Healthcare-Acquired Infections

An infection that develops in an individual after being admitted to a health care facility or undergoing a medical procedure is a healthcare-associated infection (HAI), formerly referred to as a nosocomial infection. About 1 in 31 hospital patients develops at least one healthcare-associated infection every day. HAIs increase the cost of care and delay recovery. They are associated with permanent disability, loss of wages, and even death. An example of an HAI is a skin infection that develops in a patient’s incision after they had surgery due to improper hand hygiene of health care workers.[3],[4] It is important to understand the dangers of Healthcare-Acquired Infections and actions that can be taken to prevent them.

Read more details about healthcare-acquired infections in the “Infection” chapter of Open RN Nursing Fundamentals.

Healthcare-Associated Infections by Michelle Hughes is licensed under CC BY 4.0.

References

1.

“Chain-of-Transmission” by unknown author is licensed under CC BY-NC 4.0. Access for free at https:​//ecampusontario​.pressbooks.pub/introductiontoipcp​/chapter/40/ ↵.

2.

Department of Health. (n.d.). Chain of infection in infection prevention and control (IPAC). The Government of Nunavut. https://www​.gov.nu.ca​/health/information​/infection-prevention-and-control ↵.

3.

This work is a derivative of Nursing Fundamentals by Chippewa Valley Technical College and is licensed under CC BY 4.0 ↵.

4.

Office of Infectious Disease and HIV/AIDS Policy. (n.d.). Health care-associated infections. U.S. Department of Health & Human Services. https://www​.hhs.gov/oidp​/topics/health-care-associated-infections/index.html ↵.

Physical Defenses

Physical defenses are the body’s most basic form of defenses against infection. Physical defenses include barriers such as skin and mucous membranes, as well as mechanical defenses, that physically remove microbes from areas of the body.[1]

SKIN

One of the body’s most important physical barriers is the skin barrier that is composed of three layers of closely packed cells. See Figure 4.2[2] for an illustration of layers of the skin. The topmost layer of skin, called the epidermis, consists of cells that are packed with keratin. Keratin makes the skin’s surface mechanically tough and resists degradation by bacteria. When the skin barrier becomes broken, such as becoming cracked from dryness, microorganisms can enter and cause infection.[3]

Figure 4.2

Skin Layers

Mechanical Defenses

In addition to physical barriers, the body has several mechanical defenses that physically remove pathogens from the body and prevent infection. For example, the flushing action of urine carries microbes away from the body and is responsible for maintaining a sterile environment of the urinary tract.

The eyes have additional physical barriers and mechanical mechanisms for preventing infections. Eyelashes and eyelids are physical barriers that prevent dust and airborne microorganisms from reaching the surface of the eye. Any microbes or debris that make it past these physical barriers are flushed out by the mechanical action of blinking. Blinking bathes the eye in tears and washes debris away.[5] See Figure 4.3[6] for an example of eyelashes as a mechanical defense.

Figure 4.3

Eyelashes Are a Mechanical Defense Against Pathogens

Chemical Defenses

In addition to physical and mechanical defenses, our immune system uses several chemical defenses that inhibit microbial invaders. The term chemical mediators refers to a wide array of substances found in various fluids and tissues throughout the body. For example, sebaceous glands in the dermis secrete an oil called sebum that is released onto the skin surface through hair follicles. Sebum provides an additional layer of defense by helping seal off the pore of the hair follicle and preventing bacteria on the skin’s surface from invading sweat glands and surrounding tissue. However, environmental factors can affect these chemical defenses of the skin. For example, low humidity in the winter dries the skin and makes it more susceptible to pathogens that are normally inhibited by the skin’s low pH. Application of skin moisturizer restores moisture and essential oils to the skin and helps prevent dry skin from becoming infected.[7]

Other types of chemical defenses are pH levels, chemical mediators, and enzymes. For example, in the urinary tract, the slight acidity of urine inhibits the growth of potential pathogens in the urinary tract. The respiratory tract has various chemical mediators in the nasal passages, trachea, and lungs that have antibacterial properties. Enzymes in the digestive tract eliminate most microorganisms that survive the acidic environment of the stomach. However, feces, the end product of the digestive system, can still contain some microorganisms. For this reason, hand hygiene is vital after using the restroom or assisting a client with perineal care to prevent the spread of infection.[8]

References

1.

This work is a derivative of Microbiology by OpenStax and is licensed under CC BY 4.0. Access for free at https://openstax​.org​/books/microbiology/pages/1-introduction ↵.

2.

“OSC​_Microbio_17_02_Skin.jpg” by OpenStax is licensed under CC BY 4.0. Access for free at https://openstax​.org​/books/microbiology/pages​/17-1-physical-defenses ↵.

3.

This work is a derivative of Microbiology by OpenStax and is licensed under CC BY 4.0. Access for free at https://openstax​.org​/books/microbiology/pages/1-introduction ↵.

