CHAPTER 2
MEDICAL ASEPSIS AND
THE OSHA STANDARD
PRETEST
True or False
1.
A microorganism is a tiny living plant or animal that
cannot be seen with the naked eye.
2.
A disease-producing microorganism is known as a
nonpathogen.
3.
Microorganisms grow best in an acidic environment.
4.
Coughing and sneezing help force pathogens from
the body.
5.
An alcohol-based hand rub should be used to
sanitize hands that are visibly soiled.
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PRETEST
True or False
6. OSHA stands for Occupational Safety and Health
Administration.
7. A biohazard warning label must be fluorescent
orange or orange-red in color.
8. Prescription eyeglasses are acceptable eye
protection when handling blood.
9. Hepatitis B is an infection of the liver caused by a
virus.
10. Many people do not develop symptoms when they
first become infected with HIV.
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Content Outline
Introduction to the Medical Asepsis and the
OSHA Standard
1. Medical asepsis and infection control
a. Important in preventing the spread of disease
2. OSHA Bloodborne Pathogens Standard
a. Required by federal government
b. Purpose: To reduce the exposure of health
care employees to infectious diseases
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Microorganisms and Medical
Asepsis
•
Microorganism: tiny living plant or
animal
• Cannot be seen with naked eye
• Must be viewed by microscope
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Microorganisms and Medical
Asepsis, cont.
c. Common types of microorganisms:
• Bacteria
• Viruses
• Protozoa
• Fungi
• Animal parasites
d. Nonpathogen: Microorganism that does not
normally cause disease
e. Pathogen: Disease-producing microorganism
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Microorganisms and Medical
Asepsis, cont.
2. Medical asepsis: Practices that are
employed to reduce the number and hinder the
transmission of pathogens
a. Object or area is clean and free from
infection
•
•
All pathogens are eliminated
Nonpathogens are still present
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Growth Requirements for
Microorganisms
1. Proper nutrition
a. Autotroph: uses inorganic or nonliving
substances for food
b. Heterotroph: uses organic or living
substances for food
2. Oxygen
a. Aerobe: needs oxygen to grow
b. Anaerobe: grows best in absence of oxygen
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Growth Requirements for
Microorganisms, cont.
3. Temperature
a. Optimum growth temperature: temperature
at which a microorganism grows best
b. 98.6˚ F: most microorganisms grow best
(human body temperature)
4. Darkness: microorganisms grow best in
darkness
5. Moisture: microorganisms need moisture for
cell metabolism and to carry away wastes
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Growth Requirements for
Microorganisms, cont.
6. pH
a. Most microorganisms prefer a neutral
pH
b. Too acidic or too basic: microorganisms
die
7. If growth requirements taken away
from microorganisms
a. Unable to survive
b. One way to reduce growth and
transmission of microorganisms in
medical office
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Infection Process Cycle
1. Pathogen must have continuous cycle to
survive
a. If cycle broken: pathogen dies
2. Responsibility of MA to break cycle
a. By practicing good techniques of medical
asepsis
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Infection Process Cycle, cont.
3. Components of the infection process
cycle:
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Infection Process Cycle, cont.
a. Reservoir host: one that becomes infected
by the pathogen (people, animals)
• Source of transfer of the pathogen
• Provides nourishment for growth and
multiplication of pathogen
b. Means of exit from the reservoir host:
mouth, nose, throat, ears, eyes, intestinal
tract, urinary tract, reproductive tract, and
open wounds
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Infection Process Cycle, cont.
c. Means of transmission from one person to
another
•
Direct contact with infected person or
discharge
• Indirect transfer by:
– Water vapor from the lungs
1) Breathing
2) Coughing
3) Sneezing
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Infection Process Cycle, cont.
– Contaminated hands and equipment
– Contaminated food and water
– Insects
d. Means of entry into the host: mouth, nose,
throat, ears, eyes, intestinal tract,
reproductive tract, open wounds, breaks in
the skin, and mucous membranes
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Infection Process Cycle, cont.
e. Susceptible host: one who is capable of
being infected by the pathogen
•
•
Low resistance increases susceptibility
Contributes to low resistance:
– Poor health
– Poor hygiene
– Poor nutrition
– Stress
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Protective Mechanisms of the Body
1. Helps prevent entrance of pathogens
2. Helps break infection process cycle
3. Includes:
a. Skin: most important defense mechanism
of body
• Provides protective barrier against entrance
of microorganisms
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Protective Mechanisms of the Body,
cont.
b. Mucous membranes: line nose and throat,
respiratory, GI, and genital tracts
•
Protects from invasion by microorganisms
c. Mucus and cilia: in nose and respiratory
tract
•
•
Mucus: traps microorganisms that enter the
body
Cilia: beat toward outside to remove pathogens
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Protective Mechanisms of the Body,
cont.
