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 OSHA guidelines, the Blood-Borne Pathogen Standard, reporting guidelines, and isolation procedures.

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

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

Apply Your Knowledge What is your role as a medical assistant in control of infection in the medical office? ANSWER: To apply principles of infection control by following correct sanitization, disinfection, and sterilization procedures. Correct!

Infection Control Measures 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

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

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

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

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

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

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

Disinfection Adequate for instruments that do not penetrate skin or mucus membranes and surfaces not considered sterile OR Second step in infection control prior to sterilization Will not kill spores, certain viruses

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

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

Disinfection (cont.) Choose the correct disinfectant Germicidal soap products Alcohol Acid products Formaldehyde Glutaraldehyde – “cold disinfection” Bleach Iodine and iodine compounds

Disinfection (cont.) Handling disinfected supplies Prevent contamination with other surfaces Use sterile transfer forceps Wear gloves Store in clean, moisture-free environment

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

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

Sterilization: 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

Sterilization: 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

Sterilization: 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

Sterilization: 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

Sterilization: The Autoclave (cont.) Prevent incomplete sterilization Correct timing Adequate temperature Properly wrapped packs Adequate steam levels Timing Preset for load types Use sterilization indicators

Sterilization: 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

Sterilization: Sterile Technique Surgical scrub During surgical procedures Do not touch sterile items without sterile gloves or transfer forceps Aseptic technique Throughout surgical procedures Caring for surgical wounds

Sterilization: Surgical Asepsis 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 waste Biological agents that can spread disease to living things

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

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

OSHA Guidelines (cont.) Universal Precautions Prevent health-care workers from exposure to infections Assume that all blood and blood and body fluids are infected with blood-borne pathogens Standard Precautions Combination of Universal Precautions and Body Substance Isolation guidelines Used in hospitals to prevent transmission of disease

OSHA Guidelines (cont.) Categories of tasks I.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

OSHA Guidelines (cont.) 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

OSHA Guidelines (cont.) 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

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

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

© 2009 The McGraw-Hill Companies, Inc. All rights reserved ANSWER: There are three categories of risk: Category 1: Expose a worker to blood, body fluids, or tissues and require specific protective measures Category 2: Usually do not involve risk of exposure, but precautions are required in certain situations Category 3: No risk of exposure, so no special protection is required

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

Reporting Guidelines (cont.) National Notifiable Disease Surveillance System (Table 20-2) Examples HIV/AIDS  Cholera Rubella  Hepatitis Legionellosis  Lyme disease Mumps  Smallpox Tetanus  Tuberculosis

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.

Isolation Guidelines CDC guidelines Types of precautions needed Patients requiring precautions Create an environment that protects against pathogens Standard Precautions

Isolation Guidelines (cont.) PPE Select appropriate PPE for mode of transmission Gloves Masks, face shields, respirators Gowns Table 20-3

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!

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

Immunizations: 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)

Immunizations (cont.) When administering. you must explain The need for immunization Side effects Soreness at site Low-grade fever General malaise

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 Pregnant patients Avoid live virus vaccines FDA categories A, B, C, D, and X Elderly More likely to develop side effects 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 no cost to employee

Preventing Disease Transmission Patient education Health promotion Disease prevention Disease treatment Medical Assistant role in patient education Share responsibility Reinforce and explain instructions

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

Goal of patient education Help patients take care of themselves Encourage patients to participate actively in their own health care Preventing Disease Transmission (cont.)

In Summary Medical Assistant Sanitization, disinfection, and sterilization break the cycle of infection by ridding instruments and equipment of pathogens. The medical assistant plays a vital role in reducing patient vulnerability by encouraging patients to maintain a correct immunization status and by being aware of special immunization concerns of certain patients.