1. Chapter 15
Infection Control

2. 15:1 Principles of Infection Control
Understanding infection control is essential for all health care workers
Provide a basic knowledge of how disease is transmitted
Main emphasis on prevention of disease transmission
AU: In the Lesson Plans, the title for 15:1 is “Understanding the Principles of Infection Control.” Is the shorter title here OK?

3. 15:1 Principles of Infection Control
Microorganism or microbe
Small living organism
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

4. 15:1 Principles of Infection Control
Microorganism or microbe
Many are part of normal flora of body
Nonpathogens are beneficial to body processes
Pathogens cause infections and disease
Most prefer warm, dark environments

5. 15:1 Principles of Infection Control
Microorganism or microbe
Need source of food and moisture
Need for oxygen varies (aerobic/anaerobic)
Human body is ideal supplier of all microorganism requirements

6. Classes of Microorganisms
Bacteria
Simple, one-celled organisms
Multiply rapidly
Classified by shape and arrangement

7. Classes of Microorganisms
Bacteria
Cocci are round or spherical in shape (refer to Figure 15-1 in text)
Bacilli are rod shaped (refer to Figure 15-3 in text)
Spirilla are spiral or corkscrew shaped (refer to Figure 15-4 in text)
Set text in lowercase (3x)

8. Classes of Microorganisms
Antibiotics are used to kill bacteria
Some bacteria strains are multidrug resistant (superbugs)
MRSA
VRE--vancomycin-resistant enterococci
MRAB--Multi-Resistant Acinetobacter Baumannii
CRE--Carbapenem-Resistant Enterobacteriaceae

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

10. Classes of Microorganisms
Fungi
Simple, plantlike organisms
Live on dead organic matter
Yeast and molds can be pathogenic
Antibiotics do not kill
Antifungal medications for treatment
Plant-like changed to plantlike

11. Classes of Microorganisms
Rickettsiae
Parasitic microorganisms that cannot live outside the cells of another living organism
Transmitted to humans by bites of fleas, lice, ticks, mites
Antibiotics are effective against many

12. Classes of Microorganisms
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
Not affected by antibiotics

13. Classes of Microorganisms
Viruses
Those infecting animals can mutate to infect humans
Severe acute respiratory syndrome (SARS)
West Nile virus (WNV)
Monkeypox
Ebola and Marburg
H5N1, H1N1

14. Classes of Microorganisms
Hepatitis B
Caused by HBV
Transmitted by blood serum and body secretions
Affects the liver

15. Classes of Microorganisms
Hepatitis B
Expensive vaccine is available for protection
Employers must provide vaccine at no cost to employees with occupational exposure to blood or other body secretions

16. Classes of Microorganisms
Hepatitis C
Caused by HVC
Transmitted by blood/blood-containing body fluids
Many infected individuals are asymptomatic
Can cause severe liver damage
No vaccine available

17. Classes of Microorganisms
Acquired Immune Deficiency Syndrome (AIDS)
Caused by human immunodeficiency virus (HIV)
Suppresses the immune system
Individual becomes susceptible to cancers and infections that would not affect a healthy person
No cure and no vaccine

18. Classes of Microorganisms
Helminths
Multicellular parasites also known as worms or flukes
Transmitted
By eating contaminated food
Being bitten by infected insects
When worms enter the skin

19. Types of Infection Some pathogens Produce poisons called toxins
Cause an allergic reaction
Attach and destroy the living cells they invade

20. Types of Infection Endogenous Exogenous
Disease originates within the body
Metabolic disorders, tumors, congenital abnormalities
Exogenous
Disease originates outside body
Pathogens, trauma, temperature extremes

21. Types of Infection
Hospital-acquired or healthcare-associated infection (HAI)
Formerly nosocomial
Staphylococcus, pseudomonas
Opportunistic
Occur when body defenses are weak
Kaposi’s sarcoma

22. Chain of Infection
Present for disease to occur and spread from one individual to another
Infectious agent
Reservoir
Portal of exit

23. Chain of Infection Mode of transmission Portal of entry
Susceptible host
Refer to Figure 15-9 in text

24. Chain of Infection Body defenses Mucous membranes Tears Cilia Fever
Coughing and sneezing
Inflammation response
HCL in the stomach
Immune response

25. Chain of Infection
Eliminate any step in the chain and infection is stopped
Follow practices to interrupt or break chain
Remember, pathogens are everywhere
Transmission prevention is a continuous process

