UNDERSTANDING THE

PRINCIPLES OF INFECTION CONTROL

MICROBE/MICROORGANISM Small living organism

Not visible to the naked eye Found everywhere Part of your normal flora Some microorganisms cause infection—

called pathogens or germs At times a microorganism that is beneficial

in one area can cause problems in another area

Microorganisms like: Warm environment Darkness Source of food and moisture

MICROORGANISMS: Bacteria

One-celled, multiply rapidlyCocci

Diplococci, Streptococci, StaphlococciBacilliSpirilla

AntibioticsSome strains of bacteria have become

antibiotic resistant Illnesses:

Strep throat, pneumonia, pertussis, tetanus, UTI, gonorrhea, syphilis

MICROORGANISMS: Protozoa

Found in decayed materials, bird feces, contaminated water, insect bites

Malaria, trichomonas, African sleeping sicknes Fungi

Plant like organisms that live on dead organic matter Yest and Molds

Athletes foot, thrush, yeast infections, ring worm

Antifungal Rikettsia

Parasitic organisms Found on fleas, lice, ticks, mice

MICROORGANISMS: Viruses

Smallest microorganismCan’t reproduce unless in another living sellSpread by body secretionsDifficult to kill

Diseases:Cold, measles, chicken pox, warts, herpes,

polio, influenza, mumps

VIRUSES Able to mutate and change genetic

information SARS

Variant of the common cold Flu like symptoms to respiratory failure and death

West Nile Virus Mosquito are the carriers Mild fevers to death

MonkeypoxEbolaH5N1 Virus (Bird Flu)

Contact with infected poultry or surfaces Death rate is 50-60%

VIRUSES IN HEALTH CARE Hepatitis B

Destroys and scars liver cells Hepatitis C

Serious liver damage Acquired immunodeficiency syndrome

(AIDS)Caused by human immunodeficiency virus

(HIV)No cure or vaccine Suppresses the immune system

Individuals are not able to fight off infections Important to take precautions

MICROORGANISMS: Helminths

Multicellular parasitic organismsTransmitted through eggs or larvae in

contaminated foods, contaminated meat or infected insects

Some can penetrate the skin to enter the body

Types:HookwormsTrichinella spiralisEntrobiasisTape worm (taenio solium)

INFECTIONS Pathogenic microorganisms cause infections

in different waysProduce toxinsCause allergic reactionsAttack and destroy living cells

Classifications:Endogenous: originated within the body

Tumors, metabolic disorders, congenital abnormalitiesExogenous: originated outside the body

Trauma, radiation, chemical agentsNonsocomial: Infections from a health care

facilityOpportunistic: infections that occur when body

defenses are weakened

CHAIN OF INFECTION Factors must exist for disease to occur and

spread Causative agent: pathogen that can cause a

disease Reservoir: area where the agent can live Portal of exit: way to escape the reservoir Mode of transportation: way for the causative

agent to be transmitted to another host Portal of entry: Way to get into the host Susceptible host: individual who can contact the

disease Ending the chain:

If any part is eliminated, the spread will be stopped

ASEPTIC TECHNIQUES Ways to maintain cleanliness and eliminate

or prevent contamination Hand washing Disposable gloves Proper cleaning of instruments and equipment Thorough cleaning of the environment

3 Levels Antisepsis: prevent or inhibit growth

Alcohol, betadine Disinfection: destroys or kills

spores and viruses may not die with disinfection Bleach solutions

Sterilization: destroys all Autoclaving

BIOTERRORISM Use of microorganisms or biological agents

as weapons CDC has identified major bioterrorism threats

Small poxAnthraxPlagueBotulismTalaremiaFilovirus

Bioterrorism act of 2002Requires development of a plan against

bioterrorism to increase security in the US

STANDARD PRECAUTIONS Blood Born pathogen Standards

1991 by OSHAMust be followed by all health care facilitiesRegulations

Develop a written exposure control plan Identify all employees who have potential exposure Provide Hep B vaccinations Provide personal protective equipment Provide hand washing supplies and areas Ensure work site is clean Dispose of infectious materials properly Label biohazard wastes and post signs Provide training

