Chapter 17; Medical Asepsis and Infection Control

Vector

(biologic) a living non human carrier of disease, usually an arthropod; (mechanical) a carrier of disease that does not support growth; examples include contaminated inanimate objects

What PPE should you wear when assisting the physician with a wound irrigation?

A wound irrigation requires wearing gloves and covering the eyes, nose, and mouth. This procedure has the potential to splash microorganisms into the environment.

Blood-Borne Pathogen Standard Training

According to OSHA, health care facilities, including physician offices, must provide training to newly hired employees who will be exposed to blood or other possibly infectious material while caring for patients. This training must be repeated yearly and include any new issues or policies recommended by OSHA, the CDC, the Department of Health and Human Services, or the US Public Health Service. The following items must be included in the training: • A description of blood-borne diseases, including the transmission and symptoms • Personal protective equipment (PPE) available to the employee and the location of the PPE in the medical office • Information about the risks of contracting Hepatitis B and about HPV vaccine • The exposure control plan and postexposure procedures, including follow-up care, in the event of an exposure

After drawing a blood specimen from a patient, you notice that the tube of blood is leaking onto the examination table where you put it while finishing the procedure. How do you clean up the blood spill?

Again, all blood should be considered contaminated and should be cleaned up using the commercially prepared spill kit or with the items assembled from the office. The broken blood tube should be placed in a sharps container, and once the blood has been wiped up, the table should be disinfected.

Conditions that Favor the Growth of Pathogens

All microorganisms require certain conditions to grow and reproduce. To reduce the number of microorganisms and potential pathogens in a clinical setting, you must eliminate as many of their life requirements as possible. These requirements include the following: • Moisture • Nutrients • Temperature • Darkness • Neutral pH • Oxygen If any one of these conditions is altered in any way, the growth and reproduction of the pathogen will be affected. Your roll as a professional medical assistant in a medical office includes using this knowledge of microbial growth to inhibit the growth and reproduction of microorganisms in the office.

Handling Environmental Contamination

Although not all equipment for surfaces in the medical office must be sterile (free from all microorganisms), all equipment and areas must be clean. Sanitization is cleaning or washing equipment or surfaces by removing all visible soil. Because you may be expected to perform cleaning tasks routinely or when the surfaces become spoiled with visible blood or body fluids, you should understand how these procedures are correctly performed. Any surface contaminated with biohazardoud material should be promptly cleaned using an approved germicide or a dilute bleach solution. OSHA requires that spill kits or appropriate supplies be available, and commercial kits make cleaning contaminated surfaces relatively safe and easy. If your office does not purchase commercial kits, you should gather and store the following items together in the event that a biohazardous spill occurs: • Eye protection, such as goggles • Clean examination gloves • Absorbent powder, crystals, or gel • Paper towels • A disposable scoop • At least one biohazard waste bag • A chemical disinfectant Although most medical offices use disposable patient gowns and drapes, some offices continue to use cloth. Hygienic storage of clean linens is recommended, and proper handling of soiled linens, disposable or not, is required.

Temperature

Although some microorganisms can survive even in freezing or boiling temperatures, those that thrive at a normal body temperature of 98.6°F are most likely to be pathogenic to humans. Many microorganisms that leave an infected person can survive for a while at room temperature; therefore, surfaces that are contaminated with dried organic material should be considered possibly pathogenic.

Skin

As long as the skin is kept clean and remains intact or unbroken, staphylococcal (Staph) bacteria are not considered dangerous. Washing the skin frequently will flush away many of these bacteria along with any other microorganisms.

Direct Transmission

Direct contact between the infected reservoir host and the susceptible host produces direct transmission. Direct transmission may occur when one touches contaminated blood or body fluids, shakes hands with someone who has contaminated hands, inhales infected air droplets, or has intimate contact, such as kissing or sexual intercourse, with someone who is contaminated.

Disinfection

Disinfectants, or germicides, inactivate virtually all organized pathogenic microorganisms but not necessarily all microbial forms, including spores, on inanimate objects. The following factors may affect disinfection: • Prior cleaning of the object • The amount of organic material on the object • The type of microbial contamination • The concentration of the germicide or chemical disinfectant that kills Pathogens • The length of exposure to the germicide • The shape or complexity of the object being disinfected • The temperature of the process Disinfection is categorized into three levels -- high, intermediate, and low. High-level disinfection destroys most forms of microbial life except certain bacterial spores. Intermediate-level disinfection destroys many viruses, fungi, and some bacteria. Low-level disinfection destroys many bacteria and some viruses.

