1 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Chain of Infection  Infectious diseases can spread only if certain factors occur. These factors, or links, make up the chain of infection. Break the chain, and you break the infectious process.  Wearing appropriate protective equipment and effective hand washing can break the chain of infection.

2 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Chain of Infection  Infectious agent  Reservoir host – an infected patient  Method of transmission –NEEDLESTICKS, BLOOD SPILL, BLOOD SPATTER, contaminated hands, equipment or supplies  Portal of entry into a new host – exposure to contaminated equipment, BROKEN SKIN, PUNCTURED SKIN  Susceptible host – unvaccinated, exposed individual

3 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Standard precautions prevent the spread of infection *Intact integumentary system is first line of defense

4 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Infectious Bodily Secretions  OSHA has designated the following bodily fluids as potentially infectious with blood- borne pathogens:   Cerebrospinal fluid (CSF); synovial, pleural, pericardial, peritoneal, mucous, and amniotic fluids   Blood, vaginal and seminal secretions, saliva, and human tissue

5 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. OSHA Standards for Healthcare Workers  Healthcare workers face significant health risks from occupational exposure to blood or other potentially infectious materials that may contain hepatitis B virus (HBV), hepatitis C virus (HCV), or the human immunodeficiency virus (HIV).  The MA should use precautions for all patients, regardless of knowledge of their individual health histories.  Implementation of the Bloodborne Pathogen Standard also protects patients from any blood-borne infection the healthcare worker may be carrying.

6 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Bloodborne Pathogen Standard  Employers must keep a confidential sharps injury log that describes the device involved and the details of how and where the incident occurred.  Must have available sharps management devices, such as self-sheathing or retracting needles, and needleless intravenous (IV) systems.  Should wash exposed area immediately or as soon as possible after exposure.

7 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Exposure Control Plan  Plan must detail employee protection procedures.  Must identify job classifications and/or specific work-related tasks that might lead to exposure.  Must contain specifics on controls including PPE, training, hepatitis B immunization, record keeping, postexposure follow-up, and labeling and disposal of biohazard waste.  Must be reviewed and updated at least annually to incorporate the use of safer medical devices.  Must be available to employees for review and training.

8 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Compliance Guidelines  Safety and infection control fundamentals go beyond knowledge of the disease cycle.  Five basic parts to compliance:   Barrier protection   Environmental protection   Housekeeping controls   Hepatitis B vaccination   Postexposure follow-up

9 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Barrier Protection  Protective equipment must be used if you will be involved in any of these activities:   Touching a patient's blood and body fluids, mucous membranes, or broken skin   Handling items and surfaces contaminated with blood and body fluids   Performing venipuncture, finger punctures, injections, and other vascular-access procedures

10 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Barrier Protection   Proper handling, processing, and disposing of all specimens of blood and body fluids.   Cleaning and decontaminating spills of blood or other body fluids.

11 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Personal Protective Equipment (PPE)  Specialized clothing or equipment that prevents blood or other potentially infectious material from passing through to reach the healthcare worker  Includes latex gloves, face masks, face shields, protective glasses, laboratory coats, barrier gowns, shoe covers, mouthpieces, and resuscitation bags that protect the healthcare worker from potentially infectious substances

12 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Personal Protective Equipment (PPE)

13 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. PPE Guidelines  Protective equipment contaminated with body fluids of any kind must be removed and placed in a designated area or biohazard container.  Protective eyewear and/or face shields must be worn whenever splashes, sprays, or droplets may occur.  All PPE must be removed before the worker leaves the medical facility.

14 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Environment Protection  Minimize splashing, spraying, and spattering of drops.  Bandage any breaks on hands before gloving.  Do not recap, bend, break, or resheath contaminated sharps.  Immediately after use dispose of sharp items in a labeled, leakproof, puncture-resistant biohazard container.

15 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Environment Protection  All specimens must be placed in a container that prevents leakage.  Contaminated equipment should be sanitized before being repaired in the office or transported to the manufacturer.  Eating, drinking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is reasonable likelihood of contamination from blood-borne pathogens.  Food and drink cannot be kept in the same areas as potentially infectious materials.

16 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Housekeeping Controls  Immediately decontaminate areas after accidental spills and at the end of each procedure.  Sharps containers must be upright and as close as possible to the work usage area; not overfilled; replaced on a routine basis with the lid closed securely.

17 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Housekeeping Controls: Cleaning Spills

18 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Housekeeping Controls  Use appropriate equipment to pick up spilled material or broken glassware.  Place in impervious biohazard bag or container.  Use an absorbent professional biohazard spill preparation as directed to decontaminate the site.  Wear gloves to handle soiled linen; should be double-bagged and transported in labeled, leakproof biohazard bags.  Biohazard waste must be collected in impermeable red biohazard-labeled bags or containers and sealed.

19 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Housekeeping Controls

20 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Hepatitis B Vaccination  Must be available free of charge within 10 days of starting employment to all employees who are at risk.  Intramuscular injection in three doses; second injection 4 weeks after first, and third injection 6 months after first.  U.S. Public Health Service does not currently recommend routine boosters.  Should have blood titer drawn after completion to determine if antibodies are present.  Employees have the right to decline immunization but must sign a declination form.

21 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Hepatitis B Vaccination Occupational Safety and Health Administration: Available at:

22 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Postexposure Follow-up  Postexposure follow-up involves immediate cleansing of the site, completion of an exposure incident form, confidential medical evaluation, examination of the source individual and worker’s blood, health counseling, and confidential treatment of all medical records.

23 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Critical Thinking Application  Rosa’s office has been especially busy today. While administering an injection to a frightened 6-year-old child, a co-worker has an accidental needlestick. She tells Rosa about the incident but does not know what to do. What steps should be taken to manage the situation?

24 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Role of the Medical Assistant  It is important that aseptic techniques and infection control be done on such a routine basis that they become an unbreakable habit.  MA should teach patients about infection control and the potential danger of blood and body fluids, including demonstrating aseptic techniques, the management of infectious materials at home, and the importance of frequent and consistent hand washing.