chapter © 2011 the mcgraw-hill companies, inc. all rights reserved. 3 infection control techniques

CHAPTER

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3Infection Control

Techniques

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33-2

Introduction

• Patients coming to the office for treatment may be more susceptible to infections

• Immunizations and patient education are important methods of infection control

You will be introduced to Occupational Safety and Health Administration (OSHA) guidelines, the Blood-Borne Pathogen Standard, reporting

guidelines, and isolation procedures.

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MA’s Role in Infection Control

• To control infectious diseases, the cycle of infection must be broken

• Apply principles of infection control in office setting

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MA’s Role in Infection Control (cont.)

• Follow correct sanitization, disinfection, and sterilization procedures

• Help patients understand basic disease prevention

• Educate patients about immunizations

• Administer immunizations

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Apply Your Knowledge

What is your role as a medical assistant in controlling infection in the medical office?

ANSWER: To apply principles of infection control by following correct sanitization, disinfection, and sterilization procedures.

Correct!

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Infection Control Methods

• Eliminate elements needed for disease to occur

• Knowledge of – Medical asepsis

• Based on cleanliness• As few microorganisms as possible

– Surgical asepsis• Sterile environment• No microorganisms

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Medical Asepsis

• Keep office clean:– Reception area: sick vs. well

patients– Reception room clean, well

lit, and ventilated – Keep furniture in good repair– Strict “no food or drink”

policy– Empty trash as necessary

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Medical Asepsis (cont.)

• During medical assistant procedures– Prevent cross-contamination

• Hand washing– Beginning of day– After breaks – Before and after each patient– Before and after handling

equipment or specimens– After blowing your nose or

coughing

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33-9

Medical Asepsis (cont.)

• Other precautions– Avoid leaning against sinks, supplies,

equipment– Avoid touching your face and mouth– Use tissues when you cough or sneeze, and

always wash your hands afterward– Avoid working directly with patients when you

have a cold; wear gloves and mask if you must

– Stay home if you have a fever

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Apply Your Knowledge

Describe the difference between medical and surgical asepsis.

ANSWER: Medical asepsis is based on cleanliness and reducing the number of microorganisms as much as possible. Surgical asepsis is maintaining a sterile environment by eliminating all microorganisms.

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Sanitization• Scrubbing with a brush and

detergent to remove blood, mucus, and other contaminants or media where pathogens can grow

• For cleaning items that touch only healthy, intact skin

OR• First step in disinfection and

sterilization for other equipment

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Sanitization (cont.)

• Collect items for sanitization– Place in water and special

detergent solution– Use utility gloves– Separate sharps from other

equipment

• Scrub items– Follow manufacturers’

guidelines– Dry thoroughly– Examine carefully

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Sanitization (cont.)

• Rubber and plastic items

• Syringes and needles – use disposable whenever possible

• Ultrasonic cleaning – For delicate instruments and those with

moving parts– Sound waves generated through a cleaning

solution to loosen contaminants

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Apply Your Knowledge

What is sanitation, and what types of items is it adequate for cleaning?

ANSWER: Sanitation is scrubbing with a brush and detergent to remove blood, mucus, and other contaminants or media where pathogens can grow. It is adequate for cleaning items that touch only healthy, intact skin.

Nice Job!

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Disinfection

• Adequate for instruments that do not penetrate skin or mucous membranes and surfaces not considered sterile

OR

• Second step in infection control prior to sterilization

• Will not kill spores, certain viruses

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Disinfection (cont.)

• Using disinfectants– Cleaning products

applied to inanimate materials to reduce or eliminate infectious organisms

• Antiseptics are anti-infective cleaning agents used on human tissue

– Follow manufacturers’ guidelines

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Disinfection (cont.)

– Factors impacting effectiveness of disinfectants

• Number of times solution is used• Wet items – surface moisture may

dilute solution• Traces of soap left from

sanitization – alters chemical composition

• Evaporation

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Disinfection (cont.)

• Choose the correct disinfectant– Germicidal soap products– Alcohol– Acid products– Formaldehyde– Glutaraldehyde – “cold

disinfection”– Bleach– Iodine and iodine compounds

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Disinfection (cont.)

• Handling disinfected supplies

– Prevent contamination with other surfaces

– Use sterile transfer forceps

– Wear gloves

– Store in clean, moisture-free environment

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Apply Your Knowledge

What is the difference between a disinfectant and an antiseptic?

