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Chapter 13 Infection Control Objectives Identify five classes of microorganisms by describing the characteristics of each class List the six components of the chain of infection Differentiate between antisepsis, disinfection, and sterilization Wash hands according to recommended aseptic technique Objectives Observe standard precautions while working in the laboratory or clinical area Wash, wrap, and autoclave instruments, linen, and equipment Operate an autoclave with accuracy and safety Follow basic principles on using chemicals for disinfection Objectives Clean instruments with an ultrasonic unit Open sterile packages without contaminating the contents Don sterile gloves without contaminating the gloves Prepare a sterile dressing tray without contaminating the supplies Change a sterile dressing without contaminating the materials Objectives Don and remove a transmission-based isolation mask, gloves, and gown Relate specific basic tasks to the care of a patient in a transmission-based isolation unit Define, pronounce, and spell all the key terms Chapter 13:1 Understanding the Principles of Infection Control Microorganism or microbe-Small living organism that is not visible to the naked eye – Must be viewed under a microscope – Found everywhere in the environment – Two types: • Nonpathogens • Pathogens – Aerobic vs anaerobic Classes of Microorganisms Bacteria Protozoa Fungi Rickettsiae Viruses Helminths Bacteria Simple, one-celled organisms that multiply rapidly Classified by shape and arrangement – Cocci • Round or spherical in shape • Diplococci, Streptococci, Staphlococci – Bacilli • Rod shaped – Spirilla • Spiral or corkscrew shaped Protozoa One-celled animal-like organisms Found in decayed materials and contaminated water Many contain flagella which allow them to move freely Some are pathogenic Fungi Simple, plant-like organisms Live on dead organic matter Yeasts and molds are two common forms that can be pathogenic Rickettsia Parasitic microorganisms Cannot live outside the cells of another living organism Commonly found in fleas, ticks, lice Transmitted to humans by bites Viruses Smallest microorganisms-Visible only under electron microscope Cannot reproduce unless inside another living cell Spread from human to human by blood and other body secretions More difficult to kill Diseases of Major Concern to Health Care workers HBV HCV AIDS Hepatitis B Serum hepatitis Transmitted by blood, serum, and other body secretions Leads to destruction and scarring of liver cells Vaccine developed to protect individuals: Under federal law, employers must offer the vaccine at no cost to any health care worker with occupational exposure to blood or other body secretions Hepatitis C Transmitted by blood and blood-containing body fluids Many individuals with Hep C are asymptomatic or are often diagnosed with flu Can cause severe liver damage Vaccine is being developed Can even remain active in dried blood for several days Acquired Immune Deficiency Syndrome (AIDS) Caused by HIV virus Suppresses immune system No cure and no vaccine available Helminths (worms or flukes) Multicellular parasitic organisms Transmitted by contaminated food/meat or insect bites or through skin Types of Infection Classified by: – Way they cause infection/disease • Toxins • Allergic reaction • Attack/destroy living cells they invade – Endogenous/exogenous – Nosocomial – Opportunistic Types of Infection Endogenous: – Originates within the body Exogenous: – originates outside the body Nosocomial: – Acquired in a health care facility Opportunistic: – Occur when body’s defenses are weak Chain of Infection Aseptic Techniques Major way to break the chain of infection Asepsis-absence of pathogens Sterile-free from all organisms Contaminated-organisms and pathogens are present Aseptic Techniques Antisepsis: prevent or inhibit growth of pathogenic organisms – Not effective against spores/viruses – Ex: alcohol and betadine Disinfection: process that destroys/kills pathogens – Bleach solutions and zephirin Sterilization: process that destroys all microorganisms Chapter 13:2 Bioterrorism Bioterrorism-use of microorganisms as weapons to infect humans, animals, or plants – – – – – Dead plague victims in 1346 Smallpox in 1763 WWI and WWII Sarin gas in 1995 Anthrax in mail in 2001 Biologic Agents Characteristics of ideal microorganisms: – – – – – – Inexpensive/Readily available/Easy to produce Spread through air easily/Spread by ingesting Survives sunlight, drying, and heat Causes death or severe disability Easily transmitted from person to person Difficult to prevent and/or has no effective treatment Biologic Agents Smallpox Anthrax Plague Botulism Tularemia Filoviruses Preparing For Bioterrorism Community-based surveillance to detect early indications of a bioterrorism attack Notification of the public when a high-risk situation is detected Strict infection-control measures and public education about the measures Funding for studying pathogenic organisms, developing