© 2009 Delmar, Cengage Learning Chapter 14 Infection Control

© 2009 Delmar, Cengage Learning

Chapter 14

Infection Control


14:1 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 transmission


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

(continues)


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

(continues)


Microorganisms or Microbes(continued)

• 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


Microbe Classifications

• Bacteria

• Protozoa

• Fungi

• Rickettsiae

• Viruses


Bacteria

• Simple, one-celled organisms

• Multiply rapidly

• Classified by shape and arrangement

(continues)


Bacteria(continued)

• Cocci are round or spherical in shape– Diplococci—in pairs – Streptococci—in chains– Staphylococci—clusters or groups

• Examples of diseases

(continues)


Bacteria(continued)

• Bacilli are rod shaped– Occur singly, in pairs, or in chains– May have flagella– Ability to form spores


(continues)


Bacteria(continued)

• Spirilla are spiral or corkscrew shaped– Includes comma-shaped vibrio and corkscrew

spirochete

• Diseases include syphilis and cholera


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


Protozoa

• One-celled, animal-like organism

• Found in decayed materials and contaminated water

• May have flagella for movement

• Some are pathogenic



Fungi

• Simple, plant-like organisms

• Live on dead organic matter

• Yeast and molds

• Can be pathogenic


• Antibiotics do not kill

• Antifungal medications


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


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

(continues)


Viruses(continued)

• Viruses infecting animals can mutate to infect humans

• Examples include:– Severe acute respiratory syndrome (SARS)– West Nile Virus (WNV)– Monkeypox– Ebola and Marburg– H5N1


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

(continues)


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, written statement must be signed documenting refusal


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

(continues)


Hepatitis C (continued)

• Currently, no vaccine ready for use

• Vaccine is in development stage

• Extremely difficult to destroy HVC

• Can survive and remain active for several days in dried blood

• Health care workers must follow precautions to protect against virus


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• Take precautions for prevention


Helminths

• Multicellular parasites otherwise known as worms or flukes

• Are transmitted:– By eating contaminated food– Being bitten by infected insects– When worms enter the skin


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


Classifications of Diseases and Infections

• Endogenous

• Exogenous

• Nosocomial

• Opportunistic


Endogenous

• Originates within the body

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


Exogenous

• Originates outside the body

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


Nosocomial

• Acquired in a health care facility

• Usually present in facilities and carried by health care workers to the patient

• Many are antibiotic-resistant

• Can cause serious and even life-threatening infections

(continues)


Nosocomial(continued)

• Examples are staphylococcus, pseudomonas, and enterococci

• Infection-control programs are used in facilities to prevent and deal with nosocomial infections


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


Chain of Infection

• 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


Common Body Defenses

• Mucous membranes• Cilia• Coughing and sneezing• HCL in the stomach• Tears• Fever• Inflammation response • Immune response


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


Aseptic Techniques

• Asepsis: absence of disease-producing microorganisms

• Contaminated: any object or area that may contain pathogens

• Major aim: maintaining cleanliness and eliminating or preventing every aspect of contamination


Common Aseptic Techniques

• Thorough handwashing

• Good personal hygiene

• Disposable gloves

• Cleaning instruments and equipment

• Proper cleaning of environment


Levels of Aseptic Control

• Antisepsis—used on the skin

• Disinfection—used mainly on objects

• Sterilization—use of steam under pressure, gas, radiation, and chemicals on objects


Summary

• Important for health care workers to know and use proper aseptic techniques at all times

• Prevents spread and transmission of disease


14:2 Bioterrorism

• Bioterrorism: use of microorganisms or biologic agents for warfare

• Infecting humans, animals, or plants

• Have been used over time by different nations not only in war but also on innocent people


Biologic Agents

• Microorganisms with characteristics suitable for bioterrorism:– Inexpensive, available, easily produced, spreads

quickly– Maintains its survival– Brings death or disability– Travels from person to person– Difficult to prevent/treat

(continues)


Biologic Agents(continued)

• High priority agents include:– Smallpox: contagious and infectious disease,

result of the Variola virus– Anthrax: infectious disease caused by

Bacillus anthracis– Plague: infectious disease from the bacteria

Yersinia pestis

(continues)


Biologic Agents(continued)

– Botulism: paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinum

– Tularemia: infectious disease from the bacteria Fracisella tularensis

– Filoviruses: infectious diseases causing severe hemorrhagic fever known as Ebola virus and Marburg virus


Preparing for Bioterrorism

• Bioterrorism attack would result in a public health emergency

• Would have impact on health care facilities

• Social disorder would ensue

• Comprehensive plan

(continues)


Preparing for Bioterrorism(continued)

• Bioterrorism Act 2002 passed by Congress and signed into law

• Involves local, regional, state, and national government and includes:– Early detection by communities– Public to be notified– Infection control and education– Funding available

(continues)


Preparing for Bioterrorism(continued)

– Guidelines and restrictions– Nationwide immunizations– Protection of food/water supplies– Trained personnel available– Emergency management controls– Investigation of potential threats– Preparation of health care facilities– Efficiency of communication


Summary

• All health care workers need to be aware

of bioterrorism

• Attack could occur at any time

• Being prepared and properly trained will result in saving many lives


14:3 Washing Hands

• Major aspect of standard precautions

• Most important aseptic technique

• Hands are perfect media for the spread of pathogens


Purpose of Handwashing

• Prevent and control spread of pathogens

• Protect the health care worker from disease and illness


Recommendations for Handwashing

• Regular handwashing with plain soap and water

• Antiseptic handwashing with antimicrobial soap and water

• Antiseptic hand rub with alcohol-based cleaner (waterless)


