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Pearson's Comprehensive
Medical Assisting
Administrative and Clinical Competencies
THIRD EDITION
CHAPTER
34
Infection Control
Lesson 2:
Infection Control: Precautions
and Standards
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Lesson Objectives
Upon completion of this lesson, students
should be able to:
1. Define and spell the terms to learn for
this chapter.
2. Explain standard precautions and
transmission based precautions.
3. Define medical asepsis.
4. Explain and perform the correct
procedure for hand washing.
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Infection Control:
Precautions and Standards
• Universal Precautions
 1985: CDC established universal
precautions to protect health care
workers and patients from HIV, HBV,
and bloodborne pathogens
 Theory
• Treat all blood and bodily fluids as if they
are contaminated
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Infection Control:
Precautions and Standards
• Universal Precautions
 Later, CDC included precaution that all
moist body secretions should be
considered contaminated (except sweat)
 Practices include proper hand hygiene
and use of gloves when handling blood
or performing invasive procedures, such
as venipuncture
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Hepatitis and HIV/AIDS
• Hepatitis A (HAV)
 Means of transmission
• Fecal/oral route; material; sexually
transmitted
 Signs and symptoms
• Fever, loss of appetite, jaundice, nausea,
vomiting, malaise, dark urine, whitish
stools
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Hepatitis and HIV/AIDS
• Hepatitis B (HBV)
 Means of transmission
• Contact with contaminated body fluids,
including blood, semen, saliva, breast
milk
 Signs and symptoms
• Fever, loss of appetite, jaundice, nausea,
vomiting, malaise, dark urine, whitish
stools
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Hepatitis and HIV/AIDS
• Hepatitis B (HBV)
 30% have no signs or symptoms
 Can lead to lifelong infection, scarring of
the liver, liver cancer, or liver failure
and death
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Hepatitis and HIV/AIDS
• Hepatitis C (HCV)
 Means of transmission
• Contact with contaminated blood,
particularly through sharing of needles;
passed from mother to baby during birth
process
 Signs and symptoms
• 80% do not develop signs and symptoms
 If symptoms do develop, mimic HAV
and HBV
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Hepatitis and HIV/AIDS
• Human ImmunoDeficiency Virus and
Acquired Immune Deficiency Syndrome
(HIV and AIDS)
 Means of transmission: Sexual contact;
passed from mother to baby; contact
with contaminated blood
 Signs and symptoms: HIV virus may
develop into acquired immune
deficiency syndrome (AIDS)
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Hepatitis and HIV/AIDS
• Human ImmunoDeficiency Virus and
Acquired Immune Deficiency Syndrome
(HIV and AIDS)
 Symptoms before the development of
AIDS: loss of appetite, weight loss,
diarrhea, skin rash, fatigue, night
sweats, swollen lymph glands, poor
resistance to infection
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Critical Thinking Question
1. Which bodily fluid does not require the
use of standard precautions?
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Infection Control:
Precautions and Standards
• Standard Precautions
 Developed by CDC
 Use these precautions when caring for
all patients, whatever their diagnosis
 Guidelines apply to all blood, body fluid
secretions, and excretions except sweat,
whether blood is visible or not
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Infection Control:
Precautions and Standards
• Standard Precautions
 Hand washing
 Use of personal protective equipment
(PPE) whenever touching or exposed to
patients' body fluids
• Gloves
• Gowns
• Masks
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Infection Control:
Precautions and Standards
• Standard Precautions
 Hand sanitizing one of the best means
of reducing the spread of
microorganisms
 Hand hygiene
• Not wearing artificial fingernails or
extenders when having direct contact
with high-risk patients
 Natural fingernails kept short
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Infection Control:
Precautions and Standards
• Standard Precautions
 Hand hygiene
• Hand washing with soap and water or
use of alcohol-based hand rubs
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Infection Control:
Precautions and Standards
• Standard Precautions
 Personal protective equipment
•
•
•
•
•
Gloves
Gowns
Face masks or shields
Protective eyewear
Respirators
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Infection Control:
Precautions and Standards
• Standard Precautions
 Respiratory hygiene/cough etiquette
• Cover mouth or nose when coughing
• Dispose of tissues appropriately
• Perform hand hygiene after contact with
respiratory secretions
• Use mask when appropriate
• Provide at least 3 feet of space between
persons with respiratory infections
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Infection Control:
Precautions and Standards
• Standard Precautions
 Safe injection practices
• Use of aseptic technique and of singleuse items; no multidose vials kept in
immediate treatment area
 Use of masks to cover face and reduce
risk of splash when inserting catheters
or when performing procedures
involving lumbar puncture
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Infection Control:
Precautions and Standards
• Standard Precautions
 Ask patient if he or she has history of
latex sensitivity
 Ask about allergies
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Infection Control:
Precautions and Standards
• Standard Precautions
 Symptoms to latex sensitivity
• Contact dermatitis, swelling, itching, and
rhinitis and may, in some cases, include
anaphylaxis
 Latex-free gloves, syringes, IV tubing,
and solution bags should always be
available
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FIGURE 34-4
Standard precautions.
