in this module we want to look specifically at issues of infection control patients enter the Healthcare System quite often because they have a disease or there's some infectious process that's in place other times they come in to health care for procedures that puts them at risk for infection so again infection control is one of our major safety initiatives that we can be a part of as nurses and that we need to focus on again on the reading modules or the reading guides for the module we're going to be looking at information from two texts they're going to be a few things from nursing skills and again the hyperlink to those sections are built into the Reading Guide or you can open up Nursery skills and go to those two areas and then we'll be looking at information from nursing fundamentals as well as just the high points that are emphasized here in the lecture so again for your module reading I'll read over the infection or over the objectives and as we're looking at the objectives notice that in objective two is identifying terms and those are coming from 9.4 and nursing fundamentals um look over those be aware of the definitions of those so you can pick those out in a situation or in a matching type scenario so again those items on module two is mainly are in section two um and objective two you're looking for definitions of the terms and when we're looking at things like item E Local versus secondary versus systemic or the next one primary versus opportunistic or acute versus chronic be able to compare and contrast those terms so and there's other things there that'll be the main focus so again a few items a few areas you're going to look at nursing skills but we're looking at the issues of PPE again we're also going to draw on the things that you've practiced and have performed in in the lab activities as well so we want to first start just talking about some basics of infections and infectious diseases so while we're dealing with um is how can we interrupt The Chain of Infection to either keep an infectious disease from happening or to cut down on its spread so Chain of Infection um you have been exposed to possibly in physiology and pathophysiology um so we're looking at the fact that there's an infectious agent a microbe a bacteria or virus or fungus something that can cause disease so that would be a pathogen anything that has the ability to cause a disease those exist in a reservoir um we can think of mosquito-borne illnesses the reservoir may be stagnant water or it may be inside the mosquito itself or in some things like West Nile disease which is normally spread among horses through mosquito bites the reservoir may be a horse that has a the virus inside it and it's growing so anyway so we have the Infectious agent that exists in a reservoir and some has some way of getting out of that Reservoir and coming into contact with people then so that would be the portals of exit uh to get from that Reservoir to the individuals would be modes of transmission so when we're looking at that for most common infection control processes we're looking at Airborne contact UM ingested some way of the pathogen getting from its Reservoir to a potential new host or a susceptible host once that pathogen has gotten out into the environment and has reached a possible host or possible patient who may be at risk we're looking for portals of Entry can it get past the normal barriers so again in an admin physiology and pathophysiology will talk about the fact that our normal barriers are our Skin Barrier some of the chemicals in our mucous membranes that type of thing so if once a pathogen gets past that and gets inside the body then we have to decide is the host that it gets inside are they susceptible or are defense mechanisms such as our immune system or inflammatory system are they strong enough to fight off the pathogen in which case infection doesn't happen or is the individual susceptible where those defense mechanisms don't work and that point we can start having the development of infectious and it just keeps this Chain of Infection going so from a nursing standpoint we're really looking at disease being present in people in our patients or in ourselves and so that gets into the stages of pathogenesis how this happens so when we look at the Chain of Infection we're really looking at the areas after it exits the reservoir whatever the pathogen is and we're looking at modes of transmission um on through the portal this portals of entry and the susceptible hosts so with the stages of pathogenesis then we have exposure so the pathogen has been transmitted and we have adhesion to where the pathogen um connects to our mucous membrane to our skin to our body surfaces and then if our defense mechanisms don't work we have Invasion it gets past that primary barrier it gets into the system and then if our secondary um modes of defense or inflammatory process or immune response if they're not strong enough to handle the pathogen quickly then we have the development of infections so these are the stages or the part of the Chain of Infection in the stages that were that we become involved in in our nursing care once an infection or a pathogen is able to get inside a susceptible host is going to go through a process that results in the disease or the signs and symptoms of the disease and the disease is going to run a course so these would be the periods of the disease so in this slide in this diagram the periods of disease spend some time in the reading material to identify what the various terms are what is the incubation period what is the prodromal period so again some definitions of the periods of disease are going to be important to be aware of so again the information that you need for that is in your reading so how do we go about controlling infections how do we keep them from spreading and causing problems keep in mind patients that come into the hospital setting in particular or people that are in an Extended Care Facility often have decreased resistance to diseases so they are susceptible hosts to any number of pathogens also it's particularly in the hospital setting where you have a number of people that are in with a number of different illnesses we've increased the number of pathogens that are available so controlling the spread of those pathogens becomes a primary focus of everything that we're doing at in providing nursing care and creating a clean environment so some interventions that are part