d. Coughing and sneezing: force pathogens
from body
e. Tears and sweat: remove pathogens
f. Urine and vaginal secretions
•
•
Are acidic in nature
Pathogens cannot grow in acid
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Protective Mechanisms of the Body,
cont.
g. Stomach secretes hydrochloric acid
•
•
Used for digestion
Discourages growth of pathogens that enter
stomach
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Hand Hygiene
1. Hand hygiene: process of cleansing or
sanitizing the hands
a. Most important medical aseptic practice to
prevent spread of infection
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Hand Hygiene, cont.
b. Includes:
•
•
•
Handwashing with detergent soap and water
Handwashing with antimicrobial soap and
water
Applying an alcohol-based hand rub
c. CDC issued new recommendations for hand
hygiene
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Resident and Transient Flora
2. Resident and Transient Flora
a. General categories of microorganisms
found on the hands
3. Resident flora (normal flora)
a. Normally reside in epidermis and dermis
b. Generally harmless and nonpathogenic
c. Difficult to remove (attached to deeper
skin layers)
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Transient Flora
4. Transient flora: picked up in day-to-day
activities
a. Grow in epidermis (superficial skin layers)
b. Picked up in the course of daily activities
•
In medical office, may include:
- Contact with an infected patient
- Touching contaminated equipment or
surfaces
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Transient Flora
c. Often pathogenic
d. Attached loosely to skin
e. Easily removed by:
•
•
Handwashing
Applying an alcohol-based hand rub
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Handwashing
5. Handwashing
a. Use detergent (plain) soap and water
•
Detergent: breaks down and emulsifies dirt and
oil
b. Friction must be used: to ensure removal of
all transient flora
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Use Friction During Handwashing
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Handwashing, cont.
c. CDC recommends that handwashing be
performed:
•
•
•
When the hands are visibly soiled with dirt or
body fluids
Before eating
After using the restroom
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CDC Recommendations
d. CDC recommends if hands are not visibly
soiled:
•
•
Use of alcohol-based hand rub rather than
handwashing
Reason: Repeated handwashing tends to dry
the hands (leads to irritation, chapping,
dermatitis)
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Antiseptic Handwashing
6. Antiseptic Handwashing
a. Use of antimicrobial soap and water
b. Contains an antiseptic
•
Antiseptic: An agent that functions to kill or
inhibit the growth of microorganisms
c. Sanitizes the hands by
•
•
Mechanical scrubbing
Action of the antiseptic
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Antiseptic Handwashing, cont.
d. Removes all soil and transient flora
e. Advantage: Deposits antibacterial film on
skin to inhibit bacterial growth
f. Perform antiseptic handwash: Before
assisting with minor office surgery
g. Examples of antiseptics in antimicrobial
soaps:
•
•
•
Triclosan
Chlorhexidine
Hexachlorophene
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Alcohol-Based Hand Rubs
7. Alcohol-Based Hand Rubs
a. For sanitizing hands: when not visibly soiled
b. Consists of 60% to 90% alcohol
•
Types
– Gels
– Lotions
– Foams
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Alcohol-Based Hand Rubs, cont.
c. More effective than
regular soap and
water for:
• Removal of transient
flora
• Reducing bacterial
count
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Alcohol-Based Hand Rubs, cont.
d. Advantages
•
•
•
•
More accessible than sinks
Do not require rinsing
Less time required to sanitize hands
Contain emollients to prevent drying of hands
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Alcohol-Based Hand Rubs, cont.
a. Disadvantages
• More expensive
than soap
• Brief stinging
sensation if applied
to broken skin
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What Would You Do?
What Would You Not Do?
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What Would You Do?
What Would You Not Do?
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Infection Control
8. Infection Control
a. Other good aseptic practices include:
•
•
•
Follow OSHA Bloodborne Pathogens Standard
Keep office free from dirt and dust
Keep reception and examining rooms well
ventilated and bright
– Light discourages growth of
microorganisms
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Infection Control, cont
• Eliminate insects
– Means of transmission of microorganisms
• Dispose of wastes properly
– Handle wastes as if they contain pathogens
• Do not let soiled items touch clothing
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Infection Control, cont
• Avoid coughs and sneezes of patients
– Water vapor may contain pathogens
• Wear minimal jewelry or no jewelry at all
– Microorganisms can lodge in grooves and
crevices
• Teach patients how to prevent spread of
infection
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Gloves
9. Gloves
a. CDC recommendation
•
Wear clean disposable gloves when you are
likely to come in contact with any body
substance (e.g., blood, urine, feces, mucous
membranes, nonintact skin)
– Examples:
1) Administering an injection
2) Performing venipuncture
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Gloves, cont.
b. Advantages of clean disposable gloves:
•
•
•
Reduces hand contamination by 70% to 80%
Prevents cross-contamination between
patients
Protects patients and health care workers from
infection
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Gloves, cont.
c. Important to change gloves before and
after patient contact
d. Sterile gloves: used to perform sterile
procedures
•
Examples:
– Dressing change
– Minor office surgery
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OSHA Bloodborne Pathogens
Standard
Purpose of the Standard
1. Occupational Safety and Health
Administration (OSHA)
a. Established by the federal government
b. Purpose of OSHA: To assist employers in
providing a safe and healthy working
environment for their employees
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Purpose of the Standard, cont.
