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Infection Control for
Future Health
Professionals
Washing Hands
Copyright © 2004 by Thomson
Delmar Learning. ALL RIGHTS
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• Major aspect of standard precautions
• Most important aseptic technique
• Hands are perfect media for the spread
of pathogens
2
Asepsis
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• The absence of disease producing microorganisms, or
pathogens.
• Any object or area that may contain pathogens is considered
to be contaminated.
3
Purpose of Handwashing
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• Prevent and control spread of pathogens
• Protect the health care worker from disease and illness
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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
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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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When to Wash Hands (continued)
6
Principles of Handwashing
• Use soap as a cleansing agent
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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
• With an orange stick, brush, or rub
against the palms
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• Soap aids in the removal of germs
through its sudsy action and alkali
content
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Chain of Infection
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A source or the causative agent
Reservoir (host) where it can live
Portal of exit or a way to escape from the reservoir
Mode of transmission in order to travel to another reservoir or
host to live
• Portal of entry (same as the portal of exit) is how the source gets
into the reservoir
• Susceptible host-a person likely to get an infection or disease
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• The chain of infection is process involving:
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9
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Copyright © 2007, 2003 by Mosby,
Inc., an affiliate of Elsevier Inc.
SOURCE
• IS THE PATHOGEN
• EXAMPLE E. COLI
Slide 10
• WHERE IT CAN
GROW AND
MULTIPLY
• E. COLI NOMRALLY
LIVES IN THE COLON
Copyright © 2007, 2003 by Mosby,
Inc., an affiliate of Elsevier Inc.
RESERVOIR
Slide 11
 EXITS ARE THE
RESPIRATORY, GI,
URINARY, &
REPRODUCTIVE TRACTS,
BREAKS IN SKIN, BLOOD
 A BOWEL MOVEMENT IS
A PORTAL OF EXIT
Copyright © 2007, 2003 by Mosby,
Inc., an affiliate of Elsevier Inc.
PORTAL OF EXIT
Slide 12
• FAILURE TO PROPERLY
WASH HANDS AFTER
BOWEL MOVEMENT
LEAVES FECAL
MATERIAL ON HANDS
Copyright © 2007, 2003 by Mosby,
Inc., an affiliate of Elsevier Inc.
METHOD OF TRANSMISSION
Slide 13
Copyright © 2007, 2003 by Mosby,
Inc., an affiliate of Elsevier Inc.
PORTAL OF ENTRY
• PORTALS OF ENTRY &
EXIT ARE THE SAME
Slide 14
SUSCEPTIBLE HOST
• VERY YOUNG OR OLD
• ILL
• WERE EXPOSED TO THE
PATHOGEN
• DO NOT FOLLOW INFECTION
CONTROL PRACTICES
Copyright © 2007, 2003 by Mosby,
Inc., an affiliate of Elsevier Inc.
• PERSONS AT RISK FOR
INFECTION:
Slide 15
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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
An aerobic organism or
aerobe is an organism
that can survive and
grow in an oxygenated
environment.
An anaerobic organism
can not grow and
survive in an
oxygenated
environment.
