Chapter 19- Infection control

What is the goal of hand washing?

(Because the hands themselves cannot be sterilized, the goal of hand washing is to reduce skin bacteria through the use of mechanical friction, antimicrobial soaps, and warm, running water

•What is the procedure to follow for a torn glove?

(If a glove is torn during the procedure, the glove should be removed, the hands washed carefully, and a new glove put on as soon as possible.)

Hep B vaccine Availability in workplace Description •How is vaccination effectiveness checked?

- Must be available free of charge to all employees at risk for exposure. If they refuse, a form must be provided for declination permanently or at the time - Intramuscular injection in three doses (Employees should have a blood titer drawn after completion of the injection cycle to determine whether they have created antibodies against the disease.)

What's a portal of exit? what is used to prevent it?

-How a pathogen escapes a reservoir host Exits or Orphaces include the mouth, nose, eyes, ears, intestines, urinary tracts, reproductive tracts, and open wounds -Use standard precautions to help control spread of infection or break chain

What is the Portal of Entry?

-How transmitted pathogen gains entry into a new host. Can be the same list for exit -May be mouth, nose, eyes, intestines, urinary tract, reproductive system, or an open wound -Where anatomic defenses come into play

When Gloves Must Be Worn

-Touching a patient's blood, body fluids, mucous membranes, or skin that is not intact -Handling items and surfaces contaminated with blood and body fluids -Performing venipuncture, finger sticks, injections, and other vascular procedures -Assisting with any surgical procedure -Handling, processing, and disposing of all specimens of blood and body fluids -Cleaning and decontaminating spills of blood or other body fluids

Hand Hygiene facts (times to wash) (Requirements) (substitutes)

-Wash correctly before and after every patient -Warm water, antimicrobial soap, friction -Alcohol-based hand rubs may substitute unless hands are visibly contaminated

CDC's Hand Hygiene Recommendations 1. For Visibly soiled hands 2. For Alcohol-based hand rubs Allergic contact dermatitis from alcohol hand rubs is ?

1. Wash a minimum of 15 seconds with antimicrobial soap and warm, running water. Friction 2. -Used before and after contact with each patient, and also after removing gloves -To use properly, apply the label-recommended amount to palm of one hand and rub hands together, covering all surfaces until hands are dry uncommon

•The body's defense mechanisms eliminate the virus within ? in most acute infections.

2 to 3 weeks

Aseptic Techniques asepsis? Medical asepsis? surgical asepsis?

A-Free from infection or infectious material MA- Destruction of disease-causing organisms after they leave the body. Can still cause infections, but by using these techniques we can prevent spread of disease. SA- Destruction of all organisms before they enter the body. Want to have before surgery

OSHA Standards for the Healthcare Setting: Universal Precautions

All blood and certain body fluids must be treated as if known to be infectious for blood-borne pathogens; hep b, c, a, AIDS ØPrecautions must be implemented for all patients, regardless of the information available about person's individual health history

why are antibiotics useless against viruses?

Antibiotics are unable to destroy viral invaders that enter a normal cell and multiply within the cell. The only way to destroy a viral invader is to destroy the host cell.

define disease types infectious disease example

Any sustained, harmful alteration of the normal structure, function, or metabolism of an organism or cell - Any disease caused by the growth of pathogenic microorganisms in the body Any disease caused by the growth of pathogenic microorganisms in the body - covid

What are the compliance guidelines?

Barrier (PPE) Environmental Housekeeping controls Hep B vaccination Post-exposure follow-up

Barrier Protection

Barrier protection, or PPE, includes specialized clothing or equipment that prevents the healthcare worker from coming into contact with blood or other potentially infectious material ØDisposable gloves, face masks, face shields, protective glasses, shoe covers, laboratory coats, barrier gowns, mouthpieces, and resuscitation bags

Potentially Infectious Materials

Body fluids ØSemen ØVaginal secretions ØCerebrospinal fluid (CSF) ØSynovial fluid ØPleural fluid ØPeritoneal fluid ØAmniotic fluid ØSaliva in dental procedures ØAny body fluid that is visibly contaminated and in situations in which it is difficult/impossible to differentiate between body fluids

What are the three levels of disinfectants defined by the CDC with examples?

CDC defines three levels of disinfectants: ØLow-level disinfectants can kill most vegetative bacteria, some fungi, and some viruses ØIntermediate-level disinfectants can kill mycobacteria, vegetative bacteria, most viruses, and most fungi, but they do not kill spores ØHigh-level disinfectants will kill all microorganisms except large numbers of bacterial spores •An example of a low-level disinfectant is hydrogen peroxide. •An example of an intermediate-level disinfectant is isopropyl alcohol. •An example of a high-level disinfectant is Cidex OPA.

