Transcript Kinns Chapter_027

Infection Control
Chapter 27
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
1
Learning Objectives





Define, spell, and pronounce the terms listed
in the vocabulary.
Describe the characteristics of pathogenic
microorganisms and the diseases they
cause.
Apply the chain-of-infection process to
healthcare practice.
Compare viral and bacterial cell invasion.
Differentiate between humoral and
cell-mediated immunity.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
2
Learning Objectives





Summarize the impact of the inflammatory
response on the body’s ability to defend itself
against infection.
Analyze the differences among acute, chronic,
latent, and opportunistic infections.
Specify potentially infectious bodily fluids.
Integrate OSHA’s requirement for a sitebased Exposure Control Plan into office
management procedures.
Explain the major areas included in the OSHA
Compliance Guidelines.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
3
Learning Objectives





Remove contaminated gloves while following
Standard Precautions principles.
Perform an eyewash procedure for the
removal of contaminated material.
Summarize the management of
postexposure evaluation and follow-up.
Apply the concepts of medical and surgical
asepsis to the healthcare setting.
Demonstrate the proper hand-washing
technique for medical asepsis.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
4
Learning Objectives




Differentiate among sanitization, disinfection,
and sterilization procedures.
Demonstrate the correct procedure for
sanitization of contaminated instruments.
Apply patient education concepts to infection
control.
Discuss legal and ethical concerns regarding
medical asepsis and infection control.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
5
Disease

An alteration in the normal structure or
function of an organism or a cell.

Causes specific clinical signs, symptoms, and
laboratory findings that set it apart.

A disease could be either inherited,
drug-induced, autoimmune, degenerative,
or infectious.

Any disease caused by the growth of
pathogenic microorganisms in the body is
considered an infectious disease.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
6
Conditions Required
for Microbial Growth
To maintain a healthcare environment that is as
free as possible of pathogenic organisms, the
medical assistant (MA) must prevent or eliminate
as many growth requirements as possible.

Nutrients

Moisture

Temperature

Oxygen—aerobes or anaerobes

Neutral pH
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
7
Chain of Infection


Infectious diseases can spread only if certain
factors occur. These factors, or links, make
up the chain of infection. Break the chain, and
you break the infectious process.
Wearing appropriate protective equipment
and effective hand washing can break the
chain of infection.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
8
Chain of Infection






Infectious agent
Reservoir host – an infected patient
Means or portal of exit – coughing, sneezing, blood
product, specimen, etc.
Method of transmission – contaminated hands,
equipment or supplies; air borne; contaminated food
or water; etc.
Portal of entry into a new host – exposure to
contaminated equipment, inhalation, broken skin, etc.
Susceptible host – unvaccinated, weak, debilitated
individual
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
9
Chain of Infection
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
10
Reservoir Hosts

May be people, insects, animals, water, food,
examination rooms, contaminated instruments,
and so on

Supply nutrition for the organism, allowing it to
multiply

Either cause infection in the host and/or exit
from the host to cause disease in another host
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
11
Portal of Exit

How the pathogen escapes the reservoir host

Includes mouth, nose, eyes, intestines, urine,
reproductive tract, and so on

Standard precautions prevent spread
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
12
Transmission

Direct—contact with infected person or with
discharges (feces, urine, sputum, etc.)

Indirect—from droplets expelled with
coughing, sneezing, or speaking; vectors;
contaminated food; contaminated objects
called fomites.

Controlled with sanitization, disinfection,
sterilization, and so on
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
13
Portal of Entry




How the pathogen gains entry to a new host
Similar to means of exit (e.g., mouth, eyes,
nose)
Intact integumentary system is first line of
defense
Inflammatory response and immune system
are second lines of defense


Humoral immunity—produces antibodies specific
to antigen exposure
Cell-mediated immunity—destroys pathogens at
the site; e.g., phagocytosis
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
14
Susceptible Host

Must be capable of supporting the pathogen

Susceptibility depends on:

Location of entry

Dose of pathogen
Health state of new host
Immunization status


Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
15
Critical Thinking Application

Tommy Anderson, a 5-year-old patient, is
seen in the office because of an outbreak of
impetigo. Rosa must apply the concepts of
the chain of infection and infection control
methods to teach Tommy and his mother how
to prevent the spread of the infection to other
members of the family. What procedures
should she follow after Tommy’s visit to
prevent the spread of the infection to other
patients, other staff members, and herself?
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
16
Infectious Agents

Pathogenic microorganisms include:

Viruses—smallest; obligate intracellular parasites;
palliative treatment; EX: hepatitis B
 Bacteria—classified by their morphology; some
produce spores; normal flora vs. pathogenic
microbes; EX: tuberculosis
 Protozoa—unicellular parasites; frequently
transmitted by vectors; EX: giardiasis
 Fungi—molds and yeasts; mycotic infections and
tineas; EX: candidiasis
 Rickettsiae—similar to both viruses and bacteria;
carried by vectors; EX: Rocky Mountain spotted fever
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
17
Antibiotic Resistance

Antibiotic resistance is one of the world’s most
significant public health problems.

