Our body (skin, nails, eyes, oropharynx, genitalia, and gastrointestinal tract) contains 10 trillion cells and a hundred trillion bacteria (Davis, 1996; Kaiser, 2022). Every hour, one person in a room adds 37 million bacteria to the air (Qian et al., 2012). There are a variety of pathogens that colonize (live inside and outside) our body. Colonization is an abundance of microorganisms without clinical symptoms (CDC, 2022). Different areas of the body that are warm, moist, dark environments, such as the axilla, groin, and armpits, are more colonized than others (Grice & Segre, 2011). Pathogens living on our skin are more beneficial than harmful; however, colonized patients may become a source of potential transmission or become infected. The skin is vital as the body’s first line of protection against pathogens. The normal flora of the skin has several predominant bacteria (i.e., Staphylococcus spp., Propionibacterium , Streptococcus ; Grice & Segre, 2011). Viruses and parasites are not part of the normal flora (Davis, 1996). The level of protection provided by the skin is determined by the individual’s anatomy and physiology, susceptibility to infection, and morbidity (Davis, 1996). Normal flora is harmless in a healthy person and provides protection against opportunistic pathogens. These pathogens are so small that they are not visible to the naked eye. Examples of normal flora causing an infection are dental caries and abscesses in an immunocompromised patient (i.e., a vulnerable Reservoirs and risks Healthcare workers assess risks daily in each situation they encounter and should know where pathogens live (reservoirs) and actions to take to decrease the potential for their spread. In 2020, the CDC implemented a national training collaborative, Project Firstline, to train HCWs on infection prevention and control. Easy-to-understand education materials are available regarding reservoirs and the risks of spread. Bodily reservoirs include the skin as well as respiratory, cardiovascular, and gastrointestinal systems. Environmental reservoirs include water, wet and dry surfaces, dirt, and medical devices (CDC, 2022). Everyday actions HCWs can take to reduce the spread risk are hand hygiene, wearing appropriate PPE, and cleaning and disinfecting. There are additional actions HCWs can take specific to the reservoir and task or procedure. The pathogens on the skin are Staphylococcus aureus, Streptococcus , and a yeast ( Candida ). Situations that involve the skin include needlesticks, surgery, and anything that requires touching the skin. Healthcare workers can prevent potential transmission by performing hand hygiene, wearing appropriate PPE (gloves), cleaning and disinfecting devices and surfaces, following injection safety practices, and covering nonintact skin (source control). The pathogens that live in the respiratory system are Pseudomonas, Staphylococcus aureus , and viruses like influenza and SARS-CoV-2. Situations that involve the respiratory system include providing oral care, assisting with continuous positive airway pressure (CPAP) used for sleep apnea, and giving a nebulized medication or intubation. Healthcare workers can prevent potential transmission by performing hand hygiene, wearing appropriate PPE, and cleaning and disinfecting devices and surfaces. The pathogens that can live in the blood are human immunodeficiency virus (HIV), hepatitis B and C, and any bacteria that come from an exogenous route. Situations that involve blood include inserting an IV and giving an injection, surgery, and touching soiled linens. Healthcare workers can prevent potential transmission during those situations by performing hand hygiene, wearing appropriate PPE, cleaning and disinfecting, following injection safety practices, and following best practices for linen management (CDC, 2019; CDC, 2022). The pathogens that can live in the gastrointestinal (GI) system are Escherichia coli, Klebsiella, Candida , and C. difficile (a bacterial spore). Situations involving the GI system include
patient). There are two ways a patient can acquire an infection, endogenous and exogenous (CDC, 2022). Endogenous infections are from pathogens on the patient’s body, and exogenous infections are from pathogens recently transmitted from another person or a contaminated surface. Resident (normal) skin flora is in the deep layers of skin and can be more challenging to remove with hand hygiene (CDC, 2002). Resident flora is not likely to be an HAI. Unlike resident flora, transient flora colonizes the superficial layers of the skin and can easily be removed by hand hygiene. Transient flora is picked up by the HCW’s hands during direct patient contact or while touching the patient’s surroundings (WHO, 2009a). The transient flora then colonize the superficial skin layers of the HCW’s hands. Transient flora are most often associated with HAIs. Examples of transient flora are methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and multidrug- resistant gram-negative bacteria (Boyce, 2021). Healthcare Consideration: The CDC has a quick tool that can be used to look up any pathogen. Go to the main CDC.gov webpage and locate “ Health Topics A-Z .” This is an index of diseases and conditions, healthy living topics, workplace safety, environmental health, violence, injury and safety, global health, and much more. assisting with toileting or changing a diaper, bathing a patient, and changing linens. Healthcare workers can prevent potential transmission by performing hand hygiene, wearing appropriate PPE, cleaning and disinfecting, and following best practices for textile and waste management (CDC, 2019; CDC, 2022). Water is not sterile; however, it is safe to drink and is not a problem for healthy individuals. Acinetobacter, Serratia, Pseudomonas , and Legionella are pathogens that live in water. Situations that involve water are toileting, cleaning, and handwashing. Healthcare workers can prevent potential transmission from water or wet surfaces by performing hand hygiene, wearing appropriate PPE, cleaning and disinfecting devices and surfaces, and following best sterilization practices (CDC, 2019; CDC, 2022). Additional measures include implementing a water management program to prevent the spread of Legionella in healthcare settings. Because infections from Legionella have been increasing, the CDC (2021) published a toolkit to assist healthcare facilities in developing a plan. Maintenance and housekeeping departments work together to implement the plan. High-touch surfaces are dry surfaces that can contain pathogens for a long time. Pathogens commonly found on dry surfaces include C. diff , norovirus, Candida , and rotavirus. Situations involving dry surfaces involve using equipment and devices, transporting patients, and touching environmental surfaces. Healthcare workers can prevent potential transmission by performing hand hygiene, wearing appropriate PPE, cleaning and disinfecting devices and surfaces, and following best practices for device sterilization (CDC, 2019; CDC, 2022). Pathogens that live in dirt and soil are Aspergillus and Cryptococcus . Situations that involve dirt and soil in healthcare are construction and renovations. Healthcare workers can prevent potential transmission from dirt and soil by performing hand hygiene, cleaning and disinfecting devices and surfaces, improving ventilation, and using barriers to prevent construction debris and “dirty” air from entering patient care areas (CDC, 2019; CDC, 2022). Pathogens found on patient care items and devices can cause outbreaks in healthcare settings (Kanamori et al., 2017; McCafferty et al., 2018). Biofilm is commonly found on or inside devices and offers the potential for pathogen transmission (Alfa, 2019; Khatoon et al., 2018). Biofilm is a complex community of bacteria adhering to and residing on a surface.
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