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