26. Aseptic Techniques Asepsis Sterile Contaminated
Absence of disease-producing microorganisms
Sterile
Free of all organisms
Contaminated
Any object or area that may contain pathogens

27. Aseptic Techniques Handwashing Good personal hygiene
Use of disposable gloves
Properly cleaning instruments and equipment
Thorough cleaning of environment

28. Aseptic Techniques Antisepsis Disinfection
Prevent or inhibit growth of pathogens
Can usually be used on skin
Disinfection
Destroys or kills pathogens
Used mainly on objects

29. Aseptic Techniques Sterilization
Destroys all microorganisms, including spores and viruses
Use of steam under pressure, gas, radiation, and chemicals on objects

30. 15:2 Bioterrorism Use of microorganisms or biologic agents as weapons
Infecting humans, animals, or plants
Has been used over time by different nations not only in war but also on innocent people

31. Biologic Agents Microorganisms suitable for bioterrorism
Inexpensive, available, easily produced, spreads quickly
Maintains its survival
Brings death or disability
Transmissible from person to person
Difficult to prevent and treat

32. Biologic Agents High-priority agents
Smallpox: contagious and infectious disease, result of a variola virus
Anthrax: infectious disease caused by spores called Bacillus anthracis
Plague: infectious disease from the bacteria Yersinia pestis

33. Biologic Agents High-priority agents
Botulism: paralytic illness resulting from a nerve toxin produced by Clostridium botulinum
Tularemia: infectious disease from bacteria Fracisella tularensis
Hemorrhagic fever: infectious diseases caused by filovirus (Ebola virus and Marburg virus)

34. Preparing for Bioterrorism
Bioterrorism attack could cause epidemic and public health emergency
Would have impact on health care facilities
Social disorder could ensue
Comprehensive plan is needed

35. Preparing for Bioterrorism
Bioterrorism Act of 2002 involves local, regional, state, and national government
Early detection by communities
Public notification
Infection control and public education
Funding for research and study of pathogens

36. Preparing for Bioterrorism
Bioterrorism Act of 2002
Guidelines and restrictions on transport of pathogens
Mass immunization
Protection of food and water supplies
Trained personnel

37. Preparing for Bioterrorism
Bioterrorism Act of 2002
Emergency management policies
Criminal investigation of potential threats
Preparation of health care facilities
Efficiency of communication

38. 15:3 Washing Hands Major aspect of standard precautions
Most important aseptic technique
Most effective method of infection control
Hands are perfect medium for spread of pathogens
What was sign of a good surgeon before the days of germ theory?????

39. 15:3 Washing Hands Regular handwashing with plain soap and water
Antiseptic handwashing with antimicrobial soap and water
Antiseptic hand rub with alcohol-based cleaner (waterless)

40. 15:3 Washing Hands
World Health Organization (WHO) on when to wash hands
Before patient contact
Before clean or aseptic procedure
After contact with a patient’s skin
After touching patient surroundings

41. 15:3 Washing Hands Also wash hands On arrival at facility
After contact with a patient’s intact skin
Before moving from contaminated body site to clean body site during patient care
If hands become contaminated during a procedure

42. 15:3 Washing Hands Also wash hands
Before applying and immediately after removing gloves
When gloves are torn or punctured
Before and after handling specimens
After contact with soiled or contaminated item

43. 15:3 Washing Hands Also wash hands
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 contact with mouth or mucous membranes

44. 15:3 Washing Hands Use soap as a cleansing agent Use warm water
Use friction
Clean all hand surfaces
Point fingertips downward
Use dry paper towels to turn faucet on and off

45. 15:3 Washing Hands Clean nails during handwashing
Waterless hand cleaning with alcohol-based gel, lotion, or foam
Use if hands are not visibly dirty or contaminated with blood or body fluids
After 6 to 10 cleanings hands must be washed with soap and water

46. 15:4 Observing Standard Precautions
Blood and body fluids are main ways pathogens are spread
Three 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

47. Bloodborne Pathogens Standard
Established in 1991 by OSHA
Must be followed by all health care workers
Civil penalties if not implemented by employer and followed by employees

48. Bloodborne Pathogens Standard
Develop written exposure control plan
Identify all employees with occupational exposure
Provide hepatitis B vaccines free of charge
Provide personal protective equipment (PPE)