4.

This work is a derivative of Microbiology by OpenStax and is licensed under CC BY 4.0. Access for free at https://openstax​.org​/books/microbiology/pages/1-introduction ↵.

5.

This work is a derivative of Microbiology by OpenStax and is licensed under CC BY 4.0. Access for free at https://openstax​.org​/books/microbiology/pages/1-introduction ↵.

6.

“Eyelashes​_of_a_2-month-old_baby_boy.png” by Karthik​.yerramilly is licensed under CC BY-SA 4.0 ↵.

7.

This work is a derivative of Microbiology by OpenStax and is licensed under CC BY 4.0. Access for free at https://openstax​.org​/books/microbiology/pages/1-introduction ↵.

8.

This work is a derivative of Nursing Fundamentals by Chippewa Valley Technical College and is licensed under CC BY 4.0 ↵.

Standard Precautions

Standard precautions are used by health care workers during client care when contact or potential contact with blood or body fluids may occur. Standard precautions should also be used when assisting a client with activities of daily living (ADLs) and using water, soap, or lotion. Standard precautions are based on the principle that all blood, body fluids (except sweat), nonintact skin, and mucous membranes may contain transmissible infectious agents. These precautions reduce the risk of exposure for the health care worker and protect patients from potential transmission of infectious organisms.[1]

According to the Centers for Disease Control and Prevention (CDC), standard precautions include the following[2]:

• Using proper hand hygiene at the appropriate times
• Using personal protective equipment (e.g., gloves, gowns, masks, eyewear) whenever exposure to infectious agents may occur
• Implementing respiratory hygiene for staff, patients, and visitors
• Proper cleaning and sanitizing of the environment, equipment, and devices
• Handling laundry safely
• Using transmission-based precautions when indicated

Hand Hygiene

The easiest and most effective way to break the chain of infection is by using proper hand hygiene at appropriate times during patient care. Knowing when to wash your hands, how to properly wash your hands, and when to use soap and water or hand sanitizer are vital for reducing the spread of infection and keeping yourself healthy. Hand hygiene is the process of removing, killing, or destroying microorganisms or visible contaminants from the hands. There are two hand-hygiene techniques: handwashing with soap and water and the use of alcohol-based hand rub (ABHR), also referred to as hand hygiene gel or hand sanitizer.[3]

Health care providers’ hands are the most common mode of transmission of microorganisms. As a nursing assistant, your hands will touch many people and objects when providing care. When you touch a client, their personal items, medical equipment, or their surrounding environment, you can indirectly transmit microorganisms to the client, another client, yourself, equipment, or a new environment. Microorganisms can easily be transferred from your hands to others or objects in the health care setting if proper hand hygiene practices are not followed. Consistent and effective hand hygiene is vital for breaking the chain of transmission.[4]

It is essential for all health care workers to use proper hand hygiene during specific moments of patient care[5]:

• Immediately before touching a patient
• Before performing an aseptic task, such as emptying urine from a Foley catheter bag
• Before moving from a soiled body site to a clean body site
• After touching a patient or their immediate environment
• After contact with blood, body fluids, or contaminated surfaces (with or without gloves)
• Immediately after glove removal

See Figure 4.4[6] for an illustration of the five moments of hand hygiene.

Figure 4.4

Moments of Hand Hygiene

Hand hygiene also includes health care workers keeping their nails short with tips less than 0.5 inches and no nail polish. Nails should be natural, and artificial nails or tips should not be worn. Artificial nails and chipped nail polish have been associated with a higher level of pathogens carried on the hands of health care workers despite using proper hand hygiene.[7]

Review the Moments of Hand Hygiene by clicking on the interactive activity below.

This work is a derivative of Your 4 Moments for Hand Hygiene by Michelle Hughes and is licensed under CC BY 4.0.

Proper hand hygiene includes handwashing with soap and water or the use of alcohol-based hand rub. Both procedures are described in the following sections.

HANDWASHING WITH SOAP AND WATER

Handwashing involves the use of soap and water to physically remove microorganisms from one’s hands. Certain health care situations require handwashing with soap and water instead of using alcohol-based hand rub (ABHR). For example, hands must be washed with soap and water if they are visibly soiled, have been exposed to blood or body fluids, or have been exposed to norovirus, C. difficile, or Bacillus anthracis. The mechanical action of lathering and scrubbing with soap for a minimum of 20 seconds is vital for removing these types of microorganisms.[8]

Soap is required during handwashing to dissolve fatty materials and facilitate their subsequent flushing and rinsing with water. Soap must be rubbed on all surfaces of both hands followed by thorough rinsing and drying. Water alone is not suitable for cleaning soiled hands. The entire procedure should last 40 to 60 seconds, and soap approved by the health agency should be used.[9]

When washing with soap and water, the Centers for Disease Control and Prevention (CDC) recommends the following steps[10]:

• Wet hands with warm or cold running water and apply facility-approved soap.
• Lather hands by rubbing them together with the soap. Use the same technique as the hand rub process to clean the palms and fingers, between the fingers, the backs of the hands and fingers, the fingertips, and the thumbs.
• Scrub thoroughly for at least 20 seconds.
• Rinse hands well under clean, running water.
• Dry the hands, using a clean towel or disposable toweling, from fingers to wrists.
• Use a clean paper towel to shut off the faucet.

