Kinns Chapter 27 Infection Control

Which of the following procedures require the use of disposable gloves. 1. Assisting with a vaginal examination 2. Performing a routine urinalysis 3. Measuring a patient's temperature, pulse, and respirations 4. Performing a patient interview 5. Drawing blood from a 6-year-old child

1. Assisting with a vaginal examination 2. Performing a routine urinalysis 3. Drawing blood from a 6-year-old child

List five different bodily fluids that have been identified as potentially infectious by the CDC.

1. Cerebrospinal fluid (CSF); synovial, pleural, pericardial, peritoneal, mucous, and amniotic fluids 2. Liquid or semiliquid blood 3. Vaginal and seminal secretions 4. Saliva in dental procedures 5. Body fluid visibly contaminated with blood

List the chain of infection in order.

1. Infectious Agent 2. Reservoir Host 3. Portal of exit 4. Mode of transmission 5. Portal of entry 6. Susceptible host

Name the ways the body naturally defends itself from infection.

1. Intact Skin 2. Mucous membranes 3. Cilia hairlike projections line the respiratory tract and move in coordinated upward motion to trap foreign substances 4. Sneezing/coughing 5. Secretions 6. Neutral pH

Describe the five conditions needed for microorganisms to grow.

1. Nutrients-Carbs, proteins, and fats 2. Moisture 3. Temperature- many flourish at body temp 4. Oxygen- some require O2 to grow, others don't 5. Neutral pH

Identify four safety rules that should be followed in the ambulatory care setting to comply with Osher's environmental protection guidelines.

1. Observe warning labels on biohazard containers and equipment. 2. Minimize splashing or spraying of potentially infectious materials. Blood that splatters onto open areas of the skin or mucous membranes is a proven mode of transmission of HBV. 3. Bandage any breaks or lesions on your hands before gloving. 4. If exposed body surfaces, such as the eyes, come in contact with body fluids, flush with water and/or scrub with soap and water as soon as possible using an eye wash unit.

Describe three things the medical assistant can do to promote environmental protection of the office

1. Observe warning labels on biohazard containers and equipment. 2. Minimize splashing, spraying, and spattering of drops of potentially infectious materials. Splattering of blood onto skin or mucous membranes is a proven mode of transmission of HBV. 3. Bandage any breaks or lesions on the hands before gloving.

List the five groups of infectious organisms

1. Viruses 2. Bacteria 3. Protozoa 4. Fungi 5. Rickettsiae

Describe the procedure for proper hand washing.

1.Remove all jewelry except your wristwatch, which should be pulled up above your wrist or removed, and a plain gold wedding ring. 2.Turn on the faucet with a paper towel and regulate the water temperature to lukewarm. 3.Allow your hands to become wet, apply soap, and lather using a circular motion with friction while keeping your fingertips pointed downward. Rub well between your fingers. If this is the first hand washing of the day, thoroughly inspect the area under each fingernail and clean with a nail brush or an orange stick. 4.Rinse well, holding your hands so that the water flows from your wrists downward to your fingertips. 5.Wet your hands again and repeat the scrubbing procedure using a vigorous, circular motion over the wrists and hands for at least 1 to 2 minutes. 6.Rinse your hands a second time, keeping your fingers lower than your wrists. 7.Dry your hands with paper towels. Do not touch the paper towel dispenser as you get the towels. 8.If the faucets are not foot operated, turn off the water faucet with the paper towel. 9.After you finish drying your hands and turning off the faucets, discard the used towels in a bio-hazardous waste container. 10.Apply a water-based antibacterial hand lotion to prevent chapped or dry skin.

Sanitization

A cleansing process that reduces the number of microorganisms to a safe level as dictated by the public health guidelines

Antigen

A foreign substance that causes the production of a specific antibody

Disinfectant

A liquid chemical that is capable of eliminating many or all pathogens but is not effective against bacterial spores

Latent

A persistent infection in which the symptoms cycle through periods of relapse and remission

Interferon

A protein formed when a cell is exposed to a virus; the protein blocks viral action on the cell and protects against viral invasion

Urticaria

A skin eruption that creates inflamed wheals; hives

Palliative

A substance that relieves or alleviates the symptoms of a disease without curing the disease

Spores

A thick-walled, dormant form of bacteria that is very resistant to disinfection measures

List four types of infection.

