Infection Control
Objectives:

After you take this class, you will be able to:

1. List some of the reasons why residents and patients are at risk for getting infections.
2. Discuss the cycle of infection and ways that you can break the cycle.
3. Detail the components of standard precautions and transmission precautions.
4. Describe specific ways to prevent the spread of infection, including handwashing, the proper use and disposal of gowns, gloves, masks, eye protection, handling hazardous waste and sharps, patient care supplies and equipment handling and environmental controls.

What is Infection Control?


Infection control helps hospitals, nursing homes, assisted living homes and other places where healthcare is provided. It stops the spread of infection, or germs, to patients, residents, staff and visitors.
We can all help control infections by doing special things in these areas:

• The environment. We can all help to keep the patient rooms clean and sanitary. Clean rooms and a clean hospital or nursing home spread less germs.
• Equipment and supplies. We must use sterile dressings on open skin surfaces to prevent infection. We must also keep patient equipment and supplies clean in order to prevent the spread of germs.
  
  
• Our work practices. All healthcare workers must make infection control a part of everything we do. We must use standard precautions. We must wash our hands and we must do several other things while we work in order to stop the spread of germs from one person to another. We must make infection control a part of everything we do.
• Our own state of health. Healthcare workers who come to work with a cold or flu can spread it to their patients. We must get enough rest, a good diet and the hepatitis B shot so that we can stay well and work without harming the ones we care for. We should also stay home when we have a bad cold, flu or another illness that our patients can catch from us.
• Our patients' and residents' state of health. Many older people and those with a history of breathing problems get the pneumonia and flu vaccines to protect them against these common illnesses.

Why Are Infections A Big Problem in Hospitals and Nursing Homes?
Infections are a big problem in hospitals and nursing homes for many reasons. They are a problem because:

• We do not know when we are spreading germs. We cannot see them. They are very, very, very tiny and cannot be seen.
• People in hospitals and nursing homes are at great risk of getting an infection. Also, infections can spread very quickly in hospitals and nursing homes.
• They cause deaths, longer lengths of stay and they cost a lot of money.

Germs are very tiny. We cannot see them with our eyes as we work.
Germs are all over the world. They are found all over and in our own bodies. Some germs are good for us. These good germs keep us healthy. For example, we have good germs in our intestines that help us digest food and prevent other infections.
Many other germs can cause great harm and illnesses. Harmful germs that can make people ill are called "pathogens". They cause infections and diseases. They can cause wound infections, colds, pneumonia, AIDS/HIV and other diseases. Many of these diseases can cause serious harm and even death. These illnesses can be passed from one person to another without the person knowing that they are spreading it because these germs are very tiny and small. We cannot see them.
Invisible germs from our hands will grow and multiply in a couple of days if we rub our hand with a cotton swab and then wipe it on a special dish with food to grow. After a couple of days, we can put some of these grown germs under the microscope to see exactly what they are.


Germs will grow and multiply when they are fed and given a good place to live and grow. Nursing assistants and other healthcare workers can stop the growth of germs by taking away the things that feed germs and help them to grow. Germs like moisture and darkness. They grow very well when they are wet and kept in the dark.
Germs also like the food we eat. Leftover food on the patient’s tray is more than enough food to grow germs. We can help in our battle against germs by keeping patients and their environment clean, dry and bright with light.
We can see dirt on our hands, but we cannot see germs on our hands. Handwashing is the best way to rid our hands of germs that we cannot see. Infection control must be a part of EVERYTHING we do.

People in hospitals and nursing homes are at great risk of getting an infection
Infections spread very quickly in hospitals and other healthcare places for a couple of reasons. They spread quickly because people in hospitals are ill and very often weak. People that are ill and weak get infections because they are not able to fight it off as well as well as they could if they were healthy and well. 

People in hospitals and nursing homes are also at risk for getting infections because they all live together in one area, rather than their own homes. Germs and disease can spread very quickly from one sick patient or resident to another when people live in a large group.
Our patients are also at risk for infection because they may have a weak and poor immune system. This makes them less able to fight off an infection. A disease, like AIDS/HIV, the common cold or the flu, some medications, old age and being an infant, can cause this weakness.

