Module 3C: Infection Control and Saftey Flashcards
Purpose of infection control
To minimize and remove a variety of disease-causing micro-organisms from the health care environment.
Micro-organisms
An organism that can only been seen through a microscope, including bacteria, protozoa, algae, and fungi.
Pathogenic
Causes disease.
Medical asepsis
Clean technique that includes frequent hand hygiene, proper use of gloves, cleaning and sterilizing medical equipment, and sanitizing surfaces.
Communicable diseases
An illness that is spread from one person to another or from an animal to a person or from a surface or food.
Transmission
Can occur in various ways but mainly from direct contact with the pathogen.
For the transmission of a disease to occur, there must be a pathogen or infectious agent present.
Varicella (chicken pox)
Direct or indirect contact from infected droplets or airborne secretions
Viral meningitis
Direct contact, respiratory secretions, and oral-fecal route
Bacterial meningitis
Direct contact and infected droplets from respiratory tract
Conjunctivitis (pinkeye)
Direct or indirect contact with eye discharge or discharge from upper respiratory tract of infected patient
Rhinovirus (common cold)
Direct or indirect contact from airborne or respiratory secretion droplets
Strep throat
Direct contact with infected individual, respiratory secretions
Pertussis (whooping cough)
Direct contact with respiratory secretion droplets
Influenza (flu)
Direct contact with respiratory secretion droplets
Pathogens
Disease causing micro-organisms:
- viruses
- bacteria
- fungi
- parasites: can be further classified as protozoa, helminths, ectoparasite, and rickettsia.
Nonpathogens
Harmless and do not cause disease.
Normal flora
Micro-organisms that live on or within the body without causing disease.
Responsible for many important functions, such as synthesizing and excreting vitamins as well as preventing colonization of pathogens.
Virus Examples
Rhinovirus (common cold)
Varicella (chicken pox)
HIV/AIDS
Hepatitis
Coronavirus
Bacteria Examples
E. coli (urinary tract infections)
Vibrio cholerae (cholera)
Bordetella pertussis (whooping cough)
Fungi Examples
Histoplasmosis (lung infection passed on by certain bird/bat droppings)
Tinea pedis (athlete’s foot)
Candida albicans (yeast infection)
Parasite Examples
Toxoplasmosis
Pinworm
Tapeworm
Scabies
Lice
Lyme disease
Chain of Infection
For the transmission of a pathogen to occur, the following links in the cycle of infection must be connected.
- Infectious agent
- Reservoir/source
- Portal of exit
- Mode of transmission
- Portal of entry to host
- Susceptible host
If this chain is interrupted, it can break the infection process, thus preventing the continuation of the cycle and halting infection.
Sign vs Symptom
Sign is a manifestation that can be perceived (ex: fever, swollen lymph nodes, tachycardia)
Symptom is a manifestation of something that is only apparent or felt by patient (ex: chills, pain and aching, nausea)
Signs of Infectious Diseases
Fever
Swollen lymph nodes
Tachycardia
Septicemia
Chest sounds
Skin eruptions
Leukopenia
Symptoms of Infectious Diseases
Chills
Pain and aching
Nausea
Fatigue/malaise
Headache
Sore throat
Chest tightness
Direct transmission
Takes place when there is contact with an infected person or body fluid that is carrying the pathogen
Indirect transmission
Occurs when there is an intermediate step between the portal of exit and portal of entry
Ex: Contact with a mosquito, pencil, or contaminated table
Portals of entry to host
Pathogens often enter a host via an open wound or through the mouth, nose, eye, intestines, urinary tract, or reproductive system.
Factors that make a host susceptible
Several variables make the human body—especially of a compromised patient—the ideal susceptible host.
Factors such as overall health, age, and the condition of a person’s immune system affect the chances of them becoming a host for a disease transmission.
Universal precautions
Precautions that apply when it is possible that one might come into contact with:
- Blood products (human)
- Human tissue
- Body fluids such as cerebrospinal fluid, amniotic fluid, and pleural fluid
- Any body fluid visibly contaminated with blood
- Vaginal secretions and semen
Regardless of the patients’ infection status.
