INFECTION CONTROL
Introduction
Infection diseases are certainly a much greater health problem in developing countries than in developed ones. Infection involves interaction between the animal body and infecting microorganism. The prevention and control of infection is one of the principal concerns of health personnel. The most common cause of infection is microorganism. It is important to keep in mind the source, method of transfer and modes and spread of microorganism. It is in order to help infection control.
Definition
Infection is the invasion and multiplication of microorganism in body tissue. This agent causing the infection is called pathogen.
Source of infection
Þ Human: The commonest sources of infection for human are human. The parasite may originate from patient or carrier. A carrier is one who habours the pathogen but never suffered from the disease caused by pathogen.
Þ Animals: Animal act as sources of human infection. Infections disease transmitted from animals to human being care called zoonoses. Zoonotic disease may be bacterial, viral, protozoal or fungal.
Þ Insects: Blood sucking insects may transmit pathogen to human being. The diseases so caused are called arthropod-borne disease. Insects such as mosquitoes, tick, mites, flies, fleas and lice that transmit infection are called vectors.
Þ Soil & Water: Some pathogen can survive in the soil for very long periods spores of tetanus bacilli may remain viable in soil for several decades and serve as source of infection.
Water may act as source of infection either due to contamination with pathogenic microorganism.
Þ Food: Contaminated food may act as source of infection. The presence of pathogen in food may be due to external contamination or due to existent infection in meat or another animal products.
Infection control
Infection control is possible through asepsis. Teaching about medical asepsis and infection control is a challenging nursing responsibility.
Asepsis
Freedom from infection or prevention of contact with micro-organism. Asepsis is of two types,
I. Medical Asepsis
II. Surgical Asepsis
I. Medical Asepsis
Medical asepsis refers to all practices used to protect the client and his environment from the transmission of disease producing organism. Medical asepsis includes the following practices.
q Cleaning of Articles
An article is considered to be clean when it is free from pathogenic organism. The following steps should be considered while cleaning the article.
1. Rinse the article first with cold water
2. Then wash with hot water and soap
3. Use an abrasive such as a stiff bristled brush and a paste or powder to wash the articles
4. Rinse the article with clean water
5. Dry them with a towel
6. Disinfect or sterilize if indicated
q Hand Washing
Hand washing is the most effective way to help prevent the spread of organisms. It is the most important for prevent nosocomial infection. The points to be kept in mind while washing hands,
1. Cut short nail
2. Remove the jewellery of any type
3. Open the tap and wet hands and forearm. Always hold the hand below the elbow joint
4. Apply soap and detergent
5. Wash hands thoroughly
6. Rinse the hands by keeping the hands well below the elbow level
7. Repeat the procedure
8. Dry the arms and hands, starting at elbow and working towards the hands
9. Turn off the water tap using a paper towel
q Gown Technique
The isolation gown should be made with long sleeve, long skirt and high neck to cover the clothing of the wearer. On wearing gown remove watch and ring. First tie the neck band then waist band. While removing gown
1. Wash hands
2. Untie waist band
3. Wash hand
4. Untie the neck ties
5. Slide the gown down the arms and over the hands by holding inside
6. Hold the gown with both the hands and rolled discarded in the container
7. Wash hands
q Face Mask
Mask is generally used to prevent the spread of microorganism to and from the client, through respiratory tract.
II. Surgical Asepsis
Surgical asepsis refers to all the procedure used to keep object or areas sterile or completely free from all microorganism.
q Hand washing
In surgical washing hands should be cleans for about 3 to 5 min. When washing hands they are held above the level of the elbow. So the water should run from least contaminated area to contaminated area.
q Handling Sterile Object
Sterile glove or sterile forceps are used for handling sterile items.
q Opening a sterile package
Sterile packages may be opened on a flat surface or while held in the hands. A sterile item should be covered if it is not used immediately. While opening the flap farthest away is opened first with care not to reach over the sterile field. Then the side flap are opened and the slap nearest to the nurse is opened last.
q Pouring sterile solution
The outer surface of the bottle and cap are considered unsterile, whereas the inside area and the solution are considered sterile. The nurse pours the sterile liquid into a sterile container without reaching over the sterile container.
q Putting on sterile gloves
Sterile gloves are donned in a way that allow only the inside of the glove to come in contact with the hands.