What's an opportunistic infection? Give an example

Caused by organisms not typically pathogenic but occur in hosts with an impaired immune system response •Like with HIV, over time, the person's immune system becomes weakened, and diseases result that are not typically seen in patients with a healthy immune system, such as certain types of pneumonia and oral candidiasis/yeast infections •Basically, become susceptible from lowered immunity.

Once in a host or reservoir, a pathogen either ... or ... in the case of vector-borne disease

Causes infection in the host or exits the host in great enough numbers to cause disease in another host

Define Sanitization what its used for

Cleansing process that reduces number of microorganisms to a safe level Removes debris such as blood and other body fluids from instruments or equipment. Wear gloves while performing sanitization

bacterial shapes Spherical Rod Spiral

Cocci Bacilli Spirilla

Define Sterilization What are its requirements?

Destruction of all microorganisms; Essential for surgical asepsis An Area should be set aside in each office for sterilization. Clear, clean plastic bags in which to store sterile packs may be kept in sterile area •The area should be divided into two sections. •One section is used for receiving contaminated materials. •The other section should be reserved for receiving the sterile items after removal from the autoclave.

in the OSHA standard precaution requirements to employers, what do the following mean... Exposure Control Plan includes

ECP-each medical office must have one. the purpose is to identify tasks where there is a potential for exposure. Includes a timetable, hep b vaccine requirements, documented steps for an exposure incident, evaluation for incident, and training records for (3yrs)

in the OSHA standard precaution requirements to employers, what do the following mean... Engineering controls and work practices examples what employer enforces examples

Engineering: the provider must provide controls, or equipment and facilities that minimize the possibility of exposure EX: puncture resistant containers, handwashing equipment The employer must also enforce work practice controls, which minimize exposure by enforcing proper techniques. EX: proper handwashing, needle safety, techniques for minimizing splashing

What are natural methods of the body used to limit the amount of pathogens entering the body? (via portal of exit and entry)

Eyebrows, hairs in ears, earwax, tears, nasal hairs, secretions, and saliva

Fungi-- Description? Treatment? Examples?

Grow in warm, moist, environments. HIGHLY CONTAGIOUS-wash hands Very hard to treat, it is fast to react to medications. Meds must be given for a full time period dosage even after symptoms have left. Treat with antifungal agents. Examples include mushrooms, molds, and yeasts. Ringworm and jock-itch are famous.

Discuss the stages of an acute infection

Incubation- the period of time Prodromal Acute Declining Convalescent

List the Chain of Infection Components in order what are they required for?

Infectious agent Reservoir host Portal of exit Mode of transmission Portal of entry Susceptible host • Certain factors are required for an infectious disease to spread. These factors, or links, make up the chain of infection.

what are some common errors in disinfection?

Instruments are not thoroughly sanitized; attached organic matter inhibits or prevents action of disinfectant Sanitized instruments are not dried Disinfectant solution is left in an open container; evaporation changes its concentration Solutions are not changed after the recommended period Solutions are not prepared properly or are not mixed properly Manufacturer's recommended temperature for use and storage are not maintained

what are Interferons?

Interferon produced by cells helps protect cells from viruses

How does a latent viral infection like herpes simplex virus type I cycle?

It enters the body and causes the original lesion. It then lies dormant, in nerve cells away from the surface, until a certain provocation [illness with fever, sunburn, or stress] causes it to leave the nerve cell and seek the surface again. Once the virus reaches the superficial tissues, it becomes detectable for a short time and causes a new outbreak at the site

Explain the principle of standard precautions and list the 5 major areas included in OSHA compliance guidelines

It is also called Bloodborne Pathogen standard. It also includes Universal Precautions. It is a safeguard all hc employees and their pts who are at risk of exposure from blood or OPIM. Basically for precaution, any item contaminated should be handled with precaution and PPE. It requires: Exposure control plan, engineering controls and work practices, PPE, Exposure incident management, and communication of potential hazards to all employees. Barrier (PPE) Environmental Housekeeping controls Hep B vaccination Post-exposure follow-up

Legal and Ethical Issues in asepsis conclude

It is imperative that disinfection and sterilization are performed precisely and effectively Carelessness can cause nosocomial infections in patients •Typically, the medical assistant is alone when performing a medical aseptic procedure; therefore, if contamination occurs, he or she is the only one who knows. •If contamination should occur, the medical assistant must start over again with clean supplies.

What comprises standard precautions?

