In this video, our subject is infection control. We will discuss the chain of infection, how to break the chain of infection, an introduction to infection control, techniques of medical asepsis, how to wash your hands, how to use personal protective equipment or PPE for standard precautions, how to use standard precautions, and how to use isolation or transmission-based precautions. In health care facilities, infection can spread easily from one person to the next. Why?
Well, first of all, many of the people in health care facilities are there because they're being treated for an infectious disease. As a result, you have many infectious people in close proximity, both to one another and to people who are free from infection. Secondly, people who are already ill are more at risk. for infection from other people simply because they are in a weakened more vulnerable condition and they're also more susceptible because in many cases they are elderly or very young during a typical work day you will interact with many patients or residents in other words you will become a common link between them unless you and your co-workers take special precautions you can become the means of passing illness from one person to another as you move from room to room providing care. Not only that, you or your family can become infected as well.
That's why the skills in this video are so important. The principles and techniques of infection control you will learn will help you prevent the spread of the microbes that cause infections and illness in patients, in residents, and in you. Organisms that are too small to be seen with the naked eye are called microbes. Examples of microbes are bacteria, fungi, viruses, and parasites.
Some microbes are harmless or even helpful, but others can cause illness. Microbes capable of causing illness are called pathogens. When a pathogen causes an illness, we call the illness an infection.
A communicable infection is an infection that can be transmitted from one person to another. In order for a person to acquire a communicable infection, six key conditions must be met. Together, these six conditions are the links that make up the chain of infection. By breaking this chain, you can help stop the spread of communicable disease in your facility.
The six conditions in the chain of infection are Pathogen Reservoir, portal of exit, method of transmission, portal of entry, and susceptible host. In order for the chain of infection to remain intact, each of these conditions must be present. Condition number one in the chain of infection requires that a pathogen be present.
Pathogens, remember, are microbes capable of causing illness. A reservoir is a place where something is stored or held in reserve. In healthcare, a reservoir is any place where a pathogen can live while waiting for an opportunity to infect someone.
Condition number two in the chain of infection requires the presence of a reservoir. Potential reservoirs include the bodies of humans and other animals, food and water, and objects called fomites that have come in contact with an infected person's body or body fluids. Pathogens collect and live in these reservoirs and in some cases they multiply. The third condition in the chain of infection is that pathogens must have a way to leave the reservoir, that is a portal of exit or exit door.
A pathogen might leave via the respiratory tract in mucus, via the gastrointestinal tract in feces or saliva, via the skin and blood or drainage from a wound, or via the urinary tract excreted in the urine. The fourth condition in the chain of infection is that there must also be a method of transmission. That is, a way for the microbe to get from the reservoir to another person. Direct transmission requires close contact between an infected and a non-infected person. In such cases, the reservoir consists of the infected person's body or bodily fluids and the method of direct transmission of infection could involve touching the infected person or breathing contaminated air after the person talks, sneezes or coughs.
Indirect transmission involves a fomite, again an object or surface that has been soiled or contaminated by an infected person. Transmission occurs when a non-infected person touches a fomite. Examples of fomites that can be easily contaminated include drinking glasses, side rails, and bed linens. Indirect transmission may involve a vector instead of a fomite.
A vector is a living creature such as a mosquito, tick, or rodent that transmits a pathogen. Examples of diseases that are transmitted by vectors include West Nile virus, Lyme disease, malaria, and plague. Condition number five in the chain of infection requires a portal of entry, that is, a doorway into an uninfected person.
The same organ systems that served as portals of exit also serve as portals of entry. Portals of entry include the respiratory tract, the gastrointestinal tract, the genitourinary tract, and breaks in the skin. Medical devices such as indwelling catheters, feeding tubes, and intravenous lines increase a person's risk of infection by providing more efficient pathways through these portals. The sixth and final condition in the chain of infection is that a susceptible person or host must be available to the pathogen as a new target for infection. The key word here is susceptible.
After all, there is a never-ending onslaught of pathogens struggling to gain entry at the many portals into the human body. The body's defense system is capable of fighting off most of them, either through natural defenses or with the assistance of medicines and vaccines. But when those defenses fail, we become susceptible hosts and complete the chain of infection. People with reduced defenses have an increased likelihood of becoming hosts. People who are very young or very old, those in poor general health, people undergoing chemo and radiation therapy, those who are under stress or fatigued, and people with indwelling medical devices all are at increased risk for having reduced defenses.
You can break the chain of infection by removing any one of the six required elements or links. You can eliminate a reservoir by ensuring, for example, that bedpans are properly cleaned after each use. You might eliminate a portal of exit by ensuring that the person's dressings are intact, notifying the nurse that a dressing needs to be reinforced with tape, for example.