Ex: human immunodeficiency virus (HIV) and the hepatitis B virus.
Standard Precautions
Minimum infection prevention practices that apply to all patient care, regardless of known infection status.
General Standard Precautions
General guidelines:
- Wash hands before and after every procedure.
- Use gloves with encountering patient blood/body fluids, handling anything contaminated with blood, performing venipuncture, handling blood specimens, and cleaning up body fluids or blood.
- Cover any scratches or breaks in the skin.
Refrain from eating, drinking, or chewing gum while working.
- Wear appropriate personal protective equipment (PPE) if blood or body fluid splatter could occur.
- Clean all spills immediately with appropriate cleaning supplies.
- Dispose of sharps immediately.
- Place sharps or broken glass in a puncture-proof container.
- Dispose of all biohazard waste in appropriate biohazard container.
3 categories for job tasks and the potential for exposure to blood borne pathogens
Category I: Tasks that have a chance of body fluids or blood spilling or splashing, or tasks that can cause exposure to blood or body fluids such as a minor surgical procedure
Category II: Tasks that do not usually involve chance of exposure, such as CPR; precautions must still be taken
Category III: Tasks that do not require any PPE, such as taking a patient’s vital signs
Personal protective equipment (PPE)
Gear worn when there is a chance of coming in contact with blood or body fluids. This helps reduce the risk of contact with blood or body fluids and helps break the cycle of infection.
Employers must provide PPE to all employees when there is a potential for exposure to blood or body fluids. It is the employee’s responsibility to use the PPE when contact with blood or body fluids is anticipated.
In the health care setting, this includes gloves, gowns/aprons, shoe covers, lab coats, masks and respirators, protective eyewear, and face shields.
Biohazard waste
Materials that present a potential or actual risk to the health of humans, animals, or the environment.
Needle Safety and Prevention Act
Signed into law in November 2000, which requires the institution of safety measures in workplaces where there is an occupational exposure to blood or other potentially infections materials.
- Health care professionals must implement the use of devices that help reduce the risk of needlestick injuries such as needle safety devices.
- Facilities must also maintain a detailed logbook of any needlestick or sharps injuries from dirty or contaminated sharps.
- Health care facilities must also implement work practice controls to help reduce the risk of injury at work by altering the way a task is performed.
Return to work guidelines
If a health care professional has a fever or feels sick, refrain from contact with patients to reduce the risk of spread.
Stay home and only return to work if the MA has been fever-free for at least 24 hours without the use of any fever-reducing medications.
Occupational Safety and Health Administration (OSHA)
Agency that creates regulations that employers must follow for employees to remain safe while working.
Transmission-based precautions
contact, droplet, and airborne precautions
Contact precautions
Transmission through direct and indirect touching
- using proper PPE such as gloves and gown, washing hands before and after working with the patient, and disinfecting the exam room are all precautions that should be taken.
Droplet precautions
Transmission by contact of secretions and usually occurs when an infected person coughs or sneezes
- get the patient to an exam room as quickly as possible, have the patient put on a face mask, and have the health care professional use appropriate PPE such as mask and gloves.
Airborne precautions
Transmission by infectious agents floating in the air, which can expose anyone around the patient
- allow the patient to enter the facility by a different route, place the patient in an isolation room, have the patient place a face mask on, and have the health care working use appropriate PPE such as mask, gloves, and gown.
Types of Bloodborne Pathogen Exposures
Needlesticks; cuts; or blood or bodily fluid coming into contact with the eyes, nose, mouth, or other non-intact skin
OSHA Bloodborne Pathogens Standard
Established to reduce the risk of occupational exposure to infectious disease
- Requires employers to have a written exposure control plan to protect their employees who have the potential for exposure based on their job duties and responsibilities.
CDC’s employers exposure control plan
Employers are required to update their exposure control plan annually to align with changes that help reduce the potential for exposure.
The following must be detailed in the employer’s exposure control plan.
- engineering controls
- workplace controls
- PPE (Employers must provide personal protective equipment to employees)
- Hepatitis B Vaccinations
- Post-Exposure Follow-Up
- Labels and Signs to Communicate Hazards
- Information and Training to Employees
- Documented Employee Medical Training Records
Engineering Controls
Devices used to isolate or remove the blood-borne pathogen hazard from the workplace.
