Download Infection Control Techniques

CHAPTER
33
Infection Control
Techniques
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-2
Learning Outcomes
33.1 Describe the medical assistant’s role in
infection control.
33.2 Describe methods of infection control.
33.3 Compare and contrast medical and surgical
asepsis.
33.4 Describe how to perform aseptic hand
washing.
33.5 Compare and contrast the procedures for
sanitization, disinfection, and sterilization.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-3
Learning Outcomes (cont.)
33.6 Describe measures used in sanitization.
33.7 List various methods used in disinfection
and the advantages and disadvantages of
each.
33.8 Discuss the goal of surgical asepsis.
33.9 Explain what an autoclave is and how it
operates.
33.10 List the steps in the general autoclave
procedures.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-4
Learning Outcomes (cont.)
33.11 Explain how to wrap and label items for
sterilization in an autoclave.
33.12 Describe how to complete the sterilization
procedure using an autoclave.
33.13 Define the Blood-Borne Pathogens Standard
and Universal Precautions as described in
the rules and regulations of the Occupational
Safety and Health Administration (OSHA).
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-5
Learning Outcomes (cont.)
33.14 Explain the role of Universal Precautions in
the duties of a medical assistant.
33.15 List the procedures and legal requirements
for disposing of hazardous waste.
33.16 Describe Centers for Disease Control and
Prevention (CDC) requirements for reporting
cases of infectious disease.
33.17 Discuss the need for specific guidelines for
isolating patients in health-care settings.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-6
Learning Outcomes (cont.)
33.18 Describe the appropriate use of personal
protective equipment in various situations.
33.19 Explain the purpose of immunization.
33.20 Describe your role in educating patients
about immunizations.
33.21 Explain how to educate patients in
preventing disease transmission.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-7
Introduction
• Patients coming to
the office for
treatment may be
more susceptible to
infections
• Immunizations and
patient education
are important
methods of infection
control
You will be introduced to Occupational Safety and
Health Administration (OSHA) guidelines, the
Blood-Borne Pathogen Standard, reporting
guidelines, and isolation procedures.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-8
MA’s Role in Infection Control
• To control infectious
diseases, the cycle of
infection must be
broken
• Apply principles of
infection control in
office setting
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-9
MA’s Role in Infection Control (cont.)
• Follow correct
sanitization, disinfection,
and sterilization
procedures
• Help patients understand
basic disease prevention
• Educate patients about
immunizations
• Administer
immunizations
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-10
Apply Your Knowledge
What is your role as a medical assistant in
controlling infection in the medical office?
ANSWER: To apply principles of infection control by
following correct sanitization, disinfection, and
sterilization procedures.
Correct!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-11
Infection Control Methods
• Eliminate elements needed for disease
to occur
• Knowledge of
– Medical asepsis
• Based on cleanliness
• As few microorganisms as possible
– Surgical asepsis
• Sterile environment
• No microorganisms
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33-12
Medical Asepsis
• Keep office clean:
– Reception area: sick vs. well
patients
– Reception room clean, well
lit, and ventilated
– Keep furniture in good repair
– Strict “no food or drink”
policy
– Empty trash as necessary
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-13
Medical Asepsis (cont.)
• During medical assistant
procedures
– Prevent cross-contamination
• Hand washing
– Beginning of day
– After breaks
– Before and after each patient
– Before and after handling
equipment or specimens
– After blowing your nose or
coughing
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-14
Medical Asepsis (cont.)
• Other precautions
– Avoid leaning against sinks, supplies,
equipment
– Avoid touching your face and mouth
– Use tissues when you cough or sneeze, and
always wash your hands afterward
– Avoid working directly with patients when you
have a cold; wear gloves and mask if you
must
– Stay home if you have a fever
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-15
Apply Your Knowledge
Describe the difference between medical and
surgical asepsis.
ANSWER: Medical asepsis is based on cleanliness and
reducing the number of microorganisms as much as
possible. Surgical asepsis is maintaining a sterile
environment by eliminating all microorganisms.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-16
Sanitization
• Scrubbing with a brush and
detergent to remove blood,
mucus, and other
contaminants or media where
pathogens can grow
• For cleaning items that touch
only healthy, intact skin
OR
• First step in disinfection and
sterilization for other
