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    2chain of Disease

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    yuuki konno

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    2chain of Disease

    Uploaded by

    yuuki konno
    57 views43 pages

    Original Title

    2Chain of Disease (1)

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    © © All Rights Reserved

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    Copyright:

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    57 views43 pages

    2chain of Disease

    Uploaded by

    yuuki konno

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 43

    Chain

    of
    Disease
    Learning Objectives
     Discuss chain of infection and different types of mode of
    transmission
     Define isolation precautions and describe different types
    isolation precautions.
     Describe standard precautions procedures and conditions
    under which to use standard precautions
     Describe contact precautions and conditions under which
    to use contact precautions.
     Describe conditions under which to use droplet
    precautions.
     Describe conditions under which to use airborne
    precautions.
    Mode of Transmission
    A microorganism may be spread by a single
    or multiple routes.
     Contact, direct or indirect
     Droplet
     Airborne
     Vector-borne (usually arthropod) and
     Common environmental sources or vehicles
    - includes food-borne and waterborne,
    medications e.g., contaminated IV fluids
    Contact transmission
    1. Direct-contact
     Direct body surface-to-body surface contact and
     Physicaltransfer of microorganisms between a
    susceptible host and an infected or colonized
    person.
    2. Indirect-contact
     Contactof a susceptible host with a contaminated
    intermediate object, usually inanimate, such as
    contaminated instruments, needles, or dressings,
    or contaminated hands or gloves
    Droplet transmission
    Droplet generation
    coughing,
    sneezing,
    talking,
     procedures
    such as suctioning and
    bronchoscopy
    Droplet transmission
    Droplet deposited on the host’s conjunctivae,
    nasal mucosa, or mouth.
    Airborne transmission
     Small-particleresidue {5µm or
    smaller} of evaporated droplets
    containing microorganisms
     Suspended in the air for long
    periods of time
     Dispersed by air currents
     Inhaledby a susceptible host
    within the same room or over a
    longer distance
    Definition of Isolation Precautions
    Source: Mosby's Medical Dictionary, 8th edition. ©
    2009, Elsevier.
    Special precautionary measures,
    practices, and procedures used in
    the care of patients with
    contagious or communicable
    diseases
    7 Categories Recommended in Isolation
     1. Strict Isolation – to prevent highly contagious or virulent
    infections.
     2. Contact Isolation – to prevent the spread of infection
    primarily by close or direct contact.
     3. Respiratory Isolation-to prevent transmission of
    infectious diseases over short distances through the air.
     4. TB Isolation- for TB patients with positive smear or with
    chest-xray which strongly suggests active tuberculosis.
     5. Enteric Isolation –is for infectious with direct contact
    with feces.
    7 Categories Recommended in Isolation
    Drainage/ Secretion precaution- to
     6.

    prevent infections that are


    transmitted by direct or indirect
    contact with purulent materials or
    drainage from an infected body site.
    7. Universal Precaution – which is
    applied when handling blood and body
    fluids.
    1996 CDC
    Guidelines for
    Isolation
    Precautions in
    Hospitals
    Hospital infection
    control practices
    advisory
    committee
    (HICPAC)
    Fundamentals of isolation precautions
     Handwashing and gloving
     Personal protective equipment :
     Masks, respiratory protection, eye protection,
    face shields, gowns and protective apparel
     Patient-care equipment and articles
     Linen and laundry
     Routine and terminal cleaning
     Patient placement
     Transport of infected patients
    Isolation Precautions
    Types of Isolation
    Precautions

    Standard precautions
    Transmission-based

    precautions
    Contact precautions
    Airborne precautions
    Droplet precautions
    Definition of standard precautions

     Apply to all patients receiving care in hospitals


    regardless of their diagnosis or presumed
    infection status.
     Apply to (1) blood; (2) all body fluids, secretions,
    and excretions except sweat, regardless of
    whether or not they contain blood; (3) nonintact
    skin; and (4) mucous membranes.
    Standard Precaution - Hand hygiene
     Handwashing with either plain or antiseptic
     containing soap and water, and use of alcohol-based
     products (gels, rinses, foams) that do not require the
     use of water

     Perform hand hygiene:


     Before and after patient contact
     After removing gloves or any other PPE item
     Aftertouching blood, body fluids, secretions, excretions,
    and contaminated items, whether or not gloves are worn
    Standard precautions
    Personal protective equipment (PPE)
     The selection of PPE based on
     The nature of patient interaction and/or
     The likely mode(s) of transmission
     Designated containers for used disposable or
    reusable PPE should be placed in a convenient to
    the site of removal
     Handhygiene is always the final step after
    removing and disposing of PPE
    Standard precautions - prevent HCWS
    Exposure to Bloodborne Pathogens
     Preventneedles and other sharps
    instrument injuries
     Prevent mucous membrane exposures
     Safe
    work practices and PPE to protect
    mucous membranes and non-intact skin
    Standard precautions: Environmental
    measures
     Cleanand disinfect non-critical surfaces in
    patient-care areas are part of SP.