Ex: Needles with safety devices, sharps disposable containers, and needless systems
Workplace Controls
Practices in the workplace that reduce the chances of exposure by changing or mandating the way a task is performed.
Ex: Handwashing procedures, disposal of sharps, and packaging lab specimens
Hepatitis B Vaccinations
Employers must provide hepatitis B vaccinations to all employees with a risk of exposure within 10 days of employment at no cost
Post-Exposure Follow-Up
Employers must follow up with any professional who had an exposure incident at no cost to the employee. All employee diagnoses must remain confidential.
Labels and Signs to Communicate Hazards
Labels are required to be on all regulated waste and storage containers containing potentially infectious materials.
Ex: Warning labels posted to containers, refrigerators, and freezers used to store blood or other infectious materials
Information and Training to Employees
Employers must provide regular training that covers the dangers of blood-borne pathogens
Documented Employee Medical Training Records
Medical training and records must be maintained for each employee
Don
put on
Doff
remove
Donning nonsterile gloves
- Perform handwash.
- Select appropriate size of nonsterile gloves.
- Place hand through opening and pull glove up to wrist.
- Repeat on other hand.
- Adjust gloves as necessary.
Doffing nonsterile, contaminated gloves
- Grasp palm of glove of nondominant hand with dominant hand.
- Pull glove off the nondominant hand in a downward motion while turning the glove inside out. 3. Hold in dominant hand.
- Roll the glove up into the dominant hand.
- Place two fingers of the ungloved hand under the cuff of the other gloved, dominant hand, making sure not to touch the outside of the glove.
- Pull the glove over the hand, turning it inside out over the other glove.
- Throw away the gloves in the appropriate container.
- Wash hands.
What PPE is the most widely used in a health care setting?
gloves
Asepsis
The state of being free from disease-causing micro-organisms
Aseptic Techniques for Various Clinical Situations
- Clean and disinfect the office daily. Be sure to focus on all high-traffic areas, (for example, examination rooms, restrooms, height/weight scale area, patient check in/out areas) and inspect office surfaces or objects that can be contaminated or require frequent disinfection.
- Remove trash.
- Move sick and contagious patients from the reception area to an exam room or separate them from well patients upon arrival to a medical facility.
Provide appropriate personal protective equipment including gloves, gowns, masks, and eye protection as needed for each situation. - Do not allow eating or drinking in lab, clinical, or patient areas.
- Post reminder signs regarding good hand hygiene and covering coughs or sneezes.
Disinfection
The process of destroying pathogens or rendering them inactive on a surface or instruments.
Medical asepsis
Aka clean technique
The goal of medical asepsis is to reduce the number of pathogenic micro-organisms and prohibit their growth
Ex:
- Washing hands prior to and after each patient encounter
- Assuring the workspace has been wiped down with sanitizing wipes between patient encounters
- Using proper PPE, such as gloves and masks, when in contact with bodily fluids
- Proper cleaning of supplies
- Setting up the laboratory area with a “clean” side and “dirty” side
- Properly covering coughs or sneezes and washing hands afterward
Handwashing
A medical aseptic technique that is routinely used.
This type of asepsis does not provide for a complete pathogen-free environment, but it greatly reduces their numbers and their ability to multiply and continue the chain of infection.
Surgical asepsis
The complete removal of all micro-organisms and must be used during invasive procedures.
The goal of surgical asepsis is to eliminate micro-organisms from entering the body.
During procedures such as invasive procedures, wound care, endoscopies, and insertion of urinary catheters, all PPE and instruments used should be sterile.
Supplies used during these procedures would consist of the use of sterile gloves, gowns, and drapes.
When to Use Medical vs Surgical Asepsis
Medical asepsis: used for most noninvasive procedures and if the skin and mucous membranes are intact
Surgical asepsis: used for invasive procedures (surgeries endoscopies, and insertion of urinary catheters) and wound care
When to use handwashing vs sanitizer
Alcohol-based hand sanitizers: can be used if a sink is not available and on hands that are not visibly soiled.