49. Bloodborne Pathogens Standard
Provide adequate handwashing facilities and supplies
Ensure worksite is maintained in a clean, sanitary condition
Follow measures for immediate decontamination of surfaces when contaminated
Dispose of infectious waste correctly

50. Bloodborne Pathogens Standard
Enforce rules on limited activities (eating, drinking, etc.) in any potentially contaminated area
Provide appropriate, color-coded, and labeled containers for contaminated sharps and other infectious or biohazard wastes

51. Bloodborne Pathogens Standard
Post signs at entrance to work areas with exposure to biohazardous materials
Label biohazard items with red biohazard symbol (refer to Figure in text)
Confidential medical evaluation and follow-up for employee after exposure incident
Provide employee training
Set text in lowercase

52. Needlestick 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 Pathogens Standard to requirements of this act

53. Needlestick Safety Act
Employer requirements
Identify and use effective and safer medical devices
Incorporate changes in annual update of exposure control plan

54. Needlestick Safety Act
Employer requirements
Solicit input from nonmanagerial employees who are responsible for direct patient care
Maintain a sharps injury log

55. Standard Precautions
Rules developed by the CDC to prevent spread of infection
Every body fluid considered potentially infectious
All patients considered potential sources of infection
Refer to Figure in text

56. Standard Precautions Use in any situation where you might contact
Blood or any fluid that contains blood
Body fluids, secretions, and excretions
Mucous membranes
Nonintact skin
Tissue or cell specimens

57. Standard Precautions Handwashing before and after patient contact
Gloves
For possible contact with blood, bodily fluids, secretions, excretions, mucous membranes, tissue specimens, or nonintact skin
Handling and cleaning contaminated items or surfaces

58. Standard Precautions Gloves When performing invasive procedures
When performing venipuncture or blood tests
Hands must be washed immediately after removal of gloves
Gloves must not be reused

59. Standard Precautions Gowns
For procedures that cause splashing or spraying
Help prevent contamination of clothing or uniform
Contaminated gowns must be handled per policy
Hands must be washed immediately after gown removal

60. Standard Precautions Masks and eye protection
For procedures that cause splashing or spraying
Prevent exposure of mucous membranes of mouth, nose, and eyes to pathogens
Use masks once and discard; change every 30 minutes if needed

61. Standard Precautions Masks and eye protection
Protective eyewear and face shields protect front, top, bottom, and sides of eyes
If not disposable, must be cleaned and disinfected before reuse

62. Standard Precautions Sharps
Use extreme caution to avoid cuts and punctures
When possible, use safe needles or needleless devices
Use sharps containers
Follow laws regarding disposal of sharp objects

63. Standard Precautions Spills or splashes
Wipe up with disposable cleaning cloths
Wear gloves when wiping up
Use disinfectant such as 10-percent bleach solution
Clean all contaminated surfaces
Absorbent powder can be used for large spills

64. Standard Precautions Resuscitation devices
Use to avoid need for mouth-to-mouth resuscitation
Place in convenient location, have readily accessible

65. Standard Precautions Waste and linen disposal Injuries
Wear gloves, follow agency policy
Use biohazard bags appropriately
Injuries
Immediately report cut or injury, needlestick, or splashing of blood or body fluids
Follow agency policy

66. 15:5 Sterilizing with an Autoclave
Sterilization prevents spread of infection
Autoclave uses steam under pressure or gas to sterilize
Most efficient method of sterilization
Destroys all microorganisms
Available in various sizes and types

67. 15:5 Sterilizing with an Autoclave
Preparation of items before sterilization
Wrap items that are to remain sterile
Autoclave indicators ensure sterilization
Load the autoclave correctly
Time period for sterilization varies (refer to Figure 15-31)

68. 15:5 Sterilizing with an Autoclave
Store items properly after autoclaving
Sterilized items can remain sterile for 30 days
Dry-heat sterilization in some autoclaves
Follow directions on specific autoclave
Follow agency policy for sterilization

69. 15:6 Using Chemicals for Disinfection
Chemicals disinfect, but do not sterilize
Most do not kill spores and viruses
Used to disinfect instruments that do not penetrate body tissue
Proper cleaning of items is essential
Chemical solutions used

70. 15:6 Using Chemicals for Disinfection
Antirust tablets or solutions may be added
Requirements for disinfection
Chemical must completely cover items
Care of chemical solutions
Proper handling of disinfected items