Latex gloves, masks, wound care, correct disposal of waste products, and hand washing

•The ? set the standards for governmental regulation of medical waste; however, that law expired in 1991. •Each healthcare facility must hire a ? whose employees are trained to collect and haul away biomedical waste in special containers.

Medical Waste Tracking Act biomedical waste disposal service

What are helminths?

Multicellular pathogen that include tapeworms, roundworms, and flatworms. A. type of protozoa

Whats another name for a fungal infection?

Mycotic Infections

OSHA's Bloodborne Pathogens Standard: Needlestick safety and prevention act An employer who fails to comply with OSHA's Bloodborne Pathogens Standard could face...

Needlestick Safety and Prevention Act ØEmployers must keep a confidential sharps injury log that describes the device involved and details of how and where incident occurred •An employer who fails to comply with OSHA's Bloodborne Pathogens Standard could face a maximum penalty of $7,000 for the first violation and up to $70,000 for repeated violations.

Why is proper sanitization so important before disinfection?

No chemical can kill unless it reaches all instrument surfaces; therefore, complete sanitization is absolutely necessary.)

Explain the process of Inflammation response in the body

Once the body experiences trauma or is exposed to pathogens. There is a release of inflammation mediators (histamine, prostaglandins, kinins); this causes an INC WBCs to site Three things happen from mediators: BV dilate, BV INC permeability, and Chemotaxis. -Dilation causes inflammation and heat -Permeability causes edema and pain -Chemotaxis attracts WBCs Everything leads to phagocytosis

What is antibiotic resistance? Who is to blame? What are ways to reduce resistance?

One of the world's most significant public health problems Resistance occurs when an antibiotic is used inappropriately to treat an infection (some of the bacteria that survive the initial antibiotic treatment may mutate, allowing the microorganism to survive even in the presence of the antibiotic.) patient (not taking meds) and doctor (overprescribing) ØPrescribe antibiotic therapy only when it will benefit the patient ØTreat the patient with an antibiotic that is specific to the infecting pathogen ØPrescribe the recommended dose and treatment duration of the medication

in the OSHA standard precaution requirements to employers, what do the following mean... PPE ex Exposure Incident management

PPE: the employer must provide. EX: gowns, goggles, shields EIM: when an exposure incident is reported, the employer must arrange for an immediate and confidential medical evaluation. Must include -Documenting of how exposure occured -identifying and testing source individual -testing employers blood -provide counseling -evaluating, treating, and following up with illness

What's a latent infection? Examples Treatment

Persistent infection in which symptoms cycle through periods of relapse and remission ØExamples include cold sores (1), genital herpes, and varicella (pox)---all herpes No cure

What's a Chronic Infection? Example?

Persists for a long period, sometimes for life Some chronic infections are asymptomatic, but virus is transmissible An example is hepatitis B

Define Disinfection What are some examples and precautions when using agents?

Process of killing pathogenic organisms or of rendering them inactive Disinfecting agents vary in effectiveness and must be used according to instructions. Bleach, alcohol, and Cidex are examples.

Inflammation response is?

Process results in four classic symptoms of inflammation: ØErythema (redness) ØEdema (swelling) ØPain ØHeat

What helps control the transmission of pathogens?

Proper sanitation of water and food, the use of sanitization, disinfection, and sterilization procedures; and the use of germicides, such as Wavicide and Cidex

Whats an acute infection? Prodromal period? Treatment?

Rapid onset of symptoms, but lasts a relatively short period of time Prodromal period is the time when patient first shows vague, nonspecific symptoms of disease Symptoms appear after the tissue damage begins; virus already invading. Palliative care comes into play.

Environmental Protection

Refers to minimizing risk of occupational injury by isolating or removing any physical or mechanical health hazard in medical workplace ØRead warning labels on biohazard containers and equipment, know where they are ØMinimize splashing or spraying of potentially infectious materials ØBandage any breaks or lesions (portal of entry) on your hands before gloving

What are reservoirs?

Second link -Can be people, insects, animals, water, food, or contaminated instruments. -A pathogen must gain entrance into a host or else they will die, so they enter a R that supplies them nutrition for multiplication

Suggestions for Asepsis and Infection Control Education

Set up an information table in the waiting room with take-home pamphlets and literature Mail, e-mail, or post a periodic newsletter to patients about infection control Demonstrate and explain aseptic procedures to patients and family members

Viruses-- Description? Treatment? Examples?

Smallest of all pathogens Intracellular parasites that take over DNA or RNA of invaded cell Treatment is palliative (relief of symptoms) Cannot be cured, just treat the symptoms ie Tylenol for reducing pain common cold, influenza A and B, herpes (1 and 2) (chickenpox=shingles), infectious hepatitis (B and C), acquired immunodeficiency syndrome (AIDS), which is caused by HIV.

