Unit 13 Infection Control Copyright 2004 by Thomson

13: 1 Understanding the 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 2

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 3

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 § Sometimes nonpathogenic microorganisms can become pathogenic Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 4

Microbe Classifications § § § Bacteria Protozoa Fungi Rickettsiae Viruses Copyright © 2004 by

Bacteria § Simple, one-celled organisms § Multiply rapidly § Classified by shape and arrangement

Bacteria – Cocci § § § Round or spherical in shape Diplococci Streptococci Staphylococci

Bacteria – Bacilli § § § Rod-shaped Occur singly, in pairs, or in chains May have flagella Ability to form spores Examples of diseases Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 8

Bacteria – Spirilla § Spiral or corkscrew shape § Includes comma-shaped vibrio and corkscrew spirochete § Diseases include syphilis and cholera Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 9

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 10

Protozoa § One-celled, animal-like organism § Found in decayed materials and contaminated water § May have flagella for movement § Some are pathogenic § Examples of diseases Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 11

Fungi § § § § Simple, plant-like organisms Live on dead organic matter Yeast and molds Can be pathogenic Examples of diseases Antibiotics do not kill Antifungal medications Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 12

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) § Examples of diseases § Antibiotics are effective against many of them Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 13

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 14

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 15

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, a written statement must be signed documenting refusal Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 16

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 17

Hepatitis C (continued) § § § Currently, no vaccine ready for use Vaccine is in development stage Extremely difficult to destroy HVC Can survive several days in dried blood Health care workers must follow precautions to protect against virus Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 18

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 § Important to take precautions to prevent Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 19

Growth of Microorganisms § § § 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 20

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 21

Classifications of Diseases and Infections § § Endogenous Exogenous Nosocomial Opportunistic Copyright © 2004

Endogenous § Originates within the body § Examples: metabolic disorders, congenital abnormalities, tumors, and infections caused by microorganisms within the body Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 23

Exogenous § Originates outside the body § Examples: radiation, chemical agents, trauma, electric shock,

Nosocomial § Acquired in a health care facility § Usually present in the facility and carried by health care workers to the patient § Many are antibiotic-resistant § Can cause serious and even life-threatening infections Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 25

Nosocomial (continued) § Common examples are staphylococcus, pseudomonas, enterococci § Infection control programs are used to prevent and deal with nosocomial infections Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 26

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 27

Chain of Infection § Must be 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 28

Causative Agent § Pathogen must be present § Examples include bacteria or virus Copyright

Reservoir § Place where causative agent can live § Examples: human body, animals, and

Portal of Exit § Way for causative agent to escape from the reservoir § Examples: urine, feces, saliva, blood, tears, mucous discharge, sexual secretions, and draining wounds Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 31

Mode of Transmission § Must be transmitted to another reservoir or host where it can live § Direct contact: person-to-person, spread by physical or sexual contact § Indirect contact: from contaminated substances to the person Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 32

Portal of Entry § Way to enter a new reservoir or host § Examples: breaks in the skin or mucous membranes, respiratory tract, digestive tract, genitourinary tract, and circulatory system Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 33

Susceptible Host § Individual who can contract the disease § Usually the person can fight off the causative agent and not contract the disease Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 34

Common Body Defenses § § § Mucous membranes Cilia Coughing and sneezing HCL in

Common Body Defenses (continued) § Fever § Inflammation response – leukocytes § Immune response

Increased Susceptibility § When large numbers of pathogens invade the body § When body

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 38

Aseptic Techniques § Major way to break the chain of infection § Asepsis: absence of disease-producing microorganisms or pathogens § Contaminated: any object or area that may contain pathogens § Major aim: maintaining cleanliness and eliminating or preventing contamination Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 39

Common Aseptic Techniques § § Handwashing Good personal hygiene Disposable gloves Proper cleaning of instruments and equipment § Thorough cleaning of environment Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 40

Levels of Aseptic Control § Antisepsis § Disinfection § Sterilization Copyright © 2004 by

Antisepsis § Prevent or inhibit the growth of pathogenic organisms § Usually not effective against spores and viruses § Can usually be used on the skin § Examples: alcohol and betadine Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 42

Disinfection § Destroys or kills pathogenic organisms § Not always effective against spores and viruses § Chemical disinfectants are used § Can irritate or damage the skin, so mainly used on objects, not people § Examples: bleach solutions and zephirin Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 43

Sterilization § Destroys all microorganisms § Steam under pressure, gas, radiation, and chemicals § Autoclave is the most common equipment used Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 44

Summary § Important for health care workers to know and use proper aseptic techniques

13: 2 Washing Hands § Major aspect of standard precautions § Most important aseptic technique § Hands are perfect media for the spread of pathogens Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 46

Purpose of Handwashing § Prevent and control spread of pathogens § Protect the health

When to Wash Hands § § When arrive at facility Immediately before leaving facility Before and after every patient contact Anytime the hands become contaminated during a procedure § Before applying gloves § Immediately after removing gloves Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 48

When to Wash Hands (continued) § Before and after handling any specimen § After contact with any soiled or contaminated item § After picking up any item off the floor § After personal use of the bathroom § After you cough, sneeze, or use a tissue § Before and after any contact with mouth or mucous membranes Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 49

Principles of Handwashing § § § Use soap as a cleansing agent Use warm water Use friction Clean all surfaces Point fingertips down while washing hands Use dry paper towels to turn faucet on and off § Clean nails Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 50

13: 3 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 an area, object, or person is contaminated with blood or body fluids Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 51

Bloodborne Pathogen Standards § Established in 1991 by OSHA § Must be followed by all health care workers § Civil penalties if not implemented and followed Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 52

