RET 1024 Introduction to Respiratory Therapy Module 3.0 Infection Control.

RET 1024RET 1024Introduction to Respiratory Introduction to Respiratory TherapyTherapy

Module 3.0Module 3.0

Infection ControlInfection Control


Nosocomial Infection;Nosocomial Infection;

An infection acquired after An infection acquired after hospitalization hospitalization

- AKA: - AKA: hospital-acquired infectionhospital-acquired infection


Nosocomial Infection;Nosocomial Infection;

Account for an estimated 2 million Account for an estimated 2 million infections and 90,000 excess deaths infections and 90,000 excess deaths annuallyannually


Nosocomial InfectionNosocomial Infection Infections acquired by those in the Infections acquired by those in the

intensive care unit (ICU) account for >20% intensive care unit (ICU) account for >20% of all HAIs of all HAIs (CDC 2007)(CDC 2007) Immunocompromised by disease and/or treatmentImmunocompromised by disease and/or treatment Major traumaMajor trauma Respiratory failureRespiratory failure Myocardial infarctionMyocardial infarction CHFCHF OverdoseOverdose


Nosocomial InfectionNosocomial Infection Approximately 25% of patients undergoing Approximately 25% of patients undergoing

mechanical ventilation develop pneumonia mechanical ventilation develop pneumonia as a complicationas a complication


Nosocomial InfectionNosocomial Infection Approximately 30% of patients who Approximately 30% of patients who

develop ventilator-acquired pneumonia develop ventilator-acquired pneumonia (VAP) will die(VAP) will die


Nosocomial InfectionNosocomial Infection Historically, non-disposable respiratory Historically, non-disposable respiratory

equipment was identified as a major cause equipment was identified as a major cause of respiratory infectionof respiratory infection


Nosocomial InfectionNosocomial Infection Today, procedures have evolved, and with Today, procedures have evolved, and with

the advent of single-patient use equipment, the advent of single-patient use equipment, infections associated with respiratory infections associated with respiratory equipment have decreased significantlyequipment have decreased significantly


Nosocomial InfectionNosocomial Infection Healthcare workers must remain vigilant to Healthcare workers must remain vigilant to

protect their patients and themselves protect their patients and themselves against infection; to do so, requires strict against infection; to do so, requires strict adherence to infection control proceduresadherence to infection control procedures


Infection control procedures aim to:Infection control procedures aim to:

Eliminate the sources of infectious agentsEliminate the sources of infectious agents

Create barriers to their transmissionCreate barriers to their transmission

Monitor and evaluate the effectiveness of Monitor and evaluate the effectiveness of controlcontrol


Spread of InfectionSpread of Infection Infection occurs when a pathogen Infection occurs when a pathogen

overcomes the barrier of the hostovercomes the barrier of the host

Pathogen; Pathogen; a microorganism capable of a microorganism capable of producing a diseaseproducing a disease

Host; Host; an organism in which another, usually an organism in which another, usually parasitic, is nourished and harboredparasitic, is nourished and harbored


Spread of InfectionSpread of Infection Three elements needed to spread an Three elements needed to spread an

InfectionInfection Source of pathogensSource of pathogens Route of transmissionRoute of transmission Susceptible hostSusceptible host


Source of PathogensSource of Pathogens PeoplePeople

Patients, personnel, visitorsPatients, personnel, visitors Acute disease with symptomsAcute disease with symptoms Incubation period (exposed, but no Incubation period (exposed, but no

symptoms yet)symptoms yet) Colonized by pathogens without Colonized by pathogens without

symptomssymptoms Autogenous infection (originating from Autogenous infection (originating from

within the body)within the body)


Source of PathogensSource of Pathogens Contaminated objectsContaminated objects

EquipmentEquipment

LinenLinen

MedicationMedication


Transmission RouteTransmission Route ContactContact DropletDroplet AirborneAirborne Common vehicleCommon vehicle VectorborneVectorborne

NOTE: NOTE: Some organisms may be spread by multiple Some organisms may be spread by multiple routesroutes


Contact TransmissionContact Transmission Direct Contact

Body-surface-to-body-surface contact (person-to-Body-surface-to-body-surface contact (person-to-person)person)

Indirect ContactIndirect Contact Contaminated object (fomite) to host contactContaminated object (fomite) to host contact

Clothing (uniforms, lab coats, isolation gowns)Clothing (uniforms, lab coats, isolation gowns) EquipmentEquipment DressingsDressings InstrumentsInstruments Shared toysShared toys


Droplet TransmissionDroplet Transmission Contaminated respiratory dropletsContaminated respiratory droplets

Discharged into the air (up to 10 feet) during:Discharged into the air (up to 10 feet) during: Coughing, sneezing, talkingCoughing, sneezing, talking Suctioning, bronchoscopy, intubation, Suctioning, bronchoscopy, intubation,

cough inductioncough induction Deposited on the host’s mucosal surfacesDeposited on the host’s mucosal surfaces

