1. Infection Control for Future Health Professionals

2. Washing Hands Major aspect of standard precautions Most important aseptic technique Hands are perfect media for the spread of pathogens Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 2

3. Asepsis The absence of disease producing microorganisms, or pathogens. Any object or area that may contain pathogens is considered to be contaminated. 3 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

4. Purpose of Handwashing Prevent and control spread of pathogens Protect the health care worker from disease and illness Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 4

5. When to Wash Hands When arrive at facility Immediately before leaving facility Before and after every patient contact Anytime the hands become contaminated during a procedure Before applying gloves Immediately after removing gloves Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 5

6. When to Wash Hands (continued) Before and after handling any specimen After contact with any soiled or contaminated item After picking up any item off the floor After personal use of the bathroom After you cough, sneeze, or use a tissue Before and after any contact with mouth or mucous membranes Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 6

7. Principles of Handwashing Use soap as a cleansing agent Soap aids in the removal of germs through its sudsy action and alkali content Use warm water Use friction Clean all surfaces Point fingertips down while washing hands Use dry paper towels to turn faucet on and off Clean nails With an orange stick, brush, or rub against the palms Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 7

8. Chain of Infection The chain of infection is process involving: A source or the causative agent Reservoir (host) where it can live Portal of exit or a way to escape from the reservoir Mode of transmission in order to travel to another reservoir or host to live Portal of entry (same as the portal of exit) is how the source gets into the reservoir Susceptible host-a person likely to get an infection or disease Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 8

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10. SOURCE IS THE PATHOGEN EXAMPLE E. COLI Slide 10 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

11. RESERVOIR WHERE IT CAN GROW AND MULTIPLY E. COLI NOMRALLY LIVES IN THE COLON Slide 11 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

12. PORTAL OF EXIT  EXITS ARE THE RESPIRATORY, GI, URINARY, & REPRODUCTIVE TRACTS, BREAKS IN SKIN, BLOOD  A BOWEL MOVEMENT IS A PORTAL OF EXIT Slide 12 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

13. METHOD OF TRANSMISSION FAILURE TO PROPERLY WASH HANDS AFTER BOWEL MOVEMENT LEAVES FECAL MATERIAL ON HANDS Slide 13 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

14. PORTAL OF ENTRY PORTALS OF ENTRY & EXIT ARE THE SAME Slide 14 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

15. SUSCEPTIBLE HOST PERSONS AT RISK FOR INFECTION: VERY YOUNG OR OLD ILL WERE EXPOSED TO THE PATHOGEN DO NOT FOLLOW INFECTION CONTROL PRACTICES Slide 15 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

16. 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 16 An aerobic organism or aerobe is an organism that can survive and grow in an oxygenated environment. An anaerobic organism can not grow and survive in an oxygenated environment.

17. Microorganisms or Microbes (continued) Called nonpathogens when not harmful to the body Some cause infections and disease Called pathogens (germs) when able to harm the body Sometimes nonpathogenic microorganisms can become pathogenic Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 17

18. Microbe Classifications Bacteria Protozoa Fungi Rickettsiae Viruses Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 18

19. Bacteria Simple, one-celled organisms Multiply rapidly Classified by shape and arrangement Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 19

20. Bacteria – Cocci Round or spherical in shape Diplococci Streptococci Staphylococci Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 20

21. Diseases from Bacterial Cocci Diplococci-gonorrhea, meningitis, pneumonia Streptococci-strep throat, rheumatic fever Staphylococci-boils, wound infections, toxic shock

22. Bacteria – Bacilli Rod-shaped Occur singly, in pairs, or in chains May have flagella Ability to form spores (thick walled capsules Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 22

23. Diseases from Bacterial Bacilli Tuberculosis Tetanus Pertussis Botulism Diphtheria Typhoid

24. Bacteria – Spirilla Spiral or corkscrew shape Includes comma-shaped vibrio and corkscrew spirochete Diseases include syphilis and cholera Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 24

25. 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 25

26. Protozoa One-celled, animal-like organism Found in decayed materials and contaminated water May have flagella for movement Some are pathogenic Examples of diseases Malaria Amebic dysentery Trichomonas African sleeping disease Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 26

27. Fungi Simple, plant-like organisms Live on dead organic matter Yeast and molds Can be pathogenic Examples of diseases Ringworm Athlete’s foot Histoplasmosis Yeast vaginitis Thrush Antibiotics do not kill Antifungal medications Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 27

28. 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 Typhus fever Rocky Mountain Spotted Fever Antibiotics are effective against many of them Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 28

29. 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 Examples: measles & mumps Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 29

30. Health Care Workers Major concerns: Hepatitis B Hepatitis C HIV 30 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

31. 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 31

32. 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, a written statement must be signed documenting refusal Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 32

