UNIT-11 INFECTION CONTROL IN CLINICAL SETTINGS Bsc nursing 1st year

                         UNIT: 11

    INFECTION CONTROL IN

        CLINICAL SETTINGS

SHORT ANWERS

1. Define infection.

ANS: Infection is injurious contamination of body or parts of the body by bacteria, 

viruses, fungi, protozoa, and rickettsia or by the toxin that they may produce.

2. Define nosocomial infection.

ANS: Nosocomial infections comes from Greek words “Nosus” meaning disease and 

“Komeion” meaning to take care of. It is also called as HOSPITAL ACQUIRED 

INFECTION.

Which infections first appear 48hrs or more after hospital admission or within 30 days 

after discharge are considered as Nosocomial Infection.

3. What is the meaning of isolation.

ANS: Isolation is the separation of a patient from contact with others in order to control 

the spread of an infectious or communicable disease.

4. Define medical asepsis.

ANS: Measures used to prevent the spread of organisms from place to place is called 

as medical asepsis. All the measures aimed at reducing the number or spread of 

microorganisms.

5. List four antiseptic agents.

ANS: a. Chlorhexidine and other biguanides. These are used on open wounds and for 

bladder irrigation.

 b. Antibacterial dye. These help to treat wounds and burns.

 c. Peroxide and permanganate. These are often used in antiseptic mouthwashes.

 d. Halogenated phenol derivative.

6. Define surgical asepsis?

Ans. Surgical asepsis: - Sterile technique is used to prevent the introduction or spread

of pathogens from the environment into the patient.

7. Enlist types of infection?

Ans. There are four types of infection: -

 1. Bacterial Infection

 2. Viral infection

 3. Fungal infection and

 4. Prion infection

1.Bacterial Infection- Bacteria are single celled microorganisms, also known as

Prokaryotes

2. Viral Infections-Viral infection occur due to infection with a virus.

3. Fungal Infection- A fungus is often a multicellular parasite that can decompose and

absorb organic matter using an enzyme.

However, some types such as yeasts are single called.

4. Prion Infection- A prion is a protein that contains no genetic material and is usually

harmless

8. Define Asepsis?

Ans. Asepsis- Is the state of being free from disease- causing contaminants (such as

bacteria, viruses, fungi and parasites) or preventing contact with microorganisms.

9. list down types of hospital waste?

Ans. The types of hospital waste are: -

1. Infectious waste

 2. Pathological waste

 3. Sharps

 4. Pharmaceutical waste

 5. Genotoxic waste

 6. Chemical waste

 7. Radioactive waste

10. Differentiate between sterilization and disinfection?

Ans. The difference between sterilization and disinfection are:

Sterilization: -

1. In this, the medium is made completely free from all the microbes.

2. It kills both vegetative cells and spores.

3. It completely remove microbes from the objects that can come in direct contact.

Disinfection

1. In this, the number of harmful microbes is minimized to a minimal level.

2. It kills only vegetative cells not the spores.

3. It reduces microbes form the objects that can come in direct contact with the skin or

the mucus.

SHORT ESSAYS

1.Discuss the role of Nurse in Infection Control?

Ans. Nurses should be Familiar INTERVENTIONS.

• ISOLATION PRECAUTIONS 

HYPERTHERMIA INTERVENTION –ELIMINATE UNDERLYING CAUSE –FEVER

MANAGEMENT

• HEALTH TEACHING

• ANTIBIOTIC THERAPY

• PSYCHOSOCIAL SUPPORT

• HEALTH CARE RESOURCES.

Personal Protective Equipment

 • Gowns

• Respiratory Masks

 • Eye Protection

 • Gloves

 • Specimen Collection

 • Bagging Trash & Linen

 • Transporting Patients.

HAND WASHING

• Proper hand washing is the single most important ay to prevent and reduce infections.

• Wash and rinse hands for 15 seconds, using a dry paper towel to turn off faucet.

