Health Occupations Infection Control Microorganism Small living organisms – Not visible to the naked eye – Need microscope to view Found everywhere in environment Normal body flora – Need for normal body processes – Called NONPATHOGENS(NOT disease producing) Others cause disease or infections – – Called PATHOGENS At some times, can be beneficial in one system, but pathogenic in another (E coli) Classification of microorganisms Bacteria – 1 celled plant that multiplies rapidly – Classified by shape & arrangement • Cocci – round or spherical – Diplococci – occurs in pairs or 2 circles » Gonorrhea, meningitis, pneumonia – Streptococci – occurs in chains » Strep throat, rheumatic fever – Staphylococci – occurs in clusters or groups » Most common pyogenic (pus causing) » Boils, wound infections, toxic shock Classification of microorganisms Bacteria – classified by shape – Bacilli • Rod shaped • Single, pairs, or chains • Many contain flagella – tails that allow movement • Can form spores or thick walled capsules – Very hard to kill • TB, tetanus, pertussis, botulism, diptheria, typhoid Classification of microorganisms Bacteria – classified by shape – Spirilla • • • • Spiral or corkscrew shape Comma-shaped – vibrio Corkscrew – spirochete Syphilis, cholera Antibiotics used to kill bacteria – Some are antibiotic resistant Classification of microorganism Protozoa – 1 celled animal like organism – Often found in decayed materials & contaminated water – May have flagella – allows for movement – May be pathogenic • • • • Malaria Amebic dysentery Trichomonas African sleeping sickness Classification of microorganism Fungi – Simple plant like organisms – Live on dead organic matter – Yeasts & molds common – Ringworm, athletes foot, histoplasmosis, yeast vaginitis, thrush – Antibiotics don’t kill • Antifungals – taken for long time – May cause liver damage Classification of microorganisms Rickettsiae – Parasites – Can’t live outside of another organisms – Found on fleas, lice, ticks, mites – Transmitted by insect bites – Typhus fever, Rocky Mountain spotted fever – Antibiotics effective Classification of microorganisms Virus – – – – Smallest, visible only with electron microscope Can’t reproduce unless inside another living cell Spread from human to human Difficult to kill • Resistant to disinfectants • Not affected by antibiotics – Cold, measles, mumps, chicken pox, herpes, warts, influenza, polio Diseases of major concern Hepatitis B – Caused by HBV virus – Transmitted by blood & body fluids – Vaccine developed – 3 immunizations – Employers MUST provide vaccine at NO cost to employees when have risk for exposure – employee may refuse but MUST be offered Diseases of major concern Hepatitis C – – – – – – – Caused by HCV virus Transmitted by blood & body fluids Often asymptomatic – no symptoms Mild symptoms often – flu like Causes major liver damage No preventive immunization at present Difficult to destroy, remains active for several days in dried blood Diseases of major concern Acquired Immune Deficiency Syndrome – Caused by HIV virus – Suppresses immune system – Can’t fight off cancers & infections that would not affect a healthy person – No cure, no vaccine – TAKE PRECAUTIONS Factors Required for Growth Prefer warm environment (body temp) Darkness also preferred – Many killed by light Need food & moisture source Need for oxygen varies – Aerobic – need oxygen – Anaerobic – need oxygen free environment Human body IDEAL Pathogens work how? Produce poisons (TOXINS) – Harm body (tetanus) – Some damage CNS (Botulism) Can cause allergic reaction – Runny nose, watery eyes, sneezing Can attack & destroy living cells they invade – Malaria – protozoa invades RBC & causes rupture Classification of disease Endogenous – Originates within body – Metabolic disorders, congenital abnormalities, tumors, infections Exogenous – Originates outside body – Pathogens, radiation, chemical agents, trauma, electric shock, temp extremes Classification of disease Noscomial – – – – – – Hospital acquired infection Present in facility, transmitted by HCP to pt Many are antibiotic resistant Cause serious/life threatening illness Staphylococcus, pseudomonas, enterococci Infection control programs in facilities to prevent & deal with infections Opportunistic – Occur when body defenses are weak – Don’t usually occur in pts with good immune systems (common in AIDS pts) Chain of infection Chain of infection Causative Agent Reservoir Susceptible host Portal of exit Portal of entry Mode of Transmission Chain of infection Factors that MUST exist to spread disease from one person to another Causative agent – Pathogen Reservoir – Place where causative agent can live • Human body, animals • Environment, fomites (contaminated objects) – – – – – Doorknobs Bedpans Linens Urinals Instruments, etc Chain of infection Portal of exit – Way for causative agent to escape reservoir • • • • • • • • Urine Feces Saliva Blood Tears Mucous discharge Sexual secretions Draining wounds Chain of infection Mode of transmission – Direct contact • Person-to-person • Contact with body secretion • CONTAMINATED HANDS! – Indirect contact • Transmitted from contaminated substances like food, air, soil, insects, feces, clothing, instruments, equipment • Touching contaminated objects & spreading pathogens on hands • Breathing in droplets carrying airborne infections • Receiving bite of insect or animal carrying pathogen Chain of infection Portal of entry – Way to enter a reservoir or host – Different portals • • • • • Breaks in skin or mucous membranes Respiratory tract Digestive tract Genitourinary tract Circulatory system Chain of infection Susceptible host – Person who can contact disease – Usually human can fight off causative agent & not contract disease – Body defenses • • • • • • • • Mucous membranes – trap pathogens Cilia- propel pathogens out of body Coughing & sneezing HCL in stomach Tears – bacteriocidal Fever Inflammation – WBC destroys pathogens Immune response – antibodies, cells secrete protective chemicals – Humans become susceptible when large numbers of pathogen invade & defenses are weak Breaking Chain of infection Can break ANY part of chain Follow practices to interrupt or break chain Prevent disease transmission Pathogens are everywhere Prevention is continuous Aseptic technique Major way to break chain Asepsis – absence of disease producing microorganisms (pathogens) Contaminated – any area that may contain pathogens Aseptic techniques – directed towards maintaining cleanliness & eliminating contamination Common aseptic techniques Handwashing & good hygiene Disposable glove use when handling secretions or contaminated objects Proper cleaning of instruments & equipment Thorough cleaning of environment Levels of aseptic control Antisepsis – – – – Prevents or inhibits pathogenic growth Ineffective against spores & viruses Can be used on skin Alcohol, betadine Disinfection – – – – – Kills pathogens Not always effective against spores/viruses Chemical disinfectants – can irritate skin Used mainly on objects, not people Lysol, bleach, zephirin Levels of aseptic control Sterilization – Process that destroys ALL microorganisms, both good & bad – Includes spores & viruses – Steam under pressure, gas, radiation, & chemicals – Autoclave is most common Observing Standard Precautions Blood & Body Fluids Main way that pathogens are spread 3 pathogens of major concern – Hepatitis B virus – Hepatitis C virus – HIV Must take extreme care when an area, object, or person is contaminated Bloodborne Pathogen Standard 1991 – OSHA Must be followed by ALL HCF Employer may face civil penalties if not enforced Regulations require: – Written exposure control plan – annual – I.D. all employees that have occupational exposure – Provide Hepatitis B vaccine free of charge – Provide PPE Bloodborne Pathogen Standards Regulations (cont): – – – – – Adequate handwashing facilities Worksite is clean & sanitary Immediate decon of contaminated surfaces Infectious waste disposal No eating, drinking, make-up application, contacts, mouth pipetting, or suctioning in a potentially contaminated area – Signs posted as biohazardous material – Evals & follow-up exams for any exposure – No cost training during work hours Needlestick Safety & Prevention Act Congress, November 2000 CDC estimate – 600,000 – 800,000 needle sticks each year Bloodborne Pathogen Standard revised – Employers must use safer devices • Syringes with sliding sheaths • Retractable needles • Needle free connections & systems Annual updates of Exposure Control plan Ask input from employees giving pt care Sharps injury log Standard Precautions Employers required to enforce rules Developed by CDC Every body fluid is potential source of infection ALL patients are considered potential sources of infection regardless of dx Standard precautions used when: – Blood or fluid containing blood contact – Mucous, sputum, saliva, CSF, urine, feces, vomitus, amniotic fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, semen, vaginal secretions – Mucous membranes – Nonintact skin – Tissue or cell specimens Handwashing MAJOR part of standard precautions Aseptic technique Hands SPREAD INFECTIONS! Purpose of handwashing – Prevent spread of pathogens – Protect HCP from disease & illness Hands should be washed when? Arrival at facility, before leaving facility Before & after every pt. contact Anytime hands are contaminated Before applying & after removing gloves Before & after handling specimens After contact with soiled item After picking up item off floor After use of bathroom After cough, sneeze, blowing nose Before & after contact with your own mucous membrane or mouth Principles of handwashing Use soap as a cleaning agent – Aids in removal of pathogens by • Suds • Alkali content – Pathogens trapped in soap & washed away – Use liquid soap from a dispenser – bar soap can contain pathogens Principles of handwashing Use warm water – Less damaging to skin than hot – Creates better lather Use friction to rub off pathogens Clean all hand surfaces – Palms – Backs/tops of hands – Areas between fingers Principles of handwashing Point fingertips downward when washing – Prevents water from getting on forearms & running down to contaminate clean hands Use dry paper towel to turn faucet off – Prevents contamination from faucet – Pathogens travel faster through wet towels Clean nails – Can use orange stick or cuticle stick (blunt end) – Scrub with a brush – Nails can be rubbed against