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Chapter 19 Infection Control 2 Learning Objectives Define and spell key terms Identify the role of the medical assistant in infection control Identify disease-producing microorganisms List common infectious diseases Identify the links in the chain of infection 3 Learning Objectives Differentiate between the stages of disease Describe the body’s defense mechanisms Demonstrate the performance of handwashing with soap and water Demonstrate the performance of hand sanitization with an alcohol-based hand rub Explain standard precautions 4 Learning Objectives List common types of personal protective equipment Describe strategies to increase health and safety in the workplace Differentiate medical asepsis and surgical asepsis Differentiate sanitization, disinfection, and sterilization 5 Learning Objectives Demonstrate equipment and instrument sanitization Demonstrate equipment and instrument disinfection Demonstrate wrapping a pack for sterilization 6 Learning Objectives Demonstrate the performance of sterilization using an autoclave Educate patients regarding methods to reduce disease transmission 7 Microorganisms and Pathogens A microorganism is a microscopic organism seen only by using a microscope Not all microorganisms cause disease Harmless microorganisms on our body are called “normal flora” Microorganisms that cause disease are called “pathogens” 8 Pathogens Require nutrients, moisture, warmth, and neutral pH to grow and thrive Aerobic pathogens require oxygen to survive Anaerobic pathogens require oxygenfree environment to survive 9 Types of Pathogens Five main types of pathogens: Bacteria Rickettsia Virus Fungus Protozoa 10 Bacteria One-celled organisms Three types: cocci—round shape, bacilli— rod shape, spirilla—spiral shape Bacterial infections include staph infections, strep throat, Lyme disease, and gonorrhea 11 Rickettsia (parasite) Parasitic nature—organism depends on host to survive Spread to humans via vectors: lice, ticks, fleas Infections include Rocky Mountain spotted fever, and typhus 12 Virus Pathogen that grows and reproduces after infecting a host cell More than 400 types Smallest of all pathogens Viral infections include common cold, hepatitis, chicken pox, and HIV 13 Fungus Yeast, mold, and mushroom Many present in body’s normal flora Many do not cause disease Fungal infections include athlete’s foot, ringworm, and yeast infections 14 Protozoa Live mainly in soil Spread through fecal–oral route by ingested contaminated food or water Some spread by mosquitoes or other insects Protozoan infections include malaria, Giardia, and trichomoniasis 15 Chain of Infection Pathogen Reservoir host Means of exit Method of transmission Means of entry Susceptible host 16 Pathogen Disease-producing Pathogens need an microorganism; environment that bacteria, virus, fungus, enables them to protozoa, and survive, grow, and rickettsia multiply Present in blood or The human body is a body fluids, called perfect environment “bloodborne pathogens” 17 Reservoir Host Human, animal, or insect that is infected with disease Other reservoirs may be water, food, and contaminated objects Host may be symptomatic or asymptomatic Reservoir host is contagious even though he or she may not appear ill 18 Means of Exit Pathogen must be able to exit reservoir host Any body opening lined with mucous membranes: eyes, nose, throat, vagina, rectum, penis Injury or surgery Blood, body fluids: vaginal secretions, semen, urine, feces 19 Mode of Transmission Direct contact— person-to-person contact or skin-toskin contact Handshaking, kissing, and sexual contact Indirect contact— fomites; ticks, fleas, lice, and countertops Indirect contact includes airborne and droplet infection—sneezing, coughing, and talking 20 Means of Entry Pathogen must find entry into new host Any opening in the body lined with mucous membranes: nose, mouth, throat, vagina, penis, rectum Wounds to the skin 21 Susceptible Host Weakened immune system Poor hygiene Inadequate nutrition Stress Chronic disease Poor environmental conditions Elderly Very young Certain medications Smoking Alcohol abuse 22 Stages of Disease Incubation stage Prodromal stage Acute stage Declining stage Convalescent stage 23 Incubation Stage Beginning stage of infection (latent) Starts when person first contacts pathogen Person may be asymptomatic Person is contagious First appearance of symptoms 24 Prodromal Stage Earliest symptoms Fever (febrile) or rash Person may state “I just don’t feel right” Person is contagious 25 Acute Stage Symptoms are at their worst Person is obviously ill Person is contagious During this time the patient should take medications, rest, and avoid contact with others 26 Declining Stage Acute stage ends Symptoms begin to decrease Patient starts to feel better 27 Convalescent Stage Symptoms are gone Recovery time Continues until patient regains homeostasis 28 Defense Mechanisms The body has natural defense mechanisms to protect itself against disease: Mechanical Chemical Cellular 29 Mechanical Defenses First line of defense against pathogens is “intact” skin Serves as barrier to environment Cilia movement in lower airways Coughing and sneezing Eyelashes and eyebrows 30 Chemical Defenses Sebaceous glands Stomach fluids Tears and saliva contain lyzozyme Interferons have antiviral activity 31 Cellular Defenses Various cells also act