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
13:1 Understanding the Principles of Infection Control

Understanding is essential to all health care workers

Provide a basic knowledge of how disease is transmitted

Main emphasis on prevention of disease

Microorganisms or
Microbes

Small living organisms

Not visible to the naked eye

Microscope must be used to see them

Found everywhere in the environment

13:1 Understanding the Principles of Infection Control

Understanding is essential to all health care workers

Provide a basic knowledge of how disease is transmitted

Main emphasis on prevention of disease

Microorganisms or
Microbes

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

Found on and in the human body

Many are part of normal flora of body

May be beneficial

Microorganisms or
Microbes (continued)

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

Bacteria

Protozoa

Fungi

Rickettsiae

Viruses

Bacteria

Simple, one-celled organisms

Multiply rapidly

Classified by shape and arrangement

Bacteria – Cocci

Round or spherical in shape

Diplococci

Streptococci

Staphylococci

Examples of diseases

Bacteria – Bacilli

Rod-shaped

Occur singly, in pairs, or in chains

May have flagella

Ability to form spores

Examples of diseases

Bacteria – Spirilla

Spiral or corkscrew shape

Includes comma-shaped vibrio and corkscrew spirochete

Diseases include syphilis and cholera

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

Protozoa

One-celled, animal-like organism

Found in decayed materials and contaminated water

May have flagella for movement

Some are pathogenic

Examples of diseases

Fungi

Simple, plant-like organisms

Live on dead organic matter

Yeast and molds

Can be pathogenic

Examples of diseases

Antibiotics do not kill

Antifungal medications

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

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

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

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, a written statement must be signed documenting refusal

Hepatitis C

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

Hepatitis C
(continued)

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

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

Important to take precautions to prevent

Growth of
Microorganisms

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

How Pathogens Cause
Infection and Disease

Some produce poisons called toxins

Some cause an allergic reaction

Others attach and destroy the living cells they invade

Classifications of
Diseases and Infections

Endogenous

Exogenous

Nosocomial

Opportunistic

Endogenous

Originates within the body

Examples: metabolic disorders, congenital abnormalities, tumors, and infections caused by
microorganisms within the body

Exogenous

Originates outside the body

Examples: radiation, chemical agents, trauma, electric shock, and
temperature extremes

Nosocomial

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

Nosocomial
(continued)

Common examples are staphylococcus, pseudomonas, enterococci

Infection control programs are used to prevent and deal with
nosocomial infections

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

Chain of Infection

Must be present for disease to occur and spread from one individual to another
–
Causative agent
–
Reservoir
–
Portal of exit
–
Mode of transmission
–
Portal of entry
–
Susceptible host

Causative Agent

Pathogen must be present

Examples include bacteria or virus

Reservoir

Place where causative agent can live

Examples: human body, animals,
and the environment

Portal of Exit

Way for causative agent to escape from the reservoir

Examples: urine, feces, saliva, blood, tears, mucous discharge, sexual secretions, and draining
wounds

Mode of Transmission

Must be transmitted to another reservoir or host where it can live

Direct contact: person-to-person, spread by physical or sexual contact

Indirect contact: from contaminated substances to the person

Portal of Entry

Way to enter a new reservoir or host

Examples: breaks in the skin or
mucous membranes, respiratory tract, digestive tract, genitourinary tract,
and circulatory system

Susceptible Host

Individual who can contract the disease

Usually the person can fight off
the causative agent and not contract
the disease

Common Body Defenses

Mucous membranes

Cilia

Coughing and sneezing

HCL in the stomach

Tears

Common Body Defenses (continued)