71. 15:7 Cleaning with an Ultrasonic Unit
Used to remove dirt, debris, blood, saliva, tissue from instruments prior to sterilization
Uses sound waves for cleaning
Method of aseptic control, not sterilization
Use only ultrasonic solutions in unit

72. 15:7 Cleaning with an Ultrasonic Unit
Care of glass beakers
Care of the permanent tank
Read manufacturer’s instructions before using ultrasonic unit
Refer to Figure in text

73. 15:8 Using Sterile Techniques
Many procedures require use of sterile techniques to protect patients from infection
Surgical asepsis keeps an object or area free from living organisms

74. 15:8 Using Sterile Techniques
Free from all organisms
Contaminated
Organisms and pathogens are present

75. 15:8 Using Sterile Techniques
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

76. 15:8 Using Sterile Techniques
Sterile field
Area used for placement of sterile supplies
All sterile items need to be checked before use
Observe agency guidelines for date
Necessary to keep sterile field dry

77. 15:8 Using Sterile Techniques
Drop technique
For gauze, pads, dressings, small items
Mitten technique
For bowls, drapes, linens
Transfer forceps
For cotton balls, small items

78. 15:9 Maintaining Transmission-Based Isolation Precautions
Some diseases are communicable
Caused by easily transmitted organisms
Epidemic
Spreads rapidly person to person, affects large numbers
Pandemic
Wide geographic area, high proportion of populace
AU: Title ok? In Lesson Plans, the title is Maintaining Transmission-Based Precautions

79. 15:9 Maintaining Transmission-Based Isolation Precautions
Use in addition to Standard Precautions
Provides extra protection against specific diseases or pathogens
Protects patient, family, health care workers
Type used depends on the causative organism of disease
AU: Title ok? In Lesson Plans, the title is Maintaining Transmission-Based Precautions

80. 15:9 Maintaining Transmission-Based Isolation Precautions
Communicable diseases spread in many ways
Direct contact with a patient
Contact with dirty linen, equipment, supplies
Contact with blood, body fluids, secretions, excretions
AU: Title ok? In Lesson Plans, the title is Maintaining Transmission-Based Precautions

81. 15:9 Maintaining Transmission-Based Isolation Precautions
Contaminated (dirty)
Items that contain disease-producing organisms; must not be touched unless protected
Clean
Items that do not contain disease-producing organisms; prevent contamination of these areas
AU: Title ok? In Lesson Plans, the title is Maintaining Transmission-Based Precautions

82. Standard Precautions Use on all patients
Patient must be in private room if he or she contaminates environment or cannot maintain appropriate hygiene
Follow recommendations for use of PPE
“They” changed to “he or she”

83. Airborne Precautions
Use for patients known or suspected to be infected with pathogens transmitted by airborne droplet nuclei
Rubella, varicella, tuberculosis, shingles
Refer to Figure in text
Change text to lowercase

84. Droplet Precautions
Use if patient is known or suspected to be infected with pathogens transmitted by large-particle droplets
Neisseria meningitis, multidrug-resistant Streptococcus meningitis, severe viral influenza
Refer to Figure in text
Change text to lowercase

85. Contact Precautions
Use if patient is known or suspected to be infected with epidemiological microorganisms transmitted by direct or indirect contact
Viral or hemorrhagic conjunctivitis or fevers, diphtheria, scabies
Refer to Figure in text

86. Ebola Virus Precautions
Strict enforcement of standard, contact, and droplet precautions
Patient is to be placed in an airborne infection isolation room (AIIR) with restricted visitation
Medical equipment is dedicated to the patient
Needles and blood draws are limited to necessity only
strict changed to initial cap. patient changed to initial cap. needles changed to initial cap.

87. Ebola Virus Precautions
Personal protective equipment (PPE) is a high priority
PPE must cover all of the skin, head, neck, body, and feet
Powered air-purifying respirator (PAPR) or a N95 respirator (at minimum) must be worn at all times
personal changed to initial cap. Powered changed to initial cap.

88. Ebola Virus Precautions
Double gloves should be worn when in direct contact with the patient
Diligent hand hygiene is essential
A separate room or area should be designated for the donning and doffing of the PPE

89. Protective or Reverse Isolation
Methods used to protect certain patients from organisms present in the environment
Used mainly for immunocompromised patients, whose body defenses cannot protect them from infection and disease
Precautions vary based on patient’s condition