opposite palm Gloves Times to wear gloves – Contact with blood, body fluids, secretions, excretions, mucous membranes, tissue specimens, nonintact skin possible – Handling or cleaning contaminated items – Performing any invasive procedures – Blood tests or IVs Gloves Must be changed after pt. contact Be careful not to contaminate skin when removing gloves Wash hands IMMEDIATELY after removal of gloves Do NOT wash or reuse gloves Gowns Worn when splashing or spraying of body fluids, blood, secretions, or excretions is likely Prevents contamination of clothing Handle contaminated agents according to agency policy Wash hands after removing gown PPE – Personal Protective Equipment Wash hands Apply gown – tie neck, waist Apply mask – tie top, then bottom Apply gloves Remove gloves Wash hands Remove mask – untie bottom, then top Remove gown – untie waist, then neck Wash hands Masks & Eyewear Worn when splashes or sprays of blood, body fluids, secretions, or excretions possible – – – – – Irrigating wounds Suctioning Dental work Delivery of baby Surgical procedures Prevents mucous membrane exposure to pathogens Masks & Eye wear Must be used once & discarded – Change every 30 min or when moist or wet – Remove by grasping ties or elastic – Wash hands immediately after removal Protective eyewear – Should protect front, top, bottom, & sides – If not disposable, needs to be cleaned & disinfected before reuse Sharp objects Use care when handling to prevent accidental cuts or sticks Needles – – – – Never bend or break after use Leave uncapped & attached to syringe Place in Sharps container (leak-proof) Label Sharps container with biohazard symbol Throw away surgical blades, razors, & other sharp objects in Sharps containers also Disposal of Sharps container – Cannot be empties or reused – Follow facility policy Spills of blood, body fluids, secretions, excretions Wipe up immediately Wear gloves, use disposable cloths to wipe up Then use 10% Bleach solution to disinfect If large spill, use absorbent powder to soak up fluid & then sweep away Mouthpieces or resuscitation devices Use to avoid mouth-to-mouth Place in convenient location & be readily accessible Waste & soiled linen disposal Wear gloves Follow agency policy Biohazard bags to hold contaminated dressings, gloves, foley catheter bags, incontinent pads, vaginal pads, emesis basins, bedpans, urinals, & body tissues Trash should be burned Soiled linen – – Laundry bags & wear gloves – Label & color code contaminated linen – If soiled with blood, body fluids, secretions, or excretions, usually placed in special bag & soaked in disinfectant before laundering Reporting cuts & injuries Employees required to report injuries, needle sticks, or splashing of blood or body fluids immediately Follow agency policy Methods of Infection Control Methods of Aseptic Control Antisepsis – Prevents or inhibits growth of pathogens – Ineffective against spores & viruses Disinfection – Destroys or kills pathogens – Not always effective against spores/viruses Sterilization – Destroys all microorganisms, both pathogens & nonpathogens – Effective against spores & viruses Autoclave Uses steam under pressure or gas Various shapes & sizes – Dr’s offices have small units – Hospitals have floor units – Pressure cooker can be used at home Prepare equipment or supplies – Wear gloves – Wash items first in soapy water, rinse with cold water, then rinse with hot water – Dry items thoroughly – Remove oily substances with alcohol or ether – Don’t leave residue – it bakes on Wrapping items for autoclaving Sterile items must be wrapped first Wrap must allow for penetration of steam or gas Types of wraps – – – – Muslin or cloth Autoclave paper Plastic or paper bags (special type) Special autoclave containers Wrap carefully so there are no open edges Autoclave indicators Show that item is sterilized Types – – – – Autoclave tape – changes color Sensitive marks on bags or wraps – change color Indicator capsules – beads that change color Placed on or by article to be sterilized Sterilization required correct time, temperature, & presssure Autoclave loading Has to be loaded correctly Steam or gas builds up at top of chamber & pushes cool, dry air out Leave space between items Place packages on side, not flat Place jars, basins, cans on sides so steam can enter & air can flow out Don’t allow contact with sides, top, or door of autoclave Time period for sterilization Time & pressure varies Separate loads so that all items require same time & pressure – Rubber tubes – short times – Instruments & needles – longer times Care of autoclaved items Make sure items are dry before removing Store in clean, dustproof area Usually items are sterile 30 days Rewrap & resterilize if: – Wraps loosen or tear – Item gets wet – Chance of contamination occurred Resterilize after 30 days – replace tape with new, date & label & resterilize Dry heat sterilization Involved high temp over long period of time – Minimum temp usual 320 –350 degrees Fahrenheit – Minimum time usually 60 min Good method for – Corrodible items like knife blades – Items destroyed by moisture like powders Can’t be used with soft rubber goods because it destroys the rubber Will melt some plastics In home care, can use oven