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Chapter 14
Infection Control
© 2009 Delmar, Cengage Learning
14:1 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 transmission
© 2009 Delmar, Cengage Learning
Microorganisms or Microbes
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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
(continues)
© 2009 Delmar, Cengage Learning
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
(continues)
© 2009 Delmar, Cengage Learning
Microorganisms or Microbes
(continued)
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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
© 2009 Delmar, Cengage Learning
Microbe Classifications
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Bacteria
Protozoa
Fungi
Rickettsiae
Viruses
© 2009 Delmar, Cengage Learning
Bacteria
• Simple, one-celled organisms
• Multiply rapidly
• Classified by shape and arrangement
(continues)
© 2009 Delmar, Cengage Learning
Bacteria
(continued)
• Cocci are round or spherical in shape
– Diplococci—in pairs
– Streptococci—in chains
– Staphylococci—clusters or groups
• Examples of diseases
(continues)
© 2009 Delmar, Cengage Learning
Bacteria
(continued)
• Bacilli are rod shaped
– Occur singly, in pairs, or in chains
– May have flagella
– Ability to form spores
• Examples of diseases
(continues)
© 2009 Delmar, Cengage Learning
Bacteria
(continued)
• Spirilla are spiral or corkscrew shaped
– Includes comma-shaped vibrio and corkscrew spirochete
• Diseases include syphilis and cholera
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
Protozoa
• One-celled, animal-like organism
• Found in decayed materials and
contaminated water
• May have flagella for movement
• Some are pathogenic
• Examples of diseases
© 2009 Delmar, Cengage Learning
Fungi
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Simple, plant-like organisms
Live on dead organic matter
Yeast and molds
Can be pathogenic
Examples of diseases
Antibiotics do not kill
Antifungal medications
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
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
(continues)
© 2009 Delmar, Cengage Learning
Viruses
(continued)
• Viruses infecting animals can mutate to
infect humans
• Examples include:
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Severe acute respiratory syndrome (SARS)
West Nile Virus (WNV)
Monkeypox
Ebola and Marburg
H5N1
© 2009 Delmar, Cengage Learning
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
(continues)
© 2009 Delmar, Cengage Learning
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, written statement must
be signed documenting refusal
© 2009 Delmar, Cengage Learning
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
(continues)
© 2009 Delmar, Cengage Learning
Hepatitis C
(continued)
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Currently, no vaccine ready for use
Vaccine is in development stage
Extremely difficult to destroy HVC
Can survive and remain active for several
days in dried blood
• Health care workers must follow precautions
to protect against virus
© 2009 Delmar, Cengage Learning
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
• Take precautions for prevention
© 2009 Delmar, Cengage Learning
Helminths
• Multicellular parasites otherwise known
as worms or flukes
• Are transmitted:
– By eating contaminated food
– Being bitten by infected insects
– When worms enter the skin
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
Classifications of
Diseases and Infections
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Endogenous
Exogenous
Nosocomial
Opportunistic
© 2009 Delmar, Cengage Learning
Endogenous
• Originates within the body
• Examples: metabolic disorders, congenital
abnormalities, tumors, and infections caused
by microorganisms within the body
© 2009 Delmar, Cengage Learning
Exogenous
• Originates outside the body
• Examples: radiation, chemical agents,
trauma, electric shock, and temperature
extremes
© 2009 Delmar, Cengage Learning
Nosocomial
• Acquired in a health care facility
• Usually present in facilities and carried by
health care workers to the patient
• Many are antibiotic-resistant
• Can cause serious and even life-threatening
infections
(continues)
© 2009 Delmar, Cengage Learning
Nosocomial
(continued)
• Examples are staphylococcus,
pseudomonas, and enterococci
• Infection-control programs are used
in facilities to prevent and deal with
nosocomial infections
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
Chain of Infection
• Present for disease to occur and spread from
one individual to another
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Causative agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
© 2009 Delmar, Cengage Learning
Common Body Defenses
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Mucous membranes
Cilia
Coughing and sneezing
HCL in the stomach
Tears
Fever
Inflammation response
Immune response
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
Aseptic Techniques
• Asepsis: absence of disease-producing
microorganisms
• Contaminated: any object or area that may
contain pathogens
• Major aim: maintaining cleanliness and
eliminating or preventing every aspect
of contamination
© 2009 Delmar, Cengage Learning
Common Aseptic Techniques
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Thorough handwashing
Good personal hygiene
Disposable gloves
Cleaning instruments and equipment
Proper cleaning of environment
© 2009 Delmar, Cengage Learning
Levels of Aseptic Control
• Antisepsis—used on the skin
• Disinfection—used mainly on objects
• Sterilization—use of steam under pressure,
gas, radiation, and chemicals on objects
© 2009 Delmar, Cengage Learning
Summary
• Important for health care workers to know
and use proper aseptic techniques at all times
• Prevents spread and transmission of disease
© 2009 Delmar, Cengage Learning