Acute infection, chronic, latent, slow.

Germicides

Agents that destroy pathogenic organisms

Permeable

Allowing a substance to pass or soak through

Anaphylaxis

An exaggerated hypersensitivity reaction that in severe cases leads to vascular collapse, bronchospasm, and shock

Candidiasis

An infection caused by a yeast that typically affects the vaginal mucosa and skin

Chronic

An infection that persists for a long period, sometimes for life

Vector

Animals or insects (ex. ticks) that transmit the causative organisms of disease

Tinea

Any fungal skin disease that results in scaling, itching, and inflammation

Transient Bacteria

Bacteria temporarily living in or on a certain body part, such as the hands

Resident Bacteria

Bacteria that live in or on a certain part of the body; such as the skin or mucosa

List five groups of infectious organisms.

Bacteria, fungi, viruses, protozas, rickettsia

Potentially infectious fluids are:

Blood, semen, vaginal sectetion

Inflammatory Process`

Bodies second line of defense against infection - responses that destroy and remove pathogenic organisms and their byproducts, or limits the extent of damage caused by the invading pathogen. Includes erythema, edema, pain and heat. Causes an increase in white blood cells.

CDC stands for ___.

Center for Disease Control

List three potentially infectious fluids.

Cerebrospinal Fluid (CSF) Synovial Pleural Pericardial Peritoneal Mucous Amniotic Fluids Blood Vaginal Seminal Secretions Saliva

List three types of bacteria and describe their shapes.

Cocci - sphere Bacilli - rod Spirilla - spiral anaphylaxis response

Fomite

Contaminated, nonliving objects (ex. examination room equipment) that can transmit infectious organisms

Pus formation

Destroyed pathogens, cells, and WBCs collect in the area and form a thick, white substance.

Sterilization

Destruction of all microorganisms

Surgical Asepsis

Destruction of organisms before the enter the body

Name a symptom of sign of latex allergy.

Difficulty breathing

List the signs and symptoms of inflammation.

Edema Erythema Pain Heat

True/False Viruses are susceptible to antibiotics.

False

True/False Viruses may be treated with antibiotics.

False

Integumentary System

First line of defense against pathogenic invasion. (mechanical barrier to infection)

Hepatitis A can be _____.

Food borne

Sterile

Free of all microorganisms, pathogenic and non-pathogenic

Name the two factors required for proper hand washing.

Friction and running water

List several items that should be included in the OSHA Exposure plan.

Housekeeping, PPE, vaccinations, post-exposure, training, medical surveillance, record keeping.

Explain the difference between cell-mediated immunity and humoral immunity.

Humoral immunity creates specific antibodies to combat antigens Cell-mediated immunity attacks the source of the infection at the cellular level.

Rosa is concerned that she may be allergic to latex. For what signs and symptoms should she look when she puts on latex gloves? Is Rosa's employer required to supply her with latex-free gloves if she does have a latex allergy? Why or why not?

Hypersensitivity reactions to latex gloves or the powder that lines them may be localized, causing urticaria, dermatitis, conjunctivitis, and rhinitis; they also may be systemic reactions, manifesting as asthmatic reactions or an anaphylactic response. Osher's guidelines require healthcare workers to wear gloves. If an employee is allergic to latex, the employer must provide the proper gloves to enable the person to perform his or her job duties.

Septicemia

If the body is too weak or the number of pathogens is too great, the bloodstream.

Enlarged lymph nodes

If the pathogenic invasion is too great for localized control, the infection may collect in the body's lymph nodes.

Antibody

Immunoglobulins produced by the immune system in response to bacteria, viruses, and other antigenic substances

Opportunistic infections

Infections caused by a normally non-pathogenic organism in a host whose resistance has been decreased

The first link in the chain of infection is:

Infectious Agent

Anaerobes

Live without oxygen

OSHA stands for

Occupational Safety and Health Administration

The relief of symptoms is called ___.