2. OSHA Occupational Exposure to
Bloodborne Pathogens Standard
a. Set of regulations: went into effect in 1992
b. Purpose: Reduce the risk to employees of
exposure to infectious diseases
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Purpose of the Standard, cont.
c. Must be followed by employees with
occupational exposure to pathogens such
as:
• Medical
• EMTs
assistants
• Law enforcement
• Physicians
officers
• Nurses
• Custodians
• Dentists and
dental hygienists
• Medical
laboratory
personnel
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Purpose of the Standard, cont.
d. Failure to comply could result in OSHA
citation
•
Payment of a penalty
Needlestick Safety and Prevention Act (NSPA)
1. Revision to Bloodborne Pathogens
Standard
a. Went into effect in 2001
b. Because of high frequency of needlestick
injuries among health care workers
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Needlestick Safety and Prevention
Act (NSPA), cont.
2. Includes stronger
measures to reduce
needlestick and other
sharps injuries
3. Requires employers to
identify and make use
of safer medical
devices
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OSHA Terminology
1. Occupational exposure: reasonably
anticipated skin, eye, mucous membrane, or
parenteral contact with blood or OPIM
2. Parenteral: piercing of skin barrier or mucous
membranes (needlesticks, human bites, cuts,
abrasions)
3. Blood: human blood, human blood
components (plasma, serum), and products
made from blood (e.g., immune globulins)
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OSHA Terminology, cont.
4. Bloodborne pathogens (BBPs):
pathogenic microorganisms in human blood
that can cause disease
a. Hepatitis B (HBV)
b. Hepatitis C (HCV)
c. Human immunodeficiency virus (HIV)
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OSHA Terminology, cont.
5. Other potentially infectious materials
(OPIM)
a. Semen, vaginal secretions
b. Body fluids: cerebrospinal, synovial,
pleural, pericardial, peritoneal, and
amniotic
c. Any body fluid visibly contaminated with
blood
d. Any body fluid that has not been identified
e. Saliva in dental procedures
f. Unfixed human tissue
g. HIV-infected tissue cultures, cells, or fluid
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OSHA Terminology, cont.
6. Contaminated: The presence or reasonable
anticipated presence of blood or OPIM on an
item or surface
7. Decontamination: The use of physical or
chemical means to remove, inactivate, or
destroy BBPs on a surface or item so that they
are no longer capable of transmitting infectious
particles and the surface or item is rendered
safe for handling, use, or disposal
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OSHA Terminology, cont.
8. Nonintact skin: skin that has a break in the
surface (e.g., dermatitis, cuts, chapping, acne)
9. Exposure incident: any eye, nose, mouth, or
other mucous membrane, nonintact skin, or
parenteral contact with blood or OPIM that
results from an employee’s duties.
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Exposure Control Plan
1. Exposure Control Plan (ECP)
2. Medical office is required to develop a
written plan
• Stipulates the protective measures that must be
followed in the medical office to eliminate or
minimize employee exposure to BBP or OPIM
a. Must be made available for review by all
staff
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Exposure Control Plan, cont.
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Exposure Control Plan, cont.
c. ECP must include:
•
•
An exposure determination: to identify
employees who must follow OSHA BBP
Standard
The method of compliance: documents the
specific health and safety control measures
that are taken to eliminate or minimize risk of
occupational exposure
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Exposure Control Plan, cont.
•
Postexposure evaluation and follow-up
procedures: procedures to follow in the event
of an exposure incident
– Includes:
1) Method of documenting and
investigating an exposure incident
2) Post-exposure evaluation
3) Medical treatment
4) Follow-up
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Exposure Control Plan, cont.
d. Employers must review and update ECP
annually:
•
To ensure plan remains current with latest info
that eliminates or reduces exposure to
bloodborne pathogens
e. ECP must also be updated whenever
necessary to reflect:
•
New/modified procedures that affect
occupational exposure
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Exposure Control Plan, cont.
3. Labeling Requirements
a. Containers and appliances containing
biohazardous materials:
•
Must be labeled with a biohazard warning label
b. Biohazard warning label must be:
•
•
Fluorescent orange or orange-red
Contain the biohazard symbol and word
BIOHAZARD
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Biohazard Warning Label
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Exposure Control Plan, cont
• Must be attached to the following:
– Regulated waste containers
– Refrigerators and freezers used to store
blood and OPIM
– Containers and bags used to store,
transport, or ship blood or OPIM
• Purpose of labeling requirement:
– To alert employees to possible exposure
– Especially when the nature of the material is
not readily identifiable
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Exposure Control Plan, cont.