• Alcohol based hand wash is also available in all patient care areas.

Hands should be washed:

• Before and after patient contact

• Before putting on gloves and after taking them off

• After touching blood and body substances (or contaminated patient-care equipment),

broken skin, or mucous membranes (even if you wear gloves)

• Between different procedures on the same patient.

All Nursing Staff should follow Standard Precautions.

• Guidelines for preventing exposure to blood, body fluids, secretions, excretions

(except sweat), broken skin, or mucous membranes.

• Based on the concept that body fluids from ANY patient can be infectious.

• Should be used on every patient.

• Use necessary PPE for protection – CDC guidelines requires us to use category￾specific isolation (ex – TB isolation) in addition to Standard Precautions when a patient

is known or suspected to have an infection.

Infection Control Nurse Orientation

• Objectives: –

Understand the significance of antibiotic resistant organisms seen in hospitals.

–Understand how surveillance for hospital acquired (nosocomial) infections is

performed and the significance of surveillance data.

Nurses should Evaluate their Outcome.

• MEASURE SUCCESS OF INFECTION CONTROL TECHNIQUES

• COMPARE PATIENT’S RESPONSE TO ACTUAL OUTCOME

2. Explain the chain of infection transmission.

ANS: DEFINITION OF CHAIN OF INFECTION

• The six components involved in the transmission of microorganisms are

described as the chain of infection

• All the six components should be present to transmit an infectious disease from

one human or animal to a susceptible host.

THE CHAIN OF INFECTION

The chain of infection transmits in the order of

• Causative agent

• Reservoir

• Portal of exits

• Mode of transmission

• Portal of entry

• Susceptible host

1. TRANSMISSION TO HUMANS

• To control or prevent infection it is essential to understand that transmission

of a pathogen resulting in colonization or infection requires that six vital links.

• Each link must be present for infection or colonization to proceed and

breaking any of the links can prevent the infection.

• The aim of isolation precautions is to interrupt this links.

1. Causative Agents

• The causative agent for infection is any microorganisms capable of

producing disease.

• Microorganisms responsible for infectious disease include bacteria,

viruses, fungi, and protozoa.

• Sometimes, microorganisms are part of patient’s own body flora and can

cause infection in the immunocompromised host. These infections are

called endogenous infections.

• Infections which are acquired from external sources are called exogenous

infections

2. Reservoir

• A reservoir is the second link in the chain of infections.

• A reservoir is the place where the agents survive, grows, and multiplies

human, animal or environment.

• Pseudomonas spp. Survive and multiply in nebulizers and the hepatitis B

virus survives but does not multiply on the surface of hemodialysis

machines.

• Infectious reservoirs abound in health care settings, and may include

everything from patients, visitors, and stuff members to furniture, medical

equipment’s, medications, food, water, and blood.

• A human reservoir may be a case (a case is a patient with an acute

clinical infection) or a carrier (a carrier is a person who is colonized with a

specific pathogenic microorganism but shows no signs or symptoms of

infection)

3. Portal of exit

• The portal of exit is the path by which an infectious agent leaves its

reservoir.

• This portal is the site where the microorganism grows. Common portal of

exit associated with human reservoirs include the respiratory,

genitourinary, and gastrointestinal tracts, the skin and mucous

membranes and the placenta (transmission from mother to fetus).

4. Mode of transmission

The microorganisms can be acquired by:

• Contact transmission (direct and indirect)

• Droplet transmission (inhalation through respiratory tract)

• Airborne transmission

• Ingestion (through gastrointestinal tract)

• Inoculation (through accidental sharp injury or bites)

• Transplacental transmission (microbes may cross placenta from mother to

fetus).

 Some microorganisms use more than one transmission route to get from the

reservoir to a host.

• Direct contact: it refers to person to person spread of microorganisms through

actual physical contact.

• Indirect contact: occurs when a susceptible person comes in contact with a

contaminated object.