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Infection Control:
Precautions and Standards
• Transmission-Based Precautions
 Airborne precautions
• Designed to reduce transmission of
certain diseases, such as TB, measles, or
chickenpox
• Used when patients infected with
pathogens transmitted via airborne
droplet nuclei
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Infection Control:
Precautions and Standards
• Transmission-Based Precautions
 Airborne precautions
• Patient isolation
• Require use of mask and gown by all
health care personnel who come in
contact with the patient
• Hand washing and gloves are required
• Disposable items used if available
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Infection Control:
Precautions and Standards
• Transmission-Based Precautions
 Droplet precautions
• Used for patients suspected of being
infected with organisms spread by
droplets during sneezing, coughing, and
talking
• Mask should be worn
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Infection Control:
Precautions and Standards
• Transmission-Based Precautions
 Droplet precautions
• Gown and gloves worn if there is a
chance of coming into contact with blood
or body fluids of suspected patients
• All reusable equipment cleaned and
disinfected
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Infection Control:
Precautions and Standards
• Transmission-Based Precautions
 Contact precautions
• Used when infections are both difficult to
treat, and likelihood of microorganism
transmission among patients and health
care providers is high
• Isolating patients
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Infection Control:
Precautions and Standards
• Transmission-Based Precautions
 Contact precautions
• Wearing gowns and gloves
• If chance of coming in contact with body
fluids, a mask and protective eyewear
should be worn
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Infection Control:
Precautions and Standards
• Bloodborne Pathogen Standard
 1991: OSHA developed Bloodborne
Pathogen Standard
 2000: United States Congress passed
Needlestick Safety and Prevention Act
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Infection Control:
Precautions and Standards
• Bloodborne Pathogen Standard
 OSHA updated Standard to reflect
necessary changes brought about by
this new act
 Exposure control plan must be
implemented in each facility, evaluated
yearly
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Infection Control:
Precautions and Standards
• Bloodborne Pathogen Standard
 In addition to exposure control plan,
bloodborne pathogen standard requires
strict record keeping: log of sharps
containers and log of incidents of
occupational exposure or illnesses
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Infection Control:
Precautions and Standards
• Bloodborne Pathogen Standard
 Routine and documented employee
input must be recorded
 Safe housekeeping practices: use of
appropriate containers, bags, and
procedures
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Disposal of Infectious Wastes and
Substances
1. Check to ensure infectious waste
container is lined
2. Discard infectious waste into container
3. Contain all liquid before disposing into
container
4. Do not put contaminated glass into waste
bag
5. When infectious waste container is full,
close bag appropriately
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PROCEDURE 34-1 Disposal of Infectious Wastes and Substances
FIGURE C Place a new biohazard bag in the empty biohazard container.
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Disposal of Infectious Wastes and
Substances
6. Make sure all contents are contained
within the red bag and that bags are not
overstuffed
7. Do not mix noninfectious trash in same
large bin
8. Store full bags appropriately
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PROCEDURE 34-1 Disposal of Infectious Wastes and Substances
FIGURE D Place the properly secured red biohazard bag in the specified area for proper disposal.
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Critical Thinking Question
1. Is medical asepsis practiced in a surgical
environment?
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Infection Control:
Physical and Chemical Barriers
• Medical Asepsis
 Destruction of organisms after they
leave the body
 Hand hygiene, using disposable
equipment, and wearing gloves can help
reduce transfer of pathogens
 Aseptic techniques fundamental means
of providing safe environment in
medical facilities
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Infection Control:
Physical and Chemical Barriers
• Medical Asepsis
 Taking oral, aural, and rectal
temperatures
 Obtaining throat or vaginal cultures or
smears
 Performing venipuncture
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Infection Control:
Physical and Chemical Barriers
• Medical Asepsis
 Obtaining urine, stool, or sputum
specimens
 Administering medications
 Cleaning treatment rooms
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Critical Thinking Question
1. Can you name another situation in which
medical asepsis would be used?
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Infection Control:
Physical and Chemical Barriers
• Medical Asepsis
 Wash hands before and after any
contact with patients or equipment
 Handle all specimens and materials as
though they contain pathogens.
