CNA Training Advisor
June 2015
IN FECTION CO NTROL
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However, these bene¿ts can only be achieved when the whole SNF
community is educated about—and dedicated to—stopping the spread
of disease. Read on to learn the common avenues of infection transmission and how CNAs can aid their facility’s infection control efforts.
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Successful infection control initiatives can boost a nursing home’s
clinical and operational performance by facilitating:
• Better control over the transmission of infection among staff, residents, and visitors
• Timely responses and appropriate actions in cases of resident infection and exposure incidents
• The creation of sound internal policies and procedures that comply with key regulations
• The incorporation of infection control issues into the facility’s
quality improvement processes
• Thorough documentation that reÀects the provision of appropriate
services and actions
The ABCDs of disease transmission
The four primary methods of disease transmission are easy to remember because of their alphabetic acronym, ABCD:
• Airborne transmission. Airborne germs can travel great distances through the air and infect people who breathe the germs in.
Examples of diseases caused by airborne germs are tuberculosis,
chickenpox, inÀuenza, and certain types of pneumonia.
• Bloodborne transmission. This occurs when the blood of an infected person comes into contact with the bloodstream of another
person, allowing germs to enter the second individual’s bloodstream.
Blood and bloodborne germs are sometimes present in other body
Àuids, such as urine, feces, saliva, and vomit. Examples of diseases
caused by bloodborne germs are HIV/AIDS and viral hepatitis.
• Contact transmission. Certain germs can be transmitted
through direct contact (e.g., touching an infected individual) or indirect contact (e.g., touching an object previously handled by the
infected individual). Examples of diseases caused by contact germs
are pink eye, scabies, wound infections, and methicillin-resistant
Staphylococcus aureus.
• Droplet transmission. Some germs can only travel short distances (usually no more than three feet) through the air and rely
on respiratory droplets (i.e., those dispersed through actions like
sneezing, coughing, and talking) to spread. Examples of diseases
caused by droplet germs are Àu and pneumonia.
© 2015 HCPro, a division of BLR. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400.
June 2015
CNA Training Advisor
IN FECTION CON TRO L
The CNA’s role in prevention
Because CNAs provide regular, direct care to residents, there are inherent infection risks in many of
their day-to-day duties, including:
• Assisting with elimination
• Bathing an individual with open lesions
• Changing linens
• Feeding
• Providing catheter and perianal care
• Providing oral care
Because CNAs’ job can put them in the crosshairs of
exposure and transmission, they should use standard
precautions during all care interactions. They should
help maintain a clean environment throughout the
entire facility by cleaning spills as soon as they occur and
wiping down surfaces as necessary. In addition, CNAs
should use the following strategies whenever applicable.
Wash hands
Hand washing with soap and water is the single most
effective way to prevent the spread of infection. Since
hands are constantly touching contaminated surfaces,
they are the principal vehicle for transmitting infection.
You should wash your hands:
• Before and after each work shift
• Before and after consuming or serving food or drink
• Upon return from public places
• After caring for personal needs (e.g., using the toilet, blowing your nose, or covering a sneeze)
• After touching blood, body Àuids, waste, or objects
contaminated by these materials—even if you were
wearing gloves during the contact
• Before and after performing wound care
• Before and after wearing gloves
• Before and after each signi¿cant contact with an individual and between resident visits
•
To properly wash your hands:
Rinse hands and lather well with soap and warm
water, keeping hands lower than elbows. Use liquid soap whenever possible, as bar soap creates a
•
•
•
•
•
breeding ground for bacteria. If bar soap is the only
available option, rinse lather from soap after use.
Scrub ¿ngers, palms, backs of hands, wrists, and
between ¿ngers for at least 10 seconds.
Clean under ¿ngernails with nail brush or orange
stick if necessary.
Rinse hands thoroughly.
Use paper towels to dry hands.
Use a clean paper towel to turn off faucet.
Wear gloves
Gloves are not necessary for casual contact with residents, such as during transfers or while cleaning intact
skin. However, they should be worn whenever you:
• Touch blood, body Àuids, waste, or objects contaminated by these materials (e.g., utensils, linens, or a
surface harboring body Àuid)
• Touch a patient’s broken skin or mucous membranes (e.g., mouth, nose)
• Perform mouth care, nasal suctioning, ostomy care,
a bowel routine, wound care, or dressing changes
• Empty drainage receptacles
Change gloves between tasks and each resident visit.
Just like dirty hands, dirty gloves spread germs, so
wearing gloves is not a substitute for hand washing.
To apply sterile gloves:
• Remove any jewelry that could puncture the gloves.
• Wash and dry hands thoroughly.
• Set the package containing the sterile gloves on a
clean surface (e.g., on fresh paper towels).
• Open the package carefully, peeling the outward,
non-sterile covering away from the interior, sterile
portion of the package.
• Using your nondominant hand, grasp the sterile
glove by the upper edge of the inside cuff. Do not
touch the outside of the glove.
• Slide dominant hand into the sterile glove.
• Pick up the other glove by sliding the gloved ¿ngers
under the inside cuff without touching the exposed
hand.
• Adjust the ¿t, using ¿ngers as necessary.