See Figure 4.5[11] for an illustration of handwashing with soap and water.

Figure 4.5

How to Handwash with Soap and Water

See the “Skills Checklist: Hand Hygiene With Soap and Water” section later in this chapter for a checklist of steps and an associated demonstration video of this procedure. Common safety considerations and errors when washing hands are described in the following box.

Safety Considerations[12]

• Always wash hands with soap and water if hands are visibly soiled.
• When working with clients where C. difficile, norovirus, or Bacillus anthracis is suspected or confirmed, soap and water must be used. It is more effective in physically removing the C. difficile spores compared to ABHR, which is not as effective at penetrating the spores.
• Friction and rubbing are required to remove transient bacteria, oil, and debris from hands.
• Always use soap and water if hands are exposed to blood, body fluids, or other body substances.
• Multistep rubbing techniques using soap and water are required to promote coverage of all surfaces on hands.

Common Errors When Washing Hands With Soap and Water[13]

• Not using enough soap to cover all surfaces of the hands and wrists.
• Not using friction when washing hands.
• Not washing hands long enough. The mechanical action of lathering and scrubbing should be a minimum of 20 seconds, and the entire procedure should last 40 to 60 seconds.
• Missing areas such as the fingernails, wrists, backs of hands, and thumbs.
• Not removing all soap from hands and wrists.
• Shaking water off hands.
• Not thoroughly drying the hands.
• Drying hands from wrists to fingers or in both directions.

Practice your knowledge by clicking on this interactive learning activity.

This work is a derivative of the YouTube Hand Washing Video by Michelle Hughes and is licensed under CC BY-NC 4.0.

ALCOHOL-BASED HAND RUB

When performing hand hygiene using the alcohol-based hand rub (ABHR) technique, a liquid, gel, or foam alcohol-based solution is used. ABHR is the preferred method for hand hygiene when soap and water handwashing is not required. It reduces the number of transient microorganisms on hands and is more effective for preventing healthcare-acquired infections (HAIs) caused by Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant enterococcus (VRE). Hand hygiene with ABHR should be performed in front of the client prior to the beginning of care and at the end of the interaction. ABHR provided by the agency should be used with a 70–90% alcohol concentration.[14]

The benefits of ABHR include the following[15]:

• It kills the majority of microorganisms (including viruses) from hands.
• It requires less time than soap and water handwashing.
• It provides better skin tolerability and reduces skin irritation because it contains emollients.
• It is easy to use and available at the point of care (i.e., where three elements of the client, the health care provider, and care involving the client occur together).

Read safety considerations and common errors when using ABHR in the following box. See the “Skills Checklist: Hand Hygiene With Alcohol-Based Hand Sanitizer” section later in this chapter for a checklist of steps and an associated demonstration video of this procedure.

Safety Considerations[16]

• Do not use ABHR in combination with soap and water because it may increase skin irritation.
• Use ABHR that contains emollients (oils) to help reduce skin irritation and overdrying.
• Allow hands to dry completely before initiating tasks (e.g., touching the client or the environment or applying clean gloves).
• Use ABHR for all moments of hand hygiene if soap and water are not required.
• DO NOT use ABHR if hands are visibly soiled, have been exposed to blood or body fluids, or the client is suspected to have C. difficile, norovirus, or Bacillus anthracis.
• Only use ABHR supplied by the facility.

Common Errors When Performing an ABHR[17]

• Not letting hands air dry (for example, rubbing one’s hands on pants to dry it off).
• Shaking hands to dry.
• Applying too much alcohol-based solution.
• Not applying enough alcohol-based solution.
• Not rubbing hands long enough (a minimum of 20 seconds) and until hands are dry.
• Missing areas such as the fingernails, wrists, backs of the hands, and thumbs.

Practice your knowledge by clicking on this interactive learning activity.

This work is a derivative of Performing an Alcohol-Based Hand Rub by Michelle Hughes and is licensed under CC BY-NC 4.0.

Transmission-Based Precautions

When providing care for individuals with known or suspected infections, additional precautions are used in addition to the previously discussed standard precautions. Certain types of pathogens and communicable diseases are easily transmitted to others and require additional precautions to interrupt the spread of infectious agents to health care workers and other clients. For example, Coronavirus disease (COVID-19), C. difficile (C-diff), Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococci (VRE), Respiratory Syncytial Virus (RSV), measles, and tuberculosis (TB) require transmission-based precautions.

