1. Infection Control Chapter 19
Infection control is an essential part of the medical assistant’s responsibilities. Protecting our patients and protecting ourselves from disease is part of our daily duties as a medical assistant.

3. Learning Objectives Define and spell key terms
Identify the role of the medical assistant in infection control
Identify disease-producing microorganisms
List common infectious diseases
Identify the links in the chain of infection

4. Learning Objectives Differentiate between the stages of disease
Describe the body’s defense mechanisms
Demonstrate the performance of handwashing with soap and water
Demonstrate the performance of hand sanitization with an alcohol-based hand rub
Explain standard precautions

5. Learning Objectives List common types of personal protective equipment
Describe strategies to increase health and safety in the workplace
Differentiate medical asepsis and surgical asepsis
Differentiate sanitization, disinfection, and sterilization

6. Learning Objectives Demonstrate equipment and instrument sanitization
Demonstrate equipment and instrument disinfection
Demonstrate wrapping a pack for sterilization

7. Learning Objectives
Demonstrate the performance of sterilization using an autoclave
Educate patients regarding methods to reduce disease transmission

8. Microorganisms and Pathogens
A microorganism is a microscopic organism seen only by using a microscope
Not all microorganisms cause disease
Harmless microorganisms on our body are called “normal flora”
Microorganisms that cause disease are called “pathogens”
It is important for us to remember while we are talking about pathogens that all microorganisms do not cause disease.

9. Pathogens
Require nutrients, moisture, warmth, and neutral pH to grow and thrive
Aerobic pathogens require oxygen to survive
Anaerobic pathogens require oxygen-free environment to survive
Pathogens are disease-producing microorganisms. Understanding what they need to grow and survive helps us to be able to control the spread of pathogens.

10. Types of Pathogens Five main types of pathogens: Bacteria Rickettsia
Virus
Fungus
Protozoa
There are five main types of pathogens. For the benefit of medical assisting and infection control, we are going to learn these five.

11. Bacteria One-celled organisms
Three types: cocci—round shape, bacilli— rod shape, spirilla—spiral shape
Bacterial infections include staph infections, strep throat, Lyme disease, and gonorrhea
There are literally hundreds of bacterial infections. Bacteria can also be divided into gram positive and gram negative. Practice listing all the bacterial infections that you know about.

12. Rickettsia (parasite)
Parasitic nature—organism depends on host to survive
Spread to humans via vectors: lice, ticks, fleas
Infections include Rocky Mountain spotted fever, and typhus
Rickettsia are parasitic in nature, meaning that they need a host to survive or they live off another living thing.

13. Virus Pathogen that grows and reproduces after infecting a host cell
More than 400 types
Smallest of all pathogens
Viral infections include common cold, hepatitis, chicken pox, and HIV
There are lots of virus types and many cold and influenza types. Viral infections are hard to treat because viruses are very small and hard to isolate.

14. Fungus Yeast, mold, and mushroom Many present in body’s normal flora
Many do not cause disease
Fungal infections include athlete’s foot, ringworm, and yeast infections
Mushrooms, yeasts, and molds are all in the fungus group. Fungus resides on our body as normal flora and does not harm us.

15. Protozoa Live mainly in soil
Spread through fecal–oral route by ingested contaminated food or water
Some spread by mosquitoes or other insects
Protozoan infections include malaria, Giardia, and trichomoniasis
Protozoan infections commonly infect persons with low immunity.

16. Chain of Infection Pathogen Reservoir host Means of exit
Method of transmission
Means of entry
Susceptible host
The chain of infection explains how infection continues to spread. As medical assistants, it is our responsibility to break the chain of infection at every possible link to promote health for our patients and ourselves.

17. Pathogen
Disease-producing microorganism; bacteria, virus, fungus, protozoa, and rickettsia
Present in blood or body fluids, called “bloodborne pathogens”
Pathogens need an environment that enables them to survive, grow, and multiply
The human body is a perfect environment
The first link in the Chain of Infection is the pathogen. The pathogen is required for any infection to be present. The five types of pathogens are bacteria, virus, fungus, protozoa, and rickettsia. Pathogens can be present in our body fluids, including in blood. Pathogens are often referred to as bloodborne pathogens.

