Transcript Pneumocystis carinii

Unit 14 Infection Control
14:1 Understanding the
Principles of Infection Control
 Understanding is essential to all health
care workers
 Provide a basic knowledge of how disease
is transmitted
 Main emphasis on prevention of disease
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2
Microorganisms or
Microbes
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Small living organisms
Not visible to the naked eye
Microscope must be used to see them
Found everywhere in the environment
Found on and in the human body
Many are part of normal flora of body
May be beneficial
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Microorganisms or
Microbes (continued)
 Called nonpathogens when not harmful to
the body
 Some cause infections and disease
 Called pathogens (germs) when able to
harm the body
 Sometimes nonpathogenic
microorganisms can become pathogenic
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4
Microbe Classifications
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Bacteria
Protozoa
Fungi
Rickettsiae
Viruses
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Bacteria
 Simple, one-celled organisms
 Multiply rapidly
 Classified by shape and arrangement
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Bacteria – Cocci
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Round or spherical in shape
Diplococci
Streptococci
Staphylococci
Examples of diseases
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Bacteria – Bacilli
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Rod-shaped
Occur singly, in pairs, or in chains
May have flagella
Ability to form spores
Examples of diseases
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Bacteria – Spirilla
 Spiral or corkscrew shape
 Includes comma-shaped vibrio and
corkscrew spirochete
 Diseases include syphilis and cholera
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9
Antibiotics
 Antibiotics are used to kill bacteria
 Some strains of bacteria have become
antibiotic-resistant
 When antibiotic-resistant, the antibiotic is
no longer effective against the bacteria
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10
Protozoa
 One-celled, animal-like organism
 Found in decayed materials and
contaminated water
 May have flagella for movement
 Some are pathogenic
 Examples of diseases
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Fungi
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Simple, plant-like organisms
Live on dead organic matter
Yeast and molds
Can be pathogenic
Examples of diseases
Antibiotics do not kill
Antifungal medications
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12
Rickettsiae
 Parasitic microorganisms
 Cannot live outside the cells of another
living organism
 Transmitted to humans by the bites of
insects (e.g., fleas, lice, ticks, mites)
 Examples of diseases
 Antibiotics are effective against
many of them
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13
Viruses
 Smallest microorganisms
 Must use electron microscope to see
 Must be inside another living cell
to reproduce
 Spread by blood and body secretions
 Very difficult to kill
 Cause many diseases
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14
Virus – Hepatitis B
 Also called serum hepatitis
 Caused by HBV
 Transmitted by blood serum and
body secretions
 Affects the liver
 Vaccine available for protection
 Vaccine is expensive
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Virus – Hepatitis B
(continued)
 Vaccine given in a series of
three injections
 By law, employers must provide vaccine at
no cost to employees with occupational
exposure to blood or other body secretions
 If employee refuses, a written statement
must be signed documenting refusal
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Hepatitis C
 Caused by HVC
 Transmitted by blood and blood-containing
body fluids
 Many infected individuals
are asymptomatic
 Others have mild symptoms
 Can cause severe liver damage
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Hepatitis C
(continued)
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Currently, no vaccine ready for use
Vaccine is in development stage
Extremely difficult to destroy HVC
Can survive several days in dried blood
Health care workers must follow
precautions to protect against virus
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Acquired Immune Deficiency
Syndrome (AIDS)
 Caused by the Human Immunodeficiency
Virus (HIV )
 Suppresses the immune system
 Individual becomes susceptible to cancers
and infections that would not affect a
healthy person
 No cure presently and no vaccine
 Important to take precautions to prevent
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Growth of
Microorganisms
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Most prefer warm environments
Most prefer darkness
Need source of food and moisture
Need for oxygen varies
Human body is ideal supplier of all
the requirements
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How Pathogens Cause
Infection and Disease
 Some produce poisons called toxins
 Some cause an allergic reaction
 Others attach and destroy the living cells
they invade
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Classifications of
Diseases and Infections
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Endogenous
Exogenous
Nosocomial
Opportunistic
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Endogenous
 Originates within the body
 Examples: metabolic disorders, congenital
abnormalities, tumors, and infections
caused by microorganisms within the body
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Exogenous
 Originates outside the body
 Examples: radiation, chemical agents,
trauma, electric shock, and
temperature extremes
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Nosocomial
 Acquired in a health care facility
 Usually present in the facility and carried
by health care workers to the patient
 Many are antibiotic-resistant
 Can cause serious and even
life-threatening infections