14:2 Bioterrorism
• Bioterrorism: use of microorganisms or
biologic agents for warfare
• Infecting humans, animals, or plants
• Have been used over time by different
nations not only in war but also on innocent
people
© 2009 Delmar, Cengage Learning
Biologic Agents
• Microorganisms with characteristics suitable
for bioterrorism:
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Inexpensive, available, easily produced, spreads quickly
Maintains its survival
Brings death or disability
Travels from person to person
Difficult to prevent/treat
(continues)
© 2009 Delmar, Cengage Learning
Biologic Agents
(continued)
• High priority agents include:
– Smallpox: contagious and infectious disease,
result of the Variola virus
– Anthrax: infectious disease caused by
Bacillus anthracis
– Plague: infectious disease from the bacteria
Yersinia pestis
(continues)
© 2009 Delmar, Cengage Learning
Biologic Agents
(continued)
– Botulism: paralytic illness resulting from a nerve
toxin from the bacteria Clostridium botulinum
– Tularemia: infectious disease from the bacteria
Fracisella tularensis
– Filoviruses: infectious diseases causing severe
hemorrhagic fever known as Ebola virus and
Marburg virus
© 2009 Delmar, Cengage Learning
Preparing for Bioterrorism
• Bioterrorism attack would result in a public
health emergency
• Would have impact on health care facilities
• Social disorder would ensue
• Comprehensive plan
(continues)
© 2009 Delmar, Cengage Learning
Preparing for Bioterrorism
(continued)
• Bioterrorism Act 2002 passed by Congress
and signed into law
• Involves local, regional, state, and national
government and includes:
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Early detection by communities
Public to be notified
Infection control and education
Funding available
(continues)
© 2009 Delmar, Cengage Learning
Preparing for Bioterrorism
(continued)
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Guidelines and restrictions
Nationwide immunizations
Protection of food/water supplies
Trained personnel available
Emergency management controls
Investigation of potential threats
Preparation of health care facilities
Efficiency of communication
© 2009 Delmar, Cengage Learning
Summary
• All health care workers need to be aware
of bioterrorism
• Attack could occur at any time
• Being prepared and properly trained will
result in saving many lives
© 2009 Delmar, Cengage Learning
14:3 Washing Hands
• Major aspect of standard precautions
• Most important aseptic technique
• Hands are perfect media for the spread
of pathogens
© 2009 Delmar, Cengage Learning
Purpose of Handwashing
• Prevent and control spread of pathogens
• Protect the health care worker from disease
and illness
© 2009 Delmar, Cengage Learning
Recommendations for Handwashing
• Regular handwashing with plain soap
and water
• Antiseptic handwashing with antimicrobial
soap and water
• Antiseptic hand rub with alcohol-based
cleaner (waterless)
© 2009 Delmar, Cengage Learning
When to Wash Hands
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On arrival at facility
Immediately before leaving facility
Before and after every patient contact
After contact with patient’s skin
Before moving from a contaminated site
to a clean site
(continues)
© 2009 Delmar, Cengage Learning
When to Wash Hands
(continued)
• Anytime the hands become contaminated
during a procedure
• Before applying gloves
• Immediately after removing gloves
• When gloves are torn or punctured
• Before and after handling specimens
• After contact with any soiled or
contaminated item
(continues)
© 2009 Delmar, Cengage Learning
When to Wash Hands
(continued)
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After picking up any item off the floor
After personal use of the bathroom
Following a cough, sneeze, or using a tissue
Before and after any contact with mouth or
mucous membranes
© 2009 Delmar, Cengage Learning
Principles of Handwashing
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Use soap as a cleansing agent
Use warm water
Use friction
Clean all surfaces
Point fingertips down
Use dry paper towels to turn faucet on and
off
• Clean nails
© 2009 Delmar, Cengage Learning
Waterless Hand Cleaning
• Alcohol-based gel, lotion, or foam
• Used if hands are not contaminated with
blood or body fluids
• Apply cleaner to palm of hand
• Rub hands together vigorously for at least
15 seconds
• After six to ten cleanings hands need to be
washed with soap and water
© 2009 Delmar, Cengage Learning
14:4 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 there is an area, object, or person
contaminated with blood or body fluids
© 2009 Delmar, Cengage Learning
Bloodborne Pathogen Standards
• Established in 1991 by OSHA
• Must be followed by all health care workers
• Civil penalties if not implemented
and followed
© 2009 Delmar, Cengage Learning
Regulation Requirements
• Written exposure control plan
• Identify all employees with occupational
exposure
• Hepatitis B vaccines free of charge
• Provide personal protective equipment
(continues)
© 2009 Delmar, Cengage Learning
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
(continues)
© 2009 Delmar, Cengage Learning
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)
(continues)
© 2009 Delmar, Cengage Learning
Regulation Requirements
(continued)
• Post signs at the entrance to work
areas with occupational exposure to
biohazardous materials
• Red biohazard labels
• Provide a confidential medical evaluation
and follow-up for any employee with an
exposure incident
• Provide training to employees
© 2009 Delmar, Cengage Learning
Needle Stick Safety Act
• Passed by Congress in 2000
• Centers for Disease Control and Prevention
(CDC) estimated 600,000 to 800,000 needle
sticks per year
• OSHA revised Bloodborne Pathogen
Standard to requirements of this act
© 2009 Delmar, Cengage Learning