equipment
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-17
Sanitization (cont.)
• Collect items for
sanitization
– Place in water and special
detergent solution
– Use utility gloves
– Separate sharps from other
equipment
• Scrub items
– Follow manufacturers’
guidelines
– Dry thoroughly
– Examine carefully
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-18
Sanitization (cont.)
• Rubber and plastic items
• Syringes and needles – use disposable
whenever possible
• Ultrasonic cleaning
– For delicate instruments and those with
moving parts
– Sound waves generated through a cleaning
solution to loosen contaminants
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-19
Apply Your Knowledge
What is sanitation, and what types of items is it
adequate for cleaning?
ANSWER: Sanitation is scrubbing with a brush and
detergent to remove blood, mucus, and other
contaminants or media where pathogens can grow. It
is adequate for cleaning items that touch only healthy,
intact skin.
Nice Job!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-20
Disinfection
• Adequate for instruments that do not
penetrate skin or mucous membranes and
surfaces not considered sterile
OR
• Second step in infection control prior to
sterilization
• Will not kill spores, certain viruses
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-21
Disinfection (cont.)
• Using disinfectants
– Cleaning products
applied to inanimate
materials to reduce or
eliminate infectious
organisms
• Antiseptics are antiinfective
cleaning agents used
on human tissue
– Follow manufacturers’
guidelines
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-22
Disinfection (cont.)
– Factors impacting effectiveness
of disinfectants
• Number of times solution is used
• Wet items – surface moisture may
dilute solution
• Traces of soap left from
sanitization – alters chemical
composition
• Evaporation
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-23
Disinfection (cont.)
• Choose the correct disinfectant
– Germicidal soap products
– Alcohol
– Acid products
– Formaldehyde
– Glutaraldehyde – “cold
disinfection”
– Bleach
– Iodine and iodine compounds
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-24
Disinfection (cont.)
• Handling disinfected
supplies
– Prevent contamination
with other surfaces
– Use sterile transfer
forceps
– Wear gloves
– Store in clean, moisturefree environment
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-25
Apply Your Knowledge
What is the difference between a disinfectant and
an antiseptic?
ANSWER: Disinfectants are cleaning products applied to
inanimate materials to reduce or eliminate infectious
organisms. Antiseptics are anti-infective cleaning agents
used on human tissue.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-26
Surgical Asepsis
• Goal is to keep the
surgical environment
completely free of all
microorganisms
• Used for even minor
operations and injections
• The more extensive the
procedure, the greater the
risk of infection
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33-27
Sterilization
• Required for all instruments or supplies that
– Penetrate the skin
– Contact normally sterile areas of the body
• Object is either sterile or not sterile
– If unsure of sterility, consider it not sterile
• Prior to sterilization
– Sanitize
– Disinfect
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33-28
The Autoclave
• Primary method of
sterilization
– Pressurized steam
– Operates at lower
temperatures than dry heat
sterilization
– Moisture causes coagulation
of proteins in
microorganisms at lower
temperatures
• Cell walls burst when cell
cools, killing the
microorganism
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33-29
The Autoclave (cont.)
• Wrap sanitized and
disinfected items
– Special porous fabric,
paper, or plastic
– Items should not touch
– Label
• Check water level –
distilled water only
• Preheat, but do not
overheat
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33-30
The Autoclave (cont.)
• Load, choose correct setting, run cycle
– Temperature 250°to 270°F
– Pressure 15 to 30 pounds
• Unload
• Store items properly
– Clean, dry location
– Shelf life based on packaging, but generally 30 days
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33-31
The Autoclave (cont.)
• Clean autoclave and area
• Quality control checks
– Sterilization indicators –
confirm that items have been
exposed to correct volume
of steam at the correct
temperature for the correct
length of time
– Biological indicators – contain bacterial
spores and confirm that sterilization occurs
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-32
The Autoclave (cont.)
• Prevent incomplete sterilization
– Correct timing
– Adequate temperature
– Properly wrapped packs
– Adequate steam levels
• Timing
– Preset for load types
– Use sterilization indicators
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-33
The Autoclave (cont.)
• Temperature
– Too high – steam too little moisture
– Too low – steam too much moisture
• Do not overcrowd autoclave
• Steam level
– If incorrect, items will not be sterile at end of
cycle
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-34
Sterile Technique

