1. Chapter 14
Infection Control

2. 14:1 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 transmission

3. 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
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4. 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
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5. Microorganisms or Microbes (continued)
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

6. Microbe Classifications
Bacteria
Protozoa
Fungi
Rickettsiae
Viruses

7. Bacteria Simple, one-celled organisms Multiply rapidly
Classified by shape and arrangement
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8. Bacteria (continued) Cocci are round or spherical in shape
Diplococci—in pairs
Streptococci—in chains
Staphylococci—clusters or groups
Examples of diseases
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9. Bacteria (continued) Bacilli are rod shaped Examples of diseases
Occur singly, in pairs, or in chains
May have flagella
Ability to form spores
Examples of diseases
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10. Bacteria (continued) Spirilla are spiral or corkscrew shaped
Includes comma-shaped vibrio and corkscrew spirochete
Diseases include syphilis and cholera

11. 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

12. Protozoa One-celled, animal-like organism
Found in decayed materials and contaminated water
May have flagella for movement
Some are pathogenic
Examples of diseases

13. 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

14. 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

15. 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
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16. Viruses (continued)
Viruses infecting animals can mutate to infect humans
Examples include:
Severe acute respiratory syndrome (SARS)
West Nile Virus (WNV)
Monkeypox
Ebola and Marburg
H5N1

17. 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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18. 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, written statement must be signed documenting refusal

19. 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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20. Hepatitis C (continued)
Currently, no vaccine ready for use
Vaccine is in development stage
Extremely difficult to destroy HVC
Can survive and remain active for several days in dried blood
Health care workers must follow precautions to protect against virus

21. 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
Take precautions for prevention

22. Helminths Multicellular parasites otherwise known as worms or flukes
Are transmitted:
By eating contaminated food
Being bitten by infected insects
When worms enter the skin

23. 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

24. Classifications of Diseases and Infections
Endogenous
Exogenous
Nosocomial
Opportunistic

25. Endogenous Originates within the body
Examples: metabolic disorders, congenital abnormalities, tumors, and infections caused by microorganisms within the body

26. Exogenous Originates outside the body
Examples: radiation, chemical agents, trauma, electric shock, and temperature extremes

27. Nosocomial Acquired in a health care facility
Usually present in facilities and carried by health care workers to the patient
Many are antibiotic-resistant
Can cause serious and even life-threatening infections
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28. Nosocomial (continued)
Examples are staphylococcus, pseudomonas, and enterococci
Infection-control programs are used in facilities to prevent and deal with nosocomial infections

29. 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

30. Chain of Infection
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

31. Common Body Defenses Mucous membranes Cilia Coughing and sneezing
HCL in the stomach
Tears
Fever
Inflammation response
Immune response

32. 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

33. Aseptic Techniques
Asepsis: absence of disease-producing microorganisms
Contaminated: any object or area that may contain pathogens
Major aim: maintaining cleanliness and eliminating or preventing every aspect of contamination

34. Common Aseptic Techniques
Thorough handwashing
Good personal hygiene
Disposable gloves
Cleaning instruments and equipment
Proper cleaning of environment

35. Levels of Aseptic Control
Antisepsis—used on the skin
Disinfection—used mainly on objects
Sterilization—use of steam under pressure, gas, radiation, and chemicals on objects

36. Summary
Important for health care workers to know and use proper aseptic techniques at all times
Prevents spread and transmission of disease

37. 14:2 Bioterrorism
Bioterrorism: use of microorganisms or biologic agents for warfare
Infecting humans, animals, or plants
Have been used over time by different nations not only in war but also on innocent people

38. Biologic Agents
Microorganisms with characteristics suitable for bioterrorism:
Inexpensive, available, easily produced, spreads quickly
Maintains its survival
Brings death or disability
Travels from person to person
Difficult to prevent/treat
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39. Biologic Agents (continued)
High priority agents include:
Smallpox: contagious and infectious disease, result of the Variola virus
Anthrax: infectious disease caused by Bacillus anthracis
Plague: infectious disease from the bacteria Yersinia pestis
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40. Biologic Agents (continued)
Botulism: paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinum
Tularemia: infectious disease from the bacteria Fracisella tularensis
Filoviruses: infectious diseases causing severe hemorrhagic fever known as Ebola virus and Marburg virus

41. Preparing for Bioterrorism
Bioterrorism attack would result in a public health emergency
Would have impact on health care facilities
Social disorder would ensue
Comprehensive plan
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42. Preparing for Bioterrorism (continued)
Bioterrorism Act 2002 passed by Congress and signed into law
Involves local, regional, state, and national government and includes:
Early detection by communities
Public to be notified
Infection control and education
Funding available
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43. Preparing for Bioterrorism (continued)
Guidelines and restrictions
Nationwide immunizations
Protection of food/water supplies
Trained personnel available
Emergency management controls
Investigation of potential threats
Preparation of health care facilities
Efficiency of communication

44. Summary All health care workers need to be aware of bioterrorism
Attack could occur at any time
Being prepared and properly trained will result in saving many lives

45. 14:3 Washing Hands Major aspect of standard precautions
Most important aseptic technique
Hands are perfect media for the spread of pathogens

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

47. Recommendations for Handwashing
Regular handwashing with plain soap and water
Antiseptic handwashing with antimicrobial soap and water
Antiseptic hand rub with alcohol-based cleaner (waterless)