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CNA Training Advisor
June 2015
IN FECTION CO NTROL
Avoid touching anything outside of the sterile ¿eld
while wearing the gloves.
To remove both sterile and non-sterile gloves:
• Grasp the cuff of one glove with the opposite hand.
• Pull the glove downward carefully, turning it inside
out as it is removed, and crunch it into a ball in the
gloved hand. Continue holding the balled glove.
• Grasp the inside top of the cuff of the still-intact
glove with the ungloved hand. (This is considered
to be the cleanest part of the glove.)
• Peel the glove downward carefully, turning it inside
out over the other glove.
• Discard both gloves in a plastic trash bag, and wash
hands immediately.
Never wash or decontaminate disposable gloves.
Handle equipment safely
In addition to exercising caution when interacting
with residents, it’s also essential to take the appropriate
steps when handling objects to prevent the spread of
infection. Standard precautions include:
• Following facility procedure for use, care, cleaning,
and storage of equipment, as well as for the disposal of contaminated trash (e.g., wound dressings).
• Using disposable equipment and supplies whenever possible, as equipment has great potential to
carry and spread infection. Clean permanent items
(e.g., stethoscopes, blood pressure cuffs, and thermometers) and reusable equipment following each
use. Use disposable equipment only once.
• Handling soiled linens carefully. Hold them away
from clothing, and avoid shaking them. Never
throw soiled materials on the Àoor. Instead, roll
them up and wash according to facility policy.
• Disposing of dangerous waste very carefully. Needles
and other sharp devices should be deposited in clearly marked, puncture-proof containers, not the regular trash receptacle! Do not recap used needles—put
them in the puncture-proof container without the cap.
• Avoiding removing anything from containers
marked “biohazard.” If you must handle anything
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•
•
in one of these containers, wear gloves.
Checking your gloves and other personal protective
equipment frequently. If you see tears or holes, remove the material, wash your hands, and put on a
clean piece of equipment.
Avoiding touching your face when providing care,
unless you remove gloves and wash hands ¿rst.
Transmission-specific measures
In addition to employing universal precautions,
CNAs and other staff who are caring for residents with
existing infections may need to use more stringent
measures tailored to the speci¿c method of disease
transmission.
In the case of airborne infection:
• Ensure the resident is in a private room, possibly
one with a special air ¿lter. Keep the door closed.
• Wear a mask. If the patient has (or might have) tuberculosis, ask your supervisor for a special respiratory mask.
• Remind the resident to cover his or her nose and
mouth when coughing or sneezing.
• Ask the resident to wear a mask if he or she wants
or needs to be around others.
In the case of contact infection:
Ensure the resident is in a private room, but allow
the door to stay open if desired.
• Put gloves on before entering the room, and remove
them right before leaving. After removing them,
don’t touch anything else until you wash your hands.
• Wear a gown in the room if the resident has drainage or diarrhea, or if the resident is incontinent.
Remove the gown right before leaving the room.
•
In the case of droplet infection:
• Ensure the resident is in a private room, but allow
the door to stay open if desired.
• Wear a mask when working in close proximity to
the resident (i.e., within three feet).
• Ask the resident to wear a mask if he or she wants
or needs to be around others. H
© 2015 HCPro, a division of BLR. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400.
JUNE 2015 Volume 13 Issue No. 6
CNA Pro fesso r
IN FEC TIO N C O N TR O L Q U IZ
Mark the correct response.
Name:
1.
2.
Date:
A successful infection control program can facilitate
timely responses to resident infections.
6.
a. True
a. True
b. False
b. False
Which of the following types of germs can be spread
through direct or indirect touch?
7.
When handling soiled linens, you should __________.
a. shake the linens out to remove any dirt or crumbs
a. Airborne
3.
To save the facility money, a CNA can reuse disposable
care equipment as long as he or she disinfects it first.
b. Bloodborne
b. stow the dirty linens on the floor while you stock
the room with a fresh set
c. Contact
c. hold the linens close to your body to inspect them
d. Droplet
d. roll the dirty linens up and wash them according
to facility policy
Which of the following common CNA duties does NOT
pose a high risk for infection transmission?
8.
a. Feeding
When disposing of a needle or other sharp object,
you should NOT _____________.
b. Transferring
a. place it in a puncture-proof container
c. Assisting with elimination
b. avoid touching the sharp end
d. Providing catheter care
c. recap it carefully before disposing of it
d. None of the above
4.
5.
When washing their hands, healthcare workers should
scrub fingers, palms, backs of hands, wrists, and
between fingers for at least ______.
9.
Residents with _____ infections should be placed in a private room, though they may keep the door open if desired.
a. 5 seconds
a. airborne
b. 10 seconds
b. contact
c. 1 minute
c. droplet
d. 5 minutes
d. Both b and c
Which of the following tasks does NOT require the use
of gloves?
a. Touching blood, body fluids, or contaminated objects
b. Cleaning intact skin
c. Performing mouth care
d. Emptying drainage receptacles
10. Which of the following transmission-specific measures
should you take when providing care for a resident
who has the flu?
a. Wear a mask when working within three feet of
the resident
b. Wear a mask, gown, gloves, and goggles whenever
you are in or near the resident’s room
c. Quarantine the resident
d. No additional precautions are needed
A supplement to CNA Training Advisor