Infectious microorganisms whose presence
were once easily treated with antibiotics are
growing increasingly resistant to the drugs.

Resistance occurs when an antibiotic is used
inappropriately to treat an infection.

The pathologic organism mutates, decreasing
the effectiveness of the drug.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
18
CDC Recommendations

Prescribe antibiotic therapy only when it will
benefit the patient.

Bacterial infections can be treated with
antibiotics, but viral infections, because they
involve viral takeover of cellular DNA or RNA
material, cannot.

Treat the patient with an antibiotic that is
specific to the bacterial infection.

Prescribe the label-recommended dose and
time interval for the medication.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
19
Body’s Natural Protection






Intact skin.
Mucous membranes protect underlying
tissues and trap foreign substances.
Cilia trap invading microbes.
Sneezing and coughing expel organisms.
Body secretions, such as tears and sweat,
expel foreign substances from the body.
pH of many of the body’s organs
discourages microbial growth.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
20
The Inflammatory Response

The inflammatory response is the body’s
protective reaction to a foreign substance or
antigen.

To defend itself, the body initiates specific
responses that destroy and remove pathogenic
organisms.

The release of inflammation mediators, through
three separate actions, results in an increase in
white blood cells (WBCs) at the site.

WBCs attack the pathogen and attempt to contain
the infection at its original site.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
21
Inflammatory Response
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
22
Site of Injury


Blood vessels dilate, causing an increase in
the local blood flow, resulting in redness and
heat.
Blood vessel walls become more permeable,
which helps in releasing WBCs to the site.


Blood plasma filters out of the more permeable
vessel walls, resulting in edema, causing pressure
on nerves and pain.
Finally, chemotaxis, the release of chemical
agents, attracts WBCs.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
23
WBC Protection



WBCs form a fibrous capsule around the injury,
protecting surrounding cells from damage or
the source of infection.
Destroyed pathogens, cells, and WBCs collect
and form a thick, white substance called pus.
WBCs engage in phagocytosis, or the
engulfing and destruction of microorganisms
and damaged cells.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
24
Four Classic Signs and Symptoms
of Inflammation

Redness or erythema

Swelling or edema

Pain

Heat
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
25
Inflammatory and Infection Terms






Lymphadenopathy
Septicemia
Pyemia
Prodromal period
Chronic vs acute infection
Latent infection—relapse and remission
(e.g., oral herpes simplex)
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
26
Critical Thinking Application


Rosa’s next patient appears to have a
localized inflammatory response to a splinter.
What signs and symptoms should she expect
the patient to exhibit?
Rosa answers a telephone call from a patient
who had surgery 3 days ago. The patient is
concerned that the incision site is red, swollen,
and hot. Is this a normal post-surgical
response? How could Rosa know if the
response is abnormal?
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
27
Infectious Bodily Secretions

OSHA has designated the following
bodily fluids as potentially infectious with
blood-borne pathogens:

Cerebrospinal fluid (CSF); synovial, pleural,
pericardial, peritoneal, mucous, and amniotic
fluids

Blood, vaginal and seminal secretions, saliva, and
human tissue
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
28
OSHA Standards
for Healthcare Workers



Healthcare workers face significant health risks
from occupational exposure to blood or other
potentially infectious materials that may contain
hepatitis B virus (HBV), hepatitis C virus (HCV), or
the human immunodeficiency virus (HIV).
The MA should use precautions for all patients,
regardless of knowledge of their individual health
histories.
Implementation of the Bloodborne Pathogen
Standard also protects patients from any
blood-borne infection the healthcare worker
may be carrying.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
29
Exposure Control Plan





Plan must detail employee protection procedures.
Must identify job classifications and/or specific
work-related tasks that might lead to exposure.
Must contain specifics on controls including PPE,
training, hepatitis B immunization, record keeping,
postexposure follow-up, and labeling and disposal of
biohazard waste.
Must be reviewed and updated at least annually to
incorporate the use of safer medical devices.
Must be available to employees for review and
training.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
30
Bloodborne Pathogen Standard

Employers must keep a confidential sharps
injury log that describes the device involved
and the details of how and where the incident
occurred.

