1. © 2009 Delmar, Cengage Learning Chapter 14 Infection Control

2. © 2009 Delmar, Cengage Learning Objectives -Provide a basic understanding of microorganisms, diseases and where they come from. -Explain each the chain of infection in each microorganism -Explain how & what is needed (equipment, etc) to keep a sterile environment -Explain proper sanitation and cleaning techniques -Explain the threat of bioterrorism -Review an MSDS sheet -Review precautions of different pathogens & how they come about Define Terms (see next slide)

3. © 2009 Delmar, Cengage Learning TERMS TO KNOW: Aerobic Anaerobic AIDS Autoclave Chain of Infection Communicable Disease Droplet Precautions Helminths Hepatitis B Hepatitis C Mode of Transmission Nosocomial Opportunistic Pathogens Personal Protective Equipment Portal of Entry Portal of Exit Protozoa Reservoir Ricketsiae Sterilization Viruses

4. © 2009 Delmar, Cengage Learning Introduction Infection Control http://youtu.be/oi5Yd_wBW8g - Communicable Disease Overviewhttp://youtu.be/oi5Yd_wBW8g http://youtu.be/v0yig-sS3aM - Communicable Disease Factshttp://youtu.be/v0yig-sS3aM https://youtu.be/a2zwU2c-HZo basic first aid, pressure, wrapping http://youtu.be/75wF5JySU-c First Response: the complete guide to bleeding, wounds, & burns (watch middle part) http://youtu.be/2pHGjvsEwjM Abscess armpit http://youtu.be/tHXK3XnOx9U Staph back of shldr

5. © 2009 Delmar, Cengage Learning 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 Some cause infections and disease Called pathogens (germs) when able to harm the body May be beneficial (continues)

6. © 2009 Delmar, Cengage Learning 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

7. © 2009 Delmar, Cengage Learning Microbe Classifications Bacteria Protozoa Fungi Rickettsiae Viruses

8. © 2009 Delmar, Cengage Learning Bacteria Simple, one-celled organisms Multiply rapidly Classified by shape and arrangement –Cocci are round or spherical in shape –Bacilli are rod shaped May have flagella for locomotion –Spirilla are spiral (continues)

9. © 2009 Delmar, Cengage Learning Bacteria (continued) Cocci are round or spherical in shape –Diplococci—in pairs –Streptococci—in chains –Staphylococci—clusters or groups (continues)

10. © 2009 Delmar, Cengage Learning 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

11. © 2009 Delmar, Cengage Learning Protozoa One-celled, animal-like organism Found in decayed materials and contaminated water May have flagella for movement Some are pathogenic Examples of diseases

12. © 2009 Delmar, Cengage Learning 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

13. © 2009 Delmar, Cengage Learning 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

14. © 2009 Delmar, Cengage Learning 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 (continues)

15. © 2009 Delmar, Cengage Learning 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

16. © 2009 Delmar, Cengage Learning More Nasty Virues West Nile Ebola SARS

17. © 2009 Delmar, Cengage Learning 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 (continues)

18. © 2009 Delmar, Cengage Learning 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. © 2009 Delmar, Cengage Learning Hepatitis C Caused by HVC – hard to destroy (no vaccine for) Transmitted by blood and blood-containing body fluids Many infected individuals are asymptomatic Others have mild symptoms Can cause severe liver damage (continues)

20. © 2009 Delmar, Cengage Learning 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

21. © 2009 Delmar, Cengage Learning 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

22. © 2009 Delmar, Cengage Learning Classifications of Diseases and Infections Endogenous Exogenous Nosocomial Opportunistic

23. © 2009 Delmar, Cengage Learning Endogenous Originates within the body Examples: metabolic disorders, congenital abnormalities, tumors, and infections caused by microorganisms within the body Liver cancer 

24. © 2009 Delmar, Cengage Learning Exogenous Originates outside the body Examples: radiation, chemical agents, trauma, electric shock, and temperature extremes

25. © 2009 Delmar, Cengage Learning 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 Infection-control programs are used in facilities to prevent and deal with nosocomial infections (continues)

26. © 2009 Delmar, Cengage Learning 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

27. © 2009 Delmar, Cengage Learning 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

28. © 2009 Delmar, Cengage Learning 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

29. © 2009 Delmar, Cengage Learning Common Body Defenses Mucous membranes Cilia Coughing and sneezing HCL in the stomach Tears Fever Inflammation response Immune response

30. © 2009 Delmar, Cengage Learning Wound Care Contusion – bruising, discoloration of the skin from blunt trauma or internal inflammation