Transmission-based precautions (commonly referred to as isolation precautions) use specific types of personal protective equipment (PPE) and practices based on the pathogen’s mode of transmission. It is vital for nursing assistants to understand what PPE should be used in specific client care situations, which is determined by the pathogen’s mode of transmission and their possible risk of exposure.[21] Transmission-based precautions include three categories: contact, droplet, and airborne precautions. Read more about each type of transmission-based precaution in Table 4.1.

Signage for Transmission-Based Precautions

When a resident has an infectious illness requiring transmission-based precautions, a sign is placed on their door and a cart of PPE supplies is placed nearby. Signs vary by facility but look similar to the image in Figure 4.6.[25] Due to HIPAA regulations, the type of the pathogen and the source cannot be displayed publicly, so the sign instructs anyone wishing to enter the room to ask the nurse first. Additional information regarding the type and source of the infection can be found in the client’s nursing care plan. After you become aware of the pathogen, the source, and the required PPE, you can safely enter the room. If you are unsure about any aspect of PPE required or your risk of exposure, talk to the nurse before entering the room or providing care.

Figure 4.6

Example of Isolation Precautions Sign

View the following YouTube video from the University of Iowa about isolation precautions in a health care setting: Standard and Isolation Precautions.

References

1.

Centers for Disease Control and Prevention. (2016, January 26). Standard precautions for all patient care. https://www​.cdc.gov/infectioncontrol​/basics​/standard-precautions.html ↵.

2.

Centers for Disease Control and Prevention. (2016, January 26). Standard precautions for all patient care. https://www​.cdc.gov/infectioncontrol​/basics​/standard-precautions.html ↵.

3.

This work is a derivative of Introduction to Infection Prevention and Control Practices for the Interprofessional Learner by Hughes, Kenmir, St-Amant, Cosgrove, & Sharpe and is licensed under CC BY-NC 4.0 ↵.

4.

This work is a derivative of Introduction to Infection Prevention and Control Practices for the Interprofessional Learner by Hughes, Kenmir, St-Amant, Cosgrove, & Sharpe and is licensed under CC BY-NC 4.0 ↵.

5.

Centers for Disease Control and Prevention. (2019, April 29). Hand hygiene in healthcare settings. https://www​.cdc.gov/handhygiene/ ↵.

6.

“5Moments_Image.gif” by World Health Organization is licensed under CC BY-NC-SA 3.0 IGO. Access for free at https://www​.who.int/infection-prevention​/campaigns/clean-hands/5moments/en/ ↵.

7.

Blackburn, L., Acree, K., Bartley, J., DiGiannantoni, E., Renner, E., & Sinnott, L. T. (2020). Microbial growth on the nails of direct patient care nurses wearing nail polish. Oncology Nursing Forum , 47(2), 155-164.  ↵ 10.1188/20.onf.155-164 . [PubMed: 32078608] [CrossRef]

8.

This work is a derivative of Introduction to Infection Prevention and Control Practices for the Interprofessional Learner by Hughes, Kenmir, St-Amant, Cosgrove, & Sharpe and is licensed under CC BY-NC 4.0 ↵.

9.

This work is a derivative of Introduction to Infection Prevention and Control Practices for the Interprofessional Learner by Hughes, Kenmir, St-Amant, Cosgrove, & Sharpe and is licensed under CC BY-NC 4.0 ↵.

10.

Centers for Disease Control and Prevention. (2016, January 26). Standard precautions for all patient care. https://www​.cdc.gov/infectioncontrol​/basics​/standard-precautions.html ↵.

11.

“How​_To_HandWash_Poster.pdf” by World Health Organization is licensed under CC BY-NC-SA 3.0 IGO. Access for free at https://www​.who.int/infection-prevention​/campaigns/clean-hands/5moments/en/ ↵.

12.

This work is a derivative of Introduction to Infection Prevention and Control Practices for the Interprofessional Learner by Hughes, Kenmir, St-Amant, Cosgrove, & Sharpe and is licensed under CC BY-NC 4.0 ↵.

13.

This work is a derivative of Introduction to Infection Prevention and Control Practices for the Interprofessional Learner by Hughes, Kenmir, St-Amant, Cosgrove, & Sharpe and is licensed under CC BY-NC 4.0 ↵.

14.

Centers for Disease Control and Prevention. (2016, January 26). Standard precautions for all patient care. https://www​.cdc.gov/infectioncontrol​/basics​/standard-precautions.html ↵.

15.

Centers for Disease Control and Prevention. (2016, January 26). Standard precautions for all patient care. https://www​.cdc.gov/infectioncontrol​/basics​/standard-precautions.html ↵.