Must have available sharps management
devices, such as self-sheathing or retracting
needles, and needleless intravenous (IV)
systems.

Should wash exposed area immediately or as
soon as possible after exposure.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
31
Hand Hygiene Guidelines

Visibly soiled hands should be washed for a minimum
of 15 seconds with antimicrobial soap and warm
running water.

Alcohol-based handrubs, if used correctly, significantly
decrease the number of microorganisms, take less
time to use, and cause less irritation than traditional
hand washing.

Hand washing or alcohol handrubs should be used
before and after each patient is seen as well as after
gloves are removed.

Apply label-recommended amount of handrub to palm
of one hand and rub hands together, covering all
surfaces until hands are dry.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
32
Handrubs and Antimicrobial Soap
From Bonewit-West K: Clinical procedures for medical assistants, ed 7, St Louis, 2008, Saunders.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
33
Hand Hygiene



Studies show that even after careful hand
hygiene, healthcare workers with artificial
nails have more pathogenic microbes than
workers with natural nails.
Natural nail tips should be no longer
than ¼ inch.
Contact dermatitis from alcohol handrubs is
uncommon.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
34
Compliance Guidelines

Safety and infection control fundamentals go
beyond hand washing and knowledge of the
disease cycle.

Five basic parts to compliance:

Barrier protection

Environmental protection

Housekeeping controls

Hepatitis B vaccination

Postexposure follow-up
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
35
Barrier Protection

Protective equipment must be used if you will
be involved in any of these activities:

Touching a patient's blood and body fluids, mucous
membranes, or broken skin

Handling items and surfaces contaminated with
blood and body fluids

Performing venipuncture, finger punctures,
injections, and other vascular-access procedures
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
36
Barrier Protection



Assisting with any surgical procedure. If a glove is
torn or an injury occurs, the glove is removed and
replaced with a new glove. The instrument is
removed from the sterile field.
Handling, processing, and disposing of all
specimens of blood and body fluids.
Cleaning and decontaminating spills of blood or
other body fluids.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
37
Personal Protective Equipment (PPE)

Specialized clothing or equipment that
prevents blood or other potentially infectious
material from passing through to reach the
healthcare worker

Includes latex gloves, face masks, face
shields, protective glasses, laboratory coats,
barrier gowns, shoe covers, mouthpieces, and
resuscitation bags that protect the healthcare
worker from potentially infectious substances
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
38
Personal Protective Equipment (PPE)
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
39
PPE Guidelines

Protective equipment contaminated with body fluids
of any kind must be removed and placed in a
designated area or biohazard container.

Protective eyewear and/or face shields must be
worn whenever splashes, sprays, or droplets may
occur.
Utility gloves may be reused if they are intact
without cracks, tears, or punctures and are
disinfected after each use.


All PPE must be removed before the worker leaves
the medical facility.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
40
Environment Protection





Observe warning labels on biohazard
containers and equipment.
Minimize splashing, spraying, and spattering of
drops.
Bandage any breaks on hands before gloving.
Do not recap, bend, break, or resheath
contaminated sharps.
Immediately after use dispose of sharp items in
a labeled, leakproof, puncture-resistant
biohazard container.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
41
Environment Protection




All specimens must be placed in a container that
prevents leakage.
Contaminated equipment should be sanitized
before being repaired in the office or transported to
the manufacturer.
Smoking, eating, drinking, applying cosmetics or
lip balm, and handling contact lenses are
prohibited in work areas where there is reasonable
likelihood of contamination from blood-borne
pathogens.
Food and drink cannot be kept in the same areas
as potentially infectious materials.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
42
Housekeeping Controls




Post the schedule for cleaning and specific
information about each work area in which
exposure could occur.
Immediately decontaminate areas after accidental
spills and at the end of each procedure.
Disinfect reusable containers on a routine basis.
Sharps containers must be upright and as close as
possible to the work usage area; not overfilled;
replaced on a routine basis with the lid closed
securely.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
43
Housekeeping Controls: Cleaning Spills
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
44
Housekeeping Controls