Strict adherence to set order of
procedures




Sterile against sterile
Clean against clean
Unclean against unclean
Surgical scrub
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33-35
Surgical Asepsis
• During surgical procedures
– Do not touch sterile items
without sterile gloves
or transfer forceps
– Aseptic technique
• Throughout surgical procedures
• Caring for surgical wounds
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-36
Surgical Asepsis (cont.)
• After procedures
– Sanitize, disinfect, and sterilize reusable
items
– Disinfect surfaces
• Waste disposal
– Biohazard waste containers
• Leak-proof containers either color-coded
red or labeled with biohazard symbol
– Biohazardous materials
• Biological agents that can spread disease
to living things
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-37
Apply Your Knowledge
1. What items need to be sterilized?
ANSWER: Sterilization is required for all instruments or
supplies that penetrate the skin or come in contact with
normally sterile areas of the body.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-38
Apply Your Knowledge
2. The physician is going to remove a small growth
from your patient’s back. In order to prepare for
this procedure, what steps would you take to
prevent the spread of infection?
ANSWER: Use medical asepsis while preparing the patient,
and then use surgical asepsis during the procedure.
Right!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-39
OSHA Guidelines
• Blood-Borne Pathogen Standards
– Protect health-care workers from health
hazards on the job
– Also protect patients and others who come to
medical facilities
– Dictate how to handle infectious or potentially
infectious wastes
• Discarded
• Held for processing
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-40
OSHA Guidelines (cont.)
• Blood-Borne Pathogen
Standards
– Measures to prevent the
spread of infection
– Provide a margin of safety
by ensuring that medical
facilities meet minimal
standards for asepsis
– Requirements for training,
keeping records,
housekeeping,
and personal protective
gear
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-41
OSHA Guidelines (cont.)

Universal Precautions

Prevent health-care workers from exposure
to infections

Assume that all blood and body fluids are
infected with blood-borne pathogens
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-42
OSHA Guidelines (cont.)

Standard Precautions

Combination of Universal Precautions and
Body Substance Isolation guidelines

Used in health-care facilities to prevent
transmission of disease
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-43
OSHA Guidelines (cont.)
•
Categories of tasks
I.
Tasks that expose a worker to blood, body
fluids, or tissues and require specific
protective measures
II.
Tasks that usually do not involve risk of
exposure but require precautions in certain
situations
III. Tasks that have no risk of exposure, so no
special protection is required
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-44
Respiratory Hygiene/Cough Etiquette
• Guidelines established by CDC
– Education
– Posting signs
– Controlling source or transmission
– Proper hand hygiene
– Separating patients with respiratory infections
from other patients
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-45
Personal Protective Equipment
• Protective gear worn to protect
against physical hazards
• Employers must provide PPE at
no charge to the employee
• Disposable, sterile exam and
utility gloves
• Masks and protective eyewear
or face shields
• Protective clothing
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-46
Postprocedure Cleanup
• Decontaminate all
exposed surfaces
• Replace protective
coverings on surfaces
or equipment
• Decontaminate
receptacles
• Pick up any broken
glass with tongs
• Discard all potentially
infectious waste
materials
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-47
OSHA Guidelines (cont.)
• Apply guidelines daily on the job
• Exposure incidents
– Contact with infectious substance
– Rules apply to all serious infections – HIV,
HBV
– HBV vaccine
• Transmission to patients
– Nosocomial infection – an infection acquired
by a patient in a health-care facility
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-48
Apply Your Knowledge
OSHA divides medical tasks by level of risk.
What are these risk categories?
ANSWER: There are three categories of risk:
Category 1: Expose a worker to blood, body fluids, or
tissues and require specific protective measures
Category 2: Usually do not involve risk of exposure, but
precautions are required in certain situations
Category 3: No risk of exposure, so no special protection is
required
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-49
Reporting Guidelines
• Certain diseases must be
reported to state or county
health department
• Information is forwarded to the
CDC – control of the spread of
infection
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-50
Reporting Guidelines (cont.)
• National Notifiable Disease Surveillance
System (Table 33-2)
– Examples
•
•
•
•
•
HIV/AIDS
Rubella
Legionellosis
Mumps
Tetanus