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Nosocomial
(continued)
 Common examples are staphylococcus,
pseudomonas, enterococci
 Infection control programs are used to
prevent and deal with
nosocomial infections
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Opportunistic
 Infections that occur when the body’s
defenses are down
 Usually do not occur in normal
immune system
 Examples: Kaposi’s sarcoma (rare type of
cancer) and Pneumocystis carinii
pneumonia in individuals with AIDS
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Chain of Infection
 Must be present for disease to occur and
spread from one individual to another
– Causative agent
– Reservoir
– Portal of exit
– Mode of transmission
– Portal of entry
– Susceptible host
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Causative Agent
 Pathogen must be present
 Examples include bacteria or virus
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Reservoir
 Place where causative agent can live
 Examples: human body, animals,
and the environment
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Portal of Exit
 Way for causative agent to escape from
the reservoir
 Examples: urine, feces, saliva, blood,
tears, mucous discharge, sexual
secretions, and draining wounds
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Mode of Transmission
 Must be transmitted to another reservoir or
host where it can live
 Direct contact: person-to-person, spread
by physical or sexual contact
 Indirect contact: from contaminated
substances to the person
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Portal of Entry
 Way to enter a new reservoir or host
 Examples: breaks in the skin or
mucous membranes, respiratory tract,
digestive tract, genitourinary tract,
and circulatory system
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Susceptible Host
 Individual who can contract the disease
 Usually the person can fight off
the causative agent and not contract
the disease
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Common Body Defenses
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Mucous membranes
Cilia
Coughing and sneezing
HCL in the stomach
Tears
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Common Body Defenses
(continued)
 Fever
 Inflammation response – leukocytes
 Immune response – antibodies and
cell secretion
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Increased Susceptibility
 When large numbers of pathogens
invade the body
 When body defenses are weak
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Ending the Chain
of Infection
 Eliminate any step in the chain and
infection is stopped
 Follow practices to interrupt or
break the chain
 Remember, pathogens are everywhere
 Prevention is a continuous process
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Aseptic Techniques
 Major way to break the chain of infection
 Asepsis: absence of disease-producing
microorganisms or pathogens
 Contaminated: any object or area that may
contain pathogens
 Major aim: maintaining cleanliness and
eliminating or preventing contamination
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Common Aseptic Techniques
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Handwashing
Good personal hygiene
Disposable gloves
Proper cleaning of instruments and
equipment
 Thorough cleaning of environment
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Levels of Aseptic Control
 Antisepsis
 Disinfection
 Sterilization
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Antisepsis
 Prevent or inhibit the growth of
pathogenic organisms
 Usually not effective against spores
and viruses
 Can usually be used on the skin
 Examples: alcohol and betadine
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Disinfection
 Destroys or kills pathogenic organisms
 Not always effective against spores
and viruses
 Chemical disinfectants are used
 Can irritate or damage the skin, so mainly
used on objects, not people
 Examples: bleach solutions and zephirin
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Sterilization
 Destroys all microorganisms
 Steam under pressure, gas, radiation,
and chemicals
 Autoclave is the most common
equipment used
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Summary
 Important for health care workers to know
and use proper aseptic techniques
 Prevents spread and transmission
of disease
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14:2 Washing Hands
 Major aspect of standard precautions
 Most important aseptic technique
 Hands are perfect media for the spread
of pathogens
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Purpose of Handwashing
 Prevent and control spread of pathogens
 Protect the health care worker from
disease and illness
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When to Wash Hands
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When arrive at facility
Immediately before leaving facility
Before and after every patient contact
Anytime the hands become contaminated
during a procedure
 Before applying gloves
 Immediately after removing gloves
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When to Wash Hands (continued)
 Before and after handling any specimen
 After contact with any soiled or
contaminated item
 After picking up any item off the floor
 After personal use of the bathroom
 After you cough, sneeze, or use a tissue
 Before and after any contact with mouth or
mucous membranes
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Principles of Handwashing
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Use soap as a cleansing agent
Use warm water
Use friction
Clean all surfaces
Point fingertips down while washing hands
Use dry paper towels to turn faucet
on and off
 Clean nails
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14:3 Observing Standard
Precautions
 Blood and body fluids are the main ways
pathogens are spread
 Major pathogens: HBV, HBC, HIV
 Extreme care must be taken at all times
when an area, object, or person is
contaminated with blood or body fluids
