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Case Scenarios
These case scenarios illustrate how the principles of infection prevention and control and the standard statements in this document can be applied. They are not all-inclusive, and clinical advice should be sought from appropriate resources.
Scenario 1
Fatima, a home-visiting nurse, has a client with an open draining wound on her abdomen. A recent culture of the wound found the micro-organism Methicillin-resistant Staphylococcus aureus (MRSA).
Fatima meets the standards and reduces the risk to her client, herself and others by:
- identifying the mode of transmission;
- applying hand hygiene principles;
- choosing the appropriate barrier(s) to prevent and control the transmission of the micro-organism;
- applying the principles for safely handling, cleaning and disposing of materials and equipment; and
- communicating effectively according to the College’s Therapeutic Nurse-Client Relationship, Revised 2006 practice standard.
Scenario 2
A client enters a hospital emergency department complaining of nausea, vomiting, diarrhea and a low-grade fever. As Lisa, an ER nurse, begins to assess the client, he has an episode of diarrhea. In keeping with the hospital’s protocol on infection control, Lisa puts on a pair of gloves and a gown before providing personal care and changing the
bed linen. The ER is busy, and she finishes with the client by quickly disposing of the soiled laundry and removing her gloves and gown. She then begins to assess the vital signs of her next client. Lisa does not wash her hands before performing her assessment.
By not washing her hands, Lisa potentially transmitted micro-organisms from one client to another, and breached the facility’s protocols on infection control. The nurse educator, who observed Lisa’s actions, reinforced that hand hygiene is the single most-important infection prevention and
control practice. The educator highlighted the importance of using hand rinse stations located throughout the ER.
Scenario 3
Shawn is a nurse in a long-term care facility and is assigned to a client with a respiratory infection. The client is symptomatic and requires various degrees
of nursing care.
Shawn meets the standards and reduces the risk to the client, himself and others by:
- knowing that respiratory illnesses are transferred through airborne or droplet mechanisms;
- selecting the appropriate precautions;
- being sensitive to how the infection control barriers affect communication between him and his client;
- washing his hands before and after using personal protective equipment;
- adhering to hospital policies and manufacturer guidelines for the re-processing of equipment;
- ensuring any equipment removed from the client’s room is cleaned with an appropriate disinfectant; and
- advocating for equipment that remains within the client’s isolation room (not unit shared) or single- use items (for example, disposable stethoscopes).
Appendix
This section provides information about general infection control practices. For more information, see References on page 12 and/or consult an infection control practitioner.
Transmission of infection
The spread of infection requires an infectious agent — a pathogen that has the potential to cause infection. The pathogen may be viral, bacterial, fungal or parasitic.
The infectious agent needs a reservoir where it
can live, grow and reproduce. Reservoirs are warm, moist places. Humans, animals or the inanimate environment (for example, water, food, soil and soiled medical equipment) are potential reservoirs. Human reservoirs include individuals with an
acute infectious disease, and those who are in the incubation period of the disease and asymptomatic carriers.
The transmission of infection also requires a susceptible host. Susceptibility to an infectious agent varies among individuals. Factors that
inf luence a person’s susceptibility include age; general physical, mental and emotional health; the amount and duration of exposure to the agent;
and the immune status and inherent susceptibility of the individual. Factors such as a chronic debilitating disease, shock, coma, traumatic injury, surgical procedures or treatment with irradiation
or immunosuppressive agents increase a person’s susceptibility to infection.
How the infectious agent is transmitted from the reservoir to the susceptible host is called the mode of transmission. Transfer requires a route for the infectious agent to exit the reservoir (a portal of exit), a mode of travel to the susceptible host (a mode of transmission) and a route to enter the susceptible host (a portal of entry). An infectious agent can exit the reservoir and enter the host through various body systems (for example, respiratory, gastrointestinal, genitourinary tracts, skin lesions) and through mucous membranes.
There are five main modes of transmission.
1. Contact transmission
Direct contact transmission involves contact between the infectious agent and the susceptible host.
Indirect contact transmission involves contact between a susceptible host and a contaminated intermediate object such as a needle, instrument or other equipment.
2. Droplet transmission
Droplet transmission involves contact of the conjunctivae or mucous membranes of the nose or mouth of a susceptible host with large particle droplets (larger than five microns) that contain
an infectious agent. Droplets are released through talking, coughing or sneezing, and during procedures such as suctioning and bronchoscopy. Large particle droplets do not remain suspended in the air and generally travel less than one metre through the air.
3. vehicle transmission
Food, water or medication contaminated with an infectious agent can act as a vehicle for transmission when consumed. Contaminated instruments or devices that come in contact with body tissue or
the vascular system can also act as a vehicle for transmission.
4. Airborne transmission
Small particle residue (five microns or smaller)
of evaporated droplets may remain suspended in the air for long periods of time, or dust particles may contain an infectious agent. Infectious agents carried in this manner can be widely dispersed
by air currents and can become inhaled by, or deposited on, a susceptible host in the same room or over a longer distance, depending on environmental factors.
5. vectorborne
Vectors such as insects may harbour an infectious agent and transfer it to humans through bites (for example, West Nile virus).
Preventing transmission of infection Preventive practice focuses on interrupting the transmission of an infectious agent and includes four major elements. Practices will vary according to practice setting, the level of care that is being provided, and the inherent risk to the client and client population if transmission occurs.
The four major elements to preventive practice are:
1. Handwashing. Handwashing is the single most-important infection prevention and control practice. It is vital that nurses follow handwashing protocols that are appropriate for their clients and facility.
2. Protective barriers. Examples of protective barriers include gloves, masks, eyewear, gowns and plastic aprons. The appropriate barrier should be used when blood, secretions or bodily f luids are likely to come in contact with the nurse’s skin or mucous membranes, or could penetrate clothing.
3. Care of equipment. This involves the appropriate disposal of waste, contaminated laundry and sharps; and the cleaning, sterilization and disinfection of equipment, instruments and devices. Nurses should follow manufacturer and facility protocols in all instances.
4. Health practices of the nurse. Nurses who believe they have been contaminated with an infectious agent should contact their primary health care provider or an occupational health department
for follow-up and advice. The nurse should assess the risk of transmitting the infectious agent to others and take appropriate precautions. Nurses should also know and review their immunization status with their primary health care provider.