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Infection Control
Chapter 26
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Disease
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An alteration in the normal structure or function of an
organism or a cell.
Causes specific clinical signs, symptoms, and laboratory
findings that set it apart.
A disease could be either inherited, drug-induced,
autoimmune, degenerative, or infectious.
Any disease caused by the growth of pathogenic
microorganisms in the body is considered an infectious
disease.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 2
Conditions Required for Microbial Growth
To maintain a healthcare environment that is as free as
possible of pathogenic organisms, the MA must prevent
or eliminate as many growth requirements as possible.
– Nutrients
– Moisture
– Temperature
– Darkness—organisms grow best in dark
environments
– Oxygen—aerobes or anaerobes
– Neutral pH
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 3
Chain of Infection
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Infectious diseases can spread only if certain factors
occur. These factors, or links, make up the chain of
infection. Break the chain, and you break the infectious
process.
The chain begins with the infectious agent, which
invades the reservoir host, and continues with the
means or portal of exit from the host, the method of
transmission, the means or portal of entry into a new
host, and the presence of a susceptible host.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 4
Chain of Infection
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 5
Infectious Agents
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Pathogenic microorganisms include (see Tables 26-1
through 26-4):
– Viruses—smallest; obligate intracellular parasites; palliative
treatment
– Bacteria—classified by their morphology; some produce
spores; normal flora vs pathogenic microbes
– Protozoa—unicellular parasites; frequently transmitted by
vectors
– Fungi—molds and yeasts; mycotic infections and tineas
– Rickettsiae—similar to both viruses and bacteria; carried
by vectors; e.g., Lyme disease
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 6
Antibiotic Resistance
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Antibiotic resistance is one of the world’s most
significant public health problems.
Infectious microorganisms whose presence was once
easily treated with antibiotics are growing increasingly
resistant to the drugs.
Resistance occurs when an antibiotic is used
inappropriately to treat an infection.
The pathologic organism mutates, decreasing the
effectiveness of the drug.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 7
CDC Recommendations
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Prescribe antibiotic therapy only when it will benefit the
patient.
Bacterial infections can be treated with antibiotics, but
viral infections, because they involve viral takeover of
cellular DNA or RNA material, cannot.
Treat the patient with an antibiotic that is specific to
the bacterial infection.
Prescribe the label-recommended dose and time
interval for the medication.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 8
Reservoir Hosts
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May be people, insects, animals, water, food,
examination rooms, contaminated instruments, and so
on
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Supply nutrition for the organism, allowing it to multiply
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Either cause infection in the host and/or exit from the
host to cause disease in another host
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 9
Portal of Exit
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How the pathogen escapes the reservoir host
Includes mouth, nose, eyes, intestines, urine,
reproductive tract, and so on
Standard precautions prevent spread
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 10
Transmission
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Direct—contact with infected person or with
discharges (feces, urine, sputum, etc.)
Indirect—from droplets expelled with coughing,
sneezing, or speaking; vectors; contaminated food;
contaminated objects called fomites.
Controlled with sanitization, disinfection, sterilization,
and so on
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 11
Portal of Entry
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How the pathogen gains entry to a new host
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Similar to means of exit (e.g., mouth, eyes, nose)
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Intact integumentary system is first line of defense
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Inflammatory response and immune system are second
lines of defense
– Humoral immunity—produces antibodies specific
to antigen exposure
– Cell-mediated immunity—destroys pathogens at
the site; e.g., phagocytosis
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 12
Susceptible Host
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Must be capable of supporting the pathogen
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Susceptibility depends on:
– Location of entry
– Dose of pathogen
– Health state of new host
– Immunization status
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 13
Body’s Natural Protection
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Intact skin.
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Mucous membranes protect underlying tissues and trap
foreign substances.
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Cilia trap invading microbes.
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Sneezing and coughing expel organisms.
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Body secretions, such as tears and sweat, expel foreign
substances from the body.
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pH of many of the body’s organs discourages microbial
growth.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 14
The Inflammatory Response
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The inflammatory response is the body’s protective
reaction to a foreign substance or antigen.
To defend itself, the body initiates specific responses
that destroy and remove pathogenic organisms.
The release of inflammation mediators, through three
separate actions, results in an increase in white blood
cells (WBCs) at the site.
WBCs attack the pathogen and attempt to contain the
infection at its original site.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 15
Inflammatory Response
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Slide 16
Four Classic Signs and Symptoms of
Inflammation
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Redness or erythema
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Swelling or edema
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Pain
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Heat
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Slide 17
Site of Injury
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Blood vessels dilate, causing an increase in the local
blood flow, resulting in redness and heat.
Blood vessel walls become more permeable, which
helps in releasing WBCs to the site.
– Blood plasma filters out of the more permeable
vessel walls, resulting in edema, causing pressure on
nerves and pain.
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Finally, chemotaxis, the release of chemical agents,
attracts WBCs.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 18
WBC Protection
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WBCs form a fibrous capsule around the injury,
protecting surrounding cells from damage or the source
of infection.