vaccines, researching treatments, and determining preventative actions Strict guidelines and restrictions for purchasing and transporting pathologic microorganisms Improving the ability of health care facilities to deal with an attack Mass immunization, especially for military, first responders, police, fire department, and health care personnel Increased protection of food and water supplies Training personnel to properly diagnose and treat infectious diseases Establishing emergency management policies Criminal investigation of possible threats Improving communications so information on bioterrorism is transmitted quickly and efficiently Chapter 13:3 Washing Hands The most important method used to practice aseptic technique and prevent spread of infection Should be done: When should Handwashing be done? Frequently When you arrive at facility and immediately before leaving facility Before and after any patient contact Any time your hand become contaminated Before and after handling a specimen After contact with any soiled or contaminated item After picking up any item off of the floor When should Handwashing be done? After personal use of the bathroom After you cough, sneeze, or use a tissue Before and after any contact with your mouth, or mucous membrane (eating, drinking, smoking, applying lip balm, or inserting or removing contact lenses) Recommended method for Handwashing Soap is used as a cleansing agent Warm water Friction in addition to soap and water All surfaces on the hands must be cleaned Fingertips must be pointed downward Dry paper towels must be used to turn the faucet off and on Nails must be cleaned Chapter 13:4 Observing Standard Precautions Bloodborne Pathogens Standard Three main pathogens of concern for HCW OSHA regulations: – – – – – Develop written exposure control plan Identify employees who have exposure Provide Hep B vaccine free of charge Provide PPE Provide adequate handwashing facilities OSHA regulations cont. – – – – – Ensure that worksite is clean and sanitary Enforce rules of no eating/drinking/smoking Provide appropriate disposal containers Post signs where there are biohazards Provide confidential medical evaluation/follow-up for all exposure incidents – Provide training about the regulations and all biohazards to employees Needlestick Safety Act Employers are required to: – – – – Identify and use effective/safer medical devices Incorporate changes annually in exposure plan Solicit input from nonmanagerial employees Maintain a sharps injury log Standard Precautions Every body fluid must be considered potentially infectious Must be used when contact with: – – – – – Blood/any fluid that may contain blood Body fluids/secretions/excretions Mucous membranes Nonintact skin Tissue or cell specimens Rules of Standard Precautions Handwashing Gloves Gowns Masks and Eye Protection Sharps Spills or Splashes Resuscitation Devices Waste and Linen Disposal Injuries Chapter 13:5 Sterilizing with an Autoclave Autoclave: piece of equipment that uses steam under pressure or gas to sterilize equipment and supplies Always check directions that come with the autoclave Chapter 13:6 Using Chemicals for Disinfection Many chemicals do not kill spores and viruses Read directions before using any solution Always wash hands after handling chemicals Chapter 13:7 Cleaning with an Ultrasonic Unit Ultrasonic cleaning: uses sound waves to clean Cavitation: bubbles explode to drive cleaning solution onto the article being cleaned Chapter 13:8 Using Sterile Techniques Sterile: free from all organisms Contaminated: organisms and pathogens are present Correct techniques must be followed to avoid contamination and maintain sterility Sterile Technique Sterile object must never touch a nonsterile object If sterile articles touch skin or clothing-they are no longer sterile Any area below the waist is considered contaminated Never reach across the top of a sterile field Keep the sterile field in constant view-never turn your back 2-inch border around sterile field is considered contaminated Sterile towels/articles get wet they are contaminated If there is ever any suspicion that you have contaminated any article-START OVER. Never take a change on using contaminated equipment or supplies Chapter 13:9 Maintaining Transmission-Based Precautions Communicable disease: caused by a pathogenic organism that can be easily transmitted to others Epidemic: communicable disease spreads rapidly from person to person and affects large number of people at same time Pandemic: outbreak of disease occurs over wide geographic area and affects high proportion of the population Transmission-Based Isolation Precautions Standard vs. transmission-based Contaminated: objects contain diseaseproducing organisms Clean: objects or parts of objects do not contain disease-producing organisms Types of Precautions Standard Precautions Airborne Precautions Droplet Precautions Contact Precautions Protective or Reverse Isolation Washington State Hospital Association Droplet Precautions Washington State Hospital Association