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CHAPTER 4
Safety
&
Infection Control
Safety and Infection Control
• Goal of Safety for Health Care Facilities
– Get rid of hazards to patients and employees
– Provide safety education
– OSHA, CDC developed safe working guidelines for health care facilities
Personal Safety from Infection during Specimen Handling
• Practice universal precautions to prevent acquiring blood borne pathogens (BBP) such
as Hepatitis B, C, and HIV (AIDS)
.• Wear gloves and other personal protective equipment (PPE).
• Place warning labels on containers that contain blood or other potentially infectious
materials.
Exposure Control
• The injured health care worker should immediately cleanse the area with isopropyl alcohol and
apply an adhesive bandage if a needle stick occurs.
• Report all accidents immediately to a supervisor.
Health Care–Associated(Nosocomial) Infections
• Health care–associated (nosocomial) infections are acquired by a patient after admission to a
health care facility.
• Infection Control Programs– These programs address the issues of proper aseptic technique,
isolation procedures, education, and management of health care–associated infections.– Centers for
Disease Control and Prevention, provides infection control and safety guidelines to protect healthcare
workers.
• The cornerstone of infection protection of patients and health care workers is the use of
aseptic techniques that include:– Frequent hand washing– Use of barrier garments and personal
protective equipment– Waste management of contaminated materials
• Use of proper cleaning solutions• Following standard precautions• Using sterile procedures
when necessary
Chain of Infection
Three Components in the Chain
Source– Mode of transmission– Susceptible host
Chain of Infection
• Infection control programs aims to break the infection chain at one or more links.
• Handwashing procedures for sterile technique, proper waste disposal, appropriate laundry services,
and housekeeping are ways of controlling the sources.• Isolation techniques, control of insects and
rodents, and use of disposable equipment and supplies help interrupt the modes of transmission.
• Host susceptibility is controlled by speeding the patient’s recovery.
• Immunizations, transfusions, proper nutrition, medication, and adequate exercise help the patient to
become healthy.
Standard Precautions
• Standard precautions are designed to reduce the risk of transmission of microorganisms from both
recognized and unrecognized sources of infection in health care facilities.
• These precautions include universal precautions that are designed to prevent transmission of all
infectious agents.
• These precautions provide protection from contact with blood, all body fluids, mucous membranes,
and non-intact skin.
Standard Precautions
Airborne Precautions
Reduce the spread of airborne droplet transmission of infectious agents, such as rubella, varicella, and
tuberculosis.
Droplet Precautions
Are used to reduce the transmission of diseases such as pertussis and pneumonia.
These diseases can be transmitted through contact with eye, mouth, or nose secretions from sneezing,
coughing, or talking.
Contact Precautions
Reduce the risk of transmission of serious diseases such as herpes simplex through direct or indirect contact.
Standard Precautions
• Respiratory Hygiene and Cough Etiquette
CDC has designed measures to minimize the transmission of respiratory diseases in health care facilities.
Keys of Respiratory Hygiene/Cough Etiquette
Covering the mouth and nose during coughing and sneezing
Using tissues to avoid spreading respiratory secretions to others
Offering a mask to persons who are coughing
Turning the head away from others and maintaining separation when coughing
Use personal protective equipment to prevent skin and mucous membrane
exposure when contact with blood or other body fluids of any patient is
anticipated.
Standard Precautions
• Use of Standard Precautions
– Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or
other body fluids.
– Hands should be washed immediately after gloves are removed.
• Take Precautions to Prevent Injuries Caused by Needles, Scalpels, and other Sharp Instruments or
Devices
– During procedures
– During disposal of used needles
– When handling sharp instruments after procedures
• Prevent Infections from Bloodborne Pathogens
– Use safety-engineered needles and sharps devices.
– Do not recap needles, purposely bend or break them by hand, remove them from disposable syringes, or
handle them for any reason
• Immediately dispose of the blood tube holder and safety needle as a single unit after blood collection.•
Place disposable syringes and needles, lancets, and other sharp items, after they are used, in punctureresistant containers for transport to the biohazardous waste center.
Standard Precautions
• Isolation for Hospital Outbreaks
To control the outbreak, the need for special precautions and isolation procedures might occur.
Any health care worker entering or exiting these areas should be made aware of the special circumstances.
• Protective Environment (Reverse Isolation)
All food and articles are sterilized before they are taken into the patient’s room.
Some patients must live in these protected environments when they are recovering from cancer treatments.
• Infection Control in Special Hospital Units– Infection Control in a Nursery Unit
Newborns are easy targets for infections of all sorts because their immune systems are not fully developed at birth.
Neonates may pick up pathogens from their mothers, other babies, or hospital personnel.
Use gloves and an antiseptic for handwashing.
• Infection Control in Special Hospital Units– Infection Control in a Burn Unit
Each bed is surrounded by a plastic curtain with sleeves. Hospital personnel use these sleeves to have contact with
the patient.
All supplies and equipment are kept outside the curtain.
Gowning, gloving, double bagging, and strict handwashing procedures should be used.
All articles in the room, as well as the room itself, should be disinfected or sterilized frequently.
• Infection Control in Special Hospital Units– Infection Control in an ICU or a Postoperative Care Unit
In most hospitals, ICUs are open areas, with numerous patients in one large room.
Patients with known infections are isolated according to the types of infections they have, and strict handwashing and
gloving policies are necessary in all ICUs.