Okay, well I'm going to go get the nurse, okay? We'll be right back. Okay, thank you. Eliminate a common method of transmission. by properly disposing of contaminated items.
Items containing blood or body fluids, for example. When appropriate, use designated biohazard containers and make sure to wash your hands. Eliminate a portal of entry by wearing gloves or other personal protective equipment. Finally, you can further break the chain of infection by reducing susceptibility of hosts.
Maintaining your own general good health and receiving required immunizations help to make you less susceptible as a host. And when you help your patients or residents to maintain their good health, you help them to become less susceptible. Remember, each time you break a link in the chain of infection, you can prevent an infection from spreading.
All health care facilities follow basic practices of infection control designed to decrease the chance that an infection will spread from one person to another. The five major methods of infection control that apply to nursing assistants in medical facilities or long-term care facilities are medical asepsis, surgical asepsis, barrier methods, standard precautions, and isolation or transmission-based precautions. Medical asepsis involves killing or physically removing pathogens from surfaces, equipment, and the hands of healthcare workers, which prevents the spread of infection from one person to another.
Medical asepsis is accomplished primarily by using soap, water, antiseptics, disinfectants, or heat. To prevent infection, surgical asepsis is used for procedures that involve entering a person's body, such as surgical procedures, injections, the insertion of urinary catheters, and the insertion of intravenous catheters. Barrier methods of infection control employ a barrier, that is an object that physically prevents microbes from reaching a healthcare provider's skin or mucus membranes.
We refer to the barriers as PPE, or personal protective equipment. Examples of PPE include disposable gowns, gloves, masks, and protective eyewear. The fourth type of infection control consists of standard precautions, which are precautions taken with every patient or resident to protect against pathogens that are transmitted in blood and other body fluids. The fifth and final type of infection control consists of isolation or transmission-based precautions used when a person is known to have a disease that is transmitted a certain way.
For example, via the air, in droplets, or by direct contact. It is essential that you follow your facility's guidelines on infection control in each of these five areas very strictly. In the sections that follow, we'll provide you with some detailed tips on the most common techniques for infection control.
Proper medical asepsis begins with sanitization, which includes such basic techniques as hand washing and providing clean linens and clothing. Antisepsis takes sanitization one step further and requires the use of antiseptics, chemicals capable of killing a pathogen or preventing it from growing. Antiseptics can be used on the skin, skin or other surfaces and include rubbing alcohol, iodine, and some types of soaps.
Disinfection involves the use of stronger chemicals to kill the pathogens. Chemicals too strong to use on the skin but which are effective on non-living objects that come into contact with body fluids or substances. Objects such as bedpans, urinals, and tray tables. Sterilization is the most thorough method of killing microbes. and is used on objects such as surgical instruments that must be completely free of any microbe.
Hand washing, which in terms of medical asepsis, is the sanitization of the hands, is the single most important method of preventing the spread of infection. That's because the most common method of transmission of nasocomial infections That is, infections gotten while in the hospital or other health care setting is on the hands of health care workers. And that means on these hands and on yours.
Most nasocomial infections are caused by transient flora, which are organisms picked up from touching contaminated objects or people who have a communicable disease. When you properly wash your hands, you remove these organisms and help prevent infection. The first step in washing your hands comes even before you arrive at work.
Keep your fingernails short and unpolished and leave your jewelry at home. Long fingernails and jewelry can trap microbes and are extremely difficult to clean. It's likely that the supplies you need will already be present at the hand washing area.
If not, it's your responsibility to locate any necessary supplies, such as soap or another facility approved cleansing agent. paper towels, and a waste container. As optional supplies, you might consider hand lotion, or in certain healthcare settings, or if your nails are visibly soiled with blood or other substances, a nail brush or an orange stick.
Begin by standing away from the sink so your uniform doesn't touch it. If you're wearing long sleeves, push them up 4 or 5 inches. If you are wearing a watch, slide that up too.
If the sink has hand-controlled faucets, use a clean paper towel as a barrier when you turn the water on. Adjust the water temperature until it is warm, and then dispose of the towel. Some sinks may be equipped with foot or elbow controls instead of hand-controlled faucets.
Put your hands in the water stream with your fingers pointed down, so the water runs off your fingertips and into the sink. Remember the phrase, down the drain. Do not allow water to run up your forearms.
Dispense the soap or cleansing agent into one cupped hand. Lather well, making sure the lather extends at least an inch past your wrist. Again, keep your fingers pointed down at all times so the water runs down the drain. Rub your hands together in a circular motion, washing both the palms and backs. Continue in this circular motion for a full 10 to 15 seconds.
Put the fingers of one hand between the fingers of the other hand to clean the spaces between your fingers. Then, rub the fingernails of one hand against the other hand's palm to force soap underneath your fingernails. Alternatively, you might clean underneath your fingernails with a nail brush or the blunt edge of an orange stick.