Explain the difference between exposure risk factors and the exposure control plan.

Exposure risk factors are associated with specific jobs in terms of exposure to biohazardous or contaminated materials. The exposure control plan is a written document outlining the procedure that an employee or visitor should take to prevent contact with biohazardous material.

Disposing of Infectious Waste

Federal regulations from the Environmental Protection Agency (EPA) and OSHA set the policies and guidelines for disposing of hazardous materials, but individual states determine policies based on these guidelines. As a result, policies very widely, and you should review your state and local regulations before making waste disposal decisions. To remain compliant with any state and federal laws, facilities that are considered large generators of infectious waste and some smaller medical offices use an infectious waste service to dispose of biohazardous waste appropriately and safely. Because the fee charged by an infectious waste services is based on the type and amount of waste generated, you should follow these guidelines to help keep the cost down while maintaining safety: • Use separate containers for each type of waste. Don't put bandages in sharps containers or paper towels used for routine handwashing in a biohazard bag. • Fill sharps containers two-thirds full before disposing of them. Most containers have fill lines that must not be exceeded. • Use only approved biohazard containers. • When moving filled biohazard containers, secure the bag or top with a closure for that specific container. • If the container is contaminated on the outside, wear clean examination gloves, secure it with another approved container, and wash your hands thoroughly afterwards. • Place biohazard waste for pick up by the service in a secure, designated area.

Moisture

Few microorganisms can survive with little water or moisture. However, some microorganisms form spores and remain dormant until moisture is available.

To prevent the spread of disease in the medical office, medical assistants must meet two goals.

First, you must understand and practice medical asepsis at all times, using specific practices and procedures to prevent disease transmission. Second, you must teach the patients and their families about techniques to use at home to prevent the transmission of disease. Handwashing is the cornerstone of infection control.

How will following standard precautions help to protect you against contracting an infection or communicable disease?

Following the standard precautions will help to protect you against contracting an infection or disease by preventing entrance of the pathogenic microorganisms into your body.

Explain why wearing examination gloves does not replace handwashing.

Gloves are a barrier to prevent the skin from coming into contact with contaminated materials. However, once they are removed, standard precautions require that the hands be washed as an additional precaution.

Respiratory Tract

Hairs and cilia on the membrane lining of the nostrils are early defenses against airborne microorganisms. If these physical barriers do not stop an invasion, mucus from the membranes lining the respiratory tract should trap the microorganisms and facilitate their removal from the respiratory system as the person swallows, coughs, or sneezes.

Gastrointestinal Tract

Hydrochloric acid normally found in the stomach destroys most of the disease-producing pathogens that enter the gastrointestinal system. One bacterium, Escherichia coli (E. coli), is resident flora found in the large intestine and is necessary for digestion. It does not usually cause disease as long as it remains within the gastrointestinal tract. Heliocobacter pylori (H. pylori) also reside in the digestive tract of some individuals and may cause gastric ulcers.

Personal Protective Equipment

In any area of the medical office where exposure to biohazardous materials might occur, PPE must be made available and used by all health care workers, including medical assistants. For instance: • Gloves must be available and a accessible throughout the office. If you or a patient is sensitive to the latex found in regular examination gloves, proper alternatives such as vinyl gloves must be available. • Disposable gowns, goggles, and face shields must be available in areas where splattering or splashing of airborne particles may occur. • You must wear gloves when performing any procedure that carries any risk of exposure, such as surgical procedures or drawing blood specimens, disposing of biohazardous waste, or touching or handling surfaces that have been contaminated with biohazardous materials, or if there is any chance at all, no matter how remote, that you may come into contact with blood or body fluids.

Modes of Transmission

In the third link of the infection process cycle, the vehicle that spreads the microorganism is often called the mode of transmission. It is important for you to understand the mode of transmission used by various pathogens so that you can break this link in the infectious cycle and prevent the spread of disease.

Indirect Transmission

Indirect transmission may occur through contact with a vehicle known as a vector. Vectors include contaminated food or water, disease-carrying insects, and inanimate object such as soil, drinking glasses, wound drainage, and infected or improperly disinfected medical instruments.

What level of disinfection would you use to clean a reusable instrument that comes into contact with the vaginal mucosa, such as a vaginal speculum? Why?

Items or instruments that come into contact with unbroken mucus membranes in areas of the body that are not considered sterile (like the vagina) may be safely disinfected using a high-level disinfectant for the specified period.

