MA114 Chapter 19 infection control

MA114

1. Infection Control Chapter 19 1

2. 2 Describe the characteristics of pathogenic microorganisms. Do the following related to the chain of infection: Apply the chain of infection process to the healthcare practice. Compare viral and bacterial cell invasion. Differentiate between humoral and cell-mediated immunity. Summarize the impact of the inflammatory response on the body’s ability to defend itself against infection. Analyze the differences among acute, chronic, latent, and opportunistic infections.

3. Disease Any sustained, harmful alteration of the normal structure, function, or metabolism of an organism or cell Genetic, drug-induced, autoimmune, degenerative, communicable, or infectious An unaffected person (carrier) can transmit infection to another person 3

4. Chain of Infection Infectious agent Reservoir host Portal of exit Mode of transmission Portal of entry Susceptible host 4

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6. Viruses Smallest of all pathogens Intracellular parasites that take over DNA or RNA of invaded cell Interferon produced by cells helps protect cells from viruses Treatment is palliative (relief of symptoms) 6

7. Bacteria Tiny, simple cells that produce disease in a variety of ways Classified according to their shape, or morphology Cocci (spherical) Bacilli (rod shaped) Spirilla (spiral shaped) 7

8. Antibiotic Resistance One of the world’s most significant public health problems Resistance occurs when an antibiotic is used inappropriately to treat an infection Prescribe antibiotic therapy only when it will benefit the patient Treat the patient with an antibiotic that is specific to the infecting pathogen Prescribe the recommended dose and treatment duration of the medication 8

9. Fungi Include such organisms as mushrooms, molds, and yeasts Grow best in warm, moist environments Treatment with antifungal agents 9

10. Protozoa Unicellular parasites that can replicate and multiply rapidly once inside host Frequently are seen in tropical climates 10

11. Reservoirs Second link in chain of infection May be people, insects, animals, water, food, or contaminated instruments Must gain entrance into a host or else they will die Reservoir host supplies nutrition for organism, allowing it to multiply 11

12. Portal of Exit How pathogen escapes reservoir host Exits include mouth, nose, eyes, ears, intestines, urinary tract, reproductive tract, and open wounds Use Standard Precautions to help control spread of infection 12

13. Transmission Direct transmission occurs from contact with infected person or discharges from infected person Indirect transmission occurs from: Droplets in air expelled by coughing, speaking, or sneezing Vectors that harbor pathogens Contaminated food or drink Contact with contaminated objects (called fomites ) 13

14. Portal of Entry How transmitted pathogen gains entry into a new host May be mouth, nose, eyes, intestines, urinary tract, reproductive system, or an open wound Anatomic defenses include integumentary system, tears, cilia, mucous membranes, and pH of body fluids Second line of defense is immune system and inflammatory process Humoral immunity Cell-mediated immunity 14

15. Inflammatory Response Process results in four classic symptoms of inflammation: Erythema (redness) Edema (swelling) Pain Heat 15

16. Inflammatory Response Inflammation mediators are released and cause three different responses at cellular level Blood vessels at the site dilate Release of white blood cells (WBCs) to the site Chemotaxis, or release of chemical agents, occurs, attracting even more WBCs to the site 16

17. Acute Infection Rapid onset of symptoms but lasts a relatively short time Prodromal period is the time when patient first shows vague, nonspecific symptoms of disease Symptoms appear after the tissue damage begins 17

18. Chronic Infection Persists for a long period, sometimes for life Some chronic infections are asymptomatic, but virus is transmissible 18

19. Latent Infection Persistent infection in which symptoms cycle through periods of relapse and remission Examples include cold sores, genital herpes, and varicella 19

20. Opportunistic Infections Caused by organisms not typically pathogenic but occur in hosts with an impaired immune system response 20

21. OSHA standards Asepsis Do the following related to the Occupational Safety and Health Administration (OSHA) standards for the healthcare setting: Specify potentially infectious body fluids. Integrate OSHA’s requirement for a site-based exposure control plan into facility management procedures. Explain the major areas included in the OSHA Compliance Guidelines. Discuss protocols for disposal of biologic chemical materials. Remove contaminated gloves while following the principles of Standard Precautions. Summarize the management of post-exposure evaluation and follow-up and participate in bloodborne pathogen training and a mock exposure event. 21