Rinse your hands, again keeping your fingers pointed down at all times. Dry your hands thoroughly with a clean paper towel. Dispose of the paper towel in an approved waste container, being careful not to touch the container.
Use a new paper towel to completely cover the handle, then turn off the faucet. Dispose of this towel also. As you leave the hand washing area, open the door by covering the knob or handle with another clean paper towel.
If there is no knob or handle, Push the door open with your hip and shoulder to avoid contaminating your clean hands. After you leave the hand washing area, you may apply a small amount of hand lotion to keep your skin supple and moist. Personal protective equipment or PPE is a barrier method of infection control used to protect you from exposure to a pathogen. The type of PPE required will vary according to the potential method of transmission of the pathogen from person to person. For example, airborne diseases such as measles and tuberculosis are transmitted by the respiratory tract.
So to prevent infection, you would wear equipment that protects your respiratory system, such as a mask. Other infections only require gloves to protect you. The main thing to remember is that you use the PPE to block the portal of entry of any infectious microbes into your body.
In any situation that requires the use of PPE, you must first start by thoroughly washing your hands and then use the particular barriers that are necessary for the task at hand. In many situations, you'll use multiple barriers. In these cases, we recommend you put them on in this order.
Mask, gown, eyewear, and gloves. Take them off in the opposite order. Gloves are always removed before you reach up towards your face or neck to untie or remove other items. And remember...
Any used barriers are considered contaminated, and the outside of contaminated barriers should not make contact with your skin in order to prevent the transmission of microbes. Disposable gloves are perhaps the most commonly used barrier method of all, and they are recommended for a variety of situations. Gloves should always be worn if there is a possibility of coming into contact with blood or other body fluids or substances.
Here are some key points to keep in mind about disposable gloves. The gloves must be intact with no holes or tears. Replace any damaged gloves immediately. Gloves must fit properly. If the gloves are too tight, they will be uncomfortable and may stretch, decreasing the effectiveness of the barrier.
If the gloves are too loose, they may slip from your hands. Gloves are most commonly made of latex, but if you have or the person you are caring for has a latex allergy or sensitivity, use approved gloves made of another material. Remember that protecting yourself from pathogens is only one step toward breaking the chain of infection. When your gloves contact a pathogen, when you've touched another person, for example, or any body fluid or substance, The outside of the gloves becomes contaminated and the gloves must be removed before touching any other surface or person. Otherwise, they could transmit pathogens to whatever you touch next.
Here are the steps to safely remove your gloves. With one gloved hand, grab the other glove at the palm and pull the glove off your hand. Using your ungloved hand, slip two fingers underneath the cuff of the remaining glove.
Remove that glove. turning it inside out as you pull it off. Dispose of the soiled gloves in an approved container.
Then, wash your hands or use an alcohol-based hand rub according to your institution's policy. Gowns are called for when there is the possibility that your uniform may become soiled with body fluids or substances. Using a gown as a barrier prevents your clothing from being contaminated.
The gown is considered contaminated if it becomes wet or soiled. Paper gowns, by far the most common type in use today, are disposed of after one use. Fabric gowns, if used at the facility where you work, must be laundered after each use. Let's look at the proper way to put on and take off a gown.
To put on a gown, if you're wearing a watch, remove it. and place it in your pocket or on a clean paper towel. Push up your sleeves so that they are 4 or 5 inches above your wrists.
Wash your hands. Gather your needed supplies, which are a gown and gloves. Put the gown on by slipping your arms into its sleeves.
Secure the gown around your neck by tying its ties into a simple bow or by fastening its Velcro fastener. Reach behind you and overlap the gown's edges so that your clothes are completely covered. Secure the gown at your waist by tying the ties in a simple bow or by fastening the velcro.
Put on the gloves so that the cuffs of the gloves extend over the cuffs of the gown. To remove a gown, loosen the waist by untying the ties or unfastening the velcro. Remove and dispose of your gloves. Unfasten the neck.
Be careful not to touch your neck or the outside of the gown. Grasp the gown at the neck fasteners and pull it loose. Slip the fingers of your dominant hand under the cuff of the gown on the opposite sleeve.
Pull the sleeve over your hand. Be careful not to touch the outside of the gown because the outside surface is contaminated. Then, use your gown-covered hand to slide the sleeve over your other hand and pull the gown off both arms.
It is important to ensure that the outside of the gown does not come into contact with your skin. Hold the gown away from your body. Roll it downward turning it inside out as you go. Take care to touch only the clean side of the gown, what used to be the inside when you were wearing it.
After the gown is rolled up with its contaminated side on the inside Dispose of it in an approved container. Finish by washing your hands. Masks are worn when caring for a person who has an infection that can be transmitted through the respiratory tract and are worn any time there is a possibility that blood or body fluids may splash or spray towards your face.