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Bloodborne Pathogen
Standards
 Established in 1991 by OSHA
 Must be followed by all
health care workers
 Civil penalties if not implemented
and followed
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Regulation Requirements
 Written Exposure Control Plan
 Identify all employees with
occupational exposure
 Provide hepatitis B vaccines free of charge
 Provide personal protective equipment
(PPE)
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Regulation Requirements
(continued)
 Provide adequate handwashing facilities
and supplies
 Ensure worksite is maintained in a clean,
sanitary condition
 Follow measures for immediate
decontamination of surfaces
when contaminated
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Regulation Requirements
(continued)
 Dispose of infectious waste correctly
 Enforce rules of limited activities in any
potentially contaminated area
 Provide appropriate containers
for contaminated sharps and other
contaminated items
(color coded and labeled)
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Regulation Requirements
(continued)
 Post signs at the entrance to work areas
with occupational exposure to
biohazardous materials
 Provide a confidential medical evaluation
and follow-up for any employee who has
an exposure incident
 Provide training to employees
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Needlestick Safety
and Prevention Act
 Passed by Congress in 2000
 Centers for Disease Control and
Prevention (CDC) estimated 600,000 to
800,000 needle sticks occur each year
 OSHA revised Bloodborne Pathogen
Standard to requirements of this act
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Employer Requirements
 Identify and use effective and safer
medical devices
 Incorporate changes in annual update of
Exposure Control Plan
 Solicit input from nonmanagerial
employees who are responsible for direct
patient care
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Employer Requirements
(continued)
 Maintain a sharps injury log
 Ensure that every employee uses
standard precautions at all times
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Standard Precautions
 Rules developed by the CDC
 Every body fluid must be considered
potential source of infection
 All patients must be considered potential
source of infection
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When to Use
Standard Precautions
 Any situation where you might come in
contact with
– Blood or any fluid that contains blood
– Body fluids, secretions, and excretions
– Mucous membranes
– Nonintact skin
– Tissue or cell specimens
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Gloves
 Gloves must be changed after contact with
each patient
 When removing gloves, do not
contaminate your skin
 Hands must be washed immediately after
removal of gloves
 Gloves must not be reused
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When to Wear Gloves
 Whenever contact with body fluids,
secretions, or excretions
 When handling or cleaning contaminated
items or surfaces
 Performing any invasive procedure
 Performing venipuncture or blood tests
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Gowns
 Worn during procedures that may cause
splashing or spraying
 Helps prevent contamination of clothing
or uniforms
 Contaminated gowns must be handled
per policy
 Hands must be washed immediately after
removing gown
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Masks and Protective Eyewear
or Face Shields
 Worn during procedures that may cause
splashing or spraying
 Prevents exposure of the mucous
membranes of the mouth, nose, and eyes
 Masks are used once and discarded –
change every 30 minutes following correct
procedure and immediate handwashing
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Masks and Protective Eyewear
or Face Shields (continued)
 Protective eyewear and face shields
protect front, top, bottom, and sides
of eyes
 If not disposable, must be cleaned and
disinfected before reuse
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Sharp Objects
 Use extreme caution to avoid cuts
or punctures
 When possible, use safe needles or
needleless system
 Follow policies regarding handling needles
 Use sharps containers
 Follow laws regarding disposal of sharps
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Spills and Splashes
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Wipe up immediately
Wear gloves when wiping up
Use disposable cleaning clothes
Use disinfectant with 10% bleach solution
Clean all contaminated surfaces
For large spills, can use absorbent powder
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Resuscitation Devices
 Use to avoid the need for mouth-to-mouth
resuscitation, whenever possible
 Place in convenient location that is
readily accessible
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Waste and Soiled Linen
 Wear gloves
 Follow agency policy
 Use biohazard bags appropriately
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Reporting Cuts and Injuries
 Report any cut or injury,
needle stick, or splashing of blood or
body fluids immediately
 Follow agency policy
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Summary
 Standard precautions must be followed at
all times by all health care workers
 Observing these precautions can help
break the chain of infection
 Allow health care workers to protect
themselves, their patients, and all
other individuals
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14:4 Sterilizing with
an Autoclave
 Equipment that uses steam under
pressure or gas
 Most effective method of sterilization
 Available in various sizes and types
 Preparation of equipment or supplies
 Wrapping items for autoclaving
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Sterilizing with
an Autoclave (continued)
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Autoclave indicators
Loading the autoclave
Time period for sterilization
Care of items after autoclaving
Dry heat sterilization
