Dedication ix About the Authors xi Foreword xiii Preface xv Chapter 1 Infection Control as a Health Care Discipline 1 Historical Perspective 1 Infection Control Programs in the United States 1 Epidemiology of Nosocomial Infection 2 Status of Infection Control in Home Care and Hospice 3 References 5 Chapter 2 The Infectious Disease Process 7 Agent, Host, and Environment 7 Types of Infection 7 Normal Flora 7 Chain of Infection 8 Causative Agent 8 Reservoir of Infection 9 Portal of Exit 11 Portal of Entry 11 Mode of Transmission 11 Contact Transmission 11 Airborne Transmission 12 Vehicle Transmission 12 Vector Transmission 12 Reducing the Risk of Infection 12 Susceptible Host 12 Intrinsic Risk Factors 12 Extrinsic Risk Factors 13 Impact of Home Care and Hospice Staff 14 References 14 Chapter 3 Patient Care Practices 15 Hand Hygiene 15 Resident and Transient Microorganisms 15 Hand Hygiene Terminology 16 Indications for Handwashing and Hand Antisepsis 17 When to Use Plain Soaps Versus Antiseptic Agents for Hand Hygiene 17 Bar Soap Versus Liquid Soap 18 Hand Hygiene Facilities 18 Side Effects of Hand Hygiene 19 Considerations When Purchasing Hand Hygiene Products 19 Other Hand Hygiene Considerations 19 Behavioral Aspects of Hand Hygiene 19 Hand Hygiene Supplies Needed by Home Care Staff 20 Using the Patient's Hand Hygiene Supplies 20 Antiseptic Hand Rub 20 Fire Hazards and Storage of Alcohol-Based Hand Rubs 21 Assessment of the Patient and Home Environment 22 Wound Care 22 Clean Technique Versus Sterile Technique 23 Selecting the "Right" Technique 23 Wound Care Procedures 24 Irrigating Solution Maintenance 25 Preparing Irrigation Solutions in the Home 25 Patient Education Related to Wound Care 26 Reusing Equipment in the Home 26 Urinary Tract Care 26 Condom Catheter Drainage 27 Indwelling Catheter Insertion and Replacement Frequency 27 Catheter Maintenance 28 Meatal Care 28 Indwelling Catheter Irrigation 28 Suprapubic Catheters 28 Intermittent Catheterization 29 Cleaning and Disinfecting Intermittent Urethral Catheters 29 Cleaning and Disinfecting Urine Collection Tubing and Bags 29 Specimen Collection 29 Patient Education for Prevention of Urinary Tract Infection 29 Respiratory Therapy and Infection Control 30 Prevention of Health Care-Associated Bacterial Pneumonia 30 Breathing Circuits 30 Suctioning of Respiratory Tract Secretions 30 Cleaning and Disinfecting Tracheal Suction Catheters 31 Cleaning and Disinfecting the Inner Tracheal Cannula 31 Cleaning and Disinfecting Respiratory Equipment and Supplies 32 Other Measures to Prevent Respiratory Infection 32 Preventing Aspiration 33 Patient Education for the Prevention of a Respiratory Tract Infection 33 Prevention and Control of Influenza 33 Modifying the Host Risk for Infection Through Vaccination 33 Enteral Therapy 34 Cleaning Enteral Feeding Equipment and Supplies 34 Patient Education Related to Enteral Therapy 34 Post-Mortem Care 34 Precautions for Handling the Deceased Body 34 References 35 Chapter 4 Infection Control in Home Infusion Therapy 37 Overview 37 Causes of IV Central Line-Associated Infections 38 Types of IV Catheters and Devices 38 Peripheral Venous Catheters 38 Midline Catheter 39 Central Venous Catheters 39 Hemodialysis Catheters 40 Preventing Central Line-Associated Infections 41 Selecting an Appropriate Catheter Insertion Site 41 Peripheral Venous Access Site Selection 41 Midline Venous Access and PICC Site Selection 42 Selecting an Appropriate Type of Catheter 42 Catheter Insertion 43 Replacing IV Access Devices 43 Removing IV Access Devices 44 Replacing Administration Sets 44 Needleless Intravascular Devices 44 Replacing IV Solutions 44 Catheter Site Care 45 Skin Preparation 45 Midline and Central Venous Catheter Dressing Changes 45 Injection Cap Changes 46 Filters 46 Flushing the Catheter 47 Culturing for Suspected Infusion-Related Infections 47 TPN Administration 48 Pediatric Patients 48 Nonvascular Access Devices 48 Epidural Catheter, Port, or Pump 49 Intrathecal Catheter, Port, or Pump 49 Blood Storage