Updated: 6/14/2019

Infection Prevention

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Introduction
  • Introduction
    • there is a high risk of transmission of pathogens causing infections in the healthcare setting
    • techniques to prevent health-care associated infection in patients, healthcare providers, and other hospital staff
      • standard precautions
        • hand hygiene
        • personal protective equipment (PPE)
        • respiratory hygiene etiquette
        • safe injection and sharps practices
      • disinfection/cleaning
      • sterilization of hospital equipment
      • isolation precautions
    • key terms
      • sterilization
        • to kill or eliminate all pathogens
        • e.g., autoclave process
      • disinfection
        • to eliminate or neutralize pathogens to reduce possible contamination to a safe level
        • e.g., hand washing
Standard Precautions
  • Hand hygiene
    • handwashing with soap and water
      • more dehydrating with repeated use
      • drying with paper towels reduces the total number of bacteria on hands
    • disinfecting agents (often alcohol-based)
      • risk of contact dermatitis and irritation
    • artificial nails should not be present
  • PPE
    • should be worn when hospital staff are exposed to any body secretions
      • gloves
      • masks
      • safety glasses/face shield
      • gowns
  • Respiratory hygiene etiquette
    • covering nose and mouth while coughing
    • hand hygiene after contact with any respiratory secretions
    • using mask as needed
  • Safe injection and sharps practices
    • prompt and safe disposal of sharps
Disinfection
  • Skin or mucous membranes
    • alcohol
      • prior to puncturing the skin with a needle
      • dissolves lipid bilayer membranes and denatures proteins
      • ineffective against protozoan oocysts, some nonenveloped non-lipophilic viruses, and bacterial spores
    • chlorhexidine
      • disinfection of hands prior to surgery
      • prep a body area for a procedure
      • wound cleaning
    • iodine
      • wound cleaning or prevention of infection
  • Surfaces
    • aldehydes, halogens, hydrogen peroxide, and halogens
      • denatures cell components
      • effective against spores and all viruses
Sterilization
  • Sterilization techniques are used to kill or eliminate all pathogens, including its spores, on equipment, e.g., surgical instruments that come into contact with sterile body parts or fluids
  • Autoclave
    • direct high-pressure steam at > 121°C
      • denatures enzymes and proteins in pathogens
    • not effective against prions
      • prions must be sterilized at higher temperatures for longer periods of time
    • most commonly used
  • Dry heat or “oven” sterilization
    • temperatures of 150-170°C
      • denatures and oxidizes cell parts
    • used only on instruments made of metal or glass
  • Chemical sterilizing agents
    • aka “cold sterilization”
      • ethylene oxide gas
        • alkylation of proteins and genetic material
        • spores may resist this process
      • hydrogen peroxide gas plasma
        • free radical damage to cell parts
    • used when autoclave and dry heat cannot be used for heat- and moisture-sensitive instruments
  • Radiation
    • not commonly used
Isolation Precautions
  • Contact precautions
    • for patients with multi-drug resident (MDR) pathogens
    • gowns and gloves for all hospital staff
    • medical equipment should be dedicated to the single patient
  • Droplet precautions
    • droplets: respiratory secretions ≥ 5 microns
    • surgical mask
  • Airborne precautions
    • airborne droplet nuclei: respiratory secretions < 5 microns
    • respirator mask with 95% filtering capacity
      • requires a fit testing to ensure tight seal over nose and mouth

Pathogens with Specific Isolation Precautions
Contact Precautions
Droplet Precautions
Airborne Precautions
  • MDR bacteria
    • MRSA
    • VRE
  • Enteric infections
    • norovirus
    • E. coli
  • Viruses
    • VZV
    • HSV
    • RSV
    • parainfluenza
    • enterovirus
    • rhinovirus
  • Scabies
  • Skin and soft tissue infections
    • S. aureus
    • group A streptococcus
  • Bacteria
    • Neisseria meningitides
    • Mycoplasma pneumoniae
    • Haemophilus influenzae type B
    • Bordetella pertussis
    • group A streptococcus
    • Diphtheria
  • Viruses
    • influenza
    • rubella
    • mumps
    • adenovirus
    • rhinovirus
    • parvovirus B19
  • Tuberculosis
  • VZV
  • Measles
  • Smallpox
  • SARS
  • Ebola virus

 

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