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GERMAN 1B03 Study Guide - Final Guide: Universal Precautions, Body Fluid, Bloodborne

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Dr.Janice Hdlaki
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HTH SCI 2HH3 05 – Infection Control 1 of 12
Infection Control
Routine Practice & Additional Precautions
The chain of infection:
-Patient (most common)
-Visitor (people feel obligated to visit – nurse should act as gate keepers and keep these people out)
-Staff (health care practitioners come to work when ill)
-Environment (there are measures in place to reduce this risk)
-Food or contamination at the manufacturer (much less common than previously due to new regulations
and quality control measures)
-Contact: skin-to-skin
-Indirect contact: skin-to-inanimate object (be sure the clean your stethoscope!)
-Droplet: coughing, sneezing, spit (droplets can be propelled 1-2ms away. It’s important to consider the
radius that becomes contaminated) (light molecules can stay suspended longer)
-Airborne (e.g. TB)
-Blood and body fluids (e.g. Hep B, HIV) (may come in contact when a patient received dialysis)
-Vector (e.g. mosquito carrying. Malaria, West Nile)
Susceptible host:
-Age: neonates lack an adequate immune system; elderly have compromised immune systems (one of
the first systems to break down) and are often living in long-term care
-Immunosuppression: may be caused by drugs or illness
-No immunity: may be induced medically for the purpose of organ transplantation
-Chronic conditions: e.g. diabetes may impede healing processes
-Emergency procedure: there is insufficient time for prevention practices (e.g. skin prep, debris
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HTH SCI 2HH3 05 – Infection Control 2 of 12
What you see is only the tip of the iceberg
Infectious diseases “back in the day” were more overt and would cause outward signs of illness (e.g. spots,
Things became more complicated in the 70s and for some reason, patients infected with newer bugs present
with are fewer signs/symptoms
Routine Practices:
-Before routine practices, many countries practiced “universal precautions” when dealing with known
contaminated products  Now recommend more broadly – routine for all patients.
-Routine Practices were Published in 1999 by Health Canada (now PHAC).
-Similar to Standard Precautions, published by the CDC in 1996.
-Provincial Infectious Diseases Advisory Committee (PIDAC) for Ontario has published Guidelines for
Routine Practices and Additional Precautions 3rd revision 2012 (
-Recommends practices for the routine care of all patients in various settings and incorporates previous
precautions against blood-borne pathogens.
-The precautions are determined by the type of interaction with the patient and risk of encountering
bodily substances and not by the patient’s diagnosis.
-ALL body substances (Blood, body fluids, secretions, excretions, drainage) of ALL patients are
considered potentially infective. Thus, when doing procedures, anticipate the risk of exposure to blood
and other body fluids (e.g. wound care, catheter, etc)
To be used in conjunction with Additional Precautions, based on the method of transmission.
-Droplet and airborne
-Bacteria that are resistant to multiple antibiotics (VRE, MRSA)
-Organisms/infections of significance
Prevent transmission:
#1 way to break transmission is HAND HYGIENE. The majority of organisms we will encounter are
spread through direct and indirect contact. Our hands are the #1 culprit.
Key steps: should take 15 second
-Wet hands thoroughly before applying cleanser
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HTH SCI 2HH3 05 – Infection Control 3 of 12
-Rub palm to palm
-Right palm over left dorsum and left palm over right dorsum
-Palm to palm, fingers interlaces
-Backs of fingers to opposing palms, fingers interlocked
-Rotational rubbing of right thumb clasped in left palm and vice versa
-Rotational rubbing back and forwards with clasped fingers of right hand in left palm and vice versa
-Rinse and dry hands thoroughly
Good hand hygiene can terminate outbreaks in health care facilities, reduce transmission of antimicrobial
resistant organisms and reduce overall infection rates.
-An increase in hand hygiene adherence of only 20% results in a 40% reduction in the rate of health
care acquired infections – (millions of dollars)
Most healthcare providers believe they are already practicing good hand hygiene; in an audit conducted
about four or five years ago, it was found that the mean rate of hand hygiene was only about 35-36%. Thus,
there is lots of teaching to do!
Soap or sanitizer?
-Hand washing with soap and running water remains most sensible strategy in non health care settings
-Hand rubs with alcohol-based products significantly reduce the microorganisms, fast acting, and cause
less skin irritation.
Four moments of hand hygiene
1. Before initial patient/patient environment contact
2. Before aseptic procedure
3. After body fluid exposure
4. After patient/patient environment contact
*be aware of casual interactions (e.g. touching the bed)
Routine Practices:
Personal Protective Equipment:
oShould be used as an additional measure not as a substitute for hand hygiene.
The use of gloves does not eliminate the need for hand hygiene.
The use of hand hygiene does not eliminate the use of gloves
oTo be used when in direct contact with any body fluids or moist substances/exudate from
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