SE C T I O N T W E L V E - I N F E C T I O N C O N T R O L
Infections
An infection is a diseased state caused by the invasion and growth of microbes (organisms) in the body. General infections can be divided into two categories, namely systemic infections and local infections. A local infection is limited to a specific portion of the body whereas systemic Infections, caused by bacteria or virus, affect the bloodstream and spread to the rest of the body. The most common examples include cold, flu, mononucleosis and strep throat T ypes of Infection
There are five main types of infections: Bacteria are single celled organisms which multiply rapidly. F ungi are plants that live on other plants or animals (e.g. molds, yeasts, mushrooms). Protozoa are one celled animals which cause diseases such as malaria and sleeping sickness. Rickettsiae are microscopic forms of life found in insects such as ticks, fleas and lice. V iruses are very small microscopic organisms that grow in living cells.
Signs and Symptoms of Infection
The signs and symptoms of infection can include one or more of the following: fever; foul odor discharge; heat at the site; pain; pus; redness; aches; chills; fever; nausea; vomiting; weakness; and, swelling .
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T ransmission of Infections
Infections can be spread through: direct contact with an infected person (e.g. hands, body fluids, sex and kissing) indirect contact with objects used by an infected person (e.g. eating /drinking utensils and personal hygiene items such as razors and toothbrushes). food; water; air; animals; insects; and, bandages. Diligence is required to protect clients from becoming contaminated with infection. This is done by removing, blocking or destroying microbes through the application of medical and/or surgical aseptic techniques. Medical asepsis is a clean technique (e.g. handwashing) while surgical asepsis involves the application of sterile techniques. Sterile procedures are not usually the responsibility of Home Care Assistants
Infectious Diseases Infectious diseases are diseases caused by germs that can be passed to or among humans by several methods. Home Care Assistants need to know how these germs are transmitted and what precautionary measures should be taken in order to control their spread. T ransmission Mode
T ranscription Description Germs are carried in airborne or dust particles & are inhaled.
Airborne Germs are transmitted by coughing or sneezing. Droplet
Common E xamples of Infectious Disease Tuberculosis Measles Herpes Zoster (shingles) Varicella (chicken pox) Diphtheria Rubella (German Measles) Influenza (the flu) Mumps Meninigitis Pneumona Scarlet Fever Pertussis (whooping cough)
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Precautionary M easure HCAs, who are not immune to these diseases, should not care for infected clients. HCAs should wear a mask when in the home of someone who has TB. HCAs, who are not immune to mumps or rubella, should not care for infected clients. HCAs should wear a mask if they are within 3 feet of a coughing client.
Germs are transmitted from body surface to body surface. Contact
Intestinal Diseases (e.g.. Salmonella, E Coli) Hepatitis A & B Herpes Simplex (e.g. cold sore) Respiratory Tract Infections (e.g. common cold) Sexually Transmitted Diseases AIDS
HCAs should wear gowns & gloves when substantial contact is expected. Equipment should be cleaned & disinfected before being used by someone else.
Bloodborne Diseases Blood-borne pathogens are germs (bacteria, virus etc.) that can cause a blood-borne disease. These pathogens are found in infected human blood and certain other body fluids, particularly semen and vaginal secretions. They may be passed from person-to-person with any exposure to infected blood or infected body fluid. Blood-borne pathogens include, but are not limited to: the Hepatitis B Virus (HBV); the Human Immunodeficiency Virus (HIV); and, the Hepatitis C Virus (HCV).
Home Care Assistants can be exposed to bloodborne diseases when working with clients. If proper precautions are not taken, bloodborne pathogens can be transmitted from the client to the Home Care Assistant who, in turn, can transmit it to others.
