*Some policies and procedures may be facility specific.
Health Care Acquired Infections
Nosocomial Infections are infections that patients obtain while in
There are 40 million hospital admissions annually
2 million patients develop hospital acquired infections and
Hospital acquired infections cost $4.5 billion annually
60% of Nosocomial Infections are caused by Drug Resistant
Chain of Events
Three Elements must be present for an infection to spread to
– Source of Pathogen – Causative Agent
– Susceptible Host – Patients and/or Care Providers
– Mode of Transmission - Transmission route for microorganisms
from person to person or object to person
Chain of Infection
Breaking The Chain
Infection control policies exist to help break the chain of events
that leads to the spread of infection.
Infection Control Activities Include:
Use of Personnel Protective Equipment
Occupational Exposure Plan
Handwashing is the most important activity you can do to prevent
the spread of infection.
15-20 seconds of friction
Rinse from wrist to fingertips
Turn faucet off with paper towel
Wash before and after each patient contact
Wash after removing gloves
Wash after using the restroom
Wash before eating
Alcohol handrinse should be used if hands are not visibly soiled
CDC advisory – do not wear artificial nails, tips, overlays or decorations
on nails for healthcare workers who have direct contact with patients
Do not wear old or chipped nail polish
Keep nails short-no longer than ¼ of an inch
Scientific studies indicate increased fungal and bacterial colonization in
healthcare workers with artificial nails
Currently there are two types of Isolation Precautions:
– Standard Precautions: Used when caring for all patients, also
known as Universal Precautions
– Transmission Based Precautions: Used in addition to standard
precautions for specific disease processes.
Standard or Universal Precautions
The Key Principle
Treat all Blood, Body Fluid, Secretions and Excretions as if potentially
infectious for HIV (the virus that causes AIDS), Hepatitis B,
Hepatitis C, or other blood borne pathogens
Hepatitis B, Hepatitis C and Human Immunodeficiency Virus
(HIV) are the most commonly known bloodborne pathogens.
The main ways to become infected with these pathogens is
through sexual contact and contact with blood and other body
Since we can’t look at a person and tell if they have HIV or HBV,
we have to treat everyone as if they are infected, and follow
standard precautions at all times.
The average risk of infection after accidental exposure is:
– HIV –0.3%
– HBV-5-30% - There is a HBV vaccine series that is available to
reduce healthcare workers risk of infection.
Wash hands between patient contact
Use Alcohol hand gel when hands are not visibly soiled
Use proper Personal Protective Equipment (PPE)
Clean up spills with proper technique and disinfectants
Never re-cap needles using two hands
Discard Sharps in approved puncture resistant containers only
Keep food away from possible infectious materials
Never pick up glass with bare hands
Identify places in your work area for eye and face washing if
Personal Protective Equipment
PPE is specialized clothing or equipment used to prevent exposure to health and
Gloves should be worn anytime you could potentially come in contact with blood,
body fluids or other potentially infectious materials
Gowns, Masks, Face Shield / Eyewear should be worn anytime a splash of body
fluids is possible
Any contaminated PPE should be disposed of properly in biohazard waste
PPE is supplied by the hospitals
PPE should be in the correct size
You should know where PPE is located
Gloves - latex free and powder free are available
Handling of Needles
Never recap needles using 2
Never bend or break needles
Dispose of all needles in
nearest sharp’s disposal
Replace sharps containers
when 2/3 – 3/4 full
Must use safety devices when
PPE – Wear gloves. Also gown and eye goggles if a large spill
Contain spill with paper towels or cover; clean with 1:10 fresh
bleach / water solution, or EPA approved germicidal cleaner
then place in red bag
Disinfect by applying 1:10 bleach / water solution ; let air dry
All used linens are to be put
in soiled linen containers /
bags without separating
The biohazard symbol should be used to identify anything or any area
that may present possible exposure to Blood and Body Fluids
Transmission Based Isolation
Contact Precautions – Used to reduce transmission of
microorganisms via the contact route. Examples include
Antibiotic Resistant Organisms
Droplet Precautions – Used to reduce transmission of
microorganisms by coughing, sneezing and talking. Examples
include Bacterial Meningitis, Flu, Mumps and Rubella.
Airborne Precautions – Used to reduce transmission via the
airborne route. Examples include TB, Smallpox, SARS and
Chicken Pox – Do not allow non-immune to go in this room
Protective Precautions – For immune-compromised patients
with less than 1000 white blood cells.
