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Chapter 14
Infection Control
© 2009 Delmar, Cengage Learning
Objectives
• -Provide a basic understanding of microorganisms,
diseases and where they come from.
• -Explain each the chain of infection in each
microorganism
• -Explain how & what is needed (equipment, etc) to
keep a sterile environment
• -Explain proper sanitation and cleaning techniques
• -Explain the threat of bioterrorism
• -Review an MSDS sheet
• -Review precautions of different pathogens & how they
come about
• Define Terms (see next slide)
© 2009 Delmar, Cengage Learning
TERMS TO KNOW:
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Aerobic
Anaerobic
AIDS
Autoclave
Chain of Infection
Communicable Disease
Droplet Precautions
Helminths
Hepatitis B
Hepatitis C
Mode of Transmission
Nosocomial
Opportunistic
Pathogens
•Personal Protective Equipment
•Portal of Entry
•Portal of Exit
•Protozoa
•Reservoir
•Ricketsiae
•Sterilization
•Viruses
© 2009 Delmar, Cengage Learning
Introduction
Infection Control
• http://youtu.be/oi5Yd_wBW8g - Communicable Disease Overview
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http://youtu.be/v0yig-sS3aM - Communicable Disease Facts
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https://youtu.be/a2zwU2c-HZo basic first aid, pressure, wrapping
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http://youtu.be/75wF5JySU-c
First Response: the complete guide to bleeding, wounds, & burns (watch
middle part)
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http://youtu.be/2pHGjvsEwjM
Abscess armpit
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http://youtu.be/tHXK3XnOx9U
Staph back of shldr
© 2009 Delmar, Cengage Learning
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
Some cause infections and disease
Called pathogens (germs) when able to
harm the body
• May be beneficial
(continues)
© 2009 Delmar, Cengage Learning
Microorganisms or Microbes
(continued)
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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
© 2009 Delmar, Cengage Learning
Microbe Classifications
• Bacteria
• Protozoa
• Fungi
• Rickettsiae
• Viruses
© 2009 Delmar, Cengage Learning
Bacteria
• Simple, one-celled organisms
• Multiply rapidly
• Classified by shape and arrangement
– Cocci are round or spherical in shape
– Bacilli are rod shaped
• May have flagella for locomotion
– Spirilla are spiral
(continues)
© 2009 Delmar, Cengage Learning
Bacteria
(continued)
• Cocci are round or spherical in shape
– Diplococci—in pairs
– Streptococci—in chains
– Staphylococci—clusters or groups
(continues)
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
Protozoa
• One-celled, animal-like organism
• Found in decayed materials and
contaminated water
• May have flagella for movement
• Some are pathogenic
• Examples of diseases
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
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
(continues)
© 2009 Delmar, Cengage Learning
Viruses
(continued)
• Viruses infecting animals can mutate to
infect humans
• Examples include:
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Severe acute respiratory syndrome (SARS)
West Nile Virus (WNV)
Monkeypox
Ebola and Marburg
H5N1
© 2009 Delmar, Cengage Learning
More Nasty Virues
• West Nile
• Ebola
• SARS
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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
(continues)
© 2009 Delmar, Cengage Learning
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, written statement
must be signed documenting refusal
© 2009 Delmar, Cengage Learning
Hepatitis C
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Caused by HVC – hard to destroy (no vaccine for)
Transmitted by blood and blood-containing body fluids
Many infected individuals are asymptomatic
Others have mild symptoms
Can cause severe liver damage
(continues)
© 2009 Delmar, Cengage Learning
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
• Take precautions for
prevention
© 2009 Delmar, Cengage Learning
Helminths
• Multicellular parasites otherwise known
as worms or flukes
• Are transmitted:
– By eating
contaminated food
– Being bitten
by infected insects
– When worms
enter the skin
© 2009 Delmar, Cengage Learning
Classifications of
Diseases and Infections
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Endogenous
Exogenous
Nosocomial
Opportunistic
© 2009 Delmar, Cengage Learning
Endogenous
• Originates within the body
• Examples: metabolic disorders,
congenital abnormalities, tumors, and
infections caused by microorganisms
within the body
• Liver cancer