T he Role of the Home C are Assistant in Infection Control
To hinder the spread of infectious diseases, Home Care Assistants can: keep immunizations up to date; apply universal precautions; practice safe food handling techniques (see assignment 3); wash hands thoroughly and frequently; don:t put fingers near eyes, nose or mouth; cover mouth when coughing, sneezing or blowing nose; don:t use another person:s dirty drinking or eating utensils; wash raw fruits and vegetables before eating them; wear disposable sterile gloves when in contact with blood or body fluids; wear masks and protective eye wear when there is a risk of being splashed with blood or body fluids; avoid contact with any sharp objects; eat a balanced diet every day; get enough rest each night to feel refreshed; 165
exercise in moderation every day; bathe, wash hair and brush teeth regularly; wash cooking and eating utensils with soap and water after each use; advise clients and families to have their own personal care items (e.g. face cloth, drinking glass, toothbrush, razor); and, teach clients about infection control. T he Role C leansing Plays in Infection Control
There are several effective methods employed for preventing the spread of infections. Regardless of which method is used, all processes start with a thorough cleaning. Cleaning is the process of making all objects/surfaces free of organic and inorganic material. Generally, detergents or products containing enzymes will successfully do the job. Objects/surfaces must be cleaned thoroughly, before they are processed because organic and inorganic materials influence the efficiency of decontamination, disinfection and sterilization. Decontamination is the destruction, removal or inactivation of blood-borne pathogens on an object/surface by physical or chemical measures, which renders them incapable of spreading infectious particles. Disinfection is a process for getting rid of most or all pathogenic microorganisms (other than bacterial spores) on inanimate objects/surfaces through the use of chemical sterilizers or disinfectants. In the home environment, items can be disinfected using: o
Dry heat - Clean item and bake in an oven @ 350 degrees F. (180 degrees C.) for 1 hour. Dry Heat is used for dressings.
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Wet Heat - Clean item and boil for 20 minutes in a covered pot. Wet Heat is used for glass items.
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Bleach - Clean item and soak in a mixture of 10 cups water and 1 cup of bleach for 20 minutes. Bleach is used for blood, body fluids, feces, vomit, stained clothing, toilet and bathroom/ kitchen surfaces.
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Vinegar - Clean item and soak in a mixture of 3 cups water and 1 cup white vinegar for 20 minutes. Vinegar is used for kitchens, bath-tubs, showers, toilets, urinals, bedpans and commodes.
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Household Detergents & Hot Water are used to clean: - items, which only need to be cleaned; and, - items, which need to be cleaned prior to being disinfected.
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Commercial Solution. Follow individual instructions for usage and safety precautions.
Sterilization is the total elimination and destruction of all microorganisms through the application of steam under pressure, dry heat, ETO gas and/or liquid chemicals. This process is not usually done in the home and is utilized extensively in hospitals and medical clinics/office. 166
Using Universal Precautions to Control Infections
Universal Precautions are measures that can be followed to help prevent the spread of infection through contact with potentially infectious persons or materials. All blood and body fluids are considered potentially infectious materials and every client is handled as if he/she could have an infectious disease. Universal Precautions include processes for: hand washing; wearing personal protective equipment; handling sharp objects; handling body specimens; handling blood and body fluid spills; handling household waste; and, handling laundry. Home Care Assistants must adhere to the standards for Universal Precautions.
H andwashing W ashing H ands W ith W ater:
o o o o o o o o o o o
Turn tap on. Run water until it reaches a warm temperature. Hold hands under water flow. Apply soap so that it totally covers both hands and work soap into a frothy lather, rubbing vigorously, Clean thoroughly under nails, between fingers and on backs of hands. Wash for at least 15 O 30 seconds. Rinse hands thoroughly under running water starting at the fingertips and flowing towards the wrists, in order that the dirty water runs off the wrists. If a bar of soap is used, it should be rinsed and placed on a drain. Dry hands on a clean cloth towel or on a paper towel. Use a dry section of the towel to turn off the tap. Use a moisturizing cream on hands regularly to prevent skin from drying and cracking. Step-by-Step Directions for Washing Hands: 1.
Rub palms of both hands together:
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2.
Interlace fingers of one hand over palm of other hand; then switch hands:
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Rub palms of both hands together:
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Place back of fingers of one hand to palm of other hand, interlacing hands; then switch hands:
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Rotate thumb of one hand in palm of other hand; then switch hands:
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Rotate fingertips of one hand into palm of other hand; then switch hands:
W ashing H ands W ithout W ater:
o If hands are not visibly soiled, an alcohol-based hand rub may be used. o When using alcohol-based hand rubs, apply the product to the palm of one hand and rub hands together, covering all surfaces of hands and fingers until hands are dry. o When using an antiseptic hand cleanser or an antiseptic towelette: - use the antiseptic according to its instructions; - dry hands with a clean towel or a paper towel; - clean under the nails and between the fingers carefully; and, - use this method only if soap water are not available.