What is ultrasonic sanitization how does it work on instruments?

Sound waves can be used to sanitize instruments Instruments are placed in an ultrasonic bath of cleaner and water. Sound waves cause the solution to vibrate, which loosens the materials attached to the instruments. The process is gentle on instruments and reduces worker exposure to sharps injury

What is the Role of the Medical Assistant in Asepsis?

Spread of pathogens can be controlled only through application of the Bloodborne Pathogens Standard and by proper sanitization, disinfection, and sterilization of supplies, equipment, and work surfaces. •It is important that these techniques be done on such a routine basis that they become an unbreakable habit.

Using Standard Precautions to Remove Contaminated Gloves

The goal is minimize exposure to pathogens by aseptically removing and discarding contaminated gloves

How can we use medical asepsis in the hc field?

The goal medical asepsis helps with is to eliminate or minimize pathogens by following OSHAs bloodborne pathogens standard and disinfecting objects as soon as possible a/f contamination. This creates an environment free of pathogens

How do we use surgical asepsis?

This technique is used for any procedure that enters the bodys skin or tissues, such as sugery or injection. Everything in contact with pt should be sterile, including all PPE

Bacteria-- Description? Treatment? Examples?

Tiny, simple cells that produce disease in a variety of ways Classified according to their shape, or morphology Some bacteria can produce resistant internal structures, called spores, that make treatment difficult •The most common approach to treatment is to use antibiotics to destroy the invader or inhibit its growth. Common bacterial diseases caused by bacteria include tuberculosis, urinary tract infections, bacterial pneumonia, and strep throat

Bacteria on the Skin transient Resident most effective barrier?

Transient bacteria ØSurface bacteria introduced by fomites Resident bacteria ØFound under fingernails, in hair follicles, openings of sebaceous glands, and deeper layers of skin Most effective barrier against infection is unbroken skin

What is transmission

Two types Direct transmission occurs from contact w/ infected person or discharges from infected person Indirect transmission occurs from droplets from coughing/sleeping/sneezing, vectors, contaminated food and drink, and contact with contaminated inanimate objects (fomites)

Protozoa-- Description? Examples?

Unicellular parasites that replicate and multiply fast once inside host. Frequently seen in tropical areas. Malaria cause by ingesting feces contaminated water

What are the types of infectious agents?

Viruses Bacteria Protozoa Fungi

Postexposure Follow-Up Procedures

Wash or flush exposed area and receive confidential medical evaluation File incident report and screen and test person for HBV, HCV, and HIV Receive copy of physician's written opinion within 15 days of evaluation Receive health counseling about risks and adverse outcomes

What are some ways to educate pt/pt coach about the infection process and ways to prevent the transmission of disease?

While washing your hands, explain to the patient that this routine is part of daily hygiene Advise patient to carry an alcohol-based hand rub and use it throughout the day Explain the use of disposable tissues or bent elbow to cover nose and mouth when coughing or sneezing Discuss proper ways of discarding used tissues Instruct patient in the differences between sterile and clean dressings and bandages

Parenteral exposure includes

accidental needlesticks, occupation-related human bites, and exposure of nonintact skin

Handle soiled linen as little as possible and ? Contaminated materials and/or infectious waste must be handled with extreme ? •Biohazard waste must be collected in ?, polyethylene or polypropylene ? or containers and sealed.

always wear gloves or other protective equipment during disposal caution to prevent exposure impermeable red biohazard-labeled bags

Universal Precautions protect patients from any ? the healthcare worker may carry.

blood-borne infection

•The immune system also reacts at a cellular level with T-cell activity in ? by causing the ?

cell-mediated immunity destruction of pathogenic cells at the site of infection.

Equipment requiring repair that has been contaminated with blood or body fluids should be ? Smoking, eating, drinking, applying cosmetics or lip balm, and handling contact lenses are ? ? cannot be kept in refrigerators, freezers, or cabinets or on countertops where infectious materials could be present

decontaminated before being repaired in the office or transported for repair prohibited in work areas where there is reasonable likelihood of contamination from pathogens Food and beverages

•Instruments and objects used in medical aseptic procedures must be ?

decontaminated or sterilized before use on another patient.

Housekeeping Controls Work surfaces must be immediately decontaminated with a ? after accidental spills of blood or body fluids, at end of ? Disinfection and decontamination of all reusable containers must be done on a ? Sharps containers must be as ? to work area Never pick up ? with the hands

disinfectant each procedure, and at end of each shift routine basis close as possible spilled material or broken glassware

Contaminated objects

fomites

•Various factors contribute to a host's susceptibility:

genetic factors, quantity of organisms, and state of the individual's physical health.