Masks work to protect the mucous membranes in your mouth and nose from becoming contaminated. There are many different types of masks that are worn depending on the task to be performed and personal preference. Many types of masks have attached eye protection shields and serve to protect the eyes as well as the nose and mouth. To put on a mask, gather your supplies which in this case is a mask. Wash your hands, place the mask over your nose and mouth, Being careful not to touch your face with your hands.
Tie the top strings of the mask securely behind your head. Tie the bottom strings of the mask securely behind your neck. Make sure your mask fits snugly against your face.
so that you breathe through it and not around it. To remove a mask, wash your hands, untie the bottom strings first, and then untie the top strings. Hold on to the top strings and remove the mask.
Then, holding the mask by the ties only, dispose of it in an approved container. Wash your hands again. Protecting your eyes as a portal of entry is very important when there is the potential for body fluids to splash. If you're working with anything that might splash, you'll need protective eyewear, such as goggles, face shields, and other devices to protect your eyes. Blood and body fluids, even the fluid used to irrigate wounds, can splash and transmit pathogens into your eyes, a portal of entry.
The fourth type of infection control, after medical asepsis, surgical asepsis, and barrier methods, is standard precautions. Because pathogens such as the hepatitis virus, or HIV, can reside virtually undetected in a person's blood, and because infected blood can leave the body through any number of exit portals, you must treat every patient or resident you come in contact with as if he or she might be infected with a blood-borne pathogen. To do this, you'll employ standard precautions, which are precautions against blood-borne pathogens that must be taken with every patient or resident.
Standard precautions include the use of personal protective equipment, as demonstrated previously, and which includes masks, gowns, protective eyewear, and gloves. The proper disposal of sharps, such as used needles, razors, or broken glass in OSHA-approved containers. Note that contaminated broken glass items should not be handled, even with gloved hands.
Instead, the glass should be swept up and disposed of in an appropriate waste container. Standard precautions also include the cleanup of spills of blood or other body fluids in an approved manner. Spills of blood or other body fluids must be cleaned up with an approved cleaning agent or a solution of one-part household bleach to ten parts water.
Wear personal protective equipment while cleaning up spills. And standard precautions include hand washing. Again, the single most important method of preventing the spread of infection. In order for standard precautions to be effective, they must be used consistently. They must become your standard of professionalism.
Isolation or transmission based precautions are used when a person is known to have a disease that is transmitted a certain way. For example, via the air, in droplets, or by direct contact. Isolation precautions are used along with special environmental controls such as ventilation systems, liquid waste disposal methods, and procedures for handling contaminated linens or trash to prevent the spread of infection throughout the facility.
Airborne precautions are used when caring for people infected with pathogens that can be transmitted via the person's breath through the air. Infections that are transmitted by airborne particles that are then breathed in include measles, chickenpox, and tuberculosis. Airborne precautions include placing the person in a private room and wearing a mask. when providing care.
When the person leaves the room, he is required to wear a mask also. Droplet precautions are necessary when an infected person breathes, coughs, or sneezes, and microbes leave the body in the air or through particles of saliva or sputum. As these particles spray through the air, they dry out and remain in the air for a long time. Like dust, the dried out droplets containing microbes are in the air we breathe and on the surfaces we touch. Infections that are transmitted by droplets include mumps, influenza, whooping cough, strep throat, scarlet fever, rubella, meningitis, pneumonia, diphtheria, and epiglottitis.
Droplet precautions are the same as airborne precautions, except that with droplet precautions, it is usually necessary to wear a mask. only when you are within three feet of the infected person. Contact precautions are used when caring for people with diseases caused by pathogens that are transmitted directly by touching the person, for example, or indirectly by touching fomites. For example, contact precautions are taken with patients or residents with skin and wound infections, digestive tract infections, some types of respiratory tract infections, and head lice. or scabies infestation.
Contact precautions involve using barrier methods whenever you must touch the infected person or items contaminated with wound drainage or body substances. Patients or residents requiring isolation precautions may have to be kept in a private room with the door closed. They may not be allowed to leave their rooms unless it is absolutely necessary to do so and the people caring for them must wear PPE. When caring for a person with a communicable disease, it is sometimes easy to forget that we are caring for a person with feelings and that we risk making the person feel dirty or unwanted.
Imagine how you would feel if health care workers had to wear gloves or a mask every time they came near you. When caring for a person with a communicable disease, your first responsibility is to help prevent the spread of infection to other patients or residents, to visitors, and to yourself and your family. But at the same time, you can make the patients or residents under your care feel less isolated and less lonely by checking on them frequently, taking time to talk to them, and remembering to treat them as people with pride and self-respect. In other words, as human beings.