• Droplet transmission: results from contact with a contaminated respiratory

secretion. A person with droplet spread infection coughs, sneezes, or talks,

releasing infected secretions that spread through the air to the oral or nasal

mucous membranes of a person nearby.

• Airborne transmission: occurs when microbial particles or dust particles

containing pathogens remain suspended in the air for a prolonged period, and

then are spread widely by air currents sand inhaled. The tiny particles remain

suspended in the air for several hours and may cause infection when a

susceptible person inhales them.

5. Portal of entry

• The portal of entry for tuberculosis and diphtheria is through the respiratory tract.

Salmonella enters through the gastrointestinal tract. Hepatitis B, C, and human

immunodeficiency virus enter through the bloodstream or body fluids.

6. Susceptible host

• The final link in the chain of infection is the susceptible host.

• A susceptible host is a person who can become infected by the infectious agent.

susceptible hosts include patients, health care personnel, visitors from the

community

Risks factors to infection “susceptible host”

• The very young because their immune system does not fully develop until about

age of 6 months.

• The very old because age is associated with declining immune system function.

• Poor nutritional status and sociocultural condition.

• Open wounds and invasive procedures.

• Suppressed immune system.

• Weakened health condition.

• Presence of illness and injury.

• Presence of infectious microorganisms.

• Number of infectious microorganisms.

Hospitalized patients are more prone to develop infection as a result of:

• Surgery, invasive procedures and devices.

• Immunosuppressive drugs

• Organ transplants etc.

• Microorganisms flourish in health care setting and with breaks in infection control

procedures and practices.

2.Differentiate between Medical and surgical aasepsis?

4. Define universal precautions. Define universal precautions practiced in the

hospital.

ANS. Definition of universal precaution:

Universal precautions are recommended practices to minimize the risk of exposure to

infectious diseases and pathogens carried in blood and body fluids.

1.Body fluids to be treated with universal precautions:

• Cerebrospinal fluid

• Peritoneal fluid

• Pleural fluid

• Pericardial fluid

• Synovial fluid

• Amniotic fluid

• Urine

• Semen

• Vaginal secretions

2. Any other fluids containing visible blood including saliva.

3. Tissues and organs.

Universal precautions include.

• Care of the skin

• Hand washing

• Protective apparel

• Procedure for safe handling of sharps

• Procedure for safe disposal of sharps

• Management of blood and body fluid spillages

• Waste disposal

Care of skin:

Bacteria and viruses cannot penetrate intact skin. It is therefore vital to keep the skin in

good condition and prevent cracking, chapping, and drying of the skin.

• Regularly check skin for cuts and cover with a waterproof dressing to allow

adequate hand washing.

• Following removal of gloves wash hands.

• Ensure thorough drying of skin following hand wash.

Hand washing:

• Hand washing is considered the simplest and most important action to prevent

infection transmission.

• Microbes on human skin can be classified into two groups: Resident flora and

Transient flora

Resident flora: not easy to eliminate by scrubbing since they are adapted to living on

human hands.

Transient flora: easy to eliminate by scrubbing with soap or detergent. This kind of

microbe can be frequently found on the skin of health care workers.

Hand washing indications:

Before:

• Starting work

• Examining a patient

• Administering an injection

• Handling disinfected instruments

• Putting on gloves

• Going home

After:

• Examining a patient

• Handling instruments potentially

• Contaminated items or body

• Secretions or excretions

• Removing gloves

• Using the toilet or latrine

• Sneezing or coughing

Using protective barriers:

• The wearing of protective apparel provides the healthcare worker with a barrier

between themselves and potential blood and body fluid.

• Common barriers are gloves, aprons, masks, eye protector, caps, and sturdy

footwear.

Selection of protective barriers:

Low risk: contact with skin , no exposure to blood

• Gloves not essential. e.g injection, minor wound dressing

Medium risk: probable contact with blood

• Gloves, gown or apron may not be necessary, e.g. pelvic exam, handling of

laboratory specimens , IUD insertion , IUD removal , large open wound dressing ,

catheter insertion or removal .

