Clinical Medical AssistingChapter 5: Infection Control and Medical Asepsis

Objectives• Define and state the critical importance of infection control in

the ambulatory care setting.

• Describe the six links in the chain of infection.

• Define the five classifications of infectious microorganisms.

• Compare the routes of transmission of HIV and hepatitis B and C and discuss the risk of infection from needlestick.

• Describe the purpose of standard precautions and give six examples of ways healthcare providers should practice standard precautions.

• List eight types of body fluids and give an example of each.

• Describe personal protective equipment.

• Recognize five situations in which exposure to a patient’s blood can occur, and discuss why standard precautions are important.

Objectives (con’t)

Chapter OverviewThis chapter covers the process of infection and describes the basics of infection control and standard precautions in the ambulatory care setting. Because medical assistants provide care to many patients and deal directly with other healthcare professionals, following proper procedures to minimize the spread of infection is essential. Following infection-control procedures, including standard precautions and medical asepsis, can limit the transmission of infection and provide barriers against transmission.

Infection Control

Precautions taken in the healthcare setting to prevent the spread of disease and is an essential component of healthcare delivery.

Chain of Infection

The following steps must occur for infection to spread

• Infectious agent• Reservoir• Portal of exit• Mode of transmission• Portal of entry• Susceptible host

Infectious AgentsPathogen - bacterium, virus or other microorganism that can cause disease

Microorganism is a microscopic organism such as a virus, bacterium, fungus, parasites, or rickettsiae.

VirusesPathogens that are classified by the type of DNA or RNA.

Invade a host cell and take over the cell’s nucleus to multiply and produce other viruses

Treatment of viral infections is usually palliative.

Commonly known viruses include HIV, herpes, hepatitis, influenza, and chicken pox.

BacteriaMicroorganisms that have only one cell.

Classified according to their shape or by their ability to accept staining agents.

Gram-negative accepts red stain.

Gram-positive accepts purple stain.

FungiPlantlike organisms that can grow on cloth, food, showers, or people, or in any warm, moist environment.

Are different from bacteria.

Are single-celled or multicellular parasites.

Are aerobes (that is, they need oxygen to survive) or facultative aerobes (that is, they can survive with or without oxygen).

ParasitesOrganisms that benefit at the expense of another living organism.

Can be single-celled or multicellular.

Three Types of Parasites• Protozoa— single-celled parasites that have a nucleus and can only divide in a host organism and can cause malaria and trichomoniasis

• Metazoa— multicellular parasites that can cause hookworms, ringworms, and tapeworms

• Ectoparasite—multicellular parasites that live on the surface of the host and can cause scabies and lice

RickettsiaeIntracellular parasites that depend completely on their host for survival.

Are transmitted by fleas, ticks, mites, or lice.

Examples of this type of infection include Rocky Mountain spotted fever and Lyme disease.

ReservoirA place where a microorganism can thrive and reproduce such as in people, animals, insects, and inanimate objects such as food, water, table tops, and doorknobs.

Is the second link in the chain of infection.

Proper hygiene and cleaning of supplies, linen, and equipment can break this link in the chain of infection.

Portal of ExitFor a microorganism to cause an infection, it must leave the reservoir.

Exit can be through the discharge of body secretions or excretions or respiratory droplets.

It can also be through open wounds, the vagina, or rectum.

Mode of TransmissionThe means by which the microorganism travels from the portal of exit to another host.

Direct transmission involves direct contact between the infectious person or infected body fluids and the susceptible host and includes eating, drinking, sexual intimacy, and blood-borne transmission.

Indirect transmission can occur from inhaling contaminated air or handling or touching an infectious object).

Portal of Entry

Location where the infectious microorganism enters the host’s body such as the mouth, nose, eyes, ears, throat, intestinal tract, urinary tract, reproductive tract, open skin, punctures from invasive procedures, or tubes placed in body cavities.

Susceptible Host

The person who is susceptible to infection by a pathogen disease because they lack the immunity or physical resistance to overcome invasion by the pathogen.