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Personal Protective E quipment Disposable G loves
Disposable gloves are worn when: providing assistance with toileting; providing assistance with incontinence pads, adult diapers, and child diapers; providing bladder care; providing bowel care; bathing the rectal or groin area; handling items dirtied with blood, body fluids, secretions and excretions; handling dirtied dressings bedding, and clothing; handling feminine hygiene products; cleaning or caring for urinary catheters; coming into contact with draining wounds, broken skin, secretions, excretions blood, body fluids, or mucous membranes; cleaning up blood or body fluid spills when; cleaning/disinfecting areas exposed to blood, stool, urine or body fluids; cleaning toilets, commodes, or soiled equipment; having open skin lesions on their hands; and, bagging materials soiled with blood or other potentially infectious materials. Removing gloves: When removing disposable gloves, ensure that the hands do not come in contact with any blood or body fluids, which may be left on the gloves.
1. Grasp glove cuff with opposite gloved hand and peel off.
2. Hold removed glove in gloved hand. Slide fingers of ungloved hand under remaining glove at wrist.
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3. Peel the glove from wrist to fingertips.
4. Turn the glove inside out leaving the first glove inside the second.
Wash hands thoroughly with soap and water: - as soon as possible after removing gloves; and, - immediately after exposure to infectious material and before touching any noncontaminated objects and surfaces. Place used gloves, soiled pads, paper towels, rags, and hygiene products directly into a garbage receptacle. These soiled products should be placed in a plastic garbage bag, which is subsequently closed tightly. Place the garbage bag out to be picked up with the regular garbage. Gowns & A prons
Wear gowns/aprons when: caring for clients with infectious diseases to reduce the possibility of transmission of organisms; there is a possibility that clothing will become soiled as a result of blood and/or body substances being splashed; and, it is difficult to properly contain blood and/or body substances. Wear fluid repellent gowns when: the skin needs to be protected; and, there is a possibility that clothing may become heavily soiled from blood, body fluids, secretions and/or excretions To put on a gown: select the proper type and size of gown; 170
place the open side of the gown at the back -- if the gowns are too small, use two gowns O tie one at the front and the other at the back; slip the gown over the hands and arms by holding the arms forward, just above the head; adjust the gown at the shoulders; fasten the gown at the back of the neck; and, tie the gown firmly at the waist. To remove a gown: remove gloves; untie the gown at the waist and neck; pull the gown over the gloves; hold the contaminated gown away from the clothing; discard the gown or place in designated spot for cleaning remove gloves; and, wash hands thoroughly.
M asks and Protective Goggles
Mask Masks are specialized pieces of equipment worn over the nose and mouth to catch bacteria shed from the wearer:s nose and mouth. They reduce the transmission of Bacterial particles from the wearer into the environment and help protect the wearer from blood and body fluid splashes or spatter. To put on a mask: - place mask so that it covers mouth and nose; - fasten ties above and below at back of head; and, - fit it snugly on the bridge of nose and under the chin. To take off a mask: - ensure hands are clean; - undo the ties at the back of the head; - remove the mask by touching the ties only; - discard the mask in a designated waste receptacle; and, - wash hands. Protective Goggles Protective goggles are specially designed eyewear worn to protect the wearer:s eyes from splatters or aerosols, which may contain infectious diseases
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To put on protective goggles: - place the protective goggles on the face, covering both eyes; and, - maneuver them so they fit comfortably and effectively on the face. To take off protective goggles: - ensure hands are clean; - touch the sides or back of the protective goggles only; - place the protective goggles in a designated area for discarding or sanitization; and, - wash hands Sharp O bjects
Sharp objects refer to items used for medical purposes and include: needles; syringes with needles attached; lancets; razor blades; and, other items that could cause a puncture, cut, or abrasion. Procedures for Handling Sharp Objects Handling sharp objects should be kept to a minimum. Syringes should always be picked up by their barrel. Used needles and other sharp objects should: not be recapped, bent, sheared or broken; be discarded immediately into an appropriate sharp object disposal/puncture-proof container; and, not be carried if they are uncapped. Used needles should be left attached to the syringes. If a needle must be recapped to facilitate safe transportation: put the needle on a flat surface; and, remove hand from cap and recap the needle using one hand. Safety devices, for sharp objects, should always be used and must never be circumvented or disabled. Sharp objects should be discarded in puncture-resistant containers. If a commercial, sharp object, disposal container is not available, plastic, thick-walled, household containers, such as a bleach or vinegar bottle, could be used. Clear plastic/glass containers should not be used for sharp objects. Sharp objects should not be placed in any container that is going to be recycled or returned to a store. All containers, with sharp objects, should be kept out of reach of children and pets. Caution should be taken in situations where sharp objects may be hidden somewhere e.g. sharp objects are hidden in the laundry or garbage. 172
Used, sharp objects should be handled with care to prevent accidental cuts or punctures. Contaminated, broken glassware or dropped sharp objects should be picked up by mechanical means such as with a broom and dustpan, tongs or forceps. Hands should never be inserted into a container that contains sharp objects.