NEEDLE STICKS Safety and prevention Act

Passed in 2000CDC estimated 600,000-800,000 needle

sticks a yearRequires employees to:

Identify and use effective and safer medical devices

Incorporate changes in annual update of exposure control plan

Get input from nonmanagerial employees Maintain a sharps injury log Make sure every employee uses standard

precautions at all times to prevent contact of body fluids

HAND WASHING Major aspect of standard precautions Most important for aseptic technique Prevents spread of pathogens and

protects worker Regular Hand washing

Plain soap and water—routine cleaning Antiseptic Hand washing

Antimicrobial soap and water—invasive procedures

Antiseptic Hand rubsWaterless hand washing using alcohol-based

hand cleaners

WHEN TO WASH When you arrive and before leaving Before and after every patient contact Before and after putting on gloves If gloves rip Before and after handling a specimen

Basics Use soap Warm water Use friction to clean all surfaces Point fingertips downwards Use paper towels to dry off and shut off Clean nails

MORE INFO ABOUT HANDS Waterless hand cleaners

Proven safeRecommended when the hands are not

visibly dirty Gloves

When ever in contact with blood, body fluids, secretions, or specimens they should be worn

Change after contact with patientsWash hands after removing

Gowns/Masks/Eyeware/FaceshieldsWorn during procedures that are likely to

cause splashing or spraying

SHARPS Use care while handling sharp objects Needles

Place in a leakproof, puncture resistant container labeled with a red biohazard symbol

Surgical blades, razors, and other sharp objects must also be discarded in the sharps container

Dispose of sharps appropriately according to law

Spills or splashesWiped up immediately Gloves need to be warnDisinfect per protocol

WASTE AND SOILED LINEN DISPOSAL Wear gloves while handling waste and

soiled linen Follow policy Infectious wastes must be placed in

special biohazard bags Soiled linen should be placed in laundry

bagsGloves should be wornBags containing contaminated linen need to

be labeled Reporting cuts and injuries

Required to report

METHODS OF INFECTION CONTROL Various methods are used to achieve

infection control Different methods lead to different

levels of aseptic controlAntisepsis: prevents or inhibits growth of

pathogens, but not effective against spores and viruses

Disinfection: destroys or kills pathogenic organisms, but not always effective against spores and viruses

Sterilization: destroys all microorganisms both pathogenic and non pathogenic as well as spores and viruses

AUTOCLAVE Uses steam under pressure or gas Most efficient method of sterilization Process:

Items are washed first with soapy water to remove any residue

Items are wrapped for autoclaving Special wrapping technique to ensure no open

edges to allow contaminationAutoclave is properly loaded Indicator allows you to know when items are

sterilized—time period can varyCare of items after autoclaving

CHEMICAL DISINFECTION Chemicals used for aseptic control Disinfects, but doesn’t sterilize Used for instruments that don’t penetrate the body Preparation

Items are cleaned and debris is removedChemical solution is used

Requirements:Large enough container to fit all items Items must be separate from one anotherTight fitting lid to prevent contamination

Solution must be changed according to manufacture's instructions

ULTRASONIC UNIT Sound waves are used to produce bubbles, when the bubble strikes the item being cleaned it explodes removing the dirt and residue Aseptic Control Special cleaning solutions are used in the

unit, some are permanent solution tanks Instruments, impression trays, glass

products, jewelry can be cleaned Permanent tanks need to be drained and

cleaned according to manufacturers instructions

SUMMARY Different methods provide different

levels of aseptic control Method used depends on equipment

available and level of aseptic control required

Read manufacture's instructions before using any equipment

Make sure all items to be sterilized or disinfected are clean, rinsed, and dry before they are processed

Handle items carefully after processing to maintaining level of aseptic control

USING STERILE TECHNIQUES Many procedures require sterile

techniques to protect patient from infection

Surgical Asepsis: Procedures that keep an object or area free from living organisms

Sterile: Free from all organisms, including spores and viruses

Contaminated: organisms and pathogens are present on an article or area

Correct techniques MUST be followed to maintain sterility and prevent contamination