Defense Mechanisms

Mechanical/physical - hair-like cilia in the respiratory tract, intact skin, and mucous membranes

Chemical and secretions such as tears, sweat, urine, mucus, and saliva-

Cellular – while blood cells

Stages of Infectious Diseases

• Incubation stage—the time between the exposure to a pathogen and when the first signs and symptoms of the disease appear

• Prodromal stage—occurs between the onset of initial symptoms and the onset of symptoms that show a disease process is occurring

• Acute stage—disease processes reach its peak during the acute stage

• Declining stage—symptoms begin to subside.

• Convalescent stage—patient begins to recover and regain strength

Stages of Infectious Diseases (con’t)

Transmission of Disease

Pathogens such as viruses, bacteria, or fungi can be found in the patient’s blood or body fluids

Human Immunodeficiency Virus and AIDS

Two types of HIV : HIV-1 and HIV-2

HIV is carried in blood, blood products, semen, and other body fluids such as vaginal secretions, and possibly breast milk.

Viral Hepatitis

Is inflammation of the liver

Types of viral hepatitis are :

Hepatitis A (HAV),Hepatitis B (HBV)Hepatitis C (HCV)Hepatitis D (HDV)Hepatitis E (HEV)

Mandatory Reporting of Infectious Diseases

Certain infectious diseases must be reported to the state or local authority, and to The Centers for Disease Control and Prevention (CDC).

Some Mandatory Reporting of Infectious Diseases

Anthrax Botulism Chancroid

Chlamydia trachomatis infections

Cholera Diphtheria

Giardiasis Gonorrhea Hepatitis A, B, and C

Legionellosis Lyme disease Malaria

Measles Meningococcal disease Mumps

Pertussis Poliomyelitis Rabies (animal and human)

Rocky Mountain spotted fever Rubella Salmonellosis

Syphilis Tetanus Toxic-shock syndrome

Tuberculosis Tularemia Typhoid fever

Varicella West Nile virus Yellow fever

Universal PrecautionsStandard precautions include the following:• Hand hygiene• Personal protective equipment• Injection safety• Environmental cleaning• Medical equipment• Respiratory hygiene/cough etiquette

Hand HygieneShould be performed in the following ambulatory care situations:

• Before touching a patient, after direct contact with a patient, and in between patients, even if gloves are worn.

• Immediately after glove removal or after removal of personal protective equipment.

• Before performing an aseptic task, such as placing an IV or handling an invasive device.

Hand Hygiene (con’t)• After touching blood, body fluids, secretions, excretions

(except sweat), wound dressings, intact skin, non-intact skin, and contaminated items, even if gloves are worn.

• During patient care when moving hands from a contaminated body site to a clean body site.

• After contact with inanimate objects in the vicinity of the patient.

Personal Protective Equipment

Protects healthcare providers from exposure to or contact with infectious agents.

Examples include gloves, gowns, goggles, masks, and face shields.

Injection Safety

Methods are designed to prevent transmission of infectious disease from one patient to another, or from a patient to a healthcare provider during administration of parenteral medications or handling of needles, scalpels, and other sharp instruments or devices.

Environmental Cleaning• Clean or disinfect frequently touched surfaces in close proximity to the patient.

• Clean up spills immediately. Spilled blood or body fluids should be cleaned using a liquid germicide or a 1:10 bleach solution.

• Use EPA-registered cleaners or disinfectants specific for healthcare use.

• Follow manufacturer’s guidelines on proper use of the product.

• Place materials used to clean up a spill in a biohazard waste bag.

Medical EquipmentMedical equipment can either be reusable or be for single use.

Reusable medical equipment should be accompanied by instructions from the manufacturer for cleaning and disinfection or sterilization.