It is necessary that nursing assistants and other healthcare workers follow special infection control measures and restrict traffic in areas where there are infants, older people and very ill people. Some of these areas are the:

• labor and delivery room,
• infant nursery,
• new mothers area,
• special care units, like the ICU,
• kidney areas where people are more prone to infection,
• surgical care area and
• operating room where skin surfaces are broken with surgery

Infections Cause Deaths, Longer Lengths of Stay and a Lot of Money
According to the U.S. Centers for Disease Control (CDC):

• more than 2 million infections start every year in a hospital, nursing home or another healthcare setting
• 70,000 people die every year as the result of getting an infection in a hospital, nursing home or another healthcare setting
• every infection that is caught in a hospital, nursing home or other healthcare setting costs over $ 30, 000
• the United States spends more than $ 45 billion every year for the extra care and treatment that is needed when infections start in a hospital, nursing home or another healthcare setting

The CDC states that the leading cause of death among residents in nursing homes is infection. Infection is also the most frequent reason for a person to be moved from the nursing home to a hospital for care.
1.5 new infections start every year in nursing homes. This number means that every person in a nursing home gets an average of one infection every year. (Centers for Disease Control, 2010)
Infections lower the person's quality of life and they cause pain and suffering to the patient and their family members. Again, infection control and the prevention of infections must be a regular part of everything we do. Infections are a big and costly problem in healthcare.

The Cycle of Infection: How Infections Spread

Infections can spread from person to person when germs:

• are able to leave the body,
• have a means of transportation and
• can enter another body

Germs are everywhere. They are in the air, on our body, in our body, on our clothes, on and in food, in liquids, in human waste, on table tops, bed sheets, flowers and everywhere else.
Nursing assistants can do many things to prevent the spread of germs. We must keep foods safe. We must make sure that patients' rooms are clean and without dust. Dust carries germs through the air.
Nursing assistants cannot prevent germs from leaving someone's body. Germs will leave a person's body when they cough, sneeze, move their bowels and when they have a draining wound. We have no control over a sneeze and a cough, but we do have control over the tissues that someone is using when they sneeze or cough. Tissues are a way for germs to move from one person to another.
Tissues and our hands are vehicles for germs, just like a car is a vehicle for us to move from one place to another. We cannot get to a far away store, work or church unless we have a car or another mode of transportation to get us from our house to where we want to go.

Germs cannot move from one place to another unless they, too, have a means of transportation. If we take this away from them, they cannot move from one person to another. Tissues, hands and all other items that have, or may have, body fluids can move germs from one person to another. We can stop the spread of infection when we take the germs’ transportation away.
We can break the cycle of infection and stop infections from moving from one person to another when we:

• wash our hands properly before and after EVERY patient contact,
• wash our hands properly before and after EACH task we do,
• handle all items that have, or may have, germs in the proper way and
• do other simple things like keeping dirty bed sheets away from our clothing

EVERYONE must control infection.
How Can Infections Be Stopped?
Infections can be prevented and stopped when we:

• follow infection control and standard precautions procedures,
• handle hazardous waste properly,
• handle sharps properly,
• keep ourselves healthy,
• keep our patients healthy and
• wash our hands properly

Standard Precautions
All healthcare workers must use standard precautions when they handle and throw out items that may have blood or another body fluid. All body fluids are able to transport invisible infections so we must use standard precautions whenever we handle any substance that may have an infection.
Some examples of body fluids are:

• blood
• feces
• wound drainage
• secretions from the nose
• saliva
• sputum
• tears
• urine
• vomit
• breast milk
• fluids taken from lungs, the abdomen, the spinal area, etc.

USE STANDARD PRECAUTIONS FOR ALL PATIENTS & ALLBODY SUBSTANCES
We treat all patients as if they had an infection even when we are pretty sure that they do not. We must use standard precautions during all of our patient care.
Standard Precautions Practices
Handwashing Procedure
You MUST:

• wash your hands before and after every patient contact and
• wash your hands before and after every task even if you have worn gloves. Gloves are NOT a substitute for handwashing. Learn more about handwashing below.