Darkness

Many pathogenic bacteria are destroyed by bright light, including sunlight.

Medical Asepsis and Infection Control

Many patients are seen daily in the medical office for a variety of reasons, including physical examinations for employment, reassurance about a current health problem, and follow-up care for a chronic condition or surgical procedure. In addition, many patients request appointments because of illness. It is important for you to protect patients from each other with regard to contagious diseases and for you to protect yourself from acquiring the many microorganisms with which you will come into contact with every day.

Exit from Reservoir

Means of exit include the mucous membranes of the nose and mouth, the openings of the gastrointestinal system (mouth or rectum), and open wounds. In addition to the means of exit, the microbe must have a vehicle in which to leave the host.

Medical Asepsis

Medical asepsis does not mean that an object or area is free from all microorganisms. It refers to practices that render an object or area free from pathogenic microorganisms. Commonly known as clean technique, medical asepsis prevents the transmission of microorganisms from one person or area to any other within the medical office. Handwashing is the most important medical aseptic technique to prevent the transmission of pathogens. Always wash your hands: • Before and after every patient contact • After coming into contact with any blood or body fluids • After coming into contact with contaminated material • After handling specimens • After coughing, sneezing, or blowing your nose • After using the restroom • Before and after going to lunch, taking breaks, and leaving for the day Because you should always assume that blood and body fluids are contaminated with pathogens, you should wear gloves when handling any specimens or when contact with contaminated material is anticipated.

Exposure Risk Factors and the Exposure Control Plan

Medical offices must provide clear instructions in the policy or infection control manual for preventing employee exposure and reducing the danger of exposure to biohazardous material. The exposure risk factor for each worker by job description must be included in the written policy. Clinical medical assistants have a higher exposure risk and require access to a variety of personal protective equipment (PPE), such as gloves, goggles, and/or face shields, depending on the task at hand, and immunization against Hepatitis B at no charge to the employee. Another written policy required by OSHA for offices with 10 or more employees is the exposure control plan. The medical office must have a written plan of action for all employees and visitors who may be exposed to biohazardous material despite all precautions. In the event of an exposure, the employer must record the exposure on an OSHA 300 log and report the exposure to OSHA if one or more of the following criteria are present: • The work-related exposure resulted in loss of consciousness or necessitated a transfer to another job • The exposure resulted in a recommendation for medical treatment, such as vaccination or medication to prevent complications • The exposure resulted in the conversion of a negative blood test for a contagious disease into a positive blood test in the employee who was exposed

Nutrients

Microorganisms depend on their environment for noon nourishment. Surfaces (tables, counters, equipment, etc.) that are contaminated with organic matter (food products, body fluids, or tissue) promote the growth of microorganisms.

Oxygen

Microorganisms that need oxygen to survive are called aerobes. A few, however, do not require oxygen, these are called anaerobes. Although most pathogens are aerobic, the microbes that cause tetanus and botulism are anaerobic.

Microorganisms, Pathogens, and Normal Flora

Microorganisms, living organisms that can be seen only with a microscope, are part of our normal environment. These microorganisms are normal and referred to as normal flora or residents flora. Some microorganisms, however, are not part of the normal flora and may cause disease or infection. Disease-producing microorganisms are referred to as pathogens and are classified as bacteria, viruses, fungi, or protozoa. Transient flora can become pathogens under the right conditions. Although the body is protected by many nonspecific defenses against disease, infection or illness may occur if the natural barriers are overpowered or breached. The following are some of the body's natural defenses that may prevent the invasion of pathogens into various body organs: • Skin • Eyes • Mouth • Gastrointestinal tract • Respiratory tract • Genitourinary track

Sanitation

Most instruments, equipment, and supplies used in medical offices must be sanitized regularly according to the recommendations of the manufacture. Sanitation is the maintenance of a healthful, disease-free, and hazard-free environment. Sanitation often involves sanitization procedures that reduce the number of microorganisms on an inanimate object to a safe or relatively safe level.

Source of Transmission

Most reservoir hosts are human, animals, and insects. Human hosts include people who are ill with an infectious disease, people who are carriers of an infectious disease, and people who are incubating an infectious disease but are not exhibiting symptoms. This last group can transmit disease even though they are ambulatory and asymptomatic (have no symptoms). Animal sources, which are less common, include infected dogs, cats, birds, cattle, rodents, and animals that live in the wild. Diseases that may be transmitted to humans from infected animals include anthrax and rabies.