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Infection Control:
Physical and Chemical Barriers
• Medical Asepsis
 Use gloves for protection when handling
contaminated articles or materials, such
as specimens or instruments used
during a procedure
 Do not wear jewelry that can attract
and harbor bacteria
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Infection Control:
Physical and Chemical Barriers
• Medical Asepsis
 Use disposable equipment whenever
possible
 Dispose of all equipment properly after
use
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Infection Control:
Physical and Chemical Barriers
• Medical Asepsis
 Clean all nondisposable equipment as
soon as possible after patient use, using
approved disinfectant and wearing
appropriate gloves
 Use only clean or sterile supplies for
each patient
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Infection Control:
Physical and Chemical Barriers
• Medical Asepsis
 Use protective covering over clothes if
any danger of contaminated materials
or supplies coming into contact with
them
 Discard items that fall on the floor if
they cannot be cleaned
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Infection Control:
Physical and Chemical Barriers
• Medical Asepsis
 Any item dropped on the floor must be
resterilized or redisinfected before use
 All floors considered contaminated
 If in doubt, throw it out!
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Infection Control:
Physical and Chemical Barriers
• Medical Asepsis
 Place all wet or damp dressings and
bandages in waterproof bag to protect
persons handling waste removal
 Proper ventilation
 All examination rooms cleaned with
approved disinfectant after each patient
contact
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Infection Control:
Physical and Chemical Barriers
• Medical Asepsis
 Empty trash cans
 Replace sharps containers
 Observe for any insect infestation
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Performing Hand Washing
1. Remove jewelry
2. Stand at sink without allowing clothing to
touch sink
3. Turn on warm water with foot or knee
pedal or faucet, using a paper towel
4. Wet hands and place 1 teaspoon liquid
soap into palm; lather using a circular
motion and friction
5. Keep hands pointed down below elbow
level for the entire procedure
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Performing Hand Washing
6. Use nail cleaner to clean under fingernails
7. Rinse hands with fingers pointed down
8. If hands heavily soiled, reapply soap and
wash them again
9. Dry with paper towel and discard
10.Use dry paper towel to turn off the faucet
if knee pedal is not available; apply
antibacterial hand lotion
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PROCEDURE 34-2 Performing Hand Washing
FIGURE A–D (A) Turn on the faucet with a paper towel and stand away from the sink so that your clothing is
not touching the sink. (B) Hands and forearms should always face down below the elbow. (C) Use a nail brush or
cuticle stick to clean under the fingernails. (D) Using a paper towel, turn off the faucet.
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Infection Control:
Physical and Chemical Barriers
• Hands should always be washed with
soap and water:
 Every third time hand hygiene is
performed
 If they are visibly soiled with dirt or
body fluids
 Before eating
 After using the restroom
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Infection Control:
Physical and Chemical Barriers
• Alcohol-Based Hand Rubs
 As with regular hand washing:
• Jewelry should be removed
• 2 to 3 ml of gel placed in palm of the
hand and thoroughly spread over surface
of both hands up to ½ inch above the
wrist
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Infection Control:
Physical and Chemical Barriers
• Alcohol-Based Hand Rubs
 As with regular hand washing:
• Continue to rub hands together until dry,
approximately 15 to 30 seconds
• Waterless hand sanitizers kill 99.9
percent of common microorganisms in 15
seconds
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FIGURE 34-5 Dispense 2–3 ml of hand sanitizer into the palm of the hand.
racorn/Shutterstock
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Infection Control:
Physical and Chemical Barriers
• Protective Clothing/Personal Protective
Equipment
 To protect patient from any
microorganisms that might be present
on health care worker's uniform
 To protect health care worker from
carrying microorganisms away from the
patient
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Infection Control:
Physical and Chemical Barriers
• Protective Clothing/Personal Protective
Equipment
 Protective devices assist in protecting
health care worker from contamination
with bloodborne pathogens
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Infection Control:
Physical and Chemical Barriers
• Protective Clothing/Personal Protective
Equipment
 Nonsterile gloving technique used for
procedures such as drawing blood and
specimen collection
 Wearing each piece of PPE not needed
for every procedure
 PPE should be chosen in consideration
of the possibility of contamination
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Infection Control:
Physical and Chemical Barriers
• Protective Clothing/Personal Protective
Equipment
 When wearing mask, it should fit snugly
over nose, mouth, and chin
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Infection Control:
Physical and Chemical Barriers
• Protective Clothing/Personal Protective
Equipment
 If wearing more than one piece of PPE,
maintain medical asepsis when
removing it
•
•
•
•
Remove
Remove
Remove
Remove
gloves
goggles or face shield
gown
mask or respirator
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FIGURE 34-6 The mask covers both the mouth and nose to prevent exposure to body fluids and airborne
droplets.