4. Communicating Hazards to Employees
a. Employees with risk of occupational
exposure must participate in a training
program
•
•
Must present the Exposure Control Plan
Must focus on measures that employees must
take for their safety
b. Training provided:
•
•
At the time of initial assignment to tasks in
which occupational exposure may occur
Annually thereafter
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Exposure Control Plan, cont
c. Must maintain record of training sessions
(for 3 years) including:
•
•
•
•
Presentation dates
Content
Names/qualifications of trainers
Names/titles of employees attending
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Exposure Control Plan, cont.
5. Recordkeeping
OSHA Requirements
a. OSHA Medical Record
•
•
•
•
Required for every employee with occupational
exposure
Must be kept confidential (except for review by
OSHA)
Must include: employee’s name, SSN, hepatitis
B vaccination status, results of any
postexposure examinations, medical testing,
follow-up procedures, written evaluation of any
exposure incident and copy of exposure
incident report
Must maintain records for duration of
employment plus 30 years
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Exposure Control Plan, cont.
2. Sharps Injury Log
a. Employers with more than 10 employees at
risk for occupational exposure:
•
Must maintain a log of injuries from
contaminated sharps
b. Must include:
•
•
•
Type and brand of device involved in injury
Location of incident (e.g., work area)
Explanation of how the incident occurred
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Exposure Control Plan, cont.
c. Log must be maintained in a way that
protects confidentiality of injured
employees
•
Example: Removal of personal identification
d. Purpose of log:
•
•
•
Keep track of needlestick injuries
Identify problem areas that need attention
Identify ineffective devices that need to be
replaced
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Engineering Controls
Measures to eliminate or minimize the risk of
occupational exposure
1. Engineering Controls
a. Measures that isolate or remove health
hazards from workplace
b. Must be examined, maintained, or replaced
to as required to ensure their effectiveness
c. Examples:
•
•
•
•
Readily accessible handwashing facilities
Safer medical devices
Biohazard sharp containers and bags
Autoclave
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Engineering Controls:
Biohazard Sharps Containers
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Engineering Controls, cont.
d. Safer Medical Devices
•
Safer medical device: a device that, based on
reasonable judgment, will make an exposure
incident involving a contaminated sharp less
likely to occur
• Includes:
– Sharps with engineered sharps injury
protection (SESIP):
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Engineering Controls, cont.
1) Nonneedle sharp
2) Needle device with a built-in safety
feature (e.g., safety-engineered syringes
and phlebotomy devices)
– Needleless system: does not use needles
(e.g., jet injection syringe uses air to
administer an injection rather than needle)
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Engineering Controls, cont.
• Employers are required to evaluate and
implement safer medical devices that lower
occupational exposure to the lowest extent
feasible
– Input from employees using the devices
must be taken into consideration
• ECP must include documentation that:
» Safer medical devices are being
evaluated and implemented
– Input was obtained from employees in
selecting safer medical devices
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Work Practice Controls
2. Work Practice Controls
a. Reduce likelihood of exposure by
alternating manner in which the technique
is performed
b. Includes:
•
•
•
Perform all procedures involving blood or OPIM
in a manner to minimize splashing, spraying,
spattering, and generation of droplets of these
substances
Observe warning labels on biohazard
containers and appliances
Bandage cuts and other lesions on the hands
before gloving
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Work Practice Controls, cont.
• Sanitize hands after removing gloves
– Whether or not the gloves are visibly
contaminated
• If hands or other skin surfaces come in contact
is made with blood or OPIM:
– Wash with soap and water as soon as
possible
• If mucous membranes of eyes, mouth, nose
come in contact with blood or OPIM:
– Flush with water as soon as possible
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Work Practice Controls, cont.
•
•
Do not break or shear contaminated needles
Do not remove, recap or bend a contaminated
needle: Except in unusual circumstances when
no other alternative is possible
– If must remove: must use a one-handed
technique using a sharps container with an
unwinder
– If must recap: must use a one-handed
scooping technique
1) Two-handed technique is strictly
prohibited
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Work Practice Controls, cont.
• Place contaminated sharps in a punctureresistant leakproof container immediately after
use
– Contaminated sharps: contaminated objects
that can penetrate the skin (needles,
lancets, scalpels, broken glass, capillary
tubes)
• Do not eat or drink, smoke, apply cosmetics or
lip balm, or handle contact lenses in areas
where occupational exposure may occur
• Do not store food or drink in refrigerator,
freezers, cabinets, shelves, or countertops
where blood or OPIM are present
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Work Practice Controls, cont.
• Place blood specimens or OPIM in leakproof
containers during collection, handling,
processing, storage, transportation, or shipping
– Make sure containers are closed
– Container must be labeled and/or colorcoded with biohazard warning
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Work Practice Controls, cont.