22. OSHA Standards, Asepsis, and Sanitization Apply the concepts of medical and surgical asepsis to the healthcare setting. Discuss proper hand washing and demonstrate the proper hand washing technique for medical asepsis. Differentiate among sanitization, disinfection, and sterilization procedures, and select barrier/personal protective equipment while demonstrating the correct procedure for sanitizing contaminated instruments. Discuss the role of the medical assistant in asepsis. 22

23. OSHA Standards for the Healthcare Setting Universal Precautions: All blood and certain body fluids must be treated as if known to be infectious for blood-borne pathogens Precautions must be implemented for all patients, regardless of the information available about person’s individual health history 23

24. Potentially Infectious Materials Body fluids Semen Vaginal secretions Cerebrospinal fluid (CSF) Synovial fluid Pleural fluid Peritoneal fluid Amniotic fluid Saliva in dental procedures Any body fluid that is visibly contaminated and in situations in which it is difficult/impossible to differentiate between body fluids 24

25. OSHA’s Bloodborne Pathogens Standard Needlestick Safety and Prevention Act Employers must keep a confidential sharps injury log that describes the device involved and details of how and where incident occurred Parenteral exposure includes accidental needlesticks, occupation-related human bites, and exposure of nonintact skin 25

26. CDC’s Hand Hygiene Recommendations Visibly soiled hands Wash a minimum of 15 seconds with antimicrobial soap and warm, running water Alcohol-based hand rubs Used before and after contact with each patient, and also after removing gloves To use properly, apply the label-recommended amount to palm of one hand and rub hands together, covering all surfaces until hands are dry Healthcare workers with artificial nails have more pathogenic microbes under their nails Natural nail tips should be no longer than ¼ inch 26

27. Barrier Protection Barrier protection, or PPE, includes specialized clothing or equipment that prevents the healthcare worker from coming into contact with blood or other potentially infectious material Disposable gloves, face masks, face shields, protective glasses, shoe covers, laboratory coats, barrier gowns, mouthpieces, and resuscitation bags 27

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29. When Gloves Must Be Worn Touching a patient’s blood, body fluids, mucous membranes, or skin that is not intact Handling items and surfaces contaminated with blood and body fluids Performing venipuncture, finger sticks, injections, and other vascular procedures Assisting with any surgical procedure Handling, processing, and disposing of all specimens of blood and body fluids Cleaning and decontaminating spills of blood or other body fluids 29

30. Using Standard Precautions to Remove Contaminated Gloves The goal is minimize exposure to pathogens by aseptically removing and discarding contaminated gloves 30

31. Environmental Protection Refers to minimizing risk of occupational injury by isolating or removing any physical or mechanical health hazard in medical workplace Read warning labels on biohazard containers and equipment Minimize splashing or spraying of potentially infectious materials Bandage any breaks or lesions on your hands before gloving 31

32. Environmental Protection If any body surface is exposed to potentially infectious material, scrub area with antimicrobial soap and warm, running water as soon as possible after exposure If your eyes come into contact with body fluids, continuously flush them with water as soon as possible for a minimum of 15 minutes using an eye wash unit Contaminated needles and other sharps should never be recapped, bent, broken, or resheathed 32

33. Environmental Protection Contaminated sharps should not be processed in a way that requires employees to reach into containers to grasp them Immediately after use, dispose of syringes and needles, scalpel blades, and other sharp items in a labeled, leak-proof, puncture-resistant biohazard container All specimens must be placed in a container that prevents leakage during collection, handling, processing, storage, transport, and shipping 33

34. Environmental Protection Equipment requiring repair that has been contaminated with blood or body fluids should be decontaminated before being repaired in the office or transported for repair Smoking, eating, drinking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is reasonable likelihood of contamination from pathogens Food and beverages cannot be kept in refrigerators, freezers, or cabinets or on countertops where infectious materials could be present 34