Follow Standard Precautions .
Follow instructions posted on the door.
Always wear gloves when entering the room.
Always wear gown when entering the room.
Patients with MRSA and Entercoccus are examples of patients
who should be placed in Contact Isolation.
Students must be supervised by their preceptor the first time
they enter a Contact Precautions room.
(Methicillin Resistant Staph Aureus)
MRSA is transmitted via direct contact between people or contaminated
S. aureus produces an ENZYME, betalactamase, which allows it to
become RESISTANT to penicillins
In 1960, Methicillin became available for treating penicillin resistant S.
S. aureus developed strains resistant to Methicillin and by the mid
1970’s MRSA became a problem
MRSA are resistant to many antibiotics, but can be treated with
Vancomycin, some VRSA (Vancomycin Resistant Staph Aureus) are
now being reported
Located in normal flora of the GI and female reproductive tract,
also transmitted via the contact route.
Third most common cause of hospital acquired infections.
Infection occurs in: urinary tract, wounds, central lines
VRE – Enterococcus has acquired vancomycin resistance
VRE – 70% from urinary site – nursing home residents
VRE – Reportable to state from sterile body sites
Risk Factors for Developing
Patients with extended length of stay
Patients with previous admissions
Overuse and misuse of antibiotics
Nursing home residents
Preventing The Spread of Drug Resistant
Wash hands between each patient contact
Place patient in Contact Isolation Precautions
Use and dispose of PPE correctly
Follow strict isolation technique
Use antibiotics appropriately
Follow Standard Precautions.
Follow Instructions Posted on the Door.
Wear an Isolation Mask if coming within 3-6 feet of the patient.
Some hospitals may require a mask upon entering the patient
Patients with the flu should be placed in Droplet Precautions.
Students must be supervised by their preceptor the first time
they enter a Droplet Precautions room.
10% to 20% of U.S. population will get the flu
36,000 will die, 114,000 will be hospitalized
Most who die will be over 65, but children younger that 2 will be
as likely as elderly to be hospitalized
Healthcare employee vaccination rate has been about 35%,
CDC goal is over 80%
Recommendation for flu vaccine
Young children <2 (6 months or younger not eligible)
Immunocompromised and/or with chronic disease
Healthcare worker taking care of or living with above
*Per CDC current data
Standard Precautions should be followed
Place patient in a negative pressure room
Door remains closed
Personnel entering room must wear an N95 Particulate Respirator
*Employees must be medically screened and fit tested to wear the
Due to the fit test requirement, students are not to enter the room of
patients in TB isolation.
Visitors/Family are encouraged to refrain from entry to the TB patient’s
room. If entry is elected these individuals are strongly encouraged to
wear an approved dust-mist mask, supplied by the hospital.
*Students have not been screened and fit tested and will not be allowed
to care for patients in Airborne Precautions.
Disseminated Herpes Zoster
SARS (Severe Acute Respiratory Syndrome)
One third of the world has been infected with TB
TB Infection: Body holds the germ in check, but PPD is positive
TB Disease: 10% of persons infected will develop active disease, half
within 2 years of exposure
Active disease is defined as having the bacteria, being contagious, and
symptomatic. A person can be infected with TB but not be
symptomatic or contagious.
40-50% of TB patients have a delayed diagnosis an average of 6 days
resulting in exposure of 25-45 workers for each undiagnosed patient
Health Care Workers should have annual PPD testing done
QUESTIONS to detect TB
Have you been coughing for over 3 weeks?
Have you been coughing at all and have any of the following:
a. Coughing up blood?
b. Sweats at night?
c. Loss of weight without trying?
d. Persistent fever?
Exposure Control Plan
OSHA requires that all hospitals develop an Exposure Control Plan
– Reduce your risk of exposure to blood and body fluids
– Provide the use of PPE (Personal Protective Equipment)
– Provide the use of Engineering Controls – ex. Negative pressure rooms
for TB patients, sharps disposal containers
– Provide a Hepatitis B vaccine program
– The plan is located in the Epidemiology Manual (Infection Control) in
Needlestick or Blood Exposure
“Actions to Take if Exposure Occurs”
First Aid – thoroughly wash area
If your eyes get splashed, flush them with water
Notify supervisor immediately
Notify Occupational/Employee Health
Complete Needlestick/Exposure forms- this will allow for testing
of the source patient
HIV source - begin post -exposure prophylaxis within 2 hours