•
Before contaminated equipment is serviced or
shipped: must be decontaminated if blood or
OPIM are present
• If an exposure incident occurs:
– Perform first-aid measures immediately
1) Example: Needlestick injury should be
immediately washed with soap and
water
– Report incident to employer
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Personal Protective Equipment
1. Personal Protective Equipment (PPE)
a. Clothing or equipment that protects an
individual from contact with blood or OPIM
b. Must be used when occupational exposure
remains after instituting engineering and
work practice controls
c. Examples:
• Gloves
• Chin-length
face shields
• Masks
• Protective
eyewear
• Laboratory coats
• Gowns
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Personal Protective Equipment,
cont.
d. Type of protection depends on degree of
exposure anticipated:
•
Gloves
– Use when it is reasonably anticipated that
hands will have contact with:
1) Blood
2) OPIM
3) Mucous membranes
4) Nonintact skin
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Personal Protective Equipment,
cont.
– Also use when:
1) Performing vascular access procedures
(e.g., venipuncture)
2) Handling or touching contaminated
surfaces or items
– Gloves: cannot prevent a needlestick or
other sharps injury
– Can prevent pathogen from entering body
through break in skin (cut, abrasion, burn,
rash)
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Personal Protective Equipment,
cont.
•
Chin-length face shields or mask in
combination with eye protection
– Wear whenever the following may be
generated from blood or OPIM:
1) Splashes
2) Spray
3) Spatter
4) Droplets
– Example: Removing a stopper from a tube
of blood
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Personal Protective Equipment,
cont.
•
Protective clothing
– Use when gross contamination can reasonably be
anticipated during performance of a task or
procedure
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Personal Protective Equipment,
cont.
e. Personal Protective Equipment Guidelines
•
PPE must not allow blood or OPIM to pass
through it and reach:
– Skin
– Underlying garments (work clothes, street
clothes, undergarments)
– Eyes
– Mouth
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Personal Protective Equipment,
cont.
•
Employer must provide PPE at no cost to
employee
– Must be:
1) Available in appropriate sizes
2) Readily accessible
3) Used correctly
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Personal Protective Equipment,
cont.
– Employer must ensure PPE is:
1) Cleaned
2) Laundered
3) Repaired
4) Replaced
5) Disposed of as necessary
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Personal Protective Equipment,
cont.
• Alternatives must be provided for employers
allergic to regular gloves
– Hypoallergenic gloves
– Powderless gloves
• Replace gloves as soon as practical if become:
– Contaminated
– Torn
– Punctured
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Personal Protective Equipment,
cont.
•
Eye protection must have solid side shields
– Acceptable:
1) Chin-length face shields
2) Goggles
3) Glasses with solid side shields
– Not acceptable: Prescription eyeglasses
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Personal Protective Equipment,
cont.
• Remove contaminated garments as soon as
possible
– Place in appropriate container for washing
• Remove all PPE before leaving office
• Place PPE in designated area or container after
removal for:
– Storage
– Washing
– Decontamination
– Disposal
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Personal Protective Equipment,
cont.
•
Utility gloves can be decontaminated and
reused if not damaged
• Can briefly or temporarily decline the use of
PPE if it:
– Prevents proper health care
– Poses an increased hazard to MA or coworkers safety
1) Circumstances must be investigated: to
determine if situation can be prevented
in the future
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Housekeeping
4. Housekeeping
a. To ensure the work site is maintained in a
clean and sanitary condition
b. Written schedule must be developed and
implemented
•
For cleaning and decontaminating each area
where exposure occurs
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Housekeeping, cont.
c. Includes:
•
Clean and decontaminate equipment and work
surfaces after procedures involving blood or
OPIM
– Cleaning: use a detergent soap
– Decontamination: use a disinfectant
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Housekeeping, cont.
• Clean and decontaminate
equipment and work
surfaces as soon as
possible after exposure to
blood and OPIM
– To decontaminate
blood spills: OSHA
recommends 10%
solution of sodium
hypochlorite
(household bleach)
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Housekeeping, cont.
• Inspect and decontaminate all reusable
receptacles on a regular basis (e.g., waste
containers)
• Do not pick up broken contaminated glassware
with hands
– Use mechanical means (brush and dustpan)
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Housekeeping, cont.
• Protective covering may be used to cover work
surfaces/equipment (e.g., plastic wrap)
– Must be removed or replaced if
contamination occurs
• Handle contaminated laundry as little as
possible using PPE
– Place in leakproof bag
– Must bear a biohazard label and/or be colorcoded red
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Housekeeping, cont.
