1. Chapter 13
Infection Control

2. 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

3. 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

4. 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

5. Microbe Classifications
Bacteria
Protozoa
Fungi
Rickettsiae
Viruses

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

7. 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)

8. 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)

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

10. 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

11. 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

12. 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

13. 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

14. 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)

15. 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

16. 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

17. 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

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

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

20. 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

21. 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

22. 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

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

24. 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

25. 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

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

27. 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

28. 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 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.

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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)

35. 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)

36. 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

37. 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

38. 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

39. 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

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

41. 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)

42. 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

43. 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

44. 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

45. Classifications of Precautions
Standard precautions
Airborne precautions
Droplet precautions
Contact precautions

46. 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

47. 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

48. 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

49. 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

50. 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

51. 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

52. 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 – 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

53. 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

54. 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

55. 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

56. 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

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

58. 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

59. 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