H andling Specimens
Home Care Assistants may Be required to handle specimens in a client:s home Ie.g. urine, sputum and feces). Specimens may be needed to send to the laboratory or to test urine. Procedures for Handling Specimens Put disposable gloves on. Obtain the specimen, following directions provided by the Supervisor/Medical Person. Label the specimen with the client:s name, address, date and time of collection. Place label on the container and not on the lid. Use a clean or sterile container, as directed by Supervisor/Medical Person. The container will vary depending on the type of specimen needed. Put the lid on the container as soon as the specimen is collected. Place container in a plastic bag. Remove gloves and discard gloves. Wash hands. Store the specimen as directed and advise client/family of its location. Follow any directions for ensuring the specimen is sent to the lab.
Blood Sugar L evel T ests
Clients/families are responsible for conducting blood sugar levels. The procedure is not done by Home Care Assistants. Home Care Assistants should not touch the lancets (blades used to prick tissue) or the dipsticks (apparatus used to capture the blood sample), which are used in the process because they are contaminated. (Note: Dipsticks can also be used to test urine.) Home Care Assistants may record the test results. They should also ensure that the lancets and dipsticks are disposed of as directed by the Supervisor/Medical Person. (Normally, lancets are placed into sharp object containers. Dipsticks are placed into some type of biohazard container or they are labeled with biohazard stickers.) H andling Blood & Body F luid Spills
Blood and body fluid spills can occur anywhere, even in the home environment. Therefore, certain procedures should be followed to prevent contamination:
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Put on protective eyewear and plastic aprons, if there is a chance of being splashed with blood/body substances. Put on disposable gloves. Confine and contain the spill as soon as possible. Soak up as much of the spill as possible using absorbent, disposable materials. Place the absorbent, contaminated materials into doubled-bagged, plastic, garbage bags. Wash and disinfect contaminated surfaces with disposable sponges/cleaning cloths: Use a solution of 1 part bleach to 10 parts water for disinfecting. Use cold water on blood spills. Use warm to hot water on non blood spills. Dry the area, where the spill occurred, to prevent a slippery surface. Discard disposable sponges/cleaning cloths in double-bagged, plastic, garbage bags. Clean spillage area with water and detergent. Wash hands thoroughly with soap and warm water. If glass items break, sweep the broken pieces into a dust pan -- do not pick up the broken pieces with the fingers. If a spill occurs on a carpet, avoid damaging the area with chlorine O instead, use a detergent and arrange for an industrial cleaning of the carpet as soon as possible. If any part of the body has been in contact with blood/body substances, the exposed area(s) should be washed immediately. Clean any contaminated equipment with cold water and detergent; then disinfect it. H andling Household W aste
Household Medical Waste Household medical waste is any waste that is generated as a result of health care activities in the home. It includes paper towels, diapers, incontinence pads, hypodermic needles, bandages, dressing wrappers, old dressings and used intravenous tubing. Used intravenous tubing is tubing that has been used to administer blood/blood products. Note: Unused intravenous tubing has not been utilized and, therefore, is not considered to be medical waste. Household medical waste does not include any hazardous waste, radioactive waste, or regular household waste. Usually, medical wastes, produced in the home, do not pose a serious health concern unless the waste is infectious. Infectious Waste Infectious waste is medical waste that presents significant health risk, such as the possibility of causing disease in another human being, should that person come into contact with the waste. Infectious waste includes wastes that are contaminated with blood, body fluids, or sharp objects from people who have infectious diseases.
