Infection Control. Infection Control. Infection Control. Disease. Infection

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1 Disease Any deviation or interruption of the normal structure or function of any part, organ, or system of the body Caused by microbes Absence of health HCPs need to understand infectious diseases and how they are spread and controlled Infection Growth of a microbe in a host resulting in illness Caused by pathogenic organisms Hospitals are : gathering place for the sick breeding ground for germs easy transmission due to frequent close contact Employees have a professional duty to follow infection control policies Promotes safety yours, patients, co-workers, visitors 1

2 Hospital acquired infections (HAI) previously eradicated infections are returning (measles, whooping cough, diphtheria) new diseases are being discovered (ESBL, flu strains) developing resistance to treatment (MRSA, VRE) Micro-organisms too small to be seen by the naked eye bacteria, viruses, protozoa, prions, fungi Most micro-organisms are necessary for our well being Most micro-organisms do not cause infections (normal flora) skin, digestive tract, mucous membranes Protect from other diseases Good bacteria vs. bad bacteria Micro-organisms that cause infection = pathogen Colonized vs Infected Carry bacteria without evidence of infection (fever, increased WBC) are colonized Once infected and treated bacteria become dormant Dormant bacteria can be transmitted from one patient to another Usually by the hands/equipment of health care workers 2

3 Types of Pathogens Bacteria Viruses Fungi Parasitic protozoa Bacteria Small single cell organisms Grow independently/reproduce without a host Classified according to shape: cocci, bacilli, spiral/spirochetes Dye is used to determine : gram ( ) or gram (+) Stained and heated to determine acid fast or non acid fast Aerobic vs. anaerobic vs. facultative Cell wall is essential for survival Antibiotics are used to attack and destroy the cell wall Bacteria Staphylococcus and streptococcus = gram + cocci MRSA, strep throat, necrotizing fasciitis E. Coli = gram bacillus infectious diarrhea, vaginal infections Tuberculosis = acid fast bacillus Adapt to new conditions easily and become resistant to antibiotics 3

4 Sub-cellular organisms Viruses Smallest disease causing organisms Viewed only with electron microscope Contain genetic material (DNA/RNA) Covered with a lipoprotein that has spikes so they can attach to a host HIV, influenza, Hepatitis B Viruses Cannot survive independently Attach to host cells that have a specificity Hepatitis liver Influenza respiratory tract HIV lymphatic system Difficult to create antiviral drugs that are not toxic to the host cells Relatively few antiviral agents exist Epstein Barr - mononucleosis, chronic fatigue syndrome Varicella herpes zoster, chicken pox Fungi (fungus) Single cell are typically yeast which reproduce by forming buds Multi cell chains are typically mold which reproduce by forming spores Over 100,000 diverse species (most common are yeast and mold) Most serve useful purposes cheese, breads, antibiotics, alcohol Decompose plants and animals to fill the soil with nutrients 4

5 Can be destructive erode wood and leather Fungi (fungus) Cause infections athletes foot and ringworm Opportunistic infections (immunosuppressed patients) pneumocystis carinii pneumonia and candidiasis Protozoa Complex single cell organisms Generally live in the environment Some are parasitic and live in a host Most will produce some form of resistant strain Complicated lifestyles traveling back and forth between hosts and infected vectors Malaria Protozoa Infect the GI tract, GU tract, respiratory and circulatory system Amebiasis and guardiasis (GI tract) diarrhea Trichomoniasis (GU tract) causes discharge from penis or vagina (STD) Toxoplasmosis (blood, lymphatic, and neurological systems) found in cat feces and undercooked meats can affect any of these systems 5

6 Establishing an Infection Encounter Entry Spread Multiplication Damage Outcome Encounter: infectious organism comes in contact with a host Entry: Access to the organism thru a portal of entry nose, eyes, mouth, ears, blood, vagina, penis, wound, GI/GU etc Spread/Multiplication: Infectious organism travels through body and multiplies Overcomes body s immune defenses Damage: Either direct or indirect Causes tissue and cell death by activating inflammatory and immune responses Outcome Results in any of three outcomes: Host gains control and eliminates microbe Microbe overcomes host s immunities - causes disease Host and microbe compromise and live in a symbiotic state 6