Principles of Infection Control

Most transmissions of infectious disease in the medical office can be prevented by strict adherence to guidelines issued by the Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC).

Hepatitis B and Human Immunodeficiency Viruses

One of the most persistent health care concerns in the medical office is the transmission of Hepatitis B virus (HBV) and human immunodeficiency virus (HIV). Although HIV is the most visible public concern, HBV has been an occupational hazard for health care professionals for many years. HBV is more viable than HIV and may survive in a dried state on clinical equipment and counter services at room temperature for more than a week. HBV and HIV are both transmitted through exposure to contaminated blood and body fluids. Accidental punctures with sharp objects contaminated with blood are one way to become infected, but the viruses may also enter the body through broken skin. While there is no vaccine to prevent infection with HIV, employers whose workers, including clinical medical assistants, are at risk for HBV exposure are mandated by OSHA to provide the vaccine to prevent HBV at no cost to the employee. This vaccine is given in a series of three injections that normally produce immunity to the disease. In the event of exposure to blood or body fluids infected with HBV, the postexposure plan should include an immediate blood test of the employee. Repeat blood titers should be obtained at specific intervals, usually 6 weeks, 3 months, 6 months, 9 months, and one year, as a comparison. The same schedule of evaluation is required after HIV exposure. Again, there is no vaccine to prevent HIV, but other HIV treatments for preventing transmission are being tested.

The medical office where you work has a policy about not opening windows that do not have screens in examination rooms and the reception area. Why do you think this policy is or is not important?

Opening screenless windows allows insects to come into the office. Insects may be reservoir hosts to certain diseases and contaminate items in the medical office.

What are pathogenic microorganisms? How does the body prevent an invasion and subsequent infection naturally?

Pathogenic microorganisms are microscopic organisms that cause disease. Natural ways that the body stops an invasion or destroys pathogens include tears (wash microbes away from the eyes and contain lysozyme, an effective disinfectant); hydrochloric acid in the stomach (produces a pH that kills many microbes that may get into the stomach); unbroken or intact skin (provides a barrier to invading microorganisms); the mucous membranes and cilia lining the respiratory tract (trap microorganisms that may be inhaled).

Standard Precautions

Standard precautions are a set of procedures recognized by the CDC to reduce the chance of transmitting infectious microorganisms in any health care setting, including medical offices. These precautions pertain to contact with blood, all body fluids excepts sweat, damaged skin, and mucus membranes and require that you: • Wash your hands with soap and water after touching blood, body fluids, secretion, and other contaminated items, whether you have worn gloves or not. • Use an alcohol-based hand rob (foam, lotion, or gel) to decontaminate hands if the hands are not visibly dirty or contaminated. • Where clean nonsterile examination gloves when contact with blood, body fluids, secretions, mucus membranes, damaged skin, and contaminated items is anticipated. • Change gloves between procedures on the same patient after exposure to potentially infectious material. • Wear equipment to protect your eyes, nose, and mouth and avoid soiling your clothes by wearing a disposable gown or apron when performing procedures that may splash or spray blood, body fluids, or secretion. • Dispose of single-use items appropriately; do not disinfect, sterilize, and reuse. • Take precautions to avoid injuries before, during, and after procedures in which needles, scalpels, or other sharp instruments have been used on a patient. • Do not recap use needles or otherwise manipulate them by bending or breaking. If recapping is necessary to carry a used needle to a sharps container, use the one-handed scoop technique or a device for holding the needle sheath. • Place used disposable syringes and needles and other sharps in a puncture-resistant container or sharps container as close as possible to the area of use. • Use barrier devices (mouthpieces, resuscitation bags) as alternatives to mouth-to-mouth resuscitation. • Do not eat, drink, or put candy, gum, or mints into your mouth while working in the clinical area.

Levels of Infection Control

Sterilization, the highest level of infection control, destroys all forms of microorganisms, including spores, on inanimate surfaces. The next highest level of infection control is disinfection. Disinfectants or germicides inactivate virtually all recognized pathogenic microorganisms except spores on inanimate objects. There are three levels of disinfection -- high, intermediate, and low. The lowest level of infection control is sanitization, which is cleaning any visible contaminates from the item using soap or detergent, water, and manual friction.