for Home Transfusions 49 Blood Storage During Transport 49 Blood Storage in the Patient's Home 50 Infection Control in Pharmaceutical Services 50 Pharmacy Sterile Compounding Requirements 50 Medication Storage 52 Storage and Transport of Parenteral Medications 52 Medication Storage in the Patient's Home 52 Preparation of Parenteral Medication in the Home 52 Multidose Vials 53 Nursing Care and Administration of Parenteral medications 53 Patient and Caregiver Education 53 References 54 Appendix 4-A Summary of the USP-NF Chapter <797> 57 Appendix 4-B Summary of the CDC's Guidelines for the Prevention of IV Access Device-Related Infections 61 Chapter 5 Infection Control in Pediatrics, Pets, and Preparation of Food 65 Infection Control in Caring for Pediatric Patients 65 Diapering a Child 65 Cleaning and Disinfecting Diaper Changing Areas 66 Cleaning and Disinfecting Clothing and Linen 66 Cleaning and Disinfecting "Potty Training" Equipment 66 Washing and Disinfecting Toys 66 Preparing Infants' Bottles 66 Preparing Infant Formula 67 Animal-Assisted Activities and Animal-Assisted Therapy 68 Animal-Assisted Activities 68 Animal-Assisted Therapy 68 Difference Between Animal-Assisted Activities and Animal-Assisted Therapy 69 Transmission of Zoonotic Diseases 69 Preparing the Patient's Meals 71 Overview of Foodborne Illnesses 71 Shopping for the Patient 71 Food Storage in the Patient's Home 76 Preparing the Patient's Food 76 Cooking and Serving the Patient's Food 77 Microwaving the Patient's Food 77 What If the Patient's Power Goes Out? 77 Immunocompromised Patients 77 Health Department Warnings 78 References 78 Chapter 6 Personal Protective Equipment and Staff Supplies 79 Use of Personal Protective Equipment 79 Needlestick Prevention Equipment 79 Gloves 79 Types of Gloves 80 When to Wear Gloves 80 When Gloves Should Be Changed or Removed 80 Latex Allergies 80 Preventing Allergic Reactions to Latex in the Workplace 81 Masks, Respiratory Protection, Eye Protection, and Face Shields 82 When to Wear a Mask 82 Gowns 82 Donning and Removing Personal Protective Equipment 82 Resuscitation Equipment 85 Patient Transport Outside the Home 85 Staff Member Access to Personal Protective Equipment 85 Training 85 Nursing Supply Bag 85 "Bag Technique" 86 Bag Contents 87 Infection Control Supplies 87 References 88 Chapter 7 Multidrug-Resistant Organisms 89 Basic Science: Bugs Versus Drugs 89 How Are MDROs Acquired or Developed? 90 Epidemiology of MDROs 91 Identifying Patients with MDROs 92 Managing Patients with MDROs in Home Care 94 Education of Home Care and Hospice Staff 96 References 96 Chapter 8 Isolation Precautions in Home Care 99 Isolation Guidelines 100 Standard Precautions 100 Transmission-Based Precautions 100 Airborne Isolation 101 Droplet Precautions 102 Contact Precautions 104 Initial Assessment and Implementation of Precautions 105 Informing Others of Isolation Precautions While Maintaining Patient Confidentiality 106 Patient and Family Education Related to Isolation Precautions 107 References 107 Appendix 8-A Type and Duration of Precautions for Selected Infections and Conditions 109 Chapter 9 Guidelines for Cleaning and Disinfection 121 Spaulding's Scheme 121 Definition of Terms 121 Levels of Disinfection 123 Governmental Oversight 123 Cleaning and Disinfecting Patient Care Equipment 124 How to Prepare a Bleach Disinfecting Solution 125 Bleach Disinfecting Solution Storage 125 Noncritical Item Disinfection Guidelines 125 Disinfecting Guidelines for Cleaning Semicritical Items 126 Disinfecting Guidelines for Critical Items 126 Cleaning and Disinfecting Other Items in the Home 128 Environmental Surfaces 128 Linens and Laundry 128 Dishes, Glasses, Cups, and Eating Utensils 129 Storage of Medical Equipment and Supplies in the Home Care or Hospice Organization's Facility 129 Storage of Medical Equipment and Supplies During Transport to and from the Patient's Home 129 Storage of Medical Equipment and Supplies in the Patient's Home 130 References 130 Chapter 10 Medical Waste Management 131 