16.

Centers for Disease Control and Prevention. (2016, January 26). Standard precautions for all patient care. https://www​.cdc.gov/infectioncontrol​/basics​/standard-precautions.html ↵.

17.

Centers for Disease Control and Prevention. (2016, January 26). Standard precautions for all patient care. https://www​.cdc.gov/infectioncontrol​/basics​/standard-precautions.html ↵.

18.

Centers for Disease Control and Prevention. (2016, January 26). Standard precautions for all patient care. https://www​.cdc.gov/infectioncontrol​/basics​/standard-precautions.html ↵.

19.

This work is a derivative of Nursing Fundamentals by Chippewa Valley Technical College and is licensed under CC BY 4.0 ↵.

20.

Centers for Disease Control and Prevention. (2020, April 29). Infection control. https://www​.cdc.gov/infectioncontrol​/index.html ↵.

21.

This work is a derivative of Introduction to Infection Prevention and Control Practices for the Interprofessional Learner by Hughes, Kenmir, St-Amant, Cosgrove, & Sharpe and is licensed under CC BY-NC 4.0 ↵.

22.

Office of Infectious Disease and HIV/AIDS Policy. (n.d.). Health care-associated infections. U.S. Department of Health & Human Services. https://www​.hhs.gov/oidp​/topics/health-care-associated-infections/index.html ↵.

23.

This work is a derivative of Introduction to Infection Prevention and Control Practices for the Interprofessional Learner by Hughes, Kenmir, St-Amant, Cosgrove, & Sharpe and is licensed under CC BY-NC 4.0 ↵.

24.

Siegel, J. D., Rhinehart, E., Jackson, M., Chiarello, L., & Healthcare Infection Control Practices Advisory Committee. (2019, July 22). 2007 guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Centers for Disease Control and Prevention. https://www​.cdc.gov/infectioncontrol​/guidelines​/isolation/index.html ↵. [PMC free article: PMC7119119] [PubMed: 18068815]

25.

“contact-precautions-sign-P.pdf” by U.S. Department of Health and Human Services and Centers for Disease Control and Prevention is licensed in the Public Domain. Access for free at https://www​.cdc.gov/infectioncontrol​/basics​/transmission-based-precautions​.html#anchor_1564058318 ↵.

Gloves

Gloves are disposable, one-time-use coverings that protect the hands of health care providers. See Figure 4.7[1] for an image of nonsterile medical gloves in various sizes in a health care setting. Gloves are used to protect the hands of a health care worker from coming into contact with a client’s potentially infected body fluids and to protect patients from coming into contact with potential contaminants on health care workers’ hands during certain procedures and treatments. Gloves should also be worn by a health care worker when there is a risk of transmitting their own body fluids from nonintact skin on their hands to other individuals. However, gloves should not be worn for routine activities such as taking vital signs or transferring a client in a wheelchair unless indicated due to transmission-based precautions.

Figure 4.7

Gloves

Gloves are typically made from latex, nitrile, and vinyl. Many people are allergic to latex, so be sure to check for latex allergies for the patient and other members of the health care team. Most gloves are not hand-specific and can be worn on either the left or right hand. Gloves come in a variety of sizes such as small, medium, large, and extra large and should have a snug fit, not too tight or too loose, to provide better protection to the health care provider.[2]

Gloves should always be used in combination with proper hand hygiene that is performed prior to applying gloves and repeated again after gloves are removed. Gloves are task-specific and should not be worn for more than one task or procedure on the same client because some tasks may have a greater concentration of microorganisms than others. For example, gloves are worn to assist a client with incontinent care, but gloves should be removed, hand hygiene performed, and new gloves applied before assisting with oral care. Gloves should never be reused or washed to be reused. Reusing gloves has been linked with the transmission of infectious microorganisms.

Gloves should never replace hand hygiene for several reasons[3]:

• Gloves may have imperfections such as holes or cracks that are not visible.
• Hands may have become contaminated while removing the gloves.
• Gloves may have become damaged while wearing.

Fingernails should be short prior to applying gloves so they do not puncture the gloves. Put on (don) gloves after hands are completely dry after performing hand hygiene. There is no specific method for putting on gloves, but care should be taken when donning gloves to avoid tearing. Gloves should be applied so they completely cover the wrists. Gloves must be removed carefully, followed by proper hand hygiene, to prevent the spread of infection.[4]

REMOVING GLOVES

See Figure 4.8[5] for an illustration of properly removing gloves. Hand hygiene should be performed following glove removal to ensure the hands will not carry potentially infectious agents that might have penetrated through unrecognized tears or contaminated the hands during glove removal.

