INFECTION CONTROL

Watch the Infection Control presentation.

Infection control is the set of methods used to control and prevent the spread of disease. It is the responsibility of all members of the Care Team. Know your facility's infection control policies and procedures. They help protect you, residents, and others from disease.

Learning to control infection is a method of lowering the incidence of illness and disease. The procedures and guidelines you learn will take on a new level of value.

Read pages 59-60 and in Chapter 5 of your text, make sure you know and understand each of the below infection control terminology.

• Infection control
• Microorganism
• Infections
• Pathogens
• Systemic infection
• Localized infection
• Nosocomial infection (hospital-acquired infection)
• Asepsis
• Clean
• Dirty

The Centers for Disease Control and Prevention (CDC) and Standard Precautions

The CDC is a federal government agency that issues guidelines to protect and improve health. It promotes public health and safety through education.
Standard Precautions means treating all blood, body fluids, non-intact skin, and mucous membranes (lining of mouth, nose, eyes, rectum, or genitals) as if they were infected. This is the only safe way of doing your job.

Question: Why should Standard Precautions be followed on every resident in your care?
Answer: Because you cannot tell by looking at a person whether he or she has an infectious disease.

Review the Standard Precautions measures in your text

• Wear gloves.
• Wash hands.
• Remove gloves immediately when finished with a procedure.
• Immediately wash skin surfaces.
• Wear a gown.
• Wear a mask and goggles.
• Wear gloves when handling sharp objects.
• Avoid nicks and cuts.
• Bag all contaminated supplies.
• Clearly label body fluids.
• Dispose of contaminated waste properly.

NAs should wash their hands

Hand washing is the single most important you can to do prevent the spread of disease.

• Arrival at work
• Before and after touching meal trays
• Before and after feeding residents
• Before, between, and after all resident contact
• After contact with body fluids
• After handling contaminated items
• Before putting on gloves and after removing gloves
• Before getting clean linen
• After touching garbage or trash
• After picking up things from the floor
• After using the bathroom
• After blowing nose or sneezing into hand
• Before and after eating
• After smoking
• After touching areas on the body
• Before and after applying makeup
• Before leaving facility

PPE (personal protective equipment) must be worn; Following is when you should wear gloves

• If you might touch blood or any body fluid
• During mouth care or care of any mucous membrane
• During perineal care
• Providing personal care on broken skin
• Providing personal care if NA has cuts on hands
• Shaving resident
• Disposing of soiled linens, gowns, dressings, and pads

Gloves should be changed:

• Immediately before contact with mucous membranes or broken skin
• If gloves become soiled, worn, or damaged

Question: What is MRSA (methicillin-resistant Staphylococcus aureus)?
Answer: Some staph bacteria are resistant to antibiotics. MRSA is a type of staph that is resistant to antibiotics called beta-lactams. Beta-lactam antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. While 25% to 30% of the population is colonized with staph, approximately 1% is colonized with MRSA.

Question: Who gets staph or MRSA infections?
Answer: Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems. These healthcare-associated staph infections include surgical wound infections, urinary tract infections, bloodstream infections, and pneumonia.

Question: What is community-associated MRSA (CA-MRSA)?
Answer: Staph and MRSA can also cause illness in persons outside of hospitals and healthcare facilities. MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as CA-MRSA infections. Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people.

Question: How common are staph and MRSA infections?
Answer: Staph bacteria are one of the most common causes of skin infection in the United States and are a common cause of pneumonia, surgical wound infections, and bloodstream infections. The majority of MRSA infections occur among patients in hospitals or other healthcare settings; however, it is becoming more common in the community setting. Data from a prospective study in 2003, suggests that 12% of clinical MRSA infections are community-associated, but this varies by geographic region and population.

Question: What does a staph or MRSA infection look like?
Answer: Staph bacteria, including MRSA, can cause skin infections that may look like a pimple or boil and can be red, swollen, painful, or have pus or other drainage. More serious infections may cause pneumonia, bloodstream infections, or surgical wound infections.

Question: Are certain people at increased risk for community-associated staph or MRSA infections?
Answer: CDC has investigated clusters of CA-MRSA skin infections among athletes, military recruits, children, Pacific Islanders, Alaskan Natives, Native Americans, men who have sex with men, and prisoners.
Factors that have been associated with the spread of MRSA skin infections include: close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and surfaces, crowded living conditions, and poor hygiene.

Question: How can I prevent staph or MRSA skin infections?
Answer: Practice good hygiene:

• Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer.
• Keep cuts and scrapes clean and covered with a bandage until healed.
• Avoid contact with other people?s wounds or bandages.
• Avoid sharing personal items such as towels or razors.

Question: Are people who are positive for the human immune deficiency virus (HIV) at increased risk for MRSA? Should they be taking special precautions?
Answer: People with weakened immune systems, which include some patients with HIV infection, may be at risk for more severe illness if they get infected with MRSA. People with HIV should follow the same prevention measures as those without HIV to prevent staph infections, including practice good hygiene, cover wounds (e.g., cuts or abrasions) with clean dry bandages, avoid sharing personal items such as towels and razors, and contact their doctor if they think they have an infection.

Question: Can I get a staph or MRSA infection at my health club?
Answer: In the outbreaks of MRSA, the environment has not played a significant role in the transmission of MRSA. MRSA is transmitted most frequently by direct skin-to-skin contact. You can protect yourself from infections by practicing good hygiene (e.g., keeping your hands clean by washing with soap and water or using an alcohol-based hand rub and showering after working out); covering any open skin area such as abrasions or cuts with a clean dry bandage; avoiding sharing personal items such as towels or razors; using a barrier (e.g., clothing or a towel) between your skin and shared equipment; and wiping surfaces of equipment before and after use.