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Procedures for H andling W astes:
All wastes should be: - sorted into correct categories at the spot where they are produced; - placed in proper containers; and, - kept in separate packaging during collection, storage and transportation to ensure waste material is not released. Hands should be washed with soap and hot water for 15 seconds after contact with garbage. Soiled bandages, disposable sheets and medical gloves should be placed in securely fastened plastic bags before being placed in garbage receptacles.
H andling L aundry
Procedures for handling laundry: Separate areas for clean and soiled laundry should be used. Laundry should be sorted in the laundry room, not in the client:s room. Clothing/linen, soiled with blood or body fluids, should be put into bags at the spot where the soiling occurred. Dangerous objects should not be thrown into the clothing/linen bags/hampers. Disposable gloves should be worn whenever any clothing/linen, soiled with blood (including menstrual blood) or body fluid, is handled. Plastic aprons should be worn, when indicated. Clothing/linens that are to be transported should be: placed in leak proof bags e.g. plastic garbage bags; closed securely; placed loosely into bags; and, placed into bags identified as being potentially infectious. Protective gloves should be worn when bagging clothing/linens that have been soiled with body substances/blood (including menstrual blood). Wash hands with hot water and soap for 15 seconds after gloves are removed. Other protective clothing should be worn as necessary. Paper towels and/or running water should be used to remove solid materials from clothing/linens prior to laundering. Urine, stool and vomit should be flushed down the toilet. Relevant cleaning methods should be used when washing laundry, i.e.: separation of items; suitable water temperature; and, appropriate machine cycle. Use a water temperature of at least 140 F. (60 C) to ensure decontamination. Control the risk of contaminated, slime building up in the washing machine by using a water temperature higher than 140 F. (60 C) at least once a week. 175
If washing in cooler water, use bleach or other laundry disinfectant. Follow the instructions on the bleach/disinfectant container. If clients have suppressed immunity systems or if clothing/linens are heavily soiled: use higher water temperatures of at least 190 F. (90 C); or, use a water temperature of at least 140 F. (60 C) with bleach Ensure clothing/linens that are/may be contaminated with fecal material are not washed with items that may be used around food. Dry laundry as soon as it is washed -- don:t leave it sitting for long periods in the washing machine, as dampness can promote the growth of micro-organisms. Clothing/linens should be stored in a manner that prevents contamination. Clean linens/clothing should be stored separately from used linen/clothing. Laundry equipment should be maintained in sanitary condition. Laundry baskets or other transport items should be cleaned and sanitized after use. Client:s laundry should not be taken home for laundering due to the increased risk of crossinfection
H andling E quipment
Home Care Assistants may be required to handle Personal Care items and Special Equipment. Personal Care Items
Personal care items consist of items clients use for grooming and body hygiene such as toothbrush, razor, hair comb & brush, manicure and pedicure set, etc. Special Equipment
Special equipment refers to items that clients use to assist with bathing, toileting, mobility, transportation and sleeping (e.g. bath bench, commode, raised toilet set, crutches, walking cane, walker, wheelchair, scooter, bed, etc.). Procedures for H andling Personal C are Items and Special E quipment.
All items/equipment, used for client care, should be kept clean and in proper running order. Blood, fluid and tissue should not be allowed to dry on any reusable item and should be cleaned quickly. All objects/equipment should be thoroughly cleaned to remove blood, tissue, fluids/body secretions/excretions and other residue before they are disinfected or sterilized. All special equipment, used for client care, should be cleaned and disinfected before it is used for another individual. All special equipment, used for one client, which could harbor disease-causing microorganisms (e.g. commodes, raised toilet seat, etc.), should be wiped with a disinfectant at least once a day or whenever visible soiling is evident.
