Unit 13 Infection Control - Delmar

Unit 13 Infection Control

13:1 Understanding the

Principles of Infection Control

 Understanding is essential to all health care workers

 Provide a basic knowledge of how disease is transmitted

 Main emphasis on prevention of disease

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

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Microorganisms or

Microbes

 Small living organisms

 Not visible to the naked eye

 Microscope must be used to see them

 Found everywhere in the environment

 Found on and in the human body

 Many are part of normal flora of body

 May be beneficial


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Microorganisms or

Microbes

(continued)

 Called nonpathogens when not harmful to the body

 Some cause infections and disease

 Called pathogens (germs) when able to harm the body

 Sometimes nonpathogenic microorganisms can become pathogenic


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Microbe Classifications

 Bacteria

 Protozoa

 Fungi

 Rickettsiae

 Viruses


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Bacteria

 Simple, one-celled organisms

 Multiply rapidly

 Classified by shape and arrangement


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Bacteria – Cocci

 Round or spherical in shape

 Diplococci

 Streptococci

 Staphylococci

 Examples of diseases


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Bacteria – Bacilli

 Rod-shaped

 Occur singly, in pairs, or in chains

 May have flagella

 Ability to form spores



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Bacteria – Spirilla

 Spiral or corkscrew shape

 Includes comma-shaped vibrio and corkscrew spirochete

 Diseases include syphilis and cholera


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Antibiotics

 Antibiotics are used to kill bacteria

 Some strains of bacteria have become antibiotic-resistant

 When antibiotic-resistant, the antibiotic is no longer effective against the bacteria


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Protozoa

 One-celled, animal-like organism

 Found in decayed materials and contaminated water

 May have flagella for movement

 Some are pathogenic



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Fungi

 Simple, plant-like organisms

 Live on dead organic matter

 Yeast and molds

 Can be pathogenic


 Antibiotics do not kill

 Antifungal medications


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Rickettsiae

 Parasitic microorganisms

 Cannot live outside the cells of another living organism

 Transmitted to humans by the bites of insects (e.g., fleas, lice, ticks, mites)


 Antibiotics are effective against many of them


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Viruses

 Smallest microorganisms

 Must use electron microscope to see

 Must be inside another living cell to reproduce

 Spread by blood and body secretions

 Very difficult to kill

 Cause many diseases


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Virus – Hepatitis B

 Also called serum hepatitis

 Caused by HBV

 Transmitted by blood serum and body secretions

 Affects the liver

 Vaccine available for protection

 Vaccine is expensive


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Virus – Hepatitis B

(continued)

 Vaccine given in a series of three injections

 By law, employers must provide vaccine at no cost to employees with occupational exposure to blood or other body secretions

 If employee refuses, a written statement must be signed documenting refusal


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Hepatitis C

 Caused by HVC

 Transmitted by blood and blood-containing body fluids

 Many infected individuals are asymptomatic

 Others have mild symptoms

 Can cause severe liver damage


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Hepatitis C

(continued)

 Currently, no vaccine ready for use

 Vaccine is in development stage

 Extremely difficult to destroy HVC

 Can survive several days in dried blood

 Health care workers must follow precautions to protect against virus


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Acquired Immune Deficiency

Syndrome (AIDS)

 Caused by the Human Immunodeficiency

Virus (HIV )

 Suppresses the immune system

 Individual becomes susceptible to cancers and infections that would not affect a healthy person

 No cure presently and no vaccine

 Important to take precautions to prevent


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Growth of

Microorganisms

 Most prefer warm environments

 Most prefer darkness

 Need source of food and moisture

 Need for oxygen varies

 Human body is ideal supplier of all the requirements


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How Pathogens Cause

Infection and Disease

 Some produce poisons called toxins

 Some cause an allergic reaction

 Others attach and destroy the living cells they invade


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Classifications of

Diseases and Infections

 Endogenous

 Exogenous

 Nosocomial

 Opportunistic


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Endogenous

 Originates within the body

 Examples: metabolic disorders, congenital abnormalities, tumors, and infections caused by microorganisms within the body


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Exogenous

 Originates outside the body

 Examples: radiation, chemical agents, trauma, electric shock, and temperature extremes


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Nosocomial

 Acquired in a health care facility

 Usually present in the facility and carried by health care workers to the patient