Supplies Required for Isolation Procedures:
Disposable gloves– Gown– Mask– Protective eyewear
Specific Isolation Techniques and Procedural Steps
• Isolation Item Disposal•
Supplies Needed– Garbage bag– Linen hamper– Large red isolation bag– Specimen container– Plastic
bag with biohazard label– Laundry bag
Puncture-resistant disposal container for needle and sharps– Gloves– Antiseptic agent or antimicrobial
agent
Turn isolation bags halfway inside out and leave them near the door outside the room.– Take only the
needed supplies into the room.
If collecting a blood specimen, use a tourniquet in the room or leave the one brought in.– Label the
specimen at the bedside and leave the pen in the room.
Put used needles, swabs, and so forth inappropriate containers inside the room.– Remove any blood on
the outside of the specimen container with a paper towel.– While standing in the doorway and touching
only the inside of the isolation bag, place the specimen inside the bag.– Wash gloved hands in the room
and turn the faucet off with a paper towel.
Removal of Isolation Gown, Mask, and Gloves
• Pull off the first glove turning it inside out.
• Place the rolled-up glove into the palm of the hand that is still gloved.
• Remove the second glove slipping the index finger of the ungloved hand between the glove and the
hand
.• Then pull the glove down and off as it turns inside out.
• Dispose of both gloves in a red garbage bag in the isolation room
.• After the removal of gloves, remove the goggles or face shield by touching the head band or ear
pieces
.• Do not touch the outside of goggles or face shield because of contamination.
Removal of Patient’s Specimen from Isolation Room
• Follow the required procedure for entering the isolation room.• Label blood tube(s) as required and
include “isolation” on label.• Collect the blood and place the tube(s)in a clean plastic biohazard bag
outside the room as shown in Figure 4-32.
• Complete hand hygiene.• Transport specimen(s) to the lab with lab request form.
Disinfectants and Antiseptics
• Disinfectants are chemical compounds used to remove or kill pathogenic
microorganisms.
• Disinfectants are generally used on surfaces and instruments because
they are too corrosive for direct use on skin.
• Antiseptics are chemicals used to inhibit the growth and development of
microorganisms but do not necessarily kill them.
• Antiseptics may be used on human skin.
• Gloves and gowns should be worn when performing decontamination
procedures.
Fire Safety
• Fire safety is the responsibility of all employees.• Be familiar with the use and location of fire
extinguishers and the procedures to follow during a fire.• Become skillful in and knowledgeable about
the use of fire safety equipment.• Learn How to Use Fire Extinguishers
– Class A fires (wood, paper, clothing, and trash) require an ABC extinguisher or pressurized water
extinguisher.
– Class B fires (liquids, grease, and chemical fires) need an ABC extinguisher or carbon dioxide
(CO2)extinguisher.
• Learn How to Use Fire Extinguishers– Class C fires are electrical fires and aCO2, halon, or ABC
extinguisher can be used.
• Emergency Response to Possible Fire– Things NOT to do in a fire response
Block entrances Re-enter the building Panic Run
• Emergency Response to Possible Fire– Things to do in a fire response Pull the nearest fire alarm Call 911
or the hospital’s fire emergency number Remove patients from danger Close windows and doors Use an ABC
extinguisher for small fire Leave the area immediately by stairs Drop to ground and roll Crawl to the exit
• Use of an ABC Extinguisher– Pull pin off the fire extinguisher • Use of an ABC Extinguisher– Aim the
extinguisher at the base of fireand squeeze the handle– Spray the solution toward the base ofthe fire
Chemical Safety
• Pouring Preservatives
– Example of a preservative is hydrochloric acid (HCl).
• Labeling
– Single most important step in the proper handling of chemicals.
– Laboratory workers should be able to ascertain from appropriate labels not only the contents of the container
but also the nature and extent of hazards posed by the chemicals.
• NFPA Labeling System for Hazardous Chemicals
– The system uses a diamond-shaped symbol, four colored quadrants, and a hazard rating scale of 0 to 4.
– The health hazard is shown in the blue quadrant.
– The flammability hazard is shown in the red quadrant.
– The instability hazard is indicated in the yellow quadrant.
– The specific hazard is shown in the white quadrant.
– Common laboratory chemicals require regulatory labels.
Chemical Safety
• Safety Showers and the Eyewash Station
The victim of a chemical accident must
immediately rinse the affected area for
at least 15 minutes after removing contaminated clothing.
• Safety Showers and the Eyewash Station
–In case of a chemical spill in the eye, the victim should rinse his/her eyes at
the eyewash station for a minimum of15 minutes
.– Contact lenses must be removed before rinsing in order to thoroughly cleanse
the eyes.
– The victim should not rub the eyes.
– Take the victim to the emergency department for treatment after his/her eyes have been rinsed for 15 minutes
Radiation Safety
The Three Cardinal Principles of Self-protection
1. Time
2. Shielding
3. Distance
Equipment and Safety in Patients’ Rooms
• Make certain that all specimen collection supplies, needles, and equipment are either properly
disposed of or returned to the specimen collection tray after blood collection.
• Check on position of bed rails.
• Check for food or liquid spilled on the floor.
• Report a patient’s alarm for the IV drip.
• If the patient is in unusual pain or is unresponsive, notify the nursing station immediately.
• Make certain that all specimen collection supplies, needles, and equipment are either properly disposed
of or returned to the specimen collection tray after blood collection.
• Check on position of bed rails.
Patient Safety Related to Latex Products
• Symptoms of an Allergic Reaction to Latex
– Skin rash
– Hives
– Nasal, eye, or sinus irritation
– Sometimes, shock