Cholera
Hepatitis
Lyme disease
Smallpox
Tuberculosis
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-51
Apply Your Knowledge
How is the information on reportable diseases
used by the CDC?
ANSWER: The CDC uses the information reported to
them to help control the spread of infection.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-52
Isolation Guidelines
• CDC guidelines
– Types of precautions needed
– Patients requiring precautions
• Create an environment that protects
against pathogens
• Standard Precautions
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-53
Isolation Guidelines (cont.)
• Select appropriate PPE
– Gloves
– Masks, face shields,
respirators
– Gowns
• Table 33-3
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-54
Apply Your Knowledge
Mrs. Findley brings her child with chickenpox into the
medical office. What type of personal protective
equipment should you use when caring for this child?
ANSWER: Chickenpox requires airborne and contact
precautions, so you should use gloves and a mask and goggles
or a respirator.
Nice!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-55
Immunizations
• Immunization
– Administration of a vaccine
or toxoid to protect
susceptible individuals from
infectious diseases
• Reduces risk of infection
spread
– Decreases the susceptibility
of the host
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-56
Immunization Recommendations
• Immunization schedules for children
–
–
–
Advisory Committee on Immunization
Practices
American Academy of Pediatrics
American Academy of Family Physicians
• Immunization schedules for adults
– The National Coalition of Adult Immunization
(NCAI)
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-57
Immunizations (cont.)
• When administering, you must explain
– The need for immunization
– Side effects
• Soreness at site
• Low-grade fever
• General malaise
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-58
Immunizations (cont.)
• Concerns
– Pediatric patients
• Do not give if child has fever
• Informed consent – explain
benefits and risks
• Contraindications – symptoms that render the
use of a remedy or procedure inadvisable because
of the risk
• Immunization records
– National Childhood Vaccine Injury Act of 1988
– Instruct parents keep record as proof of immunization
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-59
Immunizations (cont.)
– Pregnant patients
• Avoid live virus vaccines
• FDA categories A, B, C, D, and X
– Elderly
• Dispel common misconception and cost
concerns
• More likely to develop side effects
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-60
Immunizations (cont.)
– Immunocompromised patients
• May experience minimal to dangerous effects
• Adjust dosage or delay administration
• Must also consider immunization status of family
and caregivers
– Health-care workers
• Hepatitis B vaccination
offered by employer at no
cost to employee
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-61
Apply Your Knowledge
What is an immunization?
ANSWER: An immunization is the administration of a
vaccine or toxoid to protect susceptible individuals
from infectious diseases.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-62
Preventing Disease Transmission
• Patient education
– Health promotion
– Disease prevention
– Disease treatment
• Medical assistant role in patient education
– Share responsibility
– Reinforce and explain instructions
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-63
Preventing Disease Transmission
(cont.)
• Educate patient on
– Nutrition and diet
– Exercise and weight control
– Prevention of STDs
– Smoking cessation
– Alcohol and drug abuse prevention and
treatment
– Proper use of medications and prescribed
treatments
– Stress-reduction techniques
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-64
Preventing Disease Transmission
(cont.)
• Goal of patient education
– Help patients take care of
themselves
• Encourage patients to
participate actively in
their own health care
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-65
Apply Your Knowledge
What three areas should patient education
focus on? What is the medical assistant’s role
in patient education?
ANSWER: Patient education should focus on health
promotion, disease prevention, and disease treatment.
The medical assistant shares responsibility with the
physician and other staff members and should reinforce
and explain instructions given by others.
Bravo!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-66
In Summary
33.1 It is the medical assistant’s responsibility to apply the
principles of infection control by following correct
sanitization, disinfection, and sterilization procedures,
helping patients understand basic disease prevention,
administering immunizations, and teaching patients
about the importance of immunizations.