 Many are antibiotic-resistant

 Can cause serious and even life-threatening infections


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Nosocomial

(continued)

 Common examples are staphylococcus, pseudomonas, enterococci

 Infection control programs are used to prevent and deal with nosocomial infections


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Opportunistic

 Infections that occur when the body’s defenses are down

 Usually do not occur in normal immune system

 Examples: Kaposi’s sarcoma (rare type of cancer) and Pneumocystis carinii pneumonia in individuals with AIDS


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Chain of Infection

 Must be present for disease to occur and spread from one individual to another

– Causative agent

– Reservoir

– Portal of exit

– Mode of transmission

– Portal of entry

– Susceptible host


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Causative Agent

 Pathogen must be present

 Examples include bacteria or virus


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Reservoir

 Place where causative agent can live

 Examples: human body, animals, and the environment


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Portal of Exit

 Way for causative agent to escape from the reservoir

 Examples: urine, feces, saliva, blood, tears, mucous discharge, sexual secretions, and draining wounds


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Mode of Transmission

 Must be transmitted to another reservoir or host where it can live

 Direct contact: person-to-person, spread by physical or sexual contact

 Indirect contact: from contaminated substances to the person


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Portal of Entry

 Way to enter a new reservoir or host

 Examples: breaks in the skin or mucous membranes, respiratory tract, digestive tract, genitourinary tract, and circulatory system


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Susceptible Host

 Individual who can contract the disease

 Usually the person can fight off the causative agent and not contract the disease


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Common Body Defenses

 Mucous membranes

 Cilia

 Coughing and sneezing

 HCL in the stomach

 Tears


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Common Body Defenses

(continued)

 Fever

 Inflammation response – leukocytes

 Immune response – antibodies and cell secretion


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Increased Susceptibility

 When large numbers of pathogens invade the body

 When body defenses are weak


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Ending the Chain of Infection

 Eliminate any step in the chain and infection is stopped

 Follow practices to interrupt or break the chain

 Remember, pathogens are everywhere

 Prevention is a continuous process


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Aseptic Techniques

 Major way to break the chain of infection

 Asepsis: absence of disease-producing microorganisms or pathogens

 Contaminated: any object or area that may contain pathogens

 Major aim: maintaining cleanliness and eliminating or preventing contamination


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Common Aseptic Techniques

 Handwashing

 Good personal hygiene

 Disposable gloves

 Proper cleaning of instruments and equipment

 Thorough cleaning of environment


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Levels of Aseptic Control

 Antisepsis

 Disinfection

 Sterilization


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Antisepsis

 Prevent or inhibit the growth of pathogenic organisms

 Usually not effective against spores and viruses

 Can usually be used on the skin

 Examples: alcohol and betadine


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Disinfection

 Destroys or kills pathogenic organisms

 Not always effective against spores and viruses

 Chemical disinfectants are used

 Can irritate or damage the skin, so mainly used on objects, not people

 Examples: bleach solutions and zephirin


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Sterilization

 Destroys all microorganisms

 Steam under pressure, gas, radiation, and chemicals

 Autoclave is the most common equipment used


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Summary

 Important for health care workers to know and use proper aseptic techniques

 Prevents spread and transmission of disease


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13:2 Washing Hands

 Major aspect of standard precautions

 Most important aseptic technique

 Hands are perfect media for the spread of pathogens


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Purpose of Handwashing

 Prevent and control spread of pathogens

 Protect the health care worker from disease and illness


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When to Wash Hands

 When arrive at facility

 Immediately before leaving facility

 Before and after every patient contact

 Anytime the hands become contaminated during a procedure

 Before applying gloves

 Immediately after removing gloves


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When to Wash Hands

(continued)

 Before and after handling any specimen

 After contact with any soiled or contaminated item

 After picking up any item off the floor

 After personal use of the bathroom

 After you cough, sneeze, or use a tissue

 Before and after any contact with mouth or mucous membranes


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Principles of Handwashing

 Use soap as a cleansing agent

 Use warm water

 Use friction

 Clean all surfaces

 Point fingertips down while washing hands

 Use dry paper towels to turn faucet on and off

 Clean nails


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13:3 Observing Standard

Precautions

 Blood and body fluids are the main ways pathogens are spread

 Major pathogens: HBV, HBC, HIV

 Extreme care must be taken at all times when an area, object, or person is contaminated with blood or body fluids