18. Reservoir Host Human, animal, or insect that is infected with disease
Other reservoirs may be water, food, and contaminated objects
Host may be symptomatic or asymptomatic
Reservoir host is contagious even though he or she may not appear ill
A reservoir host is a person who has the pathogen present in his or her body. The reservoir host may be sick and have symptoms of illness or may be perfectly healthy in appearance. A person who is ill but does not show symptoms is called asymptomatic.

19. Means of Exit Pathogen must be able to exit reservoir host
Any body opening lined with mucous membranes: eyes, nose, throat, vagina, rectum, penis
Injury or surgery
Blood, body fluids: vaginal secretions, semen, urine, feces
In order for the Chain of Infection to continue to spread, the pathogen must be able to leave the reservoir host to infect another person.

20. Mode of Transmission
Direct contact—person-to-person contact or skin-to-skin contact
Handshaking, kissing, and sexual contact
Indirect contact— fomites; ticks, fleas, lice, and countertops
Indirect contact includes airborne and droplet infection—sneezing, coughing, and talking
Transmission includes direct contact, indirect contact, and airborne transmission.

21. Means of Entry Pathogen must find entry into new host
Any opening in the body lined with mucous membranes: nose, mouth, throat, vagina, penis, rectum
Wounds to the skin
Just as the pathogen has to leave the reservoir host in order to continue to spread, the pathogen also has to find a way to enter another person. The means of exit are exactly like the means of entry—mucous-lined membranes and wounds or nonintact skin.

22. Susceptible Host Weakened immune system Poor hygiene
Inadequate nutrition
Stress
Chronic disease
Poor environmental conditions
Elderly
Very young
Certain medications
Smoking
Alcohol abuse
A variety of conditions contribute to a person being a susceptible host. Medical assistants work to make sure that we do not become a susceptible host. By eating well, exercising, practicing good hygiene, and so forth, medical assistants can lessen the amount of times they are ill.

23. Stages of Disease Incubation stage Prodromal stage Acute stage
Declining stage
Convalescent stage
There are several stages in the disease process. In some illnesses, there are not clear definitions between the stages.

24. Incubation Stage Beginning stage of infection (latent)
Starts when person first contacts pathogen
Person may be asymptomatic
Person is contagious
First appearance of symptoms
This is also called the latent stage. The person is contagious but may not know he or she is sick. The incubation stage includes the first appearance of symptoms.

25. Prodromal Stage Earliest symptoms Fever (febrile) or rash
Person may state “I just don’t feel right”
Person is contagious
The prodromal stage follows the incubation stage. This stage marks the interval between the earliest symptoms and the appearance of a rash or elevated temperature.

26. Acute Stage Symptoms are at their worst Person is obviously ill
Person is contagious
During this time the patient should take medications, rest, and avoid contact with others
The acute stage includes the time when the symptoms are at their worst and the patient is obviously ill. The patient is still contagious and should take care to stay home and rest.

27. Declining Stage Acute stage ends Symptoms begin to decrease
Patient starts to feel better
The declining stage begins when symptoms begin to lessen. The patient may still be ill but notices that he or she may be feeling just a bit better.

28. Convalescent Stage Symptoms are gone Recovery time
Continues until patient regains homeostasis
The convalescent stage is the recovery period. Symptoms are gone, and the patient knows he or she is feeling better. This stage lasts until the patient is fully recovered and homeostasis has returned.

29. Defense Mechanisms
The body has natural defense mechanisms to protect itself against disease:
Mechanical
Chemical
Cellular
The body has natural defense mechanisms to fight disease.

30. Mechanical Defenses
First line of defense against pathogens is “intact” skin
Serves as barrier to environment
Cilia movement in lower airways
Coughing and sneezing
Eyelashes and eyebrows
The first line of defense to fight pathogens entering our body is intact skin. This means no openings in our skin of any kind—no hangnails, no paper cuts, all skin is intact. The skin acts as a barrier to pathogens.

31. Chemical Defenses Sebaceous glands Stomach fluids
Tears and saliva contain lyzozyme
Interferons have antiviral activity
Sebaceous glands secrete an oily substance that actually kills some types of pathogens.
Stomach fluids are highly acidic and effectively kill pathogens if pathogens are swallowed.
Tears and saliva are acidic which is not conducive to bacterial growth.
Interferons have antiviral activity. Some are produced by white blood cells in response to pathogen invasion.

32. Cellular Defenses
Various cells also act to protect the body from pathogens
Inflammatory response
Cell-mediated immunity
Antibody-mediated immunity
Various cells act to protect the body from pathogens.