• If outside of biohazard container
becomes contaminated: place in a
second suitable container
• Biohazard sharps containers must be:
– Closable
– Puncture resistant
– Leakproof
– Bear a biohazard label and/or be
color-coded red
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Housekeeping, cont.
d. Guidelines for biohazard sharps containers:
•
Locate as close as possible to area of use
– To avoid transporting a contaminated
needle through workplace
• Maintain in upright position
– To keep contents inside
• Do not reach into container
• Replace on regular basis (three-fourths full
recommended)
– Do not allow to overfill
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Biohazard Sharps Containers
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Hepatitis B Vaccination
5. Hepatitis B Vaccination
a. Physicians must offer vaccine series free of
charge to all employees who have
occupational exposure
•
Within 10 days of initial assignment
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Hepatitis B Vaccination, cont.
b. Exceptions
•
•
•
•
•
Employee has previously received vaccine
series
Employee is immune to hepatitis B (as
confirmed through antibody testing)
Vaccine is contraindicated for medical reasons
Personnel who decline must sign waiver form
– Filed in employee’s OSHA record
Employee who declines: may later request
vaccine (free of charge)
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Hepatitis B Waiver Form
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Universal Precautions
6. Universal Precautions
a. Recommendations by CDC
b. Were issued before OSHA BBP Standard
c. Concept: All human blood and certain body
fluids are treated as if known to be
infectious for HIV, hepatitis B, hepatitis C,
and other BBPs
d. OSHA Standard states: Universal
Precautions must be observed
e. Forms the heart of the OSHA Standard
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What Would You Do?
What Would You Not Do?
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102
What Would You Do?
What Would You Not Do?
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103
Regulated Medical Waste (RMW)
1. Generated through diagnosis, treatment,
and immunization of patients
2. RMW: Any waste that poses a threat to health
and safety
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Regulated Medical Waste (RMW),
cont.
3. Includes:
a. Any liquid or semiliquid blood or OPIM
b. Items contaminated with blood or OPIM that
would release these substances in a liquid
or semiliquid state if compressed
c. Items caked with dried blood or OPIM that
are capable of releasing these materials
during handling
d. Contaminated sharps
e. Pathological and microbiological wastes
that contain blood or OPIM
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Regulated Medical Waste (RMW),
cont.
4. RMW must be properly discarded
a. To prevent the transfer of disease
b. Examples:
•
RMW: Dressing saturated with blood
– Discard in a biohazard bag
• Not RMW: Bandage with a spot of blood
– Discard in regular waste container
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Guidelines for
Discarding Medical Waste
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Handling Regulated Medical Waste
1. Must be handled carefully to prevent an
exposure incident
a. Guidelines
• Place RMW directly into biohazard containers:
do not mix with regular trash
• Biohazard containers used must be:
(Includes biohazard bags and sharps
containers)
– Closable
– Leakproof
– Suitably constructed to contain contents
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Handling Regulated Medical Waste,
cont.
•
Close lid of sharps container before removal
from examining room:
– To prevent spilling contents
1) Never open, empty or clean a
contaminated sharps container
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Handling Regulated Medical Waste,
cont.
•
Securely close and tie biohazard bags before
removal from examining room
– To provide additional protection: doublebag
1) By placing primary bag inside a second
biohazard bag
• Remove full biohazard containers to a secure
area away from general public
– Using gloves
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Disposal of Regulated Medical
Waste
1. Each state responsible for developing
RMW disposal policies
2. Most offices use commercial medical
waste service: Must be licensed and
have EPA permit
a. Pickup RMW from office
b. Transport RMW to a facility for incineration
• Destroys pathogens
• Renders it harmless
c. Disposed of in a landfill
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Disposal of Regulated Medical
Waste, cont.
3. Steps for preparing and storing RMW for
pickup:
a. Place biohazard bags and containers in
receptacle provided by service (e.g.,
cardboard box)
•
•
Seal box with tape
Biohazard warning label must appear on two
opposite sides of box
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Preparing Regulated
Medical Waste for Pickup
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Disposal of Regulated Medical
Waste, cont.
b. Store boxes:
•
•
In locked room inside facility
In locked container outside the facility
– Storage area should be labeled with one of
following :
1) “Authorized Personnel Only”
2) Biohazard symbol
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Disposal of Regulated Medical
Waste, cont.
c. Many states require a tracking record:
•
•
Completed when RMW is picked up
Specifies:
– Type of RMW
– Quantity of RMW (in pounds)
– Where it is being sent
• Signed by RMW service and medical office
• After RMW destroyed: record of disposal sent
to office
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Bloodborne Diseases
1. Biggest threats to health care workers
a. Hepatitis B
b. Hepatitis C
c. HIV (human immunodeficiency virus)
2. Hepatitis is much easier to transmit than
HIV
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Bloodborne Diseases, cont.