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Bloodborne Pathogen

Standards

 Established in 1991 by OSHA

 Must be followed by all health care workers

 Civil penalties if not implemented and followed


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Regulation Requirements

 Written Exposure Control Plan

 Identify all employees with occupational exposure

 Provide hepatitis B vaccines free of charge

 Provide personal protective equipment

(PPE)


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(continued)

 Provide adequate handwashing facilities and supplies

 Ensure worksite is maintained in a clean, sanitary condition

 Follow measures for immediate decontamination of surfaces when contaminated


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(continued)

 Dispose of infectious waste correctly

 Enforce rules of limited activities in any potentially contaminated area

 Provide appropriate containers for contaminated sharps and other contaminated items

(color coded and labeled)


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(continued)

 Post signs at the entrance to work areas with occupational exposure to biohazardous materials

 Provide a confidential medical evaluation and follow-up for any employee who has an exposure incident

 Provide training to employees


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Needlestick Safety and Prevention Act

 Passed by Congress in 2000

 Centers for Disease Control and

Prevention (CDC) estimated 600,000 to

800,000 needle sticks occur each year

 OSHA revised Bloodborne Pathogen

Standard to requirements of this act


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Employer Requirements

 Identify and use effective and safer medical devices

 Incorporate changes in annual update of

Exposure Control Plan

 Solicit input from nonmanagerial employees who are responsible for direct patient care


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Employer Requirements

(continued)

 Maintain a sharps injury log

 Ensure that every employee uses standard precautions at all times


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Standard Precautions

 Rules developed by the CDC

 Every body fluid must be considered potential source of infection

 All patients must be considered potential source of infection


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When to Use


 Any situation where you might come in contact with

– Blood or any fluid that contains blood

– Body fluids, secretions, and excretions

– Mucous membranes

– Nonintact skin

– Tissue or cell specimens


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Gloves

 Gloves must be changed after contact with each patient

 When removing gloves, do not contaminate your skin

 Hands must be washed immediately after removal of gloves

 Gloves must not be reused


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When to Wear Gloves

 Whenever contact with body fluids, secretions, or excretions

 When handling or cleaning contaminated items or surfaces

 Performing any invasive procedure

 Performing venipuncture or blood tests


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Gowns

 Worn during procedures that may cause splashing or spraying

 Helps prevent contamination of clothing or uniforms

 Contaminated gowns must be handled per policy

 Hands must be washed immediately after removing gown


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Masks and Protective Eyewear or Face Shields

 Worn during procedures that may cause splashing or spraying

 Prevents exposure of the mucous membranes of the mouth, nose, and eyes

 Masks are used once and discarded – change every 30 minutes following correct procedure and immediate handwashing


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Masks and Protective Eyewear or Face Shields

(continued)

 Protective eyewear and face shields protect front, top, bottom, and sides of eyes

 If not disposable, must be cleaned and disinfected before reuse


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Sharp Objects

 Use extreme caution to avoid cuts or punctures

 When possible, use safe needles or needleless system

 Follow policies regarding handling needles

 Use sharps containers

 Follow laws regarding disposal of sharps


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Spills and Splashes

 Wipe up immediately

 Wear gloves when wiping up

 Use disposable cleaning clothes

 Use disinfectant with 10% bleach solution

 Clean all contaminated surfaces

 For large spills, can use absorbent powder


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Resuscitation Devices

 Use to avoid the need for mouth-to-mouth resuscitation, whenever possible

 Place in convenient location that is readily accessible


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Waste and Soiled Linen

 Wear gloves

 Follow agency policy

 Use biohazard bags appropriately


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Reporting Cuts and Injuries

 Report any cut or injury, needle stick, or splashing of blood or body fluids immediately

 Follow agency policy


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Summary

 Standard precautions must be followed at all times by all health care workers

 Observing these precautions can help break the chain of infection

 Allow health care workers to protect themselves, their patients, and all other individuals


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13:4 Sterilizing with an Autoclave

 Equipment that uses steam under pressure or gas

 Most effective method of sterilization

 Available in various sizes and types

 Preparation of equipment or supplies

 Wrapping items for autoclaving


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Sterilizing with an Autoclave

(continued)