35. Housekeeping Controls Work surfaces must be immediately decontaminated with a disinfectant after accidental spills of blood or body fluids, at end of each procedure, and at end of each shift Disinfection and decontamination of all reusable containers must be done on a routine basis Sharps containers must be as close as possible to work area Never pick up spilled material or broken glassware with the hands 35

36. Housekeeping Controls Handle soiled linen as little as possible and always wear gloves or other protective equipment during disposal Contaminated materials and/or infectious waste must be handled with extreme caution to prevent exposure 36

37. Protocols for Disposal of Biologic Chemical Materials Biomedical waste should be collected in containers that are leakproof and strong Workers who handle biomedical waste should observe Standard Precautions Biologic waste containers/boxes should not be held in healthcare facilities for more than 30 days Sharps are instruments intended to cut or penetrate the skin Boxes for disposal of chemicals should be labeled with the chemicals’ names and any other pertinent data 37

38. Hepatitis B Vaccination Must be available free of charge to all employees at risk for exposure Intramuscular injection in three doses 38

39. Postexposure Follow-Up Wash or flush exposed area and receive confidential medical evaluation File incident report and screen and test person for HBV, HCV, and HIV Receive copy of physician’s written opinion within 15 days of evaluation Receive health counseling about risks and adverse outcomes 39

40. Aseptic Techniques Asepsis Free from infection or infectious material Medical asepsis Destruction of disease-causing organisms after they leave the body Surgical asepsis Destruction of organisms before they enter the body 40

41. Bacteria on the Skin Transient bacteria Surface bacteria introduced by fomites Resident bacteria Found under fingernails, in hair follicles, openings of sebaceous glands, and deeper layers of skin Most effective barrier against infection is unbroken skin 41

42. Hand Hygiene Wash correctly before and after every patient Warm water, antimicrobial soap, friction Alcohol-based hand rubs may substitute unless hands are visibly contaminated 42

43. Sanitization Cleansing process that reduces number of microorganisms to a safe level Removes debris such as blood and other body fluids from instruments or equipment Wear gloves while performing sanitization 43

44. Ultrasonic Sanitization Sound waves can be used to sanitize instruments Instruments are placed in an ultrasonic bath of cleaner and water 44

45. Disinfection Process of killing pathogenic organisms or of rendering them inactive Disinfecting agents vary in effectiveness and must be used according to instructions 45

46. Levels of Disinfectants CDC defines three levels of disinfectants: Low-level disinfectants can kill most vegetative bacteria, some fungi, and some viruses Intermediate-level disinfectants can kill mycobacteria, vegetative bacteria, most viruses, and most fungi, but they do not kill spores High-level disinfectants will kill all microorganisms except large numbers of bacterial spores 46

47. Common Errors in Disinfection Instruments are not thoroughly sanitized; attached organic matter inhibits or prevents action of disinfectant Sanitized instruments are not dried Disinfectant solution is left in an open container; evaporation changes its concentration Solutions are not changed after the recommended period Solutions are not prepared properly or are not mixed properly Manufacturer’s recommended temperature for use and storage are not maintained 47

48. Sterilization Destruction of all microorganisms Essential for surgical asepsis Area should be set aside in each office for sterilization Clear, clean plastic bags in which to store sterile packs may be kept in sterile area 48

49. Role of the Medical Assistant in Asepsis Spread of pathogens can be controlled only through application of the Bloodborne Pathogens Standard and by proper sanitization, disinfection, and sterilization of supplies, equipment, and work surfaces 49

50. Patient Coaching While washing your hands, explain to the patient that this routine is part of daily hygiene Advise patient to carry an alcohol-based hand rub and use it throughout the day Explain the use of disposable tissues or bent elbow to cover nose and mouth when coughing or sneezing Discuss proper ways of discarding used tissues Instruct patient in the differences between sterile and clean dressings and bandages 50

51. Suggestions for Asepsis and Infection Control Education Set up an information table in the waiting room with take-home pamphlets and literature Mail, e-mail, or post a periodic newsletter to patients about infection control Demonstrate and explain aseptic procedures to patients and family members 51

52. Legal and Ethical Issues It is imperative that disinfection and sterilization are performed precisely and effectively Carelessness can cause nosocomial infections in patients 52

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