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Infection Control for Future Health Professionals Washing Hands Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • Major aspect of standard precautions • Most important aseptic technique • Hands are perfect media for the spread of pathogens 2 Asepsis Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • Prevent and control spread of pathogens • Protect the health care worker from disease and illness 4 • • • • • • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. When to Wash Hands 5 • • • • • • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. When to Wash Hands (continued) 6 Principles of Handwashing • 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 • With an orange stick, brush, or rub against the palms Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • Soap aids in the removal of germs through its sudsy action and alkali content 7 Chain of Infection • • • • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • The chain of infection is process involving: 8 9 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 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 • • • • • • • 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. Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Microorganisms or Microbes 16 • • • • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Microorganisms or Microbes (continued) 17 • • • • • Bacteria Protozoa Fungi Rickettsiae Viruses Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Microbe Classifications 18 Bacteria Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • Simple, one-celled organisms • Multiply rapidly • Classified by shape and arrangement 19 • • • • Round or spherical in shape Diplococci Streptococci Staphylococci Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Bacteria – Cocci 20 Diseases from Bacterial Cocci • Diplococci-gonorrhea, meningitis, pneumonia • Streptococci-strep throat, rheumatic fever • Staphylococci-boils, wound infections, toxic shock • • • • Rod-shaped Occur singly, in pairs, or in chains May have flagella Ability to form spores (thick walled capsules Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Bacteria – Bacilli 22 Diseases from Bacterial Bacilli • • • • • • Tuberculosis Tetanus Pertussis Botulism Diphtheria Typhoid Bacteria – Spirilla Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • Spiral or corkscrew shape • Includes comma-shaped vibrio and corkscrew spirochete • Diseases include syphilis and cholera 24 Antibiotics Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • 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 25 • One-celled, animal-like organism • Found in decayed materials and contaminated water • May have flagella for movement • Some are pathogenic • Examples of diseases • • • • Malaria Amebic dysentery Trichomonas African sleeping disease Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Protozoa 26 • • • • • Simple, plant-like organisms Live on dead organic matter Yeast and molds Can be pathogenic Examples of diseases • • • • • Ringworm Athlete’s foot Histoplasmosis Yeast vaginitis Thrush • Antibiotics do not kill • Antifungal medications Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Fungi 27 • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Rickettsiae 28 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 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 29 Health Care Workers • Major concerns: Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • Hepatitis B • Hepatitis C • HIV 30 • Also called serum hepatitis • Caused by HBV • Transmitted by blood, serum and body secretions • Affects the liver • Vaccine available for protection • Vaccine is expensive Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. (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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Hepatitis C 33 Hepatitis C • • • • • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. (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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Acquired Immune Deficiency Syndrome (AIDS) 35 Bloodborne Pathogen Standards Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • 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 36 • 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: • • • • • Gloves Gowns Masks Lab coats Face shields • Adequate handwashing facilities, containers for infectious or biohazardous wastes Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Bloodborne Pathogen Standards 37 Needlestick Safety and Prevention Act • • • • • Identify safer medical devices Use safer medical devices Make annual changes to exposure control plan Input from direct care staff Sharps injury log Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • In 2001 OSHA revised the standard in response to the Needlestick Safety and Prevention Act 38 Standard Precautions Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • Rules developed by the CDC • Every body fluid must be considered potential source of infection • All patients must be considered potential source of infection 39 When to Use Standard Precautions • • • • • Blood or any fluid that contains blood Body fluids, secretions, and excretions Mucous membranes Nonintact skin Tissue or cell specimens Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • Any situation where you might come in contact with 40 • • • • • 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) • • • • • • • contact with blood body fluids Excretions secretions mucous membranes non-intact skin tissue or cell specimens Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Gloves 41 • • • • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Gowns 42 • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Masks and Protective Eyewear or Face Shields 43 • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Sharp Objects 44 • • • • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Spills and Splashes 45 Resuscitation Devices Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • Use to avoid the need for mouth-to-mouth resuscitation, whenever possible • Place in convenient location that is readily accessible 46 Waste and Soiled Linen Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • Wear gloves • Follow agency policy • Use biohazard bags appropriately 47 Reporting Cuts and Injuries Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • Report any cut or injury, needle stick, or splashing of blood or body fluids immediately • Follow agency policy 48 • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Maintaining TransmissionBased Isolation Precautions 49 • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. How Communicable Diseases Spread 50 • • • • Standard precautions Airborne precautions Droplet precautions Contact precautions Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Classifications of Precautions 51 Protective or Reverse Isolation Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • Method used to protect certain patients from organisms present in the environment • Used mainly for immunocompromised patients • Precautions vary depending on patient’s condition 52 • • • • • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Growth of Microorganisms 53 • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Nosocomial Infections 54 • • • • • • • • Mucous membranes Cilia Coughing and sneezing HCL in the stomach Tears Fever Inflammation response – leukocytes Immune response – antibodies and cell secretion Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Common Body Defenses 55 • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Antiseptics 56 • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Disinfection 57 • Destroys all microorganisms • Steam under pressure, gas, radiation, and chemicals • Autoclave is the most common equipment used Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Sterilization 58 • 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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Sterile Technique 59 Wet Surfaces Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. • 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