33.2 The two basic methods of infection control are
medical asepsis (clean technique) and surgical
asepsis (sterile technique).
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-67
In Summary (cont.)
33.3 The goal of medical asepsis is to prevent the spread
of infection in the medical environment by reducing
the number of microorganisms. Surgical asepsis
requires that all organisms be eliminated.
33.4 Aseptic hand washing removes accumulated dirt and
microorganisms by wetting your hands, applying
soap, carefully scrubbing every surface of the hands,
rinsing, and carefully drying with clean paper towels.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-68
In Summary (cont.)
33.5 Sanitization is the scrubbing of instruments and
equipment with special brushes and detergent to
remove blood, mucus, and other contaminants or
media where pathogens can grow. Disinfection uses
special cleaning products applied particularly to
instruments and equipment to reduce or eliminate
infectious organisms. Sterilization is usually
accomplished through the use of steam and pressure
in an autoclave.
33.6 Sanitize instruments by soaking them in a disinfecting
solution, carefully scrubbing every surface of each
instrument, rinsing thoroughly, and allowing them to
dry.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-69
In Summary (cont.)
33.7 There are several types of disinfectants, each with
different properties. Choose a disinfectant based on
the type of instrument and the level of disinfection
required.
33.8 The goal of surgical asepsis is to destroy all
microorganisms.
33.9 An autoclave is a device that uses steam and
pressure to sterilize instruments and equipment.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-70
In Summary (cont.)
33.10 The general steps for using the autoclave include
preparing the instruments, checking the water level,
preheating the chamber, loading the instruments,
choosing the correct settings, running the autoclave,
and allowing the instruments to dry at the end of the
cycle.
33.11 Instruments should be carefully wrapped in a porous
material, bag, or envelope and labeled with the
contents of the pack, date, and your initials.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-71
In Summary (cont.)
33.12 To ensure that the sterilization procedure is
complete, you should make sure you use the correct
amount of time, the correct temperature, and
adequate levels of steam. In addition, you should
avoid overcrowding the chamber.
33.13 Laws set forth in the OSHA Blood-Borne Pathogens
Standard of 1991 dictate how you must handle
infectious or potentially infectious waste generated
during medical or surgical procedures. According to
these rules, any potentially infectious waste
materials must be discarded or held for processing
in biohazardous waste containers
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-72
In Summary (cont.)
33.14 Standard Precautions prevent health-care workers
from exposing themselves and others to infections.
Following Standard Precautions means assuming
that all blood and body fluids are infected with bloodborne pathogens.
33.15 OSHA requires that all hazardous waste be placed
in properly labeled biohazard containers and
disposed of in an appropriate manner.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-73
In Summary (cont.)
33.16 The CDC requires reporting of certain diseases to
the state or county department of health, who then
reports the information to the National Notifiable
Disease Surveillance System of the CDC.
33.17 The CDC issued the current Guideline for Isolation
Precautions in Hospitals to ensure that an
environment is created that protects people from
disease-causing microorganisms.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-74
In Summary (cont.)
33.18 There are a number of different types of personal
protective equipment, including gloves, gown,
masks, and goggles. Choosing the correct type
depends on the exposure type.
33.19 Immunizations prevent infection by reducing the
susceptibility of the host to infection.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-75
In Summary (cont.)
33.20 As a medical assistant, you should educate patients
about the importance of getting immunizations and
following the immunization schedule. You should
also discuss potential hazards and side effects of
immunizations.
33.21 You should emphasize the basic principles of
hygiene and disease prevention, including frequent
hand washing, routine bathing and dental care,
covering coughs and sneezes, eating well, and
avoiding stress.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
33-76
End of Chapter 33
Soap and education are
not as sudden as a
massacre, but they are
more deadly in the long
run.
~ Mark Twain
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.