33. Hepatitis C Caused by HVC Transmitted by blood and blood-containing body fluids Many infected individuals are asymptomatic Others have mild symptoms Can cause severe liver damage Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 33

34. Hepatitis C (continued) Currently, no vaccine ready for use Vaccine is in development stage Extremely difficult to destroy HVC Can survive several days in dried blood Health care workers must follow precautions to protect against virus Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 34

35. 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 Important to take precautions to prevent Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 35

36. Bloodborne Pathogen Standards OSHA established standards for contamination with blood and body fluids that must be followed by all health care facilities in 1991 Must be followed by all health care workers Civil penalties if not implemented and followed Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 36

37. Bloodborne Pathogen Standards Some of the regulations that must be followed: Written exposure plan Provide Hepatitis B free of charge to all employees who have potential for exposure Provide PPE: Gloves Gowns Masks Lab coats Face shields Adequate handwashing facilities, containers for infectious or biohazardous wastes 37 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

38. Needlestick Safety and Prevention Act In 2001 OSHA revised the standard in response to the Needlestick Safety and Prevention Act Identify safer medical devices Use safer medical devices Make annual changes to exposure control plan Input from direct care staff Sharps injury log 38 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

39. 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 39

40. 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 Nonintact skin Tissue or cell specimens Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 40

41. 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 Always wear (even if you ANTICIPATE) contact with blood body fluids Excretions secretions mucous membranes non-intact skin tissue or cell specimens Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 41

42. Gowns 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 42

43. Masks and Protective Eyewear or Face Shields Worn during procedures that may cause splashing or spraying Prevents exposure of the mucous membranes of the mouth, nose, and eyes Masks are used once and discarded – change every 30 minutes following correct procedure and immediate handwashing Protective eyewear and face shields protect front, top, bottom, and sides of eyes If not disposable, must be cleaned and disinfected before reuse Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 43

44. Sharp Objects Use extreme caution to avoid cuts or punctures Leave uncapped after use When possible, use safe needles or needleless system Follow policies regarding handling needles Use sharps containers Follow laws regarding disposal of sharps Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 44

45. Spills and Splashes Wipe up immediately Wear gloves when wiping up Use disposable cleaning clothes Use disinfectant with 10% bleach solution Clean all contaminated surfaces For large spills, can use absorbent powder Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 45

46. Resuscitation Devices Use to avoid the need for mouth-to-mouth resuscitation, whenever possible Place in convenient location that is readily accessible Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 46

47. Waste and Soiled Linen Wear gloves Follow agency policy Use biohazard bags appropriately Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 47

48. Reporting Cuts and Injuries Report any cut or injury, needle stick, or splashing of blood or body fluids immediately Follow agency policy Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 48

49. Maintaining Transmission- Based Isolation Precautions Some diseases are communicable (contagious)– caused by organisms that can be transmitted easily Extra precautions must be used in addition to the Standard Precautions Help prevent spread of disease to others Protects patient, family, and health care workers Type used depends on the causative organism of the disease Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 49

50. How Communicable Diseases Spread Direct contact with a patient Contact with dirty linen, equipment, and supplies Contact with blood, body fluids, secretions, and excretions Droplets from sneezing, coughing, or spitting Discharges from wounds Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 50

51. Classifications of Precautions Standard precautions Airborne precautions Droplet precautions Contact precautions Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 51

52. 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 52

53. Growth of Microorganisms 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 53

54. Nosocomial Infections Acquired in a health care facility Usually present in the facility and carried by health care workers to the patient Many are antibiotic-resistant Can cause serious and even life-threatening infections Common examples are staphylococcus, pseudomonas, enterococci Infection control programs are used to prevent and deal with nosocomial infections Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 54

55. Common Body Defenses Mucous membranes Cilia Coughing and sneezing HCL in the stomach Tears Fever Inflammation response – leukocytes Immune response – antibodies and cell secretion Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 55

56. Antiseptics Prevent or inhibit the growth of pathogenic organisms Usually not effective against spores and viruses Can usually be used on the skin Examples: alcohol and betadine Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 56

57. Disinfection Destroys or kills pathogenic organisms Not always effective against spores and viruses Chemical disinfectants are used Can irritate or damage the skin, so mainly used on objects, not people Examples: bleach solutions and zephirin Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 57

58. Sterilization Destroys all microorganisms Steam under pressure, gas, radiation, and chemicals Autoclave is the most common equipment used Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 58

59. Sterile Technique 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 Correct techniques must be strictly followed to maintain sterility and prevent contamination Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 59

60. Wet Surfaces Organisms and pathogens travel quickly through wet surfaces If sterile item gets wet, contamination has occurred Use extreme care while pouring solutions into sterile bowls Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 60