When to Wash Hands

• On arrival at facility

• Immediately before leaving facility

• Before and after every patient contact

• After contact with patient’s skin

• Before moving from a contaminated site to a clean site

(continues)


When to Wash Hands(continued)

• Anytime the hands become contaminated during a procedure

• Before applying gloves

• Immediately after removing gloves

• When gloves are torn or punctured

• Before and after handling specimens

• After contact with any soiled or contaminated item (continues)


When to Wash Hands(continued)

• After picking up any item off the floor

• After personal use of the bathroom

• Following a cough, sneeze, or using a tissue

• Before and after any contact with mouth or mucous membranes


Principles of Handwashing

• Use soap as a cleansing agent

• Use warm water

• Use friction

• Clean all surfaces

• Point fingertips down

• Use dry paper towels to turn faucet on and off

• Clean nails


Waterless Hand Cleaning

• Alcohol-based gel, lotion, or foam

• Used if hands are not contaminated with blood or body fluids

• Apply cleaner to palm of hand

• Rub hands together vigorously for at least 15 seconds

• After six to ten cleanings hands need to be washed with soap and water


14:4 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 there is an area, object, or person contaminated with blood or body fluids


Bloodborne Pathogen Standards

• Established in 1991 by OSHA

• Must be followed by all health care workers

• Civil penalties if not implemented and followed


Regulation Requirements

• Written exposure control plan

• Identify all employees with occupational exposure

• Hepatitis B vaccines free of charge

• Provide personal protective equipment

(continues)


Regulation Requirements(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

(continues)



• 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)

(continues)



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

• Red biohazard labels• Provide a confidential medical evaluation

and follow-up for any employee with an exposure incident

• Provide training to employees


Needle Stick Safety Act

• Passed by Congress in 2000

• Centers for Disease Control and Prevention (CDC) estimated 600,000 to 800,000 needle sticks per year

• OSHA revised Bloodborne Pathogen Standard to requirements of this act


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

(continues)


Employer Requirements(continued)

• Maintain a sharps injury log

• Ensure that every employee uses standard precautions at all times


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


When to Use Standard Precautions

• 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


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


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/blood tests


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


Masks and Eye Protection

• Worn during procedures that may cause splashing or spraying

• Prevents exposure of mucous membranes of the mouth, nose, and eyes to pathogens

• Use masks once then discard—change every 30 minutes if needed

(continues)


Masks and Eye Protection(continued)

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

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


Sharp Objects

• Use extreme caution to avoid cuts and punctures

• When possible, use safe needles or needleless system

• Follow policies regarding needles

• Use sharps containers

• Follow laws regarding disposal of sharp objects


Spills or Splashes

• Wipe up immediately• Wear gloves when wiping up• Use disposable cleaning clothes• Use disinfectant which contains 10%

bleach solution• Clean all contaminated surfaces• For large spills, can use absorbent

powder to absorb fluid


Resuscitation Devices

• Use to avoid the need for mouth-to-mouth resuscitation

• Place in convenient location that is readily accessible


Waste and Linen Disposal

• Wear gloves

• Follow agency policy

• Use biohazard bags appropriately


Injuries

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



Summary

• Standard precautions need to be followed at all times by every health care worker

• Observing these precautions can help break the chain of infection

• Health care workers can protect themselves, their patients, and all other individuals


14:5 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

(continues)


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



14:6 Using Chemicals for Disinfection

• May not kill spores and viruses

• Disinfect, but do not sterilize

• Used to disinfect instruments that do notpenetrate body

• Preparation of items

• Chemical solutions used

(continues)


Using Chemicals for Disinfection (continued)

• Read manufacturer’s instructions

• Antirust tablets or solutions added

• Requirements for disinfection

• Chemical must completely cover items

• Care of chemical solutions


14:7 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

(continues)


Cleaning with an Ultrasonic Unit (continued)

• Care of glass beakers

• Care of the permanent tank

• Read manufacturer’s instructions before using any ultrasonic unit


Summary

• Different methods provide different levels of aseptic control

• Method used depends on equipment and level of aseptic control required

• Read manufacturer’s instructions• Clean, rinse, and dry all equipment

before processing• Handle all items carefully


14:8 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

(continues)


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

(continues)


Using Sterile Techniques(continued)

• Clean working area required

• Handling of sterile supplies

• Sterile field: area used for placement of sterile supplies

• All sterile items need to be checked

• Observe agency guidelines for date

• Necessary to keep sterile field dry


Removing Articles from Sterile Wraps

• Drop technique—for gauze, pads, dressings, and small items

• Mitten technique—for bowls, drapes, and linens

• Transfer forceps—for cotton balls and small items


14:9 Transmission-BasedIsolation Precautions

• Some diseases are communicable – Caused by organisms that can be transmitted easily

• Epidemic—spreads from person to person and affects large numbers

• Pandemic—spreads over a wide geographic area

• These precautions are in addition to the Standard Precautions

(continues)


Transmission-BasedIsolation Precautions

(continued)

• Helps prevent spread of disease

• Protects patient, family, and health care workers

• Type used depends on the causative organism of the disease


How Communicable Diseases Spread

• Direct contact with a patient

• Contact with dirty linen, equipment, and supplies

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


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


Classifications of Precautions

• Standard precautions

• Airborne precautions

• Droplet precautions

• Contact precautions


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


Summary

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

• Variations caused by different factors

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

Documents

© 2009 Delmar, Cengage Learning Chapter 14 Infection Control