removal of the catheter

2. SURGICAL SITE INFECTION (SSI):- The incidence of post operative infection is

higher in elderly patients. Most wound infections manifest within a week of surgery.

Causative agents:- E.coli, Proteus, Enterococci and coagulase negative staphylococci.

Sign and symptoms:-

 Pain /Tenderness

 Localized swelling

 Redness

 Purulent discharge from the incision

Measures to prevent infection:-

 Use aseptic techniques while changing the dressing.

 Daily change the dressing of surgical site.

 Check the surgical site for any redness, swelling and purulent discharge.

 Use sterile gauze for dressing.

 Wash hands.

3. BLOOD STREAM INFECTION (BSI) catheter related:- Infection that is caused by

intravenous cannulation or central line catheter is known as blood stream infection.

Causative agents:-Gram negative bacilli are the common pathogens.

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Sign and symptoms:-

 Fever

 Chills

 Positive blood culture test for agent

 Redness

 Swelling

 Pain

 Hypotension

Measures to prevent BSI:-

 Wash hands before and after the procedure.

 Daily review of line for redness and swelling.

 Promptly removal of unnecessary lines.

 Use barrier precautions.

4. VENTILATOR ASSOCIATED PNEUMONIA (VAP):- The patient should be on

mechanical ventilation (either through an endo-tracheal tube or through tracheostomy) in
an ICU for more than 48 hours to be considered to be a case under consideration for
VAP.

Causative agents:- Streptococcus pneumonia, Haemophilus influenza, Pseudomons

Sign and Symptoms:-

 Fever

 Hypoxemia

 Rales and dullness to percussion

 New onset of purulent sputum or change in character of sputum

 Same organism isolated from blood culture as from respiratory tract with no other
source of infection.

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Measures to prevent infection:-

 Hand washing

 Elevation of head end of bed

 Maintain oral hygiene

 Management of or-pharyngeal and tracheal secretions

 Changing in placement of feeding tube

 Usage of antiseptic mouthwash

ROLE OF NURSE IN PREVENTION OF NOSOCOMIAL INFECTION:-

1. Prevent patient to patient spread of infection.

2. Provide isolation according to guidelines.

3. Perform hand hygiene.

4. Use gloves when handling any body fluids.

5. Avoid wearing artificial finger nails.

6. Use protection in isolation.

7. Get vaccination done against infections.

8. Avoid risk of airborne disease by vaccination e.g. Influenza.

9. Prevent patient exposure to contaminated medical equipment by sterilization,

disinfection.

10. Follow guidelines for routine removal and replacement of IV lines.

11. Remove urinary catheter at earliest time possible.

12. Remove endo-tracheal and NG tubes as soon as possible.

PREVENTION AND SAFETY MEASURES:-

UNIVERSAL PRECAUTIONS (BARRIER NURSING)

HAND HYGIENE:-

Purpose: - To remove transient microorganisms from the skin of the hands.

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Technique:-

 Hand washing (40-60 sec): wet hands and apply soap rub all surfaces, rinse hands and dry
thoroughly with a single use towel, use towel to turn off facet.

 Hand rubbing (20-30 sec): apply enough product to cover all areas of the hands, rub
hands until dry.

STEPS OF HAND WASHING

 Wash palms and fingers

 Wash back of hand

 Wash fingers and knuckles

 Wash thumbs.

 Wash fingertips

 Wash wrists

PERSONAL PROTECTIVE EQUIPMENT:-

 Masks

 Gloves

 Gowns & Aprons

 Eye protective ware(goggle)

 Boots or overshoes

ASEPTIC TECHNIQUES

 Minimize the risk of introduction pathogenic microorganisms into susceptible sites.

 Prevent the transfer of potential pathogens from the contaminated site to other sites,
patient or staff.

 Thus, aseptic technique are those used whenever there is a break in skin integrity, as in a
surgical wound dressing or when natural defence mechanisms are bypassed as in
intravascular cannulation and endotracheal suction.

 Aseptic techniques involve the use of sterile equipment including sterile gloves if the
susceptible site is to be manipulated. For e.g. surgery.

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  When a non-touch technique is used and the risks related to contamination of the
operators hands only, non sterile gloves may be adequate.

 Invasion procedure provides a major opportunity for entry of pathogens into the body.
For e.g. intravascular devices have been shown to increase the risk of infection.

 Adequate disinfection of skin mucosal surfaces and hands must be undertaken prior to
invasive procedures to reduce the number of potential pathogens at the site.

Isolation

 Isolation refers to various measures taken to prevent contagious diseases from being
spread from a patient other patients, health care workers and visitors or from others to a
particular patient.

