Chapter 13Infection Control

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

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

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

Microbe Classifications

• Bacteria• Protozoa• Fungi • Rickettsiae • Viruses

Bacteria

• Simple, one-celled organisms• Multiply rapidly• Classified by shape and arrangement

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Bacteria(continued)

• Cocci are round or spherical in shape• Diplococci—in pairs • Streptococci—in chains• Staphylococci—clusters or groups

• Diseases• Gonorrhea• Meningitis• Pneumonia

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Bacteria(continued)

• Bacilli are rod shaped• Occur singly, in pairs, or in chains• May have flagella• Ability to form spores

• Diseases• Urinary Tract Infection (UTI)• Wound Infections• Toxic Shock

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Bacteria(continued)

• Spirilla are spiral or corkscrew shaped• Includes comma-shaped vibrio and corkscrew spirochete

• Diseases include syphilis and cholera

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• Nosocomial Infection – Infection obtained while in a Hospital setting

MRSA • Methicillin Resistant Staphylococcus Aureus

VRE – Vancomycin Resistant Enterococci

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

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

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

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)

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

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

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

Endogenous

• Originates within the body• Examples: metabolic disorders, congenital abnormalities, tumors, and

infections caused by microorganisms within the body

Exogenous

• Originates outside the body• Examples: radiation, chemical agents, trauma, electric shock, and

temperature extremes

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

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

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

Common Body Defenses

• Mucous membranes• Cilia• Coughing and sneezing• HCL (acid) in the stomach• Tears• Fever• Inflammation response • Immune response

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

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

Common Aseptic Techniques

• Thorough handwashing• Good personal hygiene• Disposable gloves• Cleaning instruments and equipment• Proper cleaning of environment

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

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 1348. 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.

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

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

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

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

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

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)

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

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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

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

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

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

Bloodborne Pathogen Standards

• Established in 1991 by OSHA• Must be followed by all health care workers• Civil penalties if not implemented and followed

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

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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

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

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

Classifications of Precautions

• Standard precautions• Airborne precautions• Droplet precautions• Contact precautions

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

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

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

Examples of PPE’s • 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

• 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

• Sharps• Use extreme caution to avoid cuts and punctures• When possible, use safe needles or needleless system• Use sharps containers

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

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

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 – 20 - 30 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

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

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

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

13:9 Transmission-BasedIsolation 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

How Communicable Diseases Spread

• Direct contact with a patient• Contact with dirty linen, equipment, and supplies• Contact with blood, body fluids, secretions, and excretions

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

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