Destroyed pathogens, cells, and WBCs collect and form
a thick, white substance called pus.
WBCs engage in phagocytosis, or the engulfing and
destruction of microorganisms and damaged cells.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 19
Inflammatory and Infection Terms
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Lymphadenopathy
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Septicemia
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Pyemia
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Prodromal period
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Chronic vs acute infection
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Latent infection—relapse and remission (e.g., oral
herpes simplex)
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 20
Infectious Bodily Secretions
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OSHA has designated the following bodily fluids as
potentially infectious with blood-borne pathogens:
– Cerebrospinal fluid (CSF); synovial, pleural, pericardial,
peritoneal, mucous, and amniotic fluids
– Blood, vaginal and seminal secretions, saliva, and human tissue
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 21
OSHA Standards for Healthcare Workers
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Healthcare workers face significant health risks from
occupational exposure to blood or other potentially
infectious materials that may contain hepatitis B virus
(HBV), hepatitis C virus (HCV), or the human
immunodeficiency virus (HIV).
The MA should use precautions for all patients,
regardless of knowledge of their individual health
histories.
Implementation of the Bloodborne Pathogen Standard
also protects patients from any blood-borne infection
the healthcare worker may be carrying.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 22
Exposure Control Plan
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Plan must detail employee protection procedures.
Must identify job classifications and/or specific workrelated tasks that might lead to exposure.
Must contain specifics on controls including PPE,
training, hepatitis B immunization, record keeping,
postexposure follow-up, and labeling and disposal of
biohazard waste.
Must be reviewed and updated at least annually to
incorporate the use of safer medical devices.
Must be available to employees for review and training.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 23
Bloodborne Pathogen Standard
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Employers must keep a confidential sharps injury log
that describes the device involved and the details of
how and where the incident occurred.
Must have available sharps management devices, such
as self-sheathing or retracting needles, and needleless
intravenous (IV) systems.
Should wash exposed area immediately or as soon as
possible after exposure.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 24
Hand Hygiene Guidelines
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Visibly soiled hands should be washed for minimum of
15 seconds with antimicrobial soap and warm running
water.
Alcohol-based handrubs, if used correctly, significantly
decrease number of microorganisms, take less time to
use, and cause less irritation than traditional hand
washing.
Hand washing or alcohol handrubs should be used
before and after each patient is seen as well as after
gloves are removed.
Apply label-recommended amount of handrub to palm
of one hand and rub hands together, covering all
surfaces until hands are dry.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 25
Handrubs and Antimicrobial Soap
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Slide 26
Hand Hygiene
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Studies show that even after careful hand hygiene,
healthcare workers with artificial nails have more
pathogenic microbes than workers with natural nails.
Natural nail tips should be no longer than ¼ inch.
Contact dermatitis from alcohol handrubs is
uncommon.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 27
Compliance Guidelines
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Safety and infection control fundamentals go beyond
hand washing and knowledge of the disease cycle.
Five basic parts to compliance:
– Barrier protection
– Environmental protection
– Housekeeping controls
– Hepatitis B vaccination
– Postexposure follow-up
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 28
Barrier Protection
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Protective equipment must be used if you will be
involved in any of these activities:
– Touching a patient's blood and body fluids, mucous
membranes, or broken skin
– Handling items and surfaces contaminated with
blood and body fluids
– Performing venipuncture, finger punctures,
injections, and other vascular-access procedures
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Slide 29
Barrier Protection
– Assisting with any surgical procedure. If a glove is
torn or an injury occurs, the glove is removed and
replaced with a new glove. The instrument is
removed from the sterile field.
– Handling, processing, and disposing of all specimens
of blood and body fluids.
– Cleaning and decontaminating spills of blood or
other body fluids.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 30
Personal Protective Equipment (PPE)
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Specialized clothing or equipment that prevents blood
or other potentially infectious material from passing
through to reach the healthcare worker
Includes latex gloves, face masks, face shields,
protective glasses, laboratory coats, barrier gowns,
mouthpieces, and resuscitation bags that protect the
healthcare worker from potentially infectious
substances
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 31
Personal Protective Equipment (PPE)
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 32
PPE Guidelines
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Protective equipment contaminated with body fluids of
any kind must be removed and placed in a designated
area or biohazard container.
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Protective eyewear and/or face shields must be worn
whenever splashes, sprays, or droplets may occur.
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Utility gloves may be reused if they are intact without
cracks, tears, or punctures.
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All PPE must be removed before the worker leaves the
medical facility.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 33
Environment Protection
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Observe warning labels on biohazard containers and
equipment.
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Minimize splashing, spraying, and spattering of drops.
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Bandage any breaks on hands before gloving.
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Do not recap, bend, break, or resheath contaminated
sharps.
Immediately after use dispose of sharp items in a
labeled, leakproof, puncture-resistant biohazard
container.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 34
Environment Protection
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All specimens must be placed in a container that
prevents leakage
Contaminated equipment should be sanitized before
being repaired in the office or transported to the
manufacturer.
Smoking, eating, drinking, applying cosmetics or lip
balm, and handling contact lenses are prohibited in
work areas where there is reasonable likelihood of
contamination from blood-borne pathogens.