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Items that come in contact with the skin only and not with mucous membranes, need to only be wiped down with a detergent or low-level disinfectant (e.g. crutches, canes, walkers, wheelchair, and blood pressure cuff). Re-usable objects, which touch mucous membranes, can be cleaned and disinfected by soaking in bleach and water. Personal Protective Equipment should be worn when handling contaminated equipment and when using chemical products. Gloves should be worn when handling and transporting used client special equipment. Hands should be washed immediately with soap and hot water for a minimum of 15 seconds after contacting contaminated items. Personal care items used for grooming should normally be cleaned using hot water and detergent. Oxygen equipment should be cleaned and handled as demonstrated by the supplier or a Registered Nurse. . C atheters & D rainage Bags
Catheterization equipment should be cleaned and handled as follows unless advised otherwise by a Registered Nurse. Home Care Assistants often are responsible for cleaning catheters; and emptying and cleaning drainage bags. Note: Only Registered Nurses should insert or remove catheters. Procedures for Cleaning a C atheter
Cleanse catheter once per shift or more frequently, if required. Wash hands and wear disposable gloves. Ensure privacy and advise client what is being done and why. Cover the client with a bath blanket and use a bed protector. Perform peri-care prior to cleansing, after bowel movements, and/or when vaginal drainage is present. Separate labia or retract foreskin. Check for crusts, abnormal drainage or secretions. Cleanse the catheter using soap, water, and clean cloth. Wipe from the meatus (opening at the end of the urethra) downward about four inches. Repeat as necessary using a new cloth each time. Rinse well to ensure all soap is removed. Avoid pulling on catheter. Ensure catheter is secured properly. i.e.: tape the catheter to the inner thigh leaving enough slack so it does not cause friction at the urethra; ensure urine flows freely, that there are no kinks in the tubing, and that the patient is not sitting or lying on the tubing; coil the tubing and attach securely to bed linens or chair; 177
keep the drainage bag below the bladder to prevent urine from flowing backward into the bladder; and, ensure there are no leaks where the catheter connects to the drainage bag. Procedures for Emptying the D rainage Bag
Empty the drainage bag at the end of each shift or as needed. Wash hands and wear disposable gloves. Place a paper towel on floor and set graduate container on it. Open the clamp on the bottom of the drainage bag. Allow all urine to drain into the graduate container being careful not to let the drain touch the inside of the container. Close the clamp and replace the clamped drain in the holder on the bag. Measure urine. Record amount of output (1 ounce = 30 ml.) and color of urine (e.g. “dilute”C “amBer”C “concentrated”C “tea”C “cranBerry” or other.N _ote anything present in urine such as blood, crystals, stones, or particles. Note any foul odors.) Be careful when changing the drainage bag to prevent urine from spilling. Be alert for any leakage, particularly at the point where the catheter and drainage bag connect. Do not place drainage bag directly onto the floor but instead put it on a stand that prevents contact with the floor. Procedures for Cleaning the E mptied D rainage Bag
Wash hands and wear disposable gloves. Rinse emptied drainage bag with water. (Use syringe, if available, as it enables water to be inserted into bag more easily.) Insert 6 syringes (about 12 ounces) of water. Discard “rinsing” water from Bag. Prepare a solution of water and soap (6 syringes of water and 2 squirts of soap) in one bowl. Insert into bag and swish around bag. Discard soapy solution from bag. Rinse bag with 6 syringes of water. Discard rinsing water from bag. Mix a solution of ½ cup vinegar and 6 syringes of water in second bowl. Insert vinegar solution into drainage bag. Gently swirl the vinegar solution around drainage bag to wet the entire inside. Leave vinegar solution in drainage bag until the bag is to be used. When drainage bag is needed, empty vinegar solution. Change urinary Bags when necessary and in accordance with the manufacturer:s directions
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Summary
Some bacterial, viral, or parasitic infections are contagious even before symptoms appear. Therefore, it is important for Home Care Assistants to take the necessary steps to know the signs of infections and infectious diseases and to know how to control them. Precautions necessary to prevent the spread of germs are the same for all diseases and should be followed regularly and consistently for every person, in every setting. Universal precautions and medical sepsis need to be followed when handling body fluids, feces, soiled linens and clothing. The single most important precaution is hand washing. Other universal precautions include properly caring for and cleaning special equipment, utensils, personal care items, clothing, and bed linens; wearing protective clothing whenever necessary; and, properly disposing of wastes.
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