Infection control 101 Nephrology Nursing Journal, Sept-Oct, 2010 by Linda Duval

Goal To provide an overview of infection control and its importance in the daily provision of health care. Objectives 1. Discuss the application of asepsis and sepsis techniques in infection control. 2. Explain the three principles of infection control practices of medical and surgical sepsis. 3. List measures to help prevent infections. 4. Outline suggested nursing measures to help prevent the spread of infection. The world has numerous living organisms with which humans, for the most part, co-exist on a daily basis. However, in providing care to the community of patients who are on dialysis and immunocompromised, it is incumbent upon healthcare professionals to provide safe, quality care, including basic infection control practices. These practices are not new, and for most, are integrated into the routine provision of dialysis care. The challenge within existing time constraints is to make sure routine practices do not lapse into shortcuts concerning infection control practices. Hand washing or hand hygiene is the first step in preventing the transmission of infection, and yet, breaks in infection control practices, especially hand hygiene, occur more frequently than they should (Centers for Disease Control and Prevention [CDC], 2002). This article reviews basic infection control as a reminder of its importance in the daily provision of health care. Basic Definitions Asepsis is the absence of disease-producing microorganisms, called pathogens. Asepsis can be separated into two types: medical and surgical. Medical asepsis refers to infection control practices that endeavor to decrease the number and/or transfer of disease-producing organisms from one person or place to another. These practices are usually known as clean technique. Surgical asepsis includes practices that keep objects and areas completely free of organisms, known as sterile technique. It is important to understand the application of these techniques in infection control. The use of clean technique is vital because there are always organisms in the environment that in some individuals and under certain circumstances can cause infections. Clean technique is commonly used both in and outside the healthcare community because it is assumed that pathogens are likely to be present, even if the exact kind of pathogen is unknown. Community-acquired infections can be from various public sources (such as water and food). A general example would be public water fountains. Today, water fountains are considered by many as unsafe sources for drinking water because unknown pathogens may be present after use by multiple individuals. This has led those concerned about potential infection issues toward purchasing bottled water versus the use of public water fountains. Likewise, there are times when an organism is known to be present in the environment or within the patient. These occurrences lead to additional precautions being implemented (for example, isolation). Isolation techniques include the use of specific measures related to the way an organism is transmitted.

In the dialysis community, an important example of understanding transmission would be viruses, such as hepatitis and human immunodeficiency virus (HIV). Hepatitis B (HBV) is a serious viral disease that affects the liver. HBV is spread through contact with the blood or other body fluids of an infected person. HBV can survive outside the body at least seven days and still be capable of causing infection. Conversely, hepatitis C (HCV) and HIV are transmitted primarily through large or repeated percutaneous (passage through the skin) exposures to infectious blood. However, these viruses are very fragile with limited survivability outside of the body. The hemodialysis (HD) procedure requires many interfaces with blood, requiring isolation for hepatitis B (CDC, 2001). Any blood spills, including dried blood, which can still be infectious, should be cleaned using 1:10 dilution of one part household bleach to 10 parts of water for disinfecting the area (CDC, 2001). Gloves should be used when cleaning up any blood spills. Appropriate cleaning and isolation techniques are critical in preventing the transmission of certain viruses. Contamination is the process by which something becomes unclean or unsterile. Disinfection is the process by which pathogenic organisms, generally spores, are destroyed (for example, a disinfectant). It is not usually intended to be used for destroying pathogens in or on individuals. An antiseptic is a substance that inhibits the growth of bacteria. Certain antiseptics can be used safely on patients. A bacteriostat is a substance that prevents the growth of bacteria. A bactericide kills bacteria but not necessarily their spores. The term germicide is used interchangeably with bactericide. A fungicide kills fungi, and a virucide kills viruses. Sterilization is the process by which all microorganisms, including spores, are destroyed. Hand Washing So what do we do? There are many references to universal precautions, prevention of infection tools, surveillance, and monitoring of infectious diseases. Repeatedly, however, the most important practice is hand washing (CDC, 2002; Kaye et al., 2006; Mody, Saint, Kaufman, Kowalski, & Krein, 2008). It is an easy concept, and yet, this is where technique tends to falter. Studies on hand-washing techniques have been reported in literature for centuries. Despite much evidence to support the practice of hand washing, contaminated hands are considered by many to be the prime factor in cross-infections to date. It seems worth repeating that hand washing is recommended before and after any delivery of patient care. Preventative Measures Measures to prevent infections include: * Clean hands frequently, especially before providing any direct patient care. * Hand hygiene can be done with plain or antiseptic-containing soap and water or the use of alcohol-based products for routine decontamination of hands in all clinical situations, except when hands are visibly soiled. * Remember to clean under fingernails as well. Numerous studies reflect subungual areas of the hand hide high concentrations of bacteria, most frequently coagulase-negative staphylococci, gram-negative rods (pseudomonas), and yeasts. * Keep soiled items and equipment from touching clothing. * Avoid having patients and/or staff cough, sneeze, or breathe directly on others. Provide disposable wipes and/or instructions to cover their mouths when close contact is necessary.

* Clean away from yourself, especially when scrubbing. * Avoid raising dust. Do not shake linens (for example, sheets, blankets). * Dispose of soiled or used items directly into appropriate containers or holders. * Pour liquids to be discarded directly into the drain to avoid splattering in the sink.

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