 Types of isolation:-

 Strict isolation

 Contact isolation

 Respiratory isolation

 Blood and body fluids isolation

 Reverse isolation

TRANSMISSION BASED PRECAUTION:-

There are three type of transmission precautions:-

 Airborne precautions:-These are used for infections which are transmitted by droplet
nuclei. Droplets are generated in the course of talking, coughing or sneezing and during
procedure that involve the respiratory tract such as suction, physiotherapy, intubation or
broncho-scopy. Small droplet nuclei of size <5 can be widely dispersed by air current
sand can reach the alveoli of the susceptible host and cause infection.Patient under
airborne isolation precautions areas. The door must be closed. e.g.T.B and measles.

 Droplet precautions:- Infections which are spread by large droplets such as pneumonic
plague, influenza, rubella, invasive meningococcal disease (meningitis). Place the client
in private room or with another client infected with the same organism. Wear mask if
working within the patient or potentially contaminated items after removing gloves and
before taking care of another patient.

 Respiratory hygiene and cough etiquette:- Persons with respiratory symptoms should
apply source control measures: cover their nose and mouth when coughing/sneezing with

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 tissue or mask, dispose of used tissues and mask and perform hand hygiene after contact
wit respiratory secretions.

 Contact Precautions:-These precautions are used for patient to prevent the transmission
of communicable diseases and of epidemiological important microorganisms which are
causing infection or colonization.

PREVENTION OF CROSS INFECTION IN HOSPITAL

 The hospital should be well ventilated.

 Maintain the general cleanliness of hospital.

 Sweeping and mopping of the floor should be done with antiseptic lotions.

 Damp dusting should be done to keep the articles free from dust.

 All articles are kept clean and dry.

 Bed lockers, stools etc should be washed and cleaned.

 The mattress, pillows and other unwashable articles are exposed to sunlight and aired.

AIM OF SAFETY MEASURES

 To prevent the transmission of disease from patient to patient, from patients to nurses,
health care workers.

 To prevent injury to nurse while handling the patient & waste.

 To prevent general exposure to the harmful toxic effects of ctotoxic, geotaxis, chemical
biomedical waste as much as possible

MEASURES OF PROTECTION

1. Personal protective devices

2. General protective measure

3. Case of injury caused by infected sharps

4. Other measures of safety

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ROLE OF NURSE MANAGER IN INFECTION CONTROL:-

The prevention, monitoring and reporting of infections of both patients and staff is an important
responsibility of the nurse manager.

1. To train the new staff regarding the infection control and reporting.

2. In-service education for new and previous staff on topic related to infection control.

3. Development of infection control policies so as to minimize or prevent infection.

4. Nurse must report unusual events that take place in hospital settings.

5. Nurse must educate client and family about infection control.

6. Nurse must gather statistical data regarding epidemiology of nosocomial infection.

7. Enforce hospital policy regarding decontamination of objects following

contamination with body fluids.

8. Keep clean supplies separate from used or soiled items.

9. Monitor patient for evidence of infection at any location.

10. Assess treatment effectiveness of all identified infections.

11. Administer antibiotics to prevent infection.

12. Monitor vital signs of patient.

13. Assess for dehydration.

14. Monitor weight, daily input and output and electrolyte levels.
15. Obtain blood cultures as prescribed.

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 BIBLIOGRAPHY

 Satish Gupta The short textbook of medical microbiology Jaypee Publisher, 9th
edition Pp 57-66

 D.R Arora. Textbook of microbiology published by CBS Publishers & distributers

2nd edition Pp 56-64

 Prof.C.PBaveja Textbook of microbiology Published by Arya Publishers,1st

edition Pp 631-683

 K. Park’s Textbook of preventive & social medicine Published by Banarsidas

Bhanot Publisher ,18th edition Pp 106-595

 D.K Sharma, Hospital Administration And Human Resource Management,

Edition 6th, Published by Ashok k Ghosh, Page No. 398-410.

 Piyush Gupta, Text Book of Preventive And Social Medicine, Addition 2nd,
Published by Satish Kumar Jain, Page No. 155-180.

 Shebeer.P.Basheer, S. Yaseen Khan, A concise Text Book of Advanced Nursing

Practice, EMMESS Medical Publishers, Page No. 324-341.

 http://www.who.int/injecton_safety/sign/en/

 http://www.cdc.gov.ncidod/dhqp/pdf/isolation2007.pdf

 http://www.cdc.gov/HAI/prevent/prevent_pubs.html

 http://www.biomedcentral.com/

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