Nasal mucosaNasal mucosa MouthMouth


Droplet TransmissionDroplet Transmission Contaminated respiratory dropletsContaminated respiratory droplets

Currently Currently Health Care Infection Control Health Care Infection Control practices Advisory Committee (HICPAC) practices Advisory Committee (HICPAC) guidelines state it may be prudent to don a guidelines state it may be prudent to don a mask when within 6 feet of the patient or mask when within 6 feet of the patient or upon entry into the room of a patient who is upon entry into the room of a patient who is on droplet isolationon droplet isolation


Droplet TransmissionDroplet Transmission

Haemophilus InfluenzaeHaemophilus Influenzae Pneumonia / EpiglotitisPneumonia / Epiglotitis

Influenza virusInfluenza virus

Rubella (German measles)Rubella (German measles)


Airborne TransmissionAirborne Transmission Contaminated droplet nucleiContaminated droplet nuclei

Residue of evaporated water droplets containing Residue of evaporated water droplets containing infectious microorganisms infectious microorganisms Can remain suspended in air for long periodsCan remain suspended in air for long periods Respirable particles of less than Respirable particles of less than 5 5 mm

Dust particlesDust particles Act as fomitesAct as fomites


Airborne TransmissionAirborne Transmission

Mycobacterium tuberculosis (TB)Mycobacterium tuberculosis (TB) Rubeola (Measles)Rubeola (Measles) Varicella-zoster (Chicken Pox)Varicella-zoster (Chicken Pox)

Note:Note: Special air handling and ventilation, as Special air handling and ventilation, as well as respiratory protection are required well as respiratory protection are required

Mycobacterium Tuberculosis


Common Vehicle TransmissionCommon Vehicle Transmission Pathogens in water and foodPathogens in water and food

FoodFood SalmonellosisSalmonellosis Hepatitis AHepatitis A

WaterWater ShigellosisShigellosis CholeraCholera

Medications (e.g., heparin solution)Medications (e.g., heparin solution)


Vectorborne TransmissionVectorborne Transmission Animals or insects transfer pathogensAnimals or insects transfer pathogens

MalariaMalaria West Nile VirusWest Nile Virus RabiesRabies

Note:Note: Vectorborne transmission are of little Vectorborne transmission are of little significance in hospital-acquired infectionssignificance in hospital-acquired infections


Spread of Infection to the LungsSpread of Infection to the Lungs Pathogens enter the lungs via:Pathogens enter the lungs via:

Aspiration of contaminated - Aspiration of contaminated - Oropharyngeal secretionsOropharyngeal secretions Gastric secretionsGastric secretions

Inhaled droplets, droplet nuclei, or dust Inhaled droplets, droplet nuclei, or dust particles containing pathogens (fomites)particles containing pathogens (fomites)

HematogenousHematogenous Via the bloodVia the blood


HostHost Host infection dependent upon:Host infection dependent upon:

Virulence of the organismVirulence of the organism

Resistance of the host Resistance of the host


HostHost Increased susceptibility:Increased susceptibility:

Diabetes mellitusDiabetes mellitus LymphomaLymphoma LeukemiaLeukemia NeoplasiaNeoplasia Those treated with:Those treated with:

Corticosteroids, irradiation, certain Corticosteroids, irradiation, certain antimicrobials, immunosuppressive agentsantimicrobials, immunosuppressive agents


HostHost Increased susceptibility:Increased susceptibility:

AgeAge Chronic diseaseChronic disease ShockShock ComaComa Traumatic injuryTraumatic injury Surgical procedureSurgical procedure


HostHost Most nosocomial pneumonias occur in surgical Most nosocomial pneumonias occur in surgical

patients, especially those who have had chest patients, especially those who have had chest or abdomen proceduresor abdomen procedures Clearance mechanisms impairedClearance mechanisms impaired

Bacterial enters lower airwayBacterial enters lower airway

IntubationIntubation AnesthesiaAnesthesia Surgical painSurgical pain Narcotics and sedativesNarcotics and sedatives


HostHost Surgical Patients with Highest Risk of PneumoniaSurgical Patients with Highest Risk of Pneumonia

ElderlyElderly Severely obeseSeverely obese COPDCOPD History of smokingHistory of smoking Those with artificial airwaysThose with artificial airways

