Chapter 13 Infection Control

13:1 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

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 Called nonpathogens when not harmful to the body Some cause infections and disease Called pathogens (germs) when able to harm the body

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

Microbe Classifications Bacteria Protozoa Fungi Rickettsiae Viruses

Bacteria Simple, one-celled organisms Multiply rapidly Classified by shape and arrangement (continues)

Bacteria (continued) Cocci are round or spherical in shape Diseases Diplococci—in pairs Streptococci—in chains Staphylococci—clusters or groups Diseases Gonorrhea Meningitis Pneumonia (continues)

Bacteria (continued) Bacilli are rod shaped Diseases Occur singly, in pairs, or in chains May have flagella Ability to form spores Diseases Urinary Tract Infection (UTI) Wound Infections Toxic Shock (continues)

Bacteria (continued) Spirilla are spiral or corkscrew shaped Includes comma-shaped vibrio and corkscrew spirochete Diseases include syphilis and cholera

Antibiotics VRE – Vancomycin Resistant Enterococci 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 Nosocomial Infection – Infection obtained while in a Hospital setting MRSA Methicillin Resistant Staphylococcus Aureus VRE – Vancomycin Resistant Enterococci

Protozoa One-celled, animal-like organism Found in decayed materials and contaminated water May have flagella for movement Some are pathogenic Diseases Malaria African Sleeping Sickness Trichomonas

Fungi Simple, plant-like organisms Live on dead organic matter Yeast and molds Can be pathogenic Antibiotics do not kill Antifungal medications Diseases Athlete’s Foot Yeast Infections Thrush

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) Antibiotics are effective against many of them Diseases Rocky Mountain Spotted Fever, Typhus Fever

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 Viruses infecting animals can mutate to infect humans Examples include: Severe acute respiratory syndrome (SARS) West Nile Virus (WNV) Chickenpox Ebola and Marburg H5N1 (Swine Flu)

3 Viral Diseases of Major Concern Hepatitis B Affects the liver & caused by HBV Transmitted by blood and body secretions 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 Hepatitis C Caused by HCV Transmitted by blood and blood-containing body fluids Many infected individuals are asymptomatic 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

Helminths Multicellular parasites otherwise known as worms or flukes Hookworms – infect small intestine, heart and lungs Trichinosis – eating raw or uncooked pork Pinworm Tapeworm Are transmitted: By eating contaminated food Being bitten by infected insects When worms enter the skin

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

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

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

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 Examples are staphylococcus, pseudomonas, and enterococci Infection-control programs are used in facilities to prevent and deal with nosocomial infections

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

Chain of Infection Present for disease to occur and spread from one individual to another Causative agent Microorganism Reservoir Insect, Air, Water, Door Handle Portal of exit Coughing, Sneezing, Blood Mode of transmission Direct or Indirect Contact Portal of entry Break in the skin, Respiratory, Digestion Susceptible host Body defenses are weak

Common Body Defenses Mucous membranes Cilia Coughing and sneezing HCL (acid) in the stomach Tears Fever Inflammation response Immune response

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

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

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

Levels of Aseptic Control Antisepsis— Inhibit the growth of microorganisms. Or Remove pathogens from the area Used on the skin Soap, Germ-x, Betadine Disinfection—Destroys most microorganisms. Not always effective against viruses & spores. Used mainly on objects Alcohol, Bleach, Clorox, Lysol Sterilization—use of steam under pressure, gas, radiation, and chemicals on objects Boiling water, Autoclave

13:2 Bioterrorism Bioterrorism: use of microorganisms or biologic agents for warfare First used by the Tartar Army throwing dead bodies of plaque victims over the walls of Caffa in 1348. Caused an epidemic in the city The British Army providing Delaware Indians with blankets with smallpox in 1763 In 2001 an individual sent Anthrax spores via the United States Postal system.

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

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

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

Preparing for Bioterrorism (continued) Bioterrorism Act 2002 passed by Congress and signed into law Government involvement includes: Early detection by communities Public to be notified Infection control and education Funding available Guidelines and restrictions Nationwide immunizations Protection of food/water supplies Trained personnel available Emergency management controls Efficiency of communication Investigation of potential threats Preparation of health care facilities

13:3 Washing Hands Major aspect of standard precautions Most important aseptic technique Hands are perfect media for the spread of pathogens Prevent and control spread of pathogens Protect the health care worker from disease and illness

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

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 Anytime the hands become contaminated during a procedure Before applying gloves Immediately after removing gloves When gloves are torn or punctured (continues)

When to Wash Hands (continued) Before and after handling specimens After contact with any soiled or contaminated item 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

Principles of Handwashing Use soap as a cleansing agent Use warm water Use friction & circular motions for 15 seconds Clean all surfaces Point fingertips down Use dry paper towels to turn faucet on and off Clean nails

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

13:4 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

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

Regulation Requirements Written exposure control plan Identify all employees with occupational exposure Hepatitis B vaccines free of charge Provide personal protective equipment (gloves, masks, gowns) Provide adequate hand washing facilities and supplies Ensure worksite is maintained in a clean, sanitary condition Follow measures for immediate decontamination of surfaces when contaminated (continues)

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) Post signs at the entrance to work areas with occupational exposure to bio hazardous materials Red biohazard labels Provide a confidential medical evaluation and follow-up for any employee with an exposure incident Provide training to employees

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

Employer Requirements Identify and use effective and safer medical devices Incorporate changes in annual update of exposure control plan Solicit input from non-managerial employees who are responsible for direct patient care Maintain a sharps injury log Ensure that every employee uses standard precautions at all times

Classifications of Precautions Standard precautions Airborne precautions Droplet precautions Contact precautions

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 Precautions Taken for Every Patient, Every Time

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 Non-intact skin Tissue or cell specimens

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 Wear Gloves - Whenever contact with body fluids, secretions, or excretions

Examples of PPE’s Gowns Masks and Eye Protection Sharps 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 Masks and Eye Protection Prevents exposure of mucous membranes of the mouth, nose, and eyes to pathogens Sharps Use extreme caution to avoid cuts and punctures When possible, use safe needles or needleless system Use sharps containers

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

Waste and Linen Disposal Wear gloves Follow agency policy Use biohazard bags appropriately Injuries Report any cut or injury, needle stick, or splashing of blood or body fluids immediately

13:5 Sterilizing with an Autoclave Equipment that uses steam under pressure or gas Most effective method of sterilization Different Articles require different times 15 – 20 - 30 minutes Temperature at 250 – 254 F Pressure usually 15 PSI Autoclave tape is an indicator for correct temp & pressure Must be loaded correctly 30 Day sterile period

13:8 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 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

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

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

13:9 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 Helps prevent spread of disease Protects patient, family, and health care workers Type used depends on the causative organism of the disease

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

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

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