High risk: contact with blood likely, splashing probable, uncontrolled bleeding.

• Gloves, apron, eyewear, mask. e.g., major surgical procedures, oral surgery,

vaginal delivery.

Procedure for safe handling of sharps:

• Needles must never be re sheathed or recapped.

• Staff must obtain assistance when taking blood or giving injections to

uncooperative or confuse patients.

• Never carry sharps by the hand, if transporting always place in an appropriate

container

• Needles must never be broken or bent prior to disposal.

• Needles must never be passed from hand to hand.

• When performing phlebotomy, cannulation, or giving injections, all staff must

wear appropriate disposable gloves.

• Never reuse a sharp

Procedure for safe disposal of sharps:

• Do not dispose of sharps with other clinical waste.

• Sharps bins to be kept in location that precludes injury to patients, visitors, and

staff ensuring that sharps bins are situated at a suitable height i.e not placed on

the floor or above shoulder height.

• Always dispose of needles as a complete unit into a sharps container never

disassemble prior to stealing and disposal.

• Never force a sharp into a sharp’s container

Management of spillage:

Blood

Disinfectant:

a. 1% hypochlorite solution.

b. NaDCC (sodium dichloroisocyanurate) granules

Procedure: wear protective clothing. soak up excess fluid using disposable paper

towels. cover area with towels soaked in 1% hypochlorite and NaDCC. Leave for at

least 2 mins. dispose of as infectious waste. clean area with hot water and detergent dry

area using disposable paper towels dispose of protective clothing as above wash

hands.

urine and vomits.

Disinfectant: 1% hypochlorite solution, NaDCC granules

Procedure: the excess urine or vomit must be mopped up with paper towels first. this is

because if urine or vomit comes into direct contact with the chlorine product toxic fumes

will be released. the room should be well ventilated before this procedure is carried out.

Spillage of body fluids not containing blood/for blood on carpet or soft

furnishing.

Disinfectant: 1% hypochlorite solution, NaDCC granules

Procedure: wear protective clothing PPE. soak up fluid with paper towels. wash area

with hot water and detergent. rinse with hot water. dispose of paper towels and

protective clothing in clinical waste. Wash hands.

5. Discuss on management of isolation unit?

ANS: Isolation: The separation of a person with infectious disease from contact with

others for the period of communicability.

Purposes:

• To prevent cross contamination between patients and hospital personnel.

• To confine and contain any infectious disease agent.

• To confine and contain all blood and body fluids.

Basic principles:

• Wash hands prior to entering and exiting rooms.

• Careful disposal of contaminated materials.

• Knowledge of disease and mode of transmission.

• Protection of client and public during transport.

Transmission based precautions:

• Airborne precautions

• Droplet precautions

• Contact precautions

Airborne precautions: causative agents of diseases under airborne precautions are

less than 5 um, thus can be carried away by air currents.

Diseases under airborne precaution:

• Measles

• Tuberculosis

• Varicella

Patient placement:

• Single room with negative air pressure

• 6 to 12 air exchanges per hour

• Room door closed.

Protection for HCW:

• Apply standard precautions.

• N95 respirator will be used as PPE.Patient transport:

• Limit patient movement

• The patient should wear a surgical mask outside the isolation room.

Droplet precautions: causative agents of diseases under droplet precautions are

greater than 5 um. They can travel up to 3 feet before falling to the ground.

Diseases under droplet precautions:

• Hemophilus influenza type B disease, including meningitis, pneumonia , epiglottis

and sepsis.

• Streptococcal (group A) pharyngitis, scarlet fever in infants and young children

• Influenza and mumps

Patient placement:

• Private room

• Cohort nursing

• Maintain special separation of at least 3 feet in between.