STERILE SUPPLIES Clean free working area

Sterile + non-sterile=unsterileSterile+ sterile=sterileSterile+ wet surface= unsterile

Handling Sterile suppliesTouching skin or clothing=unsterileBelow the waste=unsterileHold items away and in front of the body

Sterile field: area used for placement of sterile supplies

STERILE FIELD BASICS Keep the sterile field in constant view Never reach over the top of a sterile field Never turn your back to a sterile field Avoid coughing, sneezing or talking over a

sterile field Keep sterile fields clean and dry 2-inch area around sterile field =unsterile Check all items before use Use appropriate methods for removing

articlesDropMitten

STERILE GLOVES Worn while doing sterile procedures Make sure sterile tray is open and all

sterile items are ready before putting gloves on

Observe correct technique When gloves are on hands hold away

from the body and above waist Handle only sterile objects while

wearing sterile gloves Change gloves if contamination occurs

STERILE DRESSING Proper authorization Use an infectious waste bag for

contaminated dressings Wear disposable gloves while removing a

dressing Note type, color and amount of drainage

on dressings Put on sterile gloves to cleanse area and

apply new dressing Cleanse wound with proper technique If contamination occurs, start over

http://www.youtube.com/watch?v=uyNm47QKW_c&feature=related

TRANSMISSION BASED ISOLATION PRECAUTIONS Many different diseases in the healthcare

fieldSome diseases are communicable or caused by

an organism that is easily transmitted Epidemic

Occurs when the communicable disease spreads rapidly from person to person

Affects a large number of people at the same time Pandemic

Exists when the outbreak of the disease occurs over a wide geographical area

Affects high proportion of the populationTravel is a concern

TRANSMISSION BASED ISOLATION Required for communicable diseases

TuberculosisWound infectionsPertussis

Standard precautions do not eliminate the need for specific transmission based isolation precautionsTransmission based provides extra

protection against the spread of specific diseases or pathogens

TRANSMISSION ISOLATION Type of transmission-based isolation

depends on what the causative organism is and how it is transmittedPersonal Protective Equipment (PPE)

Gowns, gloves, face shields, masks

Terms:Contaminated/Dirty

Items that contain disease-producing organisms Must not be touched unless your protected

Clean Items that don’t contain organisms Effort needs to be given to prevent contamination

to clean parts

CLASSIFICATIONS OF PRECAUTIONS

Standard: Used for all patientsGloves, gowns, face masks when neededPrivate room if patient is infectious

Airborne precautions: patients with known or suspected infections transmitted by droplets in the airVaricella, tuberculosis, herpes zoster, measlesUse standard precautions as well as

respiratory precautions Private room with door closed Air in room should be filtered or discharged

outdoors Everyone must wear a respiratory filtering mask

(HEPA) Patient should not be transported from room, if

necessary mask needs to be worn

CLASSIFICATIONS OF PRECAUTIONS Droplet Precautions

Patients with known or suspected infections with pathogens transmitted by large droplet particles Influenza, meningitis, pneumonia, mumps, diphtheria

Standard precautionsPatient should be in private room or with patient of

the same infectionMask when working within 3 feet

Contact PrecautionsPatients with suspected infection with rapidly

spreading microorganisms that can be transmitted by direct or indirect contact GI diseases, respiratory, skin,wound infections,

pediculosisStandard precautionsPrivate room, gloves, gown if contactEquipment should be left in room

CLASSIFICATIONS OF PRECAUTIONS

Protective or Reverse IsolationMethod to protect patients from certain

organisms present in the environment Immunocompromised

Burns, malnourished, chemotherapy, radiation, bone marrow transplant, immune system failure

Precautions depend on patient’s condition Frequent disinfecting

Exact procedures vary depending on facilityType of units provided varySupplies or isolation equipment vary

Learn specific facility precautions, but basic principles remain the same.

TEST 4 100 points

25 matching9 T/F9 multiple choice5 Short answer/Essay

Chain of infection Needle contamination Reverse isolation Hand washing Protective Equipment Airborne/Standard/Contact/Droplet Aseptic/Sterile/Disinfection Study worksheets and past tests