33. Inflammatory Response
Inflammation occurs when damage or trauma is done to tissues
Body responds by releasing chemical substances such as histamine, prostaglandins, and kinins
Histamine causes dilation of blood vessels to improve circulation to the injured area which increases white blood cells to the scene.
Prostaglandins produce vasodilation, vascular permeability, and platelet aggregation, and they stimulate pain receptors.
Kinin is a chemical that increases blood flow and the permeability of small blood capillaries.

34. Inflammatory Response
Chemical substances initiate changes: dilation of blood vessels, increased permeability of blood vessels, attraction of white blood cells
Localized inflammation is indicated by redness, swelling, heat, pain, and decreased function. Some of this occurs because the body is at work healing itself.

35. Phagocytosis
Phagocytosis—the ability of white blood cells to engulf pathogens and cellular debris and then destroy that matter
Phagocytosis occurs by white blood cells in response to infection.

36. Immunity Protection from infectious disease Active or passive
Further categorized as acquired naturally or passively
Immunity is defined as protection from infectious disease.

37. Active Natural Immunity
Develops when body is exposed to pathogenic microorganisms
Microorganisms contain antigens (cell markers)
White blood cells develop antibodies
Antibodies protect during second exposure
An example of active natural immunity is when a person is infected with varicella. Varicella is the virus that causes chicken pox. The person gets sick, recovers, and never “catches” chicken pox again. The person had the disease and will never get this disease again due to the antibodies the person has.

38. Active Artificial Immunity
Develops when antigen is purposely introduced into body
Vaccine
Live, weakened, dead microorganism
Stimulates antibody formation without causing disease
Active artificial immunity occurs when a person receives a vaccine to produce immunity. An example includes the tetanus vaccine. After you receive the tetanus injection, you are protected against tetanus. The vaccine stimulated antibodies that will protect you from becoming ill.

39. Passive Natural Immunity
Develops when antibodies from mother cross placenta to fetus
Provide protection to fetus for several months
Additional antibodies are found in breastmilk
Passive natural immunity occurs when a mother gives birth and the newborn does not get ill for a short period of time. Passive immunity is short term. Another example of passive natural immunity is when a mother breastfeeds her infant. The child receives the mother’s antibodies through breast milk and will not become ill.

40. Passive Artificial Immunity
Develops when preformed antibodies from animal or human are then injected into an individual with known exposure
Antiserum provides temporary passive immunity
Helps in cases of exposure to rabies, botulism, venomous snake or spider bites, hepatitis, and diptheria
Passive artificial immunity occurs when preformed antibodies are developed in an animal or human and are then injected into an individual with a known exposure. A person with a known exposure to hepatitis can be injected with gamma globulins to produce a short-term immunity to hepatitis A. The injection boosts the person’s immunity.

41. Standard Precautions Centers for Disease Control and Prevention (CDC)
Occupational Safety and Health Administration (OSHA)
Workplace guidelines to promote safety
Bloodborne pathogens
Personal protective equipment
Standard precautions are guidelines to protect everyone from exposure incidents.

42. Personal Protective Equipment
Degree of risk to exposure
Gloves, masks, eye protection, shoe covers, and gowns
Personal protective equipment (PPE) must be provided by your employer. It is up to you to wear it.

43. Disposal of Biohazardous Waste
Containers that hold blood or body fluids
Containers are required to have biohazardous labels
Biohazardous waste is any waste that may contain blood or body fluids. Recognize these labels, and dispose of material properly.

44. Sharps and Needlestick Safety
“Sharps”—needles, scalpel blades, capillary tubes, and broken glass or slides
Dispose of in puncture-resistant containers
Never recap an uncapped needle
Replace biohazard containers when full
Protect yourself from exposure by following Standard Precautions and disposing of materials appropriately.

45. Vaccinations
If no Hepatitis B vaccination prior to employment, the employer must provide it for the employee within 10 days of employment at no cost to employee
Series of three injections
Documentation
Test for TB exposure
Protect yourself by getting vaccinated to hepatitis B. If you are not immunized upon employment, your employer provides this service at no charge to you.

46. Exposure Control
All employers must have exposure control plan and review with employees
Exposure incident is any contact with blood or body fluid, and any accidental injury
Report exposure to employer immediately
Follow policy and procedure for your facility
Exposure control plans are in place to protect employees and also patients. Know the exposure control plan at your place of employment.