Gloves
You MUST:

• wear gloves whenever you may touch any body fluid, including when you empty a urine bag, urinal or bed pan,
• remove your gloves and throw them away after each use in the proper manner. Most hospitals and nursing homes use red bags to throw away gloves and all other things that are not sharp.
• NEVER use gloves more than once. They must be thrown out after every use. They CANNOT be re-used.
  
  
• Wash your hands immediately after taking off your gloves and
• NEVER walk around the hall with gloves that have touched a patient or a body fluid

Masks, Eye Protection & Face Shields
You MUST:

• use personal protective equipment like a mask, eye protection and a face shields if you are near a patient care activity that may involve a splash or spray of body fluids,
• use a special mask or an Ambu-bag when you are doing CPR or rescue breathing and
• dispose of all single use personal protective equipment immediately after use.

Gowns
You MUST:

• wear a gown when you are doing something that may soil your clothes with body fluids. You should wear a plastic gown when the body secretion is wet. A plastic gown does not let wet body fluids go through the gown to your clothes or uniform.
• take the gown off, throw it away and
• wash your hands immediately after taking the gown off.

Patient Care Equipment and Supplies
You MUST:

• carefully handle all dirty patient care equipment so that it does not touch your clothing or another patient,
• use single use patient supplies with one patient. Do NOT share these items with other patients.
• throw away all single use patient care equipment and supplies in the proper manner and
• write the patient’s name and room number on all patient care supplies, like urinals and bedpans.

Environmental Control
You MUST:

• routinely clean all visibly dirty items such as bedside tables and night stands,
• make sure that all wheelchairs, beds, rails and walkers are kept routinely kept clean by the house keeper or another person at your hospital or nursing home and
• keep your own food and drinks out of patient care areas and only in the staff refrigerator. These items cannot be put in the medication refrigerator or the patient refrigerator.

Linen
You MUST:

• keep the linen cart covered
• keep all linen off the floor
• keep dirty linen and all other objects away from your body and clothing and
• place dirty linen in the proper bag

Patients’ Beds and Chairs
You MUST:

• NOT sit on patient’s beds or chairs. Sitting on patient beds and chairs can spread infections to patients and residents from our uniform.

Transmission Precautions
At times a person may have an infection that is very hard to control. We use special transmission precautions, in addition to standard precautions, when a person has an infection that is hard to control. For example, special transmission precautions are necessary when a person has TB, a severe virus infection, the mumps or another disease that others can catch very quickly.
People with these special precautions are usually kept in a private room. There are 3 kinds of these precautions:
1. airborne
2. droplet
3. contact or touching
A person with TB is put on airborne precautions. When a person has TB they are put in a special room and a sign is put outside of the person’s door. This sign tells you what you must do before you enter the room, what you must do while you are in the room and what you must do when you are leaving the room. All people going into their room must wear a special mask, called a HEPA mask.
A person with a bad respiratory infection, like the mumps or the flu is put on airborne isolation. Nursing assistants and other health care providers have to wear a regular mask when they enter this person’s room.
People are put on contact precautions for serious wound or skin infections and for bad infections that affect the gastrointestinal tract. It is necessary to wear a gown and gloves when entering the room of a person that is on contact isolation. You must also use a special soap when washing your hands.
Special Waste Handling
Everyone must also throw away all body fluids and trash or waste as if it were infected with germs in order to prevent infections from spreading.
We must throw away all gowns, gloves, masks, bandages and other items, other than sharp items, in a special red bag. This red trash bag contains hazardous waste. These special red bags are moved and handled by people that have been trained about how to do it safely.


Safe Handling of Sharps
Infections can be prevented when we handle and throw away sharp objects and items, such as needles, in the proper way. Because needles and sharp objects may break through the red trash bags, they must be put into hard puncture proof containers. Many of these hard red containers are found on the walls of the patient rooms and on the nurses’ medication cart. These sharp items are also treated as hazardous waste.


Keeping Yourself Healthy
There are many things that you can do to stay healthy. When you keep yourself healthy you can easily fight off many infections. Your patients cannot get an illness or infection from you when you are healthy.

