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Course: Fundamentals of Nursing�Topic: Infection Control

The Nurses International Community

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Student Learning Outcomes

Learners will be able to:

Describe the types of immunity.
Describe standard precautions.
Describe transmission precautions.

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Immunity

Centers for Disease Control and Prevention [CDC], 2024; National Cancer Institute, n.d.

Where the immune system assists in preventing repeated infection in the future.

Production of antibodies within the body.

Three types of immunity:

Innate
Adaptive or Active
Passive

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The premise of immunity is activated by the body when there is recognition of an infection, or foreign body, within the body. When immunity is achieved, disease-specific antibodies are developed within the body. An antibody is a protein that attacks the invader within the body, but are specific to each virus/disease. The recognition is achieved through innate immunity, adaptive immunity, or passive immunity. Immunity is a shield of protection protecting the body through memory of how to fight off the infection.

Centers for Disease Control and Prevention. (2017, March 10). Immunity types. CDC.

https://www.cdc.gov/vaccines/vac-gen/immunity-types.htm

National Cancer Institute. (n.d.) Immunity. NCI Dictionaries. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immunity

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Innate Immunity

Innate immunity

Existing barriers on body

Skin
Mucous membrane

First line of defense within immune response.

National Cancer Institute, n.d.

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Adaptive or Active Immunity

Adaptive/Active

Natural immunity

Person is infected with the disease or virus.
Body mounts an immune response by developing antibodies.
Takes time to develop antibodies, not immediate.

Vaccine-induced immunity

Person is vaccinated with a weakened virus or disease to provoke the body’s production of antibodies.

Long-lasting immunity
Body immediately recognizes invader if re-presents itself in the future and begins creating antibodies to neutralize .

CDC, 2024

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Passive Immunity

Passive

When client is given antibodies.
Own body does not produce antibodies from exposure.
Immune globulin.

Blood product containing antibody.
Can target disease or virus immediately because antibodies are already present.

Placenta crossing.

Newborns can achieve passive immunity through placenta from mother.

Not long-lasting protection -- may last weeks to months.

CDC, 2024

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Critical Thinking Questions

The nurse gives their client an annual flu vaccine. What type of immunity does this client receive?

A pregnant mother is advised to receive the TDAP vaccine to best protect their newborn baby from pertussis after birth. What type of immunity does the baby receive from the mother getting vaccinated?

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Standard Precautions

Minimum level of protection that should be applied to every client.
Should be utilized no matter the known health or infection status of the client.

Hand hygiene
Personal protective equipment utilization
Respiratory hygiene and etiquette
Sharp safety
Safe injection practice
Sterilization of instruments and devices
Clean and disinfected environmental surfaces

CDC, 2024

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What is PPE?

PPE: Personal Protective Equipment.
Equipment and clothing items worn by provider that help prevent disease transmission from client.
Based upon infection status of client determines what level of PPE is being utilized.
Examples:

Gloves: protect hands from fluids
Gown: protect body, clothing, and skin
Mask: protects mouth and nose
Eyewear: protects eyes
Face shields: protects whole face including eyes, mouth, and nose.

CDC, 2024

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Donning PPE

CDC, n.d.-b

Donning PPE

Put gown on and fasten around the neck and waist.
Put on mask and tie if necessary. Ensure a snug fit around nose and mouth.
Put on goggles and/or face shield.
Put on gloves and pull up over the cuffs of the gown if wearing.

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Doffing PPE

Take off gloves.
Remove by pinching palm of one hand to remove glove, then pull other glove off by placing finger under wrist cuff and pulling off.
If hands get contaminated, wash hands before advancing.
Remove goggles and/or face shields.
Remove by the back where less contamination occurs.
Remove gown.
Undo ties and turn gown inside out as pulling off, touching only inside.
Take off mask.
Take off from ties, the front is contaminated so do not touch front.
Wash hands.

CDC, n.d.-a

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Transmission Precautions

Dependent on client’s infectious status, additional PPE and precautions should be implemented in addition to standard precaution.

Contact, Droplet, and Airborne.

Different precautions may be utilized together if a virus has more than one potential route of infection.
Clients should ideally be grouped together by precaution or viral process if able.

Example: two clients together in a room with influenza.