47. Biohazard Spill
Protect yourself with PPE, control spill with paper towels
Cover entire spill with 10% bleach solution and let stand for 20 minutes
Clean up spill with mechanical device, do not use hands
Repeat bleach application, wait another 20 minutes
Always protect yourself by wearing personal protective equipment (PPE). If necessary, ask another person to assist you in the cleanup of the spill. If you are uncertain regarding how to clean the spill, ask another person for assistance. Always protect yourself.

48. Asepsis Condition free from pathogens Handwashing Sanitization
Disinfection
Asepsis refers to a condition free from pathogens. There are three levels involved.

49. Hand Sanitization
Single most effective way to prevent the spread of disease
Soap and warm water, rub vigorously 15 seconds
Antiseptic hand wash, cover all surfaces of hands, and air dry
Hand washing is the single most effective thing we can do to prevent the spread of pathogens and disease. Simple hand washing can be done with soap and water or with alcohol-based hand sanitizers. Alcohol-based hand sanitizers must contain 60% to 90% alcohol for effectiveness.

50. Typical Times to Wash Hands
Beginning work
Before and after rooming patients
Before and after cleaning exam rooms
Before and after assisting the physician with procedures
Before and after cleaning equipment
Before and after using the restroom
Before and after taking a break or eating lunch
At the end of the day
Hand washing should be done many times throughout your day. These are examples of when to wash your hands.

51. Sanitization of Equipment
Inactivating or removing microorganisms on reusable equipment and surfaces to a safe level
Chemicals, heat, and gas are used
Low-suds detergents are commonly used
Read labels, follow manufacturer’s directions, rinse all instruments, and protect yourself
The medical assistant should wear utility gloves or heavy-duty gloves when sanitizing equipment. The medical assistant should also wear other appropriate personal protective equipment (PPE) such as a gown and goggles.

52. Disinfection More thorough than sanitization
Kills bacteria and most microorganisms but not spores
Use different disinfectants for surfaces and equipment vs. skin surfaces
Read labels and follow manufacturer’s directions
Iodine, household bleach, and 70% alcohol
Disinfection typically involves the application of a substance to equipment, surfaces, or other items to kill pathogenic microorganisms. Disinfection can be done to countertops and trays, some types of furniture, and even the skin.

53. Sterilization
Complete destruction of all microorganisms including spores
Autoclave sterilization involves heat, pressure, steam, and time
Sanitize and disinfect instruments and equipment before sterilizing
All surfaces of instruments must be exposed
In surgical asepsis, all instruments and supplies must be sterile. Sterilization includes the destruction of all microorganisms, including spores.

54. Sterile Packs Sanitize and disinfect instruments prior to wrapping
Hinged instruments should be left open, surfaces of instruments should not be touching
Use indicator tape and label
Follow the instructions provided to wrap packs for sterilization. All hinged instruments must be left open. The pack is to be wrapped exactly the way it is explained so anyone opening the pack can do so in the proper manner.

55. Chemical Sterilization
Certain instruments should not be autoclaved; for example, fiberoptic endoscopes
Sterilize using chemicals
Solution is caustic; wear PPE
Immerse for a specified time
Sterilization can occur by a variety of means. Chemical sterilization includes the use of chemicals. The instruments are placed in the chemical solution for a specific amount of time before sterilization has occurred.

56. Medical Asepsis
Destruction of pathogenic organisms after they leave the body
Follow standard precautions
Consider specimens to be contaminated
Medical aseptic technique is a method of performing procedures and providing patient care so that pathogenic organisms are not transmitted from the ill patient to other patients or anyone else.

57. Surgical Asepsis
Destroying all pathogenic organisms before they enter the body
Use surgical aseptic technique
Normal protective barriers are punctured or disrupted
Injections, urinary catheterization, wound care, and surgical procedures
Surgical aseptic technique protects the patient while performing invasive procedures. Any break in the skin is a way for pathogens to enter. When patients undergo procedures that include making an incision into the skin, they are at a greater risk for pathogen invasion.

58. Discussion List five types of pathogens
Discuss difference between aerobes and anaerobes
Discuss differences in handwashing with soap and handwashing with alcohol-based hand sanitizer
Identify procedures that require medical asepsis vs. surgical asepsis

59. Credits