to protect the body from pathogens Inflammatory response Cell-mediated immunity Antibody-mediated immunity 32 Inflammatory Response Inflammation occurs when damage or trauma is done to tissues Body responds by releasing chemical substances such as histamine, prostaglandins, and kinins 33 Inflammatory Response Chemical substances initiate changes: dilation of blood vessels, increased permeability of blood vessels, attraction of white blood cells 34 Phagocytosis Phagocytosis—the ability of white blood cells to engulf pathogens and cellular debris and then destroy that matter 35 Immunity Protection from infectious disease Active or passive Further categorized as acquired naturally or passively 36 Active Natural Immunity Develops when body is exposed to pathogenic microorganisms Microorganisms contain antigens (cell markers) White blood cells develop antibodies Antibodies protect during second exposure 37 Active Artificial Immunity Develops when antigen is purposely introduced into body Vaccine Live, weakened, dead microorganism Stimulates antibody formation without causing disease 38 Passive Natural Immunity Develops when antibodies from mother cross placenta to fetus Provide protection to fetus for several months Additional antibodies are found in breastmilk 39 Passive Artificial Immunity Develops when preformed antibodies from animal or human are then injected into an individual with known exposure Antiserum provides temporary passive immunity Helps in cases of exposure to rabies, botulism, venomous snake or spider bites, hepatitis, and diptheria 40 Standard Precautions Centers for Disease Control and Prevention (CDC) Occupational Safety and Health Administration (OSHA) Workplace guidelines to promote safety Bloodborne pathogens Personal protective equipment 41 Personal Protective Equipment Degree of risk to exposure Gloves, masks, eye protection, shoe covers, and gowns 42 Disposal of Biohazardous Waste Containers that hold blood or body fluids Containers are required to have biohazardous labels 43 Sharps and Needlestick Safety “Sharps”—needles, scalpel blades, capillary tubes, and broken glass or slides Dispose of in puncture-resistant containers Never recap an uncapped needle Replace biohazard containers when full 44 Vaccinations If no Hepatitis B vaccination prior to employment, the employer must provide it for the employee within 10 days of employment at no cost to employee Series of three injections Documentation Test for TB exposure 45 Exposure Control All employers must have exposure control plan and review with employees Exposure incident is any contact with blood or body fluid, and any accidental injury Report exposure to employer immediately Follow policy and procedure for your facility 46 Biohazard Spill Protect yourself with PPE, control spill with paper towels Cover entire spill with 10% bleach solution and let stand for 20 minutes Clean up spill with mechanical device, do not use hands Repeat bleach application, wait another 20 minutes 47 Asepsis Condition free from pathogens Handwashing Sanitization Disinfection 48 Hand Sanitization Single most effective way to prevent the spread of disease Soap and warm water, rub vigorously 15 seconds Antiseptic hand wash, cover all surfaces of hands, and air dry 49 Typical Times to Wash Hands Beginning work Before and after rooming patients Before and after cleaning exam rooms Before and after assisting the physician with procedures Before and after cleaning equipment Before and after using the restroom Before and after taking a break or eating lunch At the end of the day 50 Sanitization of Equipment Inactivating or removing microorganisms on reusable equipment and surfaces to a safe level Chemicals, heat, and gas are used Low-suds detergents are commonly used Read labels, follow manufacturer’s directions, rinse all instruments, and protect yourself 51 Disinfection More thorough than sanitization Kills bacteria and most microorganisms but not spores Use different disinfectants for surfaces and equipment vs. skin surfaces Read labels and follow manufacturer’s directions Iodine, household bleach, and 70% alcohol 52 Sterilization Complete destruction of all microorganisms including spores Autoclave sterilization involves heat, pressure, steam, and time Sanitize and disinfect instruments and equipment before sterilizing All surfaces of instruments must be exposed 53 Sterile Packs Sanitize and disinfect instruments prior to wrapping Hinged instruments should be left open, surfaces of instruments should not be touching Use indicator tape and label 54 Chemical Sterilization Certain instruments should not be autoclaved; for example, fiberoptic endoscopes Sterilize using chemicals Solution is caustic; wear PPE Immerse for a specified time 55 Medical Asepsis Destruction of pathogenic organisms after they leave the body Follow standard precautions Consider specimens to be contaminated 56 Surgical Asepsis Destroying all pathogenic organisms before they enter the body Use surgical aseptic technique Normal protective barriers are punctured or disrupted Injections, urinary catheterization, wound care, and surgical procedures 57 Discussion List five types of pathogens Discuss difference between aerobes and anaerobes Discuss differences in handwashing with soap and handwashing with alcoholbased hand sanitizer Identify procedures that require medical asepsis vs. surgical asepsis 58 Credits 59