Identify the appropriate PPE for the following scenarios: Body fluids Secretions/Excretions Blood Nonintact Skin mucous membranes

gloves on all. Face shields are to be worn whenever the presence of droplets, splashes, or sprays are possible. Gowns when blood or body fluids

What is the best ways to prevent spread or continuation of chain of infection?

hand washing, antiseptics, disinfection, and sterilization Also, using standard precautions, universal precautions, and PPE help limit spread

•The immune system responds by producing antibodies specifically designed to combat the presence of a foreign substance, or antigen. This process is called

humoral immunity.

Second line of defense is

immune system and inflammatory process ØHumoral immunity ØCell-mediated immunity

Anatomic defenses include...

include integumentary system, tears, cilia, mucous membranes, and pH of body fluids

•Hypersensitivity reactions to ? or the powder that lines them may be localized, involving urticaria, dermatitis, conjunctivitis, and rhinitis, or they may be systemic, producing asthmatic reactions or anaphylaxis.

latex gloves

Protocols for Disposal of Biologic Chemical Materials Biomedical waste should be collected in containers that are ? Workers who handle biomedical waste should observe ? Biologic waste containers/boxes should not be held in healthcare facilities for more than ? ? are instruments intended to cut or penetrate the skin Boxes for disposal of chemicals should be ?

leakproof and strong Standard Precautions 30 days Sharps labeled with the chemicals' names and any other pertinent data

Healthcare workers with artificial nails have ? pathogenic microbes under their nails Natural nail tips should be no longer than

more ¼ inch

•Blood that splatters onto ? is a proven mode of transmission of hepatitis B virus (HBV).

open areas of the skin or mucous membranes

Contaminated sharps should not be ? Immediately after use, dispose of syringes and needles, scalpel blades, and other sharp items in a ? All specimens must be placed in a ?

processed in a way that requires employees to reach into containers to grasp them labeled, leak-proof, puncture-resistant biohazard container container that prevents leakage during collection, handling, processing, storage, transport, and shipping

•The goal of aseptic hand washing is to

protect you from infection and to prevent cross-contamination from one patient to another.

in the OSHA standard precaution requirements to employers, what do the following mean... Communication of potential hazards to employees

right to know law. OSHA claims each employee must have the right to know what chemicals they are working with. Includes ID of chemical, physical and health hazards, precautions for handeling, carcinogens, contact info for the manufactorers and first aide procedures.

If any body surface is exposed to potentially infectious material, ? If your eyes come into contact with body fluids, ? Contaminated needles and other sharps should never be ?

scrub area with antimicrobial soap and warm, running water as soon as possible after exposure continuously flush them with water as soon as possible for a minimum of 15 minutes using an eye wash unit recapped, bent, broken, or resheathed

•A systemic infection, called ?, may occur when an infection spreads to the bloodstream. It ultimately could affect the entire body.

septicemia or blood poisoning

•Needle units are now required to have ? for use after injection.

sliding shields or some other protective device

•Everything that comes into contact with the patient should be ?

sterile, including gowns, drapes, instruments, and the gloved hands of the surgical team.

•If the host is ? (i.e., capable of supporting the growth of the infecting organism), the organism multiplies. •If conditions are right, the organism reaches infectious levels, and the susceptible host can ?

susceptible start the chain of infection all over.

•The inflammatory response starts when ? •Body's natural defense to organisms is to ?

the body experiences trauma or is exposed to pathogens. swarm what its invading to try and expel it

The best way for hc workers to prevent the spread of disease... #1 best way

use infection control procedures to break the chain to stop the disease process/spread handwashing

How would you sanitize equipment?

using gloves, When you are ready to sanitize instruments, drain off the soaking solution and rinse each instrument in cold, running water. Clean each instrument and rinse in hot water and then check carefully that they are in proper working order before they are disinfected or sterilized.

•The physician caring for the exposed employee must receive ? •If screening is done, OSHA requires that the employee be ?

written details of the exposure incident, including the route and circumstances surrounding the incident. informed of the results of the source individual's tests.

When do you wash hands

•Use this procedure after you finish with one patient and before you attend to another patient; after you finish handling one specimen and before you handle another specimen; before and after you use toilet facilities; whenever you touch something that causes your hands to become contaminated; when you arrive at work and before you leave the office; before and after eating; and at the end of the day.

what is phagocytosis

•engulfing and destruction of microorganisms and damaged cells.