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
(continues)
© 2009 Delmar, Cengage Learning
Employer Requirements
(continued)
• Maintain a sharps injury log
• Ensure that every employee uses
standard precautions at all times
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
When to Use Standard Precautions
• Any situation where you might come
in contact with:
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Blood or any fluid that contains blood
Body fluids, secretions, and excretions
Mucous membranes
Nonintact skin
Tissue or cell specimens
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
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/blood tests
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
Masks and Eye Protection
• Worn during procedures that may cause
splashing or spraying
• Prevents exposure of mucous membranes of
the mouth, nose, and eyes to pathogens
• Use masks once then discard—change every
30 minutes if needed
(continues)
© 2009 Delmar, Cengage Learning
Masks and Eye Protection
(continued)
• Protective eyewear and face shields protect
front, top, bottom, and sides of eyes
• If not disposable, must be cleaned and
disinfected before reuse
© 2009 Delmar, Cengage Learning
Sharp Objects
• Use extreme caution to avoid cuts
and punctures
• When possible, use safe needles or
needleless system
• Follow policies regarding needles
• Use sharps containers
• Follow laws regarding disposal of
sharp objects
© 2009 Delmar, Cengage Learning
Spills or Splashes
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Wipe up immediately
Wear gloves when wiping up
Use disposable cleaning clothes
Use disinfectant which contains 10%
bleach solution
• Clean all contaminated surfaces
• For large spills, can use absorbent powder
to absorb fluid
© 2009 Delmar, Cengage Learning
Resuscitation Devices
• Use to avoid the need for mouth-to-mouth
resuscitation
• Place in convenient location that is
readily accessible
© 2009 Delmar, Cengage Learning
Waste and Linen Disposal
• Wear gloves
• Follow agency policy
• Use biohazard bags appropriately
© 2009 Delmar, Cengage Learning
Injuries
• Report any cut or injury, needle stick, or
splashing of blood or body fluids
immediately
• Follow agency policy
© 2009 Delmar, Cengage Learning
Summary
• Standard precautions need to be followed at
all times by every health care worker
• Observing these precautions can help break
the chain of infection
• Health care workers can protect themselves,
their patients, and all other individuals
© 2009 Delmar, Cengage Learning
14:5 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
(continues)
© 2009 Delmar, Cengage Learning
Sterilizing with an Autoclave
(continued)
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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
© 2009 Delmar, Cengage Learning
14:6 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
(continues)
© 2009 Delmar, Cengage Learning
Using Chemicals for Disinfection
(continued)
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Read manufacturer’s instructions
Antirust tablets or solutions added
Requirements for disinfection
Chemical must completely cover items
Care of chemical solutions
© 2009 Delmar, Cengage Learning
14:7 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
(continues)
© 2009 Delmar, Cengage Learning
Cleaning with an Ultrasonic Unit
(continued)
• Care of glass beakers
• Care of the permanent tank
• Read manufacturer’s instructions before
using any ultrasonic unit
© 2009 Delmar, Cengage Learning
Summary
• Different methods provide different levels
of aseptic control
• Method used depends on equipment and
level of aseptic control required
• Read manufacturer’s instructions
• Clean, rinse, and dry all equipment
before processing
• Handle all items carefully
© 2009 Delmar, Cengage Learning
14:8 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
(continues)
© 2009 Delmar, Cengage Learning
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
(continues)
© 2009 Delmar, Cengage Learning
Using Sterile Techniques
(continued)
• Clean working area required
• Handling of sterile supplies
• Sterile field: area used for placement
of sterile supplies
• All sterile items need to be checked
• Observe agency guidelines for date
• Necessary to keep sterile field dry
© 2009 Delmar, Cengage Learning
Removing Articles from Sterile Wraps
• Drop technique—for gauze, pads, dressings,
and small items
• Mitten technique—for bowls, drapes,
and linens
• Transfer forceps—for cotton balls and
small items
© 2009 Delmar, Cengage Learning
14:9 Transmission-Based
Isolation Precautions
• Some diseases are communicable
– Caused by organisms that can be transmitted easily
• Epidemic—spreads from person to
person and affects large numbers
• Pandemic—spreads over a wide
geographic area
• These precautions are in addition to
the Standard Precautions
(continues)
© 2009 Delmar, Cengage Learning
Transmission-Based
Isolation Precautions
(continued)
• Helps prevent spread of disease
• Protects patient, family, and health
care workers
• Type used depends on the causative
organism of the disease
© 2009 Delmar, Cengage Learning
How Communicable Diseases Spread
• Direct contact with a patient
• Contact with dirty linen, equipment,
and supplies
• Contact with blood, body fluids, secretions,
and excretions
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
Classifications of Precautions
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Standard precautions
Airborne precautions
Droplet precautions
Contact precautions
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
Summary
• Exact procedures for maintaining
transmission-based isolation will vary
from one facility to another
• Variations caused by different factors
• Basic principles remain the same in any
facility and are directed toward preventing
the spread of disease
© 2009 Delmar, Cengage Learning