Fever

Inflammation response – leukocytes

Immune response – antibodies and
cell secretion

Increased Susceptibility

When large numbers of pathogens
invade the body

When body defenses are weak

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

Aseptic Techniques

Major way to break the chain of infection

Asepsis: absence of disease-producing microorganisms or pathogens

Contaminated: any object or area that may contain pathogens

Major aim: maintaining cleanliness and eliminating or preventing contamination

Common Aseptic Techniques

Handwashing

Good personal hygiene

Disposable gloves

Proper cleaning of instruments and equipment

Thorough cleaning of environment

Levels of Aseptic Control

Antisepsis

Disinfection

Sterilization

Antisepsis

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

Disinfection

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

Sterilization

Destroys all microorganisms

Steam under pressure, gas, radiation,
and chemicals

Autoclave is the most common
equipment used

Summary

Important for health care workers to know and use proper aseptic techniques

Prevents spread and transmission
of disease

13:2 Washing Hands

Major aspect of standard precautions

Most important aseptic technique

Hands are perfect media for the spread
of pathogens

Purpose of Handwashing

Prevent and control spread of pathogens

Protect the health care worker from disease and illness

When to Wash Hands

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

When to Wash Hands (continued)

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

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

13:3 Observing Standard Precautions

Blood and body fluids are the main ways pathogens are spread

Major pathogens: HBV, HBC, HIV

Extreme care must be taken at all times when an area, object, or person is contaminated with
blood or body fluids

Bloodborne Pathogen Standards

Established in 1991 by OSHA

Must be followed by all
health care workers

Civil penalties if not implemented
and followed

Regulation Requirements

Written Exposure Control Plan

Identify all employees with
occupational exposure

Provide hepatitis B vaccines free of charge

Provide personal protective equipment (PPE)

Regulation Requirements (continued)

Provide adequate handwashing facilities and supplies

Ensure worksite is maintained in a clean, sanitary condition

Follow measures for immediate decontamination of surfaces
when contaminated

Regulation Requirements (continued)

Dispose of infectious waste correctly

Enforce rules of limited activities in any potentially contaminated area

Provide appropriate containers
for contaminated sharps and other contaminated items
(color coded and labeled)

Regulation Requirements (continued)

Post signs at the entrance to work areas with occupational exposure to biohazardous materials

Provide a confidential medical evaluation and follow-up for any employee who has an exposure
incident

Provide training to employees

Needlestick Safety
and Prevention Act

Passed by Congress in 2000

Centers for Disease Control and Prevention (CDC) estimated 600,000 to 800,000 needle sticks
occur each year

OSHA revised Bloodborne Pathogen Standard to requirements of this act

Employer Requirements

Identify and use effective and safer medical devices

Incorporate changes in annual update of Exposure Control Plan

Solicit input from nonmanagerial employees who are responsible for direct patient care

Employer Requirements (continued)

Maintain a sharps injury log

Ensure that every employee uses standard precautions at all times

Standard Precautions

Rules developed by the CDC

Every body fluid must be considered potential source of infection

All patients must be considered potential source of infection

When to Use
Standard Precautions

Any situation where you might come in contact with
–
Blood or any fluid that contains blood
–
Body fluids, secretions, and excretions
–
Mucous membranes
–
Nonintact skin
–
Tissue or cell specimens

Gloves

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

When to Wear Gloves

Whenever contact with body fluids, secretions, or excretions

When handling or cleaning contaminated items or surfaces

Performing any invasive procedure

Performing venipuncture or blood tests

Gowns

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

Masks and Protective Eyewear or Face Shields

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

Masks and Protective Eyewear or Face Shields (continued)

Protective eyewear and face shields protect front, top, bottom, and sides
of eyes

If not disposable, must be cleaned and disinfected before reuse

Sharp Objects

Use extreme caution to avoid cuts
or punctures

When possible, use safe needles or needleless system

Follow policies regarding handling needles

Use sharps containers

Follow laws regarding disposal of sharps

Spills and Splashes

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

Resuscitation Devices

Use to avoid the need for mouth-to-mouth resuscitation, whenever possible

Place in convenient location that is
readily accessible

Waste and Soiled Linen

Wear gloves

Follow agency policy

Use biohazard bags appropriately

Reporting Cuts and Injuries

Report any cut or injury,
needle stick, or splashing of blood or
body fluids immediately

Follow agency policy

Summary

Standard precautions must be followed at all times by all health care workers

Observing these precautions can help break the chain of infection

Allow health care workers to protect themselves, their patients, and all
other individuals