CDC, 2024

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Additional PPE is utilized during client care when certain disease or viral processes are diagnosed in order to prevent transmission. It is important to have knowledge on routes of transmissions from varying infections to know how to safely protect oneself and other clients by providing barriers of transmission through utilization of the appropriate PPE. Organizational policy may also determine how to care for certain clients, such as if similar transmission route clients should be grouped together or isolated. Nurses should also know where the PPE can be found within the environment.

Centers for Disease Control and Prevention. (2019, July 22). III. Precautions to prevent transmission of infectious agents. CDC.

https://www.cdc.gov/infectioncontrol/guidelines/isolation/precautions.html#

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Contact Precautions

When:

When condition is spread through contact, directly or indirectly.

Example: rotavirus, draining wounds.

PPE:

Gown & glove when in contact with client or their environment.

Nursing Considerations:

Transport client out of their room only if necessary.
Use disposable equipment if possible (stethoscopes, blood pressure cuffs).
Clean and disinfect client room, environment, and equipment frequently.

CDC, 2024; Wisconsin Department of Health Services, 2020

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Droplet Precautions

When:

When condition is spread through droplets in air by client talking, coughing, or sneezing.

Example: influenza, smallpox.

PPE:

Standard + Mask within client’s environment.

Nursing Considerations:

Transport client out of their room only if necessary

Mask client when transporting.

CDC, 2024; Wisconsin Department of Health Services, 2020

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Airborne Precautions

When:

When condition is spread through small particles in air current.

Example: tuberculosis, measles, chickenpox.

PPE:

Standard + fitted N95 respirator mask.

Nursing Considerations:

Transport client out of their room only if necessary.

Mask client when transporting.
Place client in airborne infection isolation room and keep door closed.

Keep susceptible personnel out of client environment.

CDC, 2024; Wisconsin Department of Health Services, 2020

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Critical Thinking Question

On a pediatric ward, a client is admitted with skin lesions after known contact with a friend with chickenpox.

What type of room should this client be admitted to?

What PPE should the providers wear within the environment?

What type of transmission precaution is this considered?

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Client Considerations

Clients perceptions during care with providers wearing appropriate PPE.
Stigmatization of client care from healthcare provider.
Example: clients under contact precautions.

Potential decreased client satisfaction.
Client perception of delay of care.
Increased psychological stress from isolation.

Morgan et al., 2009

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References:

Centers for Disease Control and Prevention. (2024, April) Personal Protective Equipment. CDC.https://www.cdc.gov/niosh/emres/safety/ppe.html

Centers for Disease Control and Prevention. (n.d.-b). PPE sequence [Printable handouts]. CDC. https://www.cdc.gov/healthcare-associated-infections/media/pdfs/ppe-sequence-p.pdf?CDC_AAref_Val=https://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf

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References:

Centers for Disease Control and Prevention. (2024, April). Transmission-based precautions. CDC. https://www.cdc.gov/infection-control/hcp/basics/transmission-based-precautions.html

Centers for Disease Control and Prevention. (2024, July). Immunity types. CDC.https://www.cdc.gov/vaccines/basics/immunity-types.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/vac-gen/immunity-types.htm

Centers for Disease Control and Prevention. (2024, May). Standard precautions. CDC.https://www.cdc.gov/dental-infection-control/hcp/summary/standard-precautions.html?CDC_AAref_Val=https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/standard-precautions.html

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References:

Centers for Disease Control and Prevention. (2019, July 22). III. Precautions to prevent transmission of infectious agents. CDC. https://www.cdc.gov/infectioncontrol/guidelines/isolation/precautions.html#

Morgan, D. J., Diekema, D. J., Sepkowitz, K., & Perencevich, E. N. (2009). Adverse outcomes associated with contact precautions: A review of the literature. American Journal of Infection Control, 37(2), 85-93. https://doi:10.1016/j.ajic.2008.04.257

National Cancer Institute. (n.d.) Immunity. NCI Dictionaries. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immunity

Wisconsin Department of Health Services. (2020, June 23). Infection control and prevention-transmission-based precautions. Wisconsin Department of Health Services. https://www.dhs.wisconsin.gov/ic/transmission.htm#:~:text=There%20are%20three%20types%20of,transmission%20of%20a%20specific%20disease.

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