48. When to Wash Hands On arrival at facility
Immediately before leaving facility
Before and after every patient contact
After contact with patient’s skin
Before moving from a contaminated site to a clean site
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49. When to Wash Hands (continued)
Anytime the hands become contaminated during a procedure
Before applying gloves
Immediately after removing gloves
When gloves are torn or punctured
Before and after handling specimens
After contact with any soiled or contaminated item
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50. When to Wash Hands (continued)
After picking up any item off the floor
After personal use of the bathroom
Following a cough, sneeze, or using a tissue
Before and after any contact with mouth or mucous membranes

51. Principles of Handwashing
Use soap as a cleansing agent
Use warm water
Use friction
Clean all surfaces
Point fingertips down
Use dry paper towels to turn faucet on and off
Clean nails

52. Waterless Hand Cleaning
Alcohol-based gel, lotion, or foam
Used if hands are not contaminated with blood or body fluids
Apply cleaner to palm of hand
Rub hands together vigorously for at least 15 seconds
After six to ten cleanings hands need to be washed with soap and water

53. 14:4 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 there is an area, object, or person contaminated with blood or body fluids

54. Bloodborne Pathogen Standards
Established in 1991 by OSHA
Must be followed by all health care workers
Civil penalties if not implemented and followed

55. Regulation Requirements
Written exposure control plan
Identify all employees with occupational exposure
Hepatitis B vaccines free of charge
Provide personal protective equipment
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56. 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
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57. 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)
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58. Regulation Requirements (continued)
Post signs at the entrance to work areas with occupational exposure to biohazardous materials
Red biohazard labels
Provide a confidential medical evaluation and follow-up for any employee with an exposure incident
Provide training to employees

59. Needle Stick Safety Act
Passed by Congress in 2000
Centers for Disease Control and Prevention (CDC) estimated 600,000 to 800,000 needle sticks per year
OSHA revised Bloodborne Pathogen Standard to requirements of this act

60. 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
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61. Employer Requirements (continued)
Maintain a sharps injury log
Ensure that every employee uses standard precautions at all times

62. 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

63. 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

64. 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

65. 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/blood tests

66. 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

67. Masks and Eye Protection
Worn during procedures that may cause splashing or spraying
Prevents exposure of mucous membranes of the mouth, nose, and eyes to pathogens
Use masks once then discard—change every 30 minutes if needed
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68. Masks and Eye Protection (continued)
Protective eyewear and face shields protect front, top, bottom, and sides of eyes
If not disposable, must be cleaned and disinfected before reuse

69. Sharp Objects Use extreme caution to avoid cuts and punctures
When possible, use safe needles or needleless system
Follow policies regarding needles
Use sharps containers
Follow laws regarding disposal of sharp objects

70. Spills or Splashes Wipe up immediately Wear gloves when wiping up
Use disposable cleaning clothes
Use disinfectant which contains 10% bleach solution
Clean all contaminated surfaces
For large spills, can use absorbent powder to absorb fluid

71. Resuscitation Devices
Use to avoid the need for mouth-to-mouth resuscitation
Place in convenient location that is readily accessible

72. Waste and Linen Disposal
Wear gloves
Follow agency policy
Use biohazard bags appropriately

73. Injuries
Report any cut or injury, needle stick, or splashing of blood or body fluids immediately
Follow agency policy

74. Summary
Standard precautions need to be followed at all times by every health care worker
Observing these precautions can help break the chain of infection
Health care workers can protect themselves, their patients, and all other individuals

75. 14:5 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
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76. 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

77. 14:6 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
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78. Using Chemicals for Disinfection (continued)
Read manufacturer’s instructions
Antirust tablets or solutions added
Requirements for disinfection
Chemical must completely cover items
Care of chemical solutions

79. 14:7 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
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80. Cleaning with an Ultrasonic Unit (continued)
Care of glass beakers
Care of the permanent tank
Read manufacturer’s instructions before using any ultrasonic unit

81. Summary Different methods provide different levels of aseptic control
Method used depends on equipment and level of aseptic control required
Read manufacturer’s instructions
Clean, rinse, and dry all equipment before processing
Handle all items carefully

82. 14:8 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
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83. 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
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84. Using Sterile Techniques (continued)
Clean working area required
Handling of sterile supplies
Sterile field: area used for placement of sterile supplies
All sterile items need to be checked
Observe agency guidelines for date
Necessary to keep sterile field dry

85. Removing Articles from Sterile Wraps
Drop technique—for gauze, pads, dressings, and small items
Mitten technique—for bowls, drapes, and linens
Transfer forceps—for cotton balls and small items

86. 14:9 Transmission-Based Isolation Precautions
Some diseases are communicable
Caused by organisms that can be transmitted easily
Epidemic—spreads from person to person and affects large numbers
Pandemic—spreads over a wide geographic area
These precautions are in addition to the Standard Precautions
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87. Transmission-Based Isolation Precautions (continued)
Helps prevent spread of disease
Protects patient, family, and health care workers
Type used depends on the causative organism of the disease

88. How Communicable Diseases Spread
Direct contact with a patient
Contact with dirty linen, equipment, and supplies
Contact with blood, body fluids, secretions, and excretions

89. 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

90. Classifications of Precautions
Standard precautions
Airborne precautions
Droplet precautions
Contact precautions

91. 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

92. Summary
Exact procedures for maintaining transmission-based isolation will vary from one facility to another
Variations caused by different factors
Basic principles remain the same in any facility and are directed toward preventing the spread of disease