Occupational Safety and Health Administration Guidelines for the Medical Office

The Occupational Safety and Health Administration (OSHA) is the federal agency responsible for ensuring the safety of all workers, including those in health care. OSHA promulgates and enforces federal regulations that must be followed by all medical offices. The practice of individual offices regarding employees' health and safety must be either put into a policy or procedure manual or compiled separately as an infection control manual. Regardless of where the office policies are kept, however, they must be readily available to both employees of the medical office and OSHA representatives.

Given the six conditions that favor the growth of pathogens, explain how you can alter the growth and reproduction of microorganisms by changing these factors.

The conditions that favor the growth of microorganisms include moisture, nutrients, a warm temperature, darkness, a neutral or slightly alkaline pH, and oxygen. To prevent the growth of microbes, remove any moisture or sources of nutrition, use heat higher than 98.6°F, expose the area to light, or clean with acidic or alkaline chemicals.

Eyes

The eyelashes act as a barrier by trapping does that may carry microorganisms before they have an opportunity to enter the eye. If any microorganisms do enter the eye, the enzyme lysozyme normally found in tears will destroy some microorganisms, including bacteria.

How are the first and fifth links of the infection cycle related?

The first link in the infection cycle (the reservoir host) provides nutrients and an incubation site for the pathogen. The fifth link (the susceptible host) allows the pathogen to enter and begin growing, thus becoming the new reservoir host, repeating the cycle.

Mouth

The greatest variety of microorganisms in the body is in the mouth. Saliva is slightly bactericidal, and good oral hygiene will remove or prevent the growth of many of the pathogens in the mouth.

Latex Allergy and Prevention

The incidence among health care workers of allergic reactions to proteins in latex has increased in recent years. The proteins in latex, a product of the rubber tree that is used to make many products including examination gloves, may cause allergic reactions, especially with repeated exposure. The reactions may be mild (skin redness or rash, itching, or hives) or severe (difficulty breathing, coughing, or wheezing). Respiratory reactions often result when the powder in the gloves becomes airborne and is inhaled as the gloves are removed after use. To protect yourself from exposure and allergy to latex, the following guidelines may be useful: • Use gloves that are not latex for tasks that do not involve contact or potential contact with blood or body fluids • When contact with blood or body fluids is possible, wear powder-free latex gloves. Powder-free gloves contain less protein than the powdered ones, reducing the risk of allergy • Avoid wearing oil-based lotions or hand creams before applying latex gloves. The oil in these products can break down the latex, releasing the proteins that cause the allergic reactions • Wash your hands thoroughly after removing latex gloves • Recognize the symptoms of latex allergy in yourself, your co-workers, and your patients

The Infection Cycle

The infection cycle is often thought of as a series of specific links in a chain involving a causative agent or invading microorganisms. • The first link in the chain is the reservoir host, this is the person who is infected with the microorganism. • The second link in the chain is the manner in which the pathogen leaves the reservoir host. • The third link in the chain, the means of transmission, involves the vehicle that is used by the pathogen when it leaves the reservoir host and spreads through the environment. • The fourth link in the chain of the infection process cycle is the portal of entry. • The final, and fifth link in the infection process cycle is the susceptible host.

Neutral pH

The pH of a solution refers to the measurement of its acid-base balance on a scale of 1 to 14, with 7 being neutral. Many microorganisms are destroyed in an environment that is not neutral. The pH of blood (7.35 - 7.45) is preferred by microorganisms that thrive in the human body.

Genitourinary Tract

The reproductive and urinary systems provide a less hospital environment for microorganisms. The slightly acidic environment of these body systems reduces the ability of many microorganisms to survive. In addition, frequent urination flashes the urinary tract and removes many transient microorganisms.

Which virus is more of a threat to the clinical medical assistant, HIV or HBV? Why?

The virus that is actually more of a threat to the medical assistant is HBV. HBV may live on dried body secretions on an inanimate surface for up to 2 weeks. In the "right" circumstances, contact with these dried secretions may cause infection in the exposed individual. Hepatitis B is a serious disease and may cause scarring and destruction of the liver tissue (leading to liver failure), an increased risk for developing liver cancer, and death.

Susceptible Host

This host is one to whom the pathogen is transmitted after leaving the reservoir host. If the conditions in the susceptible host are conductive to reproduction of the pathogen, the susceptible host becomes a reservoir host and the cycle repeats itself. The susceptible host is unable to resist the invading pathogens for a variety of reasons: • Age. As the body ages, defense mechanisms begin to lose their effectiveness. The immune system is no longer as active or as efficient as in youth. The immune system may also not be fully functional in a very young child. • Existing disease. The stress of an existing illness may deplete the immune system and allow microorganisms to cause illness in someone who might otherwise be able to fight it naturally. • Poor nutrition. A diet deficient in nutrients such as proteins, carbohydrates, fats, vitamins, or minerals will not allow cells of the body to repair or reproduce as they are weakened by disease. • Poor hygiene. Although multitudes of microbes exist on our skin, keeping the numbers down by practicing good hygiene will reduce the numbers of pathogens.