Figure 4.8

How to Remove Gloves to Prevent Contamination

Properly removing gloves includes the following steps[6]:

• Grasp the outside of one glove near the wrist. Do not touch your skin.
• Peel the glove away from your body, pulling it inside out.
• Hold the removed glove in your gloved hand.
• Put your fingers inside the glove at the top of your wrist and peel off the second glove.
• Turn the second glove inside out while pulling it away from your body, leaving the first glove inside the second.
• Dispose of the gloves safely. Do not reuse.
• Perform hand hygiene immediately after removing the gloves.

Review infection prevention and control practices related to glove usage in the following interactive activity.

This work is a derivative of Infection Prevention and Control Practices by Michelle Hughes and Kendra Allen is licensed under CC BY 4.0.

Isolation Gowns

Isolation gowns are protective garments worn to protect clothing from the splashing or spraying of body fluids and reduce the transmission of microorganisms. Isolation gowns can be disposable or reusable. The gowns should have long sleeves with a snug fit at the wrist, cover both the front and the back of the body from the neck to the thighs, and overlap at the back.

Gloves should fit over the cuffs of the gown. Gowns should fasten at the neck and waist using ties, snaps, or Velcro.[7]

Disposable gowns are made from materials that make them resistant to fluids. Reusable gowns are made of tightly woven cotton or polyester and are chemically finished to improve their ability to be fluid resistant; they are laundered after each use. Gowns are considered task-specific and should be changed if they become heavily soiled or damaged. Isolation gowns should be put on immediately prior to providing client care and should be removed immediately after care is completed before leaving the room. After use, gowns should be discarded into an appropriate receptacle for disposal or to be laundered if the gown is reusable. See Figure 4.9[8] for an image of an isolation gown.

Figure 4.9

Isolation Gown

Special care should be taken when removing the gown to prevent contamination of clothing and skin. The front of the gown is always considered to be contaminated. Ties at the front are considered contaminated, but ties at the side and the back are considered uncontaminated.[9]

See the “Donning/Doffing PPE” checklists later in this chapter for steps for proper removal of gowns. Review information related to using isolation gowns in the following interactive activity.

This work is a derivative of Important Considerations When Wearing Gowns by Audrey Kenmir and is licensed under CC BY 4.0.

Eye Protection

Eye protection in health care settings includes face shields, visors attached to masks, and goggles that are used to protect the eyes from blood or body fluids. Eye protection should be worn by health care workers during patient care when there may be splashing or spraying of body fluids or within six feet of a coughing client. For example, eye protection is worn when emptying a urinary catheter or assisting a nurse in irrigating a wound or suctioning a client’s airway.

Eye protection can be disposable, like face shields, or reusable, like eye goggles. If eye protection is reusable, it should be cleaned before reuse. Face shields and visors attached to masks offer better visibility than goggles. Eye protection should fit comfortably and securely while allowing for visual acuity. Eyeglasses can be worn under face shields or goggles.[10] See Figure 4.10[11] for an image of eye goggles with and without a face shield.

Figure 4.10

Eye Goggles With and Without a Face Shield

Review information related to the use of eye protection in the following learning activity.

This work is a derivative of Important Considerations When Wearing Eye Protection by Michelle Hughes and is licensed under CC BY-NC 4.0.

Masks

Masks are protective coverings worn by health care providers to protect the mucous membranes of their nose and mouth. In long-term care settings, masks are typically secured by elastic loops around the ears. The top edge of the mask has a bendable strip to secure the seal of the mask over the bridge of the nose. Some situations require masks to be combined with a face shield or a visor that covers the eyes. See Figure 4.11[12] for an image of masks used with eyeglasses and an eyeshield.

Figure 4.11.

Medical Mask With and Without an Eye Shield

Medical masks should be worn when providing care that may cause splashing or spraying of blood or body fluids or within six feet of a client who is coughing or has been placed in droplet precautions. Medical masks should also be worn by health care providers who are coughing to prevent transmission of exhaled respiratory droplets to clients.

Medical masks can differ in their filtration effectiveness and the way in which they fit. Single-use disposable medical masks are effective when providing care to most clients and should be changed when damp or soiled. When medical masks become moist, they may not provide an effective barrier to microorganisms. A medical mask, when properly worn, should fit snugly over the nose, mouth, and under the chin so that microorganisms and body fluids cannot enter or exit through the sides of the mask. If the health care worker wears glasses, the glasses should be placed over the top edge of the mask. This will help prevent the glasses from becoming foggy as the person wearing the mask exhales.

REMOVING FACEMASKS

Like the isolation gown, the front of the mask is considered contaminated. The mask should be removed by taking the ear loop off and placing it in the appropriate disposal area. It is important to properly remove masks to avoid contamination. See Figure 4.12[13] for an illustration of how to remove a facemask according to the CDC. See the “Donning/Doffing PPE With a Mask and Face Shield or Goggles” checklist for more details.

Figure 4.12

Removing Facemasks

Review information on wearing medical masks in the following interactive learning activities.