Palliative Treatment

Hereditary

Pertaining to a characteristic, condition, or disease transmitted from parent to offspring on the DNA chain

Pathogenic

Pertaining to a disease-causing microorganism

Autoimmune

Pertaining to a disturbance in the immune system in which the body reacts against its own tissue

Acute

Rapid onset of symptoms but last relatively short time

Medical Asepsis

Removal of disease-causing organisms or destruction of the organisms after they leave the body

Aerobes

Require oxygen to grow

For proper handwashing, you need:

Running water and friction

Rhinitis means ____.

Runny nose

_____________ is the cleansing process that reduces the number of microorganisms to a safe level as dictated in public health guidelines.

Sanitation

__________ is the cleansing process that decreases the number of microorganisms to a safe level as dictated in public health guidelines.

Sanitization

Contaminated

Soiled with pathogens or infectious material, non-sterile.

List several barriers or types of personal protective equipment that are commonly used in physicians' offices.

Specialized clothing, latex gloves, face masks, protective glasses, laboratory coats, and mouthpieces.

Coccie bacteria are ____.

Spherical-shaped

Instruments in surgery are ____.

Sterile

Antiseptic

Substances that inhibit the growth of microorganisms on living tissues

Parenteral

The injection or introduction of substances into the body by any route other than the digestive tract

Remission

The partial or complete disappearance of the clinical and subjective characteristics of a chronic or malignant disease

Pyemia

The presence of pus-forming organisms in the blood

Disinfection

The process of killing pathogenic organisms or rendering them inactive

Relapse

The recurrence of the symptoms of a disease after apparent recovery

Describe the impact of the inflammatory response on the body's ability to defend itself against infection.

Through the inflammatory response, the body prevents the invasion of microorganisms after trauma or limits the number of these invaders. This process has four classic symptoms: erythema, pain, edema, and heat. When cellular damage occurs, inflammatory mediators are released, which cause blood vessels to dilate and become permeable and chemotaxis to occur; this brings more WBCs to the site.

Coagulate

To form clots

Hand Sanitation should be performed after gloves have been removed.

True

True/False two factors needed for proper hand washing are friction and running water.

True

True/False Hand washing must be performed after taking off gloves.

True

When removing contaminated gloves, ____.

Turn inside out one over the other

Hypersensitivity to latex products may include the following symptoms:

Urticaria, Dermatitis, conjunctivitis, rhinitis,

Explain the five major areas included in the OSHA compliance guidelines.

a. Barrier protection devices b. Environmental protection c. Housekeeping controls d. Hepatitis B immunizations e. Postexposure follow-up

Rosa is explaining the signs and symptoms of inflammation to a patient. List the four classic symptoms.

a. Erythema b. Edema c. Pain d. Heat

List six common errors of disinfection.

a. Instruments are not thoroughly sanitized, and attached organic matter inhibits or prevents the action of the disinfectant. No chemical can kill unless it reaches all instrument surfaces; therefore, complete sanitization is absolutely necessary. b. Sanitized instruments are not dried, and the moisture on the instruments dilutes the disinfectant solution beyond the effective concentration. c. A solution is left in an open container, and evaporation changes its concentration. d. Solutions are not changed after the recommended period for use has expired. e. Solutions are not prepared properly or not mixed properly before use. f. The manufacturer's recommended temperature for use and storage is not maintained.

Employers with workers who are at risk for occupational exposure to blood or other infectious materials must implement an Occupational Safety and Health Administration (OSHA) Exposure Control Plan that details employee protection procedures. List seven items that should be included in the plan.

a. PPE b. Training c. Medical surveillance d. Hepatitis B vaccination e. Record keeping for workplace injuries f. Labeling hazardous materials g. Engineering controls

Rosa is helping to update the OSHA Exposure Control Plan in her office. She wants to include a policy for wearing gloves. List six different times gloves should be worn.

a. When touching a patient's blood and body fluids, mucous membranes, or skin that is not intact. b. When handling items and surfaces contaminated with blood and body fluids. c. When performing venipuncture, finger sticks, injections, and other vascular procedures. d. When cleaning. e. When handling, processing, and disposing of all specimens of blood and body fluids. f. When decontaminating spills of blood or other body fluids.