Portal of Entry

This is the route by which the pathogen enters the next host. With inhalation of contaminated air droplets, the respiratory system is the portal of entry. Another portal of entry is the gastrointestinal system; the pathogen enters the body in contaminated food or drink. Any break in the skin or mucous membranes can be a portal of entry for pathogenic microorganisms.

How would you respond to an employee in the medical office who is unsure about how to clean up a spilled urine specimen? Is this biohazardous?

Urine may be biohazardous and should be cleaned up by applying clean examination gloves, using paper towels or absorbing powder to absorb the urine, and placing all items used for cleaning up the spill into a biohazardous waste container. Once the urine is absorbed and discarded appropriately, the area or floor should be disinfected.

Vehicle of Transmission

Vehicles include mucus or air droplets from the oral or nasal cavities and direct contact between an unclean hand and another persons or objects. Sneezing and coughing without covering the nose and mouth are excellent methods of transmitting microorganisms into the environment and potential hosts.

Reservoir

While this person may or may not show signs of infection, his or her body is serving as a source of nutrients and an incubator in which the pathogen can grow and reproduce. These persons are also called carriers, or reservoirs, of disease. The reservoir host may transmit disease only when the pathogen has a means of exit.

Immunization

act or process of rendering an individual immune to specific disease

Spores

bacterial life form that resists destruction by heat, drying, or chemicals; spore-producing bacteria include botulism and tetanus

Anaerobe

bacterium that does not require oxygen for growth and reproduction

Resistance

body's immune response to prevent infections by invading pathogenic microorganisms

Viable

capable of growing and living

Germicide

chemical that kills most pathogenic microorganisms; disinfectant

Exposure Risk Factors

conditions that tend to put employees at risk for contact with biohazardous agents such as blood borne pathogens

Disease

definite pathologic process having a distinctive set of symptoms and course of progression

Biohazardous

describing a substance that is a risk to the health of living organisms

Pathogens

disease-causing microorganisms

Personal Protective Equipment (PPE)

equipment used to protect a person from exposure to blood or other body fluids

Virulent

highly pathogenic and disease-producing; describes a microorganism

Infection

invasion by disease-producing microorganisms

Disinfection

killing or rendering inert most but not all pathogenic microorganisms

Postexposure Testing

laboratory tests that may be performed after a person comes into contact with a biohazard

Sanitation

maintenance of a healthful disease-free environment

Resident Flora

microorganisms normally found in the body; also known as normal flora

Normal Flora

microorganisms normally found in the body; also known as resident flora

Transient Flora

microorganisms that do not normally reside in a given area; transient flora may or may not produce disease

Aerobe

microorganisms that require oxygen to live and reproduce

Microorganisms

microscopic living organisms

Carriers

person infected with a microorganism but without signs of disease

Sanitization

process used to lower the number of microorganisms on a surface by cleansing with soap or detergent, water, and manual friction

Sterilization

process, act, or technique for destroying microorganisms using heat, water, chemicals, or gases

Medical Asepsis

removal or destruction of microorganisms

Bactericidal

substance that kills or destroys bacteria

Occupational Safety and Health Administration (OSHA)

the federal agency that oversees working conditions, with the mission to protect employees from work-related hazards

Standard Precaution

usual steps to prevent injury or disease

Asymptomatic

without any symptoms

Exposure Control Plan

written plan required by the Occupational Safety and Health Administration that outlines an employer's system for preventing infection

Guidelines for Maintaining Medical Asepsis

• Avoid touching your clothing with soiled linens, table paper, supplies, or instruments. Roll used table paper or linens inward with the clean surface outward. • Always consider the floor to be contaminated. Any items dropped onto the floor must be considered dirty and be discarded or cleaned to its former level of asepsis before being used. • Clean tables, counters, and other surfaces frequently and immediately after contamination. Clean areas are less likely than dirty ones to harbor microorganisms or encourage their growth. • Always presume that blood and body fluids from any source are contaminated. Follow the guidelines published by OSHA and the CDC to protect yourself and to prevent the transmission of disease.