Learn about the role of environment in disease transmission and how to implement standard and transmission-based precautions to prevent the spread of antibiotic resistant bacteria and other infections in your facility.
2.1 The chain of infection
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來自 The University of North Carolina at Chapel Hill 的課程
Infection Prevention in Nursing Homes
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從本節課中
Isolation Precautions
The goal of this module is to review the types of isolation and when to use them. To obtain CE Credit for this module: Take the Quiz and complete the evaluation at the end of the module, you will be directed to your course completion certificate.
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Evelyn CookAssociate Director
North Carolina Statewide Program for Infection Control and Epidemiology (SPICE)
Hi and welcome to Module 2: Isolation Precautions.
As you learned in Module 1, standard precautions are the foundation for
preventing the spread of germs like bacteria, fungi and viruses.
Many of these germs spread even with the use of standard precautions and
the addition of isolation precautions or transmission based precautions
is required, based on how harmful these germs are and how they spread.
In this module, we will review standard precautions and
describe the three isolation precaution categories.
Contact precautions, d1roplet precautions, and airborne precautions.
We use the word transmission when talking about the spread of germs.
The learning objectives for
this module are, to review and understand standard precautions.
To understand contact, droplet, and airborne precautions.
To understand when to implement contact, droplet, and airborne precautions, and
to understand the role of the resident in contact, droplet and airborne precautions.
To fully understand how to control the spread of germs, it is important to know
how infections are spread from one person to another through the chain of infection.
There are six links in the Chain of Infection.
The infectious agent or germ.
A reservoir where the germ normally lives.
A portal of exit from the infected person.
A means of transmission between persons.
A portal of entry in a susceptible person.
And a susceptible person.
The infectious agent is any harmful germ that causes disease.
In module one, you learned about antibiotic-resistant bacteria,
like MRSA, but there are other harmful germs that also cause infection.
There are viruses like flue and norovirus, fungi like candida,
parasites like giardia or arthropods like scabies or mites.
All of these can cause illness and infections in nursing homes.
Reservoirs are places where germs hang out, grow and increase in numbers.
These can be a person, animal, or environmental surface, like a bed rail or
BP cuff.
In people, germs can hang out on people's skin.
In the digestive tract like the mouth, stomach or intestines, and
in the respiratory tract like the nose or throat.
In order for a germ to spread from one person to another
it has to have a way to get out of the reservoir.
Some of the most common ways to get out are through the skin, nose and
anus, but there are numerous ways for a germ to escape.
Look at the diagram to see some of these exit points.
Once a germ leaves the body, it has to have a way to spread.
There are three main types of spreading or transmission.
Contact spread, droplet spread, and airborne spread.
Diseases spread by contact, or touching, like MRSA are spread through
physical contact with the infected person, called direct contact.
Or through physical contact with a contaminated surface or
device such as a towel or BP cuff, called indirect contact.
Droplet-spread diseases, like flu, are spread through infected
droplets that are generated when a person coughs, sneezes, laughs, or talks.
The infected droplets can either have direct contact with another person,
like coughing in someone's face.
Or through indirect contact,
when the droplets settle on a surface that is touched or contacted by another person.
Droplets generally travel less than six feet and do not stay in the air for
very long because they are heavy.
Airborne spread diseases like tuberculosis are spread through
very small infected droplets called aerosols or droplet nuclei.
These very small droplets can stay suspended in the air for
a very long time and can be breathed in by another person.
They can be transmitted over long distances such as an entire common room
like a cafeteria.
Another thing that has to be present for a germ to infect another person is a way for
the germ to enter the body of the new person.
The most common portals, or places of entry, are respiratory tract, nose or
mouth, gastrointestinal tract, mouth, urinary tract and breaks in the skin.
Take a moment to look at the diagram to see additional portals of entry for germs.
The final link in the chain of infection is that the person being infected must be
vulnerable or susceptible to the infectious agent.
Some of the factors that affect the susceptibility of the person or host are,
being very young or older, high stress, being fatigued or
worn out, having poor nutrition, having other diseases and illnesses.
Such as diabetes, obesity, renal disease or lung disease.
Not being vaccinated and having breaks in the skin.
Certain medications like chemotherapy
can make a person more likely to become infected.
Now that we know how infections are spread, let's look at how we can break
the chain of infection and stop the spread of infection.
>> Previously on gowns and gloves, Nurse Priscilla breaks the news to Mr.
Houston that his wife has been exposed and colonized with MRSA.
Will Elaine become infected with MRSA, and
what's going on between Dimitri and Priscilla?
Find out on Gowns and Gloves.
>> And I have something really cool.
>> Hi, I'm Vanessa, Prucilla's with another resident.
>> Oh. >> She asked me to come in and
talk to Mrs. Houston about the precautions that we'll be taking to help control
the spread of MRSA here at Sunnyside.
You're currently on standard precautions, which is what we use for
everyone here at the facility.
>> Well, we noticed when we were moved down here
a lot of people had carts outside their rooms and signs on their doors.
>> Yes, those residents have been placed under contact precautions.
We use contact precautions for residents with infections from bacteria like MRSA
to help control the spread between residents.
I can't tell you about their specifics, but that is what those signs and
carts indicate.
>> I don't understand this scene it all.
Why don't I have one of those signs or carts outside my room?
At the moment your character is colonized which means you have the MRSA bacteria
on your skin and in your nose.
You don't have an active infection like some of the other residents.
That's why is not necessary right now for
you to be put on contact precautions and put a sign on the door.
See the main thing is that the staff wear gloves,
practice good hand hygiene and never share personal items between residents.
>> So what do I do now that I'm colonized?
>> Well Vanessa will be relaying all of the information for
what your character is to do.
Again the main thing is to practice good hand hygiene.
Wash with soap and water, antiseptic soap and water, or
an FDA approved alcohol based hand gel.
>> Great. [LAUGH] Good hand hygiene, I get that.
Now, we ready?
Action. >> Mrs.Houston since you're on standard
precaution, all staff will need to wear gloves when providing care for you and
wash their hands before and after caring for you.
If you see and we're not washing our hands or
using an alcohol based hand gel, you need to remind us.
You two both of you need to make sure that you wash your hands before
leaving the room and after you return to it.
>> This is painful.
I feel as though I'm being punished.
And what happens if i want to have visitors or leave the room?
Well right now there is no restriction on your movement throughout the facility.
Just make sure you wash your hands before you leave the room and
before you participate in any activity.
The same rules apply to you too, Mr. Houston.
Is there anything else I can help you out with?
>> No >> I just wish Priscilla were here.
>> Elaine that is so rude.
>> But I still feel that I'm being punished, I'm being penalized for
something that I am not responsible for.
Please leave.
>> Mrs.Hughes >> I said, get out.
[MUSIC]
I can't be isolated at the end of this hall.
It ruins our plan.
>> Not so fast, darling.
We could use this to our advantage.
[MUSIC]
Yes, it's me.
[MUSIC]