Endotracheal / Tracheostomy tubesEndotracheal / Tracheostomy tubes


Infection Control StrategiesInfection Control Strategies Infection control aims to break the chain of Infection control aims to break the chain of

events causing the spread of infectionevents causing the spread of infection


Infection Control StrategiesInfection Control Strategies

1.1. Decrease host susceptibilityDecrease host susceptibility

2.2. Eliminate the source of pathogensEliminate the source of pathogens

3.3. Interrupt the transmission routesInterrupt the transmission routes


Decrease host susceptibilityDecrease host susceptibility Hospital efforts focus on employee Hospital efforts focus on employee

immunization and chemoprophylaxisimmunization and chemoprophylaxis


Decrease host susceptibilityDecrease host susceptibility ImmunizationsImmunizations

Hepatitis BHepatitis B Varicella (chicken pox)Varicella (chicken pox) Rubella (German measles)Rubella (German measles) Measles Measles Pertussis (Whooping cough)Pertussis (Whooping cough)

When working with infants and childrenWhen working with infants and children

InfluenzaInfluenza


Decrease host susceptibilityDecrease host susceptibility ChemoprophylaxisChemoprophylaxis

Postexposure TreatmentPostexposure Treatment Bordetella pertussis (whooping cough)Bordetella pertussis (whooping cough) Neisseria meningitis (meningococcal meningitis)Neisseria meningitis (meningococcal meningitis) Bacillus anthracis (anthrax)Bacillus anthracis (anthrax) Influenza virusInfluenza virus HIVHIV Group A streptococciGroup A streptococci


Eliminating Source of PathogensEliminating Source of Pathogens Procedure to remove pathogens from the Procedure to remove pathogens from the

environment fall into two major categoriesenvironment fall into two major categories

General SanitationGeneral Sanitation

Specialized Equipment ProcessingSpecialized Equipment Processing


Eliminating Source of PathogensEliminating Source of Pathogens General SanitationGeneral Sanitation

Help keep overall environment cleanHelp keep overall environment clean Sanitary laundry managementSanitary laundry management Sanitary food preparationSanitary food preparation Sanitary housekeepingSanitary housekeeping Environmental control of the airEnvironmental control of the air

Specialized ventilation systemsSpecialized ventilation systems Environmental control of the waterEnvironmental control of the water


Eliminating Source of PathogensEliminating Source of Pathogens Specialized equipment handlingSpecialized equipment handling

Decontamination of equipment capable of Decontamination of equipment capable of spreading infectionspreading infection CleaningCleaning DisinfectionDisinfection Sterilization Sterilization


Specialized Equipment HandlingSpecialized Equipment Handling CleaningCleaning

Removes dirt and organic material from Removes dirt and organic material from equipment, usually by washingequipment, usually by washing Failure to do this will render subsequent processing Failure to do this will render subsequent processing

ineffective !!!ineffective !!! Should be done in a designated “Dirty” areaShould be done in a designated “Dirty” area


Specialized Equipment HandlingSpecialized Equipment Handling CleaningCleaning

Soaps, detergents, or enzymatic cleaners Soaps, detergents, or enzymatic cleaners should be usedshould be used Some contain germicideSome contain germicide Automated washers availableAutomated washers available

(pasteurization / chemical disinfection cycle)(pasteurization / chemical disinfection cycle)

Must be rinsed and driedMust be rinsed and dried Reassembled asepticallyReassembled aseptically

Designated “Clean” areaDesignated “Clean” area


Specialized Equipment HandlingSpecialized Equipment Handling DisinfectionDisinfection

Destroys the vegetative form of pathogens on Destroys the vegetative form of pathogens on inanimate objects except bacterial sporesinanimate objects except bacterial spores Physical methodsPhysical methods Chemical methodsChemical methods


Specialized Equipment HandlingSpecialized Equipment Handling Physical DisinfectionPhysical Disinfection

PasteurizationPasteurization Submersion in a water bath at temperatures below Submersion in a water bath at temperatures below

boiling (70boiling (70 C) for 30 minutes C) for 30 minutes Kills vegetative bacteria and most virusesKills vegetative bacteria and most viruses Does not kill bacteria sporesDoes not kill bacteria spores


Specialized Equipment HandlingSpecialized Equipment Handling Chemical DisinfectionChemical Disinfection

Low-LevelLow-Level

IntermediateIntermediate

High-LevelHigh-Level


Specialized Equipment HandlingSpecialized Equipment Handling Low-Level DisinfectantsLow-Level Disinfectants

Kills most bacterial, some viruses and fungiKills most bacterial, some viruses and fungi

Will not kill Mycobacterium tuberculosis (TB) Will not kill Mycobacterium tuberculosis (TB) spores and nonlipid virusspores and nonlipid virus


Specialized Equipment HandlingSpecialized Equipment Handling Low-Level DisinfectantsLow-Level Disinfectants

Acetic acidAcetic acid Mostly used for homecare equipment Mostly used for homecare equipment

(1:3 white vinegar/water solution )(1:3 white vinegar/water solution )

Quaternary ammoniumsQuaternary ammoniums Hospital use – surface disinfection, e.g., floors, Hospital use – surface disinfection, e.g., floors,

countertops, walls, etc.countertops, walls, etc.


