Module 3.

0 Infection Control

RET 1024 Introduction to Respiratory Therapy

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Nosocomial Infection;
An infection acquired after hospitalization - AKA: hospital-acquired infection

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Nosocomial Infection;

Account for an estimated 2 million infections and 90,000 excess deaths annually

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Nosocomial Infection
Infections acquired by those in the intensive care unit (ICU) account for >20% of all HAIs (CDC 2007)
Immunocompromised by disease and/or treatment Major trauma Respiratory failure Myocardial infarction CHF Overdose

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Nosocomial Infection
Approximately 25% of patients undergoing mechanical ventilation develop pneumonia as a complication

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Nosocomial Infection
Approximately 30% of patients who develop ventilatoracquired pneumonia (VAP) will die

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Nosocomial Infection
Historically, non-disposable respiratory equipment was identified as a major cause of respiratory infection

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Nosocomial Infection
Today, procedures have evolved, and with the advent of single-patient use equipment, infections associated with respiratory equipment have decreased significantly

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Nosocomial Infection
Healthcare workers must remain vigilant to protect their patients and themselves against infection; to do so, requires strict adherence to infection control procedures

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Infection control procedures aim to:
Eliminate the sources of infectious agents Create barriers to their transmission Monitor and evaluate the effectiveness of control

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Spread of Infection
Infection occurs when a pathogen overcomes the barrier of the host
Pathogen; a microorganism capable of producing a disease Host; an organism in which another, usually parasitic, is nourished and harbored

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Spread of Infection
Three elements needed to spread an Infection
Source of pathogens Route of transmission Susceptible host

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Source of Pathogens
People
Patients, personnel, visitors Acute disease with symptoms Incubation period (exposed, but no symptoms yet) Colonized by pathogens without symptoms Autogenous infection (originating from within the body)

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Source of Pathogens
Contaminated objects
Equipment Linen Medication

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Transmission Route
Contact Droplet Airborne Common vehicle Vectorborne
NOTE: Some organisms may be spread by multiple routes

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Contact Transmission
Direct Contact
Body-surface-to-body-surface contact (person-to-person)

Indirect Contact
Contaminated object (fomite) to host contact
Clothing (uniforms, lab coats, isolation gowns) Equipment Dressings Instruments Shared toys

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Droplet Transmission
Contaminated respiratory droplets
Discharged into the air (up to 10 feet) during: Coughing, sneezing, talking Suctioning, bronchoscopy, intubation, cough induction Deposited on the hosts mucosal surfaces Nasal mucosa Mouth

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Droplet Transmission
Contaminated respiratory droplets
Currently Health Care Infection Control practices Advisory Committee (HICPAC) guidelines state it may be prudent to don a mask when within 6 feet of the patient or upon entry into the room of a patient who is on droplet isolation

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Droplet Transmission
Haemophilus Influenzae
Pneumonia / Epiglotitis

Influenza virus Rubella (German measles)

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Airborne Transmission
Contaminated droplet nuclei
Residue of evaporated water droplets containing infectious microorganisms Can remain suspended in air for long periods Respirable particles of less than 5 m

Dust particles
Act as fomites

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Airborne Transmission
Mycobacterium tuberculosis (TB) Mycobacterium Tuberculosis Rubeola (Measles) Varicella-zoster (Chicken Pox)
Note: Special air handling and ventilation, as well as respiratory protection are required

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Common Vehicle Transmission
Pathogens in water and food
Food
Salmonellosis Hepatitis A

Water
Shigellosis Cholera

Medications (e.g., heparin solution)

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Vector borne Transmission
Animals or insects transfer pathogens
Malaria West Nile Virus Rabies

Note: Vectorborne transmission are of little significance in hospital-acquired infections

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Spread of Infection to the Lungs
Pathogens enter the lungs via:
Aspiration of contaminated Oropharyngeal secretions Gastric secretions

Inhaled droplets, droplet nuclei, or dust particles containing pathogens (fomites) Hematogenous
Via the blood

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Host
Host infection dependent upon:
Virulence of the organism

Resistance of the host