     Cleanand disinfect all frequently touched


    surfaces in patient-care areas

     EPA-registered disinfectants or detergents


    Standard precautions: Patient Care
    equipment and instruments/devices

     Cleanand
    maintain medical
    equipment and
    instruments/devi
    ces according to
    the
    manufacturers’
    instructions
    Standard Precautions: Textile and
    Laundry
     Key principles for handling of soiled laundry:

     Don’t
    shaking items or handle them in any way that
    may aerosolize infectious agents

     Avoid contact with one’s body and personal clothing

     Contain soiled items in a laundry bag or designated


    bin
    Standard Precautions – 2007 guidelines
    for isolation precautions

     Three new elements added to standard precautions:

     Respiratory hygiene/cough etiquette

     Safe injection practices

     Use of masks for insertion of catheters or injection into


    spinal or epidural areas
    Respiratory hygiene and cough
    etiquette
     Three elements include:
     Educate healthcare workers, patients, and visitors
     Post signs in appropriate language(s)
     Source control measures:
     Cover the nose/mouth when coughing or sneezing
     Use tissue paper respiratory secretions and dispose in the waste
    receptacle
     Perform hand hygiene after contact with respiratory secretions and
    contaminated objects
     Place a surgical mask on the coughing person when tolerated and
    appropriate
     Spatial separation, ideally >3 feet
    Safe injection practices
     Largeoutbreaks of HBV and HCV among
    patients in the United States
     The primary breaches
     Reinsertion of used needles into a multiple-
    dose vial or solution container (e.g., saline
    bag)
     Useof a single needle/syringe to
    administer intravenous medication to
    multiple patients.
    Masks for special lumbar puncture
    procedures or central line placement
     Facemasks limit dispersal of oro-
    pharyngeal droplets during:
     central venous catheters placement
     Placement of catheter or injection to
    epidural space
     HICPAC recommends the use of a face mask
    when placing a catheter or injection to
    epidural space.
    TRANSMISSION-BASED PRECAUTIONS
    TRANSMISSION-BASED PRECAUTIONS -
    Patient Placement
     Single
    patient rooms - always indicated for
    patients placed on airborne precautions
    and preferable for those who require
    contact of droplet precautions

     Cohort patients with same organism


    TRANSMISSION-BASED PRECAUTIONS -
    Management of visitors
     Visitorsas sources of healthcare associated
    infections – e.g., pertussis, influenza,
    tuberculosis
     Cough etiquette
     Use of barrier precautions by visitors
     Educate patients and family members
     Follow signs for isolation precautions
    TRANSMISSION-BASED PRECAUTIONS -
    Contact Precautions
    Infections
     spread by direct or indirect contact with patients or
    patient-care environment – shigellosis, C. difficile, MRSA
    Limit patient movement

    Private/SINGLE room or cohort with patients with same infection

    Wear disposable gown and gloves when entering the patient room

    Remove and discard used disposable gown and gloves inside the

    patient room
    Wash hands immediately after leaving the patient room

    Clean patient room daily using a hospital disinfectant, with

    attention to frequently touched surfaces (bed rails, bedside
    tables, lavatory surfaces, blood pressure cuff, equipment
    surfaces)
    Use dedicated equipment if possible (e.g., stethoscope)

    Contact Precautions cont.
    GLOVES
     Use gloves when entering the room.
     Change gloves after contact with infective material.
     Remove gloves before leaving the room.
     Wash hands or use appropriate gel after glove removal.
     Do not touch infective material or surfaces with hands.
     Clean, non-sterile gloves are usually adequate.

    GOWN
     Use protective gown when entering the room if
     direct contact with patient or
     potentially contaminated surfaces or
     equipment near patient is anticipated or
     if the patient has diarrhea or
     colostomy or wound drainage that is not covered by a dressing.
    Droplet Precautions
     Reduce the risk of transmission by large particle droplets
    (larger than 5 m in size).

     Requires close contact between the source person and the


    recipient

     Droplets usually travel 3 feet or less

     E.g.,influenza, rubella, parvovirus B19, mumps, H.


    influenzae, and Neisseria meningitidis
    Droplet Precautions
     A private/single room or

     Cohort with patient with active infection with same


    microorganism

     Use a mask when entering the room and definitely if within 3


    feet of patient

     Limit movement and transport of the patient. Use a mask on


    the patient if they need to be moved and follow respiratory
    hygiene/cough etiquette

     Keep at least 3 feet between infected patient and visitors


    Airborne Precautions
     Tuberculosis, measles, varicella

     Place the patient in an airborne infection isolation room (AIIR)

     Pressure should be monitored with visible indicator

     Useof respiratory protection (e.g., fit tested N95 respirator) or powered air-
    purifying respirator (PAPR) when entering the room

     Limit
    movement and transport of the patient. Use a mask on the patient if they
    need to be moved

     Keep patient room door closed.

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