Infection Control for Future Health Professionals

Washing Hands • Major aspect of standard precautions• Most important aseptic technique• Hands are perfect media for the spread

of pathogens

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Asepsis• The absence of disease producing microorganisms, or

pathogens.• Any object or area that may contain pathogens is considered

to be contaminated.

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Purpose of Handwashing• Prevent and control spread of pathogens• Protect the health care worker from disease and illness

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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

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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

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Principles of Handwashing• Use soap as a cleansing agent

• Soap aids in the removal of germs through its sudsy action and alkali content

• 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

• With an orange stick, brush, or rub against the palms

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Chain of Infection• The chain of infection is process involving:

• A source or the causative agent• Reservoir (host) where it can live• Portal of exit or a way to escape from the reservoir• Mode of transmission in order to travel to another reservoir or

host to live• Portal of entry (same as the portal of exit) is how the source gets

into the reservoir• Susceptible host-a person likely to get an infection or disease

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SOURCE• IS THE PATHOGEN • EXAMPLE E. COLI

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RESERVOIR• WHERE IT CAN

GROW AND MULTIPLY

• E. COLI NOMRALLY LIVES IN THE COLON

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PORTAL OF EXIT EXITS ARE THE

RESPIRATORY, GI, URINARY, & REPRODUCTIVE TRACTS, BREAKS IN SKIN, BLOOD

A BOWEL MOVEMENT IS A PORTAL OF EXIT

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METHOD OF TRANSMISSION• FAILURE TO PROPERLY

WASH HANDS AFTER BOWEL MOVEMENT LEAVES FECAL MATERIAL ON HANDS

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PORTAL OF ENTRY• PORTALS OF ENTRY &

EXIT ARE THE SAME

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SUSCEPTIBLE HOST• PERSONS AT RISK FOR

INFECTION:• VERY YOUNG OR OLD• ILL• WERE EXPOSED TO THE

PATHOGEN• DO NOT FOLLOW INFECTION

CONTROL PRACTICES

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Microorganisms orMicrobes• 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

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An aerobic organism or aerobe is an organism that can survive and grow in an oxygenated environment. An anaerobic organism can not grow and survive in an oxygenated environment.

Microorganisms orMicrobes (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

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Microbe Classifications• Bacteria• Protozoa• Fungi • Rickettsiae • Viruses

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

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

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Diseases from Bacterial Cocci• Diplococci-gonorrhea, meningitis, pneumonia• Streptococci-strep throat, rheumatic fever• Staphylococci-boils, wound infections, toxic shock

Bacteria – Bacilli• Rod-shaped• Occur singly, in pairs, or in chains• May have flagella• Ability to form spores (thick

walled capsules

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Diseases from Bacterial Bacilli• Tuberculosis• Tetanus• Pertussis• Botulism• Diphtheria• Typhoid

Bacteria – Spirilla• Spiral or corkscrew shape• Includes comma-shaped vibrio and corkscrew spirochete• Diseases include syphilis and cholera

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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

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Protozoa • One-celled, animal-like organism• Found in decayed materials and

contaminated water• May have flagella for movement• Some are pathogenic• Examples of diseases

• Malaria• Amebic dysentery• Trichomonas• African sleeping disease

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Fungi • Simple, plant-like organisms• Live on dead organic matter• Yeast and molds • Can be pathogenic• Examples of diseases

• Ringworm• Athlete’s foot• Histoplasmosis• Yeast vaginitis• Thrush

• Antibiotics do not kill• Antifungal medications

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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• Typhus fever• Rocky Mountain Spotted Fever

• Antibiotics are effective against many of them C

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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• Examples: measles & mumps

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Health Care Workers• Major concerns:

• Hepatitis B• Hepatitis C• HIV

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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

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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

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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

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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

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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

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Bloodborne Pathogen Standards• OSHA established standards for contamination with blood and body

fluids that must be followed by all health care facilities in 1991 • Must be followed by all health care workers• Civil penalties if not implemented and followed

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Bloodborne Pathogen Standards• Some of the regulations that must be followed:

• Written exposure plan• Provide Hepatitis B free of charge to all employees who have

potential for exposure• Provide PPE:

• Gloves• Gowns• Masks• Lab coats• Face shields

• Adequate handwashing facilities, containers for infectious or biohazardous wastes

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Needlestick Safety and Prevention Act• In 2001 OSHA revised the standard in response to the

Needlestick Safety and Prevention Act• Identify safer medical devices• Use safer medical devices• Make annual changes to exposure control plan• Input from direct care staff• Sharps injury log

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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

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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

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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• Always wear (even if you ANTICIPATE)

• contact with blood• body fluids• Excretions• secretions• mucous membranes• non-intact skin• tissue or cell specimens

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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

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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

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

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

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Sharp Objects• Use extreme caution to avoid cuts

or punctures• Leave uncapped after use• When possible, use safe needles or

needleless system• Follow policies regarding handling needles• Use sharps containers• Follow laws regarding disposal of sharps

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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

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Resuscitation Devices• Use to avoid the need for mouth-to-mouth resuscitation,

whenever possible• Place in convenient location that is

readily accessible

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Waste and Soiled Linen• Wear gloves • Follow agency policy• Use biohazard bags appropriately

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Reporting Cuts and Injuries• Report any cut or injury,

needle stick, or splashing of blood or body fluids immediately

• Follow agency policy

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Maintaining Transmission-Based Isolation Precautions• Some diseases are communicable (contagious)– caused by

organisms that can be transmitted easily• Extra precautions must be used in addition to the Standard

Precautions• Help prevent spread of disease to others• Protects patient, family, and health care workers• Type used depends on the causative organism of the disease

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How Communicable Diseases Spread• Direct contact with a patient• Contact with dirty linen, equipment, and

supplies• Contact with blood, body fluids,

secretions, and excretions• Droplets from sneezing, coughing, or

spitting• Discharges from wounds

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Classifications ofPrecautions• Standard precautions• Airborne precautions• Droplet precautions• Contact precautions

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Protective orReverse 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

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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

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Nosocomial Infections • 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• Common examples are staphylococcus, pseudomonas,

enterococci• Infection control programs are used to prevent and deal with

nosocomial infections

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Common Body Defenses• Mucous membranes• Cilia• Coughing and sneezing• HCL in the stomach• Tears• Fever• Inflammation response – leukocytes• Immune response – antibodies and cell secretion

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Antiseptics • 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

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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

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Sterilization • Destroys all microorganisms• Steam under pressure, gas,

radiation, and chemicals

• Autoclave is the most common equipment used

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Sterile Technique• 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• Correct techniques must be

strictly followed to maintain sterility and prevent contamination

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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

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