An infection is the result of an
interaction between a susceptible hose
and an infectious agent (bacteria,
viruses, fungi, parasites) a clinical
syndrome caused by the invasion and
multiplication of a pathogen in the
Thecourse of an infection can be
divided into four major phases:
2. Period of Clinical illness
Health Care institutions can present a danger
in infectious disease transmission
‣ Nosocomial infection - a hospital-acquired
‣ Iatrogenic infection – a direct result of treatments
Goal4 of the National Patient Safety Goals
(NPSG’s) is directed toward infection related
sentinel events: “Preventing health-care
Healthcare-associated infections are a
serious problem and health care workers
need to strive toward preventing the
1. Skin and mucous membrane
2. Respiratory system
3. Gastrointestinal system
4. Circulatory system
1. Inflammatory response
Local reaction to an infectious agent
Serves to localize, destroy, dilute,
neutralize, remove a pathogen
Signs – redness, heat, swelling and pain
2. Immune response
Immunity is a measure of a person’ s ability to
fight disease by forming immunoglobulins (
antibodies formed against invading antigens),
or producing interferon.
Source of infection
Portal of Entry to Portal of exit
susceptible host from Reservoir
Infectious agent—bacteria, viruses, fungi
Reservoir—natural habitat of the organism
Portal of exit—point of escape for the
Means of transmission—direct contact,
indirect contact, airborne route
Portal of entry—point at which organisms
enter a new host
Susceptible host—must overcome resistance
mounted by host’s defenses
What is the type of organism – virus, bacteria,
fungi, parasites, etc.
Level of virulence
Number of organisms
Number of organisms
Competence of person’s immune system
Lengthand intimacy of contact between
person and microorganism
Which of the following is the most significant
and commonly found infection-causing agent
in healthcare institutions?
Answer: A. Bacteria
Bacteria are the most significant infection-
causing agents in the healthcare system.
Bacteria can be categorized by shape, by their
reaction to the Gram stain, or according to
their need for oxygen.
Fungi (molds and yeasts) can cause infection
and are present in the air, soil, and water.
Viruses cause infections including the
common cold, and do not respond to
Food, water, milk
Which one of the following infections or
diseases may be spread by touching a
contaminated inanimate article?
C. E. coli
Answer: D. Influenza
Influenza may be spread if a person touches a
contaminated article and then touches his
eyes or nose.
The reservoir for rabies is animals; for
Giardia, water; and for E. coli, water or food.
Breaks in skin
Blood and tissue
Breaks in the host barriers
Lack of effective resistance
Changes in host defense
Intact skin and mucous membranes
Normal pH levels
Body’s white blood cells
Age, sex, race, hereditary factors
Immunization, natural or acquired
Fatigue, climate, nutritional and general
Use of invasive or indwelling medical devises
Use of invasive medical devices
Antibiotic-resistant organisms developed in
Constant surveillance by infection-control
committees and nurse epidemiologists
Written infection-prevention practices for all
Hand hygiene recommendations
Infection control precaution techniques
Keeping patient in best possible physical
Incubationperiod—organisms growing and
Prodromalstage—person is most infectious,
vague and nonspecific signs of disease
stage of illness—presence of specific
signs and symptoms of disease
Convalescent period—recovery from the
In which of the following stages of infection
is the patient most contagious?
A. Incubation period
B. Prodromal stage
C. Full stage of illness
D. Convalescent period
Answer: B. Prodromal stage
The patient is most infectious during the
prodromal stage when early signs and
symptoms of the disease are present but are
often vague and nonspecific. During this
stage, the patient often does not realize he or
she is contagious and spreads the infection.
Risk for Infection RT:
Altered immune response
Effects of medication
Altered skin integrity
Lack of proper immunization
The patient will:
1. demonstrate effective hand hygiene
2. identify the signs of infection
3. maintain adequate nutrition
4. demonstrate proper disposal of soiled
Although it is impossible to ensure
that the patient’s environment is
free of microorganisms, there are
many steps that a nurse can take
to reduce the spread of
microorganisms and thus promote
safety for both the patient and the
‣ Reduce the risk of health care–associated
According to the Centers for Disease Control and
Prevention, each year, millions of people acquire an
infection while receiving care, treatment, and
services in a health care organization.
Consequently, health care-associated infections
(HAIs) are a patient safety issue affecting all types
of health care organizations.