This work is a derivative of Important Considerations When Wearing Medical Masks by Michelle Hughes and is licensed under CC BY 4.0.

This work is a derivative of Important Considerations When Wearing Medical Masks by Michelle Hughes and is licensed under CC BY 4.0.

Respirators and PAPRs

Residents requiring airborne transmission precautions are transferred to a hospital immediately upon suspicion or confirmation of an airborne illness as respiratory protection used with airborne transmission precautions requires special equipment. Respirator masks with N95 or higher filtration are worn by health care professionals to prevent inhalation of infectious small airborne particles. It is important to apply, wear, and remove respirators appropriately to avoid contamination. A user-seal check should be performed by the wearer each time a respirator is donned to minimize air leakage around the facepiece. See Figure 4.13[14] for CDC recommendations when wearing disposable respirators.

Figure 4.13

How to Put On and Take Off a Respirator Mask

A newer piece of equipment used for respiratory protection is the powered air-purifying respirator (PAPR). A PAPR is an air-purifying respirator that uses a blower to force air through filter cartridges or canisters into the breathing zone of the wearer. This process creates an air flow inside either a tight-fitting facepiece or loose-fitting hood or helmet, providing a higher level of protection against aerosolized pathogens, such as COVID-19, during respiratory suctioning. See Figure 4.14[15] for an example of PAPR in use.

Figure 4.14

PAPR

Resident Considerations During Isolation Precautions

There are a lot of things to consider when preventing the spread of infection among residents, staff, equipment, and surfaces. It is important to think about the tasks you will be performing for residents and determine ahead of time what you might be exposed to in order to select the appropriate PPE. The perspective and needs of clients placed in isolation precautions should also be considered. PPE makes communication more difficult by hiding facial expressions and making hearing more difficult, and therapeutic touch is less personal when wearing gloves. Caregivers often spend less time interacting with clients in transmission-based precautions due to the labor intensiveness of putting on and taking off PPE, resulting in clients often developing feelings of loneliness and social isolation due to less frequent interactions. Try to keep the resident’s routine as normal as possible and apply extra effort to interact with the client.

When transporting a client with transmission-based precautions within a facility, keep these principles in mind[16]:

• Limit transport for essential purposes only, such as diagnostic and therapeutic procedures that cannot be performed in the patient’s room.
• When transporting, use appropriate barriers on the patient consistent with the route and risk of transmission. For example, for a resident with a skin infection with MRSA, be sure the area is covered.
• Notify health care personnel in the receiving area of the impending arrival of the patient and of the precautions necessary to prevent transmission.

References

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“Surgery Centre Accriditation.jpg” by Accredia is licensed under CC BY-SA 4.0 ↵.

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This work is a derivative of Introduction to Infection Prevention and Control Practices for the Interprofessional Learner by Hughes, Kenmir, St-Amant, Cosgrove, & Sharpe and is licensed under CC BY-NC 4.0 ↵.

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This work is a derivative of Introduction to Infection Prevention and Control Practices for the Interprofessional Learner by Hughes, Kenmir, St-Amant, Cosgrove, & Sharpe and is licensed under CC BY-NC 4.0 ↵.

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This work is a derivative of Introduction to Infection Prevention and Control Practices for the Interprofessional Learner by Hughes, Kenmir, St-Amant, Cosgrove, & Sharpe and is licensed under CC BY-NC 4.0 ↵.

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“poster-how-to-remove-gloves.pdf” by Centers for Disease Control and Prevention is in the Public Domain. Access for free at https://www​.cdc.gov/vhf​/ebola/resources/posters.html ↵.

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Siegel, J. D., Rhinehart, E., Jackson, M., Chiarello, L., & Healthcare Infection Control Practices Advisory Committee. (2019, July 22). 2007 guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Centers for Disease Control and Prevention. https://www​.cdc.gov/infectioncontrol​/guidelines​/isolation/index.html ↵. [PMC free article: PMC7119119] [PubMed: 18068815]

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This work is a derivative of Introduction to Infection Prevention and Control Practices for the Interprofessional Learner by Hughes, Kenmir, St-Amant, Cosgrove, & Sharpe and is licensed under CC BY-NC 4.0 ↵.

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“U.S. Navy Doctors, Nurses and Corpsmen Treat COVID Patients in the ICU Aboard USNS Comfort (49825651378).jpg” by Navy Medicine is in the Public Domain ↵.

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This work is a derivative of Introduction to Infection Prevention and Control Practices for the Interprofessional Learner by Hughes, Kenmir, St-Amant, Cosgrove, & Sharpe and is licensed under CC BY-NC 4.0 ↵.

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This work is a derivative of Introduction to Infection Prevention and Control Practices for the Interprofessional Learner by Hughes, Kenmir, St-Amant, Cosgrove, & Sharpe and is licensed under CC BY-NC 4.0 ↵.