31. © 2009 Delmar, Cengage Learning

33. Amputations & Burns

34. © 2009 Delmar, Cengage Learning Cleaning an Open Wound

35. © 2009 Delmar, Cengage Learning Cleaning & Referring Open Wounds Refer for stitches or medical attention if: –Wounds are 0.25 in deep / 0.75 in long or more –Over eye, head, joints, fingers, face lips –If fatty tissue, bone, muscle, tendons are exposed –If persists for 15 min or more –contains glass or other debris –has an object sticking out of it, such as a twig/metal –spurts blood (could have cut/severed artery) GET A TETANUS SHOT within 48 hrs

36. © 2009 Delmar, Cengage Learning 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

37. © 2009 Delmar, Cengage Learning Common Aseptic Techniques Thorough handwashing Good personal hygiene Disposable gloves Cleaning instruments and equipment Proper cleaning of environment

38. © 2009 Delmar, Cengage Learning 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 Bioclave

39. © 2009 Delmar, Cengage Learning HANDWASHING (disinfection) Prevent and control spread of pathogens Protect the health care worker from disease and illness Wet with warm water, soap, scrub (20s), rinse (finger tips down), turn off tap with paper towel, dry hands with new paper towel.

40. © 2009 Delmar, Cengage Learning 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 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 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 (continues)

41. © 2009 Delmar, Cengage Learning 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

42. © 2009 Delmar, Cengage Learning Biologic Agents 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 (continues)

43. © 2009 Delmar, Cengage Learning 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

44. © 2009 Delmar, Cengage Learning Biologic Agents (continued) –Botulism: paralytic illness resulting from a nerve toxin from the bacteria Clostridium botulinum Spores are in the soil, water, from food, injecting needles. –Filoviruses: infectious diseases causing severe hemorrhagic fever known as Ebola virus and Marburg virus

45. © 2009 Delmar, Cengage Learning 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 (continues)

46. © 2009 Delmar, Cengage Learning Needle Stick Safety Act Passed by Congress in 2000 Because occupational exposure to bloodborne pathogens from accidental sharps injuries in healthcare and other occupational settings continues to be a serious problem, Congress felt that a modification to OSHA's Bloodborne Pathogens Standard was appropriate 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

47. © 2009 Delmar, Cengage Learning Employer Requirements (continued) Maintain a sharps injury log Ensure that every employee uses standard precautions at all times

48. © 2009 Delmar, Cengage Learning 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 Whenever contact with body fluids, secretions, or excretions When handling or cleaning contaminated items or surfaces Performing any invasive procedure Performing venipuncture/blood tests

49. © 2009 Delmar, Cengage Learning Gowns Worn during procedures that may cause splashing or spraying Helps prevent contamination of clothing or uniforms Contaminated gowns must be handled per policy/biohazard container Hands must be washed immediately after removing gown

50. © 2009 Delmar, Cengage Learning 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 (continues)

51. © 2009 Delmar, Cengage Learning Sharp Objects Use extreme caution to avoid cuts and punctures When possible, use safe needles or needleless system Follow policies regarding needles

52. © 2009 Delmar, Cengage Learning 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

53. © 2009 Delmar, Cengage Learning Resuscitation Devices Use to avoid the need for mouth-to- mouth resuscitation Place in convenient location that is readily accessible

54. © 2009 Delmar, Cengage Learning What is the Sequence for Donning (putting on) vs. Removing Personal Protective Equipment? DONNING: 1.GOWN 2.MASK or Respirator 3.GOGGLES or Face shield 4.GLOVES REMOVING: 1.GLOVES 2.FACE SHIELD 3.GOWN 4.MASK or Respirator

55. © 2009 Delmar, Cengage Learning Waste and Linen Disposal Wear gloves Follow agency policy Use biohazard bags appropriately

56. © 2009 Delmar, Cengage Learning MSDS Sheets A material safety data sheet (MSDS) – is a detailed information bulletin prepared by the manufacturer or importer of a chemical that describes the physical and chemical properties, physical and health hazards, routes of exposure, precautions for safe handling and use, emergency and first-aid procedures, and control measures. Information on an MSDS aids in the selection of safe products and helps prepare employers and employees to respond effectively to daily exposure situations as well as to emergency situations.

57. © 2009 Delmar, Cengage Learning Injuries Report any cut or injury, needle stick, or splashing of blood or body fluids immediately Follow agency policy

58. © 2009 Delmar, Cengage Learning Classifications of Precautions Standard precautions Airborne precautions Droplet precautions Contact precautions

59. © 2009 Delmar, Cengage Learning 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