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Updated: Nov 4 2021

Infection Prevention

  • 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. Chlorhexidine-alcohol solutions significantly decrease the risk for central line associated bloodstream infections (CLABSI).
        • 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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