Specialized Equipment HandlingSpecialized Equipment Handling Intermediate DisinfectantsIntermediate Disinfectants

Kills all vegetative bacteria and fungi, but have Kills all vegetative bacteria and fungi, but have variable activity against spores and certain variable activity against spores and certain virusesviruses



Alcohol Alcohol (70% Ethyl, 90% Isopropyl) (70% Ethyl, 90% Isopropyl) Not sporicidalNot sporicidal Surface disinfectant, e.g., stethoscopes, ventilators, Surface disinfectant, e.g., stethoscopes, ventilators,

etc.etc.

PhenolicsPhenolics Not sporicidalNot sporicidal Surface disinfectantSurface disinfectant

(added to detergents to enhance germicidal activity)(added to detergents to enhance germicidal activity)



Iodophors (iodine + surace-active organic Iodophors (iodine + surace-active organic compounds)compounds) Used on skin and tissueUsed on skin and tissue


Specialized Equipment HandlingSpecialized Equipment Handling High-Level DisinfectantsHigh-Level Disinfectants

GlutaraldehydeGlutaraldehyde

Hydrogen peroxideHydrogen peroxide

Peracetic acidPeracetic acid

Chlorine (sodium hypochlorite)Chlorine (sodium hypochlorite)



Glutaraldehyde (Trade name: CIDEX)Glutaraldehyde (Trade name: CIDEX) Kills vegetative bacteria, Mycobacterium Kills vegetative bacteria, Mycobacterium

turburculosis, fungi, viruses and spores in <10 turburculosis, fungi, viruses and spores in <10 minutesminutes

Commonly used to disinfect/sterilize Commonly used to disinfect/sterilize endoscopes, endoscopes, e.g., fiber optic bronchoscopes,e.g., fiber optic bronchoscopes, respiratory care respiratory care equipment, and spirometry tubingequipment, and spirometry tubing



Hydrogen PeroxideHydrogen Peroxide 6% solution is bactericidal, fungicidal, viricidal in 10 6% solution is bactericidal, fungicidal, viricidal in 10

minutes,minutes, Sterilizes (sporicidal) in 6 hoursSterilizes (sporicidal) in 6 hours Does not produce harsh fumesDoes not produce harsh fumes



Peracetic acidPeracetic acid Kills all microorganisms, including sporesKills all microorganisms, including spores



Sodium HypochloriteSodium Hypochlorite 1:50 dilution kills vegetative bacteria, bacterial 1:50 dilution kills vegetative bacteria, bacterial

spores, and Mycobacterium tuberculosis in 10 spores, and Mycobacterium tuberculosis in 10 minutesminutes

1:10 dilution used to clean blood spills1:10 dilution used to clean blood spills


Specialized Equipment HandlingSpecialized Equipment Handling SterilizationSterilization

Complete destruction of all forms of microbial Complete destruction of all forms of microbial lifelife


Specialized Equipment HandlingSpecialized Equipment Handling SterilizationSterilization

IncinerationIncineration Dry heatDry heat BoilingBoiling AutoclavingAutoclaving Ionizing radiationIonizing radiation Ethylene oxideEthylene oxide


Specialized Equipment HandlingSpecialized Equipment Handling Steam Sterilization (Autoclaving)Steam Sterilization (Autoclaving)

Steam under pressureSteam under pressure Commonly 15 psi at 121Commonly 15 psi at 121 C for 15 minutes C for 15 minutes Equipment must be cleaned and wrapped in muslin, Equipment must be cleaned and wrapped in muslin,

linen, or paperlinen, or paper Most respiratory equipment can be damaged by this Most respiratory equipment can be damaged by this

processprocess


Specialized Equipment HandlingSpecialized Equipment Handling Ethylene Oxide (EtO)Ethylene Oxide (EtO)

Toxic gasToxic gas Equipment must be cleaned and wrapped in muslin, Equipment must be cleaned and wrapped in muslin,

paper, or polyethylene using EtO indicator tapepaper, or polyethylene using EtO indicator tape Acute exposure may cause:Acute exposure may cause:

Airway inflammationAirway inflammation NauseaNausea DiarrheaDiarrhea HeadacheHeadache DizzinessDizziness ConvulsionConvulsion


Specialized Equipment HandlingSpecialized Equipment Handling Equipment Handling ProcedureEquipment Handling Procedure

Equipment handling procedures help Equipment handling procedures help prevent the spread of pathogensprevent the spread of pathogens Will be covered in LabWill be covered in Lab

RET 1024 Introduction to Respiratory Therapy Module 3.0 Infection Control.

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Transcript of RET 1024 Introduction to Respiratory Therapy Module 3.0 Infection Control.