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Microorganisms or
Microbes
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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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Microorganisms or
Microbes (continued)
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Bacteria
Protozoa
Fungi
Rickettsiae
Viruses
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Microbe Classifications
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Bacteria
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• Simple, one-celled organisms
• Multiply rapidly
• Classified by shape and arrangement
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Round or spherical in shape
Diplococci
Streptococci
Staphylococci
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Bacteria – Cocci
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Diseases from Bacterial Cocci
• Diplococci-gonorrhea, meningitis, pneumonia
• Streptococci-strep throat, rheumatic fever
• Staphylococci-boils, wound infections, toxic shock
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Rod-shaped
Occur singly, in pairs, or in chains
May have flagella
Ability to form spores (thick
walled capsules
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Bacteria – Bacilli
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Diseases from Bacterial Bacilli
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Tuberculosis
Tetanus
Pertussis
Botulism
Diphtheria
Typhoid
Bacteria – Spirilla
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• Spiral or corkscrew shape
• Includes comma-shaped vibrio and corkscrew spirochete
• Diseases include syphilis and cholera
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Antibiotics
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• 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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• 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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Malaria
Amebic dysentery
Trichomonas
African sleeping disease
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Protozoa
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Simple, plant-like organisms
Live on dead organic matter
Yeast and molds
Can be pathogenic
Examples of diseases
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Ringworm
Athlete’s foot
Histoplasmosis
Yeast vaginitis
Thrush
• Antibiotics do not kill
• Antifungal medications
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Fungi
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• 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
• Typhus fever
• Rocky Mountain Spotted Fever
• Antibiotics are effective
against many of them
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Rickettsiae
28
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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
• Examples: measles & mumps
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Health Care Workers
• Major concerns:
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• Hepatitis B
• Hepatitis C
• HIV
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• 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
31
Virus – Hepatitis B
• 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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(continued)
32
• 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
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Hepatitis C
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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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(continued)
34
• 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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Acquired Immune Deficiency
Syndrome (AIDS)
35
Bloodborne Pathogen
Standards
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• OSHA established standards for contamination with blood and body
fluids that must be followed by all health care facilities in 1991
• Must be followed by all health care workers
• Civil penalties if not implemented and followed
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• Some of the regulations that must be followed:
• Written exposure plan
• Provide Hepatitis B free of charge to all employees who have
potential for exposure
• Provide PPE:
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Gloves
Gowns
Masks
Lab coats
Face shields
• Adequate handwashing facilities, containers for infectious or
biohazardous wastes
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Bloodborne Pathogen
Standards
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Needlestick Safety and
Prevention Act
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Identify safer medical devices
Use safer medical devices
Make annual changes to exposure control plan
Input from direct care staff
Sharps injury log
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• In 2001 OSHA revised the standard in response to the
Needlestick Safety and Prevention Act
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Standard Precautions
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• 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
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Blood or any fluid that contains blood
Body fluids, secretions, and excretions
Mucous membranes
Nonintact skin
Tissue or cell specimens
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• Any situation where you might come in contact with
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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
Always wear (even if you ANTICIPATE)
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contact with blood
body fluids
Excretions
secretions
mucous membranes
non-intact skin
tissue or cell specimens
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Gloves
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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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Gowns
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• 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
• 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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Masks and Protective Eyewear
or Face Shields
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• Use extreme caution to avoid cuts
or punctures
• Leave uncapped after use
• 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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Sharp Objects
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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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Spills and Splashes
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Resuscitation Devices
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• 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
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• Wear gloves
• Follow agency policy
• Use biohazard bags appropriately
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Reporting Cuts and Injuries
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• Report any cut or injury,
needle stick, or splashing of blood or
body fluids immediately
• Follow agency policy
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• Some diseases are communicable (contagious)– caused by
organisms that can be transmitted easily
• Extra precautions must be used in addition to the Standard
Precautions
• 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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Maintaining TransmissionBased Isolation Precautions
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• Direct contact with a
patient
• Contact with dirty linen,
equipment, and supplies
• Contact with blood, body
fluids, secretions, and
excretions
• Droplets from sneezing,
coughing, or spitting
• Discharges from wounds
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How Communicable
Diseases Spread
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Standard precautions
Airborne precautions
Droplet precautions
Contact precautions
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Classifications of
Precautions
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Protective or
Reverse Isolation
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• 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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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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Growth of Microorganisms
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• 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
• Common examples are staphylococcus, pseudomonas,
enterococci
• Infection control programs are used to prevent and deal with
nosocomial infections
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Nosocomial Infections
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Mucous membranes
Cilia
Coughing and sneezing
HCL in the stomach
Tears
Fever
Inflammation response – leukocytes
Immune response – antibodies and cell secretion
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Common Body Defenses
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• 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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Antiseptics
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• 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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Disinfection
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• Destroys all
microorganisms
• Steam under
pressure, gas,
radiation,
and chemicals
• Autoclave is the most
common
equipment used
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Sterilization
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• 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
• Correct techniques must be
strictly followed to maintain sterility
and
prevent contamination
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Sterile Technique
59
Wet Surfaces
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• 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
60