Protection for HCW:

• Standard precautions

• Surgical mask if working within 3 feet of the patient.

Patient transport:

• Limit movement

• Mask the patient with surgical mask

Contact precautions: use in addition to standard precaution, for patients known or

suspected to have serious illness transmitted through contact.

Types of transmission:

• Direct contact transmission• Indirect contact transmission

Diseases under contact precaution:

• Multi drug resistant microorganisms, VRE, MRSA , ESBL , B . cepacia

• RSV infection in infants, young children , and immunocompromised patients

• Clostridium deficient enterocolitis

Patient placement:

• Private room

• cohort nursing

protection for HCW:

• Hand washing

• Gloves

• Gown

Patient transport:

• Limit movement

Reverse isolation: Isolation procedure designed to protect a patient from infectious

organisms that might be carried by staff, other patients, visitors or on droplet in air or

equipment or materials.

Client consideration:

• Isolation

• Boredom

• Loneliness

• Self esteem

conclusion: As with all infection control measures , isolation precautions are designed

to prevent the spread of infection from one person to another. The responsibility for the

practice of infection control lies in the hands of every health care worker.

6. Explain in detail barrier nursing.

Ans. Barrier Nursing: - The nursing technique by which a patient with an infectious

disease is prevented from infecting other people is called barrier nursing

Types of precautions- Barrier nursing

1. Contact precautions

2. Airborne precautions

3. Droplets precautions

4. Three more elements have been added to standard precautions.

They are: - 4.1 . Respiratory hygiene/ cough etiquette

4.2. Safe injection practice

4.3. Use of masks for insertion of catheters or injection into spinal or epidural areas.

1. Contact Precautions: - clean, non - sterile gloves are usually adequate for routine

care of the patients.

- Use gloves before providing care to patients.

- Change gloves after contact with infective material.

2. Airborne precautions: - used to prevent or reduce the transmission of micro -

organisms that are airborne in small droplets nuclei (5u or smaller in size) or dust

particles containing the

infections agent.

3. Droplets precautions: --used to reduce the risk of transmission of microorganisms

transmitted by large particle droplets (larger than 5u in size)

4.1. Respiratory hygiene/ cough etiquette: -

- informing personal if they have any symptoms

Instructing patients and providers not to touch eyes, nose, or mouth.

- Health care workers should use standard precautions with all patients

4.2. Safe injection practices:-

- Correct disposal in appropriate container.

- Avoid Re-sheathing needle.

-Avoid removing needle.

- Discard syringes as single unit.

Barrier Technique Infections control: -

1. Aseptic technique

2.Isolation

3. Safer handling of sharps

4. Linen handling and disposal

5. Waste disposal

6. Handling biological spills

7. Environmental cleaning

8. Risk assessment

9. Staff health

7. Write in detail on body defenses against infection

Ans. Body defense against infection are: -

Immunity: - The body's defense against disease causing organisms, malfunctioning

cells and forge in particles.

Overview of immunity: -

- Reconnaissance Recognition and response.

Two major kinds of defense have evolved that counter threats.

- Innate immunity

- Acquired immunity

Innate Immunity: - Is present before any exposure to pathogens and it effective from the

times of birth.

Innate immunity includes:

- Species resistance

- physical barriers

- phagocytic cells

- Immunological surveillance

-Interferons

- complement system.

-Inflammation

- fever

Adaptive defense also called:

- Specific defenses

- Specific immunity

-Adaptive immunity

- Develops only after exploits including agents such as microbes, toxins or other foreign

substance.

Involves a very specific response to pathogens

Active Immunity: - you produce the antibodies.

- your body has been exposed to the antigen in the past through: Exposure to the actual

disease causing antigen- you fought it, you won, you remember it.

How long active immunity last?

- It depends on antigen.

Some disease- causing bacteria multiply into new forms that our body doesn't

recognize, requiring annual vaccination like the flu shot.

Passive Immunity: -

You don't produce the antibodies.