Needle Stick Safety and Prevention Act 131 Modifications to the Bloodborne Pathogen Standard 131 Devices with Engineered Sharps Injury Protection Features 132 Definitions 134 Segregation of Waste 135 General Waste 135 Medical Waste 135 Sharps 136 Waste Storage During Transport to the Home Care or Hospice Organization 138 Separating Waste from Clean Equipment and Supplies 138 Medical Waste Storage in the Home Care or Hospice Organization 138 Medical Waste Transport 139 Department of Transportation 139 United States Postal Service 139 OSHA Labeling Requirements 139 Blood Spills in the Home 140 Blood Spills on Carpeted Surfaces 140 References 141 Appendix 10-A Needle Disposal 143 Appendix 10-B Staff Education 149 Appendix 10-C Lancet Disposal 153 Chapter 11 Surveillance of Home Care-Acquired Infections 163 Infection Surveillance 163 Why Study Home Care-Acquired Infections? 164 Assessment of the Population 168 Selection of Outcomes or Processes for Measurement 169 Developing Definitions for Home Care-Acquired Infections 171 Data Collection Methods 173 Period of Surveillance 174 Defining Denominators 174 Retrospective Versus Concurrent Data Collection 174 Identifying Home Care-Acquired Infections 177 Aggregation and Analysis of Infection Data 177 Use of Data for Improvement of Patient Care 183 Ongoing Measurement 183 Validating Surveillance Data 183 Use of Software for Surveillance 184 Getting Started 184 References 184 Chapter 12 Outbreak Investigations 187 What Is an O
Editorial Reviews
This paperback, an official publication of the Association for Professionals in Infection Control and Epidemiology, Inc., describes in detail the measures needed in home care to prevent and contain infections. It is a first in this subject matter. The authors intend to provide assistance in the struggle to meet the Joint Commission on Accreditation of Healthcare Organization's Standards, which require an organized approach to infection control planning as well as performance measurement, including surveillance of home care-acquired infections. The book is also intended to serve as a reference source and is very much needed as home care providers have a professional, moral, and ethical responsibility to reduce infections. The purposes are met within the limitations of current research. This book will serve as a guide for home care nurses as well as other team members. It is appropriate for libraries and for students in the healthcare professions. The background of the authors is well suited for their preparation of this content. Following an overview of the historical perspectives of infection control and the infectious disease process, the authors discuss thoroughly the procedures that make up the routine of a home care provider. Each section includes CDC guidelines. There is also a special chapter for occupational health. The appendixes include an extensive guide to bloodborne pathogens, a national directory, and a resource listing. Multiple other appendixes provide vital information. The extensive index facilitates timely use of the text. This text serves as a starting point, a first in the discussion, debate, and study of infection control in home care. It is very muchneeded given the growing field of home care, but also because of the characteristics of patients and the changes in infections.
Provides information to home care and hospice organizations for the prevention, control, and surveillance of infection. Thirteen chapters cover topics including infection control as a health care discipline; the infectious disease process; patient care practices; infection control in home infusion therapy; pediatrics, pets, and preparation of food; personal protective equipment and staff supplies; isolation precautions; cleaning and disinfection equipment; medical waste management; surveillance of infections; outbreak investigations; occupational health; and organizing for infection control in home care. Annotation c. by Book News, Inc., Portland, Or.
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