Handwashing: when hands are visibly contaminated or dirty
CDC Hand Hygiene Recommendations
- Before and after patient contact
- After contact with contaminated surfaces
- Contact with blood or body fluids
- Before performing an aseptic procedure, such as blood draws and medication administration
- Before and after contact with supplies or equipment near patients
- After contact with contaminated body site prior to contact with a clean body site
- After glove removal
- Hands are visibly soiled
- After using the restroom (soap and water)
- Before and after eating (soap and water)
- When arriving and before leaving work (soap and water)
Handwashing Techniques
- Remove all jewelry except a plain ring or band.
- Turn on the faucet and regulate the water temperature to lukewarm.
- Wet the hands
- Apply approximately 3 milliliters or 3 pumps of soap, and lather using a circular motion with friction while holding the fingertips downward. The friction that is created with this step helps to lift debris from the skin.
- Rub hands well while interlacing fingers together to create friction and use circular motions around wrist. This process should be continued for at least 15 seconds (preferably 20 seconds). Microbes tend to concentrate near and under the nails, so pay special attention to those areas, ensuring the water is flowing down from the wrist to the fingertips.
- Rinse the hands a second time, always keeping fingers lower than the wrist.
- Dry both hands with paper towels. Do not touch the paper towel dispenser when obtaining the towels. If an automated paper towel dispenser is not available, make sure to have paper towels ready prior to beginning handwashing.
8 If the faucets are not foot operated, turn them off with a dry paper towel. - Discard the paper towel in a covered waste container.
Alcohol-Based Rubs/Sanitizer
In certain circumstances and when hands are not visibly soiled, an alcohol-based sanitizer with a minimum of 60% alcohol can be used.
- Start by pushing watch and uniform sleeves above wrists and removing rings.
- When using an alcohol-based sanitizer, dispense proper amount per manufacturer’s recommendations into the palm of one hand.
- Rub both hands together, creating friction, making sure to cover all surfaces, including palms, backs of hands, fingers, and between fingers.
- Continue rubbing until the solution has dried.
Sanitization
The cleaning process that reduces the number of micro-organisms to a safe level.
Gloves must always be worn during the sanitization process.
Ultrasonic sanitization
Used for very delicate instruments to avoid damage to the equipment.
Rather than using friction to remove the debris, the sound waves loosen the debris so the object is free from excess material going into the disinfection or sterilization phase.
Ultrasonic sanitization also reduces the risk of potential sharps injury for the health care professional.
Disinfection
The process of destroying pathogens or rendering them inactive on surfaces and items, such as countertops and surgical instruments.
Even though it does not destroy all the microbial spores or certain viruses, it greatly reduces the spread of infection by destroying or limiting microbial activity.
Instrument disinfection
The process can often require lengthy submersion of instruments in a chemical solution that must touch every surface area of the instrument.
Ex:
- Glutaraldehyde: used in the clinical setting but usually requires a long submersion time to be fully effective and can be costly.
- 1:10 bleach solution: a cheaper and effective alternative
*Chemical disinfectants cannot be used on patients and are reserved for medical supplies, equipment, clinical surroundings, and surfaces.
Alcohol
Level: Intermediate
Typical Use:
- Fixed equipment
- Patient care items
- Drying agent
Advantages:
- Fast acting
- No residue
- Non-staining
Disadvantages:
- Wet contact time a minimum of 5 min
- Flammable
- Inactivated by organic material
- Tends to harden and swell plastic
- Alcohol is a fixative, increasing the difficulty of residual soil removal.
Chlorine (Chlorinated compounds)
Level: Low or Intermediate
Typical Use:
- Dialysis machines
- Bleach for laundry
- Bathtubs
- A 1:10 dilution recommended for cleaning blood spills
Advantages: Fast-acting (minimum contact time 2.5 min)
Disadvantages:
- Inactivated by organic matter
- Corrosive
- Stains fabric, plastics
- Relatively unstable
Iodophores
Level: Low
Typical Use: Patient care equipment
Advantages: Fast-acting (<2 min)
Disadvantages:
- Corrosive to metals
- Detrimental to some plastics
- Stains fabrics and other materials
- Requires a longer contact time to kill fungi
Phenols
Level: Low or Intermediate
Typical Use: Housekeeping for walls and floors
Advantages: For housekeeping use; residual activity that can be reactivated when moisture is applied
Disadvantages:
- For patient care items; residual activity can harm patients.