Respiratory Hygiene/Cough Etiquette

• Contain respiratory secretions in those who have signs and symptoms of a respiratory infection.• Post signs at the entrance of healthcare facilities with instructions to cover their mouths/noses when coughing or sneezing (see Figure 5.19), use and dispose of tissues, use masks when available, and use proper handwashing techniques.• If possible, place febrile respiratory symptomatic patients at least 3 feet away from others in common waiting areas.

Expanded Precautions

Designed to reduce the risk for contact, droplet, or airborne transmission of pathogens, and should be used in addition to standard precautions.

Contact PrecautionsApplies to patients with the presence of:

• Stool incontinence• Draining wounds• Uncontrolled secretions• Pressure ulcers• Presence of tubes or bags of draining body fluids• Generalized rash

Droplet PrecautionsApplied to patients known or suspected to be infected with a pathogen that can be transmitted via a droplet such as respiratory viruses and bordetella pertussis.

Use standard precautionsIsolate patient in exam room with door closedPersonal protective equipment should be usedDisinfect exam room and medial equipment

Airborne PrecautionsApplies to patients known or suspected to be infected with a pathogen that can be transmitted via the air such as tuberculosis, measles, and chicken pox.

Patients should use a dedicated isolation entrancePatients should be placed in an airborne infection isolation room with a closed door.

Standard precautions should be followed.

Personal protective equipment should be used.

Blood and Body Fluids

Refer to blood, secretions, and excretions of a patient.

Pathogens found in the patient’s blood or body fluids and can be transmitted from the infectious person or infected body fluids to a susceptible host.

NeedlesticksTo prevent needlestick injury and reduce the risk of infection, healthcare workers should do the following:

• Avoid the use of needles if safe and effective alternatives are available

• Never recap used needles

• Avoid removing needles from syringes

• Dispose of used needles in sharps disposal containers immediately

Infectious Waste

Any item that has come in contact with blood or body fluids.

Should be handled with PPE such as gloves and placed in appropriate biohazard containers.

Infectious waste is either burned or autoclaved before it is disposed of.

Medical AsepsisSurgical asepsis - the use of practices to prevent transmission of infectious organisms and eliminate microorganisms during surgery.

Medical asepsis - the use of practices to help contain and prevent the transmission of infectious organisms and to maintain an environment free from contamination.

Skills for the Medical Assistant (Labs)

Medical assistant must be proficient in the skills necessary to minimize the spread of infection

Performing Hand Hygiene When Hands Are Visibly Soiled

Good hand hygiene is one of the most effective methods to prevent direct and indirect transmission of pathogens in ambulatory care settings

Handwashing must be performed on a regular basis before and after each patient contact and procedure.

Performing Hand Hygiene When Hands Are Not Visibly Soiled

Good hand hygiene is one of the most effective methods to prevent direct and indirect transmission of pathogens in ambulatory care settings.

Hand hygiene must be performed on a regular basis before and after each patient contact and procedure

Donning Personal Protective Equipment

Donning personal protective equipment protects the medical assistant from exposure to or contact with infectious agents.

Removing Personal Protective Equipment

Correctly removing personal protective equipment protects the medical assistant from exposure to contaminated materials and limits opportunities for self-contamination.

The location for removal of PPE will depend on the category of isolation precautions a patient is on and the amount and type of PPE worn by the medical assistant.

Sanitizing Instruments

Instruments must be cleaned to remove all tissue and debris prior to use.

Sanitization is the process of washing and scrubbing to remove all blood, body fluids, and tissue.

Performing Chemical Disinfection of Instruments

Heat-sensitive items must be sterilized using chemical disinfectants before use.

Summary• Infection-control procedures such as medical asepsis and surgical asepsis are precautions taken in the healthcare setting to prevent the spread of disease.

• The chain of infection are the steps or links that must be connected in sequential order for the spread of infection to occur.

• An infectious agent is a microorganism that has the ability to cause a disease.

• The portal of entry is the place where the infectious microorganism enters the host’s body.

• Standard precautions are a set of measures from the Centers for Disease Control and Prevention (CDC) that should be used by all healthcare professionals.