Use appropriate equipment to pick up spilled
material or broken glassware.
Place in impervious biohazard bag or container.
Use an absorbent professional biohazard spill
preparation as directed to decontaminate the site.
Wear gloves to handle soiled linen; should be
double-bagged and transported in labeled,
leakproof biohazard bags.
Biohazard waste must be collected in impermeable
red biohazard-labeled bags or containers and
sealed.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
45
Housekeeping Controls
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
46
Hepatitis B Vaccination





Must be available free of charge within 10 days
of starting employment to all employees who are
at risk.
Intramuscular injection in three doses; second
injection 4 weeks after first, and third injection
6 months after first.
U.S. Public Health Service does not currently
recommend routine boosters.
Should have blood titer drawn after completion
to determine if antibodies are present.
Employees have the right to decline
immunization but must sign a declination form.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
47
Hepatitis B Vaccination
Occupational Safety and Health Administration: Available at: www.osha.gov
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
48
Postexposure Follow-up

Postexposure follow-up involves immediate
cleansing of the site, completion of an
exposure incident form, confidential medical
evaluation, examination of the source
individual and worker’s blood, health
counseling, and confidential treatment of all
medical records.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
49
Critical Thinking Application

Rosa’s office has been especially busy today.
While administering an injection to a
frightened 6-year-old child, a co-worker has
an accidental needlestick. She tells Rosa
about the incident but does not know what to
do. What steps should be taken to manage
the situation?
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
50
Aseptic Techniques: Prevention
of Disease Transmission

Medical asepsis.

Surgical asepsis.

Medical aseptic techniques: Create an
environment as free of pathogens as possible
to prevent reinfection or cross-infection.

Surgical aseptic or sterile technique: Used
when the patient’s skin or mucous membranes
are disrupted. Prevents patient exposure to all
microbes (e.g., for minor surgery, urinary
catheterizations, injections).
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
51
Hand Washing





Reduce skin bacteria with mechanical friction,
antimicrobial soap, and warm running water.
Goal is to remove or decrease the numbers of
transient bacteria on the surface of the skin,
thus preventing transient bacteria from
becoming resident bacteria.
Proper hand washing depends on two factors:
warm running water and friction.
All jewelry except a plain wedding band should
be removed.
Lotion may be used to prevent cracked or
chapped skin.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
52
Hand Washing





Wash hands under running water with fingertips
pointing down.
Apply antimicrobial soap and use friction to
hands and wrists.
Run water from the wrists down toward the
fingertips.
Alcohol handrubs may substitute for hand
washing unless hands are visibly contaminated.
Handrubs can be more effective in reducing
nosocomial infections than hand washing.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
53
Hand Washing Continued
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
54
Sanitization




Cleaning of contaminated articles or surfaces to
reduce the number of microorganisms to a safe
level as dictated in public health guidelines.
Removes debris such as blood and other body
fluids from instruments or equipment.
Must wear utility gloves to prevent possible
personal contamination.
Completed immediately after use in a separate
workroom or area to avoid cross-contamination.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
55
Sanitization





Separate sharp instruments from others to
prevent injury and protect instruments.
Open hinges and scrub serrations and
ratchets.
Rinse instruments in hot water and check
proper working order.
Items should be hand dried.
Ultrasonic sanitizers are helpful because they
do not damage instruments and workers are
protected from accidental sharps injuries.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
56
Sanitization
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
57
Disinfection

Process of killing pathogenic organisms or
making them inactive.

Not always effective against spores and viruses.

1:10 bleach solution is an effective disinfectant
for surfaces contaminated with viruses, including
HIV.

Important to follow the manufacturer’s guidelines
on how to properly prepare and use each
disinfectant.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
58
Disinfection
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
59
Disinfection Errors






Instruments not thoroughly sanitized and
organic matter inhibit or prevent action.
Moisture on instruments dilutes disinfectant
solution beyond effective concentration.
Solution left in an open container.
Solutions not changed as recommended and
expire.
Not prepared properly.
Recommended manufacturer’s temperature
for use and storage is not maintained.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
60
Sterilization




Destruction of all microorganisms.
Requires space for a sink as well as receiving
basins, proper cleaning agents, brushes,
autoclave wrapping paper, sterilizer
envelopes and tape, sterilizer indicators,
disposable gloves, and designated biohazard
waste containers.
Another area needed for storage of sterile
items.
Details discussed in Chapter 56.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
61
Role of the Medical Assistant


It is important that aseptic techniques and
infection control be done on such a routine
basis that they become an unbreakable habit.
MA should teach patients about infection
control and the potential danger of blood and
body fluids, including demonstrating aseptic
techniques, the management of infectious
materials at home, and the importance of
frequent and consistent hand washing.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
62