Regulation Requirements § Written Exposure Control Plan § Identify all employees with occupational exposure § Provide hepatitis B vaccines free of charge § Provide personal protective equipment (PPE) Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 53

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 54

Regulation Requirements (continued) § 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) Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 55

Regulation Requirements (continued) § Post signs at the entrance to work areas with occupational exposure to biohazardous materials § Provide a confidential medical evaluation and follow-up for any employee who has an exposure incident § Provide training to employees Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 56

Needlestick Safety and Prevention Act § Passed by Congress in 2000 § Centers for Disease Control and Prevention (CDC) estimated 600, 000 to 800, 000 needle sticks occur each year § OSHA revised Bloodborne Pathogen Standard to requirements of this act Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 57

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 58

Employer Requirements (continued) § Maintain a sharps injury log § Ensure that every employee uses standard precautions at all times Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 59

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 60

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 61

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 62

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 or blood tests Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 63

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 64

Masks and Protective Eyewear or Face Shields § Worn during procedures that may cause splashing or spraying § Prevents exposure of the mucous membranes of the mouth, nose, and eyes § Masks are used once and discarded – change every 30 minutes following correct procedure and immediate handwashing Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 65

Masks and Protective Eyewear or Face Shields (continued) § Protective eyewear and face shields protect front, top, bottom, and sides of eyes § If not disposable, must be cleaned and disinfected before reuse Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 66

Sharp Objects § Use extreme caution to avoid cuts or punctures § When possible, use safe needles or needleless system § Follow policies regarding handling needles § Use sharps containers § Follow laws regarding disposal of sharps Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 67

Spills and Splashes § § § Wipe up immediately Wear gloves when wiping up Use disposable cleaning clothes Use disinfectant with 10% bleach solution Clean all contaminated surfaces For large spills, can use absorbent powder Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 68

Resuscitation Devices § Use to avoid the need for mouth-to-mouth resuscitation, whenever possible § Place in convenient location that is readily accessible Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 69

Waste and Soiled Linen § Wear gloves § Follow agency policy § Use biohazard

Reporting Cuts and Injuries § Report any cut or injury, needle stick, or splashing of blood or body fluids immediately § Follow agency policy Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 71

Summary § Standard precautions must be followed at all times by all health care workers § Observing these precautions can help break the chain of infection § Allow health care workers to protect themselves, their patients, and all other individuals Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 72

13: 4 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 73

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 Follow agency policy for sterile supplies Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 74

13: 5 Using Chemicals for Disinfection § May not kill spores and viruses § Disinfect, but do not sterilize § Used to disinfect instruments that do not penetrate body § Preparation of items § Chemical solutions used Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 75

Using Chemicals for Disinfection (continued) § § § Read manufacturer’s instructions Antirust tablets or solutions added at times Requirements for chemical disinfection Chemical must completely cover items Care of chemical solutions Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 76

13: 6 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 77

Cleaning with an Ultrasonic Unit (continued) § Care of glass beakers § Care of the permanent tank § Read manufacturer’s instructions before using any ultrasonic unit Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 78

Summary § Different methods provide different levels of aseptic control § Method used depends on equipment available and level of aseptic control required § Read manufacturer’s instructions § Clean, rinse, and dry all equipment before processing § Handle items carefully after processing Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 79

13: 7 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 80

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 81

Using Sterile Techniques (continued) § Clean working area required § Handling of sterile supplies § Sterile field: area used for placement of sterile supplies § Rules of working within sterile area Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 82

Removing Articles from Sterile Wraps § Drop technique § Mitten technique § Transfer forceps

Wet Surfaces § Organisms and pathogens travel quickly through wet surfaces § If sterile item gets wet, contamination has occurred § Use extreme care while pouring solutions into sterile bowls Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 84

Sterile Gloves § Worn while performing sterile technique § Make sure tray is open and all sterile items are ready before putting sterile gloves on your hands § Are sterile on the outside and contaminated on the inside § Observe correct technique when putting on sterile gloves Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 85

Sterile Gloves (continued) § When gloves are on, hold hands away from body and above waist § Handle only sterile objects when wearing sterile gloves § Change gloves any time contamination occurs Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 86

Sterile Dressings § Obtain proper authorization § Use an infectious waste bag § Wear disposable gloves for removing a dressing § Note type, color, and amount of drainage on dressing § Put on sterile gloves to cleanse area and apply new dressing Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 87

Sterile Dressings (continued) § Cleanse wound or incision with correct technique § Apply inner and outer dressing, taking care to maintain sterility of dressings § Remove sterile gloves properly and dispose of properly Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 88

Sterile Dressings (continued) § Apply tape correctly to hold dressing in place § If contamination occurs at any time during the procedure, start over § Commercially prepared sterile supplies are widely available Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 89

13: 8 Maintaining Transmission. Based Isolation Precautions § Some diseases are communicable – caused by organisms that can be transmitted easily § These precautions are in addition to the Standard Precautions Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 90

Maintaining Transmission-Based Isolation Precautions (continued) § Help prevent spread of disease to others § Protects patient, family, and health care workers § Type used depends on the causative organism of the disease Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 91

How Communicable Diseases Spread § Direct contact with a patient § Contact with dirty linen, equipment, and supplies § Contact with blood, body fluids, secretions, and excretions Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 92

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 93

Classifications of Precautions § § Standard precautions Airborne precautions Droplet precautions Contact precautions Copyright

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 95

Summary § Exact procedures for maintaining transmission-based isolation will vary from one facility to another § Variations caused by different factors § Know and follow procedures at your facility § Basic principles remain the same in any facility and are directed toward preventing the spread of disease Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 96