- Corrosive to some plastics
Quaternary ammonium (Quats)
Level: Low or Intermediate
Typical Use:
- Housekeeping for walls and floors
- Can be used on certain instruments if thoroughly rinsed
Advantages:
- Wetting agents with built-in detergent properties
Disadvantages:
- Typical contact time 6 to 10 min
- Can be inactivated by cotton or charcoal
- Not compatible with soap
Order of Cleaning
- Hand hygiene: Complete aseptic handwashing or use an alcohol-based sanitizer. Use a clean paper towel to handle doorknobs or faucets to help avoid contaminating clean hands with micro-organisms.
- Examination table: Remove disposable paper covering over examination table by tightly rolling it up to ensure the contaminated side is on the inside.
- Surfaces: Disinfect work surfaces beginning with the examination table, sink, countertop, and computer keyboard.
Low-level disinfection
Kills most vegetative bacteria and some viruses and fungi
Used for: Exam tables and countertops
Ex: Hydrogen peroxide
Intermediate-level disinfection
Kills vegetative bacteria and most viruses and fungi but does not kill spores
Used for: Stethoscopes, percussion hammers, blood pressure cuffs
Ex: Isopropyl alcohol
High-level disinfection
Kills all micro-organisms except for a small number of bacterial spores
Used for: Instruments that do not penetrate soft tissues or bone but contact mucous membranes, such as endoscopes
Ex: Cidex OPA
Safety Data Sheets (SDSs)
Sheet that contains properties of a chemical; physical, health, and environmental health hazards; protective measures; and safety guidelines.
Information required on SDS
- Identification: Product identifier, manufacturer information, recommended use, restrictions on use
- Hazard identification: All hazards related to the chemical, including hazard classification (combustible) and label requirements
- Composition/ingredients: Chemical ingredients contained in the product
- First-aid measures: Initial treatment from exposure, including symptoms and routes of exposure
- Fire-fighting measures: Appropriate extinguishing methods and chemical hazards from fire, including proper extinguishing equipment and special protective equipment
- Accidental release measures: Emergency procedures, PPE, containment, and cleanup in case of spills
- Handling and storage: Safe handling and appropriate storage requirements
- Exposure controls/personal protection: Recommended exposure limits and PPE necessary to reduce exposure
- Physical and chemical properties: Chemical characteristics such as appearance, odor, and pH
- Stability and reactivity: Chemical stability and potential reactions
- Toxicological information: Routes of exposure, effects of exposure, and symptoms
- Other nonmandatory content: Ecological information, disposal considerations, transport information, and regulatory information
Autoclaves
Autoclaving is the most widely accepted method to achieve sterilization. This process uses moist heat and pressure to achieve sterilization.
Sterilization
The destruction of all living organisms, including pathogens and their spores
Autoclave Techniques
- To ensure all equipment is sterilized, the recommended temperature an autoclave must reach is between 250° and 270° F.
- The amount of time necessary to establish sterility fluctuates depending on what items are being sterilized and how they are wrapped. It is always suggested to follow the manufacturer’s guidelines.
- Generally, unwrapped items are sterilized for 20 min and wrapped items for 30 min.
- The most widely used cycle is the gravity cycle in ambulatory health care facilities. This is used to sterilize stainless steel instruments.
- Instruments should be wrapped prior to autoclaving.
Wrapping Instruments
- Instruments should be wrapped prior to autoclaving.
- Wrapping can be performed using disposable double-ply autoclave paper or peel-apart polypropylene pouches. When using autoclave paper, it is recommended to use at least two layers to maintain sterilization.
- Discard any autoclave paper that is torn or has holes.
- Wrap hinged instruments in open position by placing a gauze between the tip.
- When using pouches, place the handle of the instrument into the end of the bag that will be opened first.
- When using autoclave paper, use specialized autoclave tape to seal the package, in addition to placing an indicator strip inside with the instrument.