-a mother will pass immunities on to her baby during pregnancy- through the placenta.

Acquired Immune deficiency syndrome:-

-Caused by the human immunodeficiency virus

- Discovered in 1983.

- Specifically target and kills T-cells.

- Because normal body cells are unaffected, immune response is not launched.

8. Define Nosocomial infection. Discuss on the role of nurse in prevention of

Nosocomial infection.

Ans. Nosocomial infection: - Nosocomial infection or hospital acquired infection are

infection acquired during hospital care which are not present at the time of admission.

The role of nurse in prevention of nosocomial infection are: -

1. Isolation

2. Sterilization

3. Hand washing

4. Wear gloves

5. Wear aprons

1. Isolation: - Designed to prevent transmission of microorganisms by common routes in

hospitals. Because agent and host factors are more difficult to control, interruption of

transfer of microorganisms is directed primarily at transmission.

2. Sterilization: - Sterilization of all reusable equipment such as ventilator, humidifier and

any device that come in contact with the respiratory tract.

3. Hand washing: -Use soap and running water.

- Rub your hands vigorously for 20 second.

- Wash all surfaces, including the back of between fingers.

- Rinse well

- Dry hands with paper towels.

- Turn off water using a paper towel instead of bare hands.

When: -

- After coughing or sneezing.

- After using bathroom.

- Before and after eating or cooking.

- Before and after treating wounds

- Before and after handling shared equipment.

4. Wear Gloves: - They worn for two reason:

Provide a protective barrier and prevent contamination of hand.

- likelihood that microorganisms present on the

-Hands will be transmitted to the patients during invasive and other patients care

procedure.

5. Wear Aprons: -

Wearing an apron during patients care reduces the risk of infection.

-Aprons is must fir preventing yourself from getting disease.

 Conclusion

- These is no official national approach and no real managerial support from authorities

for nosocomial infection.

- Only thing is proper asepsis, proper hand washing and sterilization.

9.Define sterilization. Explain method of sterilization?

Ans. Sterilization: - sterilization is defined as killing all forms of life, including the most

heat resistant forms, i. e., bacterial spores, etc.

Methods of sterilization:

There are three methods of sterilization:

1. Physical method

2. Chemical methods

3. Mechanical methods

1.Physical Method: - sunlight has an active germicidal effect due to its content of

ultraviolet rays.

- It is a natural method of sterilization case of water tanks, rivers, and lakes.

2.Heat: - Heat is most reliable and commonly employed method sterilization. Two types

of heat are used dry and moist heat.

3. Ozone: - It is a technique of low temperatures sterilization i. e., 25°c to 35° c.

4. Filtration: - The process is done mainly for antibiotics solution, sugars, etc.

5. Radiation: - Two types of radiation technique may be used for sterilization.

1. Ionizing radiation

2. Nonionizing radiation

Chemical method of sterilization: -

1 Alcohol: - Ethyl alcohol and Isopropyl alcohol are most frequently used.

They act by Denaturing bacterial proteins.

2. Aldehyde: - Different concentration of different aldehyde are used against, different

kind of microbes.

3. Phenols:- The lethal effect of phenol is due to cell membrane damage this releasing

cell contents and causing lysis.

4. Halogens: - chlorine and iodine are two commonly used.

5. Oxidizing agents: - Hydrogen peroxide, per acetic acid etc, are used by releasing free

radicals which are the active ingredient in these methods.

6. Salts: - salts of heavy metal such as Copper, mercury, silver, etc. Gives toxic effects

on bacteria.

7. Surface active agents: - they are Bactericidal for almost all positive bacteria

8. Dyes: - They have very low Bactericidal activity.

9. Gases: - Formaldehyde gas, Ethylene oxide, Beta propiolactone (BPl)

3. Mechanical methods: -

The solution to be sterilized is passed through depth - filter or screen- filter which

includes.

# Particulates filters

# Microbial filters

# Final filters.