1. Grasping edge of folded cuff
2. Lifting and holding glove with fingers down
3. Putting first glove on with cuff folded
4. Sliding fingers of gloved hand under cuff of second glove
5. Inserting hand with cuff folded
6. Adjusting glove on both hand
q Positioning a sterile Drape
The sterile drape which ideally is waterproof may be used to extend the sterile working area. Using sterile glove allows the nurse to handle the entire drape surface. For protection when positioning the upper edges of the drape should be folded over the sterile gloved hand.
Isolation & Barrier Technique
Isolation is a protective procedure that limit the spread of infections disease among hospitalized patients, hospital personnel, and visitors. Barriers that prevent common vehicles from the transmission of pathogen.
Þ Universal Precautions
In 1987 in an effort to protect health care workers, the CDC issued recommendations for universal precaution. The CDC recommended that health care workers use gloves, gown, mask and protective eye wear when exposure to blood or body fluid was likely and that all patients should be considered potentially infected. Universal precautions also recommended the use of puncture resistant containers for disposing of all needles and sharps.
Þ Meeting needs of patient in isolation
The psychological implication of isolation precaution are usually great. The points to be remembered.
· Isolation is temporary
· The precaution and protective equipment worn by the staff protect the patient, the caregiver and other patients
· Hand washing before and after visiting the patient is the most effective measure to prevent spread of the disease.
Þ Using the infection control – Nurse
In the hospital the infection control nurse is responsible for educating patients and staff about effective infection control technique and for collecting statistics about infection.
Disinfection
It means destroying of all the pathogenic organism. It is of two types,
1. Concurrent disinfection: Immediate disinfection of all contaminated article and bodily discharges during the course of the disease.
· Cleansing the isolation unit daily
· Disinfection of all articles
· Disposal of all waste by incineration
· Safe disposal of excreta
2. Terminal disinfection: Disinfection of client unit with all the articles used by the client on his discharge, death or release from isolation.
· Fumigation with surphur
· Fumigation with formalin
Sterilization
Sterilization is the process by which an object become free of all the microorganism. By sterilization both pathogenic and non-pathogenic organism are destroyed.
The traditional methods of sterilization process are,
1. Boiling
2. Cold sterilization or disinfection by using disinfectant
3. Fumigation / gas sterilization
4. Ultraviolet light sterilization or radiation
5. Dry heat sterilization / hot air sterilizer
6. Steam under pressure / autoclaving
Þ Boiling
Total immersion in boiling water (100oc) for 10 minutes will kill most of the pathogenic organism and is the common and reliable method of disinfecting instruments.
Advantages: Boiling can be used in the home environment and other situation when other methods are not available. It is one of the economic ways of sterilizing article.
Disadvantages: Some bacteria and virus and all spores are resistant to boiling. This boiling become ineffective in sterilizing article.
Þ Cold Sterilization
A chemical disinfectant acts by coagulating the bacterial protein or by changing the composition of protein so that it no longer exists in the same form. Commonly used antiseptics and disinfectants are the following
Savlon – 1:1000
Hydrogen peroxide – as available in material
Spirit – 70% alcohol
Cidex – as available in market
Mercurochrome – 2% solution
Lysol – 1:100 etc,
Þ Fumigation
Total surface exposure to formaldehyde gas under conditions of controlled humidity, temperature and time exposure will destroy all vegetative forms of bacteria, virus and most of the spores. Agents are formalin tablet, ethylene oxide liquids, etc.
Þ Ultraviolet Light sterilization
Ultraviolet light sterilization is effective for disinfecting working surface and air inside the rooms.
Þ Hot Air Sterilization
High temperature and comparatively long exposure times are required. It is not a suitable sterilizing agent for fabrics and dressing. It is the method of choice for fine metal cannula and for glass syringes. The articles which are damaged by the moisture are sterilized by this method.
Þ Autoclaving
Autoclaving or sterilization under pressure is the most widely used, economical and one of the most effective method. This method uses high temperature, pressure and humidity to destroy bacterial life. For effective sterilization, the steam in the autoclave should be at 15 lbs / inch2 pressure at 121oc temperature. This pressure and temperature should be maintained for 30 minutes.
Microorganisms are present everywhere skin, articles and air. So infection control practices are important to reduce the risk of all type of disease. As a nurse, we have a responsibility to reduce transmission of microorganisms. So they should follow strict aseptic techniques. Asepsis both surgical and medical, sterilization, disinfection, isolation and barrier techniques are some of the infection control practices.