Question: What should I do if I think I have a staph or MRSA infection?
Answer: See your healthcare provider.

Question: Are staph and MRSA infections treatable?
Answer: Yes. Most staph and MRSA infections are treatable with antibiotics. If you are given an antibiotic, take all of the doses, even if the infection is getting better, unless your doctor tells you to stop taking it. Do not share antibiotics with other people or save unfinished antibiotics to use at another time.

However, many staph skin infections may be treated by draining the abscess or boil and may not require antibiotics. Drainage of skin boils or abscesses should only be done by a healthcare provider.

If after visiting your healthcare provider the infection is not getting better after a few days, contact them again. If other people you know or live with get the same infection tell them to go to their healthcare provider.

Question: Is it possible that my staph or MRSA skin infection will come back after it is cured?
Answer: Yes. It is possible to have a staph or MRSA skin infection come back (recur) after it is cured. To prevent this from happening, follow your healthcare provider?s directions while you have the infection, and follow the prevention steps after the infection is gone.

Question: If I have a staph, or MRSA skin infection, what can I do to prevent others from getting infected?
Answer: You can prevent spreading staph or MRSA skin infections to others by following these steps:

• Cover your wound. Keep wounds that are draining or have pus covered with clean, dry bandages. Follow your healthcare provider?s instructions on proper care of the wound. Pus from infected wounds can contain staph and MRSA, so keeping the infection covered will help prevent the spread to others. Bandages or tape can be discarded with the regular trash.
• Clean your hands. You, your family, and others in close contact should wash their hands frequently with soap and warm water or use an alcohol-based hand sanitizer, especially after changing the bandage or touching the infected wound.
• Do not share personal items. Avoid sharing personal items such as towels, washcloths, razors, clothing, or uniforms that may have had contact with the infected wound or bandage. Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Drying clothes in a hot dryer, rather than air-drying, also helps kill bacteria in clothes.
• Talk to your doctor. Tell any healthcare providers who treat you that you have or had a staph or MRSA skin infection.

Question: What should I do if someone I know has a staph or MRSA infection?
Answer: If you know someone that has a staph or MRSA infection you should follow the prevention steps.

Question: What is VRE (vancomycin-resistant enterococci)?
Answer: Enteroccocci are bacteria that are normally present in the human intestines and in the female genital tract and are often found in the environment. These bacteria can sometimes cause infections. Vancomycin is an antibiotic that is often used to treat infections caused by enterococci. In some instances, enterococci have become resistant to this drug and thus are called vancomycin-resistant enterococci (VRE). Most VRE infections occur in hospitals.

Question: What types of infections does VRE cause?
Answer: VRE can live in the human intestines and female genital tract without causing disease. However, sometimes, it can be the cause of urinary tract infections, blood stream infections and wound infections.

Question: Are certain people at risk of getting VRE?
Answer: The following persons are at an increased risk becoming infected with VRE:

• Persons who have been previously treated with vancomycin and combinations of other antibiotics such as penicillin and gentamicin
• Persons who are hospitalized, particularly when they receive antibiotic treatment for long periods of time
• Persons with weakened immune systems such as patients in Intensive Care Units, or in cancer or transplant wards
• Persons who have undergone surgical procedures such as abdominal or chest surgery
• Persons with medical devices that stay in for some time such as urinary catheters or central intravenous catheters.

Question: How common is VRE?
Answer: VRE was not reported in U.S. hospitals until 1989. Data reported to the Centers for Disease Control and Prevention during 2004 showed that VRE caused about 1 of every 3 infections in hospital intensive care units.

Question: What is the treatment for VRE?
Answer: Most VRE infections can be treated with antibiotics other than vancomycin. The treatment of VRE is determined by laboratory testing to determine which antibiotics are effective. For persons who get VRE infections and have urinary catheters, removal of the catheter when it is no longer needed can help getting rid of the infection. People who are colonized (bacteria are present, but have no symptoms of an infection) with VRE do not usually need treatment.

Question: How is VRE spread?
Answer: VRE is usually passed to others by direct contact with stool, urine or blood containing VRE. It can also be spread indirectly via the hands of healthcare providers or on contaminated environmental surfaces. VRE usually is not spread through casual contact such as touching or hugging. VRE is not spread through the air by coughing or sneezing.

Question: How can I prevent the spread of VRE?
Answer: If you or someone in your household has VRE, the following are some measures to prevent spread of VRE:

• Always wash your hands thoroughly after using the bathroom and before preparing food. Clean your hands after close contact with persons who have VRE. Wash with soap and water (particularly when visibly soiled) or clean with alcohol-based hand cleaner.
• Frequently clean areas of your home such as your bathroom that may become contaminated with VRE. Use a household disinfectant or a mixture of one-fourth cup bleach and one quart of water to clean those areas and surfaces that are touched frequently.
• Wear gloves if you may come in contact with body fluids that may contain VRE, such as stool. Always wash your hands after removing gloves.
• Be sure to tell any healthcare providers that you have VRE so that they are aware of your infection.

Question: What should I do if I think I have VRE?
Answer: Talk with your healthcare provider and get medical care if you think you have VRE.

Chapter 5 must be read completely. It's a very important chapter in your text. Please contact your instructor if you have questions.