ANSWER: Disinfectants are cleaning products applied to inanimate materials to reduce or eliminate infectious organisms. Antiseptics are anti-infective cleaning agents used on human tissue.

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Surgical Asepsis• Goal is to keep the

surgical environment completely free of all microorganisms

• Used for even minor operations and injections

• The more extensive the procedure, the greater the risk of infection

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Sterilization• Required for all instruments or supplies that

– Penetrate the skin– Contact normally sterile areas of the body

• Object is either sterile or not sterile– If unsure of sterility, consider it not sterile

• Prior to sterilization– Sanitize– Disinfect

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The Autoclave• Primary method of

sterilization

– Pressurized steam

– Operates at lower temperatures than dry heat sterilization

– Moisture causes coagulation of proteins in microorganisms at lower temperatures

• Cell walls burst when cell cools, killing the microorganism

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The Autoclave (cont.)

• Wrap sanitized and disinfected items– Special porous fabric,

paper, or plastic– Items should not touch– Label

• Check water level – distilled water only

• Preheat, but do not overheat

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The Autoclave (cont.)

• Load, choose correct setting, run cycle

– Temperature 250°to 270°F

– Pressure 15 to 30 pounds

• Unload

• Store items properly

– Clean, dry location

– Shelf life based on packaging, but generally 30 days

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The Autoclave (cont.)

• Clean autoclave and area

• Quality control checks– Sterilization indicators –

confirm that items have been exposed to correct volume of steam at the correct temperature for the correct length of time

– Biological indicators – contain bacterial spores and confirm that sterilization occurs

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The Autoclave (cont.)

• Prevent incomplete sterilization– Correct timing– Adequate temperature– Properly wrapped packs– Adequate steam levels

• Timing– Preset for load types– Use sterilization indicators

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The Autoclave (cont.)

• Temperature – Too high – steam too little moisture– Too low – steam too much moisture

• Do not overcrowd autoclave

• Steam level – If incorrect, items will not be sterile at end of

cycle

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Sterile Technique

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Surgical Asepsis

• During surgical procedures– Do not touch sterile items

without sterile gloves or transfer forceps

– Aseptic technique• Throughout surgical procedures• Caring for surgical wounds

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Surgical Asepsis (cont.)

• After procedures– Sanitize, disinfect, and sterilize reusable

items– Disinfect surfaces

• Waste disposal– Biohazard waste containers

• Leak-proof containers either color-coded red or labeled with biohazard symbol

– Biohazardous materials• Biological agents that can spread disease

to living things

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Apply Your Knowledge

ANSWER: Sterilization is required for all instruments or supplies that penetrate the skin or come in contact with normally sterile areas of the body.

1. What items need to be sterilized?

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Apply Your Knowledge

ANSWER: Use medical asepsis while preparing the patient, and then use surgical asepsis during the procedure.

2. The physician is going to remove a small growth from your patient’s back. In order to prepare for this procedure, what steps would you take to prevent the spread of infection?

Right!

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OSHA Guidelines

• Blood-Borne Pathogen Standards– Protect health-care workers from health

hazards on the job– Also protect patients and others who come to

medical facilities– Dictate how to handle infectious or potentially

infectious wastes• Discarded • Held for processing

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OSHA Guidelines (cont.)

• Blood-Borne Pathogen Standards – Measures to prevent the

spread of infection– Provide a margin of safety

by ensuring that medical facilities meet minimal standards for asepsis

– Requirements for training, keeping records, housekeeping, and personal protective gear

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OSHA Guidelines (cont.)

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OSHA Guidelines (cont.)

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OSHA Guidelines (cont.)

• Categories of tasksI. Tasks that expose a worker to blood, body

fluids, or tissues and require specific protective measures

II. Tasks that usually do not involve risk of exposure but require precautions in certain situations

III. Tasks that have no risk of exposure, so no special protection is required

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Respiratory Hygiene/Cough Etiquette

• Guidelines established by CDC – Education– Posting signs– Controlling source or transmission– Proper hand hygiene– Separating patients with respiratory infections

from other patients

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Personal Protective Equipment

• Protective gear worn to protect against physical hazards

• Employers must provide PPE at no charge to the employee

• Disposable, sterile exam and utility gloves

• Masks and protective eyewear or face shields

• Protective clothing

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Postprocedure Cleanup• Decontaminate all

exposed surfaces

• Replace protective coverings on surfaces or equipment

• Decontaminate receptacles

• Pick up any broken glass with tongs

• Discard all potentially infectious waste materials

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OSHA Guidelines (cont.)