going to be part of your daily role in nursing we'll be maintaining a clean environment in areas where we're doing procedures or doing sterile and sterile procedures they're looking at surgery that type of thing sterilization of equipment is a very specialized Focus so sterilization is going to be handled by a specific Department to make sure supplies are ready to go if they need to be sterilized locally we'll also be making sure that any sterile supplies that we get from outside sources that the packaging is still intact and those items are still sterile before we start using them um in a more general term sense we're going to work on disinfecting so disinfection can it can happen anywhere in the hospital any facility in nursing in the offices um Extended Care facilities and Clinics disinfection is just a matter of wiping down surfaces using a disinfectant solution so it's just really important it's why you clean the ear pieces on the stethoscopes if you're going to be sharing them that's a disinfection process um again wiping down surfaces making sure patient areas are clean it's going to help cut down on the spread of pathogens on individual basis we're going to practice standard precautions around all patients and standard precautions consist of anti-ygiene respiratory hygiene and the use of a PPE when they're indicated and we'll talk about each of these in a little bit with coming slides a hand hygiene we've practiced in the lab we've talked about hand washing with soap and water we can also use alcohol-based hand cleansers in appropriate settings and your text readings talk about that and we'll look at that in a couple slides from now as well so along with standard precautions there are going to be times we're going to take TR or we're going to utilize transmission precautions so transmission precautions come into play when the disease process is very has a higher virulence it's very contagious it can spread easily and we know the method or mode of transmission that it prefers and we can take steps to break that part of the chain so the three main transmission precautions or isolation precautions that we would focus on are the contact the droplet and the Airborne and they sort of move up in the level of PPE that are involved because of the nature of the pathogens again all of these are based on starting out with standard precautions so again we've got the hand washing the respiratory hygiene happening before we even get into this so contact isolation we're looking at pathogens that are spread through direct contact quite often there exist in body fluids around the surface of the skin they may be in the blood so if we have any blood exposure exposure to the body's um body fluids um from the patient that may contain the passage and we want to block that so again along with hand washing PP at this point are going to be Glam gown and gloves and if the patients in isolation we're going to have dedicated equipment so we'll have stethoscopes blood pressure cuffs or blood pressure monitoring equipment that's going to stay in that room with that patient ideally if those things are taken out of the room they have to be wiped down and disinfected thoroughly before they go into another room but ideally we would keep that dedicated equipment in the room for use with just that patient for the length of the times they're there be aware normally hand washing or hand hygiene when we walk into the patient room can consist of soap and water or of the alcohol-based hand cleansers with certain um pathogens specifically C diff which is a GI infection the pathogen causing C diff does not is not broken down with alcohol-based hand cleanser so in that case we want the full use of soap and water in that physical scrubbing so again that will be specified on any rooms that have Specific Instructions so generally we're going to do hand hygiene again if it's a case of something like C diff and it's specified that hand hygiene has to be with soap and water otherwise alcohol-based hand cleansers will be acceptable for most others ask contact isolation then we move into droplet and droplet and Airborne are both cases where pathogens are spread from our respiratory system or at least our upper Airways so droplet precaution or droplet isolation situation is dealing with a pathogen that exists in our nose and mouth area and our sinuses quite often so that when we sneeze or cough they attach to large water droplets that come out with a sneezing cough and they will ride those until they come into contact with a potential host the droplets are large enough they usually fall off over after a distance of a several feet um so this is where a social distancing comes into place that is going to be sometimes be sufficient however if we're going to be inside that range that's a droplets would normally fall then we're going to add to our PPE so again we start out with universal or standard precautions we've added the gloves and the Gown we've got the dedicated dedicated equipment in the room at this point since it is now coming through the air on those droplets we are also going to wear a mask to protect us from breathing it in or having it come in contact with our upper Airway and possibly goggles or face Shields if we're going to be close enough that we have any concern about getting into our eyes so Mass goggles and face shield to protect our eyes Master protect our Airway and then all the standard PPE from contact isolation the mask in this case can be a basic surgical mask it's tightly woven enough that it will block the large droplets and that will in most cases be sufficient to block the pathogen from making its way to our upper Airways from droplet precautions we moved to airborne precautions in this case the pathogen goes on very small moisture particles that um we expel when we cough or sneeze or even talking and breathing and they're light enough that they can circulated around in the air so in this case we're going to do all the PPE from contact and droplet but instead of a surgical mask we're going to need to use a fit tested n95 respirator or if for some reason we're not able to wear a n95 respiratory respirator with a good fit we may go to a paper or a hood um type apparatus to protect us these patients then will also be in specialized rooms that tend to have negative pressure we want to make sure that those Airborne particles don't leave the room and go out into the hallway to circulate through the rest of the hospital