7 Most organisms are fragile Require moisture, nutrients, right temperature to exist Some pathogens mutate to adapt to environment Some pathogens are resistant to extremes Spores: tetanus, anthrax, botulism Viruses: herpes (both oral and genital) HCW are exposed to numerous pathogens every day in-patients, out-patients, visitors, and co-workers carry germs Increase your susceptibility when resistance is low stress, fatigue, poor nutrition Take care of yourself its your best defense (and hand hygeine) External Defense Against Infection Mechanical barriers such as clothing, dressings, and gloves Normal Microbial Flora Hand washing Antibiotics Immunizations/Vaccines 7

8 Protected from pathogens: Body s Defense Against Infection natural resistance immune system (intact skin, cilia, chemicals) acquired resistance immunization series, active immunity short term passive immunity (Rabies, flu, pneumonia, tetanus) weaken over time New and once eradicated diseases are emerging in epidemic numbers HCW are on the front line department protects employees, patients, visitors Participate in research and develop policy based on recommendations CDC (Center for Disease Control) national WHO (World Health Organization) - international Infectious Diseases Diseases travel just as fast as humans Travel into areas previously not ventured carry infection back International sales big culprit New strains are mutated mostly due to overuse of abx Breakdown in public health standards Bioterrorism Hantavirus, dengue fever, rotavirus, swine flu USA Cholera South America, Africa Diphtheria - Russia 8

9 Nosocomial Infections (HAI) 2 million hospitalized patients acquire annually About 90,000 will die from complications of the infection Pay for performance ALL ARE PREVENTABLE!!!! Community Acquired vs Hospital Acquired Age Risk Factors for Infection Heredity Nutritional status Stress Inadequate rest or exercise Health history/personal lifestyle/habits Inadequate defenses Routes of Transmission Air Droplet Contact Transmission may be exogenous or endogenous 9

10 Blood Borne Pathogens Disease-causing microorganisms present in human blood Considered nosocomial Two types are of concern in hospital setting: HIV (human immunodeficiency virus) HBV (hepatitis B virus) HIV Virus specifically infects immune system in host Responsible for acquired immunodeficiency syndrome (AIDS) Symptoms: weight loss, muscle/joint pain, glandular pain/swelling, night sweats May be asymptomatic after exposure to HIV for as long as 10 years May take up to 1 year for results of blood test to become positive for HIV antibodies Can be controlled with behavior changes and antiviral drugs Occurrence is on the rise again d/t heroin abuse HBV Primarily affects liver, results in swelling, soreness, and loss of normal function Symptoms: weakness, fatigue, anorexia, nausea, abdominal pain, fever, and headache Leads to yellow skin color (jaundice) May be asymptomatic Blood will test positive 2 to 6 weeks after symptoms develop Can recover in 6 to 8 weeks, but blood test will always show they were exposed 10

11 Typically includes hand hygiene with gloves (gown, mask, goggles when appropriate) Used when you may have contact with blood, body fluids, mucous membranes, and wounds Practice biosafety in medical imaging Standard Precautions Hand Hygiene Must be performed before and after each patient Can always find examples of poor technique Rarely can be traced back to a culprit May have hygiene police in your facility Easiest most effective way to prevent spread of infection do not practice what we preach not enough sinks, soap dries skin, too busy, lack of role models Waterless Soaps Golf ball size dollop 15 seconds of vigorous rub Air dry do not wipe off Portability is a plus Not effective for Cdif, noro virus, or anthrax 11

12 Visibly soiled hands should be washed with soap and water Gloves should always be worn Hand hygiene after removing Artificial nails prohibited ¼ tip no longer Handling Contaminated Waste Good housekeeping Clean equipment Clean linen Fold or ball up linen Use approved receptacles Avoiding Spread Most items are patient specific bedpans, urinals, commodes, basin IV poles, BP cuff, thermometers should be cleaned Disposable items should be discarded Blood and body fluids go into a biohazard container Needle safety Specimens secure tightly, label, transport appropriately 12

13 Xrays of Isolation Patients Patients feel rejected/untouchable Express a friendly interest Avoid displays of fear or repulsion Typically requires two people (one clean and one dirty) Prepare the room Prepare yourself References 13