13:4 Sterilizing with
an Autoclave

Equipment that uses steam under pressure or gas

Most effective method of sterilization

Available in various sizes and types

Preparation of equipment or supplies

Wrapping items for autoclaving

Sterilizing with
an Autoclave (continued)

Autoclave indicators

Loading the autoclave

Time period for sterilization

Care of items after autoclaving

Dry heat sterilization

Follow directions on specific autoclave

Follow agency policy for sterile supplies

13:5 Using Chemicals
for Disinfection

May not kill spores and viruses

Disinfect, but do not sterilize

Used to disinfect instruments that do not penetrate body

Preparation of items

Chemical solutions used

Using Chemicals for
Disinfection (continued)

Read manufacturer’s instructions

Antirust tablets or solutions added at times

Requirements for chemical disinfection

Chemical must completely cover items

Care of chemical solutions

13:6 Cleaning with an
Ultrasonic Unit

Uses sound waves for cleaning

Method of aseptic control

Only ultrasonic solutions should be
used in unit

Permanent tank of ultrasonic unit

Items cleaned in ultrasonic unit

Cleaning with an
Ultrasonic Unit (continued)

Care of glass beakers

Care of the permanent tank

Read manufacturer’s instructions before using any ultrasonic unit

Summary

Different methods provide different levels of aseptic control

Method used depends on
equipment available and level of
aseptic control required

Read manufacturer’s instructions

Clean, rinse, and dry all equipment
before processing

Handle items carefully after processing

13:7 Using Sterile Techniques

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

Using Sterile
Techniques (continued)

Important to differentiate between sterile and contaminated areas or items while using sterile
technique

Correct techniques must be
strictly followed to maintain sterility and
prevent contamination

Using Sterile
Techniques (continued)

Clean working area required

Handling of sterile supplies

Sterile field: area used for placement of sterile supplies

Rules of working within sterile area

Removing Articles from
Sterile Wraps

Drop technique

Mitten technique

Transfer forceps

Wet Surfaces

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

Sterile Gloves

Worn while performing sterile technique

Make sure tray is open and all sterile items are ready before putting sterile gloves on your hands

Are sterile on the outside and contaminated on the inside

Observe correct technique when putting on sterile gloves

Sterile Gloves
(continued)

When gloves are on, hold hands away from body and above waist

Handle only sterile objects when wearing sterile gloves

Change gloves any time
contamination occurs

Sterile Dressings

Obtain proper authorization

Use an infectious waste bag

Wear disposable gloves for removing
a dressing

Note type, color, and amount of drainage on dressing

Put on sterile gloves to cleanse area and apply new dressing

Sterile Dressings
(continued)

Cleanse wound or incision with
correct technique

Apply inner and outer dressing, taking care to maintain sterility of dressings

Remove sterile gloves properly and dispose of properly

Sterile Dressings
(continued)

Apply tape correctly to hold dressing
in place

If contamination occurs at any time during the procedure, start over

Commercially prepared sterile supplies are widely available

13:8 Maintaining Transmission-Based Isolation Precautions

Some diseases are communicable – caused by organisms that can be transmitted easily

These precautions are in addition to the Standard Precautions

Maintaining Transmission-Based Isolation Precautions (continued)

Help prevent spread of disease to others

Protects patient, family, and
health care workers

Type used depends on the causative organism of the disease

How Communicable
Diseases Spread

Direct contact with a patient

Contact with dirty linen, equipment,
and supplies

Contact with blood, body fluids, secretions, and excretions

Terms Defined

Contaminated or dirty: items that contain disease-producing organisms; must not be touched
unless protected

Clean: items that do not contain
the organisms; protect these areas
from contamination

Classifications of
Precautions

Standard precautions

Airborne precautions

Droplet precautions

Contact precautions

Protective or
Reverse Isolation

Method used to protect certain
patients from organisms present in
the environment

Used mainly for
immunocompromised patients

Precautions vary depending on
patient’s condition

Summary

Exact procedures for maintaining transmission-based isolation will vary from one facility to
another

Variations caused by different factors

Know and follow procedures at your facility

Basic principles remain the same in any facility and are directed toward preventing the spread of
disease