Thegoal of QSEN is to address the challenge
of preparing future nurses with the
knowledge, skills and attitudes (KSA)
necessary to continuously improve the quality
and safety of the healthcare systems in which
They have 6 competencies and Safety is one
of the main competencies.
Infection control measures used in the
‣ Medical Asepsis
‣ Standard Precautions
‣ Isolation Precautions
Practicesdesigned to reduce
the numbers of pathogenic
microorganisms and limit
their growth and
transmission in the patient’s
1. Helps the patient fight a current infection
and prevent its spread.
2. Prevents the patient from being re-infected
by the same pathogen.
3. Prevents the patient from being infected
with a new pathogen.
4. Prevents health care professionals and
visitors who come in contact with the
patient from being infected.
5. Helps decrease the chance of the patient acquiring a
◦ The infections can be simple and uncomplicated,
or major and life threatening. Patients are at
risk for nosocomial infection because they often
have weakened immune systems and because
the health care facility contains patients and
equipment that harbor infection.
The desired result is:
◦ to reduce the transmission of the
microorganisms from one person to another.
◦ Or from one person to an object
The first line of defense in
medical asepsis is hand hygiene.
Proper hand-hygiene is considered
the single most effective way to
stop the spread of microorganisms
and preventing infection.
Reduction in the
pathogens on the
Assess that the fingernails are short
Highest concentration of organisms on the
hands are found UNDER THE NAILS.
Jewelryshould be removed, especially
rings with stones. Wedding bands may be
Skin is free of lesions
‣ If the skin should have a small lesion, bandage
the area then double glove.
At the start of each shift
After sneezing or coughing
After using the bathroom
After handling contaminated items
Beforeand after giving patient care and between
After handling body excretions- even with gloves
Beforeand after performing any
After removing gloves
At the end of each shift before
leaving the health facility
1. Hand-washing is one of the most effective
methods of preventing the spread of
2. Usually 15 seconds should be allowed to
wash the hands
3. Clean from the cleanest
area to the dirtiest area
2. Running Water
4. These 3 are necessary to remove
5. Do not touch the sink when washing hands –
6. Keep clean items separate from dirty ones.
7. Turn off water with a dry paper
towel – wet acts as a wick.
8. Jewelry makes it difficult to adequately
cleanse the hands. It is best to not wear
jewelry in the clinical setting. Wedding
bands are acceptable sometimes.
9. If using hand lotion—allow hands to dry
about 30 minutes before applying. Do NOT
apply hand lotion immediately after washing
Alcohol-based hand rubs (foam or gel) kill
more effectively and more quickly than
handwashing with soap and water.
They are less damaging to skin than soap and
water, resulting in less dryness and irritation.
They require less time than handwashing with
soap and water.
Bottles/dispensers can be placed at the point
of care so they are more accessible.
HAND RUB (foam and gel)
‣ Apply to palm of one hand (the amount used
depends on specific hand rub product).
‣ Rub hands together, covering all surfaces,
focusing in particular on the fingertips and
fingernails, until dry. Use enough rub to require
at least 15 seconds to dry.
ALCOHOL-BASED HAND RUBS ARE MORE
EFFECTIVE IN KILLING BACTERIA THAN
SOAP AND WATER.
Standard Precautions are:
‣ Those precautions designed
for the care of all patients
in hospitals regardless of
their diagnosis or
presumed infection status.
of guidelines developed by the
Centers for Disease Control and
Prevention (CDC) for preventing
contact with potentially infectious
blood or body fluids that may
harbor diseases regardless of
whether or not they contain visible
body fluids, secretions and excretions
regardless of whether or not they contain visible
Nasal secretions, tears
Spinal fluid/ cerebrospinal fluid
Synovial, pleural, peritoneal , pericardial,
Allmoist body surfaces, mucus membranes
Used for all patient’s, not just those
with known infections
These precautions should be
implemented whenever contact with
potentially infectious material is
Used to protect the caregiver.
1. Hand Hygiene
2. Personal Protective Devices
Mask, Eye Protection, Face Shield, Gown
3. Respiratory Hygiene/ Cough Etiquette
4. Avoid recapping of needles; dispose of sharp
5. Handle Patient-care equipment appropriately
6. Use adequate Environment controls
7. Review room assignments
Hands must be washed after
patient contact regardless of the
use of gloves. Even if you wear
gloves, wash your hands
hands cannot be effectively
Gloves can be used to avoid direct contact
with infectious material
Wear gloves to handle:
‣ Body fluids
‣ Secretions, Excretions
‣ Contaminated items
Change gloves before preceding to the next
task, or touching non-contaminated items
even on the same patient.
