Chapter 7
Controlling the Spread of Germs
GOALS
After reading this chapter, you will be able to:
- Apply general infection‑control measures.
- Clean, disinfect, and sterilize objects appropriately.
- Use Standard Precautions and Isolation Precautions.
- Explain isolation to a person in isolation.
After practicing the corresponding skills, you will be able to wash hands, don & doff protective clothing, and correctly handle trash and contaminated laundry.
Key Terms
Clean items are free of pathogens; items contacting a person or their environment are considered contaminated and cannot be reused for another person.
Mrs. Louise Wang, 53, has highly contagious staph pneumonia and is in isolation. She has a colostomy and needs assistance with personal care and transfers. Explain protective gear and the purpose of isolation to reduce fear and loneliness.
Germs & Infection
Microorganisms include bacteria, viruses, fungi, yeasts, and molds. Harmful ones are called pathogens. Infection control—one of the six principles of care—uses precautions to stop spread.
Recognizing Infection (Box 7‑1)
- Fever; flushed face; headache
- Red/draining eyes; stuffy nose; cough; sore throat
- Loss of appetite; nausea; stomach pain; vomiting; diarrhea
- Cloudy or smelly urine
- Joint pain; muscle ache
- Skin rash; sores; redness/swelling or drainage at wounds/incisions
- General swelling
Report suspected infection promptly; early recognition prevents spread.
How Germs Spread
Direct Contact
Germs move directly from one person to another via skin or body openings (e.g., ungloved stoma care then eating).
Indirect Contact
Germs transfer via contaminated objects (e.g., shared glasses, tissues, equipment, linens). Food/water contamination is common.
Everyday Infection Control
- Wash hands regularly and correctly.
- Use antimicrobial liquid soap when possible.
- Eat well, exercise, and stay home if sick.
- Clean → Disinfect → Sterilize as appropriate (e.g., bleach 1/4 cup to 1 gallon water; boil 20 minutes).
- Handle linens carefully; avoid shaking; bag at point of use.
- Use personal items only for each person; cover bedpans/urinals when transporting.
- Prepare/serve/store food safely.
Precautions
- Keep fingernails short; clean under nails.
- No rings (except simple band); move watch above wrist or remove.
- Rinse bar soap before/after use if liquid soap not available.
When to Wash
- On duty start/end; before/after each person; after glove removal.
- After bathroom use; cough/sneeze/nose blow; smoking.
- Before food handling or clean linens; after dirty linens.
- Any time it may be important.
Standard & Isolation Precautions
Standard Precautions apply to all care whenever body fluids may be present. OSHA’s Bloodborne Pathogens Standard requires exposure plans, annual review, and offering Hepatitis B vaccination to at‑risk workers.
Box 7‑4 — Ten Standard Precautions
- Wear disposable gloves.
- Wash hands/skin immediately if contaminated; after removing gloves; before new gloves.
- Wear protective clothing (gown/mask) when required.
- Dispose of sharps in biohazard container—never recap.
- Wear gloves if you have cuts/sores.
- Clean spills of blood/body fluid promptly with fresh disinfectant.
- Handle linens carefully.
- Bag contaminated articles carefully (double‑bag if needed).
- Use leakproof, covered waste containers.
- Know where resuscitation masks/bags are kept.
Isolation Categories & Equipment
| Precaution | Airborne | Droplet | Contact |
|---|---|---|---|
| Private room, door closed | Yes | Yes | Yes |
| Hand hygiene on entry/exit | Yes | Yes | Yes |
| Gown | Yes | Task‑specific | Yes (with wound contact) |
| Mask | Yes (HEPA) | Yes | Yes (close/direct care) |
| Gloves | Yes | Task‑specific | Yes (with wound contact) |
| Bag linens & contaminated articles | Yes | Yes | Yes |
| Disinfect/throw away articles after use | Yes | No | No |
Note: Wear protective eyewear if splashes are possible.
Protective Equipment
- Gowns: dry, single‑use; full coverage neck‑to‑knees.
- Masks: change if moist; replace after ~20 minutes of wear.
- Protective eyewear: shields eyes from splashes.
- Gloves: disposable (vinyl/nitrile); discard after use; utility gloves for housekeeping may be decontaminated and reused in home settings.
- Plastic bags: leakproof; label contaminated items/bags appropriately.
Preparation & Completion Standards
Preparation
- Wash hands; gather supplies; focus on task.
- Knock, introduce, identify, explain procedure.
- Place supplies; prepare; don gloves.
- Lock equipment brakes; adjust bed; provide privacy.
Completion
- Ensure safety, comfort, alignment.
- Dispose of trash/laundry; clean & store equipment.
- Call‑light in reach; bed in proper position; remove privacy curtain.
- Say good‑bye; dispose of gloves; wash hands; note/record/report.
Responding to the Person’s Needs
Isolation can feel lonely, scary, or embarrassing. Explain the why of PPE and isolation; check in often; listen; and support emotional needs alongside physical care.
End of Chapter 7 — Controlling the Spread of Germs