• Apply guidelines daily on the job

• Exposure incidents– Contact with infectious substance– Rules apply to all serious infections – HIV,

HBV– HBV vaccine

• Transmission to patients– Nosocomial infection – an infection acquired

by a patient in a health-care facility

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Apply Your Knowledge

ANSWER: There are three categories of risk:Category 1: Expose a worker to blood, body fluids, or

tissues and require specific protective measuresCategory 2: Usually do not involve risk of exposure, but

precautions are required in certain situationsCategory 3: No risk of exposure, so no special protection is

required

OSHA divides medical tasks by level of risk. What are these risk categories?

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Reporting Guidelines

• Certain diseases must be reported to state or county health department

• Information is forwarded to the CDC – control of the spread of infection

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Reporting Guidelines (cont.)

• National Notifiable Disease Surveillance System (Table 33-2)

– Examples • HIV/AIDS Cholera• Rubella Hepatitis• Legionellosis Lyme disease• Mumps Smallpox• Tetanus Tuberculosis

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Apply Your Knowledge

How is the information on reportable diseases used by the CDC?

ANSWER: The CDC uses the information reported to them to help control the spread of infection.

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Isolation Guidelines

• CDC guidelines – Types of precautions needed– Patients requiring precautions

• Create an environment that protects against pathogens

• Standard Precautions

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Isolation Guidelines (cont.)

• Select appropriate PPE– Gloves– Masks, face shields,

respirators– Gowns

• Table 33-3

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Apply Your Knowledge

Mrs. Findley brings her child with chickenpox into the medical office. What type of personal protective equipment should you use when caring for this child?

ANSWER: Chickenpox requires airborne and contact precautions, so you should use gloves and a mask and goggles or a respirator.

Nice!

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Immunizations

• Immunization– Administration of a vaccine

or toxoid to protect susceptible individuals from infectious diseases

• Reduces risk of infection spread– Decreases the susceptibility

of the host

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Immunization Recommendations

• Immunization schedules for children– Advisory Committee on Immunization

Practices– American Academy of Pediatrics– American Academy of Family Physicians

• Immunization schedules for adults– The National Coalition of Adult Immunization

(NCAI)

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Immunizations (cont.)

• When administering, you must explain– The need for immunization– Side effects

• Soreness at site• Low-grade fever• General malaise

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Immunizations (cont.)

• Concerns– Pediatric patients

• Do not give if child has fever

• Informed consent – explain benefits and risks

• Contraindications – symptoms that render the use of a remedy or procedure inadvisable because of the risk

• Immunization records– National Childhood Vaccine Injury Act of 1988– Instruct parents keep record as proof of immunization

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Immunizations (cont.)

– Pregnant patients• Avoid live virus vaccines• FDA categories A, B, C, D, and X

– Elderly• Dispel common misconception and cost

concerns• More likely to develop side effects

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Immunizations (cont.)

– Immunocompromised patients• May experience minimal to dangerous effects• Adjust dosage or delay administration• Must also consider immunization status of family

and caregivers

– Health-care workers• Hepatitis B vaccination

offered by employer at nocost to employee

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Apply Your Knowledge

What is an immunization?

ANSWER: An immunization is the administration of a vaccine or toxoid to protect susceptible individuals from infectious diseases.

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Preventing Disease Transmission

• Patient education– Health promotion – Disease prevention– Disease treatment

• Medical assistant role in patient education– Share responsibility– Reinforce and explain instructions

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Preventing Disease Transmission (cont.)

• Educate patient on – Nutrition and diet– Exercise and weight control– Prevention of STDs– Smoking cessation– Alcohol and drug abuse prevention and

treatment– Proper use of medications and prescribed

treatments– Stress-reduction techniques

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Preventing Disease Transmission (cont.)

• Goal of patient education– Help patients take care of

themselves

• Encourage patients to participate actively in their own health care

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Apply Your Knowledge

What three areas should patient education focus on? What is the medical assistant’s role in patient education?

ANSWER: Patient education should focus on health promotion, disease prevention, and disease treatment.

The medical assistant shares responsibility with the physician and other staff members and should reinforce and explain instructions given by others.

Bravo!

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Soap and education are not as sudden as a massacre, but they are more deadly in the long run.

~ Mark Twain

End of Chapter 3