© 2009 Delmar, Cengage Learning
Exogenous
• Originates outside the body
• Examples: radiation, chemical agents,
trauma, electric shock, and temperature
extremes
© 2009 Delmar, Cengage Learning
Nosocomial
• Acquired in a health care facility
• Usually present in facilities and carried by health care
workers to the patient
• Many are antibiotic-resistant
• Can cause serious and even life-threatening infections
• Infection-control programs are used
in facilities to prevent and deal with nosocomial
infections
(continues)
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
Chain of Infection
• Present for disease to occur and spread
from one individual to another
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Causative agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
Common Body Defenses
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Mucous membranes
Cilia
Coughing and sneezing
HCL in the stomach
Tears
Fever
Inflammation response
Immune response
© 2009 Delmar, Cengage Learning
Wound Care
Contusion – bruising, discoloration of the skin from blunt
trauma or internal inflammation
© 2009 Delmar, Cengage Learning
© 2009 Delmar, Cengage Learning
© 2009 Delmar, Cengage Learning
Amputations & Burns
© 2009 Delmar, Cengage Learning
Cleaning an Open Wound
© 2009 Delmar, Cengage Learning
Cleaning & Referring Open Wounds
• Refer for stitches or medical attention if:
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Wounds are 0.25 in deep / 0.75 in long or more
Over eye, head, joints, fingers, face lips
If fatty tissue, bone, muscle, tendons are exposed
If persists for 15 min or more
contains glass or other debris
has an object sticking out of it, such as a twig/metal
spurts blood (could have cut/severed artery)
• GET A TETANUS SHOT within 48 hrs
© 2009 Delmar, Cengage Learning
Aseptic Techniques
• Asepsis: absence
of disease-producing
microorganisms
• Contaminated:
any object or area
that may contain pathogens
• Major aim:
maintaining
cleanliness and
eliminating or
preventing every
aspect
of contamination
© 2009 Delmar, Cengage Learning
Common Aseptic Techniques
• Thorough handwashing
• Good personal hygiene
• Disposable gloves
• Cleaning instruments
and equipment
• Proper cleaning
of environment
© 2009 Delmar, Cengage Learning
Levels of Aseptic Control
• Antisepsis—used on the skin
• Disinfection—used mainly on objects
• Sterilization—use of steam under
pressure, gas, radiation, and chemicals
on objects
• Bioclave
© 2009 Delmar, Cengage Learning
HANDWASHING (disinfection)
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Prevent and control spread of pathogens
Protect the health care worker from disease and illness
Wet with warm water, soap, scrub (20s), rinse (finger tips down), turn off
tap with paper towel, dry hands with new paper towel.
© 2009 Delmar, Cengage Learning
When to Wash Hands
(continued)
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Anytime the hands become contaminated during a procedure
Before applying gloves
Immediately after removing gloves
When gloves are torn or punctured
Before and after handling specimens
After contact with any soiled or
contaminated item
On arrival at facility
Immediately before leaving facility
Before and after every patient contact
After contact with patient’s skin
Before moving from a contaminated site
to a clean site
After picking up any item off the floor
After personal use of the bathroom
Following a cough, sneeze, or using a tissue
Before and after any contact with mouth or mucous membranes
(continues)
© 2009 Delmar, Cengage Learning
14:2 Bioterrorism
• Bioterrorism: use of microorganisms or
biologic agents for warfare
• Infecting humans, animals, or plants
• Have been used over time by different
nations not only in war but also on
innocent people
© 2009 Delmar, Cengage Learning
Biologic Agents
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High priority agents include:
– Smallpox: contagious
and infectious disease,
result of the Variola virus
– Anthrax: infectious disease
caused by
Bacillus anthracis
– Plague: infectious disease from the
bacteria Yersinia pestis
(continues)
© 2009 Delmar, Cengage Learning
Principles of Handwashing
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Use soap as a cleansing agent
Use warm water
Use friction
Clean all surfaces
Point fingertips down
Use dry paper towels to turn faucet on
and off
• Clean nails
© 2009 Delmar, Cengage Learning
Biologic Agents
(continued)
– Botulism: paralytic illness resulting from a nerve
toxin from the bacteria Clostridium botulinum
• Spores are in the soil, water, from food, injecting needles.
