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A model used to understand the infection process is the chain of infection, a circle of links, each representing a component in the cycle. Each link must be present and in sequential order for an infection to occur. The links are: infectious agent, reservoir, portal of exit from the reservoir, mode of transmission, and portal of entry into a susceptible host. Understanding the characteristics of each link provides the nurse with methods to support vulnerable patients and to prevent the spread of infection. An awareness of this cycle also provides the nurse with knowledge of methods of selfprotection.

Definition:
INFECTIOUS AGENT A microbial organism with the ability to cause disease. The greater the organism's virulence (ability to grow and multiply), invasiveness (ability to enter tissue) and pathogenicity (ability to cause disease), the greater the possibility that the organism will cause an infection. Infectious agents are bacteria, virus, fungi, and parasites. RESERVOIR A place within which microorganisms can thrive and reproduce. For example, microorganisms thrive in human beings, animals, and inanimate objects such as water, table tops, and doorknobs. PORTAL OF EXIT A place of exit providing a way for a microorganism to leave the reservoir. For example, the microorganism may leave the reservoir through the nose or mouth when someone sneezes or coughs. Microorganisms, carried away from the body by feces, may also leave the reservoir of an infected bowel.

MODE OF TRANSMISSION Method of transfer by which the organism moves or is carried from one place to another. The hands of the health care worker may carry bacteria from one person to another. PORTAL OF ENTRY An opening allowing the microorganism to enter the host. Portals include body orifices, mucus membranes, or breaks in the skin. Portals also result from tubes placed in body cavities, such as urinary catheters, or from punctures produced by invasive procedures such as intravenous fluid replacement. SUSCEPTIBLE HOST A person who cannot resist a microorganism invading the body, multiplying, and resulting in infection. The host is susceptible to the disease, lacking immunity or physical resistance to overcome the invasion by the pathogenic microorganism.

PREVENTION AND CONTROL OF INFECTION:

Breaking the Chain Nurses maintain the immediate health care environment. Because they provide care for a variety of patients, the risk of contamination from pathogenic (Any disease producing microorganism) microorganisms is increased. The practice of medical asepsis and standard precautions provides the nurse with techniques for destroying or containing pathogens and for preventing contamination to other people or to bedside materials and equipment. Medical Asepsis - Techniques used to control and to reduce the spread of pathogenic microorganisms. A medical aseptic technique is hand washing. The practice of medical asepsis helps to contain infectious organisms and to maintain an environment free from contamination. The techniques used to maintain medical asepsis include hand washing, gowning and wearing facial masks when appropriate, as well as separating clean from contaminated or potentially contaminated materials and providing information to patients about basic hygienic practices. Appropriate hand washing by the nurse and the patient remains the most important factor in preventing the spread of microorganisms. One common example of medical asepsis involves the steps taken by the nurse to ensure that only clean linen is applied to each patient's bed. Clean linen remains in the clean linen cabinet until taken to the patient's room. The hands of the health care worker are washed before handling the clean linen. Unused bed linen from one patient's room cannot be returned to the clean linen cabinet and cannot be used for any other patient. This linen is considered soiled and placed in the soiled linen bag.

Patient Situation: 1 The Spread of Infection

An elderly patient, hospitalized with a gastrointestinal disorder, was on bed rest and required assistance for activities of daily living. The patient had frequent uncontrolled diarrhea stools and the nurse provided excellent care to maintain cleanliness and comfort. Following one episode of cleaning the patient and changing the bed linen, the nurse immediately went to a second patient to provide care. The nurse's hands were not washed before assisting the second patient. Let's examine the chain of infection as it applies to this situation.

Escherichia coli

Large intestine E. coli, bacteria in the large intestine of humans forms the greater part of the normal intestinal flora.

E. coli exited the body in feces.

The nurse removed the contaminated linen from the bed. The E. coli organism contaminated the hands of the nurse who then provided morning care to another patient.

The second patient receiving care had a Foley catheter. The nurse manipulated the tubing attached to the catheter. The E. coli organism on the nurse's hands contaminated the catheter tubing and ascended to the patient's meatus and then into the urinary bladder.

The second patient with a Foley catheter. This patient was elderly and had a chronic illness necessitating complete bed rest. The Foley catheter contaminated by the E. coli organism provided a direct route into the urinary bladder.

Patient Situation: 2 The Nurse Breaks the Chain

A patient assigned for morning care has an open wound on her left lower leg. The wound is draining and when last cultured, the microorganism MRSA was identified. In preparation for bedmaking, hands of the nurse were washed. Clean linen and a bag for soiled linen were gathered from the linen room and placed on the patient's clean bedside stand. To remove the soiled linen from the bed, the following procedure was followed:

1. 2. 3. 4. 5. 6. 7.

Hands washed Gloves worn Each side of the soiled linen ends folded towards the middle of the bed Soiled linen held away from the nurse's clean uniform Soiled linen placed in the linen bag for later discard Protective gloves removed Hands washed

The nurse applied principles of medical asepsis and standard precautions with the use of body substance isolation to contain the infectious organism at many points in the chain of infection.

MRSA (Methicillinresistant organism)

Patient's infected wound BREAK IN THE CHAIN Nurse used proper hand washing techniques, wore protective gloves and properly handled the linen.

Draining from the open wound

MRSA commonly transferred on hands of the nurse by indirect contact

BREAK IN THE CHAIN Proper hand washing, gloving and handling of linen BREAK IN THE CHAIN Organisms isolated with use of medical asepsis and body substance isolation PROTECTED

Discuss: Mode of transmission Proper waste disposal Biodegradable Non-biogredable Infectious Objective for Beginning Nursing Students 1. Identify the six links in the chain of infection. 2. Describe factors that increase the susceptibility of an individual to an
infection.

3. Explain specific ways a nurse, while providing patient care, can decrease
the incidence of contamination by an infectious agent.

4. Describe four medical aseptic techniques the nurse practices.

5. Demonstrate appropriate hand washing technique and describe how to

incorporate hand washing into nursing practice.

6. Identify frequently occurring patient care situations that require the nurse
to wear protective barrier gloves.

7. Demonstrate appropriate handling of bed linen, soiled and clean. 8. Explain the primary components of standard precautions: universal
precautions and body substance isolation.

9. Describe how the components of standard precautions must be

incorporated while providing patient care.