Define nosocomial

acquired or occurring in a hospital

Define Antibody

an immunoglobulin produced by the immune system in response to invading bacteria, viruses, or other antigenic substances.

Rosa is helping to update the OSHA Exposure Control Plan in her office. She wants to include a policy for wearing gloves. All of the following are times gloves should be worn EXCEPT: a. When touching a patient's blood and body fluids, mucous membranes, or skin that is not intact. b. Handling items and surfaces contaminated with blood and body fluids. c. While taking a patient's medical history d. Performing venipuncture, finger sticks, injections, and other vascular procedures. e. Cleaning f. Handling, processing, and disposing of all specimens of blood and body fluids g. Decontaminating spills of blood or other body fluids.

c. While taking a patient's medical history

Inflammation mediators that are released at the site of cellular damage perform which of the following functions? a. Increase blood flow to the site b. Increase the permeability of blood vessel walls c. Cause more red blood cells (RBCs) to be attracted to the site of injury d. Both A and B e. All are correct

d. Both A and B

Which of the following are potentially infectious fluids? a. Synovial b. Pleural c. cerebrospinal fluid (CSF) d. mucous e. Blood f. Peritoneal g. amniotic fluids h. human tissue i. All of the above

i. All of the above

Rhinitis

inflammation of the mucous membranes of the nose

Viruses form a substance called ____.

interferon

A/an ________________ infection is usually acquired during hospitalization or in a healthcare setting.

nosocomial

The most important step in achieving asepsis is:

washing hands

While performing venipuncture, Rosa receives an accidental needlestick. Describe the postexposure instructions and follow-up procedures.

• The employee should immediately wash or flush the exposed area. • The employee should immediately report the incident to the supervisor. • The employee should receive a confidential medical evaluation. The physician caring for the exposed employee must receive written details regarding the exposure incident including the route and circumstances surrounding the incident. All documentation related to the exposure must remain confidential, not disclosed to any individual without the employee's express written permission, and kept for at least the duration of the worker's employment plus 30 years. • An incident report must be filed that documents the details surrounding the exposure incident, the route or type of exposure, and the identity, if known, of the source individual. The source individual is the person, living or dead, whose blood or potentially infectious material was the source of the occupational exposure. • The source individual, if known, is immediately screened for HBV and HIV. State law determines whether the employee may be told the results of the source individual's tests. • The exposed employee is tested for HBV and HIV if consent is given. If the employee refuses the tests but blood is drawn, the sample must be stored 90 days for the worker to decide whether screening is wanted. • If the employee has not been vaccinated against HBV, vaccination is offered. • The employee must receive a copy of the healthcare provider's written opinion within 15 days of completion of the evaluation. • The employee must receive health counseling regarding the risk of illness or other adverse outcomes of exposure and the potential for as well as consequences of transmission of the disease to family, patients, and others.

Rosa realizes that her patient needs to be educated about proper asepsis. However, in a busy office, the staff does not have a lot of extra time. What can Rosa do during her time with the patient to educate the person properly about aseptic techniques?

• While hand washing, explain to the patient that this routine is part of daily hygiene and is particularly important for patients who are very young or old or who seem to get sick frequently. Discuss with the patient that hands should be washed before and after meals; after sneezing, coughing, or nose blowing; after using the bathroom; before and after changing a dressing; and after changing an infant's diaper. • Explain to the patient how using disposable tissues to cover the nose and mouth when coughing or sneezing reduces the possibility of transmitting illness between household members. • Discuss proper ways of disposing of used tissues, especially when a member of the household is suspected of having a communicable disease. • Instruct the patient about the differences between sterile and clean dressings and bandages. Show him or her step by step how to change a dressing properly and then how to dispose of the contaminated items. • Set up an information table in the waiting room with take-home pamphlets and literature. • Mail a periodic newsletter to patients about infection control, especially during flu season. • Demonstrate and explain aseptic procedures to patients and/or family members, inviting them to participate.