• Eat a good diet,
• Get plenty of rest,
• Exercise,
• Manage your stress,
• Get a hepatitis B shot if you have not already had one,
• Get the flu shot every year,
• Get the pneumonia shot if your doctor thinks that it is a good idea for you to get one and
• Stay away from other sick people in your home, as much as possible.

You should not go to work if you have been exposed to an illness like measles and if you have a cold with a fever or heavy mucous, the flu or another infection.
 
If other members of your household or family are affected with an infectious disease such as tuberculosis, pneumonia, chickenpox or the measles, you should also call your supervisor.

Keeping Your Patients and Residents Healthy
Nursing assistants and other healthcare providers can work together to keep their patients and residents as healthy as possible.
We can help them to:

• get a good diet,
• get plenty of fluids,
• get enough sleep and rest,
• manage their stress,
• get their flu, pneumonia or hepatitis B shots and
• stay away from infections and other sick people, as much as possible.

Handwashing
Simple handwashing is the single most effective thing that we can do to prevent the spread of germs and infection in hospitals, nursing homes and other healthcare places. The success of handwashing has been proven over and over again. Yes, handwashing is the MOST important thing that you can do to prevent the spread of infection from one person to another.
Healthcare worker hands carry most infections. It is our hands that carry germs from one person to another. We must wash our hands, keep our nails short and clean and avoid wearing a ring, other than a small and clean wedding band. Germs like to hide under moist and dark nails and rings. Rings and nails transport germs.
You use soap, water, lots of rubbing and a little time to wash your hands. Never hurry through the process. Do not ever skip a step. Do not forget to wash your hands. Remember, infections from your hands can kill your patients.


HANDWASHING

You MUST wash your hands:

• as soon as you come to work
• before you go into a patient or resident room
• when you are leaving a patient or resident room
• before and after each task you do
• before and after you touch a person
• before and after you put gloves on
• before you leave a rest room
• before taking a break
• before and after you eat or handle food
• after you cough or sneeze
• after you blow your nose
• after handling garbage or trash
• when you are leaving work

REMEMBER- WASH YOUR HANDS BEFORE & AFTER EVERY PATIENT CONTACT OR VISIT
Proper Handwashing
The correct hand washing procedure is simple and takes less than 20 seconds to complete.
These are the steps that you must follow when you are washing your hands:
1. Turn on the water
2. Wet your hands up to your wrists
3. Apply a good amount of soap to your hands and wrists while the water remains running
4. Rub your hands together to work up suds
5. Rub the front and back of your hands, rub between your fingers, rub around the edges of your nails, clean under your nails, rub your wrist up to about 8 inches above your hand. THIS RUBBING SHOULD CONTINUE FOR AT LEAST 15 SECONDS. Hold your hands down lower than your elbows, but do NOT touch any part of the sink. Put a little more water on your hands if the soap dries out while you are rubbing.

6. Rinse your hands well under the running water without touching the sink and while keeping your fingers LOWER than your wrist
7. Take a paper towel and dry your hands
8. Turn the water off with the paper towel, NOT your clean hands
9. Throw the paper towel away

If you forget a step, start all over again from step 1. If you make a mistake and touch the sink, start all over again from step 1. 

Summary
Nursing assistants must give their patients and residents good care and not infections. Since most hospital and nursing home infections are caused by those who give the care, the solution to this problem will come when we all follow infection control measures all the time and with everything we do.
Do NOT forget to wash and wash and wash your hands!
References
Berman, Audrey, Shirlee Snyder, Barbara Kozier and Glenora Erb. (2010). Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice. 8th Edition. Pearson Prentice Hall.
 

Hockenberry, Marilyn J. and David Wilson. (2010).Wong's Essentials of Pediatric Nursing. 8th Edition. Elsevier Mosby.

Nettina, Sandra M. (2009). The Lippincott Manual of Nursing Practice. 7th Ed. Lippincott, Williams and Wilkins.

The Centers for Disease Control. (2010). Infection Control. [online]http://www.cdc.gov 


Copyright © 2010 Alene Burke