3. After needlestick injury, chances of
contracting infection from:
a. Hepatitis B–infected blood: 6% to 30%
b. Hepatitis C–infected blood: 2%
c. HIV-infected blood:
•
•
0.3% after a needlestick injury
0.09% after a mucous membrane exposure
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Hepatitis B
1. Infection of liver
2. Caused by hepatitis B virus (HBV)
3. Most common means of transmission in
office:
a. Blood
b. Blood components (serum, plasma)
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Hepatitis B
4. Health care workers are most likely to
contract through:
a. Needlestick injuries
b. Cuts with contaminated sharps
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Hepatitis B, cont.
5. Spread less efficiently by:
a. Blood splashes to eyes, mouth, and
nonintact skin
b. Through body fluids (e.g., vaginal
secretions)
6. Number of health care workers
contracting hepatitis B have declined
due to:
a. OSHA BBP Standard
b. Hepatitis B vaccination
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Hepatitis B, cont.
7. Postexposure Prophylaxis (PEP): Treatment
administered after exposure to an infectious
disease to prevent the disease
a. Administration of a passive and active immunizing
agent
•
Administer within 24 hours (preferable) but no later
than 7 days
– Hepatitis B Immune Globulin (HBIB) :
1) Passive immunizing agent (contains
antibodies)
2) Provides temporary immunity (1 to 3 months)
3) Gives hepatitis B vaccine a chance to work
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Hepatitis B, cont.
– Hepatitis B Vaccine:
1) Active immunizing agent (stimulates the
body to produce antibodies)
2) Brand names
(a) Recombivax HB
(b) Engerix B
3) Given IM in 3 doses (0, 1, and 6 months)
4) Mild side effects:
(a) Soreness at injection site (most
common)
(b) Serious reactions are rare
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Hepatitis B, cont.
b. If MA has had hepatitis B
vaccine:
•
No treatment required
– Unless antibody level is low:
then booster dose is given
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Hepatitis B, cont.
8. Acute Viral Hepatitis B
a. Acute symptoms
•
•
Occur approx 12 weeks after exposure
Last 1 to 4 few weeks
– May take 6 months to fully recover
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Hepatitis B, cont.
b. Symptoms vary from mild to severe:
•
One third are asymptomatic and unaware they
are infected
• One third have mild flulike symptoms: fatigue,
headache, loss of appetite, nausea, vomiting,
malaise, muscle and joint pain
• One third have severe symptoms: abdominal
pain, dark urine, clay-colored stools, jaundice,
liver enlargement and tenderness
– May require hospitalization
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Hepatitis B, cont.
c. Small percentage (0.5% to 2%): develop
fulminant hepatitis
•
Almost always fatal
d. Treatment:
•
No medications available
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Hepatitis B, cont.
• Supportive care to defenses of body with
hepatitis B to overcome the disease:
– Restricted activity
– Rest
– Avoid alcohol
– Well-balanced diet
– Adequate fluid intake
– Precautionary measures to prevent
transmission to others
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Hepatitis B, cont.
e. Most patients (90%): recover fully after
acute phase
•
•
•
•
Body produces antibodies that completely
destroys the virus
Recover fully
Have lifelong immunity
Not infectious to others
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Hepatitis B, cont.
9. Chronic Viral Hepatitis B
a. The 10% who do not recover from acute
phase
b. Remain infected
c. Go on to develop chronic hepatitis B
d. Produce antibodies to hepatitis B
•
Not enough to remove virus from body
e. May or may not experience symptoms
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Hepatitis B, cont.
f. Become carriers: capable of transmitting
disease to others
g. Increased risk of developing:
•
•
Liver cancer
Cirrhosis
– Significant number (25%) of these patients
eventually die from liver failure
h. Treatment: Antiviral drugs (40% effective)
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Hepatitis C
1. No preventative vaccine available
2. Most likely means of contracting in
medical office:
a. Needlesticks and other sharps injuries
b. Chance of health care worker contracting
much lower than contracting hepatitis B
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Hepatitis C, cont.
3. Symptoms
a. Most have no symptoms
b. If symptoms occur: mild and flulike
c. Of individuals infected with acute
hepatitis C:
•
•
•
55% to 85%: Develop chronic hepatitis C
20%: Develop liver disease after 10 to 30 years
Cirrhosis
Liver cancer
1% to 5% die from liver failure
d. Treatment: Antiviral drugs (40% effective)
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Other Forms of Viral Hepatitis
1. Hepatitis A, D, and E
2. Hepatitis A
a. Not considered major occupational hazard
b. Only occasionally transmitted to health care
worker
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Other Forms of Viral Hepatitis, cont.
3. With all types of hepatitis:
a. Virus invades the liver
b. Cause inflammation
c. Result in similar symptoms
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What Would You Do?
What Would You Not Do?
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135
What Would You Do?
What Would You Not Do?