 Autoclave indicators

 Loading the autoclave

 Time period for sterilization

 Care of items after autoclaving

 Dry heat sterilization

 Follow directions on specific autoclave

 Follow agency policy for sterile supplies


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13:5 Using Chemicals for Disinfection

 May not kill spores and viruses

 Disinfect, but do not sterilize

 Used to disinfect instruments that do not penetrate body

 Preparation of items

 Chemical solutions used


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Using Chemicals for

Disinfection

(continued)

 Read manufacturer’s instructions

 Antirust tablets or solutions added at times

 Requirements for chemical disinfection

 Chemical must completely cover items

 Care of chemical solutions


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13:6 Cleaning with an

Ultrasonic Unit

 Uses sound waves for cleaning

 Method of aseptic control

 Only ultrasonic solutions should be used in unit

 Permanent tank of ultrasonic unit

 Items cleaned in ultrasonic unit


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Cleaning with an

Ultrasonic Unit

(continued)

 Care of glass beakers

 Care of the permanent tank

 Read manufacturer’s instructions before using any ultrasonic unit


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Summary

 Different methods provide different levels of aseptic control

 Method used depends on equipment available and level of aseptic control required

 Read manufacturer’s instructions

 Clean, rinse, and dry all equipment before processing

 Handle items carefully after processing


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13:7 Using Sterile Techniques

 Many procedures require use of sterile techniques to protect a patient from infection

 Surgical asepsis keeps an object or area free from living organisms

 Sterile: free from all organisms

 Contaminated: organisms and pathogens present


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Using Sterile

Techniques

(continued)

 Important to differentiate between sterile and contaminated areas or items while using sterile technique

 Correct techniques must be strictly followed to maintain sterility and prevent contamination


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Using Sterile

Techniques

(continued)

 Clean working area required

 Handling of sterile supplies

 Sterile field: area used for placement of sterile supplies

 Rules of working within sterile area


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Removing Articles from

Sterile Wraps

 Drop technique

 Mitten technique

 Transfer forceps


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Wet Surfaces

 Organisms and pathogens travel quickly through wet surfaces

 If sterile item gets wet, contamination has occurred

 Use extreme care while pouring solutions into sterile bowls


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Sterile Gloves

 Worn while performing sterile technique

 Make sure tray is open and all sterile items are ready before putting sterile gloves on your hands

 Are sterile on the outside and contaminated on the inside

 Observe correct technique when putting on sterile gloves


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Sterile Gloves

(continued)

 When gloves are on, hold hands away from body and above waist

 Handle only sterile objects when wearing sterile gloves

 Change gloves any time contamination occurs


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Sterile Dressings

 Obtain proper authorization

 Use an infectious waste bag

 Wear disposable gloves for removing a dressing

 Note type, color, and amount of drainage on dressing

 Put on sterile gloves to cleanse area and apply new dressing


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Sterile Dressings

(continued)

 Cleanse wound or incision with correct technique

 Apply inner and outer dressing, taking care to maintain sterility of dressings

 Remove sterile gloves properly and dispose of properly


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Sterile Dressings

(continued)

 Apply tape correctly to hold dressing in place

 If contamination occurs at any time during the procedure, start over

 Commercially prepared sterile supplies are widely available


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13:8 Maintaining Transmission-

Based Isolation Precautions

 Some diseases are communicable – caused by organisms that can be transmitted easily

 These precautions are in addition to the



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Maintaining Transmission-Based

Isolation Precautions

(continued)

 Help prevent spread of disease to others

 Protects patient, family, and health care workers

 Type used depends on the causative organism of the disease


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How Communicable

Diseases Spread

 Direct contact with a patient

 Contact with dirty linen, equipment, and supplies

 Contact with blood, body fluids, secretions, and excretions


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Terms Defined

 Contaminated or dirty: items that contain disease-producing organisms; must not be touched unless protected

 Clean: items that do not contain the organisms; protect these areas from contamination


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Classifications of

Precautions

 Standard precautions

 Airborne precautions

 Droplet precautions

 Contact precautions


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Protective or

Reverse Isolation

 Method used to protect certain patients from organisms present in the environment

 Used mainly for immunocompromised patients

 Precautions vary depending on patient’s condition


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Summary

 Exact procedures for maintaining transmission-based isolation will vary from one facility to another

 Variations caused by different factors

 Know and follow procedures at your facility

 Basic principles remain the same in any facility and are directed toward preventing the spread of disease


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