Chemical disinfection May not kill spores & viruses Disinfects but DOES NOT sterilize Few chemicals kill spores & viruses – Required submersion in chemical for 10 or more hours – Need to read entire label of chemical to determine effectiveness Can use for instruments that don’t penetrate body – – – – Dental instruments Percussion hammers Scissors thermometers Chemical disinfection Prep of items – Remove particles & debris – Wash & use brush – Rinse thoroughly – soap reduces effectiveness – Dry items to keep chemical at most effective strength Chemical disinfectants 10% bleach – sodium hypochlorite 90% isopropyl alcohol Formaldehyde-alcohol 2% phenolic germicide Glutaraldehyde Iodophor Benzalkonium or Zephiran Cidex Chemical disinfection Read instructions before use – Some solutions are mixed or diluted – Some can be used only for specific items – Directions tell recommended times Antirust tablets – Chemicals can cause rust – Antirust tabs may reduce chemical effectiveness Chemical disinfection Container – Large enough to accommodate & keep items separate – Tight fitting lid Disinfectant must completely cover item Removal of items – – – – Wash hands Use sterile pick-ups or forceps Place items on sterile towel to dry Store in dust-free environment Ultrasonic unit Uses sound waves for cleaning – Sound produces millions of microscopic bubbles in solution – When bubbles hit item, they explode • Called cavitation • Drives cleaning solution onto item • Also removes dirt – Doesn’t kill spores or viruses – antiseptic – Used for jewelry, instruments, impression trays, glass – can’t use with pearls or pasted stones Sterile Technique Surgical asepsis Procedures that keep an object or area free from ALL living organisms Sterile vs contaminated Be careful with work area – other objects can contaminate sterile items Must have dry work surface Don’t allow item to touch you or any nonsterile surface Hold sterile items away from body, keep in front of you Surgical asepsis Hold sterile items above waist Sterile field – area where you can place sterile items – Usually a sterile towel on a tray or inside of sterile wrap – Never reach across sterile field – Never turn back to sterile field – 2 inch border around is considered contaminated Removing items from sterile wrap Drop technique Mitten technique Transfer forceps Sterile gloves & dressings Demo sterile gloves Sterile dressing change – Disposable gloves – remove old dressings – Sterile gloves – clean with circular motion – Inner & outer dressings – Remove sterile gloves – Apply tape Transmission based precautions Pts have communicable diseases Still need to use standard precautions Transmission based extra! Disease spread through – Direct contact with pt – Contact with dirty linen, equipment, supplies – Contact with blood, body fluid, secretions, excretions, sneezing, coughing, spitting, wound drainage Transmission based precautions Protect pt, family, & HCP Type of precaution depends on organism, how transmitted, & if antibiotic resistant Items that are dirty or contaminated – Contain disease & must not be touched unless protected with PPE – Outside of gown, gloves, cap, mask, & waist ties of gown Items that are clean – Inside of gown & gloves, neckband of gown, ties at neck, mask ties 4 types of precautions Airborne precautions – Disease transmitted by airborne droplet nucleii, small particles of evaporated droplets that contain pathogens & are suspended in air – Rubella, varicella, TB, shingles – Use standard precautions – Private room with closed door – Air discharged to outdoors or filtered – N-95, HEPA, or N-100 mask worn when in room • Special filters & fit • No beards – need hood mask – If susceptible to disease, don’t enter room – Pt wears mask if outside of room Droplet precautions Pathogens transmitted by large particle droplets through sneezing, coughing, talking, laughing H flu meningitis & pneumonia, Neisserais, sinusitis, otitis media, diptheria, pertussis, mumps, flu Standard precautions & private room if possible Needs distance of 3 feet or mask worn Masks recommended anywhere in room Pt wears mask if outside room Contact precautions Followed if pt suspected to have a pathogen that can spread rapidly from person to person directly or indirectly GI, resp, skin, wound infections, E coli, Shigella, Hepatitis A, conjunctivitis, herpes, impetigo, lice, scabies, staph Standard precautions with private room Gloves worn upon entering room Gloves changed after contact with contaminated material Remove gloves before leaving room, wash hands Contact precautions Gown must be worn if chance of contact Remove gown before leaving room Pt should stay in room if at all possible Daily cleaning & disinfection of room Equipment should be left in room & used only for this pt. All equipment removed from room MUST be disinfected Protective isolation (reverse) Protects pt from organisms in environment Immunocompromised pts, burns, transplants, chemo, radiation, AIDS Room cleaned & disinfected before pt arrives Frequent disinfection necessary Sterile or clean gown, gloves, masks when entering room All equipment & supplies are clean, disinfected, or sterile Special filter to purify air
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