or that the air that is uh you know moved out of that room through the normal through the normal vent ventilation system we want to block that to make sure that it is again negative pressure and anything coming out room is kept separate from the rest of the hospital and very important in this case that the patient is in private room and whenever possible that will be the status for any of the isolations in this case the patient's door needs to be kept closed to maintain that negative pressure and to also help block any Airborne passages from going outside the room and circulating and the number the Personnel that enter this room then are going to be um kept to a minimum again they're going to be people who are properly attired in their PPE they have a properly fitting n95 respirator or a paper hood on and they're only in for a long enough period to do what they need to do for the patient so those are the primary transmission precautions that we're going to focus on and again these are to protect us as caregivers and also to protect other patients there by making sure that we contain the pathogen to the room in the area where the infected patient is at there is another kind of isolation that you'll run into it's called reverse isolation reverse isolation is put into place not for our protection as caregivers or the patients around it's for the protection of the patient in the room these are patients who have who are at very high risk uh and susceptibility to any kind of pathogens so um a primary example would be a patient who's undergoing cancer treatment so the white blood cells and their immune system has effectively been knocked out or anybody who has an immune deficiency disease or Disorder so they can't Mount up an immune response we need to protect them so the reverse isolation is going to be gowns gloves masks um so very similar to the droplet precautions goggles or face Shields wouldn't be necessary but again the focus of reverse isolation is not our protection or the protection of the patients outside that room but it's for the protection of the patient that's in the room because they are very susceptible when we want to cut down um the potential of bringing any outside pathogens into that room again hand hygiene is uh probably the most important thing we can do to help cut the spread of infection and the spread of pathogens and it is necessary as part of universal or standard precautions as well as involved with all the transmission precautions so again the diagram this diagram from the readings talks about the five moments of hand hygiene so just be familiar with when is it appropriate when is it necessary and vital that we wash our hands as caregivers so again look over this material in the reading in the reading materials we've talked or and practiced and checked you off in the lab on hand washing with soap and water the information on your the left here is just a refocus of that so just be familiar again with those steps what are the essential parts of that and we've talked about the fact that it is also appropriate in probably most cases through the day to use an alcohol-based and what wash those instructions and the guidelines for that are also included in your reading so please spend some time looking over those guidelines both the steps critical aspects of it and those are covered on the the figure shown here on the slide that are from your text and also in the body of the slide you mentioned respiratory hygiene earlier and we've not really talked about it in lab but it's just the standard um behaviors and actions that we've all learned just in our involvement in any kind of a crowd or a gathering of people if you have to cover if you need to cough cover your mouth and your cough preferably with a tissue that we can dispose of then right away if we don't have a tissue available then coughing into our upper arm the sleeve of our upper arm is the next acceptable it's still not ideal but we want to keep from sneezing out into uh the air in general where those pathogens that we might have in our upper Airway can become airborne or followed on the droplets um anytime that we cough even when we use a tissue we want to make sure we cleanse our hands immediately afterwards again and hygiene becomes the most critical type thing respiratory hygiene involves covering our mouths when we cough if we have any symptoms of an upper respiratory infection or issues going on it was important that we take it upon ourselves to wear a mask when we're involved in patient care then again to help protect the patient from anything we might be carrying so even if it's just allergies but the patient doesn't know that for their psychological safety as well as physical physiological safety would be important for us to wear a mask when we're providing care yeah in terms of PPE again we've practice those in lab we've talked about the importance so please just review again the information from the reading materials on in the videos that are included on donning and Doffing gloves gowns masks go over the procedure that we've used in lab and then remember when would we use face Shields or goggles and where do they fit into the donning and Doffing process a last thing I want you to focus on from the readings is just the idea of or the steps um and general guidelines for sterile technique we talked about them briefly in lab when we had you working on donning and Doffing sterile gloves and opening up the sterile back of the four for the 4x4 gauze that type of thing but uh in this table from the reading again look over and just sort of summarize it in your mind what are the important or key concepts of sterilia essentially comes down to anytime anything sterile comes in contact with anything that's not sterile it is no longer sterile anytime there's any question whether something is sterile or not we assume it's not sterile anytime there's a suggestion that still really has been compromised even if we can't prove it we assume that it has so just look through these 10 steps Awards 10 guidelines and be familiar with it these are sort of the common rules of dealing with a sterile field and maintaining a sterile field and those are the key points of things we want to look at on infection control and as you move on into your clinical classes you get involved in clinical settings you're going to start working on these on a lot more detail and they'll be just part of your normal everyday practice As you move forward