– Filoviruses: infectious diseases causing severe
hemorrhagic fever known as Ebola virus and
Marburg virus
© 2009 Delmar, Cengage Learning
Preparing for Bioterrorism
• Bioterrorism attack would result in a
public health emergency
• Would have impact on health care
facilities
• Social disorder would ensue
• Comprehensive plan
(continues)
© 2009 Delmar, Cengage Learning
Needle Stick Safety Act
• Passed by Congress in 2000
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Because occupational exposure to bloodborne pathogens from
accidental sharps injuries in healthcare and other occupational settings
continues to be a serious problem, Congress felt that a modification to
OSHA's Bloodborne Pathogens Standard was appropriate
• Centers for Disease Control and
Prevention (CDC) estimated 600,000 to
800,000 needle sticks per year
• OSHA revised Bloodborne Pathogen
Standard to requirements of this act
© 2009 Delmar, Cengage Learning
Employer Requirements
(continued)
• Maintain a sharps injury log
• Ensure that every employee uses
standard precautions at all times
© 2009 Delmar, Cengage Learning
Gloves
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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
Whenever contact with body fluids,
secretions, or excretions
• When handling or cleaning contaminated items or surfaces
• Performing any invasive procedure
• Performing venipuncture/blood tests
© 2009 Delmar, Cengage Learning
Gowns
• Worn during procedures that may cause
splashing or spraying
• Helps prevent contamination of clothing
or uniforms
• Contaminated gowns must be handled
per policy/biohazard container
• Hands must be washed immediately
after removing gown
© 2009 Delmar, Cengage Learning
Masks and Eye Protection
• Worn during procedures that may cause
splashing or spraying
• Prevents exposure of mucous
membranes of the mouth, nose, and
eyes to pathogens
• Use masks once then discard—change
every 30 minutes if needed
(continues)
© 2009 Delmar, Cengage Learning
Sharp Objects
• Use extreme caution to avoid cuts
and punctures
• When possible, use safe needles or
needleless system
• Follow policies regarding needles
© 2009 Delmar, Cengage Learning
Spills or Splashes
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Wipe up immediately
Wear gloves when wiping up
Use disposable cleaning clothes
Use disinfectant which contains 10%
bleach solution
• Clean all contaminated surfaces
• For large spills, can use absorbent
powder to absorb fluid
© 2009 Delmar, Cengage Learning
Resuscitation Devices
• Use to avoid the need for mouth-tomouth resuscitation
• Place in convenient location that is
readily accessible
© 2009 Delmar, Cengage Learning
What is the Sequence for Donning
(putting on) vs. Removing Personal
Protective Equipment?
DONNING:
1. GOWN
2. MASK or Respirator
3. GOGGLES or Face shield
4. GLOVES
REMOVING:
1. GLOVES
2. FACE SHIELD
3. GOWN
4. MASK or Respirator
© 2009 Delmar, Cengage Learning
Waste and Linen Disposal
• Wear gloves
• Follow agency policy
• Use biohazard bags appropriately
© 2009 Delmar, Cengage Learning
MSDS Sheets
A material safety data sheet (MSDS) –
is a detailed information bulletin prepared
by the manufacturer or importer of a
chemical that describes the physical and
chemical properties, physical and health
hazards, routes of exposure, precautions
for safe handling and use, emergency
and first-aid procedures, and control
measures. Information on an MSDS aids
in the selection of safe products and
helps prepare employers and employees
to respond effectively to daily
exposure situations as well as
to emergency situations.
© 2009 Delmar, Cengage Learning
Injuries
• Report any cut or injury, needle stick, or
splashing of blood or body fluids
immediately
• Follow agency policy
© 2009 Delmar, Cengage Learning
Classifications of Precautions
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Standard precautions
Airborne precautions
Droplet precautions
Contact precautions
© 2009 Delmar, Cengage Learning
Summary
• Exact procedures for maintaining
transmission-based isolation will vary
from one facility to another
• Variations caused by different factors
• Basic principles remain the same in any
facility and are directed toward
preventing the spread of disease
© 2009 Delmar, Cengage Learning