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“IMG_2021-scaled” and “IMG_2026-scaled” by unknown author are licensed under CC BY-NC-4.0. Access for free at https:​//ecampusontario​.pressbooks.pub/introductiontoipcp​/chapter/eye-protection/ ↵.

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“Screen-Shot-2021-05-05-at-3.57.19-PM” and “Screen-Shot-2021-05-05-at-3.57.41-PM” by unknown author are licensed under CC BY-NC 4.0. Access for free at https:​//ecampusontario​.pressbooks.pub/introductiontoipcp​/chapter/masks/ ↵.

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“fs-facemask-dos-donts.pdf” by Centers for Disease Control and Prevention is in the Public Domain. Access for free at https://www​.cdc.gov/coronavirus​/2019-ncov/hcp/using-ppe.html ↵.

14.

“fs-respirator-on-off.pdf” by Centers for Disease Control and Prevention is in the Public Domain. Access for free at https://www​.cdc.gov/coronavirus​/2019-ncov/hcp/using-ppe.html ↵.

15.

“PAPRs_in_use_01​.jpg" by Ca​.garcia.s is licensed under CC BY-SA 4.0 ↵.

16.

Siegel, J. D., Rhinehart, E., Jackson, M., Chiarello, L., & Healthcare Infection Control Practices Advisory Committee. (2019, July 22). 2007 guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Centers for Disease Control and Prevention. https://www​.cdc.gov/infectioncontrol​/guidelines​/isolation/index.html ↵. [PMC free article: PMC7119119] [PubMed: 18068815]

References

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Occupational Safety and Health Administration. (n.d.). Bloodborne pathogens and needlestick prevention. United States Department of Labor. https://www​.osha.gov​/bloodborne-pathogens ↵.

2.

"Sharps Container" by Landon Cerny is licensed under CC BY 4.0 ↵.

3.

"Blood Spill Kit" by Landon Cerny is licensed under CC BY 4.0 ↵.

Other Considerations

The effectiveness of the immune system gradually decreases with age, making older adults more vulnerable to infection. Early detection of infection can be challenging in older adults because they may not have a fever, but instead develop subtle changes like new confusion or weakness that may result in a fall. The most common infections in older adults are urinary tract infections (UTI), pneumonia, influenza, and skin infections.[2]

References

1.

Office of Infectious Disease and HIV/AIDS Policy. (n.d.). Health care-associated infections. U.S. Department of Health & Human Services. https://www​.hhs.gov/oidp​/topics/health-care-associated-infections/index.html ↵.

2.

Office of Infectious Disease and HIV/AIDS Policy. (n.d.). Health care-associated infections. U.S. Department of Health & Human Services. https://www​.hhs.gov/oidp​/topics/health-care-associated-infections/index.html ↵.

References

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Chippewa Valley Technical College. (2022, December 3). Hand Hygiene With Soap and Water. [Video]. YouTube. Video licensed under CC BY 4.0. https://youtu​.be/w29Ad7Cmsxo ↵.

References

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Chippewa Valley Technical College. (2022, December 3). Hand Hygiene With Alcohol-Based Hand Sanitizer. [Video]. YouTube. Video licensed under CC BY 4.0. https://youtu​.be/rTuO8SYYfNo ↵.

References

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Chippewa Valley Technical College. (2022, December 3). Removing Gloves. [Video]. YouTube. Video licensed under CC BY 4.0. https://youtu​.be/nYDB6b3K-MY ↵.

2.

“Ch.5-Taking-off-PPE-–-Step-8,” Ch.5-Taking-off-PPE-Step-1a-.png,” “Ch.5-Taking-off-PPE-Step-1c.png,” “Ch.5-Taking-off-PPE-Step-1d,” “Ch.5-Taking-off-PPE-Step-1e.png,” and “Ch.5-Taking-off-PPE-Step-2.png” by unknown author are licensed under CC BY-NC 4.0. Access for free at https:​//ecampusontario​.pressbooks.pub/introductiontoipcp​/chapter​/putting-it-all-together-putting-on-and-taking-off-full-ppe/ ↵.

References

1.

Chippewa Valley Technical College. (2022, December 3). Donning/Doffing PPE Without a Mask. [Video]. YouTube. Video licensed under CC BY 4.0. https://youtu​.be/yP1eIqGJSS8 ↵.

References

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Centers for Disease Control and Prevention. (n.d.). Sequence for putting on personal protective equipment [Handout]. https://www​.cdc.gov/hai​/pdfs/ppe/ppe-sequence.pdf ↵.

2.

Chippewa Valley Technical College. (2022, December 3). Donning/Doffing PPE With a Mask and Face Shield or Goggles. [Video]. YouTube. Video licensed under CC BY 4.0. https://youtu​.be/H-rXxFkmWBY ↵.