Follow directions on specific autoclave
Follow agency policy for sterile supplies
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14:5 Using Chemicals
for Disinfection
 May not kill spores and viruses
 Disinfect, but do not sterilize
 Used to disinfect instruments that do not
penetrate body
 Preparation of items
 Chemical solutions used
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Using Chemicals for
Disinfection (continued)
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Read manufacturer’s instructions
Antirust tablets or solutions added at times
Requirements for chemical disinfection
Chemical must completely cover items
Care of chemical solutions
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13:6 Cleaning with an
Ultrasonic Unit
 Uses sound waves for cleaning
 Method of aseptic control
 Only ultrasonic solutions should be
used in unit
 Permanent tank of ultrasonic unit
 Items cleaned in ultrasonic unit
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Cleaning with an
Ultrasonic Unit (continued)
 Care of glass beakers
 Care of the permanent tank
 Read manufacturer’s instructions before
using any ultrasonic unit
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Summary
 Different methods provide different levels
of aseptic control
 Method used depends on
equipment available and level of
aseptic control required
 Read manufacturer’s instructions
 Clean, rinse, and dry all equipment
before processing
 Handle items carefully after processing
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14:7 Using Sterile Techniques
 Many procedures require use of
sterile techniques to protect a patient
from infection
 Surgical asepsis keeps an object or area
free from living organisms
 Sterile: free from all organisms
 Contaminated: organisms and
pathogens present
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Using Sterile
Techniques (continued)
 Important to differentiate between sterile
and contaminated areas or items while
using sterile technique
 Correct techniques must be
strictly followed to maintain sterility and
prevent contamination
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Using Sterile
Techniques (continued)
 Clean working area required
 Handling of sterile supplies
 Sterile field: area used for placement of
sterile supplies
 Rules of working within sterile area
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Removing Articles from
Sterile Wraps
 Drop technique
 Mitten technique
 Transfer forceps
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Wet Surfaces
 Organisms and pathogens travel quickly
through wet surfaces
 If sterile item gets wet, contamination
has occurred
 Use extreme care while pouring solutions
into sterile bowls
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Sterile Gloves
 Worn while performing sterile technique
 Make sure tray is open and all sterile items
are ready before putting sterile gloves on
your hands
 Are sterile on the outside and
contaminated on the inside
 Observe correct technique when putting
on sterile gloves
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Sterile Gloves
(continued)
 When gloves are on, hold hands away
from body and above waist
 Handle only sterile objects when wearing
sterile gloves
 Change gloves any time
contamination occurs
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Sterile Dressings
 Obtain proper authorization
 Use an infectious waste bag
 Wear disposable gloves for removing
a dressing
 Note type, color, and amount of drainage
on dressing
 Put on sterile gloves to cleanse area and
apply new dressing
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Sterile Dressings
(continued)
 Cleanse wound or incision with
correct technique
 Apply inner and outer dressing, taking
care to maintain sterility of dressings
 Remove sterile gloves properly and
dispose of properly
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Sterile Dressings
(continued)
 Apply tape correctly to hold dressing
in place
 If contamination occurs at any time during
the procedure, start over
 Commercially prepared sterile supplies are
widely available
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13:8 Maintaining TransmissionBased Isolation Precautions
 Some diseases are communicable –
caused by organisms that can be
transmitted easily
 These precautions are in addition to the
Standard Precautions
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Maintaining Transmission-Based
Isolation Precautions (continued)
 Help prevent spread of disease to others
 Protects patient, family, and
health care workers
 Type used depends on the causative
organism of the disease
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How Communicable
Diseases Spread
 Direct contact with a patient
 Contact with dirty linen, equipment,
and supplies
 Contact with blood, body fluids, secretions,
and excretions
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Terms Defined
 Contaminated or dirty: items that contain
disease-producing organisms; must not be
touched unless protected
 Clean: items that do not contain
the organisms; protect these areas
from contamination
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Classifications of
Precautions
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Standard precautions
Airborne precautions
Droplet precautions
Contact precautions
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Protective or
Reverse Isolation
 Method used to protect certain
patients from organisms present in
the environment
 Used mainly for
immunocompromised patients
 Precautions vary depending on
patient’s condition
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Summary
 Exact procedures for maintaining
transmission-based isolation will vary from
one facility to another
 Variations caused by different factors
 Know and follow procedures at your facility
 Basic principles remain the same in any
facility and are directed toward preventing
the spread of disease
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