Dana Neely/Getty Images
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Applying and Removing Nonsterile
Gloves
• Perform hand hygiene
• Choose appropriate size gloves for your
hands
• Hold a glove at the wrist opening and
insert fingers, pulling the glove up to
wrist
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Applying and Removing Nonsterile
Gloves
• Apply the second glove in the same
manner, checking for holes and other
flaws
• If any flaws are found, discard the
gloves and obtain new gloves
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PROCEDURE 34-3 Applying and Removing Nonsterile Gloves
FIGURE B Grasp the glove just below the cuff.
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PROCEDURE 34-3 Applying and Removing Nonsterile Gloves
FIGURE C Pull glove over the hand while turning the glove inside out.
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Applying and Removing Nonsterile
Gloves
• To remove gloves, grasp glove covering
your nondominant hand at palm and
pull it away
• Pull the glove off and hold it in the
palm of the gloved dominant hand
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Applying and Removing Nonsterile
Gloves
• While holding soiled glove in your
gloved hand, slide the index finger of
ungloved hand below the cuff of the
remaining glove and peel it down,
inverting it over the first glove
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PROCEDURE 34-3 Applying and Removing Nonsterile Gloves
FIGURE D Place the ungloved index and middle fingers inside the cuff of the glove, running the cuff downward.
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PROCEDURE 34-3 Applying and Removing Nonsterile Gloves
FIGURE E Pull down the cuff and turn the glove inside out as you remove your hand.
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Applying and Removing Nonsterile
Gloves
• Both gloves will be in a ball and inside
out
• Dispose of gloves in a biohazard
container
• Perform hand hygiene
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Performing Transmission-Based
Precaution: Isolation Techniques
• Review orders and agency protocols
regarding isolation procedures
• Assemble necessary protective
equipment appropriate for level of
isolation necessary
• Remove lab coat and jewelry
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Performing Transmission-Based
Precaution: Isolation Techniques
• Perform hand hygiene
• Apply appropriate disposable apparel
• Apply the cap to cover hair and ears
completely
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Performing Transmission-Based
Precaution: Isolation Techniques
• Apply gown over outer garments as
follows:
 Hold gown in front of the body and
place arms through the sleeves
 Pull the sleeves on, covering the wrists
 Tie gown securely at the neck and the
waist
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Performing Transmission-Based
Precaution: Isolation Techniques
• Apply the mask by:
 Placing the top of mask over the bridge
of the nose and pinch the metal strip to
secure a snug fit on the nose, tying it if
needed
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PROCEDURE 34-4 Performing Transmission-Based Precaution: Isolation Techniques
FIGURE A Examples of personal protective equipment: gloves, mask, gown, and face shield with glasses.
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Performing Transmission-Based
Precaution: Isolation Techniques
• Apply protective eyewear
• Apply nonsterile gloves, pulling the
cuffs of the glove up and over the cuffs
of the gown, covering them completely
• Enter isolation room and perform
patient tasks as needed
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Performing Transmission-Based
Precaution: Isolation Techniques
• Exit isolation room; immediately
remove barrier protections in following
order:
 Untie waist of the gown
 Remove gloves
 Wash hands
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Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly
Performing Transmission-Based
Precaution: Isolation Techniques
• Exit isolation room; immediately
remove barrier protections in following
order:
 Untie neck of the gown
 Remove gown by pulling it down from
the shoulders
 Turn gown inside out and remove arms
from the sleeves
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Performing Transmission-Based
Precaution: Isolation Techniques
• Exit isolation room; immediately
remove barrier protections in following
order:
 The inside of the gown is not
contaminated
 Holding gown away from the body with
contaminated area on the inside, fold
and place it in a biohazard container
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PROCEDURE 34-4 Performing Transmission-Based Precaution: Isolation Techniques
FIGURE B Remove gown by pulling it down from the shoulders.
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PROCEDURE 34-4 Performing Transmission-Based Precaution: Isolation Techniques
FIGURE C Turn the gown inside out and remove arms from sleeves (inside of gown is not contaminated).
Andrey Popov/Shutterstock
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PROCEDURE 34-4 Performing Transmission-Based Precaution: Isolation Techniques
FIGURE D Holding the gown away from the body with contaminated area on the inside, fold and place the gown
in a biohazard container.
Slaven MD/Custom Medical Stock Photo
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Performing Transmission-Based
Precaution: Isolation Techniques
• Remove protective eyewear
• Remove mask; discard in biohazard
container
• Perform hand hygiene
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Beaman | Routh | Papazian-Boyce | Sesser | Mills | Maly
Questions?
Pearson's Comprehensive Medical Assisting:
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