Food and drink cannot be kept in the same areas as
potentially infectious materials.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 35
Housekeeping Controls
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Post schedule for cleaning and specific information
about each work area where exposure could occur.
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Immediately decontaminate areas after accidental spills
and at the end of each procedure.
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Disinfect reusable containers on routine basis.
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Sharps containers must be upright and as close as
possible to the work usage area; not overfilled;
replaced on a routine basis with lid closed securely.
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Slide 36
Housekeeping Controls
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Slide 37
Housekeeping Controls
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Use appropriate equipment to pick up spilled material
or broken glassware.
Place in impervious biohazard bag or container.
Use an absorbent professional biohazard spill
preparation as directed to decontaminate the site.
Wear gloves to handle soiled linen; should be doublebagged and transported in labeled, leakproof biohazard
bags.
Biohazard waste must be collected in impermeable red
biohazard-labeled bags or containers and sealed.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 38
Housekeeping Controls
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 39
Hepatitis B Vaccination
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Must be available free of charge within 10 days of
starting employment to all employees who are at risk.
Intramuscular injection in three doses; second injection
4 weeks after first, and third injection 6 months after
first.
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U.S. Public Health Service does not currently
recommend routine boosters.
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Should have blood titer drawn after completion to
determine if antibodies are present.
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Employees have right to decline immunization but must
sign a declination form.
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Slide 40
Hepatitis B Vaccination
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Slide 41
Postexposure Follow-up
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Postexposure follow-up involves immediate cleansing of
the site, completion of an exposure incident form,
confidential medical evaluation, examination of the
source individual and worker’s blood, health counseling,
and confidential treatment of all medical records.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 42
Aseptic Techniques: Prevention of Disease
Transmission
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Medical asepsis.
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Surgical asepsis.
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Medical aseptic techniques: Create an environment as
free of pathogens as possible to prevent reinfection or
cross-infection.
Surgical aseptic or sterile technique: Used when the
patient’s skin or mucous membranes are disrupted.
Prevents patient exposure to all microbes (e.g., for
minor surgery, urinary catheterizations, injections).
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Slide 43
Hand Washing
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Reduce skin bacteria with mechanical friction,
antimicrobial soap, and warm running water.
Goal is to remove or decrease the numbers of transient
bacteria on the surface of the skin, thus preventing
transient bacteria from becoming resident bacteria.
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Proper hand washing depends on two factors: running
water and friction.
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All jewelry except a plain wedding band should be
removed.
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Lotion may be used to prevent cracked or chapped
skin.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 44
Hand Washing
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Wash hands under running water with fingertips
pointing down.
Apply antimicrobial soap and use friction to hands and
wrists.
Run water from the wrists down toward the fingertips.
Alcohol handrubs may substitute for hand washing
unless hands are visibly contaminated.
Handrubs can be more effective in reducing nosocomial
infections than hand washing.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 45
Hand Washing
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Slide 46
Sanitization
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Cleaning of contaminated articles or surfaces to reduce
the numbers of microorganisms to a safe level as
dictated in public health guidelines
Removes debris such as blood and other body fluids
from instruments or equipment
Must wear utility gloves to prevent possible personal
contamination
Completed immediately after use in a separate
workroom or area to avoid cross-contamination
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Slide 47
Sanitization
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Separate sharp instruments from others to prevent
injury and protect instruments.
Open hinges and scrub serrations and ratchets.
Rinse instruments in hot water and check proper
working order.
Items should be hand dried.
Ultrasonic sanitizers are helpful because they do not
damage instruments and workers are protected from
an accidental sharps injury.
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Slide 48
Sanitization
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Slide 49
Disinfection
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Process of killing pathogenic organisms or making them
inactive.
Not always effective against spores and viruses.
1:10 bleach solution is an effective disinfectant for
surfaces contaminated with viruses, including HIV.
Important to follow manufacturer’s guidelines on how
to properly use each disinfectant.
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Slide 50
Disinfection
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Slide 51
Disinfectant Errors
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Instruments not thoroughly sanitized, and organic
matter inhibits or prevents action.
Moisture on instruments dilutes disinfectant solution
beyond effective concentration.
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Solution left in an open container.
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Solutions not changed as recommended and expire.
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Not prepared properly.
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Recommended manufacturer’s temperature for use and
storage is not maintained.
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Slide 52
Sterilization
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Destruction of all microorganisms.
Requires space for a sink as well as receiving basins,
proper cleaning agents, brushes, autoclave wrapping
paper, sterilizer envelopes and tape, sterilizer
indicators, disposable gloves, and designated biohazard
waste containers.
Another section should needed for storage of sterile
items.
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Slide 53
Role of the Medical Assistant
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It is important that aseptic techniques and infection
control be done on such a routine basis that they
become an unbreakable habit.
MA should teach patients about infection control and
the potential danger of blood and body fluids, including
demonstrating aseptic techniques, the management of
infectious materials at home, and the importance of
frequent and consistent hand washing.
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Slide 54