- Label the outside with the date, the time, initials, and the instrument that it contains.
Sterilization indicators
- Change colors only when sterilization is achieved by steam reaching its optimum temperature for the required length of time.
- Two types of sterilization indicators are chemical and biologic.
- Lines on autoclave tape will turn black when sterilization is achieved. Autoclave pouches have indicator arrows that change colors to indicate sterilization is achieved.
Chemical sterilization
This is used for instruments that cannot tolerate the high temperatures of the autoclave.
Process:
1. The chemicals used must be mixed precisely to the instructions on the bottle and marked with a preparation and expiration date.
2. Contents requiring sterilization must be submerged in the chemical bath for 8 hours with a closed lid.
3. Once completed, the items are removed with forceps and rinsed with water until all chemicals are removed.
- These items cannot be wrapped and are no longer considered sterile once out of the chemical fluid.
- This process is good for items such as endoscopes, which would be damaged if autoclaved.
- Not considered practical in an ambulatory health care facility.
Sterile Handling
To ensure equipment sterility:
- The CDC no longer identifies a specific timeframe to use sterilized items, but most facilities have specific protocols to follow, such as using oldest to newest sterilized items. As a rule, double-layer fabric or paper-wrapped packages are considered sterile for 30 days.
- Packages should be stored in a dry, covered area, and confirm the item does not show signs of watermarks.
- Packages should be inspected, after they are completely dry, to ensure they are intact and do not have any tears or punctures.
What two things need to be completed prior to sterilization?
Sanitization and disinfection
Biohazard waste bag
Items contaminated with blood/bodily fluids such as gloves, gauze, and dressings
Biohazard waste box
Items contaminated with blood/bodily fluids such as table covers and disposable gowns
Biohazard sharps container
Needles, lancets, and sharp objects
Types of Biohazard Waste Container
- Biohazard waste bag
- Biohazard waste box
- Biohazard sharps container
Guidelines for handling biohazard materials
- Wear proper PPE, including gloves.
- Immediately place biohazard materials in appropriate receptacle.
- Keep containers upright and closed.
- Drop items into sharps containers and avoid pushing them in.
- Discard of disposable sharps container when it has reached the fill line.
When should gloves be worn?
- Encountering blood, body fluids, or other potentially infectious materials (OPIM)
- Handling anything contaminated with blood or body fluids
- Performing injections or venipuncture
- Assisting a provider with a surgical procedure
- Handling blood specimens or any body fluids
- Cleaning up body fluids or blood
Steps to follow after an exposure
- With exposure to blood, Immediately wash the area that was cut or punctured by a needle with soap and water, flush any splashes to the face with water, or irrigate the eyes with an eye wash station or clean water.
- Report immediately to supervisor
- Employee involved in the incident must receive a medical evaluation. All information must remain confidential, and documentation must be kept for the duration of employment plus 30 years.
- Complete an incident exposure form.
- Vaccination is offered for hepatitis B.
- Health care provider provides copy of written opinion within 15 days of evaluation.
- Employee receives health counseling.
Quality control (QC)
Performed to ensure the reliability of test results through detecting and eliminating error.
Temperature Logs
Refrigerator should always be maintained between 36° F and 46° F.
This guarantees test kits, blood specimens, vaccinations, and other stored materials are not out of date.
Daily temperatures for both refrigerators and freezers must be measured and logged where medications and vaccinations are stored to verify the required temperatures are maintained.
Calibration
In accordance with the manufacturer’s guidelines, equipment used to test patient specimens must be calibrated regularly.
Control samples
Used to ensure accuracy of a test prior to running a patient sample.
Depending on the test, it can be used before each patient sample is processed or every time a new test package is opened.
Reagent control
Run every time new testing products or supplies are opened.
This can include staining materials and reagents such as urinalysis test strips.
Maintenance
In accordance with the manufacturer’s guidelines, equipment should be routinely maintained, and any work performed should be logged.
Documentation
Document all procedures with quality control log, equipment maintenance log, reagent control log, and temperature log.
Quality Control Procedure
- Calibration
- Control samples
- Reagent control
- Maintenance
- Documentation