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136
Acquired Immunodeficiency
Syndrome (AIDS)
1. Chronic disorder of immune system
2. Eventually destroys body’s ability to fight
off infection
3. Caused by retrovirus: human
immunodeficiency virus (HIV)
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
4. Clarification of terms:
a. HIV: refers to the virus and the infection
b. AIDS: refers to the last stage of the HIV
infection
•
HIV and AIDS refer to different stages of the
same disease
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
5. When HIV gains entrance into body:
a. Attacks and destroys certain white blood
cells (WBCs) known as CD4+ T cells
•
CD4+ T cells: Protect body against viral, fungal
and protozoal infections
b. As more CD4+T cells are destroyed
•
Immune system is gradually weakened
c. After a long period of time: may last 10
years or more
•
•
Immune system becomes so ravaged by attack
Patient eventually succumbs to diseases
associated with AIDS
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
6. AIDS characterized by:
a. Opportunistic infections
•
Opportunistic infection: An infection that
results from a defective immune system that
cannot defend itself from pathogens normally
found in the environment
b. Unusual cancers
•
Rarely affects individuals with healthy immune
systems
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
7. Stages of AIDS
a. Stage 1: Acute HIV Infection
•
Flulike illness may occur
– 1 to 4 weeks after exposure
– Disappears within 1 week to 1 month
– Often mistaken for other viral infections
• Many people do not develop symptoms
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
• Symptoms of Acute HIV infection:
-fever
-sweats
-fatigue
-loss of appetite
-diarrhea
-pharyngitis
-myalgia
-arthralgia
-adenopathy
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
•
Stage 2: Asymptomatic Period
– After early symptoms subside (if occur at all):
1) Long incubation period usually occurs
2) Last months to years (depending on
individual)
– No symptoms are present
1) Individual looks and feels well
2) May not realize HIV is present
– Only way to detect HIV during this time: blood
tests
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
– HIV antibodies are produced several months
after exposure
1) Are unable to destroy HIV
2) Used as a basis for tests to detect
presence of HIV
(a) Tests may not be able to detect HIV
for 3 to 6 months after infection
– HIV is very active
1) Gradually weakens immune system
– HIV can still be transmitted to others
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
c. Stage 3: Symptomatic period
•
Series of lesser symptoms may occur before
full-blown AIDS develops:
– Lymph node enlargement for more than 3
months
– Lymphadenopathy
– Lack of energy
– Unexplained weight loss
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
–
–
–
–
–
–
Recurrent fevers
Sweats
Diarrhea
Yeast infections (oral and vaginal)
Skin rashes, flaky skin
Herpes infections, shingles
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
d. Stage 4: AIDS
•
AIDS-defining conditions occur:
– Opportunistic infections: Pneumocystis carinii
(rare type of pneumonia)
– Unusual cancers: Kaposi’s sarcoma (rare type
of cancer)
1) In normal individuals with healthy immune
systems
(a) Do not usually occur (or produce only
mild illness)
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
• Damage to nervous system may occur
– Results in dementia
• CDC’s definition of AIDS:
– A CD4+ T cell count of less than 200 cells/L
and/or the presence of one or more AIDSdefining conditions
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
• As HIV infection progresses:
– Patient becomes overwhelmed by infection
and cancer
– Body cannot fight back because of severely
damaged immune system
– Patient eventually succumbs to AIDSdefining conditions
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
8. Transmission of AIDS
a. Not transmitted through casual or extensive
(family members) contact
b. Spread primarily through:
•
•
Sexual contact
Sharing drug needles with infected person
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
•
Untreated HIV-infected women:
– Can transmit HIV to baby
1) During pregnancy
2) During birth
3) Through breastfeeding
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
c. Risk of AIDS to health care workers is low
•
•
HIV is not easily transmitted
CDC statistics of occupational exposure since
1985:
– 57 documented cases
– 138 possible cases
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Acquired Immunodeficiency
Syndrome (AIDS), cont.
d. Serious nature of HIV infection
•
Warrants strict adherence to OSHA BBPs
Standard
e. Most HIV carriers are asymptomatic
•
Important to minimize risk of exposure at all
times
– Also protects against other bloodborne
pathogens:
1) Hepatitis B
2) Hepatitis C
3) Syphilis
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POSTTEST
True or False
1.
2.
3.
4.
5.
Bacteria and viruses are examples of
microorganisms.
An anaerobe can exist only in the presence of
oxygen.
The optimum growth temperature is the temperature
at which a microorganism grows the best.
Medical asepsis are practices which help keep an
area free from infection.
Resident flora are picked up in the course of daily
activities and are usually pathogenic.
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POSTTEST, CONT.
True or False
6.
The purpose of the OSHA Standard is to prevent
exposure of employees to bloodborne pathogens.
7. OSHA requires the Exposure Control Plan to be
updated annually.
8. An engineering control is a physical or mechanical
device used to remove health hazards from the
workplace.
9. A reagent strip that has been used to test urine is an
example of regulated medical waste.
10. The most common means of transmitting hepatitis C
is through sexual intercourse.
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155