Made of vinyl or latex -- vinyl are used
if allergy to latex is present.
Masks provide barrier protection against
splashes and sprays, and airborne
Masks come in various types depending on
their permeability to airborne particles.
Eye goggles or glasses and face shields
provide barrier protection against
splashes and sprays.
Gown – should be water
impermeable to provide barrier
Handleequipment in a manner that
prevents personal skin and mucous
membrane exposure and cross
contamination to other patient’s.
Reusable equipment must be cleaned/
disinfected and reprocessed before using
it in the care of another patient.
Each hospital, clinic has procedures
for care, cleaning, and disinfection of
of blood or body fluids need to
be handled with special procedures.
Handledin a way to prevent contamination of
skin, mucous membranes, and clothing.
Foldsoiled linen with contaminated area to
the inside. Do not shake.
Holdaway from body and place in
appropriate bag and dispose
all sharp objects in a
Do not re-cap needles
Immediatelydiscard after use. Do not
attempt to bend or break a needle before
discarding. Throw away the whole thing.
Isolation precautions are utilized when:
‣ patients have a greater susceptibility to
infection than others
‣ A patient or patient’s body fluids are a carrier
of microorganisms that can easily be
transmitted to other patients, family
members, or health care workers.
In addition to standard precautions, the
CDC recommends three categories of
transmission-based precautions. They
‣ 1. Airborne precautions
‣ 2. Droplet precautions
‣ 3. Contact precautions
The fourth type of isolation is protective
Used when the organism is capable of
remaining in the air for prolonged periods
of time and can be transported in the air .
Most common organisms are:
‣ Chicken pox
Must wear a special particulate filter mask
A private negative air pressure room is
used for patients needing airborne
‣ Negative air pressure rooms are used for
patients needing airborne precautions
‣ Bring air into the room from the hallway and
have a separate exhaust system.
‣ Outside the room is isolation cart that contains
supplies needed to care for the patient and
protects persons entering the room.
Caring for the patient in airborne isolation
‣ Personal Care - **Remember it is the disease
that is being isolated, not the patient.
Place linens in proper contaminated –waste
container, and soiled paper towels in an
isolation waste container.
‣ Food Service – disposable paper trays and
disposable dishes that are discarded in proper
isolation waste container. Do not put tray
back on the food cart.
‣ Contaminated articles – according
to agency policy, usually double
bagged or color-coded waste
bags to indicate contaminated waste.
patients on airborne precautions should
wear surgical masks when leaving the
negative air pressure room for
x-rays, tests, or
Organisms that can be spread by large-
Examples of organisms include:
Single rooms are preferable
Patients with same disease can share
the same room
Standard surgical masks and gloves
must be worn for anyone entering the
Gloves should be worn anytime
handling tissues or items contaminated
with the respiratory secretions
Keep visitors 3 feet from the infected
Purposeis to prevent the transmission of
disease by direct or indirect contact
‣ Direct contact involves:
‣ Indirect contact involves:
Contact with inanimate objects – doorknobs, light
switches, tabletops, telephones
Examples of diseases are: staph, herpes,
diphtheria, and many others
Contact precautions include use of barrier
precautions such as gloves and
impermeable gowns to prevent direct
contact with infectious organism
‣ With patients who are infected by a multi-drug
resistant organism (MDRO)
‣ For patient with diarrhea
‣ When coming into contact with draining wounds
‣ Patients with acquired antibiotic resistance
Place the patient in a private room if possible
Wear PPE when entering the room for all
interactions that may involve contact with the
patient or contaminated areas in the patient’s
Remove PPE before leaving the room and
perform hand hygiene
Avoid sharing patient-care equipment
Youhave gone in Mr. A.’s room to perform a
What type of isolation is he in?
Whatequipment would you use?
‣ A. Gloves only
‣ B. Gloves and gown
‣ C. Gloves, gown, and mask
with patients who are
immunocompromised such as:
‣ Organ transplants
1. __ Influenza A. Airborne
2. __ Diarrhea B. Droplet
3. __ Tuberculosis C. Contact
D. Protective / Strict
4. __ AIDS
5. __ Chicken pox
6. __ Draining wound
7. __ Chemotherapy pt’s
Mrs. B. is on airborne isolation.
What specific equipment is used in airborne
isolation that is not used in other types of
When would the nurse apply goggles
or a face mask?